Beneficiary Problem Resolution Processes
In accordance with Title 9, California Code of Regulations, Chapter 11, Subchapter 5, and the
Mental Health Plan Contract,
Mental Health Plans (MHP) must have problem resolution processes that enable a beneficiary to resolve a problem or concern about any issue related to the MHP’s performance, including the delivery of specialty mental health services.
Each MHPs beneficiary problem resolution process must include a system
to receive and resolve beneficiary grievances, appeals, expedited appeals, and
State Fair Hearings. The MHPs process must meet State and Federal requirements outlined in MHSUDS Information Notice 18-010E. Annual Beneficiary Grievance and Appeal Report (ABGAR)
MHPs are required to report to the Department of Health Care Services annually on October 1st the total number of grievances, appeals, and expedited appeals filed during the previous fiscal year, categorized by type and disposition.
Special Term and Condition #5 requires that the state will provide to the Centers for Medicare and Medicaid Services the annual grievance and appeals reports by November 1st of each year.
The ABGAR statewide summary data is now housed on the California Health and Human Services Open Data Portal.
