You have the right to file a Grievance or an Appeal/Expedited Appeal online, orally, or in writing at any time without retaliation. You may authorize another person to act on your behalf. If you need assistance in completing the Grievance/Appeal/Expedited Appeal Request Online Form, you may request assistance from your provider or a Patients’ Rights Advocate (PRA) by calling (213) 738-4888 or (800) 700-9996 . Consumers can access free of charge language assistance (including consumers for whom English is not their primary language and/or who are Deaf or Hard of Hearing) and culture-specific providers and services by contacting the ACCESS Center at (800) 854-7771 or the Patients’ Rights Office. Persons with speech or hearing limitations are contacted through California Relay Services (800) 735- 2929.

Grievance

A Grievance is an expression of dissatisfaction concerning services received from the Los Angeles County Department of Mental Health and/or any of its contract providers.

• You may resolve your concern(s) by speaking directly with your provider or mental health program representative.
• If you chose, a PRA can work with you to resolve any problems you have with your provider or services.
• You may file a Grievance online, verbally, or in writing at any time. A PRA will be assigned to your grievance. You and any authorized parties will be notified in writing of the outcome of your grievance within 90 calendar days of receipt.

Appeal or Expedited Appeal

You have the right to file an Appeal or Expedited Appeal with the Patients’ Rights Office when services were denied, reduced, changed or you did not receive services in a timely manner.

• An Appeal or Expedited Appeal is a request by a consumer or his/her representative for review of a Notice of Adverse Benefit Determination (NOABD) received by the Mental Health Plan.
• You may file an Appeal or Expedited Appeal online, verbally, or in writing at any time.
• You may obtain a form for your Appeal from your mental health provider or from the Patients’ Rights Office.
• A PRA will be assigned to your appeal.
• The Appeal must be filed within 60 days of the NOABD being issued. A beneficiary has the right to continued services while an appeal is pending resolution.
• The Patients’ Rights Office will inform the beneficiary or authorized parties in writing of the outcome of an appeal within 30 calendar days of receipt or no later than 72 hours after receipt for expedited appeals.
• The period for resolving an Appeal and Expedited Appeal may be extended up to 14 days if the beneficiary requests an extension or if the Local Mental Health Plan determines there is a need for additional information.

State Hearing

A State Hearing is an independent review by an Administrative Judge conducted by the State of California Department of Social Services regarding your Appeal.

• It is the final arbiter of Appeals for NOABD.
• You may request a State Hearing or Expedited State Hearing only if you have Medi-Cal as your insurance and only after exhausting the Appeal or Expedited Appeal process.
• If you want a State Hearing, your request must be made within 120 days from the date you receive the Notice of Appeal Resolution (NAR). Contact PRO to get assistance to file a Hearing.
• Beneficiaries will be notified by the State about their hearing resolution within 90 days for Standard Hearing and within 3 working days of an Expedited Hearing.

For technical and non-technical issues, please email the Patients' Rights Office at PCG@dmh.lacounty.gov or call (213) 738-4888 / (800) 700-9996 for assistance.