Transcription
GUIDE TOMedi-Cal Mental Health Services
If you are having anemergency, pleaseIf youare havingcall 9-1-1or visitthenearesthospitalpleasean emergency,emergencyroom.call 9-1-1 or visit theIn What Other Languages And Formats AreThese Materials Available?nearest hospitalIf you would likeemergencyinformationroom.additionalto help you decide ifthisIf isanwouldemergency,youlikepleaseseetheadditional information toinformation on State ofhelp you decide if this isCaliforniapage 6 inemergency, pleasethisanbooklet.see the information onState of California page6 in this bookletHow To Get AProvider List:You may ask for, and yourMental Health Plan (MHP)should give to you, adirectory of people, clinicsand hospitals where you canget mental health services inyour area. This is called a‘provider list’ and containsnames, phone numbers andaddresses of doctors,therapists, hospitals and otherplaces where you may beable to get help. You mayneed to contact your MHPfirst, before you go to seekhelp. Call 1-800-854-7771 or213-738-4949 to request aprovider list and to ask if youneed to contact the MHPbefore going to a serviceprovider’s office, clinic orhospital for help.DMH Websitewww.dmh.co.la.ca.us
Introduction to Medi-CalMental Health ServicesWhy Did I Get This Booklet And Why Is It Important?You are getting this booklet because you are eligible for Medi-Caland need to know about the mental health services that Los AngelesCounty offers and how to get these services if you need them.If you havetroubleunderstandingthis booklet,please call theMHP at(800) 854-7771 or(213) 738-4949 tofind out aboutIf you are now getting services from Los Angeles County, this bookletjust tells you more about how things work. This booklet tells you aboutmental health services, but does not change the services you aregetting. You may want to keep this booklet so you can read it again.If you are not getting services right now, you may want to keep thisbooklet in case you, or someone you know, need to know aboutmental health services in the future.What Is A Mental Health Emergency?An emergency is a serious mental or emotional problem such as:When a person is a danger to himself, herself, or others becauseof what seems like a mental illness, orWhen a person cannot get or use the food, shelter, or clothingthey need because of what seems like a mental illness.other ways youcan get thisIn an emergency, please call 9-1-1 or take the person to a hospitalemergency room.importantinformation.How Do I Use This Booklet?This booklet will help you know what specialty mental health servicesare, who may receive them, and how you can get help from the LosAngeles County MHP.This booklet has two sections. The first section tells you how to gethelp from the Los Angeles County MHP and how it worksThe second section is from the State of California and gives you moregeneral information about specialty mental health services. It tellsyou how to get other services, how to resolve problems, and whatyour rights are under the program.This booklet also tells you how to get information about the doctors,clinics and hospitals that the Los Angeles County MHP uses to provideservices and where they are located.Welcome to Medi-Cal Mental Health Servicesi
What is My County’s Mental Health Plan (MHP)?Mental health services are available to people on Medi-Cal,including children, young people, adults and older adults in LosAngeles County.Sometimes these services are available through your regular doctor.Sometimes they are provided by a specialist, and called ‘specialty’mental health services. These specialty services are provided throughthe Los Angeles County “Mental Health Plan” or MHP, which isseparate from your regular doctor. The Los Angeles County MHPoperates under rules set by the State of California and the federalgovernment. Each county in California has its own MHP.If you feel you have a mental health problem, you maycontact the Los Angeles County MHP directly at (800) 854-7771.This is a toll-free telephone number that is available 24-hours aday, seven days a week. Verbal and oral interpretation of yourrights, benefits and treatments is available in your preferredlanguage. You do not need to see your regular doctor first orget permission or a referral before you call.You may alsorequest a StateFair Hearing.Please see page26 in the State ofCalifornia sectionof this booklet formore information.If you believe you would benefit from specialty mental healthservices and are eligible for Medi-Cal, the Los Angeles County MHPwill help you find out if you may get mental health treatments andservices. If you would like more information about specific services,please see the sections on ‘Services’ on the State of California page9 in this booklet.What If I Have A Problem Getting Help?If you have a problem getting help, please call the Los AngelesCounty MHP’s 24-hour, toll-free phone number at (800) 854-7771. Youmay also call your county’s Patient’s Right Advocate at (213) 7384949.If that does not solve your problem, you may call the State of California’sOmbudsman for help:(800) 896-4042 - CA Only(916) 654-3890(800) 896-2512 TTYFAX: (916) 653-9194EMail: ombudsman@dmh.ca.govii
Medi-Cal Mental Health ServicesTable of ContentsLos Angeles CountyLos AnglesCountyWelcome To The Los Angeles County Mental Health Plan . 1Basic Emergency InformationImportant Telephone Numbers . 2How DO I Know If Someone Needs Help Right Away?. 2What Specialty Mental Health Services Does Los Angeles CountyProvide? . 2Los Angeles County Mental Health Plan Services/InformationHow Do I Get These Services? . 3What Does It Mean To Be “Authorized” To Receive Mental HealthServices And What Is The Amount, Duration And Scope Of ServicesProvided? . 3How Do I Get More Information About Doctors, Therapists, ClinicsAnd Hospitals? . 4In What Other Languages And Formats Are These MaterialsAvailable? . 4Can I See Any Doctor, Therapist, Clinic Or Hospital On The“Provider List? . 4What If I Want To Change Doctors, Therapists Or Clinics? . 4How Do I Get A “Provider List” . 4Can I Use The “Provider List” To Find Someone To Help Me? . 4What If I Want To See A Doctor, Therapist, Clinic Or Hospital ThatIs Not Listed On Los Angeles County’s “Provider List?” . 5What If I Need Urgent-Care Mental Health Services OnA Weekend Or At Night? . 5How Do I Get Mental Health Services That My Mental HealthProvider Does Not Offer? . 5What If I Need To See A Doctor For Something Other Than MentalHealth Treatment? . 5What Can I Do If I Am Not Satisfied With My Mental HealthTreatment? . 6What Is Beneficiary Services? What Does It Do? How Do I ContactThe Staff? .6Does Los Angeles County Keep My Mental Health Records Private? .6State of CaliforniaGeneral Statewide InformationState ofCaliforniaHow Do I Know if Someone Needs Help Right Away? . 1County Mental Health PlansWhat Are Mental Health Services? . 2Where Can I Get Mental Health Services? . 2How Do I Get Services? . 2Welcome to Medi-Cal Mental Health Services
Medi-Cal Mental Health Services‘State of California (Continued)State ofCaliforniaImportant Information About Medi-CalWho Can Get Medi-Cal? . 3Do I Have To Pay For Medi-Cal? . 3How Do I Get Medi-Cal Services That Are Not Covered by theMental Health Plan? . 4What is the Child Health and Disability Prevention (CHDP)Program? . 5Basic Emergency InformationAre You Having an Emergency? . 6What Kind of Emergency-Related Services Are Provided? . 7When Does My County MHP’s Responsibility for CoveringPost-Stabilization Care End? . 8Services(ADULTS AND OLDER ADULTS)How Do I Know When I Need Help? . 9What Are Signs I May Need Help? . 9What Services Are Available? . 10(CHILDREN, ADOLESCENTS, AND YOUNG PEOPLE)How Do I Know When A Child Needs Help? .How Do I Know When An Adolescent or Young Person NeedsHelp? .What Services Are Available? .Are There Special Services Available For Children, Adolescentsand Young Adults? .What Are Therapeutic Behavioral Services (TBS)? .Who Can Get TBS? .Are There Other Things That Must Happen For Me To Get TBS? .How Do I Get TBS? .Who Decides If I Need TBS and Where Can I Get Them? .What Should Be In My TBS Plan? .12131314141515151616Medical Necessity’ CriteriaWhat is ‘Medical Necessity’ and Why is it so Important? . 17What Are the ‘Medical Necessity’ Criteria for Coverage ofSpecialty Mental Health Services Except for Hospital Services? . 17What Are the ‘Medical Necessity’ Criteria for Covering SpecialtyMental Health Services for People under 21 Years of Age? . 18Notice of ActionWhat Is A Notice Of Action? .When Will I Get A Notice of Action? .Will I Always Get A Notice Of Action When I Don’t Get ServicesI Want? .What Will The Notice of Action Tell Me? .What Should I Do When I Get A Notice Of Action? .2020212121
Medi-Cal Mental Health ServicesState of California (Continued)State ofCaliforniaProblem Resolution ProcessesWhat If I Don’t Get the Services I Want From My County MHP? . 22Can I Get Help to File an Appeal, Grievance, or State Fair Hearing? . 22What If I Need Help to Solve a Problem with my MHP but Don’tWant to File a Grievance or Appeal? . 22(THE APPEALS PROCESSES - Standard and Expedited)What Is a Standard Appeal? .When Can I File an Appeal? .How Can I File an Appeal? .How Do I Know If My Appeal is Resolved? .Is There a Deadline to File an Appeal? .When Will My Appeal Be Resolved? .What If I Can’t Wait 45 Days For My Appeal Decision? .What Is an Expedited Appeal? .2324242424252525(THE STATE FAIR HEARING PROCESSES - Standard and Expedited)What Is a State Fair Hearing? .What Are My State Fair Hearing Rights? .When Can I File For a State Fair Hearing? .How Do I Request a State Fair Hearing? .Is There a Deadline For Filing a State Fair Hearing? .Can I Continue Services While I’m Waiting For A StateFair Hearing Decision? .What If I Can’t Wait 90 Days For My State Fair Hearing Decision?26262626272727(THE GRIEVANCE PROCESS )What Is a Grievance? . 28When Can I File a Grievance? . 28How Can I File a Grievance? . 28Your RightsWhat Are My Rights? . 30(ADVANCE DIRECTIVES)What Is an Advance Directive? . 32(CULTURAL COMPETENCY)Why Are Cultural Considerations and Language AccessImportant? . 33How Services May Be Provided to YouHow Do I Get Specialty Mental Health Services? . 35How Do I Find a Provider For the Specialty Mental HealthServices I Need? . 35Once I Find a Provider, Can the MHP Tell the Provider WhatServices I Get?. 36Which Providers Does My MHP Use? . 37
Welcome to the Los Angeles CountyMental Health PlanWe welcome you to Los Angeles County Mental Health Services,and to the Medi-Cal Mental Health Plan. The Department ofMental Health is proud to serve the people of Los Angeles Countythrough a network of clinics, field services, and hospitals and otherfacilities operated by the County and contract agencies. We strive toprovide quality, cost-effective care in the least restrictive settings inyour local communities. This means doing all we can to makeresponsible use of public funding to meet the mental health needs inLos Angeles County. Please read this brochure carefully. It containsimportant information you need to know.As your mental health services plan we will: Get answers to your questions about mental health treatment Tell you what mental health services are covered by Medi-Cal Determine what types of mental health services you need andhelp you get them Treat you with respect Ensure you receive services in a safe environment Help you get culturally competent careAs A Participant, You Also Have Specific Responsibilities: Give honest and complete information about your mentalhealth needs Take an active part in your mental health treatment Keep your appointments as scheduled Call if you cannot keep your appointment Work on treatment goals with your provider1Los Angeles County
Los Angeles CountyMental Health PlanImportant Telephone NumbersEmergency911Mental Health Access(800) 854-7771Telecommunication Center(562) 651-2549 (TDD/TTY)Beneficiary Services(213) 738-4949Patient’s Rights Office(800) 700-9996Chief Information Privacy Officer(213) 974-2164How Do I Know If Someone Needs Help Right Away?Even if there is no emergency, a person with mental health problemsneeds help right away if one or more of these things are true. Hearing or seeing things others believe are not there Extreme and frequent thoughts of, or talking about, death Giving away their things Threatening to kill themselves (suicide) Wanting to hurt themselves or othersIf one or more of these things is true, call 911 or the Los AngelesCounty MHP at (800) 854-7771 (24-hours toll free). Mental Healthworkers are on-call 24-hours a day.The otherservices that aresometimesneeded areincluded in thelist on pages 9(adults) and 12(children) in theState ofCalifornia sectionof this booklet.What Specialty Mental Health Services Does Los AngelesCounty Provide?Mental Health Services Available To You: Psychiatric Inpatient Hospital Services – Specialty mental healthservices in the hospital. Psychiatry Services – Specialty mental health services from amental health provider who is a licensed physician/doctor andspecialized in psychiatry. Psychology Services – Specialty mental health services receivedfrom a licensed mental health provider that is a psychologist todiagnose and treat mental health disorders. Targeted Case Management – Specialty mental health services andactivities that help people access and receive communityservices need to help establish and/or keep an independentway of life. Rehabilitative Services – Specialty mental health services that helppeople improve, maintain and restore daily living in thecommunity. Psychiatric Nursing Facility Services – Specialty mental healthservices in settings that are licensed as a skilled nursing facility.Los Angeles County2
Los Angeles CountyMental Health PlanThe services listed above are the services that Los Angeles CountyMHP thinks are most likely to help people who need mental healthservices. Sometimes other services may be needed. The otherservices that are sometimes needed are included in the list on pages9 (adults) and 12 (children) in the State of California section of thisbooklet.How Do I Get These Services?Call the Los Angeles County MHP Access Telecommunication Centerat (800) 854-7771. You’ll then be referred to a provider and anappointment arranged for you. For TDD/ TTY service, call (562) 6512549.What Does It Mean To Be “Authorized” To Receive MentalHealth Services And What Is The Amount, Duration AndScope Of Services Provided?You, your provider and Los Angeles County MHP are all involved in decidingwhat services you need to receive through the MHP, including how oftenyou will need services and for how long.The Los Angeles County MHP may require your provider to ask the MHP toreview the reasons the provider thinks you need services before they areprovided. The Los Angeles County MHP uses a qualified mental healthprofessional to do the review. This review process is called an MHP paymentauthorization process. The State requires the Los Angeles County MHP tohave an authorization process for day treatment intensive, dayrehabilitation, and therapeutic behavioral services (TBS).The Los Angeles County MHP follows state rules for our MHP paymentauthorization process, which are described on page 3 in the State ofCalifornia section of this booklet. If you would like more information on howLos Angeles County does MHP payment authorizations or when we requireyour provider to request an MHP payment authorization for services, pleasecontact Los Angeles County MHP at (213) 738-4949.How Do I Get More Information About Los Angeles County’sMental Health Services Including Doctors, Therapists, ClinicsAnd Hospitals?For a list of providers and additional information on the structure andoperation of the Los Angeles MHP, call Beneficiary Services at (213)738-4949, or visit the DMH website: www.dmh.co.la.ca.us.You can also walk in to pick up information at the Department ofMental Health (550 S. Vermont Ave., Los Angeles, CA 90020). Anadvocate will meet with you to help answer your questions.3Los Angeles County
Los Angeles CountyMental Health PlanIn What Other Languages And Formats Are These MaterialsAvailable?The Los Angeles County MHP can provide materials in 10 thresholdlanguages. Consumers can call ACCESS at (800) 854-7771 and/orPatient’s Rights at (800) 700-9996/(213) 738-4949 for a list of providerswho can meet his/her language need(s). Clients can also access theMHP website for a list of providers who provide services in theirlanguages (MHP website: www.dmh.co.la.ca.us). The Los AngelesCounty MHP provides information for the visually and hearingimpaired (e.g. large print documents or audio tapes) and utilizes theCalifornia Relay system and sign interpreters for the deaf or ceat(800) 700-9996 or (213) 738-4888 or California Relay services at(800) 735-2929.Can I See Any Doctor, Therapist, Clinic Or Hospital On LosAngeles County’s “Provider List”?You have the right to choose your provider. If the provider you selectis not under the Los Angeles County MHP, the Los Angeles CountyMHP does not have jurisdiction in how the services are beingprovided by that particular provider. Also, some providers may notaccept Medi-Cal for payment. It is your responsibility to inquire if theprovider accepts Medi-Cal for payment prior to accessing services. Ifyou choose to pay for the services not cover by Medi-Cal, there is norestriction as to the type of services you may receive.If you have questions, please call ACCESS 24-hours a day at(800) 854-7771 or Beneficiary Services (213) 738-4949.What If I Want To Change Doctors, Therapists Or Clinics?You can speak with the provider directly to request a change indoctors. If your request is not honored or the beneficiary feels that heneeds further assistance, you can call Patient’s Rights for assistancewith your request.How Can I Get A Copy of the “Provider” List?Call Beneficiary Services at (213) 738-4949 or pick up a provider list atthe Department of Mental Health (550 S. Vermont Ave., Los Angeles,CA 90020).Can I Use The “Provider List” To Find Someone To Help Me?Beneficiary can request referrals for providers from either the ACCESSstaff as well as staff in the Patient’s Rights Office. You can also findproviders in the areas where they wish to obtain services byaccessing the Los Angeles County MHP website.Los Angeles County4
What If I Want To See A Doctor, Clinic Or Hospital That Is Not Listed OnLos Angeles County’s “Provider List”?You have the right to choose your provider. If the provider you select is notunder the Los Angeles County MHP, Los Angeles County MHP does nothave jurisdiction in how the services are being provided by that particularprovider. Also, some providers may not accept Medi-Cal for payment. It isyour responsibility to inquire if the provider accepts Medi-Cal for paymentprior to accessing services. If you choose to pay for the services not coverby Medi-Cal, there is no restriction as to the type of services provided.If you have questions, please call ACCESS 24-hours a day at (800)854-7771 or Beneficiary Services (213) 738-4949.What If I need Urgent-care Mental Health Services On A Weekend OrAt Night?Please call 911, or call ACCESS at (800) 854-7771, or go to the nearestemergency room.You may also contact any of the organizations below, 24-hours a day, 7days a week.Suicide Prevention andSurvivor Hotline .Alzheimer’s Association Helpline .California Youth Crisis Hotline .Child Abuse Hotline .Domestic Violence –Sexual Assault Hotline .Elder Abuse Hotline .National HIV/AIDS Hotline .Substance Abuse Hotline .(877) 727-4747 (inside LA County)(310) 391-1253 (outside LA County)(800) 660-1993(800) 843-5200(800) 540-4000(800) 339-3940(800) 992-1660(800) 342-2437(800) 564-6600 (9 a.m. - 5 p.m.Monday - Friday)How Do I Get Mental Health Services That My Mental Health ProviderDoes Not Offer?If the provider does not offer the mental health services you require, youmay ask your provider for an appropriate referral. You can also call ACCESSfor referrals for specialty mental health services at (800) 854-7771/(213) 738-4949.What If I Need To See A Doctor For Something Other Than MentalHealth Treatment? How Are People Referred To Medi-Cal ServicesOther Than Mental Health Care In Los Angeles County?If you need to see a doctor for something other than mental healthtreatment, ask your provider to give you a referral. You can also ask yourregular health care provider for further information. You are alsoencouraged to look through your local yellow pages to find a medicaldoctor in their area.5Los Angeles County
Los Angeles CountyMental Health PlanFor moreinformation onGrievances,Appeals andState FairHearings, pleaseturn to thesection about‘ProblemResolutionProcesses’ in theState of Californiapage 22 in thisbooklet.What Can I Do If I Have A Problem Or Am Not Satisfied WithMy Mental Health Treatment?If you have a concern or problem or are not satisfied with yourmental health services, the MHP wants to be sure your concerns areresolved simply and quickly. Please contact Beneficiary Services (213)738-4949 to find out how to resolve your concerns.There are three ways you can work with the MHP to resolve concernsabout services or other problems. You can file a grievance verbally orin writing with the MHP about any MHP related issue. You can file anappeal verbally (and follow up in writing) or in writing with the MHP.You can also file for a state fair hearing with the Department of SocialServices.For more information about how the MHP Grievance and Appealprocesses and the State Fair Hearing process work, please turn to thesection about Grievances, Appeals and State Fair Hearings on page22 in the State of California section of this booklet.Your problem will be handled as quickly and simply as possible. It willbe kept confidential. You will not be subject to discrimination or anyother penalty for filing a Grievance or Appeal or State Fair Hearing.You may authorize another person to act on your behalf in theGrievance, Appeal, or State Fair Hearing process.What Is Beneficiary Services? What Does It Do? How Do IContact The Staff?Beneficiary Services is part of the Patient’s Rights Office. BeneficiaryServices staff can assist you with mental health services by providinginformation and referrals, assisting with problem resolution, andinvestigating grievances and appeals.Patient Beneficiary Services staff may be reached at:(213) 738-4949 for non-hospital grievances/appeals(213) 738-4888 for hospital grievances/appealsDoes Los Angeles County Keep My Mental Health RecordsPrivate?Yes, your personal health information is confidential and protectedby State and Federal law. We create a record of the care andservices you receive. We need this record to provide you with qualitycare and to comply with certain legal requirements. As required andwhen appropriate, we will ensure that the minimum necessaryinformation is released in the course of your treatment.Los Angeles County6
Medi-Cal Mental Health ServicesGeneral StatewideInformationWhy Is It Important To Read This Booklet?The first section of this booklet tells you how to get Medi-Calmental health services through your county’s Mental HealthPlan.This second section of the booklet tells you more abouthow the Medi-Cal program works, and about how MediCal specialty mental health services work in all counties ofthe state.If you don’t read this section now, you may want to keepthis booklet so you can read it later.State of California1
County Mental Health PlansIf you think youqualify for MediCal and you thinkyou need mentalhealth services,call the MentalHealth Plan inWhat Are Specialty Mental Health Services?Specialty Mental health services are special health care services for peoplewho have mental illness or emotional problems that the regular doctorcannot treat.Some specialty mental health services include: Crisis counseling to help people who are having a serious emotionalcrisis Individual, group, or family therapy Rehabilitation or recovery services that help a person with mental illnessto develop coping skills for daily living Special day programs for people with mental illnesses Prescriptions for medicines that help treat mental illness Help managing medicines that help treat mental illness Help to find the mental health services you needyour county andsay I want to findout about mentalhealth services.Where Can I Get Mental Health Services?You can get mental health services in the county where you live. Eachcounty has a Mental Health Plan for children, teens, adults and older adults.Your county Mental Health Plan has mental health providers (doctors whoare psychiatrists or psychologists, and others).How Do I Get Services At My County Mental Health Plan?Call your county Mental Health Plan and ask for services. You do not needto ask your regular doctor for permission, or get a referral. Just call thenumber for your county in the front of this booklet. The call is free.You can also go to a federal qualified health center, a rural health centeror an Indian health clinic in your area for Medi-Cal mental health services.(These are official names for different kinds of clinics in your area. If you arenot sure about a clinic in your area, ask the clinic workers. These kinds ofclinics generally serve people who do not have Medi-Cal insurance.)As part of providing mental healthMental Health Plan is responsible for: 2State of Californiaservicesforyou,yourcountyFigu
6 in this booklet These Materials Available? information on State of How To Get A Provider List: You may ask for, and your Mental Health Plan (MHP) should give to you, a directory of people, clinics and hospitals where you can get mental health services in your area. This is called a ‘provider
