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and withdrawal management services. The MCP is responsiblefor the coordination of these services.Drug Medi-Cal pays for youth over age 12 and adults who wantand need Substance Use Treatment services through our SUTSmanaged system of care. The MCP ensures available, accessible,and quality care for all Medi-Cal beneficiaries.Emergency ServicesEmergency services are covered 24 hours a day and 7 days aweek. If you think you are having a health related emergency,call 911 or go to the nearest emergency room for help.Emergency Services are services provided for an unexpectedmedical condition, including a psychiatric emergency medicalcondition.An emergency medical condition is present when you havesymptoms that cause severe pain or a serious illness or an injury,which a prudent layperson (a careful or cautious non-medicalperson) believes, could reasonably be harmful without medicalcare, and could: Put your health in serious danger, or If you are pregnant, put your health or the health of yourunborn child in serious danger, or Cause serious harm to the way your body works, or Cause serious damage to any body organ or part.You have the right to use any hospital in the case of emergency.Emergency services never require authorization.13

Who Do I Contact If I’m having Suicidal Thoughts?If you or someone you know is in crisis, please call the NationalSuicide Prevention Lifeline at 1-800-273-TALK (8255).For local residents seeking assistance in a crisis and to accesslocal mental health programs, please call 1-855-278-4204.How Do I Know When I Need Help?Many people have difficult times in life and may experiencesubstance use problems. The most important thing to rememberwhen asking yourself if you need professional help is to trustyourself. If you are eligible for Medi-Cal, and you think youmay need professional help, you should request an assessmentfrom your Santa Clara County Managed Care Plan (MCP).How Do I Know When A Child or Teenager Needs Help?You may contact your Santa Clara County MCP for anassessment for your child or teenager if you think he or she isshowing any of the signs of substance use. If the countyassessment indicates that drug and alcohol treatment services areneeded, the county will arrange for your child or teenager toreceive the services.14

How to get Specialty Mental Health ServicesSanta Clara County has specialty mental health services forchildren, youth, adults, and older adults. The number for theMental Health Service Call Center is 1-800-704-0900.Your MCP will coordinate needed specialty mental healthservices.MEDICAL NECESSITYWhat Is Medical Necessity and Why Is It So Important?One of the conditions necessary for receiving SUD treatmentservices through the Managed Care Plan is something called‘medical necessity’. This means a doctor or other licensedprofessional will talk with you to decide if there is a medicalneed for services, and if you can be helped by services if youreceive them.Medical Necessity is important because it will help the ManagedCare Plan (MCP) decide if you are eligible for substance usetreatment services and what kind of services are appropriate.What Are the Medical Necessity Criteria for Coverage of SubstanceUse Treatment Services?As part of deciding if you need SUD treatment services, theMCP will work with you and your provider to decide if theservices are medically necessary, as explained above. Thissection explains how they will make that decision.In order to receive services you must meet the following criteria: You must be enrolled in Medi-Cal15

You must reside in Santa Clara County You must have at least one diagnosis from the Diagnosticand Statistical Manual of Mental Disorders 5 (DSM) for aSubstance-Related and Addictive Disorder. Any adult, oryouth under the age of 21, who is assessed to be “at-risk” fordeveloping a SUD will be eligible for Early Interventionservices if they do not meet medical necessity criteria. You must meet the American Society of Addiction Medicine(ASAM) definition of medical necessity for services basedon the ASAM Criteria (These are national treatmentstandards for addictive and substance-related conditions).You don’t need to know if you have a diagnosis to ask for help.Your county MCP will help you get this information and willdetermine medical necessity with an assessment.Access to Treatment for UninsuredThe Managed Care Plan provides treatment for those who arenot covered by Medi-Cal, provided they do not have privateinsurance. Our system of care may be accessed by anyone whohas Medi-Cal or has no insurance whatsoever.Managed Care Plan (MCP) ResponsibilitiesThe Managed Care Plan is Responsible for: Determining if you are eligible for substance use treatmentservices from the county or its provider network. Coordinating your care. Providing a toll-free phone number that is answered 24 hoursa day and 7 days a week that can tell you about how to getservices from the MCP: 1-800-488-9919.16

You can also contact the MCP at this number to requestavailability of after-hours care: 408-792-5666. Having enough providers to make sure that you can get thesubstance use treatment services covered by the MCP, if youneed them. Informing and educating you about services available fromyour MCP. Providing sensitivity to culturally and linguisticallyappropriate substance use treatment services. Oral and writteninterpretation services are available free of cost in thethreshold languages, English, Spanish, Vietnamese,Mandarin, Tagalog and Farsi, free of charge. Providing free aids and services to people with disabilities,such as: qualified sign language interpreters and writteninformation in other formats (braille, large print, audio,accessible electronic formats, and other formats). Providing you with notice of any significant change in theinformation specified in this handbook at least 30 days beforethe intended effective date of the change. A change would beconsidered significant when there is an increase or decrease inthe amount or type of services that are available, or if there isan increase or decrease in the number of network providers,or if there is any other change that would impact the benefitsyou receive through the MCP. Informing you if any contracted provider is unable to performor otherwise support any covered service, and informing youof alternative providers that do offer the covered service.17

Contact SUTS MCP Member Services408-792-5666Information for Members Who Need Materials in ADifferent Language408-792-5666, (TTY: 800-855-7100 or 711)Information for Members Who Have Trouble Reading408-792-5666Information for Members Who Are Hearing ImpairedCalifornia Relay Service: 800-855-7100 (TTY)For Spanish 800-855-7200 (TTY)Information for Members Who Are Vision Impaired408-792-5666NOTICE OF PRIVACY PRACTICESAs a part of the Santa Clara Valley Health and Hospital SystemBHSD/SUTS values your privacy and wants to protect yourpersonal health information (PHI). Your information can onlylegally be shared with your permission or within the statutes ofthe law. We will not disclose any health information that is notin accord with the Federal, State and County laws. We want tomake sure you have been given a copy of the BeneficiaryHandbook your Notice of Privacy Practices and have signed the“Acknowledgement of Receipt” for the Managed Care PlanProblem Resolution Procedure.We take great effort to maintain your PHI. We follow HIPAAprivacy rules that define your right to be informed of yourprivacy rights. We also follow the Code of Federal Regulations(CFR) 42 part 2 – The Confidentiality of Alcohol and DrugPatient Records, about how to exchange of information, withyour consent. We offer a statement at the beginning of treatment18

that provides an explanation of your rights and practices. It isour policy to always have posted the Notice of Privacy Practicesin a public place at each of our sites. You may ask for a copy ofthe privacy notice any time you wish.Any individual identifiable information, either in electronic orphysical form, regarding your medical history, mental orphysical condition or treatment that includes elements ofidentifying information or would reveal your identity, isprotected. You have rights concerning the access, use anddisclosure of your PHI.Who Do I Contact If I Feel That I Was DiscriminatedAgainst?Discrimination is against the law. The State of California andthe Drug Medi-Cal (DMC) Managed Care Plan (MCP) complywith applicable federal civil rights laws and do not discriminateon the basis of race, color, national origin, ancestry, religion,sex, marital status, gender, gender identity, sexual orientation,age, or disability. If you believe that the State of California orthe MCP has failed to provide these services or discriminated inanother way on the basis of race, color, national origin, age,disability, or sex, you can file a grievance with:Director of Alcohol Drug and Access Services976 Lenzen Ave, San Jose, CA 95126Phone: 408-792-5680Fax: 408-947-8702You can also file a civil rights complaint electronically with theU.S. Department of Health and Human Services, Office for CivilRights through the Office for Civil Rights Complaint Portal,19

available at .You can file a civil rights complaint by mail or phone at:U.S. Department of Health and Human Services200 Independence Avenue, SWRoom 509F, HHH BuildingWashington, D.C. 202011-800-368-1019, 800-537-7697 (TDD)Complaint forms are availableat CE DIRECTIVESAn Advance Directive is a legal document that allows you tosay, in advance, what your wishes would be, if you becomeunable to make health care decisions. It is designed to allowyou to have control over your own treatment. You have theright to have an Advance Directive.It is also a written instruction about your health care that isrecognized under California law stating how you would likehealth care provided, and outlines what decisions you wouldlike to be made, if or when you are unable to speak for yourself.You may sometimes hear an advance directive described as aliving will or durable power of attorney.We provide any adult who is Medi-Cal eligible with writteninformation on the Advance directive policies if you ask for theinformation. If you would like to request the information, youshould talk to your direct provider. Or you may call MCP’sbeneficiary membership number at 408-792-5666.The California Advance Directive consists of two parts:20

Your appointment of an agent (a person of your choosing) tomake decisions about your health care, andYour individual health care instructions.If you have a complaint about advance directive requirements,you may contact:California Department of Health Care Services,Licensing and Certification ServicesP.O. Box 997413Sacramento, CA 95899-1413You may also call (800) 236-9747You may have additional rights under state laws aboutSubstance Use Treatment and may wish to contact the ManagedCare Plan at 408-792-5666.HOW TO APPLY FOR MEDI-CALAutomatic Mandatory EnrollmentIf you are already placed with a provider and you have notenrolled for Medi-Cal, your provider will assist you in doing so.You may also be assisted by the Managed Care Plan at 408-7925666.21

If you wish to apply prior to entering treatment, please note thefollowing:Where to Apply?Office NameAssistanceApplicationCenterAddress1867 Senter Rd.San Jose, CA 95112Phone #408-758-3800877-962-3633Apply for: HealthCoverage FoodAssistance FinancialAssistanceNorth County 1330 W Middlefield Road 408-278-2400OfficeMountain View, CA 94043 HealthCoverage Food Assistance FinancialAssistanceSouth County 379 Tomkins CourtOfficeGilroy, CA 95020 HealthCoverage Food Assistance FinancialAssistanceGeneralAssistanceServices1919 Senter RoadSan Jose, CA 95112CentralWellness &BenefitsCenter(CWBC)2221 Enborg LaneSan Jose, CA 95128408-758-3300408-793-8900408-885-6220 GeneralAssistance Cash AssistanceProgram forImmigrants(CAPI) Health CoverageFood Assistance FinancialAssistance(families withChildren)22

Children'sHealthInitiative:OnlineContact by Phone1-888-244-5222 HealthCoverage forChildrenwww.mybenefitscalwin.org HealthCoverage Food Assistance FinancialAssistance(families withChildren)DHCS M-F 8-5 PSTMedicalManaged CareOffice of theOmbudsman(MMCO)1-888-452-8609 Any questionsyou may haveabout the MCPUnderstandingMCP andchoices andprocessNavigating theGrievanceprocess23

SERVICESWhat Are DMC (Drug Medi-Cal) Treatment Services?Drug Medi-Cal substance use treatment services are health careservices for people who have at least one Substance UseDisorder (SUD).Services include: Outpatient Services Intensive Outpatient Treatment Partial Hospitalization Residential Treatment (subject to prior authorization) Withdrawal Management Opioid Treatment Medication Assisted Treatment Recovery Services Case ManagementIf you would

Oct 01, 2018 · member handbook that you received when you enrolled in your current Medi-Cal benefit. That could be with a Medi-Cal . Drug Medi-Cal pays for youth over age 12 and adults who want and need Substance Use Treatment services through our SUTS manag