Grievances and Client Rights

Clients receiving behavioral health services have legal rights, including the right to express their concerns about the type and delivery of their services. Clients of Siskiyou County Behavioral Health Services or one of its providers are entitled to: 

• Respectful treatment, with due consideration for their dignity and privacy;
• Services provided in a safe, caring environment;
• Informed consent to treatment and to prescribed medications, including potential side effects;
• Confidential care and record keeping;
• Request a specific provider, a change of provider, a second opinion or a change in level of care;
• Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation;
• Participate in planning their treatment and decisions regarding their health care, including the right to refuse treatment;
• Request access to their health records, to receive a copy if they wish, and to request that their records be amended or corrected;
• File a grievance about any issue pertaining to their care and treatment or appeal a decision to deny, change, reduce or terminate their services;
• Request the assistance or presence of the Patients’ Rights Advocate or representative of their choice at any time during the grievance process;
• File a request for a State Fair Hearing if not satisfied after using the Behavioral Health Plan’s appeals process; and
• Authorize any person to act on their behalf during the grievance, appeal or State Fair Hearing process.

MENTAL HEALTH SERVICES – PATIENTS’ RIGHTS

Medi-Cal members receiving services through Siskiyou County Behavioral Health have certain rights protected under state and federal laws and regulations. Siskiyou County Behavioral Health policies are developed in accordance with these requirements. All providers, contractors, and staff are responsible for understanding, respecting, and protecting client rights in compliance with applicable laws, regulations, policies, and procedures.

The Patients’ Rights Advocate represents the expressed interests and wishes of individuals receiving mental health services in Siskiyou County.

The Patients’ Rights Advocate:

• Investigates and resolves complaints regarding alleged violations or abuse of patients’ rights
• Acts as an advocate for individuals who are unable or afraid to file a complaint
• Monitors behavioral health facilities for compliance with patients’ rights laws, regulations, and policies
• Assists staff in ensuring clients are informed of their rights
• Serves as a liaison between the local advocacy program and the California Office of Patients’ Rights
• Represents clients during inpatient certification review hearings and medication hearings

If you have questions about your rights or wish to file a complaint regarding patients’ rights, you may contact the Siskiyou County Patients’ Rights Advocate.

Siskiyou County Patients’ Rights Advocate
Phone: (530) 918-7202
Address: 2060 Campus Drive,  Yreka, CA 96097

You may also contact the California Office of Patients’ Rights for additional assistance.

MENTAL HEALTH AND SUBSTANCE USE DISORDER APPEALS AND GRIEVANCES

A Medi-Cal member, provider, or authorized representative may file an appeal and/or grievance. Providers submitting an appeal or grievance on behalf of a member must have written authorization from the member.

Appeals and grievances may be submitted verbally or in writing. Siskiyou County Behavioral Health will send an acknowledgment letter within five (5) calendar days of receipt that includes:

• The date the appeal or grievance was received
• The name, telephone number, and mailing address of the Behavioral Health representative assigned to assist the member

Grievance and/or Appeal forms can be obtained in the Behavioral Health lobbies, on the Behavioral Health website at www.co.siskiyou.ca.us/BehavioralHealth or mailed by verbal request.

What Is an Appeal?

An appeal is a request for review when a Medi-Cal member disagrees with a Notice of Adverse Benefit Determination (NOABD) issued by Siskiyou County Behavioral Health.

Appeals must be submitted within 60 calendar days from the date on the NOABD.

Standard Resolution of Appeals

Appeals are generally resolved within 30 calendar days from the date they are received.

Once a decision is made, the member will receive a Notice of Appeal Resolution (NAR) stating whether the adverse benefit determination was upheld or overturned. The NAR will also include information regarding the member’s rights, including how to request a State Fair Hearing.

If an appeal is not fully resolved in the member’s favor, the member may request a State Fair Hearing after exhausting the Behavioral Health appeal process. If Siskiyou County Behavioral Health fails to meet required notice or resolution timeframes, the member may request a State Fair Hearing without completing the appeal process.

Requests for a State Fair Hearing must be submitted within 120 calendar days from the date of the NAR that upheld the adverse benefit determination.

Expedited Resolution of Appeals

Siskiyou County Behavioral Health offers an expedited appeal process when a delay could seriously jeopardize the member’s mental health or substance use disorder condition, or the member’s ability to attain, maintain, or regain maximum functioning.

An expedited appeal may be requested by the member or by a provider acting on the member’s behalf.

• If the request for expedited review is denied, the appeal will be processed under the standard timeframe.
• The member will be notified orally as soon as possible and provided written notice within two (2) calendar days explaining the reason for the denial and the right to file a grievance.

If approved, an expedited appeal will be resolved as quickly as the member’s health condition requires, but no later than 72 hours from receipt of the request.

What Is a Grievance?

A grievance is an expression of dissatisfaction regarding any matter other than an Adverse Benefit Determination.

Examples include, but are not limited to:

• Concerns about quality of care or services
• Issues related to staff or provider behavior
• Failure to respect a member’s rights
• Disagreement with an extension of time proposed by Behavioral Health to make an authorization decision

There is no time limit to file a grievance. All complaints are processed as grievances, even if the member does not formally request one.

A grievance may be filed any time either orally or in writing by the member, provider, or authorized representative.

Members will receive a written response within 30 calendar days.

IHSS FRAUD HOTLINE

To report public assistance fraud, including IHSS fraud, please contact:

Phone: 800-889-7610 or 916-784-6180

Email: Welfare Fraud Office

If you need information about resolving problems call (530) 841-4100 to speak to a Behavioral Health staff member.