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Member Handbook
Specialty Mental Health Services and Drug
Medi-Cal Organized Delivery System
Alameda County Behavioral Health Department
Administration Offices
2000 Embarcadero Cove
Oakland, CA 94606
The Alameda County Behavioral Health Department
(ACBHD) ACCESS Program
and Helpline are available 24/7.
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ACCESS Program: 1-800-491-9099
Helpline: 1-844-682-7215 (TTY:711)
Effective Date: February 1, 20261
1 The handbook must be offered at the time the
member first accesses services.
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NOTICE OF AVAILABILITY OF LANGUAGE
ASSISTANCE SERVICES AND AUXILIARY AIDS AND
SERVICES
English
ATTENTION: If you need help in your language, contact
your service provider or call ACBHD ACCESS at
1-800-491-9099 (TTY: 711). Aids and services for
people with disabilities, like documents in braille and
large print, are also available by contacting your service
provider or calling ACBHD ACCESS at 1-800-491-9099
(TTY: 711). These services are free of charge.
Arabic)( ﺔﯾﺑرﻌﻟا
دوزﻣﺑ لﺎﺻﺗﻹﺎﺑ مﻗ ،كﺗﻐﻠﺑ ةدﻋﺎﺳﻣ ﻰﻟإ ﺔﺟﺎﺣﺑ تﻧﻛ اذإ :هﺎﺑﺗﻧﻹا ﻰﺟرﯾ
ـﺑ لﺻﺗا وأ كﺑ صﺎﺧﻟا ﺔﻣدﺧﻟاACBHD ACCESS مﻗرﻟا ﻰﻠﻋ
9099-491-800-1 )TTY: 711( تﺎﻣدﺧو تادﻋﺎﺳﻣ ﺎًﺿﯾأ ﺎﻧﯾدﻟ رﻓوﺗﺗ .
ﺔﻋوﺑطﻣﻟاو لﯾارﺑ طﺧﺑ ﺔﺑوﺗﻛﻣﻟا تادﻧﺗﺳﻣﻟا لﺛﻣ ،ﺔﻗﺎﻋﻹا يوذ صﺎﺧﺷﻸﻟ
وأ كﺑ صﺎﺧﻟا ﺔﻣدﺧﻟا دوزﻣﺑ لﺎﺻﺗﻻا ﻖﯾرط نﻋ كﻟذو ،ةرﯾﺑﻛ فورﺣﺑ
ـﺑ لﺎﺻﺗﻻا ACBHD ACCESS مﻗرﻟا ﻰﻠﻋ9099-491-800-1
)TTY: 711 .(تﺎﻣدﺧ ﻲھ تﺎﻣدﺧﻟا هذھ لﻛ.
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Հայերեն (Armenian)
ՈՒՇԱԴՐՈՒԹՅՈՒՆ: Եթե Ձեզ անհրաժեշտ է
օգնություն Ձեր լեզվով, զանգահարեք ACBHD
ACCESS 1-800-491-9099 (TTY: 711): Հասանելի են
նաև աջակցման ծառայություններ և ռեսուրսներ
հաշմանդամություն ունեցող անձանց համար,
օրինակ՝ նյութեր Բրայլի գրատիպով կամ
խոշորատառ տպագրությամբ։ Զանգահարեք
ACBHD ACCESS 1-800-491-9099 (TTY: 711): Այս
ծառայությունները տրամադրվում են անվճար։
ែខ្មរ (Cambodian)
ចំណំ៖ េបើអ្នក្រត�វការជំនួយជភាសារបស់អ្នក សូ ម
ទាɩក់ទងអ្នកផ្ដល់េសវកម្មរបស់អ្នក ឬេ�ទូរសព្ទេ�
ACBHD ACCESS តាɩមេលខ 1-800-491-9099 (TTY: 711)
។ ជំនួ យ និងេសវកម្មស្រមាប់ជនពិការ ដូចជឯកសារ
សរេសរជអក្សរសា្ទ ប និងឯកសារសរេសរជអក្សរពុម្ពធំៗ
ក៏ឣចរកបាɩនផងែដរេដយទាɩក់ទងេ�អ្នកផ្ដល់េសវ
កម្មរបស់អ្នក ឬេ�ទូរសព្ទេ� ACBHD ACCESS តាɩម
េលខ 1-800-491-9099 (TTY: 711)។ េសវកម្មទាɩ ំងេនះមិន
គិតៃថ្លេឡើយ។
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繁體中文 (Chinese)
注意：如果您需要使用本民族语言获得帮助，请联系
您的服务提供商或拨打 ACBHD ACCESS 电话
1-800-491-9099（TTY：711）。通过与您的服务提供
商联系或拨打 ACBHD ACCESS 电话 1-800-491-9099
（TTY：711），还可获得为残疾人提供的辅助工具和
服务，如盲文和大字印刷文件。这些服务均免费。
ﯽﺳرﺎﻓ (Farsi)
ﮫﺟوﺗ : رﮔاﮏﻣﮐ دﻧﻣزﺎﯾﻧ دوﺧ نﺎﺑز ﮫﺑ دﯾﺗﺳھﺎﺑ ، دوﺧ تﺎﻣدﺧ هدﻧﻧﮐ مھارﻓ
هرﺎﻣﺷ ﺎﯾ1-800-491-9099 (TTY: 711) ACBHD ACCESS
دﯾرﯾﮕﺑ سﺎﻣﺗ .ﮏﻣﮐ دﻧﻧﺎﻣ ،تﯾﻟوﻠﻌﻣ یاراد دارﻓا صوﺻﺧﻣ تﺎﻣدﺧ و ﺎھ
ﮫﺧﺳﻧگرزﺑ فورﺣ ﺎﺑ پﺎﭼ و لﯾرﺑ طﺧ یﺎھ سﺎﻣﺗ ﻖﯾرط زا زﯾﻧﺎﺑ مھارﻓ
هرﺎﻣﺷ ﺎﯾ دوﺧ تﺎﻣدﺧ هدﻧﻧﮐ 1-800-491-9099 (TTY: 711)
ACBHD ACCESS تﺳا دوﺟوﻣ .ﯽﻣ ﮫﺋارا نﺎﮕﯾار تﺎﻣدﺧ نﯾادﻧوﺷ .
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�हंद� (Hindi)
ध्यान दें: अगर आपको अपनी भाषा में सहायता क� आवश्यकता
है तो 1-800-491-9099 (TTY: 711) पर कॉल करें। अगर
आपको दृ�� बािधत लोगों के िलए सहायता और सेवाएँ,
जैसे �ेल िल�प में और बड़े ��ंट में दस्तावेज़ चा�हए तो
अपने सेवा �दाता से संपकर् करें या ACBHD ACCESS को
1-800-491-9099 (TTY: 711) पर कॉल करें। ये सेवाएँ
िनःशुल्क हैं।
Hmoob (Hmong)
CEEB TOOM: Yog koj xav tau kev pab txhais ua koj hom
lus, tiv tauj rau koj tus kws muab kev pab cuam los sis
hu rau ACBHD ACCESS ntawm 1-800-491-9099
(TTY: 711). Muaj cov kev pab txhawb thiab kev pab
cuam rau cov neeg xiam oob qhab, xws li puav leej
muaj ua cov ntawv su rau neeg dig muag thiab luam
tawm ua tus ntawv loj los ntawm kev tiv tauj rau koj
tus kws muab kev pab cuam los sis hu rau ACBHD
ACCESS ntawm 1-800-491-9099 (TTY: 711). Cov kev
pab cuam no yog pab dawb xwb.
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日本語 (Japanese)
注意日本語での対応が必要な場合は 1-800-491-9099
(TTY: 711)へお電話ください。点字の資料や文字の拡
大表示など、障がいをお持ちの方のためのサービス
も用意しています。1-800-491-9099 (TTY: 711)へお電
話ください。これらのサービスは無料で提供してい
ます。
한국어 (Korean)
유의사항: 귀하의 언어로 도움을 받고 싶으시면
귀하의 서비스 제공자에게 문의하거나 ACBHD
ACCESS에 1-800-491-9099 (TTY: 711) 번으로
문의하십시오. 점자나 큰 활자로 된 문서와 같이
장애가 있는 분들을 위한 도움과 서비스도 귀하의
서비스 제공자에게 연락하거나 ACBHD ACCESS에
1-800-491-9099 (TTY: 711) 번으로 연락하여 이용할 수
있습니다. 이러한 서비스는 무료로 제공됩니다.
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ພາສາລາວ (Laotian)
ປະກາດ: ຖ້າທ່ານຕ້ອງການຄວາມຊ່ວຍເຫຼືອເປັນພາສາ
ຂອງທ່ານ ໃຫ້ໂທຫາຜູ້ໃຫ້ບໍລິການຂອງທ່ານ ຫຼື ໂທຫາ
ACBHD ACCESS ທີ່ເບີ 1-800-491-9099 (TTY: 711).
ຍັງມີຄວາມຊ່ວຍເຫຼືອ ແລະ ການບໍລິການສໍາລັບຄົນພິການ
ເຊັ່ນເອກະສານທີ່ເປັນອັກສອນນູນ ແລະ ໂຕພິມໃຫຍ່
ໂດຍໃຫ້ຕິດຕໍ່ຫາ ໂທຫາຜູ້ໃຫ້ບໍລິການຂອງທ່ານ ຫຼື ໂທຫາ
ACBHD ACCESS ທີ່ເບີ 1-800-491-9099] (TTY: 711).
ການບໍລິການເຫຼົ່ານີ້ບໍ່ຕ້ອງເສຍຄ່າໃຊ້ຈ່າຍໃດໆ.
Mien
LONGC HNYOUV JANGX LONGX OC: Beiv taux meih
qiemx longc mienh tengx faan benx meih nyei waac nor
douc waac daaih lorx ACBHD ACCESS 1-800-491-9099
(TTY: 711). Liouh lorx jauv-louc tengx aengx caux nzie
gong-bunx aengx caux ninh mbuo wuaaic mienh, beiv
taux longc benx nzangc-pokc bun hluo mbiutc aamz
caux benx domh sou se mbenc nzoih bun longc.
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Douc waac daaih lorx ACBHD ACCESS 1-800-491-9099
(TTY: 711). Naaiv nzie weih jauv-louc se benx
wang-henh tengx mv zuqc cuotv nyaanh oc.
ਪੰਜਾਬੀ (Punjabi)
ਿਧਆਨ ਿਦਓ: ਜੇ ਤੁਹਾਨੂੰ ਆਪਣੀ ਭਾਸ਼ਾ ਿਵੱਚ ਮਦਦ ਦੀ ਲੋੜ ਹੈ ਤਾਂ
ਆਪਣੇ ਸੇਵਾ ਪ�ਦਾਤਾ ਨਾਲ ਸੰਪਰਕ ਕਰੋ ਜਾਂ ACBHD ACCESS ਨੂੰ
1-800-491-9099 (TTY: 711) ਤੇ ਕਾਲ ਕਰੋ। ਅਪਾਹਜ ਲੋਕਾਂ
ਲਈ ਸਹਾਇਤਾ ਅਤੇ ਸੇਵਾਵਾਂ, ਿਜਵੇਂ ਿਕ ਬ�ੇਲ ਅਤੇ ਮੋਟੀ ਛਪਾਈ ਿਵੱਚ
ਦਸਤਾਵੇਜ਼, ਤੁਹਾਡੇ ਸੇਵਾ ਪ�ਦਾਤਾ ਨਾਲ ਸੰਪਰਕ ਕਰਕੇ ਜਾਂ
ACBHD ACCESS ਨੂੰ 1-800-491-9099 (TTY: 711) 'ਤੇ ਕਾਲ
ਕਰਕੇ ਵੀ ਪ�ਾਪਤ ਕੀਤੇ ਜਾ ਸਕਦੇ ਹਨ। ਇਹ ਸੇਵਾਵਾਂ ਮੁਫ਼ਤ ਹਨ|
Русский (Russian)
ВНИМАНИЕ! Если вам нужна помощь на вашем
языке, обратитесь к поставщику услуг или
позвоните в ACBHD ACCESS по телефону
1-800-491-9099 (TTY: 711). Помощь и услуги для
людей с ограниченными возможностями,
например документы, напечатанные шрифтом
Брайля или крупным шрифтом, также можно
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получить, обратившись к поставщику услуг или
позвонив в ACBHD ACCESS по телефону
1-800-491-9099 (TTY: 711). Эти услуги
предоставляются бесплатно.
Español (Spanish)
ATENCIÓN: Si necesita ayuda en su idioma,
comuníquese con su proveedor de servicios o llame a
ACBHD ACCESS al 1-800-491-9099 (TTY: 711). Las
ayudas y servicios para personas con discapacidades,
como documentos en braille y letra grande, también
están disponibles comunicándose con su proveedor
de servicios o llamando a ACBHD ACCESS al
1-800-491-9099 (TTY: 711). Estos servicios
son gratuitos.
Tagalog (Filipino)
ATENSIYON: Kung kailangan mo ng tulong sa iyong
wika, makipag-ugnayan sa iyong tagapagbigay ng
serbisyo o tumawag sa ACBHD ACCESS sa
1-800-491-9099 (TTY: 711). Makukuha rin ang mga
tulong at serbisyo para sa mga taong may
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kapansanan, tulad ng mga dokumento sa braille at
malaking print sa pamamagitan ng pakikipag-ugnayan
sa iyong tagpagbigay ng serbisyo o pagtawag sa
ACBHD ACCESS sa 1-800-491-9099 (TTY: 711).
Libre ang mga serbisyong ito.
ภาษาไทย (Thai)
โปรดทราบ: หากคุณต้องการความช่วยเหลือเป็นภาษาของคุณ
กรุณาติดต่อผู้ให้บริการของคุณหรือติดต่อ ACBHD ACCESS
ที่หมายเลข 1-800-491-9099 (TTY: 711) นอกจากนี้ยังพร้อม
ให้ความช่วยเหลือและบริการต่าง ๆ สําหรับบุคคลที่มีความพิการ
ด ้วย เช่น เอกสารต่าง ๆ ที่เป็นอักษรเบรลล์และเอกสารที่พิมพ์
ด้วยตัวอักษรขนาดใหญ่ โดยติดต่อผู้ให้บริการของคุณหรือ
ติดต่อ ACBHD ACCESS ที่หมายเลข 1-800-491-9099
(TTY: 711) ไม่มีค่าใช้จ่ายสําหรับบริการเหล่านี้
Українська (Ukrainian)
УВАГА! Якщо вам потрібна допомога вашою мовою,
зверніться до постачальника послуг або
зателефонуйте до ACBHD ACCESS за номером
1-800-491-9099 (TTY: 711). Допоміжні засоби та
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послуги для людей з обмеженими можливостями,
наприклад, документи, надруковані шрифтом
Брайля або великим шрифтом, також можна
отримати, звернувшись до свого постачальника
послуг або зателефонувавши до ACBHD ACCESS за
номером 1-800-491-9099 (TTY: 711). Ці послуги є
безкоштовними.
Tiếng Việt (Vietnamese)
CHÚ Ý: Nếu quý vị cần trợ giúp bằng ngôn ngữ của
mình, vui lòng liên hệ với nhà cung cấp dịch vụ của
quý vị hoặc gọi cho ACBHD ACCESS theo số
1-800-491-9099 (TTY: 711). Khi liên hệ với nhà cung
cấp dịch vụ của quý vị hoặc gọi cho ACBHD ACCESS
theo số 1-800-491-9099 (TTY: 711), quý vị cũng sẽ
được hỗ trợ và nhận dịch vụ dành cho người khuyết
tật, như tài liệu bằng chữ nổi Braille và chữ in khổ lớn.
Các dịch vụ này đều miễn phí.
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TABLE OF CONTENTS
OTHER LANGUAGES AND FORMATS .................... 15
COUNTY CONTACT INFORMATION ...................... 17
PURPOSE OF THIS HANDBOOK ........................... 20
BEHAVIORAL HEALTH SERVICES INFORMATION .. 23
ACCESSING BEHAVIORAL HEALTH SERVICES ...... 31
SELECTING A PROVIDER ..................................... 53
YOUR RIGHT TO ACCESS BEHAVIORAL HEALTH
RECORDS AND PROVIDER DIRECTORY
INFORMATION USING SMART DEVICES ............... 60
SCOPE OF SERVICES .......................................... 61
AVAILABLE SERVICES BY TELEPHONE OR
TELEHEALTH .................................................... 127
THE PROBLEM RESOLUTION PROCESS:
TO FILE A GRIEVANCE, APPEAL, OR REQUEST
A STATE FAIR HEARING ..................................... 129
ADVANCE DIRECTIVE ....................................... 159
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RIGHTS AND RESPONSIBILITIES ........................ 162
NONDISCRIMINATION NOTICE ......................... 190
NOTICE OF PRIVACY PRACTICES ...................... 196
WORDS TO KNOW ............................................ 214
ADDITIONAL INFORMATION FROM YOUR
COUNTY .......................................................... 239
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OTHER LANGUAGES AND FORMATS
Other languages
If you need help in your language call 1-800-491-9099
(TTY: 711). Aids and services for people with
disabilities, like documents in braille and large print,
are also available. Call 1-800-491-9099 (TTY: 711).
These services are free of charge.
Other formats
You can get this information in other formats, such as
braille, 20-point font large print, audio, and accessible
electronic formats at no cost to you. Call the county
telephone number listed on the cover of this
handbook (TTY: 711). The call is toll free.
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Interpreter Services
The county provides oral interpretation services from a
qualified interpreter, on a 24-hour basis, at no cost to
you. You do not have to use a family member or friend
as an interpreter. We discourage the use of minors as
interpreters, unless it is an emergency. The county
can also provide auxiliary aids and services to a family
member, friend, or anyone else with who it is
appropriate to communicate with on your behalf.
Interpreter, linguistic and cultural services are
available at no cost to you. Help is available 24 hours
a day, 7 days a week. For language help or to get this
handbook in a different language, call the county
telephone number listed on the cover of this
handbook (TTY: 711). The call is toll free.
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COUNTY CONTACT INFORMATION
We are here to help. The following county contact
information will help you get the services you need.
IMPORTANT TELEPHONE NUMBERS
Emergency 911
24/7 Helpline for
Substance Use Disorder
Services
(844) 682-7215
(TTY: 711)
24/7 ACCESS Program for
Mental Health Services
(510) 346-1000 or
(800) 491-9099
(TTY: 711)
Public Website https://www.acbh
cs.org/
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Provider Directory https://acbh.my.si
te.com/ProviderDi
rectory/s/
Digital Access to Health
Information
https://www.acbh
cs.org/plan-
administration/he
alth-records-
request-digital-
copy/
Request for Copy of Health
Records
https://www.acbh
cs.org/plan-
administration/he
alth-records-
request-hard-
copy/
Consumer Grievance and
Appeal Line
(800) 779-0787
Patient Rights Advocates (510) 835-2505
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Who Do I Contact If I’m Having Suicidal Thoughts?
If you or someone you know is in crisis, please call the
988 Suicide and Crisis Lifeline at 988 or the National
Suicide Prevention Lifeline at 1-800-273-TALK (8255).
Chat is available at https://988lifeline.org/.
To access your local programs, please call the 24/7
Access Line listed previous page.
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PURPOSE OF THIS HANDBOOK
Why is it important to read this handbook?
Your county has a mental health plan that offers
mental health services known as “specialty mental
health services”. Additionally, your county has a Drug
Medi-Cal Organized Delivery System that provides
services for alcohol or drug use, known as “substance
use disorder services”. Together these services are
known as ”behavioral health services”, and it is
important that you have information about these
services so that you can get the care you need. This
handbook explains your benefits and how to get care.
It will also answer many of your questions.
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You will learn:
• How to receive behavioral health services through
your county.
• What benefits you can access.
• What to do if you have a question or problem.
• Your rights and responsibilities as a member of
your county.
• If there is additional information about your
county, which may be indicated at the end of this
handbook.
If you do not read this handbook now, you should hold
on to it so you can read it later. This book is meant to be
used along with the book you got when you signed up
for your Medi-Cal benefits. If you have any questions
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about your Medi-Cal benefits, call the county using the
phone number on the front of this book.
Where Can I Go for More Information About Medi-
Cal?
Visit the Department of Health Care Services website at
https://www.dhcs.ca.gov/services/medi-cal/eligibility/
Pages/Beneficiaries.aspx
for more information about Medi-Cal.
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BEHAVIORAL HEALTH SERVICES INFORMATION
How to Tell if You or Someone You Know Needs
Help?
Many people go through hard times in life and may
experience mental health or substance use
conditions. The most important thing to remember is
that help is available. If you or your family member are
qualified for Medi-Cal and need behavioral health
services, you should call the 24/7 Access Line listed
on the cover of this handbook. Your managed care
plan can also help you contact your county if they
believe you or a family member need behavioral
health services that the managed care plan does not
cover. Your county will help you find a provider for the
services you may need.
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The list below can help you decide if you or a family
member needs help. If more than one sign is present
or happens for a long time, it may be a sign of a more
serious problem that requires professional help. Here
are some common signs you might need help with a
mental health condition or substance use condition:
Thoughts and Feelings
• Strong mood changes, possibly with no reason,
such as:
o Too much worry, anxiety, or fear
o Too sad or low
o Too good, on top of the world
o Moody or angry for too long
• Thinking about suicide
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• Focusing only on getting and using alcohol or
drugs
• Problems with focus, memory or logical thought
and speech that are hard to explain
• Problems with hearing, seeing, or sensing things
that are hard to explain or that most people say
don’t exist
Physical
• Many physical problems, possibly without
obvious causes, such as:
o Headaches
o Stomach aches
o Sleeping too much or too little
o Eating too much or too little
o Unable to speak clearly
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• Decline in looks or strong concern with looks,
such as:
o Sudden weight loss or gain
o Red eyes and unusually large pupils
o Odd smells on breath, body, or clothing
Behavioral
• Having consequences from your behavior
because of changes to your mental health or
using alcohol or drugs, such as:
o Having issues at work or school
o Problems in relationships with other people,
family, or friends
o Forgetting your commitments
o Not able to carry out usual daily activities
• Avoiding friends, family, or social activities
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• Having secretive behavior or secret need for
money
• Becoming involved with the legal system because
of changes to your mental health or using alcohol
or drugs
Members Under the Age of 21
How Do I Know when a Child or Person Under the
Age of 21 Needs Help?
You may contact your county or managed care plan
for a screening and assessment for your child or
teenager if you think they are showing signs of a
behavioral health condition. If your child or teenager
qualifies for Medi-Cal and the screening or
assessment shows that behavioral health services are
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needed, then the county will arrange for your child or
teenager to receive behavioral health services. Your
managed care plan can also help you contact your
county if they believe your child or teenager needs
behavioral health services that the managed care plan
does not cover. There are also services available for
parents who feel stressed by being a parent.
Minors 12 years of age or older, may not need parental
consent to receive outpatient mental health treatment
or counseling if the attending professional person
believes the minor is mature enough to participate in
the behavioral health services. Minors 12 years of age
or older, may not need parental consent to receive
medical care and counseling to treat a substance use
disorder related problem. Parental or guardian
involvement is required unless the attending
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professional person determines that their involvement
would be inappropriate after consulting with the
minor.
The list below can help you decide if your child or
teenager needs help. If more than one sign is present
or persists for a long time, it may be that your child or
teenager has a more serious problem that requires
professional help. Here are some signs to look out for:
• A lot of trouble paying attention or staying still,
putting them in physical danger or causing school
problems
• Strong worries or fears that get in the way of daily
activities
• Sudden huge fear without reason, sometimes with
racing heart rate or fast breathing
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• Feels very sad or stays away from others for two or
more weeks, causing problems with daily activities
• Strong mood swings that cause problems in
relationships
• Big changes in behavior
• Not eating, throwing up, or using medicine to
cause weight loss
• Repeated use of alcohol or drugs
• Severe, out-of-control behavior that can hurt self
or others
• Serious plans or tries to harm or kill self
• Repeated fights, use of a weapon, or serious plan
to hurt others
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ACCESSING BEHAVIORAL HEALTH SERVICES
How Do I Get Behavioral Health Services?
If you think you need behavioral health services such
as mental health services and/or substance use
disorder services, you can call your county using the
telephone number listed on the cover of this
handbook. Once you contact the county, you will
receive a screening and be scheduled for an
appointment for an assessment.
You can also request behavioral health services from
your managed care plan if you are a member. If the
managed care plan determines that you meet the
access criteria for behavioral health services, the
managed care plan will help you to get an assessment
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to receive behavioral health services through your
county. Ultimately, there is no wrong door for getting
behavioral health services. You may even be able to
receive behavioral health services through your
managed care plan in addition to behavioral health
services through your county. You can access these
services through your behavioral health provider if
your provider determines that the services are
clinically appropriate for you and as long as those
services are coordinated and not duplicative.
In addition, keep the following in mind:
• You may be referred to your county for behavioral
health services by another person or organization,
including your general practitioner/doctor,
school, a family member, guardian, your managed
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care plan, or other county agencies. Usually, your
doctor or the managed care plan will need your
consent or the permission of the parent or
caregiver of a child, to make the referral directly to
the county, unless there is an emergency.
• Your county may not deny a request to do an
initial assessment to determine whether you meet
the criteria for receiving behavioral health
services.
• Behavioral health services can be provided by the
county or other providers the county contracts
with (such as clinics, treatment centers,
community-based organizations, or individual
providers).
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Where Can I Get Behavioral Health Services?
You can get behavioral health services in the county
where you live, and outside of your county if
necessary. Each county has behavioral health
services for children, youth, adults, and older adults. If
you are under 21 years of age, you are eligible for
additional coverage and benefits under Early and
Periodic Screening, Diagnostic, and Treatment. See
the “Early and Periodic Screening, Diagnostic, and
Treatment” section of this handbook for more
information.
Your county will help you find a provider who can get
you the care you need. The county must refer you to
the closest provider to your home, or within time or
distance standards who will meet your needs.
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When Can I Get Behavioral Health Services?
Your county has to meet appointment time standards
when scheduling a service for you. For mental health
services, the county must offer you an appointment:
• Within 10 business days of your non-urgent
request to start services with the mental health
plan;
• Within 48 hours if you request services for an
urgent condition that does not require prior
authorization;
• Within 96 hours of an urgent condition that does
require prior authorization;
• Within 15 business days of your non-urgent
request for an appointment with a psychiatrist;
and,
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• Within 10 business days from the prior
appointment for nonurgent follow up
appointments for ongoing conditions.
For substance use disorder services, the county must
offer you an appointment:
• Within 10 business days of your non-urgent
request to start services with a substance use
disorder provider for outpatient and intensive
outpatient services;
• Within 48 hours if you request services for an
urgent condition that does not require prior
authorization;
• Within 96 hours of an urgent condition that does
require prior authorization;
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• Within 3 business days of your request for
Narcotic Treatment Program services;
• A follow-up non-urgent appointment within 10
days if you’re undergoing a course of treatment for
an ongoing substance use disorder, except for
certain cases identified by your treating provider.
However, these times may be longer if your provider
has determined that a longer waiting time is medically
appropriate and not harmful to your health. If you have
been told you have been placed on a waitlist and feel
the length of time is harmful to your health, contact
your county at the telephone number listed on the
cover of this handbook. You have the right to file a
grievance if you do not receive timely care. For more
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information about filing a grievance, see “The
Grievance Process” section of this handbook.
What Are Emergency Services?
Emergency services are services for members
experiencing an unexpected medical condition,
including a psychiatric emergency medical condition.
An emergency medical condition has symptoms so
severe (possibly including severe pain) that an average
person could reasonably expect the following might
happen at any moment:
• The health of the individual (or the health of an
unborn child) could be in serious trouble
• Causes serious harm to the way your body works
• Causes serious damage to any body organ or part
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A psychiatric emergency medical condition occurs
when an average person thinks that someone:
• Is a current danger to themselves or another
person because of a mental health condition or
suspected mental health condition.
• Is immediately unable to provide for their needs,
such as; food, clothing, shelter, personal safety,
or access necessary medical care because of a
mental health condition or suspected mental
health condition and/or severe substance use
disorder.
Emergency services are covered 24 hours a day, seven
days a week for Medi-Cal members. Prior
authorization is not required for emergency services.
The Medi-Cal program will cover emergency
conditions, whether the condition is due to a physical
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health or mental health condition (thoughts, feelings,
behaviors which are a source of distress and/or
dysfunction in relation to oneself or others). If you are
enrolled in Medi-Cal, you will not receive a bill to pay
for going to the emergency room, even if it turns out to
not be an emergency. If you think you are having an
emergency, call 911 or go to any hospital or other
setting for help.
Who Decides Which Services I Will Receive?
You, your provider, and the county are all involved
in deciding what services you need to receive. A
behavioral health professional will talk with you and
will help determine what kind of services are
needed.
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You do not need to know if you have a behavioral
health diagnosis or a specific behavioral health
condition to ask for help. You will be able to receive
some services while your provider completes an
assessment.
If you are under the age of 21, you may also be able
to access behavioral health services if you have a
behavioral health condition due to trauma,
involvement in the child welfare system, juvenile
justice involvement, or homelessness. Additionally,
if you are under age 21, the county must provide
medically necessary services to help your
behavioral health condition. Services that sustain,
support, improve, or make more tolerable a
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behavioral health condition are considered
medically necessary.
Some services may require prior authorization from
the county. Services that require prior authorization
include Intensive Home-Based Services, Day
Treatment Intensive, Day Rehabilitation, Therapeutic
Behavioral Services, Therapeutic Foster Care and
Substance Use Disorder Residential Services. Call
your county using the telephone number on the cover
of this handbook to request additional information.
The county’s authorization process must follow
specific timelines.
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• For a standard substance use disorder
authorization, the county must decide on your
provider’s request within five (5) business days.
o If you or your provider request, or if the county
thinks it is in your interest to get more
information from your provider, the timeline
can be extended for up to another 14 calendar
days. An example of when an extension might
be in your interest is when the county thinks it
might be able to approve your provider’s
request for authorization if the county had
additional information from your provider and
would have to deny the request without the
information. If the county extends the
timeline, the county will send you a written
notice about the extension.
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• For a standard prior mental health authorization,
the county must decide based on your provider’s
request as quickly as your condition requires, but
not to exceed five (5) business days from when the
county receives the request.
o For example, if following the standard
timeframe could seriously jeopardize your life,
health, or ability to attain, maintain, or regain
maximum function, your county must rush an
authorization decision and provide notice
based on a timeframe related to your health
condition that is no later than 72 hours after
receipt of the service request. Your county
may extend the time for up to 14 additional
calendar days after the county receives the
request if you or your provider request the
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extension or the county provides justification
for why the extension is in your best interest.
In both cases, if the county extends the timeline for
the provider’s authorization request, the county will
send you a written notice about the extension. If the
county does not make a decision within the listed
timelines or denies, delays, reduces, or terminates the
services requested, the county must send you a
Notice of Adverse Benefit Determination telling you
that the services are denied, delayed, reduced or
terminated, inform you that you may file an appeal,
and give you information on how to file an appeal.
You may ask the county for more information about its
authorization processes.
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If you don’t agree with the county’s decision on an
authorization process, you may file an appeal. For
more information, see the "Problem Resolution”
section of this handbook.
What Is Medical Necessity?
Services you receive must be medically necessary and
clinically appropriate to address your condition. For
members 21 years of age and older, a service is
medically necessary when it is reasonable and
necessary to protect your life, prevent significant
illness or disability, or improve severe pain.
For members under the age of 21, a service is
considered medically necessary if it corrects,
sustains, supports, improves, or makes more
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tolerable a behavioral health condition. Services that
sustain, support, improve, or make more tolerable a
behavioral health condition are considered medically
necessary and covered as Early and Periodic
Screening, Diagnostic, and Treatment services.
How Do I Get Other Mental Health Services That Are
Not Covered by the County?
If you are enrolled in a managed care plan, you have
access to the following outpatient mental health
services through your managed care plan:
• Mental health evaluation and treatment, including
individual, group and family therapy.
• Psychological and neuropsychological testing,
when clinically indicated to evaluate a mental
health condition.
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• Outpatient services for purposes of monitoring
prescription drugs.
• Psychiatric consultation.
To get one of the above services, call your managed
care plan directly. If you are not in a managed care
plan, you may be able to get these services from
individual providers and clinics that accept Medi-Cal.
The county may be able to help you find a provider or
clinic.
Any pharmacy that accepts Medi-Cal can fill
prescriptions to treat a mental health condition.
Please note that most prescription medication
dispensed by a pharmacy, called Medi-Cal Rx, is
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covered under the Fee-For-Service Medi-Cal program,
not your managed care plan.
What Other Substance Use Disorder Services Are
Available from Managed Care Plans or the Medi-Cal
“Fee for Service” Program?
Managed care plans must provide covered substance
use disorder services in primary care settings and
tobacco, alcohol, and illegal drug screening. They
must also cover substance use disorder services for
pregnant members and alcohol and drug use
screening, assessment, brief interventions, and
referral to the appropriate treatment setting for
members ages 11 and older. Managed care plans
must provide or arrange services for Medications for
Addiction Treatment (also known as Medication
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Assisted Treatment) provided in primary care,
inpatient hospital, emergency departments, and other
contracted medical settings. Managed care plans
must also provide emergency services necessary to
stabilize the member, including voluntary inpatient
detoxification.
How Do I Get Other Medi-Cal Services (Primary
Care/Medi-Cal)?
If you are in a managed care plan, the county is
responsible for finding a provider for you. If you are not
enrolled in a managed care plan and have "regular"
Medi-Cal, also called Fee-For-Service Medi-Cal, then
you can go to any provider that accepts Medi-Cal. You
must tell your provider that you have Medi-Cal before
you begin getting services. Otherwise, you may be
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billed for those services. You may use a provider
outside your managed care plan for family planning
services.
Why Might I Need Psychiatric Inpatient Hospital
Services?
You may be admitted to a hospital if you have a mental
health condition or signs of a mental health condition
that can’t be safely treated at a lower level of care,
and because of the mental health condition or
symptoms of mental health condition, you:
• Represent a danger to yourself, others, or property.
• Are unable to care for yourself with food, clothing,
shelter, personal safety, or necessary medical
care.
• Present a severe risk to your physical health.
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• Have a recent, significant deterioration in the
ability to function as a result of a mental health
condition.
• Need psychiatric evaluation, medication
treatment, or other treatment that can only be
provided in the hospital.
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SELECTING A PROVIDER
How Do I Find a Provider For The Behavioral Health
Services I Need?
Your county is required to post a current provider
directory online. You can find the provider directory
link in the County Contact section of this handbook.
The directory contains information about where
providers are located, the services they provide, and
other information to help you access care, including
information about the cultural and language services
that are available from the providers.
If you have questions about current providers or would
like an updated provider directory, visit your county’s
website or use the telephone number located on the
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cover of this handbook. You can get a list of providers
in writing or by mail if you ask for one.
Note: The county may put some limits on your choice
of providers for behavioral health services. When you
first start receiving behavioral health service services
you can request that your county provide you with an
initial choice of at least two providers. Your county
must also allow you to change providers. If you ask to
change providers, the county must allow you to
choose between at least two providers when possible.
Your county is responsible for ensuring that you have
timely access to care and that there are enough
providers close to you to make sure that you can get
covered behavioral health services if you need them.
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Sometimes the county’s contracted providers choose
to no longer provide behavioral health services
because they may no longer contract with the county,
or no longer accept Medi-Cal. When this happens, the
county must make a good faith effort to give written
notice to each person who was receiving services
from the provider. You are required to get a notice 30
calendar days prior to the effective date of the
termination or 15 calendar days after the county
knows the provider will stop working. When this
happens, your county must allow you to continue
receiving services from the provider who left the
county, if you and the provider agree. This is called
“continuity of care” and is explained below.
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Note: American Indian and Alaska Native individuals
who are eligible for Medi-Cal and reside in counties
that have opted into the Drug Medi-Cal Organized
Delivery System, can also receive Drug Medi-Cal
Organized Delivery System services through Indian
Health Care Providers.
Can I Continue To Receive Specialty Mental Health
Services From My Current Provider?
If you are already receiving mental health services from
a managed care plan, you may continue to receive care
from that provider even if you receive mental health
services from your mental health provider, as long as
the services are coordinated between the providers
and the services are not the same.
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In addition, if you are already receiving services from
another mental health plan, managed care plan, or an
individual Medi-Cal provider, you may request
“continuity of care” so that you can stay with your
current provider, for up to 12 months. You may wish to
request continuity of care if you need to stay with your
current provider to continue your ongoing treatment or
because it would cause serious harm to your mental
health condition to change to a new provider. Your
continuity of care request may be granted if the
following is true:
• You have an ongoing relationship with the provider
you are requesting and have seen that provider in
the last 12 months;
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• You need to stay with your current provider to
continue ongoing treatment to prevent serious
detriment to the member's health or reduce the
risk of hospitalization or institutionalization.
• The provider is qualified and meets Medi-Cal
requirements;
• The provider agrees to the mental health plan’s
requirements for contracting with the mental
health plan and payment for services; and
• The provider shares relevant documentation with
the county regarding your need for the services.
Can I Continue To Receive Substance Use Disorder
Services From My Current Provider?
You may request to keep your out-of-network provider
for a period of time if:
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• You have an ongoing relationship with the provider
you are requesting and have seen that provider
prior to the date of your transition to the Drug
Medi-Cal Organized Delivery System county.
• You need to stay with your current provider to
continue ongoing treatment to prevent serious
detriment to the member's health or reduce the
risk of hospitalization or institutionalization.
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YOUR RIGHT TO ACCESS BEHAVIORAL HEALTH
RECORDS AND PROVIDER DIRECTORY
INFORMATION USING SMART DEVICES
You can access your behavioral health records and/or
find a provider using an application downloaded on a
computer, smart tablet, or mobile device. Your county
may have information available on their website for
you to consider before choosing an application to get
your information in this way. For more information on
the availability of your access, contact your county by
referring to the “County Contact Information” section
within this handbook.
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SCOPE OF SERVICES
If you meet the criteria for accessing behavioral
health services, the following services are available to
you based on your need. Your provider will work with
you to decide which services will work best for you.
Specialty Mental Health Services
Mental Health Services
• Mental health services are individual, group, or
family-based treatment services that help
people with mental health conditions to develop
coping skills for daily living. These services also
include work that the provider does to help make
the services better for the person receiving care.
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These kinds of things include assessments to
see if you need the service and if the service is
working; treatment planning to decide the goals
of your mental health treatment and the specific
services that will be provided; and “collateral”,
which means working with family members and
important people in your life (if you give
permission) to help you improve or maintain your
daily living abilities.
• Mental health services can be provided in a
clinic or provider’s office, your home or other
community setting, over the phone, or by
telehealth (which includes both audio-only and
video interactions). The county and provider will
work with you to determine the frequency of your
services/appointments.
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Medication Support Services
• These services include prescribing,
administering, dispensing, and monitoring of
psychiatric medicines. Your provider can also
provide education on the medication. These
services can be provided in a clinic, the doctor’s
office, your home, a community setting, over the
phone, or by telehealth (which includes both
audio-only and video interactions).
Targeted Case Management
• This service helps members get medical,
educational, social, prevocational, vocational,
rehabilitative, or other community services when
these services may be hard for people with a
mental health condition to get on their own.
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Targeted case management includes, but is not
limited to:
o Plan development;
o Communication, coordination, and referral;
o Monitoring service delivery to ensure the
person’s access to service and the service
delivery system; and
o Monitoring the person’s progress.
Crisis Intervention Services
• This service is available to address an urgent
condition that needs immediate attention. The
goal of crisis intervention is to help people in the
community so that they won’t need to go to the
hospital. Crisis intervention can last up to eight
hours and can be provided in a clinic or
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provider’s office, or in your home or other
community setting. These services can also be
done over the phone or by telehealth.
Crisis Stabilization Services
• This service is available to address an urgent
condition that needs immediate attention. Crisis
stabilization lasts less than 24 hours and must
be provided at a licensed 24-hour health care
facility, at a hospital-based outpatient program,
or at a provider site certified to provide these
services.
Adult Residential Treatment Services
• These services provide mental health treatment
to those with a mental health condition living in
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licensed residential facilities. They help build
skills for people and provide residential
treatment services for people with a mental
health condition. These services are available
24 hours a day, seven days a week. Medi-Cal
does not cover the room and board cost for
staying at these facilities.
Crisis Residential Treatment Services
• These services provide mental health treatment
and skill building for people who have a serious
mental or emotional crisis. This is not for people
who need psychiatric care in a hospital. Services
are available at licensed facilities for 24 hours a
day, seven days a week. Medi-Cal does not cover
the room and board cost for these facilities.
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Day Treatment Intensive Services
• This is a structured program of mental health
treatment provided to a group of people who
might otherwise need to be in the hospital or
another 24-hour care facility. The program lasts
three hours a day. It includes therapy,
psychotherapy and skill-building activities.
Day Rehabilitation
• This program is meant to help people with a
mental health condition learn and develop
coping and life skills to better manage their
symptoms. This program lasts at least three
hours per day. It includes therapy and skill-
building activities.
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Psychiatric Inpatient Hospital Services
• These are services provided in a licensed
psychiatric hospital. A licensed mental health
professional decides if a person needs intensive
around-the-clock treatment for their mental
health condition. If the professional decides the
member needs around-the-clock treatment, the
member must stay in the hospital 24 hours a day.
Psychiatric Health Facility Services
• These services are offered at a licensed
psychiatric health facility specializing in 24-hour
rehabilitative treatment of serious mental health
conditions. Psychiatric health facilities must
have an agreement with a nearby hospital or
clinic to meet the physical health care needs of
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the people in the facility. Psychiatric health
facilities may only admit and treat patients who
have no physical illness or injury that would
require treatment beyond what ordinarily could
be treated on an outpatient basis.
Therapeutic Behavioral Services
Therapeutic Behavioral Services are intensive
short-term outpatient treatment interventions for
members up to age 21. These services are designed
specifically for each member. Members receiving
these services have serious emotional disturbances,
are experiencing a stressful change or life crisis, and
need additional short-term, specific support services.
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These services are a type of specialty mental health
service available through the county if you have
serious emotional problems. To get Therapeutic
Behavioral Services, you must receive a mental
health service, be under the age of 21, and have
full-scope Medi-Cal.
• If you are living at home, a Therapeutic
Behavioral Services staff person can work
one-to-one with you to decrease severe behavior
problems to try to keep you from needing to go to
a higher level of care, such as a group home for
children and young people under the age of 21
with very serious emotional problems.
• If you are living in an out-of-home placement, a
Therapeutic Behavioral Services staff person can
work with you so you may be able to move back
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home or to a family-based setting, such as a
foster home.
Therapeutic Behavioral Services will help you and
your family, caregiver, or guardian learn new ways of
addressing problem behavior and increasing the kinds
of behavior that will allow you to be successful. You,
the Therapeutic Behavioral Services staff person, and
your family, caregiver, or guardian will work together
as a team to address problematic behaviors for a
short period until you no longer need the services. You
will have a Therapeutic Behavioral Services plan that
will say what you, your family, caregiver, or guardian,
and the Therapeutic Behavioral Services staff person
will do while receiving these services. The Therapeutic
Behavioral Services plan will also include when and
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where services will occur. The Therapeutic Behavioral
Services staff person can work with you in most
places where you are likely to need help. This includes
your home, foster home, school, day treatment
program, and other areas in the community.
Intensive Care Coordination
This is a targeted case management service that
facilitates the assessment, care planning for, and
coordination of services to beneficiaries under
age 21. This service is for those that are qualified for
the full-scope of Medi-Cal services and who are
referred to the service on basis of medical necessity.
This service is provided through the principles of the
Integrated Core Practice Model. It includes the
establishment of the Child and Family Team to help
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make sure there is a healthy communicative
relationship among a child, their family, and involved
child-serving systems.
The Child and Family Team includes professional
support (for example: care coordinator, providers,
and case managers from child-serving agencies),
natural support (for example: family members,
neighbors, friends, and clergy), and other people who
work together to make and carry out the client plan.
This team supports and ensures children and
families reach their goals.
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This service also has a coordinator that:
• Makes sure that medically necessary services
are accessed, coordinated, and delivered in a
strength-based, individualized, client-driven,
culturally and language appropriate manner.
• Makes sure that services and support are based
on needs of child.
• Makes a way to have everyone work together for
the child, family, providers, etc.
• Supports parent/caregiver in helping meet
child’s needs
• Helps establish the Child and Family Team and
provides ongoing support.
• Makes sure the child is cared for by other
child-serving systems when needed.
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Intensive Home-Based Services
• These services are designed specifically for each
member. It includes strength-based interventions
to improve mental health conditions that may
interfere with the child/youth’s functioning. These
services aim to help the child/youth build
necessary skills to function better at home and in
the community and improve their family’s ability
to help them do so.
• Intensive Home-Based Services are provided
under the Integrated Core Practice Model by the
Child and Family Team. It uses the family’s
overall service plan. These services are provided
to members under the age of 21 who are eligible
for full-scope Medi-Cal services. A referral based
on medical necessity is needed to receive these
services.
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Therapeutic Foster Care
• The Therapeutic Foster Care service model
provides short-term, intensive, and trauma-
informed specialty mental health services for
children up to the age of 21 who have complex
emotional and behavioral needs. These services
are designed specifically for each member. In
Therapeutic Foster Care, children are placed
with trained, supervised, and supported
Therapeutic Foster Care parents.
Parent-Child Interaction Therapy (PCIT)
• PCIT is a program that helps children ages 2-7
who have difficult behaviors and helps their
parents or caregivers learn new ways to handle
them. These behaviors might include getting
angry or not following rules.
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• Through PCIT, a parent or caregiver wears a
headset while playing with their child in a special
playroom. A therapist watches from another
room or on video and gives advice to the parent
or caregiver through the headset. The therapist
helps the parent or caregiver learn how to
encourage healthy behavior and improve their
relationship with their child.
Functional Family Therapy (FFT)
• FFT is a short and focused counseling program
for families and youth ages 11-18 who have
difficult behaviors or trouble dealing with their
emotions. This could include breaking rules,
fighting, or using drugs.
• FFT works with a youth’s family and sometimes
other members of the youth’s support system
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like teachers or doctors to help reduce the
youth’s unhealthy behavior.
Multisystemic Therapy (MST)
• MST is a family-based program for youth ages
12-17 who show serious difficulty with behavior.
MST is often used for youth who have had trouble
with the law or might be at risk of becoming
involved with the law, or at risk of becoming
removed from their home because of their
behavior.
• MST involves family and community supports in
therapy to help youth work on behaviors such as
breaking the law or using drugs. MST also helps
parents learn skills to help them handle these
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behaviors at home, with their peers, or in other
community settings.
• Through MST, parents and caregivers can learn
how to handle challenges with their kids or
teenagers. They will also learn to better deal with
issues at home, with friends, or in their
neighborhood. The program respects different
cultures and focuses on helping families in their
own homes and communities. It also works with
schools, the police, and the courts.
• How often families meet with the program can
change. Some families might just need short
check-ins, while others might meet for two hours
every day or every week. This help usually lasts
for 3 to 5 months.
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Justice-Involved Reentry
• Providing health services to justice-involved
members up to 90 days prior to their
incarceration release. The types of services
available include reentry case management,
behavioral health clinical consultation services,
peer supports, behavioral health counseling,
therapy, patient education, medication services,
post-release and discharge planning, laboratory
and radiology services, medication information,
support services, and assistance to enroll with
the appropriate provider, for example a Narcotic
Treatment Program to continue with Medication
Assisted Treatment upon release. To receive
these services, individuals must be a Medi-Cal or
CHIP member, and:
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o If under the age of 21 in custody at a Youth
Correctional Facility.
o If an adult, be in custody and meet one of
the health care needs of the program.
• Contact your county using the telephone
number on the cover of this handbook for more
information on this service.
Medi-Cal Peer Support Services (varies by county)
• Medi-Cal Peer Support Services promote
recovery, resiliency, engagement, socialization,
self-sufficiency, self-advocacy, development of
natural supports, and identification of strengths
through structured activities. These services can
be provided to you or your designated significant
support person(s) and can be received at the
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same time as you receive other mental health or
Drug Medi-Cal Organized Delivery System
services. The Peer Support Specialist in
Medi-Cal Peer Support Services is an individual
who has lived experience with behavioral health
or substance use conditions and is in recovery,
who has completed the requirements of a
county’s State-approved certification program,
who is certified by the county, and who provides
these services under the direction of a
Behavioral Health Professional who is licensed,
waivered, or registered with the State.
• Medi-Cal Peer Support Services include
individual and group coaching, educational
skill-building groups, resource navigation,
engagement services to encourage you to
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participate in behavioral health treatment, and
therapeutic activities such as promoting
self-advocacy.
• Members under age 21 may be eligible for the
service under Early and Periodic Screening,
Diagnostic, and Treatment regardless of which
county they live in.
• Providing Medi-Cal Peer Support Services is
optional for participating counties. Refer to the
“Additional Information About Your County”
section located at the end of this handbook to
find out if your county provides this service.
Mobile Crisis Services
• Mobile Crisis Services are available if you are
having a mental health crisis.
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• Mobile Crisis Services are provided by health
providers at the location where you are
experiencing a crisis, including at your home,
work, school, or other community locations,
excluding a hospital or other facility setting.
Mobile Crisis Services are available 24 hours a
day, 7 days a week, and 365 days a year.
• Mobile Crisis Services include rapid response,
individual assessment, and community-based
stabilization. If you need further care, the mobile
crisis providers will also provide warm handoffs
or referrals to other services.
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Assertive Community Treatment (ACT) (varies by
county)
• ACT is a service that helps people with serious
mental health needs. People who need ACT have
typically been to the hospital, visited the
emergency room, stayed in treatment centers
and/or had trouble with the law. They might also
have been homeless or not able to get help from
regular clinics.
• ACT tailors services to each person and their
own needs. The goal is to help people feel better
and learn how to live in their community. A team
of different experts works together to provide all
kinds of support and treatment. This team helps
people with their mental health, teaches them
important life skills, coordinates their care, and
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offers support in the community. The overall aim
is to help each person recover from their
behavioral health condition and live a better life
within their community.
• Providing ACT is optional for participating
counties. Refer to the “Additional Information
About Your County” section located at the end of
this handbook to find out if your county provides
this service.
Forensic Assertive Community Treatment (FACT)
(varies by county)
• FACT is a service that helps people with serious
mental health needs who have also had trouble
with the law. It works just like the ACT program,
but with some extra features to help people who
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are at high risk or have been previously involved
with the criminal justice system.
• The FACT team is made up of experts who have
special training to understand the needs of
people who have had trouble with the law. They
provide the same types of support and treatment
as ACT, like helping with behavioral health,
teaching life skills, coordinating care, and
offering community support.
• The goal is to help each person feel better, stay
out of trouble, and live a healthier life in their
community.
• Providing FACT is optional for participating
counties. Refer to the “Additional Information
About Your County” section located at the end of
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this handbook to find out if your county provides
this service.
Coordinated Specialty Care (CSC) for First
Episode Psychosis (FEP) (varies by county)
• CSC is a service that helps people who are
experiencing psychosis for the first time. There
are many symptoms of psychosis, including
seeing or hearing things that other people do not
see or hear. CSC provides quick and combined
support during the early stages of psychosis,
which helps prevent hospital stays, emergency
room visits, time in treatment centers, trouble
with the law, substance use, and homelessness.
• CSC focuses on each person and their own
needs. A team of different experts works
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together to provide all kinds of help. They assist
with mental health treatment, teach important
life skills, coordinate care, and offer support in
the community. The goal is to help people feel
better, manage their symptoms, and live well in
their community.
• Providing CSC for FEP is optional for
participating counties. Refer to the “Additional
Information About Your County” section located
at the end of this handbook to find out if your
county provides this service.
Clubhouse Services (varies by county)
• Clubhouses are special places that help people
recover from behavioral health conditions. They
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focus on people's strengths and create a
supportive community.
• In a Clubhouse, people can find jobs, make
friends, learn new things, and develop skills to
improve their health and well-being. People also
work alongside Clubhouse staff to contribute to
shared Clubhouse needs, like making lunch for
other Clubhouse members. The goal is to help
everyone be members of a community,
encourage others to achieve their goals, and
improve their overall quality of life.
• Providing Clubhouse Services is optional for
participating counties. Refer to the “Additional
Information About Your County” section located
at the end of this handbook to find out if your
county provides this service.
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Enhanced Community Health Worker (CHW)
Services (varies by county)
• CHWs are health workers who have special
training and are trusted members of their
communities.
• The goal of Enhanced CHW Services is to help
stop diseases, disabilities, and other health
problems before they get worse. Enhanced CHW
Services include all the same parts and rules as
regular CHW preventive services, but they are
tailored for people who need extra behavioral
health support. The goal is to give extra support
to keep these members healthy and well.
• Some of these services include: health
education and training, including control and
prevention of chronic or infectious disease;
behavioral, perinatal, and oral health conditions;
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and injury prevention; health promotion and
coaching, including goal setting and creating
action plans to address disease prevention and
management.
• Providing Enhanced CHW Services is optional for
participating counties. Refer to the “Additional
Information About Your County” section located
at the end of this handbook to find out if your
county provides this service.
Supported Employment (varies by county)
• The Individual Placement and Support (IPS)
model of Supported Employment is a service
that helps people with serious behavioral health
needs find and keep competitive jobs in their
community.
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• By participating in IPS Supported Employment,
people can get better job outcomes and support
their recovery from their behavioral health
condition.
• This program also helps improve independence,
a sense of belonging, and overall health and
well-being.
• Providing Supported Employment is optional for
participating counties. Refer to the “Additional
Information About Your County” section located
at the end of this handbook to find out if your
county provides this service.
In-Reach Services (varies by county)
• Community Transition In-Reach Services help
people who are in a psychiatric hospital or
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facility for a long time or are at risk of staying
there for a long time. The program works with
you, your family, the hospital or facility, and
other support people to help you move back into
the community. The goal is to help you avoid
long stays in the psychiatric hospital or other
care centers.
Substance Use Disorder Services
What are Drug Medi-Cal Organized Delivery
System County Services?
Drug Medi-Cal Organized Delivery System county
services are for people who have a substance use
condition, meaning they may be misusing alcohol or
other drugs, or people who may be at risk of
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developing a substance use condition that a
pediatrician or general practitioner may not be able
to treat. These services also include work that the
provider does to help make the services better for
the person receiving care. These kinds of things
include assessments to see if you need the service
and if the service is working.
Drug Medi-Cal Organized Delivery System services
can be provided in a clinic or provider’s office, or
your home or other community setting, over the
phone, or by telehealth (which includes both audio-
only and video interactions). The county and provider
will work with you to determine the frequency of your
services/appointments.
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American Society of Addiction Medicine (ASAM)
The county or provider will use the American Society
of Addiction Medicine tool to find the appropriate
level of care. These types of services are described
as “levels of care,” and are defined below.
Screening, Assessment, Brief Intervention, and
Referral to Treatment (American Society of
Addiction Medicine Level 0.5)
Alcohol and Drug Screening, Assessment, Brief
Interventions, and Referral to Treatment (SABIRT) is
not a Drug Medi-Cal Organized Delivery System
benefit. It is a benefit in Medi-Cal Fee-for-Service and
Medi-Cal managed care delivery system for
members that are aged 11 years and older. Managed
care plans must provide covered substance use
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disorder services, including this service for members
ages 11 years and older.
Early Intervention Services
Early intervention services are a covered Drug
Medi-Cal Organized Delivery System service for
members under age 21. Any member under age 21
who is screened and determined to be at risk of
developing a substance use disorder may receive
any service covered under the outpatient level of
service as early intervention services. A substance
use disorder diagnosis is not required for early
intervention services for members under age 21.
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Early Periodic Screening, Diagnosis, and
Treatment
Members under age 21 can get the services described
earlier in this handbook as well as additional
Medi-Cal services through a benefit called Early and
Periodic Screening, Diagnostic, and Treatment.
To be able to get Early and Periodic Screening,
Diagnostic, and Treatment services, a member must
be under age 21 and have full-scope Medi-Cal. This
benefit covers services that are medically necessary
to correct or help physical and behavioral health
conditions. Services that sustain, support, improve,
or make a condition more tolerable are considered to
help the condition and are covered as Early and
Periodic Screening, Diagnostic, and Treatment
services. The access criteria for members under 21
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are different and more flexible than the access
criteria for adults accessing Drug Medi-Cal
Organized Delivery System services, to meet the
Early and Periodic Screening, Diagnostic, and
Treatment requirement and the intent for prevention
and early intervention of substance use disorder
conditions.
If you have questions about these services, please
call your county or visit the DHCS Early and Periodic
Screening, Diagnostic, and Treatment webpage.
Outpatient Treatment Services (American Society
of Addiction Medicine Level 1)
• Counseling services are provided to members up
to nine hours a week for adults and less than six
hours a week for members under age 21 when
medically necessary. You might get more hours
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based on your needs. Services can be provided
by someone licensed, like a counselor, in
person, by telephone, or by telehealth.
• Outpatient Services include assessment, care
coordination, counseling (individual and group),
family therapy, medication services,
Medications for Addiction Treatment for opioid
use disorder, Medications for Addiction
Treatment for alcohol use disorder and other
non-opioid substance use disorders, patient
education, recovery services, and substance use
disorder crisis intervention services.
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Intensive Outpatient Services (American Society
of Addiction Medicine Level 2.1)
• Intensive Outpatient Services are given to
members a minimum of nine hours with a
maximum of 19 hours a week for adults, and a
minimum of six hours with a maximum of
19 hours a week for members under age 21 when
medically necessary. Services may exceed the
maximum based on individual medical
necessity. Services are mostly counseling and
education about addiction-related issues.
Services can be provided by a licensed
professional or a certified counselor in a
structured setting. Intensive Outpatient
Treatment Services may be provided in person,
by telehealth, or by telephone.
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• Intensive Outpatient Services include the same
things as Outpatient Services. More hours of
service is the main difference.
Partial Hospitalization (varies by county)
(American Society of Addiction Medicine Level 2.5)
• Members under age 21 may get this service
under Early and Periodic Screening, Diagnostic,
and Treatment regardless of the county where
they live.
• Partial Hospitalization services include 20 or
more hours of services per week, as medically
necessary. Partial hospitalization programs have
direct access to psychiatric, medical, and
laboratory services and meet the identified
needs which warrant daily monitoring or
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management but can be appropriately
addressed in a clinic. Services may be provided
in person, by telehealth, or by telephone.
• Partial Hospitalization services are similar to
Intensive Outpatient Services, with an increase
in the number of hours and additional access to
medical services being the main differences.
Residential Treatment (subject to authorization by
the county) (American Society of Addiction
Medicine Levels 3.1 – 4.0)
• Residential Treatment is a program that provides
rehabilitation services to members with a
substance use disorder diagnosis, when
determined as medically necessary. The
member shall live on the property and be
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supported in their efforts to change, maintain,
apply interpersonal and independent living skills
by accessing community support systems. Most
services are provided in person; however,
telehealth and telephone may also be used to
provide services while a person is in residential
treatment. Providers and residents work
together to define barriers, set priorities,
establish goals, and solve substance use
disorder-related problems. Goals include not
using substances, preparing for relapse triggers,
improving personal health and social skills, and
engaging in long-term care.
• Residential services require prior authorization
by the Drug Medi-Cal Organized Delivery System
county.
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• Residential Services include intake and
assessment, care coordination, individual
counseling, group counseling, family therapy,
medication services, Medications for Addiction
Treatment for opioid use disorder, Medications
for Addiction Treatment for alcohol use disorder
and other non-opioid substance use disorders,
patient education, recovery services, and
substance use disorder crisis intervention
services.
• Residential Services providers are required to
either offer medications for addiction treatment
directly on-site or help members get
medications for addiction treatment off-site.
Residential Services providers do not meet this
requirement by only providing the contact
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information for Medications for Addiction
Treatment providers. Residential Services
providers are required to offer and prescribe
medications to members covered under the
Drug Medi-Cal Organized Delivery System.
Inpatient Treatment Services (subject to
authorization by the county) (varies by county)
(American Society of Addiction Medicine Levels
3.1 – 4.0)
• Beneficiaries under age 21 may be eligible for the
service under Early and Periodic Screening,
Diagnostic, and Treatment regardless of their
county of residence.
• Inpatient services are provided in a 24-hour
setting that provides professionally directed
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evaluation, observation, medical monitoring,
and addiction treatment in an inpatient setting.
Most services are provided in person; however,
telehealth and telephone may also be used to
provide services while a person is in inpatient
treatment.
• Inpatient services are highly structured, and a
physician is likely available on-site 24 hours
daily, along with Registered Nurses, addiction
counselors, and other clinical staff. Inpatient
Services include assessment, care coordination,
counseling, family therapy, medication services,
Medications for Addiction Treatment for opioid
use disorder, Medications for Addiction
Treatment for Alcohol use disorder and other
non-opioid substance use disorders, patient
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education, recovery services, and substance use
disorder crisis intervention services.
Narcotic Treatment Program
• Narcotic Treatment Programs are programs
outside of a hospital that provide medications to
treat substance use disorders, when ordered by
a doctor as medically necessary. Narcotic
Treatment Programs are required to give
medications to members, including methadone,
buprenorphine, naloxone, and disulfiram.
• A member must be offered, at a minimum,
50 minutes of counseling sessions per calendar
month. These counseling services can be
provided in person, by telehealth, or by
telephone. Narcotic Treatment Services include
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assessment, care coordination, counseling,
family therapy, medical psychotherapy,
medication services, care management,
Medications for Addiction Treatment for opioid
use disorder, Medications for Addiction
Treatment for alcohol use disorder and other
non-opioid substance use disorders, patient
education, recovery services, and substance use
disorder crisis intervention services.
Withdrawal Management
• Withdrawal management services are urgent
and provided on a short-term basis. These
services can be provided before a full evaluation
has been done. Withdrawal management
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services may be provided in an outpatient,
residential, or inpatient setting.
• Regardless of the type of setting, the member
shall be monitored during the withdrawal
management process. Members receiving
withdrawal management in a residential or
inpatient setting shall live at that location.
Medically necessary habilitative and
rehabilitative services are prescribed by a
licensed physician or licensed prescriber.
• Withdrawal Management Services include
assessment, care coordination, medication
services, Medications for Addiction Treatment
for opioid use disorder, Medications for
Addiction Treatment for alcohol use disorder and
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other non-opioid substance use disorders,
observation, and recovery services.
Medications for Addiction Treatment
• Medications for Addiction Treatment Services
are available in clinical and non-clinical settings.
Medications for Addiction Treatment include all
FDA-approved medications and biological
products to treat alcohol use disorder, opioid
use disorder, and any substance use disorder.
Members have a right to be offered Medications
for Addiction Treatment on-site or through a
referral outside of the facility. A list of approved
medications include:
o Acamprosate Calcium
o Buprenorphine Hydrochloride
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o Buprenorphine Extended-Release Injectable
(Sublocade)
o Buprenorphine/Naloxone Hydrochloride
o Naloxone Hydrochloride
o Naltrexone (oral)
o Naltrexone Microsphere Injectable
Suspension (Vivitrol)
o Lofexidine Hydrochloride (Lucemyra)
o Disulfiram (Antabuse)
o Methadone (delivered only by Narcotic
Treatment Programs)
• Medications for Addiction Treatment may be
provided with the following services:
assessment, care coordination, individual
counseling, group counseling, family therapy,
medication services, patient education, recovery
services, substance use disorder crisis
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intervention services, and withdrawal
management services. Medications for
Addiction Treatment may be provided as part of
all Drug Medi-Cal Organized Delivery System
services, including Outpatient Treatment
Services, Intensive Outpatient Services, and
Residential Treatment, for example.
• Members may access Medications for Addiction
Treatment outside of the Drug Medi-Cal
Organized Delivery System county as well. For
instance, Medications for Addiction Treatment,
such as buprenorphine, can be prescribed by
some prescribers in primary care settings that
work with your managed care plan and can be
dispensed or administered at a pharmacy.
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Justice-Involved Reentry
• Providing health services to justice-involved
members up to 90 days prior to their
incarceration release. The types of services
available include reentry case management,
behavioral health clinical consultation services,
peer supports, behavioral health counseling,
therapy, patient education, medication services,
post-release and discharge planning, laboratory
and radiology services, medication information,
support services, and assistance to enroll with
the appropriate provider, for example a Narcotic
Treatment Program to continue with Medication
Assisted Treatment upon release. To receive
these services, individuals must be a Medi-Cal or
CHIP member, and:
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o If under the age of 21 in custody at a Youth
Correctional Facility.
o If an adult, be in custody and meet one of
the health care needs of the program.
• Contact your county using the telephone
number on the cover of this handbook for more
information on this service.
Medi-Cal Peer Support Services (varies by county)
• Medi-Cal Peer Support Services promote
recovery, resiliency, engagement, socialization,
self-sufficiency, self-advocacy, development of
natural supports, and identification of strengths
through structured activities. These services can
be provided to you or your designated significant
support person(s) and can be received at the
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same time as you receive other mental health or
Drug Medi-Cal Organized Delivery System
services. The Peer Support Specialist in
Medi-Cal Peer Support Services is an individual
who has lived experience with behavioral health
or substance use conditions and is in recovery,
who has completed the requirements of a
county’s State-approved certification program,
who is certified by the counties, and who
provides these services under the direction of a
Behavioral Health Professional who is licensed,
waivered, or registered with the State.
• Medi-Cal Peer Support Services include individual
and group coaching, educational skill-building
groups, resource navigation, engagement
services to encourage you to participate in
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behavioral health treatment, and therapeutic
activities such as promoting self-advocacy.
• Members under age 21 may be eligible for the
service under Early and Periodic Screening,
Diagnostic, and Treatment regardless of which
county they live in.
• Providing Medi-Cal Peer Support Services is
optional for participating counties. Refer to the
“Additional Information About Your County”
section located at the end of this handbook to
find out if your county provides this service.
Recovery Services
• Recovery Services can be an important part of
your recovery and wellness. Recovery services
can help you get connected to the treatment
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community to manage your health and health
care. Therefore, this service emphasizes your
role in managing your health, using effective
self-management support strategies, and
organizing internal and community resources to
provide ongoing self-management support.
• You may receive Recovery Services based on
your self-assessment or your provider’s
assessment of risk of relapsing. You may also
receive Recovery Services in person, by
telehealth, or by telephone.
• Recovery Services include assessment, care
coordination, individual counseling, group
counseling, family therapy, recovery monitoring,
and relapse prevention components.
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Care Coordination
• Care Coordination Services consists of activities
to provide coordination of substance use
disorder care, mental health care, and medical
care, and to provide connections to services and
supports for your health. Care Coordination is
provided with all services and can occur in
clinical or non-clinical settings, including in your
community.
• Care Coordination Services include coordinating
with medical and mental health providers to
monitor and support health conditions,
discharge planning, and coordinating with
ancillary services including connecting you to
community-based services such as childcare,
transportation, and housing.
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Contingency Management (varies by county)
• Members under age 21 may be eligible for the
service under Early and Periodic Screening,
Diagnostic, and Treatment regardless of their
county of residence.
• Providing Contingency Management Services is
optional for participating counties. Refer to the
“Additional Information About Your County”
section located at the end of this handbook to
find out if your county provides this service.
• Contingency Management Services are an
evidence-based treatment for stimulant use
disorder where eligible members will participate
in a structured 24 week outpatient Contingency
Management service, followed by six or more
months of additional treatment and recovery
support services without incentives.
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• The initial 12 weeks of Contingency Management
services include a series of incentives for
meeting treatment goals, specifically not using
stimulants (e.g., cocaine, amphetamine, and
methamphetamine). Participants must agree to
urine drug tests as often as determined by the
Contingency Management services program.
The incentives consist of cash equivalents
(e.g., gift cards).
• Contingency Management Services are only
available to members who are receiving services
in a non-residential setting operated by a
participating provider and are enrolled and
participating in a comprehensive, individualized
course of treatment.
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Mobile Crisis Services
• Mobile Crisis Services are available if you are
having a substance use crisis.
• Mobile Crisis Services are provided by health
providers at the location where you are
experiencing a crisis, including at your home,
work, school, or other community locations,
excluding a hospital or other facility setting.
Mobile Crisis Services are available 24 hours a
day, 7 days a week, and 365 days a year.
• Mobile Crisis Services include rapid response,
individual assessment, and community-based
stabilization. If you need further care, the mobile
crisis providers will also provide warm handoffs
or referrals to other services.
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Traditional Health Care Practices
• Traditional health care practices are expected to
improve access to culturally responsive care;
support these facilities' ability to serve their
patients; maintain and sustain health; improve
health outcomes and the quality and experience
of care; and reduce existing disparities in access
to care.
• Traditional health care practices encompass two
new service types: Traditional Healer and
Natural Helper services. Traditional Healer
services include music therapy (such as
traditional music and songs, dancing,
drumming), spirituality (such as ceremonies,
rituals, herbal remedies) and other integrative
approaches. Natural Helper services may help
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with navigational support, psychosocial skill
building, self-management, and trauma support.
• Contact your county using the telephone
number on the cover of this handbook for more
information about this service.
Enhanced Community Health Worker (CHW)
Services (varies by county)
• CHWs are health workers who have special
training and are trusted members of their
communities.
• The goal of Enhanced CHW Services is to help
stop diseases, disabilities, and other health
problems before they get worse. Enhanced CHW
Services include all the same parts and rules as
regular CHW preventive services, but they are
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tailored for people who need extra behavioral
health support. The goal is to give extra support
to keep these members healthy and well.
• Some of these services include: health
education and training, including control and
prevention of chronic or infectious disease;
behavioral, perinatal, and oral health conditions;
and injury prevention; health promotion and
coaching, including goal setting and creating
action plans to address disease prevention and
management.
Providing Enhanced CHW Services is optional for
participating counties. Refer to the “Additional
Information About Your County” section located at
the end of this handbook to find out if your county
provides this service.
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Supported Employment (varies by county)
• The Individual Placement and Support (IPS)
model of Supported Employment is a service
that helps people with serious behavioral health
needs find and keep competitive jobs in their
community.
• By participating in IPS Supported Employment,
people can get better job outcomes and support
their recovery from their behavioral health
condition.
• This program also helps improve independence,
a sense of belonging, and overall health and
well-being.
• Providing Supported Employment is optional for
participating counties. Refer to the “Additional
Information About Your County” section located
at the end of this handbook to find out if your
county provides this service
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AVAILABLE SERVICES BY TELEPHONE
OR TELEHEALTH
In-person, face-to-face contact between you and your
provider is not always required for you to be able to
receive behavioral health services. Depending on your
services, you might be able to receive your services
through telephone or telehealth. Your provider should
explain to you about using telephone or telehealth and
make sure you agree before beginning services via
telephone or telehealth. Even if you agree to receive
your services through telehealth or telephone, you can
choose later to receive your services in-person or
face-to-face. Some types of behavioral health services
cannot be provided only through telehealth or
telephone because they require you to be at a specific
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place for the service, such as residential treatment
services or hospital services.
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THE PROBLEM RESOLUTION PROCESS:
TO FILE A GRIEVANCE, APPEAL, OR REQUEST
A STATE FAIR HEARING
What If I Don’t Get the Services I Want From My
County?
Your county must have a way for you to work out any
problems related to the services you want or are
receiving. This is called the problem-resolution
process and it could involve the following:
• The Grievance Process: A verbal or written
expression of unhappiness about anything
regarding your specialty mental health services,
substance use disorder services, a provider, or
the county. Refer to the Grievance Process
section in this handbook for more information.
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• The Appeal Process: An appeal is when you don’t
agree with the county's decision to change your
services (e.g., denial, termination, or reduction to
services) or to not cover them. Refer to the Appeal
Process section in this handbook for more
information.
• The State Fair Hearing Process: A State Fair
Hearing is a meeting with an administrative law
judge from the California Department of Social
Services (CDSS) if the county denies your appeal.
Refer to the State Fair Hearing section in this
handbook for more information.
Filing a grievance, appeal, or requesting a State Fair
Hearing will not count against you and will not impact
the services you are receiving. Filing a grievance or
appeal helps to get you the services you need and to
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solve any problems you have with your behavioral
health services. Grievances and appeals also help the
county by giving them the information they can use to
improve services. Your county will notify you,
providers, and parents/guardians of the outcome
once your grievance or appeal is complete. The State
Fair Hearing Office will notify you and the provider of
the outcome once the State Fair Hearing is complete.
Note: Learn more about each problem resolution
process below.
Can I Get Help With Filing an Appeal, Grievance, or
State Fair Hearing?
Your county will help explain these processes to you
and must help you file a grievance, an appeal, or to
request a State Fair Hearing. The county can also help
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you decide if you qualify for what’s called an
“expedited appeal” process, which means it will be
reviewed more quickly because your health, mental
health, and/or stability are at risk. You may also
authorize another person to act on your behalf,
including your provider or advocate.
If you would like help, contact your county using the
telephone number listed on the cover of this
handbook. Your county must give you reasonable
assistance in completing forms and other procedural
steps related to a grievance or appeal. This includes,
but is not limited to, providing interpreter services and
toll-free numbers with TTY/TDD and interpreter
capability.
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If You Need Further Assistance
Contact the Department of Health Care Services,
Office of the Ombudsman:
• Phone: # 1-888-452-8609, Monday through Friday,
8 a.m. to 5 p.m. (excluding holidays).
OR
• E-mail: MMCDOmbudsmanOffice@dhcs.ca.gov.
Please note: E-mail messages are not considered
confidential (please do not include personal
information in the e-mail message).
You may also get free legal help at your local legal aid
office or other groups. To ask about your State Fair
Hearing rights, you can contact the California
Department of Social Services Public Inquiry and
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Response Unit at this phone number: 1-800-952-5253
(for TTY, call 1-800-952-8349).
Grievances
What Is a Grievance?
A grievance is any expression of dissatisfaction you
have with your behavioral health services that is not
covered by the appeal or State Fair Hearing process.
This includes concerns about the quality of your care,
how you are treated by staff and providers, and
disagreements about decisions regarding your care.
Examples of grievances:
• If you feel that a provider has been rude to you or
has not respected your rights.
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• If the county needs more time to make a decision
about approving a service your provider has
requested for you, and you disagree with this
extension.
• If you are not satisfied with the quality of care you
are receiving or the way your treatment plan is
being communicated to you.
What Is the Grievance Process?
The grievance process will:
• Involve simple steps to file your grievance orally or
in writing.
• Not cause you to lose your rights or services or be
held against your provider.
• Allow you to approve another person to act on
your behalf. This could be a provider or an
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advocate. If you agree to have another person act
on your behalf, you may be asked to sign an
authorization form, which gives your county
permission to release information to that person.
• Make sure the approved person deciding on the
grievance is qualified to make decisions and has
not been a part of any previous level of review or
decision-making.
• Determine the duties of your county, provider, and
yourself.
• Make sure the results of the grievance are
provided within the required timeline.
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When Can I File a Grievance?
You can file a grievance at any time if you are unhappy
with the care you have received or have another
concern regarding your county.
How Can I File a Grievance?
You may call your county’s 24/7 toll-free Access Line
at any time to receive assistance with a grievance.
Oral or written grievances can be filed. Oral
grievances do not have to be followed up in writing. If
you file your grievance in writing, please note the
following: Your county supplies self-addressed
envelopes at all provider sites. If you do not have a
self-addressed envelope, mail your written grievances
to the address provided on the front of this handbook.
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How Do I Know If the County Received My
Grievance?
Your county is required to provide you with a written
letter to let you know your grievance has been
received within five calendar days of receipt. A
grievance received over the phone or in person, that
you agree is resolved by the end of the next business
day, is exempt and you may not get a letter.
When Will My Grievance Be Decided?
A decision about your grievance must be made by your
county within 30 calendar days from the date your
grievance was filed.
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How Do I Know If the County Has Made a Decision
About My Grievance?
When a decision has been made about your
grievance, the county will:
• Send you or your approved person a written notice
of the decision;
• Send you or your approved person a Notice of
Adverse Benefit Determination advising you of
your right to request a State Fair Hearing if the
county does not notify you of the grievance
decision on time;
• Advise you of your right to request a State Fair
Hearing.
You may not get a written notice of the decision if your
grievance was filed by phone or in person and you
agree your issue has been resolved by the end of the
next business day from the date of filing.
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Note: Your county is required to provide you with a
Notice of Adverse Benefit Determination on the date
the timeframe expires. You may call the county for
more information if you do not receive a Notice of
Adverse Benefit Determination.
Is There a Deadline to File a Grievance?
No, you may file a grievance at any time. Do not
hesitate to bring issues to the county’s attention. The
county will always work with you to find a solution to
address your concerns.
Appeals
You may file an appeal when you do not agree with the
county's decision for the behavioral health services
you are currently receiving or would like to receive.
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You may request a review of the county’s decision by
using:
• The Standard Appeal Process.
OR
• The Expedited Appeal Process.
Note: The two types of appeals are similar; however,
there are specific requirements to qualify for an
expedited appeal (see below for the requirements).
The county shall assist you in completing forms and
taking other procedural steps to file an appeal,
including preparing a written appeal, notifying you of
the location of the form on their website or providing
you with the form upon your request. The county shall
also advise and assist you in requesting continuation
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of benefits during an appeal of the adverse benefit
determination in accordance with federal regulations.
What Does the Standard Appeal Process Do?
The Standard Appeal Process will:
• Allow you to file an appeal orally or in writing.
• Make sure filing an appeal will not cause you to
lose your rights or services or be held against your
provider in any way.
• Allow you to authorize another person (including a
provider or advocate) to act on your behalf. Please
note: If you authorize another person to act on
your behalf, the county might ask you to sign a
form authorizing the county to release information
to that person.
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• Have your benefits continued upon request for an
appeal within the required timeframe. Please
note: This is 10 days from the date your Notice of
Adverse Benefit Determination was mailed or
personally given to you.
• Make sure you do not pay for continued services
while the appeal is pending and if the final
decision of the appeal is in favor of the county’s
adverse benefit determination.
• Make sure the decision-makers for your appeal
are qualified and not involved in any previous level
of review or decision-making.
• Allow you or your representative to review your
case file, including medical records and other
relevant documents.
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• Allow you to have a reasonable opportunity to
present evidence, testimony, and arguments in
person or in writing.
• Allow you, your approved person, or the legal
representative of a deceased member’s estate to
be included as parties to the appeal.
• Give you written confirmation from your county
that your appeal is under review.
• Inform you of your right to request a State Fair
Hearing, following the completion of the appeal
process.
When Can I File an Appeal?
You can file an appeal with your county when:
• The county or the contracted provider determines
that you do not meet the access criteria for
behavioral health services.
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• Your healthcare provider recommends a
behavioral health service for you and requests
approval from your county, but the county denies
the request or alters the type or frequency of
service.
• Your provider requests approval from the county,
but the county requires more information and
does not complete the approval process on time.
• Your county does not provide services based on
its predetermined timelines.
• You feel that the county is not meeting your needs
on time.
• Your grievance, appeal, or expedited appeal was
not resolved in time.
• You and your provider disagree on the necessary
behavioral health services.
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How Can I File an Appeal?
• You may file an appeal via one of the following
three methods:
o Call your county’s toll-free phone number
listed on the cover of this handbook. After
calling, you will have to file a subsequent
written appeal as well; or
o Mail your appeal (The county will provide self-
addressed envelopes at all provider sites for
you to mail in your appeal). Note: If you do not
have a self-addressed envelope, you may
mail your appeal directly to the address in the
front of this handbook; or
o Submit your appeal by e-mail or fax. Please
refer to the ‘County Contact Information’
section of this handbook to find the
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appropriate method (e.g., email, fax)
for submitting your appeal..
How Do I Know If My Appeal Has Been Decided?
You or your approved person will receive written
notification from your county of the decision on your
appeal. The notification will include the following
information:
• The results of the appeal resolution process.
• The date the appeal decision was made.
• If the appeal is not resolved in your favor, the
notice will provide information regarding your right
to a State Fair Hearing and how to request a State
Fair Hearing.
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Is There a Deadline to File an Appeal?
You must file an appeal within 60 calendar days of the
date on the Notice of Adverse Benefit Determination.
There are no deadlines for filing an appeal when you
do not get a Notice of Adverse Benefit Determination,
so you may file this type of appeal at any time.
When Will a Decision Be Made About My Appeal?
The county must decide on your appeal within 30
calendar days of receiving your request.
What If I Can’t Wait 30 Days for My Appeal
Decision?
If the appeal meets the criteria for the expedited
appeal process, it may be completed more quickly.
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What Is an Expedited Appeal?
An expedited appeal follows a similar process to the
standard appeal but is quicker. Here is additional
information regarding expedited appeals:
• You must show that waiting for a standard appeal
could make your behavioral health condition
worse.
• The expedited appeal process follows different
deadlines than the standard appeal.
• The county has 72 hours to review expedited
appeals.
• You can make a verbal request for an expedited
appeal.
• You do not have to put your expedited appeal
request in writing.
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When Can I File an Expedited Appeal?
If waiting up to 30 days for a standard appeal decision
will jeopardize your life, health, or ability to attain,
maintain or regain maximum function, you may
request an expedited resolution of an appeal.
Additional Information Regarding Expedited Appeals:
• If your appeal meets the requirements for an
expedited appeal, the county will resolve it within
72 hours of receiving it.
• If the county determines that your appeal does
not meet the criteria for an expedited appeal, they
are required to provide you with timely verbal
notification and will provide you with written
notice within two calendar days, explaining the
reason for their decision. Your appeal will then
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follow the standard appeal timeframes outlined
earlier in this section.
• If you disagree with the county's decision that
your appeal does not meet the criteria for
expedited appeal, you may file a grievance.
• After your county resolves your request for an
expedited appeal, you and all affected parties will
be notified both orally and in writing.
State Fair Hearings
What Is A State Fair Hearing?
A State Fair Hearing is an independent review
conducted by an administrative law judge from the
California Department of Social Services (CDSS) to
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ensure you receive the behavioral health services that
you are entitled to under the Medi-Cal program.
Please visit the California Department of Social
Services website https://www.cdss.ca.gov/hearing-
requests for additional resources.
What Are My State Fair Hearing Rights?
You have the right to:
• Request a hearing before an administrative law
judge, also known as a State Fair Hearing, to
address your case.
• Learn how to request a State Fair Hearing.
• Learn about the regulations that dictate how
representation works during the State Fair
Hearing.
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• Request to have your benefits continue during the
State Fair Hearing process if you request for a
State Fair Hearing within the required timeframes.
• Not pay for continued services while the State Fair
Hearing is pending and if the final decision is in
favor of the county’s adverse benefit
determination.
When Can I File for a State Fair Hearing?
You can file for a State Fair Hearing if:
• You filed an appeal and received an appeal
resolution letter telling you that your county
denied your appeal request.
• Your grievance, appeal, or expedited appeal
wasn’t resolved in time.
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How Do I Request a State Fair Hearing?
You can request a State Fair Hearing:
• Online: at the Department of Social Services
Appeals Case Management website:
https://acms.dss.ca.gov/acms/login.request.do
• In Writing: Submit your request to the county
welfare department at the address shown on the
Notice of Adverse Benefit Determination, or mail
it to:
California Department of Social Services
State Hearings Division
P.O. Box 944243, Mail Station 9-17-37
Sacramento, CA 94244-2430
• By Fax: 916-651-5210 or 916-651-2789
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You can also request a State Fair Hearing or an
expedited State Fair Hearing:
• By Phone:
o State Hearings Division, toll-free, at
1-800-743-8525 or 1-855-795-0634.
o Public Inquiry and Response, toll-free, at
1-800-952-5253 or TDD at 1-800-952-8349.
Is There a Deadline to Ask for a State Fair Hearing?
You have 120 days from the date of the county’s
written appeal decision notice to request a State Fair
Hearing. If you didn’t receive a Notice of Adverse
Benefit Determination, you may file for a State Fair
Hearing at any time.
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Can I Continue Services While I’m Waiting for a
State Fair Hearing Decision?
Yes, if you are currently receiving authorized services
and wish to continue receiving the services while you
wait for the State Fair Hearing decision, you must
request a State Fair Hearing within 10 days from the
date the appeal decision notice was postmarked or
delivered to you. Alternatively, you can request the
hearing before the date your county says that services
will be stopped or reduced.
Note:
• When requesting a State Fair Hearing, you must
indicate that you wish to continue receiving
services during the State Fair Hearing process.
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• If you request to continue receiving services and
the final decision of the State Fair Hearing
confirms the reduction or discontinuation of the
service you are receiving, you are not responsible
for paying the cost of services provided while the
State Fair Hearing was pending.
When Will a Decision Be Made About My State Fair
Hearing Decision?
After requesting a State Fair Hearing, it may take up to
90 days to receive a decision.
Can I Get a State Fair Hearing More Quickly?
If you think waiting that long will be harmful to your
health, you might be able to get an answer within three
working days. You can request for an Expedited State
Fair Hearing by either writing a letter yourself or asking
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your general practitioner or mental health
professional to write a letter for you. The letter must
include the following information:
1. Explain in detail how waiting up to 90 days for
your case to be decided can seriously harm your
life, health, or ability to attain, maintain, or regain
maximum function.
2. Ask for an “expedited hearing” and provide the
letter with your request for a hearing.
The State Hearings Division of the Department of
Social Services will review your request for an
expedited State Fair Hearing and determine if it meets
the criteria. If your request is approved, a hearing will
be scheduled, and a decision will be made within
three working days from the date the State Hearings
Division receives your request.
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ADVANCE DIRECTIVE
What is an Advance Directive?
You have the right to an advance directive. An advance
directive is a written document about your health care
that is recognized under California law. You may
sometimes hear an advance directive described as a
living will or durable power of attorney. It includes
information about how you would like health care
provided or says what decisions you would like to be
made, if or when you are unable to speak for yourself.
This may include such things as the right to accept or
refuse medical treatment, surgery, or make other
health care choices. In California, an advance
directive consists of two parts:
• Your appointment of an agent (a person) making
decisions about your health care; and
• Your individual health care instructions.
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Your county is required to have an advance directive
program in place. Your county is required to provide
written information on the advance directive policies
and explain the state law if asked for the information.
If you would like to request the information, you
should call the telephone number on the cover of this
handbook for more information.
You may get a form for an advance directive from your
county or online. In California, you have the right to
provide advance directive instructions to all of your
healthcare providers. You also have the right to
change or cancel your advance directive at any time.
If you have a question about California law regarding
advance directive requirements, you may send a
letter to:
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California Department of Justice
Attn: Public Inquiry Unit
P. O. Box 944255
Sacramento, CA 94244-2550
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RIGHTS AND RESPONSIBILITIES
County Responsibilities
What is my County Responsible for?
Your county is responsible for the following:
• Figuring out if you meet the criteria to access
behavioral health services from the county or its
provider network.
• Providing a screening or an assessment to
determine whether you need behavioral health
services.
• Providing a toll-free phone number that is
answered 24 hours a day, seven days a week, that
can tell you how to get services from the county.
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The telephone number is listed on the cover of
this handbook.
• Making sure there are sufficient behavioral health
providers nearby so that you can access the
services covered by your county when necessary.
• Informing and educating you about services
available from your county.
• Providing services in your language at no cost to
you, and if needed, providing an interpreter for you
free of charge.
• Providing you with written information about what
is available to you in other languages or
alternative forms like Braille or large-size print.
Refer to the “Additional Information About Your
County” section located at the end of this
handbook for more information.
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• Informing you about any significant changes in the
information mentioned in this handbook at least
30 days before the changes take effect. A change
is considered significant when there is an
increase or decrease in the quantity or types of
services offered, if there is an increase or
decrease in the number of network providers, or if
there is any other change that would impact the
benefits you receive from the county.
• Making sure to connect your healthcare with any
other plans or systems that may be necessary to
help transition your care smoothly. This includes
ensuring that any referrals for specialists or other
providers are properly followed up on and that the
new provider is willing to take care of you.
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• Making sure you can keep seeing your current
healthcare provider, even if they are not in your
network, for a certain amount of time. This is
important if switching providers would harm your
health or raise the chance of needing to go to the
hospital.
Is Transportation Available?
If you struggle to attend your medical or behavioral
health appointments, the Medi-Cal program helps in
arranging transportation for you. Transportation must
be provided for Medi-Cal members who are unable to
provide transportation on their own and who have a
medical necessity to receive Medi-Cal covered
services. There are two types of transportation for
appointments:
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• Non-Medical: transportation by private or public
vehicle for people who do not have another way to
get to their appointment.
• Non-Emergency Medical: transportation by
ambulance, wheelchair van, or litter van for those
who cannot use public or private transportation.
Transportation is available for trips to the pharmacy or
to pick up needed medical supplies, prosthetics,
orthotics, and other equipment.
If you have Medi-Cal but are not enrolled in a managed
care plan, and you need non-medical transportation
to a health-related service, you can contact the non-
medical transportation provider directly or your
provider for assistance. When you contact the
transportation company, they will ask for information
about your appointment date and time.
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If you need non-emergency medical transportation,
your provider can prescribe non-emergency medical
transportation and put you in touch with a
transportation provider to coordinate your ride to and
from your appointment(s).
For more information and assistance regarding
transportation, contact your managed care plan.
Member Rights
What Are My Rights as a Recipient of Medi-Cal
Behavioral Health Services?
As a Medi-Cal member, you have the right to receive
medically necessary behavioral health services from
your county. When accessing behavioral health
services, you have the right to:
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• Be treated with personal respect and respect for
your dignity and privacy.
• Get clear and understandable explanations of
available treatment options.
• Participate in decisions related to your behavioral
health care. This includes the right to refuse any
treatment that you do not wish to receive.
• Get this handbook to learn about county services,
county obligations, and your rights.
• Ask for a copy of your medical records and
request changes, if necessary.
• Be free from any form of restraint or seclusion that
is imposed as a means of coercion, discipline,
convenience, or retaliation.
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• Receive timely access to care 24/7 for emergency,
urgent, or crisis conditions when medically
necessary.
• Upon request, receive written materials in
alternative formats such as Braille, large-size
print, and audio format in a timely manner.
• Receive behavioral health services from the
county that follows its state contract for
availability, capacity, coordination, coverage, and
authorization of care. The county is required to:
o Employ or have written contracts with enough
providers to make sure that all Medi-Cal
eligible members who qualify for behavioral
health services can receive them in a timely
manner.
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o Cover medically necessary services
out-of-network for you in a timely manner,
if the county does not have an employee or
contract provider who can deliver the
services.
Note: The county must make sure you do not
pay anything extra for seeing an
out-of-network provider. See below for
more information:
Medically necessary behavioral health
services for individuals 21 years of age or
older are services that are reasonable
and necessary to protect life, to prevent
significant illness or significant disability,
or to alleviate severe pain. Medically
necessary behavioral health services for
individuals under 21 years of age are
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services that sustain, support, improve,
or make more tolerable a behavioral
health condition.
Out-of-network provider is a provider who
is not on the county’s list of providers.
o Upon your request, provide a second opinion
from a qualified health care professional
within or outside of the network at no extra
cost.
o Make sure providers are trained to deliver the
behavioral health services that the providers
agree to cover.
o Make sure that the county's covered
behavioral health services are enough in
amount, length of time, and scope to meet
the needs of Medi-Cal-eligible members. This
includes making sure that the county's
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method for approving payment for services is
based on medical necessity and that the
access criteria is fairly used.
o Make sure that its providers conduct thorough
assessments and collaborate with you to
establish treatment goals.
o Coordinate the services it provides with
services being provided to you through a
managed care plan or with your primary care
provider, if necessary.
o Participate in the state's efforts to provide
culturally competent services to all, including
those with limited English proficiency and
diverse cultural and ethnic backgrounds.
• Express your rights without harmful changes to
your treatment.
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• Receive treatment and services in accordance
with your rights described in this handbook and
with all applicable federal and state laws such as:
o Title VI of the Civil Rights Act of 1964 as
implemented by regulations at 45 CFR
part 80.
o The Age Discrimination Act of 1975 as
implemented by regulations at 45 CFR
part 91.
o The Rehabilitation Act of 1973.
o Title IX of the Education Amendments of 1972
(regarding education programs and activities).
o Titles II and III of the Americans with
Disabilities Act.
o Section 1557 of the Patient Protection and
Affordable Care Act.
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• You may have additional rights under state laws
regarding behavioral health treatment. To contact
your county's Patients' Rights Advocate, please
contact your county by using the telephone
number listed on the cover of the handbook.
Adverse Benefit Determinations
What Rights Do I Have if the County Denies the
Services I Want or Think I Need?
If your county denies, limits, reduces, delays, or ends
a service you think you need, you have the right to a
written notice from the county. This notice is called a
"Notice of Adverse Benefit Determination". You also
have a right to disagree with the decision by asking for
an appeal. The sections below inform you of the
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Notice of Adverse Benefit Determination and what to
do if you disagree with the county’s decision.
What Is an Adverse Benefit Determination?
An Adverse Benefit Determination is defined by any of
the following actions taken by the county:
• The denial or limited authorization of a requested
service. This includes determinations based on
the type or level of service, medical necessity,
appropriateness, setting, or effectiveness of a
covered benefit;
• The reduction, suspension, or termination of a
previously authorized service;
• The denial, in whole or in part, of payment for a
service;
• The failure to provide services in a timely manner;
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• The failure to act within the required timeframes
for standard resolution of grievances and appeals.
Required timeframes are as follows:
o If you file a grievance with the county and the
county does not get back to you with a written
decision on your grievance within 30 days.
o If you file an appeal with the county and the
county does not get back to you with a written
decision on your appeal within 30 days.
o If you filed an expedited appeal and did not
receive a response within 72 hours.
• The denial of a member’s request to dispute
financial liability.
What Is a Notice of Adverse Benefit Determination?
A Notice of Adverse Benefit Determination is a written
letter that your county will send you if it decides to
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deny, limit, reduce, delay, or end services you and
your provider believe you should get. The notice will
explain the process the county used to make the
decision and include a description of the criteria or
guidelines that were used to determine whether the
service is medically necessary.
This includes denial of:
• A payment for a service.
• Claims for services that are not covered.
• Claims for services that are not medically
necessary.
• Claims for services from the wrong delivery
system.
• A request to dispute financial liability.
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Note: A Notice of Adverse Benefit Determination is
also used to tell you if your grievance, appeal, or
expedited appeal was not resolved in time, or if you
did not get services within the county’s timeline
standards for providing services.
Timing of the Notice
The county must mail the notice:
• To the member at least 10 days before the date of
action for termination, suspension, or reduction
of a previously authorized behavioral health
service.
• To the member within two business days of the
decision for denial of payment or decisions
resulting in denial, delay, or modification of all or
part of the requested behavioral health services.
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Will I Always Get A Notice Of Adverse Benefit
Determination When I Don’t Get The Services I
Want?
Yes, you should receive a Notice of Adverse Benefit
Determination. If you do not receive a notice, you may
file an appeal with the county or if you have completed
the appeal process, you can request a State Fair
Hearing. When you contact your county, indicate you
experienced an adverse benefit determination but did
not receive a notice. Information on how to file an
appeal or request a State Fair Hearing is included in
this handbook and should also be available in your
provider’s office.
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What Will the Notice of Adverse Benefit
Determination Tell Me?
The Notice of Adverse Benefit Determination will tell
you:
• What your county did that affects you and your
ability to get services.
• The date the decision will take effect and the
reason for the decision.
• If the reason for the denial is that the service is
not medically necessary, the notice will include a
clear explanation of why the county made this
decision. This explanation will include the
specific clinical reasons why the service is not
considered medically necessary for you.
• The state or federal rules the decision was
based on.
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• Your rights to file an appeal if you do not agree
with the county’s decision.
• How to receive copies of the documents, records,
and other information related to the county’s
decision.
• How to file an appeal with the county.
• How to request a State Fair Hearing if you are not
satisfied with the county’s decision on your
appeal.
• How to request an expedited appeal or an
expedited State Fair Hearing.
• How to get help filing an appeal or requesting a
State Fair Hearing.
• How long you have to file an appeal or request a
State Fair Hearing.
• Your right to continue to receive services while
you wait for an appeal or State Fair Hearing
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decision, how to request continuation of these
services, and whether the costs of these services
will be covered by Medi-Cal.
• When you have to file your appeal or State Fair
Hearing request by if you want the services to
continue.
What Should I Do When I Get a Notice of Adverse
Benefit Determination?
When you get a Notice of Adverse Benefit
Determination, you should read all the information in
the notice carefully. If you don’t understand the
notice, your county can help you. You may also ask
another person to help you.
You can request a continuation of the service that has
been discontinued when you submit an appeal or
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request for a State Fair Hearing. You must request the
continuation of services no later than 10 calendar
days after the date the Notice of Adverse Benefit
Determination was post-marked or delivered to you,
or before the effective date of the change.
Can I Keep Getting My Services While I Wait for a
Appeal Decision?
Yes, you might be able to keep getting your services
while you wait for a decision. This means you can keep
seeing your provider and getting the care you need.
What Do I Have to Do to Keep Getting My Services?
You must meet the following conditions:
• You ask to keep getting the service within
10 calendar days of the county sending the Notice
of Adverse Benefit Determination or before the
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date the county said the service would stop,
whichever date is later.
• You filed an appeal within 60 calendar days of the
date on the Notice of Adverse Benefit
Determination.
• The appeal is about stopping, reducing, or
suspending a service you were already getting.
• Your provider agreed that you need the service.
• The time period the county already approved for
the service has not ended yet.
What If the County Decides I Do Not Need the
Service After the Appeal?
You will not be required to pay for the services you
received while the appeal was pending.
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Member Responsibilities
What are my responsibilities as a Medi-Cal
member?
It is important that you understand how the county
services work so you can get the care you need. It is
also important to:
• Attend your treatment as scheduled. You will have
the best result if you work with your provider to
develop goals for your treatment and follow those
goals. If you do need to miss an appointment, call
your provider at least 24 hours in advance, and
reschedule for another day and time.
• Always carry your Medi-Cal Benefits Identification
Card (BIC) and a photo ID when you attend
treatment.
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• Let your provider know if you need an oral
interpreter before your appointment.
• Tell your provider all your medical concerns. The
more complete information that you share about
your needs, the more successful your treatment
will be.
• Make sure to ask your provider any questions that
you have. It is very important you completely
understand the information that you receive
during treatment.
• Follow through on the planned action steps you
and your provider have agreed upon.
• Contact the county if you have any questions
about your services or if you have any problems
with your provider that you are unable to resolve.
• Tell your provider and the county if you have any
changes to your personal information. This
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includes your address, phone number, and any
other medical information that may affect your
ability to participate in treatment.
• Treat the staff who provide your treatment with
respect and courtesy.
• If you suspect fraud or wrongdoing, report it:
o The Department of Health Care Services asks
that anyone suspecting Medi-Cal fraud, waste,
or abuse to call the DHCS Medi-Cal Fraud
Hotline at 1-800-822-6222. If you feel this is an
emergency, please call 911 for immediate
assistance. The call is free, and the caller may
remain anonymous.
o You may also report suspected fraud or abuse
by e-mail to fraud@dhcs.ca.gov or use the
online form at
http://www.dhcs.ca.gov/individuals/Pages/Sto
pMedi-CalFraud.aspx.
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Do I Have To Pay For Medi-Cal?
Most people in Medi-Cal do not have to pay anything
for medical or behavioral health services. In some
cases you may have to pay for medical and/or
behavioral health services based on the amount of
money you get or earn each month.
• If your income is less than Medi-Cal limits for your
family size, you will not have to pay for medical or
behavioral health services.
• If your income is more than Medi-Cal limits for
your family size, you will have to pay some money
for your medical or behavioral health services. The
amount that you pay is called your ‘share of cost’.
Once you have paid your ‘share of cost,’ Medi-Cal
will pay the rest of your covered medical bills for
that month. In the months that you don’t have
medical expenses, you don’t have to pay anything.
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• You may have to pay a ‘co-payment’ for any
treatment under Medi-Cal. This means you pay an
out-of-pocket amount each time you get a
medical service or go to a hospital emergency
room for your regular services.
• Your provider will tell you if you need to make a
co-payment.
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NONDISCRIMINATION NOTICE
Discrimination is against the law. Alameda County
Behavioral Health Department (ACBHD) follows State
and Federal civil rights laws. ACBHD does not
unlawfully discriminate, exclude people, or treat them
differently because of sex, race, color, religion,
ancestry, national origin, ethnic group identification,
age, mental disability, physical disability, medical
condition, genetic information, marital status,
gender, gender identity, or sexual orientation.
ACBHD provides:
• Free aids and services to people with disabilities
to help them communicate better, such as:
• Qualified sign language interpreters
• Written information in other formats (large
print, braille, audio or accessible electronic
formats)
• Free language services to people whose primary
language is not English, such as:
• Qualified interpreters
• Information written in other languages
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If you need these services, contact your service
provider or call ACBHD ACCESS at 1-800-491-9099
(TTY: 711. Or, if you cannot hear or speak well, please
call 711 (California State Relay). Upon request, this
document can be made available to you in braille,
large print, audio, or accessible electronic formats.
HOW TO FILE A GRIEVANCE
If you believe that ACBHD has failed to provide these
services or unlawfully discriminated in another way
on the basis of sex, race, color, religion, ancestry,
national origin, ethnic group identification, age,
mental disability, physical disability, medical
condition, genetic information, marital status,
gender, gender identity, or sexual orientation, you
can file a grievance with ACBHD’s Consumer
Assistance Line. You can file a grievance by phone,
in writing, or in person:
• By phone: Contact Consumer Assistance
between 9am -5pm, Monday through Friday, by
calling 1-800-779-0787. Or, if you cannot hear
or speak well, please call 711 (California State
Relay).
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• In writing: Fill out a grievance form or write a
letter and send it to:
Consumer Assistance
2000 Embarcadero Cove, Suite 400
Oakland, CA 94606
• In person: Visit your provider’s office or the
Mental Health Association, 2855 Telegraph
Ave, Suite 501, Berkeley, CA 94705, and say
you want to file a grievance.
Grievance Forms are available online, visit:
https://www.acbhcs.org/plan-administration/file-a-
grievance/.
OFFICE OF CIVIL RIGHTS – CALIFORNIA
DEPARTMENT OF HEALTH CARE SERVICES
You can also file a civil rights complaint with the
California Department of Health Care Services, Office
of Civil Rights by phone, in writing, or electronically:
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• By phone: Call 916-440-7370. If you cannot
speak or hear well, please call 711 (California
State Relay).
• In writing: Fill out a complaint form or send a
letter to:
Department of Health Care Services
Office of Civil Rights
P.O. Box 997413, MS 0009
Sacramento, CA 95899-7413
Complaint forms are available at:
https://www.dhcs.ca.gov/discrimination-
grievance-procedures
• Electronically: Send an email to
CivilRights@dhcs.ca.gov.
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OFFICE OF CIVIL RIGHTS – U.S. DEPARTMENT OF
HEALTH AND HUMAN SERVICES
If you believe you have been discriminated against on
the basis of race, color, national origin, age, disability
or sex, you can also file a civil rights complaint with
the U.S. Department of Health and Human Services,
Office for Civil Rights by phone, in writing, or
electronically:
• By phone: Call 1-800-368-1019. If you cannot
speak or hear well, please call
TTY/TDD 1-800-537-7697.
• In writing: Fill out a complaint form or send a
letter to:
U.S. Department of Health and Human
Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
• Complaint forms are available at
http://www.hhs.gov/ocr/office/file/index.html.
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• Electronically: Visit the Office for Civil Rights
Complaint Portal at
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
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NOTICE OF PRIVACY PRACTICES
A statement describing the county’s policies and
procedures for preserving the confidentiality of
medical records is available and will be given to you
upon request.
If you are of the age and capacity to consent to
behavioral health services, you are not required to get
any other member’s authorization to get behavioral
health services or to submit a claim for behavioral
health services.
You can ask your county to send communications
about behavioral health services to another mailing
address, email address, or telephone number that you
choose. This is called a “request for confidential
communications.” If you consent to care, the county
will not give information on your behavioral health
services to anyone else without your written
permission. If you do not give a mailing address, email
address, or telephone number, the county will send
communications in your name to the address or
telephone number on file.
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The county will honor your requests to get confidential
communications in the form and format you asked for.
Or they will make sure your communications are easy
to put in the form and format you asked for. The
county will send them to another location of your
choice. Your request for confidential communications
lasts until you cancel it or submit a new request for
confidential communications.
This Notice of Privacy Practices (“Notice”)
describes how your protected health information
(PHI) may be used and disclosed and how you can
get access to this information, as required by the
Health Insurance Portability and Accountability Act
of 1996 (HIPAA) and other laws. Please review it
carefully.
Who We Are
This single Notice applies to all departments and
programs within Alameda County Health
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(“AC Health”), an agency of the County of Alameda
and a HIPAA-covered entity. AC Health includes the
following departments and programs: Behavioral
Health (Mental Health and Drug Medi-Cal Organized
Delivery System (DMC-ODS) Health Plans), Public
Health, Environmental Health, and additional services
such as Healthcare for Homeless, Homelessness and
Housing Services, Emergency Medical Services,
Healthy Schools and Communities, Health PAC, and
Social Health Information Exchange (SHIE).
AC Health may share your protected health
information (PHI) with individuals and organizations
known as Business Associates and Qualified Service
Organizations who perform essential services on our
behalf. These include administrative support services
such as data analysis, billing or claims processing,
accreditation, auditing, laboratory services,
information technology, as well as direct clinical
services provided under contract through our health
plans or other approved service arrangements. While
providing these services, Business Associates may
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Your Information.
Your Rights.
Our Responsibilities.
In the following sections,
we’ll explain how we use
and disclose your health
information, outline your
rights, and describe our
responsibilities. We
encourage you to take a
few minutes to review this
information carefully.
also collect, create, or receive PHI and share it with
AC Health as necessary to support care delivery,
coordination, payment, or operations. All Business
Associates are legally and contractually required to
protect your PHI and may only use or disclose it as
permitted under HIPAA and their agreement with
AC Health.
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Your Information:
Our Uses and Disclosures
We generally use and disclose (share) your health
information to provide treatment (to care for you),
process payment (to bill for your services), and support
healthcare operations (to run our organization).
Treat You To provide you with medical,
behavioral health (mental health and
substance use disorder), or dental
care and coordinate your treatment
across our programs and share it with
other professionals who are treating
you.
Example: A behavioral health
provider may work with your primary
care provider to ensure your
treatment plan supports both your
mental and physical health needs.
Bill For Your
Services
We can use and share your health
information to bill and get payment
from Medi-Cal, Medicare, health
plans or other insurance carriers.
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Example: We give information about
you to your health insurance plan so it
will pay for your services.
Run Our
Organization
We can use and share your health
information to operate our programs,
improve your care, and contact you
when necessary.
Example: We may use health
information about you to manage your
treatment and services, for quality
improvement, or staff training.
Substance
Use Disorder
(SUD)
Treatment
Records
(42 CFR Part 2
Protections)
Some records about substance use
treatment are specifically protected
under federal law (42 CFR Part 2).
These rules now work with HIPAA so
that your health care team can share
information safely to help coordinate
your care while keeping it private.
How we may use and disclose your
SUD treatment information depends
on the type of consent you have given:
General consent: If you have given us
general permission, we may use and
share your SUD records for treatment,
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payment, or healthcare operations
(TPO). This lets us share your
information with other health care
providers and organizations involved
in your care.
Consent for another purpose: If you
give us permission for a different
purpose, we may use and disclose
your SUD treatment records only in
ways you allow.
Without your consent: If you have not
given permission, we will only share
your SUD records in the ways
permitted by 42 CFR Part 2.
Care
Coordination
and CalAIM
Programs
We participate in California Advancing
and Innovating Medi-Cal (CalAIM), a
program that helps coordinate care
for Medi-Cal members with complex
needs. As part of this effort, we may
share your health information with
other approved providers and
organizations involved in your care,
such as health plans, community-
based organizations, housing
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providers, or behavioral health
providers, to better coordinate service
through programs like Enhanced Care
Management (ECM) or Community
Supports. This sharing happens only
as allowed by law and only when
necessary to support your treatment
and services.
Additional Uses and Disclosures: We may also use or
disclose your health information for the following
purposes as allowed or required by law.
Public Health
and Safety
Issues
We can share health information
about you for certain situations such
as:
Preventing disease, injury or disability
Reporting births and deaths
Helping with product recalls
Reporting adverse reactions to
medications
Reporting suspected abuse, neglect,
or domestic violence
Preventing or reducing a serious
threat to anyone’s health or safety
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Research We can share health information with
third parties for research purposes.
Comply With
the Law
We will share information about you if
state or federal laws require it,
including with the U.S. Department of
Health and Human Services if it wants
to see that we’re complying with
federal privacy law.
Organ and
Tissue
Donation
Requests
We can share health information
about you with organ procurement
organizations.
Health
Oversight
We can use or share your health
information with health oversight
agencies for activities authorized by
law.
Coroner,
Medical
Examiner, or
Funeral
Director
We can share health information with
a coroner, medical examiner, or
funeral director when an individual
dies.
Workers’
Compensation
We can use or share health
information about you for workers’
compensation claims.
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Government
Requests and
Law
Enforcement
We can use or disclose your health
information with health oversight
agencies for activities authorized by
law; for special functions such as
military or national security activities,
or to protect the President and other
authorized persons; and in limited
circumstances, for law enforcement
purposes or with a law enforcement
official.
Inmates If you are in custody of a correctional
institution or law enforcement official,
we may disclose your health
information for your health and safety,
the health and safety of others, or for
the administration and safety of the
facility.
Serious and
Imminent
Threats
We may disclose your health
information when needed to lessen a
serious or imminent threat to the
health or safety of you, the public, or
another person.
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Lawsuits and
Legal Actions
We can disclose health information
about you in response to a court or
administrative order, or in response to
a subpoena.
Your Rights
When it comes to your health information, you have
certain rights. This section explains your rights and
some of our responsibilities to help you.
Access Your
Records
You can ask to see or get an
electronic or paper copy of your
medical record and other health
information we have about you.
We will provide a copy or a summary
of your health information, usually
within 30 days of your request.
Request
Amendments
You can ask us to correct health
information you believe is incorrect
or incomplete. We may say “no” to
your request, but we’ll tell you why
in writing within 60 days.
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Request
Restrictions
You may request restrictions on the
use or disclosure of your health
information, though we may not be
able to agree in all cases.
Request
Confidential
Communication
You can ask us to contact you in a
specific way (for example: home or
office phone) or to send mail to a
different address. We will say “yes”
to all reasonable requests. You must
make this request in writing, and you
must tell us how or where you wish
to be contacted.
Receive an
Accounting of
Disclosures
You can ask for a list (accounting) of
the times we’ve shared your health
information for six years prior to the
date you ask, who we shared it with,
and why. We will include all the
disclosures except for those about
treatment, payment, and healthcare
operations, and certain other
disclosures (such as any you asked
us to make). We will provide one
accounting a year for free but may
charge a reasonable, cost-based fee
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if you ask for another one within
12 months.
Get a Paper
Copy of this
Privacy Notice
You can ask for a paper copy of this
Notice at any time, even if you have
agreed to receive the Notice
electronically. We will provide you
with a paper copy promptly.
Choose
Someone to Act
for You
If you have given someone medical
power of attorney or someone is
your legal guardian, that person can
exercise your rights and make
choices about your health
information. We will make sure the
person has this authority and can
act for you before we take any
action.
File a
Complaint
If you believe your privacy rights
were violated, you can file a
complaint with us by calling
510-618-3333 or email us at
ACHealth.Compliance@acgov.org
You may also file a complaint with
the U.S. Department of Health and
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Your Rights Under
California Law
Human Services Office for Civil
Rights by sending a letter to:
HHS Office for Civil Rights
90 7th Street, Suite 4-100 |
San Francisco, CA 94103
By Phone: 1800-368-1019
Online
www.hhs.gov/ocr/privacy/hipaa/
complaints/
We will not retaliate against you for
filing a complaint.
Your Rights Under California Law
Some of your health information is subject to special
protection under California law because it is
considered sensitive information. This includes
information related to HIV test results; substance use
treatment; mental health; genetic testing; reproductive
health services (including abortion-related care); and
gender-affirming care. We may use or share this
information within AC Health and with our business
associates when needed to treat you, bill for your care,
or run our organization. When required by law, we will
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obtain your written authorization before making other
types of disclosures.
Youth and Minor Confidentiality Rights: In some
circumstances, we are permitted or required to deny
access to a parent or guardian of a minor. For example:
When minors legally consent, we will not share their
information with parents or guardians without the
minor’s written permission, unless required or
permitted by law (e.g., court order, medical
emergency, mandated reporting).
Minor ages 12 and older can consent to certain
sensitive services, including mental health, substance
use disorder treatment, reproductive health services,
HIV/STI testing and treatment.
Minors can request that we send communication
(e.g., test results, bills) to a different address, phone
number, or email to protect their privacy. This is called
a confidential communications request, and we are
required to honor it.
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Your Choices
For certain health information, you can tell us your
choices about what we share. If you have a clear
preference for how we share your information in the
situations described below, talk to us. Tell us what you
want us to do, and we will follow your instructions.
In these
cases, you
have both
the right
and choice
to tell us to:
Share information with your family, close
friends, or others involved in your care.
Share information in a disaster relief
situation.
Have us communicate with you in a
specific way (e.g., phone, email, office
address, etc.).
Ask us not to share your information with
your health plan about a service you paid
for out-of-pocket in full.
If you are not able to tell us your
preference, for example—if you are
unconscious, we may go ahead and
share your information if we believe it is
in your best interest. We may also share
your information when needed to lessen
a serious and imminent threat to health
or safety.
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In these
cases, we
will not
share your
information
unless you
give us
written
permission:
Marketing purposes.
Sale of your information.
Most sharing of psychotherapy and SUD
counseling notes.
We will not share your SUD treatment
record, or any testimony about it, in any
civil, criminal, administrative, or
legislative proceedings against you,
unless you have authorized the use or
disclosure by consent, or a court has
ordered it after providing you notice.
Even if you have given us written
permission, you may revoke it in writing
at any time.
In the case
of
fundraising
or media
campaign
We may contact you for fundraising or
media campaign efforts, but you can tell
us not to contact you again.
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Our Responsibilities
We are required by law to maintain the privacy and
security of your protected health information.
We will let you know promptly if a breach occurs that
may have compromised the privacy or security of your
information.
We must follow the duties and privacy practices
described in this Notice and give you a copy of it.
We will not use or share your information other than as
described here unless you tell us we can in writing. If
you tell us we can, you may change your mind at any
time. Let us know in writing if you change your mind.
For more information visit: www.hhs.gov/ocr/privacy/
hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of This Notice
We can change the terms of this Notice, and the
changes will apply to all information we have about
you. The new Notice will be available upon request, in
our office, and on our website.
Effective Date of Notice: 2013
Revised: Aug 2017; June 2022; November 2025
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WORDS TO KNOW
988 Suicide and Crisis Lifeline: A phone number that
provides free, confidential support for people
experiencing a mental health crisis, including suicidal
thoughts. It is available 24/7 to connect callers with
trained counselors who can offer help and support.
Administrative law judge: A judge who hears and
decides cases involving adverse benefit
determinations.
American Society of Addiction Medicine (ASAM):
A professional medical society representing doctors
and other healthcare professionals who specialize in
addiction treatment. This organization created the
ASAM Criteria, which is the national set of criteria for
addiction treatment.
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Appeal resolution: The process of resolving a
disagreement you have with a decision made by the
county about coverage of a requested service. In
simpler terms: It is how you get a second look at a
decision you do not agree with.
Application Programming Interfaces (APIs): APIs are
like messengers that allow different software
programs to "talk" to each other and share
information.
Assessment: A service activity designed to evaluate
the current status of mental, emotional, or behavioral
health.
Authorization: Giving permission or approval.
Authorized representative: Someone legally allowed
to act on behalf of another person.
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Behavioral Health: Refers to our emotional,
psychological, and social well-being. In simpler terms:
It is about how we think, feel, and interact with others.
Benefits: Health care services and drugs covered
under this health plan.
Benefits Identification Card (BIC): An ID card to
verify your Medi-Cal health insurance.
Care Coordination Services (Coordination of Care):
Helps people navigate the healthcare system.
Caregiver: Someone who provides care and support
to another person who needs help.
Case manager: Registered nurses or social workers
who can help a member understand major health
problems and arrange care with the member’s
providers.
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Case management: It is a service to assist members
in accessing needed medical, educational, social,
rehabilitative, or other community services. In other
words, it helps people get the care and support they
need.
CHIP (Children's Health Insurance Program): A
government program that helps families get health
insurance for their children if they cannot afford it.
Civil Rights Coordinator: Ensures that an
organization (like a school, company, or government
agency) complies with laws that protect people from
discrimination.
Client-driven: Something that is focused on the
needs and preferences of the client.
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Community-based organizations: Groups of people
who work together to improve their community.
Community-based adult services (CBAS):
Outpatient, facility-based services for skilled nursing
care, social services, therapies, personal care, family
and caregiver training and support, nutrition services,
transportation, and other services for members who
qualify.
Community-based stabilization: Helps people
experiencing a mental health crisis get support within
their own community instead of going to a hospital.
Continuation of service: See continuity of care.
Continuity of care: The ability of a plan member to
keep getting Medi-Cal services from their existing out-
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of-network provider for up to 12 months if the provider
and county agree.
Copayment (co-pay): A payment a member makes,
generally at the time of service, in addition to the
insurer's payment.
Covered Services: Medi-Cal services for which the
county is responsible for payment. Covered services
are subject to the terms, conditions, limitations, and
exclusions of the Medi-Cal contract, any contract
amendment, and as listed in this Member Handbook
(also known as the Combined Evidence of Coverage
(EOC) and Disclosure Form).
Culturally competent services: Providing services
that are respectful of and responsive to a person's
culture, language, and beliefs.
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Designated significant support person(s): Person(s)
who the member or the provider thinks are important
to the success of treatment. This can include parents
or legal guardians of a minor, anyone living in the same
household, and other relatives of the member.
DHCS: The California Department of Health Care
Services. This is the State office that oversees the
Medi-Cal program.
Discrimination: The unfair or unequal treatment of
someone based on their race, gender, religion, sexual
orientation, disability, or other characteristics.
Early and periodic screening, diagnostic, and
treatment (EPSDT): Go to “Medi-Cal for Kids and
Teens.”
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Family-based treatment services: Provides support
and treatment to children and their families to address
mental health challenges within the home
environment.
Family planning services: Services to prevent or
delay pregnancy. Services are provided to members of
childbearing age to enable them to determine the
number and spacing of children.
Fee-for-Service (FFS) Medi-Cal: Payment model in
which Behavioral Health providers are paid for each
individual service they provide patient, rather than a
per-patient monthly or annual fee. Medi-Cal Rx is
covered under this program.
Financial liability: Being responsible for paying a debt
or cost.
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Foster home: A household that provides 24-hour
substitute care for children who are separated from
their parents or guardians.
Fraud: An intentional act to deceive or misrepresent
made by a person with knowledge that the deception
or misrepresentation could result in some
unauthorized benefit to themselves or someone else.
Full-scope Medi-Cal: Free or low-cost health care for
people in California that provides more than just
emergency health care. It provides medical, dental,
mental health, family planning, and vision (eye) care. It
also covers treatment for alcohol and drug use,
medicine your doctor orders, and more.
Grievance: A member’s verbal or written expression of
dissatisfaction about a service covered by Medi-Cal, a
managed care plan, a county, or a Medi-Cal provider.
A grievance is the same as a complaint.
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Guardian: A person legally responsible for the care
and well-being of another person, usually a child or
someone who cannot care for themselves.
Hospital: A place where a member gets inpatient and
outpatient care from doctors and nurses.
Hospitalization: Admission to a hospital for treatment
as an inpatient.
Indian Health Care Providers (IHCP): A health care
program operated by the Indian Health Service (IHS),
an Indian Tribe, Tribal Health Program, Tribal
Organization or Urban Indian Organization (UIO) as
those terms are defined in Section 4 of the Indian
Health Care Improvement Act (25 U.S.C. section 1603).
Initial Assessment: An evaluation of the member to
determine the need for mental health services or
substance use disorder treatment.
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Inpatient Detoxification: A voluntary medical acute
care service for detoxification for members with
severe medical complications associated with
withdrawals.
Integrated Core Practice Model: A guide that outlines
the values, standards, and practices for working with
children, youth, and families in California.
Licensed mental health professional: Any provider
who is licensed in accordance with applicable State of
California law such as the following: licensed
physician, licensed psychologist, licensed clinical
social worker, licensed professional clinical counselor,
licensed marriage and family therapist, registered
nurse, licensed vocational nurse, licensed psychiatric
technician.
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Licensed psychiatric hospital: A mental health
treatment facility that is licensed to provide 24-hour
inpatient care for mentally disordered, incompetent,
or a danger to themselves or others.
Licensed residential facility: Facilities that provide
residential nonmedical services to adults who are
recovering from problems related to alcohol or other
drug (AOD) misuse or abuse.
Managed care plan: A Medi-Cal health plan that uses
only certain doctors, specialists, clinics, pharmacies,
and hospitals for Medi-Cal recipients enrolled in that
plan.
Medi-Cal: California’s version of the federal Medicaid
program. Medi-Cal offers free and low-cost health
coverage to eligible people who live in California.
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Medi-Cal for Kids and Teens: A benefit for Medi-Cal
members under the age of 21 to help keep them
healthy. Members must get the right health check-ups
for their age and appropriate screenings to find health
problems and treat illnesses early. They must get
treatment to take care of or help the conditions that
might be found in the check-ups. This benefit is also
known as the Early and Periodic Screening,
Diagnostic, and Treatment (EPSDT) benefit under
federal law.
Medi-Cal Peer Support Specialist: An individual who
has lived experience with behavioral health or
substance use conditions and is in recovery, who has
completed the requirements of a county’s State-
approved certification program, who is certified by the
county, and who provides services under the direction
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of a Behavioral Health Professional who is licensed,
waivered, or registered with the State.
Medi-Cal Rx: A pharmacy benefit service that is part
of FFS Medi-Cal and known as “Medi-Cal Rx” that
provides pharmacy benefits and services, including
prescription drugs and some medical supplies to all
Medi-Cal members.
Medically necessary (or medical necessity): For
members 21 years of age or older, a service is
medically necessary when it is reasonable and
necessary to protect life, to prevent significant illness
or significant disability, or to alleviate severe pain. For
members under 21 years of age, a service is medically
necessary if it is to correct or ameliorate a mental
illness or condition discovered by a screening service.
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Medication Assisted Treatment (MAT): The use of
FDA approved medication in combination with
counseling or behavioral therapies to provide a
“whole-patient” approach to the treatment of
substance use disorder.
Member: An individual who is enrolled in the Medi-Cal
program.
Mental health crisis: When someone is experiencing
a situation where their behaviors or symptoms put
themselves or others at risk and require immediate
attention.
Mental health plan: Each county has a mental health
plan that is responsible for providing or arranging
specialty mental health services to Medi-Cal
members in their county.
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Network: A group of doctors, clinics, hospitals, and
other providers contracted with the county to provide
care.
Non-emergency medical transportation:
Transportation by ambulance, wheelchair van, or litter
van for those who cannot use public or private
transportation.
Non-medical transportation: Transportation when
traveling to and from an appointment for a Medi-Cal
covered service authorized by a member’s provider
and when picking up prescriptions and medical
supplies.
Office of the Ombudsman: Helps solve problems
from a neutral standpoint to make sure that members
receive all medically necessary and covered services
for which plans are contractually responsible.
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Out-of-home placement: A temporary or permanent
removal of a child from their home to a safer
environment like with a foster family or in a group
home.
Out-of-network provider: A provider who is not part
of the county’s contracted network.
Out-of-pocket: A personal cost to a member to
receive covered services. This includes premiums,
copays, or any additional costs for covered services.
Outpatient mental health services: Outpatient
services for members with mild to moderate mental
health conditions including:
• Individual or group mental health evaluation and
treatment (psychotherapy)
• Psychological testing when clinically indicated to
evaluate a mental health condition
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• Outpatient services for the purposes of monitoring
medication therapy
• Psychiatric consultation
• Outpatient laboratory, supplies, and supplements
Participating provider (or participating doctor): A
doctor, hospital, or other licensed health care
professional or licensed health facility, including
sub-acute facilities that have a contract with the
county to offer covered services to members at the
time a member gets care.
Plan development: A service activity that consists of
development of client plans, approval of client plans,
and/or monitoring of a member’s progress.
Prescription drugs: A drug that legally requires an
order from a licensed provider to be dispensed, unlike
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over-the-counter (“OTC”) drugs that do not require a
prescription.
Primary care: Also known as “routine care”. These are
medically necessary services and preventative care,
well-child visits, or care such as routine follow-up
care. The goal of these services is to prevent health
problems.
Primary care provider (PCP): The licensed provider a
member has for most of their health care. The PCP
helps the member get the care they need. A PCP can
be a:
• General practitioner
• Internist
• Pediatrician
• Family practitioner
• OB/GYN
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• Indian Health Care Provider (IHCP)
• Federally Qualified Health Center (FQHC)
• Rural Health Clinic (RHC)
• Nurse practitioner
• Physician assistant
• Clinic
Prior authorization (pre-approval): The process by
which a member or their provider must request
approval from the county for certain services to ensure
the county will cover them. A referral is not an
approval. A prior authorization is the same as pre-
approval.
Problem resolution: The process that allows a
member to resolve a problem or concern about any
issue related to the county’s responsibilities, including
the delivery of services.
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Provider Directory: A list of providers in the county’s
network.
Psychiatric emergency medical condition: A mental
disorder in which the symptoms are serious or severe
enough to cause an immediate danger to the member
or others or the member is immediately unable to
provide for or use food, shelter, or clothing due to the
mental disorder.
Psychological testing: A test that helps understand
someone's thoughts, feelings, and behaviors.
Referral: When a member’s PCP says the member
can get care from another provider. Some covered
care services require a referral and pre-approval (prior
authorization).
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Rehabilitative and habilitative therapy services and
devices: Services and devices to help members with
injuries, disabilities, or chronic conditions to gain or
recover mental and physical skills.
Residential shelter services: Provides temporary
housing and support to people who are homeless or
experiencing a housing crisis.
Screening: A quick check conducted to determine the
most appropriate services.
Share of cost: The amount of money a member must
pay toward their medical expenses before Medi-Cal
will pay for services.
Serious emotional disturbances (problems): Refers
to a significant mental, behavioral, or emotional
disorder in children and adolescents that interferes
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with their ability to function at home, school, or in the
community.
Specialist (or specialty doctor): A doctor who treats
certain types of health care problems. For example, an
orthopedic surgeon treats broken bones; an allergist
treats allergies; and a cardiologist treats heart
problems. In most cases, a member will need a
referral from their PCP to go to a specialist.
Specialty mental health services (SMHS): Services
for members who have mental health services needs
that are higher than a mild to moderate level of
impairment.
Strength-based: Looking at what someone can do,
instead of just focusing on their problems.
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Substance use disorder services: Services that help
people who are struggling with addiction to drugs or
alcohol.
Telehealth: A way of delivering health care services
through information and communication technologies
to facilitate a patient’s health care.
Trauma: A deep emotional and psychological distress
that results from experiencing or witnessing a
terrifying event.
Trauma-informed specialty mental health services:
These services recognize that many people struggling
with mental health issues have experienced trauma,
and they provide care that is sensitive to and
supportive of those who have been traumatized.
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Treatment Plan: A plan to address a member’s needs
and monitor progress to restore the member’s best
possible functional level.
TTY/TDD: Devices that assist people who are deaf,
hard of hearing, or have a speech impairment to make
and receive phone calls. TTY stands for
“Teletypewriter”. TDD stands for “Telecommunications
Device for the Deaf”.
Vocational services: Services that help people find
and keep jobs.
Waitlist: A list of people who are waiting for something
that is not currently available, but may be in the future.
Warm handoff: A smooth transfer of care from one
provider to another.
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ADDITIONAL INFORMATION FROM YOUR COUNTY
ACBHD is committed to your wellness. We respect
your voice and support equity in health care services.
We would like you to know that this information is
readily available in the languages listed below:
• Spanish: Este folleto está disponible en
Español
• Vietnamese: Tập sách này có bằng tiếng Việt
• Korean: 이 책자는 한국어로 제공됩니다.
• Chinese (Traditional): 這本手冊有中文版
• Chinese (Simplified): 这本手册有中文版
• Farsi: .نﯾا تﺎﻋﻼطا ﮫ ﺑ نﺎﺑز ﯽﺳرﺎﻓ دوﺟوﻣ تﺳا
• Tagalog (Tagalog/Filipino): Ang impormasyong
ito ay maaaring makuha sa Tagalog.
• Arabic: .ﺔﯾﺑرﻌﻟا ﺔﻐﻠﻟﺎﺑ لﯾﻟدﻟا اذھ رﻓوﺗﯾ
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If you need this information in any language not listed
above, please contact your current care provider or
ACBHD at the phone number listed on the cover of
this booklet.
ACBHD is offering the following new services:
• Multisystemic Therapy (MST)
• Assertive Community Treatment (ACT)
• Forensic Assertive Community Treatment
(FACT)
• Coordinated Specialty Care (CSC) for First
Episode Psychosis
• Supported Employment
• Medi-Cal Peer Support Services
Please contact your current service provider or call
ACBHD ACCESS at 1-800-491-9099 to inquire about
adding these services to your care plan.