The purpose of the policy is to outline beneficiary rights and the rights of other service recipients and describe the required activities to reinforce and support rights.
BHSD and its provider network have mechanisms in place to protect and ensure beneficiary rights.
DHCS defines beneficiary rights to include but not be limited to:
- Be treated with personal respect and respect for your dignity and privacy.
- Receive information on available treatment options and alternatives; and have them presented in a manner they can understand.
- Participate in decisions regarding their mental health care, including the right to refuse treatment.
- Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, punishment or retaliation as specified in federal rules about the use of restraints and seclusion in facilities such as hospitals, nursing facilities and psychiatric residential treatment facilities where you stay overnight for treatment.
- Request and receive a copy of their medical records, and request that they be amended or corrected.
- Receive the information in this booklet about the services covered by the MHP, other obligations of the MCP and their rights as described here.
- The right to receive this information and other information provided to them by the MCP in a form that is easy to understand. This means, for example, that the MCP must make its written information available in the languages that are used by at least 5 percent or 3,000, whichever is less, of Medi-Cal eligible people in the MHP’s county and make oral interpreter services available free of charge for people who speak other languages.
- This also means that the MCP must provide different materials for people with special needs, such as people who are blind or have limited vision or people who have trouble reading.
- Receive specialty mental health services from a MCP that follow the requirements of its contract with the State in the areas of availability of services, assurances of adequate capacity and services, coordination and continuity of care, and coverage and authorization of services.
For beneficiaries, BHSD is required to:
- Employ or have written contracts with enough providers to make sure that all beneficiaries who qualify for behavioral health services can receive them in a timely manner.
- Cover medically necessary services out-of-network for beneficiaries in a timely manner, if the MCP doesn’t have an employee or contract provider who can deliver the services. “Out-of-network provider” means a provider who is not on the MCP’s list of providers. The MCP must make sure beneficiaries do not pay anything extra for seeing an out-of-network provider.
- Make sure providers are qualified to deliver the specialty mental health services that the providers agreed to cover.
- Make sure that the specialty mental health services the MCP covers are adequate in amount, duration and scope to meet the needs of the beneficiaries it serves. This includes making sure the MCP’s system for authorizing payment for services is based on medical necessity and uses processes that ensure fair application of the medical necessity criteria.
- Ensure that its providers perform adequate assessments of individuals who may receive services and work with the individuals who will receive services to develop a treatment plan that includes the goals of treatment and the services that will be delivered.
- Provide for a second opinion from a qualified health care professional within the MHP’s network, or one outside the network, at no additional cost to the beneficiary.
- Coordinate the services it provides with services being provided to an individual through a managed care health plan or with your primary care provider, if necessary, and in the coordination process, to make sure the privacy of each individual receiving services is protected as specified in federal rules on the privacy of health information.
- Provide timely access to care, including making services available 24-hours a day, 7 days a week, when medically necessary to treat an emergency psychiatric condition or an urgent or crisis condition.
- Participate in the State’s efforts to promote the delivery of services in a culturally competent manner to all individuals, including those with limited English proficiency and diverse cultural and ethnic backgrounds.
- Must ensure the beneficiary’s treatment is not adversely affected as a result of them using their rights.