Sacramento County Mental Health Plan

锘縎acramento County

Mental Health Plan (MHP)

Beneficiary Handbook

Specialty Mental Health Services

7001-A East Parkway, Suite 300

Sacramento, CA 95823

Revised Date: September 2023

Effective Date: January 1, 20241

1

The handbook must be provided at the time the beneficiary first accesses services.

LANGUAGE TAGLINES

English Tagline

ATTENTION: If you need help in your language call 1-916-875-6069, California Relay 711.

Aids and services for people with disabilities, like documents in braille and large print, are

also available. Call 1-916-875-6069, California Relay 711. These services are free of

charge.

(Arabic) ??????? ?????????

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1-916-875-6069, California Relay 711. ? ????? ????? ??? ????? ?? ???????? ??????:??? ????????

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??????? ????? (Armenian)

?????????????: ??? ??? ?????????? ? ???????? ??? ??????, ?????????? 1-916875-6069, California Relay 711. ? ??? ??? ??????? ???????? ?? ???????????????

???????????????? ??????? ?????? ?????, ??????` ?????? ???????? ??

????????? ???????? ???????? ?????????? 1-916-875-6069, California Relay 711.

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????????????? ? (Cambodian)

????? ?????? ????? ??????? ??? ??????? ?? ? ?? ?????????? 1-916-875-6069,

California Relay 711. ? ????? ??? ?????? ?????? ??????

?? ???????????????????? ??????????????? ? ??????????????????????

?????????????? ?? ?????????? 1-916-875-6069, California Relay 711. ?

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简体中文标语 (Chinese)

请注意：如果您需要以您的母语提供帮助，请致电 1-916-875-6069, California Relay 711.。

另外还提供针对残疾人士的帮助和服务，例如盲文和需要较大字体阅读，也是方便取用的。

请致电 1-916-875-6069, California Relay 711.。这些服务都是免费的。

(Farsi) ????? ?? ???? ??????

.????? ???????1-916-875-6069, California Relay 711. ? ????? ??? ???????? ?? ???? ??? ??? ?????? ?????:??????

? ???.? ??? ????? ?????? ????? ??????? ?? ???? ? ??? ?? ???? ???????????? ? ????? ????? ????? ????? ????????

.? ??? ????? ?????? ????? ???????.????? ???????1-916-875-6069, California Relay 711.

????? ?? ????? (Hindi)

??? ?? : ??? ???? ???? ???? ?? ?????? ?? ?????? ?? ?? 1-916-875-6069, California

Relay 711. ?? ??? ??? ? ????? ???? ????? ?? ??? ?????? ?? ?????? , ?? ?? ????? ?? ??? ?????? ?? ??

?????? ???? 1-916-875-6069, California Relay 711. ?? ??? ??? ? ?? ?????? ??: ??? ?? ?

Call your Mental Health Plan at 916-875-6069 toll-free at 1-888-881-4881 or visit

online at dhs. Sacramento MHP is available Monday-Friday

8:00am -5:00pm.

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Nqe Lus Hmoob Cob (Hmong)

CEEB TOOM: Yog koj xav tau kev pab txhais koj hom lus hu rau 1-916-875-6069,

California Relay: 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 thiab luam tawm ua tus ntawv loj. Hu rau 1916-875-6069, California Relay 711. Cov kev pab cuam no yog pab dawb xwb.

日本語表記 (Japanese)

注意日本語での対応が必要な場合は 1-916-875-6069, California Relay 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。 1-916-875-6069, California Relay 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。

??? ???? (Korean)

????: ??? ??? ??? ?? ???? 1-916-875-6069, California Relay

711.??? ??????. ??? ? ??? ? ??? ?? ??? ?? ??? ??

??? ???? ?? ?????. 1-916-875-6069, California Relay 711.???

??????. ??? ???? ??? ?????.

???????????? (Laotian)

?????: ?? ??? ???? ??????????? ????? ? ???????????? ????? ??????? 1-916-875-6069, California

Relay 711. ??????????? ????? ? ????????????????????????????

???? ??????????? ???????????? ??????????????? ??? ???????

1-916-875-6069, California Relay 711. ?????????????? ? ???? ??? ?? ??????? ???? ???????.

Mien Tagline (Mien)

LONGC HNYOUV JANGX LONGX OC: Beiv taux meih qiemx longc mienh tengx faan

benx meih nyei waac nor douc waac daaih lorx taux 1-916-875-6069, California Relay 711.

Liouh lorx jauv-louc tengx aengx caux nzie gong bun taux ninh mbuo wuaaic fangx mienh,

beiv taux longc benx nzangc-pokc bun hluo mbiutc aengx caux aamz mborqv benx domh

sou se mbenc nzoih bun longc. Douc waac daaih lorx 1-916-875-6069, California Relay

711. Naaiv deix nzie weih gong-bou jauv-louc se benx wang-henh tengx mv zuqc cuotv

nyaanh oc.

?????? ??????? (Punjabi)

???? ???: ?? ?? ????? ???? ???? ???? ??? ?? ?? ? ?? ??? ??? ???

1-916-875-6069, California Relay 711. ????? ?? ??? ?? ?????? ??? ???????, ???? ?? ???? ???

???? ???? ???? ???????, ?? ????? ??| ??? ??? 1-916-875-6069, California Relay 711.

?? ??????? ???? ??|

Call your Mental Health Plan at 916-875-6069 toll-free at 1-888-881-4881 or visit

online at dhs. Sacramento MHP is available Monday-Friday

8:00am -5:00pm.

3

Русский слоган (Russian)

ВНИМАНИЕ! Если вам нужна помощь на вашем родном языке, звоните по номеру 1916-875-6069, California Relay 711. Также предоставляются средства и услуги для

людей с ограниченными возможностями, например документы крупным шрифтом

или шрифтом Брайля. Звоните по номеру 1-916-875-6069, California Relay 711. Такие

услуги предоставляются бесплатно.

Mensaje en espa?ol (Spanish)

ATENCI?N: si necesita ayuda en su idioma, llame al 1-916-875-6069, California Relay

711. También ofrecemos asistencia y servicios para personas con discapacidades, como

documentos en braille y con letras grandes. Llame al 1-916-875-6069, California Relay

711. Estos servicios son gratuitos.

Tagalog Tagline (Tagalog)

ATENSIYON: Kung kailangan mo ng tulong sa iyong wika, tumawag sa

1-916-875-6069, California Relay 711. Mayroon ding mga tulong at serbisyo para sa mga

taong may kapansanan,tulad ng mga dokumento sa braille at malaking print. Tumawag sa

1-916-875-6069, California Relay 711. Libre ang mga serbisyong ito.

??????????????? (Thai)

????????: ??????? ?????????????????????? ??????????? ??????????????????

? ??????

1-916-875-6069, California Relay 711. ????????? ????? ????? ??????????????????????????? ?

???????????????

? ?

? ???????? ???? ?????????? ?

???? ?? ????????????????????????

? ?

? ??? ??????????????????? ??????????????????

? ?????? 1-916875-6069, California Relay 711. ?????

? ?? ?? ??????????????????????????

Прим?тка укра?нською (Ukrainian)

УВАГА! Якщо вам потр?бна допомога вашою р?дною мовою, телефонуйте на номер 1916-875-6069, California Relay 711. Люди з обмеженими можливостями також можуть

скористатися допом?жними засобами та послугами, наприклад, отримати документи,

надрукован? шрифтом Брайля та великим шрифтом. Телефонуйте на номер 1-916875-6069, California Relay 711. Ц? послуги безкоштовн?.

Kh?u hi?u ti?ng Vi?t (Vietnamese)

CH? ?: N?u qu? v? c?n tr? giúp b?ng ng?n ng? c?a mình, vui lòng g?i s?

1-916-875-6069, California Relay 711. Chúng t?i c?ng h? tr? và cung c?p các d?ch v?

dành cho ng??i khuy?t t?t, nh? tài li?u b?ng ch? n?i Braille và ch? kh? l?n (ch? hoa). Vui

lòng g?i s? 1-916-875-6069, California Relay 711. Các d?ch v? này ??u mi?n phí.

Call your Mental Health Plan at 916-875-6069 toll-free at 1-888-881-4881 or visit

online at dhs. Sacramento MHP is available Monday-Friday

8:00am -5:00pm.

4

TABLE OF CONTENTS

OTHER LANGUAGES AND FORMATS ......................................................................... 6

NONDISCRIMINATION NOTICE .................................................................................... 8

GENERAL INFORMATION ........................................................................................... 11

IMPORTANT INFORMATION ABOUT THE MEDI-CAL PROGRAM............................. 14

HOW TO TELL IF YOU OR SOMEONE YOU KNOW NEEDS HELP ........................... 18

ACCESSING SPECIALTY MENTAL HEALTH SERVICES ........................................... 21

SELECTING A PROVIDER ........................................................................................... 29

YOUR RIGHT TO ACCESS MEDICAL RECORDS AND PROVIDER DIRECTORY

INFORMATION USING ................................................................................................. 31

SCOPE OF SERVICES ................................................................................................. 32

ADVERSE BENEFIT DETERMINATIONS BY YOUR MENTAL HEALTH PLAN .......... 41

THE PROBLEM RESOLUTION PROCESS: TO FILE A GRIEVANCE OR APPEAL .... 45

THE GRIEVANCE PROCESS....................................................................................... 47

THE APPEAL PROCESS (STANDARD AND EXPEDITED) ......................................... 50

THE STATE FAIR HEARING PROCESS ...................................................................... 55

ADVANCE DIRECTIVE ................................................................................................. 59

BENEFICIARY RIGHTS AND RESPONSIBILITIES ...................................................... 61

Call your Mental Health Plan at 916-875-6069 toll-free at 1-888-881-4881 or visit

online at dhs. Sacramento MHP is available Monday-Friday

8:00am -5:00pm.

5

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