| Provider: A person or entity who is licensed, certified, or otherwise recognized or authorized under State law governing the healing arts to provide specialty mental health services and who meets the standards for participation in the Medi-Cal program and is contracted with the Los Angeles County Department of Mental Health (DMH/Department).
Program of Service: A specific location and/or provider listed and approved to provide services through DMH.
Practitioner: Staff who provide services to beneficiaries (i.e., psychiatrist, psychologist, nurse, psychiatric social worker, case manager, therapist, etc.).
Voluntary Change of Provider: Changes of program of service and/or practitioner, resulting from beneficiary requests. The following occurrences do not constitute a voluntary change of provider: -
A beneficiary changes program of service due to staff turnover, staff reorganization, or termination of a provider contract; -
A beneficiary moves to a different geographic area within Los Angeles County and, therefore, changes program of service and practitioner; -
A beneficiary changes program of service from a child to an adult provider; and -
A beneficiary is discharged or services are terminated. Grievance: A beneficiary's verbal or written expression of dissatisfaction about any matter other than an Adverse Benefit Determination. Grievances include, but are not limited to, quality of care or services provided and aspects of interpersonal relationships with providers of the Department.
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| Beneficiaries have the right to request a change in program of service and/or practitioner to achieve maximum benefit from mental health services. Every effort shall be made to accommodate such requests.
DMH shall report to DHCS, no later than October 1st of each year, data based on the prior fiscal year the number of: - Medi-Cal beneficiaries who request a voluntarily change of provider during the fiscal year.
- Grievances raised through the beneficiary problem resolution process.
DMH's Quality Improvement Unit shall review data from the Patients' Rights Office (PRO) regarding voluntary change of provider requests on a quarterly and annual basis. Data trends shall be shared with appropriate divisions including Outpatient Services division and appropriate action shall be taken based on the data.
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