LOS ANGELES COUNTY
DEPARTMENT OF MENTAL HEALTH
  Policy 302.07 Access to Care
 
  PROCEDURES
 
  1. If a client or potential client is experiencing a behavioral health crisis and is in need of mobile crisis services by a mobile crisis team, the mobile crisis team shall arrive at the community based location where the crisis is occurring within 60 minutes of the client being determined to require mobile crisis services.
     
  2. If a client or potential client who requests services appears to need emergent services, the need shall be addressed as soon as possible and in all cases within the same day as the request
     
    1. The services may be provided by the provider (in-person or telehealth) or through referral to an appropriate provider (e.g. Urgent Care Center).
       
    2. Every effort shall be made to handle the emergent need by the provider prior to referral, including rescheduling non-emergent appointments.
       
    3. Whether by the provider (in-person or telehealth) or through referral, services commensurate with the level of need shall in all cases be provided (e.g., crisis intervention, brief psychotherapy, medication support).
       
    4. If a referral is made to another provider, arrangements shall be made to ensure the safe transport of the client to that provider.
       
  3. If the client or potential client needs urgent services, an appointment shall be offered within 48 hours unless pre-authorization for the service is required. If pre-authorization is required, the appointment shall be offered within 96 hours.
     
    1. If the request comes in on Friday and cannot be addressed on the same day, the potential client/client shall be referred to a provider that is available 24/7 such as an urgent care, mobile crisis team or, if enrolled, an intensive program that has 24/7 availability (e.g., Full Service Partnership).
       
  4. If screening/triage indicates the client or potential client needs expedited services (e.g., in distress, has run out of medications, or is about to run out of medications), an appointment shall be offered in such a time as to prevent significant deterioration in mental health status.
     
    1. Triage shall include a review of current risk and safety concerns.
       
    2. Triage may be initiated by any appropriately assigned practitioner; however, if any significant risk/safety concerns are identified, it must be completed by an Authorized Mental Health Discipline (AMHD).
       
    3. The next offered service after a mobile crisis service by a mobile crisis team where the client is not hospitalized shall be considered expedited.
       
  5. If the client or potential client is being discharged or has been recently discharged from an acute psychiatric inpatient facility or psychiatric hold, or an emergency room for a mental health emergency an appointment shall be offered within five (5) business days from the discharge date or date of request (if after the discharge date and within seven (7) days of discharge).
     
    1. The initial appointment within this required time frame, may be with any appropriate staff.
       
    2. If the client is discharged with medication, the client shall also be given an appointment with a psychiatrist, psychiatric nurse practitioner or pharmacist within a time frame to ensure the client does not run out of medications.
       
  6. If the client or potential client is being released from jail or juvenile justice facility an appointment shall be offered within five (5) business days from the release date or date of request (if after the release date and within seven (7) days of release).
     
  7. If the client or potential client requests routine Mental Health Services (MHS), Targeted Case Management (TCM), or Medication Support Services (MSS) not requiring a psychiatrist, an appointment shall be offered within 10 business days from the request date.
     
  8. If the client or potential client requests routine MSS from a psychiatrist, an appointment shall be offered within 15 business days from the request date.
     
  9. The appointment times for routine services may be extended beyond the 10 or 15 business day standard when:
     
    1. The referring/treating practitioner or the practitioner providing screening and/or triage has determined and documented in the client’s clinical record that a longer waiting time shall not have a detrimental impact on the health of the client.
       
      1. The determination shall be made by an AMHD acting within the scope of his/her practice and consistent with professionally recognized standards of practice.
         
    2. The service is a follow-up for an on-going condition and the service is scheduled in advance according to the time frame set in accord with the frequency agreed upon by the client and practitioner providing the service.
       
  10. All the above time frame requirements apply for re-scheduled missed/canceled appointments.
     
    1. For missed appointments, the time frame is determined from the request date for a new appointment.
       
    2. For canceled appointments, the time frame is determined from the cancellation date.
       
  11. A Notice of Adverse Benefit Determination (NOABD) shall be issued when the Los Angeles County Department of Mental Health (LACDMH) System of Care is unable to serve a member within the time frames stated in this policy and in accord with DMH Policy 200.04.
     
  12. Each provider shall implement quality review procedures, including corrective actions, to ensure appointments are offered within the time frames established by this policy.
    The Quality Assurance Unit shall monitor timely access for the DMH System of Care on at least a quarterly basis.