Patient's Rights Advocate

Some of the duties of the PRA include:

  • Helps make sure that Medi-Cal beneficiaries are informed of their rights
  • Advocates for Medi-Cal beneficiaries
  • Receives and investigates complaints, grievances and appeals
  • Helps clients change providers when needed
  • Monitors mental health facilities, services and programs to be sure that patient’s rights are protected
  • Provides training and education for providers and beneficiaries
  • Exchanges information with the State Patient’s Rights Program

 

 

 

Frequently Asked Questions

How do I get help from the Patients' Rights Advocate?

To get help from the Patients' Rights Advocate: 

  1. Call the Patients' Rights Advocate (PRA) at (805) 781-4738
  2. The PRA will talk with you by phone or meet with you at a clinic location that is convenient for you
  3. If your request must be given in writing, the PRA will help you with this if needed.
  4. Consumer Request Form is available at all our clinic locations or for download
  5. Pre-addressed, postage paid envelopes are available at out clinic locations.  Send mail to:

                 San Luis Obispo County Behavioral Health
                 Patients’ Rights Advocate
                 2180 Johnson Ave.
                 San Luis Obispo, CA 93401

What are my rights?

Medi-Cal beneficiaries have a number of rights, including the rights to be treated with dignity and respect. 

View a useful summary:
My Rights at a Glance

Cuáles son mis Derechos?

 

The links below have even more information about our services and your rights:
Guide to Medi-Cal Mental Health Services
Guía para Servicios de Salud Mental de Medi-Cal
Notice of Nondiscrimination
Rights for Individuals In Mental Health Facilities
Derechos de las personas en instituciones de salud mental

 

UIDE T

 

What is an Appeal or Expedited Appeal?

An Appeal is a request by a Medi-Cal beneficiary, a beneficiary's representative, or a provider for a review of an "Action" or "Adverse Benefit Determination" taken by SLO Behavioral Health. "Action" and "Adverse Benefit Determination" are the fancy terms used by the State to describe our decision to not give you a service you ask for. We will always mail a written explanation of the action we take, and the notice we send will explain exactly how to file an appeal. The Patients' Rights Advocate is available to help you file the appeal if needed. 

SLO Behavioral Health has sixty (60) calendar days after we review your appeal to reach a decision. If you believe that waiting that long will create a serious problem for you, please talk with the PRA about an Expedited Appeal. 

If we don't agree with your Appeal, you have a right to file for a State Fair Hearing. 
 

What is a Grievance?

A Grievance is when you tell us by phone, in person, or in writing that you are dissatisfied with something we've done, other than deny or reduce services (those are things you can Appeal if you are a Medi-Cal beneficiary).

The Consumer Request Form is one way to let us know about your grievance, or you can call the Patients' Rights Advocate at (805) 781-4738.

What is a Fair Hearing?

A Fair Hearing is an independent review conducted by the California Department of Health Care Services and the California Department of Social Services to make sure that Medi-Cal beneficiaries receive the services to which they are entitled. Beneficiaries must first file an Appeal and wait for SLO Behavioral Health to resolve the Appeal. A Fair Hearing may then be requested if the  Appeal or Expedited Appeal was not decided completely in the Medi-Cal beneficiary's favor. 

The Patients' Rights Advocate is available to help file the Fair Hearing Request. Directions are on the Consumer Request Form.