Patients' Rights Advocate

The Patients' Rights Advocate helps Medi-Cal beneficiaries and other consumers understand their rights and access problem solving processes. Duties include:

  • Providing written informational materials
  • Advocating for consumers
  • Investigating complaints
  • Monitoring programs to be sure that patients' rights are protected
  • Training providers and consumers about rights
  • Communicating with the State Patients' Rights Program

FAQs

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

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

View a useful summary:

The links below have even more information about our services and your rights:

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 the County of San Luis Obispo Behavioral Health Department (SLOBHD). "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. SLOBHD will always mail a written explanation of the action taken, and the notice will explain exactly how to file an appeal. The Patients' Rights Advocate (PRA) is available to help you file the appeal if needed. 

A client, provider, and/or authorized representative may file an appeal orally or in writing within 60 calendar days from the date on the Adverse Benefit Determination. Appeals filed by the provider on behalf of a client require written consent from the client/parent/legal guardian. SLOBHD will send written acknowledgement of all standard appeals within 5 calendar days of receipt. 

SLOBHD has 30 calendar days after we review your appeal to reach a resolution. If you believe that waiting that long will create a serious problem for you, please talk with the PRA about an expedited appeal. Expedited appeals will be expedited as medically necessary and resolved within 72 hours. 

If you do not agree with how your appeal is resolved, you have a right to file for a State Fair Hearing. State Fair Hearings must be filed with the state within 120 days from the date of the notice of appeal resolution. 

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 (PRA) at (805) 781-4738.

A client may file a grievance at any time. The PRA will send written acknowledgement of your grievance within 5 calendar days. The PRA will resolve grievances within 30 calendar days.

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.

Reference