County of San Bernardino - Department of Behavioral Health

Consumer Information

State Informing Materials

Services are provided in clinics within the four regions (Central Valley, Desert/Mountain, East Valley, West Valley) of the County of San Bernardino. At these clinics, clients can get behavioral health screening; help with medication and support services.
State Informing Materials

For Those Requesting or Receiving Mental Health Services San Bernardino County Department of Behavioral Health Providing consumers with quality mental health services regardless of race, color, religion, sex, national origin, political belief, disability, marital status or age.

	Guide to Medi-Cal Mental Health Services
	(English) (Spanish) (Large Fonts) Revised July 01, 2005

Fee-for-service network provider lists contain the names of all fee-for-service providers who are:

(1) credentialed with the San Bernardino County Mental Health Plan
(2) in good standing (i.e., license is current, malpractice insurance is in effect, etc.)
(3) have not indicated that they are not accepting Medi-Cal consumers.

The fact that a provider is on one of these lists does not indicate that they currently have openings for new clients. Some providers may have openings, others may not, and still others may have waiting lists.

We recommend that clinicians who are giving the names of FFS providers to consumers notify those consumers at the time the referrals are given that some of the providers may not have openings. Because the status of a provider's practice is always in flux, it is not possible to remove or reinstate providers names on the lists based upon their having openings.

If in using these lists clinicians or clinic supervisors discover information which is factually incorrect (e.g., telephone numbers or addresses which are in error, specialty information which is not valid), please contact Access Unit, at 381-2420.

Fee for Service Providers List
	Provider's by Area
	Proveedores Por Area En Españo

DBH Providers List

Problem Resolution Materials

Access Unit

850 E. Foothil Blvd

Rialto, CA 92376

(909) 381-2420

1(888) 743-1478

1(888) 743-1481 [TDD] Fax (909) 421-9272

Call or write the Access Unit and forms & envelopes are available in clinics and office lobbies.

Notice of Actions - A (English) (Spanish) - The NOA-A (Assessment) form is used when the MHP or its provider assesses a Medi-Cal beneficiary and determines that the beneficiary does not meet medical necessity criteria and no specialty mental health services will be provided. The NOA-A form was modified to include information regarding appeals and expedited appeals.

Notice of Actions - B (English) (Spanish) - The NOA-B (Denial of Services) form is used when a provider requests payment authorization for a specialty mental health service and the MHP denies or modifies the provider's request and the beneficiary did not receive the service. The NOA-B form was modified to include information regarding appeals and expedited appeals.

Notice of Actions - C (English) (Spanish) - The NOA-C (Post-Service Denials) form is used when a provider requests payment authorization for a specialty mental health service and the MHP denies or modifies the provider's request and the beneficiary already received the service. This is a new form that reads "this is not a bill" so that the beneficiary knows that s/he is not responsible for the cost of the service rendered but retrospectively denied or modified.

Notice of Actions - D (English) (Spanish) - The NOA-D (Delayed Grievance/Appeal Decisions) is a new form to be used when the MHP does not provide the resolution of a grievance, appeal, or expedited appeal within the required time frames.

Notice of Actions - E (English) (Spanish) - The NOA-E (Lack of Timely Services) is a new form to be used when the MHP does not provide services in a timely manner according to their own standards for timely services.

Notice of Actions - Back (English) (Spanish) - The NOA-Back is the backside of all NOA forms and was modified to include information about appeals, expedited appeals, and expedited SFHs, and delete references to grievances.

Grievance Poster - This poster defines the process for a grievance, appeal, and a request for State Fair Hearing.

Grievance Forms (English) (Spanish) - A grievance is an oral or written expression of your dissatisfaction about any matter other than an Action (as action is defined)

Appeal Forms (English) (Spanish) - An appeal is an oral or written request for review of an action (as action is defined). An oral appeal must be followed up in writing.

An ACTION is defined as:
1. Denies or limits authorization of requested service, including the type or level of service;
2. Reduces, suspends, or terminates a previously authorized service;
3. Denies, in whole or in part, payment for a service;
4. Fails to provide services in a timely manner, as determined by the MHP or;
5. Fails to act within the timeframes for disposition of standard grievances, the
resolution of standard appeals or the resolution of expedited appeals

State Fair Hearings (SFH) Call 800-952-5253
File an Appeal or for a State Fair Hearing if received an ACTION.

Second Opinion Forms (English) (Spanish) - The Mental Health Plan will provide a second opinion by a licensed mental health professional employed by, contracting with or otherwise made available by the MHP when the MHP or its providers determine that the medical necessity criteria have not been met and that the beneficiary is, therefore, not entitled to any specialty mental health services from the MHP. The MHP shall determine whether the second opinion requires a face-to-face encounter with the beneficiary.

Change of Provider Request - (English) (Spanish)

Advance Health Care Directive Brochure (English)(Spanish) - This brochure explains your right to make healthcare decisions and how you can plan now for your medical care if you are unable to speak for yourself in the future. Este folleto explica su derecho a tomar una decisión medica y como usted puede planear su cuidado medico en caso de que en un futuro usted no pudiera hacerlo por sí mismo.

NOPP (English) (Spanish) Your health information is personal and private, and we must protect it. This notice tells you how the law requires or permits us to use and disclose your health information. Este anuncio describe como la información protegida de salud obtenida acerca de usted puede ser usada y revelada, a sí mismo como también presenta información de cómo puede usted obtener acceso a su información.

EPSDT Brochure (English) (Spanish)