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
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.
Fee-for-service network provider lists contain the names of all
fee-for-service providers who are:
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
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 - 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
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.
Second Opinion Forms (English)
- 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.
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