California Code of Regulations
Title 9 - Rehabilitative and Developmental Services
Division 1 - Department of Mental Health
Chapter 11 - Medi-Cal Specialty Mental Health Services
Subchapter 1 - General Provisions
Article 2 - Definitions, Abbreviations and Program Terms
Section 1810.203.5 - Appeal
Current through Register 2024 Notice Reg. No. 38, September 20, 2024
"Appeal" means:
(a) A request by a beneficiary or a beneficiary's representative for review of an action as defined in Section 1810.200;
(b) A request by a beneficiary or a beneficiary's representative for review of a provider's determination to deny or modify a beneficiary's request for a covered specialty mental health service;
(c) A request by a beneficiary or a beneficiary's representative for review of the timeliness of the delivery of a specialty mental health service when the beneficiary believes that services are not being delivered in time to meet the beneficiary's needs, whether or not the mental health plan has established a timeliness standard for the delivery of the service.
(d) A request by an MHP and/or MHP subcontractor for review of client record review findings that resulted in the disallowance of paid claims.
1. New section
filed 5-19-2006; operative 6-18-2006 (Register 2006, No. 20).
2. New
subsection (d) and amendment of NOTE filed 7-7-2010; operative 8-6-2010 (Register
2010, No. 28).
Note: Authority: Section 14680, Welfare and Institutions Code. Reference: Sections 5778 and 14684, Welfare and Institutions Code; and Title 42, Code of Federal Regulations, Part 438, Subpart F.
