Consumer Problem Resolution

Sacramento County maintains a 24-hour toll free telephone, (888) 881-4881, for public access to services and information. QM operates a public line M-F: 8:00am to 5:00pm, (916) 875-6069, for consumer and provider complaints.

Clients may choose to resolve concerns related to mental health services either directly with the provider or through the QM problem resolution process. Informal complaints can be made by telephone, but formal grievances must be made in writing. Assistance with the complaint process is available at Patient’s Rights (916) 737-7104, County adult and family consumer liaisons, and/or QM staff. Medi-Cal beneficiaries may file for a State Fair Hearing whether or not they have received a Notice of Action denying services. A Fair Hearing can be requested at any time before, after, or during the problem resolution process. Complaint and grievance materials are available in the common areas at provider sites or can be obtained by contacting QM. Member handbooks and problem resolution brochures are available in English, Spanish, Russian, Vietnamese, Laotian, Chinese, Hmong, and Mein.

Provider Complaints

QM responds to provider complaints regarding service or payment related issues. QM also responds to complaints about Notices of Action that deny, modify, defer, or take any action other than approval of services in 30 days.

Provider Site Certification

Ensuring the safety and confidentiality of County consumers is of utmost importance to QM. Facility inspections are formulated to confirm that the building meets fire safety codes, State Department of Mental Health (DMH), and County standards. The facility must be able to store and maintain medical records and medications at county security standards.

Professional and Staff Qualifications

Competent staff is essential to effective services. QM sets standards in accordance with scope of practice guidelines and MediCal regulations. The professional standing and license of independent practitioners is verified through QM processes. Organizational non-licensed staff must also meet County guidelines in order to receive a staff number and bill services. Assistance is available to organizational providers seeking to complete their internal verification processes.

Review of Medical Records

An important monitoring duty involves the review of medical records for accuracy and service quality. DMH and County guidelines are employed to evaluate quality of care. Utilization reviews often reveal trends in service needs and staff training issues. QM conducts monthly system wide reviews and assists providers in performing internal reviews.

Training and Education

The best way to ensure that quality care is delivered is by offering training and assistance. QM provides clinical training. Whenever possible, Continuing Educational Credits (CEU) are available. Topics include orientation, proper documentation practices, how to credential staff, consumer problem resolution processes, and cultural competency.

County Quality Improvement Committee

This committee brings together system wide participants to evaluate and make recommendations to support quality of care issues. Its membership is comprised of a consumer liaison, consumer family member, Mental Health Board member, adult and children’s services program coordinators, cultural competency program coordinator, medical director, Mental Health Treatment Center program coordinator, adult and children’s ACCESS Team program coordinators, individual provider and agency provider.