County Mental Health Plan (MHP) Grievances, Appeals, and Fair Hearings
County Mental Health Plan (MHP) Grievances, Appeals, and Fair Hearings
This resource offers information about what to do if you are dissatisfied with your county's mental health services and how to file a complaint.
Disclaimer: This publication is legal information only and is not legal advice about your individual situation. It is current as of the date posted. We try to update our materials regularly. However, laws are regularly changing. If you want to make sure the law has not changed, contact DRC or another legal office.
Each county has a “Mental Health Plan” (MHP). Your county’s MHP provides Medi-Cal mental health services, sometimes call “Specialty Mental Health Services” (SMHS). Your county may provide these services directly (for example, at a county clinic) or through other providers.
If you are unhappy with your county MHP services, you may file a complaint. The complaint is called a grievance. Your MHP will make a decision on your grievance and let you know the result.
If the county MHP denies a service that you need, or makes another decision about your services that you disagree with, you may file an appeal. Your MHP will make a decision on your appeal and let you know the result. If you disagree with the decision on your appeal, you may have a right to a state fair hearing.
This publication covers grievances, appeals, and state fair hearings.
For information on Medi-Cal SMHS for adults — Specialty Mental Health Services Covered by County Mental Health Plans – Adults Ages 21 and Older.
For information on Medi-Cal SMHS for children and youth — Specialty Mental Health Services through a County Mental Health Plan – Children and Youth Under Age 21..
A. FILING A GRIEVANCE AGAINST A COUNTY MENTAL HEALTH PLAN (MHP)
You can file a grievance if you are unhappy with an experience you had with your MHP (for example, if you are unhappy with the quality of care or services provided or how you are being treated).1
How do I file a grievance against my MHP?
You can file a grievance against your MHP orally or in writing at any time.2 Counties must post notices and provide booklets explaining the grievance process.3 MHPs must also provide this information to you by mailing you a copy, emailing you a copy, or posting the information online and informing you of the internet address where the information can be found.4 Providers should also have grievance forms and self-addressed envelopes you can use.5
The MHP must let you know that it received your grievance by sending you written acknowledgements within five (5) days of receiving the grievance.6
To learn more about the grievance process in your county MHP, please refer to the addendum at the end of this publication. You will see a list of the Grievance, Appeals, and Beneficiary Handbooks for each county.
You may have a legal representative represent you in the grievance.7 You may also allow another person (such as a friend or family member) to represent you.8
Who makes the decisions on my grievance?
All grievances related to medical quality of care issues are sent to your MHP’s medical director for action.9 Your MHP must ensure that the person making the final decision on your grievance has not participated in any prior decision related to the grievance.10 Additionally, the person deciding will generally be a health care professional with clinical expertise in treating your condition.11
When will I get a decision on my grievance?
Your MHP should process the grievance by recording the grievance in a log within one (1) working day of receiving the grievance.12 MHP staff can provide you with information regarding the status of your grievance.13
Your MHP will make a decision on your grievance and let you know the result. According to state law, MHPs must make a decision on your grievance and let you know within ninety (90) calendar days of receiving the grievance.14
B. APPEALING COUNTY MENTAL HEALTH PLAN (MHP) DECISIONS ABOUT YOUR SERVICES
An appeal is a review of a county MHP’s decision about your services. You can appeal when an MHP decision negatively affects your services, for example if the MHP denies or terminates a service that you need.
When an MHP denies or modifies your services, the MHP must provide you with written notice. This may be called a “Notice of Action” or a “Notice of Adverse Benefit Determination.”15 This is a written notice from the MHP letting you know that the MHP has taken certain actions.16
You must file an appeal within sixty (60) calendar days from the date on the notice that you received from the MHP.17 If you do not file your appeal within sixty (60) days, your appeal may be denied.
If you do not receive a notice, but your services are denied, reduced, suspended, or terminated, you should still file an appeal as soon as possible.
In addition to filing an appeal, you also have the right to ask for a second opinion from a licensed mental health professional if the county denies you a Specialty Mental Health Service (SMHS).18
What types of MHP decisions can I appeal? What is an Adverse Benefit Determination?
As noted above, you can appeal when an MHP decision negatively affects your services, for example if the MHP denies or terminates a service that you need. This is usually called an “Adverse Benefit Determination.”19 An Adverse Benefit Determination is an MHP decision that affects your services. An Adverse Benefit Determination includes the seven actions below:
- If you are denied or limited access to a service;
- If your service is reduced, suspended, or terminated;
- If your MHP denies your payment for a service;
- If you are not provided services in a timely manner;
- If an MHP does not act within the timeframes regarding standard grievances and appeals;
- If you live in a rural area with little access to providers and you are denied the right to obtain services outside your network; or
- If you are denied the request to dispute cost sharing, copayments; premiums; deductibles, coinsurance, and other enrollee financial liabilities.20
How do I file an appeal?
Counties must post notices and provide booklets explaining the appeal process.21 MHPs must provide this information to you by mailing you a copy, emailing you a copy, or posting the information online and informing you of the internet address where the information can be found.22
You can file a standard appeal orally or in writing.23 If you file an appeal orally, you must follow up with a written appeal.24 You should keep a copy of your written appeal for your records.
Your MHP must let you know it has received your appeal by sending you written acknowledgement within five (5) days of receiving the appeal.25
To learn more about the appeal process for your county, please see the addendum at the end of this publication. You will see a list of the Grievance, Appeals, and Beneficiary Handbooks for each county.
Can I get help filing an appeal?
You are allowed to have a lawyer represent you in your appeal.26 You may also allow another person (such as a friend or family member) to represent you.27 If your appeal is about services provided through a contracted provider, you may authorize the provider to represent you in the appeal/expedited appeal process against your MHP.28
California law requires each county to provide a Patients’ Rights Advocate (PRA). The Patients’ Rights Advocate’s job is to empower and assist people in exercising their civil and human rights.29 You can ask your MHP for your Patients’ Rights Advocate’s contact information. You can also find a list of Patients’ Rights Advocates in each county at https://www.disabilityrightsca.org/system/files/file-attachments/2020PRADirectoryAccessible.pdf.
Can I still receive benefits if I file an appeal?
You may ask to have your benefits continue while you go through the appeal process. This is called “Aid Paid Pending.” You must request Aid Paid Pending in writing before your services are reduced, suspended, or terminated.30
If your benefits are continued or reinstated while the appeal is pending, the benefits must be continued until one of the following occurs:
- You withdraw the appeal.
- You do not request a state fair hearing and continuation of benefits within ten (10) calendar days after the MHP sends notice of an adverse resolution to your appeal.31
Please note that the MHP may try to recover any continued benefits if the final decision is against you.32
Who makes the decision on my appeal?
The person deciding your appeal will generally be a health care professional with clinical expertise in treating your condition.33 Your MHP must ensure that the person making the final decision on your appeal has not participated in any prior decision related to the appeal.34
When will I get a decision on my appeal?
According to California guidance, your MHP must issue a decision and notify you within thirty (30) days of receiving the appeal.35 MHP staff can provide you with information regarding the status of your appeal.36 The MHP may take an additional fourteen (14) days if you request an extension or the MHP determines that there is a need for additional information and the delay is in your interest.37
When the MHP makes a decision on your appeal, it will send you a Notice of Appeal Resolution explaining the decision. The Notice of Appeal Resolution must include the results of the resolution process, the date it was completed, the right to request a State Fair Hearing and how to make that request, and the right to request and receive benefits while the hearing is pending and how to make that request.38
Can I file an expedited appeal?
You can file an expedited appeal with the MHP if you or your provider believe the regular appeal process (described above) could seriously jeopardize your health, life, or ability to maintain maximum function.39
You can make an oral request with an MHP for an expedited appeal. Unlike regular appeals, you do not have to follow up your oral request for expedited appeal with a request in writing.40 However, we suggest you always follow up in writing and keep a copy for your records.
You can make an oral request with an MHP for an expedited appeal. Unlike regular appeals, you do not have to follow up your oral request for expedited appeal with a request in writing.21 However, we suggest you always follow up in writing and keep a copy for your records.
The MHP must let you know that it has received your expedited appeal.41
When will I get a decision on my expedited appeal?
According to California law, the MHP must notify you of its decision within seventy-two (72) hours of receiving your appeal.42 The MHP may take an additional fourteen (14) days if you request an extension or if the MHP shows it needs additional information.43
C. REQUESTING A STATE FAIR HEARING IF YOU DISAGREE WITH THE APPEAL DECISION
If you disagree with the MHP’s decision on your appeal, you can request a state fair hearing.44 A state fair hearing is a review of an MHP decision or action.
You must file an appeal and complete the appeal process before you can request a state fair hearing.45 The appeal process is described in Section B, above.
How do I request a state fair hearing?
If you completed the appeal process and disagree with the decision, you can request a state fair hearing with the California Department of Social Services.46 The California Department of Social Services will hold a state fair hearing to independently review your appeal and determine your rights. The California Department of Social Services is a state agency that is separate from the county MHP.
Your county MHP must provide you with information on the right to request a fair hearing and how to make the request.47
You have one-hundred and twenty (120) days to request a state fair hearing from the date of the MHP’s decision regarding the appeal.48 If you do not receive a written decision from the MHP, you should file your request for state hearing as soon as possible.
Can I get help filing a state fair hearing?
You are allowed to have a lawyer represent you in your state fair hearing.49 You may also authorize another person (such as a friend or family member) to represent you.50
California law requires each county to provide a Patients’ Rights Advocate (PRA) to empower and assist recipients of mental health services to exercise their civil and human rights.51 You can ask your MHP for the contact information for your Patients’ Rights Advocate. You can also find a list of Patients’ Rights Advocates in each county at https://www.disabilityrightsca.org/system/files/file-attachments/2020PRADirectoryAccessible.pdf.
Can I keep my benefits during a state fair hearing?
You may keep receiving your benefits while the state fair hearing is pending, but only if you request “Aid Paid Pending” before your services are reduced, suspended, or terminated.52 You should request Aid Paid Pending in writing.
If your benefits are continued or reinstated while the state fair hearing is pending, the benefits must be continued until one of the following occurs:
- You withdraw the request for state fair hearing.
- A state fair hearing office issues a hearing decision against you.53
Please note that you may be liable for the costs of any continued benefits if the final decision is adverse to you.54
Addendum: Mental Health Plan Grievances and Appeals Forms by County
Below is a list of the standard Grievances and Appeals forms for each county. Some counties do not have standard forms.
To learn more about your county MHP’s specific Grievance and Appeal forms and procedures, please consult your county MHP’s Beneficiary Handbook. You can also contact your MHP by calling their toll-free number, available at this website: https://www.dhcs.ca.gov/individuals/Pages/MHPContactList.aspx.
Alameda County
Grievance and Appeal Form
- Grievance and Appeal Form [English]
- Grievance and Appeal Form [Spanish]
- Grievance and Appeal Form [Korean]
- Grievance and Appeal Form [Chinese]
- Grievance and Appeal Form [Vietnamese]
- Grievance and Appeal Form [Tagalog]
- Grievance and Appeal Form [Arabic]
- Grievance and Appeal Form [Persian, Farsi]
Beneficiary Handbook
- Beneficiary Handbook [English]
- Beneficiary Handbook [Spanish]
- Beneficiary Handbook [Korean]
- Beneficiary Handbook [Chinese]
- Beneficiary Handbook [Vietnamese]
- Beneficiary Handbook [Tagalog]
- Beneficiary Handbook [Arabic]
- Beneficiary Handbook [Persian, Farsi]
Alpine County
Grievance and Appeal Form
Beneficiary Handbook
Amador County
Grievance and Appeal Form
Beneficiary Handbook
Butte County
Grievance and Appeal Form
- Grievance and Appeal Form [English]
- Grievance and Appeal Form [Spanish]
- Grievance and Appeal Form [Hmong]
Beneficiary Handbook
Calaveras County
Beneficiary Handbook
Colusa County
Grievance and Appeal Form
Beneficiary Handbook
Contra Costa County
Grievance and Appeal Form
Beneficiary Handbook
Del Norte
Grievance and Appeal Form
Beneficiary Handbook
El Dorado
Grievance and Appeal Form
Beneficiary Handbook
Fresno
Grievance and Appeal Form
- Grievance Form [English]
- Appeal Form [English]
- Grievance Form [Spanish]
- Appeal Form [Spanish]
- Grievance Form [Hmong]
- Appeal Form [Hmong]
Beneficiary Handbook
Glenn
Grievance and Appeal Form
Beneficiary Handbook
Humboldt
Grievance and Appeal Form
Beneficiary Handbook
Imperial
Grievance and Appeal Form
Beneficiary Handbook
Inyo
Grievance and Appeal Form
Beneficiary Handbook
Kern
Grievance and Appeal Form
Beneficiary Handbook
Kings
Grievance and Appeal Form
Beneficiary Handbook
Lake
Grievance and Appeal Form
Beneficiary Handbook
Lassen
Grievance and Appeal Form
Beneficiary Handbook
Los Angeles
Grievance and Appeal Form
- Grievance and Appeal Form [English]
- Grievance and Appeal Form [Spanish]
- Grievance and Appeal Form [Korean]
- Grievance and Appeal Form [Chinese]
- Grievance and Appeal Form [Vietnamese]
- Grievance and Appeal Form [Cambodian]
- Grievance and Appeal Form [Russian]
- Grievance and Appeal Form [Tagalog]
- Grievance and Appeal Form [Armenian]
- Grievance and Appeal Form [Arabic]
- Grievance and Appeal Form [Farsi]
Beneficiary Handbook
- Beneficiary Handbook [English]
- Beneficiary Handbook [Spanish]
- Beneficiary Handbook [Korean]
- Beneficiary Handbook [Chinese]
- Beneficiary Handbook [Vietnamese]
- Beneficiary Handbook [Cambodian]
- Beneficiary Handbook [Russian]
- Beneficiary Handbook [Tagalog]
- Beneficiary Handbook [Armenian]
- Beneficiary Handbook [Arabic]
- Beneficiary Handbook [Farsi]
Madera
Grievance and Appeal Form
Beneficiary Handbook
Marin
Grievance and Appeal Form
- Grievance and Appeal Form [English]
- Grievance and Appeal Form [Spanish]
- Grievance and Appeal Form [Vietnamese]
Beneficiary Handbook
Mariposa
Grievance and Appeal Form
Beneficiary Handbook
Mendocino
Grievance and Appeal Form
Beneficiary Handbook
Merced
Grievance and Appeal Form
Beneficiary Handbook
Modoc
Grievance and Appeal Form
Beneficiary Handbook
Mono
Grievance and Appeal Form – Not Listed. For more information, please contact your county’s access line at (800) 687-1101.
Beneficiary Handbook
Monterey
Grievance and Appeal Form
Beneficiary Handbook
Napa
Grievance and Appeal Form
Beneficiary Handbook
Nevada
Grievance and Appeal Form
Beneficiary Handbook
Orange
Grievance and Appeal Form
- Grievance and Appeal Form [English]
- Grievance and Appeal Form [Spanish]
- Grievance and Appeal Form [Korean]
- Grievance and Appeal Form [Chinese]
- Grievance and Appeal Form [Vietnamese]
- Grievance and Appeal Form [Arabic]
- Grievance and Appeal Form [Farsi]
Beneficiary Handbook
Placer
Grievance and Appeal Form
Beneficiary Handbook
Plumas
Grievance and Appeal Form
Beneficiary Handbook
Riverside
Grievance and Appeal Form
Beneficiary Handbook
Sacramento
Grievance and Appeal Form
- Grievance Form [English]
- Appeal Form [English]
- Grievance Form [Spanish]
- Appeal Form [Spanish]
- Grievance Form [Chinese]
- Appeal Form [Chinese]
- Grievance Form [Vietnamese]
- Appeal Form [Vietnamese]
- Grievance Form [Russian]
- Appeal Form [Russian]
- Grievance Form [Hmong]
- Appeal Form [Hmong]
- Grievance Form [Arabic]
- Appeal Form [Arabic]
Beneficiary Handbook
San Benito
Grievance and Appeal Form
Beneficiary Handbook
San Bernardino
Grievance and Appeal Form
Beneficiary Handbook
San Diego
Grievance and Appeal Form
Beneficiary Handbook
San Francisco
Grievance and Appeal Form
- Grievance and Appeal Form [English]
- Grievance and Appeal Form [Spanish]
- Grievance and Appeal Form [Chinese]
- Grievance and Appeal Form [Vietnamese]
- Grievance and Appeal Form [Russian]
- Grievance and Appeal Form [Tagalog]
Beneficiary Handbook
San Joaquin
Grievance and Appeal Form
- Grievance Form [English]
- Appeal Form [English]
- Grievance Form [Spanish]
- Appeal Form [Spanish]
- Grievance Form [Chinese]
- Appeal Form [Chinese]
Beneficiary Handbook
San Luis Obispo
Grievance and Appeal Form
Beneficiary Handbook
San Mateo
Grievance and Appeal Form
Beneficiary Handbook
Santa Barbara
Grievance and Appeal Form
Beneficiary Handbook
Santa Clara
Grievance and Appeal Form – Not Listed. For more information, please contact your county’s access line at (800) 704-0900.
Beneficiary Handbook – Not Listed. For more information, please contact your county’s access line at (800) 704-0900.
Santa Cruz
Grievance and Appeal Form
Beneficiary Handbook
Shasta
Grievance and Appeal Form
Beneficiary Handbook
Siskiyou
Grievance and Appeal Form
Beneficiary Handbook
Solano
Grievance and Appeal Form – Not Listed. For more information, please contact your county’s access line at (800) 547-0495.
Beneficiary Handbook
Sonoma
Grievance and Appeal Form
Beneficiary Handbook
Stanislau
Grievance and Appeal Form
Beneficiary Handbook
Sutter/Yuba
Grievance and Appeal Form
Beneficiary Handbook
Tehama
Grievance and Appeal Form
Beneficiary Handbook
Trinity
Grievance and Appeal Form
Beneficiary Handbook
Tulare
Grievance and Appeal Form
Beneficiary Handbook
Tuolumne
Grievance and Appeal Form – Not Listed. For more information, please contact your county’s access line at (800) 630-1130.
Beneficiary Handbook
Ventura
Grievance and Appeal Form
Beneficiary Handbook
Yolo
Grievance and Appeal Form
- Grievance Form [English]
- Appeal Form [English]
- Grievance Form [Spanish]
- Appeal Form [Spanish]
- Grievance Form [Russian]
- Appeal Form [Russian]
Beneficiary Handbook
- 1. 42 C.F.R. § 438.400(b).
- 2. 42 C.F.R. § 438.402(c)(2)-(3); 9 C.C.R. § 1850.206(a); MHSUDS Information Notice No. 18-010E (March 27, 2018) at 3, available at https://www.dhcs.ca.gov/services/MH/Documents/Information%20Notices/NOABD%20IN/MHSUDS_IN_18-010_Federal_Grievance_Appeal_System_Requirements.pdf.
- 3. 42 C.F.R. § 438.10(g)(2)(xi); 9 C.C.R. § 1850.205(c)(1)(B).
- 4. 42 C.F.R. § 438.10(g)(3).
- 5. 9 C.C.R. § 1850.205(c)(1)(C).
- 6. 42 C.F.R. § 438.406(b)(1); 9 C.C.R. § 1850.205(d)(4); MHSUDS Information Notice No. 18-010E (March 27, 2018) at 3, available at https://www.dhcs.ca.gov/services/MH/Documents/Information%20Notices/NOABD%20IN/MHSUDS_IN_18-010_Federal_Grievance_Appeal_System_Requirements.pdf.
- 7. 42 C.F.R. § 438.402(c)(1)(ii); 9 C.C.R. §§ 1850.205(c)(2)-(3).
- 8. 9 C.C.R. § 1850.205(c)(2).
- 9. 22 C.C.R. § 53858(e)(2).
- 10. 42 C.F.R. § 438.406(b)(2)(i).
- 11. 42 C.F.R. § 438.406(b)(2)(ii).
- 12. 9 C.C.R. § 1850.205(d)(1).
- 13. 9 C.C.R. § 1850.205(d)(3).
- 14. 42 C.F.R. § 438.408(b)(1); MHSUDS Information Notice No. 18-010E (March 27, 2018) at 3-4, available at https://www.dhcs.ca.gov/services/MH/Documents/Information%20Notices/NOABD%20IN/MHSUDS_IN_18-010_Federal_Grievance_Appeal_System_Requirements.pdf(under some circumstances, the timeframe may be extended by up to 14 calendar days).
- 15. 9 C.C.R. § 1850.210(a).
- 16. 9 C.C.R. § 1810.200.
- 17. 42 C.F.R. § 438.402(c)(2)(ii); MHSUDS Information Notice No. 18-010E (March 27, 2018) at 9, available at https://www.dhcs.ca.gov/services/MH/Documents/Information%20Notices/NOABD%20IN/MHSUDS_IN_18-010_Federal_Grievance_Appeal_System_Requirements.pdf.
- 18. 9 C.C.R. § 1810.405(e).
- 19. 9 C.C.R. § 1810.230.5.
- 20. 42 C.F.R. § 438.400(b).
- 21. 42 C.F.R. § 438.10(g)(2)(xi); 9 C.C.R. § 1850.205(c)(1)(B).
- 22. 42 C.F.R. § 438.10(g)(3).
- 23. 42 C.F.R. § 438.402(c)(3)(ii); 9 C.C.R. § 1850.207(a).
- 24. 9 C.C.R. § 1850.207(b).
- 25. 42 C.F.R. § 438.406(b)(1); 9 C.C.R. §1850.205(d)(4); MHSUDS Information Notice No. 18-010E (March 27, 2018) at 10, available at https://www.dhcs.ca.gov/services/MH/Documents/Information%20Notices/NOABD%20IN/MHSUDS_IN_18-010_Federal_Grievance_Appeal_System_Requirements.pdf.
- 26. 42 C.F.R. § 438.402(c)(1)(ii); 9 C.C.R. §§1850.205(c)(2)-(3).
- 27. 9 C.C.R. § 1850.205(c)(2).
- 28. Id.
- 29. 9 C.C.R. § 863.1(a); 9 C.C.R. § 863(b).
- 30. 42 C.F.R. § 438.420(a).
- 31. 42 C.F.R. § 438.420(c); 42 C.F.R. § 438.408(d)(2).
- 32. 42 C.F.R. §§ 438.420(d), 431.230(b).
- 33. 42 C.F.R. § 438.406(b)(2)(ii).
- 34. 42 C.F.R. § 438.406(b)(2)(i).
- 35. 42 C.F.R. § 438.408(b)(2); MHSUDS Information Notice No. 18-010E (March 27, 2018) at 10, available at https://www.dhcs.ca.gov/services/MH/Documents/Information%20Notices/NOABD%20IN/MHSUDS_IN_18-010_Federal_Grievance_Appeal_System_Requirements.pdf.
- 36. 9 C.C.R. § 1850.205(d)(3).
- 37. The MHP may take an additional 14 days if the MHP shows they need additional information and the delay is in your interest. 42 C.F.R. § 438.408(c)(1)(i)-(ii). If the MHP does not issue a decision within that timeframe, that will be considered a denial. See MHSUDS Information Notice No. 18-010E (March 27, 2018) at 10-11, available at https://www.dhcs.ca.gov/services/MH/Documents/Information%20Notices/NOABD%20IN/MHSUDS_IN_18-010_Federal_Grievance_Appeal_System_Requirements.pdf.
- 38. 42 C.F.R. § 438.408(e).
- 39. 42 C.F.R. § 438.410(a); 9 C.C.R. § 1850.208(a).
- 40. 42 C.F.R. § 438.406(b)(3); 9 C.C.R. §1850.208(b).
- 41. 42 C.F.R. § 438.406(b)(1); 9 C.C.R. §1850.205(d)(4).
- 42. 42 C.F.R. § 438.408(b)(3); MHSUDS Information Notice No. 18-010E (March 27, 2018) at 12, available at https://www.dhcs.ca.gov/services/MH/Documents/Information%20Notices/NOABD%20IN/MHSUDS_IN_18-010_Federal_Grievance_Appeal_System_Requirements.pdf.
- 43. 42 C.F.R. § 438.408(b)(3)-(c).
- 44. 42 C.F.R. § 438.402(c)(1)(i).
- 45. 42 C.F.R. § 438.408(f)(1)(i).
- 46. Id.
- 47. 42 C.F.R. § 438.408(e)(2)(i); 9 C.C.R. § 1850.207(h)(3).
- 48. 42 C.F.R. § 438.408(f)(1)-(2); MHSUDS Information Notice No. 18-010E (March 27, 2018) at 14, available at https://www.dhcs.ca.gov/services/MH/Documents/Information%20Notices/NOABD%20IN/MHSUDS_IN_18-010_Federal_Grievance_Appeal_System_Requirements.pdf.
- 49. 22 C.C.R. § 51014.1(b)(2).
- 50. 22 C.C.R. § 51014.1(b)(2).
- 51. 9 C.C.R. § 863.1(a); 9 C.C.R. § 863(b).
- 52. 42 C.F.R. § 438.420; 22 C.C.R § 51014.2; 9 C.C.R. § 1850.215.
- 53. 42 C.F.R. § 438.420(c).
- 54. 42 C.F.R. §§ 438.420(d), 431.230(b).