Anti-Gag Requirement. The CONTRACTOR shall not prohibit or otherwise restrict a Provider, if the Provider is acting within the lawful scope of practice, from advising or advocating for a Member who is a patient of the Provider in the following areas: The Member’s health status, medical care, or treatment for the individual’s condition of disease, including any alternative treatment that may be self-administered, regardless of whether such care or treatment are Covered Services; Any information the Member needs in order to decide among relevant treatment options; The risks, benefits and consequences of treatment or non-treatment; or The Member’s right to participate in decisions regarding their health care, including the right to refuse treatment and to express preferences about future treatment decisions. This subsection, however, shall not be construed as requiring the CONTRACTOR to provide or reimburse any service if the CONTRACTOR: Objects to the provision of a counseling or referral service on moral or religious grounds, provided that the CONTRACTOR notifies Members and HCA as required by this Agreement and adheres to all requirements in 42 C.F.R. § 438.102; Through written policies and procedures, the CONTRACTOR makes available information on its policies and procedures regarding such service to prospective Members before enrollment and to Members at least thirty (30) Calendar Days prior to the date the CONTRACTOR adopts a change in policy regarding such a counseling or referral service; Notifies HCA within ten (10) Business Days after the effective date of this Agreement of its current policies and procedures regarding CONTRACTOR’s objection to providing such counseling or referral services based on moral or religious grounds, or within fifteen (15) Calendar Days after CONTRACTOR adopts a change in policy regarding such counseling or referral services; Can demonstrate that the service in question is not included in the Covered Services; or Determines that the recommended service is not a Medically Necessary Service.
Anti-Gag Requirement. 4.5.3.1 The CONTRACTOR shall not prohibit or otherwise restrict a provider, if the provider is acting within the lawful scope of practice, from advising or advocating for a Member who is a patient of the provider in the following areas:
