Common use of Enrollee/Provider Communication Clause in Contracts

Enrollee/Provider Communication. The Contractor may not prohibit, or otherwise restrict, a health care professional, acting within the lawful scope of practice, from advising or advocating on behalf of a member about: (1) the member’s health status, medical care, or treatment options including any alternative treatment that may be self-administered; (2) any information the member needs in order to decide among all relevant treatment options; (3) the risks, benefits, and consequences of treatment or non-treatment; or (4) the member’s right to participate in decisions regarding his or her health care, including the right to refuse treatment, and to express preferences about future treatment decisions. The Contractor, which would otherwise be required to provide, reimburse for, or provide coverage of, a counseling or referral service because of the requirement in the paragraph above, is not required to do so if the Contractor objects on moral or religious grounds. If the Contractor elects this option, the Contractor agrees to furnish information about the services it does not cover as follows: • To EOHHS, upon execution of this Agreement or whenever the Contractor adopts the policy during the term of this Agreement. • To potential members, before and during enrollment. • To members, within thirty (30) days after adopting the policy with respect to any particular service. EOHHS reserves the right to adjust the Contractor’s rates in ATTACHMENT J as a consequence of the Contractor’s policy.

Enrollee/Provider Communication. The Contractor may not prohibit, or otherwise restrict, a health care professional, acting within the lawful scope of practice, from advising or advocating on behalf of a member about: (1) the member’s health status, medical care, or treatment options including any alternative treatment that may be self-administered; (2) any information the member needs in order to decide among all relevant treatment options; (3) the risks, benefits, and consequences of treatment or non-treatment; or (4) the member’s right to participate in decisions regarding his or her health care, including the right to refuse treatment, and to express preferences about future treatment decisions. The Contractor, which would otherwise be required to provide, reimburse for, or provide coverage of, a counseling or referral service because of the requirement in the paragraph above, is not required to do so if the Contractor objects on moral or religious grounds. If the Contractor elects this option, the Contractor agrees to furnish information about the services it does not cover as follows: •  To EOHHS, upon execution of this Agreement or whenever the Contractor adopts the policy during the term of this Agreement. •  To potential members, before and during enrollment. •  To members, within thirty (30) days after adopting the policy with respect to any particular service. EOHHS reserves the right to adjust the Contractor’s rates in ATTACHMENT J as a consequence of the Contractor’s policy.