Enrollee Rights and Responsibilities. In accordance with 42 CFR § 438.100, the Contractor shall have written policies and procedures regarding enrollee rights and shall ensure compliance of its staff and affiliated providers with any applicable Federal and State laws that pertain to enrollee rights. Policies and procedures shall include compliance with: Title VI of the Civil Rights Act of 1964, as implemented at 45 CFR Part 80; the Age Discrimination Act of 1975, as implemented by regulations at 45 CFR Part 91; the Rehabilitation Act of 1973; Titles II and III of the Americans with Disabilities Act; and other laws regarding privacy and confidentiality. At a minimum such enrollee rights include the right to:
a. Receive information in accordance with 42 CFR § 438.10.
b. Be treated with respect and with due consideration for his or her dignity and privacy.
c. Receive information on available treatment options and alternatives presented in a manner appropriate to the enrollee’s condition and ability to understand.
d. Participate in decisions regarding his or her health care, including the right to refuse treatment.
e. Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation, as specified in other Federal regulations on the use of restraints and seclusion.
f. Request and receive a copy of his or her medical records and request that they be amended or corrected, as specified in 45 CFR §§ 164.524 and 164.526.
g. Free exercise of rights and the exercise of those rights do not adversely affect the way the Contractor and its providers treat the enrollee.
h. Be furnished health care services in accordance with 42 CFR §§ 438.206 through 438.210. The written policies and procedures shall also address the responsibility of Enrollees to pay for unauthorized health care services obtained from Outside Providers and their right to know the procedures for obtaining authorization for such services. The Contractor shall also have policies addressing the responsibility of each Enrollee to cooperate with those providing health care services by supplying information essential to the rendition of optimal care, following instructions and guidelines for care that they have agreed upon with those providing health care services, and showing courtesy and respect to providers and staff. A written description of the rights and responsibilities of Enrollees shall be included in the Enrollee information materials provided to new Enrollees. A copy of the Contractor's p...
Enrollee Rights and Responsibilities. The Contractor shall have written policies and procedures regarding the rights of Enrollees and shall comply with any applicable federal and Puerto Rico laws and regulations that pertain to Enrollee rights, including those set forth in 42 CFR 438.100 and in the Puerto Rico Patient’s Xxxx of Rights Act 194 of August 25, 2000; the Puerto Rico Mental Health Law of October 2, 2000, as amended and implemented; and Law 11 of April 11, 2001, creating the Office of the Patient Advocate. These rights shall be included in the Enrollee Handbook. At a minimum, the policies and procedures shall specify the Enrollee’s right to:
6.5.1 Receive information pursuant to 42 CFR 438.10;
6.5.2 Be treated with respect and with due consideration for the Enrollee’s dignity and privacy;
6.5.3 Have all records and medical and personal information remain confidential, except to the extent it may be or must be disclosed by law.
6.5.4 Receive information on available treatment options and alternatives, presented in a manner appropriate to the Enrollee’s condition and ability to understand;
6.5.5 Participate in decisions regarding his or her health care, including the right to refuse treatment;
6.5.6 Be free from any form of restraint or seclusion as a means of coercion, discipline, convenience or retaliation, as specified in 42 CFR 482.13(e) and other federal regulations on the use of restraints and seclusion;
6.5.7 Request and receive a copy of his or her Medical Records pursuant to 45 CFR Parts 160 and 164, subparts A and E, and request to amend or correct the record, as specified in 45 CFR 164.524 and 164.526, respectively;
6.5.8 Be furnished health care services in accordance with 42 CFR 438.206 through 438.210;
6.5.9 Freely exercise his or her rights, including those related to filing a Grievance or Appeal, and that the exercise of these rights will not adversely affect the way the Enrollee is treated;
6.5.10 Not be held liable for the Contractor’s debts in the event of insolvency; not be held liable for the Covered Services provided to the Enrollee for which ASES does not pay the Contractor; not be held liable for Covered Services provided to the Enrollee for which ASES or the MiSalud Plan does not pay the Provider that furnishes the services; and not be held liable for payments of Covered Services furnished under a contract, Referral, or other arrangement to the extent that those payments are in excess of amount the Enrollee would owe if the Provider provided the services direct...
Enrollee Rights and Responsibilities. The Contractor shall have written policies and procedures that are in compliance with Title VI of the Civil Rights Act of 1964 as implemented by regulations at 45 C.F.R. part 80; the Age Discrimination Act of 1975 as implemented by regulations at 45 C.F.R. part 91; the Rehabilitation Act of 1973; Title IX of the Education Amendments of 1972; Titles II and III of the Americans with Disabilities Act; Section 1557 of the ACA and 42 C.F.R. 438.100, and designed to protect the rights of Enrollees and enumerate the responsibilities of each Enrollee. A written description of the rights and responsibilities of Enrollees shall be included in the Enrollee information materials provided to new Enrollees. The Contractor shall provide a copy of these policies and procedures to all of the Contractor’s Network Providers to whom Enrollees may be referred. In addition, the Contractor shall provide these policies and procedures to any Out-of-Network Provider upon request from the Provider. The Contractor’s written policies and procedures that are designed to protect the rights of Enrollees, in accordance with federal and state law, shall include, without limitation, the right to:
A. Respect, dignity, privacy, confidentiality, accessibility and nondiscrimination;
B. A reasonable opportunity to choose a PCP and to change to another Provider in a reasonable manner;
C. Consent for or refusal of treatment and active participation in decision choices;
D. Ask questions and receive complete information relating to the Enrollee’s medical condition and treatment options, including Specialty Care;
E. Voice Grievances and receive access to the Grievance process, receive assistance in filing an Appeal, and request a State Fair Hearing from the Contractor and/or the Department;
F. Timely access to care that does not have any communication or physical access barriers;
G. Prepare Advance Medical Directives pursuant to KRS 311.621 to KRS 311.643;
H. Assistance with Medical Records in accordance with applicable federal and state laws;
I. Timely referral and access to medically indicated Specialty Care;
J. Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation;
K. Receive information in accordance with 42 C.F.R. 438.10;
L. Be furnished health care services in accordance with 42 C.F.R. Part 438; and
M. Any American Indian enrolled with the Contractor eligible to receive services from a participating I/T/U provider or an I/T/U PCP sh...
Enrollee Rights and Responsibilities. Shall include the right to the Medicaid Fair Hearing Process for Medicaid enrollees.
Enrollee Rights and Responsibilities. Dental Office shall abide by Enrollee rights and responsibilities denoted under the Contract between LIBERTY and OHCA, which can be found at: xxx.xxxxx.xxx.
Enrollee Rights and Responsibilities. 6.3.1 The Contractor shall have written policies and procedures regarding the rights of Enrollees and shall comply with any applicable Federal and Puerto Rico laws and regulations that pertain to Enrollee rights, including those set forth in 42 CFR 438.100, and in the Puerto Rico Patient’s Xxxx of Rights Act 194 of August 25, 2000; the Puerto Rico Mental Health Law Act 408 of October 2, 2000, as amended and implemented; and Law 77 of July 24, 2013 which created the Office of the Patient Advocate. At a minimum, the policies and procedures and content of Choice Counseling activities shall specify the Enrollee’s right to:
6.3.1.1 Receive information pursuant to 42 CFR 438.10;
6.3.1.2 Be treated with respect and with due consideration for the Enrollee’s dignity and privacy;
6.3.1.3 Have all records and medical and personal information remain confidential;
6.3.1.4 Be free from any form of restraint or seclusion as a means of coercion, discipline, convenience, or retaliation, as specified in 42 CFR 482.13(e) and other Federal regulations on the use of restraints and seclusion;
6.3.1.5 Choose an Authorized Representative to be involved as appropriate in making care decisions;
6.3.1.6 Freely exercise his or her rights, including those related to filing a Grievance or Appeal, and that the exercise of these rights will not adversely affect the way the Enrollee is treated;
6.3.1.7 Receive Information about Covered Services and how to access Covered Services and Network Providers;
Enrollee Rights and Responsibilities. Contractor must review its Provider Manual, Bulletins and all Provider policies and procedures at least annually to ensure that Contractor’s current practices and Contract requirements are reflected in the written policies and procedures.
Enrollee Rights and Responsibilities. The MCO demonstrates a commitment to treating members in a manner that acknowledges their rights and responsibilities.
A. Written policy on enrollee rights The MCO has a written policy that recognizes the following rights of members:
1. To be treated with respect, and recognition of their dignity and need for privacy;
2. To be provided with information about the MCO, its services, the practitioners providing care, and members' rights and responsibilities;
3. To be able to choose primary care practitioners, within the limits of the plan network, including the right to refuse care from specific practitioners;
4. To participate in decision-making regarding their health care;
5. To voice grievances about the MCO or care provided;
6. To formulate advance directives; and
7. To have access to his/her medical records on accordance with applicable Federal and State laws.
B. Written policy enrollee responsibilities - The MCO has a written policy that addresses members' responsibility for cooperating with those providing health care services. This written policy addresses members' responsibility for:
1. Providing, to the extent possible, information needed by professional staff in caring for the member; and
2. Following instructions and guidelines given by those providing health care services.
C. Communication of policies to providers - A copy of the organization's policies on members' rights and responsibilities is provided to all participating providers.
D. Communication of policies to enrollees/members - Upon enrollment, members are provided a written statement that includes information on the following:
1. Rights and responsibilities of members;
2. Benefits and services included and excluded as a condition of memberships, and how to obtain them, including a description of:
a. Any special benefit provisions (example, co-payment, higher deductibles, rejection of claim) that may apply to service obtained outside the system; and
b. The procedures for obtaining out-of-area coverage;
3. Provisions for after-hours and emergency coverage;
4. The organization's policy on referrals for specialty care;
5. Charges to members, if applicable, including:
a. Policy on payment of charges; and
b. Co-payment and fees for which the member is responsible.
6. Procedures for notifying those members affected by the termination or change in any benefit services, or service delivery office/site;
7. Procedures for appealing decisions adversely affecting the members' coverage, benefits, or ...
Enrollee Rights and Responsibilities. 6.5.1 The Contractor shall have written policies and procedures regarding the rights of Enrollees and shall comply with any applicable Federal and Puerto Rico laws and regulations that pertain to Enrollee rights, including those set forth in 42 CFR 438.100, and in the Puerto Rico Patient’s Xxxx of Rights Act 194 of August 25, 2000; the Puerto Rico Mental Health Law Act 408 of October 2, 2000, as amended and implemented; and Law 77 of July 24, 2013 which created the Office of the Patient Advocate. These rights shall be included in the Enrollee Handbook. At a minimum, the policies and procedures shall specify the Enrollee’s right to:
Enrollee Rights and Responsibilities. The MCO demonstrates a commitment to treating members in a manner that acknowledges their rights and responsibilities.
