Common use of Enrollee Rights and Responsibilities Clause in Contracts

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 policies and procedures regarding Enrollee rights and responsibilities shall be provided to all Plan Providers and any Outside Providers to whom Enrollees may be referred.

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, 1964 as implemented at 45 CFR Part 80; the Age Discrimination Act of 1975, 1975 as implemented by regulations at 45 CFR Part 91; the Rehabilitation Act of 1973; and 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 policies and procedures regarding Enrollee rights and responsibilities shall be provided to all Plan Providers providers and any Outside Providers to whom Enrollees may be referred.