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 directly; and 6.5.11 Only be responsible for cost-sharing in accordance with 42 CFR 447.50 through 42 CFR 447.59.
Appears in 2 contracts
Samples: Contract for Health Services Administration (Triple-S Management Corp), Contract for Administration of Health Services (Triple-S Management Corp)
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 Federal and Puerto Rico laws and regulations that pertain to Enrollee rights, including those set forth in 42 CFR 438.100 438.100, and in the Puerto Rico Patient’s Xxxx Bill 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 11 77 of April 11July 24, 2001, creating 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:
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 convenience, or retaliation, as specified in 42 CFR 482.13(e) and other federal 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, record as specified in 45 CFR 164.524 and 164.526, respectively;
6.5.8 ; Choose an Authorized Representative to be involved as appropriate in making care decisions; Provide informed consent; Be furnished with 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 ; Receive Information about Covered Services and how to access Covered Services and Network Providers; Be free from harassment by the Contractor or its Network Providers with respect to contractual disputes between the Contractor and its Providers; Participate in understanding physical and Behavioral Health problems and developing mutually agreed-upon treatment goals; 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 Contractor’s 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 the amount the Enrollee would owe if the Provider Contractor provided the services directly; and
6.5.11 and Only be responsible for cost-sharing in accordance with 42 CFR 447.50 through 42 CFR 447.59447.56 and as permitted by the Puerto Rico Medicaid and CHIP State Plans and Puerto Rico law as applicable to the Enrollee.
Appears in 1 contract
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 Federal and Puerto Rico laws and regulations that pertain to Enrollee rights, including those set forth in 42 CFR 438.100 438.100, and in the Puerto Rico Patient’s Xxxx Bill 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 11 77 of April 11July 24, 2001, creating 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:
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 convenience, or retaliation, as specified in 42 CFR 482.13(e) and other federal 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, record as specified in 45 CFR 164.524 and 164.526, respectively;
6.5.8 ; Choose an Authorized Representative to be involved as appropriate in making care decisions; Provide informed consent; Be furnished with 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 ; Receive Information about Covered Services and how to access Covered Services and Network Providers; Be free from harassment by the Contractor or its Network Providers with respect to contractual disputes between the Contractor and its Providers; Participate in understanding physical and Behavioral Health problems and developing mutually agreed-upon treatment goals; 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 Contractor’s 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 directly; and
6.5.11 Only be responsible for cost-sharing in accordance with 42 CFR 447.50 through 42 CFR 447.59.of
Appears in 1 contract
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 's Bill of Rights Act 194 of August 25, 200025,2000; 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 '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 '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 '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, 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 '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 Contractor's 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 Contractor provided the services directly; and
6.5.11 Only be responsible for cost-sharing in accordance with 42 CFR 447.50 through 42 CFR 447.59.
Appears in 1 contract
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, in hard copy or electronic format, 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 MI Salud 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 directly; and
6.5.11 Only be responsible for cost-sharing in accordance with 42 CFR 447.50 through 42 CFR 447.59.
Appears in 1 contract
Samples: Contract for Health Services Administration (Triple-S Management Corp)
