Common use of Member Rights and Responsibilities Clause in Contracts

Member Rights and Responsibilities. The CONTRACTOR shall provide each Member with written information in the Member handbook that encompasses all the provisions in this Section 4.15.3. The CONTRACTOR must ensure that each Member is free to exercise their rights and that the exercise of these rights does not adversely affect the way the CONTRACTOR and its Contract Providers or the State treats the Member. The CONTRACTOR must have written policies regarding the Member’s and/or Representatives’ rights, including but not limited to, the guaranteed right to: Be treated with respect and with due consideration for their dignity and privacy; Receive information on available treatment options and alternatives, presented in a manner appropriate to their condition and ability to understand; Make and have honored an Advance Directive consistent with State and federal laws; Receive Covered Services in a nondiscriminatory fashion; Participate in decisions regarding their health care, including the right to refuse treatment; Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation, as specified in federal regulations on the use of restraints and seclusion; Request and receive a copy of their medical records and to request that they be amended or corrected as specified in 45 C.F.R. § 164.524 and part 526; Choose a Representative to be involved as appropriate in making care decisions; Provide informed consent; Voice Grievances about the care provided by the CONTRACTOR and to make use of the Grievance, Appeal and Fair Hearing processes without fear of retaliation; Choose from among Contract Providers in accordance with the CONTRACTOR’s prior authorization requirements; Receive information about Covered Services and how to access Covered Services, and Contract Providers; Be free from harassment by the CONTRACTOR or its Contract Providers in regard to contractual disputes between the CONTRACTOR and Providers; and Participate in understanding Physical Health and Behavioral Health problems and developing mutually agreed-upon treatment goals. The CONTRACTOR shall ensure that each Member (and/or as appropriate, Representative) is free to exercise their rights and that the exercise of those rights does not adversely affect the way the CONTRACTOR or its Contract Providers treat the Member (and/or Representative). Members and/or Representatives, to the extent possible, have a responsibility to: Provide information that the CONTRACTOR and its Contract Providers need in order to care for the Member; Follow the plans and instructions for care that they have agreed upon with their Providers; and Keep, reschedule, or cancel a scheduled appointment rather than to simply fail to keep it.

Member Rights and Responsibilities. The CONTRACTOR In accordance with 42 C.F.R. § 438.100, the Contractor shall provide each Member with written information in the Member handbook that encompasses all the provisions in this Section 4.15.3. The CONTRACTOR must ensure that each Member is free to exercise their rights and that the exercise of these rights does not adversely affect the way the CONTRACTOR and its Contract Providers or the State treats the Member. The CONTRACTOR must have written policies and procedures regarding Member rights and shall ensure compliance of its staff and affiliated Providers with any applicable Federal and State laws that pertain to Member rights. Policies and procedures shall include compliance with: 1. Member Rights At a minimum, such Member rights include the Member’s and/or Representatives’ rights, including but not limited to, the guaranteed right to: : a. Receive information in a manner and format that may be easily understood in accordance with 42 C.F.R. § 438.10; b. Be treated with respect and with due consideration for their his or her dignity and privacy; ; c. Receive information on available treatment options and alternatives, alternatives presented in a manner appropriate to their the Member’s condition and ability to understand; Make and have honored an Advance Directive consistent with State and federal laws; Receive Covered Services in a nondiscriminatory fashion; ; d. Participate in decisions regarding their 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 federal other Federal regulations on the use of restraints and seclusion; ; f. Request and receive a copy of their medical records his or her Medical Records and to request that they be amended or corrected corrected, as specified in 45 C.F.R. §§ 164.524 and part 526; Choose a Representative to be involved as appropriate in making care decisions; Provide informed consent; Voice Grievances about the care provided by the CONTRACTOR and to make use 164.526; g. Free exercise of the Grievance, Appeal and Fair Hearing processes without fear of retaliation; Choose from among Contract Providers in accordance with the CONTRACTOR’s prior authorization requirements; Receive information about Covered Services and how to access Covered Services, and Contract Providers; Be free from harassment by the CONTRACTOR or its Contract Providers in regard to contractual disputes between the CONTRACTOR and Providers; and Participate in understanding Physical Health and Behavioral Health problems and developing mutually agreed-upon treatment goals. The CONTRACTOR shall ensure that each Member (and/or as appropriate, Representative) is free to exercise their rights and that the exercise of those rights does do not adversely affect the way the CONTRACTOR or Contractor and its Contract Providers treat the Member; and h. Be furnished health care services in accordance with 42 C.F.R. § 438.206 through 438.210. The written policies and procedures shall also address the responsibility of Members to pay for unauthorized health care services obtained from non-participating 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 Member (and/or Representative). Members and/or Representatives, to cooperate with those providing health care services by supplying information essential to the extent possiblerendition of optimal care, have a responsibility to: Provide information that the CONTRACTOR following instructions and its Contract Providers need in order to care for the Member; Follow the plans and instructions guidelines for care that they have agreed upon with their Providers; those providing health care services, and Keep, rescheduleshowing courtesy and respect to Providers and staff. A written description of the rights and responsibilities of Members shall be included in the Member information materials provided to new Members. A copy of the Contractor's policies and procedures regarding Member rights and responsibilities shall be provided to all Network Providers and any Out-of-network Providers to whom Members may be referred. 2. Member Protections The Contractor agrees to protect Members from certain payment liabilities and not hold Members liable for: a. Any and all debts of the Contractor if it should become insolvent; b. Payment for services provided by the Contractor if the Contractor has not received payment from the State for the service(s), or cancel if the Provider, under contract or other arrangement with the Contractor, fails to receive payment from the State or Contractor; c. The payments to Providers that furnish covered services under a scheduled appointment rather than contract or other arrangement with the Contractor that are in excess of the amount that normally would be paid by the Member if the services had been received directly from the Contractor; and d. The Contractor agrees to simply fail to keep ithonor and be bound by Section 1128B(d)(1) of the Balanced Budget Act of 1997 which protects Members against balance billing by Subcontractors.