Common use of Member Rights and Responsibilities Clause in Contracts

Member Rights and Responsibilities. The Contractor shall have written policies and procedures that are designed to protect the rights of Members and enumerate the responsibilities of each Member. 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 these policies and procedures shall be provided to all of the Contractor’s Network Providers to whom Members may be referred. In addition, these policies and procedures shall be provided 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 Members shall include, without limitation, the right to: A. Respect, dignity, privacy, confidentiality 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 Member’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; and J. Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation. K. Any Indian enrolled with the Contractor eligible to receive services from a participating I/T/U provider or a I/T/U primary care provider shall be allowed to receive services from that provider if part of Contractor’s network, The Contractor shall also have policies addressing the responsibility of each Member to: A. Become informed about Member rights; B. Abide by the Contractor’s and Department’s policies and procedures; C. Become informed about service and treatment options; D. Actively participate in personal health and care decisions, practice healthy lifestyles; E. Report suspected Fraud and Abuse; and F. Keep appointments or call to cancel.

Member 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 CFR part 80; the Age Discrimination Act of 1975 as implemented by regulations at 45 CFR 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 CFR 438.100, and designed to protect the rights of Members and enumerate the responsibilities of each Member. 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 these policies and procedures shall be provided to all of the Contractor’s Network Providers to whom Members may be referred. In addition, these policies and procedures shall be provided 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 Members Members, in accordance with federal and state law, shall include, without limitation, the right to: A. Respect, dignity, privacy, confidentiality 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 Member’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 medical records in accordance with applicable federal and state laws; I. Timely referral and access to medically indicated specialty care; and 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 CFR 438.10; L. Be furnished health care services in accordance with 42 CFR 438.206 through 438.210; M. Any Indian enrolled with the Contractor eligible to receive services from a participating I/T/U provider or a I/T/U primary care provider shall be allowed to receive services from that provider if part of Contractor’s network, The Contractor shall also have policies addressing the responsibility of each Member to: A. Become informed about Member rights; B. Abide by the Contractor’s and Department’s policies and procedures; C. Become informed about service and treatment options; D. Actively participate in personal health and care decisions, practice healthy lifestyles; E. Report suspected Fraud and Abuse; and F. Keep appointments or call to cancel.

Member Rights and Responsibilities. The Contractor shall have written policies and procedures that are designed to protect the rights of Members and enumerate the responsibilities of each Member. 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 these policies and procedures shall be provided to all of the Contractor’s Network Providers to whom Members may be referred. In addition, these policies and procedures shall be provided 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 Members shall include, without limitation, the right to: A. Respect, dignity, privacy, confidentiality 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 Member’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; and J. Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation. K. Any Indian enrolled with the Contractor eligible to receive services from a participating I/T/U provider or a I/T/U primary care provider shall be allowed to receive services from that provider if part of Contractor’s network, . The Contractor shall also have policies addressing the responsibility of each Member to: A. Become informed about Member rights; B. Abide by the Contractor’s and Department’s policies and procedures; C. Become informed about service and treatment options; D. Actively participate in personal health and care decisions, practice healthy lifestyles; E. Report suspected Fraud and Abuse; and F. Keep appointments or call to cancel.

Member Rights and Responsibilities. The Contractor shall have written policies and procedures that are designed to protect the rights of Members and enumerate the responsibilities of each Member. 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 these policies and procedures shall be provided to all of the Contractor’s Network Providers to whom Members may be referred. In addition, these policies and procedures shall be provided 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 Members shall include, without limitation, the right to: A. Respect, dignity, privacy, confidentiality 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 Member’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; and J. Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation. K. Any Indian enrolled with the Contractor eligible to receive services from a participating I/T/U provider or a I/T/U primary care provider shall be allowed to receive services from that provider if part of Contractor’s network, . The Contractor shall also have policies addressing the responsibility of each Member to: A. Become X. Xxxxxx informed about Member rights; B. Abide by the Contractor’s and Department’s policies and procedures; C. Become informed about service and treatment options; D. Actively participate in personal health and care decisions, practice healthy lifestyles; E. Report suspected Fraud and Abuse; and F. Keep appointments or call to cancel.