Common use of Member Rights under Medicaid Clause in Contracts

Member Rights under Medicaid. Contractor shall have written policies regarding the Member rights and responsibilities under Medicaid law specified below and Contractor shall: a. Ensure Members are aware that a second opinion is available from a qualified Health Care Professional within the Provider Network, or that the Contractor will arrange for Members to obtain a qualified Health Care Professional from outside the Provider Network, at no cost to the Members. b. Ensure Members are aware of their civil rights under Title VI of the Civil Rights Act and ORS Chapter 659A, that Member has a right to report a complaint of discrimination by contacting the Contractor, OHA, the Bureau of Labor and Industries (BOLI) or the Office of Civil Rights (OCR). c. Provide notice to Members of Contractor’s nondiscrimination policy and process to report a complaint of discrimination on the basis of race, color, national origin, religion, sex, sexual orientation, marital status, age, or disability in accordance with all applicable laws including Title VI of the Civil Rights Act and ORS Chapter 659A. d. Provide equal access for both males and females under 18 years of age to appropriate facilities, services and treatment under this Contract, consistent with OHA obligations under ORS 417.270. e. Make Certified or Qualified Health Care Interpreter services available free of charge to each Potential Member and Member. This applies to all non-English languages, not just those that OHA identifies as prevalent. Contractor shall notify its Members and Potential Members that oral interpretation is available free of charge for any language and that written information is available in prevalent non-English languages in Service Area(s) as specified in 42 CFR 438.10(d)(4). Contractor shall notify its Members how to access oral interpretation and written translation services f. Have in place a mechanism to help Members and Potential Members understand the requirements and benefits of Contractor's plan and develop and provide written information materials and educational programs consistent with the requirements of OAR 410-141-3280 and 410-141-3300. g. Allow each Member to choose his or her health professional from available Participating Providers and facilities to the extent possible and appropriate. For a Member in a Service Area serviced by only one PHP, any limitation the Contractor imposes on his or her freedom to change between PCPs or to obtain services from Non-Participating Providers if the service or type of provider is not available with the Contractor’s Provider Network may be no more restrictive than the limitation on Disenrollment under Exhibit B, Part 3, Section 6.b. h. Require, and cause its Participating Providers to require, that Members receive information on available treatment options and alternatives presented in a manner appropriate to the Member's condition, preferred language and ability to understand. i. Allow each Member the right to be actively involved in the development of Treatment Plans if Covered Services are to be provided and to have Family involved in such treatment planning. j. Allow each Member the right to request and receive a copy of his or her own Health Record, (unless access is restricted in accordance with ORS 179.505 or other applicable law) and to request that the records be amended or corrected as specified in 45 CFR Part 164. k. Furnish to each of its Members the information specified in 42 CFR 438.10(f)(2)-(3), and 42 CFR 438.10(g), if applicable, as specified in the CFR within 30 days after the Contractor received notice of the Member’s Enrollment from OHA or for Members who are Fully Dual Eligible, within the time period required by Medicare. Contractor shall notify all Members of their right to request and obtain the information described in this section at least once a year. l. Ensure that each Member has the right to have access to Covered Services which at least equals access available to other persons served by Contractor. m. Ensure Members are free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliations specified in federal regulations on the use of restraints and seclusion. n. Require, and cause its Participating Providers to require, that Members are treated with respect, with due consideration for his or her dignity and privacy, and the same as non-Members or other patients who receive services equivalent to Covered Services. o. Ensure that each Member is guaranteed the right to participate in decisions regarding his or her health care, including the right to refuse treatment, and has the opportunity to execute a statement of wishes for treatment, including the right to accept or refuse medical, surgical, Substance Use Disorders or mental health treatment and the right to execute directives and powers of attorney for health care established under ORS 127.505 to 127.660 and the OBRA 1990 -- Patient Self-Determination Act. p. Ensure, and cause its Participating Providers to ensure, that each Member is free to exercise his or her rights, and that the exercise of those rights does not adversely affect the way the Contractor, its staff, Subcontractors, Participating Providers or OHA, treat the Member. Contractor shall not discriminate in any way against Members when those Members exercise their rights under the OHP. q. Ensure that any cost sharing authorized under this Contract for Members is in accordance with 42 CFR 447.50 through 42 CFR 447.90 and with the General Rules. r. Notify Members of their responsibility for paying a Co-Payment for some services, as specified in OAR 410-120-1230. s. If available, utilize electronic methods of communications with Members, at their request, to provide Member information. t. Contractor may use electronic communications for purposes described in Subsection s above only if: (1) The recipient has requested or approved electronic transmittal; (2) The identical information is available in written form upon request; (3) The information does not constitute a direct Member notice related to an adverse Action or any portion of the Grievance, Appeals, Contested Case Hearings or any other Member rights or Member protection process; (4) Language and alternative format accommodations are available; and (5) All HIPAA requirements are satisfied with respect to personal health information.

Member Rights under Medicaid. Contractor shall have written policies regarding the Member rights and responsibilities under Medicaid law specified below and Contractor shall: a. Ensure Members are aware that a second opinion is available from a qualified Health Care Professional within the Provider Network, or that the Contractor will arrange for Members to obtain a qualified Health Care Professional from outside the Provider Network, at no cost to the Members. b. Ensure Members are aware of their civil rights under Title VI of the Civil Rights Act and ORS Chapter 659A, that Member has a right to report a complaint of discrimination by contacting the Contractor, OHA, the Bureau of Labor and Industries (BOLI) or the Office of Civil Rights (OCR). c. Provide notice to Members of Contractor’s nondiscrimination policy and process to report a complaint of discrimination on the basis of race, color, national origin, religion, sex, sexual orientation, marital status, age, or disability in accordance with all applicable laws including Title VI of the Civil Rights Act and ORS Chapter 659A. d. Provide equal access for both males and females under 18 years of age to appropriate facilities, services and treatment under this Contract, consistent with OHA obligations under ORS 417.270. e. Make Certified or Qualified Health Care Interpreter services available free of charge to each Potential Member and Member. This applies to all non-English languages, not just those that OHA identifies as prevalent. Contractor shall notify its Members and Potential Members that oral interpretation is available free of charge for any language and that written information is available in prevalent non-English languages in Service Area(s) as specified in 42 CFR 438.10(d)(4)438.10(c)(3) . Contractor shall notify its Members how to access oral interpretation and written translation services f. Have in place a mechanism to help Members and Potential Members understand the requirements and benefits of Contractor's plan and develop and provide written information materials and educational programs consistent with the requirements of OAR 410-141-3280 and 410-141-3300. g. Allow each Member to choose his or her health professional from available Participating Providers and facilities to the extent possible and appropriate. For a Member in a Service Area serviced by only one PHP, any limitation the Contractor imposes on his or her freedom to change between PCPs or to obtain services from Non-Participating Providers if the service or type of provider is not available with the Contractor’s Provider Network may be no more restrictive than the limitation on Disenrollment under Exhibit B, Part 3, Section 6.b. h. Require, and cause its Participating Providers to require, that Members receive information on available treatment options and alternatives presented in a manner appropriate to the Member's condition, preferred language and ability to understand. i. Allow each Member the right to be actively involved in the development of Treatment Plans if Covered Services are to be provided and to have Family involved in such treatment planning. j. Allow each Member the right to request and receive a copy of his or her own Health Record, (unless access is restricted in accordance with ORS 179.505 or other applicable law) and to request that the records be amended or corrected as specified in 45 CFR Part 164. k. Furnish to each of its Members the information specified in 42 CFR 438.10(f)(2)-(3438.10(f)(4), 42 CFR 438.10(f)(6) and 42 CFR 438.10(g), if applicable, as specified in the CFR within 30 days after the Contractor received notice of the Member’s Enrollment from OHA or for Members who are Fully Dual Eligible, within the time period required by Medicare. Contractor shall notify all Members of their right to request and obtain the information described in this section at least once a year. l. Ensure that each Member has the right to have access to Covered Services which at least equals access available to other persons served by Contractor. m. Ensure Members are free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliations specified in federal regulations on the use of restraints and seclusion. n. Require, and cause its Participating Providers to require, that Members are treated with respect, with due consideration for his or her dignity and privacy, and the same as non-Members or other patients who receive services equivalent to Covered Services. o. Ensure that each Member is guaranteed the right to participate in decisions regarding his or her health care, including the right to refuse treatment, and has the opportunity to execute a statement of wishes for treatment, including the right to accept or refuse medical, surgical, Substance Use Disorders or mental health treatment and the right to execute directives and powers of attorney for health care established under ORS 127.505 to 127.660 and the OBRA 1990 -- Patient Self-Determination Act. p. Ensure, and cause its Participating Providers to ensure, that each Member is free to exercise his or her rights, and that the exercise of those rights does not adversely affect the way the Contractor, its staff, Subcontractors, Participating Providers or OHA, treat the Member. Contractor shall not discriminate in any way against Members when those Members exercise their rights under the OHP. q. Ensure that any cost sharing authorized under this Contract for Members is in accordance with 42 CFR 447.50 through 42 CFR 447.90 447.60 and with the General Rules. r. Notify Members of their responsibility for paying a Co-Payment for some services, as specified in OAR 410-120-1230. s. If available, utilize electronic methods of communications with Members, at their request, to provide Member information. t. Contractor may use electronic communications for purposes described in Subsection s above only if: (1) The recipient has requested or approved electronic transmittal; (2) The identical information is available in written form upon request; (3) The information does not constitute a direct Member notice related to an adverse Action or any portion of the Grievance, Appeals, Contested Case Hearings or any other Member rights or Member protection process; (4) Language and alternative format accommodations are available; and (5) All HIPAA requirements are satisfied with respect to personal health information.

Member Rights under Medicaid. Contractor shall have written policies regarding the Member rights and responsibilities under Medicaid law specified below and Contractor shall: a. Ensure Members are aware that a second opinion is available from a qualified Health Care Professional within the Provider Network, or that the Contractor will arrange for Members to obtain a qualified Health Care Professional from outside the Provider Network, at no cost to the Members. b. Ensure Members are aware of their civil rights under Title VI of the Civil Rights Act and ORS Chapter 659A, that Member has a right to report a complaint of discrimination by contacting the Contractor, OHA, the Bureau of Labor and Industries (BOLI) or the Office of Civil Rights (OCR). c. Provide notice to Members of Contractor’s nondiscrimination policy and process to report a complaint of discrimination on the basis of race, color, national origin, religion, sex, sexual orientation, marital status, age, or disability in accordance with all applicable laws including Title VI of the Civil Rights Act and ORS Chapter 659A. d. Provide equal access for both males and females under 18 years of age to appropriate facilities, services and treatment under this Contract, consistent with OHA obligations under ORS 417.270. e. Make Certified or Qualified Health Care Interpreter services available free of charge to each Potential Member and Member. This applies to all non-English languages, not just those that OHA identifies as prevalent. Contractor shall notify its Members and Potential Members that oral interpretation is available free of charge for any language and that written information is available in prevalent non-English languages in Service Area(s) as specified in 42 CFR 438.10(d)(4)438.10(c)(3) . Contractor shall notify its Members how to access oral interpretation and written translation services f. Have in place a mechanism to help Members and Potential Members understand the requirements and benefits of Contractor's plan and develop and provide written information materials and educational programs consistent with the requirements of OAR 410-141-3280 and 410-141-3300. g. Allow each Member to choose his or her health professional from available Participating Providers and facilities to the extent possible and appropriate. For a Member in a Service Area serviced by only one PHP, any limitation the Contractor imposes on his or her freedom to change between PCPs or to obtain services from Non-Participating Providers if the service or type of provider is not available with the Contractor’s Provider Network may be no more restrictive than the limitation on Disenrollment under Exhibit B, Part 3, Section 6.b. h. Require, and cause its Participating Providers to require, that Members receive information on available treatment options and alternatives presented in a manner appropriate to the Member's condition, preferred language and ability to understand. i. Allow each Member the right to be actively involved in the development of Treatment Plans if Covered Services are to be provided and to have Family involved in such treatment planning. j. Allow each Member the right to request and receive a copy of his or her own Health Record, (unless access is restricted in accordance with ORS 179.505 or other applicable law) and to request that the records be amended or corrected as specified in 45 CFR Part 164. k. Furnish to each of its Members the information specified in 42 CFR 438.10(f)(2)-(3), and 42 CFR 438.10(g), if applicable, as specified in the CFR within 30 days after the Contractor received notice of the Member’s Enrollment from OHA or for Members who are Fully Dual Eligible, within the time period required by Medicare. Contractor shall notify all Members of their right to request and obtain the information described in this section at least once a year. l. Ensure that each Member has the right to have access to Covered Services which at least equals access available to other persons served by Contractor. m. Ensure Members are free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliations specified in federal regulations on the use of restraints and seclusion. n. Require, and cause its Participating Providers to require, that Members are treated with respect, with due consideration for his or her dignity and privacy, and the same as non-Members or other patients who receive services equivalent to Covered Services. o. Ensure that each Member is guaranteed the right to participate in decisions regarding his or her health care, including the right to refuse treatment, and has the opportunity to execute a statement of wishes for treatment, including the right to accept or refuse medical, surgical, Substance Use Disorders or mental health treatment and the right to execute directives and powers of attorney for health care established under ORS 127.505 to 127.660 and the OBRA 1990 -- Patient Self-Determination Act. p. Ensure, and cause its Participating Providers to ensure, that each Member is free to exercise his or her rights, and that the exercise of those rights does not adversely affect the way the Contractor, its staff, Subcontractors, Participating Providers or OHA, treat the Member. Contractor shall not discriminate in any way against Members when those Members exercise their rights under the OHP. q. Ensure that any cost sharing authorized under this Contract for Members is in accordance with 42 CFR 447.50 through 42 CFR 447.90 447.60 and with the General Rules. r. Notify Members of their responsibility for paying a Co-Payment for some services, as specified in OAR 410-120-1230. s. If available, utilize electronic methods of communications with Members, at their request, to provide Member information. t. Contractor may use electronic communications for purposes described in Subsection s above only if: (1) The recipient has requested or approved electronic transmittal; (2) The identical information is available in written form upon request; (3) The information does not constitute a direct Member notice related to an adverse Action or any portion of the Grievance, Appeals, Contested Case Hearings or any other Member rights or Member protection process; (4) Language and alternative format accommodations are available; and (5) All HIPAA requirements are satisfied with respect to personal health information.

Member Rights under Medicaid. Contractor shall have written policies regarding the Member rights and responsibilities under Medicaid law specified below and Contractor shall:: Contract # (XXXXXX) Exhibit B – Part 3 Page CCO 2.0 Contract Template Exhibit B – Statement of Work – Part 3 - Patient Rights and Responsibilities, Engagement and Choice Page 53 of 358 a. Ensure Members are aware that a second opinion is available from a qualified Health Care Professional within the Provider Network, or that the Contractor will arrange for Members to obtain a qualified Health Care Professional from outside the Provider Network, at no cost to the Members. b. Ensure Members are aware of their civil rights under Title VI of the Civil Rights Act and ORS Chapter 659A, that Member has a right to report a complaint of discrimination by contacting the Contractor, OHA, the Bureau of Labor and Industries (BOLI) or the Office of Civil Rights (OCR). c. Provide written notice to Members of Contractor’s nondiscrimination policy and process to report a complaint of discrimination on the basis of race, color, national origin, religion, sex, sexual orientation, marital status, age, or disability in accordance with all applicable laws including Title VI of the Civil Rights Act and ORS Chapter 659A. d. Provide equal access for both males and females under 18 years of age to appropriate facilities, services and treatment under this Contract, consistent with OHA obligations under ORS 417.270. e. Make Certified CertifiedOHA certified or Qualified Health Care Interpreter Interpreterqualified health care interpreter services available free of charge to each Potential Member and Member. This applies to all non-English languageslanguages and sign language, not just those that OHA identifies as prevalent. Contractor shall notify its Members and. Contractor shall notify its Members, Potential Members, and Potential Members Provider Network that oral and sign language interpretation is isservices are available free of charge for any spoken language and sign language and that written information is available in prevalent non-English languages in Service Area(s) as specified in 42 CFR §438.10(d)(4). Contractor shall notify its Members. Contractor shall notify Potential Members and Members in its Member Handbook, Marketing Materials, and other Member materials, and its Provider Network in Contractor’s new hire or other on-boarding materials and other communications, about how to access oral and sign language interpretation and written translation services. f. Have in place a mechanism to help Members and Potential Members understand the requirements and benefits of Contractor's plan and develop and provide written information materials and educational programs consistent with the requirements of OAR 410-141-3280 and 410-141-3300. g. Allow each Member to choose his or her herthe Member’s own health professional from available Participating Providers and facilities to the extent possible and appropriate. For a Member in a Service Area serviced by only one PHPPHPPrepaid Health Plan, any limitation the Contractor imposes on his or her herMember’s freedom to change between PCPs PCPsPrimary Care Providers or to obtain services from Non-Participating Providers if the service or type of provider providerProvider is not available with the Contractor’s Provider Network may be no more restrictive than the limitation on Disenrollment under Sec. 9, below of this Exhibit B, Part 3, Section 6.b. h. Require, and cause its Participating Providers to require, that Members receive information on available treatment options and alternatives presented in a manner appropriate to the Member's condition, preferred language and ability to understand. i. Allow each Member the right to be actively involved in the development of Treatment Plans if Covered Services are to be provided and to have Family involved in such treatment planning. j. Allow each Member the right to request and receive a copy of his or her own Health Record, (unless access is restricted in accordance with ORS 179.505 or other applicable law) and to request that the records be amended or corrected as specified in 45 CFR Part 164. k. Furnish to each of its Members the information specified in 42 CFR 438.10(f)(2)-(3), and 42 CFR 438.10(g), if applicable, as specified in the CFR within 30 days after the Contractor received notice of the Member’s Enrollment from OHA or for Members who are Fully Dual Eligible, within the time period required by Medicare. Contractor shall notify all Members of their right to request and obtain the information described in this section at least once a year. l. Ensure that each Member has the right to have access to Covered Services which at least equals access available to other persons served by Contractor. m. Ensure Members are free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliations specified in federal regulations on the use of restraints and seclusion. n. Require, and cause its Participating Providers to require, that Members are treated with respect, with due consideration for his or her dignity and privacy, and the same as non-Members or other patients who receive services equivalent to Covered Services. o. Ensure that each Member is guaranteed the right to participate in decisions regarding his or her health care, including the right to refuse treatment, and has the opportunity to execute a statement of wishes for treatment, including the right to accept or refuse medical, surgical, Substance Use Disorders or mental health treatment and the right to execute directives and powers of attorney for health care established under ORS 127.505 to 127.660 and the OBRA 1990 -- Patient Self-Determination Act. p. Ensure, and cause its Participating Providers to ensure, that each Member is free to exercise his or her rights, and that the exercise of those rights does not adversely affect the way the Contractor, its staff, Subcontractors, Participating Providers or OHA, treat the Member. Contractor shall not discriminate in any way against Members when those Members exercise their rights under the OHP. q. Ensure that any cost sharing authorized under this Contract for Members is in accordance with 42 CFR 447.50 through 42 CFR 447.90 and with the General Rules. r. Notify Members of their responsibility for paying a Co-Payment for some services, as specified in OAR 410-120-1230. s. If available, utilize electronic methods of communications with Members, at their request, to provide Member information. t. Contractor may use electronic communications for purposes described in Subsection s above only if: (1) The recipient has requested or approved electronic transmittal; (2) The identical information is available in written form upon request; (3) The information does not constitute a direct Member notice related to an adverse Action or any portion of the Grievance, Appeals, Contested Case Hearings or any other Member rights or Member protection process; (4) Language and alternative format accommodations are available; and (5) All HIPAA requirements are satisfied with respect to personal health information.

Member Rights under Medicaid. Contractor shall have written policies regarding the Member rights and responsibilities under Medicaid law specified below and Contractor shall: a. Ensure Members are aware that a second opinion is available from a qualified Health Care Professional within the Provider Network, or that the Contractor will arrange for Members to obtain a qualified Health Care Professional from outside the Provider Network, at no cost to the Members. b. Ensure Members are aware of their civil rights under Title VI of the Civil Rights Act and ORS Chapter 659A, that Member has a right to report a complaint of discrimination by contacting the Contractor, OHA, the Bureau of Labor and Industries (BOLI) or the Office of Civil Rights (OCR). c. Provide written notice to Members of Contractor’s nondiscrimination policy and process to report a complaint of discrimination on the basis of race, color, national origin, religion, sex, sexual orientation, marital status, age, or disability in accordance with all applicable laws including Title VI of the Civil Rights Act and ORS Chapter 659A. d. Provide equal access for both males and females under 18 years of age to appropriate facilities, services and treatment under this Contract, consistent with OHA obligations under ORS 417.270. e. Make Certified certified or Qualified Health Care Interpreter qualified health care interpreter services available free of charge to each Potential Member and Member. This applies to all non-English languages, not just those that OHA identifies as prevalent. Contractor shall notify its Members and Potential Members that oral interpretation is available free of charge for any language and that written information is available in prevalent non-English languages in Service Area(s) as specified in 42 CFR 438.10(d)(4). Contractor shall notify its Members how to access oral interpretation and written translation services. f. Have in place a mechanism to help Members and Potential Members understand the requirements and benefits of Contractor's plan and develop and provide written information materials and educational programs consistent with the requirements of OAR 410-141-3280 and 410-141-3300. g. Allow each Member to choose his or her health professional from available Participating Providers and facilities to the extent possible and appropriate. For a Member in a Service Area serviced by only one PHP, any limitation the Contractor imposes on his or her freedom to change between PCPs or to obtain services from Non-Participating Providers if the service or type of provider is not available with the Contractor’s Provider Network may be no more restrictive than the limitation on Disenrollment under Exhibit B, Part 3, Section 6.b. h. Require, and cause its Participating Providers to require, that Members receive information on available treatment options and alternatives presented in a manner appropriate to the Member's condition, preferred language and ability to understand. i. Allow each Member the right to be actively involved in the development of Treatment Plans if Covered Services are to be provided and to have Family involved in such treatment planning. j. Allow each Member the right to request and receive a copy of his or her own Health Record, (unless access is restricted in accordance with ORS 179.505 or other applicable law) and to request that the records be amended or corrected as specified in 45 CFR Part 164. k. Furnish to each of its Members the information specified in 42 CFR 438.10(f)(2)-(3), and 42 CFR 438.10(g), if applicable, as specified in the CFR within 30 days after the Contractor received notice of the Member’s Enrollment from OHA or for Members who are Fully Dual Eligible, within the time period required by Medicare. Contractor shall notify all Members of their right to request and obtain the information described in this section at least once a year. l. Ensure that each Member has the right to have access to Covered Services which at least equals access available to other persons served by Contractor. m. Ensure Members are free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliations specified in federal regulations on the use of restraints and seclusion. n. Require, and cause its Participating Providers to require, that Members are treated with respect, with due consideration for his or her dignity and privacy, and the same as non-Members or other patients who receive services equivalent to Covered Services. o. Ensure that each Member is guaranteed the right to participate in decisions regarding his or her health care, including the right to refuse treatment, and has the opportunity to execute a statement of wishes for treatment, including the right to accept or refuse medical, surgical, Substance Use Disorders or mental health treatment and the right to execute directives and powers of attorney for health care established under ORS 127.505 to 127.660 and the OBRA 1990 -- Patient Self-Determination Act. p. Ensure, and cause its Participating Providers to ensure, that each Member is free to exercise his or her rights, and that the exercise of those rights does not adversely affect the way the Contractor, its staff, Subcontractors, Participating Providers or OHA, treat the Member. Contractor shall not discriminate in any way against Members when those Members exercise their rights under the OHP. q. Ensure that any cost sharing authorized under this Contract for Members is in accordance with 42 CFR 447.50 through 42 CFR 447.90 and with the General Rules. r. Notify Members of their responsibility for paying a Co-Payment for some services, as specified in OAR 410-120-1230. s. If available, utilize electronic methods of communications with Members, at their request, to provide Member information. t. Contractor may use electronic communications for purposes described in Subsection s above only if: (1) The recipient has requested or approved electronic transmittal; (2) The identical information is available in written form upon request; (3) The information does not constitute a direct Member notice related to an adverse Action or any portion of the Grievance, Appeals, Contested Case Hearings or any other Member rights or Member protection process; (4) Language and alternative format accommodations are available; and (5) All HIPAA requirements are satisfied with respect to personal health information.