Common use of Members’ Rights and Responsibilities Clause in Contracts

Members’ Rights and Responsibilities. The Contractor shall furnish Medicaid MHN program members with both verbal and written information about the nature and extent of their rights and responsibilities as a member of the Contractor's plan. The rights afforded to current members are detailed in MHN Policy and Procedure Guide, Members’ Xxxx of Rights. The written information shall be written at a reading comprehension level no higher than fourth (4th) grade, “or as determined appropriate by SCDHHS.” The minimum information shall include: the member's rights to receive written information about the Contractor's managed care plan including information on the structure and operation of the Plan; the network providers/subcontractors providing the member's health care, including information on any providers who are non-English speaking; information about the amount, duration, and scope of benefits available and how to obtain these benefits; confidentially of patient information; the right to file grievances or complaints about the Contractor and/or care provided; any restrictions on the member’s freedom of choice among network providers; the extent to which, and how, after-hours and emergency coverage are provided; and any other information that affects the member's enrollment into the Contractor's plan. The Contractor shall notify the Medicaid MHN program members at least annually following initial enrollment of their right to request and receive this information. The Medicaid MHN program members’ responsibilities shall include but are not limited to: informing the Contractor of the loss or theft of their ID card; presenting their ID card when using health care services; to be familiar with the plan’s procedures to the best of the member's abilities; and/or to call or contact the Contractor to obtain information and have questions clarified; to provide participating network providers with accurate and complete medical information; follow the prescribed treatment of care recommended by the provider or let the provider know the reasons the treatment cannot be followed, as soon as possible; and make every effort to keep any agreed upon appointments, and follow-up appointments and to access preventive care services.

Appears in 1 contract

Samples: Contract for the Purchase and Provision of Services

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Members’ Rights and Responsibilities. The Contractor shall furnish Medicaid MHN program members with both verbal and written information about the nature and extent of their rights and responsibilities as a member of the Contractor's plan. The rights afforded to current members are detailed in MHN the Policy and Procedure Guide, Members’ Xxxx of Rights. The written information shall be written at a reading comprehension level no higher than fourth (4th) grade, “or as determined appropriate by SCDHHS.” The minimum information shall include: the member's rights right to receive written information about the Contractor's managed care plan including information on the structure and operation of the Plan; the network providers/subcontractors providing the member's health care, including information on any providers who are non-English speaking; information about the amount, duration, and scope of benefits available and how to obtain these benefits; confidentially confidentiality of patient information; the right to file grievances or complaints about the Contractor and/or care provided; any restrictions on the member’s freedom of choice among network providers; the extent to whichif applicable, information regarding advance directives as described in 42 CFR §417.436 (2006, as amended) and how42 CFR §489, after-hours and emergency coverage are provided; Subpart I (2006, as amended) and any other information that affects the member's enrollment into the Contractor's plan. Information regarding advance directives shall include a description of the applicable state law (Chapter 66, Section 44) and must reflect any changes in state law as soon as possible, but no later than 90 days after the effective date of the change. The Contractor shall notify provide the Medicaid MHN program members at least annually following initial enrollment member written evidence of their right to request and receive this informationcoverage. The Medicaid MHN program members’ responsibilities shall include but are not limited to: informing the Contractor of the loss or theft of their ID card; presenting their ID card when using health care services; to be being familiar with the plan’s procedures to the best of the member's their abilities; and/or to call calling or contact contacting the Contractor to obtain information and have questions clarified; to provide providing participating network providers with accurate and complete medical information; follow following the prescribed treatment of or care recommended by the provider or let letting the provider know the reasons the treatment cannot be followed, as soon as possible; and make making every effort to keep any agreed upon appointments, appointments and follow-up appointments appointments; and to access accessing preventive care services.

Appears in 1 contract

Samples: Contract for Medical Services

Members’ Rights and Responsibilities. The Contractor shall furnish Medicaid MHN program members MCO Members with both verbal and written information about the nature and extent of their rights and responsibilities as a member Medicaid MCO Members of the Contractor's health plan. The rights afforded to current members Medicaid MCO Members are detailed in MHN the MCO Policy and Procedure Guide, Members’ Xxxx of Rights. The written information shall be written at prepared on a reading comprehension level no higher than fourth (4th) grade, or as determined appropriate by SCDHHS.” the Department. The minimum information shall include: the memberMedicaid MCO Member's rights right to receive written information about the Contractor's managed care plan health plan, including information on the structure and operation of the Planhealth plan; the network providersProviders/subcontractors Subcontractors providing the memberMedicaid MCO Member's health care, including information on any providers who are non-English speaking; information about the amount, duration, and scope of benefits available and how to obtain these benefits; confidentially confidentiality of patient information; the right to file grievances or complaints about the Contractor and/or care provided; any restrictions on the member’s freedom of choice among network providers; the extent to whichinformation regarding advance directives as described in 42 CFR §417.436 (2009, as amended) and how42 CFR 489, after-hours and emergency coverage are provided; Subpart I (2009, as amended) and any other information that affects the memberMedicaid MCO Member's enrollment into the Contractor's health plan. Information regarding advance directives shall include a description of the applicable State law (Chapter 66, Section 44) and must reflect any changes in State law as soon as possible, but no later than ninety (90) calendar days after the effective date of the change. The Contractor shall notify provide the Medicaid MHN program members at least annually following initial enrollment MCO Member written evidence of their right to request and receive this informationcoverage. The Medicaid MHN program membersMCO Members’ responsibilities shall include include, but are not limited to: informing the Contractor of the loss or theft of their ID cardcards; presenting their ID card cards when using health care services; to be being familiar with the Contractor’s health plan’s procedures to the best of the member's their abilities; and/or to call calling or contact contacting the Contractor to obtain information and have questions clarified; to provide providing participating network providers Providers with accurate and complete medical information; follow following the prescribed treatment of care recommended by the provider or let letting the provider Provider know the reasons the treatment cannot be followed, as soon as possible; and make making every effort to keep any agreed upon appointments, ; and follow-up appointments and to access accessing preventive care services.

Appears in 1 contract

Samples: Contract for Medical Services

Members’ Rights and Responsibilities. The Contractor shall furnish Medicaid MHN MCO program members with both verbal and written information about the nature and extent of their rights and responsibilities as a member of the Contractor's plan. The rights afforded to current members are detailed in MHN MCO Policy and Procedure Guide, Members’ Xxxx Bill of Rights. The written information shall be written at a reading comprehension level no higher than fourth (4th) grade, “or as determined appropriate by SCDHHS.” The minimum information shall include: the member's rights to receive written information about the Contractor's managed care plan including information on the structure and operation of the Plan; the network providers/subcontractors providing the member's health care, including information on any providers who are non-English speaking; information about the amount, duration, and scope of benefits available and how to obtain these benefits; confidentially confidentiallyconfidentiality of patient information; the right to file grievances or complaints about the Contractor and/or care provided; any restrictions on the member’s freedom of choice among network providers; the extent to whichinformation regarding advance directives as described in 42 CFR 417.436 (2006, as amended) and how42 CFR 489, after-hours and emergency coverage are provided; Subpart I (2006, as amended) and any other information that affects the member's enrollment into the Contractor's plan. Information regarding advance directives shall include a description of the applicable State law (Chapter 66, Section 44) and must reflect any changes in State law as soon as possible, but no later than 90 days after the effective date of the change. The Contractor shall notify provide the Medicaid MHN program members at least annually following initial enrollment member written evidence of their right to request and receive this informationcoverage. The Medicaid MHN MCO program members’ members responsibilities shall include but are not limited to: informing the Contractor of the loss or theft of their ID card; presenting their ID card when using health care services; to be bebeing familiar with the plan’s plans procedures to the best of the member's abilities; and/or to call callcalling or contact contactcontacting the Contractor to obtain information and have questions clarified; to provide provideproviding participating network providers with accurate and complete medical information; follow followfollowing the prescribed treatment of care recommended by the provider or let letletting the provider know the reasons the treatment cannot be followed, as soon as possible; and make makemaking every effort to keep any agreed upon appointments, and follow-up appointments appointments; and to access accessaccessing preventive care services.

Appears in 1 contract

Samples: Managed Care Organization Contract Amendment

Members’ Rights and Responsibilities. The Contractor shall furnish Medicaid MHN program Program members with both verbal and written information about the nature and extent of their rights and responsibilities as a member members of the Contractor's plan. The rights afforded to current members are detailed in the MHN Policy and Procedure Guide, Members’ Xxxx of Rights. The written information shall be written prepared at a reading comprehension level no higher than fourth (4th) grade, “or as determined appropriate by SCDHHS.” The minimum information shall include: the member's rights to receive written information about the Contractor's managed care plan including information on the structure and operation of the Plan; the network providers/subcontractors providing the member's health care, including information on any providers who are non-English speaking; information about the amount, duration, and scope of benefits available and how to obtain these benefits; confidentially information on the confidentiality of patient information; the right to file grievances or complaints about the Contractor and/or care provided; any restrictions on the member’s freedom of choice among network providers; the extent to which, and how, after-hours and emergency coverage are provided; and any other information that affects the member's enrollment into the Contractor's plan. The Contractor shall notify the Medicaid MHN program Program members at least annually following initial enrollment of their right to request and receive this information. The Medicaid MHN program Program members’ responsibilities shall include but are not limited to: informing the Contractor of the loss or theft of their Medicaid ID cardcards; presenting their ID card cards when using health care services; to be being familiar with the plan’s procedures to the best of the member's their abilities; and/or to call calling or contact contacting the Contractor to obtain information and have questions clarified; to provide providing participating network providers with accurate and complete medical information; follow following the prescribed treatment of care recommended by the provider or let letting the provider know the reasons the treatment cannot be followed, as soon as possible; and make making every effort to keep any agreed upon appointments; and, and follow-up appointments and to access accessing preventive care services.

Appears in 1 contract

Samples: Contract for Medical Services

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Members’ Rights and Responsibilities. The Contractor shall furnish Medicaid MHN program members with both verbal and written information about the nature and extent of their rights and responsibilities as a member members of the Contractor's plan. The rights afforded to current members are detailed in MHN the Policy and Procedure Guide, Members’ Xxxx Bill of Rights. The written information shall be written at prepared on a reading comprehension level no higher than fourth (4th) grade, “or as determined appropriate by SCDHHS.” The minimum information shall include: the member's rights right to receive written information about the Contractor's managed care plan including information on the structure and operation of the Plan; the network providers/subcontractors providing the member's health care, including information on any providers who are non-English speaking; information about the amount, duration, and scope of benefits available and how to obtain these benefits; confidentially confidentiality of patient information; the right to file grievances or complaints about the Contractor and/or care provided; any restrictions on the member’s freedom of choice among network providers; the extent to whichif applicable, information regarding advance directives as described in 42 CFR §417.436 (2009, as amended) and how42 CFR Part 489, after-hours and emergency coverage are provided; Subpart I (2009, as amended) and any other information that affects the member's enrollment into the Contractor's plan. Information regarding advance directives shall include a description of the applicable state law (Chapter 66, Title 44) and must reflect any changes in state law as soon as possible, but no later than ninety (90) calendar days after the effective date of the change. The Contractor shall notify provide the Medicaid MHN program members at least annually following initial enrollment member written evidence of their right to request and receive this informationcoverage. The Medicaid MHN program members’ responsibilities shall include but are not limited to: informing the Contractor of the loss or theft of their ID cardcards; presenting their ID card cards when using health care services; to be being familiar with the plan’s procedures to the best of the member's their abilities; and/or to call calling or contact contacting the Contractor to obtain information and have questions clarified; to provide providing participating network providers with accurate and complete medical information; follow following the prescribed treatment of or care recommended by the provider or let letting the provider know the reasons the treatment cannot be followed, as soon as possible; and make making every effort to keep any agreed upon appointments, and follow-up appointments and to access accessing preventive care services.

Appears in 1 contract

Samples: Contract for Medical Services

Members’ Rights and Responsibilities. The Contractor shall furnish Medicaid MHN program members with both verbal and written information about the nature and extent of their rights and responsibilities as a member of the Contractor's plan. The rights afforded to current members are detailed in MHN Policy and Procedure Guide, Members’ Xxxx Bill of Rights. The written information shall be written at a reading comprehension level no higher than fourth (4th) grade, “or as determined appropriate by SCDHHS.” The minimum information shall include: the member's rights to receive written information about the Contractor's managed care plan including information on the structure and operation of the Plan; the network providers/subcontractors providing the member's health care, including information on any providers who are non-English speaking; information about the amount, duration, and scope of benefits available and how to obtain these benefits; confidentially of patient information; the right to file grievances or complaints about the Contractor and/or care provided; any restrictions on the member’s freedom of choice among network providers; the extent to which, and how, after-hours and emergency coverage are provided; and any other information that affects the member's enrollment into the Contractor's plan. The Contractor shall notify the Medicaid MHN program members at least annually following initial enrollment of their right to request and receive this information. The Medicaid MHN program members’ responsibilities shall include but are not limited to: informing the Contractor of the loss or theft of their ID card; presenting their ID card when using health care services; to be familiar with the plan’s procedures to the best of the member's abilities; and/or to call or contact the Contractor to obtain information and have questions clarified; to provide participating network providers with accurate and complete medical information; follow the prescribed treatment of care recommended by the provider or let the provider know the reasons the treatment cannot be followed, as soon as possible; and make every effort to keep any agreed upon appointments, and follow-up appointments and to access preventive care services.

Appears in 1 contract

Samples: Contract for the Purchase and Provision of Services

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