Specification of Rights Sample Clauses

Specification of Rights. Each enrollee has a right: • To receive information in accordance with the standards set forth in this contract; • To be treated with respect and due consideration of his or her dignity and privacy; • To accessible services; • To choose providers from among those affiliated with the MCO; • To participate in decision-making regarding his or her health care, including the right to refuse treatment; • To receive information on available treatment options or alternative courses of care, presented in a manner appropriate to the enrollee’s condition and ability to understand; • To request and receive his or her medical records, and to request that they be amended or corrected, for which the MCO will take action in a timely manner of no later than 30 days from receipt of a request for records, and no later than 60 days from the receipt of a request for amendments, in accordance with the privacy rule as set forth in 45 CFR parts 164.524 and 164.526, upon their effective dates, to the extent they apply; • To obtain a prompt resolution of issues raised by the enrollee, including complaints, grievances, or appeals and issues relating to authorization, coverage, or payment of services; • To offer suggestions for changes in policies and procedures; • To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation, as specified in other Federal regulations on the use of restraints and seclusion; and • To be furnished health care services as set forth in this contract. MCOs must have policies and procedures to protect and promote these rights, as follows: • Enrollee privacy The MCO must implement procedures to ensure the confidentiality of medical records and any other health and enrollment information that identifies a particular enrollee in accordance with Article II, Section 5.7.