ContractMedicaid Service Coordination Agreement • November 15th, 2012
Medicaid Service Coordination Agreement Statement of Rights and Responsibilities Name of the Person: Medicaid Number (CIN#): The purpose of this document is to outline your rights and responsibilities under the Medicaid Service Coordination (MSC) program and what your service coordinator will do for you. This document must be reviewed with you at the time of enrollment in MSC and s igned. It only needs to be signed once but must be reviewed once a year with your service coordinator. This document should be forwarded to the chosen provider whenever you change MSC vendors. Rights and Responsibilities Informed ChoiceYou and your service coordinator will talk about Informed Choice. Your service coordinator will help you make informed choices. Informed Choice The service coordinator assists individuals on his/her caseload to understand and make informed choices. A person has made an informed choice when he or she has made a decision based on a good understanding of the options available and
