Louisiana Administrative Code
Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE
Part XXXIII - Behavioral Health Services
Subpart 1 - Healthy Louisiana and Coordinated System of Care Waiver
Chapter 1 - Managed Care Organizations and the Coordinated System of Care Contractor
Section XXXIII-107 - Enrollee Rights and Responsibilities
Universal Citation: LA Admin Code XXXIII-107
Current through Register Vol. 50, No. 9, September 20, 2024
A. The enrollees rights shall include, but are not limited to the right to:
1.
participate in treatment decisions, including the right to:
a. refuse treatment;
b. seek second opinions; and
c. receive assistance with care coordination
from the primary care providers (PCPs) office or the enrollee's behavioral
health provider;
d.
Repealed.
2. express a
concern about their provider or the care rendered via a grievance
process;
3. appeal an MCO and CSoC
contractor decision through the MCOs and CSoC contractors internal process
and/or the state fair hearing process;
4. receive a response about a grievance or
appeal decision within a reasonable period of time determined by the
department;
5. receive a copy of
his/her medical records;
6. be
furnished health care services in accordance with federal regulations,
including those governing access standards;
7. choose a participating network health care
professional in accordance with federal and state regulations; and
8. be allowed to receive a specialized
service outside of the network if a qualified provider is not available through
the network.
B. The Medicaid recipient/enrollees responsibilities shall include, but are not limited to:
1. informing their MCO or CSoC
contractor of the loss or theft of their Medicaid identification
card;
2. presenting their
identification card when accessing behavioral health services;
3. being familiar with their MCOs or CSoC
contractors procedures to the best of his/her abilities;
4. contacting their MCO or CSoC contractor,
by telephone or in writing (formal letter or electronically, including email),
to obtain information and have questions clarified;
5. providing participating network providers,
or any other authorized provider, with accurate and complete medical
information;
6. following the
prescribed treatment of care recommended by the provider or letting the
provider know the reasons the treatment cannot be followed, as soon as
possible;
7. making every effort to
keep any agreed upon appointments and follow-up appointments and contacting the
provider in advance if unable to do so; and
8. accessing services only from specified
providers contracted with their MCO or CSoC contractor.
AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.
Disclaimer: These regulations may not be the most recent version. Louisiana may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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