New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 308 - MANAGED CARE PROGRAM
Part 8 - MEMBER EDUCATION
Section 8.308.8.11 - MEMBER RIGHTS AND RESPONSIBILITIES
Universal Citation: 8 NM Admin Code 8.308.8.11
Current through Register Vol. 35, No. 18, September 24, 2024
The MCO shall provide each member or the member's authorized representative with written information concerning his or her rights and responsibilities.
A. These include the right:
(1) to be treated with respect and with
due consideration for his or her dignity and privacy;
(2) to receive information on available
treatment options and alternatives, presented in a manner appropriate to his or
her condition and ability to understand such information;
(3) to make and have honored his or her
advance directive that is consistent with state and federal laws;
(4) to receive covered services in a
nondiscriminatory manner;
(5) to
participate in decisions regarding his or her health care, including the right
to refuse treatment;
(6) to be free
from any form of restraint or seclusion used as a means of coercion,
discipline, convenience or retaliation, as specified in federal regulations on
the use of restraints and seclusion;
(7) to request and receive a copy of his or
her medical records and to request that they be amended or corrected as
specified in
45 CFR
164.524 and 526;
(8) to choose an authorized representative to
be involved, as appropriate, in making his or her health care
decisions;
(9) to provide informed
consent;
(10) to voice grievances
concerning the care provided by the MCO;
(11) to appeal any action regarding medicaid
services that the member or his or her authorized representative or authorized
provider believes is erroneous;
(12) to protect the member, his or her
authorized representative or authorized provider who uses the grievance,
appeal, and HSD administrative hearing processes from fear of
retaliation;
(13) to choose from
among contracted providers in accordance with his or her MCO's prior
authorization requirements;
(14) to
receive information about covered services and how to access these covered
services, and providers;
(15) to be
free from harassment by the MCO or its contracted providers in regard to
contractual disputes between the MCO and the provider;
(16) to participate in understanding physical
and behavioral health problems and developing mutually agreed-upon treatment
goals; and
(17) to be assured that
the MCO complies with any other applicable federal and state laws including:
Title VI of the Civil Rights Act of 1964 as implemented by regulations in 45
CFR part 80; the Age Discrimination Act of 1975 as implemented by regulations
45 CFR part 91; the Rehabilitation Act of 1973; Title IX of the Education
Amendments of 1972 (regarding education programs and activities); Titles II and
III of the Americans with Disabilities Act; and section 1557 of the Patient
Protection and Affordable Care Act.
B. The MCO shall ensure that each member or the member's authorized representative or authorized provider is free to exercise his or her rights, and the exercise of those rights does not adversely affect the way that the MCO or provider treats the member or member's authorized representative or authorized provider.
C. The member or his or her authorized representative or authorized provider, to the extent possible, has a responsibility:
(1) to provide information
that the MCO and providers need in order to care for the member, such
information includes, but is not limited to the member's:
(a) most current mailing address;
(b) most current email address, if one is
available;
(c) most current phone
number, including any land line and cell phone, if available; and
(d) most current emergency contact
information;
(2) to
follow the care plans and instructions from his or her provider that have been
agreed upon;
(3) to keep a
scheduled appointment; and
(4) to
reschedule or cancel a scheduled appointment rather than simply fail to keep
it.
Disclaimer: These regulations may not be the most recent version. New Mexico 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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