Current through all regulations passed and filed through September 16, 2024
(A)
A managed care entity (MCE)
must develop and implement written policies in accordance with
42 C.F.R. 438.100
(October 1, 2021), as applicable, to
ensure each member has and is informed of his or her right to:
(1) Receive all services the
MCE is
required to provide pursuant to the terms of
the MCE
provider agreement or contract, as applicable,
with the Ohio department of medicaid (ODM).
(2) Be treated with respect and with due
consideration for their dignity and privacy.
(3) Be ensured of confidential handling of
information concerning their diagnoses, treatments, prognoses, and medical and
social history.
(4) Be provided
information about their health. Such information should also be made available
to the individual legally authorized by the member to have such information or
the person to be notified in the event of an emergency when concern for a
member's health makes it inadvisable to give him/her such
information.
(5) Be given the
opportunity to participate in decisions involving their health care.
(6) Receive information on available
treatment options and alternatives, presented in a manner appropriate to the
member's condition and ability to understand.
(7) Maintain auditory and visual privacy
during all health care examinations or treatment visits.
(8) Be free from any form of restraint or
seclusion used as a means of coercion, discipline, convenience, or
retaliation.
(9) Request and
receive a copy of their medical records, and to be able to request that their
medical records be amended or corrected.
(10) Be afforded the opportunity to approve
or refuse the release of information except when release is required by
law.
(11) Be afforded the
opportunity to refuse treatment or therapy. Members who refuse treatment or
therapy will be counseled relative to the consequences of their decision and
documentation will be entered into the medical record accordingly.
(12) Be afforded the opportunity to file
grievances, appeals, or state hearings pursuant to the provisions of rule
5160-26-08.4 of the
Administrative Code.
(13) Be
provided written member information from the MCE:
(a) At no cost to the member,
(b) In the prevalent non-English languages of
members specified by ODM, and
(c) In alternative formats and in an
appropriate manner that takes into consideration the special needs of
members.
(14) Receive
necessary oral interpretation and oral translation services at no
cost.
(15) Receive necessary
services of sign language assistance at no cost.
(16) Be informed of specific student
practitioner roles and the right to refuse student care.
(17) Refuse to participate in experimental
research.
(18) Formulate advance
directives and to file any complaints concerning noncompliance with advance
directives with the Ohio department of health.
(19) Change primary care providers (PCPs) no
less often than monthly. The MCO must mail written confirmation to the member of
his or her new PCP selection prior to or on the effective date of the
change.
(20) Appeal to or file
directly with the United States department of health and human services office
of civil rights any complaints of discrimination on the basis of race, color,
national origin, age or disability in the receipt of health services.
(21) Appeal to or file directly with the ODM
office of civil rights any complaints of discrimination on the basis of race,
color, religion, gender, gender identity, sexual orientation, age, disability,
national origin, military status, genetic information, ancestry, health status
or need for health services in the receipt of health services.
(22) Be free to exercise their rights and to
be assured that exercising their rights does not adversely affect the way the
MCE, the
MCE's
providers, or ODM treats the member.
(23) Be assured the
MCE must
comply with all applicable federal and state laws and other laws regarding
privacy and confidentiality.
(24)
Choose his or her health professional to the extent possible and
appropriate.
(25) For female
members, to obtain direct access to a woman's health specialist within the
network for covered care necessary to provide women's routine and preventive
health care services. This is in addition to a member's designated PCP if the
PCP is not a woman's health specialist.
(26) Be provided a second opinion from a
qualified health care professional within the MCO'snetwork. If
such a qualified health care professional is not available within the
MCO'snetwork, the
MCO must arrange for a second opinion outside the
network, at no cost to the member.
(27) Receive information on their
MCE.