State Plan Amendment - Title XIX of the Social Security Act
Supplement 4 - Enrollee Rights and Requirements
PCCM beneficiaries have the following rights:
- To receive information in accordance with CFR42 §438.10.
- To be treated with respect and with due consideration for his or her dignity and privacy.
- To receive information on available treatment options and alternatives presented in a manner appropriate to the enrollee's condition and ability to understand.
- To participate in decisions regarding his or her health care, including the right to refuse treatment.
- To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
- To be informed of PCP enrollment requirements, be given adequate time to make the informed decision and to be provided with the information necessary to do so.
- To receive a copy of his or her medical records, and to request that they be amended or corrected.
- To be free to exercise his or her rights, and that the exercise of those rights does not adversely affect the way the PCP or the State treat the enrollee.
- Beneficiaries must access managed care covered services from their PCP or designated covering provider (DCP).
Non PCP services:
- Beneficiaries must obtain PCP or DCP referrals prior to receiving managed care covered services from other providers.
Verify Medical Assistance Eligibility:
- Beneficiaries must show their Medical Assistance Identification Card to all providers prior to receiving covered medical services.
Non covered services:
- Beneficiaries are responsible for payment of services for non-covered medical care. This includes medical care identified as managed care services not received from the PCP or DCP and not prior referred.
Accept PCP enrollment:
- Beneficiaries must select their PCP or accept OMS default assignment of PCP.