La. Admin. Code tit. 50 § XXXIII-107

Current through Register Vol. 50, No. 11, November 20, 2024

Section XXXIII-107 - Enrollee Rights and Responsibilities

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d. Repealed.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.

La. Admin. Code tit. 50, § XXXIII-107

Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 38:361 (February 2012), Amended by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office of Behavioral Health, LR 412354 (11/1/2015), Amended by the Department of Health, Bureau of Health Services Financing and the Office of Behavioral Health, LR 43322(2/1/2017).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.