480 Neb. Admin. Code, ch. 3, § 002

Current through September 17, 2024

Section 480-3-002 - PARTICIPANT RIGHTS AND RESPONSIBILITIES

002.01PARTICIPANT RIGHTS. In addition to the rights afforded to all persons, a participant enrolled in the Department's Division of Medicaid and Long-Term Care (MLTC) program has the right to:

(A) Be treated with dignity and respect;

(B) Be protected from abuse, neglect, exploitation and other threats to personal health, safety and well-being;

(C) Appoint an authorized representative to act on their behalf as a paid provider cannot sign their own claim on behalf of the participant; the signature of another competent representative of the participant, with the knowledge of the service delivery is required;

(D) Participate with the services coordinator in the service plan development process, and receive services in a person-centered manner that is in accordance with the approved service plan. Lead the process of service plan development when possible; and, include a representative that the individual has freely chosen, as well as other individuals chosen by the participant to contribute to the process. Person-centered services are delivered in a manner that is attentive to the participant's needs and maximizes personal independence;

(E) Have the services coordinator explain what services are available, how those services will assist the participant and what the participant's rights and responsibilities are;

(F) Request assistance with finding appropriate providers;

(G) Confirm that services were received in the manner authorized in the person-centered plan (PCP) according to Department procedures.

(H) Openly communicate with the services coordinator and receive information in a manner that is easy to understand;

(I) Meet privately with the services coordinator;

(J) Receive ongoing assistance from the services coordinator;

(K) Choose the participant's services coordinator among approved and willing services coordination options. Request changes of services coordination in accordance with availability in the service area;

(L) Make informed choices regarding the services and supports outlined in the personcentered plan (PCP), and the provider from which the participant will receive the services and supports. Access files, records or other information related to enrollment in and delivery of services under the Medicaid Home and Community-Based Services (HCBS) Waiver Program;

(M) Be assured of confidentiality of personal and sensitive health care information pursuant to relevant confidentiality and information disclosure laws;

(N) Request assistance with problems, concerns and issues, and suggest changes without fear of repercussion;

(O) Be fully informed about how to contact the services coordinator with problems, concerns, issues or inquiries;

(P) Be informed of the right to appeal decisions made by the Department about Waiver eligibility or services pursuant; and

(Q) Be informed of the right to file a formal complaint with the Department.

002.02PARTICIPANT RESPONSIBILITIES. Participants of Waiver services have the following responsibilities:

(A) Upon enrollment, the participant must sign a Waiver consent form;

(B) Participate in determinations of eligibility and enrollment in the Waiver and development and implementation of the person-centered plan (PCP), and any backup service plans. Cooperation includes providing accurate and complete information and medical history. The participant must continue to cooperate with any redetermination of eligibility or services. Lack of cooperation during the determination process may lead to denial of eligibility and enrollment;

(C) Decide who, besides the services coordinator, will participate in the service planning process;

(D) Participate in the recruitment, selection, and dismissal of providers;

(E) It is the participant's responsibility to ensure that the provider is properly trained. The participant will work with the services coordinator and their physician to ensure that the provider is properly trained to deliver Waiver services that meet the participant's specific needs. When appropriate, the participant will personally train the provider;

(F) Not direct the service provider to provide a service, perform a function, or take any action that is not permitted under Medicaid rules and regulations and all other applicable laws, rules, regulations, or that has not been authorized by the Department or the contracted agency;

(G) Notify the services coordinator within 10 calendar days when a change in provider or services is desired. Notification must include the proposed end date of the former provider or service, and the proposed start date of the new provider or service;

(H) Authorize the exchange of information for development of the service plan with all of the participant's service providers, and in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations set forth in 45 Code of Federal Regulations (CFR) parts 160 and 164 and the Medicaid safeguarding information requirements set forth in 42 CFR 431.000 to 431.306 along with Neb. Rev. Stat. § 68-312 to 68-314;

(I) Communicate to the provider personal preferences about the duties, tasks and procedures to be performed, and when appropriate, about provider performance concerns;

(J) Report to, and work with, the services coordinator to resolve problems and concerns with any service delivery issues including, but not limited to, service disruption, complaints and concerns about the provider, or health and safety issues;

(K) Keep scheduled appointments and notify the provider and Services Coordinator if a scheduled visit or service is going to be missed;

(L) Treat the services coordinator and providers with respect;

(M) Provide a safe environment in which services can be delivered;

(N) Report to the services coordinator within 10 calendar days, any significant changes in the participant's condition, living arrangements, or circumstances; and

(O) Refuse to participate in dishonest or illegal activities involving providers. Report dishonest or illegal activities to the services coordinator; and

(P) Validate service delivery in accordance with Department procedures, including but not limited to, the date and location of service delivery, arrival and departure times of the provider, and verification of service delivery by both the provider and the participant, or their authorized representative.

480 Neb. Admin. Code, ch. 3, § 002

Adopted effective 11/26/2014.

Amended effective 10/3/2021