482 Neb. Admin. Code, ch. 7, § 002

Current through September 17, 2024

Section 482-7-002 - RIGHTS AND RESPONSIBILITIES

The following rights and responsibilities apply to a member participating in Heritage Health. The health plans haves the requirement to inform the member, in writing and verbally, regarding their rights and responsibilities. No person may be subjected to discrimination in any Departmental program or activity based on their race, color, sex, age, national origin, religious creed, political beliefs, or disability.

002.01MEMBER RIGHTS. The member has the right to:

(A) Be treated with respect, dignity, and without discrimination or retaliation;

(B) Be given information about their illness, or medical condition; understand the treatment options, risks and benefits; and make an informed decision about whether they will receive treatment;

(C) Participate in decisions about their healthcare including the right to refuse treatment;

(D) Talk with their doctor and health plan and know their medical information will be kept confidential;

(E) Choose their health plan and primary care physician provider;

(F) Have access to their health plan and primary care provider;

(G) Receive medical care in a timely manner;

(H) Request a copy of their medical record and request changes to their medical record;

(I) Make a complaint about the provider or health plan, and receive a timely response;

(J) Receive information on the medical services provided by their health plan;

(K) Change their primary care provider at any time;

(L) Change their health plan within 90 days of initial enrollment or every 12 months without cause thereafter;

(M) Have Heritage Health and health plan materials explained or interpreted;

(N) Have interpreters at no cost, if necessary, during medical appointments and in all discussions with their primary care provider or health plan;

(O) Request an appeal if services are denied, terminated, or reduced;

(P) Make advance directives, if desired, and receive assistance if needed; and

(Q) Receive proper medical care twenty-four (24) hours a day, seven (7) days a week.

002.02MEMBER RESPONSIBILITIES. The member has the responsibility to:

(A) Understand, to the best of his or her ability, how Heritage Health is used to receive health care;

(B) Choose a primary care provider within the health plan's network;

(C) Take their Medicaid ID card and health plan ID card to all medical appointments and to the pharmacy for prescriptions;

(D) Keep their scheduled appointments;

(E) Call their doctor's provider's office at least 24 hours in advance if their appointment must be rescheduled;

(F) Tell their doctor about any medical problems;

(G) Ask questions about things they do not understand;

(H) Follow the provider's orders and advice;

(I) Assist with the transfer of their medical records;

(J) Receive services from their primary care provider unless referred elsewhere by their primary care provider; and

(K) Cooperate with all Heritage Health inquiries and surveys.

002.03PROVIDER RIGHTS AND RESPONSIBILITIES. Providers participating in Heritage Health or Dental Benefits Manager have the same rights and responsibilities as any Medicaid enrolled provider pursuant to Title 471 NAC.

482 Neb. Admin. Code, ch. 7, § 002