CCM Member Bill of Rights and Responsibilities

Enrollee Bill of Rights

Your Rights

You have a right to be treated with respect.

You have the right to be treated with dignity and respect at all times, to have your care kept private, and to get compassionate, considerate care from all CCM staff and contractors at all times.

You have the right:

• To get your health care in a safe, clean environment.
• To be free from harm. This includes physical or mental abuse, neglect, physical punishment, being placed by yourself against your will, excessive medication, and any physical or chemical restraint that is used on you for discipline or convenience of staff and that you do not need to treat your medical symptoms.
• To be encouraged to use your rights in CCM.
• To get help, if you need it, to use the Medicare and Medicaid complaint and appeal processes, and your civil and other legal rights.
• To be encouraged and helped in talking to CCM staff about changes in policy and services you think should be made.
• To use a telephone while at the PACE center.
• To not have to do work or services for CCM.

You have a right to protection against discrimination.

We may not discriminate against you because of your:

• Race
• Color
• National Origin
• Religion
• Age
• Sex
• Mental or physical ability
• Source of payment for your health care (For example, Medicare or Medicaid)

If you think you have been discriminated against for any of these reasons, contact a staff member at CCM to help you resolve your problem.

If you have any questions, you can call the Office of Civil Rights at 1-800-368-1019 (TYY 1-800-537-7697).

You have a right to information and assistance.

You have the right:

• To have someone help you if you have a language or communication barrier so you can understand all information given to you.
• To get accurate, easy to understand information and to have someone help you make informed health care decisions.
• To have CCM interpret the information into your preferred language in a culturally competent manner, if needed.
• To get marketing materials and this statement of your rights and responsibilities in English and in your principal language.
• To get a written copy of your rights from CCM. CCM must also post these rights in a visible, public place in the PACE center.
• To be fully informed, in writing, of the services offered by CCM. This includes telling you which services are provided by contractors instead of the CCM staff. You must be given this information before you join, at the time you join, and when there is a change in services.
• To look at, or get help to look at the results of the most recent review of CCM. Federal and State agencies review PACE programs. You also have a right to review how CCM plans to correct any problems that are found at inspection.

You have the right to a choice of providers.

You have the right to choose a health care provider within CCM’s network and to get quality health care. Women have the right to get services from a qualified women’s health care specialist for routine or preventive women’s health care services.

You have a right to access emergency services.

You have the right to get emergency services when and where you need them without CCM’s approval. A medical emergency is when you think your health is in serious danger.

You have a right to participate in treatment decisions.

You have the right to fully participate in decisions related to your health care. If you cannot fully participate in your treatment decisions or you want to have someone you trust help you, you have the right to choose that person to act on your behalf. You have the right:

• To have treatment options explained to you, to be fully informed of your health status and how well you are doing, and to make health care decisions. This includes the right not to get treatment or take medications. If you choose not to get treatment, you must be told how this will affect your health.
• To have CCM help you create an advance directive, a written document that says how you want medical decisions to be made if you lose the ability to make decisions for yourself.
• To participate in making and carrying out your plan of care. You can ask for your plan of care to be reviewed at any time.
• To request a reassessment by your Interdisciplinary Team.
• To be given advance notice, in writing, of any plan to move you to another treatment setting and the reason you are being moved.

You have a right to have your health information kept private

You have the right to talk with health care providers in private and to have your personal health care information kept private as protected under State and federal laws. You also have the right to look at and receive copies of your medical records, and to request amendments to those records. If you have any questions about privacy rules, call the Office for Civil Rights at 1-800-368-1019 (TYY 1-800-537-7697). You have the right:

• To be assured of confidential treatment of all information contained in your medical records, including information contained in an automated data bank.
• To be assured that your written consent will be obtained for the release of information to persons not otherwise authorized under law to receive it.
• To provide written consent that limits the degree of information and the persons to whom information may be given.

You have a right to file a complaint.

You have the right to complain about the services you receive or that you need and don’t receive, the quality of your care, or any other concerns or problems you have with CCM. You have the right to a fair and timely process for resolving concerns. You have the right:

• To a full explanation of the complaint process.
• To be encouraged and helped to freely explain your complaints to CCM staff and outside representatives of your choice. You must not be harmed in any way for telling someone your concerns. This includes being punished, threatened, or discriminated against.
• To appeal any treatment decision by CCM, staff, or contractors.

You have a right to leave the program.

If for any reason, you do not feel that CCM is what you want, you have the right to leave the program and may initiate disenrollment at any time. If you leave, you will still be in the Medicare and/or Medicaid programs if eligible and get Medicare and/or Medicaid-covered services. But, you will not get your Medicare and Medicaid services through CCM.

Your Responsibilities

As a member of CCM, you are responsible for:

• Being seen by your doctor if a change in your health status occurs.
• Sharing complete and accurate health information with your health care providers.
• Informing staff of any change in your health and making it known if you do not understand or are unable to follow instructions.
• Following the treatment plan recommended by CCM.
• Cooperating with and being respectful to staff, and not discriminating against staff because of race, color, national origin, religion, age, sex, or mental or physical ability.
• Notifying CCM in advance whenever you will not be home to receive services or care that have been arranged for you.
• Informing CCM before permanently moving out of the service area or any lengthy absence from the service area.
• Being responsible for your actions if you refuse treatment or do not follow CCM’s instructions.
• Being responsible for paying your financial obligations.