Rights and Responsibilities of a Molina Complete Care (MCC) Member

MCC Member Rights:

  • Be treated carefully, with respect and privacy for his or her dignity and privacy.
  • Be treated fairly, whatever their:
    • Race.
    • Religion.
    • National origin.
    • Gender.
    • Age.
    • Ethnic background.
    • Disability.
    • Behavioral health condition (intellectual).
    • Sexual preference.
    • Genetic information.
    • Source or ability of payment.
  • Keep treatment and other information kept private. We share treatment records without an okay only when the law allows it.
  • Get care easily and when they need it.
  • Be able to get an emergency/replacement caregiver for critical services within two hours.
  • Learn about treatment options and in a way that:
    • Respects culture.
    • They can understand.
    • Fits their needs.
  • Take part in making their plan of care.
  • Get information in a language they can understand. Know about providers who speak languages other than English. And get things translated at no cost.
  • Get information in other ways if they ask for it.
  • Get information about MCC and its:
    • Providers.
    • Programs.
    • Services.
    • Role in the treatment process.
  • Get information about clinical rules followed in their care.
  • Ask providers about their work history and training.
  • Not be kept alone or forced to do something they do not want to do. This is based on a federal law.
  • Give their thoughts on the Rights and Responsibilities policy.
  • Ask for a certain type of provider.
  • Have their provider make care decisions based on the treatment they need.
  • Get health care services that obey state and federal laws about their rights.
  • Help make decisions about their health care. This includes the right:
    • To get a second medical opinion from a qualified health care provider within the network or have a second opinion arranged outside the network at no cost.
    • To say no to treatment. This is their right unless the court says otherwise.
  • File a complaint or grievance about:
    • MCC.
    • A provider.
    • The care they receive.
  • File an appeal about a MCC action or decision. They can ask for a State Fair Hearing if they are not happy with the result of the appeal.
  • Sign a form saying that you know your health information may be shared in a public way during the State Fair Hearing process. this applies if their provider asks for a State Fair Hearing for them. Their provider will need them to sign this form.
  • Request and receive a copy of their medical records at no cost once year:
    • If there are any changes needed to their medical records, they may request these be changed and/or amended at any time.
    • We will respond to the request within 30 days with either delivery of the medical records or a written denial that includes why the request was denied. If they receive a denial, they will get information about how to seek review of the decision.
  • Use their rights. This will not affect the way MCC and its providers treat them.
  • Get written information on advance directives and their rights under state law. We can get them information on how to create their own advance directive. (An advance directive tells doctors the kind of care they would want if you become too sick to decide.)
  • Talk with their provider about the types of treatment that are right for them. The cost or benefit coverage do not affect this.
  • Get information about how and where to access benefits from the state that are not covered under their plan. This could include cost-sharing. It could also include transportation.
  • Ask for information in a way that they can get to it easily. This applies if they have a visual, hearing or physical disability. This will help them know what benefits and services they have access to.
  • Receive information about MCC, its services, its practitioners and providers and member rights and responsibilities.
  • Be free from any form of restraint or seclusion as a means of coercion, discipline, convenience or retaliation.
  • Receive treatment for any emergency medical condition at any hospital or other setting that may lead to more harm if they don’t get treatment right away.
  • Request information about a doctor’s contract status, including physician incentive plans or other compensation arrangements, use of referral services, member survey results and whether stop-loss insurance is required. To get this information, please call Member Services at (800) 424-5891 (TTY/TDD: 711).
  • Exercise his or her rights and that the exercise of those rights shall note adversely affect service delivery to the member 42 CFR 438.100(c).

 

MCC Member Responsibilities:

  • Get treatment they need from a provider.
  • Treat with respect anyone giving them care.
  • Give providers and MCC the information they need. This helps providers give them quality care. It helps us give them the right service.
  • Ask questions about their care. This helps them and their providers understand their health problems. It helps create treatment goals and plans they agree on.
  • Follow their treatment plan. The member and their provider should agree on this plan.
  • Follow the plan for taking their medicine. The member and their provider should agree on the plan.
  • Tell their providers and PCP about changes in their medicine. This includes medicines other doctors give them.
  • Come to all their provider visits. Call their provider as soon as they know they need to cancel a visit.
  • Tell their provider when they think the treatment plan isn’t working.
  • Tell their provider if they have problems playing copays.
  • Share their worries about the quality of your care.
  • Tell someone if they suspect abuse and fraud (this is someone not being honest).
    • Call the Molina Healthcare AlertLine. They can reach this number 24 hours a day and 7 days a week.
    • They don’t have to give their name when they call.
    • All calls will be looked into and will stay private.
    • They can report fraud, waste and abuse:
    • They may also report fraud, waste and abuse to the state or federal government.