Rights and Responsibilities

First Choice VIP Care Plus (Medicare-Medicaid Plan) must honor your rights as a member of the plan.

Rights

• You have the right to get information from First Choice VIP Care Plus in a way that works for you (in languages other than English, in Braille, in large print, or other alternate formats).
• You have the right to be treated with fairness and respect at all times.
• You have the right to get timely access to your covered services and drugs.
• You have the right to have the privacy of your personal health information protected.
• You have the right to get information about the plan, its network of providers, and your covered services.
• You have the right to make decisions about your care and for First Choice VIP Care Plus to support those decisions.
• You have the right to make complaints and to ask us to reconsider decisions we have made.
• You have the right to disenroll from the plan.
• You have the right to know your treatment options and participate in decisions about your health care.
• You have the right to give instructions about what is to be done if you are not able to make medical decisions for yourself.
• You have the right to make complaints and to ask us to reconsider decisions we have made.
• You have the right to be treated with dignity and respect.
• You have the right to be afforded Privacy and confidentiality in all aspects of care and for all health care information, unless otherwise required by law.
• You have the right to be provided a copy of your medical records, upon request, and to request corrections or amendments to these records, as specified in 45 C.F.R. part 164.
• You have the right not to be discriminated against based on race, ethnicity, national origin, religion, sex, age, sexual orientation, medical or claims history, mental or physical disability, genetic information, or source of payment.
• You have the right to have all plan options, rules, and benefits fully explained in a manner appropriate to your condition, including through use of a qualified interpreter if needed.
• You have the right to access to an adequate network of primary and specialty Providers who are capable of meeting your needs with respect to physical access, and communication and scheduling needs, and are subject to ongoing assessment of clinical quality including required reporting.
• You have the right to choose a plan and Provider at any time, including a plan outside of the demonstration, and have that choice be effective the first calendar day of the following month.
• You have the right to have a voice in the governance and operation of the integrated system, Provider or health plan, as detailed in this three-way contract.
• You have the right to participate in all aspects of care, including the right to refuse treatment, and to exercise all rights of Appeal.
• You have a responsibility to be fully involved in maintaining your health and making decisions about your health care, including the right to have advanced directives and to refuse treatment if desired, and must be appropriately informed and supported to this end. Specifically:
• • You have the right to receive a Health Risk Assessment (HRA) upon enrollment in a plan and to participate in the development and implementation of an ICP. The assessment must include considerations of social, functional, medical, behavioral, wellness and prevention domains, an evaluation of the your strengths and weaknesses, and a plan for managing and coordination of your care. You or your designated representative, also have the right to request a reassessment by the interdisciplinary team, and be fully involved in any such reassessment.
  • You have the right to receive complete and accurate information on your health and Functional Status by the interdisciplinary team.
  • You have the right to be provided information on all program services and health care options, including available treatment options and alternatives, presented in a culturally appropriate manner, taking into consideration your condition and ability to understand. A participant who is unable to participate fully in treatment decisions has the right to designate a representative. This includes the right to have translation services available to make information appropriately accessible. Information must be available before enrollment, at enrollment, and at the time a participant's needs necessitate the disclosure and delivery of such information in order to allow the participant to make an informed choice.

• You have the right to be encouraged to involve caregivers or family members in treatment discussions and decisions.
• You have the right to have an Advance Directives explained and to establish them, if you so desire, in accordance with 42 C.F.R. §§489.100 and 489.102.
• You have the right to receive reasonable Advance Notice, in writing, of any transfer to another treatment setting and the justification for the transfer.
• You have the right to be afforded the opportunity file an Appeal if services are denied that he or she thinks are medically indicated, and to be able to ultimately take that Appeal to an independent external system of review.
• You have the right to receive medical and non-medical care from a team that meets the your needs, in a manner that is sensitive to the your language and culture, and in an appropriate care setting, including the home and community.
• You have the right to be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, a perceived safety measure, or retaliation.
• You are free to exercise your rights and that the exercise of those rights does not adversely affect the way the plan, and its Providers or the State Agency treat you.
• You have the right to receive timely information about plan changes. This includes the right to request and obtain the information listed in the Orientation materials at least once per year, and, the right to receive notice of any significant change in the information provided in the Orientation materials at least thirty (30) calendar days prior to the intended effective date of the change.
• You have the right to be protected from liability for payment of any fees that are the obligation of the plan.
• You have the right to not to be charged any Cost Sharing for Medicare Parts A and B services.

You also have responsibilities as a plan member.

Responsibilities

• If you have any other health insurance coverage or prescription drug coverage in addition to our plan, you are required to tell us.
• Tell your health care providers that you are enrolled in our plan. Show your plan membership card whenever you get your medical care or Part D prescription drugs.
• Help your providers help you by giving them information, asking questions, and following through on your care.
• Be considerate. We expect all our members to respect the rights of other patients. We also expect you to act in a way that helps the smooth running of your provider's office, hospitals, and other offices.
• Make timely payment. As a plan member, you are responsible for these payments.
• Read the Member Handbook (PDF) to learn what is covered and what rules you need to follow to get covered services and drugs.
• Participate in an initial health screen upon enrollment in the plan and a comprehensive assessment within the first 60 or 90 days of enrollment.
• Tell us if you move. If you are going to move, it's important to tell us right away. Call 1-888-978-0862 (TTY/TDD 711), 8 a.m. to 8 p.m., seven days a week.