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Member Rights and Responsibilities

Members of Commonwealth Care Alliance’s (CCA’s) programs have the following rights and responsibilities in addition to the Notice of Privacy Practices which describes how medical information about the member may be used and disclosed and how the member can get acces to this information:

  1. Right to be informed of their rights and protections
    • Commonwealth Care Alliance has established member rights and protections which they are free to exercise without fear of negative consequences.
    • Commonwealth Care Alliance notifies members of their rights and protections at least annually, in a manner appropriate to their condition and ability to understand. Members have the right to receive information including all enrollment notices, informational materials, and instructional materials in a manner and format that may be easily understood. Alternative formats include but are not limited to materials printed in larger font and interpreted into different languages or other alternate formats.
    • Members are informed about changes or updates to their rights and protections within a reasonable time frame but no more than 120 days.
  2. Right to be treated with fairness and respect
    • Members have the right to be treated with dignity, respect and fairness at all times and with due consideration for their dignity and privacy.
    • Commonwealth Care Alliance does not discriminate against a member due to medical condition (including physical and mental illness), claims experience, receipt of healthcare, medical history, genetic information, evidence of insurability, race, color, age, gender, religion, national origin, or any disability.
    • If a member needs assistance with communication, such as a language interpreter or a document translation, he/she should call Commonwealth Care Alliance’s Member Services department.
    • Members have the right to be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation.
  3. Right to privacy of and access to medical records
    • Federal and state laws protect the privacy of a member’s medical records.
    • Any personal information provided to Commonwealth Care Alliance upon enrollment and thereafter is protected.
    • The laws that protect a member’s privacy provide rights related to receiving information and the manner in which information is used.
    • Members have the right to request and receive a copy of their medical record, including in electronic form when available, and request that the record be amended or corrected.
  4. Right to see plan providers, receive covered services and have prescriptions filled within a reasonable period of time
    • Members have the right to choose a plan provider. Commonwealth Care Alliance will inform members on which providers are accepting new patients.
    • Members have the right to visit a women’s health specialist without a referral.
    • Members have the right to access their providers in a timely manner and to see specialists when care from a specialist is needed.
    • Members have the right to timely access to prescriptions at any network pharmacy.
    • Timely access means that a member may receive an appointment or services within a reasonable amount of time.
  5. Right to know treatment choices and participate in decisions about healthcare
    • Members have the right to receive full information from their providers presented in a manner appropriate to the members’ condition and ability to understand.
    • Members have the right to participate fully in decisions regarding their healthcare.
    • A member’s rights include being fully informed of the recommended treatment choices, irrespective of cost or coverage by Commonwealth Care Alliance.  This includes the right to be informed of the different Medication Management Treatment Programs Commonwealth Care Alliance offers.
    • Members have the right to be informed about any risks involved in their care.
    • Members must be told in advance if any proposed medical care or treatment is part of a research experiment and be given the choice of refusing experimental treatments.
    • A member has the right to receive a detailed explanation from Commonwealth Care Alliance if he/she believes that a plan provider has denied care that he/she believes he/she is entitled to receive.
    • A member has the right to refuse treatment including the right to leave a hospital or other medical facility, even if a doctor advises the member not to leave. If a member refuses treatment, the member accepts responsibility for his/her health as a result of refusing treatment.
    • One Care and Senior Care Options (SCO) members have the right to information regarding the resources and options available for personal care supports and to voluntarily choose between a self-directed or agency model for services.
  6. Right to use advance directives
    • A member has the right to ask someone, such as a family member or friend, to assist the member with decisions about his/her healthcare.
    • A member has the right to give his/her doctors written instructions about how he/she wishes them to handle his/her medical care if he/she becomes unable to make decisions.
    • If a member decides that he/she does not wants to utilize Massachusetts’ Medical Order for Life Sustaining Treatment (MOLST) form as the advance directive, there may be several other avenues to pursue creating an advanced directive and they should contact appropriate legal services for advice.
    • According to the law, no one can deny a member care or discriminate against a member based on whether or not a member has signed an advance directive. If a member has signed an advance directive and he/she believes that a doctor or hospital has not followed the instructions, the member may file a complaint with the Massachusetts Department of Public Health, Office of Patient Protection.
  7. Right to make a complaints
    • A member has the right to make a complaint if he/she has concerns or problems related to the coverage or care received.
    • Commonwealth Care Alliance treats all members fairly, even if a member makes a complaint.
    • The member has the right to receive a summary of information about the appeals and grievances that members have filed against Commonwealth Care Alliance.
  8. Right to receive Information on Grievances and Appeals Rights
    • Members are informed, at least annually, about their grievance and appeal rights.
  9. Right to receive Information about Healthcare coverage
  10. Right to be informed that they will not be billed
    • Upon enrollment, Commonwealth Care Alliance informs enrollees about their right not to be balance-billed by a provider for any service.
  11. Right to receive information about Commonwealth Care Alliance, SCO, One Care, Plan Providers, Drug Coverage, and Costs
    • Members have the right to request and receive information from Commonwealth Care Alliance regarding Commonwealth Care Alliance, the SCO or One Care program including information about the financial condition, healthcare providers and their qualifications and about how SCO and One Care compares to other health plans.  Members have the right to know from Commonwealth Care Alliance the manner in which providers are reimbursed.
    • Members have the right to request and receive information regarding the Part D program including information about Commonwealth Care Alliance’s network pharmacies.
    • In order to receive this information in alternate formats, a member is to call Member Services.
  12. Right to reasonable accommodation
    • Commonwealth Care Alliance informs members of their right to reasonable accommodation as provided by law and makes reasonable accommodation means available to its members.
    • Steps to be taken by a member if he/she feels that he/she has been treated unfairly or rights have not been respected, depending on the situation:
      • If a member thinks that he/she has been treated unfairly due to medical condition, claims experience, receipt of healthcare, medical history, genetic information, evidence of insurability, race, color, national origin, gender, sexual orientation, disability, age or religion, Commonwealth Care Alliance should be contacted or the Office for Civil Rights may be contacted.
      • For other concerns or problems a member may call Member Services.
  13. Along with rights, members have some responsibilities including:
    • To become familiar with coverage and rules that a member must follow;
    • To give his/her doctor and other providers the information needed to provide care to him/her and to follow treatment plans and instructions received;
    • To act in a way that supports the care given to other patients and helps the smooth running of a member’s doctor’s office, hospitals and other offices;
    • To inform Member Services of any questions, concerns, problems or suggestions that a member may have.
  14. Commonwealth Care Alliance staff receives training about members’ rights and are responsible for implementing relevant procedures.

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Last Updated 01/01/2016