9712 PARTICIPANT RIGHTS AND RESPONSIBILITIES

9712.1 Each ADHP provider shall develop a written statement of the participant’s rights and responsibilities consistent with the requirements of this section, which shall be given to each participant in advance of receiving services.

9712.2 The written statement of the participant’s rights and responsibilities shall be prominently displayed at the provider’s business location and available at no cost upon request by the general public.

9712.3 Each participant shall have the following rights:

1. (a) To be treated with courtesy, dignity and respect;
2. (b) To participate in the planning of his or her care and treatment;
3. (c) To receive treatment, care, and services consistent with the person-centered service plan and to have the ADHP plan of care modified for achievement of outcomes;
4. (d) To receive services by competent provider personnel who can communicate with the participant in accordance with the Language Access Act of 2004, effective June 19, 2004 (D.C. Law 15-167; D.C. Official Code §§ 2-1931 et seq.);
5. (e) To refuse all or part of any treatment, care, or service and be informed of the consequences;
6. (f) To be free from mental and physical abuse, neglect and exploitation from persons providing services;
7. (g) To be assured of the privacy of protected health and financial information in accordance with all the provisions of applicable District and federal laws;
8. (h) To voice a complaint or grievance about treatment, care, or lack of respect for personal property by persons providing services without fear of reprisal;
9. (i) To have access to his or her records;
10. (j) The right to participate in activities and receive services in a fully integrated setting to the same extent as people not receiving Medicaid Health Care Benefit Services;

(k) To be informed orally and in writing of the following:

(1) Services to be provided, including any limits;

(2) Amount charged for each service, the amount of payment required from the participant and the billing procedures, if applicable;

(3) Whether services are covered by health insurance, Medicare, Medicaid, or any other third party sources;

(4) Acceptance, denial, reduction or termination of services with notices to be issued at least fifteen (15) days before the effective date of reduction or termination;

(5) Complaint and appeal procedures including contact information about agencies or programs that can respond to complaints such as the Ombudsman's office, or the District's Protection and Advocacy Program for Individuals with Disabilities;

(6) Name, address and telephone number of the Provider;

(7) Telephone number of the District of Columbia Medicaid fraud hotline;

(8) Participant's freedom from being forced to sign for services that were not provided or were unnecessary; and

(9) A statement, provided by DHCF, defining health care fraud and ways to report suspected fraud.

9712.4 Each participant shall be responsible for the following:

(a) Treating all ADHP personnel with respect and dignity;

(b) Providing accurate information when requested;

(c) Informing provider personnel when instructions are not understood or cannot be followed;

(d) Cooperating in making a safe environment for care within the ADHP site; and

(e) Reporting suspected fraud, waste and abuse.

9712.5 Each provider shall take appropriate steps to ensure that each participant, including participants who cannot read or those who have a language or a communication barrier, has received the information required pursuant to this section.

9712.6 Each Provider shall document in the participant's records, described under Section 9713, the steps taken to ensure that each participant has received the information.

SOURCE: Final Rulemaking published at 63 DCR 1031 (January 29, 2016).