1. A. The enrollee’s rights shall include, but are not limited to the right to:

   1. 1. participate in treatment decisions, including the right to:

      1. a. refuse treatment;
      2. b. seek second opinions; and
      3. c. receive assistance with care coordination from the primary care providers (PCP’s) office or the enrollee's behavioral health provider;
   2. 2. express a concern about their provider or the care rendered via a grievance process;
   3. 3. appeal an MCO and CSoC contractor decision through the MCO’s and CSoC contractor’s internal process and/or the state fair hearing process;
   4. 4. receive a response about a grievance or appeal decision within a reasonable period of time determined by the department;
   5. 5. receive a copy of his/her medical records;
   6. 6. be furnished health care services in accordance with federal regulations, including those governing access standards;
   7. 7. choose a participating network health care professional in accordance with federal and state regulations; and
   8. 8. be allowed to receive a specialized service outside of the network if a qualified provider is not available through the network.

2. B. The Medicaid recipient/enrollee’s responsibilities shall include, but are not limited to:

   1. 1. informing their MCO or CSoC contractor of the loss or theft of their Medicaid identification card;
   2. 2. presenting their identification card when accessing behavioral health services;
   3. 3. being familiar with their MCO’s or CSoC contractor’s procedures to the best of his/her abilities;
   4. 4. contacting their MCO or CSoC contractor, by telephone or in writing (formal letter or electronically, including email), to obtain information and have questions clarified;
   5. 5. providing participating network providers, or any other authorized provider, with accurate and complete medical information;
   6. 6. following the prescribed treatment of care recommended by the provider or letting the provider know the reasons the treatment cannot be followed, as soon as possible;
   7. 7. making every effort to keep any agreed upon appointments and follow-up appointments and contacting the provider in advance if unable to do so; and
   8. 8. accessing services only from specified providers contracted with their MCO or CSoC contractor.

Authority Note

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.

Historical Note

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 38:361 (February 2012), amended by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office of Behavioral Health, LR 41:2354 (November 2015), amended by the Department of Health, Bureau of Health Services Financing and the Office of Behavioral Health, LR 43:322 (February 2017).