Rights as A Participant

As a participant of services, participants have specific rights. They are:

Civil and Personal Rights

·        The right to be treated with dignity and respect;

·        The right to be free from threats and intentional injury;

·        The right not to be discriminated against based on race, ethnicity, national origin, religion, gender, age, current or anticipated mental or physical disability, sexual orientation, genetic information, or source of payment;

·        The right not to be filmed, taped, or photographed without your consent;

·        The right to have information provided in a language or method you understand.

Rights About Applying for Services

·        The right to have personal, medical, and financial information held confidential and private unless otherwise specified by law;

·        The right to be informed about programs for which you may be eligible;

·        The right to oral and written notice about eligibility, including the reasons for the decision and description of appeal rights from the Department of Public Welfare’s fair hearing procedures;

·        The right to oral and written notice of the outcome of an eligibility interview - and the reasons for the decision - if it results in a change in services (for example, increased, decreased, or terminated services);

·        The right to have an initial eligibility determination within 90 days of application;

·        The right to have a functional and financial eligibility screening for publicly funded long-term care services and the right to be told of the outcome of the screening.

Rights About the Process Used to Determine Your Services

·        The right to accurate, unbiased information and assistance;

·        The right to accept or refuse any information, referrals, or services if you are your own legal decision maker;

·        The right to have an in-home interview within seven working days after a request for services is made;

·        The right to choose a service coordination agency and service coordinator (SC);

·        The right to be involved in developing your service plan;

·        The right to include friends, family or others of your choosing to be included in your service planning activities, decision-making, and service delivery;

·        The right to request the involvement of a Registered Nurse (RN) in the service planning process.

Rights About Getting Services

·        The right to have input on the services you get based on an individual service plan, described in writing that includes the supports, services, and resources needed to meet your goals;

·        The right to choose a provider (or, at your request, to have a provider chosen for you). You are not required –nor can you be forced -- to use a specific provider or to use one provider for all services;

·        The right to ask for a change of provider, for any reason, at any time, through your SC;

·        The right to see your personal record and to ask that it be changed;

·        The right to an alternative accessible format, including cognitively accessible formats, and/or reasonable accommodations when seeking assistance from the Service Coordination Agency. (Such modifications may include, but not be limited to, interpreters – including American Sign Language, taped material, and adaptive devices/technology.)

Right to File A Complaint

·        The right to file a complaint about your services with either your service coordinator or with the Office of Long-Term Living.

Right to File a Grievance – Timely Access to Formal Hearings

·        The right to file a grievance about any service, including eligibility determinations for Medicaid Waiver services or state-funded programs, or get a hearing in accordance with procedures set forth under 55 Pa. Code, Chapter 275 (relating to appeal and fair hearing);

·        The right to timely access to a formal administrative hearing as required by Medicaid rules.

·        The right of not having to file a complaint within the Office of Long-Term Living before filing a grievance.

Responsibilities as A Participant

There are specific responsibilities you must meet when you apply for or get services provided through the Office of Long-Term Living. If you do not meet these responsibilities, you may lose your services. Your responsibilities include:

·        To treat service coordinators (SCs) and direct care workers, providers, and others with respect and dignity;

·        To not engage in behavior that puts you or others at risk – if you put your health and safety or the health and safety of others at risk, you may lose your services;

·        To give accurate and timely information to your SC to help in the eligibility determination process and service plan development;

·        To provide information about other services you have in place that are paid for by other programs, such as Medicare or private insurance;

·        To use informal supports, including your family, friends, neighbors, or other support system to help you whenever possible;

·        To be active in making decisions and looking for and picking resources that best meet your needs;

·        To adhere to program requirements - failure to do so may result in loss of services;

·        To tell your service provider when you are unable to keep scheduled appointments, or when you will be hospitalized or away from home for a significant period of time;

·        To give documentation of eligibility-related items, when asked as a condition of getting or continuing to get services;

·        The legal responsibility, under penalty of law, to be truthful, accurate, and complete when giving information needed for eligibility determination, as attested to on the relevant program forms;

·        To allow all on-site monitoring visits by the SC;

·        To submit accurate time sheets and to report potential fraud and abuse;

·        To have an individual back-up plan for times when your direct care worker is not available.

For Financial Eligibility Determination, Your Responsibilities as a Participant include:

·        To tell the County Assistance Office (CAO) and your SC of any private health insurance you have. (You must use private insurance to pay your medical bills before these expenses are charged to a state or Medicaid program. You must also let the county know when you are no longer covered under private insurance.);

·        To tell the CAO when there are changes in your medical costs. (For example, these changes might include when your condition changes, your doctor no longer feels it is necessary to purchase drugs or when there is no longer a need to pay for therapy because private insurance has begun to pay for it.);

·        To tell the CAO if you give assets to another person (including but not limited to money, property, monetary gifts, etc.). This may affect your eligibility for Medicaid waiver programs;

·        To report to the CAO changes in finances, which may affect your eligibility or the amount of benefits or services you receive. Check with your local CAO for details. (These changes might include an increase or decrease in your income or a change in the amount of assets you have; it might also include receiving an inheritance.);

·        To report to the CAO changes in household circumstances, which might affect your eligibility for the amount of benefits or services that you receive. (These changes may include when any of your children reach 18 years of age, when someone moves in or out of the household, marital status, or when you or any other household occupant becomes pregnant or has a baby.);

·        To report to your SC and the CAO a change in address, contact information, and any other pertinent information that may affect eligibility or service delivery.

Participant Choice

Do I Have a Choice of How I Get Services and Where I Get Them From?

·        Yes, you have the right to choose how and where you will get services. You may choose to either receive services in your home or to enter a nursing facility.

·        If you decide to get services in your home, you will work with your service coordinator (SC) to make decisions about who will give those services to you.

·        You may choose your provider from a list of agencies that are qualified to provide your services.

·        You may also choose to “self-direct” your services. If you decide to self-direct, you are the employer of your direct care workers and are responsible to hire, train, and supervise your own workers.

·        Your SC will give you a Service Provider Choice Form. The form includes more information about the right to choose your own providers and the right to self-direct.

Do I Have to Use a Provider that my Service Coordinator (SC) Suggests?

·        No, you do not have to use a provider that your SC suggests.

·        You can choose from a complete list of qualified agencies to provide your services.

·        You also can self-direct your services.

Can I Choose Any Provider?

·        You can choose from a list of agencies that are qualified to perform the services you have listed on your Individual Service Plan.

·        If you choose to self-direct, you are responsible for hiring, training, and supervising the direct care worker you have hired to provide your services.

Can I Choose Any Service?

·        You can choose services available in your program based on your assessed needs as identified in your Individual Service Plan.

Who Do I Contact if I’m Being Denied a Choice of Providers?

·        You should first contact your SC to share your concerns.

·        If you are not satisfied after talking to your SC, contact the Mississippi Division of Medicaid, between 8:00 a.m. and 4:30 p.m., Monday through Friday.

o  Toll-free: 800-421-2408

o  Phone: 601-359-3789

o  Fax: 601-359-5252

o  Mailing address: 550 High Street, Suite 1000, Jackson, MS 39201