What Are My Member Rights and Responsibilities?

Rights

You, as a Member of Partners’ Health Plan, have the right to

• Get information about Partners’ structure and operations, services, providers and practitioners.
• Have member rights and responsibilities presented in a way you can understand.
• Have information presented in a culturally and linguistically appropriate way, including the right to receive oral interpreter services at no cost.
• Be treated with respect and recognition of dignity and right to privacy by Partners staff, network providers, and others who are part of your health team.
• Express freedom of speech and freedom of religious expression.
• Connect to providers in our network to get the services you need.
• Get treatment in the most natural, age-appropriate, and independent setting as possible.
• Get information about changes in benefits, services or providers. Partners will notify members in writing of any important changes to programs or services.
• Get information on available treatment options in a way you can understand.
• Make suggestions about Partners’ member rights and responsibilities policy.
• Make suggestions to us about our policies and services by calling the 24-hour, toll-free Access to Care Line at 1-888-235-HOPE (4673) (Relay NC 711 or TTY (English) 1-800-735-2962; (Spanish) 1-888-825-6570, and asking to speak to a Member Engagement Specialist. If you would prefer to email your suggestions, they can be sent to the Member Engagement department at memberquestions@partnersbhm.org or by completing our feedback form online at https://www.partnersbhm.org/feedback/. If you prefer to contact someone other than Partners, you may contact the NC Department of Health and Human Services (NC DHHS) Customer Service Center at 1-800-662-7030.
• Participate with providers and practitioners in making decisions about healthcare, including the right to refuse treatment.
• Prepare Advance Directives. These are instructions for your care if, in the future, you are unable to make decisions about your care.
• Ask questions when you do not understand your care or what you are expected to do.
• Have an open discussion with service providers or practitioners on appropriate or medically necessary treatment options for your conditions, regardless of cost or what your benefits cover. You may need to decide among related treatment options, risks, benefits and consequences, including your right to refuse treatment and to express your preferences about future treatment decisions regardless of limits of what your benefits cover.
• Voice concerns or complaints about us or the care you receive. You may voice your concerns in a confidential and secure way by filing a grievance/complaint by:
  • Telephone—1-888-235-HOPE (4673)
  • Mail – Partners Health Management, C/o Grievances/Complaints, 901 South New Hope Road, Gastonia, NC 28054
  • Email – Grievances@partnersbhm.org
  • Online – Use our feedback form https://www.partnersbhm.org/feedback/
  • Or In person – Every employee at Partners can take your grievance/complaint

• Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
• Receive a second opinion from a qualified behavioral health professional within the Partners network, or one that is out of network at no cost to the member.
• Request and receive a copy of your medical records and request a change to it.
• Disagree with what is written in your medical records. If you disagree, you have the right to write a statement to be placed in your file. However, the original notes will also stay in the record until the time for retention ends according to the MH/DD/SAS retention schedule. (11 years for adults; 12 years after a minor reaches the age of 18; 15 years for DUI records)
• You have the right to appeal if you disagree with our decision to deny, reduce, suspend, or terminate a service. An appeal is a request for review. Your provider and care coordinator can help you file a request using the Appeals Request Form.
• Have a state-level Fair Hearing.
• Take part in creating a written, person-centered treatment plan that builds on your needs, strengths and choices. A treatment plan must be put into action within 30 days after services start.
• Participate in the creation of an Individual Support Plan (ISP) to request services specific to people with IDD or a Person-Centered Plan for other services.
• Help create and update your treatment plan or ISP and consent to treatment goals in that plan.
• If you live in an Adult Care Home, you have the right to report any suspected violation of your rights to the North Carolina Division of Health Service Regulation, who oversees licensed facilities in our state. You may contact them by phone at 1-800-624-3004 or 1-919-855-4500.

Rights of Minors

Under NC state law, minors have the right to treatment for the following conditions without the consent of a parent or guardian:

• Venereal diseases
• Pregnancy
• Use of controlled substances or alcohol
• Emotional disturbances

Do I have additional rights if I have an intellectual or developmental disability?

Information about rights for individuals living with an intellectual or developmental disability is found in the Mental Health, Developmental Disabilities, and Substance Abuse Act of 1985. (1985, c. 589, s.2; 1989, c. 625, ss. 1, 2.), available on the internet at

http://www.ncga.state.nc.us/EnactedLegislation/Statutes/HTML/ByChapter/Chapter_122C.html

What are my rights if I am in a 24-hour facility?

If you live in a 24-hour facility, you have the right to

• Receive necessary medical care if you are sick. If your insurance does not cover the cost, then you will be responsible for payment.
• Send and receive unopened mail and have access to writing material, postage, and staff assistance, if requested.
• Contact and consult with the Grievance/Member Rights Coordinator at 1-888-235-HOPE (4673).
• Contact and see a lawyer, your own doctor, and other private professionals. This will be at your own expense, not at the expense of the facility.
• Contact and consult with your parent or legal guardian at any time, if you are under 18 years of age.
• Make and receive confidential telephone calls. All long-distance calls will be at your expense, not at the expense of the facility.
• Have visitors between 8:00 a.m. and 9:00 p.m. Visiting hours must be available at least six hours each day. Two of those hours must be after 6 p.m. If you are under the age of 18, visitors cannot interfere with school or treatment.
• Communicate and meet with other individuals. These meetings and communications may be supervised if your treatment team feels it is necessary.
• Make visits outside the facility, unless your Person-Centered Plan states otherwise.
• Be outside daily and have access to facilities or equipment for physical exercise several times per week.
• Have individual storage space for your private belongings.
• Keep personal possessions and clothing, except items prohibited by law.
• Keep and spend a responsible sum of your own money.
• Participate in religious worship, if you choose.
• Retain a driver’s license, unless you are prohibited to do so by a court of law.

You also have the right and responsibility to give Partners input on policies and services.

The best way to give this input is to:

• Complete Partners Needs Assessment Survey every year
• Attend Consumer and Family Advisory Committee or Human Rights Committee meetings
• Committee and meeting information can be found at www.PartnersBHM.org/consumer-family-advisory-committee/ or www.PartnersBHM.org/human-rights-committee/
• Attend a Partners Board Meeting
• Meeting information can be found at www.PartnersBHM.org/partners-board-directors/
• Submit a formal grievance/complaint
• Visit www.PartnersBHM.org/feedback and choose the submission method you prefer

Partners looks forward to your suggestions for how we can treat you, your family, and your community better. If you have questions or would like more information, call 1-888-235-HOPE (4673).

Can my rights be restricted?

Your rights can only be restricted by your treatment team for reasons related to your care or treatment. You must be part of your own treatment team and must be involved in making the decision. You have the right to have an advocate or someone you trust involved. A Human Rights Committee must approve the plan to restrict your rights. Any restriction will be documented and kept in your medical record.

What if my rights have been violated?

If you feel that your rights have been violated, Partners wants to hear from you! Please call 1-888-235-HOPE (4673), or follow the instructions on page 10 of the Member Handbook.

Exercising Your Rights

You are free to exercise all these rights. Exercising these rights will not negatively impact your access to services or the way that Partners or our network providers treat you.

RESPONSIBILITIES

In addition to your rights as a member, you can reach the best results for yourself by taking on the following responsibilities:

• Understanding your benefits and plan before receiving care.
• Always carrying your Medicaid or other insurance card with you.
• Understanding the roles of the providers and professionals who deliver your services or treatment.
• Contacting your provider when you have a concern or need help.
• Sharing the information needed for your care.
• Following the plans and instructions for care that you have agreed to with your providers.
• Using emergency room services only for injuries and illnesses that require immediate treatment.
• Understanding your health problems and taking part, as much as you can, in creating treatment goals.
• Telling the doctor or nurse about any changes in your health.
• Asking questions when you do not understand your care or what you are expected to do.
• Inviting people who will be helpful and supportive to you to be included in creating your treatment plan.
• Respecting the rights and property of other members and of provider staff
• Respecting other members’ needs for privacy.
• Working on the goals of your person-centered plan.
• Keeping all the scheduled appointments that you can.
• Canceling an appointment at least 24 hours in advance, if you cannot keep it.
• Paying for services, if payment is included in your established agreement.
• Informing staff of any medical condition that is contagious.
• Taking medications as they are prescribed for you.
• Telling your doctor if you are having unpleasant side effects from your medications, or if your medications are not helping you feel better.
• Telling your provider if you do not agree with their suggestions.
• Telling your provider when or if you want to end treatment.
• Cooperating with those trying to care for you.
• Being considerate of other members and family members.
• Seeking additional support services in your community.
• Reading, or having read to you, written notices from Partners about changes in benefits, services or providers.
• Requesting a discharge plan when you leave a provider; being sure you understand it and being committed to following it.
• Contacting our Access to Care Call Center, Monday-Saturday, 7 a.m. to 6 p.m. if you feel that your rights have been violated at 1-888-235-HOPE (4673). You may also email Member Engagement Department at memberquestions@partnersbhm.org . If you prefer to contact someone other than Partners, you may contact the NC DHHS Customer Service Center at 1-800-662-7030.