Participants Rights And Responsibilities

Your Rights and Responsibilities

At CalOptima PACE, we are dedicated to providing you with quality health care services so you may remain as independent as possible. Our staff is committed to treating each and every participant with dignity and respect, and ensuring that all participants are involved in planning for their care and treatment.

As a CalOptima PACE participant, you have the following rights:

YOU HAVE THE RIGHT TO BE TREATED WITH RESPECT.

You have the right to be treated with dignity and respect at all times, have all of your care kept private, and receive compassionate, considerate care. You have the right to:

  • Receive your health care in an accessible manner and in a safe, clean environment.
  • Be free from harm. Harm includes physical or mental abuse, neglect, excessive medications, physical punishment or being placed by yourself against your will, as well as any physical or chemical restraint used on you for discipline or convenience of staff that you do not need to treat your medical symptoms or prevent injury.
  • Be free from hazardous procedures.
  • Receive treatment and rehabilitation services designed to promote your functional ability to the optimal level and to encourage your independence.
  • Receive care from professionally trained staff that has the education and experience to carry out the services for which they are responsible.
  • Participate in a program of services and activities that promote positive attitudes on usefulness and capabilities and are designed to encourage learning, growth and awareness of constructive ways to develop your interests and talents.
  • Self determination within the day care setting, including the opportunity to: 1)Participate in developing a plan for services; 2)Decide whether or not to participate in any given activity; 3)Be involved to the extent possible in program planning and operation.
  • To be cared about in an atmosphere of sincere interest and concern in which needed support and services are provided.
  • Be ensured of auditory and visual privacy during all health care examinations and treatment visits.
  • Be encouraged and assisted to exercise your rights in CalOptima PACE.
  • Receive assistance, if you need it, to use the Medicare and Medi-Cal complaint and appeal processes, and your civil and other legal rights.
  • Be encouraged and helped in talking to CalOptima PACE staff about voicing your complaints and recommending changes in policies and services to CalOptima PACE staff and to outside representatives of your choice. There will be no restraint, interference, coercion, discrimination or reprisal by our staff if you do so.
  • Use a telephone while at the CalOptima PACE Center, make and receive confidential calls and/or have such calls made, if necessary.
  • Not have to do work or services for CalOptima PACE.

YOU HAVE A RIGHT TO PROTECTION AGAINST DISCRIMINATION.

Discrimination is against the law. Every company or agency that works with Medicare and Medi-Cal must obey the law. They cannot discriminate against you because of your:

  • Race
  • Ethnic origin
  • National origin
  • Religion
  • Age
  • Sex
  • Sexual orientation
  • Mental or physical disability
  • Source of payment for your health care (for example, Medicare or Medi-Cal)

As a participant of CalOptima PACE, you have the right to receive competent, considerate, respectful care from staff and contractors without regard to race, national/ethnic origin, religion, age, sex, sexual orientation, mental or physical disability, or source of payment for your health care.

If you think you have been discriminated against for any of these reasons, contact a staff member at CalOptima PACE to help you resolve your concerns.

If you have any questions, you can call the Office for Civil Rights toll-free at 1-800-368-1019. TDD/TTY users should call 1-800-537-7697.

YOU HAVE A RIGHT TO INFORMATION AND ASSISTANCE.

You have the right to receive accurate, easy to understand information and to have someone help you make informed health care decisions. You have the right to:

  • Have someone help you if you have a language or communication barrier in order that you can understand all information provided you.
  • Have someone interpret all information given to you into your preferred language in a culturally competent manner, if your first language is not English and you cannot speak English well enough to understand the information being given to you.
  • Have the Enrollment Agreement discussed fully and explained to you in a manner you understand.
  • Receive marketing materials and CalOptima PACE Rights in English and any other frequently used language in your community. You can also receive these materials in Braille, if necessary.
  • Receive a written copy of your rights from CalOptima PACE. CalOptima PACE will post these rights in a public place in the CalOptima PACE Center where it is easy to read them.
  • Be fully informed, in writing, of the services offered by CalOptima PACE. This includes telling you which services are provided by contractors instead of the CalOptima PACE staff. You will be given this information before you join CalOptima PACE, at the time you join and when there is a change in services.
  • Review, with assistance if needed, the results of the most recent review of CalOptima PACE. Federal and State agencies review all PACE programs. You also have a right to review how CalOptima PACE plans to correct any problems that are found at inspection.

YOU HAVE A RIGHT TO A CHOICE OF PROVIDERS.

  • You have the right to choose a health care provider within the CalOptima PACE network and to receive quality health care.
  • Women have the right to get services from a qualified women’s health care specialist for routine or preventive women’s health care services.

YOU HAVE A RIGHT TO ACCESS EMERGENCY SERVICES.

You have the right to receive emergency services when and where you need them without CalOptima PACE approval. A medical emergency is when you think your health is in serious danger – when every second counts. You may have a bad injury, sudden illness or an illness quickly getting much worse. You can get emergency care anywhere in the United States.

YOU HAVE A RIGHT TO PARTICIPATE IN TREATMENT DECISIONS.

You have the right to fully participate in all decisions related to your health care. If you cannot fully participate in your treatment decisions or you want to have someone you trust help you, you have the right to choose that person to act on your behalf. You have the right to:

  • Have all treatment options explained to you in a language you understand, be fully informed of your health and functional status and how well you are doing, and make health care decisions.
  • Be informed of all treatment prescribed by the interdisciplinary team prior to being treated, when and how services will be provided, and the names and functions of people providing your care.
  • Refuse treatment or medications. If you choose not to receive treatment, you must be told how this will affect your health.
  • Be assured that decisions regarding your care will be made in an ethical manner.
  • Be assured that you and your family will be educated about an illness affecting you so that you can help yourself, and your family can understand your illness and help you.
  • Receive information on advance directives and have CalOptima PACE help you create an advance directive. An advance directive is a written document that says how you want medical decisions to be made in case you cannot speak for yourself.
  • Participate in making and carrying out your plan of care, which will be designed to promote your functional ability to the highest level and encourage your independence. You can ask for your plan of care to be reviewed at any time. You also can request a reassessment by the interdisciplinary team at any time.
  • Appeal any treatment decision made by CalOptima PACE or our contractors through our appeals process and request a State hearing.
  • Be given advance notice, in writing, of any plan to move you to another treatment setting, and the reason you are being moved.

YOU HAVE A RIGHT TO HAVE YOUR HEALTH INFORMATION KEPT PRIVATE.

You have the right to:

  • Talk with health care providers in private and have your personal health care information kept private as protected under state and federal laws.
  • Review and receive copies of your medical records and request amendments to those records.
  • Be assured that all information contained in your health record will be held in confidence, including information contained in any automated data bank. CalOptima PACE will require your written consent for the release of information to persons not otherwise authorized under law to receive it. You may provide written consent, which limits the degree of information and the persons to whom information may be given.
  • Be assured of confidentiality when accessing Sensitive Services such as Sexually Transmitted Disease (STD) and HIV testing.
  • There is a new participant privacy rule that gives you more access to your own medical records and more control over how your personal health information is used. If you have any questions about this privacy rule, you may call the Office for Civil Rights toll-free at 1-800-368-1019. TDD/TTY users should call 1-800-537-7697.

YOU HAVE A RIGHT TO FILE A COMPLAINT.

You have a right to complain about the services you receive, or that you need and do not receive, about the quality of care, or any other concerns or problems you have with CalOptima PACE. You have the right to a fair and timely process for resolving concerns with CalOptima PACE. You have the right to:

  • A full explanation of the complaint and appeals process.
  • Assistance to exercise civil, legal and participant rights, including the CalOptima PACE grievance process, the Medi-Cal State hearing process and the Medicare and Medi-Cal appeals processes.
  • Be encouraged and helped to freely explain your complaints to CalOptima PACE staff and outside representatives of your choice. You must not be harmed in any way for telling someone your concerns. This includes being punished, threatened or discriminated against.
  • Appeal any treatment decision by CalOptima PACE, staff or contractors.

YOU HAVE A RIGHT TO LEAVE THE PROGRAM.

If for any reason you do not feel that CalOptima PACE is what you want, you have the right to leave the program at any time.

If you feel any of your rights have been violated, please report them immediately to your social worker or call our office during regular business hours at:

1-714-468-1100 or Toll-Free 1-855-785-2584

If you want to talk with someone outside of CalOptima PACE about your concerns, you may call:

1-800-MEDICARE (1-800-633-4227), or 1-888-452-8609 (Department of Health Care Services Office of the Ombudsman)

Date Revised June 7, 2017

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