Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-538 - Managed care › Section 182-538-180 - Rights and protections

Current through Register Vol. 24-14, July 15, 2024
(1) People have
				medicaid-specific rights when applying for, eligible for, or receiving
				medicaid-funded health care services.
(2) All applicable statutory and
				constitutional rights apply to all medicaid people including, but not limited
				to:
(a) The participant rights under WAC
				246-341-0600;
(b) Applicable necessary supplemental
				accommodation services including, but not limited to:
(i) Arranging for or providing help to
				complete and submit forms to the agency;
(ii) Helping people give or get the
				information the agency needs to decide or continue eligibility;
(iii) Helping to request continuing
				benefits;
(iv) Explaining the
				reduction in or ending of benefits;
(v) Assisting with requests for
				administrative hearings; and
(vi)
				On request, reviewing the agency's decision to terminate, suspend, or reduce
				benefits.
(c) Receiving
				the name, address, telephone number, and any languages offered other than
				English of providers in a managed care organization (MCO);
(d) Receiving information about the structure
				and operation of the MCO and how health care services are delivered;
(e) Receiving emergency care, urgent care, or
				crisis services;
(f) Receiving
				poststabilization services after receiving emergency care, urgent care, or
				crisis services that result in admittance to a hospital;
(g) Receiving age-appropriate and culturally
				appropriate services;
(h) Being
				provided a qualified interpreter and translated material at no cost to the
				person;
(i) Receiving requested
				information and help in the language or format of choice;
(j) Having available treatment options and
				explanation of alternatives;
(k)
				Refusing any proposed treatment;
(l) Receiving care that does not discriminate
				against a person;
(m) Being free of
				any sexual exploitation or harassment;
(n) Making an advance directive that states
				the person's choices and preferences for health care services under 42 C.F.R.
				Sec. 489 Subpart I;
(o) Choosing a
				contracted health care provider;
(p)
				Requesting and receiving a copy of health care records;
(q) Being informed the cost for copying, if
				any;
(r) Being free from
				retaliation;
(s) Requesting and
				receiving policies and procedures of the MCO as they relate to health care
				rights;
(t) Receiving services in
				an accessible location;
(u)
				Receiving medically necessary services in accordance with the early and
				periodic screening, diagnosis, and treatment (EPSDT) program under WAC
				182-534-0100, if the person
				is age twenty or younger;
(v) Being
				treated with dignity, privacy, and respect;
(w) Receiving treatment options and
				alternatives in a manner that is appropriate to a person's condition;
(x) Being free from seclusion and
				restraint;
(y) Receiving a second
				opinion from a qualified health care professional within an MCO provider
				network at no cost or having one arranged outside the network at no cost, as
				provided in 42 C.F.R. Sec. 438.206(b)(3);
(z) Receiving medically necessary health care
				services outside of the MCO if those services cannot be provided adequately and
				timely within the MCO;
(aa) Filing
				a grievance with the MCO if the person is not satisfied with a
				service;
(bb) Receiving a notice of
				action so that a person may appeal any decision by the MCO that:
(i) Denies or limits authorization of a
				requested service;
(ii) Reduces,
				suspends, or terminates a previously authorized service; or
(iii) Denies payment for a service, in whole
				or in part.
(cc) Filing
				an appeal if the MCO fails to provide health care services in a timely manner
				as defined by the state or act within the time frames in 42 C.F.R. Sec.
				438.408(b); and
(dd) Requesting an
				administrative hearing if an appeal is not resolved in a person's
				favor.