LAC 50:XXXIII.107. Enrollee Rights and Responsibilities

A. The enrollee’s rights shall include, but are not limited to the right to: 1. participate in treatment decisions, including the right to: a. refuse treatment; b. seek second opinions; and c. receive assistance with care coordination from the primary care providers (PCP’s) office or the enrollee's behavioral health provider; 2. express a concern about their provider or the care rendered via a grievance process; 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. receive a response about a grievance or appeal decision within a reasonable period of time determined by the department; 5. receive a copy of his/her medical records; 6. be furnished health care services in accordance with federal regulations, including those governing access standards; 7. choose a participating network health care professional in accordance with federal and state regulations; and 8. be allowed to receive a specialized service outside of the network if a qualified provider is not available through the network. B. The Medicaid recipient/enrollee’s responsibilities shall include, but are not limited to: 1. informing their MCO or CSoC contractor of the loss or theft of their Medicaid identification card; 2. presenting their identification card when accessing behavioral health services; 3. being familiar with their MCO’s or CSoC contractor’s procedures to the best of his/her abilities; 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. providing participating network providers, or any other authorized provider, with accurate and complete medical information; 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. 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. accessing services only from specified providers contracted with their MCO or CSoC contractor.