6 Colo. Code Regs. § 1011-1 Chapter 02, pt. 7

Current through Register Vol. 47, No. 20, October 25, 2024

Part 7 - CLIENT RIGHTS

7.1Client Rights Policy

7.1.1 The facility or agency shall develop and implement a policy regarding client rights. The policy shall ensure that each client or, where appropriate, the client's designated representative, has the right to:

(A) Participate in all decisions involving the client's care or treatment.

(B) Be informed about whether the facility or agency is participating in teaching programs, and to provide informed consent prior to being included in any clinical trials relating to the client's care.

(C) Refuse any drug, test, procedure, or treatment and to be informed of risks and benefits of this action.

(D) Receive care and treatment, in compliance with state statute, that is respectful; recognizes a person's dignity, cultural values and religious beliefs; and provides for personal privacy to the extent possible during the course of treatment.

(E) Be informed of, at a minimum, the first names and credentials of the individuals that are providing services to the client. Full names and experience of the service providers shall be provided upon request to the client or the client's designated representative.

(F) Receive, upon request:

(1) Prior to initiation of non-emergent care or treatment, the estimated average charge to the client. This information shall be presented to the client in a manner that is consistent with all state and federal laws and regulations.

(2) The facility's or agency's general billing procedures.

(3) An itemized bill that identifies treatment and services by date. The itemized bill shall enable clients to validate the charges for items and services provided and shall include contact information, including a telephone number for billing inquiries. The itemized bill shall be made available either within 10 business days of the request, or 30 days after discharge, or 30 days after the service is rendered - whichever is later.

(G) Give informed consent for all treatment and procedures. It is the responsibility of the licensed independent practitioner and other service providers to obtain informed consent for procedures that they provide to the client.

(H) Register complaints with the facility or agency and the Department and to be informed of the procedures for registering complaints including contact information.

(I) Be free of abuse and neglect.

(1) The facility or agency shall develop and implement policies and procedures that prevent, detect, investigate, and respond to incidents of abuse or neglect.

(a) Prevention includes, but is not limited to, adequate staffing to meet the needs of the clients, screening employees for records of abuse and neglect, and protecting clients from abuse during investigation of allegations.

(b) Detection includes, but is not limited to, establishing a reporting system and training employees regarding identifying, reporting, and intervening in incidences of abuse and neglect.

(2) The Facility or Agency shall investigate, in a timely manner, all allegations of abuse or neglect and implement corrective actions in accordance with such investigations.

(J) Be free from the improper application of restraints or seclusion. Restraints or seclusion shall be used only in a manner consistent with Part 8 of these rules.

(K) Expect that the facility or agency in which the client is admitted, can meet the identified and reasonably anticipated care, treatment, and service needs of the client.

(L) Care delivered by the facility or agency in accordance with the needs of the client.

(M) Confidentiality of all client records.

(N) Receive care in a safe setting.

(O) Disclosure as to whether referrals to other providers are to entities in which the facility or agency has a financial interest.

(P) Formulate advance directives and have the facility or agency comply with such directives, as applicable, and in compliance with applicable state statute.

(Q) Request that an in-network healthcare provider provide services at an in-network facility or agency if available.

7.1.2 The facility or agency shall disclose the policy regarding client rights to the client or the client's designated representative prior to treatment or upon admission, where possible. For any services requiring multiple client encounters, disclosure provided at the beginning of such care or treatment course shall meet the intent of the regulations.

7.1.3 Pursuant to Section 25-3-121, C.R.S., facilities and agencies shall provide the disclosure contained in Appendix A, at a minimum, to all clients whose comprehensive major medical health plans are regulated by the Colorado Division of Insurance, about the potential effects of receiving emergency or nonemergency services from an out-of-network facility or agency or an out-of-network provider who provides services at an in-network facility or agency.

Required disclosures by carriers and healthcare providers may be found in rules promulgated by the Department of Regulatory Agencies, Division of Insurance and Division of Occupations and Professions.

(A) The facility or agency shall provide the disclosure contained in Appendix A on the following occasions:

(1) For emergency services: After performing an appropriate medical screening examination and determining that a client does not have an emergency medical condition or after treatment has been provided to stabilize an emergency medical condition. The disclosure shall be provided to the client or their designated representative for signature prior to discharge or at the time of admission for continuing nonemergency services;

(2) For nonemergency services: prior to the provision of any services, the disclosure shall be provided to the client or their designated representative for signature.

(B) The facility or agency shall provide the disclosure contained in Appendix A minus the signature block on the following occasions:

(1) With billing statements and billing notices issued by the facility or agency; and

(2) With other forms or communications related to the services being provided pursuant to insurance coverage.

7.1.4 Each facility or agency shall post a clear and unambiguous notice in a public location in the facility or agency specifying that complaints may be registered with the facility or agency, the Department, and with the appropriate oversight board at the Department of Regulatory Agencies (DORA). Upon request, the facility or agency shall provide the client and any interested person with contact information for registering complaints.

7.2Client Grievance Mechanism

7.2.1 All facilities or agencies that have a client capacity of fifty-one (51) or higher shall have a client grievance mechanism plan that shall be submitted to the Department in the manner and form prescribed by the Department.

7.2.2Client Grievance Plan and Procedure

(A) The facility or agency shall develop and implement a written client grievance mechanism plan that shall include, but not be limited, to the following:

(1) A client care advocate that serves as a liaison between the client and the facility or agency. The plan shall describe:

(a) The qualifications, job description, and level of decision-making authority of the client care advocate.

(b) How each client will be made aware of the client grievance mechanism and how the client care advocate may be contacted.

(c) The process for receiving and investigating a client grievance in situations when the client care advocate is not available or is the subject of the grievance.

(2) The facility or agency shall implement a grievance procedure with, at minimum, the following components:

(a) The ability for clients to submit grievances, either orally or in writing, to a facility or agency staff member. If the grievance is submitted to a staff member other than the client care advocate, the staff member shall submit the grievance to the client care advocate by the next working day.

(b) Prior to initiating an investigation, the client care advocate shall contact the client within three (3) working days of receipt of the grievance to acknowledge receipt of such grievance.

(c) The client care advocate shall investigate the grievance and respond to the client in writing within fifteen (15) business days of submission of the grievance.

(d) The client care advocate shall provide the client with a final, written outcome of the investigation within a reasonable time, not to exceed thirty (30) calendar days following the client care advocate's receipt of the grievance.

(3) A means to inform the client regarding how to lodge a grievance and that the facility or agency encourages clients to speak out and to present grievances without fear of retribution.

(4) A requirement that new employees will be trained regarding the grievance mechanism plan and that all staff with direct client contact will be briefed at least annually regarding the plan.

(5) How clients will be informed that interpretation and translation services are available regarding the grievance procedure for clients unable to understand or read English and how language assistance services will be provided.

6 CCR 1011-1 Chapter 02, pt. 7