D.C. Mun. Regs. tit. 29, r. 29-5014

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 29-5014 - BENEFICIARY RIGHTS AND RESPONSIBILITIES

5014.1

Each Provider shall develop a written statement of a beneficiary's rights and responsibilities consistent with the requirements of this section, which shall be given to each beneficiary in advance of receiving services or during the initial care planning visit before the initiation of services.

5014.2

The written statement of the beneficiary's rights and responsibilities shall be prominently displayed at the Provider's business location and available at no cost upon request by a member of the general public.

5014.3

Each Provider shall develop and implement policies and procedures outlining the following beneficiary's rights:

(a) To be treated with courtesy, dignity and respect;

(b) To control his or her own household and lifestyle;

(c) To participate in the planning of his or her care and treatment;

(d) To receive treatment, care, and services consistent with the plan of care and to have the plan of care modified for achievement of outcomes;

(e) To receive services by competent personnel who can communicate with the beneficiary in accordance with the Language Access Act of 2004, effective June 19, 2004 (D.C. Law 15-167; D.C. Official Code §§ 2-1931 et seq.);

(f) To refuse all or part of any treatment, care, or service and be informed of the consequences;

(g) To be free from mental and physical abuse, neglect and exploitation from persons providing services;

(h) To be assured that for purposes of record confidentiality, the disclosure of the contents of the beneficiary's records is subject to all the provisions of applicable District and federal laws;

(i) To voice a complaint or grievance about treatment, care, or lack of respect for personal property by persons providing services without fear of reprisal;

(j) To have access to his or her records; and

(k) To be informed orally and in writing of the following:

(1) Services to be provided, including any limits;

(2) Amount charged for each service, the amount of payment required from the beneficiary and the billing procedures, if applicable;

(3) Whether services are covered by health insurance, Medicare, Medicaid, or any other third party sources;

(4) Acceptance, denial, reduction or termination of services;

(5) Complaint and appeal procedures;

(6) Name, address and telephone number of the Provider;

(7) Telephone number of the District of Columbia Medicaid fraud hotline;

(8) Beneficiary's freedom from being forced to sign for services that were not provided or were unnecessary; and

(9) A statement, provided by DHCF, defining health care fraud and ways to report suspected fraud.

5014.4

Each beneficiary shall be responsible for the following:

(a) Treating all Provider personnel with respect and dignity;

(b) Providing accurate information when requested;

(c) Informing Provider personnel when instructions are not understood or cannot be followed;

(d) Cooperating in making a safe environment for care within the home; and

(e) Reporting suspected fraud, waste and abuse to DHCF via the fraud and abuse complaint form available at www.dc-medicaid.com.

5014.5

Each Provider shall take appropriate steps to ensure that each beneficiary, including beneficiaries who cannot read or those who have a language or communication barrier, has received the information required pursuant to this section. Each Provider shall document in the records the steps taken to ensure that each beneficiary has received the information.

D.C. Mun. Regs. tit. 29, r. 29-5014

Final Rulemaking published at 60 DCR 15537 (November 8, 2013); amended by Final published at 63 DCR 014134 (11/18/2016)

Authority: An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program, and for other purposes approved December 27, 1967 (81 Stat.774; D.C. Official Code § 1-307.02 (2012 Repl.)) and Section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6) (2012 Repl.)).