Section 118-5-18 - CLIENT RIGHTS AND ACCESS TO TREATMENT18.1Information about Rights.18.1.1 Client Notification. Clients will be fully informed at the time of admission and as needed during ongoing treatment, of their rights and responsibilities, and of all the rules and regulations governing client conduct and responsibilities. Documentation of this will be found in each client record. Such rights and responsibilities shall be posted at the treatment site and provided to the client in writing or in other format sufficient to ensure that the client can understand. Clients who are unable to read English shall have the rules and regulations explained verbally or translated. The provision of copies of the rights and responsibilities or the explanation/translation shall be documented in writing, and placed in the client's record.18.1.2 Ongoing assistance. Clients will be encouraged and assisted throughout treatment to understand and exercise their rights as clients, including rights:18.1.2.1 To report, without fear of retribution, any instances of suspected abuse, neglect, or exploitation of clients being served in the program;18.1.2.2 To use a grievance and appeal process, in accordance with State laws and regulations;18.1.2.3 To provide Input into program policies and services through client satisfaction surveys;18.1.2.4 To choose and designate a personal advocate, who can speak for or on the behalf of the client, and who is protected from fears of retaliation, retribution or coercion in the exercise of advocacy.18.1.3 Program rules and client non-compliance. Clients have the right to be informed of program rules and the consequences of non-compliance. Program rules shall be confined to those that ensure good order and the safety and health of clients and staff, shall not be overly restrictive in their scope or consequence, and shall not be applied arbitrarily or capriciously. Involuntary withdrawal of medication or discharge from treatment shall be a sanction of last resort.18.2Treatment Rights.18.2.1 Right to choice of provider. Clients have the right to a choice of health care providers that is sufficient to ensure access to appropriate high-quality health care. They have the right to change providers without fear of coercion, retaliation, the imposition of administrative sanctions, or requirements imposed that have no reasonable role in the orderly and timely transfer of care.18.2.2 Non-discrimination. Treatment provided will be fair and impartial regardless of age, race, sex, color, physical or mental impairment, religion or ancestry, familial or marital status, sexual orientation, genetic information, or source of payment. Treatment will be provided in an atmosphere of dignity and trust between program, program staff and client.18.2.3 Treatment standards. Treatment will be provided according to accepted clinical practice, taking into account the individual needs of the client, and shall be adequate and humane.18.2.4 Least restrictive treatment. Clients will receive services within the least restrictive and most accommodating environment possible. Consideration shall be made of individual needs, including work and family responsibilities, to provide treatment and access to services that is most accommodating, and least intrusive and disruptive for most clients. Restrictions on access to services shall be limited to those that constitute legitimate operational requirements and the maintenance of good order.18.2.5 Client involvement in treatment choices. Changes in treatment regimens, including changes in time schedules, dosing schedules or amounts, or any other element of a treatment plan, shall be made with the full involvement and consent of the client. Changes shall not be arbitrary, capricious, done solely for the convenience of the provider, or without clinical merit.18.3Right to Give and Withhold Consent.18.3.1 Clients have the right to the option to give or withhold informed consent prior to being involved in research projects, and the right to retain a copy of the informed consent form.18.4Rights to Confidentiality.18.4.1 Protection of confidentiality. Clients have the right to communicate with health care providers in confidence and to have the confidentiality of their individually identifiable health care information protected.18.4.2 Access to records. Clients also have the right to review and copy their own medical records and request amendments to their records.18.4.3 Information about limits of confidentiality. Clients have the right to be informed of the extent and limits of confidentiality, including the conditions under which information can be released without client consent, the use of identifying information for purposes of central registry, program evaluation, billing, and statutory requirements for reporting abuse.18.5Complaints and Grievances.18.5.1 All clients have the right to a fair and efficient process for resolving differences with health care providers. Programs shall develop and display or otherwise make available to clients grievance procedures that specify the process for dispute resolution. The following elements must be assured:18.5.1.1 clients may express verbally or in writing their dissatisfaction or complaints;18.5.1.2 clients may initiate grievance procedures and pursue those procedures;18.5.1.3 the review of the complaint or grievance by a party other than staff member(s) involved in the dispute;18.5.1.4 the receipt of a decision in writing, with the reasoning articulated; and18.5.1.5 time frames and deadlines that are reasonable and fair, and that apply to both the client and the provider. Minimally, responses should occur within ten working days at each step of the process, unless time extensions are agreed upon by all parties. The time frame will apply to both client and the provider and must be included in the written explanation of rights.18.6Policies and Procedures Regarding Client Rights.18.6.1 Policies regarding rights and exceptions. There shall be written policies and procedures designed to enhance the dignity of all clients and to protect their civil rights.18.6.1.1 Residential facilities shall develop policies around visitation, telephone privileges, and client mail.18.6.1.2 Any program making exceptions to or restrictions of the rights of a client, shall record the exception in the client's record. The exception must be signed by the administrator or physician.18.6.2 Written explanation of rights. A handout explaining client's rights, fee schedule, program rules and regulations shall be prepared.18.6.2.1 The handout shall be provided to each client on admission.18.6.2.2 A copy of the handout shall be posted in a prominent place accessible to all clients.18.6.2.3 A document of receipt of these forms shall be maintained in the client record.18.6.3 Client fees. 18.6.3.1 A reasonable fee shall be assessed for service.18.6.3.2 A client who has the means to pay shall not be exempted from reasonable fees.18.6.3.3 Client eligibility for government or private sector benefits shall be assessed and whenever possible, enrollment sought. If it is determined that clients are eligible for government or private sector benefits, they will be encouraged to apply.18.6.4 Human Subject Research. 18.6.4.1 No client shall be allowed to participate in any experimental or research project without the full knowledge, understanding and written consent of the client (and legal guardian if appropriate).18.6.4.2 All experimental or research projects conducted shall comply with applicable state and federal laws, rules, regulations, and guidelines.18.7Policies and Procedures Regarding Access to Treatment.18.7.1 Adaptive Equipment. There shall be specific policies and procedures governing the availability and provision of adaptive equipment and auxiliary aids.18.7.2 Interpretive Services. There shall be specific policies and procedures governing the availability and provision of interpretive services, whether spoken language or sign.14-118 C.M.R. ch. 5, § 18