Section 182-538-180 - Rights and protections(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.Wash. Admin. Code § 182-538-180
Adopted by WSR 19-24-063, Filed 11/27/2019, effective 1/1/2020