Rights & Responsibilities

As an enrollee of CareFirst CHPDC you are entitled to certain rights and responsibilities

At CareFirst CHPDC we always strive to bring you great health care service backed up by friendly and courteous enrollment services. Below you will find a list of your rights and responsibilities of your health care enrollment with us.

Your Rights and Responsibilities

You have a right to:

• Be treated with respect and with due consideration for his or her dignity and privacy.
• To receive information about the organization, its services, its practitioners and providers and enrollee rights and responsibilities
• Access information about the organization (including programs and services provided on behalf of the client organization), its staff’s qualifications and any contractual relationships
• Receive understandable information in your chosen language.
• Know that when you talk with your doctors and other providers its private
• Have an illness or treatment explained to you in a language you can understand
• Have a candid discussion of appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage.
• Voice complaints or appeals about the organization or the care it provides and receive instructions on how to use the complaint process, including the organization’s standards of timeliness for responding to and resolving complaints and issues of quality.
• Make recommendations regarding the organization's enrollee rights and responsibilities policy.
• Participate in decisions regarding his or her health care, including the right to refuse treatment.
• Know their case manager and know how to request a change in case manager.
• Be supported by the organization to collaborate on decisions with their practitioners.
• Be informed of all case management services available, even if a service is not covered, and to discuss options with treating practitioners.
• Receive information on available treatment options and alternatives, presented in a manner appropriate to the enrollee’s condition and ability to understand.
• Be free of restraint or seclusion used as coercion, discipline, convenience or retaliation, as specified in other federal regulations on the use of restraints and seclusion.
• To request and received a copy of his or her medical records, and request that they be amended or corrected.
• Have personally identifiable data and medical information kept confidential; know what entities have access to your information; know procedures used by the organization to ensure security, privacy and confidentiality.
• Choose an eligible PCP/PDP from within CareFirst CHPDC’s network and to change your PCP/PDP
• Make a Grievance (Complaint) about the care provided to you and receive an answer
• Request an Appeal or a Fair Hearing if you believe CareFirst CHPDC was wrong in denying, reducing or stopping a service or item
• Receive Family Planning Services and supplies from the provider of your choice
• To be furnished health care services that are available and accessible in a timely manner; coordinated; sufficient in amount, duration, or scope; and provided in a culturally competent manner to meet your specific needs.
• Receive information on advance directives and choose not to have or continue any life-sustaining treatment
• Receive a copy of the CareFirst CHPDC Enrollee Handbook and/or Provider Directory
• Continue treatment you are currently receiving until you have a new treatment plan
• Receive interpretation and translation services free of charge if you need them
• Refuse oral interpretation services
• Get an explanation of prior authorization procedures
• Receive information about CareFirst CHPDC’s financial condition and any special ways we pay our doctors
• Obtain summaries of customer satisfaction surveys
• Receive CareFirst CHPDC’s “Dispense as Written” policy for prescription drugs
• Free to exercise his or her rights, and that the exercise of those rights does not adversely affect the way CareFirst CHPDC or its network providers, sub-contractors, or the District treat the Enrollee.
• Decline participation or disenroll from programs and services offered by the organization.

You are responsible for:

• Treating those providing your care with respect and dignity
• Supplying information (to the extent possible) that the organization and its practitioners and providers need in order to provide care.
• Following the rules of the D.C. Medicaid Managed Care Program and CareFirst CHPDC
• Following instructions, you receive from your doctors and other providers
• Follow the mutually agreed-on case management plan or notify the case manager if they cannot follow the plan offered by the organization.
• Going to Appointments you schedule or that CareFirst CHPDC schedules for you
• Telling your doctor at least 24 hours before the Appointment if you have to cancel
• Asking for more explanation if you do not understand your doctor’s instructions
• Going to the Emergency Room only if you have a medical emergency
• Telling your PCP about medical and personal problems that may affect your health
• Reporting to Economic Security Administration (ESA) and CareFirst CHPDC if you or a family member have other health insurance
• Trying to understand your health problems and participate in developing treatment goals
• Helping your doctor in getting medical records from providers who have treated you in the past
• Telling CareFirst CHPDC if you were injured as the result of an accident or at work
• Notify the organization and their usual care provider if they disenroll from the program.