HSCSN and our team of health care professionals are proud partners in your health care. As an enrollee, you have a right to certain services. It is our job to make sure we respect those rights. By working together, we can deliver the best care possible and make sure that you get the most out of your benefits.
Your Rights and Responsibilities as an Enrollee
You can ask for this in writing. HSCSN will provide it within five (5) business days. All of this information will be prepared in advance and requires DHCF's prior approval.
You have a right to:
- Be treated with respect and dignity.
- Know that what you tell your health care providers is private.
- Get information about an illness or treatment in a language you can understand.
- Help make decisions about your care.
- Have your doctors explain all of the treatment choices and the risks of each choice. This helps you make choices about your care.
- Refuse treatment or care.
- Be free from any form of restraint or seclusion except for emergency situations.
- See your medical records. Request a change if information is incorrect.
- Choose or change your doctor, PCP or PDP. You need to choose someone from the HSCSN network.
- Make a Grievance (Complaint) about the care provided to you and receive an answer.
- Ask for an Appeal or a Fair Hearing if you believe HSCSN was wrong in denying, reducing, or stopping a service or item.
- Get family planning services and supplies from the provider of your choice.
- Get medical care without unnecessary delay.
- Get information on advance directives. You can choose if you want to continue or stop care that is keeping you or your child alive.
- Get HSCSN’S Enrollee Handbook and Provider Directory.
- Keep getting your current care until you have a new treatment plan.
- Receive interpretation and translation services free of charge.
- Turn down any offer for interpretation services.
- Get transportation to medical appointments free of charge.
- Get information about certain services that we need to approve before you can use them. (Prior Authorization)
- Get information about HSCSN’s finances and any special ways we pay our doctors.
- Get reports about customer satisfaction surveys.
- Get HSCSN’s “Dispense as Written” policy for prescription drugs.
- Get a list of prescription drugs covered by HSCSN.
- Get fair treatment.
- Get health care services that are on time and coordinated. You will get
- The right amount of services
- Services for the right amount of time.
- The right range of services.
- Ask for your medical records, free of charge.
- Get an explanation of prior authorization procedures.
- Get understandable information in your chosen language.
- Have a candid discussion of appropriate or medical treatment options for your conditions, regardless of cost or benefit coverage.
- Make suggestions to HSCSN about your rights and responsibilities.
- Get a second opinion from a qualified health care professional within HSCSN’s network, or, if necessary, obtain one outside the network, at no cost to you.
- Get information about how and where to access any benefits available under HSCSN’s plan, annually, and at least 30 days prior to any change.
- Follow Federal and State laws*.
- Use these rights without worrying about any kind of punishment from HSCSN, its providers, subcontractors or the District of Columbia (D.C)
*Title VI of the Civil Rights Act of 1964 as implemented by regulations at 45 CFR part 80; the Age Discrimination Act of 1975 as implemented by regulations at 45 CFR part 91; the Rehabilitation Act of 1973; Title IX of the Education Amendments of 1972 (regarding education programs and activities; Titles II and III of the Americans with Disabilities Act; and section 1557 of the Patient Protection and Affordable Care Act.
You are responsible for:
- Meeting with you or your child’s Care Manager as often as needed to plan services.
- Treating HSCSN staff and health care providers with respect and dignity.
- Following the rules of the D.C. Medicaid Managed Care Program and HSCSN.
- Following instructions from your doctors and other providers.
- Going to your scheduled appointments.
- Having a grown-up (adult) with enrollees under 18 years old when going to medical appointments.
- Telling your providers at least 24 hours before an appointment if you need to cancel.
- Asking your doctor to explain any advice or recommendations again if you do not understand.
- Going to the emergency room only if you have a medical emergency.
- Telling your PCP or PDP about medical, dental, and personal problems that may affect your health.
- Telling your doctors and other providers about your health conditions.
- Telling the Economic Security Administration and HSCSN if you or a family member has other health insurance, a change in your address or phone number.
- Telling the Economic Security Administration and HSCSN if there is a change in your family (for example, a death or birth).
- Trying to learn about your health problems and helping in making treatment goals.
- Helping your health care providers get medical records from providers who have treated you in the past.
- Telling HSCSN if you were injured in an accident or at work.
Title VI of the Civil Rights Act of 1964 as implemented by regulations at 45 CFR part 80; the Age Discrimination Act of 1975 as implemented by regulations at 45 CFR part 91; the Rehabilitation Act of 1973; Title IX of the Education Amendments of 1972 (regarding education programs and activities; Titles II and III of the Americans with Disabilities Act; and section 1557 of the Patient Protection and Affordable Care Act.