Common use of Exercising Your Rights Clause in Contracts

Exercising Your Rights. You have the right to:  Exercise your civil, legal and participants rights, including the Medicare and Medicaid complaint and appeals processes and to receive a full explanation of the complaint process.  Be encouraged and helped to voice your complaints and recommend changes in policies and services to our staff and to outside representatives of your choice. There will be no restraint, interference, coercion, discrimination or reprisal by our staff if you do so.  Appeal any treatment decision made by PACE CNY or our contractors.  Initiate the process to leave the PACE CNY program at any time. If you feel any of your rights have been violated, please report them immediately to your social worker or call our office during regular business hours at (000) 000-0000. If you are not satisfied with the resolution of your concern or complaint you may contact the New York State Department of Health at (000) 000-0000 or 0-000-000-0000. Participant Responsibilities We also believe that you and your caregiver play crucial roles in the delivery of your care. To assure that you remain as healthy and independent as possible, please establish an open line of communication with those participating in your care and be accountable to the following responsibilities: You have the responsibility to:  Cooperate with the interdisciplinary team in implementing your care plan.  Accept the consequences of refusing any treatment recommended by the multidisciplinary team.  Provide the multidisciplinary team with a complete and accurate medical history.  Use only those services authorized by PACE CNY.  Take all prescribed medications as directed and to not provide your medications to anyone else.  Call the PACE CNY provider for direction in the case of an urgent situation.  Notify PACE CNY within 48 hours or as soon as reasonably possible if you require emergency services out of the service area.  Notify PACE CNY in writing when you wish to initiate the disenrollment process.  Pay required monthly fees as appropriate.  Treat our staff with respect and consideration.  Not to ask staff to perform tasks that they are prohibited from doing by PACE or agency regulations.  Voice any dissatisfaction you may have with your care.  Notify PACE CNY when you will not be home to receive scheduled services.  Keep medical appointments that have been made on your behalf.

Exercising Your Rights. You have the right to:  Exercise your civil, legal and participants rights, including the Medicare and Medicaid complaint and appeals processes and to receive a full explanation of the complaint process.  Be encouraged and helped to voice your complaints and recommend changes in policies and services to our staff and to outside representatives of your choice. There will be no restraint, interference, coercion, discrimination or reprisal by our staff if you do so.  Appeal any treatment decision made by PACE CNY or our contractors.  Initiate the process to leave the PACE CNY program at any time. If you feel any of your rights have been violated, please report them immediately to your social worker or call our office during regular business hours at (000) 000-0000. If you are not satisfied with the resolution of your concern or complaint you may contact the New York State Department of Health at (000) 000-0000 or 0-000-000-0000. Participant Responsibilities We also believe that you and your caregiver play crucial roles in the delivery of your care. To assure that you remain as healthy and independent as possible, please establish an open line of communication with those participating in your care and be accountable to the following responsibilities: You have the responsibility to:  Cooperate with the interdisciplinary team in implementing your care plan.  Accept the consequences of refusing any treatment recommended by the multidisciplinary team.  Provide the multidisciplinary team with a complete and accurate medical history.  Use only those services authorized by PACE CNY.  Take all prescribed medications as directed and to not provide your medications to anyone else.  Call the PACE CNY provider physician for direction in the case of an urgent situation.  Notify PACE CNY within 48 hours or as soon as reasonably possible if you require emergency services out of the service area.  Notify PACE CNY in writing when you wish to initiate the disenrollment process.  Pay required monthly fees as appropriate.  Treat our staff with respect and consideration.  Not to ask staff to perform tasks that they are prohibited from doing by PACE or agency regulations.  Voice any dissatisfaction you may have with your care.  Notify PACE CNY when you will not be home to receive scheduled services.  Keep medical appointments that have been made on your behalf.

Exercising Your Rights. You have the right to:  Exercise your Assistance to exercise civil, legal and participants participant rights, including {PACE Organization} grievance process, the Medi-Cal State hearing process and the Medicare and Medicaid complaint and Medi-Cal appeals processes and to receive a full explanation of the complaint processprocesses.  Be encouraged and helped to voice Voice your complaints and recommend changes in policies and services to our staff and to outside representatives of your choice. There will be no restraint, interference, coercion, discrimination or reprisal by our staff if you do so.  Appeal any treatment decision made by {PACE CNY Organization} or our contractors.  Initiate the contractors through our appeals process to leave the PACE CNY program at any timeand request a State hearing. If you feel any of your rights have been violatedviolated or you are dissatisfied and want to file a grievance or an appeal, please report them this immediately to your social worker or call our office during regular business hours at (000) 000-0000{PACE Program telephone number } or our toll free line at {PACE Program telephone number}. If you are not satisfied with the resolution Please refer to other sections of your concern or complaint {PACE Organization} Member Enrollment Agreement Terms and Conditions booklet for details about {PACE Organization} as your sole provider; a description of {PACE Organization} services and how they are obtained; how you may contact obtain emergency and urgently needed services outside {PACE Organization}’s network; the New York State Department grievance and appeals procedure; conditions for disenrollment; and a description of Health at (000) 000-0000 or 0-000-000-0000premiums, if any, and payment of these. Participant Responsibilities We also believe that you and your caregiver play crucial roles in the delivery of your care. To assure that you remain as healthy and independent as possible, please establish an open line of communication with those participating in your care and be accountable to for the following responsibilities: You have the responsibility to:  Cooperate with the interdisciplinary team Interdisciplinary Team in implementing your care plan.  Accept the consequences of refusing any treatment recommended by the multidisciplinary teamInterdisciplinary Team.  Provide the multidisciplinary team Interdisciplinary Team with a complete and accurate medical history.  Use Utilize only those services authorized by {PACE CNYOrganization}.  Take all prescribed medications as directed and to not provide your medications to anyone elsedirected.  Call the {PACE CNY provider Organization} physician for direction in the case of an urgent situation.  Notify {PACE CNY Organization} within 48 hours or as soon as reasonably possible if you require emergency services out of the service area.  Notify {PACE CNY Organization} in writing when you wish to initiate the disenrollment process.  Pay required monthly fees as appropriate.  Treat our staff with respect and consideration.  Not to ask staff to perform tasks that they are prohibited from doing by PACE or agency regulations.  Voice any concerns or dissatisfaction you may have with your care.  Notify PACE CNY when you will not be home to receive scheduled services.  Keep medical appointments that have been made on your behalf.CHAPTER 8

Exercising Your Rights. You have the right to:  Exercise • Receive assistance in exercising your civil, legal and participants participant rights, including On Lok Lifeways’ grievance process, the Medi-Cal fair hearing process and the Medicare and Medicaid complaint and Medi-Cal appeals processes and to receive a full explanation of the complaint processprocesses.  Be encouraged and helped to voice • Voice your complaints and recommend changes in policies and services to our staff and to outside representatives of your choice. There will be no restraint, interference, coercion, discrimination or reprisal by our staff if you do so.  • Appeal any treatment decision made by PACE CNY On Lok Lifeways or our contractorscontractors through our appeals process and to request a State fair hearing.  Initiate • Disenroll from the process to leave the PACE CNY program at any timetime by giving 20-day written notice. If you feel any of your rights have been violatedviolated or you are dissatisfied and want to file a grievance or an appeal, please report them this immediately to your social worker or call our office during regular business hours at (000) 000-0000. If you are not satisfied with the resolution of your concern or complaint you may contact the New York State Department of Health at (000) 000-0000 or our toll-free telephone number at 0-000-000-0000. If you would like to talk to someone outside of On Lok Lifeways about your concerns you may contact 0-000-XXXXXXXX (0-000-000-0000) or 0-000-000-0000 (California Department of Health Care Services Office of the Ombudsman.) Please refer to other sections of your On Lok Lifeways Member Enrollment Agreement Terms and Conditions for details about On Lok Lifeways as your sole provider; a description of On Lok Lifeways services and how they are obtained; how you may obtain Emergency Services and Urgent Care outside On Lok Lifeways’ network; the grievance and appeals procedure; disenrollment; and a description of premiums, if any, and payment of these. Participant Responsibilities We also believe that you and your caregiver play crucial roles in the delivery of your care. To assure that you remain as healthy and independent as possible, please establish an open line of communication with those participating in your care and be accountable to for the following responsibilities: You have the responsibility to:  • Cooperate with the interdisciplinary team Interdisciplinary Team in implementing your care plan.  • Accept the consequences of refusing any treatment recommended by the multidisciplinary teamInterdisciplinary Team.  • Provide the multidisciplinary team Interdisciplinary Team with a complete and accurate medical history.  Use • Utilize only those services authorized by PACE CNYOn Lok Lifeways.  • Take all prescribed medications as directed and to not provide your medications to anyone elsedirected.  • Call the PACE CNY provider On Lok Lifeways physician for direction in the case of an urgent situation.  • Notify PACE CNY On Lok Lifeways within 48 hours or as soon as reasonably possible if you require emergency services Emergency Services or Urgent Care when out of the service area.  • Notify PACE CNY On Lok Lifeways in writing when you wish to initiate the disenrollment process.  • Notify On Lok Lifeways of a move or lengthy stay outside of our service area. • Pay required monthly fees as appropriate.  • Treat our staff with respect and consideration.  • Not to ask staff to perform tasks that they are prohibited from doing by PACE or agency regulations.  • Voice any dissatisfaction you may have with your care.  Notify PACE CNY when you will not be home to receive scheduled services.  Keep medical appointments that have been made on your behalf.Chapter Eight Member Grievance and