Client Bill of Rights and Responsibilities.

(1)

a description of available services, and unit charges and billing mechanisms (where applicable);

(2)

a policy on which services are covered by the insurance benefit and which services need to be paid for out-of-pocket (where applicable);

(3)

the criteria for admission to service and discharge from service;

(4)

a right to be informed of the name of their Care Manager and of the manner in which that person may be contacted;

(5)

a right for active client participation in the development and implementation of the Plan of Care. The client or officially designated representative shall, prior to implementation, receive a copy of the Plan of Care and a written list of all potential service providers to be involved in implementation of the Plan of Care;

(6)

a right for the client or officially designated representative to be fully informed of the client's health condition;

(7)

a provision for the confidential treatment of all client information retained by the agency and a requirement for written consent to release information to persons not otherwise authorized under law to receive it;

(8)

a policy regarding client access to the case record;

(9)

an explanation of the appeal procedure and the right to file an appeal of benefit eligibility or Plan of Care service authorization decisions without discrimination or reprisal from the agency;

(10)

procedures for registering and resolving complaints; and

(11)

a right to a discharge plan when the Care Management Provider Agency services are about to be terminated. If the Policy or Certificate holder is immediately eligible for Medi-Cal, the Care Management Provider Agency will prepare a transition plan. The transition plan and/or discharge plan must be provided to the Policy or Certificate holder within 30 days after receipt of notification from the Issuer that coverage will be exhausted.