***This version of the Health Care Programs Manual has been replaced and is no longer in effect. This includes all PDF versions below. Please see the current Health Care Programs Manual for policy in effect as of December 1, 2006.***

MDHS Health Care Programs Manual (Eligibility Policy through 11/30/06)

Chapter 0903 - Client Responsibilities and Rights

All chapters are numbered beginning with 09. The first chapter is 0901 (Table of Contents).

0903

CLIENT RESPONSIBILITIES AND RIGHTS

PDF(s) Jul 98

0903.03

CLIENT RIGHTS

PDF(s) Oct 99

0903.03.03

CLIENT RIGHTS -- CIVIL RIGHTS

PDF(s) Jul 98

0903.03.05

CLIENT RIGHTS -- PRIVACY RIGHTS

PDF(s) Jul 98

0903.05

CLIENT RESPONSIBILITIES

PDF(s) Jul 98

0903.05.03

CLIENT RESPONSIBILITIES -- QUALITY ASSURANCE

PDF(s) Jul 98

0903.05.05

CLIENT RESPONSIBILITIES -- PREMIUM PAYMENT

PDF(s) May 05 |Jul 00

CLIENT RIGHTS AND RESPONSIBILITIES 0903

All clients have rights and responsibilities under various laws. These rights include the right to fair treatment, to privacy and confidentiality, and to information about the programs and clients' responsibilities. Application forms, notices, and brochures include information on client rights and responsibilities. Also inform clients of their rights and responsibilities orally when appropriate and explain what will happen if they fail to carry out their responsibilities.

The following sections detail client rights:

§0903.03

Client Rights.

§0903.03.03

Client Rights--Civil Rights.

§0903.03.05

Client Rights--Privacy Rights.

The following sections detail client responsibilities:

§0903.05

Client Responsibilities.

§0903.05.03

Client Responsibilities--Quality Assurance.

§0903.05.05

Client Responsibilities--Premium Payment.

***This version of the manual is no longer in effect as of December 1, 2006.*** Current Manual.

CLIENT RIGHTS 0903.03

Protect clients' individual and civil rights at all times.

Inform clients of the following rights at application, recertification or renewal, and on request. Explain these rights orally if clients have questions or wish to file a formal complaint or appeal. All clients have a right to:

• Receive informational brochures describing the various assistance programs administered by DHS. Send appropriate brochures describing the health care programs with the application. See §0904.05.07 (Forms for New Applicants). • An explanation of all the programs, including the benefits and limitations of each. The HCAPP includes a brief explanation of the benefits and limitations of the health care programs. Provide additional information and explanation at the client’s request. Refer inquiries about cash and food assistance to the appropriate person or office. • An explanation of eligibility requirements for all programs. • Review program regulations, manuals, instructions, and state plans. Assist clients in obtaining these materials upon request. • File an application immediately. Explain how to file an application in person at the client’s request. Explain how to file a written application and the consequences of delaying filing.

Appeal for a fair hearing through the county agency or the state agency. See §0917 (Appeals).

• Be told that a formal application is needed to determine eligibility and exercise their right to appeal the county or state agency's decision. • Apply or re-apply for assistance programs even if they seem to be ineligible. • Receive prompt action or notification of delay on their application. See §0904.07.03 (Date of Application). • Receive written notice of approval or denial of the application and reason for denial. See §0916 (Notices). • Receive written notice of how the agency calculated their benefits, spenddown, or premium amount and why benefits, spenddown, or premium amount increased, decreased, or ended. See §0913 (Premiums and Spenddowns) and §0916 (Notices). • Other services and programs offered by the county or state agency. • Special help if needed to understand and provide information, such as interpreters for non-English speaking or hearing impaired clients. • Services and programs offered by other agencies, when appropriate. • Have anyone they choose represent or aid them in applications, recertifications and renewals, appeals, or any contact with the county or state agency. The person does not have to be an attorney. See §0904.11 (Authorized Representatives). • Fair treatment under federal and state law and to file a complaint if they feel they have been treated unfairly. See §0903.03.03 (Client Rights--Civil Rights). • Have information collected kept private by the state and county agency. See §0903.03.05 (Client Rights--Privacy Rights). • Protection. If there is a reason to suspect abuse or neglect of children or vulnerable adults, refer the information to social services. The client's cooperation with social services is not a condition of eligibility. • Receive medical care from the provider of their choice, within limits. See §0914 (Service Delivery).• Protection from garnishment while enrolled in MA,GAMC or MinnesotaCare and for 6 months after enrollment ends.

***This version of the manual is no longer in effect as of December 1, 2006.*** Current Manual

CLIENT RIGHTS--CIVIL RIGHTS 0903.03.03

Treat clients fairly and with understanding. Inform people of their civil rights at application and recertification or renewal. The CAF and HCAPP include civil rights information.

Do not discriminate against people on the basis of color, race, national origin, religion, political belief, sex, sexual orientation, age, marital status, receipt of public assistance, or because of physical, mental, or emotional disability.

Inform people of their right to file a complaint if they believe that the county or state agency has violated their civil rights. Include the names and addresses of these agencies in the information:

Office for Equal Employment

Opportunity (EEO), Affirmative

Action (AA), and Civil Rights

Department of Human Services

444 Lafayette Road

St. Paul, Minnesota 55155-3812

Department of Human Rights

190 E. 5th Street

St. Paul, Minnesota 55101

Applicants or enrollees in MA or federally funded MinnesotaCare may also file complaints with the U.S. Department of Health and Human Services. Unlike state law, federal law does not protect people from discrimination based on marital status, sexual orientation, or receipt of public assistance. People who feel they were discriminated against on 1 or more of these bases must file their complaints with 1 of the state agencies listed above.

The address to file a complaint with the federal agency is:

U.S. Department of Health and Human Services

Washington, DC 20201

***This version of the manual is no longer in effect as of December 1, 2006.*** Current Manual .

CLIENT RIGHTS--PRIVACY RIGHTS 0903.03.05

When you ask people to provide private or confidential data about themselves, tell them:

• The purpose and intended use of the requested data. • Whether they may refuse or if the law requires them to supply the data. • The consequences of supplying or refusing to supply the data. • The identity of other people or entities authorized to receive the data.

These elements are also known as the Tennessen Notice or Tennessen Warning. The CAF and HCAPP provide this information. Also include this information on other requests for information you send to the client.

Data collected and maintained by state and county agencies is private, unless specifically classified otherwise by law. Private data is accessible to the subject of the data or the subject's authorized representative.

State law classifies some data collected and maintained by county and state agencies as confidential. Confidential data is not accessible to the subject of the data.

Refer to the Data Practices Policy and Procedure Manual issued by DHS for further information.

Clients may review private records which contain information on them. Only the information classified as private or public is available for review. Private or public data must be actually shown to the subject of the data and not summarized.

Honor requests for review as soon as possible, but no later than 5 days following the request . Do not count weekends and holidays in the 5-day period. When the county or state agency tells the client during the initial 5 days that it needs more time, it may take an additional 5 days. The county or state agency may set the place and time of review.

Data on 2 or more people maintained in a common file because of family relationships are joint records. Delete material in joint records about the person not requesting the review to protect that person's privacy. Parents may view records of their minor children, unless the agency decides that the request is not in the best interest of the children.

Provide copies of original documents when requested by the subject of the data or the subject's authorized representative. Provide 1 free copy of a document and additional copies at the cost of reproduction.

Follow your agency’s procedures if you are assigned an application or active record of a relative or close friend. Many agencies prefer to reassign these cases when possible for the protection of all parties. If your agency does not reassign the case, be sure to protect the person’s privacy rights. Do not discuss the case with the person outside of normal business hours. Afford the person the same treatment as all other clients.

MinnesotaCare:

Notify your supervisor to have the case reassigned.

MA/GAMC:

Follow your agency’s procedures.

***This version of the manual is no longer in effect as of December 1, 2006.*** Current Manual .

CLIENT RESPONSIBILITIES 0903.05

Inform clients of their responsibilities. The CAF and HCAPP include information on client responsibilities. Also provide oral information when appropriate.

Clients must:

• Provide accurate and complete information about eligibility factors. • Complete applications and necessary forms truthfully. See §0904 (Applications). • Report changes. See §0915 (Changes in Circumstances). • Provide needed proof. • Cooperate with Quality Control (QC)/Quality Assurance (QA). See §0903.05.03 (Client Responsibilities--Quality Assurance). • Cooperate in meeting the procedural eligibility requirements of each program. See §0906 (Technical/Procedural Eligibility).

***This version of the manual is no longer in effect as of December 1, 2006.*** Current Manual .

CLIENT RESPONSIBILITIES--QUALITY ASSURANCE 0903.05.03

Federal law requires the state agency to conduct Quality Control (QC) reviews of MA cases to ensure accuracy in administering Medicaid (MA) funds. The federal agency may also conduct reviews of MA cases. QC reviews are usually conducted randomly. However, the federal agency may permit states to review specific categories of cases.

State statute requires random Quality Assurance (QA) reviews of MinnesotaCare cases to ensure accuracy of reported income and eligibility information.

Clients must cooperate with state and federal QC or QA reviews. If a client fails to cooperate with a review, the reviewer will notify the county or state agency of the failure to cooperate and the length of ineligibility.

Terminate clients from programs for which they did not cooperate with Quality Control.

Clients can become eligible to reapply by cooperating with QC before the end of the ineligibility period. If clients closed for non-cooperation with QC reapply, check with the QC reviewer. The QC reviewer will tell the county or state agency if the client cooperates. If the client does not cooperate, deny the reapplication.

GAMC does not have QC or QA reviews. However, clients who are terminated from MA or federally funded MinnesotaCare for failure to cooperate with a QC review are ineligible for GAMC.

***This version of the manual is no longer in effect as of December 1, 2006.*** Current Manual .

CLIENT RESPONSIBILITIES--PREMIUM PAYMENT 0903.05.05

MinnesotaCare:

Applicants must make an initial premium payment before coverage begins. Enrollees must continue to pay premiums to maintain coverage. Except for pregnant women and children under 2, failure to pay premiums results in cancellation. It also results in a 4-month ineligibility period unless the household shows good cause for failure to make a timely payment.

See §0913 (Premiums and Spenddowns) and §0915.11 (Fail to Pay Premium/Voluntary Cancellation).

M.S. 256L.05 subd. 3

M.S. 256L.06 subd. 3c

Minnesota Rule 9506.0030 subp. 4A1, 4B1

Minnesota Rule 9506.0040 subp. 1

M.S. 256L.06 subd. 3d

Minnesota Rule 9506.0040 subp. 6, subp. 7

MA:

People enrolled in MA for Employed Persons with Disabilities (MA-EPD) must pay monthly premiums. See §0913.01.03 (MA-EPD Premiums) and §0913.02 (Premium Payment Options).

GAMC:

No provisions.

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