Participant Rights and Responsibilities
PA Health & Wellness, and its network of doctors and other providers of services, do not discriminate against Participants based on race, sex, religion, national origin, disability, age, sexual orientation, gender identity, or any other basis prohibited by law. As a Participant, you have the following rights and responsibilities.
Participants Rights and Responsibilities
PA Health & Wellness, and its network of doctors and other providers of services, do not discriminate against Participants based on race, sex, religion, national origin, disability, age, sexual orientation,gender identity, or any other basis prohibited by law. As a Participant, you have the following rights and responsibilities.
You have the right to:
- Receive information about PA Health & Wellness, its services, its practitioner and providers and all Participant Rights and Responsibilities.
- Receive information in a manner and format that may be easily understood and is readily accessible to you.
- Make recommendations regarding the organization’s Participant Rights and Responsibilities.
- Receive accurate, easily understood information and assistance in making informed healthcare and LTSS decisions about your health plans, professionals, and facilities.
- A choice of healthcare and LTSS providers that is sufficient to ensure access to appropriate high-quality healthcare.
- Access emergency healthcare services when and where the need arises.
- Fully participate in all decisions related to your healthcare and LTSS. Participants who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family Participants, or other conservators.
- A candid discussion of appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage.
- Considerate, courteous, and respectful care from all providers of healthcare and the LTSS system at all times and under all circumstances.
- Communicate with Providers in confidence and to have the confidentiality of your individually identifiable healthcare and LTSS information protected.
- Review and copy your own medical and LTSS records and request amendments to his or her records.
- To ask for a second opinion.
- To file a Grievance if you disagree with PA Health & Wellness’s decision that a service is not medically necessary for you.
- To file a Complaint if you are unhappy about the care or treatment you have received.
- To ask for a DHS Fair Hearing.
- Be free from any form of discrimination based on race, language, special needs, creed, age, gender or political affiliations.
- Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation, as specified in other Federal regulations on the use of restraints and seclusion.
Participants need to work with their providers of health care and LTSS services. PA Health & Wellness needs your help so that you get the services and supports you need.
Participant responsibilities include:
- Taking responsibility for maximizing healthy habits, such as exercising, not smoking, and eating a healthy diet.
- Following plans and instructions for care that you have agreed to with your providers and practitioners.
- Becoming involved in specific healthcare decisions by understanding yourhealth problems and participating in developing mutually agreed-upon treatment goals, to the degree possible.
- Working collaboratively with healthcare and LTSS providers in developing and carrying out agreed-upon treatment plans.
- Disclosing relevant information supplying information, to the extent possible, that the organization and its practitioners and providers need in order to provide care, and clearly communicate wants and needs.
- Using the PA Health & Wellness’ internal complaint and appeal processes to address concerns that may arise.
- Avoid knowingly spreading disease.
- Recognizing the reality of risks and limits of the science of medical care and the human fallibility of the healthcare professional.
- Being aware of a healthcare and LTSS Provider's obligation to be reasonably efficient and equitable in providing care to other patients and the community.
- Becoming knowledgeable about your health plan and LTSS coverage and health plan and LTSS options (when available), including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.
- Showing respect for other patients, health workers, and LTSS workers.
Participants shall provide consent to PA Health & Wellness, Healthcare Providers and their respective designees for providing patient care management, outcomes improvement and research. For these purposes, Participants will remain anonymous to the greatest extent possible.