Consumer Rights and Responsibilities. Consumers have the RIGHT to receive accurate information Consumers have the RIGHT to be treated with Respect

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1 Consumer Rights and Responsibilities. Consumer s have certain rights guaranteed by the Constitution of the United States, including the first ten amendments which are known as the Bill of Rights, the Constitution of the State of North Carolina, and the laws and regulations of the United States and of the State of North Carolina. As a consumer you maintain your civil rights. Unless a consumer has been declared incompetent by a court of law, they have the same basic civil rights as other citizens. Civil Rights include the right to marry, if of age, and divorce; to sue others in court; to have and raise children; to sign contracts or to sell, buy and own property. Persons determined to be incompetent and who are assigned a court appointed guardian retain all legal and civil rights except those rights that are granted to the guardian by the court. If your consumer has a guardian, you may want to discuss your consumer s rights with them. Many legal actions have shaped the rights of consumers in North Carolina and the Federal government. The Behavioral Health system is empowered by law to make determinations on such issues as involuntary commitment and guardianship determinations that restrict certain rights of individuals. In order to insure that every consumer s rights are respected, and to further protect consumers of Mental Health, Substance Abuse and Developmental Disabilities services, the state of North Carolina and the Federal government has developed additions to these general rights. Specific consumer rights are found in State or Federal law, State and Federal Regulation or State Rules governing Mental Health, Substance Abuse, and Intellectual Developmental Disabilities services. The protection of the rights of consumers is central to the successful operation of providers doing business in the Western Highlands Network. As a provider your staff and the staff of Western Highlands Network must respect the rights of consumers at all times. Providers must offer and provide consumer s education on client rights and responsibilities whenever needed. Where needed providers will offer consumers assistance in exercising their rights. Consumers should be encouraged to discuss rights and your responsibilities with their service providers. Providers are required to make a copy of Client Rights material available to each consumer at admission and to have this information publicly available in their offices for consumer review. Consumers have the RIGHT to receive accurate information about Western Highlands Network, about the NC MH/SA/DD Health Plan, services available, providers/practitioners and their rights and responsibilities. Information should be presented in a manner appropriate to the consumer s ability to understand. Consumers have the RIGHT to be treated with Respect Provider staff and the staff of Western Highlands Network will treat consumers with respect and dignity at all times.

2 Consumers have the RIGHT to Informed Choice of Providers When Consumers call the Access line at Western Highlands Network Consumers will be given the names, locations and telephone numbers and if needed the languages spoken at local providers. Choice may be limited in rural areas or specialty services. Consumers may request services directly from a provider within our network, without a referral from Western Highlands Network staff. This is referred to as no wrong door. Consumers have the RIGHT to a Second Opinion The NC MH/SA/DD Health Plan provides consumers with a second opinion from a qualified health care professional within the network, or WHN arranges for the enrollee to obtain one outside the network, at no cost to the enrollee. Consumers have the RIGHT to Confidentiality and to Privacy Consumer care and treatment information is protected by state and federal law. Consumers will be provided a separate notice that describes how medical information about Consumers might be used and disclosed, and how Consumers can get access to their Medical Record Consumers have the RIGHT to Consent to and Refuse Treatment Consumers have the right to consent and withdraw consent for treatment at any time. Consumers have the RIGHT to a Written Treatment Plan Consumers have the right to receive treatment in the most appropriate, least restrictive environment as possible. This right requires the provider to allow the consumer or guardian to participate in the development of a written person-centered treatment plan that builds on individual needs, strengths, and preferences. Their treatment plan must be implemented within thirty (30) days of their starting service and signed by the consumer/guardian. Consumers and/or their guardians have the right to periodically review and sign their individual service plan. Consumers must be informed of the risks and benefits of any treatment as well as treatment options and alternatives. This includes the right to ask questions to help them understand their care or what they are expected to do. This right includes a candid discussion with service providers/practitioners on appropriate or medically necessary treatment options for their condition, regardless of cost or benefit coverage. They may need to decide among relevant treatment options, the risks, benefits, and consequences, including their right to refuse treatment and to express their preferences about future treatment decisions regardless of benefit coverage limitation. Consumers have the RIGHT to receive the services listed in their treatment plan. Consumers should expect quality services of the type, amount and duration authorized by Western Highlands Network.

3 Consumer services should be delivered in a manner that is appropriate for their age, their culture and their condition without discrimination. Western Highlands Network staff will support Consumers have the RIGHT to File a Complaint about any aspect of Western Highlands Network operations, including grievances about the providers in the Network and the care a consumer receives. If at anytime Consumers become unhappy with the services they are receiving, they have the right to file a complaint to the provider and/or to WHN regarding the situation. Neither WHN nor the Provider may take adverse action of any type based upon the consumer s exercise of this right. Staff of Western Highlands authorizes consumer services. If Consumers disagree with the decisions of WHN staff involving a service denial, reduction, termination or suspension of services they can file an Appeal. Call WHN and we will help Consumers file. Consumers have a RIGHT to Appeal adverse decisions made about the denial, termination, reduction or suspension of services requested on their behalf. If Consumers disagree with the decisions of WHN staff involving a service denial, reduction, termination or suspension of services they can file an Appeal. Only the service level or type can be appealed; the duration of a service authorization, or how long a service can be received, is not something that can be appealed. Providers do not have appeal rights but may act as the representative or assist their consumer and Western Highlands Network with the appeal process. Providers must have written permission from the consumer to act as their representative. Consumers have the RIGHT to be Free from Seclusion and Restraint Consumers are protected from unwarranted use of restraints and seclusion. Consumers have the RIGHT to be informed about Rules Consumers have the right to be informed of the rules that they are expected to follow under treatment with you as a provider. This information should be provided to Consumers during their first visit. Consumers have the RIGHT to be informed of the Cost of Treatment When Consumers are responsible to pay for any part of their services, the provider will inform the consumer of the cost of treatment in advance. Consumers have the RIGHT to be informed about Medications that are prescribed When medication is needed, Consumers have the right to have that medication given in accordance with accepted medical standards and upon the order of a physician. Consumers should be informed of possible adverse or side effects.

4 Consumers have the RIGHT to make Decisions for their Treatment in Advance In the event that Consumers become unable to make decisions about their treatment, Consumers may name a person to make decisions for them based on prior instructions in an Advanced Directives form. Consumers have the RIGHT to request and receive a copy of his or her medical record. This right is subject to therapeutic privilege set forth in NC G.S. 122C-53(c) and to request that the medical record be amended or corrected in accordance with 45 C.F.R. Part 164 and the provisions of NC G.S. 122C-53(c). If the doctor or therapist determines that this would be detrimental to their physical or mental well being, they can request that the information be sent to a physician or professional of their choice. Consumers have the RIGHT of freedom of speech and freedom of religious expression Consumers have the RIGHT to equal employment and educational opportunity. Consumers have the RIGHT to make recommendations regarding Western Highlands Network s consumer rights and responsibilities policy. Consumers can exercise this right by contacting the Consumer and Community Relations department at Western Highlands Network. The contact information is below. Rights in 24 Hour Facilities: If a Consumer enters a 24 hour facility, they have additional rights and responsibilities. Within 72 hours or their first 3 visits, Consumers should be given the specific rules adopted by the facility. These rules should be fully explained to Consumers. Rights of Minors: A minor has the right to agree to outpatient treatment for drugs or alcohol and for emotional disturbances without obtaining permission from their parent or guardian. An unemancipated minor who is mentally ill or a substance abuser and in need of treatment may agree to receive inpatient treatment for drugs and alcohol and for emotional disturbances at a 24 hour facility without obtaining permission from the minor s legally responsible person, but only in an emergency when the minor s legally responsible person does not come with the minor, and the facility is required to attempt to contact the minor s legally responsible person within 24 hours of the minor s emergency admission. Additional information: If at any time a consumer needs information on their rights or believes that their rights have been violated, they may contact the offices of the Western Highlands Network. Responding to consumer and family questions or complaints is the responsibility of the WHN Consumer and Community Relations Department. Office hours are Monday-

5 Friday, 8:30 AM to 5:00 PM, Telephone , or toll free at The Western Highlands Network Access Call Center is also available by calling twenty-four (24) hours a day/7 days a week/365 days a year. The Access Call Center may take complaint information and refer the complaint to be managed by the Consumer and Community Relations Department the next business day. Appeal information should be mailed or faxed to the attention of the Appeals Coordinator at 356 Biltmore Ave, Asheville, NC OR by calling OR by using the Complaint and Appeals Fax Line: When a consumer receives an adverse decision letter they may call the Appeals Coordinator to begin the appeal process and follow-up with their request in writing during the 30 day timeframe allowed for request of an appeal. Web Reference: Consumer Rights & Responsibilities