(1)PACE programs must have written policies and procedures that ensure PACE participants have the rights and responsibilities included in this rule. The PACE organization must inform a participant upon enrollment, in writing, of his or her rights and responsibilities, and all rules and regulations governing participation.
(2)PACE programs must communicate these policies and procedures to PACE staff and participating providers.
(3)PACE programs must monitor compliance with policies and procedures governing PACE participant rights and responsibilities, take corrective action as needed, and report findings to the PACE programs Quality Improvement Committee.
(4)PACE participants must have the following rights:
(a)To be treated with dignity and respect. To be free from abuse or neglect;
(b)To be treated by providers the same as other people seeking health and long term care services;
(c)To change primary care providers within the guidelines of the PACE program;
(d)To have a friend, family member, representative, or advocate, present during appointments and at other times as needed within clinical guidelines;
(e)To be actively involved in the development of his or her care plan;
(f)To be given information about his or her condition and covered and non-covered services necessary to allow an informed decision about proposed treatment(s);
(g)To consent to treatment or refuse services, and be told the consequences of that decision, except for court ordered services;
(h)To receive written materials describing rights, responsibilities, benefits available, how to access services, and what to do in an emergency;
(i)To have written materials explained in a manner that is understandable to the PACE participant;
(j)To receive necessary and reasonable services to diagnose the presenting condition;
(k)To receive covered services under the PACE program that meet generally accepted standards of practice and are medically appropriate;
(l)To obtain covered preventive services;
(m)To have access to urgent and emergency services 24 hours a day, 7 days a week as described in OAR 411-045-0080 (Provision of Services)(3);
(n)To receive a referral to specialty practitioners for medically appropriate covered services;
(o)To have a clinical record maintained that documents conditions, services received, and referrals made;
(p)To have access to one’s own clinical record, unless restricted by statute;
(q)To transfer a copy of one’s clinical record to another provider;
(r)To execute a statement of wishes for treatment, including the right to accept or refuse medical, surgical, chemical dependency or mental health treatment and the right to execute directives and powers of attorney for health care established under ORS 127 as amended by the Oregon Legislative Assembly 1993 and the OBRA 1990 — Patient Self-Determination Act;
(s)To receive written notices before a denial of, or change in, a benefit or service level is made, unless such notice is not required by federal or state regulations;
(t)To receive information on how to make a grievance with the PACE program and receive a response as defined in 411-045-0120 (Grievance Process);
(u)To request an administrative hearing with the Department of Human Services;
(v)To receive interpreter services as defined in OAR 411-045-0070 (Access to Care) of the rule;
(w)To have the use of restraints (both physical and chemical) limited to the least restrictive and most effective method available. The use of such restraints must meet the requirements in 42 CFR 460.114; and
(x)To request that a qualified specialist for women’s health services furnish routine or preventive women’s health services.
Rule 411-045-0110 — Participant Rights,