When you join a PACE program, you have certain rights and protections. CalOptima Health PACE, as your PACE program, must fully explain and provide your rights to you or someone acting on your behalf in a way you can understand at the time you join.
At CalOptima Health PACE, we are dedicated to providing you with quality health care services so that you may remain as independent as possible. This includes providing all Medicare- covered items and services and Medicaid services, and other services determined to be necessary by the Interdisciplinary Team across all care settings, 24 hours a day, 7 days a week. Our staff and contractors seek to affirm the dignity and worth of each participant by assuring the following rights:
YOU HAVE THE RIGHT TO TREATMENT
You have the right to treatment that is both appropriate for your health conditions and provided in a timely manner. You have the right:
- To receive all the care and services you need to improve or maintain your overall health condition, and to achieve the highest level of physical, emotional, and social well-being and function
- To get emergency services when and where you need them without the PACE IDT’s approval. A medical emergency is when you think your health is in serious danger— when every second counts. You may have a bad injury, sudden illness or an illness quickly getting much worse. You can get emergency care anywhere in the United States or its territories and you do not need to get permission from CalOptima Health PACE prior to seeking emergency services.
YOU HAVE A RIGHT TO BE TREATED WITH RESPECT
You have the right to be treated with dignity and respect at all times, to have all of your care kept private and confidential, and to get compassionate, considerate care. You have the right:
- To get all of your health care in a safe, clean environment, and in an accessible manner.
- To be free from harm. This includes excessive medication, physical or mental abuse, neglect, physical punishment, being placed by yourself against your will, and any physical or chemical restraint that is used on you for discipline or convenience of staff and that you do not need to treat your medical symptoms.
- To be encouraged and helped to use your rights in the PACE program.
- To get help, if you need it, to use the Medicare and Medi-Cal complaint and appeal processes, and your civil and other legal rights.
- To be encouraged and helped in talking to PACE staff about changes in policy and services you think should be made.
- To use a telephone while at the CalOptima Health PACE Center.
- To not have to do work or services for the PACE program.
- To have all information about your choices for PACE services and treatment explained to you in a language you understand, and in a way that takes into account and respects your cultural beliefs, values, and customs.
YOU HAVE A RIGHT TO PROTECTION AGAINST DISCRIMINATION
Discrimination is against the law. Every company or agency that works with Medicare and Medi-Cal must obey the law. They cannot discriminate against you because of your:
- Race
- Ethnicity
- National origin
- Religion
- Age
- Sex
- Mental or physical disability
- Sexual orientation
- Source of payment for your health care (for example, Medicare or Medi-Cal)
If you think you have been discriminated against for any of these reasons, contact a staff member at the PACE program to help you resolve your problem. If you have any questions, you can call the Office for Civil Rights at 1-800-368-1019. TTY users should call 1-800-537-7697.
YOU HAVE A RIGHT TO INFORMATION AND ASSISTANCE
You have the right to get accurate, easy-to-understand information, to have this information shared with your designated representative, who is the person you choose to act on your behalf, and to have someone help you make informed health care decisions. You have the right:
- To have someone help you if you have a language or communication barrier so you can understand all information given to you.
- To have the PACE program interpret the information into your preferred language in a culturally competent manner, if your first language is not English and you can’t speak English well enough to understand the information being given to you.
- To get marketing materials and PACE participant rights in English and in any other frequently used language in your community. You can also get these materials in Braille, if necessary.
- To have the Enrollment Agreement fully explained to you in a manner understood by you.
- To get a written copy of your rights from the PACE program. The PACE program must also post these rights in a public place in the PACE Center where it is easy to see them.
- To be fully informed, in writing, of the services offered by the PACE program. This includes telling you which services are provided by contractors instead of the PACE staff. You must be given this information before you join, at the time you join and when you need to make a choice about what services to receive.
- To be provided with a copy of individuals who provide care-related services not provided directly by CalOptima Health PACE upon request.
- To look at, or get help to look at, the results of the most recent review of your PACE program. Federal and State agencies review all PACE programs. You also have a right to review how the PACE program plans to correct any problems that are found at inspection.
- Before CalOptima Health PACE starts providing palliative care, comfort care, and end-of-life care services, you have the right to have information about these services fully explained to you. This includes your right to be given, in writing, a complete description of these services and how they are different from the care you have been receiving, and whether these services are in addition to, or instead of, your current services. The information must also explain, in detail, how your current services will be impacted if you choose to begin palliative care, comfort care, or end-of-life services, including but not limited to, the impact to the following services. Specifically, it must explain any impact to:
- Physician services, including specialist services
- Hospital services
- Long-term care services
- Nursing services
- Social services
- Dietary services
- Transportation
- Home care
- Therapy, including physical, occupational, and speech therapy
- Behavioral health
- Diagnostic testing, including imaging and laboratory services
- Medications
- Preventative healthcare services
- PACE center attendance
You have the right to change your mind and take back your consent to receive palliative care, comfort care, or end-of-life care services at any time and for any reason by letting CalOptima Health PACE know either verbally or in writing.
YOU HAVE A RIGHT TO A CHOICE OF PROVIDERS.
You have the right to choose a health care provider, including your primary care provider and specialists, from within the PACE program’s network and to get quality health care. Women have the right to get services from a qualified women’s health care specialist for routine or preventive women’s health care services.
You have the right to have reasonable and timely access to specialists as indicated by your health condition.
You also have the right to receive care across all care settings, up to and including placement in a long-term care facility when CalOptima Health PACE can no longer maintain you safely in the community.
YOU HAVE A RIGHT TO PARTICIPATE IN TREATMENT DECISIONS.
You have the right to fully participate in all decisions related to your health care. If you cannot fully participate in your treatment decisions or you want to have someone you trust help you, you have the right to choose that person to act on your behalf. You have the right:
- To have all treatment options explained to you in a language you understand, to be fully informed of your health status and how well you are doing, and to make health care decisions. This includes the right not to get treatment or take medications. If you choose not to get treatment, you must be told how this will affect your health.
- To fully understand CalOptima Health’s palliative care, comfort care, and end-of-life care services. Before CalOptima Health can start providing you with palliative care, comfort care, and end-of-life care services, the PACE program must explain all of your treatment options, give you written information about these options, and get written consent from you or your designated representative.
- To have the PACE program help you create an advance directive if you choose. An advance directive is a written document that says how you want medical decisions to be made in case you cannot speak for yourself. You should give it to the person who will carry out your instructions and make health care decisions for you.
- To participate in making and carrying out your plan of care. You can ask for your plan of care to be reviewed at any time.
- To be given advance notice, in writing, of any plan to move you to another treatment setting, and the reason you are being moved.
YOU HAVE A RIGHT TO HAVE YOUR HEALTH INFORMATION KEPT PRIVATE.
- You have the right to talk with health care provider in private and have your personal health care information kept private and confidential, including health data that is collected and kept electronically, as protected under State and Federal laws.
- You have the right to look at and receive copies of your medical records and request amendments.
- You have the right to be assured that your written consent will be obtained for the release of information to persons not otherwise authorized under law to receive it.
- You have the right to provide written consent that limits the degree of information and the persons to whom information may be given.
There is a patient privacy rule that gives you more access to your own medical records and more control over how your personal health information is used. If you have any questions about this privacy rule, call the Office for Civil Rights at 1-800-368-1019. TTY users should call 1-800-537-7697.
YOU HAVE A RIGHT TO MAKE A COMPLAINT
You have a right to complain about the services you receive or that you need and don’t receive, the quality of your care, or any other concerns or problems you have with your PACE program. You have the right to a fair and timely process for resolving concerns with your PACE program. You have the right:
- To a full explanation of the complaint process.
- To be encouraged and helped to freely explain your complaints to PACE staff and outside representatives of your choice. You must not be harmed in any way for telling someone your concerns. This includes being punished, threatened or discriminated against.
- To contact 1-800-MEDICARE (1-800-633-4227) for information and assistance, including to make a complaint related to the quality of care or the delivery of a service.
YOU HAVE THE RIGHT TO REQUEST ADDITONAL SERVICES OR FILE AN APPEAL
You have the right to request services from CalOptima Health PACE, its employees, or contractors, that you believe are necessary. You have the right to a comprehensive and timely process for determining whether those services should be provided.
You also have the right to appeal any denial of a service or treatment decision by the PACE program, staff, or contractors.
YOU HAVE A RIGHT TO LEAVE THE PROGRAM.
If, for any reason, you do not feel that the PACE program is what you want, you have the right to leave the program at any time and have such disenrollment be effective the first day of the month following the date CalOptima Health PACE receives your notice of voluntary disenrollment.
Additional Help: If you feel any of your rights have been violated, or you are dissatisfied and want to file a grievance or an appeal, please report this immediately to your social worker or call our office during regular business hours at:
1-714-468-1100 or our toll-free line at 1-844-999-PACE (7223).
If you would like to talk to someone outside of CalOptima Health PACE about your concerns, you may contact 1-800-MEDICARE (1-800-633-4227), or 1-888-804-3536 (Health Consumer Alliance- Medi-Cal Ombudsman Program).
Participant Responsibilities
We believe that you and any family member or caregiver involved in your care play crucial roles in the delivery of your care. To assure that you remain as healthy and independent as possible, please establish an open line of communication with those participating in your care and be accountable for the responsibilities listed below:
- Cooperate with the Interdisciplinary Team in implementing and following your care plan.
- Discuss with your providers if you do not want to accept a treatment or medication your IDT decides you need, and to understand and accept the consequences to your health and well-being if you refuse any recommended treatment.
- Provide the Interdisciplinary Team with a complete and accurate medical history.
- Utilize only those services authorized by CalOptima Health PACE.
- Take all prescribed medications as directed.
- Call the CalOptima Health PACE physician for direction in an urgent situation.
- Notify CalOptima Health PACE within 48 hours or as soon as reasonably possible if you require emergency services whether in or out of the service area.
- Notify CalOptima Health PACE when you wish to initiate the disenrollment process.
- Notify CalOptima Health PACE of a move or lengthy stay outside of the service area.
- Pay required monthly fees as appropriate.
- Treat our staff with respect and consideration, and without discrimination of any kind.
- Not ask staff to perform tasks that they are prohibited from doing by CalOptima Health PACE or agency regulations.
- Voice any concerns or dissatisfaction you may have with your care.
CalOptima Health PACE will make every reasonable effort to provide a safe and secure environment at the center. However, we strongly advise participants and their families to leave valuables at home. CalOptima Health PACE is not responsible for safeguarding personal belongings.