Rights and Responsibilities

Your Rights

As a TrueCare member, you have a right to:

• Make recommendations about the organization’s member rights and responsibilities.
• Get information about TrueCare, our services, our providers, and member rights and responsibilities.
• Know TrueCare and how to get services through it.
• Have information on services that are offered by TrueCare such as:
  • Covered benefits and how to get them (Coming Soon).
  • If any benefits have prior authorization (PA) requirements.
• Take part in decisions about your health care. This includes the right to say no to treatment.
• Get information about treatment options and alternatives, regardless of cost or benefit coverage, in a way that you can understand.
• Know and discuss medically needed treatment options for your condition(s). No matter the cost or benefit coverage.
• Create an advance directive (Coming Soon) without fear of being treated unfairly. (This is a written record of your wishes for medical care.)
• Make suggestions about TrueCare’s member rights and responsibility policy.
• Be treated with respect and with regard for your dignity and privacy.
• Be sure your personal information and medical records are kept private.
• Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
• Live in an integrated and supported setting in the community. Have control over aspects of your life.
• Be protected in the community.
• Voice complaints and appeals about TrueCare or the care we provide.
• Get all written member information from TrueCare:
  • At no cost to you.
  • In your primary language.
  • In other formats, to help if you have trouble reading the information. This can be for any reason.
• Choose an in-network provider for a service you are eligible and authorized to get under your Person-Centered Service Plan. This includes a primary care provider (PCP).
• Keep your Medicare PCP if you want to.
• Women have the right to see a women’s health provider for covered women’s health care.
• Ask for and get a copy of your medical records. You can also ask for them to be changed or corrected. To request records from us, call Member Services at 1-833-230-2050 (TDD/TTY: 711) Monday through Friday, 7 a.m. to 8 p.m., CT.
• A right to voice complaints or appeals about TrueCare or the care it provides.
• Get help free of charge from TrueCare and its providers if you do not speak English. This is also if you need help understanding information.
• Get help free of charge with auxiliary aids like TTD/TTY and sign language if you are hearing impaired.
• Know that TrueCare must follow all federal and state laws, and other laws about privacy that apply.
• Get all needed, available, and accessible health care services covered under TrueCare and the Medicaid state plan in a timely manner.
• Get covered services out-of-network if TrueCare is unable to provide a necessary and covered service in-network for as long as it is unable to provide the service in-network. If you are approved to go out-of-network, the services are provided at a cost no greater than it would be in-network.
• Get a written notice within seven business days if there is a change in your Care Manager.
• Get a member handbook and provider directory sent or made available to you within five business days of joining TrueCare.
• Get a second opinion of a medical treatment from a network provider. If a network provider is not available, you can get a second opinion outside the network.
• To freely exercise your rights without adverse treatment from TrueCare and/or it’s providers.
• Get the following information on TrueCare from Member Services:
• Structure, governance, and operation:
  • How TrueCare rates on quality metrics and performance measures tracked by the Mississippi Division of Medicaid (DOM) or Centers for Medicare and Medicaid Services (CMS).
  • The plan’s non-discrimination policies and the individuals responsible for overseeing those policies, as well as responding to accessibility and discrimination claims made against the plan.
  • A list of any counseling or referral services not provided by TrueCare because of moral or religious objections, and how they can obtain information on and how to get those services through DOM.
• Not be discriminated against due to race, color, religion, gender, gender identity, sexual orientation, age, national origin, veteran’s status, ancestry, medical condition (including physical and mental illness), claims experience, receipt of health care, medical history, genetic information or evidence of insurability or disability. Contact the United States Department of Health and Human Services Office for Civil Rights with any complaint of discrimination:

Your Responsibilities

• • Use providers in the TrueCare network.
  • Go to all of your planned visits to your providers. Be on time. Call 24 hours before a doctor visit if you need to cancel.
  • Follow the plans and instructions for care you have agreed to with your providers.
  • Know the steps and rules to follow to get TrueCare covered services and care.
  • Always carry your ID card. Show it when getting care.
  • Never let others use your ID card.
  • Let TrueCare, Mississippi Division of Medicaid, and providers know if you change your phone number or address.
  • Let TrueCare, Mississippi Division of Medicaid, and providers know if you are covered by other health insurance.
  • Let TrueCare, Mississippi Division of Medicaid, and providers know if your family size changes.
  • Tell your PCP about going to an Urgent Care or tell your PCP after getting medical or behavioral health care.
  • Give information (to the extent possible) that TrueCare and its providers need to provide care and to get care.
  • Tell us of suspected fraud, waste, abuse or overpayment as described in this handbook.
  • Understand as much as possible about your health problems and participate in developing mutually agreed-upon treatment goals.
  • To pay for unauthorized health care services you get from out-of-network providers and understand how to ask for authorization for such services.
  • To follow established processes for prior authorization when requesting inpatient services and letting TrueCare know of inpatient admissions.
  • To show courtesy and respect to providers and their staff.

• To report truthful and accurate information when applying for Medicaid. If a member provides inaccurate information which leads to their enrollment being discontinued, the member will be responsible for repayment of capitation premium payments.
• Report any concerns of child or adult abuse and/or neglect to TrueCare or:

SUSPECTED CHILD ABUSE:

Phone: 1-800-222-8000
Online: https://reportabuse.mdcps.ms.gov/

ADULT PROTECTIVE SERVICES:

Phone: 1-844-437-6282
Online: https://reportabuse.mdcps.ms.gov/