NY Manual
SHP Manual

SHP Provider Manual
2.1 How to Identify a Senior Health Partners Member | 2.3 Member Co-Payments

2.2 Member Rights and Responsibilities

Rights and Responsibilities of a Senior Health Partners Member

Senior Health Partners members have the right to:

·         Receive medically necessary care
·         Timely access to care and services
·         Privacy about their medical record and when they get treatment
·         Get information on available treatment options and alternatives presented in a manner and language they understand 
·         Obtain information in a language they understand; members can receive oral translation services free of charge
·         Receive information necessary to give informed consent before the start of treatment
·         Be treated with respect and dignity
·         Receive a copy of their medical records and ask that the records be amended or corrected
·         Take part in decisions about their healthcare, including the right to refuse treatment
·         Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation
·         Receive care without regard to sex, race, health status, color, age, national origin, sexual orientation, marital status or religion
·         Be told where, when, and how to get the services they need from their managed long-term care plan, including how they can get covered benefits from out-of-network providers if they are not available in the plan network
·         Complain to the New York State Department of Health or their Local Department of Social Services; and the right to use the New York State Fair Hearing System and/or a New York State External Appeal, where appropriate
·         Appoint someone to speak for them about their care and treatment
·         Seek assistance from the Participant Ombudsman program known as the Independent Consumer Advocacy Network (ICAN)

Responsibilities of Members     

To have the greatest benefit from enrollment in Senior Health Partners, members have the following responsibilities:
1.    To Participate Actively in Their Care and Care Decisions
·     To communicate openly and honestly with you (their doctor) and Care Team about health and care
·     To ask questions to be sure they understand their Person Centered Service Plan (PCSP) and to consider consequences of not following their PCSP. Their PCSP and changes to their PCSP will be discussed and documented as part of our monthly care management call
·     To share in care decisions and continue to be in charge of their own health
·     To complete self-care as planned
·     To keep appointments or inform the Care Team of the need to change appointments
·     To use Senior Health Partners providers like you for care except in emergency situations
·     To notify Senior Health Partners if they receive health services from other healthcare   providers
·     To participate in policy development by writing to us, or calling us, or being part of the member advisory council
·     To read and understand their roles and responsibilities in accordance with the “Consumer/Designated Representative Acknowledgement of the Roles and Responsibilities for Receiving CDPAS” signed by members in receipt of said service
2.    To Support the Senior Health Partners Program
·         To appropriately express opinions, concerns and suggestions to their Care Team, or through the Senior Health Partners Complaints and Appeals Process.
·         To review the Member Handbook and follow procedures to receive services.
·         To respect the rights and safety of all those involved in their care and to assist Senior Health Partners in maintaining a safe home environment.
·         To promptly notify their Care Team at Senior Health Partners of any of the following;
o   if they are leaving the service area
o   if they have moved or have a new telephone number
o   if they have changed doctors
o   any changethat may affect our ability to provide care