Medicaid Managed Care - U.S. Senate Special Committee on Aging

Standards for Members'
Rights and
Responsibilities
790
a) Members' Rights (RR 1)
NCQA's statement of rights is minimalist and does not include the
range of rights issues normally addressed in public mental health systems.
Important rights, well-established in law, are omitted, such as the
right to receive services free from discrimination based on race, gender,
age, national origin or disability; the right to give informed consent, the
right to refuse treatment, the right of access, the right to adequate care
and treatment, the right to review records, the right to execute advance
directives, and the right to be treated with respect.
Other rights recognized in mental health care settings are also missing.
The right to an individualized plan of care and to be a partner in
treatment planning, the right to care in the least restrictive setting, the
right to a second opinion and the right to change providers are not referenced.
For additional information on individual rights under managed bebatioral
health care plans, see the Bazelon Cenrer issue paper on rights flisted i*
resource attatbmen).
b) Information on Rights
Standards for distribution of information to members concerning
their rights require only that the plan 'distribute' the rganization's policy.
Entirely missing are requirements on how that should be done. Public
purchasers will want to require plans to ensure that all members
fully understand their rights and have ready access to this information
when they are concerned that their rights may be being violated. Rights
statements, for example, could be required to be distributed in all
provider offices and mailed annually with plan information.
c) Member Responsibilities(R 1)
NCQA's listing of member responsibilities is extremely problematic,
and it is unclear what happens if a member fails to carry out these
'responsibilities.' Most public systems do not take this approach to provision
of mental health care and some of the NCQA standards need to
be overridden for an effective public system. Especially problematic is
.the standard that members must follow plans and instructions for care.
Member non-compliance with treatment plans may be reflective of poor
treatment plans and lack of provider responsiveness. Attempting to compel
members' compliance through accreditation standards is unacceptable.
States should ensure that no managed care plan can disenroll a
NCQA Accreditation Standards for <strong>Managed</strong> Behavioral Healshcare Organiations
POLICY ANALYSIS BY THE BAZELON CENTER FOR MENTAL HEALTH LAWA 10J