Long-Term Care Member Rights
Members who receive long-term services and supports (LTSS) have additional rights related to care planning, service authorization, and care management.
This information applies to:
- Elderplan Plus Long-Term Care
- HomeFirst Managed Long-Term Care
Your Right to Participate in Your Care Plan
You have the right to participate in developing your Person-Centered Service Plan (PCSP).
You, your family, caregivers, and care team work together to develop a plan that reflects your needs, preferences, and goals.
Your Right to Care Management
You have the right to receive care management services that help coordinate your care and services.
Your Right to Assessments
You have the right to assessments and reassessments when your needs change.
Your Right to Review Clinical Criteria
You may request information about the clinical criteria and guidelines used to make decisions about your services and supports.
Your Right to Long-Term Care Services
You have the right to receive medically necessary long-term care services covered by your plan.
These services may include:
- Personal Care Services
- CDPAS
- Adult Day Health Care
- Home-Delivered Meals
- Personal Emergency Response Systems (PERS)
- Other covered long-term services and supports
Your Right to Aid Continuing
In certain situations, you may be able to continue receiving services while an appeal or Fair Hearing is pending. This protection is commonly known as aid-continuing. Eligibility and deadlines vary based on the type of appeal and service involved.
Your Right to Appeal Service Decisions
If services are denied, reduced, suspended, or terminated, you have the right to:
- Request a Plan Appeal
- Request a Fair Hearing
- Request an External Appeal when eligible
- Request aid-continuing when applicable
Your Responsibilities
You are responsible for:
- Participating in your care planning process
- Keeping your care team informed of changes
- Working with your care manager
- Following agreed-upon care plans