Member Rights and Responsibilities

​​​​Your Rights

Every member has the right to:

  • Receive information about Cardinal Innovations Healthcare, its services, its providers/ practitioners, and member rights and responsibilities presented in a manner you can understand
  • Receive information about changes in benefits, services, or providers. Cardinal Innovations will notify members in writing of any significant changes to programs or services

  • Receive information in culturally and linguistically appropriate formats

  • Make recommendations regarding the organization's member rights and responsibilities policy
  • Make recommendations to the LME/MCO's about its policies and services by contacting Member Engagement at memberquestions@cardinalinnovations.org​. You also may call our toll-free Anonymous Concern Line at 1-888-213-9687 or email our Quality Management Department at QMEmail@cardinalinnovations.org. If you prefer to contact someone other than Cardinal Innovations, you may contact the NC DHHS Customer Service Center at 1-800-662-7030.
  • Be treated with respect and recognition of your dignity and right to privacy
  • Participate with providers/practitioners in making decisions regarding healthcare

  • A candid discussion with service providers/ practitioners on appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage. You may need to decide among relevant treatment options, risks, benefits and consequences, including your right to refuse treatment and to express your preferences about future treatment decisions regardless of benefit coverage limitations

  • Voice complaints about the organization or the care it provides.  You may voice your concerns or file a grievance by calling 1-888-213-9687. At this number, you may leave a message to have someone return your call or you may leave an anonymous message, if you prefer
  • Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation
  • A second opinion from a qualified mental health professional within the Cardinal Innovations network, or one that is out of network at no cost to the member
     
  • Refuse treatment

  • Request and file an appeal for changes in your Medicaid mental health services—If your service has been reduced, suspended or terminated, you or your provider can request Reconsideration within 30 days of such notice. This is the first step in the Appeal Process. For further information call your assigned Care Coordinator or contact the Appeals Coordinator at (704) 939-7700

  • A fair hearing with the State
     
  • Request and receive a copy of your medical records and to request that the medical records be amended or corrected. If a doctor or therapist determines that this would be detrimental to your physical or mental well-being, you can request that the information be sent to a physician or professional of your choice

  • Disagree with what is written in your medical records. If you disagree, you have the right to write a statement to be placed in your file. However, the original notes will also stay in the record until the statute of limitations ends according to the MH/DD/SAS retention schedule (11 years for adults; 12 years after a minor reaches the age of 18; 15 years for DUI records)
     
  • A second opinion
     
  • Participate in the development of a written person-centered treatment plan that builds on your individual needs, strengths and preferences. A treatment plan must be implemented within 30 days after services start

  • Participate in the development of an Individual Support Plan (ISP) and request the services that you want to request
     
  • Help develop and update your treatment plan and consent to treatment goals in that plan
     
  • Freedom of speech and freedom of religious expression

  • Equal employment and educational opportunities

  • Treatment in the most natural, age-appropriate and least restrictive environment possible
     
  • Ask questions when you do not understand your care or what you are expected to do

 

Rights of Minors

Minors have the right to treatment for the following conditions without the consent of a parent or guardian:

  • Venereal diseases
  • Pregnancy
  • Abuse of controlled substances or alcohol
  • Emotional disturbances

 

Your responsibilities

In addition to your rights as a member of the NC MH/ DD/SAS Health Plan, you can ensure the best outcomes for yourself by assuming the following responsibilities:

  • Supplying information (to the extent possible) that Cardinal Innovations and its providers need to provide care for you
  • Following the plans and instructions for care that you have agreed to with your providers
  • Understanding your health problems and participating, to the degree possible, in developing treatment goals, telling the doctor or nurse about any changes in your health and asking questions when you do not understand your care or what you are expected to do
  • Inviting people who will be helpful and supportive to you to be included in your treatment planning
  • Respecting the rights and property of other members and of provider staff
  • Respecting other members' needs for privacy
  • Working on the goals of your person centered plan
  • Keeping all the scheduled appointments that you can
  • Canceling an appointment at least 24 hours in advance, if you cannot keep it
  • Paying for services if included in your established agreement
  • Informing staff of any medical condition that is contagious
  • Taking medications as they are prescribed for you
  • Telling your doctor if you are having unpleasant side effects from your medications, or if your medications are not helping you feel better
  • Telling your provider if you do not agree with their recommendations
  • Telling your provider when or if you want to end treatment
  • Carrying your Medicaid or other insurance card with you at all times
  • Cooperating with those trying to care for you
  • Being considerate of other members and family members
  • Seeking out additional support services in your community
  • Reading, or having read to you, written notices from Cardinal Innovations about changes in benefits, services or providers
  • Requesting a discharge plan when you leave a provider; being sure you understand it and being committed to following it
  • Contacting any of the following if you feel that your rights have been violated:
    • Our toll-free Anonymous Concern Line
      • 1-888-213-9687
    • Call or Email our Quality Management Department
    • DHHS Customer Service Center
      • 1-800-662-7030.

Any person can report a concern or complaint by calling 1-888-213-9687. The Cardinal Innovations Access Call Center is also available by calling 1‐800‐939‐5911 24 Hours a Day/7 Days a Week/365 Days a Year.

There is also additional information regarding rights & responsibilities.

 

Civil Rights

Members are entitled to all Civil Rights including:

  • To register and vote
  • To buy or sell property or own property
     
  • To sign a contract
     
  • To sue others who have wronged them

  • To marry or get a divorce

  • To procreate and raise children

Persons determined to be incompetent and that are assigned a court appointed guardian retain all legal and civil rights except those rights that are granted to the guardian by the court.

The protection and promotion of recipient rights is a crucial component of the service delivery system. All consumers are assured rights by law and it is expected that Providers will respect these rights at all times and provide consumers continual education regarding their rights as well as support them in exercising their rights to the fullest extent.

North Carolina General Statutes (GS 122C 51-67) and the North Carolina Administrative Code (APSM 95-2) outline specific requirements for notification of individuals regarding their rights as well as operational policies and procedures that ensure the protection of rights.

These statutes and regulations also outline the policy and operational requirements for the use and follow-up of restrictive interventions and protective devices.

It is expected that all Network Providers are knowledgeable of all outlined statutes and regulations regarding consumer rights and the use of restrictive interventions/protective devices and that Providers develop operational procedures that ensure compliance. The Provider is also expected to maintain an ongoing knowledge of changes to the statutes and regulations and immediately alter operations to meet changes.

Each Network Provider Agency is expected to maintain a Client Rights Committee consistent with regulations outlined in North Carolina General Statue and Administrative Code. Providers are required to submit the minutes of their Client Rights Committee meetings to Cardinal Innovations on a quarterly basis. Providers should remove any information that is not in relation to Cardinal Innovations consumers.

Cardinal Innovations maintains a Client Rights Committee that is responsible for the monitoring and oversight of Provider Client Rights Committee functions. It is a subcommittee of our Continuous Quality Improvement Committee. The committee is available to support Provider Client Rights Committees. Please contact Carol Gouge, Consumer Affairs Specialist 704-721-7018, or our Advocacy and Outreach Specialist  at 704-939-7924.