when billed by a provider, and who to call about provider billing Use of the referral system, including what services 29 Contractor must be preapproved and how to obtain a referral How to obtain copies of member records, including 30 Contractor whether contractor charges for copying Explain confidentiality policies, including HIPAA 31 OHA Notice of Privacy Practices and how to request a full copy of it Advance Directives: As set in 438.6 (i) (2) Information about – advance directive policies, including a description of member rights under applicable State law; 32 OHA Contractor’s policies for implementation of those rights if any limitation in following advance directives as a matter of conscience is allowed; Complaint process for failure to follow an advance directive Member’s right to execute a Declaration of Mental Health Treatment in accordance with ORS 127.703, 33 OHA and complaint process for failure to follow a Declaration of Mental Health Treatment Grievance System Information: Grievance, appeal and fair hearing procedures and timeframes, as provided in 42 Section 438.400 – 438.424 Explain the following: The right to file grievances, appeals and 34 OHA administrative hearings; The toll-free numbers that the member can use to file a grievance or appeal by phone; The requirements and timeframes in the filing process for grievances, appeals and hearings; The availability of assistance in the filing process;
when billed by a provider, and who to call about provider billing 29 Contractor Use of the referral system, including what services must be preapproved and how to obtain a referral 30 Contractor How to obtain copies of member records, including whether contractor charges for copying 31 OHA Explain confidentiality policies, including HIPAA Notice of Privacy Practices and how to request a full copy of it 32 OHA Advance Directives: As set in 438.6 (i) (2) – Information about advance directive policies, including a description of member rights under applicable State law; Contractor’s policies for implementation of those rights if any limitation in following advance directives as a matter of conscience is allowed; Complaint process for failure to follow an advance directive 33 OHA Member’s right to execute a Declaration of Mental Health Treatment in accordance with ORS 127.703, and complaint process for failure to follow a Declaration of Mental Health Treatment 34 OHA Grievance System Information: Grievance, appeal and fair hearing procedures and timeframes, as provided in 42 Section 438.400 – 438.424 Explain the following: The right to file grievances, appeals and administrative hearings; The toll-free numbers that the member can use to file a grievance or appeal by phone; The requirements and timeframes in the filing process for grievances, appeals and hearings; The availability of assistance in the filing process;
Appendix%20to%20Exhibit%20J%20-%20Review%20Tool%20for%20CCO%20Informational%20Material.docx