As a Vaya Health member, you are guaranteed certain rights by law. Vaya network providers must respect your rights at all times, provide you with continual education regarding your rights and support you in exercising your rights to the fullest extent possible.
Important information about your rights and responsibilities as a member of our health plan is listed below. For information about additional rights, including rights in a facility, rights as a minor and rights regarding involuntary commitment, please see Section 9 of the Vaya Health Member and Caregiver Handbook.
If you believe your rights have been violated, contact the Vaya Access to Care Line at 1-800-849-6127. You can file a grievance or complaint in person or by phone. You do not have to give your name. You may also call the N.C. Department of Health and Human Services (DHHS) Customer Service Center at 1-800-662-7030.
Additionally, you may also contact the U.S. Department of Health and Human Services Office for Civil Rights at 1-800-368-1019 (TDD toll-free 1-800-537-7697), by email at OCRPrivacy@hhs.gov or by U.S. mail at: HHS Office for Civil Rights, 200 Independence Ave. SW, Room 509F, HHH Building, Washington, DC 20201.
Individuals living in adult care homes have the right to report to the N.C. Division of Health Service Regulation (DHSR) any suspected violation of their member rights. You may contact DHSR at 1-800-624-3004 (within North Carolina) or 919-855-4500 between 8:30 a.m. – 4 p.m. on weekdays, except holidays, or by fax at 919-715-7724. You may also send a letter to N.C. DHSR, Complaint Intake Unit, 2711 Mail Service Center, Raleigh, NC 27699-2711. For more information, visit the DHSR website.
You may contact the Office of the State Long Term Care Ombudsman. Learn more or contact the office by phone at 919-855-3400, by fax at 919-715-0364 or by mail at: Office of the State Long Term Care Ombudsman, 2711 Mail Service Center, Raleigh, NC 27699-2711.
- The right to receive information in accordance with federal Medicaid requirements
- The right to confidentiality and privacy
- The right to be treated with respect and recognition of your dignity
- The right to humane care and freedom from mental and physical abuse, neglect and exploitation
- The right to live as normally as possible while receiving care and treatment
- The right to be free from unwarranted searches of your person or seizure of your possessions
- The right to be free from unnecessary or excessive medication, which shall not be used for punishment, discipline or staff convenience, and which shall be administered in accordance with accepted medical standards and only upon the order of a physician or other medical practitioner, as documented in your health record
- The right to be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation
- For enrollees who live in adult care homes, the right to report any suspected violation of your rights to the appropriate regulatory authority as outlined in N.C.G.S. § 131D-21
- The right to be free from any form of discrimination prohibited by federal or state laws, rules and regulations
- The right to freedom of speech and freedom of religious expression
- The right to exercise the same civil rights as any other citizen, including the right to vote, marry, divorce, make a will and buy, sell and own property, unless you have been adjudicated incompetent
- The right to be free from the threat of unwarranted suspension or expulsion from treatment
- The right to consent to or refuse treatment, except in a medical emergency or an involuntary commitment
- The right to receive treatment in the most natural, age-appropriate and least restrictive environment possible
- The right to participate with your treating providers in making healthcare decisions
- The right to participate in the development and periodic review of your written person-centered treatment or habilitation plan that builds on individual needs, strengths and preferences
- The right to have an individualized treatment or habilitation plan implemented within 30 days of admission to any inpatient or residential facility
- The right to ask questions of Vaya or your treating providers at any point in the process and receive accurate information
- The right to participate in a candid discussion with your treatment providers about medically necessary treatment options and alternatives for the relevant diagnosis or condition, regardless of benefit coverage limitation
- The right to be informed in advance of the benefits or risks of treatment choices and to a second opinion, at no cost to you
- The right to receive information on available treatment options and alternatives, presented in an appropriate way that you are able to understand
- The right to decide among relevant treatment options and express preferences about future treatment decisions, regardless of benefit coverage limitation
- The right to be informed of the cost of services at the first visit or during scheduling of the first appointment
- The right to voice complaint(s) or file a grievance about Vaya or about the care and treatment you receive from providers
- The right to receive written notification from Vaya about adverse decisions on requests for prior authorization
- The right to file an appeal with Vaya of the denial, reduction, suspension or termination of a service and to request a State Fair Hearing if you disagree with Vaya’s final decision
- The right to receive interpretation or translation services and other accommodations needed for accessibility, free of charge
- The right to a current listing of network providers and access to a choice of providers from within the network, to the extent possible or required by law
- The right to receive information about Vaya, our providers and your rights and responsibilities presented in a manner appropriate to your ability to understand
- The right to recommend changes to Vaya’s policies and services. If you wish to do so, please contact our Member Services Department at 1-800-849-6127 or write us at: Vaya Health, 200 Ridgefield Court, Asheville, NC 28806.
- The right to receive a written notice from Vaya of any “significant change” at least 30 days before the intended effective date of the change. This is a change that requires modifications to the N.C. State Plan for Medical Assistance, the 1915 (b)/(c) Waiver or Vaya’s contract with NC Medicaid.
- The right to make instructions for mental health, substance use disorder or IDD treatment in advance to use if you become incapable of making such decisions. The forms used to do this are called advance directives. The N.C. Secretary of State provides forms you can use to create advance directives here.
- The right to be furnished, consistent with the scope of services of Vaya’s Waiver Contract, healthcare services in accordance with federal law
In addition to your rights as a member of the Vaya Health Plan, you can ensure the best outcomes for yourself by assuming the following responsibilities:
- Seeking help when you need it and calling your provider or Vaya if you are in crisis
- Supplying all information (to the extent possible), including information about your health problems, that Vaya and its providers need in order 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 in developing mutually agreed‐upon treatment goals, to the degree possible, telling the doctor, nurse or other service provider 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
- Working on the goals of your Person-Centered Plan
- Respecting the rights and property of other individuals and of Vaya and provider staff
- Respecting the privacy and security of other individuals.
- Keeping all the scheduled appointments that you can and being on time for appointments
- Canceling an appointment at least 24 hours in advance if you are unable to keep it
- Meeting financial obligations according to 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 do not seem to be working to help you feel better
- Refrain from “doctor shopping” in an attempt to obtain more prescriptions than you need
- Telling your doctor or therapist if you do not agree with their recommendations
- Telling your doctor or therapist if and when you want to end treatment
- Carrying your Medicaid or other insurance card with you at all times, and not allowing friends, family or others to use your Medicaid card
- Cooperating with those trying to help you
- Following the rules posted in day, evening or 24-hour service programs
- Being considerate of other individuals and family members
- Seeking out additional support services in your community
- Reading, or having read to you, written notices from Vaya about changes in benefits, services or providers
- When you leave a program, requesting a discharge plan, being sure you understand it and being committed to following it
- Using the hospital emergency department only for emergency care
- Notifying the county DSS (for Medicaid enrollees), provider or the Vaya Access to Care Line (for non-Medicaid members) right away with any change in your contact information, including your address or telephone number
- Helping prevent fraud, waste and abuse