The protection and promotion of your rights is a crucial component of our service delivery system. Vaya Health members 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 fully exercising your rights.
The rights listed here are based on N.C.G.S. Chapter 122C, Article 3, as well as sections of the N.C. Administrative Code and other federal and state laws, rules and regulations. If you are concerned about your rights, you should contact the Vaya Human Rights Committee or file a grievance by calling 1-800-849-6127.
If you prefer to contact someone other than us, please call the N.C. Department of Health and Human Services at 1-800-662-7030. You can also report anonymously by calling the Vaya Compliance Hotline at 1-866-916-4255. This number is monitored by an external, third-party vendor, and your call will be completely anonymous, if you choose. You can also file a report in our EthicsPoint compliance portal.
Vaya follows the 2001 vision of the North Carolina State Plan, called “Blueprint for Change.” That plan stated people with mental health, substance use or intellectual/developmental disability service needs should have:
- A meaningful say in the design and planning of the service system
- Information about services and how to access them
- Easy, immediate access to appropriate services
- Services to prevent and resolve crises
- Satisfaction with the quality and quantity of services
- The opportunity to voice complaints
- An orderly, fair and timely system of arbitration and resolution
- Educational and employment opportunities
- Safe and humane living conditions in communities of their choice
- Reduced involvement with the criminal justice system
- Opportunities to participate in community life and make choices
- 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
- 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 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 have health information kept secure and confidential by Vaya and your providers in accordance with federal and state laws, rules and regulations
- The right to request and receive a copy of your medical record, subject to therapeutic privilege, and to request that your medical record be amended or corrected
- 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 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 DMA.
- The right to recommend changes to Vaya’s policies and services. If you wish to do so, please contact our Customer Services Department at 1-800-849-6127 or write us at: Vaya Health, 200 Ridgefield Court, Suite 206, Asheville, NC 28806.
- To supply all information (to the extent possible) that Vaya and its providers need to provide you with the best care possible
- To invite people who will be helpful and supportive to your treatment team meetings
- To cooperate with treatment providers and participate in developing mutually agreed-upon treatment goals, to the degree possible
- To work on the goals of your mutually developed Person-Centered Plan or Individual Support Plan
- To follow the plans and instructions for care agreed to with your treatment providers
- To tell your treating provider, including a doctor, nurse or therapist about any changes in your health or condition
- To understand your own health condition(s) or diagnosis, to the degree possible
- To ask questions when you do not understand your diagnosis, treatment expectations or the care you are receiving
- To keep and be on time for scheduled appointments
- If unable to keep an appointment, to cancel it at least 24 hours in advance
- To meet financial obligations according to any established agreement with your provider
- To inform your provider (and Vaya staff, if meeting in person) of any medical condition that is contagious
- To take your medications as they are prescribed
- To tell your prescriber or another doctor if you are experiencing unpleasant side effects from medications or if medications do not seem to be helping
- To tell your treating provider if you do not agree with their recommendations or want to end treatment
- To use the hospital emergency department only for emergency care
- To contact the Vaya toll-free Access to Care Line if you are in crisis and cannot reach your provider or need access to services
- To request a discharge plan that you can understand and follow when leaving a program or facility
- To be considerate of and respect the rights and property of other individuals and of Vaya and provider staff, including other members’ privacy rights
- To seek out additional support services in the community
- To read written notices from Vaya (or ask for them to be read to you), especially notices about changes in benefits, services or providers
- To notify the county Department of Social Services (for Medicaid enrollees), provider or the Vaya toll-free Access to Care Line (for non-Medicaid members) right away with any change in your contact information, including your address or telephone number
- To carry your Medicaid or other insurance card with you at all times and not allow other people to use or borrow your card
- To review any explanation of benefits carefully to ensure services billed are accurate
- To ask for a copy of documents you are asked to sign and keep them somewhere safe
- Not to share medical records or other sensitive information with anyone except Vaya, another insurance program, a doctor, agency, clinic, hospital or other healthcare provider
- Not to ask a doctor or other provider for treatment or care that you do not need
- To refuse gifts or kickbacks offered by your provider and to report the offer to Vaya
- To call Vaya’s toll-free Confidential Compliance Hotline if you have any concerns or suspicions about a provider’s billing practices or other compliance issue
- To tell Vaya about any problems you experience with services, network providers or Vaya staff
You have the right to be informed in advance of the potential risks and benefits of treatment options, including the right to refuse to take part in research studies. You have the right to consent to or refuse any treatment unless:
- It is an emergency situation; or
- You are not a voluntary patient; or
- Treatment is ordered by a court of law; or
- You are under 18 years of age, have not been emancipated and the guardian or conservator gives permission.
Yes. You may recover to the extent that you decide you no longer need services. However, you can access treatment any time you need services again. You are free to stop or discontinue services at any time or refuse a recommended treatment unless a court has ordered you to be in treatment or you have a legal guardian who makes your healthcare decisions.
In North Carolina, individuals with mental illness, substance use disorders or an intellectual/developmental disability can be involuntarily admitted to a facility if a court finds they are dangerous to themselves or others. This applies to both competent and incompetent adults.
Competent adults have the option to seek voluntary admission. We encourage our members to seek voluntary treatment when you feel the signs, symptoms and fear of losing control. If you go to a facility, and facility staff decide they do not have a treatment that would help you or that you do not need treatment, the facility will not admit you.
If you are a voluntary patient, you must be discharged within 72 hours of your own written request. An incompetent adult with a mental illness or substance use problem will have a court-appointed guardian who will act on your wishes and seek admission for you. They will be required to consent to your treatment and receive legal notices for you.
Involuntary commitment can happen when a treating provider, law enforcement officer, relative, coworker, neighbor or other person goes to a magistrate and signs an affidavit listing facts that show you are dangerous to yourself or others. The magistrate or clerk of Superior Court would then issue an order to have you examined by a physician or psychologist. The magistrate or clerk then issues a custody order to a local law enforcement officer, who locates and transports you to a physician or psychologist for evaluation, usually in an emergency department of a hospital.
If you go to a hospital yourself and appear dangerous, a physician or psychologist can recommend involuntary commitment even if no custody order has been issued. If a doctor or therapist determines that you meet commitment criteria, the law enforcement officer takes you to an inpatient facility, where a second examination is conducted, if possible, within 24 hours.
Within 10 days, a hearing is held in District Court. If the court finds by clear, cogent and convincing evidence that you meet inpatient commitment criteria, it may order commitment for up to 90 days. At the end of this 90-day period, a hearing can be held and a second commitment order issued for an additional period of up to 180 days. Re-hearings are held at the end of this second commitment and annually thereafter.
Involuntary commitment takes control out of your hands and completely interrupts the flow of your life. If you have been involuntarily committed in the past and lost a lease or a job, think about seeking help as soon as you know something is wrong. Try to go to a Comprehensive Care Center or a facility-based crisis center. Or, call the Access to Care Line at 1-800-849-6127 and ask for help.
If you enter a 24-hour treatment facility, the facility must provide you with a copy of the facility’s rules and explain them to you within 72 hours, or within your first three visits to the program. These rules will cover hygiene, grooming, your living environment, your personal funds and storage and protection of clothing and possessions. More information about this requirement can be found at 10A NCAC 27F .0100–.105.
Client rights rules for community mental health, substance use and intellectual/developmental disability services are available at on the DHHS website.
North Carolina correctional facilities must have a medical plan that includes policies for health screening of inmates upon admission, as well as administering, dispensing and controlling prescription and non-prescription medications. Jails must provide conferences with qualified medical personnel and privacy during examinations.
You will be observed twice per hour, or four times per hour if you have a record of making suicide attempts or are displaying erratic behavior.
People who apply for a permit to carry a concealed weapon in North Carolina must give consent for the details of mental health and substance use treatment and hospitalizations to be released to law enforcement. Under federal and state law, individuals with a history of substance use, involuntary commitment or certain criminal history may be denied the right to purchase a firearm or to carry a concealed weapon.
People who do not have the ability to make and communicate important decisions about their personal and financial affairs may be declared incompetent by a court and assigned a guardian to help them exercise their rights. If you have been adjudicated incompetent, your guardian is legally appointed by the court to serve as your decision-maker and advocate. However, your guardian must give you the opportunity to take part as fully as possible in all decisions affecting your life.
People who are determined to be incompetent and who are assigned a court-appointed guardian retain all legal and civil rights, except rights granted to the guardian by the court. You should read the guardianship order carefully. Often it includes language that reserves some of your rights, such as your right to associate with your own friends, make decisions about where you live or make healthcare decisions.
If you have been declared incompetent, you can have your guardianship reversed and possibly be restored to competency. You, the guardian or any other interested person can ask the clerk of Superior Court to re-open the case.
The request begins by filing a written motion or petition with the clerk in the county where the guardianship is administered. To be restored to competency, you must prove that you are able to manage your own affairs and make and communicate important decisions.
If competency is restored, the guardian is dismissed. Partial restoration of some rights is also an option. For more information about guardianship, please contact your local Department of Social Services (DSS) office.