Participant’s Bill of Rights

You have the right to be treated with dignity and respect at all times, have all of your care kept private and get compassionate, considerate care. You have the right to:

• Get all of your health care in a safe, clean environment.
• Be free from harm. This includes physical or mental abuse, neglect, physical punishment or being placed by yourself against your will, as well as any physical or chemical restraint used on you for discipline or convenience of staff that you do not need to treat your medical symptoms or prevent injury.
• Be free from hazardous procedures.
• Receive treatment and rehabilitation services designed to promote your functional ability to the optimal level and encourage your independence.
• Receive care from professionally trained staff that has the education and experience to carry out the services for which they are responsible.
• Be ensured of auditory and visual privacy during all health care examinations or treatment visits.
• Be encouraged and assisted to use your rights in Sentara PACE.
• Get help, if you need it, using the Medicare and Medicaid complaint and appeal processes, and your civil and other legal rights.
• Be encouraged and helped in talking to the staff about changes in policy and services you think should be made.
• Use a telephone while at the center, make and receive confidential calls and/or have such calls made, if necessary.
• Not have to do work or services for Sentara PACE.

Discrimination is against the law. Every company or agency that works with Medicare and Medicaid must obey the law. They cannot discriminate against you because of your:

• Race/ethnic origin
• Religion
• Age
• Sex
• Sexual orientation
• Mental or physical ability
• Source of payment for your health care (for example, Medicare or Medicaid)

As a participant of Sentara PACE, you have the right to receive competent, considerate, respectful care from staff and contractors without regard to race/ethnic origin, religion, age, sex, sexual orientation, mental or physical ability, or source of payment for your health care.

If you think you have been discriminated against for any of these reasons, contact a staff member at Sentara PACE to help you resolve your problem. If you have any questions, you can call the Office for Civil Rights toll-free at 1-800-368-1019.

You have the right to get accurate; easy to understand information and have someone help you make informed health care decisions. You have the right to:

• Have someone help you if you have a language or communication barrier so you can understand all information given to you.
• Have someone interpret all information given to you into your preferred language in a culturally competent manner, if your first language is not English and you cannot speak English well enough to understand the information being given to you.
• Have the Enrollment Agreement discussed fully and explained to you in a manner you understand.
• Get marketing materials and PACE rights in English and any other frequently used language in your community. You also can get these materials in Braille, if necessary.
• Get a written copy of your rights from Sentara PACE. Sentara PACE will post these rights in a public place in the PACE center where it is easy to see them.
• Be fully informed, in writing, of the services offered by this program. This includes telling you which services are provided by contractors instead of the staff. You will be given this information before you join Sentara PACE, at the time you join and when there is a change in services.
• Look at, or get help to look at, the results of the most recent review of Sentara PACE. Federal and state agencies review all PACE programs. You also have a right to review how Sentara PACE plans to correct any problems that are found at inspection.
• You have a right to a choice of providers.
• You have the right to choose your own primary care provider and specialists within Sentara PACE’s network and get quality health care. You have the right to request that your primary care be transferred to a different primary care physician and specialist within Sentara PACE’s network.
• Women have the right to get services from a qualified women’s health care specialist for routine or preventive women’s health care services.

You have the right to get emergency services when and where you need them without Sentara PACE’s approval. A medical emergency is when you think your health is in serious danger – when every second counts. You may have a bad injury, sudden illness or an illness quickly getting much worse. You can get emergency care anywhere in the United States.

You have the right to fully participate in all decisions related to your health care. If you cannot fully participate in your treatment decisions or you want to have someone you trust help you, you have the right to choose that person to act on your behalf. You have the right to:

• Have all treatment options explained to you in a language you understand, be fully informed of your health status and how well you are doing, and make health care decisions.
• Be informed of all treatment prescribed prior to being treated, when and how services will be provided, and the names and functions of people providing your care.
• Request reassessment by the IDT.
• Refuse treatment or medications. If you choose not to get treatment, you must be told how this will affect your health.
• Be assured that decisions regarding your care will be made in an ethical manner.
• Be assured that you and your family will be taught about an illness affecting you so that you can help yourself, and your family can understand your illness and help you.
• Receive information on advance directives and have Sentara PACE help you create an advance directive. An advance directive is a written document that says how you want medical decisions to be made in case you cannot speak for yourself.
• Participate in making and carrying out your plan of care, which will be designed to promote your functional ability to the highest level and encourage your independence.
• You can ask for your plan of care to be reviewed at any time.
• Be given advance notice, in writing, of any plan to move you to another treatment setting, and the reason you are being moved.

You have the right to:

• Talk with health care providers in private and have your personal health care information kept private as protected under state and federal laws.
• Review and receive copies of your medical records and request amendments to those records.
• Be assured that all information contained in your health record will be held in confidence, including information contained in any automated data bank. Sentara PACE will require your written consent for the release of information to persons not otherwise authorized under law to receive it. You may provide written consent, which limits the degree of information and the persons to whom information may be given.
• There is a new patient privacy rule that gives you more access to your own medical records and more control over how your personal health information is used. If you have any questions about this privacy rule you may call the Office for Civil Rights toll-free at 1-800-368-1019. TTY users should call 1-800-537-7697.

You have a right to complain about the services you receive or that you need and do not receive the quality of care, or any other concerns or problems you have with Sentara PACE. You have the right to a fair and timely process for resolving concerns with Sentara PACE. You have the right to:

• A full explanation of the complaint and appeals process.
• Be encouraged and helped to freely explain your complaints to the staff and outside representatives of your choice. You must not be harmed in any way for telling someone your concerns. This includes being punished, threatened or discriminated against.
• Appeal any treatment decision by Sentara PACE staff or contractors.

If for any reason you do not feel that Sentara PACE is what you want, you have the right to leave the program at any time.

If you feel any of your rights have been violated, please report them immediately to your social worker or call our office during regular business hours at either Sentara PACE sites: 757-502-7800 for Sentara PACE in Virginia Beach and 757-392-2650 for Sentara PACE - Churchland in Portsmouth.

In order to appoint a representative, you must complete and send in the request form.

What do I do if I am not satisfied with my health care plan or the care I receive?

We want to be sure that you are satisfied with the care that you receive from us. Please let us know right away if there is a problem or concern about any aspect of the program. As a Sentara PACE participant you have the right to file a grievance about anything you are not satisfied with regarding our program. Here are a few examples:

• The quality of Service you receive in the home, at the PACE center, or in any inpatient stay (hospital, skilled nursing facility, or nursing facility).
• Mistakes you feel have been made.
• Waiting times on the phone or in the waiting/exam room.
• Behavior of any of your care providers or program staff.
• Adequacy of center facilities.
• Quality of food provided.
• Transportation services.

Information on how to file a grievance will be reviewed with you at least annually and anytime you or your family requests it.

If you file a grievance, you will continue to receive health services the same as before you filed the grievance. Sentara PACE employees will not discuss your grievance with other participants or anyone else not involved with investigating your grievance.

You may file a grievance with any staff member, either verbally or in writing, at any time. You or your family member can telephone the center during the hours of 8 a.m. – 5 p.m. TTY users should call 844-333-8917 or call the administrative on-call staff member at 757-392-2650 OR 757-252-7800 after hours.

• Download the greivance form

Once you or your family member have filed a grievance, Sentara PACE will discuss it with you or your representative and provide you with the specific steps, including the time frames for response, that will be taken to resolve the grievance, which includes a written notification of the grievance process. We will continue to furnish you with all services at the frequency provided in the current plan of care during the grievance process.

It is the responsibility of our Site Manager to investigate and seek a resolution of the grievance, as soon as possible, but no later than 30 business days. The grievance and the resolution will be discussed by your Interdisciplinary Team during our morning staff meetings.

All efforts will be made by the team to pursue a resolution to its utmost ability, so that problems with service delivery do not go unresolved. If you or your family members are still not satisfied with the resolution proposed by the team, you will be informed, either orally or in writing, of what action you may take.

All efforts will be made by the Sentara PACE Site Manger to resolve the ongoing grievance within 30 days by using the resources of the program, including the Medical Advisory Board, Ethics Committee, and/or the Quality Assurance Committee.