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Member Quality

 

At Magellan Complete Care of Arizona (HMO SNP), we are dedicated to working with each member. We want to help you make your own choices to get what you need. We want you to know your rights and responsibilities as a member of our plan. We also want you to know our responsibilities to you. We honor those rights and responsibilities through our commitment to giving you the highest quality care.

The information on this page will help you better understand all this. It includes links to other pages with more information. If you have any questions or concerns about these, please contact us at Member Services at 1-800-424-4509 (TTY 711), 8 a.m. to 8 p.m., Monday through Friday (from October 1-March 31, 7 days a week).

En español

Quality Programs

We have important programs to make sure we provide you with outstanding healthcare. We also have healthcare partners who study our health plan and outcomes, to help us improve what we do for you. And we ask you, our members, to complete satisfaction surveys and take part in our Member Advisory Committee so we can constantly improve our services. Read more about our quality programs here.

Our top priority at Magellan Complete Care of Arizona (HMO SNP) is helping you have the best possible quality of life, which means outstanding healthcare, security and independence. Our unique way of doing that is to provide every member with their very own Care Coordination Team. Your team includes your Nurse Care Manager (NCM), your Primary Care Provider (PCP), a Community Resource Coordinator (CRC), and your caregiver from home, if you have one. Your team will work with you to create an Individual Care Plan to help you stay well and independent. If you need a new provider or specialist, your team will help you find them. They can even help you get transportation for your appointments.

The MCC of AZ (HMO SNP) Quality Improvement Program (QIP) is one of our most important programs to make sure you’re getting the very best care possible. It includes our objectives for providing safe and effective healthcare and health information. It also tells how we measure our progress. It describes how we use these results to evaluate, communicate and improve our members’ and providers’ services. You can learn more about our QIP by clicking here.

This Medicare program rates all health and prescription drug plans each year, based on a plan’s quality and performance. Medicare Star Ratings help you know how good a job our plan is doing. You can read more about our ratings here.

Member Rights

Membership Rights: as a member of MCC of AZ (HMO SNP), you have fundamental rights which we must protect. Read more here.
  • To receive information about MCC of AZ (HMO SNP)’s services, practitioners and providers, enrollment, informational or instructional materials, grievance and appeal rights, and member rights and responsibilities annually in a manner appropriate to your condition and ability to understand
  • To receive reasonable accommodation if required
  • To be treated with respect and dignity and in recognition of your rights to privacy
  • To participate with practitioners in making decisions about your health care, including the right to refuse treatment
  • To participate in a candid discussion of appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage
  • To voice complaints or appeals about the plan or the care provided
  • To make recommendations regarding your rights and responsibilities policy
  • To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation
  • To request and receive a copy of your medical record and request that the record be amended or corrected
  • To not be balanced billed by a provider for any service
  • To receive services in a culturally competent manner and nondiscriminatory manner
  • To receive updates and/or changes to the rights and responsibilities at least annually
  • To receive the Evidence of Coverage annually
  • To exercise your member rights without negative consequences
Involuntary Disenrollment: you have the right to know that MCC of AZ (HMO SNP) must end your membership in the plan if certain things happen. Read more here.

Magellan Complete Care of Arizona (HMO SNP) must disenroll you from our plan if:

  • You do not stay continuously enrolled in Medicare Part A and Part B
  • You are no longer eligible for Medicaid
  • You move out of our service area

– You are away from our service area for more than six months. If you move or take a long trip, you need to call Member Services to find out if the place you are moving or traveling to is in our plan’s area.

  • You become incarcerated (go to prison)
  • You lie about or withhold information about other insurance you have that provides prescription drug coverage
  • You intentionally give us incorrect information that information affects your eligibility for our plan

– We cannot make you leave our plan for this reason unless we get permission from Medicare first

  • You continuously behave in a way that is disruptive and makes it difficult for us to provide medical care for you and other members of our plan

– We cannot make you leave our plan for this reason unless we get permission from Medicare first

  • You let someone else use your membership card to get medical care

– We cannot make you leave our plan for this reason unless we get permission from Medicare first

– If we end your membership because of this reason, Medicare may have your case investigated by the Inspector General

  • You are required to pay the extra Part D amount because of your income and you do not pay it

– Medicare will disenroll you from our plan

If we end your membership in our plan, we must tell you our reasons in writing. We must also explain how you can make a complaint about our decision to end your membership. Please call Member Services for more information.

We cannot ask you to leave your health plan for any health-related reasons. If you ever feel that you are being encouraged or asked to leave because of your health, you should call 1-800-MEDICARE (1-800-633-4227), the national Medicare help line. TTY users should call 1-877-486-2048. You may call 24 hours a day, 7 days a week.

Nondiscrimination Notice: We treat everyone fairly and with dignity and respect. This notice explains how we do that. It also tells you what you can do if you believe you have been treated unfairly or if you believe your rights have not been respected.

Click here to read our Nondiscrimination Notice.

Multi-language Information Notice: We provide all information in the language and format that you prefer. This notice explains how we meet your language needs.
HIPAA Compliance Statement: We are very careful to protect your personal health information. This statement explains how we do this.

We follow all federal and state laws to keep your information safe. The HIPAA Compliance Statement explains how we do this.

Notice of Privacy Practices: this notice describes how your medical information about you may be used and shared with others. It also explains how you can get access to this information.
Secure communications: we are very careful with your private health information and about how we communicate with you to safeguard your privacy. Read more here.

Visit our Health & Safety Alerts page to learn how we protect your information and what you can do if you think your information has been compromised.

Member Responsibilities

If you think a provider or another member might be cheating Medicare or MCC of AZ (HMO SNP), the Fraud, Waste and Abuse Policy (FWA) explains how to report it.
If you are concerned about protecting yourself when reporting fraud, the False Claims Laws and Whistleblower Protection policy explains how your identity will be protected.
If you want to report possible fraud, waste or abuse to the federal government, please use the Office of Inspector General Hotline Form found here.
For more information and to get help with your rights and protections, you can go to the official U.S. government site for Medicare at: