Effective immediately, all Medicaid-enrolled providers, hospitals and other facilities must allow individuals providing care coordination services who are employees of or contracted with any Regional Care Organization (RCO), Probationary RCO or Health Home access to their patients receiving care in the providers’ and hospitals’ facilities. Restricting, impeding or interfering with Medicaid recipient access to medically necessary or care coordination services is strictly prohibited and may result in sanctions against the entities involved.

      Specifically:

•    Providers must not restrict, impede, or interfere with the delivery of services or care coordination benefits for any Medicaid recipient whether or not the Provider is providing such care.

•    Hospitals and other facilities must not restrict, impede or interfere with the delivery of services or care coordination benefits for any Medicaid recipient, including services or benefits that may be provided by a Provider or individual providing care coordination services that is out of network, unaffiliated, or external to the facility or hospital the Medicaid recipient is currently admitted to or seeking care from.

•    Hospitals must also not restrict or otherwise hinder such Medicaid recipients’ access to Care Coordinators or the delivery of care coordination services by an unaffiliated RCO, Probationary RCO or Health Home through the use of written and/or oral communications to recipients in the hospital about the availability of, access to or quality of care coordination services offered by an affiliated RCO, Probationary RCO or Health Home.
   

•    Access to patients receiving care in  the providers’ or hospitals’ facilities includes, but is not limited to, providing a census to a Health Home of all patients assigned to the affiliated RCO or Probationary RCO, and permitting access of Care Coordinators through face to face contact with assigned Health Homes recipients within the hospital or medical facility.

Questions or comments should be directed to Carolyn Miller, Associate Director, Project Development and Quality Improvement, via e-mail at Carolyn.miller@medicaid.alabama.gov or phone at 334-353-5539.