5002-2 FREEDOM OF CHOICE RESTRICTION - CARE MANAGEMENT PROGRAM
The state’s fiscal agent, Affiliated Computer Systems ( ACS ), administers the Care Management Program. ACS may restrict a recipient's choice of providers if they find that the recipient has used a medical service at a frequency or in an amount that is considered improper, excessive, or unusual. This restriction is imposed by placing a recipient into the Care Management Program.
When this occurs, ACS will notify the recipient of the finding and assign the individual a provider who will be the only provider available they can use for the services identified by ACS . Once placed in the Care Management Program, the recipient may not receive medical services from another enrolled provider without first getting a written referral from their care management provider except in the case of a life threatening or potentially disabling emergency.
The recipient has a right to a fair hearing to contest this finding. Recipients may request a fair hearing by contacting either their caseworker or the Medicaid Recipient Helpline toll free at 1-800-780-9972 (both inside and outside of Anchorage area). A Fair Hearing Representative from the Division of Health Care Services will then contact the recipient regarding this request.
When an individual is placed into the Care Management Program, ACS staff will enter a "PC" code for that individual on the EIS Medical Resource (MERE) screen. Although DPA will authorize the benefit in the normal manner and EIS will show a benefit issued, the Recipient Identification card (coupons) for the individual will be mailed separately by ACS , usually within three days of the system issuance.
DPA is unable to issue or print coupons for a Care Management Program recipient, but may contact ACS at 907-644-6842 or by email at Jason.Ball@acs-inc.com to request coupons on behalf of the recipient.
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