Ala. Admin. Code r. 560-X-1-.08

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-1-.08 - Recipient Rights And Responsibilities

(1) Free choice of selecting providers of health care is a legal right of every recipient of Medicaid care and services. Freedom of choice related to an individual' sopport unity to make his/her own decisions for his/her own reasons, free from the arbitrary authority of others, is a recipient's right.

(2) Where prior authorization is required for Medicaid services, a recipient's choice among qualified providers shall not be restricted except by special action of the Alabama Medicaid Agency to restrict or "lock-in" a recipient to a provider of choice. (See Chapters 4 and 5 for additional information on recipient restrictions.)

(3) A recipient who believes that his/her free choice of provider has been denied or impaired has the right to request a fair hearing before the Alabama Medicaid Agency.

(4) When a recipient fails to advise a provider of his/her Medicaid eligibility and furnish other information necessary to file the claim within the time allowed by Medicaid, the provider is under no obligation to file and may elect to file with Medicaid or to bill the patient.

Ala. Admin. Code r. 560-X-1-.08

Rule effective October 1, 1982. Amended: Effective August 10, 1987. Amended: Filed September 11, 2013; effective October 16, 2013.

Author: Kathy Hall, Deputy Commissioner, Program Administration

Statutory Authority: Social Security Act, Title XIX; 42 C.F.R. §§ 431.51, 431.54.