Alabama's Medicaid agency has issued a second warning to acute-care hospitals and other providers that they could face sanctions for blocking Medicaid patients' access to care-coordination services.
The state is transitioning its Medicaid program from fee-for-service to a managed-care model administered by provider-based entities called Regional Care Organizations.
In April, the Regional Care Organizations established medical homes to provide enhanced care coordination for patients with certain chronic conditions, such as diabetes, asthma and hepatitis C. A major component of this program is that health home staff must follow up with beneficiaries after an inpatient hospital stay.
The Alabama Medicaid Agency received reports that some hospitals were making it difficult for care coordinators to reach their patients, agency spokeswoman Robin Rawls said.
The state issued a bulletin in July informing hospitals that they must help care coordinators reach their patients.
“The issue resurfaced recently, so the agency issued the additional alert this past week to reiterate our expectations in greater detail,” Rawls said.
In response to a query about the notices, Alabama Hospital Association Chief Operating Officer Rosemary Blackmon said in an e-mail that its members are committed to the goals of more coordinated and efficient care.
The noncompliance may have less to do with hospitals intentionally trying to impede care coordination than lack of awareness about the policy, said Burr Ingram, a spokesman for Huntsville Hospital Health System. The Dec. 16 notice from the state, he said, was is in response to hospitals and health homes seeking clarification on the initial notice.
Burr also emphasized that the alerts had nothing to do with the quality of care patients received in the hospitals.
Koko Mackin, a spokesman for Blue Cross and Blue Shield of Alabama, which owns Healthcare Business Solutions and Regional Care Organization serving north Alabama, said the state's intervention will help the health homes get hospital census data that they need to help patients transition from the hospital to home.