WEBVTT

00:00:00.165 --> 00:00:04.867
Medicaid freedom of choice generally means a beneficiary may receive covered services

00:00:04.867 --> 00:00:08.002
from a qualified provider willing to serve them.

00:00:08.002 --> 00:00:11.137
But the rule has exceptions, including certain waivers

00:00:11.137 --> 00:00:12.312
and managed-care arrangements.

00:00:12.312 --> 00:00:15.055
So a small provider getting fewer referrals

00:00:15.055 --> 00:00:17.797
does not by itself prove unlawful steering.

00:00:17.797 --> 00:00:19.757
Ask for the qualified-provider list.

00:00:19.757 --> 00:00:23.676
Record which options were explained, which provider the person selected,

00:00:23.676 --> 00:00:28.769
who was willing and authorized, and any written reason a choice was denied.

00:00:28.769 --> 00:00:31.512
Compare that record with 42 CFR 431.51

00:00:31.512 --> 00:00:33.080
and the person-centered plan.

00:00:33.080 --> 00:00:35.039
Provider choice protects the beneficiary;

00:00:35.039 --> 00:00:38.174
it does not guarantee referrals to any agency.

00:00:38.174 --> 00:00:40.133
A pattern can trigger review.

00:00:40.133 --> 00:00:44.051
It is not an audit, finding, or proof of fraud.

00:00:44.051 --> 00:00:46.403
Read the source-linked record at david-medeiros.com.