Requirements for treating Medicaid patients
Providers who treat Medicaid patients are required to comply with state and federal regulations related to patient/enrollee rights.
Medicaid enrollee rights include the right to:
- Receive information on beneficiary and plan information
- Be treated with respect and with due consideration for his or dignity and privacy
- Receive culturally and linguistically appropriate services (see below)
- Participate in decisions regarding his or her health care, including the right to refuse treatment and express preferences about treatment options
- Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation
- Request and receive a copy of his or her medical records, and request those be amended or corrected
- Be furnished health care services consistent with the provider contract with Priority Health and State and federal regulations
- Be free to exercise his or her rights without adversely affecting the way the contractor, providers, or the State treats the enrollee
- Be free from other discrimination prohibited by State and federal regulations
- Receive information on available treatment options and alternatives, presented in a manner appropriate to the enrollee's condition and ability to understand
The Michigan Department of Health and Human Services requires that Priority Health providers offer services in a culturally competent manner to all members, including those with limited English proficiency or reading skills.
The federal Office of Minority Health (OMH) offers information on providing culturally competent services on their website, www.thinkculturalhealth.hhs.gov. CMS has also developed an online Health Care Language Services Implementation Guide to help your office meet this important standard.
Provider adherence to the Priority Health Provider Manual
Priority Health Medicaid's network providers must adhere to the Medicaid Provider Manual.
Priority Health Medicaid's network providers must agree that Michigan Dept. of Health and Human Services – Office of Inspector General (MDHHS-OIG) has the authority to conduct post payment evaluations of their claims paid by Priority Health Medicaid.
Priority Health Medicaid must agree to follow the appeal process as outlined in Chapters 4 and 6 of the Administrative Procedures Act of 1969; MCL 24.271 to 24.287 and MCL 24.301 to 24.306 for post payment evaluations conducted by MDHHS-OIG.
- NPI numbers
- Electronic funds transfer (EFT)
- Physician status
- Open or close to new patients
- Availability standards
- Changes to address or staff
- Provider-patient relationship
- Medical & office records
- Medicaid patient treatment
- Medicare patient treatment
- Site visits
- Fraud, waste & abuse
- Utilization Management Program