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Occasionally a Medicaid managed care patient will go to an out-of-panel hospital for elective care. If the out-of-panel hospital puts the patient on notice that (s)he will be responsible for the charges, as required by OAC 5101:3-26-11, can the patient later apply for HCAP?

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Occasionally a Medicaid managed care patient will go to an out-of-panel hospital for elective care. If the out-of-panel hospital puts the patient on notice that (s)he will be responsible for the charges, as required by OAC 5101:3-26-11, can the patient later apply for HCAP?

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No. If a patient is eligible for Medicaid, including Medicaid managed care, (s)he cannot apply for HCAP and the hospital cannot include the charges for that admission or service in any field on Schedule F.

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