Va. DMAS Hospice Provider Manual ch. IV, Individuals Enrolled In Cardinal CareManaged Care

Many individuals enrolled in the Medicaid program have their services furnished through

contracted managed care organizations (MCOs) and their network of providers. All

providers should check eligibility (refer to Chapter 3) prior to rendering services to confirm

in which health plan the individual is enrolled. The MCO may require a referral or prior

authorization in order for the individual to receive services. All MCO network hospice

providers are responsible for adhering to their MCO provider contract, as well as state

and federal regulations. Some providers may choose not to enroll in the MCO network;

the individual’s choice of provider is limited to those in the MCO network.

For those individuals enrolled in Medicaid receiving care under Medicaid fee-for-service,

the provider is responsible for adhering to this manual, as well as state and federal

regulations.