Site of Care Management Program Announcement
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Announces CareSource Georgia's Site of Care Management Program applying to Marketplace lines of business beginning July 1, 2026, affecting members who receive specialty injectable medications or infusions and providers administering them.
No material clinical or coverage changes in this revision.
Coverage Criteria
This announcement applies only to CareSource Marketplace Lines of Business. Other CareSource lines of business are not included in this Site of Care Management Program notice.
Provider Actions & Requirements
Prior authorization may be required
Some specialty infusion drugs in the program require prior approval; review the Site of Care Management Program Drug List to see which medications are affected.
Provider responsibilities under the program
Providers are responsible for checking the Site of Care Management Program Drug List, coordinating care transitions to appropriate sites, and informing members about available non‑hospital infusion settings.
- Consult the Site of Care Management Program Drug List to determine if a prescribed specialty infusion drug is included.
- Coordinate with the member to plan administration in an appropriate site of care (non‑hospital settings encouraged where clinically appropriate).
- Provide members with information on where to receive their injectable medications and infusions.
Verify whether a medication is affected
Providers and members should consult the Site of Care Management Program Drug List to determine which specialty infusion medications require prior approval; members will receive written notice if their drug is included.
- Verify inclusion of a medication on the Site of Care Management Program Drug List before scheduling infusion services.
- Confirm whether prior approval is required for that medication.
Denial risk if prior approval not obtained
Some specialty infusion drugs included in the program require prior approval; lack of prior approval for drugs on the Site of Care Management Program Drug List may trigger coverage denial or different site restrictions.
- If a drug on the Drug List is administered without required prior approval, coverage may be denied or subject to site‑of‑care restrictions.
Definitions
Site of Care Guidance
Preferred site of care: infusion center and non-hospital settings
The program directs members to receive specialty infusion treatments in settings that support comfort and may be more accessible and lower cost; non-hospital settings are encouraged where appropriate.
- Consider infusion centers and other non-hospital settings to reduce costs and improve member experience.
Background
The Site of Care Management Program directs members toward receiving specialty injectable medications and infusions in non-hospital or alternative settings when clinically appropriate to improve access and reduce costs. The program will launch on July 1, 2026 and applies to Marketplace members; providers should coordinate care transitions and member support consistent with the program’s goals.
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