Utah Administrative Code
Topic - Health
Title R414 - Integrated Healthcare
Rule R414-29 - Client Review and Restriction Policy
Section R414-29-3 - Restriction Program
Current through Bulletin 2024-06, March 15, 2024
(1) The Department may enroll a member in the Restriction Program if the member meets one or more of the following restriction criteria within the most recent 12 months of Medicaid eligibility:
(2) Once a member is found to meet or exceed restriction criteria, the Department shall perform an additional review to determine if overutilization of services was the result of limited access to care or medical necessity.
(3) When an individual is placed in the Restriction Program, the member shall have one assigned PCP and one assigned pharmacy.
(4) The Department may only pay claims for services rendered by the assigned PCP, prescriptions written by the assigned PCP, and prescriptions filled by the assigned pharmacy unless:
(5) Enrollment in the Restriction Program does not affect the restricted member's ability to access emergency services.