1. A. The department’s contract designee shall notify the recipient of the decision to lock-in providers and shall include the following additional information:

   1. 1. the department’s intention to allow the recipient to choose one primary care provider, one pharmacy provider, and up to three specialist providers, if warranted;
   2. 2. that Medicaid will make payments only to the physician and pharmacy providers chosen by the recipient and subsequently approved by the department;
   3. 3. that the recipient is advised to contact the department’s contract designee to discuss the Pharmacy Lock-In Program; and
   4. 4. that the recipient has the right to appeal the initial lock-in decision.

2. B. The department’s contract designee shall be responsible for the following:

   1. 1. initiate contact with the recipient in instances when the recipient fails to contact the department, or its contractor;
   2. 2. conduct a telephone interview when warranted with the recipient regarding the Lock-In Program and the recipient’s rights and responsibilities;
   3. 3. assist the recipient, if necessary, in exercising due process rights and complete the appropriate forms at the initial contact; and
   4. 4. notify Lock-In providers of their selection.

Authority Note

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.

Historical Note

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 32:1057 (June 2006), amended by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 37:3268 (November 2011), amended by the Department of Health, Bureau of Health Services Financing, LR 43:1182 (June 2017).