- (1) Pursuant to 42 CFR 431.54(e), the department may restrict a Medicaid member who uses services at a frequency or amount that is not medically necessary, in accordance with state utilization guidelines.
- (2) DIH shall give the member notice and opportunity for an informal hearing pursuant to this rule before imposing restrictions.
KEY: Medicaid
Date of Last Change: September 19, 2025
Notice of Continuation: August 12, 2022
Authorizing, and Implemented or Interpreted Law: 26B-1-202(1); 26B-1-204; 63G-4-102