- (1) This rule sets out the criteria and process to restrict a Medicaid member to specific Medicaid providers if the member is found to have a pattern of using Medicaid services at a frequency or amount not medically necessary.
- (2) This rule implements the requirements found in 42 CFR 431.54(e) and 42 CFR 456.3.
KEY: Medicaid
Date of Last Change: October 28, 2024
Notice of Continuation: August 22, 2022
Authorizing, and Implemented or Interpreted Law: 26B-1-213; 26B-3-108