1. (1) The department shall provide written notice to a Medicaid member that the department is placing the member in the Restriction Program at least 10 days before placing the member in the Restriction Program. The notice shall inform the member of:

   1. (a) the effective date of the member's placement in the Restriction Program;
   2. (b) the basis for the member's placement in the Restriction Program;
   3. (c) the specific element of the restriction criteria that supports the placement of the member in the Restriction Program; and
   4. (d) the assigned PCP and assigned pharmacy selected for the member, and known assigned providers and assigned prescribers for the member at the time of placement in the Restriction Program.

2. (2) The notice shall inform the member that:

   1. (a) upon placement in the Restriction Program, the member's assigned PCP must authorize Medicaid-covered prescriptions, primary care, and specialty care services for payment to be made; and
   2. (b) the member has the right to an administrative hearing, including appropriate forms, instructions, and information sufficient to request an administrative hearing and the time frame for requesting an administrative hearing.

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