1. (1) A restricted member shall remain in the Restriction Program for a total of 12 months of Medicaid eligibility. The months of eligibility need not be continuous.
2. (2) If a restricted member becomes ineligible for Medicaid, and subsequently reestablishes Medicaid eligibility, the department shall require the member to continue enrollment in the Restriction Program, unless the restricted member's loss of Medicaid eligibility is greater than one year.
3. (3) The department shall perform a review of a member's placement in the Restriction Program once the member has been enrolled in the Restriction Program for 12 months of Medicaid eligibility.
4. (4) The Restriction Program shall remove a restricted member if an annual review demonstrates the restricted member no longer meets the restriction criteria.
5. (5) The department shall inform a restricted member in writing of the member's removal from the Restriction Program.
6. (6) If at the time of annual review, a Medicaid member still meets the criteria for the Restriction Program, the department shall inform the restricted member of continued enrollment in the Restriction Program for an additional 12 months of Medicaid eligibility.
7. (7) The department shall provide notice to a Medicaid member of continuation in the Restriction Program in accordance with Section R414-29-6.

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