§17-1741-6 - Recipient over-utilization or abuse.

§17-1741-6 Recipient over-utilization or abuse.

         (a) Freedom of choice in selecting health care providers shall not include the expedient utilization or over-utilization of the community's health care providers and supplies.

         (b) When a recipient over-utilizes medical services, the department shall request the recipient's voluntary cooperation in curbing abusive utilization practices and shall monitor the recipient's case for no less than six months.

         (c) When a recipient has been shown to be over-utilizing controlled drugs with multiple prescriptions filled at more than one pharmacy and written by multiple prescribers, the department shall require the recipient to choose one primary care physician and one pharmacy to be the only approved providers of usual care. The department also reserves the right to ask the recipient to choose another provider if the physician is known to the department to be over-prescribing medications or medical services. Refer to section 17-1741-7 for specific details regarding restrictions.

         (d) When a recipient has been determined to be using excessive medical services provided by multiple physicians, the department may assist the recipient in receiving appropriate coordinated care. As a result, the department shall ask the recipient to choose one primary care provider to coordinate all usual services for the recipient and make referrals to other providers, as needed. Refer to section 17-1741-7 for specific details regarding restrictions.

        [Eff 08/01/94; am 07/06/99 ] (Auth: HRS §346-14; 42 C.F.R. §431.10) (Imp: 42 C.F.R. §§456.3, 456.23)

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