Idaho Admin. Code r. 16.03.09.915 - LOCK-IN PROCEDURES

01. Participant Responsibilities. The participant will be given thirty-five (35) days to contact the Regional Program Manager or designee and complete and sign the lock-in agreement form and select designated provider(s) in each area of misuse.

02. Appeal Stays Restriction. The Department will not implement the participant restriction if a valid appeal is noted in accordance with Section 917 of these rules.

03. Lock-In Duration. The Department will restrict participants to their designated providers for a time period determined by the Department. Upon review at the end of that period, lock-in may be extended for an additional period determined by the Department.

04. Payment to Providers. Payment to provider(s) other than the designated lock-in physician or pharmacy is limited to documented emergencies or written referrals from the primary physician.

05. Regional Programs Manager. The Regional Programs Manager, or designee will:

a. Clearly describe the participant's appeal rights in accordance with the provisions in IDAPA 16.05.03, "Contested Case Proceedings and Declaratory Rulings";

b. Specify the effective date and length of the restriction;

c. Have the participant choose a designated provider or providers; and

d. Mail the completed lock-in agreement to the Surveillance and Utilization Unit. Upon receipt of the lock-in agreement, the participant's Medicaid services will be immediately restricted to the designated provider(s).

Notes

Idaho Admin. Code r. 16.03.09.915

Effective March 17, 2022