Utah Admin. Code R414-29-5 - Selection of Assigned PCP and Assigned Pharmacy
(1) The Department shall approve an assigned
PCP and assigned pharmacy for the member when the member is placed in the
Restriction Program. When making this assignment, the Department may consider
the member's utilization history, geographic location, medical needs,
transportation needs, and the quality of services available.
(2) Within 30 days of notification of
placement in the Restriction Program, the restricted member may select an
assigned PCP and an assigned pharmacy . The restricted member's selection of an
assigned PCP and assigned pharmacy are subject to the approval of the
Department.
(3) Only the Department
may approve of any change in a assigned PCP or an assigned pharmacy .
(4) The assigned PCP and assigned pharmacy
shall remain as the assigned PCP and assigned Pharmacy for the duration of the
member's enrollment in the Restriction Program with the following exceptions:
(a) a member requests a change of assigned
PCP or assigned pharmacy within 30 days of notification of enrollment in the
Restriction Program;
(b) the
assigned PCP or assigned pharmacy changes locations;
(c) the assigned PCP or assigned pharmacy
discontinues or limits practice;
(d) the assigned PCP or assigned pharmacy
requests a change;
(e) a member has
a verified change of address, which impacts access to the assigned PCP or
assigned pharmacy ; or
(f) the
Department recommends a change when review indicates continued overutilization
by a restricted member, the assigned PCP, or both.
(5) The Department may require a change of
assigned PCP, assigned pharmacy , assigned providers, or assigned prescribers
whenever it determines the restricted member is not receiving appropriate
care.
(6) Requests from a
restricted member to change an assigned PCP or assigned pharmacy may be verbal
or be in writing.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
(1) The Department shall approve an assigned PCP and assigned pharmacy for the member when the member is placed in the Restriction Program. When making this assignment, the Department may consider the member's utilization history, geographic location, medical needs, transportation needs, and the quality of services available.
(2) Within 30 days of notification of placement in the Restriction Program, the restricted member may select an assigned PCP and an assigned pharmacy. The restricted member's selection of an assigned PCP and assigned pharmacy are subject to the approval of the Department.
(3) Only the Department may approve of any change in a assigned PCP or an assigned pharmacy.
(4) The assigned PCP and assigned pharmacy shall remain as the assigned PCP and assigned Pharmacy for the duration of the member's enrollment in the Restriction Program with the following exceptions:
(a) a member requests a change of assigned PCP or assigned pharmacy within 30 days of notification of enrollment in the Restriction Program;
(b) the assigned PCP or assigned pharmacy changes locations;
(c) the assigned PCP or assigned pharmacy discontinues or limits practice;
(d) the assigned PCP or assigned pharmacy requests a change;
(e) a member has a verified change of address, which impacts access to the assigned PCP or assigned pharmacy; or
(f) the Department recommends a change when review indicates continued overutilization by a restricted member, the assigned PCP, or both.
(5) The Department may require a change of assigned PCP, assigned pharmacy, assigned providers, or assigned prescribers whenever it determines the restricted member is not receiving appropriate care.
(6) Requests from a restricted member to change an assigned PCP or assigned pharmacy may be verbal or be in writing.