La. Admin. Code tit. 50 § XXIX-307

Current through Register Vol. 50, No. 11, November 20, 2024

Section XXIX-307 - Notification Directives

A. The department's contract designee shall notify the recipient of the decision to lock-in providers and shall include the following additional information:

1. the department's intention to allow the recipient to choose one primary care provider, one pharmacy provider, and up to three specialist providers, if warranted;

2. that Medicaid will make payments only to the physician and pharmacy providers chosen by the recipient and subsequently approved by the department;

3. that the recipient is advised to contact the department's contract designee to discuss the Pharmacy Lock-In Program; and

4. that the recipient has the right to appeal the initial lock-in decision.

B. The department's contract designee shall be responsible for the following:

1. initiate contact with the recipient in instances when the recipient fails to contact the department, or its contractor;

2. conduct a telephone interview when warranted with the recipient regarding the Lock-In Program and the recipients rights and responsibilities;

3. assist the recipient, if necessary, in exercising due process rights and complete the appropriate forms at the initial contact; and

4 notify Lock-In providers of their selection.

La. Admin. Code tit. 50, § XXIX-307

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 32:1057 (June 2006), amended by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 37:3268 (November 2011), Amended by the Department of Health, Bureau of Health Services Financing, LR 431182 (6/1/2017).

AUTHORITY NOTE: Promulgated in accordance with R.S. 46:153 and Title XIX of the Social Security Act.