Minn. R. agency 196, ch. 9505, SURVEILLANCE AND INTEGRITY REVIEW PROGRAM, pt. 9505.2238

Current through Register Vol. 49, No. 24, December 9, 2024

Part 9505.2238 - PLACEMENT IN RESTRICTED RECIPIENT PROGRAM

Subpart 1.Effect of placement.

A recipient who has been placed in the restricted recipient program is eligible to receive health care services only from the designated providers. A recipient is placed in the restricted recipient program for a period of 24 months of eligibility. The period of 24 months of eligibility begins at the time of placement in the restricted recipient program. A recipient will be given 30 days to designate specific providers. At the end of the 30 days, the department shall designate specific providers for a recipient who has failed to designate specific providers. A recipient who has been prohibited from using the personal care assistant choice or consumer-directed services option shall be prohibited from using that option for a period of 24 months of eligibility.

Subp. 2.Change in selected providers.

A recipient may change designated providers under the following circumstances:

A. a recipient may change designated providers for any stated reason after the initial three months of restriction, provided the changes do not occur more than twice in one year; and

B. a recipient may change designated providers as often as needed under the circumstances in subitems (1) to (3):

(1) if the recipient moves outside of the designated provider's local trade area;

(2) if the recipient is discharged by the designated provider; or

(3) other circumstances that require the recipient to change designated providers.

The department shall grant the recipient's request to change designated providers under this subpart if the change is consistent with protecting the integrity of the restricted recipient program.

Subp. 3.Placement renewal.

After a recipient has completed an initial 24-month period of eligibility in the restricted recipient program, the department may renew the recipient's placement in the restricted recipient program under part 9505.2165, subpart 2, item C, by sending written notice to the recipient. The recipient will remain placed in the restricted recipient program pending the resolution of an appeal of the placement renewal. If the recipient's placement is not renewed, the recipient shall be notified by the department that the recipient's participation in the restricted recipient program is over. Renewal of the recipient's placement in the restricted recipient program shall be for an additional period of 36 months of eligibility.

Subp. 4.Emergency health services.

Emergency health services provided to a recipient in the restricted recipient program by a vendor shall be eligible for payment if the service provided meets the definition of an emergency in part 9505.0175, subpart 11. The vendor must provide documentation of the emergency circumstances with the emergency service payment claim.

Minn. R. agency 196, ch. 9505, SURVEILLANCE AND INTEGRITY REVIEW PROGRAM, pt. 9505.2238

33 SR 127

Statutory Authority: MS s 256B.04