Section 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 during 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 when 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.Utah Admin. Code R414-29-5
Adopted by Utah State Bulletin Number 2021-22, effective 11/1/2021Amended by Utah State Bulletin Number 2024-21, effective 10/28/2024