Minnesota Administrative Rules

9505.2238 PLACEMENT IN RESTRICTED Next Previous RECIPIENT Next PROGRAM.

Subpart 1.

Effect of placement.

A Previous recipient Next who has been placed in the Previous restricted Next Previous recipient Next program is eligible to receive health care services only from the designated providers. A Previous recipient Next is placed in the Previous restricted Next Previous recipient Next program for a period of 24 months of eligibility. The period of 24 months of eligibility begins at the time of placement in the Previous restricted Next Previous recipient Next program. A Previous recipient Next will be given 30 days to designate specific providers. At the end of the 30 days, the department shall designate specific providers for a Previous recipient Next who has failed to designate specific providers. A Previous recipient Next 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 Previous recipient Next may change designated providers under the following circumstances:

A.

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

(1)

if the Previous recipient Next moves outside of the designated provider's local trade area;

(2)

if the Previous recipient Next is discharged by the designated provider; or

(3)

other circumstances that require the Previous recipient Next to change designated providers.

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

Subp. 3.

Placement renewal.

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

Subp. 4.

Emergency health services.

Emergency health services provided to a Previous recipient Next in the Previous restricted Next Previous 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.

Statutory Authority:

MS s 256B.04

History:

33 SR 127

Published Electronically:

August 12, 2008