Page 131

COMAR 10.09.24.01-.16 1731 State of Maryland Medical Assistance Manual Revised July 2012

(1) A recipient determined to have abused the Program shall be enrolled in the Corrective Managed Care Program in which the recipient shall be required to meet the requirements of §F(1)—(3) of this regulation.

(2) The recipient shall obtain all covered physician, hospital outpatient and inpatient, and clinic services, except methadone clinic and all other drug and alcohol abuse services and emergency services, from, or upon written referral by, a single primary medical provider.

(3) The recipient shall obtain prescribed drugs only from a single designated pharmacy provider, except in an emergency or pursuant to hospital inpatient treatment.

G. Provider Selection.

(1) The Program shall select primary medical and pharmacy providers for the recipient according to the requirements of §G(2)—(7) of this regulation.

(2) The primary medical provider may be any physician who participates in the Medical Assistance Program and whose practice is chiefly in one of the following specialties which include general practice, family practice, pediatrics, obstetrics-gynecology, or internal medicine.

(3) The Program may also designate a physician group, community health center, or clinic which participates in the Program as a physician provider and which assigns practitioners in one or more of the specialties named under §G(2) of this regulation to be the designated primary medical provider for the recipient.

(4) The Program may designate a provider which delivers limited or specialty services if the designation is in the recipient's best interest and the provider agrees to deliver or manage the recipient's primary care and refer the recipient for other services as necessary.

(5) The recipient may enroll in a Health Maintenance Organization-Medical Assistance.

(6) The pharmacy provider may be any pharmacy, or any single branch of a pharmacy chain, which participates in the Medical Assistance Program. The Health Maintenance Organization- Medical Assistance shall be the pharmacy provider as well as the primary medical provider for any recipient choosing to enroll.

(7) The recipient shall be afforded an opportunity to suggest primary medical and pharmacy providers. However, the Program is not bound by the recipient's suggestion and may designate other providers if, in its sole discretion, the recipient's choice of provider would not serve the recipient's best interest in achieving appropriate use of the health care system and of Medical Assistance benefits.

H. The Program may designate a new primary medical or pharmacy provider if the: (1) Recipient moves out of the service area of the provider;