Page 67

UPDATED: AUGUST 1999

508

OTHER ELIGIBILITY REQUIREMENTS

RECIPIENT RESTRICTION PROGRAM (RRP)

Policy: When an individual’s utilization of Medicaid services is considered excessive, following a NYS claims review, the A/R is restricted to only primary providers. The individual is given the opportunity to select which physician, clinic, or pharmacy, etc., s/he wishes to use.

References: SSL Sect.

366

Dept. Reg.

360-6

Interpretation: Through the RRP, certain Medicaid recipients are restricted to one physician, dentist, inpatient hospital, pharmacy and/or clinic for receipt of medical care or services. A provider inquiring on the Electronic Medicaid Eligibility Verification System (EMEVS), concerning a recipient's Medicaid coverage, will be informed of any limitations including the recipient's restriction status. Information in the EMEVS provider manual expands on this information. The restriction message on EMEVS will change each time a recipient either enters the RRP or is removed from the program. Further information on the RRP may be obtained from the individual in your district who administers the program or from the State Department of Health.

(MRG)

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Page 67

Official source

UPDATED: AUGUST 1999

508

OTHER ELIGIBILITY REQUIREMENTS

RECIPIENT RESTRICTION PROGRAM (RRP)

Policy: When an individual’s utilization of Medicaid services is considered excessive, following a NYS claims review, the A/R is restricted to only primary providers. The individual is given the opportunity to select which physician, clinic, or pharmacy, etc., s/he wishes to use.

References: SSL Sect.

366

Dept. Reg.

360-6

Interpretation: Through the RRP, certain Medicaid recipients are restricted to one physician, dentist, inpatient hospital, pharmacy and/or clinic for receipt of medical care or services. A provider inquiring on the Electronic Medicaid Eligibility Verification System (EMEVS), concerning a recipient's Medicaid coverage, will be informed of any limitations including the recipient's restriction status. Information in the EMEVS provider manual expands on this information. The restriction message on EMEVS will change each time a recipient either enters the RRP or is removed from the program. Further information on the RRP may be obtained from the individual in your district who administers the program or from the State Department of Health.

(MRG)