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Effective: December 1, 2006 |
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28.10.30ar1 - Minnesota Restricted Recipient Program (MRRP) (Archive) |
Archived: June 1, 2009 |
DHS may restrict enrollees to certain providers of health care services for the following reasons:
l To prevent duplication or abuse of services.
l To prevent violation of prior authorization requirements.
l To ensure continuity of care.
The Minnesota Restricted Recipient Program (MRRP) identifies enrollees who have used services at a frequency or amount that is not medically necessary or have used health services that resulted in unnecessary costs to the program. Once identified, these restricted enrollees will be placed under the care of a primary care physician or other designated providers who will coordinate their care for a 24-month period.
Because managed care enrollees' choice of providers is limited to providers enrolled in the , DHS does not identify restricted status for people enrolled in managed care. The MCO is responsible for prior authorization, monitoring use of medical services, and ensuring continuity of care.