Idaho Admin. Code r. 16.03.09.561

Current through September 2, 2024
Section 16.03.09.561 - HEALTHY CONNECTIONS: PARTICIPANT ELIGIBILITY
01.Primary Care Case Management Enrollment. Each participant in Idaho Medicaid is enrolled in Healthy Connections, unless the participant is granted an exemption by the Department described in Subsections 561.02.a. through 561.02.h. of this rule. Each participant must choose a PCP within the Healthy Connections program. If a participant fails to choose a PCP, one will be assigned to the participant by the Department. Participants of the same family may choose different Healthy Connections providers.
02.Exemption from Participation. An exemption from participation in Healthy Connections may be granted on a individual basis by the Department for a participant who:
a. Is unable to access a Healthy Connections provider within a distance of thirty (30) miles, or within thirty (30) minutes to obtain primary care services;
b. Has an eligibility period that is less than three (3) months;
c. Has an eligibility period that is only retroactive;
d. Is eligible only as a Qualified Medicare Beneficiary;
e. Has an existing relationship with a primary care physician or clinic who is not participating in Healthy Connections;
f. Is enrolled in the Medicare/Medicaid Coordinated Plan;
g. Resides in a nursing facility or an ICF/IID; or
h. Resides in a county where there are not an adequate number of providers to deliver primary care case management services.

Idaho Admin. Code r. 16.03.09.561

Effective March 17, 2022