Idaho Admin. Code r. 16.03.09.910

Current through September 2, 2024
Section 16.03.09.910 - PARTICIPANT UTILIZATION CONTROL PROGRAM

This Program is designed to promote improved and cost-efficient medical management of essential health care by monitoring participant activities and taking action to correct abuses. Participants demonstrating unreasonable patterns of utilization or exceeding reasonable levels of utilization, or both, will be reviewed for restriction. The Department may require a participant to designate a primary physician or a single pharmacy or both for exclusive provider services in an effort to protect the individual's health and safety, provide continuity of medical care, avoid duplication of services by providers, avoid inappropriate or unnecessary utilization of medical assistance, and avoid excessive utilization of prescription medications.

Idaho Admin. Code r. 16.03.09.910

Effective March 17, 2022