Restricted Recipient Program

Amida Care Community Figures 2

What Is the Restricted Recipient Program?

Historically, the New York Office of the Medicaid Inspector General (OMIG) administered a program that implemented set criteria that were used to determine a pattern of misuse or abuse of services covered under the Medicaid Program. This program, known as the Restricted Recipient Program (RRP), has been rolled into the Medicaid Managed Care benefit package, and requires Medicaid Managed Care plans, including HIV SNPs, to continue the effort in identifying such areas of concern by executing their own Restricted Recipient Program.

Amida Care has now moved forward with implementing its Restricted Recipient Program (RRP).

Restrictions could apply, but are not limited to, provider types such as: primary care physicians, outpatient clinic services, hospitals, pharmacies, and dentists. Once implemented, the restriction follows the member, regardless of a member’s plan participation.

Forms

RRP Provider Referral Form

RRP Provider Initiated Change Request Form