R414-29-3. Notifying Clients of Overutilization of Services

(1) The Department may require a client to participate in the Restriction Program based on the client's overutilization of services. The Department shall notify the client in writing of its determination. This notice shall:

(a) state the factors, or combination of factors, justifying Restriction Program participation;

(b) cite the regulation authorizing Restriction Program participation;

(c) invite the client to provide additional information justifying the use of services, within ten calendar days after the date the notice is issued;

(d) notify the client that, if he fails to submit additional written justification within ten calendar days after the date the notice is issued, the Department shall require his participation in the Restriction Program.

(e) invite the client to select a Restriction Case Manager and a Restriction Pharmacy;

(f) inform the client that if he fails to contact the Department with a choice within ten calendar days after the date the notice is issued, the Department shall assign a Restriction Case Manager and a Restriction Pharmacy without further notice.

(2) If the client submits additional information within ten calendar days after the notice is issued, the Department shall evaluate this information along with the original data, and notify the client in writing of the Department's determination.

(3) If the client disagrees with the determination, he may request a hearing. The Department shall provide the client with instructions on how to request a hearing, including a hearing request form.