Restriction Program
Managed Care Members
If you are enrolled in an accountable care organization (ACO), the ACO has a contractual policy for the Restriction Program which is closely aligned with fee-for-service. The contracts detailing the requirements of ACOs can be found in the contract for the ACO under Section 10.4. If you have questions regarding the restriction program managed by the ACOs you may find answers on the appropriate ACO’s website, or contact the ACO directly at:
Health Choice : 877-358-8797 or pharmacy services: 855-864-1404
https://ut.medicalhomeportal.org/services/provider/23845 opens in a new tab
Healthy U: 801-587-2851, opt 4 or 833-981-0212 opt 3
https://uhealthplan.utah.edu/medicaid opens in a new tab
Molina : 888-483-0760 or member services after hours 888-275-8750
https://www.molinahealthcare.com/members/ut/en-US opens in a new tab
Select Health: 801-442-5305 or 1-800-538-5038
https://selecthealth.org/plans/medicaid opens in a new tab
Fee-for-Service Members
Medicaid members may be referred to and enrolled in the Restriction Program. This program provides safeguards against inappropriate and excessive use of Medicaid services. Utah Medicaid (Fee For Service) Restriction staff uses the guidelines found in R414-29 opens in a new tab to determine if a member should be in the Restriction Program.
Fee for Service Members selected for enrollment are informed of the reasons for the issuance of a Restriction Program card. They are then restricted to one Primary Care Provider and one pharmacy. For patients in the Restriction Program, Medicaid will only pay claims for services rendered by the providers listed on the card and by providers to whom the patient has been appropriately referred. However, emergency services are not restricted.
For more information please contact us:
Local: 801-538-9045
Toll Free: 1-800-662-9651 opt #2; opt #1
Fax: 801-536-0146
Email: Medicaidrestriction@utah.gov