Medical, Dental & Pharmacy
- Medical
- Ambulatory Surgical Services
- Children's Services
- Chiropractic
- Clinic Services
- Community First Services and Supports (CFSS)
- Early Intensive Development and Behavioral Intervention (EIDBI)
- Equipment and Supplies
- HCBS
- Hearing Services
- Home Care Services
- Hospice Services
- Hospital Services
- Housing Stabilization Services
- Immunizations and Vaccinations
- Laboratory/Pathology, Radiology, and Diagnostic Services
- Language Interpreter Services
- Long-Term Care
- Medication Reconciliation
- Mental Health Services
- Optical Services
- Personal Care Assistance (PCA) Services
- Physician and Professional Services
- Recuperative Care
- Rehabilitation Services
- Renal Dialysis
- Restricted Recipient Program
- School-Based Community Services
- Substance Use Disorder
- Telehealth Services
- Transportation
- Tribal and Federal Indian Health Services
- Dental
- Pharmacy
Restricted Recipient Program
The Restricted Recipient Program (RRP) was created for the Minnesota Health Care Programs (MHCP) administered by the Minnesota Department of Human Services (DHS). The RRP is for members who have abused or misused services paid for through MHCP. You can find more information about the RRP below as well as in our provider handout.
Program Guidelines
Members are restricted to one primary care provider, one clinic, one hospital, and one pharmacy. These providers are added to various systems, such as Minnesota Information Transfer System (MN-ITS), so they can communicate with health plans and one another as to what restrictions are in place for the member.
Members are given 30 days to select a primary care provider, clinic, hospital, and pharmacy. If the member fails to do this, PrimeWest Health selects providers for the member based off of medical and pharmacy claims data. PrimeWest Health always secures confirmation of acceptance by the primary care provider prior to PrimeWest Health setting up the restriction.
Restrictions are initially set up for 24 months. If, at the end of 24 months, the member has demonstrated an ability to comply with the guidelines of the RRP, the member is discharged and restrictions are lifted. If the member did not comply with the RRP, the member is restricted for another 36 months.
Referrals
Primary care providers are encouraged to refer RRP members to other providers when they are unable to see the member or when the member needs specialty care. Primary care providers are not required to give referrals if they believe the referral is not medically necessary. Referrals must be received by PrimeWest Health RRP staff within 90 days of the date of service. Primary care providers may be asked by the recipient or another provider to generate a retroactive referral. Primary care providers may do so if the referral is deemed to be medically necessary and falls within the 90-day limit. Referrals generated by providers other than the designated primary care provider are not covered. To refer a member, complete the Restricted Recipient Referral Form on the PrimeWest Health Provider Web Portal.
Referring a Member to the RRP
- Determine if the member is enrolled in MHCP.
- Call one of the following numbers to refer the member for review:
- PrimeWest Health Provider Contact Center: 1-866-431-0802 (toll free)
- Minnesota Department of Human Services (DHS): 1-651-431-2648
Tips
- Have your scheduling staff check MN-ITS regularly to determine if the member attempting to schedule an appointment is in the RRP.
- Enforce pain contracts with chronic pain patients.
- Utilize PrimeWest Health support staff to communicate concerns, clinic policies, etc., to patients.
Role of the Primary Care Provider
Any provider enrolled as a general practitioner, internal medicine, or family practice physician may be selected by the member as his/her primary care provider. The primary care provider will be asked to review each member’s profile and/or medical and pharmacy utilization history, develop an appropriate care plan, and authorize referrals. To participate as a primary care provider, the provider must be enrolled as a PrimeWest Health provider.
Dismissal
The primary care provider always has the right to dismiss a non-compliant member. If the provider and patient relationship has become irreparable, the primary care provider must provide the member and PrimeWest Health with a formal dismissal letter. PrimeWest Health must be notified immediately.
PW_11-19_589
Updated_12/18/2025
