Restricted Recipient Program (RRP)

The Restricted Recipient Program (RRP) is for members who have misused or abused medical services provided to them through Minnesota Health Care Programs (MHCP). Placement in the RRP means that PrimeWest Health wants to help you get quality care that fits your needs.

If you are placed in the RRP, you are assigned to 1 primary care provider, 1 clinic, 1 hospital, and 1 pharmacy. These will all be within 30 miles of your home. This will let your primary care provider better manage your health care services and prescription drugs. Your primary care provider can refer you to a specialist if needed. You do not lose eligibility for MHCP-covered services because of placement in this program.

As part of the program:

  1. You may choose a network primary care clinic for your health care. Once you have chosen a clinic, you may choose a primary care provider from that clinic. The primary care provider you choose must accept you as a patient. You may only use this clinic and provider for your care unless the provider refers you to another health care provider.
  2. You may choose a hospital where you will receive hospital services, including emergency room (ER) services. The primary care provider you choose must have practicing rights at the hospital you choose. You may not use other hospitals or ERs.
  3. You may select a pharmacy where you will have all of your prescriptions filled. You may not use other pharmacies or pay cash for controlled substances.
  4. Placement in the program will stay with you if you change health plans or if you change to fee-for-service health coverage.
  5. While in the RRP, you are not allowed to use the personal care assistance (PCA) choice option or consumer-directed services.
  6. You are allowed to use the PCA shared care option when the county public health nurse (PHN) determines it is appropriate.
  7. You do not need to see or get a referral from your primary care provider for dental, chiropractic, or optical services.

Placement in the RRP is for 24 months to begin with. Your medical and pharmacy use will be reviewed at the end of the 24 months to see if you have used medical and pharmacy services appropriately. If you have not followed the program guidelines, you will be placed in the program for another 36 months.

The RRP does not apply to Medicare-covered services.