Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-43 - Program for Medically Handicapped Children › Section 3701-43-18 - Authorization for provision of treatment services and goods

Current through all regulations passed and filed through July 1, 2024
(A) The director
			 shall apply the criteria prescribed by this rule in determining whether or not
			 to authorize the provision of treatment services and goods to recipients,
			 pursuant to division (E) of section
			 3701.023 of the Revised Code. An
			 applicant's managing physician shall request authorization for provision of
			 goods or services by submitting an individualized plan of treatment as part of
			 the medical application for program eligibility under rule
			 3701-43-15
			 of the Administrative Code.
(B)
			 Requests for authorization for provision of services or goods to recipients
			 that are not included in the current individualized plan of treatment may be
			 submitted by the recipient's managing physician or other BCMH provider to the
			 director within eleven months of the date of service on forms prescribed by the
			 director.
(C) The managing
			 physician and any provider must furnish any information requested by the
			 director, including but not limited to medical or operative reports, hospital
			 discharge summaries, evaluation reports, and other descriptions of services,
			 that is necessary to determine whether the goods or services may be authorized.
			 The information must be submitted so that it is received by the director within
			 eleven months of the date of service. The managing physician and any provider
			 also shall submit any information requested by the director to evaluate the
			 results achieved by the provision of the goods or services.
(D) Subject to paragraph (E) of this rule,
			 the director shall authorize treatment services or goods if:
(1) The services or goods are included in the
			 recipient's individualized plan of treatment, submitted by the recipient's
			 managing physician, in accordance with paragraph (C)(2) of rule
			 3701-43-15
			 of the Administrative Code;
(2) The
			 services or goods meet the definition of treatment services or goods, as
			 prescribed by paragraph (X) of rule
			 3701-43-01 of the
			 Administrative Code, with respect to the specific medically eligible or
			 associated condition for which they are requested;
(3) The services or goods are furnished by
			 providers, as defined by paragraph (P) of rule
			 3701-43-01 of the
			 Administrative Code, who are approved under applicable provisions of this
			 chapter to provide the specific services or goods requested and the goods or
			 services are furnished after the effective date of the provider's
			 approval;
(4) The request for
			 authorization and any additional documentation requested by the director are
			 submitted in compliance with paragraphs (A), (B), and (C) of this rule;
			 and
(5) The services are rendered
			 or the goods furnished in Ohio. The director may waive the requirement
			 prescribed by this paragraph if comparable goods or services are not available
			 in Ohio or if the director determines that travel to obtain comparable services
			 or goods in Ohio would present an undue travel or financial hardship for the
			 recipient. In making determinations under this paragraph, the director may
			 consult with one or more members of the medical advisory council or with other
			 individuals with expertise in the area.