Ohio Admin. Code 3701-43-11 - Application and eligibility for provision of diagnostic services
(A) Application for
provision of diagnostic services as defined in paragraph (D) rule
3701-43-01 of the Administrative
Code requires the following:
(1) The
applicant , parent, guardian or other legal representative of the child for whom
services are being requested shall submit to the director a signed consent form
allowing the program to release information to persons or agencies who may
participate in or facilitate the delivery of authorized services to the child;
and
(2) The managing physician
shall sign and submit to the director a medical application on a form
prescribed by the director . The form shall be completed in full and shall
include an individual plan for diagnostic services describing the medical and
nonmedical procedures needed for diagnosing or confirming a medical condition
of the applicant . The completed medical application inclusive of signed consent
forms shall be received by the director within sixty days of the initial
examination.
(B)
Subject to paragraph (C) of this rule, an applicant is eligible for diagnostic
services if based on information submitted pursuant to paragraph (A) of this
rule the director determines that the applicant is in need of diagnostic
services to determine whether or not the applicant has a medically handicapping
or potentially medically handicapping condition.
(C) Notwithstanding paragraph (B) of this
rule, the director may determine that the applicant is not in need of
diagnostic services necessary to determine whether or not he has a medically
handicapping or potentially medically handicapping condition if either of the
following apply:
(1) Diagnostic services for
the same medically handicapping or potentially medically handicapping condition
have previously been authorized for the applicant and there has been no change
in managing physician or no substantial change in the suspected handicapping
condition that was previously approved for diagnostic services ; or
(2) Diagnostic services are being requested
for school or adoptive placement.
(D) If the completed medical application is
received by the director within sixty days of the date of initial examination
by the managing physician , eligibility for diagnostic services shall be
effective no earlier than the initial date of examination by the managing
physician .
(E) Based on the type
and number of services requested on the managing physician 's individual plan
for diagnostic services , the director shall establish for each eligible
recipient a period of eligibility for payment of diagnostic services which
shall not exceed one hundred eighty days from the effective date of
eligibility.
(F) The director
shall notify the applicant or his or her parent, guardian or other legal
representative, selected providers of major services, the local health
department and the managing physician of the approval or proposed denial of
eligibility and the effective date of eligibility, if approved. The director
shall issue this notification within sixty days of the date of receipt of the
last document necessary to make the eligibility determination or of the failure
to submit timely an application or requested additional information. A notice
of proposed denial of eligibility shall contain a statement of the reasons for
denial and a description of the reconsideration procedure established by
paragraph (B) of rule
3701-43-23 of the Administrative
Code.
Notes
Promulgated Under: 119.03
Statutory Authority: 3701.021
Rule Amplifies: 3701.021, 3701.022, 3701.023
Prior Effective Dates: 10/3/1992, 12/1/01, 9/1/08
R.C. 119.032 review dates: 05/23/2008 and 09/01/2013
Promulgated Under: 119.03
Statutory Authority: 3701.021
Rule Amplifies: 3701.021, 3701.022, 3701.023
Prior Effective Dates: 10/3/1992, 12/1/01
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.