Ohio Admin. Code 3701-43-13 - Application and eligibility for provision of service coordination
(A) An applicant
who wishes to be approved as a service coordinator shall:
(1) Have a bachelor's degree or higher in
nursing or social work and is licensed, registered, or certified in the
profession, as applicable, by the state of Ohio;
(2) Be employed through a hospital-based
interdisciplinary specialty team or physician provider office team approved by
the program for the delivery of service coordination services; and
(3) Submit a service coordinator provider
application as required in rule
3701-43-02 of the Administrative
Code, and include a copy of applicant's resume and current position description
that describes how the service coordinator will function within the team.
(B) To be eligible for
service coordination services the following applications shall be submitted to
the director within sixty days of an initial meeting between the service
coordinator and the applicant:
(1) An
applicant, parent, guardian or other legal representative of applicant shall
submit to the director a signed application on a form prescribed by the
director. The application form shall include consent and authorization for the
program to release information to persons or agencies who may participate in or
facilitate the delivery of authorized services to the applicant; and,
(2) The service coordinator,
approved as a provider in accordance with rule
3701-43-02 of the Administrative
code, shall sign and submit to the director a completed application on a form
prescribed by the director, documenting that the applicant has a medically
handicapping condition that is eligible for service coordination and that the
child's medical care is managed by an approved hospital-based interdisciplinary
specialty team or physician provider office team.
(C) An applicant shall be approved for
service coordination services if, based on the applications submitted pursuant
to paragraph (B) of this rule, the program determines the applicant is in need
of service coordination based on the applicant's medically handicapping
condition, as set forth in the operations manual, and documentation that
service coordination is provided by an approved hospital-based
interdisciplinary specialty team or physician provider office team.
(1) If the application is received by the
director within sixty days of the initial meeting between the applicant and the
service coordinator eligibility for service coordination shall be effective no
earlier than that date.
(2) If the
application is received more than sixty days after the date of the initial
meeting between the applicant and the service coordinator, the date of the
eligibility for service coordination shall be sixty days prior to the receipt
of the application by the director.
(D) The director shall establish for each
eligible recipient a period of eligibility for payment of service coordination,
which shall not exceed twelve months after the effective date of eligibility
specified under paragraph (C) of this rule, except that the director may
establish:
(1) A shorter period, based upon a
reasonable expectation that the recipient may become medically ineligible
during the period; or
(2) A longer
period, not to exceed thirty-six months, based upon a reasonable expectation
that the recipient will remain medically eligible during the period.
(E) The service coordinator must
submit a comprehensive service plan annually on behalf of each recipient of
service coordination.
(F) The
recipient of service coordination, the recipient's parent, guardian or other
legal representative, or the service coordinator shall notify the director in
writing of any changes in information included in the application form
including: name, address, phone number, change of service coordinator or
managing physician within thirty days of such a change.
(G) Applications for renewal of eligibility
shall be submitted and reviewed in the same manner as initial applications for
eligibility under this rule.
Replaces: 3701-43-13
Notes
Promulgated Under: 119.03
Statutory Authority: 3701-21
Rule Amplifies: 3701-21, 3701.022, 3701.023
Prior Effective Dates: 12/1/2001, 9/1/2008
R.C. 119.032 review dates: 09/01/2013
Promulgated Under: 119.03
Statutory Authority: 3701.021
Rule Amplifies: 3701.021, 3701.022, 3701.023
Prior Effective Dates: 12/1/2001
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