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

R.C. 119.032 review dates: 10/28/2013 and 10/28/2018
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

Prior History: (Effective: 09/01/2008
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 )