Current through all regulations passed and filed through March 18, 2024
(A) The director
shall apply the requirements prescribed by this rule in determining whether an
applicant or recipient is medically eligible for payment for treatment services
and goods by the program for medically handicapped children. An applicant or
recipient is medically eligible if he or she has been diagnosed as having a
medically eligible condition. In determining whether an applicant's or
recipient's condition is a medically eligible condition under paragraphs (B)
and (C) of this rule, the director may consult with one or more members of the
medical advisory council or with other individuals with expertise in the area.
(B) A condition is a medically
eligible condition if:
(1) The condition is a
"chronic, physically handicapping condition," defined, for purposes of this
chapter as a condition which has a degree of severity that restricts physical
development and is expected to impair health functioning for a period of one
year or more or at frequently recurring intervals;
(2) The condition is amenable to treatment
through treatment services or goods, as defined in paragraph (X) of rule
3701-43-01 of the
Administrative Code;
(3) The
condition either is a neoplasm or a congenital anomaly or affects one or more
of the following:
(a) Endocrine system;
(b) Immune system;
(c) Nervous system;
(d) Integumentary system;
(e) Cardiovascular system;
(f) Respiratory system;
(g) Digestive system;
(h) Genitourinary system;
(i) Musculoskeletal system;
(j) Sensory organs;
(k) Metabolic diseases;
(l) Diseases of the blood.
(C) Notwithstanding
paragraph (B) of this rule, conditions that are classified in one or more of
the following categories are not medically eligible conditions:
(1) Mental retardation and related diagnoses;
(2) Psychological and emotional
disorders;
(3) Learning
disabilities;
(4) Acute,
infectious or common childhood conditions unless treatment of the condition is
necessary to prevent the occurrence or exacerbation of a chronic, physically
handicapping condition, as defined in paragraph (B)(1) of this rule;
(5) Common refractive errors;
(6) Parasitic diseases;
(7) Pregnancy and pregnancy-related
diagnoses;
(8) Conditions that are
self-correcting through maturation;
(9) Developmental delays;
(10) Routine dental problems and common
malocclusions;
(11) Conditions
listed in the operational manual as not medically eligible because the director
has determined that the program does not have sufficient funding to permit
payment for treatment of the conditions. In deciding whether specific
conditions should be added to or deleted from the list of conditions not
eligible under this paragraph, the director may consult with the medical
advisory council, one or more members of the council or other individuals with
expertise in the area.
(D) None of the conditions listed in
paragraph (C) of this rule precludes treatment of a medically eligible
condition as defined in paragraph (B) of this rule.
Effective:
09/01/2008
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: 1/2/1989, 4/1/94, 12/1/01
