Section 22-A3404. AUTHORIZATION AND RE-AUTHORIZATION OF MHRS

 

3404.1 Initial authorizations for new MHRS enrollees and for those enrollees whose Medicaid certification has lapsed are limited to ninety (90) days, subject to Subsection 3403.6.  Prior authorization and re-authorization requirements are further described in section 3424. 

 

3404.2  Upon receiving an authorization plan request, DMH shall determine whether MHRS are medically necessary and issue a service authorization decision to the CSA.

 

3404.3  As part of the service authorization process, DMH may review the consumer's IRP/IPC or other clinical material if additional clinical information is required in order to evaluate consumer needs and make a level of care determination.

 

authority

Sections 104 and 105 of the Department of Mental Health Establishment Amendment Act of 2001, effective December 18, 2001 (D.C. Law 14-56; D.C. Official Code §§ 7-1131.04 and 7-1131.05 (2008 Repl.)).

source

Final Rulemaking published at 48 DCR 10297 (November 9, 2001); as amended by Final Rulemaking published at 51 DCR 9308 (October 1, 2004); as amended by Final Rulemaking published at 52 DCR 5682 (June 17, 2005); as amended by Final Rulemaking published at 59 DCR 4785 (May 11, 2012).