R414-515-4. Program Access Requirements

(1)(a) A member must meet the severity of illness and intensity of service for LTAC hospital level-of-care as determined through an evidence-based criteria review process. (b) The Department shall deny an LTAC request for reimbursement if the member does not meet the evidence-based criteria. (2) The Department may forward LTAC preadmissions, continued stays, and retroactive stays that do not meet the evidence-based criteria for secondary medical review if: (a) the LTAC provider requests the secondary medical review; or (b) review of documentation shows that LTAC is the most appropriate level-of-care for the member.