Section 1200-11-03-.07 - OUT-OF-STATE TREATMENT(1) The program may approve a provider's services in an out-of-state facility under the following conditions.(a) The referring physician shall provide evidence that requested services are not available within Tennessee, or shall provide explicit medical justification to prove such out-of-state treatment is in the best interest of the child;(b) The program shall base reimbursement for services on a negotiated rate paid by the Title V CSHCN Program in that state, or on that state's Medicaid rate, whichever is less;(c) The out-of-state length of stay and estimated hospital charge shall be within the limits established by the program;(d) The out-of-state estimated cost of out-patient follow-up and/or discharge services shall be equal or comparable to the Title V CSHCN rate in that state or that state's Medicaid rate, whichever is less;(e) The program shall provide written approval to the provider prior to the provider's performance of services.(2) In order to maintain continuity of care, the program shall refer children receiving services under these rules and regulations who move out of state to the appropriate Title V CSHCN program within the state of new residence upon written permission of the parents or legal guardian, or in the case of an emancipated minor, the minor's permission.Tenn. Comp. R. & Regs. 1200-11-03-.07
Original rule filed March 21, 2000; effective July 28, 2000. Repeal and new rule filed October 9, 2002; effective December 23, 2002. Repeal and new rules filed September 6, 2016; effective 12/5/2016.Authority: T.C.A. §§ 4-5-202, 68-1-103, 68-12-101 et seq., and 42 U.S.C. § 701(a).