31.10.21.02-1

.02-1 Uniform Treatment Plan.

A. Scope. This regulation does not apply to a person that uses a treatment plan form solely for internal purposes, unless the private review agent requires the information to authorize treatment.

B. Form Required. If a private review agent requires a health care provider to submit a treatment plan or telephonically provide the information requested on the uniform treatment plan, to enable the private review agent to conduct utilization review of services for the treatment of a mental illness, emotional disorder, or a substance abuse disorder, the private review agent shall use the uniform treatment plan form set forth in §H of this regulation.

C. Acceptance of Form by Private Review Agent. A private review agent shall accept the uniform treatment plan form as a properly submitted treatment plan form and may not require a health care provider to:

(1) Modify the uniform treatment plan form or its content except as provided in this regulation; or

(2) Submit additional treatment plan forms.

D. Instructions. A private review agent may provide a set of instructions for use by the health care provider regarding the private review agent's specific managed care requirements.

E. Modification of Form Prohibited. A private review agent may not modify the uniform treatment plan form in any manner.

F. Use of Form by Health Care Provider. A health care provider shall use and properly complete the uniform treatment plan form as provided in this regulation.

G. Submission of Form by Electronic Transfer. The uniform treatment plan form may be submitted by electronic transfer.

H. The uniform treatment plan form required by this regulation shall read as follows:

Click here to view the above document.

I. Telephonic Review. If a private review agent conducts utilization review of services for the treatment of a mental illness, emotional disorder, or a substance abuse disorder telephonically, the private review agent may not require the health care provider to provide any information that is not requested on the uniform treatment plan form.