Ohio Admin. Code 5160-17-01 - Abortions
(A) Reimbursement
for abortion services, other than those identified in paragraph (D) of this
rule, is restricted to the following circumstances when the appropriate
certification in paragraph (B) of this rule is made:
(1) Instances in which the woman suffers from
a physical disorder, physical injury, or physical illness, including a
life-endangering physical condition caused by or arising from the pregnancy
itself, that would, as certified by a physician, place the woman in danger of
death unless an abortion is performed; or
(2) Instances in which the pregnancy was the
result of an act of rape and the patient, the patient's legal guardian or the
person who made the report to the law enforcement agency, certifies in writing
that a report was filed, prior to the performance of the abortion, with a law
enforcement agency having the requisite jurisdiction, unless the patient was
physically unable to comply with the reporting requirement and that fact is
certified by the physician performing the abortion; or
(3) Instances in which the pregnancy was the
result of an act of incest and the patient, the patient's legal guardian or the
person who made the report certifies in writing that a report was filed, prior
to the performance of the abortion, with either a law enforcement agency having
the requisite jurisdiction, or, in the case of a minor, with a county children
services agency established under Chapter 5153. of the Revised Code, unless the
patient was physically unable to comply with the reporting requirement and that
fact is certified by the physician performing the abortion.
(B) Certification.
(1) Before reimbursement for an abortion can
be made, the physician performing the abortion must certify that one of the
three circumstances in paragraph (a) of this rule has occurred. The
certification must be made on the Ohio department of job and family services
"Abortion Certification Form" JFS 03197, contained in appendix A of this rule.
The physician's signature must be in the physician's own handwriting. All
certifications must contain the name and address of the patient. The
certification form must be attached to the billing invoice.
(2) The certification must be as follows:
I certify that, on the basis of my professional judgment, this service was necessary because:
(a)
The woman suffers from a physical disorder, physical injury, or physical
illness, including a life-endangering physical condition caused by or arising
from the pregnancy itself, that would, as certified by a physician, place the
woman in danger of death unless an abortion is performed; or
(b) The pregnancy was the result of an act of
rape and the patient, the patient's legal guardian or the person who made the
report to the law enforcement agency certified in writing that a report was
filed, prior to the performance of the abortion, with a law enforcement agency
having the requisite jurisdiction; or
(c) The pregnancy was the result of an act of
incest and the patient, the patient's legal guardian or the person who made the
report certified in writing that a report was filed, prior to the performance
of the abortion, with either a law enforcement agency having the requisite
jurisdiction, or, in the case of a minor, with a county children services
agency established under Chapter 5153. of the Revised Code; or
(d) The pregnancy was the result of an act of
rape and in my professional opinion the recipient was physically unable to
comply with the reporting requirement; or
(e) The pregnancy was a result of an act of
incest and in my professional opinion the recipient was physically unable to
comply with the reporting requirement.
(3) Reimbursement will not be made for
associated services such as anesthesia, laboratory tests, or hospital services
if the abortion service itself cannot be reimbursed. All abortion services for
the purposes of paragraph (A) of this rule must be submitted to the department
on a hard copy billing invoice.
(C) Documentation that supports the
certification made by the physician must be maintained by the physician in the
recipient's medical record. When the physician certifies that paragraph
(B)(2)(b) or (B)(2)(c) of this rule is true, a copy of a signed statement by
the patient, the patient's legal guardian, or the person who made the report
must be maintained in the patient's medical record.
(D) Nothing in this rule shall be construed
to deny reimbursement for drugs or devices to prevent implantation of the
fertilized ovum, or for medical procedures for the termination of an ectopic
pregnancy. The requirements stated in this rule do not apply to those abortions
that are treatments for incomplete, missed, or septic abortions.
Notes
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01, 5111.02
R.C. 119.032 review dates: 11/12/2004 and 03/01/2010
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