Section 1153.53a. Requests for waiver of hourly limits

(a) Clients who are 20 years of age or younger and who are diagnosed as having one of the medical conditions listed in this section, or conditions of equal severity, may request a waiver from the general limitation on the number of hours of covered services. The medical conditions are:

(1) Infantile autism.

(2) Atypical childhood psychosis.

(3) Borderline psychosis of childhood.

(4) Schizophrenia.

(5) Schizophrenic syndrome of childhood.

(6) Impulse control disorder.

(7) Early deprivation syndrome.

(8) Unsocialized aggressive reaction.

(9) Hyperkinetic conduct disorder.

(10) Over anxious disorder.

(11) Anorexia nervosa.

(12) Neurotic depression—with suicidal ideation.

(b) The request for a waiver shall be accompanied by supporting medical documentation and a second physician’s certification as to the medical necessity of psychotherapy beyond the general limitation.

(c) The request for a waiver is reviewed by the Office of Mental Health, Bureau of Community Programs, and acted upon within 30 days of receipt. Failure to act within 30 days constitutes approval of the waiver.

(d) Waivers are granted for periods of up to 6 months. Requests for additional waivers shall be submitted 30 days prior to the expiration of an existing waiver and are reviewed under the same conditions as specified above.

(e) Requests for waivers must be submitted to: Department of Human Services, Office of Medical Assistance, Room 515 Health and Welfare Building, Harrisburg, Pennsylvania 17120.

(f) A denial of a waiver request may be appealed under the same terms and conditions as any denial of services. See Chapter 275 (relating to appeal and fair hearing and administrative disqualification hearings). Notice of a decision of waiver request will be mailed to the MA recipient and to the provider of services.

The provisions of this § 1153.53a adopted November 13, 1981, effective November 15, 1981, 11 Pa.B. 4046.