Section 513.3 - Obligations and responsibilities of recipients.

513.3 Obligations and responsibilities of recipients. (a) The recipient is responsible for establishing that the medical, dental and remedial care, services or supplies are medically necessary to prevent, diagnose, correct or cure a medical condition and that any specific statutory or regulatory requirements for prior approval of the care, services or supplies are met.

(b) The recipient is responsible for providing all information, appropriate to the request, that the Department of Health reasonably requires to evaluate a request, including detailed health information and information concerning his or her education, training and employment, activities of daily life, and current living arrangement.

(c) The recipient must cooperate with the Department of Health in obtaining information necessary to evaluate a request. If the Department of Health determines that available information is not sufficient to enable it to make an informed determination, the recipient must submit to a clinical examination by an independent practitioner under contract with the Department of Health or by a practitioner employed or designated by the Department of Health.

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