Referral Process for the Functional Independence Restoration Program (FIRST)
Thank you for your interest in our Pain Management Center and the Functional Independence Restoration Program (FIRST), a CARF accredited inpatient pediatric chronic pain rehabilitation program at Cincinnati Children’s Hospital Medical Center. We like providers to be aware of our referral process so you can share these expectations with patients and family.
When a new patient is referred to the FIRST program, the first step is for the patient to be scheduled for an outpatient multi-disciplinary visit in the Pain Management Center where they will be evaluated by our Pain Team to determine program candidacy.
The Pain Team includes a Pain Physician, Psychologist, and Physical Therapist. At that visit, the Pain Team, in collaboration with the patient and family, will determine if the program is appropriate.
FIRST Program Admission Criteria are as follows:
- Patient ages 10-17 with a chronic pain condition and severe functional disability
- Completed diagnostic work-up and cleared for participation in physical activity
- Completion of outpatient therapies with no benefit in function (including specialty medical intervention, physical therapy and/or occupational therapy, and psychology)
- Patient/family are motivated and willing to engage in a functional approach
When making a FIRST program referral, please inform the patient and family that they will not be directly admitted to the FIRST program from the Pain Management Center visit. The program is filled on a rolling admission schedule; patients are placed on the FIRST program admission wait list only after the Pain Management Center visit occurs. The wait list for the Pain Management Center and FIRST program are separate and variable. Direct families to our program website for more information about the program and functional treatment approach.
Before we can schedule an appointment for the patient in the Pain Management Center we need to have the complete medical history, either from the last year and/or from the beginning of the current pain issue. Please include the following (information can be faxed and/or mailed):
- Complete formal referral (use the Cincinnati Children's Specialty Referral Form and Select “Chronic Pain Management-FIRST”—this is the ONLY selection that needs to be made)
- Patient demographics including contact information
- Insurance information including phone number (clear copy of front and back of card)
- Medical records from all relevant providers whom the child has seen, past and present
- MRIs or X-rays disc and reports
- Labs, if applicable
Once all information has been received and reviewed by our nursing staff, we will contact the family directly to schedule the initial Pain Management Center visit. There are instances when insurance carriers may require a prior authorization before patients can be seen.
Out-of-State Medicaid Patients
For Medicaid patients outside of Ohio, Kentucky, and Indiana, the referring physician must start the prior-authorization process by providing the insurance carrier a letter of medical necessity including clinical notes. At times, a peer-to-peer phone conversation is needed between the referring physician and the insurance clinical director for approval of out-of-network services.
