Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a) In addition
to the conditions specified in Section
7160:
(1) Acupuncture services shall;
(A) require referral for treatment by a physician
licensed by the Medical Board of California or a comparable agency of another state
when service is provided out of state. The referring physician shall be a specialist
in the appropriate specialty area to diagnose and treat the disabling
condition.
(B) Only be authorized in
those cases for the control of pain when, in the opinion of the referring physician,
all other modalities have been tried and failed.
(C) Be provided by a qualified physician,
including but not limited to, an anesthesiologist, neurologist, physiatrist or
orthopedist.
(2) Chiropractic
services shall be authorized only if:
(A) The
treatment has the concurrence of the examining or treating physician.
(B) The treatment is utilized for the correction
of a subluxation of the spine which has been demonstrated to exist by a
radiologist.
(3) Psychiatric
therapy/psychological counseling services shall include the initial evaluation and
report specified in 7160(c)(2), testing as necessary, and counseling/therapy, and
shall be subject to the following restrictions:
(A) Psychiatric therapy shall only be provided by
physicians and surgeons licensed by the Medical Board of California who practice
psychiatry.
(B) Psychological counseling
services shall only be provided by one of the following:
1. A physician and surgeon licensed by the Medical
Board of California who practices psychiatry.
2. A Psychologist licensed by the Board of
Psychology.
3. Other professionals, as
allowed within the scope of their licensure, following a special certification from
the Chief Medical Consultant, as specified in Section
7295.7. Such professionals shall be
licensed by the Board of Behavioral Science Examiners and may be either of the
following:
a. A Clinical Social Worker.
b. A Marriage, Family and Child
Counselor.
(C)
Psychological testing services shall only be provided by one of the following:
1. A physician and surgeon licensed by the Medical
Board of California who practices psychiatry.
2. A Psychologist licensed by the Board of
Psychology.
3. A Vocational
Psychologist, as defined in Section
7029.3.
4. An Educational Psychologist, if certified in
accordance with Section
7295.7.
(4) Services provided by allied health
professionals or independent health care professionals shall be provided within the
scope of their licensure. Such services, including but not limited to, speech
pathology, physical therapy, occupational therapy, or the provision of hearing aids,
visual aids, and durable medical equipment and devices, when determined by the
Department to be medical in nature, shall:
(A) Be
prescribed by a physician before authorization except when:
1. Visual aids are prescribed by an
Optometrist.
2. Rental is necessary
while the permanent equipment/device is being repaired.
3. Repairs cost 20% or less of the purchase price
and do not change the fit of the equipment/device to the client.
(B) Meet the following applicable conditions:
1. Prior to the provision of a wheelchair or a
vehicle device to be used as a wheelchair, a wheelchair evaluation must be completed
by a person recognized by the Department as a specialist, working under the
supervision of a physician as applicable to his/her licensure.
2. Physical/occupational/speech therapy shall be
supervised by a physician.
3.
Transcutaneous nerve stimulators shall be subject to the following conditions:
a. Before any purchase, a device shall be rented
for a minimum of 30 days and its use must have a demonstrated therapeutic benefit in
the relief of pain.
b. The rental period
shall not exceed three months or rental charges exceed $1,000, whichever comes
first. The rental costs shall be deducted from the purchase
price.
(b) Dental services shall be provided after
receipt of a dental plan and x-rays submitted by a dentist/orthodontist. Prior
approval of the State Dental Consultant is required if the dental restoration
program is in question, if service has been denied by Medi-Cal or if service
includes extensive treatment such as maxillo-facial dental service, maxillo-facial
prosthetics, gold or porcelain/gold crown, root canal treatment, surgical gum
treatment, full or partial dentures or bridges.
(c) Treatment of an intercurrent illness, which is
an acute medical/dental/psychiatric condition not considered a new, permanent
disability and which interrupts other planned services, shall be considered a
physical and mental restoration service. Service may include, but is not limited to,
office visits, medication, surgical procedure and hospitalization while the client
is in the rehabilitation program. Services shall not be:
(1) Subject to prior written approvals but shall
be provided after consulting with and getting verbal approval from the
Rehabilitation Supervisor with written approvals, as specified in Section
7160(a)(5), to follow
within 15 days of the authorization for service.
(2) Provided in excess of 30
days.
1. New section
filed 2-28-92; operative 3-30-92 (Register 92, No. 16).
2. Change without
regulatory effect amending NOTE filed 5-9-2013 pursuant to section
100, title 1, California Code of
Regulations (Register 2013, No. 19).
Note: Authority cited: Sections
19006
and
19016,
Welfare and Institutions Code. Reference: Sections
19006
and
19050,
Welfare and Institutions Code; and
34 CFR Sections
361.42,
361.48 and
361.50.
