Current through Reg. 50, No. 187; September 24, 2024
(1) Medical, psychological, or dental
consultation shall be required prior to treatment for extraordinary or
experimental procedures. Consultants may assist the division in:
(a) Interpreting medical, dental, or
psychological reports;
(b)
Determining the need for further diagnostics or for confirming the suitability
of restoration services as recommended by a qualified physician, dentist, or
psychologist;
(c) Determining
whether a physical or mental condition is chronic and stable or slowly
progressive;
(d) Determining the
implication of the applicant's physical or mental condition for rehabilitation
potential;
(e) Determining the
appropriate fees for medical, dental or psychological procedures;
(f) Determining the best option for various
medical procedures;
(g) Determining
the most appropriate hospital and the most cost-efficient
fee.
(2) In order to
avoid even the appearance of a conflict of interest, consultation shall not
occur with the actual provider of either a diagnostic or a treatment service
unless no other provider is available.
(3) Dental services. Dental services may be
provided to an individual if the individual's dental condition is a substantial
impediment to employment; is slowly progressive; is contributing significantly
to the complication of another physical condition; and that condition
constitutes a substantial vocational impediment.
(a) The use of a dental condition as a
primary disability is not prohibited but would be limited to the following
instances:
1. When the dental condition
creates toxicity and causes physical symptoms in other systems of the body.
This determination must be made by an internist and treatment approved by the
division's medical consultant; or
2. When the dental condition results in a
cosmetic problem that is severe enough to prevent an individual from obtaining
or retaining a job in which the individual would be serving the
public.
(b) Preventive
dental services may be provided only as an adjunct to dental treatment. A
preventive dental service in and of itself shall be
prohibited.
(4) Hearing
aids.
(a) The choice of hearing aids shall be
based on the recommendation of a licensed audiologist and the individual's
current hearing and speech capabilities. The selected hearing aid must enable
the individual to successfully complete the services in the Individualized Plan
for Employment (IPE) that are needed to secure, retain or regain employment. If
the individual prefers a more expensive hearing aid, the individual must pay
the difference in cost between the required hearing aid and the chosen
one.
(b) The purchase of a hearing
aid shall be based on the manufacturers' single unit price (MSUP) plus a
division-established allowance to cover programming, fitting, dispensing, up to
two (2) follow-up visits after the initial 30-day trial period, ear-mold(s),
and 1-year warranty.
(5)
Bariatric Surgery. The division may consider providing bariatric surgery only
if an individual's weight constitutes a substantial impediment to employment.
The division may consider providing bariatric surgery to those persons for whom
it is medically necessary, because their medical condition will not allow them
the time to lose weight by conservative approaches (balanced eating program and
therapy for one (1) year) or for whom more conservative approaches have failed
to result in weight loss. The medical risks involved in the surgery and risk of
surgery failure must justify the imposition of the following conditions:
(a) The individual must provide documented
evidence of vocational impairments that exist at the time of request;
(b) An individual requesting bariatric
surgery as an elective procedure must provide records of nutritional counseling
and attempt at weight loss with a balanced diet (may be through a weight loss
program or in consultation with a nutritionist or doctor) for at least one (1)
year prior to the division's considering sponsoring bariatric surgery. The
division may assist with the costs of counseling and weekly fees for weight
loss programs;
(c) The individual
must submit to psychological evaluation and therapeutic counseling, if
recommended, regarding the individual's current psychological status,
expectations about the surgery, and ability to maintain the extreme dietary
discipline required after surgery;
(d) The individual must provide documentation
from a doctor that the individual can safely undergo the surgery and be
expected to return to employment; and,
(e) The individual must agree to work with a
nutritionist after surgery for six (6) months.
Rulemaking Authority
413.22,
1001.02 FS. Law Implemented
413.24,
413.28,
413.30
FS.
New 5-14-12.
