Current through August, 2024
(a) Diagnosis and treatment services
(physical and mental restoration services) include:
(1) Corrective surgery or therapeutic
treatment that is likely, within a reasonable period of time, to correct or
modify substantially a stable or slowly progressive physical or mental
impairment that constitutes a substantial impediment to employment;
(2) Diagnosis of and treatment for mental or
emotional disorders by qualified personnel in accordance with State licensure
laws;
(3) Dentistry;
(4) Nursing services;
(5) Necessary hospitalization (either
inpatient or outpatient care) in connection with surgery or treatment and
clinic services;
(6) Drugs and
supplies;
(7) Prosthetic and
orthotic devices;
(8) Eyeglasses
and visual services, including visual training, and the examination and
services necessary for the prescription and provision of eyeglasses, contact
lenses, microscopic lenses, telescopic lenses, and other special visual aids
prescribed by personnel that are qualified in accordance with State licensure
laws;
(9) Podiatry;
(10) Physical therapy;
(11) Occupational therapy;
(12) Speech or hearing therapy;
(13) Mental health services;
(14) Treatment of either acute or chronic
medical complications and emergencies that are associated with or arise out of
the provision of physical and mental restoration services, or that are inherent
in the condition under treatment;
(15) Special services for the treatment of
individuals with end-stage renal disease, including transplantation, dialysis,
artificial kidneys, and supplies; and
(16) Other medical or medically related
rehabilitation services.
(b) Diagnosis and treatment services shall be
provided when necessary to correct or modify substantially, within a reasonable
period of time, a stable or slowly progressive physical or mental impairment
that constitutes a substantial impediment to employment, to enable an eligible
individual to prepare for, secure, retain, or regain an employment outcome that
is consistent with the individual's strengths, resources, priorities, concerns,
abilities, capabilities, interests, and informed choice.
(c) Diagnosis and treatment services shall be
provided in accordance with the definition in subsection (a), and the
following:
(1) The individual must be
eligible for VR services;
(2) The
services must be provided as part of a planned program of vocational
rehabilitation in accordance with the individual's IPE;
(3) Choice of physician, dentist, therapist
and other service providers, as appropriate to the needs of the eligible
individual, shall be governed by the following:
(A) The eligible individual's family
physician, specialist, or service provider may be used when they meet the
division's standards for the service in question and is the choice of the
individual or, as appropriate, the individual's representative.
(B) Where the eligible individual's service
provider of choice is not available, or when the eligible individual does not
have a preferred service provider, the individual shall be offered a choice
from among those providers who meet the division's standards for the particular
services needed, in accordance with sections 17-400.1-10 and
17-401.1-12.
(C) Under certain
circumstances where examinations and reports by qualified resource persons are
difficult to obtain, the division's medical consultant may provide necessary
services.
(D) Where an eligible
individual is or previously was a private patient of the division's medical
consultant, such status shall not in any way influence or prejudice the current
service to be provided to the individual by the consultant at the division's
request.
(4) The
determination that corrective surgery or therapeutic treatment is likely,
within a reasonable period of time, to correct or modify substantially a stable
or slowly progressive physical or mental impairment shall be based on such
factors as the expected period of employability after treatment, and the
expected effect the treatment will have in substantially improving the
individual's employability.
(5) The
division's medical consultant shall review all authorizations for diagnostic
and treatment services.
(6) Before
or simultaneously with the purchase of diagnostic or treatment services, the
division shall authorize such services in writing and shall retain a record of
such authorization, in accordance with sections 17-400.1-10 and
17-400.1-11.
(7) Diagnosis and
treatment services are subject to the use of comparable services and benefits
provisions of section 17-401.1-13 and the use of personal resources (financial
needs test) provisions of section 17-401.1-14.
(d) Diagnosis and treatment of acute and
transitory conditions not related to a diagnosed disability, such as injuries
or illnesses of thirty days duration or less, including but not limited to
accidental fractures of a temporary nature, acute appendicitis, and upper
respiratory infections, is not allowed.
(1)
All eligible individuals shall be informed that the division will not pay for
diagnosis and treatment of acute and transitory conditions not related to the
individual's diagnosed disabilities.
(2) All eligible individuals shall be
encouraged to apply for medical insurance to address their needs. Referral
services shall be provided to assist them in applying for medical insurance, in
accordance with section 17-401.1-17.
(e) The division administrator shall be
responsible for all matters pertaining to fees charged the division for goods
and services purchased in the administration of the VR program.
