Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 10 - Division of Services for the Blind › Rule 016.10.07-002 - Rule 18.04 & 18.05: Physical Restoration Services - Guidelines for delivering vocational rehabilitation services

Current through Register Vol. 49, No. 6, June, 2024
Prior
All surgery other than eye surgery must be
				prior approved by the
Approval
Program Administrator.
Refusal of
Refusal of physical restoration does not
				in and of itself constitute
Services
the basis for denial of other services
				needed to complete the consumer's rehabilitation program. The counselor should,
				however, determine whether the consumer would be able to engage in competitive
				employment without the surgery.
Services
DSB will pay for all physical restoration
				services that are properly
Purchased in
authorized. The rate of payment will
				be according to the vendor's
State
stated fee up to, but not to exceed, the
				maximum amount determined by the current Medicaid fee schedules. The fee paid
				to physicians for surgical treatment includes 15 days routine postoperative
				care. After 15 days the counselor may authorize up to three post-operative
				visits if it is decided they are needed.
Services
If DSB purchases physical restoration
				services out of state, the rate
Purchased
paid for such services may equal, but not
				exceed, that paid by the
Out of State
local Rehabilitation Service or other
				comparable public agency of that state.
NOTE:
Texarkana, Texas is
				considered in state.
DSB also will use physicians and facilities that are used by
				the Rehabilitation Service or other comparable public agency of that state. If
				information concerning fees is not available, the counselor will contact the
				nearest appropriate agency. If information regarding fees is not available
				there, the counselor will contact the nearest appropriate Vocational
				Rehabilitation Office to find the rate that the particular agency pays for the
				needed service. When an appropriate fee schedule is not available for a
				procedure being performed out-of-state or in those rare situations that an
				in-state vendor will not accept payment not to exceed the current Medicaid fee
				schedules, the counselor may be required to negotiate a special rate. In these
				cases the rate may not exceed the current Medicare fee schedule minus 20% and
				must be pre-approved by the counselor's Field Services Supervisor or the
				Program Administrator.
Medical
After the initial diagnostic medical
				examination and the eligibility
Payments
certification, payments may be made to a
				physician (general practitioner or specialist), clinic, dispensary, or hospital
				for services rendered in the treatment of the consumer. The counselor can also
				pay for medications and medical supplies incidental to such treatment.
NOTE:
Medications may only be purchased in
				conjunction with a surgical procedure or to treat a short-term illness to
				enable a consumer to return to work or training. Medications will not be
				purchased for long-term illnesses. A short-term illness for the purpose of this
				policy is one that is expected not to last over 60 days.
Psychiatric
Payments may be made to specialist in
				neuropsychiatry or to a
Treatment
psychiatric clinic or hospital for
				psychiatric treatment after the initial psychiatric diagnostic examination. In
				the case of long term mental illness counselors should determine if this is the
				primary disability. If so, the case should be referred to the Arkansas
				Rehabilitation Services.
Surgical
Payments may be made for preoperative
				care, surgical operations,
Treatment
and postoperative care. This is in
				addition to the 15 days of required postoperative care that is to be provided
				as a part of the surgical fee. Payments will be made according to the
				physician's quoted usual, customary, and prevailing fee, but not to exceed the
				current Medicaid fee schedule.