Oklahoma Administrative Code › Title 612 - State Department of Rehabilitation Services › Chapter 10 - Vocational Rehabilitation and Services for the Blind and Visually Impaired › Subchapter 7 - Vocational Rehabilitation and Services for the Blind and Visually Impaired › Part 11 - PHYSICAL AND MENTAL RESTORATION SERVICES › Section 612:10-7-98 - General guidelines for physical and mental restoration services

Current through Vol. 41, No. 20, July 1, 2024
(a) To the extent
				  that assistance is not readily available from a source other than DVR or DSBVI,
				  diagnosis and treatment of physical and mental impairments may be provided to
				  assist the individual with a disability in preparing for, securing, retaining
				  or regaining employment. Physical or mental restoration services are provided
				  only when the condition is stable, or slowly progressive. A slowly progressive
				  condition is one in which the client's functional capacity is not expected to
				  diminish so rapidly as to prevent successful completion of vocational
				  rehabilitation services, and/or employment for a reasonable period of time. The
				  individual is liable for services he or she arranged which were not planned and
				  initiated under the auspices of DVR and DSBVI. DVR and DSBVI will not pay for
				  hospitalization or treatment occurring prior to initiation of an Individualized
				  Plan for Employment (IPE). DVR and DSBVI will not pay for emergency
				  hospitalization or treatment needed at the time of referral. However,
				  diagnostic examinations or information may be paid from DVR and DSBVI funds for
				  use in eligibility determination, priority group placement, or determination of
				  vocational rehabilitation needs. Physical and/or mental restoration services
				  will be purchased only from licensed or board certified health professionals
				  unless otherwise specified in DRS policy. Payment will be made in accordance
				  with the established fee schedule of the Department.
(b) Temporary conditions with sudden onset do
				  not fall within the definition of impairment for eligibility purposes.
				  Emergency treatment of remediable conditions will not be purchased by DVR and
				  DSBVI except under intercurrent illness policy. When the staff is in doubt as
				  to the effect of such a condition upon the outcome of the IPE objectives, a
				  medical consultation may be requested.
(c) DVR and DSBVI do not provide long-term or
				  ongoing physical or psychological treatment. DVR and DSBVI funds cannot be used
				  to initiate treatment that is reasonably anticipated to last more than three
				  months unless supervisory approval has been obtained for a three month
				  extension. Additional three month extensions may be approved if the client
				  maintains reasonable progress toward achieving the vocational goal. Persons
				  needing long-term or ongoing treatment are to be referred to other medical
				  assistance sources if available.
(d) Payment from DVR and DSBVI funds may be
				  planned and authorized only after applicable third party pay sources provide
				  verification of the expense they will cover, and not cover, associated with the
				  physical or mental restoration services in question. When DVR and DSBVI funds
				  are used to supplement a third party pay source, planned services and the
				  authorization will be limited to those expenses that fall within the scope of
				  the program and that do not exceed the difference between what the third party
				  pay source will pay and the Department's established payment schedule.
(e) Individuals with chronic
				  disabilities that can be removed with little or no residual limitations will
				  not be eligible for purchase of services other than those related to the
				  required treatment.
(f) Physical
				  and mental restoration services may include but are not limited to:
(1) Braces and orthotic devices.
(2) Chiropractic services. A chiropractor
				  providing treatment must be duly licensed to practice his profession in
				  Oklahoma, have a current provider/vendor agreement with DRS, and following
				  evaluation of the client's needs, must provide a treatment plan with goals,
				  time frames and the estimated number of treatments required to meet the goals.
				  Treatment may not be extended beyond three months unless progress toward
				  treatment goals can be determined.
(3) Dental services. Dental services may be
				  provided to treat or correct dental conditions that constitute an impediment to
				  employment or participation in the rehabilitation process, produce health
				  problems or aggravate an existing disability. Dental services with a projected
				  cost over $5,000.00 require review by the DRS dental consultant and supervisory
				  approval.
(4) Dialysis and
				  treatment for end-stage-renal-disease. DVR and DSBVI may assist with the cost
				  of Medicare deductible, co-insurance, and services not covered by Medicare if
				  documentation states other resources are not available and the client is
				  actively participating in an IPE with treatment as part of the plan. Requests
				  for kidney transplants must be approved by the medical consultant.
(5) Prescription drugs and prescribed medical
				  supplies. Prescription drugs and/or prescribed medical supplies may be
				  purchased when required for proper diagnosis, for post-operative treatment, or
				  to stabilize a documented disability. The need for the drugs and/or medical
				  supplies must be documented in a physician's report. Payment will be made for
				  generic type drugs unless the physician specifically requests a brand name
				  drug.
(6) Hearing aids and
				  audiological services.
(7)
				  Hospitalization when recommended by a physician and the client is to receive
				  medical treatment or surgery. Hospitalization may also be authorized for
				  diagnostic services upon recommendation of a physician.
(8) Treatment for intercurrent illness.
				  Intercurrent illness is an illness or injury which occurs during the course of
				  an individual's vocational rehabilitation and, if not treated, will complicate
				  or significantly delay achievement of the client's employment outcome. DVR and
				  DSBVI will purchase treatment for intercurrent illness or injuries if the
				  client is not covered by health insurance or eligible for comparable services
				  and benefits, or when the provision of services through comparable services and
				  benefits would significantly interrupt or delay treatment for an individual at
				  extreme medical risk, jeopardize a job placement or impair the individual's
				  progress in achieving the planned employment outcome.
(9) Laboratory work and x-rays if required by
				  the physician to complete his examination or in conjunction with diagnosis or
				  treatment.
(10) Low vision
				  services.
(11) Medical
				  examinations, when necessary to determine eligibility, achieve a goal in the
				  IPE or when related to an intercurrent illness.
(12) Nursing services can be provided for a
				  client who is convalescing from physical restoration services if recommended by
				  the doctor of treatment. Either Registered Nurses or Licensed Practical Nurses
				  may be used to provide this service when a current medical vendor agreement is
				  on file with the Department. Volunteers may be used if less technical care is
				  needed and if approved by the client's physician.
(13) Physical and occupational therapy may be
				  provided on either an in-hospital or outpatient basis if recommended by the
				  attending physician.
(14)
				  Post-operative care of cataract patients.
(15) Prosthetic eyes, glasses and other
				  optical aids.
(A) Glasses and other visual
				  aids and services may be prescribed or provided by either an ophthalmologist or
				  an optometrist. Other optical aids recommended by optical aid clinics are
				  purchased upon the recommendation of the specialist(s) in one or more such
				  clinics. Prosthetic eyes are provided, upon the recommendation of an
				  ophthalmologist.
(B) Lenses and
				  frames for glasses purchased by DRS will be authorized at fee schedule prices.
				  The vendor may add a service charge not to exceed the established fee. An
				  additional code and fee may be added for tinting if it has been prescribed by
				  the physician or optometrist that performed the eye examination with written
				  medical/vocational justification.
(C) The fee that has been established for
				  frames will only cover the cost of plain sturdy frames. Clients do not have the
				  option of selecting more expensive frames and paying the difference between the
				  vendor's price and the amount authorized. If the vendor accepts payment from
				  the client or a representative of the client and also files a claim with the
				  Department for the same services, a violation of the Provider Agreement has
				  occurred and the vendor would be subject to sanctions.
(D) If a client selects special frames and
				  has sufficient resources to purchase them, the frames should not be included on
				  the authorization and the client would be responsible for the entire cost of
				  the frames.
(16)
				  Prosthetic limbs.
(A) Prosthetic limbs may be
				  provided if the prosthesis is recommended by a physician. The client who has
				  successfully worn a prosthesis will not be required to see an orthopedist or
				  physiatrist, or attend an amputee clinic unless some other disorder is
				  apparent.
(B) An individual who has
				  never worn a prosthesis must be seen by a physician before the prosthesis is
				  provided. The client must agree to training in its use. Gait training is
				  considered Personal Adjustment Training and does not require client
				  participation in cost. However, physical therapists providing the training are
				  recognized as medical vendors and require authorizations completed on a Medical
				  Service Authorization.
(C) Persons
				  with multiple amputations must have the special examination and training.
(D) The counselor may authorize
				  for a prescribed standard prosthesis without further review. The choice of
				  prosthesis must be closely related to its intended use in a work setting, or in
				  relation to reasonable independent living goals. Non-standard prostheses (i.e.,
				  myoelectric) will not be purchased with DRS funds unless medically justified
				  and/or required for a specific employment, or independent living, outcome. When
				  a prosthesis other than a standard prosthesis is prescribed the counselor will
				  request a consultation from the appropriate medical consultant. Justification
				  for the non-standard prosthesis must be documented in the case record.
(17) Psychiatric and
				  psychological treatment.
(A) Psychotherapy
				  may be provided for emotional conditions which may be expected to respond
				  within a reasonable period of time. Psychotherapy can be provided only by the
				  sources in (1) - (5) of this Subsection.
(i)
				  Psychiatrists certified by the American Board of Psychiatry and Neurology or
				  completed the required training and are "Board Qualified", or who have spent a
				  major portion of their time in a particular specialty for at least two years
				  and are recognized as specialists in the local community (same criteria as
				  applied to other medical specialists).
(ii) Licensed Doctors of Medicine or Doctors
				  of Osteopathy who have received specific training for and are experienced in
				  performing mental health therapeutic, diagnostic, or counseling functions.
(iii) Psychologists with a
				  doctorate in clinical or counseling psychology who hold a valid license to
				  practice psychology.
(iv)
				  Psychologists with a doctorate in clinical or counseling psychology who are
				  employed by governmental agencies exempt from the licensing law.
(v) Other licensed clinicians or those
				  employed by governmental agencies who have received administrative approval to
				  provide this treatment service.
(B) Upon receipt of a written report from the
				  therapist, the supervisor may approve additional three-month periods of
				  therapy. Clients needing long-term or ongoing psychiatric or psychological
				  treatment will be referred to the appropriate community mental health center.
(C) Personal Adjustment Counseling
				  may be provided for those persons with emotional conditions who may benefit
				  from counseling to bring about a more adequate social adjustment, alleviate
				  superficial anxiety, and to create more effective interpersonal relationships.
				  Personal Adjustment Counseling may be provided by: those individuals listed in
				  (17) (A) of this Subsection.
(18) Speech therapy/training as recommended
				  in a speech evaluation. Speech therapy, although provided by recognized
				  speech-language pathologists (SLP), is considered Personal Adjustment training
				  and is not based on financial status. The providers of speech therapy are
				  classified as medical vendors.
(19)
				  Surgery and medical treatment.
(A) Surgery
				  and complex or unusual medical treatment may be provided when recommended by a
				  specialist. Medical consultant approval will be obtained prior to planning and
				  authorizing a diagnostic procedure which could lead to immediate surgical
				  treatment. The medical consultant will give conditional approval for the
				  possible surgery if deemed necessary. Normal post-operative care is an integral
				  part of the surgery; therefore, no post-operative charges are to be paid above
				  the approved surgical fee.
(B)
				  Specified outpatient surgical services are approved for payment when provided
				  in qualified outpatient surgical facilities. Qualified facilities include
				  Medicare certified free standing ambulatory surgical centers, Medicare
				  certified hospitals offering outpatient surgical services, and hospitals which
				  have an agreement with DRS.
(C) The
				  counselor will advise the client he/she may be liable for any balance due when
				  payment by private insurance exceeds the Department allowable
				  rate.
(20) Weight loss
				  treatment. A weight loss plan or treatment are included as a service in the IPE
				  for individuals who are eligible on the basis of obesity. A licensed dietician
				  or a physician skilled in weight reduction must monitor any treatment program
				  authorized by the agency. Surgery for weight loss is not provided unless
				  medically recommended as treatment for morbid obesity, a second confirming
				  medical opinion is obtained, the surgery is approved by the DRS medical
				  consultant and supervisory approval is obtained. Before approving DRS provision
				  of surgery for treatment of morbid obesity, the supervisor shall consider the
				  individual's past experience with standard weight loss protocols, and medical
				  and behavioral factors that may impact the individual's ability to obtain
				  long-term benefit from the surgery.
(21) Wheelchairs and other durable medical
				  equipment when prescribed by a physician or recommended by an occupational
				  therapist, physical therapist, assistive technology specialist or person with
				  equivalent qualifications. Power mobility devices may be purchased for
				  individuals when necessary to assist the client in achieving IPE goals.
(A) The client, and/or client's authorized
				  representative, will participate in choosing from which vendor the wheelchair
				  or durable medical equipment will be purchased. Wheelchairs and other durable
				  medical equipment will be authorized at the agency approved fee.
(B) The client, or client's family or
				  authorized representative as appropriate, is responsible for maintaining
				  wheelchairs or other durable medical equipment in good working order. DVR and
				  DSBVI will pay for repairs to wheelchairs or other durable medical equipment
				  during the life of the case unless there is clear evidence the equipment has
				  been damaged due to client abuse or neglect. An agency-purchased wheelchair
				  will be returned to the agency if the client becomes unable to use it.
(C) Wheelchair rental may be
				  authorized for a period not to exceed six months when necessary to assist the
				  client with mobility. An exception can be made if it is documented that rental
				  is more cost effective than purchase.