(A) General Provisions Within the limitations in 34 CFR 361, 34 CFR, parts 74‑79 and this rule, RSB may provide the physical and mental health restoration services stated in this rule to a vocational rehabilitation eligible individual, to correct or substantially modify a physical or mental health condition that is stable or slowly progressive and which contributes to the eligible individual’s impediments to employment. 361.48(e), 361.5(b)(40), Sec.103(a)(6)
(B) Types of Physical or Mental Restoration
1. Medical or corrective surgical treatment;
2. Diagnosis and treatment for mental or emotional disorders are provided to an eligible individual to correct or substantially modify a mental health condition that is stable or slowly progressive and which results in a significant impediment to employment for the individual. Services are provided as described in the IPE following examination by a licensed physician or psychologist, the report of which must include findings necessary to determine the mental health of the individual and the characteristics of the impediment to employment to be treated. Services may be provided by physicians, psychologists and other mental health-related professionals. These services may be provided in a hospital setting (in-patient and out-patient), doctor’s office, rehabilitation facilities, State Hospitals and mental health facilities. Consideration may be given to convalescent and intermediate residential care facilities, half-way house and other special living arrangements.
3. Dentistry, when the general and/or special medical examination reveals the existence of serious maxillofacial problems and/or diseases of the gums and teeth that result in or exacerbate problems of speech, personal appearance, personal adjustment or other specific health problems which result in a substantial impediment to employment; NOTE: Ordinarily, dental conditions such as caries (cavities) or gum abscess do not constitute a substantial impediment to employment for the applicant, nor do multiple extractions with the provision of dentures.
4. Nursing services;
5. Inpatient or outpatient hospitalization needed in connection with surgery or treatment and clinic services;
6. Convalescent or nursing home;
7. Drugs and supplies;
8. Prosthetic, orthotic or other assistive devices, including hearing aids, essential to obtaining or retaining employment;
9. 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, that are prescribed by a physician skilled in diseases of the eye or by an optometrist, whichever the eligible individual may select;
10. Podiatry;
11. Physical, occupational, speech or hearing therapy;
12. Psychological services;
13. Therapeutic recreation services;
14. Medical or medically related social work services;
15. Treatment of either acute or chronic medical complications and emergencies which are associated with or arise out of the provision of physical and mental health restoration services, or which are inherent in the condition under treatment;
16. Special services for the treatment of end‑stage renal disease, including transplantation, dialysis, artificial kidneys, and supplies; and
17. Other medical or medically related rehabilitation services, including art therapy, dance therapy, music therapy and psychodrama.
(C) Payment for Physical or Mental Restoration All comparable services and benefits that are available from any source to meet, in whole or in part, the cost of an eligible individual’s physical or mental health restoration shall be utilized, unless to utilize these services or benefits would delay the provision of vocational rehabilitation services to any eligible individual who is at extreme medical risk, as defined in subsection (7)(C). A determination of extreme medical risk shall be based upon medical evidence provided by an appropriate licensed medical professional. Comparable benefits and services shall include, but not be limited to, Title XVIII (Medicare), Title XIX (Medicaid), public or private health insurance, Veterans Administration medical benefits and Worker’s Compensation.
1. RSB may pay hospital room and board charges as billed, based on the least expensive standard accommodation charge;
2. RSB may pay for other medical services, including physician services, laboratory and X‑ray fees and hospital outpatient care, at a rate that is determined by the Department of Social Services to be reasonable; and
3. RSB may pay for medical services received outside Missouri at the rates paid by the vocational rehabilitation agency in that state, unless the provider participates in the Missouri Title XIX program, in which case RSB limits payment to Missouri Title XIX rates.
4. Selection of provider. To the extent possible, RSB shall purchase physical and mental restoration services for eligible individuals who are eligible for Title XIX benefits from Title XIX providers who are located in Missouri.
5. Dental Fee Schedule. RSB may pay for dental services at the rates paid by the Missouri Title XIX program (per the Dental Procedure Codes Annex of the Dental Manual). In the event that a provider cannot be found that will accept the rates established by the Missouri Title XIX program, the services may be authorized at the 50th percentile rate established by the Ingenix Dental Customized Fee Analyzer (maintained by the RSB Bill Paying Unit). If the procedure code for the desired service is not covered by the Missouri Title XIX Dental Procedure Codes Annex, the service may be authorized at the 50th percentile rate established by the Ingenix Dental Customized Fee Analyzer.
6. When costs of physical and mental health restoration services reach twenty‑five thousand dollars ($25,000) regardless of the number of times the eligible individual receives services under the terms of an IPE, requests for additional physical or mental health restoration services must be reviewed and approved by the deputy director or designee.
Version 1.3