1. (a) Individuals requesting assistance from Arkansas Rehabilitation Services for a surgical procedure as a method of treatment for morbid obesity are to be informed the procedure is a major operation with the potential of both short-term and long-term complications.

2. (b)

   1. (1) Any decision to use surgery as a treatment for morbid obesity requires assessing the risk–benefit by an experienced physician or physicians.
   2. (2) Candidates for the procedure should be judged as having a low probability of success using nonsurgical measures as demonstrated by failure in an established weight control program or programs.

   3. (3) Such programs might include, in various combinations:

      1. (A) Behavior modification;
      2. (B) Exercise;
      3. (C) Low-calorie or very low-calorie diets; and
      4. (D) Drug therapy.

3. (c)

   1. (1) A diagnosis of morbid obesity alone does not indicate an individual is an appropriate candidate for this procedure.
   2. (2) High-risk conditions, such as significant diabetes mellitus, obstructive sleep apnea, obesity-related cardiomyopathy, and joint disease, would increase the likelihood an individual would be an appropriate candidate for morbid obesity surgery.

4. (d) Individuals with a diagnosis of morbid obesity may be eligible for restoration services if all the following criteria are met:

   1. (1) Have a body mass index (BMI) of at least 55 (BMI is an individual’s weight in kilograms divided by his or her height in meters squared);
   2. (2) Have an associated high-risk comorbid condition or conditions;
   3. (3) Have documentation the morbid obesity has been present for a minimum of five (5) years;

   4. (4)

      1. (A) Have documentation from a treating physician of failure by the individual in a structured weight loss program while under that physician’s care for a minimum of one (1) year.
      2. (B) This documentation must be within the last two (2) years;
   5. (5) Counselor’s impression that the individual is well motivated and understands the risks associated with the surgical procedure and the restricted eating habits that will follow; and

   6. (6)

      1. (A) If the individual has demonstrated success in a structured weight loss program in the past, the counselor will be required to assess the appropriateness of the specific morbid obesity surgical procedure.
      2. (B) Re-enrollment in a structured weight loss program should be explored.

5. (e) Procedures — Morbid obesity surgery.

   1. (1) Obtain a general medical assessment or current medical information that documents the individual’s diagnosis of morbid obesity and any other high-risk comorbid conditions.
   2. (2) Obtain a mental health assessment that indicates the individual does not have a mental health condition that might preclude this restoration service.
   3. (3) Obtain documentation from a treating physician of the individual’s failure in a structured weight loss program for at least one (1) year (this documentation must be within the last two (2) years) and the presence of morbid obesity for at least five (5) years.
   4. (4) Documentation of comorbid conditions by an appropriate physician with a statement of recommendation for weight loss surgery.
   5. (5) Obtain medical reports that document the need for referral to a surgeon for an assessment to determine the appropriateness of the specific morbid obesity surgical procedure being requested.
   6. (6) Obtain an examination from a surgeon proficient in the specific morbid obesity surgical procedure that documents the individual is an appropriate candidate for this procedure.
   7. (7) Assess the individual regarding motivation for the procedure and understanding of the associated risks.
   8. (8) The counselor will submit received reports and documentation for review and recommendation by the medical consultant.

   9. (9)

      1. (A) The counselor will submit a request to the manager with the reports and all required documentation requesting approval for the procedure.
      2. (B) As a part of the request the counselor will provide the manager the counseling issues to be addressed during the restoration and recovery process.
   10. (10) If the manager agrees that all the required documentation is present and the individual meets Arkansas Rehabilitation Services eligibility and order of selection requirements, the individual is an appropriate candidate for the procedure, and agrees with the identified counseling issues, the manager will note approval in the ECF.
   11. (11) If the manager does not agree the individual meets eligibility and order of selection criteria, is not an appropriate candidate for the requested morbid obesity surgical procedure, or is of the opinion that the identified counseling issues are inadequate or inappropriate, a memorandum of denial will be sent to the counselor notifying the counselor of the decision and noted in the ECF.
   12. (12) If the manager approves, the counselor will proceed as with any other physical restoration case.
   13. (13) During the recovery process the counselor will be required to document a minimum of three (3) counseling sessions prior to case closure.
   14. (14) It is recommended that the case be placed in post-employment status so that necessary counseling and follow-up can take place to ensure optimum benefits from the procedure.
   15. (15) Reports and recommendations will be obtained from the attending physician and attached to the ECF.
6. (f) Note. If the referred case has serious medical problems that pose serious consequences due to delay of case processing, an administrative exception may be requested.

Codification Notes: “ECF” means electronic case file.