Cal. Code Regs. tit. 9, § 7160 – Physical and Mental Restoration Services/Purchases -- General.

(a) Physical and mental restoration services/purchases shall be subject to all provisions specified in this section. Services/purchases shall be:
1. (1) Provided only in accordance with an Individualized Plan for Employment (IPE).
2. (2) Unavailable in cases of Interim Determination of Eligibility, as defined in Section 7063.
3. (3) Subject to the similar benefit provisions of Sections 7196 through 7198 and the client financial participation provisions of Sections 7190-7194.
4. (4) Prescribed/recommended by the attending physician, except as provided in Section 7160.5(a)(4).
5. (5) Reviewed/approved in writing prior to the provision of the service/purchase, except as provided in 7160.5(c) and in accordance with (b), by one or more of the following as appropriate to the service being rendered or the purchase being authorized:
  1. (A) The Medical Consultant or Psychiatric Consultant.
    The approving Medical/Psychiatric Consultant shall not be the prescribing/recommending physician specified in (4).
  2. (B) The Vocational Psychologist (if licensed by the Board of Psychology and only in districts that do not have a Psychiatric Consultant).
  3. (C) The Rehabilitation Supervisor.
  4. (D) The Medical Services Officer.
  5. (E) The District Administrator, if services or purchases cost in excess of $5,000 and when renting a wheelchair.
  6. (F) The District Administrator and the Director or the Director's designee in cases of maxillo-facial surgery costing in excess of $5,000.
  7. (G) The Chief Medical Consultant.
  8. (H) The Statewide Psychiatric Consultant.
  9. (I) The Statewide Optometric Consultant.
  10. (J) The Statewide Dental Consultant.
(b) Approval shall occur only after reaching a conclusion, based upon a careful review of the diagnostic study, that the IPE will be jeopardized if the service/purchase is not provided to individuals eligible for vocational rehabilitation services, the service is necessary to both:
1. (1) Correct or substantially modify, within a reasonable period of time, a physical or mental condition which is stable or slowly progressive. A reasonable period of time shall be determined based upon factors related to the nature of the disability.
2. (2) Prepare the individual for suitable employment.
(c) Evaluations/progress reports and final treatment reports from physicians, hospitals, rehabilitation centers and other facilities or appropriate providers shall be received and reviewed for recommendation by the Medical/Psychiatric Consultant or the Vocational Psychologist (if the conditions specified in 7160(a)(5)(B) exist) to determine the individual's status/progress related to the likelihood of achieving the desired physical/mental restoration objective.
1. (1) Progress/final treatment report(s) submitted as a result of a service purchased by the Department shall include an evaluation of the individual's progress, prognosis, functional limitations and capacities.
2. (2) In addition to the report(s) specified in (1), initial evaluations and report(s) submitted for physical/occupational/speech therapy or for psychiatric therapy/psychological counseling shall include a limited history, diagnosis, summary of functional limitations and capacities and the recommended therapy plan based upon the results of the evaluation or the provision of subsequent services.
(d) All service(s) shall be limited to six sessions/visits, except when:
1. (1) Physical therapy training in the use of a prosthetic or orthotic appliance has been recommended by the prescribing physician, or
2. (2) The need for additional sessions/visits has the concurrence of the Medical Consultant and approval of the District Administrator. A written justification prepared by the provider of service shall be submitted to the Department for review and shall include the following:
  1. (A) The basis on which the additional treatment is recommended.
  2. (B) The anticipated number of visits/sessions in excess of six.
(e) When treatment is recommended beyond six sessions/visits the Counselor shall seek alternate ways to provide service based upon available resources.

Note: Authority cited: Sections 19006 and 19016, Welfare and Institutions Code. Reference: Sections 19010 and 19050, Welfare and Institutions Code; 34 CFR Sections 361.42 and 361.48.

History

1. Amendment filed 3-2-82; effective thirtieth day thereafter (Register 82, No. 10).

2. New article 4 heading and amendment of section filed 6-21-90; operative 7-21-90 (Register 90, No. 35).

3. Amendment of subsection (a) and Note and new subsections (a)(1)-(d)(2)(B) filed 2-28-92; operative 3-30-92 (Register 92, No. 16).

4. Editorial correction of subsection (d)(2)(B)1. and deleting duplicate section (Register 95, No. 11).

5. Editorial correction of subsection (c) (Register 95, No. 43).

6. Change without regulatory effect amending subsection (a)(1) and Note filed 5-9-2013 pursuant to section 100, title 1, California Code of Regulations (Register 2013, No. 19).

7. Amendment of subsections (a)(5)(A), (b)-(c)(1) and relettering of former subsection (d)(2)(B)1. to (e) filed 2-17-2023; operative 2-17-2023 pursuant to Government Code section 11343.4(b)(3) (Register 2023, No. 7).