Ariz. Admin. Code § R6-4-402 - Service and Provider Standards, Service Authorizations, Equipment Purchasing, Workers' Compensation

A. Provider standards

1. Providers of medical diagnostic and restorative services must, as a minimum, meet the following definitions:

a. "Dentist." Dentist means a person licensed to practice dentistry or dental surgery under Chapter 11, Title 32 of the Arizona Revised Statutes.

b. "Dispensing optician." Dispensing optician means any person who is licensed under Chapter 15, Title 32 of the Arizona Revised Statutes to dispense lenses, contact lenses, frames, artificial eyes, optical devices, appurtenances thereto or parts thereof to the intended wearer on written prescription from a duly licensed physician or optometrist.

c. "Occupational therapist." Occupational therapist means a person who is a graduate of an occupational therapy curriculum accredited jointly by the Council on Medical Education of the American Medical Association and the American Occupational Therapy Association or has two years of appropriate experience as an occupational therapist and has achieved a satisfactory grade on a proficiency examination approved by the Secretary except that such determination of proficiency shall not apply with respect to persons initially licensed by a state or seeking initial qualifications as an occupational therapist after December 21, 1977.

d. "Optometrist." Optometrist means a person who is licensed to practice optometry under Chapter 16, Title 32 of the Arizona Revised Statutes.

e. "Orthotist and/or prosthetist." Orthotist and/or prosthetist means a person who is certified by the American Board for Certification for Orthotics and Prosthetics, Inc.

f. "Physical therapist." Physical therapist means a person registered to practice physical therapy under Chapter 19, Title 32, Arizona Revised Statutes.

g. "Physician." Physician means a person licensed under Chapter 13 or 17, Title 32, Arizona Revised Statutes.

h. "Physician specialist." For purposes of this program, a specialist is a licensed physician who limits his practice to specialization and who:

i. Is a diplomat of the appropriate American or Osteopathic Board; or

ii. Is a fellow of the appropriate American Specialty College or a member of an Osteopathic Specialty College; or

iii. Has been notified of admissibility to examination by the appropriate American Board or Osteopathic Board or has evidence of completion of an appropriate qualifying residency approved by the American Medical Association or American Osteopathic Association and has not lost his eligibility; or

iv. Holds a staff appointment on July 1, 1976, with specialty privileges in a hospital accredited by the Joint Commission of Accreditation of Hospitals or by the American Osteopathic Association.

i. "Podiatrist." Podiatrist means a person licensed to practice podiatry under Chapter 7, Title 32, Arizona Revised Statutes.

j. "Respiratory therapist." Respiratory therapist means a person who is a graduate of an American Medical Association approved respiratory care education and training program and who has been registered by the American Registry of Inhalation Therapist, Inc., following successful completion of the American Registered Inhalation Therapist Examination.

k. "Speech therapist or audiologist." Speech therapist means a person who has been granted the Certificate of Clinical Competence in the American Speech and Hearing Association, or who has completed the equivalent educational requirements and work experience required for such a certificate, or who has completed the academic program or is in the process of accumulating the supervised work experience required for such a certificate.

2. Psychological services for VR are to be provided only by qualified psychologists, as described below:

a. A certified psychologist who holds a current certificate for the practice of psychology issued by the Arizona State Board of Psychologist Examiners and who has the necessary skills to provide diagnosis and treatment of mental or emotional disorders; or

b. A noncertified associate psychologist who has as a minimum a master's degree in psychology, clinical psychology, counseling psychology, or educational psychology from an approved psychology training program at an accredited college or university, and the necessary skills to provide diagnosis and treatment of mental or emotional disorders, and is professionally supervised by a certified psychologist and who assumes professional responsibility and accountability for the psychological services of his staff. The supervising psychologist shall review the referral information to assist in the selection of appropriate diagnostic or treatment methods, be available for case consultation during evaluation or treatment sessions, participate in data interpretation and report development and review and co-sign evaluation or treatment reports.

3. Standards for providers of training or education:

a. Private business, vocational or technical schools. Those schools that are licensed in accordance with A.R.S. § 15-931 and provide printed curricula and fees.

b. Tutors. VR counselors shall use tutors, for fee, only when such individuals have demonstrated competence and/or training in the area of service being purchased.

c. OJT. On-the-job training shall be purchased in accordance with the instructions in R6-4-206(C)(8) through (14).

d. Orientation and mobility specialist. Bachelor's or master's degree in orientation and mobility. AAWB provisional or permanent orientation and mobility certification within six months of employment.

e. Rehabilitation teacher. One year of experience in rehabilitation teaching or related instruction of the handicapped or a master's degree in rehabilitation teaching, special education or related. AAWB provisional or permanent rehabilitation teaching certification within six months of employment. In the case of services to children, a special education certificate in the area of visually handicapped and/or deaf/blind or a special education certificate and a minimum of one year's experience.

f. Rehabilitation facilities. By 1980, all facilities utilized by VR shall be accredited, or in the process of applying for accreditation, by CARF, NAC, or other recognized accrediting bodies.

4. Interpreters for the deaf must be certifiable by the Registry of Interpreters for the Deaf whenever possible.

B. Service standards and service descriptions.

1. Medical.

a. Medical consultation may be provided only by a person currently licensed by the state as "physician."

b. The provider of restoration services shall:

i. Submit a report outlining the problem, what restoration services are necessary and timeframes in which such will be accomplished.

ii. Submit a written report to justify any services that may be required beyond 90 days.

iii. Advise counselor of all extra procedures required but not included in the original authorization.

iv. Advise counselor of costs and all changes in costs.

v. Provide billings promptly.

c. Ancillary services. All medical and related health services must be prescribed by, or under the formal supervision of, persons licensed to prescribe or supervise the provision of such services in the state.

i. Physical therapy shall provide information regarding range of motion, strength, coordination and physical tolerance. It can also recommend whether an existing orthopedic condition is stable and make recommendations for further treatment. The knowledge gained can be expressed in functional terms which is directly related to the client's vocational planning. The therapy aspect is designed to assist the individual in reaching his maximum functional level through various treatment modalities such as hydrotherapy, electrotherapy and coordinated exercises.

ii. Occupational therapy shall involve a determination of the client's level of independent living skills relating to self-care activities, homemaking activities, and ability to utilize transportation. Additionally, evaluation of upper-extremity function and perceptual skills are included. The OT evaluation also determines the suitability of the client's home in terms of architectural features and determine the need for modifications, if appropriate, as well as the need for special equipment such as splints, upper-extremity prosthesis and assistive devices.

iii. Rehabilitation nursing shall provide screening to detect possible health problems, identifies possible accident-prone clients, detects poor hygiene, possible substance abuse, behavioral and attitudinal factors and need for additional medical evaluations. The evaluation identifies the vocational significance of these factors and also indicates the manner in which the presence of certain factors might affect the evaluative findings of other services of the facility. The therapeutic aspect of Rehabilitation Nursing is expressed by its role of consultant to other members of the rehabilitation team.

d. Speech therapy shall identify disorders of voice, articulation, language or fluency along with the vocational significance of various disorders. Treatment consists of individual and group therapy to correct the diagnosed disorder.

e. Audiological services shall be utilized to determine the existence of hearing difficulties and to develop a plan to manage the deficiencies. The evaluation determines the nature of the hearing loss and its vocational significance. The treatment program might include auditory training, lip reading and counseling regarding the use of a hearing aid.

f. Interpreter services shall involve the provision of an interpreter who is certifiable by the Registry of Interpreters for the Deaf to assist the deaf person in communication with hearing people. Interpreting services are necessary if the deaf individual is to have access to, and benefit from, those services and resources available to clients in the rehabilitation process. Specifically, the interpreter must be capable of interpreting speech for the deaf individual and reverse interpreting; i.e., manual communication into speech at the level and speed at which the deaf person communicates.

2. Psychological services.

a. Psychological evaluation for the VR program requires the administration, scoring and interpretation of psychological tests which measure intelligence, personality, achievement, aptitudes, interests and other clinically significant psychological attributes of clients. The psychologist must provide reports of findings to VR counselors, including diagnosis of mental or emotional disorders, if present, and recommendations for appropriate counseling, treatment or training strategies which may render the individual more employable.

b. Consultation shall be related to the psychological aspects of individual cases so as to establish whether a psychological disability is adequately documented by the available evidence; to provide certification of severely disabled status; to assess all psychologically related needs of an individual in a VR program; to recommend appropriate restorative services. All case records reviewed will be annotated and reviews will be coordinated with medical consultants, where appropriate. Consultation can only be provided by a certified psychologist.

c. Mental restoration services. The provider of mental restoration services shall:

i. Submit a report outlining the problem, proposed services and therapy goals and timeframes in which such will be accomplished.

ii. Submit regular progress reports to the VR counselor.

iii. Advise counselor of all changes in therapy goals or changes in timeframes.

iv. Advise counselor of costs and all changes in costs.

v. Provide billings for services performed promptly.

3. Vocational evaluation shall be a comprehensive process that systematically utilizes real or simulated work as a means of determining an individual's present work ability and predicting his work potential. The process is based upon a review and consideration of all data relating to the client, including medical, psychological, social, vocational, cultural, education and economic as well as objective data obtained by assessment of the client. The process will include as appropriate for the client, paper and pencil tests, work samples, situational assessment on job stations and on the job tryout. The evaluation will generate a report to the referring VR or SRBVI counselor which will provide the counselor with an understanding of the client's capabilities and limitations as they relate to work, will provide a basis for vocational exploration and will enable the counselor to identify vocational goals which are suitable to the client's interests, aptitudes, and physical and mental capabilities.

4. Training services.

a. Work adjustment services shall be provided by rehabilitation facilities or sheltered workshops who have the resources, knowledge and accountability to provide this service. Work adjustment is a treatment/training process utilizing individual and/or group work or work-related activities. The goal of work adjustment is to assist clients in understanding the meaning, value and demands of work; to modify or develop positive attitudes toward work; to develop appropriate personal characteristics and behavior; and to develop the functional capacities necessary to reach an optimum level of vocational development. The facility will:

i. Have prior authorization to provide services from the VR counselor;

ii. Notify counselor of any changes in goals or timeframes;

iii. Provide monthly progress reports including objective data relative to client movement towards the goals;

iv. Provide billing promptly;

5. Pre-vocational adjustment shall be a work adjustment process especially designed to meet the needs of a specific target population; namely, physically or mentally disabled persons who have no known skills and who have never been employed. It is a process which is normally provided by a sheltered workshop and the goal is generally that of assisting the client to adjust to the workshop setting. Pre-vocational adjustment differs from work adjustment in that it focuses on habilitation rather than rehabilitation. Essentially, the same techniques will be utilized with modification as necessary to meet the special needs of the target group. The program must demonstrate objective client progress in development of behavior appropriate to a work setting and positive attitudes toward work. Facility responsibilities are the same as under work adjustment.

6. Personal adjustment.

a. Personal and social adjustment as provided in a rehabilitation facility shall be a formalized training process designed to assist clients in resolving problems which may not be directly work related but which, nevertheless, must be resolved if the individual is to reach his optimum level vocationally or if he is to remain in employment over an extended period of time. Included are problems which, if not resolved, will eventually carry over into employment settings and result in marginal performance, excessive tardiness, absenteeism, or possibly termination. The program must demonstrate client progress in terms of greater independence and more effective functioning in a work setting as well as in all areas of the client's life.

b. Other personal adjustment services. Personal adjustment may also include services which provide skills or techniques for the specific purpose of enabling the individual to compensate for the loss of a member of the body or the loss of a sensory function. Included may be the following: training in the use of artificial limbs, aids or appliances; remedial training; literacy training; lip reading; braille; orientation and mobility training and rehabilitation teaching.

c. Rehabilitation teaching. Rehabilitation teaching provides instruction and training in learning adaptive skills necessary because of visual problems and/or blindness. These skills include communications skills (such as braille, typing, handwriting); home management skills (such as food preparation and nutrition, adaptive sewing techniques, marketing and budgeting); personal management skills (such as clothing care and organization, laundering, identification and labeling, grooming and hygiene); adaptive recreational skills, adaptive home mechanics and use of tools; and basic orientation skills within the home to enable a person to be mobile in his home environment and the necessary case management.

d. Orientation and mobility. Orientation and mobility provides instruction in cane training to blind and visually impaired persons in learning how to travel from one part of their environment to another in a safe, efficient, graceful and independent manner. These services may include orientation to the physical environment, instruction in independent travel techniques and/or lessons in the use of the low vision aids.

e. Whether these services are provided by a facility or individuals, appropriate provider standards apply. The reporting responsibilities are the same as those stated under the paragraph dealing with work adjustment. Rehabilitation teaching, orientation and mobility services are described below.

7. OJT.

a. When an OJT establishes an employer/employee relationship, all applicable wage and hour laws shall apply.

b. The employer must be willing to provide such a service under contract.

c. Employer must be willing to observe all wage laws as they pertain; e.g., minimum wage, exceptions to minimum wage, etc.

d. Must state precisely what training will be provided and how such will be accomplished.

e. Employer must agree on timeframes and must be willing to accept payment for training as agreed in the contract.

f. Must report monthly on client's progress and submit billings on a monthly basis.

C. Authorizations for services purchased from vendors.

1. Contracts. Contracts for services may be negotiated between the counselor and vendor.

a. They should contain the following elements:

i. Identify the parties involved;

ii. The specific services being authorized;

iii. Beginning and ending dates;

iv. The manner in which services will be provided;

v. Any required ancillary services; e.g., tools and supplies, registration fees, etc.

vi. The provider of the service;

vii. Goal of service being provided;

viii. Costs involved broken down in units of a month or less;

ix. Signatures of VR counselor and vendor.

b. Contracts must be written for all training services (including OJT's).

c. Contracts are to be written and signed before services are authorized.

d. If client or other sources are being used to pay for part of the training, this must be so stated on the contract.

2. A written authorization of services shall be made simultaneously with or prior to the purchase of services and such authorization will be retained. A VR counselor who is permitted to make an oral authorization in an emergency shall promptly document such an authorization in the client's case record and confirm it in writing to the provider of the service.

D. Fee schedules. Fees shall be based on:

1. The 1969 Relative Value Studies (unrevised) of the California Medical Association for medicine, surgery, radiology and pathology with the conversion factors set by Rehabilitation Services Bureau and available through state or local VR offices.

2. ASA Relative Value Guide of 1974 with the conversion factors set by Rehabilitation Services Bureau and available through state or local VR offices.

3. General medical examination to include a routine (chemical) urinalysis according to established fee schedule.

4. Dental fee schedule is developed by Rehabilitation Services Bureau and available through state or local offices.

5. Fee schedule for eye services is developed by Rehabilitation Services Bureau and available through state or local offices.

6. Psychological evaluation fee structure. Three levels of psychological evaluation have been established and for each level there is a fee range in recognition of differences in usual and customary fees for similar services among psychologists in various areas of the state. The psychologist and the local VR counselor may wish to agree to a set fee, within the fee range, for each level of evaluation to avoid having to negotiate the fee for evaluating each client; even so, flexibility should be allowed so that the fee for a particular level of evaluation may be adjusted higher or lower, within the fee range, depending upon the complexity of a particular case. Fee ranges have been set by Rehabilitation Services Bureau and are available through the state office or local VR office. Levels of psychological evaluation and reporting. (If, in the psychologist's judgment, a lower level evaluation than requested will provide the requested information, the psychologist shall render the lower level evaluation without the VR counselor's approval and adjust the billing; however, if a higher level evaluation than requested will be necessary to adequately answer the referral questions, such evaluation must first be authorized by the VR counselor (a telephone call and a brief case discussion may accomplish this). If a VR counselor is in doubt as to which level of evaluation to obtain, advice may be sought from the VR supervisor and, where available, the VR psychological consultant.

a. Minimal evaluation. Appropriate for individuals with a known history of mental or emotional impairment and prior psychological evaluation where an updating of the previous psychological information is desired (the psychologist's report will compare prior and current findings); also appropriate for individuals for whom only minimal information is needed.

b. Moderate evaluation. Appropriate for most individuals with no prior psychological evaluation or where prior evaluations are no longer applicable, and where more than a minimal evaluation is needed; the psychologist's report will provide a fairly detailed picture of the individual's assets and liabilities in response to the referral questions.

c. Comprehensive evaluation. Appropriate for individuals requiring a very extensive or specialized psychological evaluation to answer the referral questions, whether or not prior evaluations have been rendered; the psychologist's report will provide a very extensive description of the individual's assets and liabilities.

7. Mental restoration services. (Appointments missed without prior notification will be reimbursed at 1/2 the agreed-upon fee; however, no reimbursement will be provided for a missed appointment if, before such appointment, the psychologist and individual jointly reschedule the appointment.)

a. Individual or family therapy. The VR counselor and the psychologist will agree to a reasonable fee based on the psychologist's usual and customary fees, area of treatment specialization and length of treatment session.

b. Group therapy. The VR counselor and the psychologist will agree to a reasonable fee based on the psychologist's usual and customary fees, area of treatment specialization and length of treatment session.

E. Purchase of equipment. All equipment purchases shall be made in conformance with A.R.S. § 41-730 and rules, regulations and policies established and published under its authority.

F. Inventory of equipment. All equipment purchased shall be inventoried in accordance with policies established by state Department of Administration and the Department in conformance with A.R.S. § 41-729 and rules, regulations and policies established and published under this authority.

G. Workmen's Compensation coverage for client's shall be provided in conformance to A.R.S. § 23-901 et seq.

Notes

Ariz. Admin. Code § R6-4-402

Adopted effective June 14, 1977 (Supp. 77-3). Renumbered from R6-4-302 effective May 7, 1990 (Supp. 90-2).