6A-25.013. Physical and Mental Restoration Services

(1) Medical, psychological, or dental consultation shall be required prior to treatment for extraordinary or experimental procedures. Consultants may assist the division in:

(a) Interpreting medical, dental, or psychological reports;

(b) Determining the need for further diagnostics or for confirming the suitability of restoration services as recommended by a qualified physician, dentist, or psychologist;

(c) Determining whether a physical or mental condition is chronic and stable or slowly progressive;

(d) Determining the implication of the applicant's physical or mental condition for rehabilitation potential;

(e) Determining the appropriate fees for medical, dental or psychological procedures;

(f) Determining the best option for various medical procedures;

(g) Determining the most appropriate hospital and the most cost-efficient fee.

(2) In order to avoid even the appearance of a conflict of interest, consultation shall not occur with the actual provider of either a diagnostic or a treatment service unless no other provider is available.

(3) Dental services. Dental services may be provided to an individual if the individual’s dental condition is a substantial impediment to employment; is slowly progressive; is contributing significantly to the complication of another physical condition; and that condition constitutes a substantial vocational impediment.

(a) The use of a dental condition as a primary disability is not prohibited but would be limited to the following instances:

1. When the dental condition creates toxicity and causes physical symptoms in other systems of the body. This determination must be made by an internist and treatment approved by the division’s medical consultant; or

2. When the dental condition results in a cosmetic problem that is severe enough to prevent an individual from obtaining or retaining a job in which the individual would be serving the public.

(b) Preventive dental services may be provided only as an adjunct to dental treatment. A preventive dental service in and of itself shall be prohibited.

(4) Hearing aids.

(a) The choice of hearing aids shall be based on the recommendation of a licensed audiologist and the individual’s current hearing and speech capabilities. The selected hearing aid must enable the individual to successfully complete the services in the Individualized Plan for Employment (IPE) that are needed to secure, retain or regain employment. If the individual prefers a more expensive hearing aid, the individual must pay the difference in cost between the required hearing aid and the chosen one.

(b) The purchase of a hearing aid shall be based on the manufacturers’ single unit price (MSUP) plus a division-established allowance to cover programming, fitting, dispensing, up to two (2) follow-up visits after the initial 30-day trial period, ear-mold(s), and 1-year warranty.

(5) Bariatric Surgery. The division may consider providing bariatric surgery only if an individual’s weight constitutes a substantial impediment to employment. The division may consider providing bariatric surgery to those persons for whom it is medically necessary, because their medical condition will not allow them the time to lose weight by conservative approaches (balanced eating program and therapy for one (1) year) or for whom more conservative approaches have failed to result in weight loss. The medical risks involved in the surgery and risk of surgery failure must justify the imposition of the following conditions:

(a) The individual must provide documented evidence of vocational impairments that exist at the time of request;

(b) An individual requesting bariatric surgery as an elective procedure must provide records of nutritional counseling and attempt at weight loss with a balanced diet (may be through a weight loss program or in consultation with a nutritionist or doctor) for at least one (1) year prior to the division’s considering sponsoring bariatric surgery. The division may assist with the costs of counseling and weekly fees for weight loss programs;

(c) The individual must submit to psychological evaluation and therapeutic counseling, if recommended, regarding the individual’s current psychological status, expectations about the surgery, and ability to maintain the extreme dietary discipline required after surgery;

(d) The individual must provide documentation from a doctor that the individual can safely undergo the surgery and be expected to return to employment; and,

(e) The individual must agree to work with a nutritionist after surgery for six (6) months.

Rulemaking Authority 413.22, 1001.02 FS. Law Implemented 413.24, 413.28, 413.30 FS. History–New 5-14-12.