Section 7160.5 - Limitations on Physical and Mental Restoration Services(a) In addition to the conditions specified in Section 7160: (1) Acupuncture services shall; (A) require referral for treatment by a physician licensed by the Medical Board of California or a comparable agency of another state when service is provided out of state. The referring physician shall be a specialist in the appropriate specialty area to diagnose and treat the disabling condition.(B) Only be authorized in those cases for the control of pain when, in the opinion of the referring physician, all other modalities have been tried and failed.(C) Be provided by a qualified physician, including but not limited to, an anesthesiologist, neurologist, physiatrist or orthopedist.(2) Chiropractic services shall be authorized only if:(A) The treatment has the concurrence of the examining or treating physician.(B) The treatment is utilized for the correction of a subluxation of the spine which has been demonstrated to exist by a radiologist.(3) Psychiatric therapy/psychological counseling services shall include the initial evaluation and report specified in 7160(c)(2), testing as necessary, and counseling/therapy, and shall be subject to the following restrictions: (A) Psychiatric therapy shall only be provided by physicians and surgeons licensed by the Medical Board of California who practice psychiatry.(B) Psychological counseling services shall only be provided by one of the following:1. A physician and surgeon licensed by the Medical Board of California who practices psychiatry.2. A Psychologist licensed by the Board of Psychology.3. Other professionals, as allowed within the scope of their licensure, following a special certification from the Chief Medical Consultant, as specified in Section 7295.7. Such professionals shall be licensed by the Board of Behavioral Science Examiners and may be either of the following: a. A Clinical Social Worker.b. A Marriage, Family and Child Counselor.(C) Psychological testing services shall only be provided by one of the following:1. A physician and surgeon licensed by the Medical Board of California who practices psychiatry.2. A Psychologist licensed by the Board of Psychology.3. A Vocational Psychologist, as defined in Section 7029.3.4. An Educational Psychologist, if certified in accordance with Section 7295.7.(4) Services provided by allied health professionals or independent health care professionals shall be provided within the scope of their licensure. Such services, including but not limited to, speech pathology, physical therapy, occupational therapy, or the provision of hearing aids, visual aids, and durable medical equipment and devices, when determined by the Department to be medical in nature, shall: (A) Be prescribed by a physician before authorization except when:1. Visual aids are prescribed by an Optometrist.2. Rental is necessary while the permanent equipment/device is being repaired.3. Repairs cost 20% or less of the purchase price and do not change the fit of the equipment/device to the client.(B) Meet the following applicable conditions:1. Prior to the provision of a wheelchair or a vehicle device to be used as a wheelchair, a wheelchair evaluation must be completed by a person recognized by the Department as a specialist, working under the supervision of a physician as applicable to his/her licensure.2. Physical/occupational/speech therapy shall be supervised by a physician.3. Transcutaneous nerve stimulators shall be subject to the following conditions: a. Before any purchase, a device shall be rented for a minimum of 30 days and its use must have a demonstrated therapeutic benefit in the relief of pain.b. The rental period shall not exceed three months or rental charges exceed $1,000, whichever comes first. The rental costs shall be deducted from the purchase price.(b) Dental services shall be provided after receipt of a dental plan and x-rays submitted by a dentist/orthodontist. Prior approval of the State Dental Consultant is required if the dental restoration program is in question, if service has been denied by Medi-Cal or if service includes extensive treatment such as maxillo-facial dental service, maxillo-facial prosthetics, gold or porcelain/gold crown, root canal treatment, surgical gum treatment, full or partial dentures or bridges.(c) Treatment of an intercurrent illness, which is an acute medical/dental/psychiatric condition not considered a new, permanent disability and which interrupts other planned services, shall be considered a physical and mental restoration service. Service may include, but is not limited to, office visits, medication, surgical procedure and hospitalization while the client is in the rehabilitation program. Services shall not be: (1) Subject to prior written approvals but shall be provided after consulting with and getting verbal approval from the Rehabilitation Supervisor with written approvals, as specified in Section 7160(a)(5), to follow within 15 days of the authorization for service.(2) Provided in excess of 30 days.Cal. Code Regs. Tit. 9, § 7160.5
1. New section filed 2-28-92; operative 3-30-92 (Register 92, No. 16).
2. Change without regulatory effect amending NOTE filed 5-9-2013 pursuant to section 100, title 1, California Code of Regulations (Register 2013, No. 19). Note: Authority cited: Sections 19006 and 19016, Welfare and Institutions Code. Reference: Sections 19006 and 19050, Welfare and Institutions Code; and 34 CFR Sections 361.42, 361.48 and 361.50.
1. New section filed 2-28-92; operative 3-30-92 (Register 92, No. 16).
2. Change without regulatory effect amending Note filed 5-9-2013 pursuant to section 100, title 1, California Code of Regulations (Register 2013, No. 19).