Vocational Rehabilitation Manual Chapter 24: Physical and Mental Restoration Services
24.4 How to Purchase
(Revised 02/13)
Physical and mental restoration services are paid through the ReHabWorks system. Rules and procedures for purchasing physical restoration services can be found in the Maximum Affordable Payment Schedule (MAPS) Guidelines.
For more information, see Consumer Procurement Guide, Chapter 6: Assistive Technology Purchases.Chapter 43: Purchasing Goods and Services for Consumers.
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24.5 Informed Choice in Selection of Service Providers
The consumer's informed choice of
health professionals and
appropriate facilities
shouldmust be honored, unless the health professional/ or facility does not:
· does not have a license to practice in the State of Texas for such services,
· does not meet the agency'sDARS’ standards for providing the required services, or
· is not willing to accept reimbursement in accordance with the agency'sDARS’ Maximum Affordable Payment Schedule (MAPS).
When selecting a hospital or ambulatory surgery center (ASC) facility for consumer-related services, work with the consumer and treating physician to select an appropriate facility for the individual's needs.
The following factors should be considered when selecting a hospital or ASC facility:
· Treating physician's recommendations
· Consumer's informed choice
· Availability of comparable services and benefits (to pay for all or part of costs)
· Proximity of the facility to the consumer's home and family
· Availability of specialized services, if needed
If the consumer does not know or prefer a particular hospital, ASC facility, or service provider, the counselor must provide the consumer with a listing of providers whothat do meet the criteria listed above and allow the consumer to pick the appropriate vendor.
24.6 Hearing Aids
24.6.1 General Rules
Hearing aids [either in-the-ear (ITE) or behind-the-ear (BTE)] may be purchased for consumers, only with the recommendations of an audiologist or a licensed hearing aid fitter and dispenser.
Hearing aids may only be purchased from contracted manufacturers at their state discounted cost.
Physicians are reimbursed for examinations, hearing evaluations, and fitting and dispensing services.
Licensed certified audiologists are reimbursed for hearing evaluations and fitting and dispensing services.
Licensed fitters and dispensers are reimbursed for fitting and dispensing services.
24.6.2 To Purchase a Hearing Aid
Usually with the recommendation of a physician, the counselor refers the consumer to a licensed audiologist for a hearing evaluation. A hearing evaluation must be done by an audiologist. A hearing evaluation and a service authorization for a hearing aid evaluation must be sent to the licensed hearing aid fitter and dispenser (The hearing aid fitter and dispenser can be a separate vendor or an employee in the audiologist's office).
When the audiologist or licensed hearing aid fitter and dispenser recommend an aid, they must provide the product name/model to the counselor.
The counselor generates a service authorization in ReHabWorks to the manufacturer for the state discounted cost of hearing aids, which will include shipping and handling.
The manufacturer sends the product to the dispenser and the product invoice to the counselor.
After receiving the manufacturer's product invoice, the counselor contacts the dispenser to verify receipt of the product and then pays the manufacturer for the product.
The Audiologist or Hearing Aid Fitter and Dispenser then administers the fitting of the hearing aid or aids and provides the counselor with verification of such.
The counselor then pays the service charge of the Audiologist or Licensed Hearing Aid Fitter and Dispenser.
24.6 Eyeglasses and Contact Lenses
24.6.1 General Rules
The purchase of eyeglasses (single vision, bifocal, or trifocal) and contact lenses requires a prescription from an ophthalmologist or optometrist.
Frames must be the least expensive serviceable type available. The consumer may supplement the additional cost for frames if their cost exceeds the MAPS maximum.
Lenses may have tint and/or be impact-resistant when specified in the prescription.
You may provide glasses if needed to complete diagnostic studies.
24.6.2 Purchasing Eyeglasses and Contact Lenses
Before purchasing contact lenses, compare the cost of contact lenses with the cost of glasses, and apply best-value principles. See Chapter 43: Purchasing Goods and Services for Consumers.
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