32 Miss. Code. R. 22-3.13 - OUT-OF-STATE SERVICES

It is the policy of the Agency to secure all necessary rehabilitation services within the state when they are available and appropriate.

The following are exceptions to the purchase/provision of in-state rehabilitation services:

* When the counselor and client determine that the in-state service is not adequate or poses an undue hardship on the client, service out-of-state may be considered. The counselor will document the case file as to the reason(s) the determination to use an out-of-state service provider/vendor is being considered. The District Manager MUST review cases in this category;

* When the necessary vocational rehabilitation service is not available within the state, and an out-of-state vendor is recommended to provide the service, the counselor MUST staff the case with the District Manager and the appropriate VR state office staff person responsible for the service area (i.e.; Post-secondary Education, Assistive Technology, etc.) to obtain additional recommendations/guidance;

* When a physical restoration service is recommended to be provided by an out-of-state vendor because it is not available within the state, the counselor MUST obtain, in writing, the recommendations of the local District Medical Consultant and the appropriate State Consultant (e.g., State Dental Consultant, State Medical Consultant, and State Ophthalmological Consultant). After receiving the appropriate State Consultant's recommendations, the counselor MUST staff the case with the District Manager before planning the service or issuing an authorization for the recommended out-of-state service.

If a decision is made to use an out-of-state service for any of the above reasons, the counselor will need to contact the out-of-state vendor to determine if the vendor will consider/accept:

* The Mississippi VR Fee Schedule or;

* If the Mississippi fee is not acceptable, the fee schedule of the VR Agency of the state in which the service is being obtained.

NOTE: Only after the above two options have been discussed and are not acceptable by the vendor, will the usual and customary fee being charged by the out-of-state vendor be considered. The counselor should obtain in writing the vendor's fees and the case file should document the vendor and person contacted (telephone number, etc.) with whom the service/fee arrangements are finalized. The counselor will staff this information with the District Manager prior to planning the service or issuing an authorization for the recommended out-of-state service.

When the client chooses/prefers (Informed Choice) to go out-of-state for a recommended rehabilitation service which is available in-state and would meet the individual's rehabilitation needs, the Agency is not responsible for the cost in excess of the cost of the in-state service. The counselor should analyze the extensiveness of the rehabilitation case (i.e.; the cost of professional fees, hospitalization, lodging, transportation, tuition, vocational training, etc.). Should it be determined that the service is available within the state and it is more cost effective for the service to be rendered within the state, the Agency can only authorize the amount which would normally be authorized for the service in-state based on the VR fee schedule. This should be thoroughly explained to the client, the client's family or representative, and the out-of-state vendor as appropriate.

When it appears the client prefers an out-of-state vendor this Out-of-State Services Policy should be explained in detail as early in the rehabilitation process as possible to avoid undue, unforeseen conflicts or hardships among the involved parties. It is the intent of the Agency to provide all services on a timely basis and in a cost-effective manner.

Notes

32 Miss. Code. R. 22-3.13