107 CMR, § 6.06

Current through Register 1536, December 6, 2024
Section 6.06 - Physical and Mental Restoration
(1) Physical and mental restoration services means:
(a) corrective surgery or therapeutic treatment likely to correct or substantially modify a physical or mental impairment which is stable or slowly progressive within a reasonable length of time
(b) necessary in or outpatient hospitalization, clinic services and/or drugs and supplies; in connection with surgery or treatment;
(c) prosthetic and orthotic devices;
(d) eyeglasses, contact lenses, microscopic lenses, telescopic lenses, and other visual aids
(e) special services (including transplantation and dialysis), artificial kidneys, and supplies necessary for the treatment of individuals with end stage renal disease;
(f) diagnosis and treatment for mental or emotional disorders and mental health services;
(g) dentistry;
(h) nursing services;
(i) podiatry;
(j) physical or occupational therapy;
(k) speech or hearing therapy;
(l) treatment of acute or chronic medical complications and emergencies; and
(m) other medical or medically related rehabilitation services.
(2) Physical and mental restoration services can be provided only if financial participation has been determined, any comparable benefit available to meet, in whole or in part, the cost of restoration services has been explored and:
(a) An individual had an examination by an appropriate physician, psychiatrist, psychologist or other professional who meets applicable State licensure requirements, at least 90 days prior to the provision of restoration services and restoration is consistent with examination findings.
(b) The specific services are authorized in writing by the Commission prior to provision. However, in a medical emergency the Commission may first make an oral authorization to a vendor before issuing a written authorization.
(c) Restoration services shall be provided only at institutions and facilities meeting all statutory, regulatory, accreditation, licensing, certification, approval, health and safety, and related standards applicable to such institutions and facilities and by qualified personnel who meet applicable licensing requirements of the Commonwealth of Massachusetts.
(d) Fees for restoration services are determined in accordance with applicable regulations of the Commonwealth of Massachusetts.

107 CMR, § 6.06