Audiological services pertain to the treatment of hearing disorders. When there is no generic resource available to the consumer (i.e. CCS, Medi-Cal, John Tracy Clinic, HMO orPPO Health Plan etc.), SCLARC may fund for a hearing evaluation. Hearing aids may or may not be covered by insurances. California Children’s Services (CCS) will cover hearing aids for individuals under age 22.
Medical/Dental Laboratory Services
In most instances, diagnostic and ongoing medical services are paid for by parents, private insurance, Medi-Cal or publicly funded health services. Essential diagnostic and/or ongoing medical/dental care related to the development disability may be purchased by SCLARC only with written denial by Medi-Cal, private insurance or health care service plan and verification that the individual or family is pursuing an administrative appeal of such denial, unless the regional center determines the denial does not merit appeal. The regional center may pay for such services; when coverage is being pursued but before a denial is made; pending a final administrative decision on the appeal, if the family has provided verification that an administrative appeal is being pursued; or until the commencement of services by the plan.
Only those services related directly to a consumer’s disability will be considered for SCLARC funding. For example, a consumer with a diagnosis of Down syndrome with respiratory or cardiac problems may be eligible for SCLARC funding for physician services due to the medical symptoms/complications associated with this condition. The same would be true of a consumer requesting dental services involving gum problems due to seizure medications. (Seizure medication can be funded by SCLARC if no other resource exists). Consumers who do not have Medi-Cal or insurance may be scheduled for a medical reevaluation with SCLARC’s physicians or if there is a need for emergency placement, entrance into a primary day program or participation in special events i.e. Special Olympics or a camp program, SCLARC’s physician can provide the necessary consultation.
Diagnostic laboratory services recommended by the center physicians, that are essential for determination of consumer’s eligibility and/or medical/dental management, may be considered for SCLARC funding when no other resources are available.
Anesthesia may be funded on dental evaluations/treatments if no other resources are available.
SCLARC provides nutritional services which include individualized consumer assessment and evaluation, education and training (parent group, staff, service providers, etc.), funding for nutritional replacements/supplements and referral and coordination of services (i.e. feeding programs, WIC Food Program, etc.).
Nutrition services may be indicated when there is delayed growth and development, obesity or underweight, anemia, inherited metabolic disorders, extended tube or liquid feedings, when the consumer ingests non-food items, has feeding difficulties, or is at high risk due to financial limitations/lack of education, questionable diet, etc.
Occupational/Physical Therapy Services
Occupational Therapy and/or Physical Therapy for children form birth through 36 months is provided by California Children’s Services (CCS) when the child meets their eligibility criteria. Infant programs often include OT/PT as part of the program design. OT and/or PT can be provided when the IFSP team, including a SCLARC physician, convenes to review all assessment data, recommends it and agrees that it is not an appropriate CCS referral. The IFSP team can approve interim services while CCS eligibility is pending or if CCS is at capacity for services, to ensure there is no delay in the initiation of services. OT/PT services are typically provided 1 time per week, with the option of 3 times per week if the IFSP team, including the professional opinion of the therapist, agrees that a higher frequency is necessary for the child to achieve their developmental outcomes.
Occupational Therapy and/or Physical Therapy for school aged children are to be provided by public schools of California Children’s Services (CCS).
Occupational Therapy and/or Physical Therapy for adults in most cases is provided by Medi-Cal or Medicare. The ID Team, which includes the SCLARC physician, may recommend an Occupational Therapy and/or Physical Therapy evaluation to address specific time-limited goals. If the ID Team recommends theses services and if there is no generic resource available, the regional center may purchase these services for a time-limited period.
SCLARC can purchase this service in cases where there are multiple medical problems, recent hospitalizations, ventilator dependence, oral suctioning, nasal gastric tube feeding,tracheostomy, gastrostomy, colostomy, etc. (Skilled nursing respite is time limited and based on individual consumer conditions).
A nursing assessment is required if respite services will be provided by a Registered Nurse, Licensed Vocational Nurse or Certified Home Health Aide. The nurse must document the need for these services. Nurses providing this service will be funded through a vendored Home Health Agency. The Home Health Agency will submit a Treatment Authorization Request (TAR) to the Department of Health Care Services.
SCLARC psychologists and/or behaviorists can be used for consultation to:
(1) clarify issues of differential diagnosis, (2) give referrals to mental health resources when there is suspicion of a mental disorder or severe problem behaviors, (3) determine appropriateness for DDT, (4) determine appropriateness of programs, (5) preform psychological re-evaluations when there is no current or appropriate evaluation in the consumer’s chart, and (6) perform behavioral assessments.
A vendored psychologist or SCLARC’s psychiatric consultant can complete evaluations and re-evaluations. Medi-Cal pays for evaluations and treatment (2 visits per month). Medi-Cal also pays for in-patient services.
Speech and Language
Consumers between the ages of 3 to 22 should be referred to local public school districts. Some private insurance companies will cover services depending on the family’s particular health plan and coverage. The family must investigate if speech therapy is an eligible benefit under the health plan; usually a physician’s referral is needed when trying to access services through a health plan. Medi-Cal can provide up two hours of therapy per month; a doctor’s referral will be required. Occassionally, professional training programs in speech-language pathology at the university level (Cal State system) will accept children with communication deficits in their clinical practicum programs seen by graduate students; fees may be attached and service time may be limited. Consumers without a generic resource can receive a consultation by SCLARC’s Speech-Language Pathologist to determine if a referral to a vendor is needed.
When speaking is compromised by a significant intellectual or physical handicap, the use of an augmentative/alternative/communication (AAC) system may be needed. School districts can provide these assessments for students with an IEP. Community colleges offer classes in sign language for adults. Consumers with higher intellectual capability and severe oral-motor speech difficulties may be candidates for a speech generating device. Health plans (insurances) may cover such devices if it is determined that this equipment is of medical necessity. CCS will also cover such equipment if the consumer has a qualifying condition. When no generic resource is available, SCLARC may fund the device if the need is related to an eligible condition.