While assessing the availability of or applying for comparable benefits, purchase services only when one or more of the following circumstances exists:

  • The consumer's progress toward achieving the rehabilitation goal identified on the Individualized Written Rehabilitation Plan (IWRP) would be interrupted or delayed without the purchased service.
  • The consumer's medical condition is likely to deteriorate, unless the service is provided more promptly at another hospital or clinic. The treating or examining physician must document the likely deterioration of a condition.
  • The physician who already has a relationship with the consumer does not have privileges to perform the service at the facility where the comparable services and benefits are available.
  • Specialty facilities are required, such as facilities for traumatic brain injury, traumatic spinal cord injury, or brain surgery.

When a consumer is eligible for comparable benefits that are not yet available at the time needed to ensure the consumer's progress toward the rehabilitation goal, purchase those services until comparable services and benefits become available.