Section 281.56.18. Exceptions to payment for services.

 As required by the Act and 34 CFR Section 361.50(c), the division shall have a method of allowing for exceptions to its rules regarding payment for services.

         56.18(1) Prohibitions. Pursuant to federal law, the division is subject to the following prohibitions:

            a.                The fee schedule shall not be designed in a way that effectively denies an individual a necessary service.

            b.                An absolute limit on what may be provided to an individual may not be established, whether a dollar limit on specific service categories or on the total services provided to an individual may not be established.

         56.18(2) Exception process. A request for an exception shall originate with the job candidate with assistance from qualified personnel of the division, who shall either develop a case note detailing the reason(s) why an exception is believed to be warranted or complete the appropriate form. The case note or form shall be presented to a supervisor for determination. The supervisor’s determination shall be documented by the supervisor in a separate case note or in the designated place on the form.

[ ARC 2844C , IAB 12/7/16, effective 1/11/17]