Chapter 5: Services

5.1. Overview

As a counselor, you have considerable latitude in determining those services that are reasonable and necessary to help the consumer reach his or her chosen employment goal.

You must apply and discuss with the consumer specific policies related to the implementation of services and required approvals before you add them to the IPE.

You should provide the consumer with information about services so that the consumer can make an informed choice from among the alternatives for

To the extent possible, services should be delivered in the

5.1.1 General Service Limitations

Policy encourages you to make judicious decisions. Limitations of policy cited as "ordinarily limited" apply to the typical situation. When the consumer's need exceeds these limits, document your decision-making process. See Chapter 1: Foundations, Roles, and Responsibilities, 1.2.8 Reflecting Quality Program Management in Documentation/Service Delivery Notes.

The area manager or other designated higher approval authority may grant individual exceptions to service limitations, except for those based in law or regulation, to ensure that those services necessary to achieve an employment outcome are not denied because of the limitation.

5.2 Counseling and Guidance

5.2.1 Overview

Counseling and guidance helps the consumer throughout the rehabilitation process and, in some cases, may be the only substantial service needed to achieve the employment outcome. Rehabilitation counseling is short-term and problem-centered and should not be considered "therapy." Refer the consumer who needs more intensive counseling services to an appropriate resource.

Work one-on-one to help the consumer

Whether or not listed in the IPE as a service, counseling and guidance

*Based on 34 CFR Section 361.48(c)

Essential aspects of counseling and guidance are

VR counselors are professional counselors unique to the field of vocational rehabilitation. While the goals, roles, and skills may be similar to those other counselors use, VR often poses additional challenges related to disability that must be identified so that counseling strategies can be incorporated into the counseling relationship to help the consumer. See Tips for Vocational Counseling and Guidance in the Toolbox for additional information.

5.2.2 The Frequency of Counseling and Guidance

Base the frequency and extent of counseling and guidance on such factors as

The effective use of your time in addressing the barriers identified through assessment will allow you to deliver sufficient vocational counseling to meet established goals and objectives. When the consumer appears to have severe thought disturbances or need an unusual amount of counseling, refer the consumer to another agency, such as local Texas Department of State Health Services centers, university psychology clinics, and other resources.

5.2.3 Counseling and Guidance as a Substantial Service

If counseling and guidance is the only VR service other than employment assistance, the case can meet the criteria for a successful closure only if it reflects that counseling was a substantial service (see Chapter 6: Closure). Ensuring that counseling was a substantial service may include focusing on topics that

5.3 Physical and Mental Restoration Services

5.3.1 Physical Restoration Services

Overview

The following section describes

Physical restoration includes a wide range of services provided in a variety of settings. *DRS provides physical restoration services, when necessary, to correct or substantially modify, within a reasonable time, a physical condition that is stable or slowly progressive.*

*Based on 34 CFR Sections 361.48(e) and 361.5(b)(40)

When planning any physical restoration services, you must

For additional information about the consumer’s condition and treatment and the condition’s possible impact on employment, consult the Medical Disability Guidelines.

Services Not Authorized

DRS does not authorize payment for some services because the conditions they address

Services not authorized include

Physical Restoration Services Procedures

Use the following procedures when providing physical restoration services:

  1. document how the impediments to employment are being addressed by the planned services;
  2. obtain a written recommendation for any planned services (for surgery, use DARS3110, Surgery and Treatment Recommendations);
  3. when you plan surgical services, have your local medical consultant (LMC) review the DARS3110 or treatment plan before you approve the purchase of services;
  4. when you plan certain dental procedures, have your regional dental consultant (RDC) review the treatment plan before you approve the purchase (see Chapter 1: Foundations, Roles, and Responsibilities, 1.4.3 Regional Dental Consultant (RDC) Services, for dental procedures that require review by the RDC);
  5. if you plan physical restoration services to be provided in a hospital, ambulatory surgical center, post-acute brain injury facility, or medical school, use a Medical Services Coordinator (MSC) to arrange the services. See Chapter 1: Foundations, Roles, and Responsibilities, 1.3.4 Responsibilities of the Medical Services Coordinator (MSC), which describes the MSC's functions and your responsibilities;
  6. for those services requiring the DRS medical director's approval, obtain the approval before providing them;
  7. before committing to sponsor medical services not listed in MAPS, consult with the CPCSC physical restoration specialist;
  8. if the provider requests payment that exceeds MAPS rates, obtain approval from the DRS medical director; and
  9. following the completion of services, obtain information about changes in functional limitations or work capacity from the service provider, either verbally or in writing.

    Document how the impediment to employment has changed as a result of the physical restoration service using one of the following:

    • the DARS3106, Work Restriction Checklist;
    • a case note; or
    • other written means, such as clinic notes or progress notes.

    See Tips on Using the DARS3106, Work Restriction Checklist.

    Exception: Intercurrent illness and dental treatment do not require assessment of residual functional limitations.

    If diagnostic hospitalization exceeds seven days, explain in the case notes.

Actions Contrary to a Consultant's Advice

Your decision to proceed with a physical restoration service requires documented rationale and area manager approval if it is contrary to the advice of the

Consumer Changes Physician or Hospital

If a consumer wants to change treating physicians or hospitals after admission, he or she must write a letter regarding the change to the physician or hospital. Place a copy in the case file.

Comparable Services and Benefits for Restoration Services

*Consumers requiring physical restoration services must apply for comparable services when they

You must

*Based on 34 CFR Section 361.53(c)

If comparable services and benefits are available, DRS may participate in the cost of services if the combination of DRS payment and the comparable benefit payment amount does not exceed, as appropriate, the maximum amount allowed by the

If the comparable benefit is

See Applying Comparable Benefits to Restoration Services

When you determine that the consumer is eligible, use the following and any other available benefits before expending DRS funds (see Chapter 4: Assessing and Planning, 4.5 Comparable Services and Benefits, for additional details):

Exceptions to Using Comparable Services and Benefits for Restoration Services

For exceptions to using comparable services and benefits, see Chapter 4: Assessing and Planning, 4.5.2 Exceptions to Using Comparable Services and Benefits.

5.3.2 Professional Medical Services

Medical treatment may include the services of

Payment to Medical Professionals

The following conditions apply to payment for professional medical services:

Treatment of Medical Complications

*A medical complication, either acute or chronic, that results from the physical restoration services or is inherent in the condition under treatment is considered a part of the physical restoration service.*

*Based on 34 CFR Section 361.5(b)(40)(xiv)

When severe complications arise and the consumer is no longer eligible for VR services, actively try to refer the consumer to other resources. Terminate services after arrangements have been made with the

Postoperative Care

Plan for postoperative care when you arrange for surgery. Postoperative care in the hospital ordinarily is included in the surgery fee. When postoperative care occurs after the consumer is discharged from the hospital and is not included in the surgery fee, you may authorize an additional payment.

Some types of surgery require the services of other physicians (for example, cardiologist, internist). Fees for these services are not part of the surgery fee. Plan to pay for these costs over and above the surgical fee.

Unanticipated Charges

*DRS pays for unanticipated professional services ordered during the physical restoration process. The attending physician usually orders these services "on-the-spot." Prior authorization could jeopardize the timely provision of needed services. Typical unanticipated services include, for example,

*Based on 34 CFR Section 361.50(a)

5.3.3 Hospital and Ambulatory Surgery Center (ASC) Services

Both hospitals and ambulatory surgical centers (ASC) provide medical services; however, procedures performed in an ASC do not require an overnight stay and are usually less complicated than those requiring hospitalization. This section covers such considerations for medical services as

Hospital Contracts

Hospital contracts define the business relationship between DARS and those hospitals from which DARS purchases consumer services. The contract specifies allowable payment methods for all services purchased from the hospital, which may include

Consumer Procurement and Client Services Contracting (CPCSC) maintains DARS hospital contracts. If a consumer needs a medical service at a hospital that does not have a DARS contract, the assigned medical service coordinator (MSC) must contact the regional consumer contract specialist (RCCS) to negotiate a payment rate for the medical service. A DARS3423, Exception to Contracted Hospital Purchase must be completed and submitted through the regional director for final approval by the director of Consumer Procurement and Client Services Contracting (CPCSC). If you need to purchase medical services from a hospital that does not currently have a contract with DARS, see Chapter 7: Purchasing, 7.5.8 Exceptions to Contracts.

Selecting the Appropriate Facility

The consumer's treating physician can provide guidance to help you decide whether a hospital or ASC will best meet your consumer's needs. In either case, consider the

If hospitalization is necessary, use a hospital with which DARS has a contract. When selecting a hospital, you and the consumer should consider

Payment

Hospitals must have a written contract with DARS in order to receive payment. Payment may not exceed the hospital's current payment rate under the contract. Consult the hospital contract comments in the electronic case management system to obtain the hospital's current payment rate. Obtain a copy of the operative report or discharge summary before authorizing payment.

Use MAPS codes to pay for services provided at ASCs. The MAPS codes for paying a physician and for paying an ASC facility are identical except that the code for an ASC facility is preceded by "ASC." Refer to Procedure for Purchasing Services from Ambulatory Surgical Centers and ASC Fees for further information. Obtain a copy of the operative report or discharge summary before authorizing payment.

Exceptions to the Payment Rate Limits

Hospital contracts allow payments by comparable benefits in lieu of the contracted rate when the consumer's circumstances warrant. (See 5.3.1 Physical Restoration Services/Comparable Services and Benefits for Restoration Services for the correct payment procedures when using specific comparable benefits).

A special agreement with the hospital may be executed under the terms of the hospital contract. Before providing services by special agreement, complete DARS3422, Reduced Payment Agreement. The DARS3422 must be signed by authorized hospital representatives and DARS, and placed in the consumer's case file. See Circumstances Resulting in Reduced Payment Agreements for examples.

Limits on the Duration of Hospitalization

If the treating physician expects the recommended hospitalization to exceed 30 days, you must assess the case and staff it with the

When the consumer requires hospitalization beyond what DARS originally agreed to and DARS payment will not continue, you must make other arrangements to pay for the excess hospitalization. Give written notification to

Other Services

Blood

If a consumer needs blood, arrange for replacement, if the physician has not done so. Purchase blood when replacement is impossible.

Personal Items

DARS does not pay for personal items such as

Private Room

DARS does not pay for a private room unless

Social Work Charges

DARS pays for hospital charges for social work services at the hospital contract rate when they are prescribed by attending physicians.

5.3.4 Physical Restoration Services or Procedures with Special Requirements

*Listed below are physical restoration services or procedures that have special requirements. You must review these requirements before including any of them in the consumer's plan.*

*Based on 34 CFR Section 361.50(a)

Adaptive or Assistive Technology

You may purchase an assistive or adaptive device when it is required to address your consumer's vocational need. Be aware, however, that many assistive and adaptive products on the market today do not meet DRS's best-value purchasing criteria (see Chapter 7: Purchasing, 7.6.3 Best-Value Approach to Purchasing).

For example, technologically advanced products not shown to be safe and effective by independent clinical evidence do not meet best-value criteria and should not be purchased. See Goods and Services Not to Be Purchased at This Time in the Counselors' Toolbox for a list of some commonly requested devices.

If you are uncertain about whether a product meets DRS best-value criteria, contact the CPCSC physical restoration specialist or the program specialist for physical disabilities for guidance.

Back Surgery and Steroid Injections

The area manager must review and approve all back surgery and steroid injections for the treatment of back conditions.

If the back disorder was caused by an on-the-job injury, determine whether workers' compensation insurance medical benefits are available as a comparable benefit. If necessary, contact the Texas Department of Insurance, Division of Workers' Compensation or workers' compensation insurance carrier to determine the current status of the consumer's coverage.

DRS does not provide surgery for consumers who have no radiographic evidence of a back disorder.

Back surgery for herniated nucleus pulposus requires a documented first attempt at conservative treatment.

The LMC must review any recommendation for electrical bone stimulation following back surgery before this service is provided.

Breast Implant Removal

The DRS medical director must approve sponsorship of breast implant removal (to request medical director approval, see Chapter 11: Technical Information and References, 11.1 Required Approvals and/or Consultations).

Cardiac Catheterization or Angiography

You may authorize cardiac catheterization or angiography before IPE development if necessary to assess employment goals and the services needed to attain employment.

Chiropractic Treatment

Purchase chiropractic manipulation of the spine from chiropractors after a board-certified physician specializing in musculoskeletal or neuromuscular medicine recommends this treatment in writing. The recommendation must include the number of treatments.

Authorize only the number of outpatient treatments recommended by the referring specialist. After all treatments are completed, the specialist must reevaluate the consumer before authorizing any additional treatments.

DRS pays for a maximum of 10 outpatient visits for chiropractic manipulation during the life of the case. The DRS medical director must approve treatments beyond this maximum (to request medical director approval, see Chapter 11: Technical Information and References, 11.1 Required Approvals and/or Consultations).

MAPS rates apply to chiropractic services. You may authorize and purchase only the following services:

Chiropractors may also perform functional capacity assessments. See Functional Capacity Assessment (FCA).

Cochlear Implant

All services related to cochlear and hearing-aid implants are performed by

Document how the following criteria are met before providing a cochlear implant:

The DRS State Coordinator for Deaf and Hard of Hearing Services must approve the cochlear implant surgery in advance.

The courtesy case includes

Comprehensive Medical Treatment for Spinal Cord Injury

One of the principal VR services provided to consumers with spinal cord injury is comprehensive medical treatment in an inpatient rehabilitation center. Ordinarily, this service is

For acute complications of spinal cord injury, such as substantial decubitus ulcers, severe urinary tract infections, severe respiratory conditions, or similar severe medical complications,

Dental Treatment

Dental treatment may be provided as

Area manager approval is required.

An RDC's review is required when planning specific dental procedures. For a list of these procedures, see Chapter 1: Foundations, Roles, and Responsibilities, 1.4.3 Regional Dental Consultant (RDC) Services. The DRS medical director's approval is required for dental implants.

Diabetes Insulin Pumps

DRS does not purchase insulin pumps for the medical management of diabetes.

Discograms

(Added 02/12)

DRS does not usually pay for a discogram because the test has been found to be of limited diagnostic value. The medical director approves discograms on a case-by-case basis. You must get a written justification for a discogram from the treating physician before submitting the case to the medical director for review and approval.

Electrical Bone Stimulators (EBS)

An LMC must review all EBS therapy.

If prescribed for cases of non union fractures, confirm that it has been six months since the initial fracture before authorizing service.

Eyeglasses and Contact Lenses

The purchase of single vision, bifocal, and trifocal glasses and contact lenses requires a prescription from an ophthalmologist or optometrist.

Frames must be the least expensive serviceable type available. The consumer may supplement the additional cost for frames if their cost exceeds the MAPS maximum.

Lenses may have tint and/or be impact-resistant when specified in the prescription.

You may provide glasses if needed to complete diagnostic studies.

Before purchasing contact lenses,

Functional Capacity Assessment (FCA)

A functional capacity assessment is a comprehensive series of physical tests to determine a person's ability to perform functional tasks, such as walking, lifting, or stooping.

In most cases, an FCA is not required to determine the presence of an impairment and eligibility for services. An FCA may be necessary at the completion of a physical restoration service to objectively determine a consumer’s physical capability to return to a specific job or achieve a specific employment goal.

For DRS to sponsor an FCA, the consumer must

A licensed physical or occupational therapist or chiropractor must directly supervise the assessment. The assessment must include

The professional completing the assessment must report the results of the FCA to the treating physician or evaluating specialist and the DRS counselor. If needed, consult with the treating physician for interpretation of the report and to determine the consumer’s safe work capacity and work restrictions.

Functional Electrical Stimulation (FES) Devices

DRS purchases functional electrical stimulation (FES) devices, such as the Bioness L300, Bioness H200, or the WalkAide, only for consumers with spinal cord injuries who meet specific clinical criteria and with approval from the medical director.

To purchase an FES device for a VR, ILS, or CRS consumer with spinal cord injury:

  1. consult with the program specialist for physical disabilities about the clinical criteria; and
  2. submit a courtesy case to the physical restoration specialist for the medical director to approve.

For consumers who have a disability other than a spinal cord injury, an exception to this policy may be considered only for VR. To purchase an FES device in these cases, follow this procedure:

  1. consult with the program specialist for physical disabilities;
  2. conduct a job-site analysis or observe the consumer performing the task(s) necessary to complete a VR assessment, participate in planned services, or perform a job;
  3. determine if the consumer can perform the essential task(s) using a basic assistive device, such as an ankle foot orthosis (AFO) or hand splint;
  4. if the consumer needs the additional functional capability that may be provided by an FES device, submit a courtesy case to the physical restoration specialist for the medical director to approve the purchase of an FES device for a 30-day trial period; and
  5. if the consumer is able to successfully perform identified job tasks after the 30-day trial, proceed with purchase of the FES device.

Area managers may not make exceptions to any part of the Functional Electrical Stimulation (FES) Devices policy.

Gym Memberships and Home Exercise Equipment

DRS does not purchase gym memberships or home exercise equipment, including home equipment for water therapy or strengthening.

Hearing Aids

Purchase hearing aids following

When you receive a recommendation for a complete-in-canal (CIC) hearing aid, ensure that the audiologist sufficiently justifies the added benefits of a CIC aid when compared to an alternative style with the same capabilities.

For specific information on purchasing hearing aids, see Chapter 7: Purchasing, 7.4 Purchasing Medical Assistive Devices and Supplies.

Telecoil Circuitry

Because telecoil circuitry allows better hearing with other assistive listening devices, such as telephone amplifiers and FM and auditory loop systems, purchase a hearing aid with T-switch and circuitry unless an audiologist or hearing-aid provider recommends not to purchase it.

Letter of Specification for Hearing Aid

The selected provider must present a letter of specification (not bid) that includes

Service Charge

The service charge is the dispenser's usual and customary charge (not to exceed MAPS) for

DRS pays the hearing-aid manufacturer for the hearing aid(s).

Upon receipt of a postfitting evaluation report that includes a statement that the consumer is satisfied, DRS pays the hearing-aid dispenser for the services provided. DRS must receive the postfitting evaluation report within 30 days of the consumer's receipt of the hearing aid.

Earmolds and Canal Impressions

Earmolds and canal impressions may be

Binaural

Binaural aids may be purchased

Repair

Payment of labor charges for repair of a hearing aid plus shipping and handling charges must not exceed the cost of a new aid.

FM System

You may purchase an FM system directly from a manufacturer or an audiologist.

You may not pay a fitting and dispensing fee when you purchase an FM system through an audiologist. However, you may negotiate payment for the time to train the consumer to use an FM system.

Home Health or Nursing Home Care

Provide home health care or care in a nursing home if the attending physician recommends them in the following situations:

See Outpatient Services for limitations.

Providers of home health care must be licensed by the Texas Department of State Health Services.

Nursing homes must meet the provider qualifications stated in Chapter 7: Purchasing, 7.2 Health Care Professionals—Required Qualifications.

Intercurrent Illness

When a short-term illness hinders vocational rehabilitation services, provide acute medical care as necessary. This supplemental service is limited to acute illnesses such as

These illnesses usually require less than 10 days of hospitalization or visits to the doctor's office or clinic for treatment, thus not altering the vocational plan.

Medical Assistive Devices and Supplies

See Chapter 7: Purchasing, 7.4 Purchasing Medical Assistive Devices and Supplies.

Nursing Home Care

See Home Health or Nursing Home Care.

Occupational Therapy

Purchase occupational therapy (OT) when the consumer must increase coordination, strength, or range of motion.

A physician recommends, and later reviews, the provision of OT. A licensed occupational therapist provides these services.

See Outpatient Services for limitations.

Orthoses and Prostheses

Provide an orthosis or prosthesis to enhance a consumer's employability or capability to perform activities of daily living.

Use of orthoses and prostheses is frequently a life-long need. Counsel with the consumer about his or her responsibility for future repairs, modification, and/or replacement of the orthosis or prosthesis.

A physician, physician's assistant, advanced practice nurse, chiropractor, podiatrist, or dentist prescribes orthotic and prosthetic devices. Based on the prescription, the orthotist or prosthetist recommends the design of a device that best meets the consumer's needs (see Chapter 7: Purchasing, 7.4 Purchasing Medical Assistive Devices and Supplies).

See Functional Electrical Stimulation (FES) Devices for information specific to the purchase of this specialized orthotic.

Required Medical Examinations for Orthoses and Prostheses

For orthoses, a physician's examination is required before the purchase of an initial orthosis or if there is difficulty using the current orthosis. Orthoses include

For prostheses, an orthopedist's or physiatrist's examination is required before the purchase of the first prosthesis. If the consumer has difficulty using his or her current prosthesis, an orthopedist's or physiatrist's evaluation is required before planning the purchase of a second prosthesis.

All providers of orthoses and prostheses must

Purchasing Orthoses and Prostheses

Purchase the most basic orthotic or prosthetic device that allows a consumer to meet his or her vocational needs. Consider purchasing more technologically advanced devices or components only if required by the consumer's unique vocational or medical needs. See Counselor Desk Reference, Chapter 2: Amputations, 2.4 Purchasing Prostheses for guidance.

Purchase these medically prescribed items when you receive

The letter of specification reflects the physician's written prescription. It lists the basic orthosis or prosthesis to be fabricated for the consumer and each add-on component with the

With the letter of specification, the provider includes medical or vocational justification for all additions to the basic device.

If the orthosis or prosthesis is a replacement, the letter must fully describe the design and components of the current device. The letter should also

Develop a service record for a recommended orthosis or prosthesis using the letter of specification.

Payments for orthoses or prostheses may not exceed MAPS.

If DRS' cost equals or exceeds $12,500 and the letter of specification contains no unlisted MAPS codes, then a technical review of the letter or specification by the University of Texas Southwestern (UTSW) Medical Center Prosthetics-Orthotics Program is required.

If the letter of specification contains unlisted MAPS codes, then, regardless of cost, approval by the Central Office Orthotic and Prosthetic Review Committee (OPRC) is required.

Approval Procedure for Purchasing a Prosthesis Costing $12,500 or More without Unlisted MAPS Codes

If DRS' cost for the prosthesis is $12,500 or more and there are no unlisted MAPS codes, the case will be reviewed by the University of Texas Southwestern (UTSW) Medical Center Prosthetics–Orthotics Program. Follow the procedures below.

Counselor

  1. prepares a packet containing the following required information:
    • a Prosthetic Review Cover Sheet;
    • the prescription for the prosthesis;
    • the Letter of Specification for the prosthesis;
    • prosthetist notes;
    • a DARS3602, Lower Extremity Amputation Checklist or DARS3601, Upper Extremity Amputation Checklist; and
    • additional pertinent medical or vocational records;
  2. issues a purchase order (PO) for $375.00 to

    University of Texas Southwestern Medical Center (UTSW)
    Prosthetics–Orthotics Program
    3323 Harry Hines Blvd.
    Dallas, TX 75390-9091

    VID# 3-729729729-5-000

    Use Service Category: Other Rehab Tech Services

    Level 1: Vehicle Modifications, Rehabilitation Technology Services; Residential and Job Site Modifications;

    Level 2: Prosthesis Specification Review—Contract Required;

    Level 3: Prosthesis Specification Review—Contract Required;

    Level 4: Prosthesis or Orthosis Initial Specification Review; or

    Level 4: Prosthesis or Orthosis Follow-Up Specification Review;

  3. faxes the packet to the Central Office as directed by the DARS Prosthetic Review Cover Sheet; and
  4. makes note of the required review and the submitted packet in the electronic case management system.

PSPD (Program Specialist for Physical Disabilities)

  1. reviews the packet to ensure that all required information is attached;
  2. faxes the packet to UTSW; and
  3. makes note of the packet fax date to UTSW in the electronic case management system.

UTSW

  1. reviews the packet and submits the report with an invoice to the PSPD within 10 working days of receipt. UTSW may contact the counselor directly with case questions or to clarify information.

PSPD

  1. reviews the report for completeness,
  2. acknowledges receipt of the report in the electronic case management system, and
  3. forwards the report and invoice to the counselor for payment.

Counselor

  1. reviews the report with the prosthetist and negotiates an amended letter of specification if needed,
  2. justifies in a case note any variance from the recommendations in the UTSW report, and
  3. purchases the prosthesis.

If an amended letter of specification cannot be negotiated, the prosthetist may submit additional information and the counselor may request a UTSW follow-up review of the case. The additional information must be substantive and customized to the consumer. It should not be generic information or the same information provided in the original documents. Request the UTSW follow-up review using the procedure outlined above at an additional cost of $375.00. Only one follow-up review is allowed. Questions about the UTSW report should be directed to the PSPD.

Approval Procedure for Purchasing an Orthosis or Prosthesis with Unlisted MAPS Codes

If the L-code for a device or component is not listed in MAPS when the service record is generated, the OPRC must approve the purchase of the specialized device or component regardless of cost. Refer to the Counselor's Toolbox for a complete list of specialized prosthetic and orthotic devices and components requiring OPRC approval. OPRC approval for purchase of a specialized device or component does not require a technical review by UTSW. Use the following procedures to submit a case to the OPRC for approval.

Counselor

  1. prepares a packet containing the following required information:
    • an OPRC Review Cover Sheet;
    • the prescription for the prosthesis or orthosis;
    • the Letter of Specification for the prosthesis or orthosis;
    • prosthetist notes explaining the unique medical conditions or employment requirement for the item and measurements;
    • a DARS3602, Lower Extremity Amputation Checklist or DARS3601, Upper Extremity Amputation Checklist;
    • additional pertinent medical or vocational records; and
    • the counselor case note justifying the vocational or independent living need.

OPRC

  1. reviews the request to purchase the item and decides whether to approve it based on a justified medical, vocational, or independent living need of the consumer.

CPCSC (Consumer Procurement and Client Services Contracting) or PRS (Physical Restoration Specialist)

  1. enters the committee's decision in the consumer's electronic file.

Counselor

  1. contacts the CPCSC or PRS when ready to issue the purchase order.
Warranties on Orthoses and Prostheses

Provider Warranty. The provider agrees to replace, without cost to DRS, defective parts and materials within 90 days of the consumer receiving the completed orthosis or prosthesis.

Exclusions: The following are not covered by—and do not create exclusions to—the provider's warranty:

The provider honors the manufacturer warranties and pays all costs associated with warranty replacements.

Extended Warranty. The consumer pays all costs associated with extended warranties.

Repair

Repair the current orthosis or prosthesis unless the repair cost is more than 60 percent of the replacement cost.

Calculate labor charges at prevailing hourly rates for individual providers, not to exceed $50 per hour.

Training

You must arrange training in the use of above-knee prostheses to consumers who

A prosthetist may provide training in the use of a below-knee prosthesis. If the prosthetist recommends additional training, arrange for it from a qualified physical or occupational therapist.

A qualified physical or occupational therapist may provide training in the use of an upper-extremity prosthesis.

Outpatient Services

Outpatient services may include

Provide outpatient services only when prescribed by a physician, and *only if they are likely, within a reasonable period of time, to correct or modify substantially a stable or slowly progressive physical or mental impairment that constitutes a substantial impediment to employment.*

*Based on 34 CFR Section 361.5(b)(40)

If the service provider requests an extension of treatment beyond his or her initial recommendation, assess the consumer's potential for continued progress. Your assessment may involve reviewing treatment progress notes and/or contacting the physician, LMC, and/or provider. If you determine that continuing treatment is appropriate,

Pain Management

Before sponsoring a consumer in a pain management program, verify that the pain management program complies with DRS criteria outlined in 5.3.5 Specialized Physical Restoration Programs Pain Management Programs or Pain Clinics, and that the consumer meets the following criteria:

Physical Therapy

Purchase physical therapy (PT) when required to increase

A physician recommends, and later reviews, the provision of PT. A licensed physical therapist provides these services.

See Outpatient Services for limitations.

Prescription Drugs and Medical Supplies

DRS may provide prescription drugs and medical supplies, as needed, when a consumer cannot buy or obtain them from comparable sources (see Chapter 7: Purchasing, 7.4 Purchasing Medical Assistive Devices and Supplies).

When a consumer is discharged from a medical rehabilitation facility or hospital that has an in-house pharmacy, DRS may pay for a 30-day take-home supply of the prescription drugs and medical supplies provided to the consumer.

If prescription drugs and supplies are needed beyond the 30 days, arrange with a pharmacy in the consumer's home area. Buy from the least expensive available source. When specialized prescription drugs or supplies are not readily available from a local source, buy from the hospital pharmacy.

Procedures for Pregnant Consumers

(Revised 09/10)

If an eligible consumer is pregnant, ensure that she understands DRS provides only disability-related vocational services. DRS does not pay for medical services related to the pregnancy.

Planning with the consumer how she will manage child care after the baby is born will help ensure her successful participation in the VR program.

Ectopic (tubal) pregnancy may be treated as an intercurrent illness.

Severe (Morbid) Obesity Surgery

(Revised 10/08, 08/10, 09/10, 08/11)

A consumer is severely obese when his or her body mass index (BMI) is 40 or more. Severe obesity is a disability if it results in an impediment to employment. Before considering bariatric surgery as a service for a severely obese consumer, identify the consumer’s impediment to employment.

Determining If Severe Obesity Results in an Impediment to Employment

To determine if a consumer has an impediment to employment related to severe obesity, you must use the following procedure:

  1. obtain documentation from a physician that shows the consumer’s height and weight and verify that the consumer has a BMI of 40 or more;
  2. purchase a functional capacity assessment (FCA) to evaluate the consumer’s functional capabilities and accurately measure the consumer’s work capacity;
  3. if the consumer is employed, purchase a job analysis to determine the functional requirements of the consumer’s job, and review the FCA and job analysis to determine whether the consumer can perform the critical tasks of his or her job. If the consumer can perform the critical tasks of his or her job, there is no impediment to employment related to severe obesity; and
  4. if the consumer is unemployed, use the results of the FCA and determine if the consumer can meet the physical demands of the chosen realistic job goal as defined in Choices, O*NET, or an equivalent resource. If the consumer can perform the critical job tasks of the chosen realistic job goal, there is no impediment to employment related to severe obesity.

Considering Alternatives to Bariatric Surgery

If a consumer has an impediment to employment related to severe obesity, determine whether services such as workplace modifications or assistive devices would be appropriate alternatives to bariatric surgery. Also, determine if the impediment to employment would be removed if the consumer could lose 50 to 60 pounds in a 6-month weight-loss program. If so, refer to Weight-Loss Programs.

Procedure for Requesting Approval for Bariatric Surgery

If you have determined that a consumer has significant impediments to employment related to severe obesity and nonsurgical services will not remove the impediment to employment, you may request approval to provide bariatric surgery services. Submit a courtesy file to the DRS medical director that includes documentation described in the following steps:

  1. obtain from a primary care physician or internal medicine specialist clearance for bariatric surgery and documentation of medical stability of other conditions the consumer may have;
  2. arrange for an evaluation with a bariatric focus by a psychologist or psychiatrist that includes
    • the Minnesota Multiphasic Personality Inventory (MMPI) and the Millon Behavioral Health Inventory;
    • questions to the psychologist to determine the consumer’s motivation, family support, life stressors, coping ability, realistic expectations, and the presence of mental health diagnoses that may interfere with successful dietary compliance and weight loss;
    • the need for medication management or psychological counseling to treat the underlying mental health condition (for example, anxiety or depression) that may interfere with successful dietary compliance and healthy lifestyle changes;
  3. refer the consumer to an experienced bariatric surgeon for evaluation. Use a bariatric surgeon affiliated with a "Bariatric Surgery Center of Excellence" if available. Refer to "Bariatric Surgery Centers of Excellence";
  4. have the LMC review the consumer’s case;
  5. if the bariatric surgeon and the LMC determine that the consumer is an appropriate candidate for surgery, have the consumer successfully participate in at least a 3-month prebariatric surgery, multidisciplinary program. The focus of a prebariatric surgery program is to evaluate the consumer’s motivation to make healthy lifestyle changes and comply with necessary dietary restrictions. Use the bariatric surgeon’s in-house program if one is available or create a multidisciplinary program using independent providers. Refer to "Tips For Creating a Multidisciplinary Prebariatric or Weight-Loss Program with Independent Providers." You should
    • verify that the multidisciplinary program includes nutrition, weight management, exercise, and behavioral modification counseling;
    • set appropriate expectations with the consumer for participation, responsibilities, attendance, and attaining goals;
    • set appropriate consequences for noncompliance;
    • monitor consumer progress in the prebariatric program using the DARS3515, Prebariatric Surgery Program Progress Report, and
  6. following the consumer’s successful completion of a prebariatric program, send the courtesy case to the DRS medical director for consideration of final approval of bariatric surgery. (To request the medical director’s approval, see Chapter 11: Technical Information and References, 11.1 Required Approvals and/or Consultations.)

Postbariatric Surgery Case Management

Identify the medical provider responsible for monitoring the consumer’s nutritional status and weight loss after surgery. Verify that the consumer understands and accepts responsibility to comply with the postsurgical treatment plan. Monitor the consumer’s compliance with postsurgical instructions, dietary restrictions, and progress with weight loss. Refer to "The Importance of Postbariatric Surgery Monitoring."

Speech Therapy and Speech Training

Speech therapy provides treatment for disorders of

A physician recommends, and later reviews, the provision of speech therapy. A licensed speech-language pathologist provides these services.

The speech-language pathologist may also provide

A physician's recommendation and review are not required for speech training.

See Outpatient Services for limitations.

See Adaptive or Assistive Technology for information about purchasing technology to treat speech disorders.

Spinal Cord Stimulator or Dorsal Column Stimulator

The DRS medical director must approve sponsorship of a trial or permanent implantation of a spinal cord stimulator or dorsal column stimulator. To request the medical director’s approval, see Chapter 11: Technical Information and References, 11.1 Required Approvals and/or Consultation.

Weight-Loss Programs

For information on weight-loss programs, see 5.3.5 Specialized Physical Restoration Programs, Weight-Loss Programs.

Wheelchairs

The procedures for buying a wheelchair are outlined in Chapter 7: Purchasing, 7.4 Purchasing Medical Assistive Devices and Supplies.

5.3.5 Specialized Physical Restoration Programs

This section covers the following topics:

Fees for Specialized Programs

For fee negotiation, provide information on specific services to the Consumer Procurement and Client Services Contracting (CPCSC) physical restoration specialist (PRS).

Back Schools

The curriculum previously provided by a back school is now incorporated into the consumer’s individualized physical therapy or occupational therapy program. DRS no longer sponsors back schools.

Cardiac Rehabilitation Facilities

For DRS to sponsor services in a cardiac rehabilitation facility, the consumer's physician must refer the consumer to that facility.

A cardiac rehabilitation facility must meet these criteria:

Comprehensive Rehabilitation Hospital Programs

These programs provide a coordinated and integrated service package, including

Some programs also offer the following services:

These are appropriate prevocational services for many consumers with the most significant disabilities (spinal cord injuries, etc.). See Chapter 3: Eligibility, 3.8 Required Assessments and Policies for Selected Disabilities/Spinal Cord Injury, for information on providing these services before the consumer is accepted for regular VR services.

For questions on selecting the most appropriate facility, contact the Central Office program specialist for neuromuscular disabilities.

See Chapter 7: Purchasing, 7.2 Health Care Professionals—Required Qualifications, for criteria that apply to comprehensive inpatient rehabilitation facilities.

Work Hardening

Work hardening teaches proper body mechanics, combined with functional exercises and activities, to condition muscles specifically for job-related tasks.

To determine whether work hardening is appropriate for a consumer, obtain a functional capacity assessment. For DRS to sponsor work hardening, the consumer's physician must refer the consumer. The services provided in the work-hardening program must be consistent with the assessment.

The services provided in the work-hardening program are customized to the consumer and may include

The work-hardening facility staff must include a

The facility staff also may include a

DRS does not purchase home equipment because all sponsored physical therapy programs must be conducted under the supervision of a licensed physical therapist.

Pain Management Programs or Pain Clinics

To be considered for DRS sponsorship of services in a pain clinic, the consumer's physician must refer the consumer to that facility, and the consumer must meet the criteria in Chapter 3: Eligibility, 3.8 Required Assessments and Policies for Selected Disabilities/Pain, chronic.

Pain management programs or pain clinics must meet these requirements:

Post-Acute Brain Injury Rehabilitation Services

Post-acute brain injury rehabilitation services use an interdisciplinary team approach to providing cognitive rehabilitation, independent living, and vocational services. These services are appropriate primarily for persons with acquired cognitive deficits from

The goal of these services is to increase the consumer's ability to live as independently as possible and, for vocational rehabilitation consumers, to obtain and maintain employment.

You may provide these services on either a residential or nonresidential basis. A number of factors determine which is more appropriate for the consumer.

DRS individually approves providers of post-acute brain injury rehabilitation services. Services are delivered under contract.

Weight-Loss Programs

(Revised 10/10, 06/11, 04/12)

DRS sponsors comprehensive, medically managed programs to help a consumer lose weight.

A weight loss program may be considered for a consumer if the consumer has a body mass index of 30 or greater and needs to lose up to 60 pounds in a timeframe of 6 months or less. The reason for the weight loss should be

Note: While obesity is not considered a primary disability, severe (morbid) obesity, defined as a body mass index of 40 or more, is considered a primary disability.

Document the rationale for the consumers' participation in the case file. Include copies of medical and psychological reports and case notes documenting

The program in which the consumer receives treatment must meet the following criteria:

If a multidisciplinary program is not available, a program may be created using independent providers.

See the guidance piece, “Tips for Creating a Multi-Disciplinary Pre-Bariatric or Weight Loss Program with Independent Providers.”

The local medical consultant (LMC) can provide guidance and must review all weight-loss plans. The DRS medical director must approve providing the service (to request the medical director’s approval, see Chapter 11: Technical Information and References, 11.1 Required Approvals and/or Consultations).

The CPCSC physical restoration specialist coordinates the medical director's review and determines the maximum payment allowance for any services or procedures not listed in MAPS. You may purchase participation in a weight-loss program following the approval and payment determination.

Discuss with the consumer expectations for his or her program attendance, participation, and attainment of goals. Explain the consequences for non-compliance. Work closely with the physician, weight-loss program coordinator, or independent provider to ensure that the consumer is complying with the regimen and making appropriate, documented progress. Use the DARS3510, Weight-Loss Progress Report to document monthly progress. Stop sponsoring the weight-loss program if the consumer is not complying with the weight-loss program or not making substantive progress.

5.3.6 Mental Restoration Services

This section provides an overview of mental restoration services and policy on

Overview

Mental restoration services are

*Based on CFR Section 361.5 (b)(40)(i)

Purchasing Mental Restoration Services

*Mental restoration services are purchased only when comparable benefits, such as community MHMR centers or indigent care services, are not available to provide them.*

*Based on CFR Section 361.48(e)

Provider Qualifications

(Revised 03/09, 09/10)

If a licensed psychologist or psychiatrist recommends or prescribes mental restoration services, you may purchase them from

Note: Mental restoration services provided by an intern who is working under the supervision of a licensed provider are purchased at the supervising licensed provider’s payment rate.

Limits on Purchasing Services

Mental restoration services are limited to the purchase of psychotherapy and outpatient psychiatric treatment.

Sessions with qualified providers are limited to

Visits to a psychiatrist for medication monitoring only are not subject to these limitations, but are subject to limitations on outpatient treatment (see Outpatient Services).

DRS does not pay for inpatient psychiatric treatment.

No Show Payments

A "no show" is defined as a consumer who fails to appear for a scheduled appointment without giving prior notice of cancellation to the provider. When a DRS consumer is a "no show" for a scheduled appointment with a psychiatrist, social worker, licensed professional counselor, or psychologist for a service under DRS sponsorship, the provider may claim a service fee equal to 50 percent of the usual and customary fee, or the allowable MAPS fee, whichever is less. See Guidance document example of no show payment.

5.3.7 Applied Behavior Analysis

(Added 06/12)

Overview

Applied Behavior Analysis (ABA) is used to address problem behavior that is an impediment to employment. ABA is typically used with consumers who have autism spectrum disorder, or cognitive or developmental disorders. ABA includes evaluating the problem behavior, identifying the cause, and developing a treatment plan to increase desired behaviors and decrease problem behaviors. ABA is not always indicated for autism. See guidance When to Purchase ABA Services.

Appropriate Referrals for ABA

To determine whether ABA is an appropriate intervention for your consumer, consider the following:

Provider Qualifications

Purchase ABA services based on the provider’s scope of practice, as defined below:

A Board Certified Behavior Analyst (BCBA®)—Master’s level provider

A Board Certified Assistant Behavior Analyst (BCaBA®)—Bachelor’s level provider implements the intervention plan under the supervision of a BCBA-D or BCBA. A graduate student in a behavior analysis program implements the intervention plan under the supervision of a BCBA-D or BCBA.

Fees

Fees for assessment and social skills support training and behavior intervention and are as follows.

Assessment and Individual Group
BCBA-D $125 per hour $50 per hour
BCBA $75 per hour $30 per hour
BCaBA or graduate student $50 per hour $15 per hour

Description of Services

For DRS, ABA consists of two primary services:

Social Skills Support

Social skills support is for consumers who need to learn or practice social skills necessary for employment that go beyond the scope of PSAT. These consumers have social or communication deficits, but do not necessarily have problem behaviors. ABA is not always indicated for autism. See guidance When to Purchase ABA Services.

Assessment and Recommendations, with Report

The assessment should be not exceed 4 hours. A report summarizing the assessment may include

Social Skills Support Training

Social skills support training may be individual or group training, or a combination of individual and group training, as recommended by the social skills assessment and recommendations. Social skills support training may not exceed 30 hours. It is conducted in the work environment but can be initiated in a therapeutic setting and then transferred to the work environment.

The final social skills support training report must include

Behavior Intervention

Purchase behavior intervention services for consumers whose behaviors create an impediment to employment. ABA is not always indicated for autism. See guidance When to Purchase ABA Services.

Functional Behavior Assessment, with Report

The functional behavior assessment (FBA) analyzes a consumer’s behavior in a particular environment (such as the workplace) to determine what factors are causing problem behaviors. An FBA typically takes a minimum of four hours, and is limited to a maximum of eight hours.

The FBA report summarizes data collected and provides information to assist in VR planning such as

Meet with the behavior analyst and consumer to discuss the FBA results and recommendations. If the FBA recommendations can be applied in the work setting to address the consumer’s problem behaviors, intervention with the consumer may not be necessary. If intervention is necessary, arrange for a behavior intervention plan.

Behavior Intervention Plan

In the behavior intervention plan (BIP), the behavior analyst summarizes FBA findings and describes

Development of the BIP should not exceed four hours. Intervention may vary from two to ten or more hours a week, but should not exceed 30 hours.

If an intervention is not effective within the time frame recommended in the BIP, discuss with the behavior analyst whether a new FBA and BIP would be appropriate. The approval of the area manager is required for a new FBA and BIP.

Intervention

A maximum of 30 hours of intervention may be provided

The intervention is conducted in the work environment. If necessary to meet the consumer’s needs, intervention can begin in a nonwork environment but then must be transferred to the work setting.

Documentation

A written progress report, signed by the BCBA or BCBA-D is required for payment for any assessment or intervention.

During social skills support or behavior intervention, a progress report documenting the number of hours of intervention and progress toward the planned goals must be submitted at least monthly to the counselor before payment is made.

This report must contain

The progress report must be signed by the person doing the direct intervention and, if the service is being provided by a BCaBA or graduate student, by the supervising BCBA or BCBA-D.

5.3.8 Wellness Recovery Action Plan (WRAP)

Overview

The Wellness Recovery Action Plan (WRAP) program is for adults with a severe mental health disability. The program’s primary goal is to help consumers identify and learn to use wellness tools (coping strategies and resources) when they experience triggers or early warning signs that their mental health is worsening or when things are breaking down.

Definitions

Adult with severe mental illness

An adult with severe mental illness is a person who

Wellness Recovery Action Plan (WRAP)

The WRAP program is for adults who have severe mental illness and who want to learn strategies to monitor, reduce, or eliminate uncomfortable or dangerous physical symptoms, emotions, and feelings. A participant writes a comprehensive plan to help manage his or her own illness. For specific topics in the WRAP plan, see the Wellness Recovery Action Plan section descriptions.

WRAP Service Delivery

WRAP services can be delivered either individually or in a group setting. In group settings, the ratio between WRAP facilitators and consumers cannot be greater than one WRAP facilitator to eight consumers.

WRAP facilitators who work with consumers must follow the Copeland Center’s values and ethics, process, and concepts. Facilitators must use the evidence-based model recognized by the Substance Abuse and Mental Health Services Administration. Facilitators follow the WRAP Facilitator’s Training Manual and use the PowerPoint presentation slides and CD found in the training manual during presentations. The three-day WRAP curriculum may be approved in consultation with the counselor.

Consumers Best Suited for a WRAP

A consumer who can benefit most from a WRAP will learn how to use wellness tools to manage his or her disability. This is a consumer who

The consumer will learn how to use wellness tools to move forward in recovery by developing natural supports, coping skills, and self-management skills.

The consumer must be experiencing difficulties in, or lack useful life experience in, one or more of the following areas:

WRAP Outcome

The WRAP benchmark is achieved when the consumer has

The fee for successful achievement of the WRAP benchmark is $500.00. The benchmark fee can be paid only one time per consumer.

WRAP Facilitator Qualifications

A WRAP facilitator must

The prerequisites for the WRAP facilitator certification can be met by taking the Mental Health Recovery Correspondence Course. See the Copeland Center website.

5.4 Training

5.4.1 Academic and Vocational-Technical Training

Overview

The consumer can develop his or her knowledge, skills, abilities, and other key attributes through a variety of training strategies. Reasonable and necessary training services must meet identified rehabilitation needs to help the consumer prepare for, engage in, or retain employment consistent with the suitable employment goal in the IPE. A full range of training alternatives includes

Academic training is the achievement of a degree through an institution of higher education. See Consumer Factors in College Training.

Vocational and technical training may be provided through an on-the-job training agreement, apprenticeship, or through a vocational or technical school (private or community or junior college) to achieve

Training in a community rehabilitation program addresses worker readiness, adjustment, and behavior to maximize job-match alternatives.

*Vocational and other training services include personal and vocational adjustment training, books, tools, and other training materials necessary to complete the course of training. DRS will not pay for training or training services in an institution of higher education (universities, colleges, community or junior colleges, vocational schools, technical institutes, or hospital schools of nursing) unless the counselor and consumer make maximum efforts to secure grant assistance, in whole or in part, from other sources to pay for that training.*

*Based on 34 CFR Section 361.48(f)

Monitoring Training

Monitor all consumers in training to ensure progress toward vocational outcomes.

Keep a current degree plan or similar documentation from the school in the consumer's file. Obtain regular progress reports and/or grades, and maintain contact with the consumer to assess progress toward training goals.

Grades and/or progress reports must be in the case file.

For all training not sponsored by DRS, use grade reports or instructor comments to document objective feedback in the case file.

Place a copy of the appropriate certificate of completion (for example, certification, licensure, degree) in the case file.

Withdrawals or Terminations

When a consumer withdraws or is terminated from training before completing the course, pursue a refund according to the school's policy.

Authorized Services for Training

Optional Fees and Deposits

DRS does not pay optional and/or refundable fees or deposits. DRS may pay for a parking permit on a college campus if

Books and Supplies

You may purchase books and course-related consumable supplies for consumers in college and university training.

You may purchase for consumers in training those books, tools, equipment, and consumable supplies required by vocational or technical courses and not already included in tuition.

Purchase used textbooks when available.

Room and Board Services

You may provide payment for room and board for academic training when this is the best-value decision to support academic training services.

DRS pays for room and board for vocational training only when the training is not available in the consumer's local community.

Out-of-State Schools

Use an out-of-state school when the consumer has made an informed choice to obtain training from a provider located outside Texas, and one of the following applies:

When services are obtained in another state, the rates of payment are governed by the policies and procedures outlined in Chapter 4: Assessing and Planning, 4.4.3 Planning Services in the IPE/Services from Out-of-State Providers.

Other Support Services

Authorize the support services a consumer needs to successfully complete training. The services may include

If there are no published fees for the support service, community rates apply.

Tutorial Services, Fees, and Supplies

Consider providing a tutor only when the consumer has difficulty in formal academic courses or vocational or technical training courses, and use all available school resources before paying for tutorial services.

Make sure the tutor has the necessary experience or skills to teach the consumer. If the school does not assign the tutor, document the tutor's relevant experience or skills in the case record.

Tutoring Fees. DRS does not pay more than $20 an hour for tutorial services. When appropriate, negotiate for a group rate.

Tutoring Supplies. Provide tutoring supplies, as needed.

Remedial or Developmental Courses

If a consumer requires remedial or developmental courses to strengthen academic skills, consider other resources to provide this training, including

If such resources are unavailable or impractical, DRS pays for such courses for a maximum of two semesters.

Academic Training

Tuition and Fees

DRS pays the following maximums for academic training:

The above payment limitations for tuition and required fees do not apply to nondegree training programs.

Exceptions to the limitations for tuition and fees require

Payment of out-of-state tuition at Texas colleges and universities requires the regional director's approval.

Financial Aid

Consumers entering a college or university must apply for all forms of financial aid, including a Pell Grant, as soon as you and the consumer decide that training is necessary for the consumer to reach the employment outcome. Use available financial aid before spending DRS funds. Use DARS1210, Authority for Exchange of Information, or equivalent, and ensure that documentation is in the case file.

Exception: Student financial assistance that contains a pay-back requirement, such as a loan, is excluded from the financial aid requirement.

Pay for tuition and fees with funds from the Pell Grant. Often the Pell Grant is greater than the tuition and fees and the consumer should be allowed to use this overage for other educational expenses, under the terms of the grant. If the student has defaulted on a Guaranteed Student Loan, the student will be denied a Pell Grant and other forms of financial aid. Before spending DRS funds for training, the consumer must make a good-faith effort to arrange to repay the defaulted loan.

Tuition Exemption for College Students Who Are Deaf

College tuition and/or fees may be waived for people who are deaf attending any institution of higher education using public funds, if the student

People who are deaf who request academic training are

Sponsorship of Training at Gallaudet and National Technical Institute for the Deaf (NTID)

Fees and length of training may exceed the limits on college training stated in this section.

When sponsoring a consumer at Gallaudet University or NTID, contact the state coordinator for deaf and hard of hearing services at least four weeks before registration. The state coordinator is the only DRS liaison with Gallaudet and NTID.

Payment for consumer transportation is limited to two round-trip tickets by air (coach) per year, or its equivalent. Investigate and document all other available resources before committing DRS funds for this expense.

Minimum Standards for Hours and Grades

To continue receiving DRS sponsorship, the consumer is ordinarily expected to

The counselor

Encumbrance Period

Limit each encumbrance to one semester, trimester, quarter, or other school registration period. Include related services (for example, interpreter, attendant care, note takers), whether offered by the school or an outside service provider.

Vocational and Technical Training

Selecting a Nondegree Vocational or Technical Training Provider

An approved public or private vocational or technical trade school provides nondegree vocational or technical training. Consumers can earn a certificate of completion and, in some cases, a required state certification or license. Provide the training that is reasonable and necessary to reach the employment goal in the IPE.

Use only vocational and technical schools, including correspondence and Internet courses, that

Frequently, the Texas Workforce Commission (TWC) is the licensing entity.

Out-of-state schools that provide training to a consumer must hold an appropriate license in that state. See Chapter 4: Assessing and Planning, 4.4.3 Planning Services in the IPE/Services from Out-of-State Providers).

TWC may also grant exemptions from licensing under the Proprietary Schools Act. However, most of these exemptions do not apply to the training purchased by DRS. Consequently, DRS rarely accepts these exemptions (see Training by Paid Instructor).

Contact Consumer Procurement and Client Services Contracting (CPCSC)

Financial Aid for Vocational or Technical Training

Consumers entering a vocational or technical school must apply for all forms of financial aid, including a Pell Grant, when available. The consumer must apply for financial aid as soon as you and the consumer decide that training is necessary for the consumer to reach the employment outcome. Use available financial aid before using DRS funds. Use DARS1210, Authority for Exchange of Information, or equivalent, and ensure that documentation is in the case file.

Exception: Student financial assistance that contains a pay-back requirement, such as a loan, is excluded from the financial aid requirement.

Tuition and Fees

When acceptable to the school, pay for tuition on an hourly basis. Otherwise, follow the school's policies and procedures for tuition payment. Tuition payments are limited to $3,000.

When purchasing vocational or technical training from proprietary schools, document on which basis payment is made:

For vocational or technical training schools that require a single advance payment, pay at the time of enrollment.

Use the "Contract Comments" section in the electronic case management system to obtain additional information regarding

Purchase only approved programs listed in the electronic case management system under the "Proprietary School Course Catalog" link in the vendor details.

Some vocational or technical schools are approved to provide specific health-related tests that are required before the consumer can enter training or complete certification (for example, X-rays and TB tests). The "Contract Comments" section contains information about purchasing those tests from the school.

Contact Consumer Procurement and Client Services Contracting for help in purchasing

Procedures for Providing Vocational or Technical Training

Use the following procedures when providing vocational or technical training.

  1. review with the consumer the school policies and procedures about
    • admission requirements,
    • attendance,
    • payment,
    • refunds, and
    • progress reporting;
  2. purchase only individual classes listed in the school catalog as part of an approved program;
  3. in the purchase order, provide as much detail as possible about the purchase. Document additional details in a case note (for example, actual start and end dates of training, and certificate or degree program);
  4. advise the consumer that he or she is subject to both financial aid and school regulations;
  5. caution the consumer to consult with you before signing any contractual agreement with a school;
  6. encourage the school to submit a monthly report of consumer attendance, participation, and progress. The school may use DARS3407, Training Progress Report, or provide equivalent information However, do not withhold payment if you do not receive the DARS3407, or equivalent information; and
  7. certify that the
    • school's invoice accurately reflects billed charges, and
    • progress report, if received, accurately reflects the services provided.

Correspondence Course Training

Payment must not exceed $300 per course. If payment exceeds this amount, you must document justification.

For college or university correspondence courses requiring a single payment in advance, make this payment at the time of enrollment.

Unless otherwise required, do not pay total tuition in advance. However, you may pay 10 percent initially, then pay for each completed lesson.

The consumer must submit progress reports and/or grade slips for correspondence courses. Place the reports and/or slips in the case file.

Training by Paid Instructor

Arrange paid instructor training for a consumer to acquire a particular work skill from a qualified person. This training can be

Qualifications

The trainer and the course must be

*"Schools offering a course or courses of special study or instruction financed or subsidized by local, state, or federal funds or by any person, firm, association, or agency other than the student involved, on a contract basis and having a closed enrollment, may apply to the commission [TWC] for exemption of such course or courses from this chapter [Chapter 132 — Texas Education Code] and such course or courses may be declared exempt by the commission where the commission finds the course or courses to be outside the purview of this chapter."*

According to TWC regulation, all providers of vocational training that charge a fee, including individuals, are considered "schools."

You must forward any requests to use a school with the above exemption for approval through the appropriate chain of management to the assistant commissioner. This approval is granted individually, and is not a blanket approval for an unlicensed school.

Fees

Negotiate an hourly rate of pay not to exceed prevailing community rates.

On-the-Job Training (OJT)

Overview

On-the-job training (OJT) gives a consumer training at an employer's worksite. The goal is for the consumer to learn skills for permanent employment with the employer providing the OJT, or to gain skills or work experience that he or she can use to obtain employment with another employer.

The employer pays the consumer as an employee for a negotiated length of time at an entry-level wage or more. When necessary, you may use a special certificate for a special minimum-wage rate, (see Special Minimum Wage). DRS may pay a portion of the consumer’s wages. The length of the OJT depends on the skills to be learned and the consumer's learning ability.

Consumers referred for OJT must have the potential to meet the employer’s minimum qualifications through a training experience as defined by the employer.

When you and your consumer determine that OJT is appropriate, prepare the consumer before approaching employers. Ensure that the consumer is work-ready by emphasizing such areas as attendance, transportation, work rules and culture, and standards of conduct.

OJT and Transition

For students participating in the Transition program, OJT can be a tool to help the student acquire valuable work experience. Multiple OJT work experiences over a period of time can give the student a better understanding of not only the specific job, but also the demands of the work environment in general. OJT may be purchased before the IPE is developed for Transition students only.

Negotiations

After identifying an appropriate employer, negotiate the length of the training period, the skills to be taught, and the amount to be paid by DRS each month.

If the length of training is expected to be longer than 12 months, approval from the area manager is required.

DRS can pay as much as 80 percent of the consumer’s monthly wages. Area manager approval is required if the negotiated plan will require DRS to pay 80 percent for more than 6 months.

Negotiate a payment schedule that progressively decreases throughout the training period as the consumer’s skills increase. By the end of the training period, the consumer should be ready for a permanent employment opportunity.

DRS may pay for supplies consumed in the OJT that do not become a part of the employer's inventory product.

Ensure that you and the employer both understand the expectations, including the need for a monthly progress report. (See Sample Invoice/Progress Report). Document the agreement on the purchase order. (See Service Record Worksheet).

OJT is a substantial service. Time spent in OJT cannot be counted toward the 90 days of employment required for a successful closure. The start date of employment entered in the electronic case management system must be after the date of OJT completion.

Apprenticeship Training

Apprentice training is highly desirable for equipping a worker with the extensive skills needed in craft occupations such as plumbing and electrical trades.

Trade unions usually sponsor apprenticeships, often in coordination with local community colleges.

Contact the regional program specialist for information on the availability of apprenticeship training.

5.4.2 Other Training

Overview

Other training services may include instruction in

Payment for Services

Base the DRS payment amount on published or current community rates. Do not pay for these services when the consumer is

For further information, consult the regional program specialist.

GED Tests

DRS may pay the cost of GED testing.

Adult Basic Education

The Texas Education Agency or other governmental agency programs provide adult basic education with federal funds. Do not encumber DRS funds for this activity.

5.4.3 Community Rehabilitation Program (CRP) Training

Overview

CRP training is designed for consumers who need to develop the skills, attitudes, and behaviors to

Approved CRP providers contract with DRS to deliver specific CRP services. Each contract identifies which services the provider is approved to provide. While CRPs may provide other support services, CRP training services include (see Guidance for CRP Service Definitions)

Determine which services are reasonable and necessary, depending on identified rehabilitation needs, for the consumer to achieve the employment goal in the IPE.

You may provide these services in extended evaluation as a screening device to determine a consumer's employment potential. See Chapter 4: Assessing and Planning, 4.9 Developing an IPE for Extended Evaluation.

*Each provider of vocational rehabilitation services must

*Based on 34 CFR Section 361.51

Each approved CRP provider is assigned a liaison counselor as the primary communication link between DRS and the CRP. See Chapter 1: Foundations, Roles and Responsibilities, 1.3.5 Responsibilities of the Community Rehabilitation Program (CRP) Liaison Counselor.

Referral Procedures

Each CRP develops its own admission policies and procedures. When referring a consumer to a CRP for services, forward to the CRP copies of the following documents:

Each provider must keep a current consumer case record. You must also keep a copy of the referral forms in the consumer's case file.

CRP Services, Outcome, and Procedures

(Revised 9/23/09)

The CRP may not collect money from a consumer or the consumer's family for any fees for services in excess of the fees DRS pays. If DRS and another resource are paying for a service for the consumer, the total payment must not exceed the fee specified in the DRS Standards for Providers.

A full description of CRP services, including staff qualifications, fees, and required documentation, is in the DRS Standards for Providers. Individual service policies, outcomes, and unique procedures for counselors are in the following table.

Service Expected Outcome Procedures
Vocational evaluation Refer to the DRS Standards for Providers Chapter 2: Standards for Work-Oriented CRPs, 2.3 Vocational Evaluation, Final Report for the specific information required on the final report of the comprehensive evaluation or vocational assessment. Complete DARS3480, Referral for Vocational Evaluation (or the CRP's equivalent) with the reasons for referral. Specify the need for either a comprehensive evaluation or a vocational assessment and specific referral questions to be answered through evaluation.

DRS may authorize payments for "no show".

Basic Fee:

  • $235 per day for a vocational assessment, with a maximum of $1,880 (1 to 8 days of assessment)
  • $1,880 for the comprehensive evaluation (minimum of 8 days; must include trial work)

Report is due within 10 days of service completion.

Personal social adjustment training (PSAT) PSAT services for the consumer must focus on the goals established in the Individual Adjustment Plan (IAP) and help the consumer
  • develop socially acceptable behavior,
  • build or restore confidence in self and others, and
  • understand motivation and behavior in self and others.
Within the first 10 days of training, the CRP develops an IAP to address specific goals and objectives for the consumer.

You must approve the goals and objectives by signing the IAP before you begin the services on the IAP. You may fax the approved IAP to the CRP.

The CRP must document 5 hours of training per week for the consumer receiving services before you authorize payment.

Basic Fee: $17.50 per hour for up to 5 hours per calendar week

PSAT for people who are deaf In addition to the above, PSAT for people who are deaf addresses issues unique to deafness. Same IAP requirements as for PSAT above.

Basic Fee: $21.50 per hour for up to 15 hours per calendar week

Other Information: DRS payment is limited to 15 hours per calendar week, regardless of the number of hours offered.

Work adjustment training (WAT) WAT is real work, and consumers are paid for the work they do. The CRP must conduct WAT a minimum of 25 hours per week using work that produces revenue for the CRP and compensation for the consumer.

Within the first 10 days of training, the CRP develops an IAP with specific work goals and objectives. You may pay the CRP during this initial period.

You must approve the goals and objectives by signing the IAP before beginning services. You may fax the approved IAP to the CRP.

DRS sponsorship is limited to 25 hours per week.

Basic Fee: $6.75 per hour for up to 25 hours per calendar week

Vocational adjustment training (VAT) This training allows the consumer to acquire the personal and social adjustment skills necessary to participate in job search activities. See DRS Standards for Providers:

and

You may pay the service provider upon receipt of a signed narrative statement that includes the following:
  • the number of hours the consumer participated in VAT;
  • how the training has allowed the consumer to acquire the associated skills and was necessary for the consumer to participate in job-search activities.

You must verify with the consumer that these services were provided and document the verification before payment.

Basic Fee:

  • VAT, $685.25 for 20 to 40 hours of training
  • VAT for the deaf, $1,075 for 20 to 40 hours of training
Job placement The provider supplies the necessary assistance or training for the consumer to conduct the job search and/or be placed in competitive employment, and employment is maintained for 90 days.

Placement must be within an organization or business that is not owned, operated, controlled, or governed by the CRP providing the service.

Payment systems are based on the consumer's tier level. For more details on services and fees, see
Job coach services A job coach
  • trains consumers to use public transportation services or other means of transportation to help consumers access services and employment;
  • works side by side with a consumer at a job site;
  • analyzes the job and breaks tasks into manageable components;
  • identifies and solves problems before they become crises for the consumer, employer, or co-worker;
  • teaches effective job-keeping skills to the consumer;
  • uses the least intrusive methods possible on the job; and
  • gradually reduces the time spent at the job site as the consumer becomes better adjusted and more independent.
Ordinarily, Job Coach Services do not exceed 200 hours.

To report Job Coach Services, the service provider must complete DARS3458, Job Coach Service(s) Time Log, or a form containing the same information. The service provider must initial each entry, sign the form, and submit an invoice for payment.

You must verify with the consumer and document the essential elements of the time log. If you believe the consumer cannot reliably verify the provision of services, you must contact the employer or another individual who can verify that services were provided.

To overcome employer resistance to an "outsider" job coach, an employer also may be approved as a CRP and offered a contract. Contact the regional community rehabilitation program specialist for help.

Basic Fee:

  • job coaching services, negotiated up to $37.50 per hour, individual or group
  • job coaching services for the deaf, negotiated up to $55.25 per hour, individual or group
Supported employment Supported employment provides competitive employment in the community for consumers with the most significant disabilities who
  • need individualized help finding an appropriate job match, and
  • require ongoing accommodations and support in their work environment.

Unlike the traditional vocational rehabilitation model that provides job readiness and other training activities to prepare a consumer for employment, this model is more appropriate for consumers with significant disabilities.

Payment systems are based on the consumer's Tier level. For more details on services and fees, see 5.5.4 Supported Employment Services and DRS Standards for Providers Chapter 2: Standards for Work-Oriented CRPs, General Community Rehabilitation Program Fees.
Post-acute brain injury (PABI) Post-acute brain injury services are provided for consumers with residual cognitive deficits, including behavioral and communication deficits, following an acquired brain injury, to reduce or eliminate the impact of these deficits and allow the consumer to become employed. You may purchase separately other support services not included in the per diem fees, such as physical therapy, occupational therapy, and speech therapy.

Basic Fee: for per diem fees for a particular provider, see the PABI facility contract

Room, board, and supervised living (RBSL) These services include room and board, plus 24-hour supervision. Consumers are required to sign out when leaving the residence and sign in upon return.

Sponsorship in a substance abuse halfway house is limited to three months.

To be paid, the provider must submit a completed DARS3453, Work-Oriented Residential Community Rehabilitation Programs, Monthly Progress Report (or equivalent) and an invoice.

Basic Fee: up to $35 per day

Excused Absences

DRS may pay for excused consumer absences if the absence

Excused absences must be documented on DARS3453, Work-Oriented Residential Community Rehabilitation Programs, Monthly Progress Report (or equivalent).

Payment for excused absences may not exceed the following limits:

When the CRP is closed on a recognized holiday, such as New Year's Day, Independence Day, Thanksgiving, or Christmas, that falls within the dates of service, DRS may pay for that holiday.

For consumers receiving residential post-acute brain injury services, DRS may pay the CRP for up to three therapeutic passes per month. Such passes must be part of the consumer's Individualized Treatment Plan that you approve.

5.4.4 Nontraditional Providers for Job Coaching Services

(Added 06/12)

A nontraditional provider is a person who is not currently an approved CRP and who is in a position to help a particular consumer achieve the goals required for the consumer to meet the employer’s job performance expectations. A nontraditional provider may at any time submit a request to become an approved CRP.

A nontraditional Job Coach may be used when

(See "Purchasing Job Coaching Services from Non-Traditional Providers" for more information.)

Agreement with Nontraditional Provider

You must explain the following to the nontraditional provider:

If the person agrees, request that the regional CRP specialist set up the nontraditional Job Coach as a vendor. (This could take up to a week.)

The nontraditional Job Coach may work with up to three different consumers. If the provider wants to serve more than three consumers, refer him or her to DRS Standards for Providers, Chapter 1: Basic Standards, 1.3 Community Rehabilitation Programs (CRPs), Application Process for New CRPs (1-0080) to apply to become a CRP contractor. You must contact the regional CRP specialist to reactivate the nontraditional Job Coach each time you wish to use him or her. Issue the purchase order to the nontraditional Job Coach and send a copy to the regional CRP specialist in the Regional Office.

Use the following procedures each time you need to issue or change a service record (SR) or purchase order (PO) using the nontraditional provider, after provider setup is completed:

Counselor
  1. requests the regional CRP specialist’s assistance to link a provider to nontraditional Job Coach specification.
Regional CRP Specialist
  1. requests that Consumer Procurement and Client Services Contracting (CPCSC) link the provider to the nontraditional Job Coach specification; and
  2. lets the counselor know that the provider is linked.
Counselor or RST
  1. issues or changes the needed SR or PO for a specific consumer ensuring that the detailed description specification remains on the SR or PO;
  2. enters any additional information related to the job coaching services such as goals or skills to be required of the nontraditional job coach (for example: union welder required) to the end of the detailed description specification in the electronic case management system; and
  3. informs the regional CRP specialist when the SR or PO is completed.
CRP Specialist
  1. asks CPCSC to remove the specification link to the provider.

Job Coaching by Nontraditional Provider

Follow all procedures that apply to job coaching by traditional CRP providers (See 5.4.3 Community Rehabilitation Program (CRP) Training and refer to all sections related to job coaching.)

Basic Fee Schedule

The basic fee schedule for job coaching services by nontraditional Job Coach providers is $22.00 per hour, individual or group.

5.5 Employment

5.5.1 Overview

*The vocational rehabilitation program helps eligible people enter employment. An employment outcome for the VR program consists of entering or retaining full-time or, if appropriate, part-time competitive employment in the integrated labor market, including supported employment or any other type of employment in an integrated setting, such as

The employment must be consistent with the consumer's strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice.*

*Based on 34 CFR Section 361.5(b)(16)

You provide help, to the degree needed (see Consumer Profiles) to prepare the consumer for employment that reasonably matches the planned employment outcome.

In addition to reasonable and necessary services to prepare the consumer for employment, determine strategies for the consumer to engage in and retain employment. Coordinate employment assistance after the consumer agrees to these strategies. Consider the consumer's need for licensure, tools, equipment, uniforms, or ancillary services to enter and maintain employment.

Your participation depends on the consumer's needs. The strategy or combination of strategies to achieve successful outcomes also depends on the consumer's needs. Consider a full range of employment assistance strategies that may include

Choosing the strategies most consistent with the consumer's need for help results in a more productive job search and greater progress toward successful outcomes (see Employment Assistance Guide).

When the consumer is ready to begin his or her job search, either alone or with counselor or CRP assistance, mark the case "Job Ready" in the electronic case management system. This facilitates the job search by allowing staff members to target current business or new business accounts that match the consumer's interests and knowledge, skills, and abilities (KSA). Additionally, the chance to respond to job orders from a business is greatly enhanced when information about "Job Ready" consumers who may have the qualifications and interests sought by the business is readily available. Accurately and consistently marking cases as "Job Ready" allows staff members to run queries to identify businesses that have available jobs in the desired fields. It is critical to match consumers seeking jobs with businesses that are hiring for the jobs that consumers are seeking.

5.5.2 Counselor-Directed Employment Assistance

Counselor Responsibilities

As a VR counselor, you provide as much assistance as the consumer needs to attain a successful employment outcome. The amount of counselor participation in the placement process depends on the needs of the consumer, but may include

You may also help the consumer develop the skills needed to

See Counselor-Directed Placement for more information.

Employer Contacts

Employment assistance in most cases requires contact with employers. You and the consumer should agree in advance on

Ensure that appropriate releases are in place (see DARS Business Procedures Manual, Chapter 20: Confidentiality and Use of Consumer Records and Information). For example, if the consumer asks you to release the results of an HIV antibody test to an employer, obtain a written, signed release specifically authorizing DRS to do so. The release must specify the person or classification of people (for example, potential employers) to whom DRS may release the test results.

Business Relations Unit

The Business Relations Unit (BRU) does not develop jobs for consumers. Instead, the BRU initiates contact with businesses that best serve consumer employment needs, using a "Job Ready" query as a tool to match consumer vocational goals with available jobs (businesses) in the community. The BRU may initiate a business relationship with an employer, and then "hand it off" to a unit level point of contact (POC) who will sustain the relationship. The BRU helps staff members understand the needs of businesses and identify ways to fill those needs with DARS services, consumers, community contacts, etc. For more information on the functions of the BRU, see BRU Functions.

5.5.3 Job Placement as a Purchased Service

You may purchase job placement assistance from CRP providers who are under contract to provide this service, or, in certain circumstances, from nontraditional providers.

The job placement service provider supplies the necessary training and support for the consumer to search for a job and/or enter competitive employment, and maintain the employment for 90 days. There is no minimum or maximum number of hours for this training and support.

The services rendered by the provider prepare the consumer to seek employment and enter a job that is consistent with his or her

There is a reasonable expectation that the job is permanent rather than temporary.

When you authorize job placement as a purchased service, make no benchmark payments unless the consumer's job is in an organization or business that is not owned, operated, controlled, or governed by the CRP or nontraditional provider providing the service.

Referring a Consumer to a Job Placement Provider

Finding, getting, and keeping a job may require a variety of skills such as

Consumers may need different amounts of support and assistance during the job placement process. Consumers may

Before you purchase job placement services, you and the consumer should discuss and determine the consumer's support and assistance needs and complete all sections of the DARS3430, Job Placement Services—Referral. Schedule a meeting with the provider and consumer to develop the DARS3431, Job Placement Services—Plan. Provide a copy of the DARS3430 to the provider before the meeting and any other pertinent information on reports, and/or testing.

Refer to instructions for CRP job placement referrals using DARS3430, and see also an example of DARS3430, Job Placement Services Referral.

To complete the referral process, and before issuing a purchase order for services, meet with the consumer and the provider together to

At that meeting, also complete the DARS3431, Job Placement Services—Plan.

Refer to instructions for completing DARS3431, Job Placement Services—Plan, and see also an example of a completed plan.

While it is preferable for this meeting to be held in person, any method that allows all parties to actively participate in the discussion is acceptable. You should complete all sections of the DARS3431 during this meeting. It will then serve as a "blueprint" that outlines the type of position to look for, the consumer's needs, and the amount of assistance and support to be provided to achieve the consumer's employment goal.

Update the DARS3431 as needed based on follow-up meetings with the consumer and the provider, especially if the consumer identifies different or additional employment conditions and/or employment goals.

Each benchmark payment is made only once to a job placement services provider for the consumer, even if the consumer loses a job after the completion of a benchmark and continues to receive services with that same provider. If the consumer chooses a new job placement services provider, the new provider and the DARS counselor negotiate the benchmark at which the consumer begins.

Placement Tiers

(Revised 02/11)

Some consumers learn through time how to customize applications, résumés, and interviews to particular jobs. Others require repeated assistance throughout the job search, and some require additional supports to maintain the job.

Because it is more challenging to find employment and support for some consumers than others, there are two payment tiers for purchased job placement services. You determine the placement tier based on the consumer's needs. See Placement Tiers for consumer characteristics to consider in determining the correct tier. Document the rationale for your decision in case notes.

Benchmark Payments

See a diagram of the job placement services benchmarks or a text summary of the diagram of the job placement services benchmarks.

Benchmark A: Job Placement

Assistance, training, or supports provided may include

Activities related to obtaining a placement can be taught to the consumer, completed with the consumer, or done for the consumer based on the consumer's abilities.

You pay the provider (see Fee Schedule 2-0005) when the consumer

The provider submits an invoice, accompanied by the DARS3432A, Job Placement Services—Support Summary, Benchmark A, After First Day of Paid Employment, with the employment information and summary of services for Benchmark A sections completed in full. This form must be signed by the provider and consumer or consumer's legally authorized representative.

For guidance, see a diagram of the job placement services benchmarks. See also an example of DARS3432A, Job Placement Services—Support Summary, Benchmark A.

Contact the consumer or employer to verify the contents of the DARS3432A and the consumer's employment, and document this contact in the designated section of the form.

Benchmark B: Job Placement—After 45 Days of Paid Employment

(Added 04/11)

Assistance, training, or supports provided may include

Note: Providers should meet with the consumer on or off the worksite between initial placement and the 45-day benchmark to discuss and resolve any issues related to the job.

You pay the provider (see Fee Schedule 2-0005) when the consumer

The provider submits an invoice, accompanied by a DARS3432B, Job Placement Services—Support Summary, Benchmark B, After 45 Days of Paid Employment with the employment information and summary of services for Benchmark B sections completed. The form must be signed by the provider and consumer, or the consumer's legally authorized representative.

The information provided in the summary of services should describe

For guidance, see diagram of the job placement services benchmarks. See also an example of DARS3432B, Job Placement Services—Support Summary, Benchmark B.

Contact the consumer or employer to verify the contents of the DARS3432B and the consumer's employment, and document this contact in the designated section of the form.

Note: Employment is considered "cumulative" so long as any gaps are not due to the consumer's disability. If a consumer loses a job before the 45-day benchmark and the job loss is not due to the disability, the consumer's progression within the 45-day benchmark is “frozen” until he or she becomes employed again, at which time the progression towards completion of the benchmark begins again.

Any gap in employment greater than eight weeks results in a new employment period.

Benchmark C: Job Placement—After 90 Days of Paid Employment

(Added 04/11)

You pay the provider (see Fee Schedule 2-0005) when the consumer

The provider submits an invoice, accompanied by DARS3432C, Job Placement Services—Support Summary, Benchmark C, After 90 Days of Paid Employment with the employment information and summary of services for Benchmark C sections completed. The form must be signed by the provider and consumer or the consumer's legally authorized representative.

Note: Providers should meet with the consumer on or off the worksite between the 45-day and the 90-day benchmarks to discuss and resolve any issues related to the job.

All Yes and No questions at the bottom of DARS3432C, Job Placement Services—Support Summary, Benchmark C; After 90 Days of Paid Employment must be answered. If question #1 is answered No, do not pay for Benchmark C until all parties are satisfied with the consumer's performance on the job. If any other question is answered No, an explanation must be provided in the comment section below the questions.

For guidance, see a diagram of the job placement services benchmarks. See also an example of DARS3432C, Job Placement Services—Support Summary, Benchmark C.

Contact the consumer or employer to verify the contents of the DARS3432C and the consumer's employment, and document this contact in the designated section of the form.

Professional Placement Premium

(Added 04/11)

A professional position is defined as a position that requires the completion of at least a bachelor's degree. The requirement must be stated in the employee's job description or job posting.

The decision to pursue a professional position is made during the initial meeting with the consumer and the provider, and documented on the DARS3431, Job Placement Services—Plan. Include the premium payment as a separate line item when you issue the purchase order for Benchmark C.

You pay the provider (see Fee Schedule 2-0005) when the consumer is placed in a professional job that matches the employment goal (a job that requires at least a bachelor's degree) and has otherwise completed the requirements for Benchmark C.

Along with the invoice for Benchmark C, on the DARS3432C, Job Placement Services—Support Summary, Benchmark C, After 90 Days of Paid Employment, the provider describes the job that matches the occupational goal and requires at least a bachelor's degree. A copy of the job posting or job description documenting the educational requirement must be included with the invoice.

For guidance, see a diagram of the job placement services benchmarks.

Nontraditional Providers for Placement Services

A nontraditional provider is a person who is not currently an approved CRP, and who is in a position to help a particular consumer find a job. A nontraditional provider may become an approved CRP at some point.

A nontraditional provider may be used when

(See "Who would be a good candidate for a non-traditional provider" for more information.)

Agreement with Nontraditional Provider

Explain consumer confidentiality, disclosure of information, and other pertinent ethical considerations, and your expectations for a nontraditional provider's performance. If the person agrees, request that the CRP Specialist set up the nontraditional provider as a vendor. (This could take up to a week.)

The nontraditional provider may work with up to three different consumers. If the provider wants to serve more than three consumers, refer him or her to DRS Standards for Providers Chapter 1, 1-0080 Application Process for New CRPs to apply to become a CRP contractor. You must contact the CRP specialist to reactivate the nontraditional provider each time you wish to use him or her. Issue the purchase order to the nontraditional provider and send a copy to the CRP Specialist in the Regional Office.

Use the following procedures each time you need to issue or change a service record (SR) or purchase order (PO) using the nontraditional provider, after provider setup is completed:

Counselor

requests CRP specialist assistance to link a provider to nontraditional provider specification.

CRP Specialist

  • requests that Consumer Procurement and Client Services Contracting (CPCSC) link the provider to the nontraditional provider specification; and
  • lets the counselor know that the provider is linked.

Counselor/RST

  • issues or changes the needed SR or PO for a specific consumer;
  • always clicks the “Include in Service” button in the electronic case management system to ensure that all the additional wording for nontraditional provider specifications is on the printed PO; and
  • informs the CRP specialist when the SR or PO is completed.

CRP Specialist

  • asks CPCSC to remove the specification link to the provider.

Job Placement by Nontraditional Provider

Follow all procedures that apply to Job Placement by traditional CRP providers (See 5.5.3 Job Placement as a Purchased Service) except that you do not assign a payment tier. Use the following fee schedule for nontraditional providers:

Benchmark A: Job Placement – 1 day, $500

Benchmark B: Job Placement – 45 days, $200

Benchmark C: Job Placement – 90 days, $500

5.5.4 Supported Employment Services

(Revised 10/08, 07/09, 03/11)

Overview

Supported Employment (SE) enables consumers with the most significant disabilities to enter competitive employment by providing

Supported Employment services are for consumers who have not been able to find or maintain employment through traditional vocational rehabilitation approaches and training programs.

Consumers in Supported Employment need assistance to

Often, these consumers have been

A Supported Employment service provider seeks the best possible match between a consumer's skills, interests, abilities, and support needs and the employer's unmet business needs. The employment specialist or job skills trainer addresses any barriers to employment the consumer might have and may provide short-term support, while natural supports (such as peers or co-workers) are being arranged to meet the consumer's long-term needs. An employer who hires a consumer in Supported Employment should provide the training for the consumer just as he or she would for other new employees, with help and support from the DARS counselor and the employment specialist.

Supported Employment is a "place then train" model, which is a two-part process:

  1. place a consumer with most significant disabilities in a competitive job; and
  2. provide training and support directly related to the job.

Unlike the traditional vocational rehabilitation model, which provides job readiness and other training activities to prepare a consumer for employment, this model is more appropriate for consumers with the most significant disabilities. Since the focus is on finding the best job match and providing training for that particular job, problems in transferring knowledge from an artificial training situation to a real job are eliminated.

Supported Employment (SE) Definitions

Supported Employment

Supported Employment is competitive employment in an integrated work setting, consistent with the consumer's

*Supported Employment services are appropriate for consumers with the most significant disabilities who meet all the following criteria:

This definition includes transitional employment for persons with the most significant disabilities caused by chronic mental illness.*

*Based on 34 CFR Section 363.6(c)

Most Significant Disability

A consumer is considered to have a most significant disability if he or she

Competitive Employment

*Competitive employment is work in the competitive labor market

*Based on 34 CFR Section 363.6(c)(2)(A)

Discovery Process

The discovery process entails collecting information about the consumer through interviews and observations of the consumer's abilities in multiple settings on multiple occasions. Research indicates that the Discovery Process may take as many as 20 to 30 hours per consumer (The Job Developer's Handbook, Griffin, Hammis, Geary).

Integrated Work Setting

*An integrated work setting provides an environment where consumers with disabilities regularly interact with employees who do not have disabilities and/or the general public.*

*Based on 34 CFR Section 363.6(c)(2)(B)

Support Needs Tiers

Because challenges finding employment and support are unique to each consumer, there are two payment schedules, or tiers, based on a combination of factors collected from CCSA information and summarized in the SESP Part 1.

Factors considered include the

You determine the consumer's tier with input from the SE provider. Document the determination in a case note.

Extended Services and Supports

*Extended services and supports are ongoing support services necessary to support and maintain the employment outcome, including self-employment, following VR case closure that

  • are provided or funded by sources other than DARS; and
  • involve either on-site or off-site monitoring (as requested by the consumer or legal representative) for as long as the consumer is employed.

Necessary extended services and supports are identified in the DARS1613, Supported Employment Services Plan—Part 1 (SESP Part 1) and updated as needed throughout the VR case.*

*Based on 34 CFR Section 361.5(20)

*Extended services and supports begin at Benchmark 5: Job Stability, continue beyond Benchmark 6: Service Closure, and are provided as long as the consumer needs them.*

*Based on 34 CFR Section 363.54

Examples of extended services and supports in SE provided by natural supports or service providers not funded by DARS include

Transitional Employment for Consumers with Chronic Mental Illness

*Transitional employment is a series of temporary job placements in competitive employment, in integrated work settings, for consumers needing support services on or off the worksite. In transitional employment, the Supported Employment services must include continuing job placements until suitable employment is achieved.*

*Based on 34 CFR Sections 363.6(c)(3)(v) and 361.5(b)(56)

Eligibility for Supported Employment

*A consumer is eligible for Supported Employment services when

Before developing the IPE, document in the consumer's case file the reasons the consumer is expected to need and benefit from Supported Employment services, with the basis of this determination being disability-related. Throughout the life of the case, document

*Based on 34 CFR Section 363.3(A-C)

Benchmarks of the Supported Employment Outcome System

Benchmarks are specific outcomes for which payments are made to the provider during the course of the Supported Employment (SE) process.

These include

The DRS Standards for Providers, Chapter 2: Standards for Work-Oriented CRPs, 2.11 Standards for Supported Employment Services contains a detailed description of the Supported Employment Benchmarks, including staff qualifications, service definitions, required documentation, outcomes, and payment information. Also, see the DARS Staff Diagram of Supported Employment Benchmarks or read a text summary of the DARS Staff Diagram of the Supported Employment Benchmarks.

DARS pays for job placement only if the consumer is placed in an organization or business that is not owned, operated, controlled, or governed by the CRP providing the service.

Each benchmark payment is made only once to an SE provider for the consumer, even if the consumer loses a job after the completion of a benchmark and continues to receive services with that same SE provider. If the consumer chooses a new SE provider, you and the new SE provider negotiate the benchmark at which the consumer begins. However, in such situations, the area manager must approve starting over at Benchmark 1 (CCSA and SESP Part 1).

If at any point in the process the consumer loses the job, the consumer's progression within the benchmark is "frozen" until the consumer becomes reemployed. Benchmark progression continues when the consumer becomes employed in a new position and the SESP Part 2 is revised to reflect the new position.

Because any gap in employment greater than eight weeks results in a new employment period, the consumer must complete a minimum of 30 cumulative calendar days of employment in the new job before job stability can be established.

If at any point in the process you or the consumer decides that SE is not working, the consumer ends participation in the SE process. If the consumer switches to the Supported Self-Employment Services program, the counselor and the consumer may choose a different provider. A DARS1800, Supported Self-Employment Services Plan (SSESP) must be completed before supported self-employment services begin.

The SE outcome-based system is a comprehensive service package that may encompass a variety of services traditionally purchased separately. Therefore, the following vocational rehabilitation services cannot be purchased when a consumer is receiving SE services:

Counselor and Provider Responsibilities

You are responsible for overseeing the services provided to your consumer by the Supported Employment (SE) provider. The SE provider is responsible for providing services in accordance with the DRS Standards for Providers. The DRS Standards for Providers, Chapter 2.11 Standards for Supported Employment Services, Provider Responsibilities (paragraph 2-0550) lists general standards of service provision that providers are responsible for maintaining. If you become aware that a Supported Employment provider is not meeting these, or any other, standards, you should inform the liaison counselor and the regional Community Rehabilitation Program (CRP) specialist in writing of your concerns. Your concerns will be reviewed and, if necessary, the provider will be required to develop an action plan to resolve them.

Developing the IPE for Supported Employment

(Revised 01/11)

This section contains information on developing and documenting the Individualized Plan for Employment (IPE) to include Supported Employment services as a strategy to obtain employment.

As part of the assessment to develop the IPE, determine if Supported Employment is the best service option for the consumer. Once you complete the assessment, develop the IPE with the consumer and then initiate Supported Employment services.

If, however, you believe that because of the complexity of the consumer's disability and/or life circumstances, you still do not have enough information to write a meaningful plan and choose a suitable employment goal, you may purchase the first Supported Employment benchmark (using VR money). At the conclusion of the SESP Part 1 meeting, you and the consumer complete the IPE. Purchase the remaining benchmarks using available Supported Employment funds.

Include on the IPE

For examples of completed IPEs, see DARS3495, Vocational Rehabilitation Services, Individualized Plan for Employment (IPE), Sample A and DARS3495, Sample B.

Supported Employment Funds

Use Supported Employment funds to purchase services from an SE provider when you have

When encumbering funds for Supported Employment services, you should not issue a single purchase order for all benchmarks at the beginning of the process. Instead, issue purchase orders for future benchmarks as earlier ones are completed. For more information, see the Flow Chart for Purchase Order/Invoice Process.

During the 60-day transition period between job stability and service closure, you may use SE funds to purchase only services that

Examples include replacement of prosthetic and orthotic devices, maintenance of equipment, or counseling and guidance to family members to assist the consumer's job stability.

Case Note Documentation

Before developing the IPE, document in the consumer's case record the reasons the consumer is expected to need and benefit from Supported Employment services, with the basis of this determination being disability-related.

Throughout the life of the case, document

Quality Criteria

Quality criteria are points of reference for you to use when reviewing provider documentation and services rendered to determine whether certain conditions and/or outcomes have been achieved by the consumer and/or provider and effectively documented on the appropriate reporting forms. Quality criteria for each benchmark must be met before you may authorize payment to the provider for that benchmark.

When approving an invoice for payment, review the documentation from the SE provider to ensure that all quality criteria for that benchmark have been addressed and achieved. Return documentation to the provider for correction before authorizing payment if the documentation does not include the required information. Below are links to the reporting forms and the respective quality criteria for each benchmark.

DARS1612, Career and Community Support Analysis Quality Criteria—CCSA
DARS1613, Supported Employment Services Plan—Part 1 Quality Criteria—SESP—Part 1
DARS1614, Supported Employment Services Plan—Part 2 Quality Criteria—SESP Part 2
DARS1615, Supported Employment Support Summary Quality Criteria—4-week Job Maintenance
DARS1615, Supported Employment Support Summary Quality Criteria—8-week Job Maintenance
DARS1616, Job Stability or Service Closure Justification Summary Quality Criteria—Job Stability
DARS1616, Job Stability or Service Closure Justification Summary Quality Criteria—Closure

Time Limits for Supported Employment Services

*Supported Employment services are provided for a period generally not longer than 18 months. Under some circumstances, a longer period of Supported Employment services may be necessary for an individual to achieve the employment outcome. The additional time in Supported Employment services must be established in the consumer's IPE* and justified in the case notes.

*Based on 34 CFR Sections 361.5(b)(54)(i) and 363.54

Closing a Supported Employment Case as Successful

After completion of Benchmark 6: Service Closure, close the case as a Successful Closure, following policies and procedures in Chapter 6: Closure. The provision of substantial service ends with the payment of Benchmark 5, Job Stability. If the consumer still needs services other than Supported Employment services, such as counseling and guidance, durable medical equipment, or repairs, etc.,

5.5.5 EN Employment Advancement Payments

(Added 01/10)

Under Social Security Administration's Ticket to Work Partnership Plus Program, DARS and Employment Networks (ENs) partner to provide a seamless system of service delivery that supports a consumer's efforts toward achieving and maintaining self-supporting employment. DARS provides vocational rehabilitation services, including Job Placement or Supported Employment, if appropriate, and, after VR case closure, an EN provides ongoing job supports and services to ensure that the consumer maintains and has opportunities to advance in employment. In order for an EN to partner with DARS under the Ticket to Work Partnership Plus option, the consumer's Ticket cannot be assigned to the EN during the provision of VR services.

DARS encourages Community Rehabilitation Programs (CRPs) to become ENs, and to partner with DARS to better help consumers who receive Social Security benefits achieve self-supporting employment.

The CRP-EN may be eligible to receive up to two EN Employment Advancement Payments when it

If the CRP-EN is the holder of the consumer's Ticket assignment, follow procedures in Chapter 4: Assessing and Planning, 4.10.7 Ticket to Work Program to unassign the Ticket for the duration of the VR case.

EN Employment Advancement Payment Eligibility

The following criteria must be met for a CRP-EN to be eligible for the EN Employment Advancement Payments on an individual consumer:

Payment for EN employment advancement occurs after JP or SE outcome payments have been made to the CRP-EN and after VR case closure. Payment is made to the CRP-EN for employment advancement when

  1. the consumer has one month of gross income that meets or exceeds the SGA level for the year in which the income was earned. This payment is available only during the first 12 months following VR case closure; or
  2. the consumer has gross income in 8 of 12 consecutive months which is at least 105 percent of the SGA level for the year in which the income was earned. This payment is available only during the first 18 months following the first payment.

The DRS Standards for Providers, Chapter 2: Standards for Work-Oriented CRPs, 2.12 Social Security Administration/Vocational Rehabilitation (SSA/VR) Ticket to Work Partnership Plus—EN Employment Advancement Payments contains a detailed description of the EN Employment Advancement Payment system, including service definitions, required documentation, outcomes, and payment information.

VR Counselor Responsibility

Follow procedures in Chapter 4: Assessing and Planning, 4.10.7 Ticket to Work Program to ensure that the consumer's Ticket is designated as "in use" by SSA. If the CRP chosen to provide job placement (JP) or supported employment (SE) services is an EN, discuss the assignment of the Ticket following case closure with the provider and consumer during the pre-placement meeting (for JP) or during the SESP Part 1 meeting (for SE). To facilitate informed choice, explain to the consumer (and representative, if applicable) that, following VR case closure, he or she will have the option to assign his or her ticket to the EN of his or her choice, including the CRP-EN providing services. Refer the consumer to the MAXIMUS Web site for additional information about other available ENs.

In preparation for successful case closure with Ticket consumers,

If the consumer chooses to assign his or her Ticket to the CRP-EN that provided JP or SE services during his or her VR case, the CRP-EN will monitor the consumer's employment and provide necessary support services to allow the consumer to maintain and advance in employment.

EN Employment Advancement Payment 1

The first EN Employment Advancement payment is available only during the first 12 months following case closure. When the CRP-EN anticipates that the consumer will achieve monthly gross pay that meets or exceeds the SGA level, the CRP-EN must notify you, in writing, no less than 30 days in advance. Contact the consumer, and, if appropriate,

Upon receipt of required documentation (see DRS Standards for Providers, Chapter 2: Standards for Work-Oriented CRPs, 2.12 Social Security Administration/Vocational Rehabilitation (SSA/VR) Ticket to Work Partnership Plus—EN Employment Advancement Payments), payment may be made.

EN Employment Advancement Payment 2

The second EN Employment Advancement payment is available only within the first 18 months after the first EN Employment Advancement payment. When the CRP-EN anticipates that the consumer will achieve monthly gross pay that is at least 105 percent of SGA level for 8 of 12 consecutive months, the CRP-EN must notify you, in writing, no less than 30 days in advance. Follow the same procedure as above to make the second EN Employment Advancement payment.

5.5.6 Self-Employment Services

(Revised 06/09)

The following policy and procedures apply when a consumer requests that DRS pay for the costs of starting or maintaining self-employment.

Consult the regional program specialist on every self-employment case regardless of cost.

Self-employment

DRS does not sponsor businesses involving stocks, shares, or partners.

When to Consider Self-Employment

Consider self-employment when

Conduct a thorough exploration of self-employment as an employment strategy, particularly assessing the consumer's capacity for

Also counsel the consumer about the need for and availability of worker benefits such as

When Self-Employment Is Indicated

The process for developing a plan for self-employment is progressive and begins with assessing the consumer. If self-employment is indicated as a strategy for obtaining employment

Developing the Business Plan

Before you develop the IPE, the consumer completes a business plan that

A business plan is required in every case except when

The business plan

To the extent necessary, the business plan includes the following:

Either as part of the business plan or in a separate attachment, the consumer must provide a list of

*DRS may purchase technical assistance for the consumer, including consulting services to

*Based on 34 CFR Section 361.48(s)

For experienced help in developing a business plan, consumers can use comparable benefits that are available from

Payment information for technical assistance and consultative services for self-employment is listed in the electronic case management system specifications for

The cost of such consultations is not considered as part of the cost of the self-employment plan.

Developing the IPE for Self-Employment

(Revised 06/08)

You may consider including some services specific to self-employment in the IPE, in addition to the usual scope of VR services reasonable and necessary to support the employment goal.

The following table lists some of those services, their description, and any related procedures.

Service

Description and Procedure

Business plan evaluation

If needed, purchase from individuals or organizations an evaluation of the business plan that documents

  • the viability of the business and likelihood of its success,
  • the likelihood of the consumer achieving the projected net income stated in the plan, and
  • weaknesses that must be addressed.

Tools and equipment

You may purchase tools and equipment customarily used in similar businesses. Advise the consumer that

  • DRS owns the tools and equipment that DRS provides; and
  • the consumer must not attempt to sell, pawn, loan or use as loan collateral, or exercise other unlawful control over the property. Prosecution will result. See 5.8.10 Tools and Equipment.

For guidance in obtaining these items, see:

Maintenance

Maintenance is available for a business start up

Ordinarily, maintenance does not exceed 16 weeks from the date the consumer begins self-employment.

Initial stock and supplies

Initial stock and supplies include

  • office supplies, and
  • an inventory of salable merchandise or goods needed to start the business.

Advertising

For a business start-up, you may

  • help plan advertising; and
  • if appropriate, purchase advertising.

Utilities

You may pay utilities costs for a maximum of six months during the first phase of the new business.

Rent or lease payments

You may help pay rent or lease payments for a maximum of six months and a maximum of $300 per month, during the first phase of the business. Rent or lease payment should be in line with projected income.

Advise the consumer to consider location and zoning ordinances. Location and proximity to public transportation are two important factors in a successful retail business. If the consumer requests help with negotiating or otherwise preparing a lease agreement, consult the regional program support director (RPSD).

Each purchase order for consumer rent or lease of business space must include

  • name of the building owner,
  • building location,
  • amount of space to be rented or leased,
  • amount of rent or lease payment, and
  • period of rent or lease.

You may also pay for utilities for a maximum of six months. If utilities are included in the payment, and the payment is more than $300, you may issue separate purchase orders for rent (not to exceed $300) and utilities.

Paying deposits, such as rental or utility deposits, for consumers is not allowed by the Comptroller's State of Texas Purchase Policies and Procedures Guide, and area managers cannot approve these purchases.

Legal fees

Under certain conditions, pay legal fees to a private attorney to help a consumer's rehabilitation program. Submit a memorandum to DARS Legal Services, through the management chain, covering

  • how the legal service will enhance consumer's rehabilitation program, and
  • an estimate of the attorney's fee.

Upon review and concurrence by DARS Legal Services, the DRS assistant commissioner must approve the expense.

Goods and Services Not Provided

See Chapter 7: Purchasing, 7.6.10 Goods and Services DRS Does Not Provide.

Funding

"Self-employment cost" means the cost of starting and maintaining the business as described in the business plan to which you and the consumer agreed. The area manager must approve paying for self-employment costs above $3,000. The regional director must approve pay for such costs above $10,000.

Self-employment cost does not include the cost of

The Consumer's Participation in Costs

Consumers who have income and/or liquid assets in excess of the basic living requirement (BLR; see Chapter 4: Assessing and Planning, 4.6.3: Basic Living Requirements) must pay the excess toward the self-employment cost. Additionally, the consumer must contribute any other available resources to help establish and maintain the business; for example, use of a vehicle, labor, a building, or tools.

If the consumer is pursuing a loan from a lending institution or other source, and the funds are critical to the business start-up, the consumer must provide

The IPE for self-employment must include

Actions after Receiving Required Approvals

After obtaining approvals, send a copy of the following to the regional program specialist for inclusion in the file of self-employment plans:

Closing a Case as Rehabilitated

Before closing a case in self-employment as successful, ensure that it meets all criteria in Chapter 6: Closures, 6.2.1 Requirements for a Successful Closure, and that

Business stability is the point at which you and the consumer agreed in the IPE the business revenue equals a specified level, such as

*Based on 34 CFR Section 361.56

Required Documentation for Closing as Self-Employed

Documentation must

Documenting the Length of Business Operation

Document the length of business operation through one or more of the following means:

Documenting the Income Level

Obtain and file in the case record one or more of the following documents for income verification:

5.5.7 Supported Self-Employment Services

(Added 12/10, Revised 03/11, 09/11, 11/11)

Supported Self-Employment (SSE) Overview

Supported Self-Employment (SSE) is competitive employment where the consumer solely owns, manages, and operates a business and is not considered an employee of another person, business, or organization; and the business is consistent with the consumer's strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice.

SSE enables consumers with the most significant disabilities to demonstrate

SSE is similar to self-employment but incorporates many of the concepts of Supported Employment, including that the consumer receives ongoing supports throughout the VR case and then transitions to extended services and supports, not funded by DARS, after case closure. Supports may include long-term job coaching supports, ongoing case management, peer supports, natural supports, family supports, or ongoing paid professional services for the business.

SSE businesses are typically small and require a team approach to planning and support. The business team helps explore and determine the feasibility of the proposed business, assists in the development of the business plan, launches the business, and addresses the consumer’s long-term support needs.

The SSE process combines person-centered planning strategies with the development of a business plan. The goal of the planning process is to develop an individualized, profitable, and sustainable microenterprise. This process focuses on the talents, interests, and assets of the consumer. For many consumers with disabilities, including consumers who need ongoing supports throughout their careers, SSE can be a viable option to meet their employment needs.

If the consumer has a legal guardian and you have questions about the appropriateness of planning services leading to supported self-employment, consult with your area manager. If, after discussing the case your area manager has concerns, he or she should consult with the regional director. If questions remain after these consultations, the area manager may contact Legal Services for guidance.

DRS will purchase SSE services only from community rehabilitation programs (CRPs) that employ staff who have been certified as Certified Business Technical Assistance and Consultants (CBTAC) by The Center for Social Capital. DRS identifies these certified individuals as supported self-employment specialists (SSESs).

The SSES helps the consumer (the potential business owner) develop the business plan by coordinating planning activities and facilitating the team planning process. The SSES also takes the lead in developing business ideas, conducting feasibility studies, and writing the business plan with the consumer.

Supported Self-Employment (SSE) General Definitions

Note: Definitions for terms followed by an asterisk (*) are from Making Self-Employment Work for People with Disabilities, Carrie Griffin and David Hammis, 2003.

The Business Feasibility Study* is an assessment, through the use of research tools such as surveys or statistical analyses, regarding the likelihood of a business succeeding.

The Business Plan is a formal, detailed written description of a proposed business. The business plan helps the business owner to consider all the details related to the venture and to plan accordingly. It also provides information to funding sources regarding the type of proposed business, how much funding is needed, why this amount is needed, how funding might be used, how the business will be run and marketed, and other details. (See the planning resources from the Small Business Administration).

The Business Team (BT)* is a working collection of friends, colleagues, and experienced business people assembled to help the consumer formulate an enterprise idea, launch the business, and support the venture’s growth. Typically, the BT includes four to eight people. DARS requires a minimum of two BT members to be current or past business owners, excluding the self-employment specialist. You should be invited to all BT meetings, and are encouraged to attend.

*Competitive Employment as used in the definition of supported employment is work

*Based on 34 CFR Section 363.6(a)(2)(i)

Discovery is the process of collecting information about the consumer through interviews and observations of the consumer's abilities in multiple settings on multiple occasions. Research indicates that the discovery process may take as many as 20 to 30 hours per consumer (The Job Developer's Handbook, Griffin, Hammis, Geary).

Extended Services and Supports, according to federal law, are ongoing support services necessary to support and maintain the employment outcome following VR case closure that

Necessary extended services and supports are identified in the SSESP and updated as needed throughout the VR case.

Extended services and supports begin at Benchmark 6 (SSE Business Stability), continue beyond Benchmark 7 (SSE Service Completion), and are provided as long as the consumer needs them.

Examples of extended services and supports in SSE provided by natural supports or service providers not funded by DARS include

Impairment-Related Work Expenses (IRWE) is an SSI and SSDI work incentive that allows the Social Security Administration to deduct the cost of certain impairment-related items and services that the consumer needs in order to work from the consumer’s gross earnings when Social Security Administration is determining a consumer’s "countable earnings."

An Integrated Work Setting under federal law is an environment in which people with disabilities regularly interact with nondisabled people and/or the general public.

A consumer has a Most Significant Disability if he or she

Natural Supports are supports that exist naturally in the workplace and the community. Primary consumer supports should occur naturally, and professional supports (training or consultation) should be used only when the consumer needs additional support or accommodations.

Examples of natural supports include the following:

Negotiable Employment Conditions are conditions that a consumer would like the employment specialist to consider when helping the consumer establish a business. Negotiable conditions are preferences for working conditions.

Nonnegotiable Employment Conditions are conditions that a consumer has indicated must be or must not be present in the work situation. The employment specialist must always consider these conditions when helping the consumer establish a business. Nonnegotiable conditions may include

Person-Centered Planning is planning in which the process and the products are owned and controlled by the person (consumer). The process creates a comprehensive portrait of who the person is and what the person wants to do with his or her life, and brings together all the people who are important to the person, including family, friends, neighbors, support workers, business professionals, and other professionals. This team then identifies the person's skills, preferences, and abilities that can help achieve the person's goals for supported self-employment, independent living, continuing education, and full inclusion in the community. The team also identifies areas in which the person may need assistance and support and decides how the team can meet those needs.

Plan for Achieving Self-Support (PASS) is an SSI-only work incentive. A PASS allows a consumer to set aside other income besides his or her SSI and/or resources for a specified period of time so that the consumer may pursue a work goal. When the Social Security Administration calculates an SSI payment, it does not count the income set aside under a PASS Plan. Money set aside under a PASS Plan does not count towards a consumer’s resource limit.

Eligibility for Supported Self-Employment

A consumer is eligible for supported self-employment services when

Case Note Documentation

Before developing the IPE, *document in the consumer's case record the reasons the consumer is expected to need and benefit from SSE services, with the basis of this determination being disability-related.*

*Based on 34 CFR Section 363.3(A-C.)

Throughout the life of the case, document

Supported Employment Funds

Use supported employment funds to purchase services from an SSE provider when you have

When encumbering funds for supported self-employment services, you should not issue a single purchase order for all benchmarks at the beginning of the process. Instead, issue purchase orders for future benchmarks as earlier ones are completed.

During the 90-day transition period between stability and closure completion, you may use SE funds to purchase only services that are necessary to maintain the consumer’s abilities to ensure the stability of the business. No money can be spent related to the business.

Examples of items that can be purchased include

Benchmarks of the Supported Self-Employment Outcome System

(Revised 03/11)

Benchmarks are defined outcomes for which payments are made to the provider during the course of the SSE process. These include

Note: Capital/Equity Self-Employment Premium is an outcome of payment that may be made to a provider after the achievement of Benchmark 7: Supported Self-Employment Service Completion, if all criteria have been achieved.

The DRS Standards for Providers, Chapter 2: Standards for Work-Oriented CRPs, 2.12 Standards for Supported Self-Employment Services contains a detailed description of the Supported Self-Employment Outcome-Based System, including staff qualifications, service definitions, required documentation, outcomes, and payment information.

See the DARS Staff Diagram for Supported Self-Employment Benchmarks or the text summary of the DARS Staff Diagram for Supported Self-Employment Benchmarks.

Quality Criteria for SSE

Quality criteria are points of reference for you to use when reviewing provider documentation and services rendered to determine whether certain conditions or outcomes have been achieved by the consumer and/or provider and effectively documented on the appropriate reporting forms. Quality criteria for each benchmark must be met before you may authorize payment to the provider for that benchmark.

When approving an invoice for payment, review the documentation from the SEE provider to ensure that all quality criteria for that benchmark have been addressed and achieved. Return documentation to the provider for correction before authorizing payment if the documentation does not include the required information. Below are links to the quality criteria (under construction) and respective reporting forms for each benchmark.

Benchmark 1A: Discovery, Career and Community Support Analysis (CCSA), and the CCSA Review MeetingQuality Criteria—Discovery and CCSA
Benchmark 1B: Supported Self-Employment Services PlanQuality Criteria—DARS1800, SSE Services Plan
Benchmark 2: Business Concept Development and Feasibility StudyQuality Criteria—DARS1801, Concept Development and Feasibility Study Worksheet
Benchmark 3: Business Plan and Supporting Documentation Quality Criteria— the DARS1803-1, Business Plan Support Summary Report and the DARS1803-2, Business Plan
Benchmark 4: SSE Business Start-UpQuality Criteria—SSE Business Start-Up
Benchmark 5: SSE Business MaintenanceQuality Criteria—SSE Business Maintenance
Benchmark 6: SSE Business StabilityQuality Criteria—SSE Business Stability
Benchmark 7: SSE Service CompletionQuality Criteria—SSE Service Completion
Capital/Equity Self-Employment Premium Quality Criteria—Capital/Equity Self-Employment Premium

Supported Self-Employment (SSE) Process

The counselor, the consumer, and the SSES meet, as determined in the IPE, to

If, at any point in the process, you and the consumer decide that supported self-employment is not working, the consumer will end participation in the SSE process. If the consumer switches to traditional Supported Employment Services, you and the consumer may choose a different provider. A DARS1613, Supported Employment Services Plan—Part 1 must be completed before any supported employment services are provided.

See Diagram Comparing Supported Employment and Supported Self-Employment Benchmarks or the text summary of the Diagram Comparing Supported Employment and Supported Self-Employment Benchmarks.

If, at any point in the process, the consumer wants to change any of the negotiable or nonnegotiable employment conditions, a new SSESP must be completed in an additional SSESP meeting.

The consumer must be performing the duties outlined in the DARS1800, Supported Self-Employment Services Plan (SSESP), and extended services and supports identified in the SSESP must be in place and working before you can determine that the consumer is stable in the job.

Each benchmark payment is made only once to an SSE provider for an individual consumer. If the consumer switches between supported employment and supported self-employment services, you, with approval from your area manager, negotiate the benchmark at which the consumer continues.

The Supported Self-Employment Outcome-Based System is a comprehensive service package that may encompass a variety of services traditionally purchased separately. Therefore, the following vocational rehabilitation services cannot be purchased when a consumer is receiving Supported Self-Employment Services:

Counselor and Provider Responsibilities

(Revised 11/11)

You are responsible for overseeing the services provided to your consumer by the SSE provider. Use the quality criteria to help you evaluate both the service and documentation provided by the SSE provider. The SSE provider is responsible for providing services in accordance with the DRS Standards for Providers. The DRS Standards for Providers, Chapter 2: Standards for Work-Oriented CRPs, 2.12 Standards for Supported Self-Employment Services lists general standards for providing services that providers are responsible for maintaining. If you become aware that a supported self-employment provider is not meeting these or any other standards, you should inform the liaison counselor and the regional community rehabilitation program (CRP) specialist in writing of your concerns. Your concerns will be reviewed and, if necessary, the provider will be required to develop an action plan to resolve them.

The counselor must ensure that the DARS1801, Concept Development and Feasibility Study Worksheet, the DARS1802, Planning Meeting Record, the DARS1803-1, Business Plan Support Summary Report, the DARS1803-2, Business Plan, and the DARS1805, Financial Actual Spreadsheet are submitted by the CRP and are reviewed by either the regional program specialist or the Central Office program specialist assigned to Self-Employment. Before payment of the benchmark, you and the area manager should review the program specialist’s recommendation. The area manager must approve the DARS1801, Concept Development and Feasibility Study Worksheet, the DARS1802, Planning Meeting Record, the DARS1803-1, Business Plan Support Summary Report, the DARS1803-2, Business Plan, and the DARS1805, Financial Actual Spreadsheet before the benchmark invoices are paid.

Developing the IPE for Supported Self-Employment

This section contains information on developing and documenting an Individualized Plan for Employment (IPE) that includes supported self-employment services as a strategy to obtain employment.

As part of the assessment to develop the IPE, determine if supported self-employment is the best service option for the consumer. The first Supported Self-Employment benchmark—Discovery and Career Community Support Analysis—must be purchased using VR money. At the CCSA meeting, you, the consumer, and the provider discuss the benefits and challenges of pursuing a self-employment outcome. If self-employment is the outcome chosen, complete the IPE. Purchase the remaining supported self-employment benchmarks using available Supported Employment funds. Otherwise, pursue Supported Employment Services or other options determined to meet the needs, resources, and choice of the consumer.

Include on the IPE

You may consider including some services specific to self-employment in the IPE, in addition to the usual scope of VR services reasonable and necessary to support the employment goal.

The following table lists some of those services, their description, and any related procedures.

ServiceDescription and Procedure
Tools and equipment

You may purchase tools and equipment customarily used in similar businesses. Advise the consumer that

  • DRS owns the tools and equipment that DRS provides; and
  • the consumer must not attempt to sell, pawn, loan or use as loan collateral, or exercise other unlawful control over the property. Prosecution will result. See 5.8.10 Tools and Equipment.

For guidance in obtaining these items, see

Maintenance

Maintenance is available for a business start-up

Ordinarily, maintenance does not exceed 16 weeks from the date the consumer begins self-employment.

Initial stock and supplies

Initial stock and supplies include

  • office supplies, and
  • an inventory of salable merchandise or goods needed to start the business.
Advertising

For a business start-up, you may

  • help plan advertising; and
  • if appropriate, purchase advertising.
Utilities

You may pay utilities costs for a maximum of six months during the first phase of the new business. DRS may not pay for utility deposits. See Chapter 7: Purchasing, 7.6.10 Goods and Services DRS Does Not Provide.

Rent or lease payments

You may help pay rent or lease payments for a maximum of six months and a maximum of $300 per month, during the first phase of the business. Rent or lease payments should be in line with projected income.

Advise the consumer to consider location and zoning ordinances. Location and proximity to public transportation are two important factors in a successful retail business. If the consumer requests help with negotiating or otherwise preparing a lease agreement, consult the regional program support director (RPSD).

Each purchase order for consumer rent or lease of business space must include

  • name of the building owner,
  • building location,
  • amount of space to be rented or leased,
  • amount of rent or lease payment, and
  • period of rent or lease.

You may also pay for utilities for a maximum of six months. If utilities are included in the payment, and the payment is more than $300, you may issue separate purchase orders for rent (not to exceed $300) and utilities.

Paying deposits, such as rental or utility deposits, for consumers is not allowed by the Comptroller's State of Texas Purchase Policies and Procedures Guide, and area managers cannot approve these purchases.

Legal fees

Under certain conditions, pay legal fees to a private attorney to help a consumer's rehabilitation program. Submit a memorandum to DARS Legal Services, through the management chain, covering

  • how the legal service will enhance consumer's rehabilitation program, and
  • an estimate of the attorney's fee.

Upon review and concurrence by DARS Legal Services, the DRS assistant commissioner must approve the expense.

Goods and Services Not Provided

For goods and services not provided by DRS, see Chapter 7: Purchasing, 7.6.10 Goods and Services DRS Does Not Provide.

Funding

"Self-employment cost" means the cost of starting and maintaining the business as described in the business plan to which you and the consumer agreed. The area manager must approve paying for self-employment costs above $3,000. The regional director must approve pay for such costs above $10,000.

Self-employment cost does not include the cost of Supported Self-Employment Outcome-Based Services.

The Consumer's Participation in Costs

Consumers who have income and/or liquid assets in excess of the basic living requirement (BLR) (  see Chapter 4: Assessing and Planning, 4.6.3: Basic Living Requirements) must pay the excess toward the self-employment cost. Additionally, the consumer must contribute any other available resources to help establish and maintain the business; for example, use of a vehicle, labor, a building, or tools.

If the consumer is pursuing a loan from a lending institution or other source, and the funds are critical to the business start-up, the consumer must provide

The self-employment specialist may help the provider gain a loan and be paid the Capital/Equity Self-Employment Premium. This premium is paid at closure of the case. For details, see the DRS Standards for Providers, Chapter 2: Standards for Work-Oriented CRPs, 2.12 Standards for Supported Self-Employment Services for details.

Time Limits for Supported Self-Employment Services

*Supported Self-Employment services are provided for a period generally not longer than 18 months. Under some circumstances, a longer period of Supported Self-Employment services may be necessary for an individual to achieve the employment outcome. The additional time in Supported Self-Employment services must be established in the consumer's IPE* and justified in the case notes.

*Based on 34 CFR Sections 361.5(b)(54)(i) and 363.54

5.5.8 Embedded Training and Placement Services

The goal of Embedded Training is for the host business, community rehabilitation provider (CRP), and the DARS counselor to work together to help the consumer develop skills necessary to obtain and maintain employment through skill acquisition in a business setting.

Host businesses for Embedded Training offer a high quality learning environment, allowing consumers to acquire practical skills on up-to-date equipment and under trainers familiar with the most recent working methods and technologies and develop key soft skills in the “real work” environment. Embedded training facilitates a connection between potential employers and potential employees, making recruitment much more effective and less costly for the business.

DARS Embedded Training prepares consumers to take advantage of job opportunities in high-growth, high-demand industries in the Texas workforce. Embedded-training programs allow consumers to attain both hard and soft skills, creating well rounded consumers who can compete in the competitive labor market for the industry of their choice.

Once the consumer completes the Embedded Training, he or she should have the skills necessary to earn a sustainable, livable wage and have an opportunity to advance in a career in the business industry.

Embedded training’s benefits for the business include the following:

Embedded training's benefits for the consumer include the following:

The DARS counselor must use the Embedded Training Guide , the specific fact sheet in the electronic case management system, or marketing materials provided by the CRP for the approved Embedded Training to determine if a consumer is ready to successfully complete the Embedded Training as well as to make an informed choice about the consumer's participation in the program. Embedded training is not designed for vocational exploration, trial work, stamina building, or any other prevocational activity.

The DARS counselor contacts the approved Embedded Training CRP to refer a consumer and provide pertinent information, reports, and test results to the CRP before the Embedded Training referral meeting.

The counselor is responsible for conducting a meeting with the provider and the consumer to complete the DARS3311, Vocational Skills Training Plan and Report. The consumer completes an interview with the CRP and counselor to ensure the consumer meets all criteria for the Embedded Training program, to discuss any known accommodations or special training support needs and to identify any supplies or equipment that will need to be purchased for the consumer before he or she participates in the Embedded Training.

The DARS counselor must note on the Embedded Training purchase order

For details about how to refer consumers to Embedded Training programs and what outcomes will be achieved by the consumer, refer to the Standards for Providers, Chapter 2: Standards for Work-Oriented CRPs, the DARS3310, Embedded Training Proposal, or the comments section related to the Embedded Training provider in the electronic case management system.

Each CRP has a unique fee structure for its Embedded Training program. The fee structures are in the electronic case management system under Vendor by Specification Level.

Select the following specifications:

Level 1: Community and Residential Rehabilitation Services
Level 2: Embedded Training and Placement Services
Level 3: (For this level, specify the appropriate Embedded Training and Placement Services combination for the vendor)
Level 4: (For this level, specify the appropriate Embedded Training and Placement Services combination for the vendor)

The consumer must achieve Embedded Training outcomes as defined in the

All forms must be complete, including required signatures. Verify all information on the submitted forms before approving payment. See Standards for Providers, Chapter 9: Embedded Training for required content in forms.

To request that a CRP or host business be established as an Embedded Training site, a proposal must be submitted for each site and approved by the DARS review team. For further information, see Embedded Training and Placement Site Approval Process, or contact your regional CRP specialist.

5.6 Transition Services

5.6.1 Key Terms

504 Plan

A school's written statement of services provided in accordance with Section 504 of The Rehabilitation Act is called a "504 Plan."

Section 504 requires school districts that receive federal funding to *provide a "free and appropriate public education" (FAPE) to each qualified student with a disability who is in the school district's jurisdiction, regardless of the nature or severity of the disability. Appropriate educational services are designed to meet the individual needs of such students to the same extent as the needs of students without disabilities are met. An appropriate education for a student with a disability under the Section 504 regulations could consist of education in regular classrooms, education in regular classes with supplementary services, and/or special education and related services.*

*34 CFR Part 104, Subpart D, Sections 104.31–104.39

Individualized Education Plan (IEP)

The school's written statement for a student with a disability is called an Individualized Education Plan (IEP). The IEP is developed, reviewed, and revised in a meeting in accordance with Sections 300.320–300.324, and *must include a statement of the student's present levels of academic achievement and functional performance. It must also include how the student's disability affects his or her involvement and progress in the general education curriculum (that is, the same curriculum as for students without disabilities.*

*34 CFR Section 300.320

Transition Consumer

A consumer who is 16–24 years old at application is a transition consumer. The consumer is considered to be "transitioning from school to post-school activities" until his or her DRS case is closed. If a transition consumer's case has been closed and he or she returns for services but is not aged 16–24, he or she is no longer classified as a "transition" consumer for federal reporting purposes. A transition consumer may also be referred to as the "student."

Transition Services

Transition services are a coordinated set of activities that promote the transition from school to post-school occupations and services that include post-secondary education, vocational training, integrated employment (including supported employment), continuing and adult education, adult services, independent living, and/or community participation. Transition services *must promote or facilitate the achievement of the employment outcome identified in the student's individualized plan for employment (IPE).*

*Based on 34 CFR Section 361.5(b)(55)

Transition Vocational Rehabilitation Counselor (TVRC)

A TVRC is a qualified vocational rehabilitation counselor who works with a specialty caseload of primarily transition-age consumers at assigned high schools. Vocational Rehabilitation Counselors (VRCs) do not have to be designated TVRCs to work with transition consumers.

5.6.2 Transition Services Overview

DRS provides transition planning services to eligible students with disabilities through the adult VR program to

*Based on 34 CFR Section 361.42

A student who is in special education, or who has received special education or Section 504 services, is *not automatically eligible for DRS services.*

*Based on 34 CFR Section 361.42

References to the counselor in this chapter apply to any VRCs or TVRCs working with transition consumers.

5.6.3 Providing Information to Students, Parents, and School Personnel

(Revised 06/10, 09/11)

Counselors must provide to the student, parent, and school personnel information that *describes the

*Based on 34 CFR Section 361.22

Specifically, counselors must ensure that families and students with disabilities are informed about their options and opportunities to choose methods and providers for delivery of all needed assessments, as well as decisions related to developing a plan of services. This leads to a foundation of information from which families and students can make informed choices about a coordinated plan of services for students to achieve successful transition to post-secondary activities and employment outcomes.

See Chapter 2: Initial Contact and Application, 2.4.6 Application Signatures for procedures to authorize minor children who are in foster care to participate in VR program activities.

5.6.4 Providing Transition Services

Typically, transition consumers are referred to DRS during their last two years of high school. However, depending on the complexity of the consumer's circumstances and the need for services, counselors can begin working with consumers earlier than this to help them move successfully from school to competitive employment or independent living.

Transition services are based upon the assessment of the transition consumer's needs, taking into account his or her preferences and interests and developmental maturity. This coordinated set of transition services should explore

Transition services promote or facilitate the development of the consumer's IPE while he or she is still in high school. *IPE services for transition students can include, but are not limited to,

*Based on 34 CFR Section 361.5(b)(55)

5.6.5 Developing a Transition Consumer's IPE

Transition is not separate from VR; it is a strategy of VR that helps students with needs related to their disabilities to make the best use of vocational rehabilitation services to achieve a successful vocational outcome. Not all students who are referred will be eligible. When students are not eligible, they should be referred to the Workforce Commission for Youth Employment program. All policies related to eligibility determination in Chapter 3: Eligibility, and assessing and planning of rehabilitation needs in Chapter 4: Assessing and Planning, are applicable to the provision of transition services to eligible students.

As a part of a set of coordinated transition services, counselors must work with students, parents, schools, and community partners to

Counselors must

*Based on 34 CFR Section 361.22

The IPE must

*Based on 34 CFR Section 361.22 in accordance with CFR Section 361.45

IPE services must

Transition students are usually in a career exploration stage of development while they are still in high school. Counseling and guidance, along with specific exploration activities would be expected as part of planned services. Multiple IPE amendments may be necessary as the student's rehabilitation needs change.

5.6.6 Process for Transferring a Transition Case to another VR Caseload

Generally, counselors may expect to work with transition consumers from application through successful closure and/or post-employment services. For TVRC specialty caseloads that exceed 80 active cases, it may be necessary to move a transition case from a TVRC to a VRC. Refer to Chapter 11: Technical Information and References, 11.4.1 When to Transfer Files between Offices, for processes required for transfers. The manager should ensure that the transferring TVRC and the receiving VRC work together to create a seamless transfer for consumers. The same policies apply if any other reason makes it necessary to transfer the consumer's case to another VRC, such as if the consumer moves, counselor attrition, etc.

5.6.7 Required Documentation for Transition Service Delivery

All RPM policies, procedures, and guidance related to documenting consumer service delivery must be followed for consumers participating in transition services.

Case notes for consumers receiving transition services must also include the following components unique to decision-making regarding transition services:

When applicable, the case file must include a current copy of the consumer's

5.7 Technology Services

5.7.1 Rehabilitation Technology Devices and Services

Overview

*Rehabilitation technology is the systematic application of technologies, engineering methodologies, or scientific principles to meet the needs of and address the barriers confronted by people who have disabilities in areas that include

The term includes rehabilitation engineering, assistive technology devices, and assistive technology services.*

*Based on 34 CFR Section 361.5(b)(45)

The Scope of Rehabilitation Technology Services

(Revised 10/10)

DRS sponsors

You may use rehabilitation technology services at any time during the case, as necessary, to

Consultation is available from the

See Rehabilitation Technology Resource Center (RTRC) for guidance on the services available. For additional examples of how you can use rehabilitation technology services, see Using Rehabilitation Technology. For services specific to consumers who work on farms or ranches, see Texas AgrAbility Project guidance.

Rehabilitation Engineering Services

(Revised 02/11)

Only licensed professional engineers may provide rehabilitation engineering services. Consider using an engineer's services when the service includes design or modification of a product.

Before you commit DRS funds, it is important to reach an understanding with the provider about price and delivery. For rehabilitation engineering services provided before plan development, use the following specification levels:

Level 1—Evaluation Services
Level 2—Other Evaluation Services
Level 3—Other Evaluation Services
Level 4—Other Evaluation Services.

Consult with the PSRT for

Assistive Technology Services

(Revised 02/11)

Professionals other than rehabilitation engineers may provide assistive technology services.

The Consumer's Participation in the Cost of Services

Rehabilitation technology services are subject to the policies in Chapter 4: Assessing and Planning, 4.6 Consumer Participation in Cost of Services.

Using Comparable Services and Benefits

*Although not mandated by law, use readily available comparable services and benefits before you use DRS funds, unless doing so would delay needed services.*

*Based on 34 CFR Section 361.53(b)(5)

5.7.2 Vehicle Modification Services

Overview

You may provide vehicle modification when it is the most cost-effective way for the consumer to participate in employment.

With the exception of hand controls, you may provide modifications only after you have determined the consumer eligible. You may provide hand controls during extended evaluation.

Vehicle modifications range in cost from under $1,000, for simple hand controls, to many thousands of dollars for van conversions with complex steering controls. Deciding that vehicle modification is reasonable and necessary requires you to carefully consider numerous factors, including at least the following:

See Elements of Informed Choice in Vehicle Modification for guidance on each of these factors.

All vehicle modifications that cost more than $2,500 require the area manager's approval.

The Counselor's Role in Vehicle Modification

Your role in vehicle modification is to

DRS Standards for Vehicle Modification

Some vehicles cannot be modified to meet DRS standards. You and the consumer should begin planning before buying the vehicle. Use Vehicle Selection for DRS Consumers as a guide.

All modifications must meet the standards in DRS Standards for Providers, Chapter 4, Standards for Vehicle Modification. Contact the PSRT for any questions on whether the equipment or modifications meet these standards.

Van Modifications

Vehicle modification may range from a minor modification to a passenger car, such as installing hand controls, to modifying a van to

Van modification is

Lowered-Floor Minivans

Not all new minivans are suitable for lowered-floor conversions. Manufacturers' standard electronic configurations are often not compatible with lowered-floor conversions. Because of this, manufacturers have begun offering lowered-floor vans that have been premanufactured specifically for the mobility industry. A vehicle of this type would not be readily available from traditional automobile dealerships, but many providers are now ordering and stocking them.

You should strongly encourage consumers to purchase such a converted or lowered-floor vehicle whenever possible, and DRS may pay for the conversion cost on an already converted vehicle.

If a converted vehicle is not available, and since a lowered floor is a major structural modification, DRS authorizes this modification only on new vehicles, or on used vehicles that

Limitations on Vehicle Modification Services

DRS does not sponsor modification

Carefully weigh the specific modification against

See Functional Considerations for Modifications for examples.

Evaluating the Driver

Evaluate the consumer's ability to drive using appropriate resources.

Whenever possible, use the services of a certified driving rehabilitation specialist (CDRS).

The consumer must complete driver training with the appropriate equipment if the consumer has

The consumer should have a valid driver's license with appropriate restrictions before a vehicle modification begins.

In some circumstances, however, the consumer may not have a driver's license and cannot obtain one until the modified vehicle is available. If you have reasonable assurance that the consumer can operate a modified vehicle safely, an instruction permit (valid for one year) may suffice. In this case, complete only those modifications that will allow the consumer to take the DPS driving test. Complete the remaining modifications after the consumer acquires a driver's license.

See Resources for Consumers without a Driver's License for guidance on additional resources.

Evaluating Used Vehicles

Whenever necessary, have a competent mechanic evaluate any used vehicle before it is modified.

A competent mechanic must evaluate the vehicle to ensure the sound mechanical condition of all major components when

DRS may pay for the cost of the evaluation (see DARS3494, Mechanic's Evaluation - Used Vehicle).

Reviewing the Modification Plan before the Vehicle Is Purchased

(Revised 10/10)

Before the consumer purchases a vehicle, you must request that the PSRT and Texas Transportation Institute (TTI) review a plan for modifications that cost more than $1,000.

Prepare and submit a packet to the PSRT containing the information described in step 18 of Procedure for Vehicle Modification.

Ensure that

Reviews by TTI and the PSRT before you purchase a modification can provide you and the consumer valuable information about the proposed modification.

The TTI review addresses whether the

The PSRT reviews each TTI report and follows up with you by email.

The reviews and follow-up by the PSRT provide necessary information to support your best value purchasing decisions.

No additional Central Office or TTI review is necessary.

Before issuing the modification purchase order, you must

Obtaining the Modification Proposal

You and the consumer together select an approved service provider. Give the consumer a list of approved service providers in the consumer's geographic area. If the consumer has no preference, consult the management support specialist (MSS) before selecting a service provider.

At no cost to DRS, the service provider prepares a proposal for the modification using DARS3408, Vehicle Modification Evaluation.

After you receive the proposal, decide with the consumer which modifications are reasonable and necessary for achieving the planned employment goal. Consult with the MSS and PSRT as needed.

Determining the Required Documentation for Modifications

(Revised 10/10)

Use the following table to determine the documentation required for the consumer's vehicle modification.

Modification Level

Documentation

All

A completed and signed DARS3409, Consumer Vehicle Modification Agreement before services begin

Note: Give the consumer a copy of the completed DARS3409, Consumer Vehicle Modification Agreement.

those costing $1,000 or more

For the vehicle to be modified, a copy of the

  • Certificate of Title, or
  • Tax Collector's Receipt for Texas Title Application/Registration/Motor Vehicle Tax.

The vehicle must be owned by the consumer or an immediate family member (spouse, parent, etc.).

those costing $1,000 or more and Certificate of Title showing third-party lien

A completed

Provide copies of both forms to the

  • consumer,
  • vehicle owner if not the consumer, and
  • lien holder.

The DARS3417, Vehicle Modification, Express Waiver of Right to DRS Equipment, requests that the lien holder expressly disclaim, in writing, any interest in the installed equipment. If you must make minor changes in the agreement, consult DARS Legal Services.

If the lien holder agrees and later reclaims the vehicle for any reason, DRS may

If the lien holder will not sign the disclaimer, contact the PSRT for guidance.

Completing Inspections of the Modified Vehicle

(Revised 06/09 , 10/10, 02/11)

The MSS must inspect all vehicle modifications

Place a completed copy of DARS3474, Vehicle Modification Acceptance, in the case file and give a copy to the consumer.

The Texas Transportation Institute (TTI) of Texas A&M University must inspect all modifications that cost more than $9,000. TTI may inspect a modification that costs less than $9,000 at the counselor's request.

Exception: Minivan conversions modified to lower the floor for passenger use, only, do not require TTI inspection.

For each modification inspection,

For more information, see Procedure for Vehicle Modification.

Insuring the Vehicle

When DRS provides vehicle modification services, the consumer must obtain, at the consumer's expense, insurance that covers the replacement cost of the sponsored modifications. Encourage the consumer to carry comprehensive coverage on the vehicle.

Obtain and file a copy of

Purchasing Equipment and Modification Repairs

You may sponsor repairs to adaptive equipment and vehicle modifications.

You may sponsor repairs to vehicles in certain circumstances (see Vehicle Repairs).

To sponsor equipment repairs,

  1. obtain a price quote;
  2. if over $1,000, submit to the PSRT for review;
  3. if over $2,500, area manager approval is needed;
  4. ensure the safety of the modification (provision of tie downs, etc.); and
  5. issue a purchase order to a service provider on the list of approved providers and authorized by the manufacturer to repair the equipment.

Upon completion of the repair work, the MSS must inspect the work before the vehicle is released to the consumer.

DRS does not reclaim equipment that is broken, outdated, or no longer under warranty. If in doubt, contact the PSRT.

Procedure for Vehicle Modification

(Revised 09/08, 06/09, 10/10)

Refer to the following procedure to ensure that you complete all steps for sponsoring a vehicle modification.

Responsible Party

Action

Counselor

  1. verifies that the consumer has auto insurance and a valid driver's license with appropriate restrictions (for additional information, see Evaluating the Driver);
  2. provides the consumer with Vehicle Selection for DRS Consumers if the consumer has not yet purchased a vehicle;
  3. ensures that modification to an automobile meets the consumer's needs before initiating modification to a van; and
  4. provides the consumer with a list of approved service providers within the geographic area.

Counselor and consumer, with MSS assistance as needed

  1. select a service provider for vehicle modification. If the consumer has no provider preference, the counselor consults the MSS before selecting a service provider.

MSS

  1. arranges for the approved service provider to complete DARS3408, Vehicle Modification Evaluation.

Counselor and consumer

  1. after obtaining recommendations, decide which modifications are to be sponsored and include them on an IPE or an IPE amendment. The counselor consults with MSS and PSRT as needed.

Exception: Hand controls may be purchased in extended evaluation.

Counselor

  1. obtains the consumer's signature on the DARS3409 and gives a copy of the completed form to the consumer.

If the modification costs less than $1,000,

  1. encumbers funds to the service provider, or

If the modification costs $1,000 or more, skips to step 12.

MSS

  1. arranges for the modifications.
  2. inspects the vehicle before its release to the consumer and before payment to the service provider is authorized.

Counselor

If the modification costs $1,000 or more,

  1. obtains the area manager's approval for modifications that cost more than $2,500;
  2. includes in the case file a copy of the vehicle Certificate of Title, or a copy of a Tax Collector's Receipt for Title Application/Registration/Motor Vehicle Tax;
  3. if the Certificate of Title shows a third party holds a lien against the vehicle, completes a DARS3419, Vehicle Modification Mutual Agreement and gives a copy of the completed form to the consumer;
  4. provides a copy of the agreement between DRS and the vehicle owner to the lien holder, and obtains the lien holder's signature on the DARS3417, Vehicle Modification, Express Waiver of Right to DRS Equipment;
  5. obtains an evaluation of the vehicle's condition, if pertinent, using DARS3494, Mechanic's Evaluation—Used Vehicle;
  6. obtains approval signature by area manager, MSS, or both (in addition to the counselor's signature) on the DARS3408, Vehicle Modification Evaluation, completed by the service provider;
  7. prepares and provides to the MSS a packet containing the following required information:
  8. completes and attaches DARS3397, Vehicle Modification Recommendation Cover Sheet.

MSS

  1. reviews the packet and signs DARS3397;
  2. ensures that all required information is attached;
  3. delegates an action to the program specialist for rehabilitation technology (PSRT) in electronic case management system to create the service record for Texas Transportation Institute (TTI) review; and
  4. faxes the packet to the coordinator for vehicle modifications at (512) 424-4669 in Central Office (packets may also be mailed, but mailing adds several days to the process).

PSRT

  1. reviews the packet and submits it to TTI at Texas A&M University, and
  2. issues a purchase order for $175.

TTI

  1. reviews the packet and submits a report, usually within 10 days of receipt, to the PSRT and MSS.

PSRT

  1. when the report is received, acknowledges receipt of the service in electronic case management system.

TTI

  1. submits monthly invoices to PSRT for processing and payment.

MSS

  1. forwards the report to the counselor.

Counselor

  1. if appropriate, issues a purchase order to the service provider that performs the vehicle modification.

MSS

  1. if the modification is $9,000 or more, arranges for an inspection by TTI and issues the purchase order for $2,500;
  2. inspects the vehicle before releasing the vehicle to the consumer, and before authorizing payment to the service provider;
  3. if TTI is involved in the inspection, coordinates the inspection with the TTI engineer; and
  4. at the time of release, has the consumer sign the DARS3474, Vehicle Modification Acceptance.

5.7.3 Job-Site and Home Modification Services

Overview

Provide a job-site or home modification when changes to a consumer's physical environment are needed for the consumer to perform

The process begins with a full assessment of needs, followed by consideration of accommodation alternatives, including the need for consumer training and/or education regarding the use of rehabilitation technology.

Informed consumer choice in meeting technology needs involves considering

Obtaining an Assessment of the Job Site or Home

(Revised 10/10)

Before changing the consumer's job site or home, purchase an assessment from a licensed occupational therapist (OT), physical therapist (PT), or professional engineer (PE) specializing in assistive technology. Assessment services identify options that will allow the consumer to

For assessments specific to farm or ranch employment, consider purchasing services from the Texas AgrAbility Project

Procedure for Obtaining an Assessment

(Revised 10/10)

Use the following procedure to obtain the assessment of potential modifications to the consumer's job site or home.

  1. as needed, review information in
  2. complete
  3. negotiate rates using the following guidelines:
    • for OT and PT services, negotiate a rate for assessment consistent with MAPS;
    • for PE services, negotiate a rate consistent with prevailing community rates and include travel costs as necessary; and
  4. pay upon receipt of assessment report, which is usually provided within 10 days of service.

If applicable, ensure that the consumer signs the release on DARS3394, with a copy to you, specifying what consumer information the OT, PT, or PE may provide to the employer.

For services provided by the Texas AgrAbility Project, follow procedures described in the related guidance.

Exceptions to Obtaining an Assessment

The area manager may grant an exception to the requirement to have an OT, PT, or PE assessment of the job-site or home modification when

Approvals and Other Requirements for Job-Site or Home Modifications

Before committing to job-site or home modification on the IPE, you must ensure you meet the following requirements.

Service

Approvals

Other Requirements

Job-site modification

All job-site modifications require area manager approval.

DRS-sponsored modifications are limited to adding items or equipment that can be removed without permanent damage to the employer's property should the consumer terminate employment, change job assignments, etc.

Before considering DRS sponsorship, review the employer's responsibility under the ADA.

If help is needed in assessing the nature and extent of planned modification, contact the PSRT.

Home modification

All home modifications costing more than $1,000 require area manager approval and documentation in the case folder.

Adaptive equipment may require installation, but usually does not result in permanent structural changes. Household equipment may be specially designed, selected, or altered to enable the consumer to perform homemaker duties despite his or her functional limitations.

Modifications are limited to equipment that can be removed from the residence without permanent damage to the property should the consumer move, fail to cooperate in achieving the planned objective, etc.

Procedure for Purchasing a Job-Site Modification

Use the following procedure when purchasing a modification to the consumer's job-site.

Service Description

Procedure

The services includes

  • evaluating the worksite to design or re-design a workstation in order to prevent injury or re-injury;
  • providing training in ergonomic positioning and movement; and
  • recommending technology, furniture, or positioning that prevents injury or improves functioning at work.
  1. consult with the Central Office PSRT as needed.

If the modification costs more than $700

  1. obtain from the employer a written agreement using the format and language in DARS3404, Employer Job Site Modification Agreement, before beginning the modification.

If the modification costs more than $1,000

  1. purchase a lien examination service from either a title insurance company or other source such as a law office; and
  2. if no lien is found, file a copy of the results in the case file.

If there is a lien,

  1. provide a copy of the DRS-employer agreement to the lien holder; and
  2. request that the lien holder expressly disclaim in writing any interest in the equipment installed at the job site by DRS using DARS3426, Residence or Job Site Modification, Express Waiver of Right to DRS Equipment.

If the lien holder will not sign the disclaimer,

  1. contact DARS Legal Services through the chain of command for guidance.

When circumstances require minor changes in the agreement, contact Legal Services for guidance.

Provide one copy of DARS3404, Employer Job Site Modification Agreement to the employer.

File the original DARS3404 in the case file.

Procedure for Purchasing a Home Modification

Use the following procedure when purchasing a modification to the consumer's home.

Service Description

Procedure

Creating or enhancing access to the house or apartment, or making residential features more accessible (that is, those features critical to participation in job preparation services or necessary for the consumer's employment).

May include construction of ramps, adaptive equipment such as stair glides and lifts, and household equipment.

  1. consult with the Central Office PSRT as needed to ensure that the most practical modification equipment is used; and
  2. when equipment such as a porch or ramp is attached (for example, bolted or nailed) to the property, obtain a written agreement using the format and language in DARS3403, Consumer Residence Modification Agreement, from the property owner.

If the modification costs more than $700

  1. clearly justify that the modification supports the consumer's planned employment outcome.

If the modification costs more than $1,000

  1. obtain the area manager's approval; and
  2. purchase a lien examination from either a title insurance company or other source such as a law office.

If there is a lien,

  1. provide a copy of DARS3403 to the lien holder, and request that the lien holder expressly disclaim in writing any interest in the equipment installed in the residence or job site by DRS using DARS3426, Residence or Job Site Modification, Express Waiver of Right to DRS Equipment.

If the lien holder will not sign the disclaimer,

  1. contact DARS Legal Services for guidance.

When circumstances require minor changes in the agreement, contact Legal Services for guidance whether the property is owned by the consumer or another person.

Provide one copy of DARS3403 to the property owner. Keep the original DARS3403 in the case file.

5.8 Adjunct Services

5.8.1 The Purpose and Scope of Adjunct Services

(Revised 12/09)

This section describes policies that apply to services that

These services include

5.8.2 Maintenance Services

(Revised 07/10)

*DARS may provide maintenance payments to a consumer for additional expenses incurred while

*Based on 34 CFR Sections 361.5(b)(35) and 361.48(g)

There are two types of maintenance:

You may pay either type in advance.

Maintenance Type

When Provided

Limits

Regular weekly maintenance

only for additional expenses incurred by the consumer (for example, lunches), and housing (if temporary relocation is required)

  • not to exceed $55 per week
  • ordinarily limited to 104 weeks for a consumer who is pursuing vocational training
  • ordinarily limited to 156 weeks for a consumer who has a significant disability and who is pursuing academic college-level training
  • ordinarily limited to 16 weeks for a consumer in self-employment

One-time maintenance

one-time payment to the consumer or a third party to offset the consumer's excess living expenses

See Third-party Maintenance for examples of when to provide this maintenance.

ordinarily does not exceed $40 per day

If the payment is over $400, do not use the pseudo number to create the service record. Contact CPCSC to have the consumer established as a provider.

Maintenance payments are based on economic need.

You may provide payments to help a consumer during business start-up for self-employment.

Maintenance checks, or warrants, are mailed

See Mailing Warrants for examples of exceptional circumstances.

When DRS Does Not Pay Maintenance

Do not pay maintenance when

State Law Prohibitions on Warrants for Individuals

State law prohibits the state comptroller from issuing a maintenance warrant directly to a person who owes the state or federal government delinquent taxes or a defaulted debt (for example, a Texas Guaranteed Student Loan). For more information, see the guidance document, When a Consumer Owes Money to the State or Federal Government.

5.8.3 Transportation Services

*Transportation consists of travel and related expenses that are necessary for a consumer to participate in a VR service provided under an IPE or for an assessment to determine eligibility.*

*Based on 34 CFR Sections 361.5(b)(57) and 361.48(h)

Transportation of a consumer for any purpose must be by the most economical and effective carrier.

State law prohibits the state comptroller from issuing a transportation warrant directly to a person who owes the state or federal government delinquent taxes or a defaulted debt (for example, a Texas Guaranteed Student Loan). For more information see the guidance document, When a Consumer Owes Money to the State or Federal Government.

Transportation warrants are mailed

See

Do not use petty cash for transportation except in an emergency (see DARS Business Procedures Manual Chapter 23: Accounting, 23.3 Consumer Emergency Fund).

Transportation Providers

Public Carrier. A public carrier is a vehicle or set of vehicles in the business of transporting the public; for example,

Private or Third-Party Carrier. A private carrier is a vehicle owned by a person or private organization other than the consumer, and not customarily for hire. For example, you may pay the consumer's family member, neighbor, or residential service provider to transport the consumer if he or she has

The Consumer as the Carrier. DRS reimburses the consumer for the use of the consumer's vehicle for transportation when this is the most economical and effective method.

Transporting the Consumer in the Counselor's Vehicle

Transport the consumer in your private vehicle only when transporting the consumer coincides with travel when performing your regular duties, or there is an emergency. Do not accept reimbursement from the consumer.

Exercise particular care when transporting a consumer in your private vehicle. Under the Texas Tort Claims Act, DRS can be liable should the consumer be injured because of a wrongful act or the negligence of a DRS employee. The DRS employee must exercise the degree of care that a reasonable and prudent person would exercise under the same circumstances.

One-Time Transportation

(Revised 03/08, 06/08, 07/08, 08/08, 12/08, 01/09, 03/09, 06/09, 09/09, 01/10, 06/10, 07/10, 01/11, 04/11, 07/11, 08/11, 10/11, 01/12, 04/12)

A one-time transportation expense

Do not use the pseudo number to create a service record for one-time transportation that exceeds $400. If the payment is over $400, contact Consumer Procurement and Client Services Contracting to have the consumer established as a provider.

Provider Type

Payment Rate

Public

actual cost to the consumer

Private or third-party

actual mileage times a maximum of $.55 per mile

Consumer

actual mileage times a maximum of $.21 per mile*

*Rate adjusted quarterly.

Regular Weekly Transportation

(Revised 03/08, 06/08, 08/08, 12/08, 03/09, 06/09, 09/09, 06/10, 01/11, 04/11, 07/11, 10/11, 01/12, 04/12)

Provide regular weekly transportation only when no other transportation resources are available.

Regular weekly transportation is

Provider Type

Payment Rate

Consumer

the lesser of

  • actual mileage times a maximum of $.21 per mile*, or
  • $50 per week

*Rate adjusted quarterly.

Consumers Attending Gallaudet University or the National Technical Institute for the Deaf (NTID)

Transportation for students attending Gallaudet University or the NTID is limited to two round-trip coach tickets by air per year.

Bulk Purchases of Local Bus Tickets for Consumers

With the area manager's approval (or, in the absence of the area manager, a higher management authority), the management support specialist (MSS) or the unit support technician (UST) purchases local bus tickets, passes, tokens, transfers, etc., in bulk for consumers as a decentralized purchase using the online HHSAS 53802 requisition process. For assistance, contact DARS CPCSC Consumer Procurement Group at cpcsc.cpg@dars.state.tx.us.

Relocation

If the consumer cannot participate in IPE services or employment because transportation is not available, discuss with the consumer the option of relocating to a community that meets the consumer's transportation needs.

If the consumer decides to move, then determine the extent of help necessary to achieve the move. Some consumers require minimal help (for example, helping pay for moving van rental, mileage, boxes) while others, because of disability-related limitations, may require full assistance (such as packers, movers, and unpackers).

If you will be purchasing services from a moving company, contact Consumer Procurement and Business Services for help in determining if using a state term contract results in best value.

Payment of deposits, for example rental or utility deposits, on behalf of consumers is not allowed by the Comptroller's State of Texas Purchase Policies and Procedures Guide, and area managers cannot approve these purchases.

Vehicle Repair

Like other transportation services, provide payment for the repair of the consumer's vehicle only when necessary for the consumer to participate in other planned services, such as vocational training and job-related services. See Vehicle Repairs for guidance.

Payment for vehicle repair, including parts and labor, is authorized only when

Authorization covers only repairs that are necessary to make the vehicle safe and operable.

The area manager must approve vehicle repairs exceeding $250.

Before authorizing payment, consider and document in a case note that

Vehicle repairs are authorized in Post-Closure Services only when in support of other planned services.

For additional information, see Vehicle Repairs.

Vehicle Rental

You may provide a rental vehicle if

To provide a rental vehicle, obtain

Do not request state rates because only state employees may use them.

The consumer or consumer's driver must

If the consumer does not have collision insurance, you may pay the rental agency's additional daily rate for required insurance. DRS does not pay for personal accident insurance.

The consumer must

Vehicles with hand controls and/or modified vehicles can be rented from commercial car rental agencies. Advance notice may be required to allow the provider to locate the needed vehicles or devices.

Helping the Consumer Purchase a Modified Vehicle or Vehicle for Modification

(Revised 06/09, 06/10)

Help the consumer purchase a modified vehicle or vehicle for modification only when it is necessary for the consumer to participate in other planned services, such as vocational training and job-related services, or for employment. Plan carefully whenever you consider offering this assistance. See Helping the Consumer with Purchase of a Vehicle for Modification in the Counselors' Toolbox for guidance.

Note: The ILS program does not help consumers purchase a modified vehicle or vehicle for modification.

You and the consumer must consider first the purchase of a reliable used vehicle, including a used vehicle already modified. Verify all applicable items such as the vehicle's reliability and serviceability, age, mileage, and insurance coverage.

The primary objective of this service is to defray initial costs the consumer must pay to take possession of the vehicle, such as the

Criteria for Assistance. Consider offering assistance with a vehicle purchase only when all the following conditions are met:

DRS assistance with the initial purchase of a vehicle is a maximum of $4,000, based on demonstrated financial need. Payment is in the form of a warrant payable to the consumer, which the consumer signs over to the vehicle dealer.

Required Documentation. Consider and document in a case note the following:

The area manager and regional director must review and approve before you include vehicle purchase assistance on an IPE or IPE amendment for the consumer to review and sign.

Payment Procedure. All payments are made directly to the consumer in a warrant mailed to the field office.

Hand deliver the warrant to the consumer at the vehicle dealer's location.

Witness the consumer signing over the warrant to the dealer as the vehicle down payment.

Helping the Consumer with Payments for a Modified Vehicle

When necessary, DRS may help make the consumer's vehicle payments on modified vehicles, up to the full monthly payment for up to six consecutive months. Provide this assistance only when

All payments are made directly to the consumer.

The area manager and regional director must approve before you include vehicle payment assistance on an IPE or IPE amendment for the consumer to sign.

5.8.4 Personal Attendant Services

(Revised 12/09)

*Personal attendant services (personal assistant services) involve help with daily living activities such as transferring, dressing and undressing, showering, feeding, managing bowel and bladder activities, shifting weight, mobility, and writing. Provide them only if the consumer has significant physical limitations, and only while the consumer is actively involved in other VR services such as vocational training, college training, and employment assistance.* These services do not require the level of skill of nurses or other health care professionals.

*Based on 34 CFR Section 361.5(b)(39)

Planning for Attendant Services

In determining the employment goal, consider that the consumer will eventually assume financial responsibility for attendant services.

Consider providing services that allow the consumer to do things independently (for example, an environmental control system, an automatic patient lift). The initial cost for assistive technology usually is higher than purchasing attendant care, but may be more economical in the long term.

Locating and Training Personal Attendants

You and the consumer share the responsibility for locating a suitable personal attendant. However, because of the individualized nature of these services, the consumer should assume primary responsibility for instructing the personal attendant regarding his or her specific needs. The consumer should also inform you about the attendant's job performance.

Centers for independent living and student service offices on college campuses are often sources for locating and training personal attendants.

Providing Attendant Services while Providing Employment Assistance

When employment assistance and counseling and guidance are the primary services being provided, personal attendant services are limited to a maximum of six months.

The case file must clearly document ongoing employment assistance activities while DRS is also providing personal attendant services.

You may continue providing personal attendant services for

Supporting Relocation from a Nursing Home or Institution

Personal attendant services may be provided for up to 12 months, if a consumer is relocating to a private residence from a

Comparable Benefits

*Use comparable benefits when they are

You may supplement these comparable services, as necessary, with case service funds.

*Based on 34 CFR Section 361.5(b)(10)

Fees

Negotiate fees for personal attendant services with the consumer and the attendant, but you make the final determination. The fee amount depends on

You must use any fee previously negotiated between DRS and an organization when personal attendant services are provided by that organization.

5.8.5 Interpreter Services for the Deaf

(Revised 03/09)

An interpreter conveys messages between people without contributing to the dialogue.

DRS uses interpreter services to facilitate consumer communication in the rehabilitation process. *Interpreter services are provided by qualified personnel and include sign language and oral interpretation for persons who are deaf or hard of hearing and tactile interpretation for persons who are deaf-blind.*

*Based on 34 CFR Section 361.48(j)

*Interpreter services are exempt from policy establishing economic need.*

*Based on 34 CFR Section 361.54(b)(3)(i)(G)

The state coordinator for deaf and hard of hearing services can help with obtaining interpreter services.

Maintaining Consumer Confidentiality

Inform the interpreter and consumer that information provided is maintained in confidence (see DARS Business Procedures Manual, Chapter 20: Confidentiality and Use of Consumer Records and Information).

Using Certified Interpreters

(Revised 04/12)

You must use certified interpreters when possible.

For a list of certified interpreters, use the BEI Interpreter List. For more information, and to access the necessary ID name and password, refer to the DHHS Resources page.

A certified interpreter is one who holds at least one current certificate of competency from one of the following organizations:

A DRS employee who is competent in sign language may facilitate communication between DRS staff and the consumer or other people who are deaf inside the office or related setting.

A DRS employee may not serve as an interpreter during an appeal process (see Chapter 10: Consumer Rights and Legal Issues, 10.3 Appeal and Mediation Procedures). Do not use the services of a DRS employee for consumer communication outside the office except as a last resort.

Additional information on certification levels and recommended settings is available at the DHHS Web page Situations and Recommended Interpreter Certification Levels.

Using Noncertified Interpreters

(Revised 02/10)

When a certified interpreter is not available, you may use a noncertified interpreter who is otherwise competent to interpret. In these cases, get the consumer's written approval before hiring the interpreter.

You may not use a noncertified interpreter in the following settings:

Purchasing Interpreter Services

Ordinarily, payment for interpreter services must not exceed the established DRS Fee Schedule. You should make every effort to plan service delivery according to the regular (day) rates. For specific rates and interpreter policy, see DHHS Communication Access Maximum Rates.

Colleges and Universities

DRS has contracts with several colleges and universities to offset part of the cost for interpreter services, and rates are determined by the contract terms. Therefore, fees in the DRS Fee Schedule do not apply to contracted institutions unless noted in the terms of the contract.

Payments made to colleges and universities that are not under a DRS contract must comply with the established DRS Fee Schedule.

Paying an Out-of-State Provider

When an out-of-state provider performs interpreter services

Procedures for Purchasing Interpreter Services

The rate for interpreter services depends on the

Use the following procedure to purchase the services of an interpreter.

Consumer and Counselor

  1. agree on the type of interpreter (oral or sign language) and certification level needed (for appropriate certification level, see Interpreter Settings chart).

Counselor

  1. before selecting the service provider, identifies in the service record the appropriate HHS region where services will be provided (for the appropriate HHS region, see the Table of Comparison).

Consumer

  1. selects the provider from among those available.

Counselor

  1. contacts the agency or independent service provider to request services indicating
    • certification level needed; and
    • date, time, and location of event; and
  2. compares the provider's quoted fee to the maximum allowable fee, negotiating with the service provider when necessary.

Service Provider

  1. provides the name and level of the assigned interpreter.

Counselor

  1. informs the consumer of the assigned interpreter;
  2. obtains agreement from consumer;
  3. issues a purchase order for the services; and

Upon receipt of the provider's invoice,

  1. verifies the amount charged against the maximum allowable fee in the DHHS Communication Access Maximum Rates, and
  2. pays for the services.

5.8.6 Specialized Telecommunications Assistance Program (STAP)

The DARS Office for Deaf and Hard of Hearing Services (DHHS) and the Public Utility Commission (PUC) operate the Specialized Telecommunications Assistance Program (STAP) for people whose disabilities interfere with their ability to effectively access the telephone network.

Through the STAP program, DHHS provides qualified people who have disabilities with a voucher to purchase basic specialized telecommunications equipment. For a list of the program's acceptable telecommunication devices and the value of the voucher for each device, see DHHS Specialized Telecommunications Assistance Program (STAP) Web page.

People who have disabilities and who have not used a DHHS STAP voucher in the past five years may apply for help through DHHS.

DHHS does not purchase the device for the consumer. The consumer pays all costs above the STAP voucher amount.

For a STAP application, contact one of the following:

When submitting the application, include a copy of a valid proof of residency as listed on the application.

You may certify the consumer's STAP application on the basis of disability and program criteria. You should verify the consumer's identification information, ensuring that the Social Security number is listed and the proof of residency is documented before you sign the application.

Mail the completed application with confirmation of identity and proof of residency to

DHHS STAP
P.O. Box 12607
Austin, Texas 78711

DHHS does not accept applications by fax or email.

Once DHHS approves the application,

For a list of registered vendors, see Registered Vendors (PUC).

For questions concerning STAP, contact DHHS at

5.8.7 Translator Services

*DRS provides translator services for the consumer in the

*Based on 34 CFR Section 361.51(c)

For DARS policy and procedures to access language services, see Business Procedures Manual, Chapter 35: Language Services.

All area managers

The area manager is responsible for contacting Procurement and Business Services about updates so that the provider profiles available to all staff are current. The list is also included in the Regional Communications Plan submitted to the HHS Office for Civil Rights.

Inform the translator and consumer that information provided will be maintained in confidence. See DARS Business Procedures Manual, Chapter 20: Confidentiality and Use of Consumer Records and Information for policy on protecting consumer information.

Guidelines for Translator Services

When the consumer has a limited ability to speak English, make every effort to locate a translator who

Obtain help in identifying translators from organizations such as high schools, colleges, universities, the local chamber of commerce, churches, or private translator services, where you might find representatives of the consumer's particular ethnic group.

When it is not practical for the translator to be present with you and the consumer, use a speaker-phone to communicate with the translator.

When DRS sponsors a training program, ensure that the consumer who has a limited ability to speak English is provided adequate help from

Language Line

(Revised 04/11)

You may use the Language Line telephone interpreter services when a translator is not available. See the procedure to use the Language Line on the DARSNet Employee Resources page.

5.8.8 Services to the Consumer's Family Members

You may provide services to the consumer's family members when those services

Provide any of the usual VR services

Consider only substantial services that

You must clearly describe in case notes

5.8.9 Child-Care Services

(Added 09/11)

Overview

You may purchase child care for a consumer who has children under the age of 13 if the consumer cannot complete planned vocational activities without child care. Children 13 and older who require supervision because of a disability also qualify for this service. Examples of activities related to the vocational goal include diagnostic services, physical restoration, training, and work.

Resources

Explore resources such as the consumer’s family members, neighbors, or community day care programs to see if they can meet the consumer’s child-care needs. A state-subsidized program, the Texas Workforce Commission Workforce Solutions, offers child care for low-income people who are working or participating in training or educational activities leading to employment.

If the consumer is not eligible for the Workforce Solutions program and has no comparable benefits, you may purchase child care. The consumer must select a provider who is licensed, registered, or listed on the Department of Family and Protective Services (DFPS) Web site.

The selection of a provider is the consumer’s responsibility as a parent. You may help the consumer access information about how to select appropriate, safe child care through the DFPS Web site.

Acceptable Child-Care Providers

DFPS licenses, registers, or lists the following categories of providers (see definitions at Child-Care Providers Licensed, Registered or Listed through the Department of Family Protective Services):

You may not pay for services provided by a person who is not identified on the DFPS Web site as a provider in one of these categories. Area managers may not make an exception to this policy.

If a consumer wants to use someone to provide child care who is not currently recognized by DFPS, that person must contact his or her local DFPS licensing office to learn how to become licensed, registered, or listed. The procedure for becoming a Listed Family Home requires limited documentation and may be appropriate for a family member or friend who wants to provide child care. See Procedure for Becoming Listed as a Child-Care Provider.

Establishing a Child-Care Provider as a DARS Vendor

If the consumer selects an acceptable child-care provider who is not already a DARS vendor, contact CPCSC to initiate the process. See Establishing a Child-Care Provider as a DARS Vendor.

Payment Guidelines

If no comparable benefits are available for child care, you may pay up to 100 percent of the consumer’s child-care costs during training, not to exceed the maximum rates listed on the Maximum Rates tables below. Child-care payments during training are limited to the duration of training.

You may pay for child care after a consumer has achieved employment for a total of no more than two months at the following percentages:

Payments may not exceed the maximum allowed rates listed on the Maximum Rates tables.

Maximum Rates for Child Care

Maximum Rates
For Child Care Provided During Daytime or Traditional Business Hours
(From 6:00 a.m. to 6:00 p.m., Monday through Friday)

 
Infants
(0–17 months)
Toddlers
(18–35 months)
Preschool
(3–5 years)
School Age
(6–12 years)
 Full DayPart DayFull DayPart Day Full DayPart DayFull DayPart Day
Licensed Child-Care Center$25.96$17.15$22.71 $16.22$20.55$16.22$19.47$12.98
Licensed Child-Care Home$21.63$16.07$19.00$15.45 $18.54$16.22$14.49$10.82
Registered Child-Care Home$21.10$14.92$18.54$12.36 $17.51$12.36$14.06$10.30
Listed Family Home$15.17$15.17$13.19$11.48$11.30 $8.48$9.42$6.59

Maximum Rates
For Child Care Provided During Night, Weekend, or Nontraditional Business Hours
(Reimbursed at 5% above daytime rates)

 
Infants
(0–17 months)
Toddlers
(18–35 months)
Preschool
(3–5 years)
School Age
(6–12 years)
 Full DayPart DayFull Day Part DayFull DayPart DayFull DayPart Day
Licensed Child-Care Center$27.26$18.01$23.85$17.03$21.58$17.03$20.44$13.63
Licensed Child-Care Home$22.71$16.87$19.95$16.22$19.47$17.03$15.21$11.36
Registered Child-Care Home$22.16$15.67$19.47$12.98$18.39$12.98$14.76$10.82
Listed Family Home$15.93$15.93$13.85$12.05$11.87 $8.90$9.89$6.92

1Full Day is 6–12 hours within a 24-hour period

2Part Day is < 6 hours within a 24-hour period

Some providers may charge a registration fee in addition to ordinary child-care costs. You may pay up to $100.00 to register each child who will be participating in child care. If the provider’s fee exceeds $100.00, area managers may grant an exception to exceed the $100.00 rate on a case-by-case basis.

Payment for child care is a substantial service. A consumer’s case may not be closed “successful” until the consumer has worked and paid for 100 percent of his or her child care for 90 days.

Building Service Records for Child Care

For information about selecting specification levels, see Building Service Records for Child Care Payments and Registration Fees.

5.8.10 Tools and Equipment

(Revised 12/08)

Required tools and equipment DRS buys for a consumer are the property of the State of Texas. Tools and equipment may include motorized equipment such as

You may provide required tools and equipment to the consumer when the following conditions are met:

Tools and equipment may be repaired if replacement is not cheaper.

Remind the consumer of the agreement in the IPE to

Exercise due diligence in recovering usable tools and equipment the consumer no longer needs.

Procedures for Buying, Transferring, or Reporting Lost or Stolen Tools and Equipment

The following table presents procedures for activities related to tools and equipment.

Activity Procedure
Paying for goods You must
  • obtain the consumer's signature on an itemized receipt or cash register receipt that describes each good purchased, or a DARS3425, Receipt for Items;
  • place the signed receipt in the case file.
Transferring tools or equipment Occupational tools, equipment, and supplies originally purchased for a consumer and later recovered may be transferred to another consumer if the equipment is still serviceable or under warranty.

The MSS transfers consumer equipment from one consumer location to another and

  • assesses the condition of the equipment; or
  • hires a local consultant to assess it, when necessary; and
  • reports the equipment condition to the receiving MSS.

When the recovered items are not reissued to another consumer, transfer them to the Property Management Office (PMO) located at the DRS Central Warehouse.

Document transfers and reissues in case notes of both consumers involved. Do not enter the name of one consumer in another consumer's case file.

Reporting the misappropriation of tools and equipment If a consumer sells; pawns; loans; uses as loan collateral; transfers to an unauthorized, known third party; or otherwise uses tools or equipment unlawfully,
  • notify the third party immediately that the state has title to the property, and
  • request that the property be returned; and
  • contact DARS Legal Services through appropriate management channels before DRS files theft charges against the consumer.

5.8.11 Occupational Licenses

(Added 12/08, Revised 07/10)

An occupational license is any license, permit, or other written authority from a state, city, or other governmental unit that a person must have to practice an occupation.

Occupational licenses are intended to enhance a consumer's employability, *and may be provided as appropriate to meet the consumer’s vocational needs.*

*Based on 34 CFR Section 361.48(p)

DRS pays fees only for

DRS does not pay state or municipal tax assessments on occupations. DRS management may not authorize any exceptions.

Do not pay for dues to a professional association or trade union unless paying for the dues meets best-value purchasing criteria or you can justify the purchase as critical to the success of the consumer’s employment. Enter a case note in the consumer’s file to justify the purchase. For more information, see the guidance document, When Paying for a Consumer’s Dues to a Professional Association or Trade Union Is Acceptable.