Coast Quiz 3

A client is attending work adjustment training at a local CRP and needs assistance with rent. He lives in an apartment with his family. Can VR sponsor this and, if so, who would need to approve it?

NO- Maintenance for housing is a short-term expenditure and is only provided when individuals are participating in services that are not within commuting distance of their own home. Maintenance is a limited service designed to assist the individual with meeting the additional costs incurred while participating in a rehabilitation program. (2-12)

PRE-ets does not offer support services

No transportation, clothing, supplies, payment of utilities

Is OJT subject to financial need?

No.

Repairs over this amount must be reviewed and approved by the Chief of Policy:

$2500.00

What is the maximum amount that a counselor can authorize for vehicle repairs:

$750.00

VR has sponsored 24 psychotherapy session for a client and now the therapist is recommending 12 additional sessions. Could VR sponsor more visits and who must approve if we do?

Additional sessions may be authorized with the approval of the Supervisor and the Chief of Policy. In addition to the documentation required for eligibility determination and treatment updates, a written treatment plan, justification for additional sessions, and ongoing progress reports are required when more than twenty-four sessions are authorized. (2-13-1)

A client with severe arthritis is requesting some help in her home. Specifically, she would like grab bars in her bathroom. There is also a 1-inch step up into her bathroom that she trips on occasionally. She is now working and her morning routine has been affected due to her risk of falling. The engineer is recommending grab bars and an Easy Edge ramp, at an estimated cost of $250. Describe the process you would go through in order to assist your client.

All residence modifications are subject to the individual's financial need and comparable benefits. Regardless of the residence type, modifications costing < $500 require a Rehabilitation Engineer's recommendation and one written price quote.

Your client has chosen to attend a training program that costs more than the Division will fund. What documentation must be in the file?

Financial assistance is limited to rates for tuition and fees as published in Volume V of the Reference Library (Available on the VR Intranet web page). If the individual chooses to attend a training program that will cost more than the Division is funding, the individual must demonstrate that sufficient funds are available from other resources to cover expenses that are not covered by the Division. This information must be documented in the case record by an awards letter, a loan confirmation, or other verification that sufficient funding is available. In situations where the counselor has questions about the verification of resources, a budget for the training program may be developed with the client. (2-20-1)

What if the school is not a vendor for us?

For out-of-state vendors, only those training institutions that are approved and used by that state's vocational rehabilitation program can be considered for use by NCDVRS. (2-20-5)

What is the procedure if the computer is not available at the campus bookstore?

For students enrolled in post-secondary training programs at colleges or universities which do not sell computers directly from the campus bookstore, the Counselor should purchase a computer through DVR Purchasing Section not to exceed the Division's maximum rates (rates published in Volume V on the VR intranet)- [not to exceed $2,300.00]). The Counselor must complete the DVR-0309 Client Computer Purchase Request form (most current form as available via VR intranet). This completed form should be forwarded to the DVR Purchasing Section by fax, mail, or email at [email protected]. Once verification is received from the DVR Purchasing Agent, the Counselor should generate an authorization and case service invoice to the appropriate vendor (confirmed by the purchasing agent) and maintain these documents in the case file until the computer is delivered. (2-5-1)

Who covers the workman's compensation insurance for the OJT?

Under North Carolina Workers' Compensation Law, a trainee or a Vocational Rehabilitation client for whom an on-the-job-training contract has been executed with a firm employing three or more people would be covered by the firm's Workers' Compensation Insurance if the trainee was injured during the training period. In arranging and executing on-the-job-training contacts with firms employing three or more people, it is imperative that counselors, our client and the firm's representative recognize and understand that our client is covered by the firm's Workers' Compensation Insurance. (2-20-8)

Your client needs a piece of assistive technology that costs $650. Does this require Chief of Policy approval? Why?

Your client needs a piece of assistive technology that costs $650. Does this require Chief of Policy approval? Why?

What should the counselor be cognizant of when considering vehicle repairs?

the estimated value of the vehicle versus the cost of the repairs.

During an internship, what is the maximum number of hours that the client can work per week?

28 hours per week

Can an internship and work adjustment job coaching be provided at the same time?

75. Can an internship and work adjustment job coaching be provided at the same time? An internship may be provided along with work adjustment job coaching for internships if the client requires on-the-job supports for soft skills or support in modifying work processes in addition to receiving employer supervision on hard/transferable skills (See Work Adjustment Job Coaching for Internships, 2-20-18). If job coaching is required, this shall be indicated in the internship agreement and the job coaching provider shall be involved in any formal reviews of the client's progress in the internship. While the job coach will be present on-site, the counselor shall reiterate the importance of the supervisor communicating with the counselor/VR staff person regarding any concerns about the client's participation in the internship as well as the client's progress and not considering the job coach as a substitute for relaying information. (2-20-9) Work adjustment job coaching for internships may be provided to clients that will require on-the-job supports for soft skills in addition to the instructional support that the internship supervisor will provide on internship-specific hard skills. Work adjustment job coaching for internships must be required in order for the client to be successful in the work experience but is not appropriate for individuals who will require a program of supported employment to achieve competitive employment. Work adjustment job coaching for internship services cannot be utilized to develop internship experiences. (2-20-18)

Who must approve the authorization for permanent relocation costs?

Supervisor (2-21-4)

Maintenance is not intended for what?

Maintenance is not intended to pay for those living expenses that exist irrespective of the individual's involvement with rehabilitation. (2-12)

Day care services may be provided in what situation?

May be provided as a service in support of another CORE rehabilitation service. Providers must be approved by the NC Division of Child Development. (2-8)

Supportive "counseling and guidance" is an integral part of any rehabilitation program. When can it be provided to the client?

May be provided at any time during the rehabilitation process. (2-7)

Pre employment transition . What are the 5 required services?

1-Job exploration counseling 2-Workplace readiness training 3-Work-based learning experiences 4-Instruction in self advocacy 5-Counseling on post-secondary training options

What is the Residence Modification Process

1. Review and determine previous client expenditures for Residence Modifications. 2. The Counselor must consult with the Supervisor regarding the feasibility of the project. If the project is supported by the Supervisor, the Counselor must involve the rehabilitation engineer in discussion about the project. 3. The Rehabilitation Engineer must visit and evaluate the site to determine the feasibility of the project. Residence modifications shall be directed only at the issues of accessibility and will directly address the disability-related needs. They shall be the most technically appropriate, cost effective, and safe modifications that support a client's vocational goals. 4. The Rehabilitation Engineer will then consult with the Counselor and client, develop the project specifications and provide a report to the Counselor along with an estimated cost of the project. 5. Procedures for bidding and approval required will depend on the estimated cost. a. If the estimated cost does not exceed allowable limits the project is bid out using policy procedures and NCDVRS Informal Construction Contract, then awarded by the Unit Office. b. If the project is bid locally and the bid responses exceed allowable limits, a Residence Modification Data Packet shall be submitted to the Chief of Policy for approval. c. If the project estimate exceeds allowable limits based on the type of residence, a Residence Modification Data Packet shall be submitted to the Chief of Policy for approval.

List the conditions that must exist to sponsor chiropractic services:

1. The client has signs or symptoms that are considered by a chiropractor to be related to spinal subluxation, and are not shown in the general or special examination to be due to other causes; 2. The client chooses the services of a chiropractor for spinal subluxation and/or spinal manipulation; and 3. There are no contraindications to spinal manipulations imposed by disorders other than spinal subluxation. (2-16-7)

A client recently had back surgery that VR sponsored. He has been discharged and is asking for help with a few items that the doctor prescribed, including narcotic pain meds. List the requirements for sponsoring the medication.

1. The client must sign a NCDVR Prescription Narcotic Pain Medication Contract which will be in effect for the duration of the service. 2. All prescriptions for narcotic medications for the client must be provided by one treating physician. If the client has a history or current diagnosis of substance abuse/dependence, he/she must sign VR Consent for Release of Confidential Information Form allowing the Division to release this information regarding past or current substance abuse to the treating physician. 3. VR sponsorship of narcotic medications should not exceed three prescriptions. Exceptions to sponsor more than three prescriptions requires Supervisor approval. In addition, a supervisor may approve an extension for a specified, limited, time if the client is actively being treated in a chronic pain clinic and under the medication protocols of that clinic. However, the Division is unable to purchase prescription narcotic pain medications on a long term basis for chronic pain disorders. In these situations, efforts must be made to identify long term funding sources for the prescribed medications. 4. The treating physician will provide the vocational rehabilitation counselor with a brief treatment plan for the patient. The counselor will be notified in writing of any significant changes or amendments to this plan. 5. If the patient is referred to another physician who will become the treating physician, the patient will sign VR Consent for Confidential Information Form allowing notification of the new physician of the patient's controlled substance use. 6. VR will not authorize replacements of narcotic medications that are lost, stolen, damaged, destroyed, thrown away, etc. 7. The client must inform the treating physician and rehabilitation counselor if he/she is receiving prescriptions for narcotic pain medications from any other physician. Failure to do so will result in the Division terminating sponsorship of this service. (2-16-9)

List the conditions that need to be met for VR sponsorship of surgery for morbid obesity:

1. the individual is at least 19 years old; and • medical record documentation substantiates that the individual has a BMI greater than or equal to 40 with serious complications/limitations in at least two of the following areas: o documentation of primary diseases such as arteriosclerosis, diabetes, heart disease, hypertension, pseudo-tumor cerebri, etc., is significantly complicated by clinically severe obesity o the obesity causes substantial orthopedic or physical impediments as documented by the medical history records including x-ray findings and other diagnostic test results o there is significant respiratory insufficiency or sleep apnea documented by respiratory function studies, blood gases, sleep studies o there is significant circulatory insufficiency documented by objective measurements; and 2. clinically severe obesity must be present for a period of at least three years; and 3. the individual must have made consistent efforts to lose weight over a period of 9 months or longer under physician supervision or in an organized weight loss program and failed; and 4. the individual has no correctable cause for the obesity, e.g.; an endocrine disorder. (2-16-1)

List the maximum rates based on type of residence:

A limit of $12,000 total Division case expenditures per client per case shall be placed on residence modification projects in general, with specific project limits based on the type of residence.

A client began a job at a small local auto salvage shop. He is having difficulty performing some of his job duties, which includes standing at a counter when serving customers, because of his physical disability. He is also having issues accessing the bathroom. The owner of the shop is open to changing the set-up of the shop and bathroom to meet his needs. The rehab engineer has been to visit with the client and owner. The engineer is recommending some structural changes with an estimated cost of $2750. Explain the process you would use to assist with this worksite mod

A limit of $7000.00 shall be placed on all worksite modification projects. Unit Managers shall approve and oversee the bidding and vendor selection process for projects less than, or equal to, $2500.00, while projects estimated to be greater than $2500.00 must be approved by the Chief of Policy.

Your client is a junior in college and his program requires him to have an unpaid internship. Can you sponsor the pay for your client's internship?

A paid internship may NOT be sponsored for clients in postsecondary training if the training program requires an unpaid internship. The ble .nd of paid and unpaid hours may result in a conflict regarding workers' compensation responsibility, duration of the internship and maximum hours per week. (2-20-9)

When provided as a Core service, counseling and guidance must be this:

A substantial nature that addresses separate and specific objectives with documentation of regular appointments and progress toward objectives. Counseling and guidance provided as a Core service is distinct from the general or supportive counseling relationship that exists between the counselor and client and that accompanies the provision of other Core rehabilitation services. (2-7)

What is the definition of a substantial service?

A substantial service is any Core vocational rehabilitation service that is provided within a supportive counseling and guidance relationship and contributes significantly to the individual's successful employment outcome. (2-2-1)

List the criteria for when physical restoration is viewed as a substantial service:

A. provided to substantially reduce or eliminate limitations/impediments associated with a chronic impairment; B. required by the individual in order to begin work, return to work, or maintain employment; C. provided within a supportive counseling and guidance relationship and/or in conjunction with other Core VR services. (2-16)

VR funding for supported employment training cannot exceed this time period:

According to the Workforce Innovation Opportunity Act (WIOA) VR funded SE cannot exceed twenty-four (24) months unless the IPE indicates that more than twenty-four (24) months is necessary to achieve job stability. (2-20-13)

Can an internship and supported employment be provided at the same time?

An internship may NOT be provided within a program of supported employment.

Name the reasons why a service may be provided to a family member of a client.

Any rehabilitation service may be provided to a member of the client's immediate family if the service is required in the client's rehabilitation program, is essential to the success of the rehabilitation program and is not readily available through other agencies or resources. (2-19)

You have a transition caseload. You have a 17-year-old client whose vocational goal is graphic artist. She has no work experience. The BRR in your office has established an internship opportunity for a person to work the front desk at a local hotel in the afternoons and weekends. Would it be appropriate to consider your client for this internship?

As an IPE service, an internship includes coordinating a site and tasks with a business/organization and providing support to the intern and site supervisor as the intern progresses through training. Internships may be coordinated when employment is not immediately available as a result of the client's lack of experience required for the desired job goal or when additional experience is required to allow the client to be competitive in a specific industry based on the local labor market. Internships are not intended to meet a client's goal for permanent job placement, but instead to serve as a training opportunity which primarily benefits the client over the business. When a business does not offer a paid internship, the Division may sponsor the intern's wages. (2-20-9)

A client is starting a job next Monday. She has a car (2001 Honda Civic), but needs a new wheel bearing to safely drive it. The cost is estimated to be $650. Explain what you would do in the situation to assist her.

At the discretion of the counselor, a request may be made to the policy office to conduct a DMV review before agreeing to sponsorship of repairs. Repairs up to seven hundred fifty dollars ($750.00) require only one quote from a reputable auto service vendor. (2-22-2)

An 18-year-old man on a transition caseload wants to be a librarian and would like to pursue a Master's Degree in Library Science upon graduation from High School. Would this be appropriate to put on the IPE? What documentation would be required to be in the file?

Before completing the Individualized Plan for Employment (IPE), the counselor must determine that the individual has the capacity to achieve the job choice and to perform the essential functions of the job when the training is completed. Objective data must be obtained, analyzed and included in the record to ensure that the individual can successfully complete the training program and go to work. Sources of data include secondary school transcripts with SAT scores, placement test scores, previous postsecondary school transcripts, vocational evaluation, and/or psychometric assessments. Division assistance is limited to the requirements necessary to achieve the educational credentials for the job choice. Students attending postsecondary schools including private or non-profit technical and vocational schools shall meet the institution's requirements for full-time attendance. Financial need must be established and comparable benefits used to the maximum extent, when available, in order for the Division to contribute to tuition, required fees and support services. Application for and use of comparable benefits, including the Pell Grant, is required of clients for any postsecondary training. (2-20-1)

Your client with paraplegia has gotten his driver's license and is ready to drive. He will need modifications to his current vehicle, including hand controls, a spinner knob, and pedal guard. The engineer has estimated the cost of the mods at $2200. Explain the process you would use to assist with the mods, along with the list of information to be sent for approval.

CLIENT DATA PACKET: A packet of information prepared by the Counselor and submitted to the Chief of Policy on all vehicle modification proposals that exceed $500. The packet is submitted to the Chief of Policy for casework/policy review. The packet then goes to the Rehabilitation Specialist for technical review. If the estimated amount is within the approval authority of the Supervisor, then he/she should review the case record with particular emphasis on this information generally required in the client data packet. The required components of the Client Data Packet are specific to the type of modification and are found in the applicable Client Data Packet Checklist. These checklists are located on the DVRS Intranet 'FORMS' page, under the VR Client Templates section. (2-18-2)

Give an example of both situations to explain this policy. (2-2-1) (Omission of services)

Client requires selected job placement services that can be provided by the BRR and the Counselor instead of planning WAT job coaching services (purchasing job placement services from CRP).

When can communication services be provided

Communication accessibility may be required at any time during the rehabilitation process. (2-6)

You have determined that your client is an appropriate candidate for post-secondary training. He says that he would like to attend school in another state. What is the procedure for arranging this?

Counselors should thoroughly review in-state opportunities and discuss them with the client prior to considering out-of-state vendors. Factors to consider include non-resident tuition rates, difficulty establishing vendors, excessive transportation and/or maintenance expenses, client's ability to function independently, continued counseling needs, and the client's employment plans after completion of the training. The individual must understand that some out-of-state services cannot be assured to the degree provided in state. The Supervisor must approve all out-of-state training.

What is Durable Medical Equipment?

Durable medical equipment (DME) is that which (a) can withstand repeated use; (b) is primarily and customarily used to serve a medical purpose; (c) generally is not useful to a person in the absence of an illness or injury; and (d) is appropriate for use in the home. (2-5)

A potential employer asks about the nature of your client's disability. How should you respond?

During the placement effort, the Rehabilitation Counselor should discuss functional limitations only as they relate to the client's ability to perform the essential functions of the job with or without reasonable accommodations. As the employer only needs to know whether the client has any functional limitations which will impact on specific job tasks, the Counselor must limit the discussion to any functional limitations that will impact on the client's ability to perform the job tasks or functions identified by the employer. This discussion may also include identifying reasonable accommodations which have been provided or could be provided. The specific disability should not be discussed by the Counselor with the potential employer. (2-11-1)

How many semesters can we sponsor at a College or University?

Eight to ten (10) semesters at a college or university

Who must approve policy exceptions?

Exceptions to the policies concerning the provision of services must be approved by the Chief of Policy, unless approval is specifically delegated to the Supervisor. (2-2-2)

There is a laptop available at the campus bookstore for $2000. What is the procedure for purchasing this laptop?

For students enrolled in post-secondary training programs at community colleges, colleges or universities whose bookstores sell computers directly, the Counselor should issue an authorization to the bookstore for up to the Division's maximum rate (rates published in Volume V on the VR intranet- [not to exceed $2,300.00]).

A student from out of state comes here and is determined eligible and appropriate for training. Can we pay out of state tuition rates for that student?

For those individuals who have not met NC residency requirements but who intend to remain in the state and have not relocated to North Carolina in order to receive rehabilitation services, training can be considered as part of the rehabilitation program. However, Division sponsorship is limited to the rate for NC residents. Financial need must be established, and comparable benefits used to the maximum extent, when available, in order for the Division to contribute to tuition, required fees and support services. For those individuals who are NC residents and choose to attend training programs out-of-state, Division financial assistance is limited to the NCDVRS in state rates for comparable training programs. (2-20-5)

How many semesters of Community College can we sponsor?

Four to five (5) semesters at a community college

What types of repairs will not be sponsored?

General "upkeep" items should not be authorized. (2-22-2)

According to policy, both the omission of services that are required to achieve the rehabilitation goal and the provision of services that are not required to achieve the job choice are audit exceptions to the requirements of Federal regulations.

Give an example of both situations to explain this policy. (2-2-1) Omitting a restoration service when the service is required but VR is not the funding source (client has mental health dx. and thus, mental restoration services should be planned.) The service may be occurring prior to IPE development. Omitting the service of high school instruction on the IPE when the client is in secondary education (High School)

A 32-year-old woman comes to you as a referral seeking assistance with graduate school. She had a spinal cord injury at the age of 16 that resulted in paraplegia. She has a bachelor's degree in business administration. She is self employed as a bookkeeper. She also does tax preparation. Last year, she earned $34,000. Would it be appropriate to consider sponsorship of graduate school?

Graduate training may be sponsored for those individuals who require this level of training to reach the job choice. For those individuals who have an undergraduate degree and require graduate training to advance in employment, graduate training may be sponsored subject to Supervisor approval. (2-20-4) Advanced training (including graduate and professional training) may be sponsored by the Division when necessary to maximize the potential for participants to prepare for, obtain, retain and advance in high quality jobs and high-demand careers such as law, medicine and other STEM fields. This category of training services applies to "job-driven training" meaning: training which will enhance one's existing skills to pursue high quality employment outcomes. (2-20-1)

If you send your client off to college in August and find out in December that they dropped 6 hours of class at the beginning of the semester and they completed the semester with only 10 hours of credits, what happens next?

If a student drops enough courses to change the attendance status from full-time to part-time without prior approval from the Division, sponsorship will be discontinued after the student has been provided with notification one semester or quarter prior to the change. (2-20-1)

A client has a below the knee amputation and is in need of a new prosthetic. The quote from the prosthetist is $12,500. What would you need to do in order to sponsor this for the client?

If the estimated cost is $2501 or more: o an assessment and quote is obtained from a certified prosthetist o the counselor submits a client data packet to the Chief of Policy o the Chief of Policy reviews and responds with an approval or denial external to BEAM o the purchasing agent verifies that the L codes are within the allowed fee schedule in Volume V and instructs the counselor to add the service to the plan o the counselor puts the service on the plan, and documents under "Counselor Comments": "Sole source of the vendor is warranted in accordance with Waiver section 01 NCAC 05b. 1401because a particular prosthetic appliance is needed. o the Chief of Policy approves the plan in BEAM o the purchasing agent in the Division Purchasing Section negotiates and carries out the purchase and issues the authorization (2-16-4)

If services are not initiated within a set amount of time, what must you do?

If the substantial service has not been initiated within 90 days of the projected initiation date the circumstances requiring the delay must be documented on a progress review. (2-2-3)

A client would like to pursue the vocational goal of being a diesel mechanic. There is a community college ten miles from the student's house that offers a two-year diesel mechanic program. In the next county, 50 miles away there is private vocational school that offers a ten-month program for $11,000. You have determined that the client is capable of reaching the vocational goal. How should you proceed?

If the training being considered is available through the Community College System, utilization of this resource should be given consideration and preference prior to other options. Business and trade schools may provide training that is completed more quickly for clients who are unable to participate in a community college system. However, care should be taken in evaluating business and trade school programs in relation to the client's overall vocational needs. Considerations should include the need to develop basic skills in the chosen area, the rate at which the individual learns, the need for support services, and the employability of individuals. Financial need must be established, and comparable benefits used to the maximum extent, when available, in order for the Division to contribute to tuition, required fees and support services. Division financial assistance is limited to the cost of the program or the Division's Proprietary Vocational/Business rate, whichever is less. The rate for Proprietary Vocational/Business Schools is based on the Division's rate for community college or the public university system. Private, proprietary schools may offer vocational, business, technical or other training at the physical location of the community college or university system. These courses will also be sponsored at the Division's vocational/business school rate or the cost of the program, whichever is less. (2-20-2)

Your client lost his driver's license, has just found a job and is requesting sponsorship of insurance and repairs for a moped. What would you do in this situation?

Insurance for motorcycles and mopeds will not be sponsored. Repairs to motorcycles and mopeds will not be sponsored. (2-22-1; 2-22-2)

A client has been made eligible based on arthritis in her knee. An IPE has been developed, and VR is sponsoring a continuing education course and assisting with job search. Unfortunately, she fell recently and now has a rotator cuff tear. She is asking for help with her medical treatment, including surgery. How would you handle this?

Intercurrent illnesses are defined as those illnesses that arise during the course of the rehabilitation program and interfere with completion of the intermediate program objectives. Illnesses may be either acute or chronic. Treatment of such illnesses may be sponsored by the Division. Specialty medical information is required along with a treatment plan. Financial need must be ascertained and comparable benefits used when available. (2-16)

Can an internship be provided at a CRP? With what restrictions?

Internships conducted at a CRP must be directly related to an employment goal with an opportunity specifically and uniquely offered by a CRP (i.e. human service or professional level job). The internship site must be fully integrated. If a client requires a job coach to participate in an internship the job coach cannot be employed by the CRP hosting the internship. In additional to supervisor approval, Chief of Policy approval is required in advance for internships conducted at a CRP. (2-20-9)

Can an internship be provided to a high school student?

Internships may be provided to high school students who are in their sophomore year of high school or higher either during the school year or in the summer(s) following the sophomore year.

What are the distinctions between Job Search Assistance, Job Placement Assistance and On-the-Job-Supports?

Job Search Assistance: activities that support and assist a consumer in searching for an appropriate job. Job search may include help in resume preparation, identifying appropriate job opportunities, developing interview skills and making contacts with companies on behalf of the client. Job Placement Assistance: a referral to a specific job resulting in an interview, whether or not the individual obtained the job. On-the-Job Supports: defined as support services provided to an individual who has been placed to enhance job retention. Such services include job coaching, follow-up and follow-along, and job retention services. (2-11)

You are swamped at work. You have COAST constantly. You have a client that is desperate to go to work. You simply do not have enough time to fully devote yourself to his job placement. Is it appropriate to refer your client for Work Adjustment job coaching?

Job coaching services cannot be utilized for job placement service only. (2-20-11)

Does the Social Security Administration consider the stipend that we pay for In-School work adjustment as income?

Monetary incentive payments issued to the student by the school are considered countable earned income by many public benefit programs. Clients who receive public benefits such as SSI, SSDI, food stamps and subsidized child care should explore the impact of the incentive payments on public benefits including a referral to a benefits counseling specialist or representative from the program administering the benefits. (2-20-16)

List at least five physical restoration services that can be provided by VR.

Morbid Obesity - Medically Managed Wt. Loss Programs and Surgical Intervention 2-16-1 Hearing Aids 2-16-2 Orthotics 2-16-3 Prosthetics 2-16-4 Podiatry 2-16-5 Visual Services 2-16-6 Chiropractic Services 2-16-7 Hospitalization (Diagnostic, Inpatient and Outpatient) 2-16-8 Drugs and Medical Supplies (Prescription and Non-Prescription) 2-16-9 Dental Services 2-16-10 Home Health 2-16-11 Speech Therapy 2-16-12 Physical Therapy 2-16-13 Occupational Therapy 2-16-14 Physical Capacity Assessment (PCA)/Functional Capacity Evaluation (FCE) 2-16-15

If a client is participating in an On the Job Training, has the client been hired by that employer?

OJT is typically coordinated for a client just prior to the client's start of employment, however it may be coordinated for individuals who have already been hired if the client is still in the training and orientation phase of employment and demonstrates a need for the service. Even though an employee/employer relationship exists, a client receiving OJT will be in training during the on-the-job training period. The trainer/employer is expected, however, to retain the client in employment following OJT.

The bathroom modification has been completed and the contractor has sent the invoice. What must the rehab engineer do at this point before the invoice can be processed for payment?

Payment Approval Process 1. The vendor/contractor will complete the project and send the invoice to the Rehabilitation Engineer. 2. The Rehabilitation Engineer will visit the work site to assure that all project specifications have been followed in a satisfactory manner. When the project is approved, the Rehabilitation Engineer will sign the contractor's invoice and forward it to the Counselor. 3. If the project is deemed unacceptable or incomplete, the Rehabilitation Engineer will consult with the Unit Manager, Counselor, client, and contractor to resolve the situation. The Policy Office is also an available resource for seeking resolution if a solution cannot be reached. If there are additional costs involved, an official price quote will be obtained from the contractor on letterhead or in an email and documented/approved on Form DVR-7007, Engineer Change Request. 4. The Counselor will attach a copy of the contractor's invoice to the payment approval and authorization and submit for payment. (2-18-1)

At what rate do we reimburse the employer in an OJT situation? Payment

Payment to the employer for OJT should be a reimbursement of 75% of the entry-level wage.

Define personal assistance: See IL PAS Needs Checklist on Intranet

Personal assistance is hands on assistance with two (2) or more major activities of daily living (ADL). Housekeeping or chore worker services shall be secondary to the hands on ADL activities and shall not be the only assistance that is needed. ADL tasks are basic daily living activities that must be performed to assure or support one's physical well-being. Examples of the major ADL activities include body/oral hygiene, bathing, toileting, dressing, grooming, eating, transferring, and moving about as needed in the environment. Housekeeping and chore worker activities involve basic activities that help to provide a safe and healthy living environment and promote community inclusion. Examples include cleaning, laundry, preparing meals, shopping, bookwork, and transportation. (2-15)

Name three types of training services.

Postsecondary Training 2-20-1 Vocational Training 2-20-2 College and University Training 2-20-3 Graduate Training 2-20-4 On-The-Job Training (OJT) 2-20-8 Internships 2-20-9 Work Adjustment Training 2-20-10 Brain Injury Support Services (BISS) Milestone Programs 2-20-12 Supported Employment 2-20-13 Employment Marketing Skills (Job Seeking Skills) 2-20-14 In-School Work Adjustment (ISWA) 2-20-16

What if the chair was not available on State Term Contract?

Procedures for Purchase of Non-Medical Equipment NOT available on State Term Contract (STC) See Chart in the Appendix. Estimated Cost > $500 - < $2500: 1. Verify that the item(s) are not available on the State Term Contract. Determine the estimated cost of the equipment. 2. If the estimated cost is >$500 - < $2500 the counselor completes the bid process. A minimum of three (3) written competitive quotations must be obtained as part of the bid process. The quotes must be maintained in the case record. 3. When the bids are received add the "off-contract" equipment service to the IPE, including the awarded vendor and the price quote for the equipment. 4. Supervisor approval is required. After obtaining approval, the counselor can issue the authorization to the winning bidder and complete the RFQ. (2-5-3)

Your client, who meets financial need, requires an ergonomic office chair at an estimated cost of $550. What is the procedure for purchasing this chair?

Procedures for Purchase of Non-Medical Equipment available on State Term Contract (STC) Cost > $500 - ≤ $2500: 1. Supervisor approval is required on the IPE. If approved, add the "on-contract" service to the IPE, including the quoted cost of the equipment. 2. Counselor issues an authorization to the STC vendor at the contracted amount which includes shipping, delivery and set-up charges.

A client is requesting assistance with replacing his hearing aids. In what situations would we sponsor this?

Rehabilitation Counselors may also approve sponsorship of a replacement hearing aid if the client meets one of the following criteria: A. The client is working and needs a hearing aid to maintain employment (a letter from the supervisor/employer is recommended for establishing the need). B. The client is not working and his/her current hearing aid is not meeting the communication needs of the client; C. The client has a documented rapidly progressive hearing loss. (2-16-2)

What are the conditions for supervisor approval of vehicle repair?

Repairs exceeding seven hundred fifty dollars ($750.00) will be approved by the Supervisor, and require that three quotes be obtained, with the low quote being accepted.

maximum rates based on type of residence

Residence owned by client or client's immediate family: A limit of $12,000.00 per project shall be placed on modification projects when the residence is owned by the client or client's immediate family. Mobile home owned by and located on property owned by client or client's immediate family: Modifications to a mobile home owned by the client or the client's immediate family, shall not exceed $8,500.00 per project. Mobile home owned by client or client's immediate family on rental/leased property, but mods are not permanently affixed to property: Modifications to a mobile home owned by the client or the client's immediate family, shall not exceed $8,500.00 per project. Mobile home not meeting above requirements: Modifications to a rented mobile home shall not exceed $5,500 per project. Exceptions to these amounts must be approved by the Chief of Policy and are considered on a case-by-case basis. Rental or leased residences: Modifications to rented or leased residences shall not exceed $5,500.00 per project (2-18-1)

Your client has gone through the seating clinic and has a prescription for a power wheelchair. Specifically, a Convaquip power wheelchair has been recommended by the seating clinic at cost of $1998.00. Your client meets financial need and has no comparable benefit available at this time. What is the procedure for purchasing this item?

See Chart in the Appendix- DME Purchase Procedures. Obtain a quote from the selected Convenience Contract vendor that lists: 1) the manufacturer's suggested retail price (MSRP) as documented on the manufacturer's order form when available (strongly preferred) or alternately the price quote obtained from the manufacturer; 2) the percent discount applied to the MSRP; and 3) the final price quote with discounts applied. Cost > $500 - ≤ $10,000: 1. Supervisor approval is required on the IPE. If approved, add the on-contract service to the IPE, including the price quote for the equipment. 2. Counselor issues an authorization to the Convenience Contract vendor for the price quote which includes shipping, delivery and set-up charges.

What if the wheelchair was not on the convenience contract?

See chart in the Appendix- DME Purchase Procedures. Estimated Cost >$500 - < $2500: 1. Verify that the item(s) are not available on the Convenience Contract. Determine the estimated cost of the equipment. 2. If the estimated cost is > $500 - < $2500 the counselor completes the bid process. A minimum of three (3) written competitive quotations must be obtained as part of the bid process. Written quotes obtained from each of the vendors must include the MSRP as documented on the manufacturer's order form when available or alternately the price quote obtained from the manufacturer and the discounted price quote. The quotes must be maintained in the case record. 3. When the bids are received add the off-contract equipment service to the IPE, include the awarded vendor and the price quote for the equipment. 4. Supervisor approval is required. After obtaining approval the counselor can issue the authorization to the awarded vendor and complete the RFQ. (2-5-3)

When must services be initiated and what is the timeline for initiation

Services must be initiated at the earliest time the service is available and that the client is prepared and available to participate. Delivery of substantial services should be documented within 90 days of initiation. (2-2-3)

When should they be informed of this standard?

Should the client's grades fall below the above minimum grade point average, the counselor must notify the client of the pending loss of Division assistance at least one quarter or semester before terminating assistance. This should be done at the beginning of each grading period so that the client has the following grading period to improve the grade point average to an acceptable level. (2-20-7)

A client with paraplegia due to a recent accident tells you that he wants to drive again. What process would you use to help him regain his driver's license? List everyone who should be involved in this process.

Some observations in policy... See Appendix Entry - Driver Evaluation & Training Services It may be necessary to secure both evaluation and training prior to getting a license. The evaluation must be conducted by a driver rehabilitation specialist, an individual who is licensed, trained, and experienced in evaluating individuals with specific disabilities. Individuals who have never had a driver's license are required to pass the written and eye examinations and to obtain either a driver's permit or a "Restricted Driving Permit" prior to participating in an in-vehicle evaluation or training. (2-9)

You have a client who is deaf and needs an interpreter for a job interview. What considerations must you take into account before authorizing this service?

Some observations in policy... See Appendix Entry - Hearing Disabilities Communication accessibility may be required at any time during the rehabilitation process in order to allow the individual to have access to all rehabilitation services. (2-6)

The closure of a supported employment case can occur 90 days after the completion of the stabilization phase. How long does the stabilization phase last?

Stabilization is confirmed when the client has completed his/her training objectives as indicated on the individualized service delivery plan and the client, employer, and the counselor jointly agree stabilization has been achieved. The completion date of the stabilization phase must be documented in the case record. There is no predetermined length for the stabilization period. (2-20-13)

VR transition services are provided to two population definitions.

Student with a disability Youth with a disability

Under what conditions can we sponsor summer school?

Summer school should not be authorized unless one of the following conditions exists: • Attendance during the summer will decrease the number of full-time semesters or quarters necessary to complete the training program • Summer attendance is required as part of the scheduled curriculum • The selected classes are only offered during the summer (2-20-1)

The counselor should obtain this before sponsoring permanent relocation costs:

The Counselor should obtain three competitive bids for total moving costs.

Can In-school work adjustment services be provided to a student classified as non-SD?

The Division can begin work adjustment activities for students with significant and most significant disabilities during the student's sophomore year (age 16) or younger (when there is an immediate need for services). (2-20-16)

For students who are deaf and hard of hearing and need assistive listening devices for training, who should the division encourage to purchase these devices?

The Division can encourage educational institutions to provide assistive listening devices for students who are deaf and hard of hearing. (2-5-3)

The psychologist who made the LD diagnosis has recommended that your client have a notetaker in class as an accommodation.

The Division can provide note taker services in support of other training services leading to the completion of the IPE.

Your client is struggling in a chemistry class at the local community college and has requested assistance with the sponsorship of a tutor. Do you have to determine the client's financial need first?

The Division can provide tutorial services in support of other training services leading to the completion of the IPE. Financial need and comparable benefits must be determined. (2-4-1)

A client is attending UNC Charlotte and is living on campus. What maintenance services could VR potentially provide and where would the rates for these services be found?

The Division can sponsor room and meals at the catalog rate for clients enrolled in undergraduate or graduate training programs within the UNC System, at private colleges/universities or out of state schools. All rates are noted in Volume V. (2-12-1)

Your client has gone through the seating clinic and has a prescription for a manual wheelchair. The recommended chair has a suggested retail cost of $1700. Your client is receiving SSI and has Medicaid. What is the procedure for purchasing this item?

The Division cannot invoice for durable medical purchases when the client has Medicaid, and the needed durable medical equipment is approved for Medicaid purchase. The Division can consider sponsorship of non-covered components. The Chief of Policy must approve an exception for the Division to waive Medicaid. (2-5-3)

There are many services that VR can provide to assist clients return to work. Name the three things that VR cannot purchase and/or provide under any circumstance.

The Division cannot purchase land or construct a building. Additionally, firearms cannot be purchased by the Division for clients. (2-14)

A client is continuing to have medical issues due to a stroke after a course of physical, occupational, and speech therapy. His doctor and therapists are recommending continued treatment as you reach the six-month mark of planned services. What do you need to do at this point?

The Division does not provide long-term or ongoing physical treatment. Accordingly, Division funds cannot be used to initiate treatment that is reasonably anticipated to last more than six months (per case) unless Supervisor approval has been obtained. Agreed upon extensions may be approved only if the client maintains reasonable progress toward achieving the vocational goal. An exception can be when the purchase of medication/medical supplies is expected to exceed six months duration in support of training as a major service on the Individualized Plan for Employment. It is expected that the counselor would work jointly with the client to identify comparable benefits for long term medical care. (2-16)

Under what conditions can we sponsor part-time attendance at post-secondary school?

The Division does recognize that factors related to the individual's disability or need to work while in training may interfere with full-time attendance. In such situations, with appropriate justification by the counselor and approval of the Supervisor, part-time attendance may be authorized. Lifestyle choices such as a preference for a more relaxed schedule or a pattern of repeatedly dropping courses will not be considered justifiable reasons to attend part-time. If a student drops enough courses to change the attendance status from full-time to part-time without prior approval from the Division, sponsorship will be discontinued after the student has been provided with notification one semester or quarter prior to the change. (2-20-1)

Under what circumstances can we sponsor distance learning?

The Division may sponsor individuals enrolled in licensed or accredited distance learning programs when such programs are not available through traditional on-campus programs, or when the individual has disability-related problems that prevent him or her from participating in an on-campus program. However, most students benefit from the structure and support of a traditional classroom. The Division's financial assistance for tuition and fees is limited to the rate for on-campus training published in Volume V (VR Intranet web site). The Division will not consider programs in which the entire package or curriculum must be purchased initially. The Supervisor must approve distance learning programs. This does not include individual classes that are distance learning as a part of a traditional campus-based program. (2-20-1)

List the maximum number of hours that the VR counselor can authorize and who must approve requests to exceed this amount.

The VR counselor cannot authorize greater than 28 hours per week for personal assistance. Requests to exceed 28 hours per week shall be submitted to the Supervisor. (2-15-1)

When must a Client Data Packet be sent to the Chief of Policy and Purchasing when purchasing equipment?

The client data packet is required when there is a request to: • Purchase items that exceed local purchasing limits • Waive Comparable benefits • Purchase off the state term contract when the equipment is available on the STC • Purchase from a preferred vendor • Sole source the purchase

Your client has been working for 90 days in an OJT. The OJT was completed today. When can you successfully close the case?

The client must be suitably employed for ninety (90) days following completion of training to be considered successfully rehabilitated. (2-20-8)

What is the academic standard required of clients attending a four-year university?

The client must meet the academic standards imposed by the postsecondary school and demonstrate steady progress toward completion of the training program. The client must have at a minimum a 2.00 cumulative grade point average at entry into the junior year for the agency to continue sponsorship. In the community college system, a 2.00 average is required at the end of the second semester or the average required by the school or particular curriculum in order to graduate from the program. In other programs such as proprietary vocational programs, the client shall meet the requirements of the school for each specified progress period that will enable the student to graduate or achieve the competency-based requirements at regular intervals set by the school.

The cost of transportation for a complete VR program shall not exceed this amount:

The cost of transportation for a complete vocational rehabilitation program shall not exceed $12,000. (2-21)

Your client was just placed into employment as a mechanic. You sponsored the purchase of $550 worth of mechanic tools for him to use at work. Is your client required to sign an Equipment Security Agreement?

The counselor is responsible for completing the Acknowledgement/Equipment Security agreement (DVR-1015) for any equipment costing $500 or more upon receipt of the equipment. (2-5-1)

Payment for private conveyance is based on what?

The current Volume V mileage rate. Payment is based on number of miles per trip. (2-21-2)

What does the Client Data Packet Include?

The packet should include a narrative explanation of the request for purchase with verification and/or documentation to support the request. Medical records, equipment evaluation and specifications, prescription, vendor quotes, Financial Needs Survey with supporting verification and documentation of comparable benefits must also be included. (2-5)

All services provided must be related to what?

The scope of rehabilitation services available to an individual is determined by the services required by that individual in order to reach the VR goal. All services provided must be directly related to the achievement of the goal established in concert between the client and the Counselor. (2-2)

Can tutoring services be provided to someone in secondary school?

The service cannot be provided to clients enrolled in public, private, or preparatory secondary schools. (2-4-1)

Define Rehab Engineering

The systematic application of technologies, engineering methodologies or scientific principles to meet the needs of and address the barriers confronted by individuals with disabilities in areas which include rehabilitation, education, employment, transportation, independent living and recreation.

A client has been participating in a job search and their car insurance is due. What would you do in this situation to assist your client?

The vehicle must be titled to the client as confirmed by the vehicle registration. Requests for approval should be directed to the Chief of Policy who is responsible for conducting a DMV review. Authorizations should not be issued until approval is received. Only minimal liability insurance can be authorized for a maximum of six (6) months. This service is subject to the individual's financial need and comparable benefits. (2-22-1)

Name at least three services that a rehab engineer may assess and/or recommend.

This includes services and devices which can supplement and enhance individual functions such as adapted computer access, augmentative communication, special seating and mobility, vehicle modifications, and services which can have an impact on the environment, such as accessibility, job re-design, work site modification and residence modification. (2-17-1)

Does financial need have to be determined before you sponsor this service (notetaker for LD)?

This service is not subject to financial need however, comparable benefits must be used. (2-4-2)

You are working with a client on finding a job and she is complaining of dental issues. List the conditions for when dental treatment may be provided, and what the dentist and client must be notified of prior to the examination.

Treatment may be necessary because of cosmetic appearance, dental caries and severe dental problems, and for orthodontic conditions. Evaluation of the dental condition should be provided by the dentist of the applicant or client's choice or, in certain cases (e.g., orthodontics or oral surgery), by a specialist for the problem under consideration. The dentist and the client must be notified prior to the examination that this Division will sponsor only that portion of the dental restoration that is essential to relieve the impairment resulting in the impediment to employment and that the client is responsible for any additional services and for any prophylactic care. (2-16-10)

The rate for private conveyance can be found where?

Volume V. (2-21-2)

A client reports that she has been seeing her primary care doctor for depression, but is having worsening problems. Where would you refer her, and if they couldn't help, what else could you do?

When public mental health services are not available, the Division may sponsor private therapy on an outpatient basis. Counselors may authorize up to twenty-four sessions for psychotherapy. Medication monitoring may also be sponsored by the Division when comparable benefits are not available. Psychotherapy will not be authorized to cover case management or other services managed by the Mental Health System. Inpatient therapy will not be provided. (2-13-1)

Is supervisor approval needed for an OJT?

YES. Sponsorship should normally not exceed three (3) months; however, with appropriate justification, the Supervisor may approve up to an additional three (3) months. Under no circumstances, will the OJT period exceed six (6) months.

PRE-ets age requirements

only for students with disabilities 14-21

Sponsorship of public conveyance is sponsored at:

the rate charged by the vendor. (2-21-1)

Can we sponsor remedial/developmental courses? YES. How many?

three remedial courses during the first two semesters

Public conveyance includes these:

tickets for buses, airfare, trains and other means of public transportation. Taxis may also be used. (2-21-1)

Physical restoration services may be provided as part of this:

to correct or substantially reduce a physical impairment that is stable or slowly progressive and that results in substantial impediments to employment. (2-16)

What are the five core services?

• Counseling and Guidance (refers to substantial counseling and guidance as opposed to that which is simply supportive in nature) • Diagnosis and Treatment of Impairments (Mental and Physical Restoration) • Training • Job-Related Services • Rehabilitation Technology (2-3)

Your client has requested personal assistance services (PAS). What is the criteria for a VR client to receive PAS?

• The individual must be eligible for VR services; • Determined to be either SD or MSD based on a physical disability with functional limitations in the areas of self-care and/or mobility; • The individual must require hands on personal assistance services (PAS) with two (2) or more major activities of daily living in support of one or more of the CORE VR services planned on the IPE.

Your client is asking for VR to purchase tools and other equipment for use at his job as an electrician. Which conditions should be met in order to purchase equipment for job placement?

• This service is subject to financial need. • The equipment is required for disability-related reasons and not available through other comparable benefits (i.e. the employer cannot provide it); • The equipment is usual and customary for the client's vocational goal and will be used by the client towards completion of the IPE. This must be a situation where the client has a solid employment offer or on-the-job (OJT) placement and the arrangement requires the consumer or agency to furnish their own equipment such as a telecommuting/work-from-home arrangement; • The client has the resources to safely store, insure (if appropriate), and adequately maintain the equipment. (2-5-2)