DRS Rehabilitation Policy Manual Chapter 19: Technical Information and References

Revised July 2016

19.1 Required Approvals and/or Consultations

(Revised 07/10, 10/10)

Policy establishes basic statewide operating principles that

  • define services and service limitations and
  • support the highest possible compliance with federal and state law through
  • informed consumer choice,
  • best-value purchasing, and
  • sound decision making.

Management review, consultation, and in some cases approval are necessary to implement some actions and/or decisions, including

  • exceptions to established
  • policies,
  • procedures, and
  • payment limitations; and
  • decisions about the best course of action for complex services.

Some exceptions must be implemented using specific procedures.

Policy must not create an immovable barrier to a consumer's rehabilitation. Counselors should seek waivers to policy where limitations create such a barrier. Area managers and consultants must provide expertise in mastering alternatives. See Chapter 1: Foundations, Roles, and Responsibilities.

The area manager may make an exception to any mandatory policy except to those

  • based on federal regulations or state law,
  • where it is stated that area manager exceptions are not permitted, or
  • requiring a different approval source.

In most cases, approvals are documented in a case note in the electronic case file. Approvals received electronically, such as by email, should be copied and pasted into the electronic case file. File paper approvals in the paper case file. All approvals must include a clear description of the basis for the approval.

To request a review by the medical director or Orthotic and Prosthetic Review Committee (OPRC), forward a courtesy case to the the DRS Central Office medical services team by emailing , including copies of all pertinent medical and psychological reports. The DRS Central Office program specialist for physical restoration or the DRS Central Office program specialist for disabilities documents the results of the review by the medical director or OPRC in ReHabWorks.

For a list of all items requiring approval or consultation, see Summary Table of Approvals and Consultations.

19.2 Disability Classifications and Codes[Placeholder]

(Revised 04/14, 10/15)

19.2.1 Selecting a Disability Classification

(Revised 09/10)

Disabling conditions are classified according to a structure that combines an impairment with a specific cause or source. Using prescribed categories, select the impairment and then the cause or source that best describes the consumer's primary disability; that is, the physical or mental impairment that results in a substantial impediment to

employment in VR, or

the rehabilitation goals in CRS and ILS.

Complete the following steps to select the disability code:

1.select the impairment category table that best identifies the disability:

osensory-communicative,

ophysical, or

omental;

2.select the specific impairment subcategory within the table, such as

odeafness, primary communication visual;

orespiratory; or

ocognitive; and

3.select the specific cause or source of the disabling condition in the cause or source table, such as

ocause unknown,

oamputation,

ocongenital conditions or birth injury, or

odigestive.

Using the same sequence of actions, select the secondary impairment that contributes to, but is not the primary basis of, the impediment to employment in VR or to the rehabilitation goals in CRS and ILS.

For information about eligibility requirements for specific conditions, see Chapter 3: Eligibility, 3.8 Required Assessments and Policies for Selected Conditions.

See Examples for Coding Common Disabilities in the Counselor's Toolbox for examples of coding common neurological, behavioral health, and physical disabilities.

19.2.2 Establishing the Significance of the Disability

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

When you select an impairment category, you must also determine the level of significance of the case. The level of significance of a case may be re-determined throughout the life of the case. However, if a case is designated as "significant" or "most significant," the case may not be re-determined as "not significant" without manager approval.

*A consumer's disability is considered "significant" when

it results in

oserious limits in functional capacity that require intervention not typically needed by workers without disabilities, and

oa need for multiple VR services to achieve a suitable employment outcome (that is, assessment to develop the IPE, counseling, and at least one additional substantial VR service); and

the delivery of services is realistically expected to take more than six months from the date of the IPE.*

*Based on 34 CFR Section 361.5(b)(31)

As a result of the RSA-911 reporting changes that were issued in August, 2013, states were required to further define "significance" into three levels of significance: 1) Not Significant, 2) Significant, and 3) Most Significant.

DARS definitions of three levels of significance:

1) Not Significant—No limited functional capacities.
2) Significant—One or more limited functional capacities and multiple services are needed for an extended period of time.
3) Most Significant—Three or more limited functional capacities and multiple services are needed for an extended period of time.

Document the justification for your decision in a case note. Select the correct level of significance in RHW. (See 19.2.7 Designating Level of Significance in ReHabWorks.)

19.2.3 The Significance of the Disability in SSDI and SSI Cases

(Revised 02/11, 11/15)

All consumers who receive Social Security Administration (SSA) benefits because of a disability must have their cases designated in ReHabWorks as having either a significant disability or a most significant disability for the life of the case. See 19.2.2 Establishing the Significance of the Disability.

19.2.4 The Significance of the Disability for CRS and ILS Cases

(Revised 10/15)

Level of Significance does not apply to CRS or ILS consumers' case files.

19.2.5 Designating the Level of Significance in Cases that Require Pre-Eligibility Trial Work

(Revised 12/15, 05/16)

All consumers who require pre-eligibility trial work must have their case files designated in ReHabWorks as either:

"significant" or

"most significant."

The level of significance must be:

assigned before authorizing Pre-eligibility Trial Work services; and

updated anytime when information is available to support the changes to the designated level of significance.

19.2.6 The Significance of the Disability for Cases Receiving Supported Employment Services

All consumers who require supported employment services must have their case files designated in RHW as "most significant" disability for the life of the case. Assign the level of significance at the time of eligibility or at any time thereafter when information is available to support the designation.

19.2.7 Designating the Level of Significance

The level of significance is designated at the time of eligibility on the "Disabilities" page in ReHabWorks.

To determine the level of significance of the case,

1.determine whether the impact of disability for the consumer meets the criteria for significance as defined above. You must support your designation with information from

othe consumer,

oreview of records and reports, and

ouse of the Table of Functional Capacities and Examples.

Functional limitations causing substantial impediments to employment do not always result in serious limits in functional capacity. If this is the case, select "not significant" and no further action is required.

2.determine that the consumer meets all criteria for the selected level of significance and select the corresponding response in the drop-down menu in ReHabWorks;

3.select one or more capacities in the Limited Functional Capacities page in ReHabWorks if you selected "significant" or "most significant." Ensure that the case file reflects evidence of the serious limitations in the categories selected; and

4.document your rationale

oin a case note, or

oby completing and filing in the paper file DARS1390, Checklist for Determining Significance of Disability.

5.When completing the IPE with the consumer, indicate the need for an extended time (six months or more) to deliver more substantial services than the assessment for developing the IPE and counseling services. Include in the IPE any needed interventions for each functional capacity area identified as seriously limited.

6.You must change the designation of Level of Significance of the case if you determine that the impact of the disability does not require the extent of services originally planned, or if you determine that the designation was made in error. Area manager approval is required to change a case to "not significant" if it was previously designated as "significant" or "most significant". Otherwise, the designated level of significance remains throughout the life of the case, even though the consumer's functional capacities may improve over the course of the case.

19.2.8 Table of Functional Capacities and Examples

(Revised 06/09)

The following table lists

specific capacities and

examples of the nature and extent of limits to capacities.

Capacity / Definition and Examples of Limitations
Mobility / As a result of the disability, a consumer's ability to move from place to place and move the body into certain positions is limited, and the consumer requires services or accommodations not typically needed by workers without disabilities.
Examples of seriously limited capacity in mobility requiring intervention include the following:
the consumer needs help to get to and from work, such as
ospecial training to learn to get to and from work, or
oa vehicle modification;
the consumer needs modifications, adaptive technology, or accommodations not typically made for other workers in order to move around the workplace; for example, a consumer needs
omodifications to a workstation or work environment, such as ramps or elevators;
oa scooter, wheelchair, or other mobility aid; or
oa service dog.
Self-care / As a result of the disability, a consumer's ability to perform activities related to health and hygiene are limited in a way that requires services or accommodations not typically needed by workers without disabilities.
Examples of seriously limited capacity in self-care requiring intervention include the following:
the consumer needs help to manage self-care activities such as eating, dressing, grooming, or taking medication; or
the consumer uses assistive or adaptive devices for self-care, such as braces, upper limb orthotics, or grab bars.
Seriously limited capacity in self-care may occur because of physical, cognitive, or emotional impairments and may apply to all tasks of self-care or only to specific tasks.
Self-direction / As a result of the disability, a consumer's ability to control and regulate his or her personal, social, and work life is limited in a way that requires services or accommodations not typically needed by workers without disabilities.
Examples of seriously limited capacity in self-direction requiring intervention include the following:
the consumer becomes confused or disoriented in performing routine job tasks and needs the help of a job coach or other supports;
the consumer needs ongoing help or intervention (such as a job coach or constant monitoring and redirection on the job) to begin activities related to task completion, socialization, or behavior management; or
the consumer requires supervision or assistance with managing money or time, or maintaining a schedule.
Work Skills / As a result of the disability, a consumer's capacity to acquire and maintain needed job skills is limited, and the consumer requires services or accommodations not typically needed by workers without disabilities.
Examples of seriously limited capacity in work skills requiring intervention include the following:
the consumer needs modifications, adaptive technology, or accommodations (such as a note taker, interpreter, or personal assistant to get to and from training or to plan, problem solve, or organize work functions) not typically needed by workers without a disability to acquire necessary work skills or training or to get or keep gainful employment; or
the consumer needs specialized supports not typically needed by workers without disabilities to get or keep a job; for example, a job coach or natural supports, job duty modification, or job restructuring.
The lack of work skills alone does not meet the criteria for seriously limited capacity in work skills.
Work Tolerance / As a result of the disability, a consumer's ability to consistently and adequately perform a job based on the physical, emotional, environmental, and psychological demands of the position is limited, and the consumer requires services or accommodations not typically needed by workers without disabilities.
Examples of seriously limited capacity in work tolerance requiring intervention include the following:
the consumer needs modified job duties or assistive devices to perform job duties, or needs altered work schedule or work hours, or needs frequent rest or breaks not typically needed by other workers in the workplace; or
the consumer lacks the capacity to perform effectively and efficiently job duties that require various levels of psychological demand (such as works poorly under stressful conditions or deadlines) and requires prescribed medication or specialized supports to sustain required levels of work function.
Interpersonal Skills / As a result of the disability, a consumer's ability to establish and maintain appropriate relationships with other people in the workplace is limited, and the consumer requires services or accommodations not typically needed by workers without disabilities.
Examples of seriously limited capacity in interpersonal skills requiring intervention include the following:
the consumer requires specialized services, modifications, or supports to establish appropriate relationships with co-workers, employers, and others in the workplace (for example, history of job loss because of conflicts with employers or co-workers); or
the consumer requires medication or specialized services in order to interact with others in a socially appropriate manner; or
the consumer requires specialized services or supports to reduce inappropriate behaviors that interfere with getting or keeping a job (for example, the consumer has difficulty relating to co-workers, talks excessively, or behaves inappropriately in the job or training setting).
Communication / As a result of the disability, a consumer's ability to convey and receive information efficiently and effectively is limited, and the consumer requires services or accommodations not typically needed by workers without disabilities.
Examples of seriously limited capacity in communication requiring intervention include the following:
The consumer requires modifications, adaptive technology, or accommodations (not typically required for other people) to effectively and efficiently communicate orally or in writing with people without disabilities (for example, the need for an interpreter for training, use of a TTY or TDD to perform job duties, use of a hearing aid to understand speech on the job, or use of specialized communication equipment to produce speech).

19.3 Case File Maintenance

The purpose of this section is to describe processes necessary for case file uniformity. You are ultimately responsible for the

  • management of the caseload,
  • location of case files, and
  • case correction activities.

The case file system consists of an electronic case file and paper case folder.

19.3.1 Preparing and Using the Paper Case Folder

(Revised 5/11, 11/14)

Paper case files must be prepared and maintained as follows.

DRS staff members must

  • secure all documents from the consumer case file to the folder jacket;
  • record on the tab label of each case file folder jacket, the consumer’s
  • last name and first name (for example, Smith, John A.), and
  • case ID;
  • stamp “Confidential” on the front and back of the case file folder jacket;
  • ensure that all documents are date stamped or otherwise marked with the date generated and or received in the office;
  • date stamp the first and last pages of the packets for documents with a large number of pages (such as packets of medical records); and
  • file documents so that the first document is on the bottom and the most recent is on the top.

File the following documents from bottom to top on the left side of the case file in the order received. Be sure that

  • all financial documents are grouped together, including
  • invoices,
  • bidding documentation, and
  • signed itemized receipts; and
  • all service authorizations; and
  • correspondence with providers regarding billing; and
  • all other documents relating to consumer purchases.

File the following documents from bottom to top on the right side of the case file in the order received, as follows:

  • Signed release forms
  • Signed paper individualized plan for employment (IPE) or IPE amendments
  • Correspondence
  • All records and reports and assessments
  • Copies of documents verifying the consumer’s identity and authorization for employment in the United States
  • Financial records used to verify consumer income and expenses for calculating participation in cost of services
  • Verification of eligibility for SSI/SSDI benefits
  • All other documents related to the consumer’s vocational rehabilitation program.
Exceptions:

Documents associated with billing for multiple consumer purchases may be placed in a centralized file in the field office.

Do not put documents into a consumer’s casefile that contain other consumers’ names or identifying information. If necessary, make copies of the documents and redact the identifying information of other consumers before filing the documents in each consumer’s file.

When a medical service coordinator or courtesy counselor is involved, the courtesy file becomes an extension of the main folder. The courtesy counselor forwards copies of all pertinent documents to the home counselor.

Additional Case Folders

When the volume of information on a consumer is more than a single case folder can physically hold, additional case folders can be used.

Paper case files must be prepared in accordance with DARS Business Procedures Manual Chapter 13: Records Management, 13.6.1 Preparing Closed Consumer Case Files to Box.

File the following documents from bottom to top on the left side of the case file in the order received:

all financial documents grouped together, including

oinvoices,

obidding documentation, and

osigned itemized receipts; and

all other documents relating to consumer purchases.

Exceptions:

Documents associated with billing for multiple consumer purchases may be placed in a centralized file in the field office.

When a medical service coordinator or courtesy counselor is involved, the courtesy file becomes an extension of the main folder. The courtesy counselor forwards copies of all pertinent documents to the home counselor.

File all other documents on the right side of the paper case folder in the order received, from the bottom to the top. Include originals or copies of any related reports, forms, letters, and email from the consumer or consumer's representative, not generated by ReHabWorks.