1282.00 Neuropsychological Evaluations Policy

(March 1988)

Table of Contents

Description

Definition

The neuropsychological evaluation is an in-depth evaluation of brain functioning to identify and describe abilities and deficits. The neuropsychological evaluation assesses the cognitive capabilities and limitations of the individual which include, but are not limited to: thinking and reasoning abilities, language processes, memory, attention and concentration, sensory motor abilities and the organization of behavior. This evaluation is particularly important in determining vocational programming for persons with traumatic brain injuries (TBI), since it is one of the most effective methods to determine the nature and implications of TBI and its consequences. Neuropsychological evaluations should also be considered for persons with suspected or demonstrated neoplasms, metabolic disorders, cerebrovascular disease and degenerative dementia.

Role of the Neuropsychological in the VR Process

Neuropsychological evaluations provide essential information to develop vocational program and placement approaches for consumers with TBI and other disabilities listed above. The neuropsychological evaluation goes beyond psychological evaluations by testing and evaluating specific areas of cognition and behavior. The conclusions are much more comprehensive than a psychological evaluation. The neuropsychologist has extensive training in brain-behavior relationships, neuropsychological assessment of cognitive functioning, and training to identify deficits and problems that result from organic, as distinct from psychological causes. The neuropsychological evaluation should be used by the counselor to:

  1. Provide a diagnosis and information to assist in establishing eligibility for vocational rehabilitation services.
  2. Define the degree of cognitive functioning and physical impairment to the brain.
  3. Provide a baseline against which future progress in vocational rehabilitation may be measured.
  4. Determine suitability for various types of intervention and compensatory strategies as related to the vocational goal.
  5. Provide information that will facilitate participation in educational, vocational or specialized programs.
  6. Help determine any rehabilitation of functions from neurological injury or disease. Estimates a person's ability to resume premorbid lifestyle.
  7. Help estimate the role of behavioral factors involved in a patient's functioning levels.

Standards for Neuropsychologist to Conduct Evaluations for ACCES-VR

The following standards should be applied when using professionals to conduct neuropsychological assessment for ACCES-VR consumers:

  1. A doctorate in clinical or counseling psychology or in neuropsychology from a school whose program is approved by the American Psychological Association; and
  2. Licensed as a psychologist in New York State; and
  3. One year of supervised professional post-doctoral experience in the administration and interpretation of neuropsychological evaluations.

Approval of neuropsychologist to conduct evaluations for ACCES-VR will be done through the central office Bureau of Provider Review.

Neuropsychological Content

There are a variety of tests available to neuropsychologists for assessment. The specific types of tests that are used by neuropsychologists should be determined by the nature of the person's injury and the context of the testing. Reports received from neuropsychological evaluations should include:

  1. Consumer background, including family situation, medical and pre trauma history, history since injury, and current status;
  2. Interview summary;
  3. List of tests administered;
  4. Test results;
  5. Behavioral assessment;
  6. Summary including strengths and weaknesses, suggested compensatory strategies and recommendations regarding vocational rehabilitation;
  7. Guidelines for reassessment;
  8. Recommendations for cognitive rehabilitation necessary to achieve vocational goals.

The ACCES-VR counselor, in some situations, may want to highlight possible supported employment situations for the consumer in the request for a neuropsychological evaluation. Questions concerning job coach training and related issues can be discussed in the evaluation report.

Fees for Service

Rates

Many consumers with head injuries, especially those with severe injuries, will have been in hospitals or progress that may have conducted neuropsychological evaluations. ACCES-VR counselors should secure these evaluations with consumer approval and determine what information, if any, should be updated. Consumer condition, age of the evaluation, type of vocational program and other factors will be considerations. A key person in this process will be the person who conducted the evaluation.

Administration of a battery of neuropsychological tests requires at least five hours, usually with additional time required for interpretation and report preparation. Additional administration time may also be required based on the nature of the cognitive impairments manifested by the consumer and the extent of information requested by the counselor.

The approved rate is $50 per hour for administration, interpretation and report preparation up to a maximum of 12 hours or $600. Neuropsychologists must be specifically approved by ACCES-VR to perform neuropsychological evaluations. All neuropsychological assessments will be authorized using the Case Service Code 034.

Re-Evaluations

A neuropsychological re-evaluation may be authorized only if changes in the cognitive, medical or behavioral status of the consumer require such re-evaluation and if such information is necessary to complete the IPE. The initial evaluation paid for by ACCESVR should provide specific guidelines for re-evaluations.