1370.00P Rehabilitation Technology Procedure
See corresponding policy: 1370.00 Rehabilitation Technology Policy
Note: Vocational Rehabilitation procedures provide internal guidance for ACCES-VR staff only and create no procedural or substantive rights for any individual or group.
Table of Contents
- Support System
- Fiscal Considerations
- Rehabilitation technology is an integral part of vocational rehabilitation services. This is evidenced in the 1992 Amendments to the Rehabilitation Act that places additional emphasis on the provision of rehabilitation technology services. This legislation requires State VR Agencies to identify how a broad range of rehabilitation technology services will be provided to ACCES-VR consumers at various stages of the rehabilitation process. In working with consumers and family members, counselors should explore rehabilitation technology services. Rehabilitation technology is a powerful tool that may be useful to persons with disabilities in identifying, developing and achieving their employment goal. The application of rehabilitation technology services may be of benefit to individuals with any type of disability. These services can assist individuals in achieving maximum independent functioning, increasing mobility, enhancing communication leading to increased access to employment or maintenance of employment.
- Rehabilitation technology is defined as the systematic application of technologies, engineering methodologies, or scientific principles to meet the functional needs of persons with disabilities. This includes rehabilitation engineering as well as assistive technology devices and services. Rehabilitation technology includes only those devices or services required to overcome the functional limitations imposed by an individual's disability.
Devices or services that are available under a prescription from a qualified health care professional, and/or are available through Medicaid or third party medical insurance (including prosthetic and orthotic devices, wheelchairs, hearing aids, etc.) are considered restoration services and are not rehabilitation technology. Devices or services required solely for training or employment that are not required as a result of the individual's disability are considered equipment, not rehabilitation technology.
Rehabilitation engineering is the application of scientific knowledge to practical purposes. It makes use of devices and techniques or strategies to remove or reduce barriers or obstacles to physical, behavioral or cognitive performance confronted by individuals with disabilities.
Assistive technology device means an item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of individuals with disabilities.
Assistive technology service is defined as any service that directly helps an individual with a disability select, acquire, or use an assistive technology device, including:
- assessing the needs of an individual with a disability, including how the individual functions in his/her customary environment or the environment where the device will be used, such as the home or work site;
- purchasing, leasing, or otherwise providing assistive technology devices;
- selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing assistive technology devices;
- coordinating and using other therapies, interventions, or services with assistive technology devices;
- training or technical assistance regarding rehabilitation technology required by an individual with a disability, or where appropriate, other family members;
- training or technical assistance regarding rehabilitation technology needed by the individual or others who play a major role in the individual's life. This could include professionals, employers, or other individuals who provide services such as education and rehabilitation.
- Note: This procedure does not address Home Modification and Vehicle Modification services. Separate Policies and Procedures exist for these services.
- Rehabilitation technology is an individualized service that requires an assessment of an individual's rehabilitation technology needs. Two people with similar disabilities may not have the same rehabilitation technology needs.
- ACCES-VR supports rehabilitation technology services that are necessary to meet the functional needs of an individual in achieving vocational objectives and goals. These services may be considered at any time, but must be considered and documented in the Case Record on Form VES-62, Matching People with Technology, at the following stages of the vocational rehabilitation process.
Consideration of rehabilitation technology should begin at the time staff is determining the individual's eligibility for ACCES-VR services and assessing the vocational needs of the individual. If appropriate, an individual may be referred for an assessment to determine how rehabilitation technology services may assist the individual in developing capacities to work.
Rehabilitation technology services may provide an individual with a severe disability the necessary resources to minimize functional limitations and increase the individual's ability to participate in employment. These services must be considered before a determination is made that the individual cannot benefit from vocational rehabilitation services in terms of an employment outcome.
Rehabilitation technology services must be considered and may be provided during extended evaluation to determine whether the individual with a severe disability may benefit from vocational rehabilitation services in terms of an employment outcome.
If appropriate, the Individualized Written Rehabilitation Program (IWRP) will include an assessment of the need, or expected need, for rehabilitation technology services. In developing an IWRP, the functional limitations of the individual will determine the basis for consideration of rehabilitation technology services in terms of the individual achieving a vocational goal. If appropriate, rehabilitation technology services should be listed on the IWRP as specified in ACCES-VR IWRP procedures.
During the placement process, the individual's need for rehabilitation technology must be considered. Needs for rehabilitation technology may emerge from the individual, the environment and/or the job tasks.
Follow-up activities must include a review of the rehabilitation technology services that were provided and their effectiveness in meeting the needs of the individual in terms of his/her employment outcome.
Rehabilitation technology services must be considered, as appropriate, during the assessment of the need for post employment services.
Rehabilitation technology, in the form of assistive technology devices and services, may be the responsibility of agencies, programs, and employers as reasonable accommodations under the Americans with Disabilities Act and/or under Sections 503 and 504 of the Rehabilitation Act. For instance, schools, colleges and post-secondary programs often modify computers in their technology labs to allow access by students with disabilities. (Note: Joint Agreement between the Office of Adult Career and Continuing Education Services-Vocational Rehabilitation (ACCES-VR) and the Office of Higher and Professional Education (OHPE).) Likewise, an employer may provide an ergonomic chair to allow a worker to sit comfortably at the work site. ACCES-VR will not provide rehabilitation technology that is available as a reasonable accommodation for individuals to fully participate in their programs, services or employment.
- If existing information is insufficient for determining the individual's rehabilitation technology needs, a referral for an assessment may be necessary. When making a referral for a rehabilitation technology assessment, the following information should be provided via VES-61A, Rehabilitation Technology Referral/Assessment Report:
- Social Security Number
- ACCES-VR ID Number
- Date of Birth
- District Office
- Counselor's Name
- Counselor's Phone Number
- Date of Referral for Assessment
- Primary Disability
- Secondary Disability
- Functional Limitations
- Education and Employment Background
- Vocational Goal
- Impediments to Achieving Vocational Goal
- Service that is Being Requested
- Equipment Currently Owned and/or Being Used
- Site/Situation Where Equipment Will Be Used
- Difficulty as Described by Consumer
- Consumer's Expectations/Goals for Evaluation
- Other Information Relevant to Assessment
- To the maximum extent possible, all assessments for rehabilitation technology will be conducted in the individual's customary environment or the environment where the technology will be used, such as the home or work site. The assessment will provide the following information:
- pertinent background information about the individual, including, as appropriate, the person's expressed needs and preferences, prognosis, and functional limitations that the technology must address in terms of an employment outcome;
- information about how the system functions, the environment in which the system is used or will be used by the individual, including limitations;
- a detailed recommendation of the specifications for a device, system, or service with justification, including advantages over other options, how it addresses the individual's functional limitations and vocational goals, maintenance cost, and cost benefits. If a brand or model is specified, generic equivalents, if available, should be identified;
- at least three alternatives considered, including a comparison of features, future expansion capabilities, costs, reliability, etc. If fewer options are considered, the reasons should be documented;
- the requirements for delivering the service, including training of the individual, family members and/or employer, necessary modifications to the system or site, follow-up schedule, and potential provider(s).
To meet the above informational requirements that are to be provided through the rehabilitation technology assessment, ACCES-VR has established a report protocol for vendors who provide rehabilitation technology assessments via VES-61B, Rehabilitation Technology Referral Assessment Report. This form standardizes the reporting of assessment information requirements and should be disseminated to vendors, as appropriate.
ACCES-VR's Counselor Task Force on Technology is comprised of District Office staff members and representatives from other Units within ACCES-VR. Task Force members were selected based on expressed or demonstrated interest and/or expertise in the area of rehabilitation technology. Task Force members fill an important need in District Offices by consulting on the technological needs of ACCES-VR consumers. Such consultation will ensure the most consistent and appropriate delivery of rehabilitation technology services.
Task Force Members will help District Office staff to:
- identify rehabilitation technology service options;
- ensure that the most cost effective rehabilitation technology services are considered;
- as appropriate, ensure that consumers and/or family member(s) receive necessary training as part of the rehabilitation technology services;
- ensure that a list of approved rehabilitation technology service vendors is maintained at the District Office; and
- maintain a current list of available rehabilitation technology service resources and references.
In addition, Task Force members will:
- identify potential vendors at the local level, and participate in the vendor selection and review process;
- conduct District Office staff training on rehabilitation technology services including policy and procedure, assistive technology services and devices and as new developments occur, provide staff with in-service updates; and
- conduct training for rehabilitation technology service providers on ACCES-VR's vendor selection and review process, referral, reporting, purchasing and monitoring requirements.
District Office staff are strongly encouraged to consult with designated Task Force member for the purpose of obtaining advice before a decision(s) is made. It is expected that the consultation will result in the counselor having a better understanding of the option(s)/choice(s) related to the needs of the individual. The decision to purchase or refer remains with the counselor/supervisor. A request for consultation may be made via the form: Request for Rehabilitation Technology Consultation. This form will assist staff in providing necessary information to the designated Task Force member. The Task Force member providing consultation will:
- review the request, as stated, and let the counselor know if more than a week is required to respond to the request and a timeframe will be negotiated.
- meet with the counselor, if necessary.
- The qualifications of persons or organizations conducting assessments or providing rehabilitation technology for ACCES-VR will be approved on the basis of education, experience, ability to work successfully with individuals with disabilities, and ability to provide comprehensive reports of findings and recommendations upon which to develop a plan for rehabilitation technology services. Such individuals must:
- have successfully attained skills and knowledge in the delivery of rehabilitation technology services;
- document successful experiences in providing rehabilitation technology services to individuals with disabilities in their area of expertise;
- demonstrate the ability to assess and deliver rehabilitation technology services and communicate the results effectively in a clear, concise, logical and objective manner;
- maintain adequate liability insurance.
- Standards for evaluating rehabilitation technology service providers must be developed at the District Office.
- Monitoring of vendor performance is the responsibility of the District Office. This information should be shared with appropriate member(s) of Counselor Task Force on Technology.
- Encourage that an ongoing working relationship be developed between vendor and Counselor Technology Task Force member.
- Evaluation period/process of new vendor must be developed.
- Review vendor reports (District Office staff and Counselor Task Force Member share results.)
- If vendor does not meet identified standards, remove from vendor list and notify appropriate member(s) of Counselor Task Force on Technology.
- Incorporate timeliness/cost effectiveness into vendor performance standards.
ACCES-VR has established a maximum cost for assessing an individual's need for rehabilitation technology services; however, the maximum cost limits do not apply to institution based programs. Rates for services provided at institution based programs are negotiated through Central Office's Bureau of Provider Review.
Fees negotiated at the local level should not exceed $175/half day service; $325 for full day service or $75/hour, not to exceed 20 hours of service. However, it is the responsibility of District Offices to negotiate reasonable fees, not to exceed the specified maximum amount, for their geographic region. In negotiating fees, consideration should be given to the qualifications of the service provider, the complexity and cost of necessary equipment to perform an adequate evaluation, need for travel, evaluation site, preparation of report, and research. Additional fees are not to be authorized for travel time, mileage, report writing or research, as these are included in the basic service fee considerations.
It is important, in making a referral for a rehabilitation technology assessment, that sufficient information be provided regarding the individual including the disability(ies), all known functional limitations, purpose of assessment including goals and functions to be accomplished, and where it is anticipated the person will need the technology - the environment where it will be used. Otherwise, the assessment may be inadequate in various respects, or additional time may have to be authorized for the person doing the assessment to get that information.
Depending on the nature of the disability, including whether it is stable or progressive, and the kinds of technology required, an evaluation may require only a few hours - usually sufficient for environmental control units, or augmentative communication - up to several days for more complex issues. In making a referral, the Counselor should discuss with the evaluator what is being requested and establish the time needed. Often, the assessment will be provided over several sessions, so authorization end date should allow sufficient time.
Because of complex issues, more than one vendor might be needed to assess the individual's needs. Additionally, over time, new assessments might be needed because of changes in the disability, in needs in goals, or developments in technology.
When more than one assessment is being performed by different providers, it is important that there be coordination and sharing of information to ensure compatibility of technologies and to avoid duplication of efforts.
When staff question the amount of time requested to perform an assessment, a member of the Counselor Task Force on Technology may be consulted.
No more than 20 hours may be authorized to a vendor to provide an assessment. If more time is needed, a waiver must be requested, providing full justification. A member of the Counselor Task Force on Technology may be consulted to assist in this process.
The maximum amount of time is NOT to be routinely authorized. It is expected that judgment will always be exercised to ensure that sufficient time is provided, without exceeding the time required to do the assessment.
Because of the individualized nature of rehabilitation technology services, ACCES-VR has not established a maximum cost cap for the purchase of technology devices or systems. However, Individualized Written Rehabilitation Programs for rehabilitation technology services will be subject to various levels of review based on the staff member's Plan of Supervision.
ACCES-VR will support the most cost-effective device or service that meets the vocational needs of the individual. Cost effectiveness is measured by comparing cost, level of integration, duration, quality, timeliness, proximity and appropriateness of service options to meet the individual's needs. The individual may choose to obtain more sophisticated or costly devices or services if he/she makes up the difference in cost.
ACCES-VR will not delay services to determine if comparable services and benefits are available under any other program before providing rehabilitation technology with vocational rehabilitation funds.
Note: Medically prescribed technological aids, devices and services that are funded under Medicaid or other third party insurance funds are considered physical restoration services, not rehabilitation technology services, and can only be purchased by ACCESVR after comparable benefits and services are considered.
Rehabilitation technology services provided after an individual has been determined eligible for ACCES-VR services are subject to an economic need determination. However, rehabilitation technology services that are provided to evaluate whether an individual can benefit from vocational rehabilitation services are not subject to Economic Need. Every effort should be made to obtain necessary technology for evaluations in the most cost effective manner. If the equipment can be rented or borrowed as a tryout for the consumer rather than be purchased, ACCES-VR should do so.
For economic need determination, note ACCES-VR policy on Consumer Participation in the Cost of Services.
Levels of approval for purchase of rehabilitation technology are in accordance with the individual supervisory plans, and in certain instances subject to review by the Counselor Task Force on Technology member. Purchases are also subject to policy on Request for Bid. Rehabilitation technology specifications must be in sufficient detail to be put to bid, and to enable consideration of competing systems or devices.
At any time, the counselor in consultation with his/her Senior Counselor may request a member of the Counselor Task Force on Technology to assist in or review technology problems or systems/accommodations recommendations either informally, or on a formal basis. However, when the cost of a system or accommodation exceeds $5000 then a formal review by member of Counselor Task Force on Technology is mandatory. At their discretion, district offices may establish a lower cost limit for requiring a formal review.
When the cost is more than $5000 but less than $8000, the review may be done by one member of the Counselor Task Force on Technology. When the cost is more than $8000, then the Counselor Task Force on Technology member will arrange for a peer review involving at least three members of the Counselor Task Force on Technology.
The procedure for the formal review process is as follows:
- The counselor/senior counselor will send to the Counselor Task Force on Technology member copies of all materials sent to the person doing the assessment, and all reports and recommendations received, with a "Request for Rehabilitation Technology Consultation".
- The Counselor Task Force on Technology member will review the materials, and request additional information if necessary.
- If a peer review among members of the Counselor Task Force on Technology is required, the Counselor Task Force on Technology member will share this information with at least two other members of the Counselor Task Force on Technology, and a consensus will be arrived at. In unusual circumstances, more than three members of the Counselor Task Force on Technology may be involved in a review.
- The Counselor Task Force on Technology member will prepare a written advisory opinion, which will be incorporated into the case record. Also, a copy of the consultation request and written advisory opinion will be forwarded to Central Office, District Office Administration.
- The decision making authority remains with the District Office, but the advisory opinion of the Counselor Task Force on Technology member should be addressed in documenting that decision.
- Case Record documentation must reflect that rehabilitation technology services were considered with the individual at the time of Referral and Application, Ineligibility, Extended Evaluation, development of the Base IWRP, IWRP Amendments, Placement, Follow-Up and Post-Employment Services and state whether or not they were determined necessary. Documentation should reflect the consumer's involvement in the decision.
- Review of case by representative from Counselor Task Force on Rehabilitation Technology will be documented on existing Supervisory Review Sheet.
Case service codes have been established to distinguish rehabilitation technology services. These codes will allow tracking capabilities and other benefits. When providing rehabilitation technology services, the appropriate case service code should be identified from the following list and entered on the authorization worksheet:
- Case Service Code 165 - Evaluation of Rehabilitation Technology: Includes all assessments that are used to determine the practicality and effectiveness of using rehabilitation technology including assistive devices and services. This encompasses recommendations for specifications, advantages over other options, maintenance, cost/benefits, and detail on how the device or service will address functional limitations in terms of an employment outcome.
- Case Service Code 820 - Assistive Technology Devices: Includes any piece of equipment or product system (whether commercially acquired "off-the-shelf" or modified or uniquely designed and produced) that is used to increase, maintain, or improve the functional capabilities of individuals with disabilities in terms of an employment outcome.
- Case Service Code 821 - Assistive Technology Services: Includes any service that allows an individual with a disability to select, acquire, or learn how to use an assistive technological device. This encompasses the use of a rehabilitation engineer or other professional to select, design, fit, customize, adapt, maintain, or replace assistive devices. This also includes integrating assistive devices into existing or proposed therapies, interventions, or other rehabilitation programs and services.
- Case Service Code 811 - Computers as Assistive Technology: Includes any computer system, or any piece of computer equipment, or combination of hardware and software specifically designed to increase or maintain the functional capabilities of individual's with disabilities in terms of an employment outcome. Examples of computer hardware and software needed for assistive technology includes speech recognition systems, speech synthesizers, braille printers, etc. Note: Case Service Code 250 has been changed from "Orthotics/Assistive Devices" to "Orthotics/Related Medical Devices". References to assistive devices have been removed from the definition of this case service code. Additionally, Case Service Code 810 - "Computers As Standard Equipment" includes computer system(s) needed as an ordinary requirement of the vocational objective. This definition does not include computer system(s) to minimize functional limitations posed by a disability.
Equipment and devices will remain the property of ACCES-VR until ACCES-VR transfers ownership to the individual once the individual is successfully employed. The individual must acknowledge via VES-69, Ownership of Equipment, that he/she understands that ACCES-VR retains ownership and will return the equipment or device to ACCES-VR, or repay ACCES-VR, if the goals of the IWRP are not met.
ACCES-VR will pay for the initial acquisition and installation of the system, software and supplies needed to achieve the individual's rehabilitation goal. Routine maintenance and repair is the responsibility of the party who owns the device. That is, until closing a person's case as the IWRP goal is met, ACCES-VR may pay for maintenance and repairs of the transferred to the individual at the time of placement and successful completion of the IWRP, the individual is responsible for all future costs of maintaining and repairing the device.
ACCES-VR may pay for the replacement or upgrading of assistive technology devices for eligible individuals only when the original system is no longer adequate because of the individual's disability, when there is a change in his or her vocational goal, when replacement is more cost effective than repairs or when the person will be unable to maintain employment without the replacement or upgrade.
- Memo on Payment of High-Risk Equipment Items