Determining eligibility is a cornerstone of the vocational rehabilitation (VR) process. The purpose of determining eligibility is to identify individuals with visual disabilities who can benefit from VR services in terms of employment. Eligibility determination helps the consumer to find optimal employment through a comprehensive and coordinated program of vocational rehabilitation.
The vocational rehabilitation (VR) counselor is responsible for determining an individual's eligibility for VR services, and does so by using information provided by
This responsibility for determining an individual's eligibility cannot be delegated to someone else by the counselor.
To the maximum extent possible, the counselor must
The information must reflect the current functioning or condition of the person. For example, an eye exam that is two years old, but shows that the person has been totally blind since birth, is acceptable.
The counselor should not purchase diagnostics to address basic eligibility questions unless existing data is unavailable or insufficient.
If assistive technology devices and services or worksite assessments are necessary to determine whether a consumer is eligible, they must be
Note: In ReHabWorks (RHW), if a consumer's case has been closed two or more times as Outcome Unsuccessful before or after Plan Initiated, the field director must review the case before the counselor determines eligibility.
The eligibility decision must be
When making an eligibility decision, the counselor might have diagnostics and other records that were not available at the time of application. Before entering the eligibility decision into RHW, the counselor must
The rationale for the counselor’s decisions regarding eligibility and the determination of level of significance must be documented in case notes entered in RHW. The significance designation can be changed at any time during the life of the case. See 3.14.1 Establishing the Significance of the Disability.
Persons who apply for or are eligible for vocational rehabilitation services must be active and full partners in the process. They must make meaningful and informed choices during assessments, planning, and in the selection of employment outcomes, service providers, and methods for procuring services.
Applicants should be encouraged either to bring to the office or to have available at their home the following documents when the counselor visits:
There are four eligibility criteria for certification of vocational rehabilitation (VR) services.
They are as follows:
The counselor must address all four eligibility criteria in the eligibility case note. See Chapter 40:Case Management, 40.1 Case Notes for more information.
An applicant showing documentation of receiving Social Security Disability Insurance (SSI) or SSI Supplemental Security Income (SSDI) based on being blind must be presumed eligible for vocational rehabilitation services, provided the applicant intends to:
In some cases, because of the severity of the applicant's disability, a counselor cannot presume eligibility. In those cases, the counselor must provide pre-eligibility trial work.
While gathering information from the applicant, the following questions should be addressed to help determine eligibility:
The counselor must work with the applicant to verify eligibility when the applicant:
The counselor can obtain eligibility verification by:
Veterans may also request the DD Form 214, Report of Separation, through the National Archives by submitting the Standard Form (SF) 180, which is used to request military records, by mailing or faxing the form to the National Personnel Records Center (NPRC), Military Personnel Records, 1 Archives Drive, St. Louis, MO 63138. They may also write a letter to that address to request the DD Form 214. The NPRC fax number is 314-801-9195.
The SF-180 can be obtained online, by writing a letter to the NPRC at the address above or by calling 314-801-0800 to request the form.
When the counselor enters information into the ReHabWorks Monthly Financial Information page showing that the applicant receives SSI or SSDI benefits, the counselor must also enter a case note documenting the
A person who receives either SSDI or SSI because of disability is also considered a person with a significant disability.
Eligibility must be determined within 60 days after an applicant has applied for VR services and is available for an assessment, so the counselor should start as soon as possible to gather the information needed to determine eligibility.
Forty-Five Days after Application
If 45 days after the application is signed the diagnostic information needed to determine eligibility has not been received, the counselor should contact the applicant to discuss an extension of time or case closure.
Failure to Locate Applicant
If a consumer cannot be located or does not respond to attempted contact, the case should be closed before the 60 days to determine eligibility have elapsed.
If the counselor cannot determine the applicant's eligibility within 60 days, the case must be closed unless one of the following exceptions occurs:
All exceptions to the 60-day rule must be documented in ReHabWorks.
Document that the consumer has agreed to an extension of time to determine eligibility by
If the consumer is not available, document in a case note why the consumer is not available and efforts made to obtain written authorization for an extension of time.
Note: The visual acuity to be used is the best corrected distance acuity. Best correction is the best visual acuity obtained with a simple refraction (glasses or contact lenses), not with a low vision aid, e.g., telescopic aid. The visual acuity is to be measured by the distance Snellen chart or converted to the distance Snellen equivalent in writing by an ophthalmologist or optometrist.
Eligibility is determined and documented before determining whether or not a consumer will participate in the payment of services.
Eligibility is determined without regard to sex, race, age, color, creed, or national origin.
Any individual who resides in an institution (such as a state school, state hospital, or prison) and is not expected to be released within 60 days will not be considered for services.
If a person is hospitalized at the time of referral and before applying for services, the counselor may purchase medical records to determine eligibility, but may not purchase medical services.
After a comprehensive assessment has been completed and an IPE has been developed, services may be provided in accordance with other criteria specified in this manual.
Counselor decisions must be based on vocational rehabilitation needs and not in response to emergency physical restoration referrals from community resources.
The individual has a visual impairment. For more information, including definitions, see Chapter 2: Intake, 2.2.3 Diagnostic Studies—Medical.
A visual impairment is defined as
Note: The visual acuity to be used is the best corrected distance acuity. Best correction is the best visual acuity obtained with a simple refraction (glasses or contact lenses), not with a low vision aid, such as a telescopic aid. An ophthalmologist or optometrist must
Deafblindness is a condition in which both a hearing and vision loss are present at the same time. The combined effect of these losses, even if both are mild, creates unique challenges for the person that cannot be addressed solely within a program for the deaf or a program for the blind.
Deafblind consumers should be served by DBS because deafblind specialists are available to serve DBS consumers statewide. For more information on services provided by deafblind specialists, see Chapter 12: Deafblind Services, 12.2 Services Provided.
The visual impairment constitutes or results in a substantial impediment to employment.
A substantial impediment to employment exists when a visual impairment significantly:
Other medical, psychological, vocational, educational, cultural, and social factors may combine with a visual impairment to create an impediment to employment. Examples of such factors include:
In determining eligibility for VR services, remediable conditions may be considered disabling. These conditions
Consumers with remediable conditions must be informed in their IPEs that if a remediable condition improves to the point that the consumer no longer has a visual impairment to employment, DBS can provide only counseling and guidance, information and referral, and placement services. Example: Cataracts.
Types of employment outcomes include:
The individual requires vocational rehabilitation (VR) services to prepare for, secure, retain, regain, or advance in competitive integrated employment that is consistent with the individual's strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice.
Restated, the third eligibility criterion means that the consumer must require VR services in order to be employed.
The consumer requires VR services to prepare for, secure, retain, or regain employment if he or she needs one or more of the following services:
These services must be provided, paid for, arranged, coordinated, or otherwise enhanced by the VR program.
Situations where the counselor may determine that a consumer does not require VR services include the following:
There is a presumption that the individual is capable of achieving an employment outcome, unless there is clear and convincing evidence during pre-eligibility trial work that the individual is not capable of achieving an employment outcome due to the severity of the individual's disability.
The individual must be presumed capable of achieving an employment outcome. This presumption stands unless clear and convincing evidence from pre-eligibility trial work demonstrates that the applicant cannot attain employment after receiving VR services because of the severity of the applicant's disability.
The applicant is eligible once the counselor has determined that the applicant
There is no residency requirement that excludes an applicant who is present in the state, is available for an assessment, and maintains a Texas address at application.
By definition, a person in the United States without legal status is not eligible for VR services. The counselor must verify that an applicant can legally work in the United States by reviewing original documents. The Immigration Reform and Control Act of 1986 recognizes several documents that can be used to verify employment eligibility. Documents must establish both identity and employment eligibility. The following documents establish both identity and employment eligibility:
The following documents establish identity:
The following documents establish eligibility to work:
If the person is under 18, the following documents establish identity:
A person must provide work authorization documents within three days of employment, or provide the employer with proof that he or she has applied for required documents. In this case, the actual documents must be provided to the employer within 21 days.
If the counselor is unable to determine whether a consumer will be able to benefit from vocational rehabilitation (VR) services because of the severity of his or her disability, the consumer must be provided pre-eligibility trial work services.
If eligibility has already been determined, the counselor must still evaluate the consumer in a realistic work setting through the use of trial work before closing the case with "Disability too Severe" as the reason for the closure.
Pre-eligibility trial work can be used only with consumers whose disability is expected to meet the criteria of “significant.” See 3.14.1 Establishing the Significance of the Disability.
Before authorizing pre-eligibility trial work services, the counselor must determine the level of significance in ReHabWorks (RHW). (For more information, refer to ReHabWorks Users Guide, Chapter 10: Application, 10.8 Work History.)
After the level of significance has been determined, the counselor must either:
If the applicant has a disability that is a substantial impediment to employment and is severe enough that the counselor cannot presume the person would benefit from vocational rehabilitation services, the counselor must use pre-eligibility trial work.
*The "clear and convincing evidence" standard of evidence in civil matters is similar to the "beyond a reasonable doubt" standard in criminal matters, but is slightly less rigorous. There must be a high degree of certainty before a person can be found incapable of competitive integrated employment.
Psychological testing alone is not clear and convincing evidence. Clear and convincing evidence might include a description of assessments, including trial work experiences, concluding that the consumer would be unable obtain an employment outcome because of the severity of the disability.
When the consumer (and/or consumer's representative) does not agree, and if the determination is appealed to an impartial hearing, the impartial hearing officer becomes the ultimate authority on clear and convincing evidence.*
*Based on 34 CFR Section 361.42(e)
A Trial Work Plan (TWP) must include trial work experiences that are of sufficient variety and duration to provide:
Trial work experiences must be provided in competitive integrated employment settings to the maximum extent possible, consistent with the informed choice and rehab needs of the individual.
Pre-eligibility trial work may be part of a work adjustment training program, situational assessment, or other experiences in realistic work settings, such as the Career and Community Support Analysis (CCSA). For more information, see the DBS Standards Manual for Consumer Services Contract Providers, Chapter 5: Services, 5.12.6 Benchmark 1: Discovery, the Career and Community Support Analysis (CCSA), CCSA Review Meeting, and Supported Employment Services Plan (SESP) Part 1.
The counselor must document trial work experiences in ReHabWorks in the work history section of the application. For detailed procedures on documenting the trial work experience in ReHabWorks, see the ReHabWorks Users Guide, Chapter 10 Application, 10.7 Work History.
Supported employment should be considered if it appears likely that the individual could work with available of ongoing support services after successful VR case closure.
A case should be moved out of pre-eligibility trial work immediately if:
A consumer cannot remain in pre-eligibility trial work for more than 12 months without a field director or a vocational rehabilitation (VR) supervisor or VR coordinator conducting a full case review in TxROCS before approving the extension of pre-eligibility trial work. A case reading is conducted every 90 days thereafter to determine the status of the eligibility decision.
The VR counselor must constantly assess the progress or lack of progress toward the goal of determining eligibility and to ensure appropriate expenditure of VR funds. A case note must be completed at least every 90 days documenting consumer's progress.
Services are provided in pre-eligibility trial work to explore the consumer's abilities, capabilities, and capacity to perform in work situations. Evaluations may determine whether supported employment services may be appropriate for the individual. The primary service should be utilization of work in real job situations. Other vocational rehabilitation services may also be provided which support the consumer during pre-eligibility trial work.
Assessments will be planned and provided in partnership with the consumer (and/or representative). Services will be provided in the most integrated setting possible consistent with the consumer's informed choice.
In ReHabWorks if the counselor believes that the individual meets the eligibility requirements for VR services, the counselor will read and electronically sign the following:
I certify that this individual has a visual disability; that the visual disability results in a substantial impediment to employment for the individual; and that the individual requires vocational rehabilitation services to prepare for, secure, retain, or regain employment.
This individual is presumed to be capable of achieving an employment outcome from the provision of vocational rehabilitation services.
In addition, the counselor documents the functional limitations that result from the visual impairment by checking the box for the appropriate categories.
While it is available, the counselor does not need to print the Eligibility Statement unless the consumer requests a copy or the documentation is needed by some other agency.
Note: An individual who documents receiving either SSI or SSDI due to vision loss is presumed to meet all eligibility criteria, provided the consumer intends to be employed.
An individual who applies to this agency for VR services may not be eligible.
If an individual is determined ineligible after an individual has signed an application for VR services, the counselor must offer the consumer the opportunity for a full consultation. The counselor must also provide the consumer with a written reason for ineligibility. The counselor completes a Letter of Ineligibility (DARS5102), which is produced in ReHabWorks, and sends it to the consumer unless
If the consumer has died or is unable to locate, the counselor should document this information in a case note.
Reasons that an individual may be considered ineligible:
The preliminary assessment reveals the applicant does not have a disability (as defined by DBS). The individual does not meet eligibility criterion 1.
The preliminary assessment reveals no substantial impediment to employment. The applicant does not meet eligibility criterion 2.
A case cannot be closed due to "disability too significant" unless a demonstration of clear and convincing evidence has been made through a trial work experience, either prior to determination of eligibility in extended evaluation/trial work or through the provision of VR services under an IPE or while in supported employment. The counselor must consider all VR service options (including supported employment), and determine that the severity of the disability or the resulting substantial vocational impediment prevents VR services from helping the individual obtain and maintain employment.
Medical information shows the individual's medical condition is rapidly progressive or terminal. Consult with the treating physician to determine (1) whether or not the consumer knows the prognosis and (2) how the closure decision should be communicated. The applicant does not meet eligibility criterion 2.
An applicant does not require VR services to prepare for, secure, retain, or regain employment. Applicant already is receiving the needed services, or they are readily available to the applicant without DBS providing, paying for, arranging, or coordinating the services. The applicant does not meet eligibility criterion 3.
Additionally an individual may be closed for a reason other than they have not met one of the eligibility criteria. These include:
For information on closure of a case after eligibility has been determined select:
An interagency agreement between the Division for the Blind Services (DBS) and Division for Rehabilitation Services (DRS) is designed to clarify responsibilities of DBS and DRS regarding:
The following consumers are served by DBS
If an individual has a significant loss of vision and a related secondary disability, then the individual will be served by DBS.
If an individual has a significant loss of vision and an unrelated secondary disability which is the more substantial impediment to employment, then the individual will be served by DRS.
If an individual has a visual impairment and an unrelated secondary disability and it is questionable to determine which disability constitutes the greater vocational impediment, then VR counselors from both DBS and DRS determine which agency will provide services. If the counselors cannot agree, they will refer the case through supervisory channels for assistance with the decision.
Note: A related secondary disability is one which is commonly associated with a visual loss, such as the relationship between diabetic retinopathy and diabetes. An unrelated secondary disability is one which is not associated with a visual loss such as the relationship between cataracts and alcoholism.
When it is determined that a consumer being served by one agency should be served by the other agency, the case will be closed, and a copy of the entire case file will be made available to the other agency except for the release of any information that has been restricted by the consumer.
In order to maximize use of professional resources, DBS and DRS will exchange information to expedite eligibility determinations and service delivery. All information exchanges will be considered confidential.
When selecting an impairment category, also determine the level of significance of the case, which 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
*Based on 34 CFR Section 361.5(b)(31)
RSA-911 reporting requirements require that "significance" be categorized into three levels. DARS categorizes the following three levels of significance:
Document the justification for the decision in a case note. Select the correct level of significance in ReHabWorks. See 3.14.5 Designating Level of Significance in ReHabWorks.
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 3.14.1 Establishing the Significance of the Disability.
If a person receives SSA disability benefits, but has no identifiable limitations in functional capacities, select SSI Disabled/Blind or SSDI with no limited functional capacities from the Limited Functional Capacities list in the electronic case management system.
All consumers who require pre-eligibility trial work must have their case files designated in ReHabWorks as having either a "significant disability" or a "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.
All consumers who require supported employment services must have their case files designated in ReHabWorks 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.
A counselor determines the level of significance for the consumer's disability at the time that the consumer is determined to be eligible for vocational rehabilitation services. The level is entered on the Disabilities page in ReHabWorks, based on the information provided to DBS at that time.
To determine a level of significance, do as follows:
(Functional limitations that cause 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.)
(If you selected Significant or Most significant, select one or more capacities in the Limited Functional Capacities page in ReHabWorks. Ensure that the case file reflects evidence of the serious limitations in the categories selected.)
The level of significance can be changed without management approval, provided that it is not lowered.
To change a consumer's disability to a lower level:
The designated level of significance can be raised but cannot be lowered without management approval throughout the case, even though the consumer's functional capacities may improve over time.
The following table lists specific capacities and examples of the nature and extent of limits to capacities.
|Capacity||Definition and Examples of Limitations|
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:
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:
Seriously limited capacity in self-care may occur because of blindness or physical, cognitive, or emotional impairments and may apply to all tasks of self-care or only to specific tasks.
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:
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 lack of work skills alone does not meet the criteria for seriously limited capacity in work skills.
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:
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:
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: