After determining eligibility, the next steps in the vocational rehabilitation (VR) process are to:
At every step in the rehabilitation process, provide the consumer with information to make informed choices.
Discuss with the consumer which options are consistent with the consumer's needs and attributes. This approach supports the consumer's ability to make informed choices in the development of their IPEs with respect to the selection of the following (see 34 CFR Section 361.52(b)(4)(i-v):
To the greatest extent possible, the assessment should rely on information obtained about the consumer's experiences in competitive integrated employment settings in the community and in other integrated community settings.
Information collected during these assessments may also help:
The comprehensive assessment is written after the consumer and the counselor reach an agreement. The assessment is based on the consumer's unique strengths, resources, priorities, concerns, interests, abilities, capabilities, and informed choice. The assessment must include information on
If a topic is not assessed, the reason it was not addressed is included in the assessment.
The comprehensive assessment can also include information about
Note: If the consumer has a documented hearing loss or if hearing loss is suspected, the consumer is referred to the deafblind specialist before audiological or hearing-aid evaluations are scheduled. The deafblind specialist can advise the consumer about the functional impact of combined vision and hearing loss and provide information and questions to share with his or her audiologist about certain hearing-aid features and considerations.
See Chapter 40: Case Management, 40.1.6 Comprehensive Assessment for examples of case notes.
DARS has authority to obtain a Criminal Background Check (CBC) on consumers from the Texas Department of Public Safety (DPS) (Texas Government Code, Section 411.117) for the purpose of employment planning. State law makes it unlawful for a person to obtain criminal history in an unauthorized manner, use the information for an unauthorized purpose, or disclose the information to a person not entitled to the information. Information should be safeguarded in a locked and secure cabinet and protected from unauthorized viewing. Information should not be shown to others in the office, unless they have a specific and required business need to see it.
Occupations requiring a license permit or other credential may include a CBC as part of the credentialing process.
If a consumer wants to work in an occupation or participate in a training program requiring a license, permit, or other type of credentialing, the VR counselor (VRC) should explain to the consumer why the CBC is necessary and also document in a case note the reasons for obtaining the CBC, along with a summary of the discussion with the consumer.
Requests for the CBC can be submitted only on cases determined eligible or that are in active status. Criminal history cannot be considered as part of the eligibility determination process, only as part of employment planning occurring during the comprehensive assessment and plan development process or in active status.
The CBC report is critical to the decision-making process. A VRC should not approve a vocational goal for any occupation requiring a license that the Texas Department of Licensing and Regulation (TDLR) has determined would be prohibited to individuals with criminal backgrounds. The VRC should discuss other vocational goals with the consumer if he or she has a criminal history that precludes a licensed profession. If an occupation is licensed, but not by TDLR, the VRC must contact the appropriate licensing entity to determine if it is feasible for the consumer to be licensed.
The CBC must be maintained as a permanent part of the consumer's case record. It must be placed in a sealed envelope and kept in a locked file cabinet as part of the paper case record. A note on the envelope must identify it as a CBC and indicate the date of the seal and that the CBC should not be released. If the CBC needs to be reviewed, staff members are required to sign and date when the envelope is opened and again when it is resealed. In order to maintain confidentiality, immediately upon receipt, the CBC should be printed and all electronic copies should be deleted from electronic files in a secure manner. Staff should evaluate and document the results of the CBC as instructed in Evaluating and Documenting CBC Results below.
Once a referral is made to the Criss Cole Rehabilitation Center (CCRC), the designated CCRC Admissions staff will run the report. The CCRC Admissions staff will contact the referring VRC to obtain the necessary information to complete the DARS1510. See Chapter 11: Criss Cole Rehabilitation Center, 11.4.2 Referrals for the Training Program for additional guidance related to CCRC referrals.
The VRC should explain to the consumer that the CCRC referral process requires a CBC and should document that reason for obtaining a CBC, along with a summary of the discussion with the consumer, in a case note.
Fingerprinting may be necessary in situations where multiple names come up in a CBC search. When this occurs, the only way that results of a CBC can be used is
If this verification cannot be made through the above avenues, the VRC will need to send the consumer to DPS to obtain a CBC through fingerprinting. VRCs should email firstname.lastname@example.org for assistance.
The CBC report contains criminal action that occurs in the State of Texas. CBC reports will either show no criminal action or criminal action that matches with the name and date of birth submitted. CBC reports are often incomplete and difficult to interpret. The VRC or DBS staff member should consult with his or her supervisory chain and Legal Services if assistance is needed to interpret the results. Staff can send questions regarding CBC reports to email@example.com.
CBC results should be documented in the consumer's electronic record in ReHabWorks. The case note should include the date the CBC was requested, the date the CBC was run, and the qualification impact of the results for the consumer's license or vocational goal. For example, if the consumer has a vocational goal of obtaining an occupation requiring a license and receives a CBC result that includes a felony conviction, the VRC will need to reassess the vocational goal and document the information in a case note.
The VRC should write the case note, titled CBC Results, after obtaining an interpretation or decision from Legal Services. The case note should not include any details related to the criminal background. It should state only, "The consumer does not meet the qualifications for XYZ employment outcome due to his/her criminal background." After completing the case note, the VRC should dispose of any emails or copies of the CBC information in a secure manner and keep the original CBC results in a sealed envelope in the consumer's paper file.
After the VRC obtains Legal Services' interpretation of the CBC report and determines that criminal history would preclude the consumer from obtaining a license through TDLR, he or she must notify the consumer of the results. The consumer may request a criminal history evaluation directly from TDLR to formally obtain an opinion. See the TDLR Criminal History Evaluation Letter for instructions. For occupations not licensed by TDLR, the consumer can contact the appropriate licensing entity to obtain an opinion about licensing. The VRC must not support a vocational goal of any occupation for which TDLR or another licensing agent has determined that the consumer cannot be licensed. The VRC must document the result of the consumer's inquiry to TDLR or other licensing entity.
The VRC can release a copy of the CBC report to the consumer in accordance with the Business Procedures Manual, Chapter 20: Confidentiality and Use of Consumer Records and Information, 20.10.4 Release of Information Contained in Criminal History Records and 20.8.3 Release of Consumer Criminal History Records Obtained from the Department of Public Safety.
For additional information on criminal background checks, see the DBS VR webpage on CBC.
The Vocational Evaluation process is designed to determine the consumer's present and future vocational potential including evaluating the consumer's strengths and limitations as they pertain to employment. The Division for Blind Services has contracts with approved vendors for the services. For detailed information regarding provider requirements, record keeping requirements and service delivery requirements go to Vocational Evaluation Standards in the DBS Standards Manual for Consumer Services Contract Providers Chapter 5: Services, 5.4 Vocational Evaluations.
For rates of pay, see the DBS Standards Manual for Consumer Services Contract Providers, Chapter 3: Rates.
The Individualized Plan for Employment (IPE) is the roadmap developed jointly by the consumer and the counselor to help the consumer reach a specific competitive integrated employment outcome. It is developed within the framework of informed consumer choice.
As a part of developing the IPE, the counselor provides information so that the consumer:
The counselor must complete the IPE as soon as possible, but no later than 90 days after the consumer has been determined eligible for services. See Workforce Innovation and Opportunity Act Sec. 413(b)(F).
If the IPE cannot be completed within 90 days, the counselor must:
Document in a case note:
An IPE contains:
Note: Label each service that is listed in the IPE with the appropriate service category. See services definitions of RSA.
Using A Guide for Developing Your Individualized Plan for Employment, consumers or their representatives can develop all or part of the IPE without help from a vocational rehabilitation counselor, but the counselor must approve and sign the IPE.
Counselors inform consumers that assistance with developing all or part of their IPE is also available, as appropriate, from disability advocacy organizations. In addition, a DBS regional assistant (RA) can help to develop all or part of a consumer's IPE.
When appropriate, an IPE includes:
With consumer input, the counselor develops the IPE based on a comprehensive assessment of the consumer's unique:
A comprehensive assessment must be completed before the IPE is developed. See Chapter 40: Case Management, 40.1.6 Comprehensive Assessment.
If summary case note for the comprehensive assessment is not completed in a timely manner after the IPE is signed, the counselor must state in the case note the:
Note: A counselor's decisions must be made based on a consumer's vocational rehabilitation needs and not made in response to referrals for emergency physical restoration referrals from community resources.
Informed choice is an ongoing process in the vocational rehabilitation (VR) program in which the consumer and the counselor cooperate to gather and evaluate information that the consumer uses to make informed choices about outcomes, objectives, and services that could lead to a positive competitive integrated employment outcome.
The counselor acts as a facilitator in this process. Acting on informed choice ensures that the consumer, or if appropriate, the consumer's representative:
The consumer must be informed about and involved in choosing:
In most cases, the comprehensive assessment yields the information that is necessary to help the consumer choose a competitive integrated employment outcome, the intermediate objectives, and the services needed to achieve that outcome.
Appropriate services, which are necessary to achieve a positive competitive integrated employment outcome are provided in an integrated setting. They must be consistent with consumer's informed choice.
Selection of the employment goal is based on the comprehensive assessment and must be consistent with the consumer's strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice.
Intermediate rehabilitation objectives are benchmarks on the way to attaining the competitive integrated employment outcome.
Planned services are services jointly developed by the consumer and counselor in order to achieve the intermediate objective and, ultimately, the competitive integrated employment outcome.
With the exception of obtaining and purchasing copies of reports, all rehabilitation services, including diagnostics, acquired after the plan has been written and signed, must be listed in the IPE.
DBS uses a best-value approach when purchasing goods.
This includes factors such as:
Note: It is not acceptable to request purchase of a specific brand unless there is a valid reason for excluding all comparable brands with similar specifications.
For information on consumer purchases, see Chapter 43: Purchasing Goods and Services for Consumers.
Remediable conditions must be included on the IPE to inform consumers that if a condition improves and vision is restored, DBS can provide only counseling, placement, and referral services that incur no cost to the agency. (See Chapter 3: Eligibility for more information.)
The counselor should provide the consumer with alternative providers for each service, if available. If the consumer has a service provider that the consumer wishes to use, it is the counselor's responsibility to determine whether that provider meets the standards and will accept DBS fee schedules. See the DBS Standards Manual for Consumer Services Contract Providers.
The following payment options are available:
During their first six months on the job, new counselors are strongly encouraged to ask either the VR coordinator, VR supervisor, or the field director to review all IPEs. The field director has the option to adjust this time period and/or make it mandatory.
If, before closing a case as rehabilitated, it is anticipated that post-employment services will be needed, the provision of services must be addressed on the IPE.
Federal law mandates coordination with the special education system in preparation of the IPE for students who are in special education. Refer to Chapter 33: Transition Services for details.
Before VR services are purchased for a consumer, the counselor and consumer must determine whether comparable services and benefits are available from any other program.
Copies of the IPE must be provided to the consumer or consumer's representative in writing and, if appropriate, in the native language or mode of communication of the consumer or consumer's representative. Counselors must ask the consumer about the consumer's preference.
Information about reports obtained, whether purchased or not, need not be included on the IPE.
The Division for Blind Services has developed two forms:
These forms, which are available both in ReHabWorks and in the intranet Forms Catalog, are designed to effectively document all phases of the rehabilitation process and are developed by the consumer or consumer's representative as appropriate, with or without collaboration from the counselor by using "A Guide for Developing Your Individualized Plan for Employment." The final plan requires approval of the VRC.
Technical assistance may include, but is not limited to:
Usually, the IPE is completed online and the consumer uses the computer-generated form and his or her PIN as a signature. After the IPE is printed at the DARS office, a copy is mailed to the consumer.
If the consumer agrees, the counselor may hand write the IPE (legibly) to expedite services in some cases. In other cases, the consumer may choose to have the IPE mailed for a signature (by the consumer or representative). The consumer or representative must sign the IPE before the counselor signs it. For more information on consumer signatures, see Chapter 2: Intake, 2.1.5 Completing the Profile.
Consumers should be sent a stamped, return-addressed envelope, and be informed that planned services cannot be provided until DBS receives the signed and dated IPE.
In unusual circumstances, services may be provided under an amendment before a signature is received if serious disruptions may occur and the consumer has verbally agreed. A case note should be written documenting the conversation. In cases where services are provided without a signature, the IPE should be sent to the consumer by certified mail. The counselor must receive the signed IPE within 30 days, or all services will be suspended until the IPE is received.
Counselors use DARS5151, Individualized Plan for Employment (IPE) for the initial IPE and pre-eligibility trial work. If the counselor determines that the consumer is eligible for services after the pre-trial work experience, the counselor completes a new DARS2303 with an employment goal.
For complete information on Pre-eligibility Trial Work, see Chapter 3: Eligibility, 3.1 Determination of Eligibility-Overview.
After the counselor determines eligibility, he or she provides consumers or their representatives with information about developing a plan for employment.
Consumers can choose either to:
Whichever choice is made, final approval of the IPE is the responsibility of the counselor.
See Examples: Case Documentation and Tools for examples of IPEs and IPE amendments.
ReHabWorks automatically enters the consumer's name.
When selecting an outcome, the consumer and the counselor considers the:
Note: Do not use To be determined or a similar phrase as an employment outcome.
Do not close cases with successful employment outcomes with a general occupational category.
The employment outcome for consumers in pre-eligibility trial work is to determine VR eligibility; that is, to determine the consumer's eligibility for vocational rehabilitation (VR) services.
Intermediate objectives include the steps necessary to complete the employment outcome, such as:
These objectives are useful criteria to measure progress made toward the employment outcome. The most important consideration of an intermediate objective is that the consumer understands and agrees to that objective.
The IPE is developed through sharing the comprehensive assessment information with the consumer.
The IPE typically is included in discussions about:
Examples of the objectives listed in ReHabWorks include the following. Counselors can modify the objectives or create new objectives:
Enter objective criteria by which progress toward the achievement of the employment outcome will be measured. In most cases this is the progress toward completing intermediate objectives. See the examples at the end of this item.
Documentation of progress toward the employment outcome may include:
Enter the specific services the consumer will receive to help the consumer find employment.
The following specific services are examples of goods or services that assist a consumer to become employable:
Services may be recorded on the IPE, as previously listed. It is not necessary to be any more specific, unless the consumer, consumer's representative, or the counselor believes that more detail is needed.
Certain services may be provided that are ancillary to surgery, such as anesthesiology, radiology, and pathology. These ancillary services do not need to be listed on the IPE. Service records and service authorizations are created when invoices are received.
Cataract surgery, both eyes (An entry such as this specific service implies that, integral to the completion of cataract surgery, ancillary service payments such as hospital or facility ancillary services and perhaps general follow-up fees are included. Separate entries may be made, but are generally unnecessary.) The most important determination of the level of detail to include is the consumer's understanding and desires.
A service record should be created for all services on the IPE if provided or purchased by DBS. Counselors are not required to do a service record for an arranged service. Additionally, completing a service record for routine counseling and guidance, providing a copy of an eye exam, or completing a certificate of blindness for tuition exemption does not require a service record.
While written in the IPE, the counselor may list only the term "Cataract surgery." The service record in ReHabWorks is completed for each individual service, for example, doctor for the surgery, hospital, anesthesiology, radiology, etc.
Supported Employment Note: Refer to supported employment section for specific requirements for consumers.
Enter the name of the chosen service provider.
Note: Based on options chosen to develop the IPE, the counselor may provide the consumer with a choice of providers of VR services. The chosen provider will be listed on the IPE. The selection of providers given to the consumer will be those providers who:
Whenever possible, the service will be provided in the most integrated setting that is appropriate for the service involved and consistent with the informed choice of the consumer.
Important Note: Under no circumstances should a service provider be listed as "To Be Determined" or "Consumer Choice." The specific name of the service provider is to be listed. In cases where the service is a bid process and the vendor is unknown, list "State Bid Process/Purchasing."
Enter the projected date that each service will begin.
Enter the anticipated date that each service will end.
The options include services that are purchased, arranged, or provided by DBS.
Both the Consumer Responsibilities and DBS Responsibilities sections should be worded in objective, measurable statements. Counselors may use the drop down selections available in ReHabWorks or may enter any other type of responsibility that is needed for a particular case. Responsibilities should be as specific as possible and agreed to by both parties.
Consumers are the driving force behind their rehabilitation. They must be intricately involved and actively participate. Examples of their responsibilities might include:
Example 1: I agree that I will submit grade slips to my counselor prior to the beginning of each semester. I understand if I do not do this, the Division for Blind Services may not be able to provide financial support.
Example 2: I agree to inform my counselor in advance if I am unable to attend an appointment which is being paid for or arranged by DBS. I also agree to reschedule the appointment and inform my counselor of the new date and time.
Select behavioral statements for a description and examples of which may be used in developing a consumer's responsibilities in an IPE.
Enter DBS's responsibility toward the completion of the IPE.
Example 1: DBS will keep you informed of any changes in procedures or rules that might affect your program.
Example 2: DBS will provide services in as timely a manner as possible in keeping with available staff, resources, and your priorities.
Indicate and identify any comparable services and benefits that the consumer has or has agreed to seek.
Indicate either the service or an amount of the cost of the services the consumer is providing. If none, enter none.
The consumer and counselor will discuss and agree on how often the consumer will contact the counselor. The contacts can be in days, weeks or months.
"Understandings " addresses DBS's role and obligations toward the consumers it serves. The counselor will always discuss these understandings with the consumer on a point-by-point basis.
Discuss with the consumer their rights and provide them with a copy of "Your Rights".
Obtain consumer's or consumer's representative's signature and date of signature.
The counselor reviews and approves the IPE after considering:
If the counselor does not agree with the developed IPE, the counselor should not sign it, but discuss specific points and problems areas with the consumer. If after discussing the various factors, the consumer still disagrees with the counselor, inform the consumer of their rights as outlined in "Your Rights" .
Under no circumstances does the initial IPE take effect or allow for payment of any service until it is agreed to and signed by the consumer or consumer's representative and the counselor.
A consumer or representative must sign and date an Individualized Plan for Employment (IPE) after the IPE has been developed and agreed upon by the consumer.
The IPE is available in ReHabWorks. If a consumer chooses to complete the IPE without using ReHabWorks or it is unavailable,
For more information about PINs, see ReHabWorks User Guide, Chapter 8: PINs.
If an applicant informs the counselor that he or she receives either SSI or SSDI and has a Ticket to Work, the counselor should ask if he or she has assigned the Ticket to an employment network (EN) or other agency. If the Ticket is unassigned, there is nothing more for the applicant to do. The counselor should inform the applicant that if he or she is determined to be eligible, signing the IPE assigns the Ticket to DBS.
If an applicant's Ticket is assigned to an EN, the following procedures apply.
MAXIMUS Ticket to Work
Attn: Ticket Assignment
PO Box 25105
Alexandria, VA 22313.
The individualized plan for employment (IPE) will be amended each time the vocational rehabilitation counselor and the consumer agree on a substantial change. Document the reasons for amending the IPE in ReHabWorks. Explain the nature and scope of the changes to objectives, services, or other parts of the plan and why they are necessary.
Develop an IPE amendment if substantial changes are required or where there is potential for misunderstanding with respect to the employment goal, services, and/or service providers.
(See 34 CFR Section 361.45(d))
If the dates of services on the IPE have expired, an amendment must be completed.
If the amendment includes a substantial change in the employment goal, changing the Standard Occupation Classification (SOC) job family identified in the first two digits of the SOC code might be necessary.
Use the IPE amendment in ReHabWorks. If ReHabWorks is not available, use DARS5152, DBS Individualized Plan for Employment (IPE) Amendment-VR.
As with the original IPE, the consumer may use alternate resources such as friends, family members, or private counselors for the development process.
The IPE amendment is not in effect until the vocational rehabilitation counselor (VRC) and the consumer sign the DARS5152.
A copy of the signed form will be provided to the consumer or to the consumer's representative.
(See 34 CFR Section 361.45(d)(7))
The IPE will be reviewed as often as necessary, but at least every 12 months. The annual review is conducted with the consumer to insure that the IPE continues to be relevant and addresses and provides any needed changes to assist the consumer in achieving their employment goal.
Document the results of the review in case notes. Develop an amended IPE if there are changes needed as a result of the review. The issuance of an IPE amendment is the equivalent of an annual review and restarts the 12-month clock.
An annual review that adds new specific services does not take effect until it is agreed to and signed by the consumer or consumer's representative and the counselor.
Services provided under an annual review may be provided before receiving a signature only if disruption of services may occur and the consumer has verbally agreed. A case note should be placed in the case folder documenting the conversation and the reason for providing services prior to the consumer's signature.
Important Note: If the annual review results in there being no substantive changes in services, responsibilities or other areas to the existing IPE, then an amendment is not required. The VR counselor will document in the case notes that the consumer and counselor are in agreement that no changes are needed. The counselor will also document in the case notes, progress or lack of progress that the consumer has made since the IPE was developed or last reviewed.
A computer-generated notice is placed on the action list 30 days before the anniversary date of the original IPE. When a joint review has not already been performed, this notice serves as a reminder. For more information on case actions, refer to the ReHabWorks User Guide, Chapter 6: Case Actions and Actions Lists.
Post-Closure Services are provided when circumstances change that affect the consumer's ability to retain, regain, or advance toward a successful employment outcome. Post-Closure Services are often anticipated and planned at time of closure. (Reference Post-Closure Services for additional clarification regarding eligibility.)
Provision of Post-Closure Services, whether planned at time of closure or determined necessary at a later date, is documented on the DARS5152 similar to any amendment.
Note: Post-Closure Services do not take effect until the DARS5152 is agreed to and signed by the consumer or consumer's representative and the counselor.
For information regarding the closing of cases prior to an eligibility decision, see the ReHabWorks User Guide, Chapter 21: Closure, 21.1 Closure before Case Assignment and before or after Application. For information regarding the closing of cases after eligibility has been determined, but the case will be closed as unsuccessful, select Unsuccessful Closure before Plan Initiated or Unsuccessful Closure after Plan Initiated.
For information regarding the closing of cases successful, select Successful Closure.
For criteria in closing a VR as a successful rehabilitation, select Successful Closure.
(Refer to Chapter 30: Supported Employment for specific requirements for documentation of extended ongoing support services required for consumers successfully rehabilitated in supported employment.)
Requirement: Prior to case closure, all vouchers and purchase vouchers must be completed and sent to Accounting for processing.
In some cases a consumer's actions or lack of action prevents them from progressing through the rehabilitation process and obtaining employment. In such cases behavioral statements used in the consumer responsibilities section of the IPE may help. It is important, if possible, that the counselor help the consumer understand that certain behaviors have prevented the consumer from making progress, and that unless these behaviors are addressed, VR services may not benefit the consumer in terms of employment
Listed below are some examples of behavioral statements:
Using comparable services and benefits is mandated by federal law and regulations. Full consideration of comparable services and benefits prior to the expenditure of VR case service funds is required.
Comparable services and benefits are similar to DBS-provided services but are provided or paid for (in whole or in part) by another entity such as
Comparable services and benefits do not include student loans or scholarships based on merit.
Counselors should first use comparable services and benefits unless using them would interrupt or delay the consumer's progress toward the IPE goal.
Counselors should apply alternate funding sources before spending agency funds to purchase the following:
Counselors do not have to consider comparable services or benefits for the following:
Specific provisions in the Rehabilitation Act require that maximum effort be made to secure grant assistance in whole or in part for/by consumers attending institutions of higher education. Eligibility for tuition and fee exemption for students who are blind and grant programs must be fully considered prior to expenditure of VR funds for higher education costs.
The agency shall give full consideration to the use of comparable services and benefits during the VR process. These services must be adequate in terms of:
VR funds may be used to purchase the desired service only when:
Note: A licensed medical professional determines "extreme medical risk." Federal regulations define "extreme medical risk" as "a probability of substantially increasing functional impairment or risk of death if medical services, including mental services are not provided expeditiously."
When the VR counselor is considering the use of comparable services and benefits of another agency, a conflict may exist between the desire of the consumer for direct case services, and time and effort involved in using other programs.
Counselors are encouraged to discuss with the consumer the need for and requirements of comparable services and benefits as early as possible in the rehabilitation process (during applicant status 02). The counselor must reevaluate the possibility of using comparable services and benefits throughout the VR process.
VR agencies have historically functioned as the core of the service delivery network to consumers. This agency will continue direct purchases of services to eligible consumers in those cases in which services:
The counselor's effective use of comparable services and benefits depends upon their ability to judge when it is appropriate to use them. Since the counselor works directly with the consumer in the formulation of the IPE, the counselor is in a position to determine which comparable services and benefits:
Many government programs, such as Medicaid, are required to exhaust all other sources of payment prior to providing benefits. There are some discrepancies among state, federal, and local interpretations of legislation. If there is a problem regarding first dollar issues, contact your Field Director for assistance and advice.
Document the use of comparable services and benefits on the consumer's IPE. You can also document any additional information on the case notes.
If a potential comparable services and benefits program is determined inadequate by the counselor, justification is written in the case folder prior to purchasing services with VR case money. Examples of such justification may be that the comparable services and benefits:
DBS is required to verify Medicaid eligibility for all new applicants who report a family income at or below 185 percent of the current federal poverty level
Verification is completed twice a week by Information Technology for all new applicants, and monthly for all cases, thus meeting the above requirements. Consumers are matched on Medicaid's records each month by their Social Security number (SSN), the first three characters of their last name, and the first character of their first name.
At the time the application is completed (or later if the consumer has not yet received a Medicaid card), the DBS staff should verify the consumer's Medicaid certification by requesting to see the consumer's Medicaid card. If a current Medicaid card is provided, the DBS staff member should
This information should be documented in a case note.
It is critical that the information is collected precisely as it is recorded on the consumer's Medicaid card.
Texas Medicaid & Healthcare Partnership (TMHP) is responsible for administering Medicaid claims in Texas. This responsibility includes processing claims for case management reimbursement.
TMHP uses the Automated Inquiry System (AIS) to record Medicaid eligibility information.
DBS staff may verify Medicaid eligibility by accessing the AIS database.
Each DBS field office has been assigned a Medicaid Texas Provider Identifier (TPI) number. DBS staff members must use their designated TPI number when making an AIS inquiry about a consumer's Medicaid eligibility (see 4.5.10 Authorized NPI and TPI Numbers).
AIS may be contacted Monday through Friday between 6:00 a.m. and 6:00 p.m. Central Standard Time. There is a limit of 20 transactions per phone call.
AIS will automatically disconnect the line if nothing is entered for 20 seconds. DBS staff may verify the reason for the disconnection by calling TMHP Customer Service at 1-800-925-9126.
DBS staff should follow the steps listed below to make a direct AIS inquiry.
When prompted, enter your TPI number:
Note: If the TPI number you enter is invalid, AIS will respond: "Invalid TPI (provider number) keyed. Please re-enter."
AIS will repeat your TPI number back to you. Check to make sure the TPI is correct.
Enter one of the following transaction codes:
1 -- claim status
2 -- consumer eligibility (for additional information, see 4.5.9 Transaction Code 2
3 -- benefit limitations
4 -- check amount
5 -- new TPI
9 -- speak with a customer service representative
0 -- return to main menu
AIS will provide applicable options and instructions for each transaction code selected.
Use Star/Pound ( * #) to repeat any information given.
Use Star/Star (**) to begin again if you make an error.
Use Nine/Pound (9 #) to repeat the main menu at any time.
To verify consumer eligibility using AIS, enter Transaction Code 2 in Step 4. You may inquire using the consumer's
The consumer's date of birth must be entered MMDDCCYY (for example, April 25, 1995, would be entered 04251995).
Date of service, however, must be entered MMDDYY (for example, June 13, 2014, would be entered 061314).
Medicaid National Provider Identifier (NPI) and TPI numbers have been authorized for each DBS office as follows:
|DBS Field Office||Medicaid NPI Number||Medicaid TPI Number|
Consumers receiving Social Security Disability Insurance (SSDI) or Social Security Income (SSI) based on disability must be given unique considerations during the vocational rehabilitation (VR) process as stated in 34 CFR 361.42.
Benefits Planning Query (BPQY): Completed Social Security Administration (SSA) Form 2459 for Supplemental Security Income (SSI) recipients and/or Social Security Disability Insurance (SSDI) beneficiaries. Provides information on type of SSI/SSDI benefit, amount of cash benefit, overpayment status, medical review date, health insurance, work incentives used, non-certified yearly total of earnings, and more.
Benefits Subject Matter Resource Staff: Division for Blind Services (DBS) staff members from regional, field, and satellite offices who provide information and technical assistance about federal benefits and work incentives to counselors and consumers.
Benefits Summary and Analysis (BSA): A written document, generated by a community work incentive coordinator, that provides in-depth information about all publicly funded benefits that a consumer receives.
Childhood Disability Benefits (CDB): SSA disability insurance program that provides a cash benefit to individuals who are 18 or older with a disability that began before the age of 22. In order to receive this benefit, the individual's parent must be deceased or receive a Title II Social Security cash benefit based on disability or retirement. If the parent is deceased, that parent must have a work history that qualified certain survivors for a cash benefit. Childhood disability benefits provide Medicare health coverage after a 24 month waiting period. All references to SSDI in this chapter are applicable to childhood disability beneficiaries.
Community Work Incentive Coordinator (CWIC): Employee of a Work Incentive Planning and Assistance Program funded through a grant from the SSA whose duties include provision of general information and referral, in-depth analysis of all publicly funded benefits, and recommendations for use of federal and state work incentive programs.
Disability Determination Services (DDS): SSA program, carried out by DARS, that conducts disability determinations and medical continuing disability reviews for SSI/SSDI.
Disabled Widow/Widower Benefits: SSA disability insurance program that provides a cash benefit to widows or widowers with a disability. Disabled widow/widower benefits provide Medicare health coverage after a 24 month waiting period. All references to SSDI in this chapter are applicable to disabled widows/widowers.
Employment Network (EN): DARS and community-based organizations contracted by the SSA to provide employment services under the Ticket to Work Program (TTW).
In Use SVR: TTW status assigned by the SSA to consumers who have an assignable ticket and are receiving vocational rehabilitation (VR) services from DARS under the cost reimbursement option.
Medicaid: A state-federal partnership healthcare program provided to individuals receiving SSI and administered by the Health Human Services Commission's (HHSC) Medicaid/Children's Health Insurance Program (CHIP) Division. In Texas, SSI recipients are required to receive Medicaid through STAR+PLUS, a managed care system.
Medical Continuing Disability Review (MCDR): SSA review that determines if SSI and/or SSDI eligibility will continue based on an evaluation of all evidence from the individual's initial or last disability determination, and an evaluation of current evidence related to disability.
Medicare: Federally funded healthcare program administered by the Centers for Medicare and Medicaid Services. The program is designed for older adults, SSDI beneficiaries, and individuals with end stage renal disease. Certain consumers, such as former public school teachers, may not qualify for a cash benefit but will get Medicare.
Not In Use SVR-FTPR: TTW status assigned by the SSA to consumers receiving DARS VR services who have failed to meet the program's timely progress benchmarks and who fall under the cost reimbursement option. See Program Operations Manual System (POMS), Section DI 55025.025 Timely Progress Requirements for Ticket Users.
Presumptive Eligibility: Term in 34 CFR 361.42 that means that consumers receiving SSDI or SSI based on disability or blindness must be considered eligible for VR services unless the vocational rehabilitation counselor (VRC) demonstrates by clear and convincing evidence that the consumer cannot benefit from VR services (that is, achieve an employment outcome) due to the severity of the disability.
Section 301 Payments: SSA cash benefit payments paid to eligible consumers after an unfavorable MCDR decision.
Social Security Administration (SSA): Federal entity that administers the Title XVI and Title II disability benefit programs commonly known as Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI).
Social Security Disability Insurance (SSDI): Disability insurance program that provides a monthly cash benefit to individuals with disabilities who qualify based on their earnings and time worked. SSDI also provides Medicare health insurance after a 24 month waiting period. SSDI beneficiaries with amyotrophic lateral sclerosis (ALS) are exempt from this waiting period. Individuals receiving SSDI are referred to as "beneficiaries" by SSA.
Substantial Gainful Activity (SGA): Financial guideline used by SSA that is updated each year on January 1. See the current SGA amount.
Supplemental Security Income (SSI): Needs-based program that provides individuals with little or no income or resources with a cash benefit to assist with food and shelter. To qualify, an individual must be 65 years or older and/or meet the SSA disability or blindness criteria. In Texas, individuals who are determined eligible for SSI receive Medicaid. Individuals receiving SSI are known as "recipients" in SSA.
Ticket to Work Program (TTW): Voluntary SSA program offered to individuals aged 18 to 64 who are receiving SSI or SSDI. TTW offers free job training and employment referrals among other benefits; services are provided by an employment network (EN) or by the DARS VR program.
Timely Progress: Set of yearly benchmarks in employment, education, and/or training which consumers must meet in order to gain In Use SVR status and, therefore, protection from a MCDR. See these benchmarks on the SSA's Program Operations Manual System (POMS), Section DI 55025.025 Timely Progress Requirements for Ticket Users.
Work Incentive Planning and Assistance Program (WIPA): Program funded through a grant from the SSA. Texas WIPAs are located within six existing community organizations throughout the state.
Work Incentives: State and federal programs that support an individual with a disability in finding, keeping, and advancing in employment.
Consumers determined eligible for Social Security Disability Insurance (SSDI) or Social Security Income (SSI) based on disability:
*Based on 34 CFR Section 361.42(a)(3).
Consumers are eligible for SSDI or SSI based on disability if they demonstrate intent to achieve an employment outcome that is consistent with the applicant's unique strengths, resources, priorities, concerns, abilities, capabilities, interests and informed choice. The applicant's completion of the application process demonstrates the intent to achieve an employment outcome. *
*Based on 34 CFR Section 361.42(a)(4).
Consumers determined eligible for SSDI or SSI based on disability cannot be determined ineligible for VR services unless clear and convincing evidence shows that the consumer cannot benefit from VR services. Pre-eligibility trial work must be used if there is a question regarding the consumer's ability to achieve an employment outcome.*
*Based on 34 CFR Section 361.42(e)
If there is a need to further evaluate the consumer's ability to achieve an employment outcome, a pre-eligibility trial work plan must be completed on the day that benefits are verified. If benefits are verified and the consumer is not present to complete the plan for pre-eligibility, contact the consumer and schedule to complete this as soon as possible. For more information, see 3.10 Eligibility for Pre-Eligibility Trial Work Experience.
When a consumer asserts eligibility for Social Security Disability Insurance (SSDI) or Social Security Income (SSI) based on disability, but cannot provide evidence such as an award letter, verification must be obtained.
To verify eligibility for SSDI or SSI based on disability, consumers may:
If the consumer is unable to obtain verification through the options above, the consumer may contact DARS Social Security Administration Vocational Rehabilitation (SSAVR) for verification. However, information obtained through SSAVR may not provide enough evidence for presumptive eligibility because the information provided may not specify if disability is the basis for SSI eligibility.
SSAVR verifies benefits as a courtesy to vocational rehabilitation counselors (VRCs) when there is no other way to verify that the applicant is eligible for SSDI or SSI based on disability:
If you need assistance with this process, contact a benefits subject matter resource staff member.
*If you cannot obtain evidence of eligibility for SSDI or SSI based on disability within 60 days from the date of application for VR services, you may:
*Based on 34 CFR 361.41 (b)(1)(i)(ii)
Consumers eligible for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) based on disability cannot be required to participate in the cost of vocational rehabilitation (VR) services based on liquid income or resources exceeding the basic living requirements in Chapter 2: Intake, 2.3 Consumer Participation in Cost of Services. This is the case regardless of a consumer's financial situation.
*The best-value purchasing approach explained in Chapter 43: Purchasing Goods and Services for Consumers applies to consumers eligible for SSDI or SSI based on disability.*
*Based on 34 CFR Section 361.54(b)(3)(ii)
With appropriate consent forms, State Vocational Rehabilitation Agencies and the Social Security Administration (SSA) or DARS Disability Determination Services (DDS) may exchange records about specific individuals.
Disability Determination Services (DDS) may request records for certain consumers as part of the disability determination process. The consumer's records can be released to DDS only after DBS receives another valid release as described in the Business Procedures Manual (BPM) Chapter 20: Confidentiality and Use of Consumer Records and Information, 20.10 Valid Release Authorized by the Consumer or a Representative.
For additional information on releasing consumer records and information, see BPM Chapter 20: Confidentiality and Use of Consumer Records and Information.
To obtain records from the Social Security Administration (SSA) office or Disability Determination Services (DDS), follow the procedure in BPM Chapter 20, 20.18 Release of Information between DDS and other DARS Divisions.
SSA should not charge for these records, as stated in the SSA Program Operations Manual, Section DI 13510.030 FO Instructions for Providing Medical Information to State Vocational Rehabilitation (VR) Agencies for VR Cost Reimbursement or Ticket to Work Program, Instructions for Providing Medical Information to State Vocational Rehabilitation (VR) Agencies for VR Cost Reimbursement or Ticket to Work Program.
For medical records from DARS Disability Determination Services (DRS), complete SSA Form 3288, Social Security Administration Consent for Release of Information.
For records from the Social Security Administration (SSA) Local Field Office, complete DARS3310, DDS Request for Records and, for questions, review the SSA's description of records available to request.
Consumers can use federal work incentive programs to reach employment goals, earn a living wage, and achieve self-sufficiency. However, consumers need accurate information about how their earnings will impact cash and healthcare benefits.
Provide consumers with accurate information about Social Security Income (SSI) and Social Security Disability Insurance (SSDI) benefits and work incentives at the start of and throughout the vocational rehabilitation (VR) process. Providing consumers with accurate information about SSI and SSDI benefits will help you coordinate and provide services outlined in the consumer's individualized plan for employment (IPE).
Compete the steps below to incorporate benefits and work incentives planning supports and services into the VR process:
Work Incentives Planning and Assistance (WIPA) programs, which are funded through a Social Security Administration (SSA) grant, employ individuals who are certified by SSA to provide consumers with accurate and thorough benefits and work incentives information.
Certain WIPA programs accept a fee for service from the Division for Blind Services (DBS). WIPA programs accepting fees for service can serve consumers statewide, have short wait times, and all documents are shared with the referring vocational rehabilitation counselor (VRC). See a list of WIPA programs.
To purchase WIPA benefits services, you must first determine if the consumer is eligible for SSDI or SSI based on disability. If the consumer has not been determined eligible for SSDI or SSI based on disability, you may purchase assistance with applying for Medicaid Buy-In (MBI). This is the only service you may purchase under benefits planning for a consumer not receiving SSI and/or SSDI.
Once eligibility is established, purchase WIPA benefits services by following the process below:
Use the MAPS code "WIPA" in the electronic case management system when issuing a service authorization for any of these services.
If certain conditions are met, the Division for Blind Services (DBS) receives cost reimbursement from the Social Security Administration (SSA). When the SSA provides DBS with reimbursement, it is paying DBS for the cost of the services provided to consumers who are recipients of SSDI or SSI based on disability.
Cost reimbursement from SSA requires the consumer to meet the following criteria:
For a complete explanation of SSA VR cost reimbursement, see SSA VR Reimbursement Program.
The Ticket to Work Program (TTW) is a voluntary program administered by the Social Security Administration (SSA) for consumers ages 18 to 64 who receive SSA disability benefits.
The program offers expanded options for:
TTW services are provided by employment networks (EN). All state vocational rehabilitation agencies are mandated through federal regulations to be ENs. However, there are many private providers and organizations that are also ENs. See the SSA's Choosing the Right Employment Network for You.
Inform each consumer receiving SSA disability benefits that developing an individualized plan for employment (IPE) with DARS initiates ticket assignment under TTW, and that the consumer's:
DBS receives cost reimbursement from SSA only if a consumer's VR case is closed, and only if the consumer's TTW ticket is not assigned to another EN at the same time as the consumer is receiving DARS services.
It is extremely important to check the consumer's ticket status at application. Use the following process to check the consumer's ticket status:
In some situations, the TTW's program specialist may identify consumers with tickets assigned to ENs. The vocational rehabilitation counselors (VRCs) assigned to those consumers' cases will be notified by email that the consumers' tickets are already assigned to an EN. If you receive this email, you must notify the consumer that the ticket is assigned and follow the procedures above.
The Social Security Administration's (SSA) Ticket to Work Partnership Plus Program allows DARS and a private Employment Network (EN) to partner to continue allowing the consumer to be exempt from the SSA's medical continuing disability review (MCDR) and to allow the EN to provide the consumer with ongoing job support services after the VR case's closure.
The TTW Partnership Plus Program should be considered at case closure when your consumer is:
To activate the TTW Partnership Plus Program, the consumer assigns his or her ticket to the new EN. For assistance with this process, contact the TTW's program specialist.
In addition to the regular Social Security Administration (SSA) ticket payments, Community Rehabilitation Programs (CRPs) which participate in the Ticket to Work (TTW) Partnership Plus Program are eligible for two Employment Network (EN) Employment Advancement Payments from DARS. The payments are only made after a consumer's vocational rehabilitation (VR) case is closed, and to issue a service authorization (SA) for these services, the VR case must be placed into post-closure status.
The Community Rehabilitation Program (CRP)-Employment Network (EN) provides services necessary for the consumer to retain and advance in employment to the point that the consumer can achieve one month of gross monthly pay that meets or exceeds substantial gainful activity SGA guidelines for the year in which the income was earned.
This payment is available only during the first 12 months after vocational rehabilitation (VR) case closure. For Supported Employment (SE) only, the CRP must be identified on the DARS1616, Job Stability or Service Closure Justification Summary as a primary provider and the long-term, needed support provided by the CRP must be outlined on the form.
The CRP-EN must notify the vocational rehabilitation counselor (VRC) in writing at least 30 days before the CRP-EN anticipates that the consumer will achieve the required income level so that appropriate service authorizations may be issued.
The first employment network (EN) employment advancement outcome is achieved when:
The first employment network (EN) employment advancement payment can be made no more than 12 months after vocational rehabilitation (VR) case closure.
Payment (see Fee Schedule 2-0005) is made when the DARS counselor receives and approves:
The Community Rehabilitation Program (CRP)-Employment Network (EN) provides services necessary for the consumer to retain and advance in employment to the point that the consumer can achieve 8 of 12 consecutive months of gross monthly pay that meets or exceeds 105 percent of SGA for the year in which the income was earned. This payment is available only during the first 18 months after the first EN Employment Advancement Payment.
The CRP-EN must notify the VR counselor in writing at least 30 days before the CRP-EN anticipates that the consumer will achieve the required income level so that appropriate service authorizations may be issued.
The documents below are required as proof that the consumer's ticket is currently assigned to the Community Rehabilitation Program (CR)-Employment Network (EN) for which a service authorization is to be issued:
The second employment network (EN) employment advancement outcome is achieved when:
The second employment network (EN) employment advancement payment can be made no more than 18 months after the first payment.
Payment for the second EN employment advancement (see Fee Schedule 2-0005) is made when the DARS counselor receives and approves:
The Social Security Administration (SSA) conducts medical continuing disability reviews (MCDRs) to determine whether a Social Security Disability Insurance (SSDI) beneficiary or Social Security Insurance (SSI) recipient's disability continues. MCDRs are usually conducted based upon an established diary date set by SSA. The benefits planning query (BPQY) lists the next diary date set by SSA.
If an unfavorable decision is issued by SSA as a result of an MCDR, the individual is terminated from SSA benefits. SSA exempts certain individuals from MCDRs if they are participating in the Ticket to Work Program (TTW) or vocational rehabilitation (VR) services.
Once an individualized plan for employment (IPE) is signed, DARS operations staff members from the central office notify SSA that the consumer has an open case with DBS; SSA then sends a letter to the consumer to verify that he or she is receiving services from DARS. While a consumer has an open case with DARS, SSA assigns one of two ticket statuses: "In Use SVR" or "Not In Use SVR-FTPR."
Consumers with the status "In Use SVR":
Consumers with status "Not In Use SVR-FTPR":
SSA will send a letter to the consumer if an MCDR is going to be initiated. If a consumer with an open VR case receives this notification, contact your DBS benefits subject matter resource staff member. The benefits subject matter resource staff member will work with program specialists to determine if the initiation of the MCDR was appropriate. If it was not, the program specialists will assist in requesting that the SSA stop the MCDR.
Section 301 payments are the continuation of SSI/ SSDI benefit payments and Medicaid/ Medicare after a medical continuing disability review (MCDR) is conducted and an unfavorable decision has been issued. The SSA has processes in place to identify potential Section 301 cases and to make Section 301 determinations on those cases. Section 301 payments are authorized when the consumer:
Section 301 payments continue until one of the following occurs:
If a consumer has received an unfavorable decision as the result of an MCDR, the consumer might be eligible for continued cash payments and healthcare under Section 301. Advise the consumer to contact SSA to verify participation in DBS services and request a determination of eligibility for continuation of benefits under Section 301.