7.0 Eligibility for Vocational Rehabilitation Services
Table of Contents
State of Alaska
Department of Labor and Workforce Development
Division: Vocational Rehabilitation
Policy: CS 6.0
Subject:Eligibility for Vocational Rehabilitation Services
Reference:
34 CFR § 361.42
Effective Date: 10/1/2006
Revised Date:6/30/2009, 9/16/2009
Approved: ____________________________________ 9/16/2009____________
Cheryl A. Walsh, Director Date
1.0 - Policy
An individual is eligible for ADVR services when a VR counselor determines the following criteria are met:
The individual has a physical or mental impairment;
The individual's impairment results in a substantial impediment to employment; and
The individual requires VR services to prepare for, secure, retain or regain employment consistent with the individual's strengths, resources, priorities, concerns, abilities, capabilities, interests and informed choice.
Any eligible individual receiving VR services must intend to achieve an employment outcome. The completion of the application process is sufficient evidence of the individual's intent to work.
ADVR presumes VR services will enable all eligible individuals to obtain employment. If the significance of the individual's disability prevents the VR counselor from making this presumption, the individual may participate in a trial work experience or an extended evaluation.
ADVR will make an eligibility determination within 60 days upon the receipt of a completed application unless circumstances occur which are beyond the control of ADVR.
Criteria not considered for eligibility include age, gender, race, color, national origin, type of disability, expected employment outcome, referral source, the cost of services and/or the individual's income level.
2.0 - Definitions
Functional limitations: Limitations imposed by a disability that impede or limit an individual's functioning in one or more of the following areas: mobility, work tolerance, self-care, work skills, communication, self-direction and interpersonal skills.
Impairment: Impairment is the loss or limitation of physical, mental or sensory function on a long-term or permanent basis.
ubstantial impediment to employment: An impairment which hinders an individual from preparing for, entering into, engaging in, or retaining employment consistent with the individual's abilities or capabilities and significantly limits one or more functional capacities of the individual in terms of an employment outcome. A VR counselor determines if a substantial impediment to employment exists.
3.0 - Procedures
3.1 - Assessment for Determining Eligibility and Priority of Services
An assessment is conducted in applicant status to determine if an individual is eligible for VR services, the severity of disability, and the priority of service category. The assessment to determine eligibility for services is based primarily on a review and assessment of existing, current information and is conducted in the most integrated setting possible, consistent with the individual's needs and informed choice.
The rationale for using existing data is to streamline the eligibility process and to expedite access to services. Decisions regarding whether and how specific data are to be used must be made on a case-by-case basis, and while the accuracy and timeliness of existing data are important factors in determining their usefulness, older data can be used if still pertinent.
Sources of Information
Sources of information that may be used to substantiate a physical or mental impairment and related limitations caused by the impairment include:
Existing records from qualified facilities or practitioners familiar with diagnosing or treating the impairment(s) in question, especially practitioners or facilities that are currently treating the applicant. This would include records from qualified medical personnel, mental health or developmental disability programs, substance abuse treatment clinics, and individually licensed practitioners operating within their legal scopes of practice.
When requesting medical information, the counselor should ask the medical provider to address specific issues that may affect the individual's functional ability to work or participate in vocational rehabilitation services.
Special Education records, including an Individualized Education Plan (IEP) which identifies the individual's impairment;
Veteran's Administration disability benefits records that identify the disability,
Division of Workers' Compensation records which may be obtained at no charge for State of Alaska employees. By statute, Workers' Compensation records can only be provided by using their release form which can be signed by the VR counselor.
The Department of Corrections will often have medical information on recently released prisoners;
Counselor observation of a readily visible anatomical impairment such as amputation, deformity, or muscle wasting associated with paralysis; and
Verification of current eligibility for Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI).
The existence of a substantial impediment to employment (due to a mental or physical impairment) may be substantiated by any of the information sources noted above if the record in question addresses work or training limitations. The following information may also be used to substantiate the existence of substantial barriers to employment:
Counselor observation of behavioral or functional limitations of an impairment;
Written or verbal reports or descriptions of vocationally relevant limitations from the applicant, their representative, family members, school staff, employers and others familiar with the individual.
The existence of behavioral or functional limitations alone is not sufficient to establish a substantial impediment to employment. The counselor must determine that these limitations result in a substantial, material and significant barrier (given the individual's training, education and employment history) to the individual in terms of preparing for, securing or retaining employment consistent with their abilities and capabilities.
Licensed counselors and/or certified rehabilitation counselors may conduct appraisals and assessments directly as allowed by their scope of practice and should document such findings in case notes apart from the eligibility determination.
If the applicant's informed, written consent is needed to secure information it may be obtained by using the Division's Release of Information. (See ADVR Policy and Procedures CS 2.0 - Confidentiality for further information.)
Applicants who have been determined to have a disability under SSI and/or SSDI are presumed eligible for vocational rehabilitation services unless their ability to benefit from an employment outcome is in doubt. Verification of eligibility for SSI and/or SSDI or a copy of an SSA issued "Ticket to Work" must be on file. No further eligibility assessment is necessary. However, existing assessments from SSA and additional assessments may be obtained for a determination of vocational rehabilitation needs.
Verification of disability for SSDI, SSI, Special Education, or Veterans Administration disability may include, for example:
Copies of award notice or letters notifying the applicant of eligibility.
A copy of an Individualized Educational Plan (IEP) indicating that the applicant has been determined eligible for Special Education.
Written confirmation of receipt of social Security Disability Insurance or Supplemental Security Income (on the basis of disability) from the local Social Security office or a Ticket to Work issued by SSA.
Evidence of eligibility for Special Education presumes only that the applicant has a physical or mental impairment and a substantial impediment to employment. The counselor must still determine whether the individual requires vocational rehabilitation services to achieve an employment outcome consistent with ability and capability.
An appraisal of current health is not required for eligibility in addition to information documenting the disability, but should be provided, for example, if there is a question regarding the applicant's overall health status and how it may impact employability.
The assessment to determine rehabilitation needs should begin concurrently with the assessment to determine eligibility.
To the extent that existing information does not describe the individual's current functioning, or is unavailable or insufficient to make an eligibility determination, an assessment of additional information resulting from the provision of VR services can be conducted. This may include the provision of assistive technology devices and services, and worksite assessments to determine the employment barriers faced by the individual and to determine whether an individual is eligible.
Medical or other evaluations may be purchased or provided if other sources of documentation are not available, the nature of the disability is not stable, observable, or clearly defined, or information needed to determine the severity of the disability is not available. The age of diagnostic information should be appropriate to the applicant's impairment(s) and the planned use of the information. Generally, more current information will be needed if the impairment is unstable, progressive, or the diagnosis is unclear.
Counselors shall request VR manager's and/or medical consultation, as needed, if there are questions about whether formal assessments are needed, the specific questions to be answered, and the type of assessment that is most appropriate. Consideration may be given to the following types of assessment for eligibility:
General medical evaluation: General medical evaluation should be considered when existing information does not describe the individual's impairment and impediment to employment and they are likely to be sufficiently documented in a general medical evaluation.
Medical specialty evaluations: Referral for medical specialty evaluations, such as orthopedic assessment, ophthalmologic assessment, or medical/functional evaluation at WTC, shall be considered when current information about the individual's disability is not available and there are specific questions about (1) whether a reported impairment constitutes an impediment to employment, and (2) the impact on life functions (priority).
Psychological/psychiatric: Referral for psychological evaluation should be considered when current information about the individual's disability is not available and there are specific questions about (1) whether a reported mental impairment constitutes an impediment to employment, and (2) the impact on life functions (priority). Referrals for psychological assessment shall be made via the Referral for Psychological Services, RS
Neuropsychological evaluation: Referral for neuropsychological evaluation should be conducted on an exception basis and be considered for individuals when current (within the last 12 months) information from treating sources is not available, when there are questions about (1) whether a reported impairment constitutes an impediment to employment, and (2) the impact on life functions (priority). It may also be considered if there are questions about the severity and impact on employment. Such assessment may be appropriate for individuals with a history of head injury and other neurological impairment.
Substance Use Disorder
A history of substance abuse is not sufficient to determine the existence of a substantial impediment to employment for the purpose of assessing eligibility. An assessment by a qualified substance abuse professional should be obtained to assess the individual's functional status and possible need for treatment to become employed when existing information is not available or current. Assessment information should include relevant clinical data as well as information about the individual's assets and limitations in work-related terms; i.e., physical, cognitive, emotional, social, and personal functioning.
Individuals who appear to have coexisting mental or emotional impairments should be referred to a qualified provider for a more comprehensive assessment. Standardized letters may facilitate communication with assessment professionals and treatment programs with respect to the information that is most helpful to the counselor.
Individual commitment to recovery and abstinence is also an important determinant in assessing employability and rehabilitation needs. Establishing individualized periods of abstinence to assess readiness for services is acceptable, particularly when done in collaboration with a substance abuse professional. However, a universally-applied abstinence criterion is federally prohibited and may not be used as a condition of applying for, becoming eligible for, or receiving Agency services. Providing a period of extended assessment to individuals who have had very limited success in maintaining sobriety may assess their ability to benefit from services needed to become employed.
Following the determination of eligibility, the information obtained during this assessment can serve as a starting point for the development of the IPE.
3.2 - Timeframe
ADVR makes an eligibility decision when sufficient information is available, but no longer than 60 days after a completed application is received.
If the VR counselor does not have enough information to determine eligibility within 60 days, the individual and the counselor must:
Discuss the reason for the delay, whether other methods to get the information are needed, determine the expected eligibility date and agree to extend the eligibility period or
If the significance of the disability prevents the VR counselor from presuming that VR services will enable the individual to work, the individual may complete a trial work experience and/or an extended evaluation. For further information, see ADVR Policy and Procedures CS 7.0 - Trial Work and Extended Evaluation.
If the individual does not agree to extend the eligibility determination period, the determination will be made on the available information which will most likely result in the case being closed.
3.3 - Eligibility Criteria Documentation
Impairment
The VR counselor will identify the disability or disabilities by name and use medical information to substantiate the presence of the disability and
If the individual has multiple disabilities, the counselor will use his/her professional judgment to identify the primary disability.
Impediment to employment
The VR counselor will:
Describe the physical, functional, mental and cognitive limitations of the disability or disabilities identified;
Describe the vocational/work history, considering the following:
Has the person lost jobs or had difficulty obtaining a job because of the disability;
Does the person have an unstable work history and has the disability contributed to this;
Do we know why the person left the previous job;
Is the person prevented from doing the type of work previously performed because of the restrictions of the disability;
Do the restrictions of the disability limit the kinds of jobs the person can do;
Is it likely that the person have difficulty obtaining employment because of employer attitudes;
Is there evidence of problems in daily activities and employment that relate to the disability; and
Link how the specific functional limitations presented by the disability impact the individual's ability to get, keep or prepare for a job consistent with their capacities and abilities.
VR services required for employment
The VR counselor's statement will synthesize the above information to:
Describe the VR services required by the individual as a result of the impediment to employment;
Include available no cost services such as those provided by the VA and discuss why multiple service agencies are needed; and
Include guidance and counseling and any appropriate ADVR in-house assessment services.
The eligibility statement is signed by a VR counselor with the delegated authority to determine eligibility.
3.4 - Presumption of Benefit
ADVR presumes that VR services can help an eligible individual go to work. When a VR counselor questions if an individual can benefit from VR services due to the severity of the individual's disability, the VR counselor must obtain clear and convincing evidence that the individual cannot go to work after receiving services.
To obtain clear and convincing evidence, the VR counselor explores the individual's abilities, capabilities, and capacity to work in realistic work situations through a trial work experience. For further information on trial work, see ADVR Policy and Procedures CS 7.0 - Trial Work and Extended Evaluation.
3.5 - Social Security Administration (SSA) Beneficiaries
Individuals who are receiving SSI-disability or SSDI benefits from SSA are considered to have a disability that is an impediment to employment.
The beneficiary must be informed that individuals who receive VR services intend to work. Completion of the application process is sufficient evidence the individual intends to work. While not an eligibility issue, a benefits analysis is also appropriate for SSA beneficiaries and should be done prior to IPE development. The information provided in the analysis will strengthen the individual's commitment to an employment outcome.
Verification of the individual receiving social security benefits is required and completed as part of the application process.
SSI-disabled or SSDI recipients are not automatically entitled to VR services. In order to make the individual eligible, the VR counselor must presume the individual can benefit from VR services.
If the VR counselor cannot presume VR services will enable the individual to work, clear and convincing evidence of the inability to benefit must be obtained through a trial work experience. See ADVR Policy and Procedures CS 7.0 - Trial Work and Extended Evaluation for further information
3.6 - Individuals who are currently employed
Individuals who are currently employed are not necessarily ineligible for ADVR services. "Retain employment" is addressed in the third eligibility criteria. Individuals with a disability who are employed may be eligible for ADVR services if, as a result of their disability, their employment:
Endangers the health and safety of the individual or others;
Is in jeopardy;
Is unsteady; or
Results in significant underemployment and needed services cannot be obtained from other agencies, their employer or other resources.
An individual whose job is in jeopardy is in danger of being terminated due to disability related factors. A job may be considered in jeopardy if the disability substantially hinders an individual's job retention, or an individual has confirmation of a restructuring of their position which, due to their disability, they would no longer be able to do, and requires VR services to retrain for a new position.
When considering whether an individual requires job retention services, the VR counselor should seek objective verification, such as a statement from the current employer, a job analysis or medical verification of a significant decline in functional capacity related to job function. Routine maintenance or replacement of personal medical or adaptive supplies and equipment are the responsibility of the employed individual, and generally are not sufficient grounds for a finding of eligibility for ADVR services.
Unsteady employment is work that is seasonal, intermittent, temporary, permanently part-time, or subjects the individual to a pattern of lay-offs or variations in the availability of work. Seasonal is defined as employment of less than five months duration, linked to seasonal conditions. Temporary is defined as employment for 180 days or less. Part-time is defined as permanently assigned to less than 30 hours of work per week.
Seasonal work in Alaska may be more common than in other states and is often desirable. VR services may be required when the disability prevents the individual moving from a seasonal job into year-round employment.
Underemployment is defined as employment in which there is a significant discrepancy between the individual's demonstrated abilities and capabilities and the demands of the current job. Discrepancies that could be resolved through work experience or training routinely provided to all employees would not be considered "significant". Individuals who have access to resources, but choose not to use them, are generally considered not to require ADVR services.
As with other applicants, the employed individual must meet all the eligibility criteria to be determined eligible for ADVR services.
3.7 - Ineligible
Individuals are not eligible for VR services when:
There is no disability;
There is no impediment to employment;
There is no requirement for VR services; or
The disability is too severe for the individual to benefit from VR services. An individual cannot be made ineligible for this reason unless they have gone through a trial work experience or extended evaluation.
A decision not to make an individual eligible for VR services should be done only after the VR counselor has:
Provided the individual an opportunity to talk by telephone or meet to explain why the individual is not eligible;
Provided an opportunity for the individual to ask questions; and
Provided additional information relevant to the decision.
The VR counselor will then send a letter informing the individual of the ineligibility decision and that the case will be closed. The letter will include:
An explanation of the reason(s) for the decision;
The individual's right to appeal the decision;
Information on the Client Assistance Program; and
Information on other employment related programs that are part of the Job-Center system.
4.0 - Exceptions
Any exception to policy must be approved by the Chief of Rehabilitation Services or his/her designee.
5.0 - FAQs
Question: Is an individual receiving SSI or SSDI automatically eligible for VR services?
Answer: No, see 3.5 - Social Security recipients .
Question: What is the difference between SSI and SSDI?
Answer: SSI and SSDI are programs administered by the Social Security Administration that provide benefits to individuals based on disability:
Social Security Disability Insurance (SSDI):
Eligibility is based on credits for taxable work
Benefit amount is based on Social Security earnings on the insured worker
Benefits are payable to blind or disabled workers, widow(er)s or adults disabled since childhood who are otherwise eligible
Supplemental Security Income (SSI):
Payments are made based on financial need
Payments are made to adults or children who are blind or disabled
Payments may also be made to individuals who are age 65 or older and have limited income
Question: Is a person who is employed automatically ineligible for services?
Answer: No, there are several situations where an employed individual may be eligible for VR services. See the 3.6 - Individuals who are currently employed.
Question: A VR counselor questions that an individual can benefit from VR services. The individual decides they do not want to do trial work and are OK with closing their case. What closure reason should be used?
Answer: Use declined to participate for individuals who choose not to participate or continue in their VR program. Do not use disability too significant in this scenario. It doesn't matter why the individual doesn't continue, only that they agree not to continue.
Question: I can't make an eligibility determination within 60 days because the doctor's office is slow in getting the medical records to me. Should I put the individual in trial work?
Answer: No, talk to the applicant and negotiate an extension to the 60-day determination period. Document the extension in AWARE. . Remember even with a documented extension, the case is still counted as being one where a determination was not made within 60 days. Therefore, make every effort to determine eligibility within 60 days.
Trial work is used only when a VR counselor questions that the applicant is too severely disabled to benefit from VR services.
Question: Do I have to complete the "Certificate of Significance of Disability" prior to making an eligibility determination?
Answer: Yes, the AWARE system requires the severity of disability be addressed before an eligibility date can be saved. This determination is actually an order of selection (OOS) issue that would be required if ADVR were on an OOS. See ADVR Policy and Procedures CS 17.0 - Order of Selection for more information.
Question: An individual has several medical conditions. Must I have information about each condition before I can make an eligibility decision?
Answer: No, make the decision if you have enough information to establish eligibility based on one or more of the conditions. Amend the statement when you obtain additional information.
Question: Do we have to send a letter confirming an individual is eligible for VR services?
Answer: You are not required to send a letter of eligibility unless you are unable to contact the individual by phone or in person. Even with contact, a letter is sometimes a good idea as it clearly states program eligibility. Some individuals have commented that they did not know they were eligible until well into plan development.
Be sure and record the eligibility date in AWARE when you have made the eligibility determination rather than waiting to meet with the individual. This latter scenario often results in going beyond the 60-day eligibility determination timeframe.
Question: Providing benefits analysis is referenced in 3.5 - Social Security recipients. Are we required to do an analysis at eligibility?
Answer: A benefits analysis can be provided at any time during the rehabilitation process. VR counselors will often purchase an analysis prior to making an eligibility determination as the information will help SSA recipients decide if they are truly interested in going to work. Some recipients are fully aware of their benefits and the affect employment will have on their benefits and do not require an analysis. The timing for the analysis is a judgment call on the part of the VR counselor, but should be done prior to IPE development.
