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3.01 ASSESSMENT TO DETERMINE ELIGIBILITY FOR SERVICES

Purpose

An assessment is conducted in Status 02 to determine if an individual is:

1. eligible for VR services (Status 10),

2. ineligible for VR services (Status 08), or if

3. an extended evaluation is needed to determine eligibility (Status 06).

Following the determination of eligibility, the information obtained during this assessment can serve as a starting point for the development of the IPE.

Scope

The assessment to determine eligibility for services is based primarily on a review and assessment of existing, current information. The assessment must be conducted in the most integrated setting possible, consistent with the individual's needs and informed choice. Sources of such information for the assessment can include:

1. existing medical information provided by doctors, hospitals, clinics and referral sources, including the Confidential Health Assessment (Parts I), eye examinations and specialty medical examinations; and,

2. counselor observations, education records, information provided by the individual or the individual's family, information used by the Social Security Administration, education officials and determinations made by officials of other agencies.

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.

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.

Equipment and low vision aids cannot be purchased during a preliminary assessment.

Appraisal of Current General Health Status

Federal policy requires that the assessment to determine eligibility for services include an appraisal of the current general health status of the individual. The Confidential Health Assessment fulfills this requirement. Part I of the Confidential Health Assessment utilizes the consumer's knowledge of his or her health and medical history. In addition, when necessary, a physician can complete Part II.

Completion of Part I (along with evidence of legal blindness) will enable the counselor to make a decision regarding eligibility and guide the counselor in obtaining additional existing medical information. Part II of the Confidential Health Assessment can be obtained during the comprehensive assessment when the counselor is assisting the consumer in developing a goal and determining the nature and scope of services.

Part II of the Confidential Health Assessment is not required unless the counselor decides that it is necessary in order to determine eligibility or the individual's rehabilitation needs. An existing current general medical examination report or equivalent is an acceptable substitute to Part II of the Confidential Health Assessment.

Use of Comparable Benefits

Assessment services in Status 02 are provided without a full consideration of comparable benefits. However, Medicaid benefits and other benefits known to be available must be used in accordance with established policies and procedures.

See Chapter 9.00 - Comparable Benefits for further information.

For More Information

For further information see Chapter 2.00 - VR Services, Status 02.

3.02 COMPREHENSIVE ASSESSMENT

Purpose of the Comprehensive Assessment

A comprehensive assessment of the unique strengths, resources, priorities, concerns, abilities, capabilities, interests and informed choice, including the need for supported employment is conducted, when needed, to determine the goals, objectives, nature and scope of vocational rehabilitation services. The comprehensive assessment begins after an individual has been determined eligible for vocational rehabilitation services or when there is a need to conduct an extended evaluation.

Information from the comprehensive assessment is used to develop the Individualized Plan for Employment (IPE).

Scope

The comprehensive assessment is limited to the information that is necessary to identify the rehabilitation needs of the individual and to develop the IPE. As much as possible, the primary source of such information should be existing information and information provided by the individual and, where appropriate, the individual's family.

The comprehensive assessment may include, to the degree necessary, an assessment of functional capacities, adaptive living and communication skills (e.g. rehabilitation teaching), orientation and mobility skills, employment barriers, vocational interests, interpersonal skills, intelligence and personality factors. The educational achievements, work experiences, vocational aptitudes, personal and social experiences and skills, and employment opportunities of the individual can also be identified as part of this process. Other factors that affect the employment and rehabilitation needs of the individual, such as medical, psychological or psychiatric reports, and relevant cultural, social, recreational and environmental factors, may also be considered.

The comprehensive assessment may also include an assessment of the individual's patterns of work behavior and the services needed for the individual to acquire occupational skills and develop positive work skills necessary for success in employment. This assessment may take place during a situational assessment in a real work setting.

Use of Comparable Benefits

Although expenditures can be authorized for the comprehensive assessment regardless of the individual's economic need status, the counselor should access all resources available through comparable benefits prior to using vocational rehabilitation funds.

After an individual has been determined eligible, it may become necessary to provide additional specialized assessments. These assessments may be provided at

any time during the rehabilitation process without change of status.

3.03 MEDICAL INFORMATION

Introduction

Medical information includes a variety of assessments specific to the individual. This information is gathered:

1. during the assessment to determine eligibility,

2. during the comprehensive assessment, and

3. as part of a reevaluation of any area that might have an impact upon the individual reaching his/her vocational goal.

Types of Medical Information

Medical information used by the VR counselor may include:

1. the eye examination or equivalent reports

2. the Confidential Health Assessment

3. specialist examinations or equivalent reports

4. otological and audiological examination or equivalent reports

5. psychological evaluation

Time Frames for Medical Information

An eye examination or an appraisal of general health which has been conducted within twelve months prior to the date of its use is considered sufficiently current. However, for stable medical conditions (e.g. total blindness, permanent condition), a report within the past three years can be considered sufficiently current, if it accurately reflects the individual's current health status, disability(ies) and functional limitations. For progressive disabilities or unstable medical conditions, more recent reports may be required, as determined by the counselor's discretion.

Rule

To the maximum extent possible, counselor's will use existing information when available rather than purchase new examinations or evaluations. Specialty examinations are not provided or equivalent reports are not obtained when

the eye examination indicates no visual impairment, or it has been determined that the individual is not eligible for services.

Requests for Medical Information

Requests for additional medical information should include specific questions regarding the individual's functioning such as diagnosis, prognosis, functional limitation(s), and recommendations related to treatment or employment. These questions should be addressed by the service provider in a report sent to the counselor.

Medical Information Required to Determine Eligibility

To determine the eligibility of an individual applying for VR services, the following medical information must be obtained:

1. eye examination report or equivalent by an ophthalmologist or optometrist

2. Part I, Confidential Health Assessment;

3. other specialty examinations (e.g. audiological, psychological, neurological), if necessary, in accordance with guidelines in this chapter.

Information regarding any secondary disability(ies) is not necessary for determining eligibility unless the counselor is concerned that the disability may affect eligibility for services. In most situations, information about the secondary disability may be useful after the eligibility determination when developing the scope of services during a comprehensive assessment.

If the eye examination indicates the applicant is not legally blind, she/he is not eligible for VR services from NYSCB. No further assessment services are to be purchased. If the individual is interested in being referred to VESID, the counselor should initiate the referral in accordance with the guidelines on page 4.01.06.

Purpose of the Eye Examination Report

The purpose of a medical report from an ophthalmologist or optometrist is to:

1. determine legal blindness

2. determine the nature of the visual disability

3. recommend the need for a low vision evaluation

While an existing eye examination report may be sufficient for determining eligibility, counselors may obtain a new medical eye examination if necessary to determine the individual's rehabilitation needs and develop the IPE. A counselor may also obtain a new medical eye exam when an individual has not had ongoing eye care and a new exam may contribute to preservation of residual vision.

Low Vision Evaluation

When indicated on the eye examination report or when deemed necessary by the counselor, a Low Vision Evaluation should be obtained from a optometrist specializing in low vision or an ophthalmologist.

Types of Eye Specialists

An ophthalmologist is a Doctor of Medicine(MD) who specializes in the diagnosis and treatment of eye diseases. An ophthalmologist can perform ophthalmic surgery when necessary and can prescribe glasses, contact lenses and low vision aids.

An optometrist is a Doctor of Optometry (OD) who is trained to examine the eyes and determine vision abnormalities and in some cases, can detect eye diseases and make referrals to an ophthalmologist when appropriate. An optometrist prescribes glasses, contact lenses, low vision aids and provides consultation on other visual aids (equipment) and appliances.

Confidential Health Assessment

The Confidential Health Assessment is an appraisal of the individual's current general health status. Part I: Client Interview can be completed with the consumer during the initial interview. When the form is completed prior to the initial interview, the counselor should review the information with the consumer. Part I is necessary to complete the preliminary assessment and to make a determination of eligibility.

Part II: Physician's Appraisal of Current General Health is a general medical report which supplements the information obtained in Part I. Part II is only obtained when the counselor decides it is necessary to assess some aspect of the individual's physical functioning in order to determine eligibility or the rehabilitation needs to develop the IPE. This appraisal is not required in order to make a final determination of eligibility, but may be obtained if there are functional issues related to eligibility or IPE development. Equivalent existing medical information, such as a current medical examination report, is an acceptable substitute for Part II of the Confidential Health Assessment.

Purpose of the Confidential Health Assessment

The purpose of the Confidential Health Assessment is to:

1. obtain basic information about the individual's general health;

2. provide information to assist in the eligibility decision;

3. provide information to plan for further medical evaluations, if necessary.

Medical Records

Reports of medical examinations and hospital or clinic records should be obtained when available. If the records provide information which describes current general health status, disabilities or functional limitations, they will supplement the information obtained in Part I of the Confidential Health Assessment and may substitute for Part II of the Confidential Health Assessment or the need to authorize any new examinations. Counselors may authorize $10.00 to medical providers for existing medical reports.

Purpose of Specialty Examinations

The purpose of specialty medical examinations or equivalent reports during the VR process is to assess medical issues to gain information about functional capabilities or treatment needs which may impact upon the consumer's eligibility, rehabilitation needs, employment goal and plan for services.

When to Obtain a Specialist Examination

When determining whether or not a specialist examination should be obtained, the counselor will use the following guidelines:

If existing specialty medical reports are not available or are inadequate based on the counselor's judgement or supervisory/medical consultation, then the counselor should obtain a new examination.

If the Confidential Health Assessment or other information indicates a secondary disability or indicates a need for a special medical examination, but in the counselor's

judgement a specialty examination is not necessary or appropriate, then the counselor must justify in a note why the examination is not being obtained.

Counselors can request assistance from the senior counselor or medical consultant when making this determination.

Examples of Specialist Examinations

In addition to the eye examination, other specialty medical examinations or equivalent reports may be needed, such as an examination by an internist for an applicant with diabetes, or an examination by a neurologist for an individual with a known or suspected seizure disorder.

Purpose of the Otological or Audiological Examination

The purpose of the otological or audiological examination is to evaluate an individual's hearing and provide information for further planning. Screening for hearing loss is very important for individuals with other sensory impairments such as blindness. It is critical that counselors carefully consider when to obtain an assessment and that any known or suspected hearing loss is assessed in a timely manner.

Provision of Hearing Aids

NYSCB may provide hearing aids for individuals who require the aid in order to function in employment. For individuals with a goal of homemaker, NYSCB will only provide hearing aids to individuals who have hearing loss that meets the definition of severe hearing impairment as documented by an audiologist. See Section 8.02 for information on limitations of audiological services and the definition of severe hearing impairment. The provision of hearing aids is contingent upon the individual's economic need status unless the individual meets the definition of deafblind and is identified as being deafblind on the RSA-911.

When to Obtain an Otological or Audiological Examination

The presence of a hearing loss may be suspected because it is specifically indicated

in a report by a physician or observed by the counselor in routine contacts with the applicant.

When a hearing loss is suspected, a comprehensive hearing evaluation will be obtained from a physician specializing in the diseases of the ear or from an audiologist licensed or certified in accordance with New York State law.

If a hearing loss is indicated on the Confidential Health Assessment or other medical reports or if the counselor suspects a loss, then the counselor should obtain an examination, or equivalent report if available.

Purpose of a Psychological Evaluation

The purpose of a psychological evaluation is to assess an individual's cognitive, and learning abilities and intellectual functioning, occupational interests, academic achievement and educational aptitude, perceptual and neuropsychological abilities, motor functioning and mental or emotional status to provide information about rehabilitation needs or for the development of the employment plan.

When to Obtain a Psychological Evaluation

The counselor and consumer may choose to obtain a comprehensive psychological assessment when it is necessary for the counselor and the consumer to identify intellectual, cognitive or other areas of functioning relevant to the determining eligibility, assessing rehabilitation needs and developing and implementing the plan for services. Existing psychological evaluations may suffice if reasonably current. Psychological evaluations can be obtained, as appropriate, from schools, clinics, community agencies, public and private organizations, and certified or licensed psychologists.

Psychiatric/Neuropsychological Examination

If an individual has a mental illness or if one is indicated based on the individual's history or behavior, then a psychiatric exam or a report from a physician or mental health professional may be more appropriate than a psychological evaluation.

Some individuals, particularly persons with a history of traumatic brain injury or learning disability, may benefit from a neuropsychological evaluation rather than a psychological assessment. See Chapter 15.00, Private Vendors for more information.

Payment for Ophthalmological Examinations

The fee for an ophthalmologist examination is $50.00 ($36.00 for the exam and $14.00 for the functional appraisal).

Payment for a Medical Examination to Appraise Current Health Status

The fee for a medical examination to appraise an individual's current health status is $31.50 ($19.50 for the exam and $12.00 for the functional appraisal). An additional $2.50 can be paid if a urinalysis is included.

Payment for Specialty Examinations

The fee for a speciality medical examination is $50.00 ($36.00 for the exam and $14.00 for the functional appraisal).

Economic Need

The provision of medical assessment services is not contingent upon an individual's economic need status.

Comparable Benefits

Assessment services are provided without a full consideration of comparable benefits. However, health insurance, such as Medicaid benefits and other comparable benefits known to be available must be used in accordance with established policies and procedures.

See Chapter 9.00 - Comparable Benefits for further information.

3.04 OTHER ASSESSMENT INFORMATION

Introduction

Assessment information may include a variety of information necessary to identify the individual's rehabilitation needs individual and to develop, implement and complete an Individualized Plan for Employment (IPE). Examples of non-medical assessments are: vocational assessments, academic achievement or educational assessments, rehabilitation engineering or technology evaluations.

When To Obtain Other Assessments

information may be obtained as part of:

1. the assessment to determine eligibility,

2. the comprehensive assessment, or

3. an assessment of any area that might impact on the consumer's reaching an employment goal or completing the plan for services.

Use of Other Assessment Information

When used in conjunction with medical assessments, other assessments should provide sufficient information to allow the individual and the counselor to gain a greater understanding of the individual's strengths, resources, priorities, concerns, abilities, capabilities, interests and needs (including the need for supported employment). Assessments should be conducted in the most integrated setting possible, consistent with the informed choice of the individual. The information should be used to prepare and implement the IPE.

Vocational Assessment/Situational Assessment

Vocational assessment is a brief, time-limited process of determining a person's resources, assets, interests and capabilities toward developing the skills necessary for employment. A comprehensive systematic approach engages the individual as an active participant in the assessment process. A thorough, participatory interview process with the individual is fundamental to the assessment process. Learning and cognitive ability, sensory, physical and motor skills, academic achievement and skills, interpersonal and social skills, work experience and skills and coping and problem-

solving abilities are assessed, as necessary, through a variety of methods. These may include: obtaining performance-based information by conducting situational assessments in integrated, real work settings; performing hands-on work tasks;

observation in natural work or educational settings; and standardized vocational assessment tools adapted for individuals who are blind and visually impaired.

If available, employment records can help the counselor determine the types of jobs, degree of skills, and levels of performance which demonstrate the individual's previous pattern of work activity.

Rehabilitation Engineering or Technology Related Assessments

Rehabilitation engineering or technology assessments may be obtained when appropriate to determine a person's potential to benefit from rehabilitation engineering services or assistive technology. These services may enable an individual with a significant disability to be eligible for VR services and to achieve specific intermediate objectives necessary for reaching an employment goal.

Technology Related Services (Section 8.21) addresses microcomputer-based adaptive technologies that can benefit persons who are legally blind. However, other aspects of rehabilitation engineering may be necessary for individuals to obtain employment consistent with their abilities and interests.

Federal Definition: Rehabilitation Engineering

The Rehabilitation Act of 1973, as amended in 1992, defines the term rehabilitation engineering as "the systematic application of engineering sciences to design, develop, adapt, test, evaluate, apply and distribute technological solutions to problems confronted by individuals with disabilities in functional areas, such as mobility, communications, hearing, vision, and cognition, and in activities associated with employment, independent living, education and integration into the community."

Where are Rehabilitation Engineering Services Obtained

For rehabilitation engineering services, other than microcomputer-based technology related services, the counselor should identify individuals who have demonstrated expertise in rehabilitation engineering. VESID district offices may have approved vendors for this service.

Cost of Rehabilitation Engineering Services

The services of a rehabilitation engineer can be authorized at the current rate for the vendor as approved by VESID, up to a maximum of $175half day or $325full day. If purchased on an hourly basis, up to a maximum of $75.00 per hour. Purchase of service may not exceed twenty hours of service. Additional hours can be purchased with senior counselor approval. Implementation of recommendations may require purchase of equipment (Section 8.08) or modifications.

Economic Need - Rehabilitation Engineering

Rehabilitation Engineering evaluations or consultations are not contingent upon economic need. However, recommendations which require the purchase of services such as equipment or specialized training are subject to the economic need policy for that particular service.

3.05 THE MEDICAL CONSULTATION PROCESS

Purpose

The purpose of medical consultation is to provide guidance for counselors on medical factors related to a consumer's participation in a vocational rehabilitation program.

The Local Medical Consultant

Some district offices have arrangements with a medical doctor to serve as the medical consultant to counselors in that office. If a local medical consultant is not available, the counselor can attempt to use a medical consultant from another district office or can contact the medical providers that are already involved with the individual and request further information about the individual's condition as it relates to vocational rehabilitation needs and services.

When to Use The Medical Consultant

Upon request by a counselor , the medical consultant may be used to review the medical aspects of an individual's disability, functional capabilities and the rehabilitation needs of the individual at the determination of eligibility; during the development of the service plan, particularly when restoration services are indicated; and, prior to closure in statuses 08, 28 and 30, when the reasons for closure are due to the severity of disability, or a rapidly progressive or terminal medical condition. In addition, the medical consultant can be used any time guidance is needed by the counselor to plan effectively with the consumers.

Medical Consultant's Role in the Consultation Process

The medical consultant's role in the consultation process is to assist the counselor when needed to:

1. review and interpret medical information, reports and records,

2. determine the adequacy of medical records and reports,

3. clarify the functional capacities and limitations of the individual,

4. advise on the need for specialist's examinations, and

5. advise on medical factors that may affect the service plan or employment goal,

6. advise on the need or appropriateness of medical restoration services.

For low vision services, the medical consultant does not need to routinely review services recommended by qualified low vision providers.

Counselor's Role in the Consultation Process

Prior to the medical consultation meeting, the counselor will Identify medical factors that may affect employment through:

a. discussion with and observation of the consumer, including completion of the Confidential Health Assessment,

b. procurement of specialist evaluations, reports, and hospital reports and records as needed, and

c. review of existing medical information.

At the time of the medical consultation, the counselor will present to the medical consultant a summary of the consumer's medical condition and the proposed employment goal and plan of services and questions which the counselor would like addressed by the consultant.

Documentation

After a medical consultation has taken place, the counselor will document in a case note the medical consultant's recommendations, comments and other information relevant to the consumer's medical condition and rehabilitation needs. Any written recommendations by the consultant regarding the consumer's functional limitations and their impact on planning, or additional specialty medical evaluations or any follow-ups that are needed should be signed and dated by the consultant and added to the record of services.

The medical consultant should not, under any circumstances, determine an applicant's eligibility. Eligibility decisions are the responsibility of the VR counselor.