DRS Rehabilitation Policy Manual Chapter 5: Services

Revised 12/09

RPM 5.3.4 Physical Restoration Services or Procedures with Special Requirements

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  • occupational therapy;
  • orthotics and prostheticsorthoses and prostheses;
  • outpatient services;

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Orthoses and Prostheses

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Purchasing Orthoses and Prostheses

Purchase the most basic orthotic or prosthetic device that allows a consumer to meet his or her vocational needs. Consider purchasing more technologically advanced devices or components only if required by the consumer's unique vocational or medical needs. See Counselor Desk Reference, Chapter 2: Amputations, 2.4 Purchasing Prostheses for guidance.

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If the orthosis or prosthesis is a replacement, the letter must fully describe the design and components of the current device. The letter should also

  • identify problems that have limited the consumer's ability to use the device, and
  • explain the necessity and rationale of the proposed treatment.

A purchase order (PO) for an orthosis or prosthesis should be generated using the letter of specification. Payments for orthoses or prostheses may not exceed MAPS.

Prosthetic purchases require approval if

  • DRS’ cost equals or exceeds $12,500 and the letter of specification contains no unlisted MAPS codes; or
  • the letter of specification contains unlisted MAPS codes, regardless of cost.
Approval Procedures for Purchasing a Prosthesis Costing $12,500 or More without Unlisted MAPS Codes

If the prosthesis letter of specificationDRS’ cost for the prosthesis is $12,500 or more and there are no all L-codes have MAPS feesunlisted MAPS codes, the case will be reviewed by the University of Texas Southwestern (UTSW) Medical Center Prosthetics–Orthotics Program. Follow the procedures below.

Counselor or MSC

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If UTSW does not agree with the prosthetist's letter of specification, the prosthetist may submit additional information and request a follow-up review of the case. The additional information must be substantive and customized to the consumer. It should not be generic information or the same information provided in the original documents. Request the UTSW follow-up review using the procedure outlined above at an additional cost of $375.00. Only one follow-up review is allowed. Questions about the UTSW report should be directed to the PSPD.

Approval Procedures for Purchasing Specialized Devices and Componentsan Orthosis or Prosthesis with Unlisted MAPS Codes

If the L-code for a device or component is not listed in MAPS when the service record is generated, the Central Office Orthotic and Prosthetic Review Committee (OPRC) must approve the purchase of the specialized device or component regardless of cost. Refer to the Counselor's Toolbox for a complete list of specialized prosthetic and orthotic devices and components requiring OPRC approval. Use the following procedures to submit a case to the OPRC for approval.

Counselor or MSC
  1. obtains the area manager's approval to purchase the item; and
  2. prepares a packet containing the following required information:
  3. anOPRC Review Cover Sheet;

oa completed DARS3101, LMC Review;

  • the prescription for the prosthesis or orthosis;
  • the Letter of Specification for the prosthesis or orthosis;
  • prosthetist notes explaining the unique medical conditions or employment requirement for the item and measurements;
  • a DARS3602, Lower Extremity Amputation Checklist or DARS3601, Upper Extremity Amputation Checklist; and
  • additional pertinent medical or vocational records;. and
  • the counselor case note justifying the vocational or independent living need.
OPRC
  1. reviews the request to purchase the item and decides whether to approve it based on a justified medical, vocational, or independent living need of the consumer.
CPBS (Consumer Procurement and Business Services) or PRS (Physical Restoration Specialist)
  1. enters the committee's decision in the consumer's electronic file.

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5.8.1 The Purpose and Scope of Adjunct Services

This section describes policies that apply to services that

  • support other planned VR services, or
  • are necessary for a consumer to participate in assessments to determine eligibility and rehabilitation needs.

These services include

  • maintenance,
  • consumer transportation,
  • personal attendant services,
  • interpreter services for people who are deaf,
  • special telecommunication assistance,
  • translator services,

institution-to-community coordination services,

  • services to family members,
  • tools and equipment, and
  • occupational licenses.

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5.8.4 Personal Attendant Services

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Supporting Relocation from a Nursing Home or Institution

Personal attendant services may be provided for up to 12 months, if a consumer is relocating to a private residence from a

  • nursing home,
  • community residential or group home, or
  • mental health facility.

See 5.8.8 Institution to Community Coordination (ICC) for additional help in coordinating relocation.

Comparable Benefits

*Use comparable benefits when they are

  • appropriate for the consumer's needs, and
  • available timely before case service funds are encumbered.*

You may supplement these comparable services, as necessary, with case service funds.

*Based on 34 CFR Section 361.5(b)(10)

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5.8.8 Institution to Community Coordination (ICC)

Overview

The institution to community coordination (ICC) program helps a consumer relocate from an institution to the community. ICC does not provide direct services, but coordinates existing community supports and services to help the consumer "navigate" through a service-delivery system. ICC services are time-limited and focused on coordinating the relocation process.

In the VR program, ICC supports the planned employment goal by helping the consumer who has a significant disability function independently in the community.

In the ILS program, ICC leads to achievement of the community-based service goal for the consumer who resides in an institution.

For additional information on ICC services, see the DRS Standards for Providers Chapter 9: Institution to Community Coordination (ICC).

Sequential Services and Payment Benchmarks

Before starting ICC, the consumer must understand that the services purchased by DRS are time-limited and that, when you close his or her case, the consumer is responsible for continuing the community living situation and all necessary community support.

You may purchase the following services:

Step 1, Support Analysis (SA);

Step 2, Coordination Plan (CP, DARS3832);

Step 3, Relocation Coordination (RC);

Step 4, Community Relocation (CR);

Step 5, Relocation Follow-up (RF); and

Step 6, Community Stability (CS).

You must provide identifying information to the Central Office program specialist for ICC when you initiate ICC services. Since other agencies such as DADS provide similar relocation services, the program specialist for ICC monitors the process to avoid duplicate payments by DARS and other agencies to a provider for the same service to the same consumer.

The area manager must approve providing ICC services, which may be purchased either

during extended evaluation, or

under an IPE.

After the area manager has approved the action, purchase one or more of the ICC services from an approved provider.

The Comptroller's State of Texas Purchase Policies and Procedures Guide does not allow DRS to pay deposits (for example, rental or utility deposits) on behalf of consumers, and area managers cannot approve such purchases.

Step 1, Support Analysis (SA). Purchase the SA from an ICC provider to help you and the consumer determine relocation needs and appropriateness for additional ICC services.

To ensure a complete SA, share with the ICC provider any assessments, evaluations, or medical documentation relevant to analyzing relocation and community stabilization needs.

The DARS3831, Support Analysis (SA) Checklist (Step 1), helps you determine whether the analysis addresses appropriate relocation needs, barriers, and supports.

The ICC provider receives a flat fee for this service benchmark when the required documentation is complete.

Step 2, Coordination Plan (CP) Services. The CP is a comprehensive written plan for community relocation and stabilization that addresses the needs identified in the SA. It contains specific strategies and time lines for meeting those needs. Use DARS3832, Coordination Plan (CP) (Step 2), to document the plan.

You must stop the ICC service when the consumer

needs long-term care services, but the resources cannot be identified; and

cannot relocate to and function independently in the community.

The ICC provider receives a flat fee for this service benchmark when the required documentation is complete.

Step 3, Relocation Coordination (RC) Services. The RC coordinates the relocation from an institution to the community. It implements all the strategies identified in the CP. When this service is completed, the consumer is ready to relocate, with all support and community services in place.

Document implementation of the CP strategies on DARS3833, Relocation Coordination (RC) Checklist (Step 3).

The ICC provider receives a flat fee for this service when the required documentation is complete.

Step 4, Community Relocation (CR) Services. The CR

results in the consumer's physical move from the institution to the community, and

ensures that all actions specified in the CP (DARS3832, Coordination Plan [CP] [Step 2]) are carried out.

The consumer or consumer's representative and the ICC provider must sign DARS3834, Community Relocation (CR) Checklist (Step 4).

The ICC provider receives a flat fee for this service when the required documentation is complete.

Step 5, Relocation Follow-up (RF) Services. RF provides follow-up for the consumer who has been living in the community for 90 calendar days. If the ICC provider identifies problems during this period, the provider meets with you and the consumer to find a solution, which is then documented in an amendment to the CP (DARS3832).

The ICC provider receives a flat fee for this service when the required documentation is complete.

Step 6, Community Stability (CS) Services. CS can occur anytime after RF and results in the consumer's stabilization within the community. Delivery of this service has been fulfilled when all CP strategies have been implemented.

The ICC provider receives a flat fee for this service when the required documentation is complete.

Determining the Appropriateness of ICC Services

Determining the need and extent of relocation services that are required and the expectation for successful relocation can be a lengthy process.

The Process for Determination. When you take information for a consumer application, email the program specialist for ICC the consumer's

name, and

Social Security number.

The program specialist for ICC tracks all ICC recipients for

service provision, and

possible duplication of payment through other agencies.

Services beyond the SA are appropriate for consumers who

are eligible for VR or ILS services, and

require ICC to achieve an employment or IL goal.

Document the situation in case notes when

there are no ICC providers,

there are limited providers, or

the provider is unable to immediately serve the consumer.

Where a local ICC provider is available, arrange for service as soon as possible.

Where a local ICC provider is not available,

determine whether the closest ICC provider is willing to provide services, or

contact the regional consumer contract specialist (RCCS) to develop a contract with a local provider.

Document these actions in case notes.

Serving the Consumer Who Requires Long-Term Care Services. If the consumer requires long-term care services, you must identify other sources to fund and provide these services because DRS does not purchase them on an on-going basis

DRS may purchase long-term care services only for an interim period to help the consumer achieve an employment or independent-living goal.

Providing ICC Services within the VR Program

ICC beyond the support analysis (SA) is appropriate for the consumer who

is eligible for VR services (see Chapter 3: Eligibility); and

with ICC, can reasonably expect to obtain or maintain employment in the community.

Document at profile and diagnostic interview the consumer's request for ICC to assist in the relocation from an institution to the community.

Complete the profile and diagnostic interview regardless of the consumer's reported level of functioning as referenced in Chapter 2: Initial Contact and Application, 2.2 Sources of Referrals. All policies relating to the VR program apply to ICC cases. You may provide ICC services concurrently with traditional VR services, based the consumer's needs.

With the addition of specific ICC intermediate objectives, the IPE follows policy (see Chapter 4: Assessing and Planning, 4.4 Developing the IPE).

Relocation from an institution to the community is an intermediate objective.

Providing ICC Services within the ILS Program

ICC services beyond the support analysis (SA) are appropriate for the consumer who

is eligible for IL services (see Chapter 8: Independent Living Services [ILS]); and

with ICC, has a reasonable expectation of functioning more independently in the home and the community.

Because the SA is designed to determine relocation needs and you can use it to help determine eligibility, purchase it before the plan initiation date without removing the applicant from the Interest and Waiting List.

The SA is also an important diagnostic tool that helps you plan the required relocation services, so that you can purchase them in accordance with ILS policies on

the Interest and Waiting List for purchased services, and

post-closure services.

If the consumer completes ICC and successfully maintains a community living situation, the goal set and met is "community services."

Interrupting or Terminating ICC Services

Interrupting Services. Sometimes a consumer must return to an institution for a short period, with the expectation of returning to the community. You and the consumer must determine the impact of a temporary return to the institution on the ultimate employment or independent living goal.

Consultation with the ICC provider helps you and the consumer make appropriate decisions about

additional ICC services, and

the stability of community supports.

Providing Coordination Services for Reinstitutionalization. When ICC is not successful and the consumer must return to the institution, purchase reinstitutionalization coordination services from an ICC provider. You and the consumer must agree that reinstitutionalization is necessary.

When reinstitutionalization occurs, you and the consumer reassess the consumer's ability to attain the employment or IL goal, and the services required to meet that goal.

Based upon that assessment,

amend the IPE, or

close the case as unsuccessful.

If the case is in extended evaluation, this assessment may result in a determination of ineligibility.

Technical Assistance

The Central Office program specialist for ICC is available for consultation on service delivery. To facilitate technical assistance, provide copies of the required ICC documentation to Central Office program specialist for ICC within five days of receipt.

5.8.89 Services to the Consumer's Family Members

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5.8.910 Tools and Equipment

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5.8.1011 Occupational Licenses

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