Purpose: VR can assist with the purchase of assistive technology, adaptive devices, specialized equipment, and/or job site modifications to correct, compensate, or circumvent the limitations resulting from the disability to assist individuals secure, retain, advance in, or regain employment consistent with their abilities and capabilities. Modifications must be an immediate impediment to employment and not a projected need or client preference. Agricultural work site modifications need to be referred to AgrAbility, so ATP and AgrAbility can collaborate on the assessment. See VRIS Program Manual: AgrAbility

Roles:

• ATP's role is to recommend possible accommodations that meet the client's needs.
• VR is responsible to ensure the recommendations are based on the client's impairment, essential for the employment outcome, and consistent with Nebraska VR's financial assistance policy and procedures. 

Process:

1. Ensure the client has reached maximum medical improvement (MMI). Nebraska VR can accommodate permanent restrictions, not temporary situations due to recovery. 
2. Define the impediment to employment and need for rehabilitation technology, assistive devices, adaptation, home, vehicle, or work modifications.
   • VR Specialist needs to provide an overview of the ATP process with the client and authorized representative, as appropriate.  This ensures an understanding of the recommendations identified by ATP to address their barriers to employment and that VR is responsible to determine funding. 
   • Identify the difficulty the client is experiencing with specific task(s). This strategy will result in a clearer picture of the actual work and/or home environment barriers, so appropriate accommodations may then be explored. If the client has a preconceived idea of a specific accommodation, explain this will be considered during the assessment, but there may be additional options available, and VR needs to consider the least cost option.
   • Explore what strategies/accommodations have been tried, if any. What was the outcome? 
   • Determine how the task is currently being completed. Is this a long-term solution? Is it safe? 
   • If the modification involves an employer or training facility, the VR Specialist needs to discuss with the client the need to get permission for ATP to access the work site and for VR to discuss reasonable accommodations with the employer. If permission is not provided, the assessment may not be able to be completed. 
3. Explore if existing benefits are immediately available (employer, college, home/health/vehicle insurance, Medicaid/Medicare, etc.) to cover the purchase of assistive technology, adaptive devices, specialized equipment, and/or job site modifications. If the client has medical insurance to cover all or part of the evaluation, this benefit must be utilized and documented in the QE2 Comparable Benefits screen prior to considering accessing VR funds for the remaining amount. If the client does not have medical insurance to cover the cost of the driving evaluation, authorize as Assessment Service: Career Planning - Other Assistance (assessment support service).
4. Complete the Service and Device Application (S&D) for items expected to exceed Rule 72. To expediate services, it is important to complete the S&D Application when referring to ATP to allow for a determination of readily available resources prior to receiving the completed ATP Report. See Program Chapter Comparable Services.
5. Complete the ATP Referral Form electronically (no handwritten referrals will be accepted) ensuring the most current information is reflected.
   • When completing the question, " What is the barrier to employment or training?", identify the specific task(s) causing difficulty due to the client's disability. If the client has a specific item of interest this can be shared with ATP but should not be the only information on the form. The actual barrier to employment must be identified.  
   • If information requested on the referral form is not available, VR staff will contact the client for the required information.
   • VR staff will e-mail the completed ATP Referral Form as an attachment to atp.vrforms@nebraska.gov and identify if the referral is a priority SEEN WITHIN FIVE (5) DAYS BY ATP: Use checklist-priority on the referral form to make this determination and obtain Office Director approval. See ATP Priority Service Case Checklist in this chapter for further information and discussion topics below based on the client's situation. 
6. Team Consultation of ATP recommendations.  For items over $2,000 the ATP Technology Specialist, ATP Program Supervisor, VR Specialist, Office Director, and the VR Self-Employment Team will participate in a discussion of the preliminary ATP recommendations and seek agreement prior to completing the ATP Report, getting bids, or sharing recommendations with the client.  VR needs to ensure the recommended accommodations are the least cost option that specifically accommodates the disability and necessary for the client to perform essential functions of the job, not solely for convenience and efficiency.​​​​ 
7. VR Specialist reviews ATP Report, funding email and Resource Letter with the client. 
   • Review the recommended accommodations and ensure they correct, compensate, or circumvent the limitations resulting from the disability to assist individuals to secure, retain, advance in, or regain employment consistent with their abilities and capabilities, as items of convenience are not funded by VR. 
   • Ensure the individual can maintain the upkeep of the requested equipment, if necessary, and are comfortable operating the equipment. 
   • Consults with the ATP Technology Specialist if the client has any issues/questions/concerns regarding the recommendations or venders.
   • Review funding email and discuss the outcome of exploring the identified resources in the Resource Letter to determine VR funding of recommended items. See Program Manual Authorizing Case Services 
8. Complete authorization(s). The VR Authorization must clearly specify what VR is funding and the amount ​​​​​to include a description of the specific item to be purchased, amount and service dates.
   • If Medicaid rates apply a specific amount will not be included, rather the Medicaid standard text will be included. See VRIS Medicaid Authorization & Payment Procedures  
   • For items $5,000 or more, QE2 will generate the VR Acceptance Agreement (AA) form for signatures. VR includes the form with the authorization to ATP.  ATP staff will have the VR client sign the form once the equipment is received and then return it to VR for the final signature. For more information see Equipment Issuance and Recoupment
   • If driver's training is needed upon successful completion of the driving assessment, Authorize as an IPE Service: Disability Related Skills Training to vendor. There may be travel and per diem costs for the High-Tech Driver Evaluation. The number of hours required for the evaluation depends on the client and whether they were driving prior to incurring the disability. If the client is a previous driver the required number of training hours will be approximately 15 to 20. Otherwise, the required hours will be approximately 30 to 40. Driving Training providers may be out of state, or the client may have similar expense if they need to travel a great distance. VR needs to use the least cost option and in-state providers or vendors when possible.
9. Ensure signed Acceptance Agreement form is received from ATP, includes needed signatures, then upload in client's VR casefile.
10. Using the paid ATP invoice received, Nebraska VR accounting associate pays against the VR authorization in QE2 and uploads the invoice and ATP authorization to the client's electronic case file. These do not get submitted to state office. 
11. Place the client in Employment Follow-up by clicking the EF button on the VR supported job on the employment histories screen. Assess how the modifications are meeting the client's needs, ensure they are utilizing the item, and contact ATP if there are any concerns. If there are any performance issues with the purchased item, remind the individual to explore warranty coverage. The case should not be closed if an item is malfunctioning, but instead consult with ATP and assist the individual, as needed to rectify the situation. 
12. Final Inspection. ATP is responsible for completing a final inspection to ensure the client’s needs are met and any equipment provided is working and being used correctly.

Process: ATP 

1. Upon receipt of the referral, ATP may request medical information and/or other documents necessary to adequately complete the assessment. Since ATP is administratively aligned with VR and is listed on the Vocational Rehabilitation Release of Information form an additional release of information is not required.
2. Schedules assessment at the client’s home, training site or workplace and invite VR Counselor to attend. 
3. Conducts an on-site Assistive Technology (AT) assessment, which may include:
   • Talking with the client and employer about the client’s needs.
   • Observing activities or job shadowing.
   • Assessing existing facilities, equipment, hardware, or software. 
   • Measuring, sketching, taking pictures, or videos of the site.
   • Discussing possible Assistive Technology solutions with client.
   • Demonstrating products.
   • Loaning products to client to try (ATP will emphasize these opportunities).
4. Develops assistive technology solutions.
5. Notifies ATP Coordinator when recommended items may exceed $2,000 to ensure the completion of the S&D Application (S&D) for readily available resources and to schedule case staffing with VR Specialist, Office Director, and Self-Employment Team.
6. Obtains quotes from vendors/contractors. Immediately contacts VR Specialist, ATP Program Coordinator & VR Program Director of Counseling if a client disagrees with vendor recommendation.
7. Will notify assigned VR staff of any delays in the provision of services.
8. A funding email will be sent to VR from ATP Program Specialist with a copy of the report, quote(s), and any other necessary documents including the Resource Letter, plans/specs, drawings, photos, (if applicable) along with any additional funding sources identified.
9. The completed VR authorization is sent to ATP via atp.vrforms@nebraska.gov email address. The authorizations are made out to ATP and ATP completes a separate authorization to the specific vendor. In rare cases, when a provider is not a vendor of ATP, coordination will occur in advance with VR to authorize to the client directly. A copy of the ATP Service Authorization is sent to the client and includes the time limits to complete the service. For equipment, the time will be 30 days or less, for construction it will be 60 days or less, as specified and dependent of each client's situation. Pending jobs, school, or other needs may create an urgency demanding shorter timelines for completion. 
10. Inspects the completed project to make sure the modifications meet specifications. The ATP Technology Specialist will demonstrate how to use equipment and ensure the equipment has addressed the client’s needs. 
11. Obtains client signature on Acceptance/Agreement form and sends to ATP Office in Lincoln.
12. Processes all payments to contractor or vendor.
13. Sends the VR Accounting Associate a copy of the Acceptance/Agreement form, paid invoice, ATP Service Authorization, and a copy of the VR Authorization.
14. ATP is responsible for completing a final inspection to ensure the client’s needs are met and any equipment provided is working and being used correctly.
15. Meets with the VR teams on a regular basis, but at a minimum at least quarterly to enhance the provision of ATP services. 

Process: ATP Program Supervisor

1. Locates and secures comparable benefits (grants, loans, and other funding sources) to offset all or part of the cost of the recommended technology.
2. Issues funding report in the form of an email to the VR Specialist and Accounting Associate.  Sending the funding report to both members of the Team better ensure authorizations will be processed in a timely manner.
3. Consults on cases, as needed, and coordinates a virtual meeting with the VR Specialist, VR Office Director, ATP Tech and assigned Program Team staff to discuss items that may exceed $2,000. 

Determine if the referral is a priority SEEN WITHIN FIVE (5) DAYS BY ATP: Use checklist-priority on the referral form to make this determination and obtain Office Director approval.

Risk of Job Loss: Employers and training institutions are responsible for reasonable accommodations on the training or worksite and considered an existing benefit. 

• Did VR discuss ATP services and the customary 14-30 day wait time for an assessment to be completed? Was this acceptable to the employer/training site? If not, why? 
• Is there any reason the employer cannot immediately provide the reasonable accommodation?
• Is the employer/training site aware of client involvement with VR/ATP?
• Does the employer/training site believe accommodations will likely resolve the issue and help the employee be successful?
• Please specify in the ATP referral and the VR task note the specific situation and the time frame for correction of the problem.
• Received a warning, suspension, corrective action, etc.
• Unable to complete all assigned job tasks, safety issue, rate of speed, etc.
• Why is the individual at immediate risk of losing the job? 
• Has VR visited the worksite/training site or spoken to the employer? 
• What help does the employer believe is needed?
• What reasonable accommodations have been attempted to address difficulties preforming the job and the results.

Job Offer (accommodations needed prior to start):

• Employers are responsible for reasonable accommodations on the worksite and considered an existing benefit.
• Is the job consistent with the individual's unique strengths, resources, priorities, concerns, abilities, capabilities, interests, informed choice, and labor market information?
• Is there any reason the employer cannot immediately provide the reasonable accommodation?
• Is the employer informed about the ATP worksite assessment?
• Has the individual had a prior ATP assessment for worksite “mods” prior to placement services?
• Can the client start employment without accommodations? If no, why?

Post-Secondary: Institutions are responsible for reasonable accommodations in their facilities and considered an existing benefit. 

• What specific task needs accommodated? 
• Are any accommodations currently being provided?
• What accommodations has client received previously?
• Has the client contacted the Post-Secondary Student Services Offices for accommodations?