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. Agricultural work site modifications should be referred to AgrAbility, rather than ATP. See VRIS Program Manual: AgrAbility

Roles:

• ATP's role is to recommend possible accommodations.
• VR is responsible to determine if the recommendations are essential and the determine the amount of VR financial assistance. 

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 (including Driver Control Systems), or work modifications.
   • Do not focus on gathering information to justify a pre-conceived solution or device, but rather identify what difficulty the individual is experiencing with specific tasks. This strategy will result in a clearer picture of the actual work and/or home environmental barriers, so appropriate accommodations can then be explored. 
   • 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? 
   • Do not promise specific equipment solutions, as ATP needs to determine the least cost option that meets the individual's needs. 
   • if the accommodation may involve an employer or training facility, the VR Specialist needs to discuss with the client the need to get permission for ATP to access the building and provide the assessment and recommendations. If permission is not provided, the assessment cannot be completed. 

Home Modifications. Home modifications are strictly limited to removal of disability related barriers to access and function within the home and other limited modifications which are necessary to convert ordinary living space into space essential to achieve the recipient's employment outcome. Home modifications cannot constitute the erection of new rooms, units or structures. 

Vehicle Modifications. Vehicle modifications, new or existing are strictly limited to those limited changes, adaptions, or adjustments to a client's vehicle that are essential to achieve the recipient's employment outcome and accommodate the disability by enabling the client to operate or ride in the vehicle. Driving evaluations will be completed by VR prior to making a referral to ATP for vehicle modification assessments unless the client has driven for years with no change to their diagnoses/symptoms and are needing the same modification.

Work and training sites. Employers and training facilities are responsible for reasonable accommodations and need to be included in the process. The employer/training site's need to determine reasonable accommodations needs prior to VR considering funding. If VR is considering funding accommodations on these sites, a task note is required to justify why the employer or training site is unable to provide all or part of the cost, as it is primarily their responsibility to accommodate their employees and students.

3. Determine if existing benefits are immediately available (employer, college, health & home insurance, Medicaid/Medicare, etc.) to cover the purchase of assistive technology, adaptive devices, specialized equipment, and/or job site modifications.
4. Complete the Service and Device Application (S&D) for items expected to exceed $2,000. 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. If information requested on the referral form is not available VR staff will contact the client and get the required information. VR staff will e-mail the completed ATP Referral Form as an attachment to atp.vrforms@nebraska.gov. 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. See ATP Priority Service Case Checklist in this chapter for further information and discuss topics below based on the client's situation. 

6. Team Consultation of ATP recommendations. ATP, Self-Employment Team, VR Specialist and Office Director will participate in a discussion of the preliminary recommendations and seek agreement prior to completing the ATP Report of sharing recommendations with the client.  VR needs to ensure the recommended accommodations and assistive devices are specifically required to accommodate the disability and necessary for the client to perform essential functions of maintaining the job, not solely for convenience and efficiency.​​​​ Topics to be addressed during the meeting may include: 
7. VR Specialist reviews ATP Report, funding email and Resource Letter with the client. 
   • Discuss the recommended accommodations and the client's perception of the recommendations. Do they meet their needs? Are they comfortable operating the equipment?
   • Ensure the individual can maintain the upkeep of the requested equipment, if necessary. 
   • Consults with the ATP Technology Specialist if the client has any issues/questions/concerns regarding the recommendations or venders.
   • Discuss 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  
9. Ensure signed Acceptance Agreement form is received from ATP and file in client's VR casefile.
10. Follow up with the client to assess how the modifications are meeting the individual'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 assist the individual, as needed to rectify the situation. 
11. 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 Technology Specialist

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. Provides an evaluation report with recommendations and quotes to the ATP Program Coordinator and VR Counselor.
9. Sends an ATP Service Authorization (identifying all funding sources and methods of payment for any comparable benefits) to contractor or vendor. The ATP Service Authorization sent to the contractor or vendor will include the same Standard Text that appears on the VR Authorization. A copy of ATP Service Authorization is sent to the Technology Specialist and client. Includes on the ATP Service Authorization sent to the Technology Specialist and client 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 depending on each individual 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 to 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 Coordinator

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 ensures 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 are currently being provided?
• What accommodations has client receive previously?
• Has the client contacted the Post-Secondary Student Services Offices for accommodations?