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 need to be referred to AgrAbility, so ATP and AgrAbility can collobrate 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 to ensure an understanding of the recommendations identified by ATP will address their barriers to employment and VR is responsible to determine funding. 
   • Identify what difficulty the client is experiencing with the 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 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 work site and for VR to discuss funding of reasonable accommodations with the employer. If permission is not provided, the assessment may not be able to be completed. 

Vehicle Modifications. Vehicle modifications, new or existing are strictly limited to those 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 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.

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. 

3. Determine 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.
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. 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 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.  For items over $2,000 the ATP Technology Specialist, ATP Program Coordinator, 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 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.​​​​ 
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 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  
9. Ensure signed Acceptance Agreement form is received from ATP and file 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. 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. 
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 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 with 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?