Purpose

1. To ensure a standard method of applying exceptions to purchases that exceed the Rule 72 cost containment guidelines; and
2. To provide a level of internal control for purchases exceeding $2,000 that are not a part of the Rule 72 fee schedule.

APPROVALS

Goods and services NOT part of the Rule 72 fee schedule (e.g., Public Transportation, Tutor, Other Assistance) require Office Director approval if the authorization exceeds $2,000. The following services are exempt from this approval:

1. VR Certificate Programs – rate established in written agreement and based on number of participants
2. Project Search Worksite Skills Trainer – rate established in agreement and divided equally among number of clients participating.

EXCEPTIONS Rule 72 - 006.02. 

The purpose of the Rule 72 fee schedule is to contain costs and to assure the availability of services to the largest number of individuals with significant disabilities. The intent of the schedule is to assure the lowest reasonable cost for program services, goods, and supports while allowing for sufficient flexibility to meet the client’s needs.

• • SSI/SSDI recipients- are exempt from contribution to the cost of IPE goods or services unless the amount exceeds the least cost option. If the client does not choose the lease cost option, they are responsible for the increased cost. EXCEPTION: After a search for comparable services and existing benefits, VR will grant an exception to the fee schedule for the remaining cost of the good or services.
  • Non-SSI/SSDI recipients- Clients will not be asked to contribute to the cost of IPE goods or services unless the cost exceeds Rule 72 (cost containment guidelines), or they are choosing a more costly option. If the client does not choose the least cost option, the client is responsible for the increased cost. EXCEPTION to Rule 72 may be considered, after an exploration of comparable services and benefits, loans, and client contribution. If there is no alternative to addressing the needed good or service, VR may make an exception and fund the remaining amount. 

Office Directors have the authority and discretion to make exceptions to the Rule 72 fee schedule amounts based on individual circumstances except for the following:

Exceptions for these services must be made by a Program Director designated by the Director:

• Home modification 
• Vehicle modification
• Self-employment

Exceptions for these services are based on NDE Administrative Memorandums and must be made by the VR Director

• Lodging and Per Diem
• Interpreter-Hearing Impaired

No exceptions can be made to how VR will pay (e.g., cash advance, provider purchase, or reimbursement) in the Rule 72 fee schedule.

APPROVALS

1. Complete an authorization in QE2 prior to the time the goods or services are provided to generate an authorization approval request. NOTE: Late authorizations that are determined to be an audit exception will require VR to use state funds for the cost of those goods and services. Using state funds for audit exceptions reduces the amount of state funds available for federal match.
2. An auto-generated email will be sent to the Office Director/Program Director requesting approval of the authorization.
3. Office Director reviews authorization to ensure requirements for authorizing case services have been met . See Program Manual Authorizing Case Services
4. Office Director:​
   • Approves authorization in QE2. This action generates an automated task note of what was authorized, the amount and who approved the authorization, or
   • Denies authorization in QE2. this action generates an automated task note documenting the reason for denial.

EXCEPTIONS

1. Discuss with the client how the amount above Rule 72 could be funded, including:

• Least cost alternative (Rule 72 - 004.01)
• Comparable services and benefits (Comparable Services)
• Client contribution (Client Contribution)
• Loans (below in #4)

2. If the VR Specialist determines an exception to the Rule 72 Fee Schedule is the only option, complete an authorization in QE2 to generate an exception authorization request.
3. An auto-generated email will be sent to the Office Director/Program Director requesting approval of the exception authorization. 
4. Enter a task note titled "Exception Rationale” and provide answers to the critical case questions below, including the results or outcome, and outline the rationale that led to the determination there are no alternatives to exceeding the Fee Schedule, including –

• Is purchase necessary to achieve goal? State why the purchase is necessary.
• Is the equipment available through the reuse program? If available, contact ATP rather than purchase the equipment.
• Is it Rehab Technology? Complete the S&D Application.
• Are other options available to address the need?  List other options considered.
• Is this the least costly option? Cost must be documented, including needed bids or sole source if applicable.
• What were the results of the search for comparable benefits & services? Document the search completed and list those comparable services and benefits considered and/or applied for.
• Extenuating circumstances – Document anything that contributes to the client's situation that explains the rationale for the exception.
• Does the client have the ability and resources to maintain, repair and replace purchased the goods? If applicable, document how.
• For non-SSI/SSDI:
  •  Has client contribution been explored? All clients will be asked if they and/or their family are willing or able to contribute towards the cost of services. Document the clients response to ability to contribute.
  •  Is the client willing to apply for a loan? At a minimum, Easter Seals loan information must be shared. Document the clients response to applying for Easter Seals loans and/or personal loans. List loans applied for and the outcome, or client’s inability to apply for loans and the rationale behind this. Loan Options (If the purchase will exceed the Rule 72 fee schedule or needed for Self-Employment Start-Up expenses) Discuss with the client exploring a loan through one of the following –
    • Credit Building Mini-Loan: For any assistive technology device or service requiring a loan between $100 - $1,999. Can include financial coaching and building up credit report.
    • Telework: For any assistive device or service necessary to secure a telework opportunity from home or overcome a barrier to employment requiring a loan between $1,000 - $35,000.
    • Alternative Financing Program: For any assistive device or service (selection, acquisition or use of an assistive technology device) requiring a loan between $2,000 - $35,000. 
    • Easterseals Alternative Financing Solutions (402) 930 - 4106 or 1(800) 471-6425 loan@ne.easterseals.com). There are three separate funds available to assist individuals with impairments in qualifying for lower interest rate loans, which is more likely to approve a loan than a traditional bank. 
    • Personal Bank - A client can apply through their personal bank for loan eligibility; 

5. Office Director or Program Director reviews task note and ensures responses to all critical case questions, as applicable have been answered and addressed and documents decision to approve or deny an exception to the Rule 72 Fee Schedule in a task note. 

Exception Approved:

A. Office Director/Program Director approves the exception authorization in QE2. This action generates an automated task note with the information of what was authorized, the amount and who approved the authorization.

B. VR Specialist informs client of approval and proceeds with purchase of good and/or service.

Exception Denied:

A. Office Director/Program Director denies the exception authorization in QE2. This action generates an automated task note indicating denial of the exception, the reason for denial, and who denied it.

B. VR Specialist is responsible to understand the rational and accurately share the VR program's decision with the client. If there are questions, the specialist needs to ask for clarification to provide a unified and accurate report to the individual of the program's determination. 

C. VR Specialist notifies Office Director if client disagrees with decision.

D. Office Director will follow process outlined in the Client Appeals Rights, Procedures Chapter.