Process: VR Staff

1. Ensure the client has reached maximum medical improvement (MMI) and VR is considering the accommodation of permanent restrictions, not temporary functional limitations due to recovery.
2. Explore with the client the need for rehabilitation technology, assistive devices, adaptation, home, vehicle (including Driver Control Systems), or work modifications. Do not promise specific equipment solutions, as ATP needs to determine the least cost option that meets the individual's needs. 

Worksite accommodations. By law, employers are responsible for reasonable accommodations on the worksite. VR needs to determine if there is a need for VR services in this situation or if the employer needs information to explore available resources.

• What is the specific situation is the client needing to accommodate?
• Is the employer aware ATP is able to  conduct the worksite assessment and determine reasonable accommodations for a fee? 
• Is the employer/training site aware of client involvement with VR/ATP?
• Is the employment problem related to disability?
• What reasonable accommodations have been attempted to address difficulties preforming the job and the results.
• What help does the employer believe is needed?
• Is the employer/training site aware of client involvement with VR/ATP?
• Has VR visited the worksite/training site or spoken to the employer? 
• Does the employer/training site believe accommodations will likely resolve the issue and help the employee be successful?

Post-secondary accommodations. By law, colleges and training sites are responsible for reasonable accommodations. 

• What accommodations did client receive in high school? 
• Has the student contacted the Post-Secondary Disability Service Office for accommodations?
  • What are the available accommodations?
  • What specific needs does the student feel are not being met?
  • Are there existing student services available that can assist (study groups, tutors, etc.)?
  • Is the course required or can it be substituted with another course?

Home Modifications. Home modifications are strictly limited to removal of 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 employment outcome of the client. (See Rule 72 for specific guidelines)

Vehicle Modifications. Vehicle modifications, new or exsisting are strictly limited to those limited changes, adaptions, or adjustments to a client's vehicle that enable him or her to operate or ride in the vehicle and are essential to achieve the employment outcome. Driving Control Systems

3. Discusses Rule 72 Cost Containment guidelines with the client
4. Explore funding options and resources:
   • Comparable services and benefits - (employer, college, health & home insurance, Medicaid/Medicare, Service and Delivery Application, etc.). For worksite and post-secondary accommodations determine if the employer or training facility is exploring comparable resources or actually unable to fund the worksite assessment. If VR is considering funding the assessment and/or accommodations, ensure the site specific questions have been covered above and task note the justification of VR funding the assessment. Prior to referring to ATP, the VR Specialist needs to discuss with the client the need and rationale to get permission from the employer or training facility for ATP to access the building and provide the assessment and recommendations.
   • Client contribution - Voluntary, but all individual's will be asked to participate in the cost of services. Participation in the cost can increase a feeling of ownership in the IPE.
   • Complete Service and Device Applicaiton for high cost items.
5. Referral to ATP:
   • Complete the ATP Referral Form electronically (no hand written 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.
   • For Priority Referral: Use checklist-priority to make this determination and requires Office Director approval.
6. For worksite or training facility accommodations, the client needs to provide the employer or training facility with a copy of the ATP recommendations and follow through with the worksite's process to determine reasonable worksite accommodations. The worksite process needs to explored prior to VR considering funding. If VR is considering funding a worksite accommodation, there needs to be a task note justifying why the employer is unable to provide all or part of the cost. By law this is the employer's and college's responsibility, so there needs to be a good justification for VR to take on the cost.
7. VR reviews the ATP report and funding e-mail that identifies any available community funding with the client. 
   • Discuss funding of recommended items by first considering any available community resources, personal resources (insurance, employer, college) and client contribution. It is VR's responsibility to discuss these topics and determine specific funding amounts for authorization.
   • Address the client's ability to maintain, repair and replace the item(s).
   • Determine if cost is within the Rule 72 cost containment guide or if a cost exception needs to be requested (see VRIS Rule 72 exception)
8. Consult ATP Technology Specialist with any questions/issues/concerns regarding the recommendations. VR Specialist will provide specific reason to ATP if the lowest bid vendor is not selected.
9. Complete authorization 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. E-mail the completed authorization to atp.vrforms@nebraska.gov
10. VR staff will follow up with the client to assess how the accommodations are meeting the individual's needs, ensure they are utilizing the item and contact ATP if there are any concerns.

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. Makes appointment with the client to complete an assessment at the client’s home 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 and 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. Obtains quotes from vendors/contractors. Immediately contacts VR Specialist, ATP Program Coordinator & VR Program Director of Counseling if client disagrees with vendor recommendation.
6. Will notify assigned VR staff of any delays in the provision of services.
7. Provides an evaluation report with recommendations and quotes to the ATP Program Coordinator and VR Counselor.
8. 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.
9. 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. Follows up with the client to ensure the recommended equipment is working as expected. 
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. Includes a copy of Resource Letter that identifies available resources from the Service & Device Application (S & D) with the funding email. 
4. If client did not complete the S & D Application, this will be noted for VR Counselor to follow up on.
5. Consult on cases as needed and meet with VR Program Director of Counseling to ensure the coordination of services.

Clients who self-report or who VR staff identify as needing assistive devices; adaptations; or vehicle, home, or work site modifications due to their disability will be referred to ATP for assessment.

Clients in need agricultural work site modifications should be referred to AgrAbility., rather than ATP. See VRIS Program Manual: AgrAbility

Referrals can also be made to ATP for assistance in determining an appropriate cost for used adaptive equipment.

THE FOLLOWING ITEMS ARE EXEMPT FROM THE ATP/VR PARTNERSHIP PROCESS. THESE ITEMS DO NOT NEED TO BE REFERRED TO ATP FOR ASSESSMENTS OR FOR FUNDING COORDINATION.

• Hearing aids
• An ALD recommended by an audiologist that is paired to the client's current or future hearing aid
• Eyeglasses
• Prosthetics*
• Orthotics *

*The Purchase of prosthetics or orthotics requires a prescription for each item. Prior to purchase, complete the Service & Device Application and contact ATP to see if there may be comparable benefits for the client. VR payment is based upon Medicaid rates. If any exception to the purchase is required, consult the Office Director and follow Rule 72 Exceptions process.

Note: Any of the items exempt from referral to ATP may at the discretion of the VR Specialist be referred to ATP if the ATP Technology Specialist’s involvement would be helpful. A referral may be needed to ATP for other worksite modifications or training after the purchase of the prosthetic or the orthotic device.

Driving evaluations will be completed by VR prior to making a referral to ATP for vehicle modification assessments.

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.

See Driving Control Systems Manual Chapter.

ATP/VR Referral

Service & Device Application - English

High Cost Request

Acceptance Agreement Form (Equipment Agreement)