It is important to note, bids for assistive technology are only valid for 30 days. As a result, VR needs to meet with the client as soon as possible upon receiving the report to review the results and discuss the critical case questions. 

1. Answer Critical Case Questions: Prior to the purchase of any goods and/or services the VR Specialist must answer these questions. 

• Are the goods and/or services being requested necessary for the client to achieve his/her vocational objective on the Individualized Plan for Employment (IPE)?
• Are there other reasonable options available to address the need?
• Have we completed a thorough search for comparable services and benefits to offset a part or all of the costs?
  • For example, rather than purchasing a piece of adaptive equipment so the client can perform a particular task independently, is it reasonable and feasible for a family member to do the task; or would it be more cost effective to hire a particular task done?
  • Worksite items need to be addressed with the employer as a reasonable accommodation.
  • Medical items need to explore insurance and community resources.
  • Is the assistive device available through the reuse program?
  • Applicants for and recipients of services must apply for and accept any existing comparable services or benefits. 
  • Has the client sought out and are they using all financing available from grants, loans, personal or family resources, and other resources, to offset a part or all of the costs for necessary goods and/or services? 
  • An SSA approved Plan for Achieving Self Support (PASS) does not constitute a comparable benefit or service. A PASS is a Social Security work incentive that allows an SSI recipient to set aside income and/or resources for a specified time in order to achieve an employment goal. While funds from a PASS cannot be considered a comparable benefit, PASS resources can complement VR services, particularly to cover additional costs of services, such as home and vehicle modifications, post-secondary training, and self-employment. The development and submittal of a PASS should be encouraged but the choice to do so is the recipient’s decision and is strictly voluntary. The recipient’s decision to not pursue a PASS will have no impact on VR funding for appropriate and necessary goods and services.
• If there are several options to addressing the client’s need, have we ensured the selected goods and/or services are the least cost option(s)?
• Can the client afford to maintain, repair, and replace the goods being requested?

2. Determine need for exception - If having answered the critical case questions the VR Specialist determines the necessary goods and/or services can be provided without exceeding the Fee Schedules the VR Specialist will proceed to secure the necessary goods and/or services and an exception request will not be necessary. If the client does not agree with the VR Specialist’s conclusion, then the appeal process is available for the client.
3. Loan process - If having answered the critical case questions the VR Specialist determines the necessary goods and/or services cannot be provided without exceeding the Fee Schedule, the VR Specialist will refer the client to the Easterseals loan program.  An individual can choose to go through their personal bank for loan eligibility. If they are denied, they will need to apply to the Easterseals loan program because this program is designed to assist individuals with impairments to qualify for lower interest rate loans and is also more likely to approve a loan than a traditional bank. The Easterseals loan committee meets every week resulting in timely decisions on loan applications. VR needs to ensure referrals are made to Easterseals loan program as soon as possible, as bids secured from vendors are only valid for 30 days. The reports from both ATP and AgrAbility can be helpful in the loan process as they explain the need for the assistive technology, as well as the cost estimates and could expediate the determination. The client can share all, part or none of the assistive technology report(s) with the loan committee. 
   • Easterseals Alternative Financing Solutions contact information (402) 930 - 4106 or 1(800) 471-6425 loan@ne.easterseals.com 
   • Three separate Easterseals loan funds are available:
     • 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. 
     • Telework: For an 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
     • 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
4. Rule 72 cost exception needed:
   • Client is able to secure funds from other resources and/or is eligible for and accepts a loan for part of the costs that exceeds the Fee Schedules, the VR Specialist may request in writing an exception to the Fee Schedule for the remaining amount. 
   • Client is not able to secure funds from other resources and/or is unwilling to apply for or accept a loan for costs that exceed the Fee Schedule, the VR Specialist may request an exception to the Fee Schedule. If the client says they are ineligible for a loan he/she must provide a loan refusal letter to verify denial of the loan and the reasons for the denial. The fact a client is not willing to apply for or accept a loan will be considered as part of the rationale used to either grant or deny an exception. 
   • Document rationale: The request for an exception to the Fee Schedules will be made by the VR staff member to the Office Director or appropriate Program Director. The written request will be in the form of a task entry titled "Exception Rationale." The task entry will answer the critical case questions and outline the rationale that led to the determination there are no alternatives to exceeding the Fee Schedules. Include specific amounts of the cost, least cost option, client contribution, comparable services and benefits, verification of loans and resource denials. Include any extenuating circumstances that contribute to the client's situation. 
   • Exception decision and documentation - office director or appropriate program director:
     • Agrees to make an exception to the Fee Schedule: VR Specialist has provided written documentation of all the required information and the rationale for the cost exception.  If the office director or appropriate program director is in agreement, approval is documented when the office director or appropriate program director approves the authorization in Qe2. This action generates an automated task note in the case file with the information of what was authorized, amount and who approved the authorization.
     • Does not agree to make an exception to the Fee Schedule: the office director or appropriate program director will create a task note documenting the specific rationale to deny the request.
   • The VR Specialist will provide a full consultation to the client on the decision. 
     • Exception granted - proceed as planned with the purchase of good and/or service.
     • Exception denied - The VR Specialist is responsible to understand the rational of the decision and to fully explain the VR Program determination to the individual. If there are questions, the specialist needs ask for clarification to provide a unified and accurate report to the individual of the program's determination. 
   • Correspond with client: If the office director or appropriate program director does not agree to make an exception and the client disagrees with this decision, the office director will send a letter to the client. The letter will outline the rationale for not making the exception and will include the appeal procedures.

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

Rule 72:

006.02 Exception to fee schedule. Exceptions may be granted if the Office Director or Program staff determines there is no alternative to addressing a recipient's needs for a service or support necessary to complete an assessment for determining eligibility and vocational rehabilitation needs or to achieve the employment outcome on the recipient's approved Individual Plan for Employment. 

Only an Office Director or the appropriate Program Director can make a decision to exceed the Fee Schedules. Comparable services and benefits, client contribution, least cost option and other relevant program criteria will be considered when an exception is requested.

Office Directors have the authority and discretion to make reasonable exceptions to the Fee Schedules in Rule 72, Appendix B, based on individual circumstances other than for the following:

Program staff have the authority and discretion to make reasonable cost exceptions to:

• Home modification 
• Vehicle modification
• Self-employment and establishing a small business operation

VR Director has the authority and discretion to make exceptions to any services, goods or supports, but is the only one authorized who can make exceptions to Interpreter - Hearing Impaired.