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 Authorizing Case Services Policy)
4. Office Director

a. Approves authorization in QE2. This action generates an automated task note of what was authorized, the amount and who approved the authorization; OR

b. Denies authorization in QE2. this action generates an automated task note documenting the reason for denial.

 

EXCEPTIONS

If the VR Specialist determines the necessary goods and/or services cannot be provided without exceeding the Fee Schedule, all financing available from grants, loans, personal or family resources (including client contribution), and other resources, to offset a part or all of the excess costs for necessary goods and/or services must be explored. (See Authorizing for Case Services Policy)

1. Discuss with the client how the amount in excess of Rule 72 could be funded, including –

• Least cost alternative (Rule 72 - 004.01)
• Comparable services and benefits (Comparable Services and Benefits Policy)
• Client contribution (Client Contribution)
• Loans (Authorizing Case Services Policy)

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.
• 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.
• 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.

5. Office Director or Program Director reviews task note and ensures responses to all critical case questions have been answered and addressed. Document 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.

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.

Exceptions to the fee schedule may be made if there is no alternative to addressing a clients need for a service necessary to determine eligibility or achieve the employment outcome on the approved Individual Plan for Employment. 

Comparable services and benefits, client contribution, least cost option, loan options and other relevant program criteria will be considered when an exception is requested (see Authorizing Case Services Policy)

Office Directors have the authority and discretion to make exceptions to the Rule 72 fee schedule amounts based on individual circumstances with the exception of 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.