ELIGIBILITY:

4 Requirements:

1. Permanent Impairment (diagnosis)
2. Substantial Impediment to employment (significantly restricted in the condition, manner, or duration the individual can work)
3. Benefit from VR Services  (able to obtain a competitive, integrated employment outcome from the provision of VR services)
4. Require VR Services (to prepare for, find and/or keep a job)

Process

1. Determine Impairment(s)  
   • Impairments are physiologic, biologic, or psychological dysfunctions, disorders, or losses.
     • Physical impairments are produced by any physiological disorder or condition or anatomical loss affecting one or more of the major body systems: neurological, musculoskeletal, special sense organs, respiratory (including speech organs), cardiovascular, reproductive, digestive, genitourinary, hemic and lymphatic, skin, and endocrine.
     • Mental impairments are produced by any mental or psychological disorder, such as intellectual disability, acquired brain injury, mental or emotional illness, and specific learning disabilities.
     • Impairments exist regardless of their impact (or lack of impact) on the everyday activities of the person. Determine the existence of a permanent impairment without regard to medications, prostheses, or assistive devices that may control symptoms or correct losses. A person with epilepsy has an impairment even though medications may control symptoms of the disorder. A person with a hearing loss has an impairment even though the condition is correctable with a hearing aid.
     • For further guidance on impairments of hearing, vision and drug and alcohol, see Background & Training section of this chapter.
   • Verify impairment: Any relevant impairment(s) which results in a vocational limitation to employment must be recorded in QE2 and verified either through observation (physical impairment you can actually see), or by gathering medical information that verifies the diagnosis. 
     • Observation. VR specialist observation can be used, when possible, to determine the impairment. VR staff are not 'diagnosing’ but are observing a person with an obvious impairment. If observation is used exclusively to determine eligibility, a very descriptive narrative of the impairment is required to substantiate the VR Specialist's eligibility decision in the absence of medical documentation. Observation may be used to verify impairments when:
       • the individual requires use of assistive technology (use of wheelchair, use of mobility aids, use of hearing aids, etc.).
       • the VR specialist can actually see the impairment (amputation, paraplegia, deaf, etc.)
     • Reports. Obtain a report from person licensed or certified to make a diagnosis (See below Background and Training - Who Can Diagnose in this chapter). If observation is not possible you must obtain some other type of information to verify the impairment. This might include:
       • Request for Medical Information form; copies of medical or psychological reports from the source or from the individual; 
       • MDT reports from secondary schools are acceptable for specific learning, speech, language and intellectual disabilities. IEP reports are not acceptable as this is the school's plan for services, not a diagnostic tool. See Background & Training in this chapter for more information.
       • As a last resort, examinations may be funded to obtain reports. Assure the individual understands that psychological testing may result in a mental health diagnosis and document this discussion in the task notes.
   • ​​​​​​​Determine primary impairment. Assess which impairment causes the greatest impediment to employment. If other impairments exist, also determine their level of impact on the individual's vocational functioning and rank accordingly (secondary, tertiary) . 
   • Criteria. Under no circumstances does a medical impairment or diagnosis, by itself, establish eligibility for vocational rehabilitation services. Eligibility depends on whether the individual's impairment causes or results in a substantial impediment to employment. The individual must also require and be able to benefit from the provision of VR services. Eligibility requires answering affirmatively to all 4 criteria. 
2. Determine Substantial Impediment to Employment​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​
   • Identify impediment to employment. In assessing the substantial impediment to employment, only those vocational limitations resulting from the person's impairment(s) or disabilities are considered. These limitations must be separated out from those resulting other factors or their complicating consequences. The performance of work, training, and independent living functions can be affected by a variety of factors other than the person's disability. Significant other factors include: age, geographic location, cultural expectations, poverty, lack of transportation, etc.. Ensure the eligibility determination is based on the individual's impairment and resulting vocational limitations, not other situational factors. The other factors are should be addressed in the development of the Individual Plan for Employment (IPE), but are not part of the eligibility process. ​​​​​​​Examples:
     • An individual who primarily speaks a foreign language is NOT considered to have a limitation in communication, as the limitation is not due to a disability. This is a factor to be considered in planning, not eligibility. Yet, a deaf individual who's primary language is American Sign Language, does have an impediment in communication, as this limitation is due to the disability.
   • Determine the specific limitations of vocationally relevent impairment(s). Investigate how the impairment hinders an individual from preparing for, entering into, engaging in, or retaining employment consistent with their abilities and capabilities. Based on the individual's impairment have they been:
     • Prevented from working.
     • Significantly restricted in the condition, manner, or duration under which the individual can work.
     • Currently Working. It is possible for a person to meet this criteria if currently working, but underemployed or in a job that is aggravates with their impairment. 
     • New or recent physical or mental impairments. The duration or expected duration of limitations and their seriousness need to be considered. Determine whether current limitations will be resolved or significantly reduced in seriousness by the end of the usual period of treatment and convalescence for the condition.
       • If the individual is still in recovery, it may be too soon to determine permanent functional limitations or the severity.
       • Temporary, non-chronic impairments (such as broken limbs, sprained joints and situational depression) usually do not result in long-lasting functional limitations. ​​​​​​​​​​​​​​
   • Specific questions to consider in determining substantial impediment may include, due to the impairment the individual:
     • Has lost jobs;
     • Has an unstable work history;
     • Can't do the same work;
     • Is limited in the range of jobs in their community;
     • Would have difficulty preparing for jobs (such as in training situations);
     • Would aggravate their disability by continuing in current job or previous jobs;
     • Is in danger of losing their job;
     • Has had difficulty in school; or
     • Has had difficulty in daily activities.
     • In addition, the Disability Handbook is available in each Nebraska VR office, for specific impairment information and questions to explore. 
   • Utilize existing information. In determining whether the person's physical or mental impairment causes or results in a substantial impediment to employment use existing information to the maximum extent possible. This would include VR specialist observations, information provided by other sources such as schools, work experiences and information provided by the individual or family members. One of the best indicators of an impediment to employment is the applicant's work history. An exploration of why certain employment situations were difficult, can be used to assist in determining the impediment to employment. We must seek enough information to determine the cause of the difficulty in preparing for, entering into, engaging in, or retaining employment consistent with the individual's abilities and capabilities to ensure it is based on the actual impairment(s) and not situational factors. Often, information provided by the individual and family members is sufficient for determining whether an impairment causes a substantial impediment to employment. 
3. Determine whether the individual can benefit from VR services​​​​​​​​​​​​​​
   • Determine if the person could reach an employment outcome if VR services are provided. Employment outcome is full-time or part-time competitive, integrated employment, supported employment, self-employment or telecommuting. Utilize Planning and Readiness Factors.
   • Presumed ability to benefit from VR services. It is presumed a person with a disability can reach an employment outcome with the provision of VR services unless there is clear and convincing evidence demonstrating the person is incapable of benefiting from vocational rehabilitation services. 
   • Clear and convincing evidence. In making a decision a person with a disability is not capable of benefiting in terms of an employment outcome because of the severity of the disability, first determine whether existing information provides clear and convincing evidence the applicant cannot achieve, or does not want to achieve an employment outcome; such as assessments and reports from previous work experiences conducted by:
     • Sheltered Employment program; or other current or recent period of vocational services comparable to those could be provided with extended evaluation services.
     • Community Rehabilitation facility program;
     • School work experience program;
     • Vocational Education program;
   • Trial Work Experience. If existing information does not provide this clear and convincing evidence, VR staff  must arrange for a Trial Work Experience in the most integrated setting possible with appropriate supports, assistive technology devices and support services. See VRIS Ineligible/No Longer Eligible 
4. Determine whether the individual requires VR services.
   • Determine the person requires a planned and coordinated individualized program of specific vocational rehabilitation services to prepare for, enter, engage in, or retain an employment outcome.​​​​​​​ To make this decision, consider:
     • the number and duration of specific vocational rehabilitation services required to overcome the person's functional limitations and employment impediments so that he or she can engage in competitive, integrated employment;
     • the person's need for specialized services, supports, or accommodations not typically used by the general public; and
     • the need for planning and coordination of multiple or complex services over a long duration to enable the person to prepare for, enter into, engage in, and maintain in gainful employment.

Order Of Selection and Priority Group assignment:

The agency must provide the full range of vocational rehabilitation services, as appropriate, to all eligible individuals who apply. When funding is not sufficient to serve all eligible individuals the agency must implement an Order of Selection policy (OOS).  An individual’s priority in the OOS will be determined at the time of eligibility based on the individual’s specific functional limitations of the disabling condition. When the agency is under an Order of Selection, those with the most significant disabilities will be served first. 

Priority assignment is based on the seven functional limitations (communication, interpersonal skills, mobility, self-care, self-direction, work skills, or work tolerance). A serious functional limitation is one which substantially restricts the employment options or opportunities available to the individual. In making this determination, consideration should be given to the degree in which the individual's functioning and/or need for assistance or accommodations is well below common expectations for a training or employment setting.

In assessing functional limitations, only those resulting from the individual's impairment(s) are considered. Functional capacities are NOT based on projected limitations the individual may have in the future or other situational factors (age, geographic location, cultural expectations, poverty, lack of transportation, etc.). Priority assignment is never altered to gain entry into a program or service, but on the individual's impairment and resulting limitations. A client can be moved to a higher priority group if information becomes available indicating additional or more severe functional limitations exist based on the individual's impairment(s). Utilize the individual's work history and Functional Capacity Checklist to determine appropriate functional limitations and priority group assignment. 

Nebraska VR must discuss with the applicant their eligibility and priority group assignment, as well as provide information and referral to community resources by completion of the I & R to Other Programs information, as part of this process. Nebraska VR also elects to serve individuals who require specific services or equipment to maintain employment regardless of their priority category. Priority will be given to individuals currently working, but would almost certainly lose their job if not provided specific services or equipment in the very near future that would enable job retention. An individual's eligibility and priority group determination is based on their disability and functional limitations.

See VRIS Order of Selection chapter for further information.

ELIGIBILITY EXTENSION:

Prior to the 60 day Eligibility Deadline:

1. Discuss the need for an eligibility extension with the client. Explain exactly what caused the delay, what is needed to complete the eligibility determination and why.
2. Obtain agreement with the client for the extension and estimated date it will be completed and outline the specific steps required  for the Eligibility Approval within the additional 60 days allowed. The client needs to agree to the extension for the case to remain open. 
3. Complete the Eligibility Extension screen in QE2 to request Office Director approval. 

• Only one extension is permitted, per case for a maximum of an additional 60 days or a total of 120 days. Whether the extension is 60 additional days or less than 60 days, only one extension is allowed. 
• The Eligibility Extension must be completed BEFORE the actually due date (day 59 or less). Extensions completed prior to 60 days can be backdated by the Office Director to the date the extension was completed.
• If an extension is not completed before the 60th day, is still required but the date approved by the Office Director can no longer be backdated. The actual date the Office Director approves the extension in QE2 will be recorded as the official date.

4. The date the Office Director approved the extension in QE2 is the official approval date. Approving the extension will auto generate a task note in the case file.
5. Once the an extension is completed, every effort should be made to approve the eligibility prior to the agreed upon extension date. 
6. If the extension date expires, the eligibility can still be completed but it will require an Office Director approval. The case can also be closed, if needed. 
7. In the rare occurrence when the eligibility determination exceeds the maximum 120 days without approval:

• The VR staff must enter a task note justifying the rationale for not completing the eligibility within 120 days and the specific steps to be taken by VR and/or the client to alleviate the situation;
• An automated e-mail will be generated to the Director of VR and the Specialist's Office Director for review of the case.
• All eligibilities completed after 120 days require Office Director approval.

Eligibility Requirements:

• Permanent Impairment (diagnosis)
• Substantial Impediment to employment (significantly restricted in the condition, manner, or duration the individual can work)
• Benefit from VR Services (able to obtain a competitive, integrated employment outcome from the provision of VR services)
• Require VR Services (to prepare for, secure, retain, or regain employment)

Eligibility shall NOT be based on any other factors, including:

• Any duration of residency requirement, provided the individual is present in the State; 
• Type of disability; 
• Age, gender, race, color or national origin; 
• Source of referral; 
• Type of expected employment outcome; 
• The need for specific services or anticipated cost of services required by an individual; or 
• The income level of an individual or an individual’s family.

If existing information does not provide clear and convincing evidence for the determination of eligibility, VR Specialist must arrange for a trial work experience in the most competitive, integrated setting possible and provide appropriate supports, if needed. See VRIS  Ineligible, No Longer Eligible  for specific requirements for this determination.  

Social Security Recipients. Individuals who receive SSDI or SSI on the basis of his or her disability meet all eligibility requirements, unless VR can demonstrate by clear and convincing evidence that they are incapable of benefiting in terms of reaching an employment outcome due to the severity of their disability. See VRIS Eligibility - Social Security Recipients

Disability of Vision. VR cannot serve an individual whose only disability is vision. Nebraska Commission for the Blind and Visually Impaired (NCBVI) and Nebraska VR are both vocational rehabilitation agencies. NCBVI specializes in working with individuals who experience visual impairments. If an individual is eligible for NCBVI, they need to work with that agency. If the individual is not eligible for NCBVI services based on the visual impairment, VR may assess eligibility based on other impairments. See attached Nebraska VR and NCBVI MOU

Non-Citizenship: Only a non-citizen who is authorized by the U S Department of Homeland Security to work can be served by the agency.  Application and Transfer to Employment

Approval: Only a VR Rehabilitation Specialist or VR Office Director has the authority to officially determine and approve an applicant's eligibility for VR services. VR Service Specialist can indicate an eligibility determination, but needs to clearly explain only a VR Rehabilitation Specialist or VR Office Director has the authority to officially determine eligibility for services.

Timeline: Eligibility must be completed within 60 days of the application for services. Individuals must be determined eligible prior to providing VR services under an Individualized Plan for Employment (IPE).

Eligibility Extension:  If VR staff  are unable to complete the eligibility determination within 60 days, an Eligibility Extension is required to be completed in QE2 prior to the 60 day Eligibility deadline and Office Director approval is required.

• The Eligibility Extension must be completed BEFORE the actual due date (day 59 or less).
• Only one extension is permitted, per case for a maximum of an additional 60 days for a total of 120 days. Whether the extension is sixty additional days or less than 60 days, only one extension is allowed. 

In the rare occurrence when the eligibility determination exceeds the maximum 120 days without approval:

• The VR staff must enter a task note justifying the rationale for not completing the eligibility within 120 days and the specific steps to be taken by VR and the client to alleviate the situation;
• If a case exceeds 120 days without an eligibility determination, the Director of VR will be notified by email
• All eligibilities completed after 120 days require Office Director approval.

Who Can Diagnose

A diagnosis may only be accepted from individuals licensed and/or certified to make a diagnosis.

This is limited to:

• Physicians (including Psychiatrists);
• Physician Assistants (if under the supervision of a licensed physician);
• Psychologists;
• School Psychologists for specific learning, speech, language and intellectual impairments. Information must include specific identification of type or severity (moderate intellectual disability, Learning Disability in Reading, etc). NOT generic labels such as; Behavior Disorder, Developmental Disability, Other, Multiple Impairments, Mental Handicap, Orthopedic, etc. SEE MDT information below.
• Psychological Assistants or Psychological Associates (under the supervision of a licensed psychologist);
• Advanced Practice Registered Nurses (also called Nurse Practitioners);
• Licensed independent mental health practitioners (licensed to diagnose mental health conditions.);
• Chiropractors; and
• Alcohol and Drug Counselors (licensed to diagnose alcohol and drug disorders only).
• Audiologist for hearing impairments or ENT

VR will accept a diagnosis with the signature of a physician assistant or psychological assistant without the signature of their supervising physician

Information on specific groups - See VRIS Eligibility - Social Security Recipients, Eligibility - Veterans, and Eligibility - Worker's Compensation 

Information on Selected Impairments

• Multi-Disciplinary Team (MDT) report from secondary schools: 
  • Acceptable verification for specific learning, speech, language and intellectual disabilities.
  • Verification must include type and severity (moderate intellectual disability, Learning Disability in Reading Fluency, etc.). 
  • Verifications of Behavior Disorder, Developmental Disability, Other, Multiple Impairments, Mental Handicap, Orthopedic, etc. are general categories and do not qualify as an actual diagnosis, so medical verification will need to be obtained from the diagnosing physician.
  • Additional medical diagnosis to those listed above, included on the MDT require verification from the diagnosing physician. 
  • Individualized Education Program (IEP) reports are not acceptable for diagnosis verification, as this is the school's plan for services not a diagnostic tool.
  • Best practice is to request all available school records when requesting the MDT to assist with career counseling (Psychological exam, IEP, grade transcripts and any work experience reports).
• Hearing loss. Review completed Communication Assessment Form with the individual (required). Optional form: Provide copy of "Good Meeting Rules" for clients. Consider the need for assistive listening devices and a referral to ATP. For hearing aid purchase information see Hearing Aids
• Vision. Nebraska VR cannot serve an individual whose ONLY disability is blindness or a visual impairment. If an individual has more than one disability, one of which is vision:
  • Arrange assessment by NCBVI as to whether visual impairment meets the eligibility criteria for NCBVI
  • If yes, NCBVI will serve the individual
  • If no, conduct  Initial meeting. 
  • Document in a TASK note - referral to and eligibility decision from NCBVI
    • If eligible for NCBVI, they must work with the agency who specialized in loss of vision, NCBVI
    • If not eligible for NCBVI, determine if individual is eligible for Nebraska VR program based on non-visual impairment
  • Nebraska VR staff can provide consultative services to a client of Nebraska Commission for the Blind and Visually Impaired (NCBVI) when the individual would benefit from the expertise of both programs. 
  • In rare cases an individual may have an active case with both state VR agencies (Nebraska VR and NCBVI) at the same time so long as the services provided by each are not duplicated and both VR agencies would be allowed to record a successful employment outcome. This would only occur if an existing or current Nebraska VR client’s vision becomes so severe it warrants consultation with NCBVI. NCBVI will then determine if the client is eligible and open a case or only provide consultation. 
• Alcohol or drug abuse (including marijuana)
  • A diagnosis of 'abuse' or 'dependence' is acceptable for impairment.
  • Alcohol and/or drug abuse or dependence, determine the individual is not actively using and eligibility decision is not being made based on length of sobriety.
  • Decisions on eligibility will be based on individual circumstances and not on any pre-determined length of sobriety per Federal Regulations.  To assess progress toward abstinence:
    • Consider the steps the consumer is making to establish abstinence (treatment/recovery programs, AA/NA, sponsorship)
    • What is the recovery plan and the assessment of adequate progress toward recovery?
    • Use Best Practices Guide:  https://vris.nebraska.gov/wiki/pages/B5h0v8U9M/VR_Guides_&_Resources.html 
  • Federal regulations indicate that symptoms need not be active for an individual to have a disability, and thus, a substantial limitation to a major life activity (employment). Utilize the Functional Capacity Checklist to determine specific vocational limitations and severity.
  • Previous convictions, felonies and/or incarcerations due to abuse/dependence may be used in describing the impediment to employment as they do have an effect on the individual's ability to obtain employment and/or the types of jobs they might be able to attain, but the justification and rational needs to focus on the actual functional limitations, not the external situation. Example: Due to drug dependence at a young age, the individual's decision making and skills have been delayed resulting in difficulty problem solving through peer pressure situations. His limited ability in determining the repercussions of his actions has resulted in several thefts convictions to support his drug habit.

Open Case in Two States

An individual may have an active case in two state VR agencies at the same time and both VR agencies would be allowed to record a successful employment outcome. Contact the Program Director for Counseling Services to discuss if you learn a case is open in another state VR agency or if the individual tells you they are going to apply for services from another state VR agency.

Functional Capacities Checklist

Guide for Approval of Eligibility and Priority Groups

Impairments Checklist

Information and Referral (I & R) to Other Programs

NCBVI and Nebraska VR MOU