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Massachusetts Commission for the BlindClient Services ManualJanuary 2009

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Massachusetts Commission For The Blind

CLIENT SERVICES POLICY MANUAL

VOCATIONAL REHABILITATION SERVICES

CLIENT SERVICES POLICY MANUAL ................................ ....... 1

CHAPTER 1 ................................ ................................ ................ 17

REFERRAL AND APPLICATION ................................ ............... 17

VOCATIONAL REHABILITATION................................ .............. 17

1A General Considerations ................................ .................... 17

1B Sources of Referrals ................................ ......................... 17

1C Processing of Referrals ................................ .................... 17

1D Initial Interview ................................ ................................ .. 17

CHAPTER 2 ................................ ................................ ................ 20

EVALUATION ................................ ................................ ............. 20


2A Purpose................................ ................................ .............. 20

2B General Considerations ................................ .................... 20


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2C Basic Medical Examination ................................ .............. 20

2D Use of Existing Reports ................................ .................... 20

2E Ophthalmological Examination ................................ ........ 20

2F Choice of Physician ................................ .......................... 20

2G Specialty Examinations ................................ .................... 20

2H Screening for Hearing Loss ................................ ............. 20

2I Presentation to the Ophthalmological Consultant ......... 20

2J Psychiatric or Psychological Evaluations ...................... 20

2K Psychological Testing ................................ ...................... 20

2L Evaluation at a Rehabilitation Center .............................. 20

2M Work Evaluation ................................ ................................ 20

CHAPTER 3 ................................ ................................ ................ 30

ELIGIBILITY................................ ................................ ................ 30


3A Purpose................................ ................................ .............. 30

3B General Considerations ................................ .................... 30

3C Basic Eligibility Requirements ................................ ......... 30

3D Visual Disabilities Other Than Legal Blindness ............. 30

3E Elements of Eligibility Determination .............................. 30


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3F Determination of Significant Disabil ity ........................... 30

3G Timeframe for Determining Eligibility ............................. 30

3H Case Recording on Eligibility ................................ ........... 30

3I Age................................ ................................ ...................... 30

3J Certification of Eligibility ................................ .................. 30

3K Certification of Ineligibility ................................ ............... 30

3L Annual Review of Ineligibility ................................ ........... 30

CHAPTER 4 ................................ ................................ ................ 42

COUNSELING AND GUIDANCE SERVICES ............................ 42


4A General considerations ................................ .................... 42

4B Objectives of counseling and guidance .......................... 42

4C Case recording of counseling and guidance .................. 42

CHAPTER 5 ................................ ................................ ................ 45

INDIVIDUAL PLAN FOR EMPLOYMENT ................................ .. 45


5A Purpose................................ ................................ .............. 45

5B Nature of the IPE ................................ ............................... 45


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5C Narrative Justification................................ ....................... 45

5D Joint Development of the IPE ................................ ........... 45

5E Content of the IPE ................................ ............................. 45

5F Amendments to the IPE ................................ .................... 45

5G Periodic and Annual Reviews of the IPE ......................... 45

CHAPTER 6 ................................ ................................ ................ 54

PHYSICAL AND MENTAL RESTORATION SERVICES ........... 54


6A Scope and Purpose ................................ ........................... 54

6B Criteria for Provision of Physical or Mental RestorationServices................................ ................................ ...................... 54

6C Case Recording ................................ ................................ . 54

6D Counseling During Physical or Men tal Restoration....... 54

6E Hearing Aids ................................ ................................ ...... 54

6F Complications of Physical or Mental Restoration .......... 54

6G Acute Medical Conditions ................................ ................ 54

6H Choice of Vendor ................................ .............................. 54

6I Services to Family Members ................................ ............ 54

CHAPTER 7 ................................ ................................ ................ 61


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TRAINING SERVICES ................................ ................................ 61


7A Scope and Purpose ................................ ........................... 61

7B Vocational Training ................................ ........................... 61

7C Prevocational training................................ ....................... 61

7D Personal Adjustment Training ................................ ......... 61

7E Duration of Training Services ................................ .......... 61

7F Fees for Training ................................ ............................... 61

7G Comparable Benefits ................................ ........................ 61

7H College Training Services Regulations ........................... 61

CHAPTER 8 ................................ ................................ ................ 84

READER AND NOTE-TAKING SERVICES, REHABILITATIONTEACHING SERVICES, AND ORIENTATION AND MOBILITYSERVICES ................................ ................................ .................. 84


8A Purpose................................ ................................ .............. 84

8B Reader and Note-Taking Services ................................ ... 84

8C Rehabilitation Teaching Services ................................ .... 84

8D Orientation and Mobility Services ................................ ... 84


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8E Comparable Benefits ................................ ........................ 84

CHAPTER 9 ................................ ................................ ................ 88

MAINTENANCE SERVICES ................................ ....................... 88


9A Purpose................................ ................................ .............. 88

9B Examples of Appropriate Use of Maintenance Se rvices88

9C Comparable Benefits ................................ ........................ 88

CHAPTER 10 ................................ ................................ .............. 91

TELECOMMUNICATIONS, SENSORY, AND OTHERTECHNOLOGICAL AIDS AND DEVICES ................................ .. 91


CHAPTER 11 ................................ ................................ .............. 93

OCCUPATIONAL LICENSES AND TOOLS............................... 93


11A Purpose ................................ ................................ ........... 93

11B Occupational Licenses ................................ .................. 93

11C Occupational Tools ................................ ........................ 93

CHAPTER 12 ................................ ................................ .............. 95


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TRANSPORTATION SERVICES................................ ................ 95


12A General Considerations ................................ ................. 95

12B Scope of Transportation Services ................................ 95

12C Rate of Payment ................................ ............................. 95

12D Transportation after Job Placement ............................. 95

12E Use of Comparable Benefits ................................ .......... 95

CHAPTER 13 ................................ ................................ .............. 99

SERVICES TO FAMILY MEMBERS ................................ .......... 99


13A Purpose ................................ ................................ ........... 99

13B General Considerations ................................ ................. 99

13C Examples of Services to Family Members ................... 99

13D Relationship to Consumer's IPE ................................ ... 99

13E Terminating Services to Family Members .................... 99

13F Case Recording ................................ .............................. 99

13G Application of Similar Benefits ................................ ...... 99

CHAPTER 14 ................................ ................................ ............ 105


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INTERPRETER SERVICES FOR DEAF-BLIND CONSUMERS................................ ................................ ................................ .. 105

VOCATIONAL REHABILITATION................................ ............ 105

14A General Considerations ................................ ............... 105

14B Scope of Interpreter Services ................................ ...... 105

14C Fees for Interpreter Services ................................ ....... 105

14D Arranging Interpreter Services ................................ .... 105

14E Use of Similar Benefits ................................ ................ 105

14F Resources for Interpreter Services for Personal Needs105

CHAPTER 15 ................................ ................................ ............ 109

PERSONAL ASSISTANCE SERVICES ................................ ... 109



15B Scope of Personal Assistance Services ..................... 109

15C Payment for Interpreter Services ................................ 109

15D Use of Comparable Benefits ................................ ........ 109

CHAPTER 16 ................................ ................................ ............ 112

HOMEMAKER GOALS ................................ ............................. 112


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16A General considerations................................ ................ 112

16B Eligibility Considerations ................................ ............ 112

16C Considerations When the Vocational ObjectiveChanges ................................ ................................ ................... 112

16D Considerations When the Consumer Lives Alone .... 112

16E Homemaker Checklist ................................ .................. 112

CHAPTER 17 ................................ ................................ ............ 118

ADAPTIVE HOUSING SERVICES ................................ ........... 118


17A Purpose ................................ ................................ ......... 118

17B Maximum Payment ................................ ....................... 118

17C Limitation ................................ ................................ ...... 118

17D Procedures................................ ................................ .... 118

17E Similar Benefits ................................ ............................ 118

CHAPTER 18 ................................ ................................ ............ 122

SERVICES TO ESTABLISH SMALL BUSINESS ENTERPRISES................................ ................................ ................................ .. 122

VOCATIONAL REHABILITATION CONTENTS ....................... 122


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18B Scope of Services to Establish Small BusinessEnterprises................................ ................................ ............... 122

18C Limitations on Provision of Servi ces to Establish Small Business Enterprises................................ ............................. 122

18D Consumer Evaluation ................................ ................... 122

18E Business Evaluation ................................ .................... 122

18F Bid Process................................ ................................ ... 122

CHAPTER 19 ................................ ................................ ............ 128

PLACEMENT SERVICES ................................ ......................... 128


19A General considerations................................ ................ 128

19B Responsibilities of the Regional Director .................. 128

19C Responsibilities of the Vocational RehabilitationSupervisor................................ ................................ ................ 128

19D Responsibilities of the Vocational RehabilitationCounselor................................ ................................ ................. 128

CHAPTER 20 ................................ ................................ ............ 132

POST-EMPLOYMENT SERVICES ................................ ........... 132



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20A Purpose ................................ ................................ ........... 132

20B General Considerations ................................ ............... 132

20C Examples of Post-Employment Services ................... 132

20D Criteria for Provision ................................ .................... 132

20E Post-Employment Services to Achieve More SuitableEmployment ................................ ................................ ............. 132

20F Acute Medical Conditions ................................ ............ 132

20G Supportive Vocational Rehabilitation Services ......... 132

20H Duration of Post-Employment Services ..................... 132

20I Documentation Requirements ................................ ....... 132

20K Termination of Post-Employment Services ............... 132

20L Comparable Benefits................................ .................... 132

CHAPTER 21 ................................ ................................ ............ 140

COMPARABLE BENEFITS ................................ ...................... 140



21B Services Requiring Consideration of ComparableBenefits ................................ ................................ .................... 140

21C Services Not Subject to Consideration of ComparableBenefits ................................ ................................ .................... 140


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CHAPTER 22 ................................ ................................ ............ 147

SUPPORTED EMPLOYMENT SERVICES .............................. 147



22C Criteria for Supported Employment Services ............ 147

22D Placement into Supported Employment ..................... 147

22E Extended Support Services ................................ ......... 147

22F Rehabilitation into Supported Employment ............... 147

CHAPTER 23 ................................ ................................ ............ 155

CASE RECORDING ................................ ................................ . 155


23A Purpose of Case Recording ................................ ........ 155

23B Principles of Case Recording ................................ ...... 155

23C What to Include ................................ ............................. 155

23D What Not to Include ................................ ...................... 155

23E Breakdowns in Case Recording ................................ . 155

23F Styles of Case Recording ................................ ............ 155

CHAPTER 24 ................................ ................................ ............ 162


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OTHER GOODS AND SERVICES ................................ ........... 162



24B Other Goods and Services That Are Not Provided .... 162

24C Documentation and Approval Required ..................... 162

CHAPTER 25 ................................ ................................ ............ 165

CASE CLOSURE ................................ ................................ ...... 165



25B Reasons for Case Closure ................................ ........... 165

25C Ineligibility ................................ ................................ ..... 165

25D Case Closure from Referral and Applicant Status .... 165

25E Case Closure from Extended Evaluation Status ....... 165

25F Case Closure from Active Status When NotRehabilitated ................................ ................................ ............ 165

25G Referral to Another VR Agency ................................ ... 165

25H Case Closure from Active Status When Rehabilitated165

25I Substantial Rehabilitation Services .............................. 165


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25J Suitable Employment ................................ ................... 165

25K Case Closure from Post-Employment Status ............ 165

CHAPTER 26 ................................ ................................ ............ 173

RECRUITMENT AND TRAINING SERVICES TO PROVIDE NEWEMPLOYMENT OPPORTUNITIES IN THE FIELDS OFREHABILITATION, HEALTH, WELFARE, PUBLIC SAFETY,LAW ENFORCEMENT AND OTHER APPROPRIATE PUBLICSERVICE EMPLOYMENT ................................ ........................ 173


CHAPTER 27 ................................ ................................ ............ 174

LOW-VISION SERVICES ................................ ......................... 174


27B Consumer Understanding of Low -Vision Services ... 174

27C Fees ................................ ................................ ............... 174

27D Limitations ................................ ................................ .... 174

27E Consumer's Ophthalmologist's or Optometrist'sOpinion................................ ................................ ..................... 174

27F Procedure for Approval of Devices to be ProvidedUnder VR, IL, or SR When the Acquisition Cost Is Less Than$100 174

27G Procedure for Approval of Devices to be Provided


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Under Ma When the Acquisition Cost Is Less Than $100 .... 174

27H Procedure for Approval of Devices When theAcquisition Cost Is More Than $100 ................................ ...... 174

271 Follow-up After Provision of Low -Vision Aids........... 174

27J Use of the Low-Vision Consultant .............................. 174

27K Sample Letters and Forms ................................ .......... 174

CHAPTER 28 ................................ ................................ ............ 185

TRANSITION SERVICES TO ADOLESCENTS ....................... 185


28B Preparation for Transfer from Children's Worker at Age14 185

28C Team Review ................................ ................................ . 185

28D Evaluation ................................ ................................ ..... 185

28E Case Manager Responsibilities ................................ ... 185

28F Administrative List ................................ ....................... 185

CHAPTER 29 ................................ ................................ ............ 190

EMPLOYMENT AND VOCATIONAL REHABILITATION ......... 190

RELATED EQUIPMENT ................................ ........................... 190



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29A General Considerations ................................ ............ 191

29B Role of the Technology for the Blind Program ....... 191

29C Vocational Rehabilitation Equipment ...................... 191

29D Procedures for Authorization of VocationalRehabilitation Equipment ................................ ....................... 191

29E Placement of Vocational Rehabilitation Equipment 191

29F Role of the Rehabilitation Engineer(s) ..................... 191

29G Vocational Rehabilitation Equipment ProvidedDirectly by Regional Staff ................................ ....................... 191

29H Eligibility for the Technology for the Blind Program191

29I Referral to the Technology for the Blind Program ... 191

29J Repair and Maintenance of Equipment ..................... 191

29K Equipment Not Provided ................................ ........... 191


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Chapter 1Referral and ApplicationVocational Rehabilitation

Contents

1A General Considerations

1B Sources of Referrals

1C Processing of Referrals

1D Initial Interview


A referral is defined as any individual who has requestedvocational rehabilitation services, by personal contact,telephone or letter to any MCB employee or who has beenreferred to an MCB employee for vocational rehabilitationservices by another person, organization, agency, orphysician. The following is the minimum information that isnecessary to meet the full definition of a referral: 1) the nameand address, 2) the nature of the disability, 3) age and sex, 4)date of referral, 5) source of referral, and 6) a statement thatthe person is present in the Commonwealth. All suchpersons referred to vocational rehabilitation counselors areclassified as referrals and a vocational rehabilitation casemust be opened in each instance.


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1B Sources of Referrals

Optometric and ophthalmological reports of lega l blindnessreceived in the Central Register are the most commonsources of vocational rehabilitation referrals. Such referralsare sent to the Regional Office via an Intra -Agency ReferralForm (Form 50). After the vocational rehabilitation counselorhas contacted the consumer and the result of the referral isknown, the counselor will return one copy of the form to theCentral Register with comments on the result of the referral.

Other frequent sources of referrals to VR are MCBcaseworkers in other disciplines and programs, consumersthemselves, relatives and friends, and other agencies. AnIntra-Agency Referral Form should be completed anddirected to the vocational rehabilitation counselor for thearea in each case.

1C Processing of Referrals

The objective is to acknowledge consumer referrals from thereferral source and to promptly contact the consumer toexplain services to him or her. While these processe s aretaking place the consumer is placed in Status 00.

1D Initial Interview

The purpose of the initial interview is to establish arelationship with the person who has been referred and toexplain vocational rehabilitation services. If the person is


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interested in applying for vocational rehabilitation servicesafter they have been explained, the Survey Interview form(VR-2) will be completed. The Application for Services andRelease of Information Form (VR -2A) should be signed by theconsumer at this time. If the individual state s that he or shewishes to apply for VR but does not agree to sign theApplication for Services and Release of Information Form, thecounselor should consult with the agency General Counselfor guidance on how to proceed. In many cases it will beimpossible to obtain enough information to find the personeligible for services or to develop an IPE without a signedcopy of this form.

The counselor should explain the information contained onthe Information for Vocational Rehabilitation ConsumersForm (VR-1) and on the Application for Services and Releaseof Information Form to the applicant and also provideinformation about the MCB Consumer Assistance andProgram Support Program and about the ConsumerAssistance Program at the Massachusetts Office onDisability. After the applicant has signed the Application forServices and Release of Information Form, the case must bemoved to Status 02.


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Chapter 2Evaluation

Vocational Rehabilitation

2A Purpose

2B General Considerations

2C Basic Medical Examination

2D Use of Existing Reports

2E Ophthalmological Examination

2F Choice of Physician

2G Specialty Examinations

2H Screening for Hearing Loss

2I Presentation to the Ophthalmologic al Consultant

2J Psychiatric or Psychological Evaluations

2K Psychological Testing

2L Evaluation at a Rehabilitation Center

2M Work Evaluation

2A Purpose


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The purposes of the evaluation services are:

to gather enough information to s ubstantiate whether ornot an applicant is eligible for vocational rehabilitationservices or whether an extended evaluation is necessaryto determine eligibility, the process of the actualdetermination of eligibility or ineligibility is discussed inChapter 3; and

to determine the nature and scope of services needed bythe person to attain a vocational goal.

The most important goal of evaluation is to help theconsumer learn about himself, his disability, his functionallimitations and strengths, how the information gatheredrelates to vocational choice. Therefore, where appropriate,the counselor should share and interpret informationgathered during the assessment so that the consumer mayuse the information in decision -making and fully participatein the development of the IPE.

It is important to remember that when personal informationhas been obtained form another agency or organization, itmay only be released to the consumer under the conditionsestablished by that agency. For example, informat ionmarked "confidential" by the source should only be releasedto the consumer by the source agency or organization. Inaddition, medical, or psychological information which thecounselor believes may be harmful to the consumer may notbe released directly to the consumer, but must be releasedthrough his other representative, a physician, or a licensed


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psychologist.


An applicant has a right to be determined eligible as soon asit is clear that he meets the criteria - the presence of aphysical or mental disability which for him is a handicap toemployment and a reasonable expectation that vocationalrehabilitation services will benefit him in terms ofemployability. The eligibility determinati on should not bedelayed until all the assessment material that the counselorneeds to formulate an IPE is obtained since this process canand should continue after certification of eligibility orextended evaluation. Example: A counselor determines that aparticular applicant is legally blind and has a vocationalhandicap on the basis of a general medical, anophthalmological report, and his own interviews with theapplicant. The counselor also believes that the applicant hasgood employment potential but suspects that the person mayhave a secondary psychiatric disability that should beconsidered in developing an IPE. In this case, the counselordetermines the person eligible on the basis of the informationcollected so far and then refers the person for a psychiatricevaluation.

The assessment is a continuing study. The results of theassessment are used to determine the vocational goal andthe nature and scope of services. The assessmentsynthesizes information about the consumer's strengths andlimitations that goes beyond the basic information which isneeded to determine eligibility. This information includes:


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functional limitations of the visual disability and anysecondary disability, age, intellectual assets or limitations,education, work history, social history, aptitudes, skills,vocational and recreational interests and behavior. Anumber of evaluations may be necessary to complete athorough assessment; these may include, as appropriate:specialty medical evaluation, low -vision evaluation,rehabilitation teaching evaluation, mobility evaluation,rehabilitation engineering evaluation, psychiatric orpsychological evaluation, psychological testing, workevaluation, or evaluation at a rehabilitation center. At timesfurther assessment and evaluations may be necessary afterIPE development and initiation.

2C Basic Medical Examination

A recent basic medical examination which evaluates thegeneral health status of the person is not required unlessthere are indications that the consumer has severe healthproblems that may make him or her ineligible for vocationalrehabilitation services.

2D Use of Existing Reports

The counselor will, early in the evaluation process, find outfrom the applicant the names of his doctors and anyhospitals where he has been treated and write to them formedical records. The existence of unsuspected secondarydisabilities often comes to light when the applicant is askedabout past hospitalizations.


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2E Ophthalmological Examination

A report of an ophthalmological or optometric examination isoften not necessary if the consumer is registered as legallyblind and the eye condition is stable. If the eye condition isone that may be progressive, an examination must have beenperformed no more than one year prior to the determinationof eligibility. Federal regulations require that each applicantfor vocational rehabilitation services be given the choice ofhaving an examination by an optometrist or anophthalmologist. Eligibility for VR services may bedetermined on the basis of either an optometric or anophthalmological examination. However, a consumer whohas a progressive eye disease or an eye condition whichmight be helped by medical treatment must have anophthalmological examination before an IPE is written as partof the assessment.

Some examples may help clarify this distinction. Applicantswho have relatively stable conditions such as optic neuritis,albinism, retrolental fibroplasia, or nystagmus may if theychoose to have an optometric examination for the purpose ofestablishing eligibility. This same or another optometricexamination may be used as a basis for planning services forsuch persons.

Applicants who have progressive or medically treatableconditions such as cataracts, glaucoma, macular or retinaldegeneration, retinitis pigmentosa, or diabetic retinopathymay also if they choose to have an optometric examinationfor the purpose of establishing eligibility. But such persons


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will have to have an ophthalmological examination as a basisfor planning appropriate services before the IPE isdeveloped. The ophthalmological consultant may alsorecommend an ophthalmological examin ation when it is inthe best interests of the consumer.

2F Choice of Physician

Whenever possible, the applicant's personal doctor orspecialist should provide necessary evaluations if the doctoris willing to accept our fee. If the applicant has no doctor, heshould be assisted in finding one. The counselor shouldalways give the applicant the choice of two or morephysicians.

Any licensed physician may perform a basic medicalexamination; specialists should be board -eligible in theirspecialty areas.

2F Specialty medical examinations

Any specialty medical examinations recommended by theexamining physician or the medical consultant will beobtained. Reports of specialty exam inations conductedwithin six months of the eligibility determination will beacceptable.

2G Specialty Examinations

Any specialty medical examinations recommended by theexamining physician or the medical consultant will be


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obtained. Reports of specia lty examinations conductedwithin six months of the eligibility determination will beacceptable.

2H Screening for Hearing Loss

The counselor should be alert to any sign of a possiblehearing loss, particularly with consumers who have retinitispigmentosa since that condition is often associated withhearing impairment.

A comprehensive hearing evaluation must be obtainedwhenever: the counselor thinks there may be hearing loss any medical or other records indicate a possible hearing

loss

The hearing evaluation may be performed by either anotologist or an audiologist.

2I Presentation to the Ophthalmological Consultant

The counselor may present any voca tional rehabilitation caseto the ophthalmological consultant before determination ofeligibility. The role of the ophthalmological consultant is toconfirm or deny the presence of a disability and to offerinformation and recommendations about the person' sfunctional limitations. The role of the counselor is to collectand analyze all relevant information and to decide whetherthe disability constitutes a vocational handicap and whetherthe applicant is eligible.


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When the counselor has gathered all nec essary evaluationreports, he may send or give them along with the physicalcapacities appraisal to the eye report specialist who willbring the materials to the consultation. It is most importantfor the counselor to ask specific questions of the consult antin order to get as much information as possible about theapplicant's functional limitations.

2J Psychiatric or psychological evaluations

Consumers who have been hospitalized or treated foremotional disorders in the past may be referred forevaluation to determine whether there are any currentpsychological issues that may have a bearing on thevocational rehabilitation process. Such an evaluation may bedone by either a psychiatrist or a license d psychologist.

2K Psychological testing

Psychological testing is often appropriate for consumers as asource of information for the counselor and the consumer forvocational counseling purposes. Both interests and apti tudesmay be tested. Through testing the consumer and counselormay learn about strengths and weaknesses, which willindicate areas for further vocational exploration. Wheninterpreting the results of psychological tests to a consumer,counselors should not tell the consumer the actual scoressince scores may not be meaningful or may bemisinterpreted. If the consumer would like to know theactual score, the evaluator is in a better position to determine


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how such information should be shared. Instead, themeaning of the results should be told to the consumer interms of his frame of reference; for example, "You haveabove average ability to learn"; "Your interests are similar tothose of people who work with the public," etc.

2L Evaluation at a rehabilitation center

Evaluation at a comprehensive rehabilitation Center such asthe Carroll Center for the Blind may be authorized for up tofour weeks (two weeks is usual) in order to assess theconsumer's skills in coping with blindness and possible needfor services at a comprehensive rehabilitation center.

2M Work evaluation

A consumer in applicant status may be referred for a workevaluation, including trial work experiences. A consumer inplan development status who has not previously undergone awork evaluation may also be referred for an evaluation . study. The purpose in this instance would be to obtain informationnecessary for adequate plan devel opment. The counselormay find a work evaluation useful to determine employmentpotential or employment readiness, to evaluat e physical andmental capacities and limitations, to evaluate social andpsychological factors, or to determine how the consumerrelates to co-workers and supervisors. Eight weeks isordinarily the maximum amount of time that may beauthorized for a work evaluation in either status 02 or status10. A longer evaluation may be authorized when there arelegitimate problems that prevent speedier movement. If the


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counselor expects that the consumer may need a longerperiod of evaluation services to determine eligibility, the caseshould be placed in status 06. It will take some consumerslonger than others to accustom themselves to new routines;new people and new demands so it may take longer toaccurately assess their potential. It is important that thecounselor make clear to the consumer the reasons for thework evaluation, the gains to the consumer which are hopingfor, and the procedures and routine which the consumer mayexpect when he begins the program. When the consumerhas completed the evaluation, the counselor should discusswith him the findings made by both the counselor and theconsumer as a result of the experienc e. Insights developedby the consumer can serve very useful purposes in thecounseling process.


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Chapter 3Eligibility


Contents

3A Purpose


3C Basic Eligibility Requirements

3D Visual Disabilities Other Than Legal Blindness

3E Elements of Eligibility Determination

3F Determination of Significant Disability

3G Timeframe for Determining Eligibility

3H Case Recording on Eligibility

3I Age

3J Certification of Eligibility

3K Certification of Ineligibil ity

3L Annual Review of Ineligibility

3A Purpose


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The purpose of this chapter is to assist the counselor in theprocess of determining an applicant's eligibility or ineligibilityfor vocational rehabilitation services. The procedure forconducting an annual review of ineligibility is discussed.


It is the counselor's responsibility to determine the eligibilityor ineligibility of an applicant for vocational rehabilitationservices. In making the determination, the counselor use sinformation provided by the applicant, the applicant's family,physicians who have examined or treated the applicant, anddata from other professionals and agencies who haveknowledge of the applicant. The counselor will useinformation that is existing and current and that is availablefrom other programs, particularly information used byeducation officials and the Social Security Administrationand information provided by the individual and the family ofthe individual. The counselor, of course, cons iders thepossible validity or correctness of the information basedupon the reliability of the source and his own knowledge ofthe consumer. Currency of the existing data is not afunction of when the data was produced but whether the datadescribe the current functioning of the individual.Assessments to gather additional data should only be carriedout when the existing data are not current, insufficient orinappropriate to make an eligibility determination.Consideration of the use of assistive tec hnology may benecessary in some cases to determine eligibility.

Agency consultants are available for information and


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recommendations but it is the counselor who collects andanalyzes all the relevant information and makes adetermination based on the unique circumstances of theperson. The medical consultant confirms the presence of thedisability of blindness and any other physical or mentaldisabilities and delineates the person's functional limitationsbased on material presented by the counselor, but it is thecounselor who determines whether a vocational handicapexists and whether VR services are likely to lead to theattainment of a vocational goal.

3C Basic Eligibility Requirements

To be eligible for vocational rehabilitation services a personmust meet the following criteria:

The person must have a disability of legal blindness whichfor that person constitutes or results in a substantialimpediment to employment.

The person must require vocational rehabilitation services toprepare for, secure, retain, or regain employment.

There must be a determination that the person can benefit interms of an employment outcome from vocationalrehabilitation services.

3D Visual Disabilities Other Than Legal Blindness

Applicants who have visual disabili ties but who are notlegally blind must be referred to the Massachusetts


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Rehabilitation Commission for vocational rehabilitationservices. When there is likelihood that the applicant willbecome legally blind in the future the MCB counselor shouldbe available for consultation with the MRC counselor aboutthe prognosis and appropriate services for the applicant.

3E Elements of Eligibility Determination

Disability - a physical or mental impairment that constitutesor results in a substantial impediment t o employment. Therationale for using existing data is to streamline the eligibilitydetermination process and to expedite access to vocationalrehabilitation services. All legally blind persons registeredwith MCB should be considered to have met the eli gibilityelement of being an "individual with a disability" on thebasis of the existing information in the Central Register, theeye report. The counselor will make a judgement on a case -by-case basis of whether the applicant meets the otherelements necessary to be eligible for VR services.

Substantial impediment to employment - a significantlimitation imposed by the disability that makes vocationalsuccess difficult. A legally blind person does not necessarilyhave a substantial handicap to employmen t. A legally blindperson who is currently determined eligible for disabilitybenefits under SSDI or SSI is presumed to be eligible for VRservices provided that the consumer intends to achieve anemployment outcome. SSDI and SSI beneficiaries are alsopresumed to be individuals with significant disabilities. Theagency may not apply any additional tests or steps withrespect to determining the eligibility of such individuals,


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unless the presumption of benefit from VR services in termsof an employment outcome can be rebutted by clear andconvincing evidence that the individual is incapable ofbenefiting in terms of achieving an employment outcome dueto the severity of the individual's disability.

Determination of benefit - means that the counselor hasdetermined that there is likelihood that through vocationalrehabilitation services the person will be able to achieve avocational goal consistent with his capacities and abilities.The law requires that all applicants be presumed to meet thisrequirement unless it can be demonstrated through trial workexperiences, by clear and convincing evidence, that theperson is incapable of benefiting in terms of an employmentoutcome from VR services. The standard of "clear andconvincing evidence" means with a hi gh degree of certainty.If the person cannot, even with appropriate supports,participate in trial work experiences, he or she may be foundineligible. A variety of trial work experiences must be offeredover a period of at least several months to give t he applicantevery chance to demonstrate the potential to benefit from VRservices. Trial work experiences should take place inrealistic integrated employment settings.

Requirement of Services - The individual must requireservices to prepare for, enter, engage in, or retain gainfulemployment. Thus, a consumer who is determined to be an"individual with a disability" (that is, is legally blind) andtherefore meets the first eligibility criterion, may be foundineligible for vocational rehabilitation se rvices if the persondoes not also meet the second criterion, that is, if the


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individual does not require VR services to obtain or retain anemployment outcome. An example of an person who meetsthe first eligibility criterion while not meeting the secondcriterion might be a person who, at the time of application forvocational rehabilitation services, is already employed andpossesses adequate education and training to pursueanother employment opportunity if he or she desires.

Employment Outcome - employment in the competitive labormarket, practice of a profession, self -employment,homemaking, farm or family work (including work for whichpayment is in kind rather than in cash), homeboundemployment, or other gainful work.

3F Determination of Signif icant Disability

It would be unusual for a legally blind person to be found tonot have a significant disability as defined in the federalRehabilitation Act. However, the counselor must look at eachapplicant and make a determination about whether asignificant disability is present. The definition in the Act is:

Individual with a significant disability' means an individualwith a disability--

(i) who has a severe physical or mental impairment whichseriously limits one or more functional capacities ( such asmobility, communication, self -care, self-direction,interpersonal skills, work tolerance, or work skills) in termsof an employment outcome;


36

(ii) whose vocational rehabilitation can be expected to requiremultiple vocational rehabilitation servic es over an extendedperiod of time; and

(iii) who has one or more physical or mental disabilitiesresulting from amputation, arthritis, autism, blindness, burninjury, cancer, cerebral palsy, cystic fibrosis, deafness, headinjury, heart disease, hemiple gia, hemophilia, respiratory orpulmonary dysfunction, mental retardation, mental illness,multiple sclerosis, muscular dystrophy, musculo -skeletaldisorders, neurological disorders (including stroke andepilepsy), paraplegia, quadriplegia, and other spina l cordconditions, sickle cell anemia, specific learning disability,end-stage renal disease, or another disability or combinationof disabilities determined …to cause comparable substantialfunctional limitation.

3G Timeframe for Determining Eligibility

Federal law requires that the agency must make an eligibilitydetermination within a reasonable period of time, not toexceed 60 days after the individual has submitted anapplication to receive services. Exceptions to this 60 -daytimeframe can occur only if:

1) The counselor notifies the individual that exceptionaland unforeseen circumstances beyond the control of theagency preclude the agency from completing thedetermination within 60 days and the consumer agrees thatan extension of time is warrant ed, or


37

2) The counselor and consumer are exploring applicant'sabilities, capabilities, and capacity to perform in work insituations where there is doubt that the applicant can benefitfrom Vocational Rehabilitation services in terms of anemployment outcome.

Any delay beyond the 60 days must be explained in the caserecord.

3H Case Recording on Eligibility

As a minimum the case record must include the following:

1. Medical and other information necessary to show thepresence of a disability which, for the individual consumer, isan impediment to employment.

2. The counselor's analysis showing the specific ways inwhich the medical, psychological, vocational, educationaland other related factors interfere with the person'soccupational adjustment by preventing his obtaining,retaining, or preparing for employment consistent with hiscapacities and abilities.

3. The counselor's assessments of how VR services areexpected to benefit the person in terms of an employmentoutcome.

This information is to be recorded on the certificate ofeligibility.


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3I Age

There is no upper or lower age limit that will in and of itselfresult in a finding of ineligibility. However, the person mustbe mature enough that a realistic plan of continuous serviceleading to a gainful occupation can be made.

3J Certification of Eligibility

The counselor certifies his or her finding that the consumeris eligible for vocational rehabilitation services on thecertification of eligibility form. This form certifies the res ultsof the assessment. The counselor should check that theconsumer is eligible. The counselor must also write a briefanalysis of the particular consumer's disability, employmentlimitations, and rehabilitation potential. Reference should bemade in these analyses to the consumer's functionallimitations, work history, education, and assets.

The counselor will also indicate on the form the results of hisor her determination of whether the applicant has asignificant disability and meet the criteria sp ecified in thedefinition cited in Section 3F. The counselor must alsoindicate on the form that the consumer is presumed to beeligible when the consumer receives either SSI or SSDIbenefits.

3K Certification of Ineligibility

When a counselor finds that an applicant does not meeteligibility requirements for vocational rehabilitation services,


39

a certificate of ineligibility must be completed. The caserecord must include the specific reasons for the ineligibilitydetermination and an analysis of how t he assessment datasupport the determination.

The applicant or his parent, guardian or other representativemust fully participate in the ineligibility determination (hedoes not have to agree) or must have been given clearopportunity to participate. Where a counselor is consideringfinding an applicant ineligible, he should write or call theapplicant (or parent, etc.) and offer an opportunity to come inand discuss the reasons why the applicant seems to beineligible. The applicant may be able to of fer new informationthat will affect the counselor's decision. Federal regulationsrequire that the fact that the applicant has been offered anopportunity to consult in this way with the counselor bedocumented in the case record.

The applicant must be notified in writing of the determinationof ineligibility, the reasons for the determination, and themeans of expressing any dissatisfaction - administrativereview, mediation, and fair hearing. The applicant must alsobe notified in writing of the avai lability of the ConsumerAssistance Program at the Massachusetts Office on Disabilityas well as of the address and telephone number of thatoffice.

A case closure in status 08 for any of the following reasonsdoes not constitute a decision of ineligibili ty and acertification of ineligibility is not appropriate or required:


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Died Moved out of state, or has been impossible to contact

after reasonable efforts to do so. Has been institutionalized under circumstances making

the person unavailable for evaluat ion or other essentialservices for an indefinite or considerable period of time.

Has declined to accept or use vocational rehabilitationservices after reasonable efforts have been made toencourage participation.

Note that when a person declines to pa rticipate for reasonsdetermined to be related to the severity of a disability, suchas emotional problems which cannot be satisfactorilyresolved, the reason for closure should be ineligibility ratherthan unavailability.

The following reasons for closi ng a case in status 08 doconstitute a decision of ineligibility and do requirecertification of ineligibility:

no determination that VR services may benefit theapplicant in terms of employability

an unfavorable medical prognosis no disabling condition no impediment to an employment outcome

Certification of ineligibility is also required for each case instatus 10 or above that is closed because the person is nolonger capable of achieving an employment outcome(statuses 28 and 30).


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3L Annual Review of Ineligibility

Annual reviews are required by federal regulations where thebasis for an ineligibility determination is that the person isnot capable of achieving an employment outcome. Thecounselor must be sure that the person understands thepurpose of the review and is consulted fully in thereconsideration of the determination of ineligibility. Inpractice, this means that the counselor should meet or offerto meet with the person to see if there are any newcircumstances or information that might change theineligibility decision. The review process should beginduring the eleventh month after closure and be completedwithin 60 days.

A first review must be conducted 12 months after closure andsubsequent annual reviews will be done if requested by theapplicant or his or her parent or guardian.

Annual reviews need not be conducted if: the individual has refused to participate; the individual is no longer present in the state; the individual's whereabouts are unknown; or the individual's medical condition is rapidly progressive

or terminal.


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Chapter 4Counseling and Guidance Services


CONTENTS

4A General considerations

4B Objectives of counseling and guidance

4C Case recording of counseling and guidance


Counseling and guidance is a process in which theconsumer and counselor work together to understand theconsumer’s assets, skills, limitations, interests, and goalsand to formulate and carry out a rehabilitation plan which isappropriate to the consumer's individual needs. Counselingand guidance continues through all phases of the vocationalrehabilitation process. The needs, problems, and concernsof vocational rehabilitation consumers are so variable andchangeable that flexibility has to be an essential element ofcounseling and guidance. It should be noted that at timesinterpreter services may be needed in order for the consumerand counselor to communicate effectively.

4B Objectives of counseling and guidance

Counseling and guidance may have different objectives atdifferent times during the rehabilitation proc ess.The counselor should carefully consider what the current


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objective should be at each stage of the process. Vocationalrehabilitation counseling objectives include:

To assist the consumer in understanding his or hercapacities, aptitudes, skills, and interests;

To assist the consumer to understand any limitationsand any other problems that have an impact on his orher vocational rehabilitation;

To assist the consumer to understand the servicesavailable from MCB and other community resources;

To assist the consumer to deal with issues such as thedevelopment of appropriate work or study habits,preparation for job interviews, the development ofeffective interpersonal skills, etc. ;

To assist the consumer to select suitable and realisticvocational goals;

To develop an Individual Plan for Employment with thefull participation of the consumer;

To facilitate appropriate involvement of family members,staff of other service agencies, and potential employersin the rehabilitation efforts of the consumer;

To provide follow-up counseling after the consumer isemployed until any problems are resolved and the jobappears to be secure.

4C Case recording of counseling and guidance

All of the recording in a case record should reflect thecounseling and guidance that are taking place throughout therehabilitation process. The recording should identify themajor problems which the counselor and consumer


44

encounter in working toward the rehabilitation objectives, thecontributions of the counselor and consumer in resolvingproblems, and the effectiveness of the services provided. Asa minimum, there should be a summary contact report everythree months that reflects ongoing counseling and guidanceand future counseling goals.


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Chapter 5Individual Plan for Employment


Contents

5A Purpose

5B Nature of the IPE

5C Narrative Justification

5D Joint Development of the IPE

5E Content of the IPE

5F Amendments to the IPE

5G Periodic and Annual Reviews of the IPE

5A Purpose

The Individual Plan for Employment (IPE) is intended toformalize the establishment of VR go als and objective and toassure active consumer participation in rehabilitationprogram development. The IPE is developed in face-to-facemeetings of counselor and consumer. Prior to thedevelopment of the IPE, there should be active and extensiveinvolvement of the consumer in considering various options.Although the IPE is not a legal contract, it is a definitecommitment to mutually agreed upon services and goals.


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5B Nature of the IPE

The initial IPE should be understood as the starting point,subject to addition and amendment if the consumer's needsor circumstances change. The IPE is essentially a plan ofaction with goals, objectives, and action steps but it is also astatement of understanding of rights, respon sibilities, andcertain procedures. The development of the IPE is acontinuous process that is recorded and reflected in theinitial IPE and subsequent amendments and reviews. TheIPE must be a separate part of the case record; the IPE itselfand all program attachments will be grouped together in therecord.

5C Narrative Justification

At the time the IPE is written the information which has beenobtained from the assessment is analyzed and synthesized inthe narrative justification (VR-5). The assessment is acontinuing study that begins even before eligibility isdetermined and continues throughout the case. The resultsto date of the assessment are used to determine thevocational goal and the nature and scope of services. Theassessment synthesizes information about the consumer'sstrengths and limitations that goes beyond the basicinformation which is needed to determine eligibility. Thisinformation includes: functional limitations of both the visualdisability and any secondary disability, age, intellectualassets or limitations, education, work history, aptitudes,skills, interests, and behavior. This information should be


47

discussed in the narrative justification along with theoccupational demands and labor market potential of thechosen vocational goal. The narrative justification shouldclarify the consumer's needs and make the reasoning behindthe IPE apparent.

The narrative justification is for the use of the counselor andsupervisor; a copy of it is not routinely given to theconsumer, but is available to the consumer.

5D Informed Choice and Joint Development of the IPE

The counseling process by its nature involves participationof the consumer in developing a plan. Informed choice is thecornerstone of the vocational rehabilitation process. Parentsor other significant persons in the consumer's life should beincluded in the counseling process to the extent they areneeded to help develop or clari fy the IPE for the consumer.Exercising informed choice and taking more responsibility inthe VR process makes demands on consumers, and may alsomake demands on other people in their lives. To be fullyengaged in the VR process, including development of theIPE, the consumer must gather and use information to theextent possible, participate in planning and problem solving,make and implement decisions, and seek or identify neededresources. The consumer engages in these activities tomake decisions about the selection of the employmentoutcome, VR services, service providers, service andemployment settings, and methods for procuring services.Once the IPE has been signed both by the consumer and theVR counselor, the consumer assumes the responsibilit ies


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identified in the IPE for implementing the decisions andachieving the employment outcome. It is important that therebe a shared understanding and agreement between theconsumer and the counselor about the nature of theconsumer’s needs and plan of se rvices to meet the needs.The consumer must review the proposed services andvendors with the counselor and be afforded an informedchoice of services and vendors. The consumer's choice ofvendor is to be met if at all possible.

5E Content of the IPE (VR-4)

This form is to be used for the consumer's original IPE. Allrevisions are to be made on the IPE program attachment form(VR-6). The sections of the IPE form are discussed below.

Understandings - The first page and a half of the IPEshould be discussed with the consumer. This materialprovides the consumer with a statement of whether heor she is eligible for extended evaluation or VR servicesand the basis of this determination; the conditions forchanging he IPE; the review and evaluation procedures;and consumer rights and appeal procedures.

Comparable benefits - This section on comparablebenefits should be completed even if comparablebenefits are not used to show which benefits wereconsidered in a particular case. For example, theDepartment of Employment and Training might bechecked as "Explored" with a note under "Remarks"such as "No appropriate training course." Only the


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benefits that seem to the counselor to be possiblyavailable to a particular consumer need to be explored.In those few cases when none are explored or used,simply write across the chart "None appropriate."

Program goal - The counselor must check whether theprogram goal of the IPE is extended evaluation orvocational rehabilitation.

Vocational goal - The specific occupation that theconsumer has chosen as a vocational objective must belisted.

Estimated date of achievement of program goal - This isthe date when the counselor expects to close the case instatus 26 after placement and follow -up services havebeen provided.

Intermediate objectives - Intermediate objectives aremeasurable steps or expected service outcomes that areplanned to help the consumer achieve the vocationalgoal or to complete the extended evaluation. Sinceeach service outcome represents one or more services,there may be as many intermediate objectives as thereare services or there may sometimes be only oneintermediate objective. Some examples of intermediateobjectives are: physical restoration, achievement ofspecific vocational skills, and attainment of a GED. Oneor more services may be necessary to theaccomplishment of an intermediate objective. Forexample, if the intermediate objective is the attainment


50

of typing skills, the services listed under it might be:business school and books and supplies. Theestimated date when each intermediate objective isexpected to be achieved must be recorded. The relevantservices and vendors are to be listed under eachintermediate objective and the expected beginning andending dates of each service.

Criteria to be used for review and evaluation - Thissection is to be used to record the specific consumerresponsibilities agreed to by consumer and counselorand the criteria the counselor will use to determinewhether the program is being successfully carried out.A sample entry might be: "Monthly evaluations andattendance reports submitted by the school. Consumerwill attain at least average ratings on all reports.Agreement upon specific criteria for evaluation ofprogress is in some cases a critical part of thecounseling process. If the consumer has had problemsin certain areas in the past, the criteria should reflectspecific expectations in those areas, For example, aconsumer who has had attendance problems in the pastcould agree to a criterion that specifies a maximumnumber of absences that will occur in his trainingprogram.

Counseling and guidance goals - Counseling andguidance is provided continuously during the course ofevery IPE. The counselor should record in this sectionthe primary goals that will be pursued during ongoingcounseling with the particular consumer. A sample


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entry might be: "Counselor and consumer will try toimprove his positive asser tiveness skills and ability tolook for jobs. Job-seeking skills will be explored.Counselor and consumer will meet at least once a monththroughout this IPE. "

Consumer's Statement (In his or her own wordsdescribing how he or she was informed about andinvolved in choosing goals, services, and vendors) - Theviews of the consumer about the IPE must be recordedin his or her own words. It is most important that theconsumer express any thoughts he or she may haveabout how his or her choice of goal s, services, andvendors was accommodated. If the consumer declinesto write or dictate a statement, the counselor record theconsumer's own words to that effect; for example, "Idon't want to make a statement.

Assessment of expected need for post -employmentservices - The counselor should record his orassessment of the consumer’s expected need forpost-employment services, including the type ofservices expected to be needed and the possibleduration of the need. If the counselor does not expectthat the consumer will need post -employment services,the box "None expected to be needed" should bechecked.

Periodic and annual review dates - The counselor mustestablish periodic and annual review dates and list themon the IPE; these dates may be approximate. Federal


52

law requires that every IPE have a formal review at leastonce a year.

Signatures - The consumer and counselor should signthe IPE at the same time and then it should be submittedto the supervisor for approval. The counselor shou ldhave had ongoing discussions with the supervisor aboutthe probable content of the IPE in order to minimize thecases when the supervisor will not be willing to approvethe signed IPE. After the supervisor has signed it, acopy must be mailed or given to the consumer in aformat of the consumer's choice and in his or her nativelanguage.

Statement relative to supported employment programservices attached - If the consumer is found to meet theselection criteria for supported employment programservices, this box must be checked "Yes" and the form(VR-4A) completed and attached. (14)

Statement relative to special education servicesattached - If the consumer is receiving special educationservices, this box must be checked "Yes" and the form(VR-4B) completed and attached.

5F Amendments to the IPE

An amendment is any change or addition to the original IPEsuch as a different vocational goal or a change in the plan ofservices. The counselor will write an amendment to the planwhen any part of the IPE is changed as a result of change in


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the consumer's needs, in the agency's policies, or otherfactors. The IPE may be amended at any time, whether as aresult of a periodic or annual review or at the initiativ e of theconsumer or counselor. Of course, consumer, counselor,and supervisor must all agree to any amendment. Theconsumer must review the proposed services and vendorswith the counselor and be afforded an informed choice ofservices and vendors. Each amendment is to be recorded onan IPE program attachment (VR-6); a copy must be given tothe consumer.

5G Periodic and annual reviews of the IPE

Periodic reviews of the various services or the pro gram as awhole should be done as often as is necessary in a particularcase. Periodic reviews are recorded on the IPE programattachment (VR-6). For example, if a counselor meets with aconsumer for the purpose of finding out how the consumer'straining is going, this is a periodic review and the caserecording should be made on the IPE program attachmentinstead of on a contact report. It should be noted that whenthe IPE is for extended evaluation, the law requires thatperiodic reviews be done at l east once every ninety days. Aformal review of the entire IPE must be done at least once ayear in all cases and recorded on an IPE program attachment. The consumer must review the proposed services andvendors with the counselor and be afforded an inf ormedchoice of services and vendors.


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Chapter 6Physical and Mental Restoration Services


Contents

6A Scope and Purpose

6B Criteria for Provision of Physical or Mental RestorationServices

6C Case Recording

6D Counseling During Physical or Mental Restoration

6E Hearing Aids

6F Complications of Physical or Mental Restoration

6G Acute Medical Conditions

6H Choice of Vendor

6I Services to Family Members


This chapter provides guidelines on the provision of physicaland mental restoration services to legally blind individualsunder an approved IPE. (Low-vision services, which are one


55

type of physical restoration service are discussed in Chapter27.) The purpose of physical and mental restoration servicesis to, within a reasonable period of time, correct orsubstantially modify a physical or mental condition which isstable or slowly progressive (based on findings fromphysical or psychological examinations) and which results ina substantial handicap which directly affects theemployability of the individual. In all cases, before theprovision of physical or mental resto ration services, theconsumer must have had a recent (within three months)examination by a licensed physician. The report of thisexamination must include findings necessary to determinethe health of the individual and the characteristics of hisimpairment. This report may be obtained directly from theexamining physician or from hospital or clinic records.These reports of examinations and all other relevant medicaldata must be reviewed by the medical consultant before theprovision of physical or mental restoration services. Theadvice of the medical consultant is necessary to determinewhether the medical condition is stable or slowly progressiveand whether the restoration services can be expected tocorrect or substantially modify it within a r easonable periodof time. Physical and mental restoration services mayinclude but are not limited to:

1. Services provided by: physicians (including generalistsand specialists), dentists, nurses, and otherhealth-related professionals such as audi ologists,chiropractors, mobility teachers, occupationaltherapists, optometrists, orthotists, physical therapists,podiatrists, psychologists, speech therapists. These


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professional persons are required to be licensedaccording to the licensing laws of Ma ssachusetts.

2. Services provided at: hospitals (in -patient andoutpatient), doctors' offices, rehabilitation facilities,special clinics (e. g., low vision, speech and hearing),hemodialysis facilities, State hospitals and mental healthfacilities.

7B Criteria for Provision of Physical or Mental RestorationServices

1) An approved IPE outlining the services to be provided;2) The consumer must review the propose d services and

vendors with the counselor and be afforded an informedchoice of services and vendors.

3) The physical or mental disability to be treated must bestable or slowly progressive. This disability shouldconstitute or result in a substantial h andicap toemployment and vocational rehabilitation services mayreasonably be expected to benefit the individual in termsof employability. In this context, restoration servicesshould be expected to eliminate, substantially reduce orcontain the impact of the disability or the handicappingcondition, within a reasonable period of time, or, inselected cases maintain or improve functionalcapabilities. In estimating a reasonable period of time,many factors must be considered, such as the nature ofthe disability, prognosis with respect to life expectancyand employment potential, and other contributingfactors such as age, general health, family stability and


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support, education, former type of work.4) Qualified vendors must be used. Fees are to be paid in

accordance with the regulations of the MassachusettsRate-Setting Commission.

5) Comparable benefits must be used to the greatest extentpossible. Medicare, Medicaid, and private medicalinsurance will often be available as comparable benefits.If the consumer is eligible for any of these benefits, theymust be used unless their use would result in extrememedical risk to the consumer. See Section 21E for adiscussion of extreme medical risk as it applies tocomparable benefits.

7C Case Recording

For each individual to whom physical and/or mentalrestoration services are provided, the case record mustdocument and include:

1) Pertinent information obtained in the assessment.

2) Data supporting the clinical status of the consumer’sdisabling condition as stable or slowly progressive, orthe need for extended evaluation.

3) Physical and/or mental restoration services needed toachieve the stated vocational objective and the servicesto be provided according to the Individual Plan forEmployment.

4) The way in which such services will be provided,


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probable length of time required, and a statement on theuse of other resources-health insurance, Medicaid,Medicare, other state-operated facilities and programsoperated by the Veterans Administration, etc. to beused in paying for these services.

7D Counseling During Physical or Mental Restoration

Since the consumer's full cooperation in his restorationprogram is indispensable to its success, the counselorshould be aware of the meaning that the disability has for theconsumer, his family and his employer, and of his reactionsto and feelings about the treatment he is un dergoing.Continuing counseling may be needed to help the consumeruse fully and appropriately the restoration services he isreceiving and to coordinate this program with othervocational rehabilitation services which may be providedconcurrently.

7E Hearing Aids

The purpose of a hearing aid is to amplify sound for anindividual with a hearing disability. The individual may needone or two aids depending on the nature and severity of thedisability. An audiological evalu ation and a prescription forthe specific aid(s) must be obtained and reviewed by themedical consultant before a hearing aid may be purchased.

7F Complications of Physical or Mental Restoration

Treatment of complications and emergencies, either acute or


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chronic, which are associated with or arise out of theprovision of physical or mental restoration services, or areinherent in the condition under treatment, is an integral partof rehabilitation services. These complications may be acuteor chronic in nature and may occur in or outside of thehospital. Their treatment is properly a part of the totalrehabilitation process. When a complication arises as aresult of physical or mental restor ation services, the agencyhas an obligation to continue its services as long as therehabilitation objective is considered reasonable andobtainable. If the seriousness of the complication is suchthat it interferes with the possibility of achieving therehabilitation objective, it may be necessary to reevaluate theconsumer or even to close the case as not rehabilitated orcurrently not eligible. In cases where there arecomplications, the case record should contain informationabout the nature of the complications and their relationshipto the restoration process. The treatment of suchcomplications must be approved by the agency's medicalconsultant.

7G Acute Medical Conditions

Restoration services may be pr ovided for the treatment of anacute medical condition when the following conditions aremet:

1) the duration of the illness is expected to be less thanthirty days; and

2) the consumer has been participating in and expects to


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resume participation in the services outlined in anapproved IPE; and

3) the acute medical condition, if not treated, wouldinterfere with the consumer's completion of the IPE.Such services to treat an acute illness may not beprovided in post-employment status. See Section 20Ffor a discussion of this issue.

7H Choice of Vendor

A consumer may select for the provision of restorationservices any vendor who meets the standards set forth forthe provision of the service in the regu lations of theMassachusetts Rate-Setting Commission. The consumermust review the proposed services and vendors with thecounselor and be afforded an informed choice of servicesand vendors.

7I Services to Family Members

In certain instances, services to family members of aconsumer may be necessary to the adjustment orrehabilitation of such individual. In these cases, see Chapter15.


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Chapter 7Training Services


Contents


7B Vocational Training

7C Prevocational training

7D Personal Adjustment Training

7E Duration of Training Services

7F Fees for Training

7G Comparable Benefits

7H College Training Services Regulations


This chapter contains guidelines for the provision of trainingservices, other than college training services, when providedto consumers under an approved IPE. College trainingservices are discussed in the Commission's regulations, 111CMR 6. 00. Training services are those services whichprovide the consumer with necessary knowledge and skillsor which assist the consumer to develop necessary attitudes,


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habits, or behavior in order to attain a vocational objective orto complete an extended evaluation of rehabilitation potentialTraining services must be provided by a qualified facility,person, or school which will meet the consumer's needs andfulfill the goals of the IPE in the shortest time possible at theleast cost to the Commission. All training must be providedfor the primary purpose of facilitating the consumer'svocational adjustment and enabling him or her to reach thevocational goal. The consumer must review the proposedservices and vendors with the counselor and be afforded aninformed choice of services and vendors.

7B Vocational Training

Vocational training includes any form of instruction whichprovided the knowledge and skills that are essential forperforming the tasks involved in an occupation. Vocationaltraining may be provided by a licensed or accreditededucational institution, on-the-job, by correspondence, or, invery unusual circumstances, by tutors.

7C Prevocational training

Prevocational training may include any form of academic orbasic training given for the acquisition of backgroundknowledge prerequisite or preparatory to vocational training.It may include training for the purpose of removing aneducational deficiency which interferes with the effective useof the occupational skills or knowledge already possessed bythe consumer. Examples of prevocational training are:completion of high school requirements or preparation of a


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General Equivalency Diploma (GED) examination, training inEnglish as a second language for non -English speakingconsumers.

7D Personal Adjustment Training

Personal adjustment training includes training given for oneor more of the following reasons:

1) to assist the consumer to acquire personal habits andskills to be able to function effectively in spite of adisability;

2) to develop or increase work tolerance prior to engagingin prevocational or vocational training or inemployment;

3) to orient the consumer to the world of work and todevelop work habits;

4) to provide skills and techniques to enable the consumerto compensate for blindness and to becomeindependent in areas such as mobility, communication,home management, personal management, etc.Personal adjustment training most commonly takesplace in a comprehensive rehabilitation center, such asthe Carroll Center for the Blind .

7E Duration of Training Services

The projected length of time needed to complete a training


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program must be specified on the IPE. If there is a need toextend the training period, the IPE must be amended tospecify the current projection of the duration of the trainingprogram. The duration of training should not exceed theusual time for completing the training as established by thetraining facility unless the consumer has developed anillness that has resulted in long absences from the trainingprogram.

7F Fees for Training

1) Fees for training services which have been establishedby the Massachusetts Rate-Setting Commission will notbe exceeded.

2) The maximum fees for vocational, trade, or othernon-degree granting institutions will not exceed thoserates charged to other public agencies, or the publishedrates for the institutions, whichever amount is less.

3) Payments for training services not included in the a bovemay not exceed those rates ordinarily charges otherusers in the community. For example, to determine atypical tutorial fee, the counselor might call a localcollege or other facility which provides or uses tutors.The counselor may then negotia te a fee with a privatetutor, depending on the purpose, length, and frequencyof tutoring sessions.

7G Comparable Benefits


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Comparable benefits must be used to fullest extent possiblein the provision of the services di scussed in this chapter.Consumers must make maximum efforts to secure grantassistance, including making timely application for allfinancial aid, to pay, in whole or in part, for allpost-secondary training. Post-secondary training includesuniversities, colleges, community/junior colleges, vocationalschools, technical institutes, an d hospital schools of nursing.

7F College Training Services Regulations

111 CMR 6.00: VOCATIONAL REHABILITATION SERVICES:COLLEGE TRAINING SERVICES

SECTION6.01 STATEMENT OF PURPOSE

6.02 DEFINITIONS

6.03 SCOPE OF COLLEGE TRAINING SERVICES

6.04 CONSUMER RESPONSIBILITY

6.05 DETERMINATION OF FINANCIAL NEED

6.06 REIMBURSEMENT FOR PROVISION OF NECESSARY


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BOOKS AND SUPPLIES

6.07 REIMBURSEMENT FOR PROVISION OF NECESSARYREADER SERVICES

6.08 ADMINISTRATIVE REVIEW

6.09 EFFECTIVE DATE

6.10 APPENDIX 1: FORM

6.01: STATEMENT OF PURPOSE

These regulations are published in order to establish theconditions and requirements governing the provisi on ofcollege training services. The purpose of these services is toenable blind persons to attain suitable employment outcomesunder the provisions of the Federal -State Program ofVocational Rehabilitation for the Blind. The Commissionrecognizes that consumers often have disabilities in additionto blindness. Issues which effect other disabilities may bedealt with in other regulations or policies (e.g. interpreter ornote taking services for deaf/blind consumers) and may notbe dealt with specifically in these regulations. Individualsections of these regulations must be read in the context ofthe whole, since one part may rely on another. In particular,the availability of resources other than college training


67

services must be given appropriate con sideration indetermining eligibility.

6.02: DEFINITIONS

(1) Academic Year: The period of time between September 1and August 31 of any year.

(2) College Training: Training at an accredited college, juniorcollege, community college, or other degre e-grantinginstitution.

(3) Consumer: A person who is receiving vocationalrehabilitation services from the Commission for theBlind or who has been determined to be eligible for suchservices.

(4) Commission: The Massachusetts Commission for theBlind.

(5) Commissioner: The Commissioner of theMassachusetts Commission for the Blind.

(6) Comparable Benefits: Those resources which areavailable to a consumer for payment for or provision ofspecified vocational rehabilitation services and whichmust be taken into consideration prior to payment by the


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Commission for provision of college training services,as required by the Rehabilitation Act of 1973, asamended. Particular attention should be paid to theAmericans with Disabilities Act which req uires publicaccommodations and governmental entities to provideservices to persons with disabilities.

(7) Counselor: A counselor for the blind on the staff of theCommission's Vocational Rehabilitation Program.

(8) Individualized Written Rehabilit ation Plan (IWRP): Aplan, developed jointly by the counselor and consumer,as required by the Rehabilitation Act of 1973, asamended, which defines the consumer's vocational goaland outlines the responsibilities of the consumer andthe Commission and the vocational rehabilitationservices which will be provided in order to achieve thatgoal.

(9) Regional Director: The Commission employeeresponsible for the planning, coordination, andmanagement of services in a designated geographicalarea of the Commonwealth.

(10) Vocational Rehabilitation Program: Counseling,training, physical restoration, job placement, follow up,vocational rehabilitation and other services as provided


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in P.L. 93-112, as amended.

(Note: On occasion, a term may be changed w ithoutchanging the function of the term, e.g. a regionaldirector could be called an area director withoutessentially changing the function of that position.Unless there is a material change in the function of aterm, it will not be necessary to amend theseregulations.)

6.03: SCOPE OF COLLEGE TRAINING SERVICES

(1) College training services shall only be provided when:

(a) such services are necessary to enable a consumerto reach a specific vocational outcome which hasbeen determined to be suitable by both theconsumer and the counselor and which have beenidentified in an individualized written rehabilitationplan (IWRP); and

(b) the IWRP specifies the nature, purpose, and durationof the services as well as the terms and conditionsfor the services; and

(c) the IWRP has been approved by the consumer, thecounselor, the counselor's supervisor and the


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Regional Director.

(2) College Training Services leading to a baccalaureatedegree will be limited to four academic years unless oneof the following circumstances applies:

(a) A consumer is pursuing a plan under an approvedIWRP which normally requires five years ofundergraduate training leading to one specializedundergraduate degree. In such cases, the consumermay be provided five years of full-timeundergraduate training.

(b) A consumer is pursuing a plan under an approvedIWRP which involves a cooperative plan ofeducation. In such cases, the consumer may beprovided five years of full -time undergraduatetraining.

(c) A consumer who is unable to undertake the usualfull-time course of study due to the functionallimitations of a disability or due to acute illness, maybe allowed to attend college part -time and may beallowed an extension of time of a specified duratio n. Such an exception must be approved by theRegional Director, and the reasons for the exceptiondocumented in the consumer's file.


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EXAMPLE: A consumer has to have surgery and will beunable to study full-time for six months while she isrecuperating. Acute illnesses are generally of relatively shortduration. Another consumer, who is deaf/blind, is unable tostudy full-time, because the severity of his disabilitiessubstantially slows his ability to process information. Thismay continue for the duration of his studies. In general, part -time study should be the exception, allowed for the shortesttime reasonable and the basis for the exception should bewell documented.

(d) A consumer who is eligible for vocational rehabilitationservices because s/he is seriously underemployed andis unable to undertake the usual full -time course ofstudy because s/he is employed on a full -time basis,may be allowed to attend college part -time and may beallowed an extension of time of a specified duration.Such an exception must be approved by theCommissioner or his/her designee, and the reasons forthe exception must be documented in the consumer'sfile.

(e) A consumer whose potential ability to undertake abaccalaureate degree program is undetermined, may beallowed to take a maximum of two courses per semesteron a part-time trial basis for no more than one academic


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year under an IWRP approved by the counselor, thecounselor's supervisor and the Regional Director. Thereasons for the exception must be docum ented in theconsumer's file.

(3) Full-time graduate training services leading to anadvanced degree may be provided when such a degreeis necessary for the consumer to achieve the goalestablished under the consumer's IWRP. Services willbe provided only as far as needed to achieve theminimum advanced degree needed to enter the field (e.g.JD, MD). Maximum years covered will be the norm forthe program (e.g. three for a JD, four for an MD) up to amaximum of four years. A one year extension may begranted by the Commissioner or his/her designee, underextraordinary circumstances, which must bedocumented in the consumer's file.

(4) A consumer who is eligible for vocational rehabilitationservices because s/he is seriously underemployed andwho is unable to undertake the usual full -time course ofstudy leading to an advanced degree because s/he isemployed on a full-time basis may be allowed to attendpart-time and may be granted an extension of time for aspecified duration. Such an exception mus t byapproved by the Commissioner, or his/her designee, andthe reasons for the exception documented in the


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consumer's file.

(5) The Commission will not provide college trainingservices to any person who has previously beenawarded any advanced degree , unless the advanceddegree was awarded before the onset of a new disablingcondition or a severe exacerbation of the previouslyexisting disability, and the degree is only useful in anoccupation which the person cannot pursue because ofthe functional limitation of her/his new or exacerbateddisability.

(6) The maximum payment the Commission may contributefor a consumer toward college training during anyacademic year may not exceed the total amount chargedto Massachusetts residents for two semest ers of tuitionand mandatory fees at the University of Massachusettsat Amherst, prorated for part -time students.

(7) College training services may be provided at institutionsoutside Massachusetts, if approved in the IWRP.Transportation back to a Massachusetts residence forthe holidays will be limited to two round trip tickets peryear at the lowest reasonable cost.

6.04: CONSUMER RESPONSIBILITY:


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(1) A consumer may be required by the counselor toundergo suitable intelligence scale, aptitud e, or interesttests or other appropriate evaluation prior to theformulation of the IWRP. This may include consultationwith college advisory personnel.

(2) A consumer may be required by the counselor to submita completed Statement of Vocational Obj ective, which isattached and incorporated by reference into theseregulations, prior to the formulation of the IWRP.

(3) A consumer may be required by the counselor to provideother materials necessary for the development of anIWRP for the provision of college training services suchas school transcripts.

(4) Each consumer interested in undergraduate trainingmust apply for a Massachusetts State Scholarship, a PellGrant, and at least one scholarship or grant from each ofthe colleges to which the consumer is makingapplication for admission. A consumer may be requiredto give the counselor a letter from each of the abovesources indicating the results of the grant/scholarshipapplication. A consumer may also be required to applyfor and participate in a work-study program.

(5) Each consumer interested in advanced degree training


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must apply for at least two scholarships and/or grants.A consumer may be required to give the counselor aletter from each source to which the consumer applied,indicating the results of the application. A consumermay also be required to apply for and participate in awork-study and/or teaching assistant program.

(6) Each consumer must file a Free Application for FederalStudent Aid (FAFSA) annually, no later than April 15th,with a request that a copy of the FAFSA and the analysisbe sent to the Commission, the colleges to whichapplications are being made, the Massachusetts StateScholarship Program, and Pell Grant Program. TheRegional Director may grant a waiver for the deadline ofApril 15th if the Regional Director finds thatcircumstances beyond the consumer's controlprevented the consumer from meeting this deadline.Waivers, and the reasons for granting them, must bedocumented in the consumer's file. No such waiver willbe granted if the Commission has not received a copy ofthe FAFSA at least fifteen (15) days before the collegetraining services are to commence. If such a waiver ofthe deadline of April 15 is granted, the Commissioncannot guarantee that the necessary procedures forauthorization will be completed before the consumer isscheduled to begin college training.


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(7) A consumer must notify the counselor in writing ofhis/her wish to develop an approved IWRP towardcollege training services no later than February 1st ofthe calendar year in which the training is to commenceafter that date. This requirement will be waived by theRegional Director if the Regional Director finds thatcircumstances beyond the consumer's controlprevented the consumer from meeting this deadline ofFebruary 1st.

(8) Consumers who are receiving college training serviceswill be required to submit to the counselor copies of allgrade reports issued by the college within two (2) weeksof the consumer's receipt of those grades.

(9) A consumer receiving college training services isresponsible for keeping the counselor advised regardingprogress, problems, or any circumstances which mightinterfere with the completion of the IWRP.

(10) A consumer receiving college training services may notchange the course of study specified in the IWRP unlessthere is an amendment to the IWRP agreed upon withthe counselor and approved by the counselor'ssupervisor and the Regional Director in advance of thechange. Any amendments must be signed by thecounselor, consumer and Regional Director.


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6.05: DETERMINATION OF FINANCIAL NEED

The counselor will determine the consumer's financial need inaccordance with the following standards before authorizingpaid college training services.

The existence and extent of the financial need is determinedby subtracting the following amounts from the projected totalcost for the academic year:

(1) The amount designated as "Parents' Contribution" on theanalysis of the FAFSA; and

(2) The amount designated as "Student's Contribution" onthe analysis of the FAFSA; and

(3) The amount of any Federal government grants awardedto the consumer (If the grant has not yet been awardedat the time financial need is determined, the e stimatedamount of grant eligibility that is reported on the FAFSAwill be subtracted. If the grant, when awarded, is moreor less than the estimated amount, financial need will berecalculated.); and

(4) The amount of any scholarship or grant awarded to theconsumer; and


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(5) The projected work-study and/or teaching assistantearnings. The projected total cost of tuition and fees, forthe academic year will be determined by the FinancialAid Officer of the institution which the consumer will beattending and will be reported to the counselor.

6.06: REIMBURSEMENT FOR NECESSARY BOOKS ANDSUPPLIES

(1) Reimbursement for necessary books and supplies willbe provided to a consumer receiving college trainingservices under an approved IWRP without regard tofinancial need. Necessary books and supplies do notinclude personal items or any material that is not directlyrelated to the consumer's course of study.

(2) The maximum payment which the Commission mayauthorize during any academic year for ne cessary booksand supplies for a consumer receiving college trainingservices will be determined by the Commissioner orhis/her designee on an annual basis, the date to bedetermined by Commonwealth fiscal year budgetrequirements. Rates of reimbursement are applieduniversally and may not be adjusted for individuals. Noconsumer may receive more than the actual cost ofnecessary books and supplies.


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(3) No consumer may receive more than the maximumamount established except under extraordinarycircumstances, such as theft or fire, and then only whatis necessary to replace the items so that the consumermay complete his/her course work. Exceptions may beapproved by the Commissioner or his/her designee uponsufficient showing of proof of the loss, whi ch must bedocumented in the consumer's file.

(4) Equipment, such as tape recorders, CCTVs, etc., is notincluded in the definition of "necessary books andsupplies". Such equipment may be provided whennecessary to consumers receiving college trainin gservices. Provision of such equipment will be madewithin the scope of the Commission's equipmentguidelines.

6.07: REIMBURSEMENT FOR NECESSARY READERSERVICES

(1) Reimbursement for necessary reader services will beprovided to a consumer receiving c ollege trainingservices under an approved IWRP without regard tofinancial need.

(2) The Commission may reimburse a consumer for


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necessary reader services at an hourly rate asestablished by the Commissioner, or his/her designee,on an annual basis the date to be determined byCommonwealth Fiscal Year budget requirements. Ratesof reimbursement are applied universally and may not beadjusted for individuals. A maximum of sixty hours ofservice per calendar month may be reimbursed,provided said services are associated with theconsumer's status as a registered college student, andprovided further that said reader services and studentstatus are incorporated in an individualized writtenrehabilitation plan approved by the Commission.

The sixty hour limitation of this subsection may bewaived by the Commissioner or his/her designee, upon ashowing of extraordinary circumstances. Extraordinarycircumstances do not include situations where thenormal course of study is one that requires a heavyreading schedule.

Examples of extraordinary circumstances:

A consumer, in consultation with his/her counselor,decides to pursue an accelerated program which resultsin an earlier graduation.

A consumer normally depends on a CCTV for reading


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and the equipment becomes unavailable and cannot bepromptly replaced.

(3) When a consumer receiving college training services haspossession of or reasonable access to a CCTV, scanner,or other devise that can facilitate reading, the maximumamount the Commission may aut horize forreimbursement for necessary reader services will be forfifteen hours at the hourly rate established above.

(4) If reader services are authorized, a report in the form ofproperly completed and signed certificates forreimbursement, on a form provided by the Commission,must be submitted in a timely manner. Failure to do socould result in the consumer not receivingreimbursement for that period. Consumers may need toprovide other documents in a timely manner in order toreceive payment.

(Note: Reader fee reimbursement is reimbursement to theconsumer, not the reader. Payment to the reader is theconsumer's responsibility, not the Commission's. Rate ofpayment to the reader, number of hours for which service iscontracted, etc. is not determined by or limited by theCommission. Reimbursement by the Commission to theconsumer may not meet the full need a consumer may havefor reader services.)


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6.08: ADMINISTRATIVE REVIEW

Pursuant to Section 1.00, any consumer who is dissatisfiedwith any decision made under this section, may file a requestfor Administrative Review of such action by writing to theCommission, Hearings Officer. If the consumer is dissatisfiedwith the findings of the Administrative Review, he or she mayrequest a hearing before an impartial hearings officer. TheCommission also operates a Client Assistant Program, theservices of which are available to any consumer who isdissatisfied with services under this chapter. In addition, theMassachusetts Office on Disability operates afederally-mandated Client Assistance Program, the servicesof which are also available to any consumer who isdissatisfied with services under this chapter.

6.09: EFFECTIVE DATE

The effective date of this chapter, as amended, will be thedate of publication in the Massachusetts Register. July 28,1995

REGULATORY AUTHORITY: 111 Code of MassachusettsRegulations 6.00; Chapter 6, section 131J, Massachusetts


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General Laws

6.10: APPENDIX I: FORM

STATEMENT OF VOCATI ONAL OBJECTIVE

This statement must be completed and returned by.

1. What is your vocational objective? Give us acomprehensive job description of your chosen objectiveincluding dates and responsibilities.

2. How did you arrive at this objecti ve? Give details.

3. What training is required to attain this objective? (Givespecific details on content of training program.)

4. Will such a training program equip you for employmentin other occupations? If so, what occupations?


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Chapter 8Reader and Note-Taking Services, Rehabilitation Teaching

Services, and Orientation and Mobility ServicesVocational Rehabilitation

Contents

8A Purpose

8B Reader and Note-Taking Services

8C Rehabilitation Teaching Services

8D Orientation and Mobility Services

8E Comparable Benefits

8A Purpose

The Massachusetts Commission for the B lind providesreader and note-taking services, rehabilitation teachingservices, and orientation and mobility services under anapproved Individual Plan for Employment (IPE) when they arenecessary for the consumer to reach her or her vocationalobjective. The consumer must review the proposed servicesand vendors with the counselor and be afforded an informedchoice of services and vendors.

8B Reader and Note-Taking Services


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Reader and note-taking services are those provided by aliterate person to enable a legally blind consumer necessaryaccess to printed material when the use of special media(braille, large print, etc.) would be impractical. Reader andnote-taking services are supportive rehabilitation servicesand may only be provided when necessary to enable avocational rehabilitation consumer to receive the full benefitof another vocational rehabilitation service. For example,many legally blind consumers who receive college anduniversity training services will need reader and note -takingservices to keep up with the requirements of their courses.The scope and limitations on the provision of reader andnote-taking services to support college training services maybe found at 111 CMR 6.08 in the Commission's regulations.The determination of the extent of reader and note -takingservices needed to support other vocational rehabilitationservices will be based on an assessment of individual needs.When reader and note-taking services are provided, under anapproved IPE, on a monthly basis the consumer must submitto the counselor, on a form provided by the Commission,properly completed requests for reimbursement for paymentof readers and note-takers.

8C Rehabilitation Teaching Services

Rehabilitation teaching services are provided by qualifiedCommission staff to assist consumers to develop or improvepersonal independence by mastering skills of daily livingwithout vision or with impaired visi on. Areas of instructionmay include communication, home management, and generalself-management skills necessary to enable an individual to


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participate in vocational rehabilitation services and to obtaina vocational goal. Referral of a vocational reh abilitationconsumer for evaluation for rehabilitation teaching servicesis made via an Intra-Agency Referral Form (Form 50).However, subsequent to the evaluation by the rehabilitationteacher, there should close collaboration among thevocational rehabilitation counselors, the rehabilitationteacher, and the consumer in developing the sections of theIPE relative to the specifics of the rehabilitation teachingservices and any intermediate objectives relating torehabilitation teaching. During the cou rse of serviceprovision, it is important that the rehabilitation teacher makefrequent reports to the vocational rehabilitation counselorabout the consumer's progress in meeting the intermediateobjectives.

8D Orientation and Mobility Services

Orientation and mobility services are services provided byqualified orientation and mobility specialists intended toteach legally blind consumers to travel on foot asindependently as is possible. "Mobility" i s the act of moving,while "orientation" is awareness of pertinent factors in theenvironment which enable the legally blind person to react,move, and travel in a safe and purposeful manner.Orientation and mobility services are provided by the MobilityUnit at MCB. Instruction is given either by a staff mobilityinstructor or by a mobility instructor who is employed by avendor which has a contract with the Commission. Thechoice of an instructor depends on the location of theconsumer's home and the workload of the instructor. The


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primary consideration is to provide services promptly to theconsumer. Referral of a vocational rehabilitation consumerfor evaluation for orientation and mobility is made via anIntra-Agency Referral Form (Form 50). Current eye andmedical reports must be attached to the Referral Form.Subsequent to the evaluation by the mobility instructor, thereshould close collaboration among the vocationalrehabilitation counselor, the mobility instructor, and theconsumer in developing the sections of the IPE relative to thespecifics of the orientation and mobility services and anyintermediate objectives relating to orientation and mobility.During the course of service provision, it is important that themobility instructor make frequent reports to the vocationalrehabilitation counselor about the consumer's progress inmeeting the intermediate objectives.

8E Comparable Benefits

Comparable benefits must be used to fullest extent possibl ein the provision of the services discussed in this chapter.The most likely source of comparable benefits in theprovision of reader and note -taking services are programsavailable at some colleges and post -secondary schools.


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Chapter 9Maintenance Services


Contents

9A Purpose

9B Examples of Appropriate Use of Maintenance Services

9C Comparable Benefits

9A Purpose

The Massachusetts Commission for the Blind providesmaintenance services when necessary to enable a consumerto participate in other vocational rehabilitation services beingprovided. Maintenance may only be provided in order tosupport other vocational rehabilitation services and to enablethe consumer to receive the full benefit of the other services.Maintenance is a limited service for use when thecircumstances of providing vocational rehabilitation servicesrequire assistance to the consumer in meeting the extracosts of food, shelter, clothing or subsistence. Maintenancepayments may not exceed the amount of increased expensesfor food, shelter, clothing and subsistence which thevocational rehabilitation program causes for the individual.Maintenance is not a service intended to reduce or eliminatepoverty or to improve an individual's living conditions.When used appropriately as a time -limited support to derivethe intended benefit from another vocational rehabilitation


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service, maintenance may be provided at any time from thedate of initiation of such services through the provision ofpost-employment services. The consumer must review theproposed services and vendors with the counselor and beafforded an informed choice of services and ve ndors.

9B Examples of Appropriate Use of Maintenance Services

1) The IPE calls for a consumer to attend a residentialrehabilitation facility. Maintenance will be provided bythe agency to pay the necessary room and board at ornear the facility. In many cases, the maintenancecharge is built into the rate charged to MCB by thefacility.

2) The IPE calls for the consumer to come to Boston fromanother part of the state to be tr ained to become avending facility operator. Maintenance will be providedto enable to the consumer to stay at a hotel and toobtain meals.

9C Comparable Benefits

Comparable benefits, when available, must be used to meetany need for maintenance services. Comparable benefits formaintenance are most often available to consumers intraining programs, particularly college training programs.The financial need determination process used by MCB(based on information and calculations provided by thecollege financial aid officer) when consumers are to receivecollege training services takes into account the consumer's


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maintenance needs and the application of comparablebenefits to meet these needs.


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Chapter 10Telecommunications, Sensory, and Other Technological Aids

and DevicesVocational Rehabilitation

The Massachusetts Commission for the Blind providestelecommunications, sensory, and other technological aidsand devices, under an approved IPE, when necessary toenable legally blind persons to attain suitable vocationalgoals or when necessary to enable an applicant to completean IPE for extended evaluation of rehabilitation potential. A"telecommunication system" is defined in federal regulationsas any transmission, emission, or reception of signs, signals,written images or sounds of intelligence of any nature bywire, radio, visual, or other electromagnetic system includingany intervening processing and storage. "Sensory aids andother technological aids and devices" are defined in federalregulations as electronic or mechanical equipment orhardware intended to improve or substi tute for one or moreof the human senses, for impaired mobility, or for motorcoordination. Telecommunications, sensory, and othertechnological aids and devices may be divided into two broadcategories:

1) Specialized equipment (including telecommunic ationssystems and many sensory aids and devices) whichmeets the needs of a blind person or a deaf -blindperson. Examples of such equipment include closedcircuit television systems, light probes, andcomputerized speech systems. The policies of theMassachusetts Commission for the Blind relating to


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such equipment may be found in Chapter 29.

2) Medically-prescribed sensory aids and devices such ashearing aids or low-vision devices. The policies of theMassachusetts Commission for the Blind relati ng to theprovision of low-vision devices may be found in Chapter27. Agency policies relating to the provision of othermedically prescribed sensory aids and devices may befound in Chapter 7.

3) The consumer must review the proposed services andvendors with the counselor and be afforded an informedchoice of services and vendors.


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Chapter 11Occupational Licenses and Tools


Contents

11A Purpose

11B Occupational Licenses

11C Occupational Tools

11A Purpose

Occupational licenses and tools are provided, under anapproved IPE, when necessary to enable a legally blindconsumer to reach his or her vocational objectiv e. Theintent of these services is that the consumer will have anynecessary occupational licenses and tools at the time he orshe is job-ready and seeking employment or enteringself-employment. The consumer must review the proposedservices and vendors with the counselor and be afforded aninformed choice of services and vendors.Employment-related equipment is discussed in Chapter 29.Initial stocks and supplies for small business enterprises arediscussed in Chapter 18.

11B Occupational Licenses

Occupational licenses are defined in the federal vocational


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rehabilitation regulations as "any license, permit, or otherwritten authority required by a state, city, or othergovernmental unit to be obtained in order to enter anoccupation or to enter a small business. " The Commissionwill pay for the first issuance of an occupational licensenecessary for the consumer to obtain employment or to enterself-employment. Ordinarily, the Commission will not payfor routine renewal of occupational licenses, either as aregular vocational rehabilitation service or as apost-employment service. In rare instances, such as when agovernmental unit increases licensing requirements withoutgiving sufficient notice to enable the consumer or formerconsumer to plan, the agency may, with properdocumentation, provide for renewal of an occupationallicense.

11C Occupational Tools

The provision of tools as a vocational rehabilitation service islimited to those tools needed or required by the consumer toparticipate in a training program or to obtain entry -levelemployment in the occupational area designated on his orher IPE. Tools that are ordinarily provided by the employeror that are seldom used in actual employment situations willnot be provided.


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Chapter 12Transportation ServicesVocational Rehabilitation


12B Scope of Transportation Services

12C Rate of Payment

12D Transportation after Job Placement

12E Use of Comparable Benefits


This chapter establishes standards for provision o ftransportation services which may be necessary at any timeduring the vocational rehabilitation process to enable blindindividuals to appropriately utilize other vocationalrehabilitation services provided by the Commission.

12B Scope of Transportation Services

Transportation services may only be provided when they arenecessary to enable the consumer to benefit from other VRservices and:

The Individual Plan for Employment increases the costof transportation for the consumer; and

The value of rehabilitation services would be


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substantially lost or reduced without the support oftransportation services; and

Diligent efforts have been made to find comparablebenefits and any comparable benefits have been foundto be unavailable or inadequate.

Transportation services will be provided to consumers asneeded, either for evaluation or physical restoration services,or when in a training program.

In extraordinary circumstances and with the written approvalof the Deputy Commissioner for Services, transportation maybe provided to a consumer recently placed into employmentfor a short period of time only—for example, until the secondpaycheck is received, or the first month of employment hasbeen completed.

12C Rate of Payment

1) Transportation services will be provided by the leastexpensive means that is available and usable.

2) The actual, reasonable fare charged for use of publictransportation will be the maximum payment permittedpursuant to this chapter unless in a given situation,public transportation is not available to or usable by theconsumer.

3) Where public transportation is not available to or usableby a consumer, the rate for private transportationestablished by the Massachusetts Rate SettingCommission or, if no such rate has been established,the rate allowed by the Commonwealth of


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Massachusetts, will be the maximum paymentpermitted.

4) Payment will be made only where there is fullcompliance with procedures established by theCommission, including the submission of receipts inparticular circumstances.

12D Transportation after Job Placement

In general, transportation between the consumer’s residenceand place of employment is not provided. In extraordinarycircumstances and with the written approval of the DeputyCommissioner for Services, transportation may be providedto a consumer recently placed into employment for a shortperiod of time only—for example, until the second paycheckis received, or the first month of employment has beencompleted. This transportation is only provided to allow timefor the consumer to develop a reasonable plan to commute towork.

After placement and before case closure, transportationservices may include financial assistance for reasonablerelocation and moving expenses incurred by a consumer dueto new employment when:

The new place of employment is more than 50 milesfrom the consumer's current residence;

The plan for permanent relocation is incorporated intothe Individual Plan for Employment.

At his or her discretion, the Deputy Commissioner for


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Services may waive the 50 mile requirement upon a showingof unforeseen and extraordinary circumstances.Relocation and moving expenses means direct costs such asmovers' fees and non-refundable indirect costs such astelephone or utility installation charges.

12E Use of Comparable Benefits

Comparable benefits must be used to the fullest extentpossible to pay for interpreter services. Comparableservices and benefits means services and benefits that are:

provided or paid for, in whole or in part, by other federal,state, or local public agencies, by health insurance, orby employee benefits;

available to the individual at the time needed to addressthe employment goal in the individual’s Individual Planfor Employment (IPE); and

commensurate to the services that the individual wouldreceive from MCB.


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Chapter 13Services to Family Members


Contents

13A Purpose


13C Examples of Services to Family Members

13D Relationship to Consumer's IPE

13E Terminating Services to Family Members

13F Case Recording

13G Application of Similar Benefits

13A Purpose

Services to family members are provided to assist theconsumer in the successful completion of his vocationalrehabilitation. This objective is carried out by helping thefamily to use its own resources to contribute to therehabilitation of the consumer and by supplementing orsupporting the family's resources or the resources availablein the community. The consumer must review the proposedservices and vendors with the counselor and be afforded aninformed choice of services and vendors.


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Any relatives by blood or marriage are family members. Thedefinition of a family member also includes other peopleliving in the same household with whom the consumer has aclose interpersonal relationship. Thus, a counselor maymake a judgment that an adopted brother or a longtimeroommate meets the definition of a family member when therelationship with the consumer is as close as that of arelative living in the same house. Services to familymembers are provided as part of the consumer's IPE. Theyare designed to enable the consumer to make the greatestpossible use of rehabilitation services. They are reallyintended to benefit the consumer and not the family memberalthough the family member will generally benefit from theservice. When the family member has a disability whichmight make him eligible for vocational rehabilitation services,he should be considered as a possible consumer of this oranother rehabilitation agency rather than as a family memberand should be encouraged to apply for vocationalrehabilitation services. Services to family members mayinclude any of the vocational rehabilitation services that theCommission provides to consumers (subject to anylimitations that apply to consumers) and will be provided ifappropriate without any consideration of the age of the familymember.

13C Examples of Services to Family Members

The following examples illustrate a few of the manysituations which call for the provision of appropriate services


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to family members.

(1) A consumer begins an extensive vocational trainingprogram. Since his wife is very anxious about hisaltered role, a counseling program is undertaken withher to help her understand her feelings and how she cansupport his rehabilitation program.

(2) A consumer is nearing completion of training to becomea piano tuner. The consumer lives in an area which haslittle public transportation. He and his wife havedecided that the best solution to the transportationproblem is for the consumer's wife to act as his driver inthe piano tuning business. However, the consumer'swife has never learned to drive, so the Commissionprovides a driver training course to the wife as anecessary service to a family member.

(3) Several older adolescents are receiving VR services in aregional office. The regional office provides groupcounseling to the parents of these consumers to helpthem to understand and deal with their children'sproblems related to adjustment to blindness andvocational choice.

(4) A consumer is unable to continue her vocational trainingprogram because she has no one to care for her t wosmall children. The counselor has referred her to thedepartment of social services. DSS will provide thenecessary day care service but will charge a weekly feebased on the consumer's income. The Commission


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arranges to pay the fee until the train ing program endsso that the consumer can complete her training.

13D Relationship to the Consumer's IPE

Services to family members can only be provided under theconsumer's IPE, whether the IPE is for an extendedevaluation program or a VR program. Although familymembers are often seen by counselors during theassessment, these interviews and any counseling providedduring such sessions are not considered to be a service to afamily member but rather a part of the assessment processsince services to family members cannot be provided instatus 02 or status 10 under the regulations. In developingthe IPE, it is important that both the consumer and the familymember understand that services to the famil y member areonly being provided to the extent that they are necessary forthe rehabilitation or adjustment of the consumer. Theconsumer and the family member must both be involved indeciding whether a service to a family member can make asubstantial contribution to the consumer's rehabilitation.Case data supporting the decision to provide services tofamily members must be included in the IPE and, whennecessary, elaborated in contact reports.

This data must indicate:

(1) why services are needed;

(2) which family members need the service;


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(3) what services are needed;

(4) how services are expected to contribute to therehabilitation or adjustment of the consumer;

(5) whether any similar benefit resources are available toprovide the services;

(6) how the services will be secured;

(7) how the services to be provided will be evaluated interms of meeting the objective of the consumer's IPE.

Since it is the consumer's IPE, only consumer's signature isrequired and only the consumer need be given a copy of theIPE and any amendments.

13E Terminating Services to Family Members

Services to family members must be terminated when:

(1) it is determined that the services no longer make asubstantial contribution to the consumer's vocationalrehabilitation or extended evaluation program; or

(2) the consumer's case is closed in status 08, 28, or 30; or

(3) the consumer is determined to be rehabili tated and thecase is closed in status 26. (However, services tofamily members may also be provided aspost-employment services. Supportive services such as


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regular day care may not be provided aspost-employment services. See chapter 20. ) When theconsumer has been placed in employment and the caseis ready for closure, but services to family membershave not been completed and are still expected tocontribute substantially to the consumer's rehabilitationprogram, the case cannot be closed until se rvices to thefamily member are completed, or terminated on thebasis that they no longer make a substantialcontribution to the rehabilitation of the consumer.

13F Case Recording

All records and documents pertaining to se rvices to familymembers should be kept in the consumer's folder. Whenservices to family members are provided at cost to theCommission, there should be a notation on the proposal"services to family members. " The proposal should bear theconsumer's name and other identifying information. Theprovision of services to family members, with or withoutagency cost, is to be recorded on the R -911.

13G Application of Similar Benefits

Similar benefits have particular application to the provision ofservices to family members since services needed by familymembers will very often be available through social serviceagencies, etc. VR services which require full considerationof similar benefits when provid ed to an individual consumerrequire the same consideration when provided as services tofamily members.


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Chapter 14Interpreter Services for Deaf -Blind Consumers



14B Scope of Interpreter Services

14C Fees for Interpreter Services

14D Arranging Interpreter Services

14E Use of Similar Benefits

14F Resources for Interpreter Services for Personal Needs


An interpreter for a deaf-blind person may be defined as aperson who is able to recognize the comprehension level ofthe deaf-blind person and is able to communicate effectivelyin a mode used by the deaf -blind person and to translate orinterpret accurately the statements of the deaf -blind personinto spoken English. Generally, a deaf -blind vocationalrehabilitation consumer will be assigned to a specializedworker who is skilled in communicating with deaf -blindpersons. Therefore the need to purchase interpreterservices mainly arises when the consumer needs access toservices other than counseling and guidance. However,there may be occasional situations when an interprete r isneeded to assist the counselor in communicating with the


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consumer to provide counseling and guidance services. Theconsumer must review the proposed services and vendorswith the counselor and be afforded an informed choice ofservices and vendors.

14B Scope of Interpreter Services

Interpreter services may only be provided when they arenecessary to enable the consumer to benefit from other VRservices. Some examples of appropriate use of interpreterservices are:

1) to enable a consumer to be interviewed by a potentialemployer.

2) to enable an applicant to communicate with a physicianduring a specialty, exam

3) to assist a consumer attending a communityrehabilitation program to become acquainted with thestaff and the routine.

4) to enable a consumer to participate in an administrativereview or fair hearing on his or her case.

14C Fees for Interpreter Services

Interpreters cannot be paid more than the maximum fee setby the Massachusetts Rate Setting Commission. Currentlythe maximum fee is $15 per hour. Travel time is not paid for.The Massachusetts Office of Deafness is able to tell the


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worker the fee a particular inter preter should be paid basedon his or her level of skill. If a consumer does not show upwhen an interpreter has been engaged, the interpreter isentitled to payment for two hours' time.

14D Arranging Interpreter Services

The Massachusetts Office Deafness is the best source forreferral of interpreters who are skilled in communicating withdeaf-blind persons, a worker who wishes to contract theservices of an interpreter should call MOD (727 -5106) no lessthan one week in advance of the day when the interpreter isneeded. The worker will tell the office the date, time, place,and the number of hours. MOD will locate a qualifiedinterpreter and call the worker back to confirm theengagement. MOD is not involved in the financial aspect ofthe arrangement. The proposal is written with the interpreterspecified as the vendor.

14E Use of Similar Benefits

Similar benefits must be used to the fullest extent possi ble topay for interpreter services. A number of medical,educational, and rehabilitation facilities provide interpreterservices in order to comply with section 504 of therehabilitation act of 1973, as amended. For example, beforesending a consumer for an exam at a hospital clinic, theworker should check to see whether the clinic is able toprovide interpreter services for the consumer.

14F Resources for Interpreter Services for Personal Needs


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There are limited resources to provide interpreter services todeaf-blind persons when they are needed for purposes thatare not related to vocational rehabilitation. Some of theseare:

1) Courts - if a deaf person goes to court the court mustpay for an interpreter under Massachusetts law(Chapter 221, section 92a).

2) The Massachusetts Office of Deafness will pay forinterpreters for some legal, medical, or employmentsituations. They will not pay for interpreting fo r socialor recreational activities or for services provided by agovernment-funded organization.


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Chapter 15Personal Assistance Services



15B Scope of Personal Assistance Services

15C Payment for Interpreter Services

15D Use of Comparable Benefits


Personal assistance services refers to a range of s ervices,provided by one or more persons, designed to assist anindividual with significant disabilities that include legalblindness to perform daily living activities on or off the jobthat would typically be performed by the individual if they didnot have a disability. The provision of services is intended toincrease the individual’s control in life and ability to performeveryday activities on and off the job.

15B Scope of Personal Assistance Services

Personal assistance services can be provided to individualsto enable participation in trial work experiences or extendedevaluations, or to enable participation in vocationalrehabilitation services identified in the Individual Plan forEmployment.


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The provision of funding for personal assistance services istime limited and cannot extend past the period when anindividual has been determined to have achieved theemployment outcome identified and agreed to in theIndividual Plan for Employment. Since perso nal assistanceservices will not be funded by the Vocational RehabilitationProgram after the achievement of an employment outcome, itis essential that the counselor and consumer explorealternative funding arrangements prior to case inactivation toensure a stable job placement will remain in effect.

15C Payment for Assistance Services

Agency funding will be based upon approved fee schedules.Authorizations for services will be calculated based upon thenumber of hours that are required for the consumer toprepare for and participate in vocational rehabilitationservices. It will be the responsibility of the consumer to hirethe personal care attendant(s), and to provide documentationof hours rendered when submitting invoices to the agencyfor payment.

15D Use of Comparable Benefits

Comparable benefits must be used to the fullest extentpossible to pay for personal assistance services.Comparable services and benefi ts means services andbenefits that are:

provided or paid for, in whole or in part, by other federal,state, or local public agencies, by health insurance, or


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by employee benefits; available to the individual at the time needed to address

the employment goal in the individual’s Individual Planfor Employment (IPE); and



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Chapter 16Homemaker Goals


Contents


16B Eligibility Considerations

16C Considerations When the Vocational Objective Changes

16D Considerations When the Consumer Lives Alone

16E Homemaker Checklist


A homemaker is a person who has the skills and capabilitiesto maintain a home and actively function in that capacity.Homemaking is recognized as a gainful occupation in thevocational rehabilitation program. Homemaking may be againful occupation for any person, man or woman dependingupon individual needs and circumstances. This goal is notrestricted to people who have previously functioned ashomemakers. It may be appropriate for some consumers forwhom a change in vocational objective to homemaking issuitable. It may also be appropriate for some consumerswho live alone. In order for homemaking to be considered tobe a gainful occupation, homemaking activities must beperformed by the consumer himself and the vocational


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rehabilitation services provided must have been necessary toenable the consumer to adequately perform homemakingtasks. As with all decisions about the provision of vocationalrehabilitation services, the decision to pursue a homemakergoal must be made as a result of the informed choice of theconsumer.

16B Eligibility Considerations

In making a determination of whether a person who isexpected to become a homemaker is eligible for vocationalrehabilitation services, a judgment must be made aboutwhether the person meets the second criterion of eligibility, areasonable expectation that provision of vocationalrehabilitation services will benefit the person in terms ofemployability. This judgment will often depend upon:

1) whether the person needs services to stay in his home(not eligible), or

2) whether he needs services to help him maintain or attainemployment as a homemaker (eligible).

People who need services solely for the first reas on above,independent living, are not eligible for vocationalrehabilitation services at this time, although many of themare, of course, eligible for independent living social servicesto meet their needs.

16C Considerations When the Vocational Objective Changes


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It is possible to close a consumer's case as rehabilitatedwhen the job at closure is homemaker even though thevocational objective and rehabilitation services wereoriginally directed toward other employment. The validity ofsuch closures depends, however, on whether the particularcircumstances as documented in the case justify the action.

One example where this situation arises is the person who ispreparing for other employment but who marries and decidesto stay home. Key points to consider in such a case are:

1) were substantial vocational rehabilitation servicesprovided; and

2) did the services contribute significantly to theconsumer's vocational adjustment as a homemaker.

A second example is a consumer who decides to remain athome following services with a different objective in view.Some of these situations pose an additional question: thatis, when there is little or no evidence that the consumer isperforming homemaking activities, is he actually in a gainfuloccupation? To be closed rehabilitated, the person musthimself be performing homemaking activities. It is notnecessary to demonstrate that VR services have freedanother family member to go to work in order to justify ahomemaker rehabilitation but it is necessary to demonstratethat the consumer is performing substantial homemakingactivities. For example a consumer has learned to sew as aresult of rehabilitation teaching services and has madeseveral garments for herself. Her mother performs all other


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homemaker duties in the household, this consumer could notbe considered to be employed as a homemaker because herhomemaking activities are not substantial. However, if shehad also learned to cook and made dinner every night, herhomemaking activities might be judge d to be substantialeven though her mother continued to perform some of thehomemaking activities.

If a consumer who had a vocational objective decides to stayat home but is not in fact carrying out homemaking activities,the case must be closed in statu s 28. a certain proportion ofstatus 28 closures are to be expected, so there should be nohesitation in using this closure status when thecircumstances warrant it.

In any case where the consumer changes his vocationalobjective to homemaker, the consumer record should reflectthat the consumer has made this choice and his reasons.

16D Considerations When the Consumer Lives Alone

People who live alone may be rehabilitated as homemakers.However, there may be greater difficulty in justifying thisobjective than when the consumer is responsible for thehomemaking activities of a family, the major problem is todifferentiate between self -care and homemaking activities.

Self-care activities, even though they may be essential for theconsumer to be able to perform, are not homemakingresponsibilities and do not justify a determination that aconsumer is employed as a homemaker. Some examples of


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self-care activities are:

grooming skills eating skills communication skills such as handwriting, braille,

typing, or using the telephone, or reading with the use oflow-vision aids except to the extent that such skills arenecessary to perform a specific homemaking task

orientation and mobility skills for the purpose of helpingthe person travel outside the home to medicalappointments, social visits, etc.

Successful performance on a regular basis of severalhomemaking activities does justify a determination that aconsumer is employed as a homemaker. Some examples ofhomemaking activities are: Serving Washing dishes Shopping Child care Bed making Laundry Clothing care Cleaning Sewing Communication skills (such as reading with low vision

aids to the extent that such skills are necessary toperform a specific homemaking task)

Orientation and mobility skills (to the extent that suchskills are necessary to perform a specific homemakingtask)


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16E Homemaker Checklist

A copy of the homemaker checklist must be completed priorto case closure in status 26. This form is designed to showthat the consumer has improved in his or her ability toperform the duties of a homemaker. Otherwise, theconsumer cannot be considered to have been rehabilitatedas a result of vocational rehabilitation services. Thecounselor should review the form with the consumer at thetime of plan development or pan amendment to assist inplanning needed services. The checklist form should beupdated and completed in status 22.


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Chapter 17Adaptive Housing ServicesVocational Rehabilitation

Contents

17A Purpose

17B Maximum Payment

17C Limitation

17D Procedures

17E Similar Benefits

17A Purpose

This chapter describes the conditions under which theCommission's Vocational Rehabilitat ion program will provideadaptive housing services to eligible vocational rehabilitationconsumers who, because of multiple disabilities and severefunctional limitations, need the services to reach theirvocational goal. Adaptive housing services are th osearchitectural changes or related equipment installationswhich are necessary to render a consumer's home suitablefor the pursuit or maintenance of a vocational objective underan approved IPE. The consumer must review the proposedservices and vendors with the counselor and be afforded aninformed choice of services and vendors.


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17B Maximum Payment

The maximum payment which the Commission will authorizefor all adaptive housing services under the vocationalrehabilitation program is $4,000. The Deputy Commissionerhas the authority to waive the maximum fee when he or shedetermines that there are exceptional circumstances whichwarrant a waiver. Any such circumstances will bethoroughly documented in the case reco rd by means ofenclosure of the Proposal/rationale for expenditures morethan $4,000.

17C Limitations

1) The Commission will only provide adaptive housingmodifications which are directly related to the functionallimitation imposed by a disability.

2) The Commission will not provide adaptive housingservices for the purpose of adding to the resale value orassessed value of the property. The Commission willnot provide adaptive housing services which increasethe living space in the house.

3) The Commission will not provide adaptive housingservices in a new home under construction. TheCommission will provide architectural consultation onspecific adaptations to a consumer building an adaptedhouse.


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4) The Commission will not provide adaptive housingservices to modify a consumer's home if theCommission has previously provided adaptive housingservices to modify that same home under any of itsprograms unless the Deputy Commissioner determinesthat changed conditions related to the functionallimitations of a disability make additional modificationsnecessary. Any such circumstances will be thoroughlydocumented in the case record for the DeputyCommissioner's review.

17D Procedures

Adaptive housing services may only be funded under thevocational rehabilitation program when the following stepshave been completed before the adaptive housing work hasbegun:

1) The consumer has been certified as eligible forvocational rehabilitation services; and

2) An Individual Plan for Employment has been approvedwhich includes adaptive housing as a needed service;and

3) An adaptive housing evaluation has been performed byan architect and plans have been drawn for the specificadaptations needed; and

4) The Commission has contracted with the vendor whowill perform the work and has sent authorization for the


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work to begin. In cases where the job must be sent outfor bid, the Commission will send the authorization oncethe bidding process is completed.

17E Similar Benefits

Comparable benefits must be used to the fullest extentpossible to pay for personal assistance services.Comparable services and benefits means services an dbenefits that are:

provided or paid for, in whole or in part, by other federal,state, or local public agencies, by health insurance, orby employee benefits;

available to the individual at the time needed to addressthe employment goal in the individu al’s Individual Planfor Employment (IPE); and



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Chapter 18Services to Establish Small Business Enterprises

Vocational Rehabilitation Contents

Contents


18B Scope of Services to Establish Small BusinessEnterprises

18C Limitations on Provision of Services to Establish SmallBusiness Enterprises

18D Consumer Evaluation

18E Business Evaluation

18F Bid Process


This chapter defines the scope of services the Commissionmay provide to enable a vocational rehabilitation consumerto establish a small business enterprise under an approvedIPE. Since the Commission does not provide managementservices for small business enterprises, the small businessservices provided by the Commission will be solely toestablish businesses that are managed by the consumer andwhich provide the consumer with full-time, gainful


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employment. Self-employment in a profession is a kind ofsmall business enterprise. In many cases the consumer willneed other sources of capital (his own funds, Small BusinessAdministration loans, etc. ) to make up the total required toestablish the business. The consumer must review theproposed services and vendors with the counselor and beafforded an informed choice of services and vendors. Thischapter will not address the establishment of vendingfacilities under the Randolph-Sheppard Act; services relatedto the establishment of vending facilities are provided inaccordance with Commission regulations on vendingfacilities (111 CMR 3. 00).

18B Scope of Services to Establish Small BusinessEnterprises

The scope of services provided by the Commission for theestablishment of small business enterprises will be limited tothe following services:

1) Provision of business equipment such as machinery andappliances normally found and needed at the site of aparticular kind of business. Example: a cash register ina store.

2) Provision of initial stocks which are defined as the initialinventory of merchandise or goods necessary for directresale to consumers or for further preparation for resaleto consumers. The consumer is expected to replenishthe initial stock when it is depleted.


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3) Provision of initial supplies which are defined as theexpendable items necessary to enable the consumer tocarry out the normal operation of business. Examples:paper, stamps, twine. The consumer is expected toreplace these supplies as necessary.

4) Advertising which includes media advertisements,telephone directory listings , signs, and mailings.

5) Lease or rental fees for no more than one year for thespace necessary to operate a business, trade, orprofession. Ordinarily, rental fees will only be providedfor one month.

6) Insurance fees for no more than one year to coverpersonal liability of the consumer, equipment, stocksand supplies, tools, or premises.

18C Limitations on Provision of Services to Establish SmallBusiness Enterprises

1) Provision of initial stocks and supplies is limited to theamount of such items that will be needed during the firstsix months the business will be in operation.

2) The Commission will not provide , purchase, or lease anymotor vehicles to enable a person to establish a smallbusiness.

3) The Commission will not provide funds for theconstruction of a building or the purchase of any land or


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building.

4) The Commission will not become a party to any contractbetween the consumer and any other individual ororganization in relation to the establishment of a smallbusiness enterprise.

18D Consumer Evaluation

The evaluation of the consumer's suitability to operate asmall business will ordinarily take place in status 10 as partof the assessment. Factors that must be evaluated by thecounselor include:

1) The consumer's skills - specific occupational skills areneeded in many businesses; the consumer will have tobe as well trained as he would be to become employedby someone else. The consumer will also needfinancial and management skills to operate any smallbusiness.

2) The consumer's temperament - has he or shedemonstrated the ability and preference to beself-directed and to take initiative? A consumer who hasthe temperament necessary to be successful inself-employment will be able to research and formulate asound business plan with minimal direction from thecounselor.

3) The consumer's disability in relation to the demands ofthe proposed business.


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4) The consumer's previous work history and anyexperience in business.

18E Business Evaluation

The evaluation of the feasibility of the proposed business willalso ordinarily take place in Status 10. The most importantfactor in this evaluation is the written business plan whichthe consumer must submit to the counselor. A writtenbusiness plan must be submitted because vague andimprecise planning is a major cause of small businessfailure. A detailed and realistic business plan will alsodemonstrate the consumer's commitment to the kind ofserious effort required to operate one's own business.SCORE (The Senior Corps of Retired Executives) which islocated in Boston is a resource available to provide freeconsultation to persons who wish to formulate plans forsmall businesses. The consumer is required to consult withSCORE before submitting the business plan and to alsosubmit a letter from the consultant used which states his orher opinion about the feasibility of the business plan. Thebusiness plan must include:

1) A description of the business which discusses location,market, competition, management, and personnelrequirements; and

2) a description of the finances of the business whichdiscusses sources and application of funding andincludes a capital equipment list, a list of initial capital


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requirements, and a personal financial statement.

18F Bid Process

Goods and services with a total cast of less than $500 may bepurchased under the normal proposal procedures. Itemspurchased from the same vendor that have a total cost of$500 or more must be purchased through the State bidprocedures. The Purchasing, Contracting PropertySupervisor coordinates this process. Because the bidprocess usually takes at least five weeks, it is important tostart the process well ahead of the time the consumer willneed the services. The final purchase may only be madewhen the consumer is actually ready to beginself-employment.


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Chapter 19Placement Services


Contents


19B Responsibilities of the Regional Director

19C Responsibilities of the Vocational RehabilitationSupervisor

19D Responsibilities of the Vocational RehabilitationCounselor


The ultimate goal of the Commission for the Blind’sVocational Rehabilitation Program is the placement of eachconsumer in employment consistent with his or hercapacities and abilities. It is unders tood that the consumermust play as active a role as possible for job placement to besuccessful. It is the consumer's responsibility to use all theresources at his or her disposal, in addition to the assistanceavailable from the Commission, to find an appropriate job.Employment is defined as a job in the competitive labormarket, the practice of a profession, self -employment, farmor family work, home-based employment, supported


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employment, or independent homemaking. All servicesmust, via the IPE, be geared toward the achievement of anoccupational goal. The development and provision of theplacement services are the responsibility of all staff (directservice, supervisory, and managerial), who work in thevocational rehabilitation program .

19B Responsibilities of the Regional Director

The Regional Director is responsible for organizing theoverall job placement effort within the region with theassistance of the Vocational Rehabilitation S upervisor.Specific responsibilities are to:

1) Specify objectives and action steps, as part of his or herannual plan, designed to maximize job placement withinthe region.

2) Develop and coordinate, on a regional basis, contactswith appropriate collateral agencies and employergroups.

19C Responsibilities of the Vocational RehabilitationSupervisor

The Vocational Rehabilitation Supervisor is responsible forassisting the Regional Director in all aspects of theorganization of the regional job placement effort. Specificresponsibilities are to:

1) Determine, with the assistance of the counselors, whichindustries and organizations to target for placement


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development.

2) Conduct site visits to new potential employers and shareany information and job leads obtained with thecounselors in the region.

3) Report information gathered from counselors' site visitsto employers to the Office of the Deputy Commissionerfor Services for inclusion in a centralized electronicdatabase.

19D Responsibilities of the Vocational RehabilitationCounselor

The Vocational Rehabilitation Counselor is responsible forfacilitating the consumer's ultimate job placement and,broadly, for all phases of the placement process. While anumber of persons and organizations may be involved, thecounselor is the primary planner and coordinator of theplacement effort for each consumer. Specificresponsibilities are to:

1) Assist the consumer in developing a strategy to obtain asuitable job.

2) Counseling the consumer about job-seeking skills andassisting the consumer in preparation for job interviewsthrough provision of information about the employer ,practice interviews, in preparation of resumes, etc.

3) Arrange for job interviews for the consumer, when


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appropriate.

4) Contact the prospective employer following a jobinterview to find out the employer's impression tocommunicate to the consumer.

5) Provide follow-up services to the consumer for aminimum of ninety days after employment begins.Follow-up services are intended to resolve any problemsthat may arise and to provide support to the consumer.The frequency of calls to or meetings with the consumerduring the follow-up depends on the needs of theindividual consumer and on the situation.

6) Contact prospective employers with the general goal ofpromoting the capabilities of blind workers and thespecific goal of surveying work facilities in order toidentify particular jobs that may be available to bli ndconsumers. The counselor will also seek to identifypossible adaptations that might be made to particularjobs to facilitate the employment of blind consumers.

7) Report information obtained from site visits toemployers to the Vocational Rehabilita tion Supervisor.


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Chapter 20Post-Employment ServicesVocational Rehabilitation

Contents

20A Purpose


20C Examples of Post-Employment Services

20D Criteria for Provision

20E Post-Employment Services to Achieve More SuitableEmployment

20F Acute Medical Conditions

20G Supportive Vocational Rehabilitation Services

20H Duration of Post-Employment Services

20I Documentation Requirements

20K Termination of Post-Employment Services

20L Comparable Benefits

20A Purpose


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The purpose of post-employment services is to provideappropriate vocational rehabilitation services after aconsumer has been successfully rehabilitated in order tomaintain the consumer is employment, generally,post-employment services may include any servicesnecessary to maintain employment if the services do notinvolve a complex or comprehensive effort which is unrelatedto the original IPE, for example, if a consumer develops anew, secondary disability, or if his disability becomessubstantially worse with new functional limitations, or if hehas lost his job, a complex or comprehensive effort would be needed to rehabilitate him once again. If complex orcomprehensive services are indicated, an entirely new caseshould be opened.


Post-employment services are intended to respond topreviously identified, or unexpected or persistent problemsand to supplement the services provided prior torehabilitation. However, the vocational rehabilitationprogram is not intended to provide all services a blind personmay need throughout his or her working life. Therefore, aplanned course of activities and services should bedeveloped between counselor and consumer, directedtoward the goal of self-sufficiency and job stability. Theconsumer must review the proposed services and vendorswith the counselor and be afforded an informed choice ofservices and vendors.

20C Examples of Post-Employment Services


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The following examples illustrate a few of the manysituations that can arise which call for the provision ofappropriate post-employment services:

A rehabilitated consumer who has been workingsuccessfully calls her counselor and says she is havingproblems getting along with her co -workers and is afraidshe may have to quit her job. After discussing thesituation, the counselor and consumer agree thatcounseling about the job situation would be helpful.The counselor provides the counseling over a period ofseveral months and the consumer learns how to bettercope with her job situation.

A consumer who has been rehabilitated as a homemakerhas moved and needs instruction in the use of anelectric stove since she previously used a gas stove.Rehabilitation teaching services are provided as apost-employment service and the consumer is able tocontinue to function as a homemaker.

A rehabilitated consumer has been working for fivemonths as a dispatcher. The employer is pleased withthe reliability and good judgment of the consumer butnow reports that the consumer's typing has notimproved as quickly as had been expected and thatthere will have to be considerable improvement soon ifthey are to keep him on. The counselor and consumeragree that a part-time typing course is an appropriatepost-employment service. The consumer's typing


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becomes adequate and his job is no longer in jeopardy.

20D Criteria for Provision

The following criteria must be met before providingpost-employment services:

The consumer has been previously determined to berehabilitated (closed status 26).

Post-employment services are necessary to assist theconsumer to maintain employment or to obtain moresuitable employment if there is no expected substantialchange in the type of employment.

The solution of the problem does not involve a complexor comprehensive rehabilitat ion effort and no extensivenew problems exist.

The problem that has arisen is directly related to theconsumer's original handicapping condition (forexample, a blind consumer who develops employmentproblems due to a recent hearing loss is not approp riatefor post-employment services since the new hearingproblem and any needed services to overcome it areunrelated to the consumer's original disability).

The previous data in the case is currently valid and thecase record is still available .

If any of these criteria are not met, an entirely new VR


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case should be opened to meet the consumer's needsince post-employment services are not appropriate.

20E Post-Employment Services to Achieve More SuitableEmployment

Post-employment services may not be provided simplyto upgrade a consumer's financial status. However,post-employment services may be provided to assist aconsumer to achieve more suitable employment ,especially where a determination as rehabilitated wasbased on employment which was appropriate at the timebut was below the consumer's potential. Newemployment may be considered to be more suitablewhen it is more likely to maintain the consumer inemployment, when it is closely related to the consumer'spresent job and does not require extensive training, andwhen it will significantly improve the consumer's level ofindependence.

20F Acute Medical Condition

Since medical care for acute conditions unrelated to theconsumer's disability is a service restricted to the period ofactive service before rehabilitation, such care cannot beprovided as a post-employment service. Physicalrestoration services may be provided, ho wever, forpost-employment treatment of exacerbations, recurrencesand complications of the original disability when theyjeopardize the consumer's employment. For example, aconsumer who was originally diagnosed as having a


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secondary psychiatric disabil ity and whose IPE took thisdisability into account, could be provided psychotherapy as apost-employment service if the psychiatric problem began toaffect his work performance. However, a consumer who didnot have a previously diagnosed psychiatric dis ability couldnot be provided psychotherapy as a post -employment serviceif a psychiatric disability emerged after closure in status 26.An entirely new case would have to be opened. Thereasoning behind this rule is that where extensive newvocational problems arise, a new case will assure adequateassessment and planning to overcome them.

20G Supportive Vocational Rehabilitation Services

Supportive vocational rehabilitation services such astransportation and maintenance (money for extra costs offood, shelter, etc.) may be provided as post -employmentservices only if the purpose is to enable the consumer toparticipate in other post-employment services. They cannotbe provided simply to support the consumer in employmentafter closure because employment is not a service, but,rather, a goal. So, for example, transportation to and fromwork can never be provided as a post -employment service.

20H Duration of Post-Employment Services

The period of time after closure during whichpost-employment services may be provided cannot bearbitrarily limited but must be determined on an individualbasis. (At one time there was a 24 -month limit, but nolonger.) For example, a consumer who comes back for a


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post-employment service five years after closure should begiven the service if the case record is available and all theother criteria are met.

20I Documentation Requirements

To document the provision of post -employmentservices, a written revision to the IPE is required. Therevision should specify the type of service, the provider, theanticipated amount and duration of services, anticipatedcosts and any financial participation of the consumer andalso should justify the need for the service. The consumer isplaced in status 32. Closure of post-employment servicestakes place in status 34 and the consumer's movement tostatus 34 should be noted on a contact report with thereasons for the decision to terminate the services.

20K Termination of Post-Employment Services

Successful closure of post -employment services is a mutualdecision of the counselor and consumer based upon afinding that the consumer's employment is now secure. Theconsumer should be advised that if he or she needspost-employment services again in the future, he mayreapply. Unsuccessful closure of post -employment servicesmay occur when the consumer's situation is such that he orshe cannot be expected to maintain employment.Sometimes, it will become apparent during the course ofpost-employment services that the consumer needs a newcomprehensive rehabilitation effort and then a new caseshould be opened and a new IPE developed.


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20L Comparable Benefits

Appropriate and available resources should be fully used inthe provision of post-employment services. Post -employmentservices are exempt from the requirement that VR fullyconsider comparable services and benefits available underother programs before providing the post -employmentservice. Such services as counseling, evaluation, andplacement (which normally would not be subject to thecomparable benefits requirement) should not be subject to atest when provided as post -employment services. However,when other services which normally require consideration ofcomparable benefits such as physical or mental restorationor interpreter services are provided as post -employmentservices, these services should be provided taking intoaccount any comparable benefits to the extent that they areboth appropriate and available.


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Chapter 21Comparable Benefits


Contents


21B Services Requiring Consideration of ComparableBenefits

21C Services Not Subject to Consideration of ComparableBenefits

21D Criteria for the Use of Comparable Benefits

21E Extreme Medical Risk

21F Use of Comparable Benefits for Extended EvaluationServices, Post-Employment Services, and Services toFamily Members

21G Case Documentation


This chapter outlines the Commission policy on the use ofcomparable benefits in the vocational rehabilitation program."Comparable benefits" are services or financial assistanceavailable through other agencies and programs such as the


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department of public welfare, the department o fmental health, private health insurance, title XX, ormedical assistance which is similar to or like anotherservice in supporting the goals and objectives of theconsumer's IPE. The consumer's own funds are not acomparable benefit.

The federal rehabilitation act requires that comparablebenefits must be considered and used to the extent possiblebefore spending VR funds for certain services. Comparablebenefits must be considered even though this may result indelay of services to a consumer, except that comparablebenefits do not need to be considered if the result would bedelay in provision of VR services to a consumer who is atextreme medical risk or would delay progress towardachieving the employment outcome identified in theIndividual plan for employment or an immediate jobplacement. There are factors to be considered indetermining whether a benefit or service is truly comparable.The service must:

1) be available to the individual at the time needed toensure the progress of the indiv idual toward achievingthe employment outcome in the individual's Individualplan for employment; and

2) be commensurate to the services that the individualwould otherwise receive from the vocationalrehabilitation agency.

Early in the rehabilitation proces s, when gatheringpreliminary information for case planning, the counselor


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should refer the consumer to appropriate agencies andservices for a determination of eligibility for comparablebenefits. It is important that this be done early so that theavailability and adequacy of the comparable benefit can beassessed. Comparable services will be determined to beavailable unless their use would interrupt or delay:

1) The progress of the individual toward achieving theemployment outcome identified in the Individual plan foremployment;2) An immediate job placement; or3) The provision of vocational rehabilitation services to aconsumer who is determined to be at extreme medical risk,based on medical evidence provided by an appropriatequalified medical professional.

21B Services Requiring Consideration of ComparableBenefits

The VR counselor and consumer must fully investigate thefeasibility of using available comparable benefits befo reusing MCB funds to purchase the following services whetherthey are to be provided as regular VR services or aspost-employment services:

1) physical and mental restoration;

2) maintenance;

3) interpreter services for the deaf;


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4) recruitment and training services for individuals withhandicaps in new fields of employment;

5) Occupational licenses, tools, equipment, initial stocksand supplies;

6) transportation;

7) training (personal adjustment, vocational, college etc. )services including books, tools, and other trainingmaterials. See 111 CMR 6. 00 for description of theapplication of comparable benefits to college trainingservices. NOTE: Comparable benefits do not include awardsand scholarships based on merit.

21C Services Not Subject to Consideration of ComparableBenefits

Referral, counseling and guidance, rehabilitation engineeringand placement services may be provided withoutconsideration of comparable benefits; however, with theexception of rehabilitation engineering services, theseservices are almost always provided by the agency staffwithout cost. Paid evaluation services may be providedwithout consideration of comparable benefi ts. Rehabilitationtechnology, including telecommunications, sensory, andother technological aids and devices may also be providedwithout consideration of comparable benefits. In addition,any of the services are exempt from the requirement to usecomparable benefits when they are provided as post -employment services. Counselors are encouraged to use


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appropriate comparable benefits to provide any of theseservices but they may choose to purchase the service if theybelieve that a paid service will be superior or timelier thanone available through comparable benefits.

21D Criteria for the Use of Comparable Benefits

Consumers must apply for and accept those comparablebenefit services to which they are entitled from anotheragency or program as long as the services meet the c riteriaset forth in section 21A and discussed more fully below.

The comparable benefit service need not be used if thecounselor and the consumer jointly determine and documentthat it would be inappropriate because:

1) the services provided by the comparable benefitresource are inaccessible to the consumer; for example, the training facility is 100 miles away from a commutingconsumer's or the service provider states in writingthat it cannot accommodate blind consumers; or

2) use of the comparable benefit would interfere in somedemonstrable way with the achievement of therehabilitation objective and therefore would not satisfythe requirements of the IPE; for example, the trainingprovided by the comparable benefit resource is notlikely to lead to competitive employment in the chosenfield because the training program is unaccredited; or

3) use of the comparable benefit would aggravate the


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consumer's disability; for example, the schedulemaintained by the comparable benefit facility is soirregular that a diabetic consumer's need for regularmeals and exercise would be compromised resulting inproblems controlling blood sugar. This e xampledescribes a situation which would be extremely unusual.It is not expected that there would be many instanceswhen use of a comparable benefit would aggravate theconsumer's disability.

The comparable benefit service does not have to be the bestof its kind or the most convenient to the consumer to meetthe criteria which mandate its use in place of paid vocationalrehabilitation services. Refusal or failure to apply forcomparable benefits may result in the denia l of paid services.When a consumer fails to apply for a comparable benefit, thecounselor should document the reasons in the case record.

21E Extreme Medical Risk

In addition to the criteria mentioned above (section 21D) thecircumstance of extreme medical risk to the consumer allowsprovision of services needed to lessen the extreme medicalrisk without consideration of comparable benefits. In mostcases, services that would meet this condition would bephysical and mental restoration services. Counselors mayonly make a determination that there is extreme medical riskif medical evidence indicates that the consumer is at risk ofsubstantially increased functional impairments or at risk ofdeath if services are not provided expeditiously. Thisevidence must be provided by an appropriate licensed


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medical professional and be fully documented in the caserecord.

21F Use of Comparable Benefits for Extended EvaluationServices, Post-Employment Services, and Services toFamily Members

When a particular service which normally requiresconsideration of comparable benefits is provided in extendedevaluation (status 06), in post-employment (status 32), or asservices to family members, the counselor must give fullconsideration to the use of comparable benefits.

21G Case Documentation

Completion of the comparable benefits checklist on th e IPE(form VR-4) will in most cases provide adequate casedocumentation of the consideration and use of comparablebenefits. In those instances when it may be debatablewhether the comparable benefit service is appropriate, thecounselor should provide a full explanation of the reasonsfor his or her decision on a contact report.

More documentation is required when college training isbeing provided. The requirements relative to college trainingare contained in the regulations on college training se rvices(111 CMR 6. 00, see policy memo #55).


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Chapter 22Supported Employment Services


Contents


22B Eligibility for Supported Employment

22C Criteria for Supported Employment Services

22D Placement into Supported Employment

22E Extended Support Services

22F Rehabilitation into Supported Employment


Supported employment means:Supported Employment means employment in an integrated,work setting typically found within a community, withongoing support services for individuals with the mostsignificant disabilities, where the opportunity is present to beearning, or working toward earning the commensuratecompetitive wage for the position . Some VR consumers maymake an informed choice to pursue a vocational goal ofsupported employment. Supported employment is mostappropriate:


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1) for individuals whom competitive employment has nottraditionally occurred, or for whom competitiveemployment has been interrupted, or intermittent as aresult of a significant disability; and

2) who, because of the nature and significance of theirdisabilities, need intensive supported employmentservices from the Massachusetts Commission for theBlind and extended services after transition in order toperform this work; or

3) As transitional employment for individuals with the mostsignificant disabilities due to mental illness.

A consumer should be counseled to consider supportedemployment only after all alternative vocational goals havebeen explored and it has been determined that , withoutsupports, the consumer is unemployable in the competitivelabor market at this time and can benefit from supportedemployment . A thorough assessment must be done in allcases. In the Commission's experience, a number ofconsumers whose cases were closed in supportedemployment have, after receiving supported employmentservices, become able to pursue competitive employmentgoals. However, no consumer for whom a plan leading tocompetitive employment can realistically be developedshould be provided supported employment services .

22B Eligibility for Supported Employment

A person is eligible for supported employment services if heor she is:


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1) Is eligible for VR services.2) Has not worked in competitive employment or has only

worked intermittently in competitive employment due toa severe disability. The nature of the consumer'sproblems in working competitively must be explained inthe case record so that it is clear that a competitiveemployment goal would not be realistic for theconsumer even with the provision of traditional V Rservices.

3) Has a need for on-going support services in order to beable to perform competitive work. The case recordshould explain what kinds of supports are needed andmake it clear that the consumer needs more thantransitional support services (except in the case ofmental illness as stated above) , that is, that his or herneed for support services is expected to be on -going inorder to continue to perform the job after case closure.

22C Criteria for Supported Employment Services

Supported employment services :

May be provided under regular VR funds when necessary.A consumer may need supported employment services orservices similar to supported employment services and,yet, not meet all the criteria for supported em ploymentservices provided out of Title VI (Supported Employment)funds. For example, the consumer may be expected toneed transitional support services for six months to adjustto a job; such a consumer would not meet the criterion ofneeding on-going support and could not be served under


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Title VI. However, the consumer could be provided theneeded services under the regular VR program, since thegoal would be closure into competitive employment afterthe transitional support services are completed.Supported employment services may also be providedunder regular VR funds when Title VI funds have beenexhausted.

Include evaluation of rehabilitation potential when asupplementary evaluation is necessary after the regularevaluation provided under regula r VR funds and afterdetermination of eligibility for VR. Reasons why asupplementary evaluation may be necessary include: areassessment of the suitability of the placement iswarranted; there is a change in the consumer's medicalcondition; additional information is needed in order todetermine the most suitable supported employmentplacement or what on-going support services will beneeded to support the consumer on the job.

Provision of time-limited supported employment servicessuch as: intensive on-the-job skills training such as thatprovided by job coaches in order to achieve and maintainjob stability; follow-up services including contact withemployers, consumers, and parents, when appropriate, inorder to stabilize the job placement; post -employmentservices after closure that are unavailable for the extendedservices provider and that are necessary to maintain thejob placement. Examples of appropriate post -employmentservices are: job station redesign, repair of assistivetechnology, replacement of prosthetic devices. Post -employment services cannot be provided to provide job


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coaches on an on-going basis or to provide transportationto work or to provide personal care assistance, etc.

Time-limited supported employment services providedbefore closure are not to exceed 18 months unless underspecial circumstances the eligible individual and therehabilitation counselor or coordinator jointly agree toextend the time to achieve the employment outcomeidentified in the Individual plan for employment and thespecial circumstances have been documented in the caserecord. Thus, ordinarily the supported employmentservices may not last longer than 18 months. When alonger period is planned for in the IPE, the documentationin the case record must make it clear that unusual orunexpected circumstances make the longer periodnecessary. In addition, the length of the planned servicesmust be definitely stated in the IPE or amendment.

22D Placement into Supported Employment

Must be competitive employment for which the consumeris paid in accordance with the Fair Labor Standards Act.

May be full-time or part-time, but the employment must beregular and the number of hours per week that theconsumer will work must be established in the IPE. If theemployment is part-time, the reasons must be fullyexplained.

The employment must be in an 'integrated work setting'which means a job site of either of the following types: 1)Most of the other employees are not handicapped and theconsumer interacts with them on a regular basis in theperformance of his duties. (Interaction with job coaches


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and service providers does not fulfill this requirement.) Aconsumer in this kind of work setting may be part of awork group of other handicapped employees, b ut if so, thework group may not consist of more than eighthandicapped employees and the requirements that most ofthe employees not be handicapped and that there beregular interaction still apply; or 2) There are no otheremployees or the only other employees are part of workgroup of no more than eight handicapped employees. Insuch a work site, the consumer must interact on a regularbasis in the performance of his duties with persons whoare not handicapped, including members of the generalpublic. Again, interaction with job coaches and serviceproviders does not fulfill this requirement.

22E Extended Support Services

Extended support services are:

1) On-going support services that are provided afterclosure and are necessary for the consumer to maintainhis employment. VR funds may not be used to providethese services. Another appropriate resource must beidentified before the IPE is developed and the IPEjustification must state that the other resource (forexample, a private non-profit organization or anotherstate agency) has agreed to provide and coordinate theon-going support services needed in the particular case.The case record should also contain writtendocumentation of this agreement such as a letter fromthe resource or, in the case of deaf-blind consumers


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whose on-going services will be provided by Title XXfunds, a memo from the Director of the MCB Multi -handicapped Unit.

2) Must include, at a minimum, twice -monthly monitoring atthe work site to assess employment stability. Th e IPEmay alternatively call for off -site monitoring andcoordination of support services. If off -site monitoringis determined to be appropriate, it must at a minimumconsist of at least two meetings with the consumer andone contact with the employer ea ch month. “Naturalsupports” such as a co-worker or supervisor or a non-VR case manager may provide the twice -monthlymonitoring.

3) If the consumer does not need or will not need extendedsupported employment services as described above onan on-going basis, supported employment is not theappropriate goal and the consumer should be servedunder the regular VR program.

22F Rehabilitation into Supported Employment

The criteria for successful rehabilitation into a s upportedemployment goal are that the consumer has made thetransition to extended services, that the placement is stableand the extended services will be provided by anotherresource indefinitely, and that there has been at least aninety-day follow-up period after the extended services havebegun.

The case closure documentation must include (in addition tothe usual requirements):


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The dates during which Title VI funds were used and theservices provided with them, and also any servicesprovided under regular VR funds.

A statement that the consumer is working competitivelyand the number of hours the consumer works eachweek, and that the consumer is being compensatedunder the Fair Labor Standards Act.

A description of the 'integrated work site'. A description of the extended services being provided to

the consumer and of the source of the funding for theextended services.


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Chapter 23Case Recording


23A Purpose of Case Recording

23B Principles of Case Recording

23C What to Include

23D What Not to Include

23E Breakdowns in Case Recording

23F Styles of Case Recording

23A Purpose of Case Recording

The primary purpose of case recording is to give a clearpicture of the consumer and the vocational rehabilitationprocess. Case recording should be comprehensive enough,and current enough, so that another staff member or asupervisor can pick up the threads of th e case and, if there isa change of a counselor, case progress can be carried onintelligently.

Case recording serves several other important purposes:


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It encourages good counseling relationships bringinginto focus pertinent data about the consumer.

It contributes to sound thinking on the part of thecounselor because he or she must be selective in therecording of information and must make the datameaningful.

It substantiates a particular course of action andexpenditure of public funds.

It gives information that is essential for supervision.

It reflects the effectiveness of the services provided.

Many professionals find case recording to be a tedious task.However, it must be stressed that it is a most importantresponsibility of every staff member.

23B Principles of Case Recording

1) All significant material should be recorded.

2) All forms should be filled out completely and accurately.

3) Forms or sections of forms which ca ll for an evaluationof data rather than mere facts should reflect thecounselor's thinking and interpretation and be clearlyidentified as such.

4) In addition to reflecting the counselor's thinking and


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action, the record should reflect the consumer'sthinking, perceptions, actions, and feelings as theconsumer states them and should be clearly identifiedas such.

5) Case recording should reflect the dynamics of thecounseling process. Achievement toward goals shouldbe depicted.

6) The consumer's actions and statements should bedescribed in concrete behavioral terms. Don't say "Mrs.A. is a chronic complainer"; a concrete, behavioraldescription would be “Mrs. A. says that the ABCassociation has neglected her case and that MCB hasnever helped either.”

7) Every contact report should show clearly what the nextstep in the processes will be, who is to take it, and whenit will be taken.

8) Hearsay information should not be recorded andopinions about the consumer should be identified assuch and not stated facts. The sources of allinformation about the consumer should be identified inthe case record.

23C What to Include

Generally, any significant information, events ordevelopments in the case should be recorded. Theseinclude:


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The consumer's perception of his or her vocationalproblem, including changes in the consumer'sperception of his vocational problem throughout the VRprocess.

Any new medical, vocational, personal or financialinformation that becomes available at any time duringthe VR process. Evaluation is important at all stages ofa case.

Discussion of the pros and cons of the variousvocational goals that have been explored.

Rationale for providing services in special or exceptionalsituations.

Explanation of a case being in a particular status for anunusual length of time.

Loss of contact with the consumer and attempts tocontact the consumer.

Significant changes in the consumer's situation whichmight affect the program.

Explanation of the reasons for any service interruptionsand the next steps the counselor intends to take.

The counselor’s evaluation of the consumer's jobreadiness. This evaluation need not be more than a fewparagraphs but it should state the reason s why thecounselor believes the consumer is now ready foremployment, why the consumer believes he is readyemployment, and an outline what the placement plan is.

Placement efforts such as employer contacts made onbehalf of the consumer.

The results of follow-up contacts made after jobplacement.


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23D What Not to Include

1) It is not necessary to repeat information which isrecorded on other forms or reports which are alreadypart of the case record. For example, if the counselorreceives a letter, the contents of the letter do not need tobe recorded on a contact report because the letter itselfwill be in the case.

2) It is not necessary to record status changes on contactreports when the status change can be noted on anotherform which the supervisor will see. For example, it iseasier to write: "change to status 12" across the top ofthe IPE than to write a separate contact report to makethe change.

3) It is not absolutely necessary to write a contact reporton every counseling session, phone call , etc.Counselors are expected to use judgment and commonsense in deciding what contacts or events aresignificant enough to be recorded in detail. At aminimum, there should be a summary contact reportevery three months which gives a brief picture of whathas happened since the last contact report, what willhappen now, and what is expected to happen in thefuture.

4) Psychological labels should not be used to describe aconsumer unless the case contains documentation thata psychiatric condition exists. A statement such as "Mr.


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Y. is schizophrenic" is inappropriate; it would beperhaps accurate instead to state, "Dr. P. has evaluatedMr. Y. and made a diagnosis of simple schizophrenia,"refer to Dr. P's letter of January 12.”

23E Breakdowns in Case Recording

Case recording seems to break down most often just after anIPE is written. The reason for this could be that thecounselor believes that the major p art of his job is completedand so he can turn his attention to other consumers.Another obvious point of breakdown occurs after "theconsumer completes his vocational training or other servicesand is ostensibly ready for employment. When thecounselor fails to develop and record a specific organizedplan for job placement the consumer is sometimes left on hisown to find a job when he may need the placement help ofMCB.

23F Styles of Case Recording

The style of case recording used is a matter of personalpreference as long as the necessary information recorded. Itdoesn't matter whether the counselor refers to the consumeras the consumer" or as "Mr. Jones" or whether he refers tohimself as "I" or as “the counselor.” Some counselorsnaturally write succinctly, others prefer to make detailednotes to help them think things through. The content isimportant; the style is not.

Below are descriptions of some styles of case recording


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often used by VR counselors.

1) Some counselors find it useful to record every contactwith the consumer immediately afterwards describingthe conversation and anything else of significance. Agood outline for this kind of contact report is: 1) whathappened since the last contact, 2) the goal of thiscontact, 3) the topics discussed, and 4) the next stepsagreed upon for both the counselor and the consumer.(A counseling session should not end until the nextsteps are agreed upon).

2) Some counselors prefer to write a summary contactreport every month or two to describe the progress theconsumer has made since the last report.

3) Some counselors find it helpful to organize their writingof contact reports around a mental checklist of thequestions: who? what? why? how? where? when?

4) Some counselors like to use caption headings in contactreports to save time such as "job leads to be explored"or "options for training" or "next step.”

5) Some counselors write acceptable contact reportswithout always using complete sentences. A shorthandnotation such as “Says fed up with red tape at school" issufficiently clear.


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Chapter 24Other Goods and ServicesVocational Rehabilitation

Contents


24B Other Goods and Services That Are Not Provided

24C Documentation and Approval Required


The Massachusetts Commission for the Blind provides othergoods and services under an approved Individual Plan forEmployment (IPE) when they are necessary for the consumerto reach her or her vocational objective. "Other goods andservices" are vocational rehabilitation services which are notspecified elsewhere in the Client Services Manual or in thefederal vocational rehabilitation regulations. An example of"other goods and services" would be a suit for a consumerwho is in placement status seeking a professional positionwho has no appropriate clothing for job interviews. As maybe seen from this example , “other goods and services" aremeant to meet unusual needs arising from the consumer'sindividual circumstances. It must be emphasized thatprovision of other goods and services is only allowable whenthe service is necessary to meet the vocational goal.Services that are desirable or would merely enhance theconsumer's functioning are not permitted. When "other


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goods and services" are to be provided, the case record mustspecifically document the need for the service and the factthat the vocational objective is unlikely to be attained withoutprovision of the service.

24B Other Goods and Services That Will Generally Not BeProvided

The Commission does not generally provide the followingtypes of goods and services to vocational rehabilitationconsumers unless there are exceptional circumstances andthe service has been approved by the Deputy Commissionerfor Services:

Automobiles, trucks, or vans

Adaptations to motor vehicles

air conditioners

tandem bicycles or other recreational equipment

land, buildings, or other real estate

furniture

washers, dryers, stoves, or refrigerators

experimental surgery

24C Approval Required for Provision of Other Goods and


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Services

Because "other goods and services" are by their nature,unusual services, extensive documentation of the need forthe service is required. An exact description of the servicemust be recorded on the IPE or IPE amendment andapproved by the supervisor.


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Chapter 25Case Closure


CONTENTS


25B Reasons for Case Closure

25C Ineligibility

25D Case Closure from Referral and Applicant Status

25E Case Closure from Extended Evaluation Status

25F Case Closure from Active Status When Not Rehabilitated

25G Referral to Another VR Agency

25H Case Closure from Active Status When Rehabilitated

25I Substantial Rehabilitation Services

25J Suitable Employment

25K Case Closure from Post-Employment Status


Case closure is the action taken when the counselor determines


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that the consumer has completed VR services or is unable orunwilling to complete them. Closure may occur at any timeduring the VR process.

It is very important to either close a case or place it in status 24when active rehabilitation services are no longer beingprovided. Since it is always possible to open a new case,counselors should not keep inactive cases open unless there isa definite plan to resume active services within a specified timeframe.

25B Reasons for Case Closure

There are three principal reasons for case closure: theconsumer is ineligible; the consumer is rehabilitated; or theconsumer is expected to be unavailable for an extended periodof time. The counselor will make an individual judgment aboutwhen an “extended period of time" of unavailability makes itimpractical to plan for services. Generally, an "extended periodof time" will be three or more months. Consumer ineligibilityand consumer rehabilitation are discussed elsewhere in thischapter. The consumer's case should be closed because ofunavailability in the following situations.

1) The person has died. Note in the case record how thecounselor learned that the person has died. (Notify thecentral register of the death.)

2) The person has moved out of state or been transferred toMassachusetts Rehabilitation Commission. See section25G.


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3) It has proved impossible to contact the person afterreasonable efforts have been made to do so.

4) The person has declined to accept or use vocationalrehabilitation services after reasonable efforts have beenmade to encourage his or her participation. When theperson declines to use VR services, or fails to cooperate,the counselor must make a judgment, backed bydocumentation in the case record, ab out when reasonableefforts have failed to enlist the consumer's participation.For example, a consumer who repeatedly cancelsappointments (three or more, depending on thecircumstances) without good reason is probably decliningto use VR services.

5) The person has been institutionalized under circumstancesmaking him or her unavailable to participate in services foran indefinite or considerable period of time. This, again,will be a judgment made by the counselor based on thefacts of the case. For example, a person might be a patientat a state hospital and still be available to participate in VRservices on a day basis. Another person might beimprisoned for a year with no provision for work release,and, therefore, unavailable.

25C Ineligibility

A case may be closed because the consumer has been found tobe ineligible at any time during the VR process.

There are a number of legally required actions that must betaken when a consumer is found ineligible. These steps are


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discussed in detail in chapter 3.

It should be noted that when a case is closed from status 12 orabove because of ineligibility (status 28 or 30), an IPE programattachment (form VR-6) must be completed as well as acertificate of ineligibility (form VR-3). The counselor can merelywrite on the program attachment a reference to the certificate ofineligibility which will contain the details.

25D Case Closure from Referral and Applicant Status

Status 01 is used when a person is closed from referral (00);status 08 is used for closure from applicant (02) status. Thecounselor may make a judgment to close the case because theperson is ineligible for VR services or because the person isunavailable for one of the reasons listed in section 25B. Whenthe person is ineligible, the closure action is recorded on thecertificate of ineligibility. When the person is unavailable, theclosure action and the reasons for it are recorded on a contactreport. The person must be notified in writing of the closurefrom these statuses only in cases of ineligibility.

25E Case Closure from Extended Evaluation Status

Cases in status 06 are closed in status 07. Criteria for closingcases from extended evaluation are:

1) Ineligibility The counselor will find the person ineligible forany additional VR services when it has been determinedbeyond any reasonable doubt that the person cann ot beexpected to benefit in terms of employability from VRservices.


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2) Unavailability - The person may be unavailable toparticipate in the extended evaluation for one of thereasons listed in section 25B. The case must be closed asineligible and a certificate of ineligibility completed whichexplains the reasons for the person's unavailability forevaluation.

25F Case Closure from Active Status When Not Rehabilitated

Status 28 is used for closures from statuses 1 8-24. Status 30 isused for closure from statuses 10 and status 31 for closuresfrom status 12. Status 28, status 30, and status 31 closures arerecorded on IPE program attachment (form VR-6). Thecounselor may make a judgment to close the case because theperson is ineligible for VR services or because the person isunavailable for one of the reasons listed in section 30B. Whenthe person is ineligible, the closure action is recorded on boththe certificate of ineligibility and the IPE program attachment(form VR-6). (The IPE program attachment can merely refer tothe certificate of ineligibility.) When the person is unavailable,the closure action is recorded only on the IPE programattachment. The consumer must be notified in writing of theclosure action. There is an optional form letter (VRL -2) whichmay be used for this purpose.

25G Transfer to Another VR Agency

When it is necessary to 'transfer' a consumer to another VRagency (either an agency in another state or the MassachusettsRehabilitation Commission), MCB's case must be closed instatus 08, 28, or 30, or 31. In such cases, the counselor should


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contact the other VR agency and discuss the consumer's plans. The consumer should be given the name and address of theperson to contact at the other agency and be told to contact theperson as soon as possible. A duplicate case record or asummary of case data should be sent to the consumer's newcounselor once one is assigned. MCB's case should be closedas soon as it is known that the new agency and the consumerhave made contact.

25H Closure from Active Status When Rehabilitated

In order for a case to be closed as "rehabilitated" in status 26,the following criteria must be met.

1) The consumer must have received an evaluation andcounseling and guidance.

2) The consumer must have received substantial vocationalrehabilitation services in accordance with the IPE.

3) It must be determined through follow -up that the consumerhas maintained suitable employment for at least sixty days.

The case record must show that these requirements have beenmet.

The consumer must be notified in writing of the closure action.There is an optional form letter (VRL -1) which may be used forthis purpose.

25I Substantial Rehabilitation Services


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Substantial rehabilitation services are defined as any VRservices provided within a counseling and guidancerelationship that contributes in an identifiable way to therehabilitation of the consumer. The substantiality of the servicecan best be determined by its contribution, or effect on, theconsumer's ability to reach the vocational goal, rather than onfactors such as the number of services or expendituresalthough such factors may be good indicators. In essence, theservices provided must have had a discernible impact on theperson's employability. When the facts of a given case do notsupport the substantial effect of the services on the ultimateemployment of the consumer, the case should be closed notrehabilitated (status 28).

25J Suitable Employment

An occupation may be considered suitable when; after areasonable period of adjustment (no less than 60 days), thecounselor believes that the following conditions are met:

1) The consumer and the employer are reasonably satisfied.2) The occupation is consistent with the consumer's

capacities and abilities, taking into consideration theconsumer's choice.

3) The consumer has the skills necessary to perform thework.

4) The employment and working conditions will not aggravatethe consumer’s disability. It is understood, however, thatthe consumer may choose to accept a job which, in thecounselor's opinion, does not meet this criterion. In such acase the case record should show that the counselor hasexplained to the consumer why he thinks the job may not


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be suitable and that the consumer has made the job choicein light of all the facts.

25K Case Closure from Post-Employment Status

Successful closure of post -employment services is a mutualdecision of the counselor and consumer based on a finding thatthe employment is now secure. The consumer should beadvised that if he needs post -employment services again in thefuture, he may reapply.

Unsuccessful closure of post -employment services may occurwhen the consumer's situation is such that he cannot beexpected to maintain employment. Sometimes it will becomeapparent during the course of post -employment services thatthe consumer needs a new comprehensive rehabilitation effortand, then, a new case should be opened and a new IPEdeveloped. See chapter 25 for more information aboutpost-employment services.

All closures from post-employment status are made on an IPEprogram attachment (form VR-6).


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Chapter 26Recruitment and Training Services to Provide New Employment

Opportunities in the Fields of Rehabilitation, Health,Welfare, Public Safety, Law Enforcement and Other

Appropriate Public Service EmploymentVocational Rehabilitation

The Massachusetts Commission for the Blind will, whenappropriate and available, provides recruitment and trainingservices to provide new employment opportunities in the fieldsof rehabilitation, health, welfare, public safety, law enforcement,and other appropriate public service employment.


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Chapter 27Low-Vision Services

Contents


27B Consumer Understanding of Low-Vision Services

27C Fees

27D Limitations

27E Consumer's Ophthalmologist's or Optometrist's Opinion

27F Procedure for Approval of Devices to be Provided UnderVR, IL, or SR When the Acquisition Cost Is Less Than $100

27G Procedure for Approval of Devices to be Provided Under MaWhen the Acquisition Cost Is Less Than $100

27H Procedure for Approval of Devices When the AcquisitionCost Is More Than $100

271 Follow-up After Provision of Low -Vision Aids

27J Use of the Low-Vision Consultant

27K Sample Letters and Forms


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The Commission's policies and fees for low -vision services areuniform for the social rehabilitation, vocational rehabilitation,independent living, and medical assistance programs. While theprocedures to be followed in authorizing the services are thesame for the VR, IL, and SR programs, slightly differe ntprocedures are necessary when the service is to be providedunder-toe medical assistance program. These guidelinescontain the Commission's policies and fees and the proceduresto be followed in various circumstances.

27B Consumer Understanding of Low-Vision Services

When a worker is considering referring a consumer for alow-vision evaluation, a necessary first -step is to fully explainboth the advantages and disadvantages of low -vision devices tothe consumer. The consumer should understand that low -visiondevices can help compensate for visual loss but do not restorevision or completely correct it.

The worker should explain that an aid may be useful for onlyone particular task. The effort i nvolved in learning a new visualtechnique and the necessity for extensive practice beforesubstantial usefulness can be expected should also bediscussed.

Since consumers understandably sometimes get confusedabout the relationship between low -vision providers and theCommission, it is necessary to make every effort to assure thatthe consumer understands the limits of the Commission'sauthorization of services. Some low -vision providers may ask


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the consumer to return for follow-up visits that have not beenauthorized by the worker or for visits that cannot be authorizedunder the policies outlined in this chapter. Sometimes aconsumer will get a letter from a clinic to come in for an annualcheckup. To prevent misunderstanding, the worker shouldexplain to the consumer that all visits beyond the first two mustbe approved by the worker before the Commission can acceptfinancial responsibility. Since this is a very problematic issue,the worker must supplement his verbal explanation by havingthe consumer read and sign the low-vision services informationform (see section 27K) and by giving the consumer a copy of theform to keep for his reference.

27C Fees

1. Initial low-vision evaluation visit - $35.00 maximum.

2. Second visit $20.00 maximum.

3. Third visit $20.00 maximum; (prior approval required by MAif the consumer is MA eligible, by counselor or socialworker if services are to be provided under VR or SR).

4. Total cost of the initial evaluation and subsequent visits forthe first six months period may not exceed $75.

5. After six months has passed since the initial visit, priorapproval will become necessary to schedule subsequentfollow-up visits, not to exceed a maximum of two visits at acost of $20 per visit.

6. Included in the initial evaluation fee will be the loan ofan aid or device to the patient for at least a four -week


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period.

7. Low-vision aids and devices ranging in acquisition costfrom $1.00 to $200.00 - the acquisition cost, plus amaximum markup not to exceed 40% of the acquisition costwill be allowed.

8. Low-vision aids and devices whose acquisition costexceeds $200.00 - the acquisition cost, plus a flat fee not toexceed a maximum amount of $100.00, will be allowed.

27D Limitations

1) The Commission will not provide goose neck lamps underany of its programs, unless the approval of theophthalmological consultant is obtained. Theophthalmological consultant will not approve provision of agoose neck lamp unless:

the prescribed low-vision aid cannot be used without suchlighting, and

The consumer does not have proper lighting available inhis home. When a worker believes that a goose neck lampmay be indicated, the worker will visit the consumer'shome in order to make a recommendat ion to theophthalmological consultant.

2) 2) The Commission will not provide prescription sunglassesunless the approval of the ophthalmological consultant isobtained. The ophthalmological consultant will not approveprescriptions for sunglasses unless the quantification of


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the glare factor demonstrates the need for sunglasses.

27E Consumer's Ophthalmologist's or Optometrist's Opinion

The worker must first send the attached form letter (see section27K) to notify the consumer's ophthalmologist or optometristthat the consumer is interested in a low-vision evaluation and torequest his opinion about the possible value of the evaluation.The doctor's opinion should be recorded in the case and s haredwith the consumer to help the consumer to decide whether togo for the evaluation. In cases where MA will pay for theevaluation but the consumer is an active VR, IL, or SRconsumer, the worker must send a copy of the proposal for theevaluation to the medical social worker in MS.

27F Procedure for Approval of Devices to be Provided UnderVR, IL, or SR When the Acquisition Cost Is Less Than $3 00

The purchase of a low-vision device under the VR, IL, or SRprograms may be approved by the regional director or programdirector when the acquisition co st of the device is less than$300. When three or more devices are prescribed for oneperson, the procedure below for devices more than $3 00 is to befollowed, even though the acquisition cost of each device maybe less than $300.

27G Procedure for Approval of Devices to be Provided Under MaWhen the Acquisition Cost Is Less Than $3 00

When a VR, IL, or SR consumer is eligible for medicalassistance and the acquisition co st of the device is less than$300, the worker will give the eye report specialist a packet


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containing the following:

a handwritten proposal for the prescribed device

MCB form 400b (see section 27K) completed by theprovider or prescribing professional stating the need forand potential use of the aid reco mmended and theacquisition cost.

These requests will be reviewed for approval by the low -visionconsultant. The eye report specialist will coordinate the review.

27H Procedure for Approval of Devices When the AcquisitionCost Is More Than $300

When the acquisition cost of a device is more than $3 00 or whenthree or more less expensive devices are prescribed for oneconsumer, this procedure is to be followed no ma tter whichfunding source will pay for the services. By the Tuesday beforethe ophthalmological consultant's visit (the consultant visitsevery other Thursday), the regional worker will give to the eyereport specialist a packet containing the following:

a handwritten proposal

a copy of the most recent eye report

MCB form 400a completed by the provider or prescribingprofessional stating the need for and potential use of thedevice recommended and the acquisition cost.


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These requests will be reviewed b y the ophthalmologicalconsultant and the low-vision consultant. The eye reportspecialist will coordinate the review.

27I Follow-up after Provision of Low-Vision Aids

A significant number of consumers who have been providedlow-vision aids find that they have great difficulty using them.Some consumers have aids that are not useful for the tasks theywish to perform. Some consumers' vision has changed sincethe aids were prescribed. Some consumers just need brieftraining to use the aids. The majority of consumers who havedifficulty have not practiced enough to become proficient orhave been led to expect too much improvement from the aids.Because there are a number of different problems that can makethe device useless to the consumer, follow-up is necessary inevery case.

The worker should see the consumer about two weeks after thelast scheduled visit to the low -vision clinic or provider to findout whether the consumer is regularly using the aid for thepurpose or task for which it was prescribed. If the consumer isnot using the aid regularly at that point, the worker shouldexplain to the consumer the importance of daily practice andask if the consumer is willing to try to see whether a few weeksof regular practice will help. The worker should plan to see theconsumer in another two weeks to find out whether to theconsumer now feels more comfortable using the aid.

If the worker concludes on the first or a later follow -up meetingwith the consumer that the consumer's practicing on his ownfor a time will probably not be enough to make the aid useful to


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the consumer, the worker should refer the consumer to an RTfor more extensive follow -up. There are one or morerehabilitation teachers in each region who will accept suchreferrals. If the consumer would like to use the aid at his job,referral should be made to the low -vision consultant. It isimportant to recognize and accept that some consumers,because of the difficulty of learning to use low-vision aidsefficiently, will make a decision that the potential benefit is notworth the effort. The worker might, in certain situations, ask aconsumer if he has decided that the effort is not worthwhile.Sometimes it will be a relief for the consumer to admit that hehas decided that low-vision aids are not for him. Someconsumers may wish to return the aid to the Commission. Anyaids that are returned should be sent to the low -visionconsultant.

27J Use of the Low-Vision Consultant

The low-vision consultant ordinarily becomes involved inservices to an individual consumer in one of the followingsituations:

When the worker is uncertain whether there would be anyvalue to having a low-vision evaluation. The low-visionconsultant will visit the consumer and perform a functionalvision assessment to determine whether the consumer hasenough residual vision to warrant a low -vision evaluation.

When a worker or low-vision evaluator has a questionabout whether low-vision devices could help the consumerto perform a specific task such as operating a sewingmachine, the worker may request that the low -vision


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consultant visit the consumer at home or on the job toassess the task and the environment. The consult ant'srecommendations will be useful to the worker, thelow-vision evaluator, and the ophthalmological consultantin deciding whether low -vision devices can enable theconsumer to do the task.

When a consumer is having difficulty in using an aid on thejob, the worker should refer the consumer to the low-visionconsultant for an assessment of the problem.

When a rehabilitation teacher who is providing low -visionfollow-up is unsure of the cause of the problem or the besttraining approach, referral will be made to the low-visionconsultant who may, if appropriate, design a trainingprogram for the consumer which the rehabilitation teacherwill monitor and carry out.

27K Sample Letters and Forms

The letter below must be sent to the consumer'sophthalmologist or optometrist before any low -vision evaluationis scheduled. Since ophthalmologists are one of our principalsources of referrals, it is very important to extend them thiscourtesy. A dated copy of the letter sen t is to be kept in the caserecord to be available should there be any inquiry.

Name of Patient:Address

Dear


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The above-mentioned patient is interested in having anevaluation for low-vision aids to be provided by a clinic orprofessional specializ ing in this type of service. I wouldappreciate an expression of your opinion about the possiblevalue of this kind of an evaluation for this patient. I will shareyour thoughts with the patient to aid him or her in reaching adecision about whether to have the evaluation. If the patientdecides to request the evaluation after receiving your opinion,we, as a public agency, will be required to provide theevaluation.

Also, please let me know if you recommend a particular clinic orprofessional specializing in this type of evaluation as bestsuited to evaluate this patient. If I do not hear from you withintwo weeks, I will assume you have no comments about thisevaluation.

Thank you for your assistance.

Very truly yours,

MASSACHUSETTS COMMISSION FOR TH E BLINDLOW-VISION SERVICES INFORMATION

Your worker is referring you for a low -vision evaluation to findout whether low-vision devices could help you to use yourvision better. The Commission plans to pay for up to two visitsto the doctor or clinic to make this evaluation. If a third visit is


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required, your worker must approve the visit. Otherwise, theCommission will not be responsible for the cost of a third visit.

If the clinic or doctor prescribes any low -vision devices, yourworker must approve the purchase of these devices. TheCommission will only pay for devices which it has approved inadvance.

If you are contacted at any time after the first two visits by alow-vision clinic or doctor to come in for a checkup, you mustcall your worker to find out whether any additional visits can beapproved or whether you will have to pay yourself if you wish togo. Sometimes, a doctor or clinic will contact a patient for acheckup once a year but, even so, the Commission cannot beresponsible for any visits that are not approved by its workers.

I have read and understand the above information and havebeen given a copy of it for my reference.

Consumer's Signature Date


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Chapter 28Transition Services to Adolescents

Contents


28B Preparation for Transfer from Children's Worker at Age 14

28C Team Review

28D Evaluation

28E Case Manager Responsibilities

28F Administrative List


In this chapter, the term adolescent is used to refer to ablind person between the ages of 14 and 22 (or the age ofhigh school graduation). Adolescents may be eligible forany of the services offered by the Commission dependingon the individual's needs and circumstances. However,adolescence is usually the time when a legally blind personbecomes ready to become involved in vocationalrehabilitation services. The procedures discussed in thischapter have been developed to facilitate appropriate casemanager assignment and service pla nning for theadolescent who has reached age 14 and, thus, will nolonger be served by the children's worker.


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28B Preparation for Transfer from Children’s Worker at Age 14

The children's worker will make plans to transfer eachactive case on his or her caseload when the adolescentturns 14 or, with the Regional Director's approval, by theend of the school year in which the adolescent becomes 14years of age. The children's worker will update the caserecord. This update must include discussion of:

recent contact with the adolescent

recent contact with the parents

the adolescent's progress in school

the adolescent social progress

the adolescent's activities of daily living skills

When an adolescent who is known to the Commission does nothave an active children's services case, the children's workerwill refer the adolescent to the VR counselor within 30 days ofthe adolescent's 4th birthday. The VR counselor will arrange t omeet with the adolescent and parents and prepare a reportcovering the five items listed above in preparation for a teamreview of the adolescent situation. The VR counselor will notopen a VR case unless the adolescent is referred to VR as aresult of the team review or the consumer requests VR services.

28C Team Review


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Within a month after the end of the school year in which theadolescent becomes 14, a team meeting will be initiated by theworker who has had the most recent contact with theadolescent (children’s worker or VR counselor). The purpose ofthe team meeting will be to review the adolescent needs and toassign a case manager for the immediate future. The team willbe composed of the children's worker, the VR counselor, arehabilitation teacher, and a social worker. Other professionalssuch as a multi handicapped worker or an independent livingcoordinator, who are or may be involved in the case will beinvited to participate. As a result of the team review, the teamwill decide to assign the most appropriate case manager toopen the case and make a further evaluation. The case managerassigned may be a VR counselor, a social worker, arehabilitation teacher, a multi handicapped worker, or anindependent living coordinator. At this time any active children'sservices case will be closed in the appropriate status by thechildren's worker.

28D Evaluation

1) If the case is referred to an RT by the team, the RT willconduct an evaluation of the consumer RT needs and, ifany RT services are needed, will continue as the casemanager and provide the services.

2) If the case is referred to a VR counselor, the counselor willconduct an evaluation in status 02 or 06 and, if theconsumer is determined eligible for VR services, willcontinue as the case manager and provide VR services.

3) If the case is referred to a social worker, Multi -handicappedworker, or independent living coordinator, the worker will


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conduct an evaluation of the consumer needs and will, ifappropriate, continue as the case manager.

This in-depth evaluation by the case manager may lead the casemanager to close the case as ineligible or not in need ofservices or to refer the adolescent to a worker in anotherdiscipline as a more appropriate case manager.

28E Case Manager Responsibilities

In addition to providing needed services to the consumer, thecase manager will be responsible to:

1) participate with the school in development of the educationplan for each active consumer. These plans are generallydeveloped during the months of April, may, and June; thecase manager should be sure to contact the school in timeto be involved in the process; and

2) to obtain a copy of the educational plan for each activeconsumer after it has been developed each year, all of theeducational plans should be included in the case record.

28F Administrative List

At any time that the assigned case manager finds that theadolescent does not want or need or is ineligible for activeservices, whether during the evaluation or after services havebegun, the Adolescent name will be placed on an administrativelist and any open case will be closed. The administrative list willbe the mechanism used to track those adolescents for whomactive services are not currently indicated. The regional director


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will be responsible for the maintenance of the administrative listalthough he or she may delegate this responsibility to a VRsupervisor. The person responsible for the administrative listwill ensure that each adolescent on the list is contacted by aworker by phone, letter, or visit, once a year to determine thecurrent status and possible service needs of the adolescent.These yearly contacts will be recorded in writing on contactreports and the reports will be sent to the central register forinclusion in the adolescent case record. The date of the contactwill be recorded on the administrative lists.


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Chapter 29Employment and Vocational Rehabilitation

Related EquipmentVocational Rehabilitation

Contents

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29B Role of the Technology for the Blind Prog ram

29C Vocational Rehabilitation Equipment

29D Procedures for Authorization of VocationalRehabilitation Equipment

29E Placement of Vocational Rehabilitation Equipment

29F Role of the Rehabilitation Engineer(s)

29G Vocational Rehabilitation Equ ipment Provided Directlyby Regional Staff

29H Eligibility for the Technology for the Blind Program

29I Referral to the Technology for the Blind Program

29J Repair and Maintenance of Equipment

29K Equipment Not Provided


The Commission provides four categories of equipment.

1) Vocational rehabilitation equipment. This chapter containsthe policy of the agency for provision of employment-related equipment provided under the vocationalrehabilitation program.

2) Equipment supplied under the Independent Living Social

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Services Program (ILSS). The policies of the ILSS Programin provision of equipment are not covered in this chapter.However, the ILSS Program may make use of the expertiseof the Technology for the Bl ind Program in decision-making relative to purchases of technology equipment andsoftware. The policies of the Independent Living SocialServices Program are described in the ComprehensiveAnnual Plan for Independent Living Social Services.

3) Medical equipment, which is provided either underMassHealth, or as a physical restoration service, under theVocational Rehabilitation Program. Medical equipment willnot be discussed in this chapter. Medical equipment isprovided as described in the MassHealth M edical CarePlan.

The word "equipment" will be used in this chapter only to referto the kinds of equipment included in subsection #1 above --those that are employment-related.

29B Role of the Technology for the Blind Program

The Technology for the Bl ind Program is responsible forresearching, selecting, ordering, and installing adaptiveequipment and providing consultation on the use of thatequipment by consumers involved in employment or trainingservices under an approved Individual Plan For Employment(IPE). The researching and selecting of equipment shall be donewith the consultation of an advisory board of users. Theprogram maintains an electronic inventory of all equipment andsoftware and its status. Adaptive equipment and devicesprovided by the Technology Program include but are not belimited to: computerized speech, large print and Braille output

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devices, adaptive software, Closed Circuit Televisions, talkingcalculators, Braille Writers, tactile communicators, cassettefour-track tape recorders, light probes and other optical aids,and other computer-based or non-computer-based adaptiveequipment. The Technology for the Blind Program is alsoresponsible for providing adaptive engineering services in thefield. These typical engineering services include analysis andadaptation of jobsites. The Technology for the Blind Programprovides technical support and initial training on the use ofadaptive equipment and, under appropriate circumstances,specific applications software, within agency facilities or onsite.

29C Vocational Rehabilitation Equipment

Vocational rehabilitation equipment is defined in this chapter asequipment that is necessary to enable a rehabilitation consumerto reach a vocational goal, to complete an extended evaluati on,or to complete college or other type of approved training,leading to the realization of the vocational goal under anapproved Individual plan for employment (IPE).

29D Procedures for Authorization of Vocational RehabilitationEquipment

1) The vocational rehabilitation counselor determineseligibility and places the consumer in the appropriatestatus.

2) The vocational rehabilitation counselor requests servicesor equipment from the Technology for the Blind Programusing the appropriate electronic re ferral system.

3) The Technology for the Blind staff evaluates consumer

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equipment needs and makes a recommendation forappropriate equipment.

4) The counselor develops an Individual plan for employment(IPE) or Individual plan for employment (IPE) amendm entwith the consumer, which includes provision of therecommended equipment.

5) The vocational rehabilitation supervisor approves ordisapproves the Individual Plan for Employment (IPE).

6) Upon notification of the development of an Individual Planfor Employment (IPE) or changes to an Individual Plan forEmployment by the VR Supervisor or Counselor, the staffof the Technology for the Blind Program will:

a) order the equipment or provide it from available stock,and enter the information in an ongo ing equipmenttracking database;

b) insure that the proper loan agreement is signed by theconsumer, and is on file at the Technology for theBlind Program;

c) provide or certify the provision of necessary initialtechnical training in the use of the equipment; and

e) provide appropriate follow -up assessments.

29E Placement of Vocational Rehabilitation Equipment

All equipment provided by the Massachusetts Commission forthe Blind is provided on loan and does not become the property

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of the consumer or employer. However, in general equipmentthat is required by the consumer to perform the job is placed onpermanent loan. If, at any time the consumer no longer has aneed for the equipment, the equipment will be recalled.Equipment will also be removed if the counselor or theSupervisor of the Technology for the Blind Program determinesthat the equipment is being utilized for purposes other than itsoriginal purpose of assisting the consumer in employment oremployment-related training or is being abused. The Supervisorof the Technology for the Blind Program, or the counselor, willevaluate the consumer's use of equipment one month afterplacement, and six months after placement.

The Commission for the Blind Technology for the Blind Programas a general rule does not provide personal computers (PC's).Personal computers may, however, be provided under thefollowing conditions:

1) to assist in the establishment of a small business by a blindconsumer under an approved Individual plan foremployment (IPE),

2) to high school and middle school students for use in thehome when necessary for study and homework under anapproved Individual Plan for Employment. These PCs willbe placed in the home only, and are not in lieu ofadaptations to be provided by the school district asrequired by statute.

3) as recommended by the Regional Director, to collegestudents enrolled in an approved course of studyconsisting of a minimum of three three -credit courses.This PC, plus additional necessary adapt ations will be

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placed in lieu of reader fees as specified in 107 CMR 6 (theagency's college regulations).

29F Role of the Rehabilitation Engineer(s)

The rehabilitation engineers provide technical consultation tothe Commission for the Blind under the d irection of theSupervisor of the Technology for the Blind Program. Therehabilitation engineer's role is central to the operation of theprogram. Responsibilities of the Technology for the Blind'srehabilitation engineers include:

1) to analyze, through site surveys and other contacts, jobs ortasks with a goal of enabling persons who are blind toperform them efficiently;

2) to determine, as a result of those surveys, appropriateequipment to be used in job adaptations, and to makerecommendations to the Supervisor of the Technology forthe Blind Program;

3) to design and perform engineering adaptations tocomputer related equipment, when necessary and feasible.

4) to evaluate the utility of newly developed technologicalequipment for blind persons;

5) 5) to develop or provide initial orientation and training in theuse of particular equipment systems to individualconsumers when necessary;

6) to evaluate and make recommendations to the Supervisorof the Technology for the Blind Program on the

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effectiveness of particular computer related equipment inthe employment and training of persons who are blind.

29G Vocational Rehabilitation Equipment Provided Directly byRegional Staff

When a consumer needs any of the following types ofequipment to reach his or her vocational objective, the regionalstaff will order the items directly. The costs of these items willbe paid out of the regional budgets.

1) rehabilitation teaching supplies,

2) low vision devices and accessories, such as, goosenecklamps and sunglasses. See Chapter 27 for policies andprocedures on provision of these items.

29H Eligibility for the Technology for the Blind Program

Equipment services from the Technology for the Blind Programwill be provided within the program struct ure listed below.

1) Job acquisition and retention. This includes legally blindvocational rehabilitation consumers who have an approvedIndividual plan for employment (IPE) and an opportunity toobtain a particular job which will require computer relate dequipment, and vocational rehabilitation consumers whorequire adaptive equipment for the retention ormaintenance of employment.

2) College and other approved training programs. Thisincludes legally blind vocational rehabilitation consumerswho have an approved Individual plan for employment (IPE)

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to attend college or another approved training program. Insuch a case, the appropriate adaptive equipment will belent to the consumer for the duration of the course orlonger when the accomplishment of th e vocational goal isdependent upon retention of the equipment for a specifiedperiod of time for a specified purpose under an approvedIndividual plan for employment (IPE).

3) Consumers pursuing a vocational goal of homemaker willbe eligible for placement of a Closed Circuit Televisionwhen that CCTV is to be used for recipe reading,assistance with homework and other tasks associated withmanagement of the household under an approved IPE (SeePolicy Memorandum #52 for guidelines relative tohomemaker goals).

29I Referral to the Technology for the Blind Program

Consumers meeting one of the above program criteria will bereferred to the Technology for The Blind Program by therehabilitation counselor by means of the appropriate electronicreferral system.

29J Repair and Maintenance of Equipment

The Commission will be responsible for the repair andmaintenance of equipment provided for one year after the datethe equipment is delivered to the consumer, subject toapplicable warranties. The consumer will be responsible duringthis first year to take reasonable care of the equipment, and tonotify the Technology for the Blind Program immediately in caseof equipment malfunction. After the first year, the employedconsumer will be responsible for all repai rs and maintenance of

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the equipment. Any equipment returned to the Technology forthe Blind Program after the first year must be returned in goodworking order. Consumers who have been lent equipment forcollege, or other training, will be responsible fo r the daytodaymaintenance, but not for repairs of the equipment after the firstyear.

29K Equipment Not Provided

The Commission does not generally provide the following typesof equipment unless there are exceptional circumstancesapproved in writing by the Deputy Commissioner for Services :

1) automobiles, trucks, or vans

2) adaptations to motor vehicles

3) air conditioners

4) computer printers, except for large print access,unless such printers are necessary to the vocationalgoal completion such as a small business application,or completion of college courses.

5) recreational equipment of any type

6) personal computers, except as specified in section29E.

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