DBS VR Manual Chapter 40 Revisions, December 2015

DBS Vocational Rehabilitation Manual Chapter 40: Case Management 40.1 Case Notes

40.1.2 What to Include

Select the most appropriate title from the drop-down menu for each case note in ReHabWorks. Case notes are used to document:

 routine contacts with consumers at least as often as agreed upon by the consumer and the counselor;

Note: Contact at least once every 90 days is recommended.

 An explanations of any time extensions of time needed to determine eligibility beyond the allowed 60 calendar days to determine eligibility;  the consumer's progress or lack of progress toward achieving the vocational goal;  the Individualized Plan for Employment (IPE) annual review results Joint Annual Review results if there are no substantial changes in services, responsibilities, or other areas in the existing IPE.; noting that the consumer and counselor are in agreement that no changes are needed;  Case note that the consumer and counselor are in agreement that no changes are needed to the IPE;  a summary of the contents of medical or postoperative reports,;  analysis of information and anyall conclusions reached from reports or data;  clarification of vague or inconsistent information found elsewhere in the case file;  “no-shows” of providers or consumers;  counseling and guidance;  a concise history from referral to closure; and  all case information given to others who are helping the consumer achieve a planned outcome.

When preparing case notes, select the appropriate topic from the case note-drop down menu in ReHabWorks. rRecord significant information (what, who, when, where) and decisions (what, how and why) when they are not obvious from other case file documentation. Examples of information to include in regular case notes are:

 consumer perceptions and expectations;  progress or lack of progress that consumers make; counseling efforts  the rationale for providing services in special or exceptional situations;

of 37  discrepancies in medical, diagnostic, or other recommendations and counselor decisions/ and actions to resolve them;  loss of contact with consumer and efforts/ and actions taken to restore contact;  significant changes in the consumer’s situation (disability, family, or financial situation, etc.) which might affect the program (Changes to the financial information screen will generate a case note in ReHabWorks);  changes to the disability page screen*;  changes in the availability of comparable services and benefits and efforts to secure these benefits;  employment assistance activities (including employer contacts made on behalf of consumer);  summary documentation of reports contained in the paper case folder.;

The DARS counselor will provide the Department of Veterans Affairs-Vocational Rehabilitation Employment Counselor (VA-VRE) with copies of case notes in accordance with the approved plan, at least quarterly, for each concurrent case and will document that this process has been completed:

 each time the DARS counselor notifies the VA-VRE that a veteran failed to keep an appointment with DARS or is otherwise uncooperative;  when the DARS counselor notifies the VA-VRE that the DARS case is closed; or  when the VA-VRE notifies DARS that the VA case is closed.

*Changes to the disability page screen are captured in the “Reason for Disability Update” section of the disability page and are required whenever the disability page is updated. This information must include justification for the update and references to specific records when applicable. This process will automatically generate a case note in the data system and populate the information as part of the system generated case note.

40.1.3 What Not to Include

Do not include the following in a case note:

 iInformation duplicated in other sections of ReHabWorks or on other forms or reports in the paper case folder unless: o the information is significant to that case note. If so, summarize the information; or o the case note is a summary, such as in: . a preliminary assessment,; . a comprehensive assessment,; or . an outcome case note;.

 any reference to the consumer's HIVhuman immunodeficiency virus status;  statements referring to a consumer's physical or psychiatric diagnosis unless:

of 37 o supporting documentation is in the case folder; and o the reference is relevant to that case note.

 reference to the consumer’s voter registration status.

40.1.4 Preliminary Assessment

After entering all data and meeting with the applicant, the vocational rehabilitation counselor (VRC) or TCtransition counselor begins the eligibility determination process. The counselor must document the rationale of an eligibility decision and summarize personal observations and any additional assessment reports. This process from application to an eligibility decision may require one or more case notes. The initial contact with the applicant is documented with a case note entitled "Preliminary Assessment" (see preliminary assessments for a complete description). This case note must address at least the following areasgive:

 a brief description of the visual and any secondary disabilities;  the functional limitations and the impact on employment, education, and independence;  the applicant's perception of problems or issues related to visual loss and the need for services;  the counselor's observations;  medical involvement or other resource (if applicable);  Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) status; and  the course of action.

See examples of preliminary assessment case notes.

SSI or SSDI Status

See Chapter 3.3 Presumptive Eligibility for SSDI and SSI Recipients.

If the applicant indicates that he or she is receiving SSI or SSDI, ask for documentation or other confirmation of all benefits received because of blindness. If he or she is not blind, SSI or SSDI is most likely related to another disability. Record in the case note that he or she is

 on SSI or SSDI not because of blindness, or  on SSI or SSDI, but it is unclear whether it is for blindness. Once determined, it will be recorded in the case record.

Note: If it is established that the applicant is receiving SSI or SSDI because of blindness and has a desire to work, a presumption is made that the applicant is eligible for VR services and should be certified immediately.

of 37 40.1.5 Eligibility

The counselor must address all four eligibility criteria in the eligibility case note. See Chapter 3: Eligibility, 3.2 Eligibility Criteria for VR Services.

40.1.56 Extended Evaluation/Pre-Eligibility Trial Work

See Chapter 3: Eligibility, 3.10 Pre- Eligibility Trial Work.

Prior to moving from extended evaluation into plan development or ineligibility the counselor must document results of counseling and guidance noting eligibility or ineligibility based on the following:

 discussion of the assessments planned or provided  results of any trial work and recommendations  results and recommendations of other activities.

40.1.67 Comprehensive Assessment

After determining that the consumer is eligible, but before developing the IPEindividualized plan for employment, the counselor must identify the consumer's VR vocational rehabilitation needs and the nature and scope of needed services in relation to the consumer's strengths, resources, priorities, concerns, interests, abilities, capabilities, and informed choice. This assessment must be summarized in a comprehensive assessment case note. See Chapter 4: Planning, 4.1.3 Components of a Comprehensive Assessment.

Note: While the comprehensive assessment must be completed before developing the IPE, if there is a problem in completing the comprehensive assessment case note in a timely manner after the IPE is signed, the counselor may state in the case note when the assessment was actually completed and the reason for the delay in placing the case note in ReHabWorks.

For more information about the comprehensive assessment, see Chapter 4: Planning, 4.1 Comprehensive Assessment.

See examples of comprehensive assessment summary case notes.

40.1.7 8 Active Services

While in the case is in Active Services, the counselor must document significant issues or problems that arise as well as the individual'sconsumer’s progress or lack of progress toward accomplishing the employment outcome. Examples might include:

 Consumer can't participate for 3 months due to an automobile accident.

of 37  Consumer has been accepted into CCRC.  Consumer has decided to move and cannot participate until they are relocated.  Consumer missed O&M training 2 times in a row.  Counseling and guidance efforts and any results.  Rehabilitation teacher says services are completed.  Discussion of eye medical reports/recommendations.  Discussion other training reports.

40.1.8 9 Employment

In the case notes, the counselor should note any additional information that has not been placed in the employment section of ReHabWorks, such as:

 who placed the consumer;  anyall needed accommodations;  anyall upcoming concerns or problems;  anyall other relevant information; and  the need for possible post-employment services.

40.1.9 10 Closure before Application/Closure after Application

For applicants closed as ineligible, not accepted,document in an Outcome case note that the consumer was sent a letter for not accepted (DARS5102, DBS Ineligibility Letter —VR, IL, BCP,) or, if the case is being closed because the applicant’s disability or disabilities are too severe for Pre-Eligibility Trial Work, DARS5201, DBS Disability Too Severe to Benefit from Services—VR, if being closed as too severe from extended evaluation/trial work) informing themthe applicant that the case is being closed. A DARS5102 is not required for cases being closed from initial contact, since they are being closed prior tobefore completing an application for services.

40.1.10 11 Unsuccessful Closure before Plan Initiated/Unsuccessful Closure after Plain Initiated

For cases closed as not rehabilitated (unsuccessful), document in an Outcome case note that the consumer was sent an unsuccessful letter (DARS5203) informing the consumer that the case is being closed.

When either agency (DARS or the Department of Veterans Affairs (VA)) closes a concurrent case, each counselor will notify the counselor of the other agency.

If the closure reason is unable to locate, then refer to Unable to Locate or Moved Out of State Guidelines regarding methods of attempting to locate the consumer. Document these attempts in case notes.

of 37 40.1.11 12 Successful Closure

For cases closed rehabilitated (successful):

 document in an Outcome case note that the consumer was sent a successful letter (DARS5202, DBS Successful Closure—VR); or  complete a DARS5209, Successful Closure with Post-Employment—VR, informing consumer that the case is being closed, for consumers who are going immediately from rehabilitation into post-employment a (DARS5209) informing consumer that case is being closed.

When either agency (DARS or the Department of Veterans Affairs) closes a concurrent case, each counselor will notify the counselor at the other agency.

40.1.12 13 Post-Closure

See Chapter 39: Post-Closure Services.

The Post-Closure case note must document that they are eligible for services in that:

 a continuing eye condition that meets the DBS definition of a visual impairment  issues that are affecting consumer's ability to maintain employment after being closed as rehabilitated and  the rationale for reopening of the case for post-employment services.

40.1.13 14 Outcome—Post-Closure Completed

For cases closed in Post-Closure Completed, document in an Outcome case note that the consumer was sent a letter (DARS5209, Successful Closure with Post-Employment —VR) informing consumer that case is being closed.

When either agency (DARS or the Department of Veterans Affairs) closes a concurrent case, each counselor will notify the counselor of the other agency.

40.1.14 15 Email Messages from Consumers

The list below details Rrecommendations for placement of emails in case notes:

1. E-mails should be copied and pasted into a case note if there is pertinent information in the e-mail related to the consumer's rehabilitation program. 2. Title case notes with the specific issue discussed in e-mail and also label as e- mail, i.e.that is, “Travel skills – —e-mail” or “request for maintenance – —e-mail.”. 3. Additional information may need to be added to the case note to clarify information in the e-mail and also to indicate a specific plan of action based on this communication with the consumer.

of 37 4. If there are several e-mails back and forth between staff and consumer, then it is recommended that extraneous data and redundant e-mails be deleted prior tobefore saving in the case note. 5. Instead of copying and pasting in the e-mail into a case note, the counselor or /case worker may choose to summarize the email/ or emails in a case note.

40.2 Case Folder Organization

The purpose of this section is to describe the processes that are necessary for case file uniformity. You are ultimately responsible for the:

 management of the caseload;  location of case files; and  case correction activities.

The case file system consists of an electronic case file and paper case folder.

40.2.1 Guidelines on Use of Two-Sided or Six-Sided Case Folders

Documentation maintained onin ReHabWorks should not be duplicated within the case file.

Documentation of service delivery, including contact reports and other reports, etc., are maintained in either a two- or six-sided case folder. Each region may determine which type of folder is used. Regardless of which type of folder is used, the folder order listed below must be followed.

Documentation Order

Each section of the case folder should be organized so that initial documents are on the bottom and most recent on the top unless otherwise specified. As a result of the volume of information often contained in the six-sided case folder, dividers should be used to section off certain areas of documentation. This makes the information easier to access on a routine basis.

Two-Sided Case folder

 Side 1: (top to bottom) o Invoices with references to PO numbers.Do not include a copy of thePO.

Side 1 contains, top to bottom, invoices with references to service authorization (SA) numbers and a copy of the service authorization.

Side 2: (top to bottom) contains the following articles:

of 37  CA copy of the closure letter or the page from ReHabWorks to facilitate case-file purging.  DARS5051, Application for Services (only if a paper application is taken) or DARS5052, Application Statement for VRVocational Rehabilitation, only if needed for release or paper application is taken and a pseudo PIN is used in ReHabWorks with signature.  Signed individualized plans for employment (IPEs) (DARS5151, DARS5152) only if a pseudo PIN is used with a signature.  Optional: DARS5060, Permission to Collect Information , if records are being requested and DARS5052, Application Statement for VR (only in ReHabWorks) or  DARS5061, Notice and Consent for Disclosure of Personal Information  Assessment reports in chronological order by date received (for example, medical reports, training reports, etc.).  General correspondence in chronological order, to includeincluding such thingsitems as letters to and from family;, letters to and from vendors, and Social Security packets, etc.

Six-Sided Case Folder—Vocational Rehabilitation

Side 1: Basic Information

Basic information is placed in the following order from bottom to top chronologically (most recent on top) and separated by a divider:

 oOld contact reports (CB-4) in chronological order, most recent on top, documenting activity from intake through closure and if necessary, post- employment;  DARS5051, Application for Services, only if paper application is taken or DARS5052, Application Statement for VR (only in ReHabWorks), only if needed for release or paper application is taken and pseudo PIN is used in ReHabWorks with a signature;  DARS5060, Permission to Collect Information (optional)  and DARS5061, Notice and Consent for Disclosure of Personal Information, (optional);  DARS1390, Checklist for Determining Significance of Disability (if used)  DARS5151, Individualized Plan for Employment (IPE) or DARS5152, Individualized Plan for Employment (IPE) Amendment only if a pseudo PIN is used in ReHabWorks with a signature;  Consumer Data Sheet (CDS) or Initial Contact Page from ReHabWorks (optional); and  A copy of the closure letter or page from ReHabWorks (for example, Ineligibility, Successful, and Unsuccessful closures) to facilitate case-file purging.

of 37 Side 2: Medical Information

Medical information—all reports relating to medical information, for example, eye examination results, physician notes, general physical examination, low vision reports, and psychological reports —is placed in the following order from top to bottom chronologically (most recent on top) and separated by a divider:

 all reports relating to medical information, for example, eye exam, physician notes, general physical examination, low vision reports, psychological reports, etc.

Side 3: Assessments

Assessments are placed in the following order from top to bottom chronologically and separated by dividers:

 diabetic service reports, including evaluation and training;  Orientation and Mobility reports, including evaluation and training reports;  for Transition cases, the completed Core Skills Assessment tool; and  copies of past admissions, review, and dismissals (ARDs) once side 4 is full. These should be at the bottom of side three using a tab to separate from other items.

Side 4: Education and Vocational Information (Separated by a divider, top to bottom)

Educational and vocational information areis placed in the following order from top to bottom chronologically and separated by a divider. For : vocational service information, each service type is separated by a divider. Such information might include:

 vocational evaluation or training reports;  academic-related reports, for example, exemption from payment of tuition, copies of grades, class schedules, etc.;  OJTon the job training reports, job development, and job placement reports; and   for Transition cases, copies of the child’s ARD, individualized education planIEP, individualized treatment planITP, and/or individualized family service planIFSP (updated at a minimum every three years).

Note:: Once side 4 is full of ARD paperwork, then older ARDs are moved to the bottom of side 3, the most current ARDs remain on side 4.

of 37 Side 5: Documentation of Equipment Purchases and General Correspondence

Documentation of equipment purchases and general correspondence are placed in the following order from top to bottom chronologically and separated by a divider:

 all documentation related to equipment purchases (that is, purchase packets, equipment receipts [(DARS2014, Rehabilitation Equipment Receipt and Agreement])); and  general correspondence, including such things as letters to and from family; letters to and from vendors; Social Security packets, etc.

Note:: Flyers and other mail- outs to consumers do not have to be printed and placed in the case folder. A scanned copy of the mail- out can be pasted in case notes or a brief case note can be entered summarizing the mail- out (activity, etc.).

Side 6: Purchasing DocumentsService Authorizations

Purchasing documents are placed in the following order from top to bottom and separated by a divider:

 invoices with reference to a PO.

Service authorizations (SA) and invoices with references to SAs are placed in chronological order with the most recent on top and separated by a divider.

Note:: A paper copy of the SA is required in the case file.PO is optional. Case file copies of requisitions and vouchers should have a copy of the invoice and/or reader service statement attached before filing. Service authorizationPO numbers should be written on invoices.

Second Case Folder

When the volume of information on a consumer is more than a single case folder can physically hold, a second case folder can be establishedused.

The following information must be transferred to the second case folder:

 medical release forms,  the most current IPEindividualized plan for employment,  the most current eye report, and  all documentation necessary for the current management of a case.

As a general rule, the original case folder should retain extensive past training reports and pertinent information regarding consumer purchases.

of 37 40.2.2 Preparing and Closing the Paper Case Folder

Paper case files must be prepared in accordance with BPM 13.6.1 Preparing Closed Consumer Case Files.

File the following documents from bottom to top on the left side of the case file in the order received for all cases. All financial documents must be grouped together, including:  invoices;  bidding documentation;  copies of signed service authorizations;  signed itemized receipts; and  all other documents relating to consumer purchases.

Exception: Documents associated with billing for multiple consumer purchases must be placed in a centralized file in the field office.

40.2.3 Reopening a Case

When starting a new file on a case that was previously active, copy significant documents from the closed case file for placement in the new folder. Do not remove forms, reports, and other data from the old folder.

40.2.4 Maintaining Closed Case Files

Keep all documents, including financial records, in the closed consumer paper case file, which is stored for five years.

Field offices store files for cases closed in the current and preceding fiscal year.

Ship all other closed consumer paper case files to the DARS Records Center in accordance with procedures in Business Procedures Manual, Chapter 13: Records Management, 13.6 Closed Consumer Case Files.

Retrieve closed consumer paper case files from the DARS Records Center in accordance with policy (see Business Procedures Manual, Chapter 13: Records Management, 13.7 Records Retrieval).

40.3 Time in Status

of 37 40.3.2 Benchmark Time Frames Status Benchmark Time Status 00–Initial Contact with Case 30 days Assignment Status 02–Application 60 days Status 10–Eligibility and Plan Development3 months90 days 24 months (60 months if in an educational Status 14–Active Services setting) Status 22–Employment 4 months Status 32–Post-Closure 12 months

40.3.3 Required Actions

When a case exceeds the time recommended by a benchmark, the vocational rehabilitation VR counselor (VRC) must review the case to determine whether:if

 any contact with the consumer is needed,;  the case needs to be moved to a different status,;  the case needs to be closed,; or  any other action is needed.

The case record (case note and in some cases the case action) must document all decisions made about case statusThe VRC must create a service justification case note to document all decisions made about case status. …

40.4 Guidelines for Referral and Transfer of Cases ...

40.4.3 Procedure for Transfer

The transferring and receiving region will each have 10 business days to complete the following steps.a case transfer.

1. The transferring VRC completes a case review form and gives the case review form and case file to the VR supervisor and/or coordinator. 2. The transferring VR supervisor and/or coordinator review the completed case review form and document in ReHabWorks that the case has been reviewed. 3. The transferring VR supervisor and/or coordinator contact the receiving VR supervisor and/or coordinator to discuss any pertinent details and provide any updates relating to the case.

of 37 4. The receiving VR supervisor and/or coordinator assign the case to the appropriate receiving VRC. The case may or may not be assigned to the VRC covering the ZIP code area in which the consumer lives, depending on the nature and sensitivity of the case. This decision will be at the discretion of the receiving VR supervisor and/or coordinator. 5. The receiving VRC contacts the transferring VRC to staff the case. 6. The receiving VRC notifies the consumer that the case is being transferred and provides a time frame for completing the transfer.

The transferring VRC

 documents the receiving VRC’s approval for transfer in a case note titled "Case Transfer (add to topic) Approval";  updates both the paper and online case files to ensure that they are complete and accurate;  closes or cancels service records and service authorizations for services that will not be provided;  completes an initial case review and updates both the paper and online case files to ensure they are complete and accurate (for cases being transferred from a transition VRC to an adult VRC, see Chapter 33: Transition Services, 33.10.3 Transfer to Adult Vocational Rehabilitation Services);  completes the electronic transfer in ReHabWorks; and  delivers the paper case file within 10 working days after the electronic transfer to the receiving counselor by o certified mail, UPS, or FedEx (note the tracking number in the electronic folder) if the counselor is located in a different office; or o hand-delivery if the counselor is located in the same office.

For detailed procedures on transferring a case using ReHabWorks, see the ReHabWorks Users Guide, Chapter 9: Other Case Management, 9.3 Case Transfer.

Transfer to the Criss Cole Rehabilitation Center and/or to another region

When transferring a case to the Criss Cole Rehabilitation Center (CCRC), refer to Chapter 11: Criss Cole Rehabilitation Center, 11.5.1 Case Transfers to the Criss Cole Rehabilitation Center.

Use the following procedure to transfer an active case to a different region.

1. Upon receipt of the request to transfer, the sending counselor: o documents the request to transfer, including the reason for the transfer and consumer’s current contact information in the electronic case management system; o files supporting documentation in the case file, if applicable; and o notifies his or her vocational rehabilitation (VR) supervisor or coordinator of the request for transfer.

of 37 2. Within five workdays of receiving the request to transfer, the transferring VR supervisor or coordinator completes a partial case review and emails the PDF version of the completed case review to the receiving VR supervisor or coordinator. 3. Within three workdays after completing the case review, the transferring VR supervisor or coordinator: o verifies the case review has been validated;

o documents that the case review was completed in the electronic case management system; and o mails the paper case file.

4. Within three workdays after receiving the case, the receiving VR supervisor or coordinator:

o assigns the case to the receiving counselor in ReHabWorks; o enters a case note verifying that the case was received and assigned; and o notifies the counselor that the case was assigned.

5. Within three workdays, the receiving counselor contacts the consumer to schedule an appointment to review and continue services.

Each step in the transfer should be completed promptly to avoid delay or disruption of services to the consumer. Corrective actions identified in the case review should be completed as quickly as possible before sending, in order for the transfer not to be delayed. Transfer the case in ReHabWorks and mail the folder only when all corrections have been completed.

If the VR supervisor or coordinator cannot agree on the case transfer, he or she refers the issue to the appropriate field directors.

For detailed procedures on transferring a case using ReHabWorks, see the ReHabWorks Users Guide, Chapter 9: Other Case Management, 9.3 Case Transfer.

For cases being transferred from a transition vocational rehabilitation counselor (VRC) to an adult VRC, see Chapter 33: Transition Services, 33.10.3 Transfer to Adult Vocational Rehabilitation Services

When a consumer requests a case transfer, the VRC or rehabilitation assistant must ensure that:

 the reason the case is being transferred and which office it is being transferred to is documented in ReHabWorks;  all demographic information in ReHabWorks has been updated;  disability information in ReHabWorks is current;

of 37  the individualized plan for employment (IPE), Joint Annual Review, or IPE amendment is current;  service authorizations are paid and/or closed;  service records are closed or update, as needed;  the consumer has been told when the case will be sent to the receiving office; and  the consumer is notified when file has been sent to the receiving office.

Note: Providers must be notified if a service authorization is closed without payment. The receiving unit issues new service authorizations when the case is received for ongoing services, when applicable.

Transfer within the same region

A formal case review is not required for cases that are transferred within the same region. However, the VR field director, supervisor, or coordinator must enter a case note to verify that the transfer has been completed in ReHabWorks.

40.4.4 Procedure after Transfer

Within three days of receiving the paper case file, the receiving vocational rehabilitation supervisor or coordinator assigns the case to the receiving counselor in ReHabWorks and gives the paper copy to the receiving vocational rehabilitation counselor (VRC). The assigned VRC and rehabilitation assistant should contact the consumer in a timely manner to schedule an appointment for the consumer to meet with the assigned VRC to resume services.

The receiving counselor:

 reviews the case folder,; and  reports anyall discrepancies to the VR coordinator or other assigned staff member in the region. ...

40.5 Adjusting the Phase of a Previously Closed Case

40.5.1 Phase Adjustment

Phase adjustment reestablishes a case from closure phase to active phase (plan initiated). Only 26 and 28 closures can have phases adjusted. This adjustment includes removing closure information and changing the closure flag on employment information from "yes" to "no."

of 37 Unsuccessful Case Closure

 If (status 28) after initiation of an IPEindividualized plan for employment, the Ffield Ddirector approves phase adjustment of a case that has been closed one year or less, then: o adjust the phase (back the case to active status),; and o enter a case note of explanation and approval action delegated to the Ffield Ddirector.  When either agency (DARS or the Department of Veterans Affairs (VA)) closes a concurrent case, each counselor will notify the counselor at the other agency.

System Feature—Data entered at the time of closure is lost except for employment information. Closure flag in employment information is changed from "yes" to "no."

Successful Case Closure

 If (status 26) is in error and Ffield Ddirector approves the phase adjustment, then o adjust the phase (back the case to plan initiated), and o enter a case note of explanation and approval action delegated to the Field Director.  When either agency (DARS or the VA) closes a concurrent case, each counselor will notify the counselor of the other agency.

System Feature—Data entered at the time of closure is lost except for employment information. Closure flag in employment information is changed from "yes" to "no."

If employment information is obtained on a consumer with a case previously closed unsuccessful after provision of services,:

 review the case to ensure all criteria for successful closure are met (see Successful Closures),; and  adjust closure to successful.

40.6 Updating Case Recording

40.6.1 Purpose

The purpose of this section is to provide procedures for updating print case files deficient in documentation.

40.6.2 Documentation Guidelines

It is not against agency policy or federal regulations to update a case folder so that it accurately reflects the services provided and progress that a consumer has made in his or her rehabilitation program. The updating must be clearly explained on an IPE

of 37 amendment, and a reasonable explanation of facts, circumstances, and rationale for actions taken must be entered in the case note.

40.6.3 Procedure for Updating

When substantial services have been previously provided or authorized, but not documented on the IPE, an IPE amendment is developed with the consumer. The amendment lists the previously supplied substantial services, and the dates they were provided.

In the "Amended progress review criteria" section of the IPE, the counselor documents that either all or part of the amended plan is to record services agreed to and previously provided to the consumer, but not properly documented in the IPE.

If it has been longer than one year since the significant service was provided, but was not on a plan, the counselor documents in a case note that the service was provided but not planned. Note that the consumer was contacted and was in agreement.

If there is doubt about the procedure to correct the case record, the counselor should contact his or her immediate supervisor, or VR coordinator.

40.6.4 Procedures for Updating Other Caseload Materials

When any other caseload information is missing, such as training reports, invoices, etc., the counselor attempts to obtain copies of those documents from the vendor. If copies are not available, the counselor documents in a case note the attempts to obtain the reports, and that these items are missing from the case record.

Case Note example

In an extensive counseling session with Mr. Rehab, we had the opportunity to discuss, and initiate a corrective action regarding the fact that we had not completed an annual review with him as we should have by the end of June 2006. We clarified that the majority of services during the past fiscal year were adaptive technology services, and that rehabilitation teacher services have been ongoing since June of 2006. The consumer has been very pleased with the assistance he has received from the VRT.

Today's annual review has resulted in completing of an amendment that details the corrective action for the ongoing teacher services and adaptive technology services, and includes services to provide for the following issues: work-related clothing and/or incidental supplies, as well as assistance with relocation and/or moving expenses.

Mr. Rehab is very excited about this opportunity, and hopes it will provide him the career direction that will meet his interests, motivation, and current work desire. Authorization for services will be forthcoming, based on their need.

of 37 Example of IPE Amended progress review criteria

Mr. Rehab, you are aware that our annual review and the completion of this amendment provides for corrective action regarding the fact that rehabilitation teacher services, and adaptive technologies services, although agreed to, were not on the written planning from June 1, 2006, to the present time. We have agreed that review criteria for previous and ongoing services will remain the same. Reports from the rehabilitation teacher document your training and organizational skills, communication skills, record keeping, completion of work applications, etc. The training reports also confirm your ability to use ZoomText.

40.6 Quality Assurance Improvement Methods (Quality AIM) DARS has a responsibility to consumers to provide the best services possible in order support them in achieving their employment goals. Values-based decision making should also encompass considerations of DARS financial and ethical responsibilities to taxpayers to use state and federal funds and resources appropriately and within the parameters established in the federal regulations. Case reviews are one of the key tools that the Division for Blind Services (DBS) uses to measure how well it is meeting those responsibilities and to identify areas where additional training might be needed.

Quality assurance improvement methods (Quality AIM) are the systematic monitoring and evaluation of service provision in order to ensure that DBS consumers receive high- value services.

DBS applies the Quality AIM system to measure both compliance and quality.

40.6.1 Overview

The case review process should:

 be easy to understand and use;  evaluate and measure both compliance and quality accurately; and  result in improvements in order to exceed expectations for the consumer’s experience.

The Division for Blind Services (DBS) has created a case review process that evaluates:

 compliance with federal and state mandates;  the quality of the counselor’s:

o values-based decision making; o application of the VR process; and

of 37 o ability to provide a clear and concise understanding of the consumer’s progression through the rehabilitation program as documented in the case record; and

 quality of service delivery to consumers by improving the counselor’s:

o values-based decisions about the rehabilitation process; o use of resources; o focus on suitable employment; o improved relationships; and o benefit to all concerned.

The DBS case review process identifies the decisions that affect the stability in process and helps counselors understand the interdependencies of the various levels as they create an integrated process. The process is expected to result in ongoing improvement in the overall quality of services.

The process allows reviewers to rate compliance separately from quality. This allows the reviewer to identify policy issues and areas for improvement in decision-making in order to provide targeted coaching for increased quality of services.

40.6.2 Key Terms

Quality Assurance Improvement Methods (Quality AIM)—describes the quality assurance system and monitoring processes applied to conduct case reviews in response to areas of highest risk and includes regional quarterly case review plans and action plans to address monitoring results.

Case Review Guide—describes and defines compliance and quality and describes the ratings system for each. The guide also contains a reference list of documentation that does not add quality or value and suggests alternative ways to present more useful information.

For compliance ratings, the guide lists the various requirements for each decision point, including Vocational Rehabilitation Manual references, which are color-coded to clarify the basis of the policy, whether the policy derives from federal regulations, Texas state requirements, or established best practices. Supplemental guides address compliance with policies specific to several individual services.

For quality ratings, the guide contains:

 Quality Standards—the level of quality services consumers should expect to receive and to which a professional rehabilitation counselor aspires; and  Quality Indicators—signs or flags that a reviewer might observe that are indications that the Quality Standards are being met.

of 37 The lists of indicators are not all-inclusive and should not be used as a checklist. High- quality casework will vary from case to case and from situation to situation. Reviewers can use the quality indicators as reference points and reminders, but there might be signs of quality in any given case that are not included in the lists. When a case undergoes a risk-driven review, answer questions that are pertinent to the identified risk.

Additional Ratings

In addition to the compliance and quality ratings that apply to the overall vocational rehabilitation (VR) process, counseling and guidance are areas that warrant specific review of both compliance and quality. Level of significance is reviewed for compliance only. The same rating system is used for all of them.

Performance Management within Quality AIM requires that managers and field directors be mindful of performance and give careful consideration to potential performance concerns, evaluations, or trends. Managers should decide how many cases to review for each caseload and how to work with counselors. Managers are responsible for reviews of high-risk cases based on counselor caseload where performance issues have been identified. Managers should also identify issues that might be contributing to limited success in certain populations and coach counselors, with the goal of improved outcomes.

Case Reading Review—A review that allows users to quickly review a case, or a specific aspect of a case, when a more detailed case review is not necessary. Refer to the TxROCS User’s Guide for instructions on entering a case reading review in TxROCS.

Compliance—Adhering to the federal and state laws, regulations, guidelines, and specifications that are outlined in this manual and in the Business Procedures Manual (BPM), Standards Manual for Consumer Services Contract Providers (SMCSCP), and DARS Procurement Manual (DPM). A case is compliant if it meets all of the requirements. For information about evaluating compliance, refer to vocational rehabilitation risk assessment and TxROCS User’s Guide.

Compliance and Quality Review (C&Q)—C&Q Review—A stand-alone C&Q review. C&Q reviews can be performed to meet local needs. When you initiate this review, you can select an “Entire” C&Q review or a “Partial” C&Q review in TxROCS. If you select Entire, the system ensures that you complete all sections of the review. If you select Partial, you decide which section(s) to complete. For example, you might perform a Partial C&Q Review on a case which has not yet reached the individualized plan for employment (IPE) phase, or when you want to look at only specific parts of cases, such as in the eligibility phase.

Full Review—A compliance and quality (C&Q) review of all parts of a case that has reached at least IPE, and a technical and purchasing (T&P) review of information in the

of 37 electronic and paper case record and of specific purchasing requirements. All sections of both the C&Q and T&P must be completed in a Full Review.

Overall Comments—No rating is required. Provide comments and coaching on the overall process as it unfolded in the course of the case. Do not reiterate comments – especially negative ones - that were made earlier in the review. Comment specifically on how all the individual components of the process (Eligibility, Assessing & Planning, Services, Closure) worked together to produce the outcome. Use the opportunity to coach regarding “results received” versus “results hoped for.”

Oversight Review Approach—A case review or a review of a case review that is performed by regional or central office reviewers. An oversight review is used for monitoring case quality and as a tool to coach area managers about the case review process.

Partial Review Approach—A case review approach that allows the reviewer to complete and finalize a case review without answering all of the questions in the review. The approach can be used for compliance and quality reviews or technical and purchasing reviews. It cannot be used for full reviews.

Quality—The characteristics of the level of services and other forms of support provided to the consumer throughout the life of the case. High-quality casework demonstrates values-based decision making, active participation by the consumer, and the application of all required policies and standards. Quality is assessed based on a thorough review of all related casework and documentation. Quality is rated as “exceeds expectations,” “meets expectations,” or “needs improvement.” For more information about quality assessments, refer to the vocational rehabilitation risk assessment and TxROCS Case Review Guide.

Technical and Purchasing Review (T&P)—A stand-alone T&P review. T&P reviews can be performed to meet local needs. For more information, refer to the TxROCS User’s Guide. Add link to user guide.

TxROCS Users Guide—A technical guide that explains how to navigate through the TxROCS application. The TxROCS User’s Guide is not a policy manual. [Add link]

TxROCS User Role—A distinct role that defines what the user is allowed to use in TxROCS. User roles prohibit reviewers from viewing case reviews and reports that are not within the reviewer’s assigned management unit. For more information about user roles, refer to the TxROCS User’s Guide.[Add link]

Corrective Actions—A corrective action is a step that a counselor must take to remediate errors in procedure and/or performance. For more information, refer to TxROCS User’s Guide. [Add link]

of 37 Follow Up—The procedure that the reviewer follows after the counselor has taken corrective actions.

40.6.3 TxROCS

All reviews of vocational rehabilitation cases must be entered into TxROCS. The reviews are maintained in TxROCS for a minimum of two state fiscal years.

The case review process is audited each year. TxROCS captures and organizes data from case reviews that are conducted statewide. It improves the efficiency and accuracy of recording data from the case review process, creates one repository of information instead of many separate repositories, and results in timely and accurate reporting at all organizational levels. TxROCS allows DARS to quickly and accurately provide auditors with a comprehensive list of vocational rehabilitation cases that have been reviewed.

The Division for Blind Services also uses TxROCS data to examine statewide activity and trends and to respond to ad hoc requests requiring case review data.

Responsibilities and Roles in TxROCS

The field director:

 determines the appropriate user role for all staff members based on the standard descriptions in the TxROCS User’s Guide; and  submits a completed DARS1260, Service Request for an Individual.

Exceptions to standard user role require the approval of the director of Programs Management.

Reviewers (or designees):

 document the case review in TxROCS;  identify areas of non-compliance (if applicable);  establish the corrective actions to be taken;  notify staff members about reviews and assigned corrective actions;  monitor the progress made on taking corrective actions;  validate that corrective actions have been completed;  document the validation in TxROCS; and  report serious findings (illegal, immoral, or unethical practices) immediately to the regional director.

After completing a review, the reviewer enters a case note in the consumer's electronic file to document the type of review conducted. Specific findings and assigned corrective actions are not entered in the case note.

Caseload carrying staff members (or designees):

of 37  review completed reviews;  complete any assigned corrective actions; and  acknowledge that they have completed these steps of the review in TxROCS.

40.6.4 Compliance

A case is compliant if it meets all of the requirements of the federal and state laws, regulations, guidelines, and specifications that are outlined in this manual and in the Business Procedures Manual (BPM), Standards Manual for Consumer Services Contract Providers (SMCSCP), and DARS Procurement Manual (DPM).

In following federal vocational rehabilitation (VR) regulations and Division for Blind Services (DBS) policies, vocational rehabilitation requires vocational rehabilitation counselors (VRC) to determine eligibility within 60 days. Eligibility must be determined within 60 days unless the consumer has agreed to a specific extension of time, which has been documented in the case record. For more information, refer to Chapter 3: Eligibility, 3.4 Compliance Requirement—60-Day Rule.

*You must determine a consumer's eligibility for the vocational rehabilitation (VR) program by the 60th day after the date that the application is signed, unless you:

 need to extend the time; or  cannot determine the consumer's ability to achieve an employment outcome without pre-eligibility trial work.* See Chapter 3, Eligibility, 3.10 Pre- Eligibility Trial Work.

*Based on 34 CFR Section 361.41(b)(1)

*When you cannot determine eligibility by the 60th day after the date the consumer signs the application:

1. inform the consumer of the exceptional and unforeseen circumstances (beyond DBS control) that are delaying eligibility determination; 2. obtain agreement from the consumer that the extension of time is necessary; and 3. document the reasons for the extension of time* in the electronic case management system or in a case note.

*Based on 34 CRF Section 361.41(b)(1)(i)

The VRC must also:

 enter the preliminary assessment case note in ReHabWorks no later than 10 business days after application signature;  contact consumers regularly (in accordance with the individualized plan for employment (IPE));

of 37  enter the comprehensive assessment case note in ReHabWorks no later than 10 business days after IPE signature; and  presume eligible a person who receives Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) benefits because of blindness.

*Recipients of Social Security disability benefits (that is, SSI and/or SSDI) are:

 presumed eligible for VR services*; and  determined eligible immediately after receipt of benefits is proven unless there is a question about the consumer's ability to achieve an employment outcome.

*Based on 34 CFR Section 361.42(a)(3)(i)

For more information, see Chapter 3: Eligibility, 3.3.2 Documentation of Benefits, and 40.1.4 Preliminary Assessment.

Reports That Monitor Compliance

Reports that monitor compliance are on the Compliance page of the VR database. They include:

 over-60-days eligibility determination;  TxROCS Case Review Reports;  no preliminary assessment case note;  no comprehensive assessment case note;  presumptive eligibility; and  unsigned plans.

All counselors and rehabilitation assistants should have a shortcut to the VR database on desktops. Counselors should contact the VR coordinator for help accessing the VR database.

40.6.5 Quality

An assessment of the level of services and other forms of support is provided to the consumer throughout the life of the case. High-quality casework demonstrates ethical decision making, participation by the consumer, and the application of all required policies and standards. Quality is assessed by means of a thorough review of all related casework and documentation. The quality of a service is rated as follows: the service exceeds expectations, it meets expectations, or it needs improvement.

At the caseload level, quality is measured by:

 the results of consumer satisfaction surveys;  the level of agreement between the frequency of contact planned in the individualized plan for employment IPE and the number of contacts made; and

of 37  successful outcomes, including: o consumer earnings reports; o case reviews; and o the rehabilitation rate.

Reports That Monitor Quality

The vocational rehabilitation (VR) database contains the quality measures page and can be used to access the following reports:

 consumer contacts by staff, which has the most recent case notes in each case file and is organized by staff member name;

 TxROCS Case Review; and  increased earnings, which has the cumulative increased earnings from application to closure on successfully closed cases by: o case; o caseload; and o region.

The VR performance measures production report is posted on the Division for Blind Services Program Statistics page, and includes information on:

 26 closures;  blind competitive closures;  rehabilitation rate [26 ÷ (26+28)]; and  average weekly earnings

40.6.6 Quality Assurance Improvement Methods (Quality AIM) Risk Areas

Each quarter a spreadsheet (Quality AIM Quarterly Dataset) will be posted on the intranet (DBS Quality AIM) to indicate the vocational rehabilitation (VR) cases that present the four risks stated below. Field directors, VR supervisors and coordinators, field specialists, and others tasked with conducting case reviews will be responsible for selecting cases from the list and conducting case reviews in TxROCS (full or partial as indicated below). The risk assessment conducted for the Division for Blind Servicers (DBS) VR indicates that the following risks are included DBS VR Quality AIM.

Financial Risks—Requires Full Review; Technical and Purchasing and Compliance and Quality (C&Q). Total case cost more than $20,000

Operational Risks—Requires C&Q and Entire review

 Case length—greater than two years for adult VR  Case length—greater than five years for transition services

of 37 Strategic Risks—Requires minimum of C&Q and Partial review

 Successful closures (learn from successes, ensure accuracy in closure fields)  Unsuccessful closures (learn from possible mistakes such as not identifying and/or addressing secondary disabilities)

Compliance Risks—Requires minimum of C&Q and Partial review. No counseling and guidance for more than 180 days.

Specific Guidance

Use the Quality AIM Quarterly Dataset provided by Program Reporting and Analysis (PRA) and uploaded to the intranet by central office. Each quarter you must:

 refer to the Regional Quarterly Case Review Plan (below) to determine the number and type of reviews required for the region;  sort the data (each column, one risk at a time) so that cases that present the identified risk appear at the top of the list and then choose the cases at the top of the list (for example open the longest, costliest), working your way down through the list;  choose only cases that have not been reviewed during the current fiscal year, and have not been reviewed within the past six months;  choose a variety of adult VR as well as transition cases; and  note that in the Quarterly Regional Review Plan, no more than half of the required reviews each quarter may come from the combined total count of performance management and transfer cases.

Note: When conducting performance management reviews, choose cases from the quarterly dataset when possible. For example, to review cases of counselor John Doe, select that counselor’s cases that appear in the dataset when possible.

If the case is listed in the quarterly dataset, choose the corresponding risk(s) in the TxROCS VR Risk Assessment section and continue with the appropriate type of review (full, partial).

Performance and/or Rehabilitation Rate Below 70 percent

Field directors, VR supervisors, and coordinators must be mindful of performance, including whether the rehabilitation rate falls below 70 percent. This includes management being aware of and giving careful consideration to all potential performance concerns, evaluations, or trends. In addition to ensuring that 10 percent of the region’s cases are reviewed, managers should assess how many cases to review for each caseload and how to work with counselors. As necessary, managers should:

 identify and review additional cases from a specific caseload; and

of 37  focus reviews of high-risk cases based on counselor caseload where performance issues have been identified.

Federal and State Law Related to Release of Information

All case reviews should include a review to ensure that all appropriate consent and release of information forms are signed, current, and are included in each case.

Case Reviews are Relevant to ReHabWorks

Case reviews focus on information available in ReHabWorks and documentation currently available in case folders. Historical case information prior to TWorks implementation, and therefore not available in ReHabWorks, will not be considered or reviewed.

Case Reviews Align with Agency Policy and the TxROCS User Guide

Case reviews adhere to agency policy and are conducted using the Texas Review, Oversight, and Coaching System (TxROCS) data base and associated user guide.

Service Authorizations

T he expectation is to review a minimum of 10 service authorizations. For cases identified as “costs exceed $20,000,” it is important to review enough service authorizations (for items such as readers, technology, and maintenance) to ensure that expenses are justifiable.

40.6.7 Compliance and Quality Reviews

The compliance portion of a compliance and quality (C&Q) review is used to evaluate whether specific elements of a case adhere to the federal and state laws, regulations, guidelines, and specifications that are outlined in this manual and in the Business Procedures Manual (BPM), Standards Manual for Consumer Services Contract Providers (SMCSCP), and DARS Procurement Manual (DPM).

The quality portion of a C&Q review is used to assess the level of services and other forms of support provided to the consumer throughout the life of the case. High-quality casework demonstrates values-based decision making, consumer engagement, and the application of policies and standards. It is based on a thorough review of all related casework and documentation.

Compliance and quality (C&Q) reviews are documented by completing DARS3456, Compliance and Quality Case Review—VR in TxROCS. Only directors, supervisors, coordinators, program specialists, and designees may complete a C&Q review. Compliance and Quality reviews may not be completed by administrative support staff.

of 37 TxROCS case review guide is available as a reference when completing a case review.

40.6.8 Technical and Purchasing Review

The technical portion of a technical and purchasing (T&P) review is used to evaluate whether all required information is included in the electronic and/or paper case file.

The purchasing portion of a T&P review is used to evaluate whether the appropriate purchasing policies and procedures were followed and documented, as required by the applicable federal and state laws, regulations, guidelines, and specifications that are outlined in the Vocational Rehabilitation Manual (VRM), Business Procedures Manual (BPM), Standards Manual for Consumer Services Contract Providers (SMCSCP), and DARS Procurement Manual (DPM).

Technical and purchasing reviews are documented by completing DARS3399, Technical and Purchasing Case Review—VR, in TxROCS. Directors, supervisors, coordinators, program specialists, and designees may complete T&P reviews. Designees may include management support staff; however, managers must review a designee’s work to ensure that the designee accurately represents the findings.

All directors, supervisors, and coordinators are required to monitor the operation of the assigned units. Case reviews are a required part of this monitoring. To identify the type and quantity of required reviews, directors, supervisors and coordinators, refer to the unit’s monitoring plan for the current fiscal year.

The field director and designated regional office staff members are responsible for the oversight of each unit in the assigned region, including monitoring of case review activities and ensuring implementation of recommendations.

The director of Programs Management or director of Consumer Services Support (CSS) manages and oversees the case review process statewide to ensure that the process is applied consistently. All questions about the case review process and unit monitoring plan should be directed to the CSS program director or to a designee.

Refer to the vocational rehabilitation (VR) risk assessment case review guide to access the unit monitoring plan and to identify required activities and reporting for unit, regional, and central office roles and responsibilities.

40.6.9 Case Review for Transfer of an Active Case to Another Region

Use the Quality AIM Quarterly Dataset provided by Program Reporting and Analysis (PRA) and uploaded to the intranet by Central Office and take the following steps each quarter:

 Refer to the Regional Quarterly Case Review Plan (below) to determine the number and type of reviews required for the region.

of 37  Sort the data (each column, one risk at a time) so that cases that present the identified risk appear at the top of the list, and then choose the cases at the top of the list (for example, open the longest and costliest), working your way down through the list.  Choose only cases that have not been reviewed during the current fiscal year, and have not been reviewed within the past six months.  Choose a variety of adult vocational rehabilitation (VR) as well as transition cases.  Note that in the Quarterly Regional Review Plan, no more than half of the required reviews each quarter may come from the combined total count of performance management and transfer cases.

Note: When conducting performance management reviews, choose cases from the quarterly dataset when possible. For example, to review cases of a particular counselor, select that counselor’s cases that appear in the dataset when possible.

Note: If the case is listed in the quarterly dataset, choose the corresponding risk(s) in the TxROCS VR Risk Assessment section and continue with the appropriate type of review (full, partial, etc.).

If the case is in pre-eligibility trial work, the reviewer:

 completes a full case review after the first twelve months; and  does a case reading every 3 months after the first 12 months.

40.7 Completing a Caseload Inventory

A caseload inventory differs from an individual case review in that it is not completed on a specific form but is a document created for a specific caseload using data from ReHabWorks. Staff members can use the caseload inventory to manage and review their caseload and to identify needed corrections. The professional support staff from each DBS office has been trained to create a caseload inventory. If additional support is needed, contact the Consumer Services Support Unit at (512) 377-0589.

Typically, the coordinator, with help from a rehabilitation assistant, completes a caseload inventory annually. The caseload inventory:

 identifies documentation and procedural trends;  helps counselors better manage their caseloads; and  ensures the quality of services.

A caseload inventory generally includes the following information:

 Consumer's name  Case ID  Current phase and date

of 37  Referral date  Application date  Eligibility date  Most recent plan date  Most recent contact date  Preliminary assessment date  Comprehensive assessment date  Case notes  Ineligibility and closure reasons  Additional comments

For more detailed instructions and a blank caseload inventory, see Caseload Inventory Format.

If a caseload inventory shows a need for corrective action, the counselor and the field director work together to develop an individual plan and schedule.

40.7 Quality Assurance

Quality assurance (QA) is the systematic monitoring and evaluation of service provision in order to ensure that DBS consumers receive high-value services.

DBS applies the quality assurance system to measure both compliance and quality.

40.7.1 Compliance

Compliance is a set of performance expectations that a counselor either has or has not met and includes specific actions that must be completed within a specific period of time. The VRC must ensure that the case is in compliance. DBS has several tools to measure compliance including case reviews.

In following federal VR regulations and DBS policies, VR uses these compliance requirements:

 Eligibility must be determined within 60 days unless the consumer has agreed to a specific extension of time, which has been documented in the case record.

 The preliminary assessment case note must be entered in ReHabWorks no later than 10 business days after application signature.

 VRCs must regularly contact consumers (in accordance with the IPE).

 The comprehensive assessment case note must be entered in ReHabWorks no later than 10 business days after IPE signature.

of 37  A person who receives SSI or SSDI benefits because of blindness is presumed eligible.

For more information, see Chapter 3: Eligibility, 3.3.2 Documentation of Benefits, and 40.1.4 Preliminary Assessment.

Reports That Monitor Compliance

Reports that monitor compliance are on the Compliance page of the VR database, and include

 over 60 days eligibility determination,

 no preliminary assessment case note,

 no comprehensive assessment case note,

 presumptive eligibility, and

 unsigned plans.

All counselors and RAs should have a shortcut to the VR database on their desktops. Counselors should contact their VR coordinator for help accessing the VR database.

40.7.2 Quality

The quality of a service is the degree to which the service meets the consumer's expectations. Quality is a conditional and somewhat subjective measure.

At the caseload level, quality is measured by

 the results of consumer satisfaction surveys,

 the level of agreement between the frequency of contact planned in the IPE and the number of contacts made, and

 successful outcomes, including

 consumer earnings reports,

 case reviews, and

 rehabilitation rate.

of 37 Reports That Monitor Quality

The VR database contains the quality measures page and can be used to access the following reports:

 the consumer contacts by staff report, which has the most recent case notes in each case file and is organized by staff member name.

 the increased earnings report, which has the cumulative increased earnings from application to closure on successfully closed cases by

 case,

 caseload, and

 region.

The VR performance measures production report is posted on the DBS Program Statistics page, and includes information on

 26 closures,

 blind competitive closures,

 rehabilitation rate [26 ÷ (26+28)], and

 average weekly earnings.

40.7.3 Consumer Satisfaction Surveys

DBS surveys consumers at two points in the VR process.

1. After plan development, a sample set of consumers are surveyed to measure their involvement and participation in the development of the IPE. When developing IPEs, VR counselors should inform consumers that they may receive a call regarding their satisfaction with DBS and their involvement in developing their IPE.

2. All consumers leaving active services are surveyed to determine if they achieved IPE employment goals, and their overall satisfaction with DBS services.

Contractors collect consumer satisfaction information with anonymous responses.

of 37 40.8 When a Consumer Requires Special Attention

When a DARS employee or other reliable source is aware of or observes a consumer’s behavior that could pose a threat to DARS staff members or providers, it is important to capture this information as specifically and factually as possible in the consumer’s case file by creating a case note.

A DARS employee creates a case note:

 if at any time during the rehabilitation process, a consumer verbally or physically threatens a DARS employee; or  if a consumer who is in rehabilitation has a recent history of actual or threatened physical abuse.

The employee enters the case note in the electronic case management system, under the topic “Other” and then in “add to topic,” writes “Requires Special Attention.”

A case note must include as much factual information as possible about the incident, including:

 the date;  the location;  the names and addresses of witnesses and the people involved;  what was said or done; and  the names of those willing to testify.

When other DARS staff members refer to the consumer’s online case record, the case note alerts them to use caution when working with the consumer. Additional case notes must be entered as needed to maintain an accurate record of potential risks or of changes to the circumstances.

Although it is important to alert staff to potential risk, DARS employees must exercise extreme care in using the case note titled “Other.” When you use “Other,” write “Requires Special Attention.”

Incidents affecting the security of a DARS employee or DARS property must be reported to:

 DARS management, in all cases; and  local law enforcement, if appropriate.

If local law enforcement is involved, the DARS employee places a copy of the police report in the paper file.

For more information on reporting an incident, see the Business Procedures Manual, Chapter 36: Incident Reporting.

of 37 40.8 Caseload QA

40.8.1 Caseload Review

Each person who reviews a case brings unique strengths, training experience, and thoughts on how caseload samples are best reviewed.

Case reviews are essential

 to monitor compliance with federal and state regulations regarding documentation, development of plans, and expenditure of division funds;  to guide individual counselors and ensure that consumers receive appropriate and timely services for the completion of their rehabilitation program;  to provide consistency throughout the state in general processes and procedures; and  to assess the content and context of each case folder.

The DARS2221, DBS VR Case Review Form is used by the

 counselor, and  case reviewer.

The form includes instructions, and responses include

 Y (Yes) = meets requirements,  N (No) = does not meet requirements and cannot be corrected in this casefolder, but more attention should be paid to this area in the future,  C (Correction Needed) = indicates that a specific corrective action is required to correct this problem, and  N/A (Not Applicable) = indicates that a specific review element does not apply to this case folder.

The case review form also includes fill-in-the-blank responses and a space for comments after each section.

If a region wishes to emphasize specific issues, additional review items can be added on another page.

Responsibility

The VR coordinator, program coordinator or field director generally performs case reviews. The field director may designate other professional staff members to help with the review process, when appropriate.

of 37 Filing the Case Review Form

Once a case has been reviewed, the reviewer places a case note in the folder, which includes

 a statement that the review was completed,  the name of the reviewer, and  the date of the review.

The DARS2221, DBS VR Case Review Form is never filed in the consumer's case folder. The form and any documentation are placed in a separate file with other case reviews. If the case is transferred to another office, the counselor also sends any reviews done on that case.

40.8.2 Case Review Selection Using the Risk Assessment Process

The risk assessment process helps focus case review selection so that higher-risk caseloads and cases receive more monitoring. This process also helps supervisors in making decisions and in planning and monitoring upcoming needs.

To determine the number of case reviews to perform on a caseload in a year, the FD and VR coordinator or VR supervisor review each caseload using the risk assessment spreadsheet.

The Risk Assessment Spreadsheet

The risk assessment spreadsheet tracks the level of risk in each caseload. Caseload risk criteria are rated from low to high (1 to 5), and include

 Risk Criterion 1—the counselor’s tenure,  Risk Criterion 2—the caseload rehabilitation rate, and  Risk Criterion 3—any specific supervisory concerns.

Examples

Example of Risk Criterion 1: The VRC has over three years’ work experience, so he or she would have a risk level of 2.

Example of Risk Criterion 2: According to the VR production report, the rehabilitation rate for the prior fiscal year was 62.4 percent for the caseload. The VRC would have a risk level of 5. For a new counselor, the risk level is 5.

Risk Criterion 3 includes any other areas of concern that exist concerning the VRC or caseload. Examples of specific concerns include

 lack of regular consumer contact;

of 37  missing progress reviews;  issues with KPMG reporting and frequency of audit exceptions for the last year (Note: One incident warrants no concern, more than three incidents warrants moderate concern, and more than six incidents warrant serious concern);  overlooking comparable benefits,  lagging annual reviews or amendments; and  infrequency of successful closures by midyear.

Example of Risk Criterion 3: A VRC continues to move too quickly through the comprehensive assessment, all initial IPE services are primarily evaluations, and the caseload has a high rate of 28 closures. On criterion 3, the VRC has a risk level of 5.

Risk Matrix

A minimum of 4 cases are reviewed per caseload. The spreadsheet totals the risk estimate for each caseload. Caseloads with higher risk assessments are monitored according to the following matrix:

Total Risk in Number of Complete Case Caseload Reviews 3–6 4 7–10 6 11–15 8

Examples of Cases to Be Reviewed

Cases to review are chosen to give a fair sampling of the overall quality of services. An example of a large caseload sampling includes:

 one case chosen by the VRC or TC;  several cases chosen by the FD or VR coordinator including o one active case, o one case closed successful after IPE, o one case closed unsuccessful after IPE, o one case with excessive maintenance or transportation, o one case with audit exceptions, o one case where annual reviews or amendments are in arrears, o one case open for more than 5 years, and o one case where the last contact was more than 4 months ago.

40.8.3 Completing a Caseload Inventory

A caseload inventory differs from an individual case review in that it is not completed on a specific form but is a document created for a specific caseload using data from ReHabWorks. Staff members can use the caseload inventory to manage and review

of 37 their caseload and to identify needed corrections. The professional support staff from each DBS office has been trained to create a caseload inventory. If additional support is needed, contact the Consumer Services Support Unit at (512) 377-0589.

Typically, the coordinator, with help from a rehabilitation assistant, completes a caseload inventory annually. The caseload inventory

 identifies documentation and procedural trends,  helps counselors better manage their caseloads, and  ensures the quality of services.

A caseload inventory generally includes the following information:

 consumer's name,  case ID,  current phase and date,  referral date,  application date,  eligibility date,  last plan date,  last contact date,  preliminary assessment date,  comprehensive assessment date,  case notes,  ineligibility and closure reasons, and  any additional comments.

For more detailed instructions and a blank caseload inventory, see Caseload Inventory Format.

If a caseload inventory shows a need for corrective action, the counselor and the field director work together to develop an individual plan and schedule.