OAR 582-070-0030
Limitations of Payments
(1)
Payment in Full: Vendors providing any services authorized by OVRS shall not make any charge to or accept any payment from the individual or his/her family for such services unless the amount of the service charge or payment to be borne by the individual is previously agreed to by the individual or his/her family, known to and, where applicable, approved by OVRS.(2)
Client Financial Participation and the Financial Needs Test: Except as expressly exempted, services funded by OVRS are subject to Client Financial Participation. Individuals shall be allowed or required to contribute financially as set forth in OAR 582-070-0030 (Limitations of Payments). The contribution requirements apply starting July 1, 2004 for individuals submitting applications for services, requests for post-employment services, and for annual IPE reviews.(a)
The purpose of individual participation in service costs is to encourage the commitment of the individual to their vocational rehabilitation goal, create a cooperative relationship with the individual, and conserve limited OVRS resources.(b)
Except as provided in OAR 582-070-0030 (Limitations of Payments)(2)(j) and (k), the following individuals are exempted from the Financial Needs Test and Client Financial Participation:(A)
Any individual who has been determined eligible for and is currently the recipient/beneficiary of Social Security Benefits under Title II (Social Security Disability Insurance, SSDI) or Title XVI (Supplemental Security Income, SSI) of the Social Security Act;(B)
Recipients of qualifying needs-based public assistance programs, including Self Sufficiency Cash Benefits, Oregon Health Plan, Temporary Assistance for Needy Families, and Food Stamps, and excluding financial aid for post-secondary education;(C)
Homeless or transient individuals.(c)
Except as provided in OAR 582-070-0030 (Limitations of Payments)(2)(j) and (k), the following services are exempt from Client Financial Participation:(A)
Assessment for determining eligibility, vocational rehabilitation needs, or priority for services, including assessment by personnel skilled in rehabilitation technology;(B)
Vocational rehabilitation counseling and guidance, including information and support services to assist an individual in exercising informed choice;(C)
Referral and other services necessary to assist applicants and eligible individuals to secure needed services from other agencies, including other components of the statewide workforce investment system and to advise those individuals about client assistance programs;(D)
Job related services, including job search and placement assistance, job retention services, follow-up services, and follow-along services;(E)
Personal assistance services provided by one or more persons designed to assist an individual with a disability to perform daily living activities on or off the job that the individual would typically perform without assistance if the individual did not have a disability;(F)
Auxiliary aids or services required to participate in the vocational rehabilitation program, such as interpreter services including sign language and oral interpreter services for individuals who are deaf or hard of hearing; or tactile interpreting services for individuals who are deaf-blind.(d)
Under the Financial Needs Test, individuals with annual family income of less than either 250 percent of the federal poverty guidelines or $60,000 are not subject to Client Financial Participation and are exempt from the guidelines set out in OAR 582-070-0030 (Limitations of Payments)(2)(e).(e)
Client Financial Participation shall be determined on an annual basis, not to exceed the annual cost of non-exempt services to OVRS, applying the following contribution schedule:(A)
Individuals with family income between $60,000 and $69,999 are subject to a mandatory financial contribution of $700.(B)
Individuals with family income between $70,000 and $79,999 are subject to a mandatory financial contribution of $900.(C)
Individuals with family income between $80,000 and $89,999 are subject to a mandatory financial contribution of $1300.(D)
Individuals with family income between $90,000 and $99,999 are subject to a mandatory financial contribution of $1700.(E)
Individuals with family income between $100,000 and $109,999 are subject to a mandatory financial contribution of $2100.(F)
Individuals with family income between $110,000 and $119,999 are subject to a mandatory financial contribution of $2900.(G)
Individuals with family income between $120,000 and $129,999 are subject to a mandatory financial contribution of $3700.(H)
Individuals with family income at $130,000 or higher are subject to a mandatory financial contribution of $3700 plus ten percent of their family income in excess of $130,000.(f)
OVRS shall use the following definitions to calculate Client Financial Participation:(A)
“Income” is determined by the adjusted gross income from the most recent federal tax return, unless unusual circumstances merit other documentation.(B)
“Family income” consists of income from the individual, the spouse of the individual if residing with the individual, and includes parents if the individual is under 18 and living with parents, or the parents claim the individual as a dependent on federal taxes, or the individual maintains dependent status for financial aid reasons.(C)
“Federal poverty guidelines” are the current poverty guidelines of the United States Department of Health and Human Services.(D)
“Size of the family unit” for purposes of selecting the appropriate federal poverty guideline includes those family members residing with the individual or claimed on federal taxes as dependents; but if the individual is under 18 and living with parents, or the parents claim the individual as a dependent on federal taxes, or the individual maintains dependent status for financial aid reasons, the family unit may include those family members residing with the parents or claimed on the federal taxes of the parents as dependents(g)
If the individual or their family choose not to share information about their income as part of the calculation of the financial needs test, an annual, mandatory individual contribution of $3700 shall be established, not to exceed the annual cost of non-exempt services to OVRS, unless OVRS concludes that the annual family income of a individual may exceed $130,000 in which case the individual contribution shall be established at 100 percent for items and services subject to Client Financial Participation.(h)
Subsequent Financial Needs Tests shall be conducted with the annual review of the Individualized Plan for Employment, and may also be conducted if there is a change in the financial situation of either the individual or the family unit.(i)
“Extenuating Circumstances” shall be considered when the counselor identifies other information related to the individual’s financial situation that negatively affects the individual’s ability to participate in the cost of the rehabilitation program or if requiring the expected financial contribution will result in undue delay in the rehabilitation program. In determining whether to make an adjustment for extenuating circumstances, OVRS may consider the individual’s current income and the reasons for the request. If there are extenuating circumstances that justify an exception, OVRS may delay or waive all or part of the individual’s financial contribution. In such cases the counselor shall:(A)
Obtain written approval of their supervisor;(B)
Provide documentation of the reasons for the exception;(C)
Maintain both the signed exception and the documentation of circumstances in the client individual file record.(j)
If an individual prefers an upgrade, enhancement, optional feature, or more expensive vendor of essentially the same service, equipment or item available from a less expensive vendor, and this preference is not required to satisfy the vocational rehabilitation goals that justify the expenditure, OVRS and the individual may agree that the individual shall pay the difference in cost between the service or item purchased and the service or item available that would have satisfied the vocational rehabilitation goals that justify the expenditure. In this situation, payment is required regardless of whether the financial needs test authorizes payments by the individual; and any payments by the individual in this situation do not count toward the individual’s mandated financial contribution.(k)
An Individualized Plan for Employment (IPE) may include voluntary client contributions. An agreement in an IPE to make a voluntary contribution is not enforceable.(3)
Student Financial Aid: OVRS assures that “maximum” effort is made by OVRS and the individual to secure student financial aid for any approved training in institutions of higher education. “Maximum” effort includes making timely application for such grant assistance on a consistent basis and utilizing such benefits as are available in lieu of Vocational Rehabilitation funding:(a)
Coverage: All individuals, including graduate students, must apply for all financial aid benefits each academic year. All need based grants, including Pell Grants and Student Employment Opportunity Grants, must be used to pay for educational costs, including tuition and books, before an individual may utilize VR funds for this purpose. This requirement does not apply to merit based grants, including scholarships or loans. However, individuals may voluntarily elect to use these funds, as well as work study and loans for this purpose.(b)
Other Comparable Benefits or Services: If a third party (e.g., employer, insurance company, WCD) is required to or agrees to pay or reimburse to OVRS all of the case service rehabilitation costs of the individual, the financial aid grant offer need not be applied against the plan costs nor treated as a “comparable benefit;”(c)
Late Applications: Pending determination of student aid by the financial aid officer, OVRS funds can be expended for education-related expenses between the date of application for financial aid and determination of the individual’s eligibility for federal student aid provided that such expenditures are reduced by any amounts of comparable benefits subsequently received, excepting student loans;(d)
Duplicate Payments: When student financial aid is approved, arrangements must be made promptly to reduce projected OVRS payments and/or recover duplicate payments;(e)
Parent Non-Participation: With the Field Services Manager’s approval, the counselor may fund the parental contribution portion of the student’s budget (as prepared by the college or university FAO) if the parents refuse or are unable to contribute.(4)
For Industrially-Injured Workers: OVRS shall provide only for the cost of those rehabilitation services which are not the responsibility of the employer, insurer or the Oregon Worker’s Compensation Office.(5)
Increased Cost Maintenance: OVRS shall not provide maintenance except for additional costs incurred while participating in authorized services, such as when the individual must maintain a second residence away from the regular household in order to achieve a rehabilitation goal. Such maintenance shall be provided according to the provisions under OAR 582-070-0020 (Specific Policies)(4), 582-001-0010 (Definitions for Chapter 582)(25), and 34 CFR 361.5(b) (35).(6)
Physical and Mental Restoration Services: Are provided only to ameliorate a diagnosed physical or mental condition that presents a substantial impediment to employment for the eligible individual. The services must be essential for the individual’s achievement of a vocational goal:(a)
Drugs:(A)
When a physician (MD or OD) or dentist recommends prescription medication, if practical, the lowest price (e.g., generic) shall be obtained prior to issuing an authorization;(B)
Controlled substances require a prescription; an attending physician’s statement under ORS 475.309(2)(a) does not qualify as a prescription.(b)
Dental Services: Dental care may be provided by OVRS when the condition of teeth or gums imposes a major impediment to employment (e.g., endangers health, emergency needs, or serious cosmetic needs). Dentures may be purchased from licensed dentists or certified denturists;(c)
Eye Glasses: Eye glasses may be purchased when determined essential for evaluation of eligibility or the achievement of the vocational goal, limited to basic frames and lenses unless other features are medically required (e.g., sun glasses, tints, contact lenses);(d)
Wheelchairs: OVRS may purchase a wheelchair when the equipment is required to reduce or eliminate a disability related functional limitation that is a substantial impediment to employment. Wheelchairs must be prescribed by a qualified medical specialist;(e)
Hearing Aids. OVRS may provide hearing aides only when:(A)
Essential to complete an evaluation;(B)
Necessary to reduce or eliminate a barrier to employment; or(C)
The participant requires the hearing aids to retain employment. OVRS shall document the need for a hearing aid. All hearing services must be performed by licensed audiologists.(f)
Other Prosthetic Devices: Prosthetic devices may be purchased only upon the authorization of the counselor and with a written prescription by a qualified professional;(g)
Psychotherapy: Group or individual psychotherapy may be provided in those instances when required for a person to reach a vocational goal and when an immediate and positive goal related impact is anticipated. A specific number of sessions or a specified time limit is required. OVRS may limit these services to those recommended by an OVRS psychological or psychiatric consultant;(h)
Physical or mental restoration services shall not be provided by OVRS for the treatment of an acute or chronic medical complication or emergency unless these are associated with or arise out of the provision of physical or mental restoration services in the IPE, or are inherent in the condition under treatment as described in the IPE.(i)
Corrective surgery or therapeutic treatment shall not be provided or funded by OVRS if it is not likely within a reasonable period of time to correct or modify substantially a stable or slowly progressive physical or mental impairment that constitutes a substantial impediment to employment.(7)
Services Not Provided: OVRS shall not authorize or provide funding for the following services:(a)
Any individual-incurred debt;(b)
Any services obtained by the individual prior to the date of application;(c)
Purchase of land or stationary buildings;(d)
Fines or penalties, such as traffic violations, parking tickets, library fines, etc;(e)
Breakage fees and other refundable deposits;(f)
Contributions and donations;(g)
Entertainment costs;(h)
Payments to credit card companies;(i)
Authorization to supermarkets or grocery stores for food items;(j)
Basic Maintenance;(k)
Gender reassignment surgery;(l)
Except for eye glasses or hearing aids essential to completing diagnostic/evaluation services (to determine Rehabilitation Services eligibility) in applicant status, or occupational tools or licenses essential to Extended Evaluation Services, the following may never be authorized for an individual who has applied but has not yet been found eligible for rehabilitation services:(A)
Prosthetic devices;(B)
Occupational tools and licenses;(C)
Placement services.(8)
OVRS shall not contract with individuals receiving OVRS services, except in the following circumstances:(a)
The individual is a current OVRS vendor and is receiving services from or through OVRS; or,(b)
The individual’s Individualized Plan for Employment provides for the development of a business where there is no known competition in the region of the state in which the business will be or is located. In addition, the individual’s case has been reviewed by a branch manager who concurs there is no known competition to the business or proposed business.
Source:
Rule 582-070-0030 — Limitations of Payments, https://secure.sos.state.or.us/oard/view.action?ruleNumber=582-070-0030.