92 Neb. Admin. Code, ch. 72, § 006

Current through September 17, 2024
Section 92-72-006 - Scope of Services and Fees
006.01 Fee Schedules

The program's fee schedule in Appendix B is designed to establish a reasonable cost to the program for each purchased vocational rehabilitation service, good, or support. The fee schedule applies to all services, goods, or supports. If the recipient chooses an out-of-state or nontax supported service or support, the program is not responsible for those costs in excess of the costs of the in-state or tax-supported service, good, or support.

006.02 Exceptions to Fee Schedules

Office Directors have the authority and discretion to make reasonable exceptions to the fee schedule amounts in Appendix B based on individual circumstances except for Sections 007.09, 008.05 and 009.05A of this Chapter. Exceptions regarding these three sections may be granted by Program staff designated by the Director based on the considerations or criteria described in those sections.

Exceptions may be granted if the Office Director or Program staff determines there is no alternative to addressing a recipient's need for a service or support necessary to complete an assessment for determining eligibility and vocational rehabilitation needs or to achieve the employment outcome on the recipient's approved Individualized Plan for Employment.

006.03 Financial Assistance Exclusions

The program will not provide financial assistance for fines, penalties, damages, and other settlements resulting from recipient violations (or alleged violations) of, or failure of the recipient to comply with, federal, state, local, or Indian tribal laws and regulations, including, but not limited to, traffic and parking violations. The program also will not provide financial assistance toward the recipient's outstanding financial obligations or judgments resulting from civil or criminal legal proceedings, or for the costs of any travel outside the United States. Fees to reinstate a driver's license are not considered a fine or penalty and are not precluded from financial assistance.

006.04 Medical Services

The program is not a health maintenance program, or a form of medical insurance. Individuals with disabilities may have continuing, long-term needs for health maintenance, continued treatment, or management of the physical or mental impairment, including medications and therapies for maintenance of function. Earnings and fringe benefits, family resources, and the services of appropriate public and private agencies, organizations, and service providers should be used to the maximum extent possible to meet these needs.

006.05 Medical Services Exclusions

The program will not provide financial resources for the following medical services: abortion, routine dental care, medical care for injuries or acute illnesses which are unrelated to the individual's disabling condition and are not complications of physical or mental treatment services; experimental physical or mental treatment procedures; surgical implantation of any device or organ, in whole or part, in the body; and, sex change surgery.

006.06 Treatment of physical and mental impairments

The program may provide financial assistance for the diagnosis and treatment of physical and mental impairments to the extent that financial support is not readily available from a source other than the program (such as through health insurance of the individual or comparable services and benefits). The purpose of diagnosis and treatment of physical and mental impairments is to eliminate or substantially reduce, within a reasonable period of time, the impediment to employment caused by a stable or slowly progressive impairment. Diagnosis and treatment of physical and mental impairments includes, but is not limited to:

006.06A. Corrective surgery or therapeutic treatment (including physical therapy, occupational therapy, speech or hearing therapy, and drugs and supplies).
006.06B. Necessary hospitalization in connection with surgery or treatment.
006.06C. Treatment of either acute or chronic medical complications and emergencies that are associated with or arise out of the provision of physical and mental treatment services or that are inherent in the individual's disabling condition.
006.06D. Diagnosis and treatment for mental and emotional disorders by qualified personnel under state licensure laws only to the extent that inpatient and outpatient mental health, alcohol, and drug treatment are not provided through publicly funded state treatment facilities, community mental health centers, and alcohol and drug treatment programs.
006.07 Conditions and criteria for providing financial assistance for the diagnosis and treatment of physical and mental impairments are that:
006.07A. The physical or mental impairment must be stable or slowly progressive and constitute a substantial impediment to employment.
006.07B. The necessary corrective surgery, therapeutic treatment, or other diagnosis and treatment of physical and mental impairments must reasonably be expected to eliminate or substantially reduce the impediment to employment within a reasonable length of time.
006.07C. Comparable services and benefits must be aggressively sought to pay for the costs of any diagnosis and treatment of physical and mental impairments.

92 Neb. Admin. Code, ch. 72, § 006