Chapter 3: Roles and Responsibilities of the Rehabilitation Team

3.1 Overview

This chapter explains the roles and responsibilities of the many partners who support the consumer during the rehabilitation process.

The partners share responsibility for informing and educating consumers, advocating and facilitating for them, and encouraging them. Each partner must contribute his or her expertise to make the professional relationships with the consumer as productive as possible. Partnership building is an active process.

You must:

  • think creatively to consider alternatives; and
  • practice the art of leadership.

To model the behavior expected of others effectively, leaders must first establish clear guiding principles and must lead from those principles. You must lead according to what you believe. You must lead in partnerships that contribute to the success of the consumer, such as the partnerships that you build with consumers, schools, families, businesses, other agencies, and the community. You must inform other staff members, consultants, the consumer or consumer's representative, and CRS providers about the consumer’s goals and the responsibility that each person has in attaining the goals.

3.2 Roles of Key Players

3.2.1 Consumer

The consumer-counselor relationship is valued and the following consumer roles are encouraged:

  • Owner: taking ownership of his or her rehabilitation.
  • Active partner: demonstrating motivation by actively participating in rehabilitation, throughout the phases of the process.
  • Decision-maker: engaging in the process of making an informed choice and decision.
  • Active participant: committing to following through with activities that lead to a successful rehabilitation outcome.

3.2.2 Counselor

Your roles as a counselor are as follows:

  • Source of encouragement: building confidence in partners to help the consumer live independently.
  • Role model: setting expectations for the consumer by modeling accountability, responsibility, and full engagement.
  • Problem-solver: providing tools for the consumer to accommodate or reduce the impediment to independence and to empower him or her to reach the consumer’s goals.
  • Team player: fostering a culture of honesty and respect among partners.
  • Model of competence: modeling competence in your job performance to inspire partners and consumers.
  • Advocate: advocating for consumers and putting the consumer's best interest first.
  • Source of empowerment: empowering the consumer to grow and make a difference in his or her own life by making informed choices.
  • Helper: taking a skilled-helper approach to counseling to engage the consumer fully in developing new rehabilitation opportunities and developing the skills needed for daily living.
  • Educator: conducting outreach activities to educate community partners about how services for CRS can be a valuable asset.
  • Partner: developing strong community partnerships that are built on trust and cooperation.
  • Myth breaker: clarifying with vendors, school staff, and the community any misconceptions about the consumer’s knowledge, skills, abilities, and attributes.
  • Master of alternatives: finding services, providers, and ways to overcome barriers so that the consumer can be a successful and live an independent life.

3.2.3 Manager

As a vital partner in facilitating quality, the CRS program manager's roles are as follows:

  • Leader: directing and having concern for his or her staff members and the consumers.
  • Builder of competency: building competency in his or her staff members in order for the CRS program to best serve consumers, families, community members, and taxpayers.
  • Teacher: teaching and coaching both new and experienced staff members who want to continue to learn more about the rehabilitation process and improve his or her skills and abilities.
  • Talent developer: committing to and searching out challenging opportunities for staff members to grow, innovate, and improve his or her abilities.
  • Motivator: encouraging and motivating staff members to become decision-makers and creative thinkers.
  • Visionary: enlisting others in a common vision by appealing to their values, interests, hopes, and dreams to create a cultural climate of excellence in service.
  • Source of empowerment: strengthening the CRS process and empowering the counselor to become a decision-maker by sharing information and by discussing the decisions the counselor has made and the actions he or she has taken regarding the consumer’s case.
  • Reflector: providing ongoing feedback to the counselor about how to improve accountability in order to deliver quality services.
  • Role model: exhibiting the self-confidence that it takes to provide quality services and ensure the consumer’s satisfaction.

3.3 Responsibilities of the Courtesy Counselor

A CRS courtesy counselor, who may perform courtesy work at one or more organizations, manages timely delivery of services described in the consumer’s Individualized Written Rehabilitation Plan (IWRP).

The courtesy counselor:

  • has access to pertinent electronic documents in ReHabWorks (RHW) and paper documents in the case file, such as the consumer’s IWRP and medical reports;
  • may contact the consumer and provide counseling and guidance;
  • communicates with the home CRS counselor, as needed, to maintain continuity of the consumer’s progress;
  • makes sure that funds are available and that the encumbrance complies with current policy (coordinates with the medical services coordinator assigned to the facility or region); and
  • confers, in accordance with policy, with the home counselor to decide which counselor will make a change in the services called for in the consumer’s IWRP. If the home CRS counselor is not available, contacts the manager of the home counselor for approval.

If a consumer requires services that are offered in an assigned service area that is not the assigned service area in which the consumer lives, a CRS courtesy counselor may do as follows for another CRS counselor:

  1. Enter information under Initial Contact in RHW (for instructions, see RHW Users Guide, Chapter 5 Initial Contact).
  2. Staff the case with the home CRS counselor.
  3. Assign the case to that CRS counselor in RHW (for instructions, see RHW Users Guide, Chapter 5 Initial Contact, 5.4 Assign Case) to create a system-generated action indicating that a case has been added to the assigned counselor’s caseload.
  4. Coordinate with the home CRS counselor to identify a time for the counselor to call in and participate with the application process or assessments.
  5. Complete the application with the consumer to ensure that it is documented in RHW, as required (for instructions, see RHW Users Guide, Chapter 10 Application).
  6. Explain that the home CRS counselor will work with the consumer to:
    • determine the consumer’s eligibility and complete the eligibility documentation in RHW (for instructions, see RHW Users Guide, Chapter 13 Eligibility);
    • conduct assessments;
    • develop the IWRP and complete the IWRP-related documentation in RHW (for instructions, see RHW Users Guide, Chapter 14 Plan); and
    • issue service authorizations for services, equipment, and related services
  7. Create a case note in RHW (for instructions, see RHW Users Guide, Chapter 7 Case Notes, 7.2.1 Adding a Case Note) describing the consumer; his or her disability; how, according to consumer, the disability is interfering with his or her independence, and other information that may help the CRS counselor understand the consumer's situation.
  8. Send an email to the CRS counselor informing the counselor of the referral; and
  9. Get completed releases of information.
  10. Create a paper file to include all medical information obtained from the consumer.

A courtesy counselor helps the home CRS counselor, as necessary, by:

  • documenting that the consumer agrees with the content of the IWRP or other documents;
  • delivering equipment; and
  • arranging services locally.

3.4 Responsibilities of the Medical Services Coordinator

The medical services coordinator (MSC):

  • reviews referral information and discusses with the counselor problems encountered, additional medical information needed, or related medical questions;
  • confirms the availability of comparable services and benefits, and seeks out other comparable services and benefits;
  • consults with CRS central office staff members;
  • informs the counselor about the estimated costs for medical services before encumbering funds;
  • discusses with the provider or the provider's staff members the payment allowances for related medical services;
  • coordinates services;
  • issues service authorizations;
  • communicates with the consumer, the counselor, and providers about ongoing services;
  • notifies the counselor, service provider, and the consumer if needed, about the date, time, and location for scheduled services;
  • provides the counselor with documentation on significant events in the medical services process;
  • approves claims for payment after deducting other payments;
  • processes documents on encumbrances for medical services;
  • maintains effective working relationships with CRS program staff members and the medical community;
  • recruits medical providers and consultants; and
  • serves as a resource to CRS program staff members in field offices when coordinating medical services for the consumer.

3.4.1 Medical Services Arranged by the Medical Service Coordinator

The medical service coordinator (MSC) arranges:

  • services provided by a hospital or ambulatory surgical center;
  • services for post-acute rehabilitation; and
  • evaluations and treatment provided by medical schools.

3.4.2 Procedures to Request Services of a Medical Service Coordinator

Complete the steps below to request the services of a medical service coordinator (MSC):

  1. Send an email message or delegate an action item to the assigned MSC. If you do not know who is assigned as the MSC, contact your manager.
  2. Enter a case note identifying the service to be arranged and the hospital or facility selected.
  3. Provide to the MSC:
    • pertinent medical records;
    • a completed DARS3101, Consultant Review (if applicable);
    • a completed DARS3110, Surgery and Treatment Recommendations (if applicable);
    • information about comparable benefits, including a copy of the consumer’s insurance card, Medicare or Medicaid documentation, and so on; and
    • information about the consumer’s prescriptions (if applicable).

Note: If necessary, the MSC uses the application, Individualized Written Rehabilitation Plan, and pertinent case notes in ReHabWorks and, when applicable, gets the necessary manager approvals.

  1. Confirm, when notified by the MSC, that there are adequate funds to cover the cost of the requested medical services and any unexpected medical complications.
  2. If contacted by a medical provider about services arranged by the MSC, refer the provider to the MSC.

Note: To arrange for out-of-region medical services, send an email message or delegate an action item, then enter a case note and send the information to your home MSC. If you are unsure who is assigned as your home MSC, contact a CRS central office staff member. The home MSC refers the request to the appropriate MSC for out-of-region service and asks the MSC to coordinate the requested medical services.

Refer to the Medical Services Required Practices Handbook for more information on the roles and responsibilities of the MSC and procedures for coordinating medical services for consumers.

3.5 Responsibilities of the Medical Services Technician

The role of the medical services technician (MST) is to perform advanced and complex technical support work using ReHabWorks to help the medical service coordinator (MSC) provide medical services to a consumer while establishing and maintaining appropriate business relationships with providers, consumers, and CRS program staff members.

The duties of an MST include:

  • providing information on the CRS program and services;
  • supporting the MSC in the delivery of services;
  • providing courtesy budget management;
  • purchasing goods;
  • monitoring consumer purchasing and using best business practices, as outlined in the CRS monitoring plan;
  • providing advanced levels of caseload management assistance to the MSC;
  • using automated systems; and
  • handling and safeguarding confidential information.

3.6 Responsibilities of the CRS Liaison Counselor

The primary responsibility of the CRS liaison counselor is to develop a positive working relationship with CRS providers. The CRS liaison counselor serves as a resource to the provider on issues pertaining to implementing standards, invoicing for services, addressing individual consumer case issues, and helping with other topics of mutual interest.

The CRS program manager assigns a liaison counselor to each provider. The CRS liaison counselor is the primary communication link between the provider and the CRS program.

The CRS liaison counselor must know about:

  • the provider and the services it provides for consumers;
  • the terms and conditions outlined in the provider’s contract; and
  • CRS policies related to provider operation and service delivery.

Duties of the CRS liaison counselor vary, according to the provider being served.

At least quarterly, the CRS liaison counselor must:

  1. spot check CRS case files to ensure compliance with CRS standards regarding reports, documentation, confidentiality, and so on;
  2. review any changes in staff;
  3. review any changes in the physical plant, with particular attention to safety factors and accessibility;
  4. review other safety and health issues, if applicable;
  5. address questions provider staff members may have about CRS policies and procedures;
  6. address with provider staff members any questions or concerns received from agency staff members; and
  7. review the provider's Unusual Incidents Reports, if applicable.

3.6.1 Documenting Quarterly Visits

The CRS liaison counselor:

  • documents quarterly visits on the DARS3821, CRP Liaison Counselor Quarterly Monitoring Summary;
  • maintains the summary in the CRS liaison counselor’s file; and
  • submits a copy of the form to the CRS program manager for review and analysis.

The CRS liaison counselor reports any significant irregularities or trends he or she identifies to the CRS program manager.

When a provider regularly provides three or more hours of service a day (for example, when providing post-acute brain injury (PABI), residential services), the CRS liaison counselor interviews 10 percent of the total number of consumers quarterly.

The CRS liaison counselor must immediately report to the home CRS counselor any concerns related to or raised by a particular consumer.

To ensure compliance with 24-hour supervision requirements, at least one of the liaison counselor's quarterly visits each year for residential providers must be unannounced and outside of normal working hours (for example, during evenings or weekends).

3.6.2 Providers with Permanent Locations for Delivering Consumer Services

If a CRS liaison counselor is assigned to a provider that maintains a physical location and serves CRS consumers in that location, the CRS liaison counselor must visit the location at least quarterly.

If a provider has not served consumers for an extended period, the CRS liaison counselor may request an exception to the regular quarterly monitoring cycle. The CRS program manager must approve a request for exception.

The CRS liaison counselor must copy the contract manager on communications containing exception requests and approvals.