Chapter 8: Individualized Written Rehabilitation Plan (IWRP)

8.1 Overview

This chapter outlines the important steps associated with creating an Individualized Written Rehabilitation Plan (IWRP), how to amend an IWRP, and when to perform a Joint Annual Review. The IWRP is an agreement of necessary services, identified funding sources, and description of goals between the consumer, the consumer’s representative, if any, and the counselor. The services agreed to in the IWRP are detailed and outlined policies are followed as they pertain to each service. Each IWRP is unique and is written to meet each consumer’s specific rehabilitation needs.

The assessment of the consumer’s rehabilitation needs drives the selection and delivery of services that will help the consumer prepare for his or her planned rehabilitation goals.

8.2 Defining Roles and Responsibilities

As in other partnerships, the Individualized Written Rehabilitation Plan (IWRP) should clearly define the roles and responsibilities of all partners. Review policies related to disability-specific responsibilities to ensure that the consumer is fully informed and the IWRP is developed in compliance with policy and the approved service array.

The role of the consumer is largely defined on the IWRP and must be adequately described so that the consumer can follow through successfully. The specific activities or tasks that the consumer is expected to complete must be objective and measurable; for example, acquire documented evidence that the consumer regularly attends physical therapy.

8.3 Creation of the IWRP

When creating the Individualized Written Rehabilitation Plan (IWRP) and using the template provided in ReHabWorks, select one or more of the following independent living goals: increased ability to perform self-care activities, increased mobility, and/or increased ability to communicate with others.

8.3.1 Intermediate Objectives

The intermediate objectives and services outlined on the Individualized Written Rehabilitation Plan (IWRP) must clearly support the achievement of the consumer’s independent living goals.

The IWRP decision-making process should include deliberation of:

  • the cost, accessibility, type, and duration of the services;
  • the consumer’s satisfaction with the proposed services;
  • the providers’ compliance with the Americans with Disabilities Act;
  • the qualifications of the service providers;
  • the setting in which the services are provided; and
  • the providers’ history of success with other consumers.

You document in a case note that the consumer or the consumer's representative made an informed choice and participated in the decision-making process.

8.3.2 Reasonable and Necessary Services

The Individualized Written Rehabilitation Plan (IWRP) may contain any of the following services that are reasonable and necessary for the consumer to reach his or her rehabilitation goal.

The specific services available, but not limited to, include:

  • comprehensive rehabilitation counseling and guidance;
  • physical therapy; occupational therapy, cognitive therapy, and speech therapy;
  • rehabilitation technology assessments and services, including telecommunication, sensory, and other technological aids and devices;
  • paraprofessional services;
  • physical restoration services, including corrective surgery or therapeutic treatments, prosthetic and orthotic devices, eyeglasses, and visual services;
  • transportation necessary to participate in the CRS program; and
  • recommended and prescribed durable medical equipment.

When discussing IWRP creation with the consumer, explain the CRS program best-value purchasing guidelines and the impact they may have on selecting the goods and services necessary to achieve the rehabilitation goal. You must provide each service in accordance with the policies that govern that service. Review the policies carefully before adding the service to the IWRP to ensure that the consumer's unique rehabilitation needs can be met.

8.3.3 Procedure to Develop the IWRP

Use the following procedure to develop the Individualized Written Rehabilitation Plan (IWRP):

  1. Before beginning services for CRS, you and the consumer (and/or the consumer’s representative) must complete a DARS5164, DRS Individualized Written Rehabilitation Plan (IWRP)—CRS. See 8.3.4 Items to Consider and Document When Completing the Individualized Written Rehabilitation Plan (IWRP).
  2. When completing DARS5164 and identifying the appropriate agreed-upon services, use detailed information outlining policy and indicate that services will be provided within the policy limits.
  3. Ensure that the dates on the IWRP realistically reflect the anticipated start and end dates of each service. The duration of the plan should adequately support both the individual services and the eventual rehabilitation outcome. For example, if the consumer is on the Waiting List and receives post-acute rehabilitation services, and you estimate that the consumer will not be removed from the waiting list for another month, address the dates accordingly.
  4. Review the entire IWRP with the consumer (and/or the consumer's representative) at least annually and perform a Joint Annual Review. See 8.10 Joint Annual Review for more information.
  5. Amend the IWRP, as necessary, with the consumer (and/or the consumer's representative) using DARS5160, CRS Individualized Written Rehabilitation Plan (IWRP) Amendment—CRS.
  6. Give a copy of the completed IWRP to the consumer (and/or the consumer’s representative).
  7. Inform the consumer and/ or the consumer’s representative that upon completion of the IWRP the consumer is now on the Waiting List. Provide the consumer and/or representative with the consumer’s number on the Waiting List and explain how to track the consumer’s progress on the waiting list.

8.3.4 Items to Consider and Document When Completing the Individualized Written Rehabilitation Plan (IWRP)

Consider the method by which the services are provided and the period in which the services will be implemented.

Services should be provided in the most integrated setting possible, and you may:

  • deliver them directly; pay for them or have the consumer pay for them;
  • arrange for them to be provided by a different organization;
  • coordinate them with options for cost sharing; or
  • use a combination of the methods above.

8.4 Funding, Comparable Benefits, and Exceptions

8.4.1 Identify the Appropriate Funding Source

When completing DARS5160, CRS Individualized Written Rehabilitation Plan (IWRP) Amendment—CRS and outlining services, you will identify and select the funding source.

Types of funding sources include the following:

  • Provided – A service provided directly by CRS program staff members.
  • Purchased – A service purchased with CRS funds.
  • Arranged – A service provided through a comparable benefit or resource.
  • Provided and purchased – A service that was both provided directly by CRS program staff members and purchased with CRS funds from another provider.
  • Provided and arranged – A service that was both provided directly by CRS program staff members and arranged through a comparable benefit or resource.
  • Purchased and arranged – A service that was both purchased with CRS funds and arranged through a comparable benefit or resource.

Provided, purchased, and arranged – A service that was provided directly by CRS program staff members, purchased with CRS funds from another provider, and arranged through a comparable benefit or resource.

8.4.2 Funding

Before using CRS funds, use comparable services and benefits. Do not delay services while an application for comparable services and benefits is pending.

Use CRS funds:

  1. for consumers who are currently receiving services for CRS;
  2. to assess consumers who are on the Interest List and Waiting List; and
  3. for all other consumers on the Waiting List who are ready for services.

8.4.3 Exceptions to Comparable Benefits

While assessing the availability of or applying for comparable benefits, purchase services only when one or more of the following circumstances exists:

  • The consumer's progress toward achieving the rehabilitation goal identified on the Individualized Written Rehabilitation Plan (IWRP) would be interrupted or delayed without the purchased service.
  • The consumer's medical condition is likely to deteriorate, unless the service is provided more promptly at another hospital or clinic. The treating or examining physician must document the likely deterioration of a condition.
  • The physician who already has a relationship with the consumer does not have privileges to perform the service at the facility where the comparable services and benefits are available.
  • Specialty facilities are required, such as facilities for traumatic brain injury, traumatic spinal cord injury, or brain surgery.

When a consumer is eligible for comparable benefits that are not yet available at the time needed to ensure the consumer's progress toward the rehabilitation goal, purchase those services until comparable services and benefits become available.

8.5 Documenting the Use of Comparable Services and Benefits

The exploration of and use of comparable services and benefits should be thoroughly documented throughout the case file. This includes documentation in ReHabWorks (RHW), in the form of case notes, service records, the consumer’s Individualized Written Rehabilitation Plan (IWRP), and the Closure Services page.

You must also keep in the consumer's paper case file copies of documents related to approval or denial of comparable services and benefits.

The following comparable benefits can be selected to document the use of comparable benefits when you develop service records, develop IWRPs, and complete the Closure Services pages in RHW:

  • Medicaid
  • Medicare
  • Worker's compensation medical benefits
  • Indigent health care services through the county
  • Private insurance
  • Veterans Administration hospitals or clinics
  • Scholarships
  • Other sources

Determine the consumer's responsibility for the cost of services. A consumer's eligibility for the CRS program does not depend on the consumer's income or liquid assets. However, if the consumer's net income or liquid assets exceed the basic living requirements, the consumer must participate in the cost of services, unless the:

  1. consumer receives Social Security disability benefits (Supplemental Security Income or Social Security Disability Income); or
  2. your manager grants an exception when the consumer's participation would prevent the consumer from receiving a necessary service.

8.6 Consumer “Client” Participation

To determine whether a consumer must participate in the cost of services and if the consumer has the financial ability to do so, use the following four-step procedure:

Step 1 - Determine the Requirement to Participate

When determining whether the consumer is required to participate in the cost of services:

  • consider the monthly net income and liquid assets of:
    • the consumer and the consumer's spouse; and
    • the consumer’s parents (or foster parents, legal guardian, or conservator), if the consumer's parents claims the consumer as a dependent for purposes of federal income taxes; and
  • compare the consumer's (combined with the parents’, if appropriate) monthly net income and liquid assets with the basic living requirement (BLR) levels. See Chapter 5: Application, 5.7 Basic Living Requirements for more information. 

Step 2 - If Consumer Refuses to Disclose Income

Consumers have the right not to disclose their financial information. However, when a consumer declines to provide this information, you must assume that the consumer has resources that exceed the BLR level after including any allowable BLR additions. In such a case, the consumer must fully participate in the cost of planned services, except for the costs listed in 8.7 Services Exempt from Consumer Cost Participation.

Step 3 - Get Proof of Income and Expenses

When a person applies for services, request documented proof of:

  • income (exclude any payment in-kind, such as food stamps or housing subsidies);
  • liquid assets (cash, plus assets that are easily converted to cash);
  • expenses; and/or
  • any allowable additions to the BLR.

See 5.6 Types of Income, Liquid Assets, and Required Proof.

A person eligible for Social Security disability benefits (Supplemental Security Income or Social Security Disability Income) must provide only proof of Social Security eligibility.

When a parent claims the consumer as a dependent on the parent's income tax, get proof of income and expenses from both the consumer and the consumer's parent.

Step 4 - Calculate the Consumer's Contribution

The amount that the consumer pays for goods and/or services is the amount that the consumer's liquid assets exceed the BLR level, after including any allowable BLR additions. The consumer pays the amount monthly.

The consumer must contribute the difference between the consumer's monthly net income and the BLR level after including any allowable BLR additions. The consumer's contribution must not exceed the cost of the goods and services.

Inform the consumer that failure to provide complete and accurate financial information violate federal and Texas law and results in a denial or delay of services.

If you determine that the consumer must participate in the cost of goods and/or services, then:

  1. inform the consumer that he or she must pay the service provider directly; and
  2. document in ReHabWorks that the consumer understands.

8.6.1 Documenting Consumer Participation

In the CRS program, consumer participation is reported as a service record with payment method type 'Arranged.' For instructions, see ReHabWorks Users Guide, Chapter 16 Case Service Record, 16.2.8.11 Creating, Updating, and Canceling Line Items When Payment Method Is "Arranged".

Be sure to:

  • select an appropriate Level 1-4 description, according to the documented service in the Individualized Written Rehabilitation Plan;
  • enter only "FCS 2017" in the Specification Description text box;
  • use only English (no other language) in the Specification Description text box;
  • select "Arranged" as the payment method; and
  • enter the date range for services for the entire quarter or remainder of a quarter—not for more than one quarter and not for crossing quarters.

This is the only circumstance in which service records are identified as "Arranged' in the CRS program.

8.6.2 Document Consumer Participation in a Service Record

Table: How to Build a Service Record to Document Consumer Participation.

Step

Process

Notes

1

Select Specification for Service Record

Open ReHabWorks.

Select "Case Management" from the top left corner of the menu.

Enter the case ID and select "search."

Select name of the consumer, which is hyperlinked.

Select "Case Service Records" from menu on the left side of the page.

Select "Service Record List."

Select "New" button.

Search by "Level 1-4 Description":

  • From the Level 1 Description, select the appropriate service.
  • From the Level 2 description, select the appropriate description based on the description selected in the previous step.
  • From the Level 3 description, select the appropriate description based on the description selected in the previous step.
  • From the Level 4 description, select the appropriate description based on the description selected in the previous step.

Select Search.

NOTE: Please select appropriate the Level 1–4 description according to the service documented in the consumer’s IWRP.

2

Select the appropriate service entered

Select the check box next to the service.

Select the "OK" button.

3

Enter the state fiscal year in the "Specification Description" text box

Enter only the following: "FCS 2017."

NOTE: Use English only, in the Specification Description text box. Do not enter any other language.

4

Enter the payment method

Select "Arranged."

NOTE: This is the only circumstance in which service records are identified as "Arranged' in the CRS program.

5

Search for a vendor

Select the search method.

Enter the information needed to search for a vendor.

NOTE: If you search by a vendor’s name, put an asterisk (*) at the end of the name.

6

Select a vendor

Select the desired vendor by clicking selecting the button to the left of the vendor’s name.

Select "OK."

7

Add a line item for service

Select "New Line Item."

8

Enter the dates of service

Enter the date range.

Select "OK."

NOTE: Select the date range for the entire quarter or for the remainder of a quarter. Do not create service records for more than one quarter and do not cross quarters.

9

Enter the quantity

Enter "1."

10

Enter the unit cost

Enter the calculated amount of the consumer’s participation.

11

Select the program

Select 2017 115 DRS CRS Comprehensive Rehabilitation Services.

12

Select the service category

Select the appropriate service category.

Select "OK."

13

Choose a line item

Select a line item by selecting the check box to the left of the appropriate item.

Select "OK."

14

Save the service record

Select "Save."

Select "Save" again.

8.6.3 Periodically Review the Consumer’s Proof of Income and Expenses

You must at least annually review the consumer’s income, liquid assets, and expenses and document the review results in a case note.

If the consumer's income, liquid assets, or expenses change significantly during the life of the case:

  1. reassess whether the consumer must still participate in the cost;
  2. document proof of the changes (if documentation is not available, note the reason in a case note);
  3. change the consumer's application; and
  4. document in a case note the reason for the change.

If you develop a consumer’s IWRP before you receive proof of the consumer’s income and expenses, do not include services that require consumer participation in the cost.

When you receive proof of the consumer’s income and expenses, amend the IWRP as needed.

8.7 Services Exempt from Consumer Cost Participation

Review with the consumer the extent of his or her agreement to pay for the cost of services.

Services exempt from consumer cost participation include:

  • an assessment to determine the consumer’s eligibility for services;
  • an assessment to determine the consumer’s rehabilitation needs, including associated maintenance and transportation;
  • rehabilitation-related counseling and guidance and referral for other services;
  • personal assistance services; and
  • any auxiliary aid or service (for example, interpreter services) that a consumer with a disability requires to participate in the CRS program.

Exception: Consumers eligible for Supplemental Security Income or Social Security Disability Income because of a disability are exempt from required cost participation. In addition, do not apply payment limitations. However, you must apply policy regarding use of comparable services and benefits.

8.8 Documentation to Providers

Once the Individualized Written Rehabilitation Plan (IWRP) has been completed, begin issuing referrals as needed. When issuing a referral to a service provider, include a copy of the consumer’s IWRP, along with other pertinent referral information that will help the provider assess the provider’s ability to meet the consumer’s needs. Sending complete information helps coordinate services between the consumer, providers, and the CRS program.

8.9 Amending the Individualized Written Rehabilitation Plan (IWRP)

As a counselor, you have considerable latitude in determining which services are reasonable and necessary to help the consumer reach his or her chosen rehabilitation goals. Therefore, there are circumstances in which you are required to make changes and amend the previously agreed-upon IWRP.

It is important to amend the IWRP every time you and the consumer agree on a substantial change in services. If an amendment is necessary, document the reasons in ReHabWorks. Explain the nature and scope of the changes being made to the objectives, services, or other parts of the plan and why they are necessary.

Before adding or changing the services called for in an IWRP, you must discuss with the consumer the specific policies related to the implementation of services and the approvals required.  

8.9.1 When to Amend an IWRP

Amend an Individualized Written Rehabilitation Plan (IWRP) when substantial changes are needed or when there is potential for misunderstanding about the consumer’s rehabilitation goals, services, and/or service providers.

Use the IWRP amendment in ReHabWorks. As with the original IWRP, the consumer may use alternate resources (for example, friends, family members, or private counselors) for the development process. The IWRP amendment is not in effect until you and the consumer agree to it and sign it.

After agreeing to and signing the IWRP amendment, provide a copy to the consumer or the consumer's representative.

8.9.2 Consumer Informed Choice

As when you and the consumer created the initial Individualized Written Rehabilitation Plan, provide the consumer with ample information about services and various providers. This will better enable the consumer to make an informed decision concerning services, methods of delivery, and providers.

8.9.3 Amending the IWRP When a Consumer Is Not Present

If the consumer cannot attend a meeting in person but agrees to an Individualized Written Rehabilitation Plan (IWRP) amendment, write the amendment and follow the procedures to electronically sign the amendment for the consumer. (See 5.10 Application Signatures for additional guidance.)

8.10 Joint Annual Review

The Joint Annual Review (JAR) is one of the most important tools in the counselor’s toolbox. The JAR is performed at least every 12 months. When performing a JAR with the consumer, review the consumer’s demographic information and the IWRP. Update any information that has changed. Review the consumer's progress in achieving the rehabilitation goal and determine whether you must set additional intermediate goals or adjust existing goals. Review the consumer's responsibilities and adjust as necessary.

Document the JAR in a case note in ReHabWorks. If the IWRP requires an amendment, explain how the changes are necessary to allow the consumer to achieve his or her rehabilitation goals.