Chapter 12: Closing a Case as Ineligible or before Determining Eligibility

12.1 Overview

This chapter explains what to do when closing a case as ineligible or before determining eligibility. Cases closed before determining eligibility may include cases that you have determined to be ineligible or cases needing to be closed before you are able to determine eligibility.

If you close the case before determining eligibility and you determine that the consumer may benefit from other resources, then refer them to other resources.

12.2 Closing a Case before Determining Eligibility

To close a case before determining eligibility:

  • notify the consumer(in writing, if the mailing address is known) that you are closing the case and that the consumer has a right to appeal (use the closure letter available in ReHabWorks);
  • ensure that the case file contains the justification for closing the case; and
  • use the appropriate reason for closure, as explained in the table in 12.3 Reasons for Closing a Case without Determining Eligibility. 

12.3 Reasons for Closing a Case without Determining Eligibility

Table: Reason for Closure without Determining Eligibility

Reason

Definition

Additional Closure Procedure

Death

 

No notification is required.

No Longer Interested in Services

The consumer chooses not to participate in or continue with services, or the consumer's actions (or lack of action) make it impossible for the consumer to begin or continue services. Examples include repeated missing appointments for assessment, counseling, or other services.

Make sure that the consumer is aware of the services that are available.

Advise the consumer that he or she may reapply for services in the future, if needed.

Incarcerated in Prison or Jail

The consumer is in a prison, jail, or other criminal correction facility.

Advise the consumer or the consumer’s representative that the consumer may reapply for services when the consumer is released.

Institutionalized

The consumer is in an institution such as a hospital, nursing home, or treatment centers).

Provide information about community-based services, when appropriate.

Other

Services may be denied or ended for other reasons. For example, the consumer has achieved independence at home and in the community without receiving substantial services for CRS.

Document the reason for closure.

Referred to Another Agency or Program

Services of another agency or other program are more appropriate.

Follow the procedures in Chapter 4: Initial Contact, 4.3 Outgoing Referrals to Other Resources or Vocational Rehabilitation Services. 

Transportation Not Feasible

Suitable transportation for accepting or maintaining rehabilitation is either not available or not feasible (for example, too costly, inaccessible, and so on).

Document:

  • that you considered transportation alternatives; and
  • the reasons that alternatives are not available or feasible.

Unable to Locate or Moved Out of State

Contact with the consumer is lost after repeated attempts by telephone and mail has failed over a reasonable period, and the attempts are documented.

Also used when the consumer moves out of state and gives little evidence of returning any time soon.

Document your attempts to contact the consumer over a reasonable period.

If the consumer moves to another state and additional services for CRS are necessary:

  • when possible, provide the consumer with information about the services for traumatic brain injury or traumatic spinal cord injury that are available in the state where the consumer is moving; and
  • provide the out-of-state agency with copies of appropriate case file materials, upon request.

After closing the case in ReHabWorks (RHW), complete and print the closure letter available in RHW and mail it to the consumer.

12.4 Closing a Case after Determining the Consumer Is Ineligible

Before closing any case as ineligible:

  • discuss with the consumer and/or the consumer's representative the reason for the closure;
  • ensure that the justification for the decision is fitting for the case; and

12.4.1 Ineligibility Letter

If the consumer does not meet the CRS eligibility criteria, check the appropriate box on DARS5108, CRS Ineligibility Letter (DARS5108 available only in ReHabWorks), and give the consumer a copy of the letter.

12.5 Reasons and Procedures for Closing a Case Because of Ineligibility

Table: Reason for Closing a Case as Ineligible

Reason Closed

Procedure

Severity of the Disability – The severity of the disability prevents the CRS program from helping the person function more independently at home and in the community.

Notify the consumer that the case is closed.

Send a letter to advise the consumer in writing about the decision and, if appropriate, refer him or her to another agency.

Other – Services may be denied or ended for reasons other than those described in this table.

Describe the reason for closure in a case note.

Notify the consumer that the case is closed.

Send a letter to advise the consumer in writing about the decision and, if appropriate, refer him or her to another agency.

Unable to Locate or Moved out of State

Document:

  • that repeated attempts to contact the consumer or the consumer’s family or representative by telephone and mail have failed over a reasonable period; and/or
  • that the consumer has moved out of state and explain why you believe there is no evidence that the consumer is going to return.

Consumer Is Not Functioning More Independently (valid after confirming eligibility) – You cannot verify that the consumer is functioning more independently at home and in the community.

Notify the consumer that the case is closed.

Send a letter to advise the consumer in writing about the decision and, if appropriate, refer him or her to another agency.

Services for CRS are Not Required

The consumer:

  • does not need services to function more independently at home and in the community;
  • is already receiving needed services or services are readily available without the CRS program arranging, coordinating, paying for, and/or providing the services; or
  • does not need CRS counseling and guidance.

Notify the consumer that the case is closed.

Send a letter to advise the consumer in writing about the decision and, if appropriate, refer him or her to another agency.

Refused Services – The consumer does not intend to follow through with the program.

Be certain that the consumer:

  • knows about available services; and
  • has consistently refused services.

Notify the consumer that the case is closed.

Send a letter to advise the consumer in writing about the decision and, if appropriate, refer him or her to another agency.

Failure to Cooperate -- The consumer fails to follow through with the program.

Document examples of failure to cooperate.

Notify the consumer about:

  • your intent to close the case; and
  • his or her right to appeal.

Send a letter to advise the consumer in writing about the decision and, if appropriate, refer him or her to another agency.

Institutionalized

The consumer:

  • entered an institution (such as a hospital, nursing home, or treatment center);
  • will not be available for services for an indefinite or considerable time; and
  • will not benefit from keeping the case open.

Provide information about community-based services and document the action in a case note, as appropriate.

Notify the consumer that the case is closed.

Send a letter to advise the consumer in writing about the decision. Describe the circumstances in the case notes.

Death

Contact the family only to reclaim equipment that the CRS program purchased. Be sensitive. Minimize disruption to the family.

Consult with the CRS central office program specialist about which items to reclaim.

Transferred to Another Agency or Program

When it is apparent that services from another program or agency are more appropriate than the CRS program:

  • discuss the transfer with the consumer;
  • discuss the case with the counselor from the other agency or set up an appointment for the consumer with the other agency, if appropriate; and
  • provide the other agency with any appropriate information requested.

Notify the consumer that the case is closed.

Send a letter to advise the consumer in writing about the decision. Describe the reasons for transfer in the case notes.

After closing the case in ReHabWorks (RHW), complete and print the closure letter available in RHW and mail it to the consumer.