Updated: 5/25
1601 Rehabilitation Technology
Rehabilitation Technology refers to the systematic application of technologies, engineering methodologies or scientific principles to meet the needs of, and address the barriers confronted by, individuals with disabilities. The term "rehabilitation technology" includes rehabilitation engineering services, assistive technology devices and assistive technology services. This section specifically addresses rehabilitation technology goods, services and purchasing issues in three main areas: assistive technology (Section 1602), home modifications (Section 1603), and vehicle modifications (Section 1604).
1602 Assistive Technology (AT)
Assistive Technology (AT) can be a powerful tool in providing vocational rehabilitation and independent living services to individuals with disabilities, and individuals with significant disabilities in particular. DORS fully supports the use of AT for consumers when it is deemed appropriate and necessary for assessment services and/or in order to achieve the goal specified in the Individualized Plan for Employment (IPE) or Independent Living Plan (ILP).
The
Assistive Technology Fact Sheet (RS-6q) shall be provided to consumers as early in the rehabilitation process as possible when it is suspected that AT may be a necessary component of the assessment process or of service delivery identified on the Individualized Plan for Employment (IPE).
1602.01 Terminology
The following terms have the meanings specified:
Assistive Technology Device – Any item, piece of equipment or product system, whether acquired commercially off the shelf, modified or customized, that is used to increase, maintain or improve the functional capabilities of an individual with a disability. Within this array, there are both high- and low-tech solutions that can be applied to assist individuals with disabilities achieve both employment and independence.
Assistive Technology Service – Any service that directly assists an individual with the identification, selection, acquisition or use of an assistive technology device. Such services may include, but are not limited to, evaluation, assessment, customization, coordination and training.
1602.02 Philosophy & Basic Assumptions – AT Service Provision
Informed Choice – The informed choice of the applicant or eligible individual is a critical factor in all aspects of rehabilitation, including the entire process of assessing, selecting, purchasing and training in the use of AT. When individuals are fully involved in the assessment and selection process, they are more likely to fully utilize the devices that are provided, thus increasing the chance for success. Although DORS will not always be able to purchase every service or device an individual requests, as such services need to be deemed appropriate and necessary, thorough discussions should take place with the applicant or eligible individual regarding their concerns, priorities and preferences. Applicants and eligible individuals may also exercise informed choice in the selection of AT assessments, service providers, vendors, services and devices. This is especially important if the individual has specific knowledge and experience with AT.
Early Application – For best results, AT needs to be considered and applied as early as possible in the rehabilitation process. In order to most effectively participate in certain evaluations or career assessments, the assessment and application of AT may be a necessary first step, and may occur prior to IPE/ILP development. Also, full exploration of the various vocational options which could be accessed through AT is important when choosing an employment goal. Because of technological advances, AT provision may be a continuous process throughout the life of the individual’s case with DORS. It is expected that the closer the individual moves toward the rehabilitation goal, the more specific the AT applications will become, as there will be a better understanding of the specific work tasks involved.
Provision Prior to Employment – If it is anticipated that there will be a gap between completion of skills or technology training and obtaining employment, consideration shall be given to provision of assistive technology at the completion of training so that the individual has continued ready access to the equipment and can maintain skills developed during training. If suitable equipment is not available through a loan closet or other available resources (see g and h below), rental or purchase shall be considered.
Training and Follow-up – While assessing an individual’s needs for AT, training needs may also be apparent and should be addressed. It is most beneficial to arrange pertinent training as soon as possible after the AT is recommended and provided. It is also important to periodically assess the appropriate usage, possible need for training or retraining, and continued relevance of the AT once it is issued. Such review must occur at the time of annual review of the plan or amendments of the IPE/ILP, and at the time of closure, and should also be addressed at other times during service provision as needed.
Assessment Environment – AT assessments are most effective when they are conducted in the environment in which they will be utilized (e.g., a classroom or work site), when this is practical and beneficial. When it is not practical to complete the assessment in the natural environment, a simulation of the environment and the specific tasks to be accomplished is the preferred approach.
Continuity of Service – AT services, including assessment, customization and training, should occur with the same service provider, if possible and practical, and if it is consistent with the individual’s informed choice.
Loan Closet Usage – DORS maintains a loan closet of AT devices through the Workforce & Technology Center (WTC) Rehabilitation Technology Services (RTS) department. Through this service, devices can be tried, used and returned when no longer useful or applicable to a specific individual. This service may be especially helpful when timeliness is an issue. DORS staff should communicate the philosophy of the loan closet to the individual, so that they will feel encouraged to help others by returning equipment that is no longer utilized.
Other Available Resources – DORS staff should inform the individual of other available resources for AT information and funding, including the Maryland Technology Assistance Program (MD TAP) and the Guaranteed Loan Program.
1602.03 Prescribed Assistive Aids and Devices
Telecommunications, sensory and other assistive technological aids and devices which are commonly obtained on the basis of a prescription will be purchased by DORS only with individualized prescriptions and fittings and only from licensed, approved professionals. Technical assistance will be obtained from DORS’ RTS staff or Occupational/Physical Therapy staff whenever experimental aids or devices are being considered for purchase.
1602.04 Assistive Technology Provided without an Assessment
When determined to be appropriate by the DORS counselor, there are a number of AT solutions that may be purchased without an evaluation or prescription. When determining the need for an assessment, the counselor should take into consideration the individual’s prior experience and knowledge of AT. The counselor is encouraged to consult RTS when questions arise regarding whether or not an assessment would be necessary or beneficial.
Except as noted in
Section 1602.04, the counselor may purchase assistive technology without an assessment when:
The device/product costs less than $2,500.
A medical prescription is not required.
Services are not to be provided for use at a worksite.
Services do not involve networked computers.
Such purchases are subject to other applicable agency policy regarding delegated authority and supervisory approval.
Examples of AT that can be purchased without an assessment include: notetaking devices, magnifiers, CCTVs, signaling/alerting devices, assistive listening devices, computer hardware and software, augmentative communication devices, and environmental control units.
When purchasing assistive technology without an assessment, the counselor will still be mindful that DORS will assist with the least cost solution that meets the needs of the individual.
1602.05 Smartphones
Description – A smartphone is a mobile phone offering advanced capabilities often with PC-like functionality. Most smartphones support full featured email capabilities with the functionality of a complete personal organizer. Other functionality might include internet capabilities, a built-in camera, built-in navigation, media software for playing music, browsing photos and viewing video clips. Smartphones, therefore, provide the personal digital assistant (PDA) functions that serve as assistive technology to certain persons with disabilities but go well beyond those functions to act as a miniature computers with phone capability.
Assessment required – A smartphone may be provided to an eligible DORS consumer under the terms of an IPE if the technology purchase is supported by an assistive technology assessment that specifies the individual’s circumstances related to his/her functional impairments and the training and/or employment setting that will be supported by the use of this technology. The AT assessment findings shall explicitly document the need for a smartphone rather than a PDA or other AT.
Monthly service charges/extended warranty – DORS will not be responsible for the monthly cost of the phone/internet service and will not be responsible for any extended warranty that is purchased for a smartphone.
Purchase/Approval – In addition to completion of an AT assessment justifying the need for a smartphone, review and approval of Regional Management is required. The Regional Director will consult with the RTS manager in these instances.
1602.06 Computers as AT – Policy and Procedure
Provision of computers and associated hardware and software as adaptive equipment will be considered only when it has been demonstrated that:
The eligible individual has a significant or most significant disability with functional limitations affecting communication, cognitive, vision, or motor skills; and
The computer and associated hardware and software are prescribed primarily to increase, maintain, or improve the functional capabilities of the individual; and
The computer and associated hardware and software are essential for the assessment and/or training of the individual or the microcomputer is an essential and permanent device for the independent vocational adjustment or independence of the individual.
1602.07 Referral for AT – Computer Assessment
When it has been determined by the counselor that the individual has met the criteria in
Section 1602.04, the DORS counselor has the option to proceed with equipment purchase consistent with
RSM 3, Section 1000, Purchase Policy and
RSM 3, Section 1100, Purchase Procedures. The individual may already have specific recommendations from their school system or another professional which could be utilized for AT purchase. If the counselor determines that an AT assessment is required or would be beneficial, a referral for assessment may be made to RTS or to an approved community provider of AT services.
Referrals to approved community providers of AT services shall be made in accordance with procedures established by the provider. Referrals to RTS shall be made in accordance with the following:
The DORS counselor shall complete a WTC service authorization in accordance with procedures outlined in
Section 1200. The counselor will include the reason for the referral, and forward pertinent medical, assessment and other relevant information.
The RTS case manager will contact the counselor to discuss the proposed assessment based on information provided, if needed.
When assessments are to be conducted by RTS staff at a location other than WTC, RTS staff will recommend procedures to be followed.
The appraisal/consultation will include a review and analysis of the individual’s functional skills and limitations. A written summary of the service, resulting recommendations, and any related specifications will be forwarded by RTS staff to the referral source.
1602.08 Subscription & Insurance Costs for AT
DORS will not be responsible for the monthly cost of phone/internet service and will not be responsible for the cost of any insurance for assistive technology.
1603 Home Modifications – Policy and Procedures
A limited range of home modifications may be provided if required by the DORS consumer to achieve the employment goal on an approved IPE.
The DORS Financial Need policy applies to home modifications (see
RSM 3, Section 1400)
Administrative approval (see
RSM 3, Section 1005) is required for all home modification services, at all funding levels.
All home modification services must be included on an IPE and an
Administrative Approval (RS-9h) is completed.
Home modification services may be provided, consistent with the following policy and procedures.
1603.01 Scope and Nature of Services Which Can be Provided
DORS will provide funding only for home modifications that meet the consumer's accessibility needs and, to the extent possible, fully comply with the current ADA Accessibility Guidelines. Modifications funded by DORS will include the least-cost means of safely addressing the disability needs of the individual without structural changes to the home, and use of standard construction grade materials. Upgrades or changes in construction plans once solicitation for bids has begun will not be considered, provided, or paid for by DORS.
Unless prevented by exclusions within
Section 1603.02 or restriction in
Section 1603.03 below, home modifications to a residence of an eligible individual may be authorized to the extent necessary to facilitate:
Entry and exit – Modifications may be authorized to the extent necessary for one exit/entrance to a residence. Examples include exterior door widening and provision of a ramp or lift, including modification of approach, door handle and lock, ramp and porch railings, and other related features.
Access to bathroom facility and kitchen – Modifications may be authorized to the extent necessary for an individual to enter and use a single home bathroom or kitchen. Examples include widening of the door and installation of such items as grab bars, ADA-compliant sink, toilet, roll-in shower enclosure, and assistive devices designed to facilitate use of sink, shower, bathtub, or kitchen facilities. A roll-in shower enclosure may only be considered if it does not involve fundamental alterations to the physical structure, and is not located in a unit within a multi-unit or multi-dwelling building.
Access within the residence – Modifications to non-bathroom and kitchen areas may be authorized to the extent necessary for an individual to move freely and independently within the residence to assist the individual in performing the essential activities of daily living in order to achieve an employment goal. Reconfiguration of house space may be recommended instead of modifications if those modifications would pose a safety concern or would require structural changes. Modification examples include interior door widening, installation of a stair lift or similar equipment, and installation of other adaptive equipment that is required for access to essential areas of the home but do not require structural changes to the home.
Questions about whether a specific requested modification falls within the scope of services which can be provided shall be referred to DORS Office Directors through supervisory channels.
1603.02 Excluded Services
DORS shall not authorize:
Services which directly or indirectly involve the purchase of land, construction of a permanent building, or the construction of an addition to a permanent building.
Fundamental alterations to the infrastructure of a residence including but not limited to removal or addition of load-bearing walls, creation of new rooms, or replacing existing electrical or other structural systems.
Repair or replacement of home modifications included and covered in an existing warranty or insurance policy.
Funding for home modifications that do not fully comply with current ADA Accessibility Guidelines.
Funding for new home modifications in the individual's residence within 10 years after previous residential modifications have been completed as certified by the DORS Agency Architect, unless warranted by a new RTS accessibility assessment and DORS determines that exceptional circumstances exist.
Modifications to a second bathroom or kitchen when there is an existing accessible bathroom or kitchen in the residence that meets the accessibility needs of the consumer, as determined by a DORS Occupational Therapist and Agency Architect.
A roll-in shower enclosure when the bathroom is located within a residence in a multi-unit or multi-dwelling building (i.e., condominium or apartment building).
Bathroom or kitchen accessibility modifications which require fundamental alterations to the physical structure, layout, or both will
not be considered by DORS. Fundamental alterations to the physical structure, layout or both of the bathroom or kitchen include:
Altering, moving, or rearranging the layout of a sink, shower, toilet, drain, or water conveying pipe or line.
In-floor and under-floor structures and infrastructure, or in-wall work to rework the plumbing or vent stack.
1603.03 Restrictions on Services
Home modifications shall be considered for property not owned by the individual served by DORS or the family of that individual only in exceptional circumstances. Provision of such services requires Central Office approval, through supervisory channels, as soon as the
Residential Modifications – Preliminary Information (RS-6u) form is complete and prior to the RTS assessment (see
Section 1603.07).
For individuals who have accessibility issues regarding rental property, the counselor will assist the individual in exploring:
- Responsibility of property owners according to the ADA.
- Alternate, accessible housing.
- Referral to community resources for housing assistance.
Home architectural modifications requested for an individual with an employment goal of home-based self-employment will be considered by DORS only if included as part of an approved business plan (see
Section 1400).
1603.04 Initial Request for Home Modifications – Procedures
The DORS counselor shall discuss with the consumer the need for the requested home modifications and how they relate to the disability factors and the employment.
The DORS counselor shall provide and review the policies and procedures related to the provision of home modifications, including provision and review of the
Home Modifications Fact Sheet (RS-6m).
The DORS counselor shall discuss with the consumer the consumer's responsibilities if proceeding with a home modification assessment and potential home modification:
Work cooperatively with the counselor during the initial exploration of the requested modifications, providing accurate information about the dwelling and other factors.
Annual financial participation toward modifications may be required if modifications are approved and funded by DORS. Financial participation will be determined according to the Financial Need Policy (see
RSM 3, Section 1400).
Maintain, insure, repair and provide upkeep to the modifications in keeping with any relevant warranties. In addition, individuals are responsible for obtaining and paying for maintenance, service and repairs for modifications which are no longer under warranty. DORS does not fund repairs to modifications.
When a consumer has requested home modifications, the DORS counselor will discuss the request with the supervisor and jointly determine if a home modification assessment is appropriate.
If the request is beyond the scope of home modification services DORS can provide, consider:
Referral to community resources, including Centers for Independent Living, Development Disabilities Administration and Department of Aging.
Referral to special loan programs which may assist the individual in purchasing home modifications.
1603.05 Preliminary Information – Referral to RTS for Assessment – Procedures
If the consumer continues to be interested in pursuing home modifications services, the DORS counselor shall obtain the following information regarding home accessibility issues and residence information using the
Home Modifications – Preliminary Information (RS-6u) form:
Nature of the disability, stability/prognosis, functional limitations and restricted activities.
Description of requested modifications.
Any current or previous home modifications, including any related warranty documents.
Ownership of the residence.
Any home warranty coverage documents which may be related to the modification request.
Age and general condition of the residence.
Safety issues/concerns related to the requested modifications.
Whether the individual plans to relocate in the foreseeable future.
Community covenants, zoning issues, neighborhood association, condominium association, historic district restriction, or other restrictions that may influence modifications.
The DORS counselor shall attach the signed
Home Modifications – Preliminary Information (RS-6u) form to AWARE™.
The DORS counselor shall draft an IPE amendment to include the following Planned Services:
- WTC RTS Assessment for Potential Modifications – Assessment for Home Modifications.
- WTC RTS Assessment – OT Evaluation
The DORS counselor shall obtain consumer’s signature on the draft amended IPE and assure that the consumer knows that the IPE will be in Draft until approved by Regional management.
The DORS counselor shall request review and approval for the home modification assessment by the supervisor and Regional management.
If the home modification assessment is approved by Regional management, DORS Central Office will be asked to draft a WTC Service Authorization for
WTC RTS Assessment for Potential Modification – Assessment for Home Modifications and
WTC RST Assessment – OT Evaluation.
1603.06 Role and Responsibility of the Consumer
It is the responsibility of the consumer to:
Work cooperatively with the DORS counselor during the initial exploration of the requested modifications, providing accurate information about the dwelling and other factors.
Participate financially toward modifications approved and funded by DORS according to the Financial Need Policy (RSM 3, Section 1400).
If it is determined that the consumer has an annual financial participation that is to be applied to the home modifications according to the sliding scale of the DORS Financial Need Policy, arrangements must be made with the DORS Program Income Office for the payment of the participation prior to project initiation.
Maintain, insure, repair and provide upkeep to the modifications in keeping with any relevant warranties. In addition, individuals are responsible for obtaining and paying for maintenance, service and repairs for modifications which are no longer under warranty.
1603.07 RTS Coordination of Home Modifications – Procedures
RTS is responsible for coordinating home modification services for DORS. This is accomplished through:
RTS staff, including Occupational Therapists and rehabilitation technologists with related specialties.
DORS-approved providers/vendors, to include physical and occupational therapists, contractors and construction specialists who have provided appropriate credentials to DORS (see
RSM 3, Section 1007, Vendor/Provider Approval).
For DORS consumers pursuing home modification services, RTS responsibilities include the following:
Coordination of appropriate assessment services, to assure that proposed modifications are consistent with DORS policy, that the consumer can use proposed modifications, that proposed modifications are feasible within the home, and that proposed modifications are consistent with any covenants, zoning or other restrictions.
Development of construction specifications and drawings for the modifications.
Assistance to the consumer/homeowner in presenting plans for requested modifications to homeowner associations and/or other entities, as applicable.
Coordination of the bid process with DORS Procurement staff.
Monitoring of the construction, including addressing any requested change orders.
Coordination of final inspection upon completion, to include counselor and/or supervisor.
1603.08 RTS Home Modification Assessment
RTS will coordinate an on-site modification assessment which will include an Occupational or Physical Therapist, along with the DORS Agency Architect. The counselor and/or supervisor shall also attend. During the site visit, the OT/PT will determine the consumer’s physical capacity and needs. The DORS Agency Architect shall make an assessment of the residence to determine if proposed modifications appear feasible from a construction standpoint.
If the property is governed by a neighborhood entity, RTS staff shall contact the "entity" to provide preliminary information about DORS and the home modification process as well as learn the scope and role of the entity in approving home modifications.
As required, a "Location Survey with Spot Elevations" will be completed to determine the feasibility of the proposed home modification. The authorization for this service shall be a Central Authorization.
The Agency Architect and OT/PT shall submit their reports (Architect’s report titled
WTC RTS Assessment for Home Modification; OT/PT report titled
WTC RTS Assessment-OT Residential Modification Report) to the DORS counselor indicating the home accessibility issues related to the consumer’s physical needs and the feasibility of modifications to overcome the barriers in the home. A cost estimate for the home modification will be included in the Agency Architect’s report. If CADD drafting will be required in order to provide appropriate detail for bidding and construction purposes, that service and its costs will be included in the Agency Architect’s report. The reports will also outline the next steps in the process toward a home modification.
1603.09 Modifications – Procedures
If the DORS counselor is in agreement with proceeding with home modifications as outlined in the RTS and OT reports, the counselor shall request Administrative Approval by using the
Administrative Approval (RS-9h) form. On page 1 check the box for Home Modifications. If the RTS report indicated the cost to be over $10,000.00, check the box for "Costing over $10,000.00. In the "Comments/Additional Information" section please add updated employment information relative to the request for home modifications.
Draft an amendment to the IPE to include the following planned services:
-
Service Category: "Modifications"
-
Description - Home Modifications
-
Costs (for this estimated dollar amount, refer to the Home Modification Assessment report)
-
Service Category: "WTC RTS Modifications"
-
Description - Facilitation for Home Modification
-
Costs (see Fee Schedule)
If Administrative Approval is obtained at the appropriate Administrative Management Level (refer to the
Administrative Approval Desk Reference), the following WTC Service Authorization will be drafted by DORS Central Office.
- WTC RTS Modifications – WTC Facilitation for Home Modifications:
If CADD drafting work was recommended in the
RTS Home Modification Assessment Report, a Central Authorization will also be required for that service.
Once the authorization for
WTC RTS Modifications – WTC Facilitation for Home Modification is received, the Agency Architect will proceed with the development of construction specifications and drawings. If CADD drafting work is necessary, the Agency Architect will coordinate the development of the construction specifications and drawings with the CADD drafting company. The Agency Architect shall take into account all relevant factors, including covenants, neighborhood association standards, historic district restrictions, and condominium association requirements.
The DORS counselor and RTS staff will meet with the consumer, in the consumer’s home, to review the construction specifications and drawings. The consumer will be asked to approve the specifications and drawings by signing the
Property Owner Approval (RS-6z) form. RTS staff will attach the signed
Property Owner Approval (RS-6z) form to AWARE™.
RTS staff will send the home modification specifications, drawings and Bid Form to Procurement for soliciting Bids/Quotes.
1603.10 Identification of Contractor/Competitive Bidding
DORS Procurement Policy and Procedures (RSM 3, Section 1000 and
Section 1100) and State Procurement regulations apply to home modification services.
If the estimate for the modifications is $15,000 or less:
DORS Procurement shall obtain at least three quotes from contractors for the work specified.
DORS Procurement shall send copies of the quotes to RTS staff for technical analysis.
RTS staff shall evaluate the bids and determine the lowest acceptable bid. RTS will send an award letter to the Counselor stating who the winning contractor is and the actual cost of the home modification.
DORS counselor/supervisor shall technical edit the "Modification" service on the IPE if the cost is 10% or greater than the original estimate.
DORS Procurement shall provide justification, in consultation with the Administrative & Financial Services (AFS) Director, if it is recommended that DORS use other than the lowest bidder.
DORS Procurement shall draft the contract for the winning contractor and obtain signatures from the contractor.
After the signed contract is received from the contractor, DORS Procurement will sign the contract; execute it and email it to the contractor.
Authorizations for Home Modifications will be issued by DORS Central Office once the contract has been drafted by DORS Procurement.
If the estimate for the modifications is over $15,000, DORS Procurement will solicit for bids on eMaryland Market Place and then follow the same steps as indicated for
Section 1603.10a.
If the estimate is over $50,000, the award will need Control Agency approval. Contracts that are over $50,000 are also subject to Attorney General signature. Furthermore, if it is a single bid of over $50,000 it will require Board of Public Works (BPW) approval.
Once the Contract has been executed RTS staff will develop the
Home Modifications Services Agreement (RS-6v), which spells out exactly what work will be done, the name and contact information for the contractor, the anticipated start date and completion date of the work, and responsibilities of the consumer. This form includes the official approval of the homeowner/ consumer for completion of the work at his/her residence. It also includes the requirement that any change in work described in the home modification specifications and drawings as agreed to via signatures on the
Home Modifications Services Agreement (RS-6v) requires prior written approval of DORS, facilitated by the RTS supervisor, and may require a modification of the contract.
RTS staff will review the
Home Modifications Services Agreement (RS-6v) with the consumer/homeowner and obtain required signatures, scan the Agreement into AWARE™ and advise the DORS counselor of its completion.
1603.11 Installation of Modifications
The Agency Architect/assigned RTS staff shall closely monitor the installation of modifications that are not fundamental alterations and associated construction, through intermittent and scheduled visits. The DORS counselor and RTS management will be advised of any concerns or problems encountered, regarding installation, materials, or time frames. Any change in the work described in the home modification specifications and drawings as agreed to via signatures on the
Home Modifications Services Agreement (RS-6v) requires prior written approval of DORS, facilitated by the RTS supervisor, and may require a modification of the contract.
1603.12 Completion of Modifications
The Agency Architect/assigned RTS staff shall conduct intermittent and a final inspection of modifications.
The consumer and DORS counselor and/or supervisor shall be present at the final inspection.
Upon completion of the work as described in the home modification specifications and drawings as agreed to via signatures on the
Home Modifications Services Agreement (RS-6v), the consumer, counselor and Agency Architect/assigned RTS staff shall meet at the project sight for a final inspection and homeowner/consumer signature on the
Home Modifications Final Inspection & Approval (RS-6w) form.
Home Modifications Final Inspection & Approval (RS-6w) form shall be attached to AWARE™ by RTS staff.
A final report will be submitted to the counselor which will summarize the home modification service and include photographs of the completed project.
1604 Driving Rehabilitation & Vehicle Modification Services
The Driving Rehabilitation and Vehicle Modification Program provides adapted driving evaluations, training in an adapted vehicle, and vehicle modifications to privately owned vehicles of DORS consumers who have an IPE. These services should enable individuals to achieve a competitive employment outcome by removing barriers to transportation, and should be addressed as early in the rehabilitation process as possible. The process of evaluation, training, and modifications can take up to 18 to 24 months. DORS does not purchase vehicles.
Note: Please refer to
Section 1604.06 for definitions of Terminology used within this policy. Also, refer to
Attachment 1600-1, Driver Rehabilitation and Vehicle Modification Procedures, and
Attachment 1600-2, Non-Adapted Driving Procedures, for detailed procedures.
1604.01 Determine Eligibility for Driving Rehabilitation & Vehicle Modification Services
Prior to consideration of provision of vehicle modifications, the DORS counselor shall:
Confirm that driving assessment and training services are necessary for a consumer’s personal transportation to/from employment or training/educational program, or is required as a part of their job duties.
Take into account the consumer's practical access to public or private transportation systems, including the ability to navigate to and from bus stops, paratransit scheduling and reliability, and time involved in traveling via public or private systems. DORS shall consider providing modifications to vehicles for an individual only with the justification that public or private systems are not available or would not substantially meet the individual's needs to safely transport to and from work or training, as required to achieve an employment outcome consistent with the consumer’s IPE.
Modification of a private vehicle shall be authorized only if it is the most cost-effective modification necessary for a consumer’s personal transportation to/from employment or training/educational program, as specified on the consumer’s IPE.
1604.02 Vehicle Purchases
The counselor shall inform the consumer that a vehicle intended for modification
should not be purchased until directed to do so by the RTS Driving Program Staff Specialist, following successful completion of
Attachment 1600-1, STEP 1 through STEP 7, and the consumer’s IPE has been amended to include the estimated costs of the vehicle modifications, as outlined in
Attachment 1600-1.
1604.03 Policy Requirements for All Vehicle Modifications
Read carefully before proceeding to
Attachment 1600-1:
Relationship to the Rehabilitation Goal – Vehicle modifications may be included in the IPE if those modifications are required to maintain employment or attain a vocational/employment goal, and required Administrative Approval has been obtained.
Completion of the Driving Assessment Determination & Justification (RS-6x) form with the consumer during a face-to-face meeting. Required prior to Administrative Approval for a Behind-the-Wheel Adapted Driving Assessment.
Completion of the Pre-Adapted Driving Consultation with RTS staff and the consumer.
Administrative Approval Requirement – DORS assistance with the purchase of adapted driving services and/or vehicle modifications will be provided only when pre-approved by a DORS Senior Management official. Each of the following services must be approved at specific stages of the rehabilitation process. The consumer’s IPE shall be amended, consistent with the procedures outlined in
Attachment 1600-1:
Behind-the-Wheel Adapted Driving Assessment - Car or Van (see
Attachment 1600-1, STEP 1 and
STEP 2)
Adapted Driving Equipment Training in an Adapted Car or Van, Licensing Day Training, VEAPA-Vehicle Consultation and VEAPA-Estimate (see
Attachment 1600-1, STEP 3 through STEP 6)
Vehicle Consultation-Vehicle Purchase, Pre-Bid Conference Consultation, Vehicle Modification Procurement, Fittings and Post-Modification Training (see
Section 1604.05 and
Attachment 1600-1, STEP 7)
Type of Vehicle – DORS provides vehicle modifications only to vehicles meeting National Highway Traffic Safety Administration (NHTSA) safety standards. Modifications to vehicles other than a standard sedan, van or minivan require prior approval of the AFS Director, who will explore the safety and necessity of such vehicles.
Consumer Financial Responsibility – The consumer must demonstrate that she or he currently owns a vehicle or has the financial means to purchase a vehicle and maintain, repair, and insure the vehicle and the proposed modifications, as identified on the adapted driving assessment report. The DORS Financial Need policy applies to vehicle modifications (see
RSM 3, Section 1400).
Vehicle Purchase –
DORS does not purchase vehicles.
Pre-Installed Modifications in New and Used Vehicles – A DORS consumer may choose to purchase a new or used vehicle which already includes some modifications. The cost of the vehicle and pre-installed modifications shall be the sole responsibility of the individual/family. In the event additional modifications are required, DORS may consider purchase of such modifications consistent with policy and State procurement regulations.
No Upgrades – Vehicle modifications funded by DORS will include the least-cost means of safely addressing the disability needs of the individual necessary for a consumer’s personal transportation to/from employment, training, or educational program as described in the Vehicle Equipment and Adaptation Prescription and Agreement (VEAPA).
Frequency – Vehicle modification services may be provided to an individual no more frequently than once every 10 years.
Approved Mobility Dealer Vendors – Vehicle modifications purchased by DORS shall be installed by a DORS-approved vendor who is NMEDA/QAP certified.
Wheelchair Requirements:
DORS will not modify a consumer’s vehicle if the consumer is within one year of getting a new wheelchair. Consumer can participate in an adapted driving assessment and begin adapted driving equipment training; however, that training will not be finalized until consumer has participated in the adapted driving equipment training in the new wheelchair.
DORS will not modify a consumer’s vehicle if there is not adequate back, neck and head support as determined by a Driver Rehabilitation Specialist (DRS) or Certified Driver Rehabilitation Specialist (CDRS).
Post-modification Training – All consumers receiving vehicle modifications must participate in post modification training. The DRS/CDRS will indicate the recommended number of training hours based on how long it has been since the consumer has driven a vehicle and how complex the modifications are. No consumer can take possession of their vehicle until they have received post modification training with their DRS/CDRS.
Vehicle Modification Insurance – Individuals who are provided vehicle modification services are encouraged to obtain, at their own expense, replaceable value insurance on such modifications, in addition to their vehicle insurance (see
Section 1604.04, Excluded Services, below).
Warranty/Maintenance – When modifications are covered by a warranty, consumers shall require the vendor to repair or replace defective equipment within the time frame specified in the warranty. DORS shall not be responsible for the ongoing maintenance of modifications it has provided to vehicles.
1604.04 Excluded Services
Purchase of vehicles.
Modifications to a vehicle if the individual owns or has use of another vehicle which would meet the individual’s transportation needs.
Modifications to a vehicle not owned (i.e., leased) by the individual or the individual’s family.
Modifications to a vehicle for an individual to drive if the results of a comprehensive driver’s evaluation indicates that the individual is not capable of driving due to the individual’s disability.
Mid- or high-tech modifications to a vehicle if the vehicle is more than three years old or has more than 36,000 miles on the odometer.
Low-tech modifications to a vehicle if the vehicle is more than five years old or has more than 50,000 miles on the odometer, unless a Full Maryland State Vehicle Safety Inspection confirms that the vehicle is mechanically and structurally sound. Exceptions to the age and mileage of the vehicle requires approval of the DORS Director in addition to a copy of the current (within the last six months) Maryland State Vehicle Safety Inspection Certificate.
Reimbursement to a consumer or family member for the cost of modifications purchased by the consumer or family.
Upgrades will not be considered, provided, or paid for by DORS.
DORS will not correct or replace vehicle modifications that have been damaged or destroyed in an accident.
DORS will not correct or replace vehicle modifications that have been damaged or destroyed by mechanical or electrical accessories installed post modification.
DORS will not assist with funding or reimburse for any pre-installed modifications purchased with a new or used vehicle.
DORS does not fund extended warranties or repairs to modifications.
1604.05 Procurement
State of Maryland Procurement Regulations and DORS Purchasing Policy – State of Maryland Procurement Regulations and DORS Purchasing Policy regarding purchase approval apply to vehicle modification services (see
RSM 3, Section 1000 – excluding
Section 1009.04).
1604.06 Terminology
ADED, Inc. – ADED is the Association for Driver Rehabilitation Specialists that was established in 1977 to support professionals working in the field of driver education/driver training and transportation equipment modifications for persons with disabilities through education and information dissemination. ADED offers certification for driver rehabilitation specialists.
Behind-the-Wheel - Car - Adapted Driving Assessment – This assessment is done in an adapted car to determine if and/or what type of adaptations are necessary for an individual to drive a car. During the adapted driving assessment the consumer is given a vision screening, brake reaction test, and two hours of "Behind the Wheel (BTW)" time with the Driving Rehabilitation Specialist (DRS) or Certified Driving Rehabilitation Specialist (CDRS). During the BTW time, the DRS/CDRS determines what, if any, adapted equipment is necessary in order for the consumer to drive safely. The combination of the results from the BTW assessment and the Clinical Pre-Driving Assessment (PDA) determine a consumer’s ability to drive safely. Driving Assessments are only valid for one year.
Behind-the-Wheel - Van - Adapted Driving Assessment – This assessment is done in an adapted van, instead of a car, to determine if and/or what type of adaptations are necessary for an individual to be able to drive. Consumers needing this type of assessment are usually in wheelchairs and cannot independently transfer and/or stow their wheelchair in a car. They may need to drive from their wheelchair or from a power transfer seat. Driving Assessments are only valid for one year.
Clinical Pre-Driving Assessment – During the Clinical Pre-Driving Assessment an Occupational Therapist (OT) administers physical, perceptual, cognitive, motor and reaction assessments that help to predict an individual’s capability to drive. This is required with an Adapted Driving Assessment. This assessment is a two-hour appointment and is required for individuals who have "MVA Reportable Conditions" (see below for definition). Driving Assessments are only valid for one year.
Drivers’ License with Adapted Equipment Restrictions – If the DORS consumer needs adapted equipment in order to drive safely and they have their Learners Permit, certificate of completion for the 30-hour classroom and six-hour BTW, as well as the 60 hours of practice; their DRS/CDRS will take them for the driver skills test at the MVA in the DRS’s adapted vehicle. If they pass the test they will obtain their Maryland State Driver’s License without the "J" restriction for "MUST BE ACCOMP BY REHAB/DRIVE INSTR," meaning that they no longer need to drive with a DRS/CDRS. However they will have adapted driving equipment restrictions listed on their license relative to the type of vehicle modifications they need to use in order to drive.
Driver Rehabilitation Specialist (DRS) and Certified Driver Rehabilitation Specialist (CDRS) – Specially trained individuals who are able to conduct evaluations of consumers’ physical, cognitive and behavioral abilities to drive and determine what if any adapted equipment would be necessary to drive or travel in a vehicle safely. Some DRS are certified by the Association for Driver Rehabilitation Specialists (ADED) and therefore have the credential of CDRS, or Certified Driving Rehabilitation Specialist.
Full Maryland State Vehicle Safety Inspection – A full Maryland State Vehicle Safety Inspection, performed at an authorized Inspection Station by a certified mechanic, is required if the consumer has an existing vehicle that they want DORS to fund vehicle modifications for, that exceeds the age and mileage limits indicated above in (e) and (f). For used mini and full-sized vans, as well as trucks and SUV’s, the inspection shall include the underbody structure below the sliding door or dual opening, and the rear springs. DORS fee for this service is up to $100.
High-Tech Van Modifications – For people with extremely limited functional physical abilities who are able to drive through a variety of advanced technological solutions, including electronic gas/break and steering (e.g., joystick and secondary controls (turn signals, wiper/washer, horn, headlights, AC/heat, etc.). Vehicle conversions are also in this category. A six-month lapse between the consumer's most recent driving session with the DRS/CDRS and the initiation of the DORS Procurement process will necessitate a new Driving Assessment.
Licensing Day Training – Once the consumer has received their letter from the DWS approving them to schedule their license test, the DRS/CDRS will provide brush-up training just before taking the test. The number of hours needed for this brush-up training can be found in the Adapted Driving Assessment and/or Adapted Driving Equipment training reports. Consumers who require low-tech driving equipment can take the driver skills test in their own adapted vehicle.
Low-Tech Modifications – Usually refers to spinner knobs, mechanical hand controls and pedal guards. No fully electronic driving systems. A six-month lapse between the consumer's most recent driving session with the DRS/CDRS and the initiation of the DORS Procurement process will necessitate a new Driving Assessment.
Maryland Motor Vehicle Administration (MVA) Recognized Reportable Conditions – See
Attachment 1600-3, MVA Reportable Conditions.
Mid-Tech Van Modifications – For people who can use mechanical equipment for braking and acceleration instead of fully electronic gas/brake, and minor adaptations to OEM equipment such as reduced or no-effort steering to make it easier to steer. Mid-tech usually involves a conversion which includes lowering a floor and installing a ramp. Mid-tech adaptations can also include remote secondary controls, such as blinkers, wipers, etc. No electronic driving systems. A six-month lapse between the consumer's most recent driving session with the DRS/CDRS and the initiation of the DORS Procurement process will necessitate a new Driving Assessment.
Mobility Equipment Dealer - Mobility Equipment Dealers install adapted driving equipment and work in collaboration with mobility equipment manufacturers, van conversion companies, and DRS/CDRS to provide a seamless vehicle modification based on a DRS/CDRS-issued prescription/VEAPA.
MVA Driver Wellness and Safety Division (DWS) – The DWS division is comprised of administrators and nurse case managers who review all medical and psychological information as well as Driving and Clinical Assessment and Adapted Equipment Training Reports to determine the consumer’s fitness for driving.
MVA Medical Advisory Board (MAB) – The MAB is composed of physicians from various medical specialties. The MAB may provide additional review of case materials if requested by the DWS Nurse Case Manager. They are available to provide advice for the DWS division.
NMEDA – NMEDA is a non-profit trade association of mobility equipment dealers, driver rehabilitation specialists, and other professionals dedicated to broadening the opportunities for people with disabilities to drive or be transported in vehicles modified with mobility equipment. All members work together to improve transportation options for people with disabilities.
NMEDA Quality Assurance Program (QAP) – The NMEDA QAP is the only nationally recognized accreditation program for the adaptive mobility equipment industry. The purpose of the program is to ensure the products and services provided by Quality Assurance Program (QAP) accredited locations meet or exceed customer needs and current government safety requirements. It is based on the principle that in order to satisfy customers consistently, companies must have a systematic and documented approach to quality. The program was developed to elevate the level of performance to reliably meet consumers’ personal transportation needs in the safest manner possible.
NMEDA Manufacturer Quality Assurance Program (MQAP) – The NMEDA MQAP was developed by NMEDA as a quality assurance program for equipment and conversion manufacturers. The primary objective of the program is to assure that all modified vehicles and mobility equipment produced by NMEDA members are safe and reliable. This assurance is achieved by independent review of motor vehicle safety standard compliance data including crash test results for accessible vehicle manufacturers. For mobility equipment installers and dealers, MQAP designation assures that the product being installed or sold meets applicable Federal and Canada Motor Vehicle Safety Standards (F/CMVSS) and contains all the hardware and instructions necessary for proper installations. For end users, the MQAP designation provides confidence in knowing the vehicle or mobility product is safe, has been installed by, and will be serviced by manufacturer certified technicians.
Original Equipment Manufacturer (OEM) – This refers to the vehicle and its systems as they are designed by the original manufacturer (e.g. Toyota, Honda, Chrysler, Dodge).
Passenger-Only Evaluation – An evaluation of a consumer who will NOT drive, but will be transported by another private party in the consumer’s vehicle. This type of evaluation will determine the best method and/or equipment required for entry/exit into the vehicle and/or transportation of his/her mobility aid.
Pre-Adapted Driving Consultation - The RTS staff will schedule a meeting with the DORS counselor and the consumer to review the driver rehabilitation and vehicle modification process, and ensure the consumer has the time and financial abilities to proceed through the process. The counselor will be provided a report based upon the consultation, including an updated
Driving Assessment Determination & Justification (RS-6x) form and guidance on updating or amending the IPE with accurate Adaptive Driving services.
Pre-Bid Conference Consultation - For complex and/or customized adapted driving equipment project solicitations a pre-bid conference may be recommended by the DRS/CDRS. The pre-bid conference will be held with the consumer, DRS/CDRS, RTS staff and mobility equipment dealers/bidders. This meeting is held to assure that the mobility dealers who are considering placing a bid, get a chance to speak to and see the consumer and DRS/CDRS. This allows the bidders to ask for clarifications on the specifications written in the VEAPA. The consumer can demonstrate their need for accessibility to the bidders. This will help the bidders to place more accurate bids and lessen the chance for the need for “change orders” in the middle of vehicle modification projects. DORS may provide funding for the DRS/CDRS to attend the pre-bid conference. If the pre-bid conference is “in-person”, DORS may also fund travel expenses for the DRS/CDRS.
Pre-Installed Modifications – A vehicle that already has modifications, such as a lowered floor and ramp. DORS will not reimburse for modifications/adaptations already in consumer’s vehicle at the time of purchase.
VEAPA (Vehicle Equipment Adaptation Prescription and Agreement) – This is a prescription generated by the DRS/CDRS who did the driving assessment and training with the consumer and is submitted to the RTS Driving Program Staff Specialist. VEAPAs are only valid for one year. The RTS Driving Program Staff Specialist uses the VEAPA that is written in Microsoft Excel format to write the RTS Facilitation-Adaptive Driving Process Report defined below.
VEAPA-Vehicle Consultation – Vehicle consultation involves the DRS/CDRS and the consumer going to look at vehicles at mobility equipment dealers to determine which vehicle make, model and year would be the best fit for the consumer prior to the consumer purchasing a vehicle. This service is provided after completion of Adapted Driving Equipment Training and/or after licensing.
Vehicle Consultation-Vehicle Purchase - This service provides compatibility checks between the consumer’s desired vehicle and the adapted driving equipment recommended by the DRS/CDRS. The service involves the consumer shopping and sending a VIN# for their desired vehicle, and the DRS/CDRS contacting adapted driving manufacturers to confirm vehicle combability based on the VIN#. This service can only be provided after “Vehicle Modifications” are included on a dated and issued IPE.
Vehicle Modifications – Vehicle modifications are any mechanical or structural changes to a passenger car or other motor vehicle that permits an individual with a disability to safely drive or ride as a passenger. A six-month lapse between the consumer's most recent driving session with the DRS/CDRS and the initiation of the DORS Procurement process will necessitate a new Driving Assessment.
Vehicle Modifications Fitting – The DRS/CDRS who wrote the Adapted Driving Assessment report and the VEAPA will travel to the modification vendor’s location to meet the consumer and ensure the vehicle modification fits the consumer and the consumer is able to safely drive the vehicle with the new adaptations/equipment.
Vehicle Modifications Justification – AWARE™ case notes will indicate that the counselor has discussed all available local public and private transportation resources which may meet the transportation needs of the consumer (see
Section 1604.01). Vehicle modifications will be provided only when pre-approved by a DORS Senior Management official, using the Administrative Approval process.
Vehicle Modifications Post-Modification Training – Consumers receiving DORS funded vehicle modifications must participate in adapted driving equipment training, in their newly modified vehicle, prior to taking possession of it. The number of hours required for this training will be prescribed by the DRS/CDRS.
WTC RTS Facilitation-Adaptive Driving Process Report – This document will be submitted to the DORS Counselor and will include a list of the DRS/CDRS-recommended adapted equipment identified on the VEAPA, as well as the estimated cost of the project. This document will be used by the DORS Counselor to seek Administrative Approval and amend the IPE in order to proceed with modification of a consumer’s vehicle.
WTC RTS Assessment for Potential Modification – Facilitation-Adaptive Driving Process-Vendor – This is a service provided by the RTS Driving Program Staff Specialist who will provide guidance to the consumer and DORS Counselors throughout the many phases of the driving rehabilitation process.
WTC RTS Assessment for Potential Modification – Facilitation-Adaptive Driving Process-WTC – This is a service provided by the RTS DRS/CDRS who is working with the consumer. The assigned RTS DRS/CDRS will provide the consumer and DORS counselor with guidance throughout the many phases of the driver rehabilitation process.
WTC RTS Modifications – Facilitation for Vehicle Modification – This is a service provided by the RTS Driving Program Staff Specialist and staff to assist DORS field counselors through the DORS Procurement and vehicle modification process.
1605 Non-Adapted Driving Services
The Non-Adapted Driving Program provides driving assessments to include a Non-Adapted Vehicle: Clinical Pre-Driving Assessment conducted by an Occupational Therapist (OT) and Non-Adapted Driving: Behind-the-Wheel (BTW) Assessment and BTW Driver Training by a Driving Rehabilitation Specialist (DRS) or Certified Driving Rehabilitation Specialist (CDRS) for individuals who do not require adaptations to drive a vehicle.
Note: Please refer to
Section 1605.04 for definitions of terminology used within this policy. Also, refer to
Attachment 1600-2, Non-Adapted Driving Services Procedures, for detailed procedures.
1605.01 Determine Eligibility for Non-Adapted Driving Services
Consumers meeting the following criteria may be referred for non-adapted driving services:
Driving assessment and training services are necessary for a consumer’s personal transportation to/from employment or training/educational program or is required as a part of their job duties.
If the consumer’s disability is a
reportable condition according to the MVA (see
Attachment 1600-2, STEP 3 for details), and if the consumer’s disability does not involve physical impairment to their hands, arms, shoulders, feet, legs, hips, and/or balance, which may indicate the need for adapted equipment.
If the consumer’s disability is not a reportable condition and does not require adapted equipment.
The consumer has access to a vehicle and access to another licensed driver/mentor who is over the age of 21 and has held a license for a minimum of three years. The MVA requires 60 hours of supervised practice with the mentor.
1605.02 Vehicle Purchases
DORS does not purchase vehicles.
1605.03 Non-Adapted Driving Services Procedures
See
Attachment 1600-2.
1605.04 Terminology
Non-Adapted Vehicle: Clinical Pre-Driving Assessment – During the Pre-Driving Clinical Assessment an Occupational Therapist (OT) administers physical, perceptual, cognitive, motor and reaction assessments that help to predict an individual’s capability to drive. This is required with an Adapted Driving Assessment. This assessment is a 2-hour appointment and is required for individuals who have MVA Reportable Conditions (Attachment 1600-3).
Driver Rehabilitation Specialist (DRS) and Certified Driver Rehabilitation Specialist (CDRS) – Specially trained individuals who conduct evaluations of consumers’ physical, cognitive and behavioral abilities to drive and determine what if any adapted equipment would be necessary to drive or travel in a vehicle safely. Some driver rehabilitation specialists are certified by the Association for Driver Rehabilitation Specialists (ADED) and therefore have the credential of CDRS, or Certified Driving Rehabilitation Specialist.
