Montana. Legislature. Legislative Audit Division.

Vocational Rehabilitation Program, Department of Public Health and Human Services : performance audit report (Volume 1997) online

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Employment outcomes - if services provided were necessary, if
MVR services contributed significantly to the employment outcome,
and if the consumer agreed with the closure.

Individual Written Rehabilitation Programs - were jointly developed
with and agreed to by the client, goals, objectives and services were
based on client capabilities, and comparable benefits were con-
sidered and utilized when available.

Eligibility - eligibUity determination was made within 60 days, there
was documentation of an existing physical or mental impairment
which results in a substantial handicap to employment, the client re-
quired MVR services to prepare for, enter, engage in or retain gain-
fiil employment, and comprehensive assessments were completed.

Case closure - client was notified of case closure, the Client
Assistance Program, and the appeals process.

Our work complemented the federal review in two areas — timeliness
of eligibility determination, and establishing goals, objectives, and
services based on a client's capabilities. In both cases the federal
review findings and our findings are similar. These issues are
discussed in detail in Chapter IV.



Page 4



Chapter I - Introduction



Data Limitations



DPHHS maintains a computer system to gather client data. When
we compared information in the files to information on the computer
system we found inconsistencies in some areas. Some problems
were due to the inflexibility of the computer system. For example,
the computer would not accept dates on the input forms which were
prior to the date the information was actually entered onto the
system, so actual application and closure dates could not be entered.
Also, if a case was closed before all the bills were paid, the case had
to be reopened under another status.



We also found differences between information in the counselor
notes and what the counselor wrote on the input form. We found
some categories on the input form were completed incorrectly or not
always completed.

Because of problems found concerning accuracy of some information
on the computer system, we limited the use of DPHHS's computer
information in this report. The numbers identified in the report are
based on our file review.

A new computer system was installed in July 1996, after we
completed the majority of our field work. We sent a memorandum
to the department prior to implementation of the new system
discussing the inconsistencies we found in the old system.
Department staff indicated many of the problems discussed were
addressed with the new system.



Management
Memorandum



During the course of the audit we presented recommendations to
program management which, if implemented, we believe could
result in improvements in program efficiency and effeaiveness.
These memorandums allowed DPHHS to be aware of our audit
issues prior to the end of audit work. Department staff agreed with
all reconmiendations discussed in the memorandum.



We also sent a management memorandum to DPHHS containing
recommendations which were minor relative to other issues
addressed in the report. The memorandum recommended:



Pages



Chapter I - Introduction



►■ Establishing policy and procedures for assignment of case files
in the event a counselor is on vacation, on extended leave of
absence, or there is a position vacancy. Written procedures
would help ensure supervisors are aware of the need to assign
cases when counselors are absent.

► Developing policies and a system to help counselors identify
files that should be closed. Written policies and a formalized
system would help ensure files are closed in a timely manner.

•■ Developing policies and procedures to help counselors
consistently categorize client files at closure.

►• Updating the policy and procedure manual to identify and
define policies, current purchasing limits, purchasing forms,
and documentation requirements.

MVR management indicated new policies addressing the above
recommendations are in draft or final status.



Report Organization Chapter n provides information about the Montana Vocational

Rehabilitation Program's history and answers our first audit
objective concerning the types of individuals the program serves.
Chapter III provides a summary of program efficiency and
effeaiveness. Chapter IV discusses the process used to serve clients
from application through case closure. Purchases of goods and
services are described in Chapter V. Chapter VI summarizes our
findings on organizational controls and program success and
effectiveness.



Page 6



Chapter II - Vocational
Rehabilitation Background



Introduction



Program History



The Montana Vocational Rehabilitation (MVR) Program is located
within the Disability Services Division in the Department of Public
Health and Human Services (DPHHS). MVR provides services to
persons of employable age, with physical or mental disabilities, and
helps restore them to gainful employment.

In 1947, the Montana Legislature created the Division of Vocational
Rehabilitation to administer the Vocational Rehabilitation Program
established under the federal Social Security Act. The division was
responsible for: 1) providing rehabilitation services to the state's
physically and mentally handicapped; and 2) performing disability
determinations for Social Security disability benefits and
supplemental income payments.

By 1965, federal amendments eliminated economic need as a
prerequisite for vocational rehabilitation (VR) services. If desired,
states could require economic need tests for some services purchased
after the person is determined eligible for vocational rehabilitation.
When economic need tests are conducted, VR counselors review
client financial information to determine if the client has the
financial resources to help pay for services VR is purchasing. An
example of a service in which a client would participate would be
tuition and books for a college education. Montana chose to require
an economic needs test.

The most recent change to the Act is the 1992 Rehabilitation Act
Amendments. Tliis change made adjustments to the principles,
purpose, process, and outcomes of VR programs. The 1992
amendments emphasize the importance of appropriate services and
support to people with disabilities to achieve employment outcomes.
These amendments require:

- Assisting an individual to make informed choices concerning
potential employment outcomes.

•• Development of an Individual Written Rehabilitation Program
(IWRP) with the full participation of the person with the
disability.



Page?



Chapter II - Vocational Rehabilitation Background



State Plan and State
Advisory Council
Required



► Need to match what is outlined in the IWRP with appropriate
services and support.

► Cooperative working relationships with other agencies and
programs including local education authorities to coordinate
transition services.

►■ Emphasizing quality of services provided to persons with a
disability.

►• The eligibility decision must focus on use of existing data, and
eligibility must be made within 60 days unless mutually agreed
upon between the individual and the VR counselor.

► Establishing the eligibility process as two parts: 1) determine if
the person has a disability and 2) determine if the person
requires assistance from VR to achieve an employment
outcome.

The Rehabilitation Act requires each designated state agency to
submit a State Plan every three years. The State Plan is an
agreement between the federal government and a state regarding
program administration and conduct. In the Montana State Plan,
DPHHS commits to maintaining written policies and procedures, and
compliance with federal requirements and mandates.



The Rehabilitation Act also requires states to have an advisory
council associated with their rehabilitation programs. The
Vocational Rehabilitation Advisory Council is associated with the
MVR Program. The purpose of the Advisory Council is to advise
the administrator of the MVR Program concerning policy and
program issues, delivery of services to consumers, and methods for
reaching potential consumers. Council functions include reviewing,
analyzing, and advising the MVR Program relative to implementa-
tion of both state and federal statutes which affect provisions of
rehabilitation services to persons with disabilities. The council
consists of 17 people who either have disabilities, represent disabled
groups, represent the business community, or have an interest in
disability issues. Council members are appointed by the Governor,
serve a term of not more than three years, and may not serve more
than two consecutive terms.



Pages



Chapter II - Vocational Rehabilitation Background



Advice Sought From
Associated Groups



Program EUgibility
Criteria



In addition to the Council, MVR staff seek advice from many
different groups and agencies. MVR works closely with the Client
Assistance Program, Council of State Administrators of Vocational
Rehabilitation, Job Training Partnership Act Private Industry
Councils, Social Security district offices, and the Disability Deter-
mination Unit. It is also the responsibility of regional MVR offices
to coordinate with local community rehabilitation programs, parents'
groups, school district personnel, and private businesses.

The mission of the MVR Program is "Promoting work and
independence for Montanans with disabilities." In order to achieve
this mission, MVR provides goods and services to people of an
employable age with physical or mental disabilities to help them
secure and maintain employment The federal government
established 16 years old as an employable age.



An individual is eligible for VR services if they meet two specific
criteria: 1) an individual must require vocational rehabilitation
services to prepare for, enter, engage in, or retain gainful
employment; and 2) the individual must either:

A. Have a physical or mental impairment which constitutes or
results in a substantial impediment to employment, and can
benefit in terms of an employment outcome from vocational
services; OR



B.



Be blind or have a disability and be eligible to receive
Supplemental Security Income (SSI) or Social Security
DisabUity Insurance (SSDI). (These individuals are also
considered to have severe physical or mental impairments which
seriously limit one or more functional capacities in terms of
employment outcomes.)



TTiere are no minimum or maximum income requirements to be
eligible.



Page 9



Chapter II - Vocational Rehabilitation Background



Goods and Services MVR provides counseling and guidance, vocational evaluation, and

Provided Vary vocational placement services without cost to an eligible person. In

addition, MVR may pay the cost of other vocational rehabilitation

goods and services for an eligible person in financial need.

Vocational rehabilitation goods and services purchased by MVR

include:

Medical diagnosis - medical and psychological records, exams, and
evaluations.

Vocational evaluation - assessment of eligibility and vocational
rehabilitation needs.

Rehabilitation training - personal and vocational adjustment training
including job coaching, work adjustment training, transitional
employment services, and orientation and mobility services for the
blind.

Educational training - college, vocational education and trade school
tuition, books and supplies, tutoring, interpreter services for the
deaf, and reader services for the blind.

Vocational placement - job finding, employer contact and
negotiation, job accommodation, and job placement.

Occupational licenses - professional licenses such as electrical,
plumbing, nursing, cosmetology, and teacher exams and certificates.

Occupational tools and equipment - mechanic tools, cosmetology
supplies, computer equipment and supplies, and other equipment and
supplies for self-employment.

Rehabilitation technology services - assistive technology devices
including telecommunication, sensory, and other technological aids
and equipment.

Phvsical and mental restoration - corrective surgery or therapeutic
treatment, prosthetic and orthotic devices, eye exams and eye
glasses, ear exams and hearing aids, dental exams and dental work.

Page 10



Chapter II - Vocational Rehabilitation Background

transplantation and dialysis, and diagnosis and treatment for mental
and emotional disorders.

Personal assistance - personal care attendant services.

Family services - any necessary services for family members in
support of the client's rehabilitation including day care and respite
care.



Specialized Services
Provided to Individuals
Not Able to Enter
Competitive Employment



Maintenance - additional costs incurred while participating in
rehabilitation such as clothing, hair cuts, living expenses, and food
and lodging if travel is needed for evaluation.

Transportation - gas, vehicle repairs and modification, vehicle
insurance, parking permits, bus passes, and moving expenses.

Post-emplovment services - services after successful job placement
for the purpose of maintaining employment.

For those clients not able to enter competitive employment, MVR
can also provide independent living, supported employment, and
extended employment services. Independent living services include
making housing handicapped accessible, services for daily living
activities (cooking, cleaning, shopping), and transportation services.
Supported employment is for individuals with severe disabilities who
traditionally have been unable to enter competitive employment
because of an impediment, or competitive employment was
interrupted as a result of a severe disability. Supported employment
does not require the client receive minimum wage. However, the
person must be paid wages on a basis consistent with wages paid to
non-disabled workers with similar job functions. Extended services
are ongoing support services, such as job coaching, which is needed
to support and maintain a person with a severe disability receiving
supported employment.



Page 11



Chapter II - Vocational Rehabilitation Background



Services Delivered from
Regional Omces



Services are delivered to clients from ten offices across the state.
The following map identifies the four vocational rehabilitation
regions in Missoula, Great Falls, Butte, and Billings, and the
satellite offices in Kalispell, Havre, Warm Springs, Bozeman,
Helena, and Miles City.



Figure 1
Montana Vocational Rehabilitation Regions




* Region Office

• Satellite Office



Source: Compiled by the Legislative Audit Division from MVR records.



Page 12



Chapter II - Vocational Rehabilitation Background



Program Staffing



Counselors comprise the majority of fiiU-time equivalents (FTE) in
the region offices. Each area has a Regional Administrator
overseeing region staff. The other management positions are located
in the Helena central office. Table 1 identifies the breakdown of
staff in the Helena central office and the four regions.



Table 1

Vocational Rehabilitation FTE Distribution

(Fiscal Year 1994-95)



Office/Region


Management*


Counselors**


Administrative
Support


Total


Central Office


6.75


0.00


2.00


8.75


Great Falls Region


1.00


7.50


4.50


13.00


Butte Region


1.00


9.50


5.00


15.50


Missoula Region


1.00


9.50


5.75


16.25


Billings Region


1.00


11.50


5.50


18.00


Total MVR Staff


10.75


38.00


22.75


71.50


* The management column represents all program officers in Helena and regional

administrators.
** The counselors column includes counselor supervisors since they carry a client

caseload.



Source: Compiled by the Legislative Audit Division from MVR records.



Program Funding and
Expenditures



MVR is funded by state and federal funds. State funds consist of
both General Fund and state special revenue. Table 2 identifies
MVR funding sources and expenditures for state fiscal years 1992-93
through 1994-95.



Page 13



Chapter II - Vocational Rehabilitation Background



Table 2

MVR Program Funding Sources and Expenditures

(Fiscal Years 1992-93 through 1994-95)



Fund Sources


1992-93


1993-94


1994-95


Federal


$7,547,960


$8,177,204


$ 7,827,277


State General


1,304,241


1,817,486


1,978,983


State Special


645,875


340,960


200,266


Total Expenditures


$9,498,076


$10,335,650


$10,006,526



Source: Compiled by the Legislative Audit Division from
MVR records.



State special revenue funds declined over the three fiscal years due
to switching funding from the Workers' Compensation Industrial
Accident Rehabilitation Account to state General Fund.



Mjyority of

Expenditures for Client
Benefits and Claims



Over 70 percent of fiscal year 1994-95 expenditures were for client
benefits and claims. Table 3 shows total expenditures for the MVR
Program for fiscal year 1994-95 by area of expenditure.



Page 14



Chapter II - Vocational Rehabilitation Background



Table 3

MVR Expenditures bv Category

(Fiscal Year 1994-95)



Category


Amount


Percentage
of Total


Personal Services
Operating Expenses
Equipment and Intangible Assets
Benefits and Claims


$ 2,244,694

411,875

27.520

7.322,436


22.4
4.1
0.3

73.2


Total Expenditures:


$10,006,525


100.00



Source: Compiled by the Legislative Audit Division from
Statewide Budgeting and Accounting System
records.



Federal Section 1 10 funds, which require a 21.3 percent state match,
fiind the majority of program administration and benefit costs.
Other MVR federal funding sources include Supported Employment,
Job Training Partnership Act (JTFA), Independent Living
(90 percent federal). Migrant and Seasonal Farm Worker, and
MonTech funds. State funding includes General Fund for Extended
Employment (100 percent) and Independent Living (10 percent), and
state special revenue for Workers' Compensation.

The funds are used to provide different types of goods and services
to clients. The following lists the funds and their uses:

Section 1 10 - vocational evaluations, counseling and guidance,
training and education support, physical and mental restoration, job
placement, and post-employment services.

Su pported Employment - time limited support services to people
with severe disabilities.

JTPA - training clients over age 22.



Page 15



Chapter II - Vocational Rehabilitation Background



Extended Employment - long-term job support for severely disabled
people who work in sheltered or supported employment.

Workers' Compensation - Workers' Compensation cases that are
also MVR clients.

Independent Living - helps support disabled people to allow them to
maintain independent living situations.

Migrant and Seasonal Farm Worker - provides support to disabled
migrant and seasonal workers.

MonTech - funding for a contract to provide information and
referral services as well as purchase technology-related devices for
people with disabilities.

Table 4 represents expenditures for benefits and claims for clients by
type of funding source for fiscal year 1994-95.



Table 4
MVR Benefits and Claims Expenditures for Goods and Services Purchased

(Fiscal Year 1994-95)



Funding Source


Total
Expenditures


Percent
of Total


Federal
Funds


State
Funds


Federal/State
Percentage


Section 110


$4,918,366


68


$3,870,754


$1,047,612


78/21


Supported Employment


297,421


4


297,421





100/0


JTPA


253,665


3


253,665





100/0


Extended Employment


487,783


7





487,783


0/100


Workers' Compensation


96,957


1





96,957


0/100


Subtotal Benefit Expmditures


6,054,192


83


4,421,840


1,632,352


73/27


Other funds: MonTech,
Independent Living, Migrant


1,268,244


17


1,142,596


125,648


90/10


Total Benefits Expenditures


$7,322,436


100


5,564,436


1,758,000


76/24



Source: Compiled by the Legislative Audit Division from Statewide Budgeting and Accounting
System records.



Page 16



Chapter II - Vocational Rehabilitation Background

The other funds, such as MonTech, Independent Living, and
Migrant and Seasonal Farm Workers, can be utilized by any person
with disabilities, not just MVR clients.



Types of Sampled
Clients Served by
Montana Vocational
Rehabilitation Program



We compiled client demographics from a random sample of 150
client files. The files reviewed were cases closed in fiscal year 1994-
95. The following sections provide client information gathered
during the file review.



Applicant Gender and Age



Our sample of 150 files were comprised of 90 males and 60 females.
The individual ages ranged from 17 to 70 years with the majority
being between 21 and 40. Table 5 identifies the number of
individuals in our sample in six age groups.



Table 5
Age of Ap plicant Sample Receiving MVR Services



Age Group


Number in Sample


— ,

Percentage of
Sample


17-20


16


11


21-30


41


27


3 MO


47


32


41-50


32


21


51-60


12


8


61-70


2


1


Total


150


100



Source: Compiled by the Legislative Audit Division from
MVR records.



Paget?



Chapter II - Vocational Rehabilitation Background



Occupation at Last
Employment



If provided on the application, we gathered the applicant's last
occupation prior to applying for VR services. Based upon input
from the Montana Department of Labor and Industry, we separated
occupations into six categories.

Service - Janitors, nurses, waitresses., etc.

Clerical - Clerks, cashiers, etc.

Trade - Meat cutters, electrical helpers, construction workers, etc.

Agriculture - Forest service, orchard caretakers, ranch hands, etc.

Student - Someone in high school.

Unemploved

Most applicants come from service industries. Table 6 shows the
applicants' occupation prior to applying for VR services.



Table 6
Last Held Occupation of Sampled M VR Applicants





Occupation


Percentage of Sample


Service


51


Clerical


9


Trade


25


Agriculture


4


Student


1


Unemployed


10



Source: Compiled by the Legislative Audit Division from
MVR records.



Page 18



Chapter II - Vocational Rehabilitation Background



M^or Disability of Clients



A major disability is the physical or mental condition, impairment,
or disease most responsible for an individual's work limitation.
Three-fourths of the applicants sampled listed either orthopedic
impairments or mental and emotional conditions as their major
disability. Table 7 shows the major disabilities reported by
applicants.





Table 7
Maior Disabilitv of MVR Apolicants








Major Disability


Percentage
of Sample




Orthopedic impairments (except amputations) such as back injuries,
cerebral palsy, arthritis & rheumatism, muscular dystrophy, multiple
sclerosis, Parkinson's disease, etc.


41


Mental and emotional conditions such as psychosis, neurosis,
alcohol abuse, mental retardation, autism.


34


Leukemia, asthma, diabetes, cystic fibrosis, epilepsy, congenital heart
disease, tuberculosis, emphysema, etc.


13


Deaf and/or Blind


4


Traumatic brain injury


4


Absence or amputation of a limb or extremity


2


Not listed


2


Source: Compiled by the Legislative Audit Division from MVR records.







Average Length of Time
Receiving Services from
MVR



We documented the length of time a client received services from the
MVR Program. The time began with the application date and ended
with closure date. The range of time varied from eight days to
almost seven years. About 70 percent of the individuals received



Page 19



Chapter II - Vocational Rehabilitation Background



services for less than two years. Table 8 shows the length of time
individuals received services.



Table 8
Length of Time Receiving MVR Services



Year(s) Received Services


Percentage of Sample


0-1


51


l-2yr.


21


2 - 3 yr.


11


3-4yr.


11


4 -Syr.


2


5-6yr.


4



Source: Compiled by the Legislative Audit Division from
MVR records.



Page 20



Chapter III - Program Efficiency and
Effectiveness Could be Increased



Introduction



Policies Need to be
Clarifled or Written



The goal of the Montana Vocational Rehabilitation (MVR) Program
is to promote work and independence for Montanans with
disabilities. To accomplish this mission, MVR provides services to
people of an employable age with physical or mental disabilities to
help them secure and maintain employment. Services range from


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Online LibraryMontana. Legislature. Legislative Audit DivisionVocational Rehabilitation Program, Department of Public Health and Human Services : performance audit report (Volume 1997) → online text (page 2 of 7)