Policy establishes basic statewide operating principles that
Management review, consultation, and in some cases approval are necessary to implement some actions and/or decisions, including
Some exceptions must be implemented using specific procedures.
Policy must not create an immovable barrier to a consumer's rehabilitation. Counselors should seek waivers to policy where limitations create such a barrier. Area managers and consultants must provide expertise in mastering alternatives. See Chapter 1: Foundations, Roles, and Responsibilities.
The area manager may make an exception to any mandatory policy except to those
In most cases, approvals are documented in a case note in ReHabWorks. Approvals received electronically, such as by email, should be copied and pasted into ReHabWorks. File paper approvals in the paper case file. All approvals must include a clear description of the basis for the approval.
To request a review by the medical director or Orthotic and Prosthetic Review Committee (OPRC), forward a courtesy case to the DRS Central Office medical services team by emailing firstname.lastname@example.org, including copies of all pertinent medical and psychological reports. The DRS Central Office program specialist for physical restoration or the DRS Central Office program specialist for disabilities documents the results of the review by the medical director or OPRC in ReHabWorks.
For a list of all items requiring approval or consultation, see Summary Table of Approvals and Consultations.
The purpose of this section is to describe processes necessary for case file uniformity. You are ultimately responsible for the
The case file system consists of an electronic case file and paper case folder.
Paper case files must be prepared and maintained as follows.
DRS staff members must
File the following documents from bottom to top on the left side of the case file in the order received. Be sure that
File the following documents from bottom to top on the right side of the case file in the order received, as follows:
Documents associated with billing for multiple consumer purchases may be placed in a centralized file in the field office.
Do not put documents into a consumer's case file that contain other consumers' names or identifying information. If necessary, make copies of the documents and redact the identifying information of other consumers before filing the documents in each consumer's file.
When a medical service coordinator or courtesy counselor is involved, the courtesy file becomes an extension of the main folder. The courtesy counselor forwards copies of all pertinent documents to the home counselor.
When the volume of information on a consumer is more than a single case folder can physically hold, additional case folders can be used.
When starting a new file on a case that was previously active, copy significant documents from the closed case file for placement in the new folder. Do not remove forms, reports, and other data from the old folder.
Keep all documents, including financial records, in the closed consumer paper case file, which is stored for five years.
Field offices store files for cases closed in the current and preceding fiscal year.
Ship all other closed consumer paper case files to the TWC Records Management Center in accordance with procedures (see TWC Records and Information Management Manual Section 3.4 Storage of Records at Records Management Center).
Retrieve closed consumer paper case files from the TWC Records Center in accordance with policy (see TWC Records and Information Management Manual Section 3.14 Retrieving Stored Records).
A consumer's case can be transferred from one caseload to another caseload for a variety of reasons, including, but not limited to:
Exceptions: Do not transfer a case file when a consumer temporarily moves outside of the service area to:
A request for case transfer can be made by the consumer either verbally or in writing.
The request can be submitted to:
The counselor or office receiving the request for transfer must:
A case can also be transferred or reassigned to another counselor due to a staffing change, such as when a counselor leaves DARS employment or when a new counselor is hired.
The consumer must be notified in writing when there is a change in the assigned counselor. When possible, the consumer is notified by the current counselor or rehabilitation services technician (RST) before the change in the case is assignment.
The notification must include:
If the date and contact information are not known at the time of the notification, the consumer is provided with the area manager's contact information until the information about the new counselor is available.
Case transfers must be processed in a timely manner to ensure that the transfer does not disrupt or delay the provision of services or cause undue hardship for the consumer.
If the consumer's case is closed at the time that the consumer requests a case transfer, refer to Chapter 2: Initial Contact and Application, 2.7 Opening a New Case or Adjusting the Phase of a Previously Closed Case to determine whether to reopen the case or to take a new application.
If the consumer will be reapplying for services and the paper case file is still at a DRS field office at the time of the request, the closed case file must be mailed to the receiving office within three days of the request for a transfer.
If a consumer's closed case file has been transferred to the DARS Records Center, see Business Procedures Manual, Chapter 13: Records Management, 13.7 Records Retrieval for the appropriate procedures to request the file.
Do not transfer a closed case from one case load to another case load in ReHabWorks.
If the case will be reopened or phase-adjusted, see Chapter 19: Technical Information and References, 19.4.3 Transfer of Open Cases below.
Within three days of receiving a request to transfer an open case, the current vocational rehabilitation counselor (VRC) and rehabilitation services technician (RST) team must:
Providers must be notified when service authorizations are closed without payment. The receiving unit issues a new service authorization when the case is received for ongoing services, when applicable.
A formal case review is not required for cases that are transferred within the same supervisory unit; however, the area manager must enter a case note to verify that the transfer has been completed in ReHabWorks.
The VRC/RST team to which the case is assigned must contact the consumer in a timely manner to schedule an appointment for the consumer to meet with the assigned VRC to resume services.
Within five days of receiving a request for a case transfer, the transferring area manager or the designee:
Within three days of receiving the paper case file, the receiving area manager or designee:
The VRC/RST team that the case is assigned to contacts the consumer in a timely manner to schedule an appointment for the consumer to meet with the assigned VRC to resume services.
Note: If the area managers do not agree about whether to transfer an open case, they refer the issue to the appropriate regional operations directors for their programs.
To transfer an entire caseload, the regional director sends a memorandum to the DRS assistant commissioner requesting
Case Reading Review - A review that allows users to quickly review a case, or a specific aspect of a case, when a more detailed case review is not necessary. Refer to the TxROCS User's Guide for instructions on entering a case reading review in TxROCS.
Compliance - Adhering to the federal and state laws, regulations, guidelines, and specifications that are outlined in this manual and in the Business Procedures Manual (BPM), DRS Standards for Providers (SFP), Contracting Processes and Procedures Manual (CPPM), and DARS Procurement Manual (DPM). A case is compliant if it meets all of the requirements. For information about evaluating compliance, refer to MOSAIC, Appendix C: Compliance and Quality Case Review, Section III: MOSAIC - Case Review Guide.
Compliance and Quality Review (C&Q) - A review of the compliance and quality aspects of a vocational rehabilitation case. C&Q reviews can be completed using an entire or partial approach. Refer to the TxROCS User's Guide for instructions on entering a C&Q review in TxROCS.
Entire Review Approach - A case review approach that requires the reviewer to answer all questions in the review before the review can be considered complete. The approach can be used for compliance and quality (C&Q) reviews, technical and purchasing reviews, and full reviews.
Full Review - A review that includes both a technical and purchasing (T&P) review and a compliance and quality (C&Q) review of a case that is started as a single full review in TxROCS. The reviewer must answer all questions in both the T&P and C&Q sections of the review before the review can be considered complete. Refer to the TxROCS User's Guide for instructions on entering a full review in TxROCS.
Monitoring, Oversight, and Internal Process Guide (MOSAIC) - A guide that describes the quality assurance system and monitoring processes that are used throughout MOSAIC provides information about the DRS risk assessment model. It explains how reviewers use the model to develop quarterly monitoring plans and how regions use it to develop and report on action plans to address monitoring results.
Partial Review Approach - A case review approach that allows the reviewer to complete and finalize a case review without answering all of the questions in the review. The approach can be used for compliance and quality reviews or technical and purchasing reviews. It cannot be used for full reviews.
Quality - An assessment of the level of services and other forms of support provided to the consumer throughout the life of the case. Quality casework demonstrates values- based decision making, active participation by the consumer, and the application of all required policies and standards. Quality is assessed based on a thorough review of all related casework and documentation. Quality is rated as exceeds expectations, meets expectations, or needs improvement. For more information about quality assessments, refer to MOSAIC, Appendix C: Compliance and Quality Case Review, Section III: MOSAIC - Case Review Guide.
Technical and Purchasing Review (T&P) - A review of the technical and purchasing aspects of a vocational rehabilitation case. T&P reviews can be completed using an entire or partial approach. Refer to the TxROCS User's Guide for instructions on entering a T&P review in TxROCS.
TxROCS Users Guide - A technical guide that explains how to navigate through the TxROCS application. The TxROCS User's Guide is not a policy manual.
TxROCS User Role - Distinct roles that define what the user is allowed to use in TxROCS. User roles prohibit reviewers from viewing case reviews and reports that are not within the reviewer's assigned management unit. For more information on user roles, refer to the TxROCS User's Guide.
Validate - To verify that required corrective actions have been completed appropriately. When the validator is satisfied that the corrective actions have been completed appropriately, he or she selects the "Completed Validation" button on the Actions page in TxROCS. When the validation is complete and the case review is final and no further changes may be made to the case review.
The purpose of a case review is to:
The compliance portion of a compliance and quality (C&Q) review is used to evaluate whether specific elements of a case adhere to the federal and state laws, regulations, guidelines, and specifications that are outlined in the this manual and in the Business Procedures Manual (BPM), DRS Standards for Providers (SFP), Contracting Processes and Procedures Manual (CPPM), and DARS Procurement Manual (DPM).
The quality portion of a C&Q review is used to assess the level of services and other forms of support provided to the consumer throughout the life of the case. Quality casework demonstrates values-based decision making, consumer engagement, and the application of policies and standards. It is based on a thorough review of all related casework and documentation.
Compliance and quality (C&Q) reviews are documented by completing DARS3456, Compliance and Quality Case Review-VR in TxROCS. Only managers, program specialists, and their designees may complete a C&Q review. C&Q reviews cannot be completed by administrative support staff.
The MOSAIC case review guide is available as a reference when completing a case review.
The technical portion of a T&P review is used to evaluate whether all required information is included in the electronic and or paper case file.
The purchasing portion of a T&P review is used to evaluate whether the appropriate purchasing policies and procedures were followed and documented, as required by the applicable federal and state laws, regulations, guidelines, and specifications that are outlined in the RPM, BPM, SFP, CPPM, and DPM.
Technical and purchasing (T&P) reviews are documented by completing DARS3399, Technical and Purchasing Case Review-VR, in TxROCS. Managers, program specialists, and their designees may complete T&P reviews. Designees may include management support staff; however, managers must review a designee's work to ensure that the designee accurately represents the findings.
All managers are required to monitor the operation of their units. Case reviews are a required part of this monitoring. To identify the type and quantity of required reviews, managers refer to the unit's monitoring plan for the current fiscal year. The regional director and designated regional office staff are responsible for the oversight of each unit in their region, including monitoring of case review activities.
The program director or program manager of Consumer Services Support (CSS) manages and oversees the case review process statewide to ensure that the process is applied consistently. All questions about the case review process and unit monitoring plan should be directed to the CSS program director or a designee.
Refer to the MOSAIC case review guide to access the unit monitoring plan and to identify required activities and reporting for unit, regional, and central office roles and responsibilities.
DRS uses TxROCS to capture and organize data from case reviews that are conducted statewide. DRS uses the data captured in TxROCS to:
Using TxROCS allows DRS to:
All reviews of vocational rehabilitation cases must be entered into TxROCS. The reviews are maintained in TxROCS for a minimum of two state fiscal years. The review process is audited each year.
Exceptions to standard user role require the approval of the regional director.
Reviewers (or their designees):
After completing a review, the reviewer enters a case note in the consumer's electronic file to document the type of review conducted. Specific findings and assigned corrective actions are not entered in the case note.
Caseload carrying staff members (or their designees):
Acronyms used in policy are defined within the context of policy. For an overview, see the Acronym Reference Tool.