13 CSR 40-91.020 - [Effective until 7/31/2021]Vocational Rehabilitation for the Blind

13 CSR 40-91.020. [Effective until 7/31/2021]Vocational Rehabilitation for the Blind

PURPOSE: This rule establishes the guidelines for provision of vocational rehabilitation services to eligible applicants and clients as mandated by the Rehabilitation Act of 1973 (P.L. 93-112), as amended through 1986, 34 CFR 361 and 34 CFR 363. These services are authorized by sections 207.010, 207.020, 209.010 and 209.020, RSMo.

(1) The program of vocational rehabilitation for the blind is administered according to 34 CFR 361, 34 CFR 363 and 34 CFR parts 74-81. 34 CFR 361 requires Rehabilitation Services for the Blind (RSB) to develop policies that govern the administration of the vocational rehabilitation program and allows RSB to develop limitations within which it administers some areas of the program. These areas and limitations on each area are identified in this rule, as follows:

(3)(B)1. Basic conditions of eligibility;

(3)(D) Interim determination of eligibility;(10) Vocational rehabilitation services for the individual; (11) (C)1. Individualized written rehabilitation program for supported employment placements; (12)(A) Training costs, tuition and fees;

(12)(B)Support services associated with training;

(13)(C)1.-5. Payment for physical or mental restoration;

(14) Support services; (15)(A)6.,

(15)(B)-(E) Supported employment services;

(16) Transition services;

(18)(B)-(D) Standards for facilities and other providers of services;

(20)(B) Facilities and services for groups of handicapped individuals;

(21)(A), (21)(B) Order of selection;

(22)(A), (22)(D)1.L., (22)(D)2.C. Appeal procedures;

(23) Confidentiality of information; and

(24) Forms used in administration of the vocational rehabilitation program.

(2) Definitions. The following definitions are used in this rule:

(A) Applicant is an individual who has applied for vocational rehabilitation services and whose eligibility for services has not been determined;

(B) RSB is the designated state unit that is referred to in 34 CFR 361.1(c)(2), 361.5(b)(3) and 361.6(b) and (c). The designated state unit is referred to in this rule as RSB;

(C) Client is an individual who meets the requirements to receive vocational rehabilitation services under the terms of an individualized written rehabilitation program (IWRP). A client also is an individual who meets the requirements to receive vocational rehabilitation services during a period of extended evaluation in order to determine the individual's rehabilitation potential or an individual who meets the requirements to receive services during an interim period of eligibility. In section (23), client means any person who is referred to RSB for services, who applies for services and who has received services;

(D) Client assistance project is a federally-funded, statewide program that is available to advise all applicants and clients of all services available from RSB and to assist applicants and clients in their relationships with RSB and other providers of vocational rehabilitation services, including appropriate remedies to ensure the protection of applicant and client rights;

(E) Deputy director, Division of Family Services/RSB is the state unit director referred to in 34 CFR 361.8. The state unit director is referred to in this rule as the deputy director;

(F) Division of Family Services is the sole state agency referred to in 34 CFR 361.1(a). The sole state agency is referred to in this rule as the division;

(G) Employability is a determination that, with the provision of vocational rehabilitation services, the client is likely to enter or retain full-time employment or, if appropriate, part-time employment that is consistent with the capacities and abilities of the client. The employment may be in the competitive labor market; the practice of a profession; self-employment; homemaking; farm or family work, including work for which payment is in-kind rather than in cash; sheltered employment; home-based employment; supported employment or other gainful work;

(H) Evaluation of rehabilitation potential is a comprehensive diagnostic study that is carried out for each applicant for vocational rehabilitation, so that RSB is able to determine the applicant's eligibility for services and is able to develop an IWRP for any applicant who is eligible for services;

(I) Extreme medical risk is a risk of substantially increasing functional impairment or risk of death if medical services are not provided promptly;

(J) Impartial hearing officer is an individual who is not an employee of a public agency that is involved in any decision regarding the furnishing or denial of rehabilitation services to an applicant or client; who has not been involved in previous decisions regarding the applicant or client; who has background and experience in the delivery of rehabilitation services and who has no personal or financial conflict of interest in any individual case;

(K) Rehabilitation engineering means the systematic application of technologies, engineering methodologies or scientific principles to meet the needs of and address the barriers confronted by individuals with handicaps in areas that include education, rehabilitation, employment, transportation, independent living and recreation; and

(L) Workshop is a rehabilitation facility, or that part of a rehabilitation facility, that is engaged in production or service operation for the primary purpose of providing gainful employment, as an interim step in the rehabilitation process for those individuals who cannot be absorbed readily into the competitive labor market, or during the time that employment opportunities in the competitive labor market do not exist for them.

(3) Eligibility for Vocational Rehabilitation Services.

(A) General Provisions of Eligibility.

1. RSB shall determine an applicant's eligibility for services without regard to the applicant's sex, race, color or national origin.

2. RSB shall not exclude any group of individuals from services solely on the basis of the type of disability of the members of the group.

3. RSB shall not apply an upper or lower age limit which would result in a decision of ineligibility for any applicant who meets the basic conditions of eligibility stated in subsection (3)(B); and

4. RSB shall not apply any durational or other residence requirement that would exclude from services any applicant or client who is present in the state.

(B) Basic Conditions of Eligibility. An individual's eligibility for vocational rehabilitation for the blind services is based only upon the following criteria:

1. The individual has a physical or mental disability(ies) which, for that individual, constitutes or results in a substantial handicap to employment and the individual meets the visual disability requirements of RSB.

A. Visual disability means that an individual with a nonprogressive eye disease has a central visual acuity of twenty/two hundred (20/200) or less in the better eye with best correction; or, if the central visual acuity with best correction is more than twenty/two hundred (20/200) in the better eye, there is a visual field defect in which the widest diameter of the visual field subtends an angle distance no greater than twenty degrees (20o), or has a visual efficiency that does not exceed twenty percent (20%).

B. Visual disability means that an individual with a progressive eye disease has a central visual acuity of twenty/seventy (20/70) or worse in the better eye with best correction, or has a visual efficiency that does not exceed sixty-four percent (64%), or has near vision that is decreased to the extent that the individual cannot read print that is smaller than Jaeger nine (J9) with best correction; and

2. There must be a reasonable expectation that vocational rehabilitation services may benefit the individual in terms of employability.

(C) Consultation With Missouri Division of Vocational Rehabilitation. The Missouri Division of Vocational Rehabilitation provides vocational rehabilitation services to individuals who do not meet visual disability requirements stated in this rule but who are visually impaired and who meet all eligibility requirements of the Missouri Division of Vocational Rehabilitation. RSB and the Missouri Division of Vocational Rehabilitation consult regarding individuals for whom there is a question as to which agency should provide vocational rehabilitation services to the individuals.

(D) Interim Determination of Eligibility. RSB may initiate vocational rehabilitation services to an applicant on the basis of an Interim Determination of Eligibility, referred to in this rule as IDE. RSB shall use this process only when it is critical to the applicant's vocational rehabilitation that RSB initiate services sooner than would be possible through the normal eligibility determination process and the applicant, on the basis of available information, is highly likely to be eligible for vocational rehabilitation services. The IDE, under any circumstance, shall not extend beyond ninety (90) days from the date RSB completes a certification of eligibility for the individual to receive services during an interim period. RSB shall implement the IDE process by following these guidelines:

1. In order to make an IDE, RSB shall use information that is available at the time the individual applies for vocational rehabilitation services;

2. RSB shall record the basis for the decision that, after RSB completes a comprehensive diagnostic study, it is highly likely the individual will meet the basic conditions of eligibility for vocational rehabilitation as stated in subsection (3)(B);

3. RSB shall not use the IDE process for any applicant who needs an extended evaluation of rehabilitation potential as discussed in section (8);

4. RSB shall complete a comprehensive diagnostic study as soon as possible after RSB completes a certification of eligibility for the individual to receive services during an interim period which, under no circumstance, may exceed ninety (90) days from the date RSB completes the certification of eligibility;

5. RSB and the individual shall develop an IWRP which shall contain the vocational goal, the service objective(s) that the individual will attain during the interim period and the vocational rehabilitation service(s) RSB will provide to meet each objective;

6. As soon as RSB completes a comprehensive diagnostic study, RSB shall complete a certification of eligibility for an individual who is eligible to receive vocational rehabilitation services;

7. If, while obtaining information for the comprehensive diagnostic study, RSB determines the individual is not eligible for vocational rehabilitation services, RSB shall cease delivery of all services planned for delivery during the ninety (90)-day period and shall close the individual's case immediately; and

8. All terms of this rule apply to an individual who receives services during an IDE.

(4) Authorization of Services. RSB shall not pay for any vocational rehabilitation service unless RSB authorized the service before it was provided. A vendor who provides services that are authorized by RSB must agree not to charge or accept any payment from an applicant or client or from a member of the applicant's or client's family unit unless the amount of the charge or payment is previously known to and approved by RSB.

(5) The Case Record. RSB shall maintain for each client or applicant a case record that includes, to the extent pertinent, documentation of the following factors:

(A) The comprehensive diagnostic study that supports RSB's determination of eligibility, the basis for providing services to a client during an interim period of eligibility or the need for a client to have an extended evaluation of vocational rehabilitation potential and, as appropriate, the nature and scope of vocational rehabilitation services that RSB will provide;

(B) The reasons for a RSB determination of ineligibility and that RSB reviews the ineligibility determination no later than twelve (12) months after RSB made the determination of ineligibility;

(C) RSB's determination that the client's handicaps are severe;

(D) RSB's periodic assessment of the client during an extended evaluation of vocational rehabilitation potential;

(E) An IWRP for each client, including each client who is receiving services during a period of extended evaluation or during an interim period of eligibility;

(F) For each client to whom physical and mental restoration services are provided, documentation that supports RSB's determination that the client's clinical status is stable or slowly progressive;

(G) RSB's decision to provide services to family members;

(H) Client participation in the cost of maintenance as discussed in 13 CSR 40-91.020(14)(B);

(I) Client eligibility for and use of any comparable service or benefit;

(J) RSB advised the client or applicant of the confidentiality of all information pertaining to the client's case;

(K) The reason for closing a client's case and, if RSB determines the client to be rehabilitated, the basis upon which RSB determined the client's employment is suitable;

(L) Decision to provide post-employment services after the client achieves his/her employment objective, the basis upon which RSB develops the post-employment plan, a description of the services RSB provides and the outcome of the services;

(M) Any action and decision involving a client's or applicant's request for review of RSB determinations, as discussed in section (22); and

(N) Any reviews of RSB's determination that a client to whom RSB has provided vocational rehabilitation services under the terms of an IWRP is no longer capable of achieving a vocational goal.

(6) Comparable Services and Benefits.

(A) Before RSB provides any vocational rehabilitation service to a client or members of the client's family, RSB shall determine whether comparable services and benefits are available under any other program, except when RSB is providing the following services:

1. Evaluation of rehabilitation potential;

2. Counseling, guidance and referral;

3. Vocational and other training services, including personal and vocational adjustment, books, tools and other training materials, that are not provided in institutions of higher education;

4. Job placement;

5. Rehabilitation engineering services; and

6. Post-employment services that include rehabilitation services listed in paragraphs (6)(A)1.-5.

(B) RSB shall require that if comparable services and benefits are available to a client, the client must utilize the comparable services and benefits to meet, in whole or in part, the cost of the client's vocational rehabilitation services, except in the situation stated in subsection (6)(C).

(C) RSB shall not determine whether comparable services and benefits are available under any other program if the determination of the availability of comparable services and benefits would delay the provision of vocational rehabilitation services to any client who is at extreme medical risk. RSB shall base a determination of extreme medical risk upon medical evidence provided by an appropriate licensed medical professional.

(7) Evaluation of Rehabilitation Potential.

(A) RSB shall carry out a comprehensive diagnostic study of each applicant for vocational rehabilitation services. The purposes of the comprehensive diagnostic study are to determine whether the applicant meets the basic conditions of eligibility stated in subsection (3)(B) and to determine the nature and scope of services that RSB will provide if the person is determined to be eligible.

(B) For each applicant, RSB shall obtain and evaluate the following information:

1. Current medical and, when appropriate, psychological evidence of all disabilities and other factors that relate to the applicant's handicap to employment. In each case of mental or emotional disorders, the applicant shall have an examination by a physician skilled in the diagnosis and treatment of mental or emotional disorders, or by a psychologist who is licensed or certified under state law or regulations;

2. Appraisal of the current general health status of the applicant, using all available medical information; and

3. Appraisal of the applicant's intelligence level, personality, vocational adjustment, personal adjustment, social adjustment, educational achievement, ability to acquire occupational skills, capacity for successful job performance, employability, employment opportunities, patterns of work behavior, work experience, need for rehabilitation engineering services and other pertinent information that RSB needs to determine the applicant's eligibility.

(8) Extended Evaluation. RSB shall provide vocational rehabilitation services to an applicant during a period of extended evaluation under the following circumstances:

(A) RSB determines that an applicant has a mental or physical disability(ies) that, for the applicant, constitutes or results in a substantial handicap to employment but RSB cannot determine, from information obtained during the comprehensive diagnostic study described in section (7), that the applicant will benefit in terms of employability from the provision of vocational rehabilitation services;

(B) RSB shall provide only those services that the client must have so that RSB can determine the individual's eligibility for vocational rehabilitation services;

(C) The extended evaluation period shall begin on the date that RSB certifies the applicant for extended evaluation, as discussed in subsection (9)(C), and shall not exceed a total period of eighteen (18) months during the time the applicant's case is open;

(D) RSB shall make a thorough assessment of the client's progress as often as necessary but at least once every ninety (90) days from the date of the certification for extended evaluation services. This assessment shall include periodic reports from each rehabilitation facility or person who is providing services to the client;

(E) RSB shall end the provision of services at any time before the end of the eighteen (18)-month period when RSB is able to determine whether the client is eligible for vocational rehabilitation services;

(F) RSB shall not certify more than one (1) period of extended evaluation during the time the client's case is opened; and

(G) If RSB closes a client's case and the individual reapplies for vocational rehabilitation services, RSB may provide another period of extended evaluation services if the individual needs to receive extended services in order for RSB to determine the individual's vocational potential.

(9) Certification.

(A) Certification of Eligibility. As soon as RSB determines that an applicant is eligible for vocational rehabilitation services, RSB shall complete a certification of eligibility. The certification shall include the statement that the applicant meets the basic conditions of eligibility stated in subsection (3)(B). An appropriate RSB staff member shall sign and date the certification.

(B) Certification of Interim Period of Eligibility. As soon as RSB determines that an applicant is eligible to receive vocational rehabilitation services during an interim period of eligibility, RSB shall complete a certificate of interim eligibility. The certification shall state the basis for the determination that, after completion of the comprehensive diagnostic study, the applicant will meet the basic conditions of eligibility stated in subsection (3)(B). An appropriate RSB staff member shall sign and date the certification.

(C) Certification for Extended Evaluation. As soon as RSB determines that an applicant meets the requirements stated in subsection (8)(A), an appropriate RSB staff member shall complete, sign and date a certification for extended evaluation.

(D) Certification of Ineligibility. As soon as RSB determines that the applicant or client is not eligible for vocational rehabilitation services, an appropriate RSB staff member shall complete, sign and date a certification of ineligibility. RSB shall assure that the certification states the reasons for the ineligibility determination. RSB shall carry out all activities stated in subsections (17)(B) and (C).

(10) Vocational Rehabilitation Services for the Individual. As appropriate to the vocational rehabilitation needs of each applicant or client, RSB shall make available the vocational rehabilitation services that are listed in this section. To the extent possible, within the limitations of 34 CFR 361, 34 CFR 365, 34 CFR parts 74 - 81, Chapter 34, RSMo and this rule, the applicant or client may select the vendor(s) to provide each service. RSB shall provide services in the most cost-effective manner in order to prepare the client for entry level employment that is consistent with the client's capabilities and abilities. This rule establishes the procedures for the provision of the following services and the limitations on the provision of certain services:

(A) Evaluation of vocational rehabilitation potential, including diagnostic and related services incidental to the determination of eligibility for, and the nature and scope of services RSB will provide so that the eligible person can reach a vocational goal;

(B) Counseling and guidance, including personal adjustment counseling, to maintain a counseling relationship with the applicant or client throughout the program of services, to help the applicant or client secure needed services from other agencies and to advise the applicant or client about the client assistance program;

(C) Physical and mental restoration services, as discussed in section (13);

(D) Vocational and other training services, as discussed in section (12);

(E) Maintenance, as discussed in subsection (14)(B);

(F) Transportation, as discussed in subsection (14)(A);

(G) Services to members of an applicant's or client's family, as discussed in subsection (14)(F);

(H) Interpreter services and note-taking services for deaf applicants or clients, including tactile interpreting for deaf-blind applicants or clients;

(I) Reader services, rehabilitation teaching services, note-taking services and orientation and mobility services for blind applicants and clients;

(J) Telecommunications, sensory and other technological aids and devices;

(K) Recruitment and training services to provide new employment opportunities in the fields of rehabilitation, health, welfare, public safety, law enforcement and other appropriate public service employment;

(L) Placement in suitable employment;

(M) Post-employment services necessary to maintain or regain other suitable employment;

(N) Occupational licenses, including any licenses, permits or other written authority required by a state, city or other governmental unit to be obtained in order to enter an occupation or enter a small business and tools, equipment, initial stocks and supplies;

(O) Rehabilitation engineering services; and

(P) Other goods and services that can be expected to benefit a client in terms of employability.

(11) Individualized Written Rehabilitation Program. Throughout this section, the word client means an individual who has been determined to be eligible for vocational rehabilitation services, or who is receiving vocational rehabilitation services during a period of extended evaluation or during a period of interim eligibility.

(A) General Provisions. RSB shall initiate and periodically update for each client an IWRP, referred to in sections (11)-(23) of this rule as IWRP. A copy of the IWRP, Form R-10, is in section (24). RSB shall adhere to the following procedures regarding the IWRP:

1. RSB shall provide vocational rehabilitation services according to the IWRP and shall not provide any service that is not recorded in the IWRP;

2. RSB shall develop the IWRP jointly with each client or, as appropriate, the client and a parent, guardian, legal custodian or other representative, including other suitable professional and informed advisors;

3. RSB shall provide a copy of the IWRP and all amendments to the IWRP to the client or, as appropriate, to the client and a parent, guardian, legal custodian or other representative;

4. RSB shall advise each client or, as appropriate, the client's parent, guardian, legal custodian or other representative of all RSB procedures and requirements that affect the development and review of the IWRP;

5. RSB shall initiate the IWRP after RSB completes a certification of eligibility for vocational rehabilitation services, as stated in subsection (9)(A), certification of an interim period of eligibility, as stated in subsection (9)(B), or certification for extended evaluation, as stated in subsection (9)(C);

6. RSB shall ensure that a client's IWRP and all amendments to the IWRP become a part of the client's case record;

7. RSB shall have the client or, as appropriate, the client's parent, guardian, legal custodian or other representative sign the IWRP and all amendments to the IWRP, except case closure amendments. The signature indicates the client or, as appropriate, the client's parent, guardian, legal custodian or other representative agrees to the terms of the IWRP and amendments;

8. RSB shall review each client's IWRP as often as necessary, but at least once every twelve (12) months, and shall review the IWRP of each client who is in a period of extended evaluation or interim period of eligibility as often as necessary, but at least once every ninety (90) days. RSB shall give each client or, as appropriate, the client's parent, guardian, legal custodian or other representative an opportunity to review the IWRP and, if necessary, jointly redevelop the IWRP and agree to its terms;

9. RSB shall amend a client's IWRP when-

A. There is a significant change in the client's existing IWRP;

B. RSB closes a client's case after development of an IWRP; or

C. RSB plans to provide post-employment services to a client;

10. RSB shall prepare a client's IWRP in coordination with the appropriate educational agency whenever RSB plans to provide vocational rehabilitation services to a client who is eligible for services under the Individuals With Disabilities Education Act. RSB shall include with the IWRP a summary of relevant components of the client's individualized education program; and

11. RSB shall meet the following conditions for a client when RSB is terminating services under an IWRP because RSB determines that the client is not capable of achieving a vocational goal and for an applicant when RSB is terminating services because RSB cannot determine that the applicant is eligible for service:

A. RSB shall make a decision of ineligibility only with the full participation of the client or, as appropriate, the client's parent, guardian, legal custodian or other representative unless the client refuses to participate, the client is no longer present in the state or his/her whereabouts are unknown, or the client's medical condition is rapidly progressive or terminal. When RSB obtains the full participation of the client or the client's representative, RSB shall record the views of the client or representative in the IWRP;

B. RSB shall record the rationale for the ineligibility decision as an amendment to the IWRP, certifying that the provision of vocational rehabilitation services has demonstrated the client is not capable of achieving a vocational goal. RSB prepares a certification of ineligibility, as stated in subsection (9)(D); and

C. RSB shall make a periodic review, at least annually, of the ineligibility decision, as stated in subsection (17)(D).

(B) Content of IWRP. RSB shall develop each IWRP for a client on the basis that the client is eligible for vocational rehabilitation services that will enable the client to achieve a suitable vocational goal, that vocational rehabilitation services are needed during an extended period of evaluation in order to determine whether the applicant is capable of achieving a vocational goal or the applicant meets criteria to receive services during an interim period of eligibility. RSB shall include, as appropriate, statements concerning:

1. The basis on which RSB determined the client is eligible for vocational rehabilitation services, the applicant needs an extended evaluation of vocational rehabilitation potential in order for RSB to make a determination of eligibility or the applicant needs to receive vocational rehabilitation services during an interim period of eligibility;

2. The long range and intermediate rehabilitation objectives for a client;

3. The specific vocational rehabilitation services that RSB will provide so the client will be able to achieve the established rehabilitation objectives;

4. An assessment of the client's expected need for post-employment services;

5. The projected dates for the initiation of each vocational rehabilitation service and the expected duration of each service;

6. A procedure and schedule, based upon objective criteria, for RSB to conduct a periodic review and evaluation of the client's progress toward achieving rehabilitation objectives;

7. A record of RSB's reviews and evaluations of the client's progress toward achieving rehabilitation objectives;

8. RSB's reassessment, prior to case closure, of the client's need for post-employment services;

9. The views of the client or, as appropriate, the client and a parent, guardian, legal custodian or other representative, including other suitable professional and informed advisors, concerning the client's goals and objectives and the vocational rehabilitation services RSB is providing to the client;

10. The terms and conditions for the provision of vocational rehabilitation services, including the client's responsibilities in implementing the IWRP;

11. The extent of the client's participation, if any, in the cost of vocational rehabilitation services;

12. The extent to which comparable services and benefits are available to the client under any other programs;

13. An assurance that RSB has informed the client of the client's rights and means by which the client may express and seek remedy for any dissatisfaction in the administration of his/her vocational rehabilitation case, including the opportunity for review of RSB decisions, as discussed in section (22);

14. An assurance that RSB has informed the client of the availability of a client assistance program;

15. The basis on which RSB has determined that the client is rehabilitated; and

16. RSB's plan to provide post-employment services after a client has achieved a suitable vocational goal and the basis upon which RSB develops the plan; and, if appropriate for a client who is severely handicapped, a statement of how RSB will provide these services or will arrange for provision of these services through cooperative agreements with other providers.

(C) Supported Employment Placements. In addition to the requirements stated in subsection (11)(B), for each client for whom RSB determines that supported employment is an appropriate vocational goal, the client's IWRP must contain:

1. A description of the time-limited services, not to exceed nine (9) months in duration, that RSB will provide; and

2. A description of the extended services the client needs, an identification of the state, federal or private programs that will provide the continuing support and a description of the basis for RSB's determination that continuing support is available.

(12) Training Costs. RSB provides training to an eligible client when the client needs training in order to achieve a vocational goal that is recorded in the client's IWRP. Training includes the areas of personal and vocational adjustment, academic training and vocational training.

(A) Tuition and Fees. All grants, other student financial aid and contributions that are available from any source are used to meet in whole, or in part, the costs of training. Monetary merit awards, including scholarships, that a civic, professional or social organization provides directly to a client are exempt from use as a comparable benefit unless the award specifies that the client shall use the funds to meet the cost of tuition or other specific college-related expenses. RSB does not pay any costs associated with training when resources to meet these costs are available from any other source. RSB applies the following additional limitations to payment of tuition and fees:

1. RSB may pay tuition and fees at state or other public colleges and universities in Missouri, vocational schools or rehabilitation facilities at current verified rates;

2. RSB may pay tuition and fees at private college or universities in Missouri and at colleges or universities outside Missouri up to but not to exceed similar costs at the University of Missouri-Columbia. If a deaf-blind client attends Gallaudet College, RSB may pay the full cost of tuition and fees at Gallaudet College; and

3. RSB limits payment of tuition and fees for academic and vocational training to a client's completion of the academic or training curriculum that the client needs in order to obtain entry-level employment in the occupational area that the client selects, as recorded in the client's IWRP.

(B) Support Services Associated With Training. RSB pays for necessary support services associated with training, according to section (14).

(13) Physical and Mental Restoration.

(A) General Provisions. Within the limitations in 34 CFR 361, 34 CFR parts 74-79 and this rule, RSB may provide the physical and mental restoration services stated in this rule to a vocational rehabilitation client, to correct or substantially modify a physical or mental condition that is stable or slowly progressive and which contributes to the client's handicap to employment.

(B) Types of Physical or Mental Restoration-

1. Medical or corrective surgical treatment;

2. Diagnosis and treatment for mental or emotional disorders;

3. Dentistry;

4. Nursing services;

5. Inpatient or outpatient hospitalization needed in connection with surgery or treatment and clinic services;

6. Convalescent or nursing home;

7. Drugs and supplies;

8. Prosthetic, orthotic or other assistive devices, including hearing aids, essential to obtaining or retaining employment;

9. Eyeglasses and visual services, including visual training, and the examination and services necessary for the prescription and provision of eyeglasses, contact lenses, microscopic lenses, telescopic lenses and other special visual aids that are prescribed by a physician skilled in diseases of the eye or by an optometrist, whichever the client may select;

10. Podiatry;

11. Physical, occupational, speech or hearing therapy;

12. Psychological services;

13. Therapeutic recreation services;

14. Medical or medically related social work services;

15. Treatment of either acute or chronic medical complications and emergencies which are associated with or arise out of the provision of physical and mental restoration services or which are inherent in the condition under treatment;

16. Special services for the treatment of end-stage renal disease, including transplantation, dialysis, artificial kidneys and supplies; and

17. Other medical or medically related rehabilitation services, including art therapy, dance therapy, music therapy and psychodrama.

(C) Payment for Physical or Mental Restoration. All comparable services and benefits that are available from any source to meet, in whole or in part, the cost of a client's physical or mental restoration shall be utilized, unless to utilize these services or benefits would delay the provision of vocational rehabilitation services to any client who is at extreme medical risk as defined in subsection (2)(I). A determination of extreme medical risk shall be based upon medical evidence provided by an appropriate licensed medical professional. Comparable benefits and services shall include, but not be limited to, Title XVIII (Medicare), Title XIX (Medicaid), public or private health insurance, Veterans Administration medical benefits and Worker's Compensation.

1. RSB may pay hospital room and board charges as billed, based on the least expensive standard accommodation charge.

2. RSB may pay for other medical services, including physician services, laboratory and X-ray fees and hospital outpatient care, at a rate that is determined by the Department of Social Services to be reasonable.

3. RSB may pay for medical services received outside Missouri at the rates paid by the vocational rehabilitation agency in that state, unless the provider participates in the Missouri Title XIX program, in which case RSB limits payment to Missouri Title XIX rates.

4. Selection of provider. To the extent possible, RSB shall purchase physical and mental restoration services for clients who are eligible for Title XIX benefits from Title XIX providers who are located in Missouri.

5. When costs of physical and mental restoration services reach twenty-five thousand dollars ($25,000) regardless of the number of times the client receives services under the terms of an IWRP, requests for additional physical or mental restoration services must be reviewed and approved by the deputy director or designee.

(14) Support Services. RSB may pay the cost of support services to or in behalf of a client in order for the client to benefit from physical or mental restoration, personal and vocational adjustment evaluation or training, academic training, vocational training or job placement. Support services include, but are not limited to, transportation; books, equipment, tools and supplies; reader service for visually impaired persons; interpreter service for deaf-blind persons; services to members of the client's family and maintenance.

(A) Transportation. RSB shall pay the cost of the most economical source of transportation that meets the client's rehabilitation service needs. RSB pays the cost of mileage traveled by private automobile at the rate per mile currently allowed state employees by the Department of Social of Services; bus fare and train fare at actual charges; and cab fare, only when other methods of transportation are not available, at actual charges. When a client must travel by plane, coach fare at the most feasible travel plan may be paid.

1. Physical or mental restoration. RSB may pay costs of transportation that a client needs in order to obtain physical or mental restoration that is prescribed by a provider who meets the standards in subsection (18)(D).

2. Personal and vocational adjustment training. RSB may pay costs of transportation that a client needs in order to participate in personal and vocational adjustment evaluation or training at a rehabilitation facility that meets the standards in subsections (18)(A) and (B).

A. When a client stays in rehabilitation facility residential quarters, RSB shall limit payment to the necessary trips the client makes between the client's home and the rehabilitation facility during the time the client is in evaluation or training activities at the facility. The decision regarding the number of trips that are necessary is made by RSB, the rehabilitation facility and the client.

B. When a client lives at home and commutes, the total monthly payment for transportation and meals, as described in subparagraph (14)(B)2.B., shall not exceed the cost of room and board that is available at or in conjunction with the rehabilitation facility.

3. Academic training and vocational training. RSB may pay costs of transportation that a client needs in order to participate in academic training or vocational training.

A. If a client lives at home and commutes to a public college or university in Missouri that has available dormitories, the total monthly payment for transportation and meals, as described in subparagraph (14)(B)2.B., shall not exceed the cost of double occupancy dormitory charges at the college or university the client attends.

B. If a client attends a private college or university in Missouri or a college or university outside of Missouri that has available dormitories, the total monthly payment for transportation and meals shall not exceed the cost of double occupancy dormitory charges at the University of Missouri-Columbia.

4. Job placement. RSB may pay costs of transportation that a client needs in order to seek employment.

5. Relocation expenses. RSB may pay costs of transportation that a client needs in order to relocate after obtaining employment. Payment of relocation expenses is limited to payment of moving expenses from the client's home locale to the location of the client's employment.

(B) Maintenance. RSB may pay maintenance to a client when it is necessary to meet basic living expenses so that the client can derive the full benefit of other vocational rehabilitation services that the client receives. RSB uses Form R-10B, which is in section (24), to compute the amount of the client's maintenance.

1. RSB takes into consideration the following factors in determining the amount of maintenance RSB pays to or in behalf of a client:

A. RSB considers the type of vocational rehabilitation service in which the client participates; the permanent living arrangements of the client; the living arrangements that are available to the client and the living arrangements that the client selects during participation in the vocational rehabilitation service; the cost of the client's living arrangements; the income and financial resources of the client; and the maximum maintenance payments that are stated in this rule;

B. The monthly standard allowance, referred to in this rule as MSA, for a client who is a dependent and who lives with the client's parents while participating in training is the cost of all meals the client must purchase in order to participate in training, not to exceed the limitations stated in subparagraph (14)(B)2.B.;

C. The MSA for a client who lives with the client's spouse or dependents is five hundred dollars ($500) for the client, plus two hundred fifty dollars ($250) for each additional member of the client's family unit;

D. For the purpose of determining a client's maintenance payment, RSB shall consider only the client's expenses, income and other resources if the client is emancipated and is the only member of the client's family unit;

E. The maximum maintenance payment for any client is the maximum MSA, less the client's adjusted net income or other resources available to meet the client's expenses, or five hundred dollars ($500), whichever is less, except for clients who are attending business enterprise program training or who are attending Gallaudet College, as discussed in subparagraphs (14)(B)3.I. and J.;

F. Independent client leaves home to obtain training-RSB shall consider the client is maintaining two (2) households, the one the client is leaving and the one the client will maintain while in training. RSB shall include an allowance of two thousand dollars ($2000) per month for the first family member and five hundred dollars ($500) per month for each additional member of the client's family unit who remains in the household the client is leaving. RSB shall apply the income of the client and any other members of the client's family unit toward meeting the expenses of the members of the family unit who remain at home. RSB shall apply the balance of income, if any, toward the maintenance expenses the client will have while in training;

G. Dependent client leaves home to obtain training-RSB shall consider that two (2) households are being maintained, the one the client is leaving and one the client will maintain while in training. RSB shall include an allowance of two thousand dollars ($2000) for the first family member and five hundred dollars ($500) per month for each additional member of the client's family unit who remains in the household the client is leaving. RSB shall apply the income of the members of the client's family unit toward meeting the expenses of the members of the family unit who remain at home. RSB shall apply the balance of the income, if any, of the members of the client's family unit toward the maintenance expenses the client will have while in training;

H. For the purpose of determining a client's maintenance payment, RSB shall consider that any client who is not a dependent of another individual for federal income tax purposes is the head of the client's household;

I. Determination of client's adjusted income-when a client is the only member of the client's family unit and the client must leave home for twelve (12) months or less to participate in training, RSB may deduct from the client's net income the amount of payment on deed of trust on property in which the client is living, real and personal property taxes, rent, property insurance and utilities at vacation rate, at actual costs up to a maximum of five hundred dollars ($500) per month. RSB shall document these expenses and include them on Form R-10A as a reduction of income. If the client's training exceeds a period of twelve (12) months, RSB shall not deduct the cost of maintaining the home the client left in computing the client's total adjusted net income in determining the client's maintenance payment;

J. In computing the amount of a client's adjusted net income, RSB shall deduct the cost of health insurance premiums, court-ordered payments, unreimbursable cost of earning income and, for a client who is in training, the first two hundred dollars ($200) per month of the client's earned income;

K. In addition to payment of maintenance during semesters or terms to a client who is attending a college or university, RSB may pay maintenance to the client if the client is attending consecutive semesters or terms and the between-semester or between-term break is six (6) weeks or less. In this type of situation, RSB may continue to pay maintenance to the client at the same rate RSB paid during the preceding semester or term. If the break is for a period of more than six (6) weeks, RSB shall not pay maintenance during the break and the client's maintenance may begin again on the first day of the next semester or term that the client attends a college or university; and

L. If two (2) or more clients share the same residence, the maximum monthly maintenance RSB may pay is as follows: two (2) clients, three hundred seventy-five dollars ($375) each; three (3) clients, three hundred thirty-three dollars ($333) each; or the deficit shown on Form R-10B, whichever is less.

2. Personal and vocational adjustment training. RSB may pay maintenance to a client who receives personal and vocational adjustment evaluation or training at a rehabilitation facility.

A. If a client lives in a residential rehabilitation facility while receiving personal and vocational adjustment evaluation or training, RSB may pay the contracted costs of room and board at the residential facility. RSB also may pay a maximum of one hundred twenty dollars ($120) per month for incidental expenses, less the client's adjusted net income and other resources that are available to meet these costs.

B. If a client lives at home while receiving personal and vocational adjustment evaluation or training at a rehabilitation facility, RSB may pay the costs of meals, not to exceed the maximum meal allowance established by the division for employees that are necessary in order for the client to participate in training. The total monthly payment for meals and transportation, as discussed in paragraph (14)(A)2., cannot exceed the cost of room and board that is available at or in conjunction with the rehabilitation facility the client attends.

3. Academic training and vocational training. RSB may pay maintenance that a client needs in order to participate in academic training, evaluation for vocational training or vocational training, which includes vocational skill training that a client may receive at a rehabilitation facility. Sub-para-graphs (14)(B)3.A.-I. states the different living situations a client may have while participating in academic or vocational training. The client's MSA is the amount of allowable expenses that are recorded on Form R-10B. The maximum amount of a client's maintenance payment in each living situation is the MSA less the adjusted net income and other resources the client has to help meet the expenses.

A. The dependent client lives with the client's parents while participating in training-RSB may reimburse the client for the cost of all meals the client must purchase in order to participate in training, within the limitation stated in subparagraph (14)(B)2.B. and less monthly adjusted net income and other resources the client has to apply toward the cost of meals.

B. The client lives with spouse or other dependents while the client attends a college or vocational training institution- RSB may pay to the client maximum maintenance in the amount of the client's MSA for maintenance, less adjusted net income and other resources that are available to apply toward these costs, or five hundred dollars ($500), whichever is less.

C. The client lives in a dormitory at a public college or university in Missouri- RSB may pay the charge for double occupancy room in the least expensive available air-conditioned dormitory with the maximum available meal plan, plus the maximum meal allowance established by the division for employees for each meal that is not included in the dormitory charge, plus one hundred twenty dollars ($120) per month for incidental expenses, less the client's adjusted net income and other resources that are available to help meet these costs.

D. The client lives in a dormitory at a private college or university in Missouri or at an out-of-state college or university-RSB may pay the amount of the charge for a double-occupancy room in the least expensive available air-conditioned dormitory with the maximum available meal plan at the University of Missouri-Columbia, plus the maximum meal allowance established by the division for employees per meal for each meal that is not included in the meal plan, plus one hundred twenty dollars ($120) per month for incidental expenses, less the client's adjusted net income and other resources that are available to help meet these costs.

E. A single client lives off-campus at a public college or university in Missouri that has available dormitory rooms-RSB may pay the charge for double occupancy room in the least expensive available air-conditioned dormitory with the maximum available meal plan, plus the maximum meal allowance established by the division for employees for each meal that is not included in the dormitory charge, plus one hundred twenty dollars ($120) per month for incidental expenses, not to exceed a total of five hundred dollars ($500) per month, less the client's adjusted net income and other resources that are available to help meet these costs.

F. A single client lives off-campus at a private college or university in Missouri or at an out-of-state college or university that has available dormitory rooms-RSB may pay the amount of the charge for a double occupancy room in the least expensive available air-conditioned dormitory with the maximum available meal plan at the University of Missouri-Columbia, plus the maximum meal allowance established by the division for employees for each meal that is not included in the meal plan, plus one hundred twenty dollars ($120) per month for incidental expenses, not to exceed a total of five hundred dollars ($500) per month, less the client's adjusted net income and other resources that are available to meet these costs.

G. The client lives in a dormitory at a residential rehabilitation facility while receiving vocational skill evaluation or training- RSB may pay the cost of room and board plus one hundred twenty dollars ($120) per month for incidental expenses, less the client's adjusted net income and other resources that are available to help meet these costs.

H. The client lives in rental-based living situation while receiving vocational skill evaluation or training at a training institution that does not have available dormitory rooms-RSB may pay maintenance in the amount of the client's MSA for maintenance, less adjusted net income, or five hundred dollars ($500), whichever is less.

I. The client is attending Gallaudet College-RSB may pay the full cost of room and board at Gallaudet College plus one hundred twenty dollars ($120) per month for incidental expenses, less the client's adjusted net income and other resources that are available to help meet these costs.

J. The client is participating in training to become a manager of a vending facility in RSB's business enterprise program- RSB may pay the actual amount of room and board, as arranged by RSB, plus one hundred twenty dollars ($120) per month for incidental expenses, less the client's adjusted net income and other resources that are available to help meet these costs.

4. Maintenance payments for a client who participates in academic or vocational training are contingent on the following:

A. An undergraduate student must maintain a cumulative grade point average of two-point (2.0) or above on a four-point (4.0) scale or an average of C. A graduate student must maintain a cumulative grade point average of three-point (3.0) on a four-point (4.0) scale or an average of B;

B. An undergraduate or a graduate student must carry a full course load for a full-time student as defined by the college, university or other training institution; and

C. A client who attends an institution or facility that does not operate on a semester-hour or quarter-hour system must be enrolled for a full course load as determined by the institution or facility that the client attends.

5. Job placement. RSB may pay maintenance to enable a client to seek employment or to relocate to accept employment.

A. Job seeking. RSB may pay the cost of necessary lodging and meals that a client needs in order to seek employment. Payment for lodging in Missouri is limited to the daily maximum allowances that are established by the division for lodging and payment for meals cannot exceed the limit stated in sub-paragraph (14)(B)2.B. Payment for lodging and meals outside of Missouri shall not exceed necessary and reasonable costs.

B. Relocation to accept employment. RSB may pay necessary and reasonable costs of relocation for a client who relocates to accept employment. Costs of relocation may be paid only from the date the client initiates relocation, not to exceed two (2) weeks before the date the client's employment begins, until the client's paycheck and other income for the pay period equal a full month's pay or the client's maximum allowable maintenance, whichever is less. Maximum allowable maintenance for the first month of employment is three hundred fifty dollars ($350) for food and incidentals plus the cost of initiating rent and maintaining the living quarters for the first month.

6. Maintenance to family members. RSB may pay maintenance to members of a client's family when all of the following criteria are met: the client is in training; the family members' financial support, after inclusion of the client's maintenance, is reduced as a direct result of the client's participation in training; and the payment of maintenance to family members is necessary in order for the client to complete training. Payment of maintenance to family members may not exceed two hundred fifty dollars ($250) per month for each member of the client's family, less adjusted net income or other resources that are available to help meet the living expenses of the client's family members.

(C) Books, Equipment, Tools, Supplies and Start-Up Costs for Small Businesses. RSB may pay for books, equipment, tools, supplies and start-up costs that the client needs to participate in personal and vocational adjustment training, homemaker training, academic or vocational training and to perform required job duties following employment.

1. Personal and vocational adjustment training. RSB may pay the costs of basic equipment that the client needs in order to participate in training.

2. Academic training or vocational training, including homemaker training. RSB may pay the cost of books, equipment, tools and supplies that the client needs to participate in training.

3. Job placement. RSB may pay the cost of equipment, tools and supplies that a client needs in order to perform required job duties. RSB may pay the cost of equipment, tools and supplies as soon as specific job requirements are known and specific equipment needs are identified.

4. Start-up costs for small businesses. RSB may pay no more than seventy-five percent (75%) of a client's start-up costs for establishing a small business. When RSB's payment reaches three thousand seven hundred fifty dollars ($3750), requests for payment of additional start-up costs must be reviewed and approved by the deputy director or designee. Requests for payment of additional start-up costs beyond one (1) year after the initial payment, must be reviewed and approved by the deputy director or designee. Start-up costs for establishing a small business include, but are not limited to, rent, advertising, utilities and supplies. This rule does not apply to start-up costs for vending facilities that RSB supervises according to 13 CSR 40-91.010.

5. Purchase of equipment. When the cost of training and job placement equipment during a current case reaches ten thousand dollars ($10,000), requests for purchase of additional equipment must be reviewed and approved by the deputy director or designee. When the cost of equipment purchased for a client who is in post-employment status reaches five thousand dollars ($5000) regardless of the number of times a client's case is opened for post-employment services, requests for purchase of additional equipment must be reviewed and approved by the deputy director or designee.

(D) Reader Service. RSB may provide reader service that a client needs in order to participate in a rehabilitation program, including orientation to employment. RSB will not pay the cost of reader service for a client who is in post-secondary training until after the client has applied for and used all funds that are available from the State Reader's Fund, as authorized in sections 178.160 and 178.180, RSMo.

(E) Interpreter Service for Deaf-Blind Persons. RSB may pay the cost of interpreter service when a deaf-blind client needs interpreter service in order to participate in a rehabilitation program, including orientation to employment. RSB may pay the rate that is charged by a qualified interpreter who is available to a client.

(F) Services to Family Members. RSB may provide services to members of a client's family, when the provision of such services is necessary in order for the client to become rehabilitated. RSB does not pay maintenance to members of the client's family except when the family member's financial support is reduced as a direct result of the client's participation in training.

(15) Supported Employment. RSB shall provide vocational rehabilitation services that will lead to supported employment for severely handicapped clients who are eligible for these services.

(A) The following definitions apply to the supported employment program:

1. Supported employment is competitive work in an integrated work setting with ongoing support services for any severely handicapped client for whom competitive employment has not occurred traditionally or whose competitive employment has been interrupted or intermittent as a result of the client's severe handicaps. Supported employment also is transitional employment for a client with chronic mental illness. The client needs ongoing support in order to work in the competitive, integrated work setting;

2. Competitive work is work that a client performs on either a full-time or part-time basis that averages at least twenty (20) hours per week for each pay period and for which the client's employer compensates the client in accordance with the Fair Labor Standards Act;

3. Integrated work setting means a job site where-

A. Most of the client's coworkers are not handicapped and a client is not part of a work group that is comprised solely of other individuals who are handicapped; or

B. Most of the client's coworkers are not handicapped and, if a job site described in subparagraph (15)(A)3.A. is not possible, the client is part of a work group of no more than eight (8) individuals who are handicapped; or

C. If the client works alone or if the client's only coworkers are members of a work group of no more than eight (8) individuals who are handicapped, the client must be able to have regular contact with individuals, other than personnel who provide support services, in the immediate work setting who are not handicapped;

4. Ongoing support services means continuous or periodic skill training services that a job coach provides to a client at least two (2) times per month at the job site, to enable the client to perform the work. Ongoing support services also may include, in conjunction with skill training services, other support services the client receives away from his/her work site, such as transportation, personal care services or counseling to members of the client's family;

5. Transitional employment for a client with chronic mental illness means competitive work in an integrated work setting. The client may need support services, either at the work site or away from the work site, in order to perform the work. The job placement may not be a permanent employment outcome for the client;

6. Traditionally time-limited post-employment services means services that RSB provides to support and maintain a severely handicapped client in employment. RSB shall base the services on RSB's assessment of the client's needs as recorded in the client's IWRP and shall not provide time-limited post-employment services for more than nine (9) months from the date the client obtains employment;

7. Individual with severe handicaps means a client who has one (1) or more severe physical or mental handicap that severely limit one (1) or more capacities the client needs in order to work, such as mobility, communication, self-care, work tolerance or work skills, and whose vocational rehabilitation can be expected to require multiple services over an extended period of time;

8. Job coaching means a service that includes, but is not limited to:

A. Intensive on-the-job training that the client needs in order to learn job duties and job-related responsibilities, such as transportation or coworker relationships;

B. Advocacy with employers, supervisor and coworkers to assure integration of the supported employee; and

C. Long-term services that include spot checking of client performance, employer satisfaction, job coaching or training in new duties;

9. Service provider means a rehabilitation facility or other community-based agency that will provide supported employment placement services to and provide ongoing job support to a client. The services provided by the facility or agency may include, but are not limited to:

A. Functional assessment;

B. Survey of businesses and assurance of potential work sites suited to the needs of the client;

C. Analysis of all relevant job-related variables, such as transportation, job restructuring and tax credit for employers;

D. Provision of direct training at employment sites until client is working to the employer's standards;

E. Development of internal advocacy system;

F. Gradual decrease in job coach assistance, to be replaced with employer supervision; and

G. Provision of long-term follow-up service as necessary; and

10. Community service agency means the Department of Mental Health, Senate Bill 40 Boards authorized by sections 205.968- 205.972, RSMo, relatives, employers and other public and private agencies that are perceived as the long-term support system for clients who have severe handicaps due to developmental disabilities, sensory impairments or chronic illness.

(B) RSB shall provide a number of rehabilitation services through the use of regular vocational rehabilitation case service funds in order to facilitate the delivery of services to severely handicapped blind or visually impaired clients under the provisions of the supported employment program. These services include:

1. Evaluation of rehabilitation potential, to determine an individual's eligibility for regular vocational rehabilitation services and eligibility for services through the supported employment program;

2. Counseling and guidance;

3. Personal and vocational adjustment evaluation and training;

4. Physical and mental restoration; and

5. Adaptive equipment that a client may need prior to participating in supported employment activities.

(C) RSB shall use supported employment case service funds for purchase of supported employment services from rehabilitation facilities with which Missouri has contracts for the provision of supported employment services. The services RSB purchases from rehabilitation facilities will consist primarily of job placement services that include development of job sites; contacts with potential employers to encourage them to accept severely disabled blind or visually impaired clients; and on-the-job skill training and support during the nine (9)-month period following job placement. RSB may use supported employment case service funds to provide these services.

(D) At the end of the nine (9)-month period following the client's job placement during which supported employment case service funds may be used to meet the cost of on-the-job skill training and support, the responsibility for providing ongoing support to the client is transferred to the local funding agency that has contracted with rehabilitation facilities to provide this support. RSB cannot spend either regular vocational rehabilitation case service funds or supported employment case service funds for supported employment activities after the end of the nine (9)-month period.

(E) After a client has been determined to be eligible to receive supported employment services, RSB shall meet the cost of those services with supported employment case service funds. If RSB exhausts the supported employment case service funds that are available to it, RSB may meet the cost of supported employment services for a client with regular vocational rehabilitation case service funds up to, but not exceeding, the nine (9)-month period following the client's job placement.

(16) Transition Services. RSB shall provide transition services, as needed by a client to promote the client's movement from school to post-secondary education, vocational training or suitable employment. RSB shall provide transition services through cooperative efforts with the Department of Elementary and Secondary Education, the Missouri School for the Blind and local education agencies.

(17) Case Closure. RSB shall close an applicant's or client's vocational rehabilitation case at any time in the vocational rehabilitation process when-RSB has determined that an applicant is not eligible for vocational rehabilitation services; the client has completed vocational rehabilitation services that RSB planned to provide and additional vocational rehabilitation services are either unnecessary or inappropriate, except services that RSB may provide as post-employment services; or an applicant or client is not available to receive vocational rehabilitation services.

(A) Case Closure Without an Eligibility Determination. RSB shall close an applicant's case without a determination of eligibility when the applicant is unavailable during an extended period of time to complete an evaluation of vocational rehabilitation potential and RSB has made repeated, reasonable effort to contact the applicant or, as appropriate, the applicant's representative, and to encourage the applicant's participation.

(B) Case Closure Due to a Determination of Ineligibility Before IWRP Development. When RSB determines, on the basis of clear evidence, that an applicant does not meet one (1) or more of the basic conditions of eligibility for vocational rehabilitation services or that a client no longer meets one (1) or more of the basic conditions of eligibility, RSB shall close the applicant's or client's case. RSB shall carry out the following activities in regard to case closure:

1. RSB shall make the ineligibility determination only after full consultation with the applicant or client or, as appropriate, the applicant's or client's parent, guardian, legal custodian or other representative, or after giving a clear opportunity for such consultation. RSB shall document in the case file the consultation, or the opportunity for the consultation;

2. RSB shall complete a certification of ineligibility which indicates the reasons the applicant or client is ineligible for vocational rehabilitation services. The appropriate RSB staff member shall sign and date the certification; and

3. RSB shall notify the applicant or client in writing of the action RSB has taken. The notification shall include information regarding the applicant's or client's appeal rights and the assistance that is available from the client assistance program. As appropriate, RSB shall refer the applicant or client to other agencies or programs.

(C) Case Closure Due to a Determination of Ineligibility After IWRP Development. When RSB decides to terminate vocational rehabilitation services that RSB is providing to a client because of a determination that the client is not capable of achieving a vocational goal, RSB shall amend the client's IWRP and shall close the client's case. RSB shall carry out the following activities in regard to case closure:

1. RSB shall make the ineligibility determination only after full consultation with the client or, as appropriate, the client's parent, guardian, legal custodian or other representative, or after giving a clear opportunity for such consultation, except under the following circumstances: the client has refused to participate, the client is no longer present in Missouri, the client's whereabouts are unknown or the client's medical condition is rapidly progressive or terminal. When the client or, as appropriate, the client's parent, guardian or other representative has consulted with RSB, RSB shall record the views of the individual regarding the decision; and

2. RSB shall record in an amendment to the IWRP the rationale for the ineligibility decision, which certifies that the provision of vocational rehabilitation services has demonstrated the client is not capable of achieving a vocational goal. The appropriate RSB staff member shall sign and date the certification.

A. If the amendment to the IWRP and the certification are in the form of a letter to the client, RSB shall identify the letter as an amendment to the IWRP.

B. RSB shall notify the client in writing of the action RSB is taking. The notification shall include information regarding the client's appeal rights and the assistance that is available from the client assistance program. RSB does not need to send written notification to the client when the client is deceased, the address is unknown or the client cannot be located.

C. When RSB determines a client is not eligible for additional vocational rehabilitation services because the client cannot be expected to benefit from vocational rehabilitation services in terms of employability, RSB shall refer the client for possible services under RSB's independent living rehabilitation program and, as appropriate, to other agencies or programs.

(D) Annual Review of Certain Case Closures. When RSB determines an applicant or client is ineligible for vocational rehabilitation services because the applicant or client cannot be expected to achieve a vocational goal, RSB shall review the ineligibility decision within twelve (12) months. During the review, RSB gives the applicant or client or, as appropriate, the applicant's or client's parent, guardian, legal custodian or other representative the opportunity for full consultation in the reconsideration of the decision of ineligibility.

1. RSB shall initiate the first review of a decision of ineligibility. The applicant or client or, as appropriate, the applicant's or client's parent, guardian, legal custodian or other representative shall initiate any subsequent review.

2. RSB shall not carry out the first annual review of a decision of ineligibility when the applicant or client refuses the review, the applicant or client has refused vocational rehabilitation services, the applicant or client is no longer present in the state or whereabouts are unknown, or the applicant's or client's medical condition is rapidly progressive or terminal.

(E) Case Closure as Successfully Rehabilitated. In order for RSB to determine that a client has been successfully rehabilitated, the client must have been provided an evaluation of rehabilitation potential, determined to be eligible for vocational rehabilitation services, provided counseling and guidance as essential vocational rehabilitation services, provided appropriate and substantial vocational rehabilitation services in accordance with the client's IWRP, and determined to have achieved and maintained suitable employment for at least sixty (60) days. The client's case record must contain the following information:

1. The basis on which RSB determined the client's employment is suitable;

2. The contribution of vocational rehabilitation services to the client's rehabilitation;

3. The involvement of the client or, as appropriate, the client's parent, guardian or other representative in the decision to close the client's case; and

4. Written notice to the client of the closure decision and the availability and purpose of post-employment services. The text of the written notice must identify it as an amendment to the client's IWRP.

(18) Standards for Facilities and Other Providers of Services. RSB requires providers from which RSB purchases vocational rehabilitation services to meet the standards stated in this section of this rule.

(A) Rehabilitation Facilities. A rehabilitation facility is a facility that is operated for the purpose of providing vocational rehabilitation services to clients and applicants. A rehabilitation facility must have the capability to provide, singly or in combination, one (1) or more of the following vocational rehabilitation services:

1. Vocational rehabilitation services, including under one (1) management: medical, psychiatric, psychological, social and vocational services;

2. Testing, fitting or training in the use of prosthetic or orthotic devices;

3. Prevocational conditioning or recreational therapy;

4. Physical and occupational therapy;

5. Speech and hearing therapy;

6. Psychiatric, psychological and social services;

7. Evaluation of rehabilitation potential;

8. Personal and work adjustment;

9. Vocational training with a view toward career advancement, which is provided in combination with other rehabilitation services;

10. Evaluation or control of specific disabilities;

11. Orientation and mobility services and other adjustment services to blind individuals;

12. Transitional or extended employment for those individuals with handicaps who cannot be absorbed readily into the competitive labor market;

13. Psychosocial rehabilitation services for clients and applicants with chronic mental illness; and

14. Rehabilitation engineering services.

(B) Rehabilitation Facility Accreditation. A rehabilitation facility must comply with the rehabilitation facility standards of RSB. These standards are in section (18).

(C) Academic or Vocational Training Accreditation. An agency or institution that provides academic or vocational training services must be accredited or licensed by the accrediting or licensing agency that is appropriate to the training curriculum that the agency or institution provides.

(D) Physical or Mental Restoration Provider Accreditation. A physician or any other health care provider must be certified or accredited to perform the specific service that the applicant or client requires and must be licensed to perform the service in the state in which the service is performed.

(19) Small Business Enterprises. Through the business enterprise program, which is administered according to 13 CSR 40-91.010, RSB establishes small business enterprises that are operated by severely handicapped, legally blind individuals who have received vocational rehabilitation services. RSB provides management services and supervision to the operators of the small business enterprises.

(20) Facilities and Services for Groups of Handicapped Individuals.

(A) RSB provides vocational rehabilitation services through the facilities and services for groups of handicapped individuals' grant authority. This authority is used when vocational rehabilitation services are not directly related to the individualized written rehabilitation program of an individual client but are expected to contribute to the vocational rehabilitation of a group of handicapped individuals.

(B) Prior to use of the facilities and services to groups of handicapped individuals grant authority, RSB documents the need for the services that will be provided.

1. Whenever an agency other than RSB provides vocational rehabilitation services through this grant authority, RSB will procure services through a contractual agreement between that agency and RSB.

2. Whenever RSB provides vocational rehabilitation services directly through this grant authority, RSB describes the nature and scope of the services that will be provided and the manner in which they will be provided, identifies the client population to which services will be provided and describes the evaluation process that will be used to measure the effectiveness of the services.

(21) Order of Selection. According to 34 CFR 361.36, if RSB is unable to provide vocational rehabilitation services to all eligible individuals who apply for services, RSB will implement an order of selection to ensure that those individuals with the most severe handicaps are provided services.

(A) Implementation of Order of Selection. If the deputy director decides that RSB needs to implement an order of selection, RSB will submit an amendment to the vocational rehabilitation state plan, which will initiate the order of selection.

(B) Guidelines for Delivery of Services Under an Order of Selection. RSB will provide vocational rehabilitation services to clients who require purchased services in the order stated in this subsection. RSB's provision of purchased services to a client is based entirely on the availability of funds. RSB will serve each client in each priority group in the order of his/her date of eligibility for services. According to 34 CFR 361.36(c), RSB will give special consideration to any client within each priority group whose handicapping condition is a result of disabilities sustained while the client was performing his/her duties as a public safety officer.

1. Priority group I-Every client for whom an IWRP has been developed and signed by RSB and the client and who is in case status ten (10) or above on the date the order of selection becomes effective, regardless of the severity of the client's handicap.

2. Priority group II-Every client who is legally blind or who has a visual efficiency that does not exceed twenty percent (20%) and who has one (1) or more additional disabilities that are stated in 34 CFR 361.1(c)(2) in the definition of individual with severe handicaps.

3. Priority group III-Every client who is legally blind or has a visual efficiency that does not exceed twenty percent (20%) and who does not have one (1) or more additional disabilities that are stated in 34 CFR 361.1(c)(2) in the definition of individual with severe handicaps.

4. Priority group IV-Every client who has a progressive eye disease and whose central visual acuity is twenty/seventy (20/70) or worse in the better eye with best correction, whose visual efficiency does not exceed sixty-four percent (64%) or whose near vision is decreased to the extent that the individual cannot read print that is smaller than Jaeger nine (J9) with best correction, and who has one (1) or more additional disabilities that are stated in 34 CFR 361.1(c)(2) in the definition of individual with severe handicaps.

5. Priority group V-Every client who has a progressive eye disease and whose central visual acuity is twenty/seventy (20/70) or worse in the better eye with best correction, whose visual efficiency does not exceed sixty-four percent (64%) or whose near vision is decreased to the extent that the individual cannot read print that is smaller than Jaeger nine (J9) with best correction and who does not have one (1) or more additional disabilities that are stated in 34 CFR 361.1(c)(2) in the definition of individual with severe handicaps.

(22) Appeal Procedures. An applicant for or recipient of services through RSB's vocational rehabilitation program has the right to appeal any action regarding the furnishing or denial of services. The appeal process may consist of three (3) stages, in which the procedures provide the individual and RSB the opportunity to submit additional evidence and information. Throughout the appeal procedures stated in this section, the words applicant or client also mean, if appropriate, the individual's parent, guardian, legal custodian or other representative.

(A) Administrative Review. An administrative review is not a mandatory part of the appeal process. RSB should encourage the applicant or client to have an administrative review, in an effort to resolve the disputed issue in an informal setting. If an applicant or client elects to have an administrative review, it is the first step in the appeal process. The designee of the deputy director conducts the administrative review.

(B) Fair Hearing. If an administrative review is held, the fair hearing is the second step in the appeal process. If the applicant or client does not wish to have an administrative review, the fair hearing is the first step in the appeal process. In either situation, the fair hearing must be held within forty-five (45) calendar days from the date RSB receives from the applicant or client the initial written request for a review of RSB's decision, unless the applicant or client and RSB agree to waive the forty-five (45)-day time limit. The impartial hearing officer conducts the fair hearing.

(C) Review by Deputy Director. The deputy director may decide to review the decision of the impartial hearing officer.

(D) General Guidelines. RSB staff and an applicant or client must follow these guidelines throughout the appeal procedures.

1. Administrative review and fair hearing.

A. RSB service delivery, supervisory and administrative staff inform an individual of the right to an administrative review and fair hearing at the time RSB receives an application for services during the development of an IWRP at each time the client disputes an action involving the provision or denial of services and at the time of case closure for any reason other than death.

B. RSB staff inform the applicant or client of the right to present additional evidence, information and witnesses, to be represented by counsel or other appropriate advocate and to examine all witnesses and other relevant sources of information and evidence.

C. RSB staff inform the applicant or client that the applicant or client must make a written request to the deputy director for an administrative review. If dissatisfied with the decision of the administrative review, the applicant or client must make a written request to the deputy director for a fair hearing.

D. The appropriate RSB staff schedules the administrative review or the impartial hearing officer schedules the fair hearing. The date is agreed to by RSB staff and the applicant or client.

E. The administrative review or fair hearing is held during normal working hours, at the district office where the applicant's or client's case record is located.

F. RSB staff members who are involved in case activities that led to the disputed decision are available for testimony.

G. The applicant or client may present additional evidence, information and witnesses during the administrative review or fair hearing and may be represented by counsel or other appropriate advocate.

H. The deputy director's designee or the impartial hearing officer informs all persons present of the purpose of the administrative review or fair hearing and of the confidentiality of all matters that will be discussed.

I. Before the review or hearing begins, the applicant or client must present written authorization to discuss confidential information in the presence of counsel and witnesses.

J. Following the administrative review, the deputy director's designee sends by certified mail to the applicant or client and to the deputy director a full written report of the findings and the basis for the decision. The letter from the deputy director's designee advises the applicant or client of the right to request a fair hearing and of the right to present additional evidence, information and witnesses, to be represented by counsel or other appropriate advocate and to examine all witnesses and other relevant sources of information and evidence.

K. Within thirty (30) calendar days of the completion of the fair hearing, the impartial hearing officer makes a decision and sends by certified mail to the applicant or client and to the deputy director a full written report of the findings and the basis for the decision.

L. Necessary travel and subsistence costs incurred to attend an administrative review or fair hearing may be paid from vocational rehabilitation case service funds for the following individuals, if RSB gives prior authorization for payment: the applicant or client; a parent of an unemancipated applicant or client up to the age of twenty-one (21) years, the guardian or legal custodian of an applicant or client, or a private individual who provides needed transportation because public transportation is not available or feasible. RSB does not pay the expenses of any other individual, including legal counsel or other advocate, who appears in behalf of an applicant or client at an administrative review or fair hearing.

2. Review by the deputy director. Within twenty (20) calendar days of the mailing of the decision of the impartial hearing officer, the deputy director shall notify the applicant or client whether the deputy director intends to review the decision of the impartial hearing officer. If the deputy director fails to notify the applicant or client of the intent to review the decision as required, the decision of the impartial hearing officer becomes a final decision. If the deputy director decides to review the decision of the impartial hearing officer, the deputy director shall notify the applicant or client of the right to submit additional evidence and information.

A. Within thirty (30) calendar days of notifying the applicant or client of the intent to review the decision of the impartial hearing officer, the deputy director shall notify the applicant or client by certified mail of the final decision, including a full report of the findings and the basis for the decision.

B. The deputy director may not delegate responsibility to make the final decision to any other employee of RSB.

C. Necessary travel and subsistence incurred to attend review by the deputy director may be paid from vocational rehabilitation case service funds in accordance with sub-paragraph (22)(D)1.L.

(23) Confidentiality of Information.

(A) Need to Collect Personal Information. RSB maintains a record on each client who is referred for, applies for, receives or has received services from RSB. RSB informs each client or, as appropriate, parent or guardian, service provider, cooperating agency and other interested persons of RSB's need to collect personal information and the conditions for accessing and releasing this information.

1. All client records are the property of RSB and all contracts, grants, agreements and other documents entered into by the division/RSB state this fact. RSB does not make confidential records available to the general public and does not share these records with advisory groups or other bodies that do not have official responsibility for administration of the program.

2. Except as provided in this rule, RSB discloses no confidential information obtained concerning a client, orally, in writing or by any other means, without the written consent of the client or, as appropriate, parent, guardian or legal custodian.

3. If the client is an unemancipated minor, RSB also obtains the written consent of a parent, guardian or legal custodian. If a client is eighteen (18) years of age or older or is legally emancipated, RSB discloses information regarding that client only with the consent of the client or, if the client has been declared to be incompetent, the client's guardian.

4. Except as provided in this rule, each client who is eighteen (18) years of age or older or, as appropriate, the guardian has full access to all records that contain the client's confidential information. A parent, guardian or legal custodian of a client who is under the age of eighteen (18) years has full access to the confidential information contained in the case record of that client.

5. At the time of first personal contact, RSB advises the client or, as appropriate, parent, guardian or legal custodian of the authority under which information is collected; the principal purposes for which the information will be used or released; whether the client's provision of the information is mandatory or voluntary and the effects of refusing to provide requested information; those situations in which RSB does and does not require the written consent of the client before information may be released; identification of other agencies to which information is routinely released; and the types of information that are released. All explanations to the client or, as appropriate, to the parent, guardian or legal custodian of the client must be in the individual's primary language or, if indicated, must be through a special mode of communication, including braille.

(B) Use of Client Personal Information. RSB uses all client personal information only for purposes directly connected with the administration of the program through which the client has applied for services.

(C) Removal of Case Records. RSB shall remove any case record from the appropriate RSB office only with the approval of the deputy director and, when not in use by RSB staff, each case record is filed in a file cabinet.

(D) Disclosure of Information to Entity Other Than Client. Whenever RSB discloses personal information to any person or entity other than the client or, as appropriate, parent, guardian or legal custodian, RSB advises the person or entity of the confidential nature of the information and that federal and state law and regulations prohibit disclosure of the information without the informed written consent of the client or, as appropriate, the client's parent or guardian.

(E) Release of Confidential Information With Written Consent. When a client or, as appropriate, parent, guardian or legal custodian makes a written request for release of confidential information to the client or to the client's parent, guardian or legal custodian, RSB may release all confidential information, except the following:

1. Unless RSB has purchased it, information obtained from another individual, agency or organization is released only by the providing individual, agency or organization or under conditions established by it. When release of information is prohibited by the provider of the information, RSB informs the client or, as appropriate, parent, guardian or legal custodian of the originator of the information and the client or, as appropriate, parent or guardian is informed that s/he may access it directly from the originator;

2. Information that RSB receives from or that is developed for the Social Security Administration is controlled by that agency's regulations governing confidentiality. Information in the records of the disability determination unit of the Missouri Division of Vocational Rehabilitation is available for use in delivery of services to the client. If a client requests this information, RSB tells the client to contact either the originating source of the information or the Social Security Administration. Federal law authorizes a member of congress to obtain this information. Confidentiality of this information is governed by 20 CFR part 401. This policy applies to all active and closed cases of RSB;

3. Information that RSB purchases may be released according to the terms of this rule;

4. Regardless of its source, RSB does not release to the client any information, including medical or psychological information, that RSB concludes may be harmful to the client. RSB may release such information to the client's parent, guardian, legal custodian or other legal representative or to a physician or licensed psychologist. When it releases such information, RSB informs the recipient of the information that it may be harmful to the client and that the recipient is responsible for use of the information; and

5. When the client makes a written request for release of information to another individual, agency or organization, RSB releases only that information that may be released to the client and only to the extent that the other individual, agency or organization demonstrates that the requested information is necessary for its program. RSB releases information that it determines is harmful to the client only when the other individual, agency or organization provides written assurance to RSB that the information will be used only for the purpose for which it is requested and that it will not be released to the client.

(F) Release of Confidential Information Without Written Consent. Under the following circumstances, RSB may release confidential information without the written consent of the client or, as appropriate, parent, guardian or legal custodian:

1. A RSB employee may disclose confidential information to other RSB employees in the course of providing services to the client;

2. With authorization of the deputy director, RSB may release confidential information to an organization, agency or individual who is engaged in audit, evaluation or research. With authorization of the deputy director, RSB may release confidential information in cases involving employee disciplinary action. RSB may release the information only for purposes directly connected with the administration of the program from which the client receives services or for purposes that would improve substantially the quality of life for handicapped persons, and only if the organization, agency or individual assures that the information will be used only for the purposes for which it is provided. The information will be released only to persons officially connected with the audit, evaluation, research or employee disciplinary action. The information will not be released to the client and it will be managed in a manner to safeguard confidentiality. The final product will not reveal any personal identifying information without the informed written consent of the client;

3. On a need-to-know basis, RSB may share confidential information with its trainees, interns and volunteers in the same manner as employees;

4. On a need-to-know basis, RSB may share confidential information with individuals, institutions and agencies with which RSB contracts in order to determine eligibility or to provide services under the terms of an IWRP; and

5. RSB may release confidential information without the written consent of the client, under the following circumstances: to protect the client or others, when the client poses a threat to the safety of the client or others; if required by federal law; in response to investigations in connection with law enforcement, fraud or abuse; or in response to judicial order.

(G) Release of Information Regarding Client Appeals. When a client has appealed a decision regarding denial or delivery of services, in accordance with section (22), and appeals the decision of an administrative review to the impartial hearing officer, RSB provides the officer with a copy of all case record information that has a bearing on the appeal issue, including all material relative to the administrative review.

(H) Subpoenas.

1. When a client is involved in litigation or in an administrative proceeding and a RSB employee receives a subpoena to testify, the employee appears according to the terms of the subpoena and testifies if written consent is given by the client. If no written consent is given, the employee informs the court or administrative body of the requirements of the law and regulations concerning confidentiality and testifies only upon order.

2. If a subpoena for client records only is received and if a written consent from the client for release of information is on file, confidential information may be released in accordance with this rule and with the terms of the subpoena.

3. If no written consent from the client is on file and the subpoena is from the client's attorney, RSB shall contact the attorney immediately and request a written consent for release of information from the client. If the subpoena is not from the client's attorney, RSB contacts the client or the client's attorney, if known, and requests a written consent from the client. Information may be released only after the written consent is received, unless a consent has not been received by the due date of the subpoena. In such a case, the RSB employee appears before the court or administrative body and informs it of the requirements of the law and regulations concerning confidentiality. Unless the client consents at the hearing, the employee testifies only upon order.

4. Whenever a RSB employee's or client's records have been subpoenaed, the client has not given written consent for release of information and the employee is ordered to testify or release information, the division may file a motion to quash, particularly in those cases in which the client is not represented by counsel.

5. Information governed by paragraphs (23)(E)1. and 2. is removed from the case record before the record is released, if the release occurs other than in court. A notice accompanies the record, identifying the material that has been removed and directing the person issuing the subpoena for records to the proper source for release of information. If the subpoena requires a court appearance, the information is segregated in the case record and the employee follows the order of the court, after informing the court of the federal laws and regulations governing confidentiality of information.

(I) Case Record Procedures.

1. A client or, as appropriate, the client's parent, guardian or legal custodian may submit a written request to add, delete or amend information that is contained within the client's case record. Within thirty (30) days of the receipt of the request, RSB decides whether to amend the record.

2. If the record is to be amended, RSB amends any portion of the record that is not accurate, relevant, timely or complete by making appropriate notations in the record or inserting corrective material into the case record. RSB provides a copy of the amended or corrective material to the client.

3. If RSB decides not to amend the case record, RSB informs the client in writing of the decision, the reason for the decision and the procedures the client may follow in placing the statements in the record. The client may submit a written statement of the reasons the client disagrees with the disputed information. RSB places this statement in the case record. RSB identifies any portion of the case record that is disputed and makes available a copy of the client's statement to any agency or person to whom the disputed portion of the record is disclosed.

4. Within ten (10) workdays of the receipt of a request for client information, RSB decides whether to comply with the request and informs the person who requested the information, unless an extension is made by mutual consent or due to the following circumstances: RSB may extend the time for initial determination on a request for an additional ten (10) workdays if it is necessary to search for, collect and examine a number of separate records or if there is need to consult with another agency that has an interest in the decision regarding the request. RSB makes extensions by sending a written notice to the person who makes the request, stating the reason for the extension and the date that a decision is expected. If RSB has not notified the person who requested the information by the end of the first or second ten (10)-workday period, RSB immediately informs the person of the reason for the delay of the date on which a decision may be expected.

(J) Responses to Requests.

1. When a requested case record is available, RSB notifies the person who requested the case record of the date and place that the record is available for inspection or the date that copies are available. RSB advises of any fees for copying the requested information. If the person who requested the information is unable to pick up the copied information, RSB may mail the information to the person.

2. If RSB denies a written request for a case record, RSB sends written notification to the person who requested the case record. The notification includes the identification of the person who is responsible for the denial and a reference to the specific law or regulations that authorize the withholding of the record.

3. If RSB cannot locate a requested case record or RSB knows that the record has been destroyed, RSB sends written notification to the person who requested the case record.

(K) Statement of Consent for Release of Information. A consent for release of information must be in writing and must contain the name of the client; the name and title of the person or organization to which the information is to be released; the extent or nature of the information to be released; a statement that the consent is valid for a period not to exceed thirty (30) days from the date the consent is signed, unless otherwise specified in writing by the client; a statement that the consent is subject to revocation at any time; the signature of the client; and the date of signature.

(L) Access to Case Record Information. The original case record may not be removed from the control of RSB, but may be viewed in the RSB office in compliance with this rule. A designated RSB employee is present throughout the period of time that the case record is being reviewed. All releases that require copies are provided through photocopies. RSB may charge its actual cost for copies.

(M) Case Record Memorandum. When confidential information is released or release is denied, the RSB employee who makes or denies the release records in the case record-the name of the person who made the request for information; the name of the person to whom the information was released; the date the information was reviewed or otherwise released; and the basis for release of information or denial of the request.

(24) Forms Used in Administration of the Vocational Rehabilitation Program. RSB uses the following forms and documents to administer the vocational rehabilitation program:

(A) Form R-1-Rehabilitation of the Blind Application;

(B) Form R-2-Client Data Record;

(C) Form R-3-General Medical Examination Record;

(D) Form R-9-Visual Disability Examination Report;

(E) Form R-10-Individualized Written Rehabilitation Program;

(F) Form R-10A-Financial Inventory;

(G) Form R-10B-Maintenance Eligibility;

(H) Form R-14-Equipment Ownership Agreement; and

(I) Rehabilitation Facility Standards.

(AUTHORITY: sections 207.010, 207.020, 209.010 and 209.020, RSMo 1994.* Original rule filed Aug. 11, 1978, effective Nov. 11, 1978. Amended: Filed Nov. 5, 1979, effective Feb. 11, 1980. Amended: Filed Dec. 10, 1980, effective March 12, 1981. Emergency amendment filed Feb. 23, 1982, effective March 8, 1982, expired June 10, 1982. Amended: Filed Feb. 23, 1982, effective June 11, 1982. Emergency amendment filed July 13, 1982, effective Aug. 1, 1982, expired Oct. 10, 1982. Amended: Filed July 13, 1982, effective Oct. 11, 1982. Emergency amendment filed Jan. 15, 1985, effective Feb. 1, 1985, expired May 14, 1985. Amended: Filed Jan. 15, 1985, effective April 11, 1985. Emergency amendment filed Jan. 15, 1986, effective Jan. 25, 1986, expired May 15, 1986. Amended: Filed Jan. 15, 1986, effective June 12, 1986. Emergency rescission and emergency rule filed Jan. 21, 1987, effective Jan. 31, 1987, expired May 21, 1987. Rescinded and readopted: Filed Jan. 21, 1987, effective May 11, 1987. Emergency amendment filed July 8, 1987, effective July 18, 1987, expired Nov. 15, 1987. Amended: Filed July 8, 1987, effective Oct. 11, 1987. Amended: Filed Nov. 4, 1988, effective Jan. 27, 1989. Amended: Filed April 3, 1989, effective July 1, 1989. Rescinded and read-opted: Filed June 6, 1991, effective Oct. 31, 1991. Emergency amendment filed Oct. 18, 1991, effective Oct. 31, 1991, expired Feb. 27, 1992. Amended: Filed Sept. 13, 1994, effective March 30, 1995.)

The secretary of state has determined that the publication of this rule in its entirety would be unduly cumbersome or expensive. The entire text of the material referenced has been filed with the secretary of state. This material may be found at the Office of the Secretary of State or at the headquarters of the agency and is available to any interested person at a cost established by state law.

*Original authority: 207.010, RSMo 1945, amended 1949, 1953, 1973; 207.020, RSMo 1945, amended 1961, 1965, 1977, 1981, 1982, 1986; and 209.010 and 209.020, RSMo 1939.

The following state regulations pages link to this page.