# COMAR Title 13A — State Board of Education

## Subtitle 11 — Programs for Adults With Disabilities

### Chapter 01 — Vocational Rehabilitation Services

**Authority:** Education Article, §§21-301—21-306 and 21-402—21-404, Annotated Code of Maryland

**Administrative History:** Effective date: April 3, 1989 (16:6 Md. R. 729)

**Administrative History:** Regulation .01 amended effective September 2, 1991 (18:17 Md. R. 1919)

**Administrative History:** Regulation .02B amended effective September 2, 1991 (18:17 Md. R. 1919); February 28, 1994 (21:4 Md. R. 277); August 15, 1994 (21:16 Md. R. 1388)

**Administrative History:** Regulation .03C amended effective September 2, 1991 (18:17 Md. R. 1919)

**Administrative History:** Regulation .04 amended effective September 2, 1991 (18:17 Md. R. 1919)

**Administrative History:** Regulation .06C amended effective September 2, 1991 (18:17 Md. R. 1919)

**Administrative History:** Regulation .07 amended effective August 15, 1994 (21:16 Md. R. 1388)

**Administrative History:** Regulation .07P recodified to .07Q and new Regulation .07P adopted effective September 2, 1991 (18:17 Md. R. 1919)

**Administrative History:** Regulation .09 amended effective August 15, 1994 (21:16 Md. R. 1388)

**Administrative History:** Regulation .09B amended effective September 2, 1991 (18:17 Md. R. 1919)

**Administrative History:** Regulation .11 amended effective August 15, 1994 (21:16 Md. R. 1388)

**Administrative History:** Regulation .13B amended effective September 2, 1991 (18:17 Md. R. 1919)

**Administrative History:** Regulation .15 adopted effective February 28, 1994 (21:4 Md. R. 277)

**Administrative History:** Regulation .16 adopted effective February 28, 1994 (21:4 Md. R. 277)

**Administrative History:** Chapter revised effective August 7, 2000 (27:15 Md. R. 1402)

**Administrative History:** Regulation .01 amended effective December 6, 2007 (34:24 Md. R. 2158)

**Administrative History:** Regulation .03 amended effective October 28, 2002 (29:21 Md. R. 1646)

**Administrative History:** Regulation .03-1B amended effective December 9, 2004 (31:24 Md. R. 1728); March 13, 2006 (33:5 Md. R. 522); December 6, 2007 (34:24 Md. R. 2158); November 30, 2009 (36:24 Md. R. 1859); January 21, 2013 (40:1 Md. R. 21); July 20, 2015 (42:14 Md. R. 881)

**Administrative History:** Regulation .04A amended effective March 13, 2006 (33:5 Md. R. 522)

**Administrative History:** Regulation .04D amended effective December 9, 2004 (31:24 Md. R. 1728)

**Administrative History:** Regulation .05 amended effective October 28, 2002 (29:21 Md. R. 1646); December 6, 2007 (34:24 Md. R. 2158)

**Administrative History:** Regulation .05H amended effective December 9, 2004 (31:24 Md. R. 1728)

**Administrative History:** Regulation .06 amended effective December 9, 2004 (31:24 Md. R. 1728)

**Administrative History:** Regulation .07I amended effective December 9, 2004 (31:24 Md. R. 1728)

**Administrative History:** Regulation .10 amended effective October 1, 2001 (28:19 Md. R. 1687); October 28, 2002 (29:21 Md. R. 1646)

**Administrative History:** Regulation .12 amended effective October 1, 2001 (28:19 Md. R. 1687); December 9, 2004 (31:24 Md. R. 1728)

**Administrative History:** Regulation .13B amended effective January 12, 2009 (36:1 Md. R. 23)

**Administrative History:** Regulation .14 amended effective October 28, 2002 (29:21 Md. R. 1646)

**Administrative History:** Regulation .15 amended effective October 1, 2001 (28:19 Md. R. 1687)

**Administrative History:** Regulation .15 repealed and new Regulation .15 adopted effective October 28, 2002 (29:21 Md. R. 1646)

**Administrative History:** Regulation .15 repealed and new Regulation .15 adopted effective December 9, 2004 (31:24 Md. R. 1728)

**Administrative History:** Regulation .15 repealed and new Regulation .15 adopted effective March 13, 2006 (33:5 Md. R. 522)

**Administrative History:** Regulation .15 repealed and new Regulation .15 adopted effective December 6, 2007 (34:24 Md. R. 2158)

**Administrative History:** Regulation .15 amended effective January 12, 2009 (36:1 Md. R. 23)

**Administrative History:** Regulation .15 repealed and new Regulation .15 adopted effective November 30, 2009 (36:24 Md. R. 1859)

**Administrative History:** Regulation .15 amended effective January 21, 2013 (40:1 Md. R. 21); July 20, 2015 (42:14 Md. R. 881)

**Administrative History:** Regulation .16D amended effective December 6, 2007 (34:24 Md. R. 2158)

**Administrative History:** Regulation .17 amended effective October 28, 2002 (29:21 Md. R. 1646)

**Administrative History:** Regulation .17C amended effective March 13, 2006 (33:5 Md. R. 522)

#### Regulation .01 Scope.

*COMAR 13A.11.01.01*

This chapter implements the Rehabilitation Act of 1973, as amended, 29 U.S.C. §701 et seq., 34 CFR 361 and 363, and Education Article, §§21-301—21-304, Annotated Code of Maryland, which establish a program of vocational rehabilitation services to assist transitioning students, consistent with Regulation .04A of this chapter, and adults with disabilities to become employed. Regulations .10—.13 and .15—.17 of this chapter are State-imposed requirements.

#### Regulation .02 Purpose.

*COMAR 13A.11.01.02*

This chapter implements a Statewide comprehensive, coordinated, effective, efficient, and accountable program of vocational rehabilitation, which is:

A. An integral part of the Statewide workforce investment system; and

B. Designed to assess, plan, develop, and provide vocational rehabilitation services for individuals with disabilities, consistent with their strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice, so that the individuals may prepare for and engage in gainful employment.

#### Regulation .03 Definitions.

*COMAR 13A.11.01.03*

A. In this chapter, the following words have the meanings indicated.

B. Terms Defined.

  (1) “Applicant” means an individual who:

    (a) Has requested vocational rehabilitation services provided by the Division;

    (b) Has completed and signed the Division's application form or provided equivalent information;

    (c) Has provided information necessary to initiate an assessment to determine eligibility and priority for services; and

    (d) Is available to complete the assessment process.

  (2) “Client” means an applicant for or recipient of vocational rehabilitation services provided by the Division.

  (3) “Client Assistance Program” means a program administered by the Division to provide assistance to applicants and eligible individuals including:

    (a) Advising and informing applicants and eligible individuals of all services and benefits available to them through programs authorized under the Rehabilitation Act of 1973, as amended;

    (b) Informing individuals with disabilities in the State, especially individuals with disabilities who have traditionally been unserved or underserved by vocational rehabilitation programs, of the services and benefits available to them under the Act and under Title I of the Americans with Disabilities Act of 1990, and their rights and responsibilities in connection with those benefits;

    (c) Assisting and advocating for applicants and eligible individuals in their relationships with projects, programs, and community rehabilitation programs providing rehabilitation services under the Act; and

    (d) Helping applicants and eligible individuals by pursuing, or assisting them in pursuing legal, administrative, and other available remedies when necessary to ensure the protection of their rights under the Act.

  (4) “Community rehabilitation program” means a program that:

    (a) Provides directly or facilitates the provision of vocational rehabilitation services to individuals with disabilities; and

    (b) Is approved or certified by the Division.

  (5) “Competitive employment” means work in the competitive labor market:

    (a) That is performed on a full-time or part-time basis in an integrated setting; and

    (b) For which an individual is compensated at or above the minimum wage but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals who are not disabled.

  (6) “Customary charge” means the usual charge to the general public for goods and services.

  (7) “Director” means the Assistant State Superintendent in Rehabilitation Services.

  (8) “Division” means the Division of Rehabilitation Services, the State agency designated to administer the vocational rehabilitation program.

  (9) “Eligible individual” means an individual who meets the criteria in Regulation .05 of this chapter.

  (10) “Employment goal” means the occupation or profession, consistent with the individual's strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice, which is expected to be achieved as a result of the provision of vocational rehabilitation services.

  (11) “Employment outcome” means entering or retaining full-time or, if appropriate, part-time competitive employment in the integrated labor market, supported employment, or any other type of employment that is consistent with an individual's strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice, including: self-employment, telecommuting, or business ownership.

  (12) “Extended services” means the ongoing support services and other appropriate services needed to support and maintain an individual with the most significant disability in supported employment after time-limited services have been provided by the Division.

  (13) “Extreme medical risk” means a probability of substantially increasing functional impairment or risk of death if medical services, including mental health services, are not provided expeditiously.

  (14) “Family member” or “member of the family” means a relative or guardian of an individual with disabilities or another individual living in the same household who has a substantial interest in the well-being of the individual and whose receipt of vocational rehabilitation services is necessary to enable the applicant or eligible individual to achieve an employment outcome.

  (15) “Individual's representative” means any person chosen by the applicant or eligible individual, including a parent, guardian, other family member, or advocate, unless a representative has been appointed by a court to represent the individual, in which case the court-appointed representative is the individual's representative.

  (16) “Individual with a most significant disability” means an individual:

    (a) Who meets the definition of individual with a significant disability; and

    (b) Whose disability seriously limits three or more functional capabilities (such as mobility, communication, self-care, self-direction, interpersonal skills, work tolerance, or work skills) in terms of an employment outcome.

  (17) “Individual with a significant disability” means an individual:

    (a) Who has a severe physical or mental impairment that seriously limits one or more functional capacities (mobility, communication, self-care, self-direction, interpersonal skills, work tolerance, or work skills) in terms of an employment outcome;

    (b) Whose vocational rehabilitation can be expected to require multiple vocational rehabilitation services over an extended period of time; and

    (c) Who has one or more physical or mental disabilities resulting from amputation, arthritis, autism, blindness, burn injury, cancer, cerebral palsy, cystic fibrosis, deafness, head injury, heart disease, hemiplegia, hemophilia, respiratory or pulmonary dysfunction, mental retardation, mental illness, multiple sclerosis, muscular dystrophy, musculoskeletal disorders, neurological disorders (including stroke and epilepsy), paraplegia, quadriplegia, other spinal cord conditions, sickle cell anemia, specific learning disability, end-stage renal disease, or another disability or combination of disabilities determined on the basis of an assessment of rehabilitation needs to cause comparable substantial functional limitation.

  (18) “Institution of higher education” means a university, college, community/junior college, vocational school, technical institute, or hospital school of nursing.

  (19) “Integrated work setting” means, with respect to:

    (a) The provision of services, a setting typically found in the community where applicants or eligible individuals interact with nondisabled individuals other than nondisabled individuals who are providing services to them; and

    (b) An employment outcome, a setting typically found in the community where applicants or eligible individuals interact with nondisabled individuals, other than nondisabled individuals who are providing services to them, to the same extent that nondisabled individuals in comparable positions interact with other persons.

  (20) Ongoing Support Services.

    (a) “Ongoing support services” means services that are needed to support and maintain an individual with a most significant disability in supported employment as specified in the individualized plan for employment.

    (b) “Ongoing support services” includes, at a minimum:

      (i) Twice monthly contact with the individual at the work site to assess job stability, unless it is determined that off-site monitoring is more appropriate;

      (ii) If monitoring is off-site, at least two meetings monthly with the individual.

    (c) “Ongoing support services” occur throughout the term of employment during both the time limited phase and the extended services phase.

  (21) Personal Assistance Services.

    (a) “Personal assistance services” means a range of services:

      (i) Provided by one or more persons;

      (ii) Designed to assist an individual with a disability to perform daily living activities on or off the job that the individual would typically perform if the individual did not have a disability;

      (iii) Designed to increase the individual's control in life and ability to perform everyday activities on or off the job; and

      (iv) Necessary to the achievement of an employment outcome and may be provided only while the individual is receiving other vocational rehabilitation services.

    (b) “Personal assistance services” may include training in managing, supervising, and directing personal assistance services.

  (22) “Physical or mental impairment” means an injury, disease, or other condition that materially limits, or, if not treated, is expected to materially limit, mental or physical functioning.

  (23) “Preauthorized” means an approval required from the Division before services or goods can be purchased.

  (24) “Prescription” means a written order for medicine, medical supplies, or equipment, signed by a physician, dentist, podiatrist, or other authorized professional.

  (25) “Provider” means an individual, organization, institution, corporation, or other group from which the Division may purchase goods or services for an applicant or eligible individual.

  (26) “Purchase order” means a Division document authorizing a purchase from a provider.

  (27) “Purchasing card” means the authorized use of a State of Maryland corporate credit card to make a purchase from an approved provider by an authorized user.

  (28) Rehabilitation Technology.

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

    (b) “Rehabilitation technology” includes:

      (i) Rehabilitation engineering;

      (ii) Assistive technology devices; and

      (iii) Assistive technology services.

  (29) “Substantial impediment to employment” means that a physical or mental impairment (in light of attendant medical, psychological, vocational, educational, and other related factors) hinders an individual from preparing for, entering into, engaging in, or retaining employment consistent with the individual's abilities and capabilities.

  (30) “Supported employment” means:

    (a) Competitive work in integrated work settings, or employment in integrated work settings where individuals are working toward competitive work, consistent with the strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice of the individual, for individuals with the most significant disabilities:

      (i) For whom competitive employment has not traditionally occurred, or for whom competitive employment has been interrupted or intermittent as a result of a significant disability, and

      (ii) Who, because of the nature and severity of their disabilities, need intensive supported employment services from the designated State unit and extended services after transition in order to perform this work; or

    (b) Transitional employment for individuals with the most significant disabilities due to mental illness.

  (31) “Supported employment services” means ongoing support services and other appropriate services needed to support and maintain an individual with a most significant disability in supported employment, that are:

    (a) Based on an assessment by the Division of the individual's needs as specified in an individualized plan for employment;

    (b) Provided singly or in combination and are organized and made available in such a way as to assist an individual to achieve employment; and

    (c) Provided by the Division for a period not to exceed 18 months, unless under special circumstances the eligible individual and the rehabilitation counselor jointly agree to extend the time in order to achieve the rehabilitation objectives identified in the individualized plan for employment, before transition is made to extended services provided under a cooperative agreement with other appropriate State agencies and private, nonprofit organizations.

  (32) “Transition services” means a coordinated set of activities for a student that:

    (a) Is designed within an outcome-oriented process, that promotes movement from school to post-school activities, including postsecondary education, vocational training, integrated employment (including supported employment), continuing and adult education, adult services, independent living, or community participation;

    (b) Is based upon the individual student's needs, taking into account the student's preferences and interests; and

    (c) Includes instruction, community experiences, the development of employment, and other post-school adult living objectives, and, when appropriate, acquisition of daily living skills and functional vocational evaluation.

  (33) “Transitional employment”, as used in the definition of “supported employment”, means a series of temporary job placements in competitive employment with ongoing support services for individuals with the most significant disabilities due to mental illness. In transitional employment the provision of ongoing support services must include continuing sequential job placements until job permanency is achieved.

  (34) “Vocational rehabilitation services”, when provided to an individual with disabilities, means those services listed under Regulation .08 of this chapter.

#### Regulation .03-1 Incorporation by Reference.

*COMAR 13A.11.01.03-1*

A. In this chapter, the following documents are incorporated by reference.

B. Documents Incorporated.

  (1) Division of Rehabilitation Services Fee Schedule, Rehabilitation Services Manual V (RSM V) (Maryland State Department of Education, updated through August 2014).

  (2) Medicare Fees (109 percent of the Baltimore metropolitan area rates), established by the Center for Medicare and Medicaid Services, updated annually.

#### Regulation .04 Referral and Application.

*COMAR 13A.11.01.04*

A. An individual may apply for vocational rehabilitation services by contacting the Division directly or upon referral by individuals, organizations, public or private agencies, and other sources. Students with disabilities shall be referred by local education agencies not later than the fall semester of the next to last year before the student's anticipated exit from school.

B. The individual or referral source shall, to the extent possible, make available to the Division medical, social, and vocational information to assist in the determination of eligibility for vocational rehabilitation services under Regulation .05 of this chapter.

C. The Division shall schedule an interview with the individual upon initial contact or referral to:

  (1) Explain the vocational rehabilitation process, the individual's rights, including the right to an appeal hearing, the right to pursue mediation, and the availability of the resources within the Client Assistance Program; and

  (2) Assist the individual to apply for vocational and other rehabilitation services.

D. The Division shall conduct an assessment for determining eligibility and vocational rehabilitation needs, as appropriate in each case, including:

  (1) An assessment for determining eligibility and priority for services, to determine whether the client meets the eligibility criteria under Regulation .05 or .06 of this chapter and can be served under the order of selection according to Regulation .13 of this chapter, including:

    (a) A review and assessment of existing data; and

    (b) To the extent existing data do not describe the current functioning of the individual or are unavailable, insufficient, or inappropriate to make an eligibility determination, an assessment of additional data resulting from the provision of vocational rehabilitation services, including assistive technology devices and services and worksite assessments, that are necessary to determine whether an individual is eligible;

  (2) A comprehensive assessment of the eligible individual, to the extent additional data is necessary to make a determination of the employment outcome, and the objectives, nature, and scope of vocational rehabilitation services to be included in the individualized plan for employment of an individual who meets the eligibility criteria under Regulation .05 or .06 of this chapter and meets order of selection criteria under Regulation .13 of this chapter, and the assessment shall:

    (a) Consist of a comprehensive assessment of pertinent medical, psychological, vocational, educational, recreational, and other factors relating to the individual's impediment to employment and rehabilitation needs;

    (b) Include an assessment of the unique strengths, resources, priorities, interests, and needs, including the need for supported employment services of an eligible individual, in the most integrated setting possible, consistent with the informed choice of the individual;

    (c) Include to the degree needed, an appraisal of the individual's:

      (i) Career interests,

      (ii) Personality,

      (iii) Intelligence and related functional capacities,

      (iv) Educational achievement,

      (v) Work experience,

      (vi) Personal, vocational, and social adjustment,

      (vii) Interpersonal skills,

      (viii) Vocational aptitude,

      (ix) Employment opportunities, and

      (x) Other pertinent data helpful in determining the nature and scope of services needed;

    (d) Include, as appropriate for each individual, an appraisal of the individual's patterns of work behavior, services needed to acquire occupational skill and to develop work attitudes, work habits, work tolerance, and social and behavior patterns necessary for successful job performance, and the need for rehabilitation technology services;

  (3) Other goods or services including rehabilitation technology services necessary to determine eligibility, priority for services, and rehabilitation needs;

  (4) Referral to other agencies or organizations when appropriate;

  (5) The provision of vocational rehabilitation services during trial work experiences, or an extended evaluation, or both, consistent with Regulation .06 of this chapter for the purpose of determining whether the individual can benefit from vocational rehabilitation services due to the severity of the individual's disability.

#### Regulation .05 Eligibility.

*COMAR 13A.11.01.05*

A. The eligibility requirements shall be applied by the Division without regard to sex, race, creed, color, age, national origin, residence, physical or mental disability, or political affiliation.

B. An applicant's eligibility for vocational rehabilitation services shall be based upon:

  (1) The presence of a physical or mental impairment which for the applicant constitutes or results in a substantial impediment to employment;

  (2) A presumption that the applicant can benefit in terms of an employment outcome from the provision of rehabilitation services, unless the Division demonstrates, based on clear and convincing evidence, that the applicant is incapable of benefitting in terms of an employment outcome from vocational rehabilitation services; and

  (3) A determination that the applicant requires vocational rehabilitation services to prepare for, enter into, engage in, or retain gainful employment consistent with the applicant's strengths, resources, priorities, concerns, abilities, capabilities, and informed choice.

C. An individual who has a disability or is blind as determined pursuant to Title II or Title XVI of the Social Security Act is presumed to be eligible for vocational rehabilitation services:

  (1) If the individual completes an application for rehabilitation services indicating an intention to achieve an employment outcome; and

  (2) Unless the Division can demonstrate by clear and convincing evidence that the individual is incapable of benefiting in terms of an employment outcome from vocational rehabilitation services due to the severity of the disability.

D. An individual who is eligible for Maryland Mental Hygiene Administration funded or Maryland Developmental Disabilities Administration funded supported employment is presumed to be eligible for vocational rehabilitation services and to have a most significant disability in accordance with Regulation .13 of this chapter:

  (1) If the individual completes an application for rehabilitation services indicating an intention to achieve an employment outcome; and

  (2) Unless the Division can demonstrate by clear and convincing evidence that the individual is incapable of benefiting in terms of an employment outcome from vocational rehabilitation services due to the severity of the disability.

E. An applicant is eligible for supported employment services if the applicant:

  (1) Is an individual with a most significant disability; and

  (2) Has been determined by a comprehensive assessment of rehabilitation needs, as set forth in Regulation .04D of this chapter, to need ongoing support services in order to perform work activity.

F. The Division shall certify in writing the reasons for finding an applicant eligible or ineligible for vocational rehabilitation services and shall have medical and other pertinent documentation supporting the certification.

G. Certification that an individual is ineligible for vocational rehabilitation services shall be based upon clear evidence and made in accordance with the procedures in Regulation .14A and B of this chapter.

H. The certification of eligibility or ineligibility shall be dated and signed by the vocational rehabilitation counselor.

I. The rehabilitation counselor shall determine eligibility or ineligibility not later than 60 days after the date of application unless:

  (1) The applicant has been notified that exceptional and unforeseen circumstances beyond the control of the counselor preclude the counselor from completing the determination within 60 days, the applicant agrees to a specific extension of time, and this agreement is documented in writing; or

  (2) Trial work experiences or extended evaluation is necessary in accordance with Regulation .06 of this chapter.

#### Regulation .06 Trial Work Experiences and Extended Evaluation.

*COMAR 13A.11.01.06*

A. The Division shall:

  (1) Provide vocational rehabilitation services under trial work experiences or under an extended evaluation, if the individual cannot participate in trial work, to determine vocational rehabilitation potential, if:

    (a) The applicant meets the criterion under Regulation .05B(1) of this chapter; and

    (b) A determination cannot be made under Regulation .05B(2) of this chapter because of the severity of the disability unless the applicant participates in trial work experiences or extended evaluation, or both;

  (2) Certify in writing the reasons for providing vocational rehabilitation services under this regulation;

  (3) Develop a written trial work plan or extended evaluation plan for each individual who is provided vocational rehabilitation services under this regulation;

  (4) Provide vocational rehabilitation services under this regulation for a total period not longer than 18 months; and

  (5) Provide trial work experiences, or extended evaluation if the individual cannot participate in trial work, before a determination that an individual does not meet eligibility criteria because the individual cannot benefit in terms of an employment outcome due to the severity of the disability.

B. The trial work plan or extended evaluation plan shall be dated and signed by the vocational rehabilitation counselor.

C. The Division shall assess the individual's progress as frequently as necessary but at least once every 90 days to determine whether the individual meets the criterion under Regulation .05B(2) of this chapter.

#### Regulation .07 Individualized Plan for Employment.

*COMAR 13A.11.01.07*

A. An individualized plan for employment shall be initiated and periodically updated by each eligible individual. Division staff shall advise each eligible individual who can be served under the order of selection of the options for development of the individualized plan for employment, including the availability of technical assistance from the vocational rehabilitation counselor. The individualized plan for employment shall be developed by the eligible individual or, as appropriate, the individual and the individual's representative, with assistance from the vocational rehabilitation counselor as requested by the eligible individual. Vocational rehabilitation services shall be provided in accordance with the written plan if approved by the Division.

B. The individualized plan for employment shall be based on results of assessments under Regulation .04D of this chapter to achieve the employment goal of the eligible individual.

C. The individualized plan for employment shall include, as appropriate:

  (1) The employment goal of the eligible individual based on the individual's unique strengths, abilities, capabilities, interests, and informed choice, and results of assessments under Regulation .04D of this chapter;

  (2) The month/year that employment is expected to begin;

  (3) The specific vocational rehabilitation services to be provided to achieve the established employment goal including:

    (a) When the service/activity will begin;

    (b) Where it will take place;

    (c) How it will help the individual become employed;

    (d) How it will be determined successful;

    (e) Cost; and

    (f) Who will pay;

  (4) A statement regarding post-employment services;

  (5) The terms and conditions for the provision of vocational rehabilitation services including the:

    (a) Responsibilities of the Division in implementing the individualized plan for employment;

    (b) Responsibilities of the eligible individual in implementing the individualized plan for employment;

    (c) Extent of the eligible individual's participation in the cost of services, if any; and

    (d) Extent to which comparable services and benefits:

      (i) Are available to the eligible individual under any other program, and

      (ii) Will be used;

  (6) The comments of the eligible individual or, as appropriate, the eligible individual and the individual's representative, concerning the individualized plan for employment; and

  (7) A description of the availability of the resources within the Client Assistance Program and a statement of the individual's rights and the means by which the individual may express and seek remedy for any dissatisfaction, including the right to:

    (a) Pursue mediation; and

    (b) An appeal hearing under COMAR 13A.11.07;

D. Each individualized plan for employment shall contain, for individuals with the most significant disabilities for whom a vocational goal of supported employment has been determined to be appropriate, a description of the:

  (1) Extended services needed by the individual; and

  (2) The source of extended services, or, to the extent that the source of the extended services cannot be identified at the time of the development of the individualized plan for employment, a description of the basis for concluding that there is a reasonable expectation that a source will become available.

E. The individualized plan for employment shall be reviewed as often as necessary but at least on an annual basis. The eligible individual or, as appropriate, the individual's representative, shall be given an opportunity to review the plan and, if necessary, redevelop and agree to its terms.

F. The eligible individual or, as appropriate, the eligible individual and the individual's representative, shall sign the individualized plan for employment and any amendments indicating that the individual agrees to its terms.

G. The Division counselor and supervisor, unless the counselor has delegated authority, shall review the individualized plan for employment and shall sign it if it is approved.

H. Individualized plans for employment shall be completed within the timeframe established by the Division.

I. The individualized plan for employment for students in secondary education who have been determined eligible for vocational rehabilitation services in accordance with Regulation .05 of this chapter and can be served under the order of selection in accordance with Regulation .13 of this chapter shall be:

  (1) Coordinated with the student's individualized education plan, if applicable; and

  (2) Completed before the student's exit from school.

J. The Division shall provide a copy of the individualized plan for employment and any amendments to the eligible individual or, as appropriate, the eligible individual and the individual's representative and shall advise the eligible individual or, as appropriate, the individual's representative, of the procedures and requirements affecting the development and review of the individualized plan for employment.

#### Regulation .08 Vocational Rehabilitation Services.

*COMAR 13A.11.01.08*

Vocational rehabilitation services are any goods or services necessary to assist an individual with a disability in preparing for, securing, retaining, or regaining an employment outcome that is consistent with the strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice of the individual, including:

A. An assessment for determining eligibility, priority for services, and vocational rehabilitation needs by qualified personnel, including, if appropriate, an assessment by personnel skilled in rehabilitation technology;

B. Vocational rehabilitation counseling and guidance, including information and support services to assist an individual in exercising informed choice;

C. Referral and other services to secure needed services from other agencies through cooperative agreements;

D. To the extent that financial support is not readily available from another source, diagnosis and treatment of physical and mental impairments, including:

  (1) Corrective surgery or therapeutic treatment necessary to correct or substantially modify a physical or mental condition that constitutes a substantial impediment to employment, but is of a nature that the correction or modification may reasonably be expected to eliminate or reduce the impediment to employment within a reasonable length of time;

  (2) Necessary hospitalization in connection with surgery or treatment;

  (3) Prosthetic and orthotic devices;

  (4) Eyeglasses and visual services as prescribed by qualified personnel who meet state licensure laws and who are selected by the individual;

  (5) Special services (including transplantation and dialysis), artificial kidneys, and supplies necessary for the treatment of individuals with end-state renal disease; and

  (6) Diagnosis and treatment for mental and emotional disorders by qualified personnel who meet state licensure laws;

E. Vocational and other training services, including personal and vocational adjustment, education at an institution of higher education, books and supplies, tools, and other training materials or education-related services except that training services provided at an institution of higher education may not be paid for unless maximum efforts have been made by the Division and the eligible individual to secure grant assistance, in whole or in part, from other sources to pay for the training;

F. Maintenance for additional costs incurred while participating in rehabilitation services which covers an applicant or eligible individual's living expenses, such as food, shelter, clothes, and other subsistence expenses which are necessary to support and derive the full benefit of the other vocational rehabilitation services being provided;

G. Interpreter services for applicants or eligible individuals who are deaf or hard of hearing, including tactile interpreting for individuals who are deaf-blind;

H. Reader services, rehabilitation teaching services, and orientation and mobility services for applicants or eligible individuals who are blind or visually impaired;

I. Occupational licenses, tools, equipment, and initial stocks and supplies;

J. Transportation, including adequate training in the use of public transportation vehicles and systems, that is provided in connection with the provision of any other service and needed by the individual to achieve an employment outcome;

K. Rehabilitation technology, including telecommunications, sensory, and other technological aids and devices;

L. Technical assistance and other consultation services to conduct market analyses, develop business plans, and otherwise provide resources, to the extent the resources are authorized to be provided through the Statewide workforce investment system to eligible individuals who are pursuing self-employment or telecommuting, or establishing a small business;

M. Services to members of an applicant's or eligible individual's family when necessary to assist the individual to achieve an employment outcome;

N. Job-related services including job search and placement assistance, job retention services, follow-up services, and follow-along services;

O. Specific post-employment services necessary to assist individuals with disabilities to maintain, regain, or advance in employment;

P. Supported employment services, as defined in Regulation .03 of this chapter;

Q. On-the-job or other related personal assistance services provided while an applicant or eligible individual is receiving rehabilitation services;

R. Transition services for students with disabilities that facilitate the achievement of the employment outcome identified in the individualized plan for employment;

S. Other goods and services determined necessary for the individual with a disability to achieve an employment outcome.

#### Regulation .09 Comparable Services and Benefits.

*COMAR 13A.11.01.09*

A. Before the Division provides any vocational rehabilitation services, except those services listed in §B of this regulation, to an applicant or eligible individual or to members of that individual's family, the Division shall determine whether comparable services and benefits are available under any other program.

B. This regulation does not apply to the following services:

  (1) Assessment of eligibility and priority for services and assessment of vocational rehabilitation needs;

  (2) Counseling, guidance, and referral;

  (3) Placement services;

  (4) Rehabilitation technology services; and

  (5) Post-employment services as listed under §B(1)—(4) of this regulation.

C. This regulation does not apply if the determination of the availability of comparable services and benefits would interrupt or delay:

  (1) The provision of vocational rehabilitation services to any applicant or eligible individual at extreme medical risk based on medical evidence provided by an appropriate licensed medical professional;

  (2) The progress of the eligible individual toward achieving the employment outcome identified in the individualized plan for employment of the individual in accordance with Regulation .07 of this chapter; or

  (3) An immediate job placement.

D. If comparable services and benefits are available, they shall be used to meet, in whole or in part, the cost of vocational rehabilitation services.

#### Regulation .10 Financial Participation of the Applicant or Eligible Individual in the Cost of Services.

*COMAR 13A.11.01.10*

A. The following persons shall participate annually in the cost of vocational rehabilitation services in accordance with this regulation, except for the services listed in §B of this regulation:

  (1) The applicant or eligible individual; and

  (2) Any other person who:

    (a) Claims the applicant or eligible individual as a dependent for federal tax purposes; or

    (b) Is required to provide financial information on the eligible individual's free application for federal student aid, in accordance with the Higher Education Act of 1965, as amended.

B. This regulation does not apply to the following:

  (1) Assessment and related services to determine eligibility, priority for services, and vocational rehabilitation needs;

  (2) Counseling, guidance, and referral services;

  (3) Services provided by teachers for the blind employed by the Division;

  (4) Supported employment services under Regulation .08P of this chapter;

  (5) Personal assistance services;

  (6) Placement services, including job coaching and on-job training; and

  (7) Auxiliary aids or services, for example, interpreter services or reader services, that an individual requires in order to participate in the Vocational Rehabilitation Program.

C. Amount of Financial Participation of the Applicant or Eligible Individual or Family.

  (1) The amount of the applicant's or eligible individual's annual financial participation in the cost of rehabilitation services shall be based upon available income and family unit size (number of dependents claimed for federal tax purposes) and determined in accordance with the schedule in Regulation .15 of this chapter.

  (2) The amount of the applicant's or eligible individual's annual financial participation in rehabilitation services may not exceed the cost of services provided to the individual by the Division.

D. Available income shall be calculated by:

  (1) Adding annual adjusted gross income as reported on the most recent federal tax return and current annual nontaxable income including Social Security, workers' compensation, and veteran benefits;

  (2) Subtracting any deductible medical and dental expenses as reported on the Internal Revenue Service Form 1040, Schedule A, of the most recent federal tax return; and

  (3) Subtracting any substantiated disability-related expenses not included in §D(2) of this regulation.

E. When the current income of the applicant or eligible individual or the person who claims the individual for federal income tax purposes is substantially different from that reported on the most recent federal tax return, the available income shall be determined using current financial information.

F. The applicant or eligible individual and any person required to participate in cost of services in accordance with Regulation .10 of this chapter shall:

  (1) Complete a financial statement on a form prescribed by the Division; and

  (2) Promptly notify the Division of any changes in financial status as a condition for the provision of vocational rehabilitation services.

G. An eligible individual receiving Social Security Disability Insurance, or Supplemental Security Income or other form of public assistance income is not required to participate financially in the cost of vocational rehabilitation services.

H. The Division shall review the eligible individual's financial status annually.

#### Regulation .11 Accident or Injury Claims.

*COMAR 13A.11.01.11*

If the eligible individual pursues a claim against another party arising out of an accident or injury and recovers the costs of vocational rehabilitation services provided to the individual by the Division, the individual shall agree to repay the Division the cost of those services.

#### Regulation .12 Training in Institutions of Higher Education.

*COMAR 13A.11.01.12*

A. An eligible individual who requests financial assistance for training and related services in institutions of higher education shall submit an annual financial aid application to the U.S. Department of Education, Student Financial Assistance Programs, and provide the rehabilitation counselor a copy of the resulting Student Aid Report, as a condition for the provision of those services.

B. An exception to this requirement will be considered in the following circumstances:

  (1) The individual is seeking admittance to an institution not participating in the federal student financial aid process; or

  (2) The individual is enrolling for non-degree courses, that is, selected courses that are not part of a degree program.

C. Division financial assistance for post-secondary education for individuals ineligible for federal financial aid because of previous loan default or history of drug conviction requires the approval of the Director or designee.

D. Division's Financial Assistance. The amount of financial assistance to be provided to the eligible individual by the Division shall be equal to:

  (1) The individual's educational expenses, determined in accordance with §E of this regulation;

  (2) Minus the amount of grants and scholarships not including scholarships based on merit, awarded to the individual to attend the institution of higher education;

  (3) Minus the individual/family financial participation in accordance with Regulation .10 of this chapter.

E. Educational Expenses.

  (1) The Division shall determine the eligible individual's educational expenses based on the cost of:

    (a) Training services, including tuition, mandatory fees, books, and supplies;

    (b) Training-related expenses that are necessitated by attending an institution of higher education, such as the cost of commuting to and from the institution, but only to the extent that these costs exceed the individual's normal living expenses;

    (c) Room and board, only if:

      (i) The individual resides 45 miles or more from the institution of higher education and a comparable educational program is not available within 45 miles or disability issues require residence at the institution;

      (ii) The individual does not receive comparable benefits according to Regulation .09 of this chapter for living expenses; and

      (iii) The Director or designee approves; and

    (d) Other related expenses with the approval of the Director or designee.

  (2) The cost of tuition and fees for the first 60 credits of a post-secondary program or in pursuit of a certificate or associate's degree may not exceed the rate of Montgomery (Community) College unless:

    (a) Disability issues or cost efficiency requires participation in a 4-year institution of post-secondary education for the first 60 credits; and

    (b) The Director or designee approves.

  (3) The cost of tuition, fees, room, and board beyond 60 credits in pursuit of a bachelor's degree or unless an exception has been granted in accordance with §D(2)(a) of this regulation, may not exceed the in-State rates established for the University of Maryland at College Park. Exceptions may be based on disability factors and cost efficiency and require approval of the Director.

  (4) Additional costs related to the individual's choice to attend an out-of-State or private institution are the responsibility of the individual and may not be included as educational expenses.

F. Satisfactory Academic Progress.

  (1) To be eligible for the continuation of the Division's financial assistance at an institution of higher education, an eligible individual shall:

    (a) Earn credit on a minimum of 75 percent of all credits for which the individual registered each semester or grading period;

    (b) Maintain a minimum average grade of “C” or its equivalent on all credits completed each semester or grading period; and

    (c) Maintain eligibility for financial aid in accordance with the institution of higher education's written criteria for satisfactory academic progress toward a degree or certificate.

  (2) An eligible individual shall meet the requirements set forth in §F(1) of this regulation on a minimum of six credits at an institution of higher education before being reconsidered for financial assistance by the Division if the individual:

    (a) Was dismissed by an institution of higher education; or

    (b) Stopped attending an institution of higher education due to the individual's failure to maintain satisfactory academic progress in accordance with the institution of higher education's academic requirements, or financial aid eligibility criteria.

G. The individual may not change the course of studies or major agreed on in the individualized plan for employment without prior approval of the Division.

H. Graduate Education. The Division will provide financial assistance for graduate education:

  (1) Only when it is determined to be necessary and essential to the achievement of the employment goal on the approved individualized plan for employment; and

  (2) With the approval of the Director or designee.

#### Regulation .13 Order of Selection for Services.

*COMAR 13A.11.01.13*

A. Vocational rehabilitation services shall be provided based upon the availability of funds.

B. If sufficient funds are not available to provide vocational rehabilitation services to all eligible individuals, the Division shall:

  (1) Institute an order of selection for services providing services on a priority basis to individuals in Category I, then Category II, then Category III, as follows:

    (a) Category I: Individuals with most significant disabilities, in accordance with Regulation .03B(16) of this chapter;

    (b) Category II: Individuals with significant disabilities, in accordance with Regulation .03B(17) of this chapter; and

    (c) Category III: Individuals with non-severe disabilities, who are eligible for services in accordance with Regulation .05, but do not meet the criteria in Regulation .03B(16) or (17) of this chapter; and

  (2) Hold the names of eligible individuals who cannot be served on a waiting list; and

  (3) Provide eligible individuals who cannot be served with information and referral to other federal and State programs which would meet their employment needs.

#### Regulation .14 Closure of the Record of Services.

*COMAR 13A.11.01.14*

A. The decision to close a record of services of an applicant or eligible individual shall be made only after full consultation with the individual or, as appropriate, the individual and the individual's representative, or after giving an opportunity for this consultation, except when the individual is no longer present in the State, or cannot be located. The views of the eligible individual or, as appropriate, the individual and the individual's representative shall be recorded in the record of services.

B. Whenever a record of services is closed, the Division shall give the applicant or eligible individual or, as appropriate, the individual and the individual's representative written notice of the:

  (1) Reasons for the decision;

  (2) Individual's rights and means by which the individual may express and seek remedy for any dissatisfaction, including the opportunity for an appeal hearing under COMAR 13A.11.07; and

  (3) Availability and access to the resources within the Client Assistance Program.

C. If a record of services is closed based on a determination that an individual is ineligible for services, referral shall be made to other agencies and programs, including, when appropriate, the independent living services program under COMAR 13A.11.03.

D. If a record of services is closed based on a determination that the individual is incapable of achieving an employment outcome due to the severity of the disability, the Division shall review the decision within 12 months after giving the individual written notice and opportunity to participate in the review, unless the individual refuses the review, is no longer present in the State, cannot be located, or has a medical condition which is rapidly progressive or terminal. The Division shall conduct subsequent reviews at the request of the individual or, if appropriate, the individual's representative.

E. An individual shall be considered rehabilitated if the individual has:

  (1) Been determined eligible under Regulation .05 of this chapter;

  (2) Been provided an assessment to determine eligibility and rehabilitation needs and a comprehensive assessment, if required, and counseling and guidance;

  (3) Been provided appropriate and substantial vocational rehabilitation services, in accordance with the individualized plan for employment, which contributed to the achievement of the employment outcome;

  (4) Achieved an employment outcome consistent with the individual's strengths, resources, priorities, concerns, abilities, interests, and informed choice which is in an integrated setting; and

  (5) Maintained the employment outcome for at least 90 days, and agreed with the rehabilitation counselor that the:

    (a) Employment is satisfactory, and

    (b) Individual is performing well on the job.

F. After an individual has been determined to be rehabilitated, the Division shall provide post-employment services if necessary to assist an individual to maintain or regain other suitable employment.

G. The Division shall review and reevaluate annually for a minimum of 2 years and subsequently at the request of the individual, or, if appropriate, the individual's representative, the status of each individual placed in extended employment in a community rehabilitation program or in supported employment not earning minimum wage to determine the interests, priorities, and needs of the individual with respect to competitive employment or training for competitive employment. The individual or, if appropriate, the individual's representative shall provide input into the review and sign an acknowledgement that the review and reevaluation have been conducted. If determined appropriate, the individual's record of services will be reopened.

#### Regulation .15 Financial Participation Schedule.

*COMAR 13A.11.01.15*

Annual Amount of Individual/Family Financial Participation
          
          
            Available Income
            1
            2
            3
            4
            5
            6
            7
            8
          
        
        
          
            $24,000 and below
            $ 0
            $ 0
            $ 0
            $ 0
            $ 0
            $ 0
            $ 0
            $ 0
          
          
            $24,001—$28,000
            228
            0
            0
            0
            0
            0
            0
            0
          
          
            $28,001—$32,000
            375
            263
            0
            0
            0
            0
            0
            0
          
          
            $32,001—$36,000
            553
            425
            0
            0
            0
            0
            0
            0
          
          
            $36,001—$40,000
            760
            616
            333
            0
            0
            0
            0
            0
          
          
            $40,001—$44,000
            998
            840
            525
            0
            0
            0
            0
            0
          
          
            $44,001—$48,000
            1,265
            1,093
            748
            345
            0
            0
            0
            0
          
          
            $48,001—$52,000
            1,563
            1,375
            1,000
            625
            0
            0
            0
            0
          
          
            $52,001—$56,000
            1,890
            1,688
            1,283
            878
            473
            0
            0
            0
          
          
            $56,001—$60,000
            2,248
            2,030
            1,595
            1,160
            725
            0
            0
            0
          
          
            $60,001—$64,000
            2,635
            2,403
            1,938
            1,473
            1,008
            543
            0
            0
          
          
            $64,001—$68,000
            3,053
            2,805
            2,310
            1,815
            1,320
            825
            0
            0
          
          
            $68,001—$72,000
            3,500
            3,238
            2,713
            2,188
            1,663
            1,138
            0
            0
          
          
            $72,001—$76,000
            3,978
            3,700
            3,145
            2,590
            2,035
            1,480
            648
            0
          
          
            $76,001—$80,000
            4,485
            4,193
            3,608
            3,023
            2,438
            1,853
            975
            0
          
          
            $80,001—$84,000
            5,023
            4,715
            4,100
            3,485
            2,870
            2,255
            1,333
            718
          
          
            $84,001—$88,000
            5,590
            5,268
            4,623
            3,978
            3,333
            2,688
            1,720
            1,075
          
          
            $87,001+ *
            6.5%
            6.125%
            5.375%
            4.625%
            3.875%
            3.125%
            2%
            1.25%
          
        
        
          
            * To determine amount of individual/family participation when the available income is above $88,000, multiply the individual/family income times the percentage. The Financial Participation Scale is based on 2014 Poverty Guidelines of the U.S. Department of Health and Human Services.

#### Regulation .16 Payment for Rehabilitation Services.

*COMAR 13A.11.01.16*

A. Preauthorization of Providers.

  (1) The Division may pay a provider only if the provider has been preauthorized by the Division.

  (2) Individual providers who are subject to State licensure or certification shall provide evidence of a current, valid license or certification, except in the area of specialized tutoring services for which a provider may present alternate qualifications as specified by the Division.

  (3) Institutions of post-secondary education shall provide evidence of current, valid accreditation by an appropriate state or national accrediting organization.

  (4) Private career schools shall provide evidence of a current, valid certificate of approval by the Maryland Higher Education Commission or, in the case of out-of-State private schools, by that state's equivalent certification entity.

B. Payment Procedures.

  (1) Payment may be made only for services that have been preauthorized and approved by the Division through a signed purchase order or the use of the Division's purchasing card.

  (2) For purchases initiated by purchase order, the provider shall submit an invoice for services rendered, along with any required reports, according to procedures established by the Division.

  (3) The Division may return to the provider, before payment, all invoices not properly signed, completed, and accompanied by required reports.

  (4) A provider may not charge or accept payment from the individual, the individual's family, or a third party for the authorized services unless, before providing the service, the amount of the individual's responsibility has been:

    (a) Preauthorized by the Division; and

    (b) Agreed to by the individual in writing.

C. Rate of Payment. The Division shall pay for authorized services at a rate equal to the lower of:

  (1) The provider's customary charge;

  (2) The maximum rate established in the “Division of Rehabilitation Services Fee Schedule”; or

  (3) 120 percent of the Medicare Program rate established by 42 CFR 414 and 415, for medical or surgical procedures not identified in the Division's fee schedule.

D. Exceptions to Rate of Payment. The Division's payment may exceed the maximum rate established in the “Division of Rehabilitation Services Fee Schedule” only when the Director of Field Services or the Director of the Office for Blindness and Vision Services authorizes the exception:

  (1) Because the client is at extreme medical risk, as evidenced by documentation submitted by a licensed medical professional; or

  (2) For reasons related to the disability or services included on an approved Individualized Plan for Employment.

#### Regulation .17 Payment for Goods.

*COMAR 13A.11.01.17*

A. Payment Procedures.

  (1) Preauthorization.

    (a) Payment may be made only for goods that have been preauthorized and approved by the Division through a signed purchase order or by use of the Division's purchasing card.

    (b) A provider shall be licensed or certified consistent with Regulation .16A(2) of this chapter.

  (2) For purchases initiated by purchase order, the provider shall submit the invoice for goods delivered according to procedures established by the Division.

  (3) The Division may return to the provider, before payment, all invoices not properly signed, completed, and accompanied by required reports.

  (4) A provider may not charge or accept payment from the applicant or eligible individual, the individual's family, or a third party for the authorized goods unless, before providing the goods, the amount of the individual's responsibility has been:

    (a) Preauthorized by the Division; and

    (b) Agreed to by the individual in writing.

B. Rate of Payment. The Division shall pay for authorized goods at a rate equal to the lower of the:

  (1) Provider's customary charge;

  (2) Rate established by the Department of General Services Purchasing Bureau;

  (3) Rate established as the result of competitive bidding conducted by the Division in accordance with COMAR Title 21; or

  (4) Maximum rate established in the “Division of Rehabilitation Services Fee Schedule”, which is incorporated by reference in Regulation .03-1 of this chapter.

C. Purchase Limitations.

  (1) Prescription goods may be purchased only after receipt of a current, valid prescription.

  (2) Generic drugs shall be purchased unless the physician indicates that a particular brand is medically necessary.

  (3) The Division may not pay for vehicles which require a license to operate, land, buildings, or the construction of or addition to a building.

  (4) The purchase of goods and services for a self-employment enterprise will be made only after:

    (a) The eligible individual has submitted a business plan which:

      (i) Identifies a business enterprise which meets standards established by the Division for types of businesses which can be supported;

      (ii) Meets generally accepted business standards;

      (iii) Identifies multiple funding sources as the Division may not be the primary funder of a business;

      (iv) Has been reviewed by an advisory entity established by the Division; and

      (v) Has been approved by the Division; and

    (b) Any required goods and services are:

      (i) Included on the individualized plan for employment; and

      (ii) Approved by the Division.

  (5) The Division may establish other reasonable purchase limitations in order to manage agency resources and maximize the number of employment outcomes.

D. Ownership of Goods.

  (1) The State shall retain legal title to tools, equipment, shelters, and supplies purchased as part of an eligible individual's rehabilitation program, except as provided in §D(3) of this regulation.

  (2) An eligible individual shall return goods purchased by the Division when they are no longer needed for the individual's rehabilitation program, employment, or independent living.

  (3) Title may be assigned to the eligible individual for the following:

    (a) Medical appliances not transferable to or useable by another person;

    (b) Goods provided as part of an approved business plan to be used as collateral to leverage funds for the business; and

    (c) Other exceptional circumstances with approval of the Director or designee.