Titles of Regulations: 22VAC45-70. Provision of Services in Rehabilitation Teaching (amending 22VAC45-70-10 through 22VAC45-70-80)

22VAC45-80. Provision of Independent Living Rehabilitation Services (repealing 22VAC45-80-10 through 22VAC45-80-140).

Statutory Authority: § 51.5-60 of the Code of Virginia.

Public Hearing Information: No public hearing is currently scheduled.

Public Comment Deadline: October 15, 2021.

Agency Contact: Susan K. Davis, MS, CRC, Regulatory Coordinator, Department for the Blind and Vision Impaired, 397 Azalea Avenue, Richmond, VA 23227, telephone (804) 371-3184, or email susan.davis@dbvi.virginia.gov.

Basis: Statutory authority comes from § 51.5-65 of the Code of Virginia, which identifies the functions, duties, and powers of the Commissioner of the Department for the Blind and Vision Impaired (DBVI) to adopt regulations to carry out the applicable provisions of the chapter.

Purpose: The purpose of this regulatory action is to amend 22VAC45-70 to accurately reflect DBVI's Rehabilitation Teaching/Independent Living (RT/IL) Program under which rehabilitation teaching and independent living services to eligible individuals who are blind, vision impaired, or deafblind are provided.

Additionally, this regulatory action will repeal 22VAC45-80. Among other services described in 22VAC45-80 is the operation of independent living centers for people who are blind and have secondary disabilities. DBVI does not operate independent living centers. DBVI provides independent living services through its RT/IL Program in each of six regional offices and the Virginia Rehabilitation Center for the Blind and Vision Impaired.

The action protects and improves the public safety, health, and welfare of individuals applying for or receiving rehabilitation teaching and independent living services through the DBVI by ensuring services are provided in a consistent and timely manner.

Substance: Amendments include (i) changing the title of the regulation from "Provision of Services in Rehabilitation Teaching" to "Regulations Governing the Provision of Rehabilitation Teaching and Independent Living Services"; (ii) updating the agency name; (iii) removing outdated definitions and adding new definitions that more fully describe certain terms or that reflect rehabilitation teaching and independent living services provided under DBVI's RT/IL Program; (iv) adding the words "independent living" throughout the regulation to clarify that those services are included along with rehabilitation teaching; (v) clarifying referral and application procedures, eligibility criteria, and determination requirements; and (vi) updating the name of the plan that specifies the services an individual will receive, the scope of services available to eligible individuals, and financial participation an individual may have in costs of services.

Issues: DBVI is the agency in the Commonwealth charged with updating and maintaining relevant regulations that accurately identify and describe services for eligible individuals who are blind, vision impaired, or deafblind. 22VAC45-70 and 22VAC45-80 contain redundant information and no longer accurately reflect the way DBVI provides rehabilitation teaching and independent living services. For example, federal funding for the provision of independent living services as described in 22VAC45-80 ceased to be available in 2000 and these services are now provided through the RT/IL Program, which is funded primarily through state funds. The primary advantage of this action is that it streamlines and updates 22VAC45-70 to include relevant portions of 22VAC45-80 to reflect current practice and repeals 22VAC45-80, which no longer will be necessary. There are no disadvantages to the public, agency, or Commonwealth.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. Pursuant to findings from a periodic review of both chapters, the Department for the Blind and Vision Impaired (DBVI) seeks to revise 22VAC45-70 (chapter 70) and repeal 22VAC45-80 (chapter 80) in its entirety.¹ The independent living services that are addressed in chapter 80 are no longer being provided in the same way that they were when the regulation was first promulgated, and have instead been folded into the provision of rehabilitation training covered by chapter 70. Thus, DBVI seeks to amend chapter 70 to update the department name, certain definitions, and the title and content of the chapter to align with current DBVI practices. The agency would also repeal chapter 80 since its provisions would be redundant. Background. Pursuant to the periodic review, DBVI proposes to make a number of changes to chapter 70. The most significant changes are summarized as follows:

1. Changing the title of the regulation from "Provision of Services in Rehabilitation Teaching" to "Regulations Governing the Provision of Rehabilitation Teaching and Independent Living Services."

2. Updating the agency name from "Department for the Visually Impaired" to the current name, "Department for the Blind and Vision Impaired."

3. Updating the definition of blindness and adding a definition of deafblind to reflect current practice.

4. Adding the words, "and independent living" throughout the regulation to clarify that those services are included along with rehabilitation teaching.

5. Renaming "Individualized Written Rehabilitation Program" to "Rehabilitation Teaching/Independent Living Program Plan" (RT/IL plan) to reflect that individualized plans would include both types of services.

6. Sections 20, 30, 40, 60 and 70 would be amended to update the referral process, eligibility criteria, eligibility determination process, development of the RT/IL plan, and scope of services, respectively. The proposed amendments to these sections would largely update the language to match current practice.

7. In section 30, optometrists would be added as a category of professionals who would be authorized to determine blindness for the purpose of eligibility for services. Currently, the regulation only authorizes ophthalmologists to make such determinations. However, DBVI reports that optometrists are included in eligibility determinations for their other programs and that this was merely an oversight.

8. Finally, eligibility for financial participation in cost of services (22VAC45-70-80) would be revised to include individuals with a household income that exceeds 80 percent of the federally estimated median income for Virginia. The threshold for financial participation in 22VAC45-70-80 is currently 100% of the median income, whereas the corresponding threshold in 22VAC45-80-80 (which would be repealed) has always been 80%.

Although item 7 suggests that the eligibility threshold for financial participation would be lowered for some individuals receiving rehabilitation training, DBVI reports that the proposed amendment would only reflect its current practice, which has been in place since 2012. Specifically, DBVI reports that the federal funds that once supported the Independent Living services identified in chapter 80 were no longer available after about 2000. Since then, DBVI has coordinated and provided independent living services as part of its Rehabilitation Teaching/Independent Living (RT/IL) Program and as ancillary services through its Vocational Rehabilitation Services Program.² Currently, the RT/IL program is fully state funded and serves individuals up to age 55.³

Estimated Benefits and Costs. The proposed amendments to chapter 70 as well as the repeal of chapter 80 would clarify various aspects of DBVI's RT/IL program as it currently stands, which would benefit readers of the regulation. The proposed changes would not create any new costs, either for individuals participating or seeking to participate in the RT/IL program or for the licensed professionals who provide such training and services. Lastly, by repealing chapter 80, this regulatory action would also contribute to Virginia's regulatory reform efforts by eliminating a redundant and unnecessary regulation.

Businesses and Other Entities Affected. DBVI reports that roughly 1,400 individuals were served under the RT/IL program in 2020, with roughly 800-900 individuals in the program on any given date. In general, services are provided internally by DBVI employees, including certified Rehabilitation Teachers, Orientation and Mobility Instructors, Vocational Rehabilitation Counselors, and Technology Technicians who have Master's degrees and are either licensed or certified by various organizations that have oversight over those particular professions. DBVI employees operate out of six field offices (Bristol, Roanoke, Stanton, Fairfax, Norfolk, and Richmond) and often work with individuals in their homes to develop and implement their individualized RT/IL plans. As mentioned, both individuals receiving or seeking to receive RT/IL program services, as well as providers of these services would benefit from clear and accurate information in the regulation. Individuals with a household income between 80%-100% of the federal median income would now be required to financially participate in their rehabilitation training. However, as mentioned previously this requirement has been in effect since 2012.

Small Businesses⁴ Affected. Since most services are provided directly by DBVI employees, the proposed amendments are unlikely to impact businesses, including small businesses.

Localities⁵ Affected.⁶ The proposed amendments do not introduce new costs for local governments and are unlikely to affect any locality in particular.

Projected Impact on Employment. The proposed amendments are unlikely to affect the employment by DBVI or by vendors of low vision aids and rehabilitation technology.

Effects on the Use and Value of Private Property. The proposed amendments are unlikely to affect the use and value of private property. Real estate development costs are not affected.

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¹More information about the periodic reviews can be found on the Virginia Regulatory Town Hall (Town Hall) at https://townhall.virginia.gov/L/ViewAction.cfm?actionid=5476.

²See the Agency Background Document at https://townhall.virginia.gov/l/GetFile.cfm?File= 47\5476\9153\AgencyStatement_DBVI_9153_v2.pdf. DBVI further clarified that, "there is no prohibition on how an agency determines to use or not use means testing to purchase goods and services to individuals receiving RT/IL services. However, because funds are quite limited in the RT/IL program, the agency elected to change the family income eligibility percentage for participation in cost of services from 100% to 80% of the federally estimated median income agency sometime around 2011/2012."

³Individuals over the age of 55 are covered by the Older Bling Grant, which is covered by limited federal funds and the required state match.

⁴Pursuant to § 2.2-4007.04 of the Code of Virginia, small business is defined as "a business entity, including its affiliates, that (i) is independently owned and operated and (ii) employs fewer than 500 full-time employees or has gross annual sales of less than $6 million."

⁵ "Locality" can refer to either local governments or the locations in the Commonwealth where the activities relevant to the regulatory change are most likely to occur.

⁶§ 2.2-4007.04 defines "particularly affected" as bearing disproportionate material impact.

Agency's Response to Economic Impact Analysis: The Department for the Blind and Vision Impaired concurs with the economic impact analysis performed by the Department of Planning and Budget.

Summary:

The proposed amendments (i) change the title of the regulation from "Provision of Services in Rehabilitation Teaching" to "Regulations Governing the Provision of Rehabilitation Teaching and Independent Living Services"; (ii) update the agency name throughout the regulation; (iii) remove outdated definitions and add new definitions that more fully describe certain terms or that reflect rehabilitation teaching and independent living services provided under the department's Rehabilitation Teaching/Independent Living Program; (iv) add the words "independent living" throughout the regulation to clarify that those services are included along with rehabilitation teaching; (v) clarify referral and application procedures, eligibility criteria, and determination requirements; and (vi) update the name of the plan that specifies the services an individual will receive, the scope of services available to eligible individuals, and financial participation an individual may have in costs of service.

Chapter 70

Regulations Governing the Provision of Services in Rehabilitation Teaching and Independent Living Services

Part I

Introduction

22VAC45-70-10. Definitions.

The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:

"Assessment" means the systematic evaluation or identification of the consumers' need for and ability to benefit from services.

"Blindness, legal blindness" means the condition as defined in §§ 63.1-142 and 63.1-166 of the Code of Virginia.

"Consumer" means any person undergoing an assessment or receiving a service provided by the Rehabilitation Teaching Program of the Department for the Blind and Vision Impaired.

"Blind person" means an individual who has central visual acuity of 20/200 or less in the better eye, as measured with best correction, or a limitation in the field of vision in the better eye, such that the widest diameter of the visual field subtends an angle of 20 degrees or less, as defined in § 51.5-60 of the Code of Virginia.

"DBVI" means the Department for the Blind and Vision Impaired.

"Deafblind person" means an individual:

1. a. Who has central visual acuity of 20/200 or less in the better eye with corrective lenses, or a field defect such that the peripheral diameter of visual fields subtends an angular distance no greater than 20 degrees, or a progressive visual loss having a prognosis leading to one or both of the conditions;

b. Who has a chronic hearing impairment so severe that most speech cannot be understood with optimum amplification, or a progressive hearing loss having a prognosis leading to this condition; and

c. For whom the combination of impairments described in subdivisions 1 a and 1 b of this definition cause extreme difficulty in attaining independence in daily life activities, achieving psychological adjustment, or obtaining a vocation; and

2. Who, despite the inability to be measured accurately for hearing and vision loss due to cognitive or behavioral constraints or both, can be determined through functional and performance assessments to have severe hearing and visual disabilities that cause extreme difficulty in attaining independence in daily life activities, achieving psychological adjustment, or obtaining vocational objectives.

"Department" means the Department for the Blind and Vision Impaired.

"Financial needs assessment' means an assessment to consider the financial need of an individual who is applying for or receiving rehabilitation teaching and independent living services to determine the extent of the individual's participation in the costs of services.

"Independent living" means control over one's life based on the choice of acceptable options that minimize reliance on others in making decisions and performing everyday activities. This includes managing one's affairs, participating in day-to-day life in the community, fulfilling a range of social roles, making decisions that lead to self-determination, and the minimization of physical and psychological dependence on others.

"Individualized Written Rehabilitation Teaching/Independent Living Program (IWRP) Plan" or ("Plan") means a written program of rehabilitation teaching services identified during the assessment for each consumer individual determined eligible for services by this program the Rehabilitation Teaching/Independent Living Program.

"Reasonable expectation" means that rehabilitation teaching and independent living services are anticipated to significantly assist a consumer to improve an individual to improve his ability to cope with blindness and function more independently.

"Rehabilitation teaching" means the process of guiding and instructing a blind, visually impaired consumer, or deafblind person through an individualized plan of instruction designed to develop and raise the level of adaptive coping skills and functional independence.

"Severely visually impaired" means vision less than 20/70 in the better eye with correction or a field restricted to 70 degrees or less in the better eye.

Part II

Referral

22VAC45-70-20. Referral and application.

A. To be considered for rehabilitation teaching and independent living services, DBVI must obtain the following information must be obtained from the individual seeking services:

1. Name and address;

2. Date of birth and sex gender;

3. Disability; and

4. Date of referral.

The department DBVI shall expeditiously process persons the application of an individual who is referred for rehabilitation teaching and independent living services.

B. An DBVI shall conduct an assessment by the Department for the Blind and Vision Impaired is required of each person of the rehabilitation teaching and independent living needs of an individual who applies for rehabilitation teaching services. The assessment is limited to that information that is necessary to determine eligibility for rehabilitation teaching and independent living services consistent with 22VAC45-70-30 and to determine which rehabilitation teaching services are needed.

Part III

Eligibility

22VAC45-70-30. Eligibility for rehabilitation teaching and independent living services.

A. Eligibility shall be determined without regard to sex, sexual orientation, gender identity, race, creed, color, or national origin. No individual shall be excluded or found ineligible solely on the basis of the type of disability or on the basis of age. No residence requirement shall be imposed that excludes from services any individual who is presently in the Commonwealth.

B. To be eligible for rehabilitation teaching and independent living services, a consumer an individual must have a visual limitation that constitutes or results in a substantial impediment to personal independent functioning. A consumer, and there must be a reasonable expectation that rehabilitation teaching and independent living services will significantly assist the individual to improve his ability to cope with blindness and to function more independently. An individual has a visual limitation if one or more of the following criteria are met the individual:

1. Legal blindness Is a "blind person" as defined in 22VAC45-70-10;

2. 20/100 Has distance vision of 20/70 to 20/200 distance vision in the better eye with correcting glasses or a field limitation to 30 degrees or less in the better eye, and if the person has been unable to adjust to the loss of vision, and if it is has been determined by the rehabilitation teacher that the person is to be in need of the specialized services available through the Department for the Blind and Vision Impaired's DBVI rehabilitation teaching and independent living program; or

3. Night Has night blindness or a rapidly progressive eye condition which, in the opinion of a qualified ophthalmologist or optometrist, will reduce the distance vision to 20/200 or less.

B. A reasonable expectation that rehabilitation teaching services will significantly assist the consumer to improve his ability to cope with blindness and to function more independently.

22VAC45-70-40. Eligibility determination.

Prior to or simultaneously with acceptance of a consumer an individual for rehabilitation teaching and independent living services, there shall be a determination of eligibility; a case narrative shall state the basis for the visual eligibility determination and a reasonable expectation that rehabilitation teaching will significantly and independent living services shall assist the consumer in achieving or maintaining functional independence individual to improve his ability to cope with blindness and to function more independently. When a consumer an individual is determined ineligible for rehabilitation teaching services and independent living services, the rehabilitation teacher shall inform the consumer individual of the ineligibility determination, stating the reason or reasons. This may be done during a personal contact or by a letter.

22VAC45-70-60. The Individualized Written Rehabilitation Teaching and Independent Living Program (IWRP) (Plan).

Initial plan development.

1. The IWRP Plan shall specify the rehabilitation teaching and independent living services that the consumer individual and DBVI instructor rehabilitation teacher jointly determine are necessary to raise increase the individual's level of adaptive coping skills and functional independence.

2. The IWRP Plan shall be initiated after determination of eligibility and periodically updated to include additional rehabilitation teaching and independent living services that are needed by the consumer individual.

3. Rehabilitation teaching and independent living services shall be provided in accordance with IWRP the Plan.

22VAC45-70-70. Scope of rehabilitation teaching and independent living services.

Services provided through the rehabilitation teaching services and independent living program may include:

1. Counseling to determine the consumer's individual's need for specific rehabilitation teaching and independent living services.

2. Referral to and information regarding resources and programs that, internal and external to DBVI, which might benefit the consumer individual.

3. Counseling to assist the consumer individual to cope with visual vision loss.

4. Provision of low vision services in accordance with the Regulations Governing Low Vision, 22VAC45-110.

5. Instruction in the following areas:

a. Personal management skills or activities of daily living;

b. Home management skills;

c. Communication skills, including reading and writing braille, typing, script writing, and use of electronic equipment and technology;

d. Other appropriate adaptive coping skills, i.e., to facilitate leisure and recreational activities; and

e. Information and instruction in the acquisition of and use of adaptive equipment.

Part V

Financial Participation

22VAC45-70-80. Financial participation in cost of services.

A. The Department for the Blind and Vision Impaired DBVI has elected to uniformly apply a financial needs assessment for persons receiving purchased rehabilitation teaching and independent living services and goods in the Commonwealth. Purchased services and goods may be provided at no cost to the recipient who is legally a blind person if the family's income is less than 100% 80% of the federally estimated median income for Virginia, and if the family's assets are less than 50% of the federally estimated median income as determined by the United States Department of Health and Human Services, Family Support Administration. The Department for the Blind and Vision Impaired will DBVI shall review and change its financial participation levels to match the above-referenced estimated median income level every third year annually.

B. There is shall be no financial participation in cost of services required for the assessment, counseling, low vision exams, information and referral, and instructional services provided through the rehabilitation teaching services and independent living program.

C. Consumers must be both legally blind and demonstrate financial need as determined by the financial needs assessment in order to receive any purchased services or goods other than a low vision exam.

D. Allowable deductions from income.

1. Expenses that may be deducted from family income on the financial needs assessment are unusual medical expenses and the education of a consumer the individual or family member to attend a private or public educational facility. Medical expenses such as, including routine doctors' visits and hospital insurance premiums, may not be deducted.

2. When the consumer's individual's gross family income, liquid assets, or both, exceed the financial eligibility need requirement after allowable deductions have been considered, the consumer individual and his family are required to apply the excess toward the cost of those services provided by rehabilitation teaching and independent living services for which financial need is considered.

Chapter 80

Provision of Independent Living Rehabilitation Services (Repealed)

Part I

Introduction

22VAC45-80-10. Definitions. (Repealed.)

The following words and terms, when used in this chapter, shall have the following meaning unless the context clearly indicates otherwise:

"Center for independent living" means a program of services which offers a combination of independent living services for severely handicapped individuals or groups of severely handicapped individuals.

"Client Assistance Program" means a program located within the Department for Rights of the Disabled for the purpose of advising independent living rehabilitation applicants or clients about all available services under the Rehabilitation Act of 1973, as amended, and to assist them in their relationship with programs, projects, and facilities providing independent living rehabilitation services.

"Comparable services and benefits" means any appropriate service or financial assistance available from a program other than independent living to meet, in whole or in part, the cost of independent living services and which is under an individualized written rehabilitation program for a handicapped individual.

"Economic needs test" means a test used to consider the financial need of handicapped individuals for the purpose of determining the extent of their participation in the costs of services provided by this program.

"Independent living" means control over one's life based on the choice of acceptable options that minimize reliance on others in making decisions and performing everyday activities. This includes managing one's affairs, participating in day-to-day life in the community, fulfilling a range of social roles, making decisions that lead to self-determination, and the minimization of physical and psychological dependency on others.

"Individual with a severe disability" means an individual whose ability to function independently in a family or a community or whose ability to engage or continue in employment is so limited by the severity of his physical or mental disability that independent living rehabilitation services are required in order to achieve a greater level of independence in functioning in a family or a community or engaging or continuing in employment. Independent living rehabilitation services needed by an individual with a severe disability generally are appreciably more costly and of appreciably greater duration than vocational rehabilitation services that might be provided under 34 CFR 361.

"Individualized Written Rehabilitation Program (IWRP)" means an individualized written rehabilitation program for each individual being provided specified services by this program.

"Blindness, legal blindness" means the condition as defined in §§ 63.1-142 and 63.1-166 of the Code of Virginia.

"Reasonable expectation" means an expected outcome of services provision based on a judgment or decision made jointly by an applicant (or parent or guardian) and a case manager that the services requested and provided will enable the applicant to improve independent functioning.

"Severely visually impaired" means vision less than 20/70 in the better eye with correction or a field of vision restricted to 70 degrees or less in the better eye.

22VAC45-80-20. Referrals. (Repealed.)

The department shall expeditiously and equitably process referrals for independent living services.

A referral is any person for whom independent living rehabilitation services have been requested and for whom the worker has obtained the following information:

1. Name and address;

2. Date of birth and sex;

3. Disability or disabilities; and

4. Referral source and date of referral.

Part III

Eligibility and Ineligibility

22VAC45-80-30. Eligibility for independent living services. (Repealed.)

A. Eligibility requirements shall be applied without regard to sex, race, creed, color, or national origin. No group or individual shall be excluded or found ineligible solely on the basis of the type of disability or on the basis of age. No residence requirement shall be imposed which excludes from services any individual who is presently in the Commonwealth.

B. An assessment or evaluation by the Department for the Visually Handicapped (DVH) is required of each severely disabled person who applies for independent living services. The assessment is limited to that information necessary to determine whether the individual is eligible to be provided independent living services, and to determine which independent living services are needed.

C. All applicants for independent living services must be apprised of the services of the Client Assistance Program within the Department for Rights of the Disabled.

22VAC45-80-40. Basic conditions for eligibility. (Repealed.)

The following set forth criteria for basic eligibility:

1. The presence of legal blindness, which constitutes or results in a substantial impediment to the individual's ability to function independently in the family or community.

2. A reasonable expectation that independent living services will significantly assist the individual to improve his ability to function independently in his family or community or to engage in or continue employment.

3. Center for independent living. In addition to the basic conditions for eligibility contained in subdivisions 1 and 2 of this section, an individual must possess a second severe physical, mental, or emotional disability which constitutes or results in a substantial impediment to the individual's ability to function independently in a family or community.

22VAC45-80-50. Certification of eligibility. (Repealed.)

A. Prior to or simultaneously with acceptance of an individual with a severe disability for independent living rehabilitation services, there must be a certification that the individual has met the basic requirements specified in 22VAC45-80-40.

B. The certification is approved, dated, and signed by a DVH staff member.

22VAC45-80-60. Certification of ineligibility. (Repealed.)

A. When it is determined that independent living rehabilitation services cannot be expected to assist an individual to engage or continue in employment or to function more independently in family or community, a certification of ineligibility shall be signed and dated by a DVH staff member. A copy shall be provided to the individual simultaneously.

Such determination shall be made only after full consultation with the individual or, as appropriate, his guardian, or other representative. After affording a clear opportunity for this consultation, the DVH shall ensure notification in writing of the action taken and shall inform the individual of his rights and the means by which he may express and seek remedy for any dissatisfaction, including procedures for administrative review and fair hearings. The individual shall be provided a detailed explanation of the availability of the resources within the Client Assistance Program, Department for Rights of Virginians with Disabilities; and as appropriate, referral shall be made to other agencies and facilities, including, when appropriate, the vocational rehabilitation program.

B. Review of ineligibility determination. When DVH has certified the ineligibility of an applicant for independent living rehabilitation services because of a determination that these services cannot be expected to assist the individual to engage or continue employment or to continue to function more independently in family or community, the individual's ineligibility status will be reviewed annually. The review will not be conducted in situations where the individual has refused the review, is no longer present in Virginia, or the individual's whereabouts are unknown.

22VAC45-80-70. The Individualized Written Independent Living Rehabilitation Program (IWRP). (Repealed.)

A. Initial plan development.

1. The IWRP shall be initiated and periodically updated for individually provided independent living services.

2. Independent living services shall be provided in accordance with the IWRP and approved by DVH staff member. A copy of the IWRP and any amendments shall be provided to the blind individual or his parents, guardian, or other representative.

3. The IWRP must be initiated after certification of eligibility for independent living services.

B. IWRP review. The IWRP shall be reviewed as often as necessary but at least on an annual basis. Each blind individual or his parents, guardian, or other representative shall be given an opportunity to review the IWRP and, if necessary, jointly modify the IWRP.

C. Determination of ineligibility under IWRP. If it becomes necessary to terminate services for any reason under an IWRP, the following conditions and procedures shall be met and carried out:

1. The decision shall be made only with the full participation of the blind individual, or his parents, guardian, or other representative, unless the individual has refused to participate, the individual is no longer residing in Virginia, or his whereabouts are unknown. When the full participation of the individual or a representative of the individual has been secured in making the decision, the reviews of the individual shall be recorded in the IWRP.

2. The basis for the ineligibility decision shall be recorded as an amendment to the IWRP, certifying that the provision of independent living services has not enabled the individual to function more independently in family or community or engaging or continuing employment. A certification of ineligibility is then completed.

3. There shall be at least an annual review of the ineligibility decision in which the individual is given an opportunity for full consideration in the reconsideration of the decision, except in situations where a periodic review would be precluded because the individual has refused services, has refused a periodic review, the individual is no longer living in Virginia, or his whereabouts are unknown. The first periodic review of the ineligibility decision shall be initiated by DVH staff. Any additional reviews shall be provided at the request of the individual.

D. Coordination with vocational rehabilitation, developmental disabilities and education program. The development of the IWRP for independent living services will be coordinated with the IWRP for vocational rehabilitation services if there is such a program, as well as with any individualized written rehabilitation program for the individual prepared under Developmental Disabilities Assistance and Bill of Rights Act or with any individualized education program for the individual.

Part IV

Scope of Services

22VAC45-80-80. Scope of independent living rehabilitation services for individuals. (Repealed.)

The following independent living rehabilitation services may be provided if deemed necessary to the independence of the individual:

1. Intake counseling to determine the severely handicapped individual's need for specific independent living services;

2. Counseling services, including psychological counseling, psychotherapeutic counseling, peer counseling, and related services;

3. Advocacy for disabled individuals with respect to legal and economic rights and benefits;

4. Housing incidental to the provision of independent living rehabilitation service—this includes assistance in finding adequate housing and minor modifications to make housing accessible;

5. Independent living skills, counseling, and training:

a. Special tutorial and training services;

b. Orientation and mobility;

c. Special communication skills for deaf-blind;

d. Interpreter services for deaf-blind;

e. Rehabilitation teaching; and

f. Education and training necessary for living in the community and consumer education.

6. Transportation associated with the provision of essential independent living services;

7. Reader services;

8. Recreation activities—group and individual;

9. Attendant care—attendant for short-term care--to enable a multihandicapped blind person who has potential for acquiring skills to expand his independent living skills;

10. Interpreter services for deaf-blind;

11. Services to members of a blind individual's family when needed for improving the individual's ability to live and function more independently;

12. Provision of physical, occupational, and speech therapy;

13. Purchase of special adaptive aids and appliances;

14. Vocational and other training services;

15. Information, referral, and outreach;

16. Other programs and services necessary to provide resources, training, counseling, services, or other assistance of substantial benefit on promoting the independence, productivity, and quality of life for the severely handicapped individual; and

17. Any appropriate preventive services necessary to decrease the future needs of a blind individual assisted under the program for similar services.

Part V

Financial Participation

22VAC45-80-90. Participation by blind individuals and blind multihandicapped in the cost of independent living serv. (Repealed.)

A. An economic needs test will be utilized to determine the extent of client participation in the cost of independent living services. Services exempt from consideration for financial participation will be diagnostic and evaluation, counseling, guidance and referral, and interpreter services for the deaf.

B. Groups exempt are:

1. Recipients of General Relief;

2. Recipients of Aid to Families with Dependent Children by the client or family in which the client is dependent;

3. Recipients of Supplemental Security Income (SSI); and

4. Recipients of Social Security Disability Income (SSDI).

C. The department will make an assessment of similar benefits available to pay for independent living rehabilitation services. The department will not pay program costs which could otherwise be provided by similar benefits unless it is documented that the delay in securing such benefits would be detrimental to the Independent Living Rehabilitation Program.

D. Financial eligibility will be based on the following:

1. Gross income. A uniform income level will be used for all independent living clients. An annual review of the income levels stated below will be made and updated as needed.

The income eligibility is based on 80% of the federal estimated median income in Virginia, which is published annually in the Federal Register. The median income levels will be reviewed on an annual basis and updated as appropriate. The chart below reflects the gross income level and liquid assets exceptions for financial eligibility as applied to the Independent Living Program.

[NORMAL LIVING REQUIREMENTS]
Family Unit	Monthly Income	Annual Income
1	$1,313.00	$15,760.00
2	1,717.00	20,609.00
3	2,122.00	25,459.00
4	2,526.00	30,308.00
5	2,929.00	35,157.00
6	3,334.00	40,007.00
7	3,410.00	40,916.00
8	3,485.00	41,825.00

Add $300 per month for each additional person in the family, if more than eight.

2. Income for real property. Real property will not be considered for financial eligibility, but income from such property is to be considered as part of the client's income.

3. Liquid assets. Will be applied toward the cost of services when the liquid assets exceed the amount established for financial eligibility.

Exemptions for Liquid Assets
Number in Family	Amount
1	$10,000.00
2	11,200.00
3	12,400.00
4	13,600.00
5	14,800.00
6	16,000.00
7	17,200.00
8	17,400.00

4. Allowable deduction.

a. Unusual medical costs. The only deductions that will be considered will be unusual medical expenses which are not of a routine nature and for which the costs will not be covered by comparable services and benefits. Medical conditions that are not considered routine are those which are acute or traumatic and which place an additional burden upon the family income and resources. Those routine medical expenses that could not be deferred would include routine doctors' visits and hospital insurance premiums.

b. Tuition costs for client or family member to attend a private or public educational facility.

When the client's gross income, liquid assets, or both exceed the financial eligibility requirement after allowable deductions have been considered, the client and his family will have to apply the excess toward the cost of those services provided by independent living for which there is financial need considered.

Part VI

Client's Rights

22VAC45-80-100. Appeal procedures. (Repealed.)

A. The Virginia Department for the Visually Handicapped affords any resident of Virginia who has a complaint pertaining to services sought or provided the right to a review and a fair hearing.

B. When an individual files a formal complaint, he will meet with the employee and his supervisor. The grievant will be reminded as to the availability of the Client Assistance Program within the Department for Rights of Virginians with Disabilities to assist him in the appeals process.

C. If resolution is not reached at Step B, the assistant deputy commissioner for services meets with the grievant, his representative, the employee, and his supervisor.

D. If resolution is not reached at Step C, the grievant can request a hearing before an impartial hearing officer.

E. The impartial hearing officer will submit his decision to the commissioner of the Department for the Visually Handicapped, who can either accept or overturn the decision of the impartial hearing officer.

F. DVH independent living staff will inform each applicant or individual being provided independent living rehabilitation services of the procedure to file a complaint, including the name and addresses of those persons with whom to file a complaint.

22VAC45-80-110. Protection, use, and release of personal information. (Repealed.)

A. The DVH Independent Living Rehabilitation Services Program considers all personal information about prospective clients, current clients, and past clients as confidential information.

B. Individuals referred for independent living rehabilitation services will receive an explanation at intake of the confidentiality of personal information including:

1. The need for confidential information;

2. Conditions for accessing and releasing this information;

3. The authority under which confidential information is collected;

4. The principle purpose for which DVH will use or release the information;

5. Explanation of whether information the client is providing is mandatory or voluntary and the effects of not providing the information;

6. Identification of those situations where the agency does or does not require the client's written permission to release the information; and

7. Identification of agencies to which information is routinely released.

C. Explanation of policies and procedures affecting personal information will be made by appropriate media by DVH's independent living rehabilitation services to individuals who do not communicate in English or who rely on special modes of communication.

D. DVH's Independent Living Rehabilitation Program will use personal information only for purposes directly connected with the administration of the Independent Living Rehabilitation Services Program. Identifiable personal information will not be shared by DVH's independent living rehabilitation services with advisory or other bodies which do not have official responsibility for the administration of the program.

E. When requested in writing, DVH's Independent Living Rehabilitation Services will make all case information promptly available to the individual or his representative.

F. Personal information obtained by DVH's Independent Living Rehabilitation Services from other agencies or organizations will be released only by, or under conditions established by the other agency or organization.

G. DVH's Independent Living Rehabilitation Services will release personal information to an organization, agency, or individual for audit, evaluation, or research when such endeavors are directly connected with the administration of the Independent Living Rehabilitation Program, when it would significantly improve the quality of life for the visually handicapped individual, and when assurances are given that:

1. The information will be used only for the purpose for which it is being provided;

2. The information will be released only to persons officially connected with the audit, evaluation, or research;

3. The information will not be released to the individual involved;

4. The information will be managed in a manner to safeguard confidentiality; and

5. The final product will not reveal any identifying personal information without the informed, written consent of the involved individual or his representative.

H. DVH's Independent Living Rehabilitation Services will release personal information to other agencies or organizations for program purposes only if they demonstrate that the information is necessary for their program and upon receipt of informed, written consent of the individual.

I. Medical or psychological information which is determined by a physician or psychologist to be harmful to the individual may be released when the other agency or organization assures DVH that the information will be used only for the purpose for which it is provided and that it will not be released to the involved individual.

J. DVH's Independent Living Rehabilitation Services will release any personal information required:

1. To fulfill federal law;

2. To fulfill court order or in response to a law-enforcement investigation of fraud or abuse (except where expressly prohibited by federal law); and

3. To protect the individual or others when the individual poses a threat to the safety of himself or others.

K. Upon the request of the secretary of education or his designee, the DVH's Independent Living Rehabilitation Program will release to the secretary or his designee a complete and certified copy of the case record including transcripts of the fair hearing decision for the purpose of the secretary's review of the final decision.

Part VII

Independent Living Center Services

22VAC45-80-120. Centers for independent living. (Repealed.)

The department operates independent living centers for blind multihandicapped Virginians in its regional offices. The centers shall adhere to the regulations in the previous sections of these regulations.

22VAC45-80-130. Governing board of centers for independent living. (Repealed.)

A. There shall be a governing board consisting of a majority number of persons with disabilities.

B. Independent living advisory committees.

1. Each independent living center shall have an advisory committee consisting of no less than seven persons, established for the purpose of assistance in planning, developing, and implementing a comprehensive system of delivering independent living services to blind and blind multihandicapped individuals.

2. The advisory committee shall contain a majority number of persons with disabilities.

22VAC45-80-140. Staff. (Repealed.)

Independent living center staff shall include as large a proportion of persons with disabilities as is practicable.