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16.9. Driver Rehabilitation Program Procedures
(1) Referrals for driver evaluation must be received from the physician or appropriate Licensed Independent Provider most knowledgeable of the patient’s physical and mental problem(s). NOTE: Those patients referred with a psychiatric diagnosis may
require additional input from their mental health provider in order to clarify the effects the psychiatric diagnosis would have on the driving task.
(2) The primary care physician of Veterans and Servicemembers referred for driver rehabilitation, who are not already involved with a rehabilitation treatment team, have the option to refer the Veterans or Servicemembers to a team-based comprehensive rehabilitation needs-assessment to assess any physical, behavioral, or functional problems that may need to be addressed.
b. Other Participation Criteria.
(1) The patient must be eligible for a valid state permit or license in the state in which the patient resides.
(2) The patient must be willing to release medical information to the state in accordance with individual Department of Motor Vehicles (DMV) policy.
(3) The patient must be in compliance with state law and vehicle codes regarding operation of a motor vehicle. This includes being free from illegal substances which would affect the Veterans ability to drive. NOTE: The ultimate goal of the Driver Rehabilitation Program is to return the Veteran to full driving capability with appropriate modifications to the vehicle. The program cannot make a legal determination whether a Veteran with a progressive disorder can safely operate a motor vehicle. The determination whether someone should maintain his or her driver’s license is the responsibility of the state in which he or she resides. NOTE: Please refer to Privacy Fact Sheet Reporting to state Department of Motor Vehicles January 2017 at https://vaww.vets.vaco.portal.va.gov/sites/privacy/vhapo/Pages/FactSheets.aspx . This is an internal VA Web site and is not available to the public.
(4) Treatment may be terminated if the patient is using illegal substances, abusing prescription medication, or consuming alcohol at risky levels, as determined by the Driver Rehabilitation Specialist. If treatment is terminated because of alcohol or drug abuse, the Driver Rehabilitation Specialist must contact the referring provider– it is recommended that the provider refer the individual to the VHA Substance Use Disorder Program. The patient may be re-admitted to the Driver Rehabilitation Program only after written certification by the referring provider that the patient no longer constitutes a likely safety risk due to use of drugs or alcohol.
(5) Termination from the Driver Rehabilitation Program before successful completion of the program for other than medical reasons will be based upon professional judgment of the Driver Rehabilitation Specialist.
(6) Final determination of patient’s capacity to drive and be licensed rests with the appropriate State licensing agency. The final responsibility for licensing the patient who completes the VA Driver Rehabilitation Program rests with the individual Veteran or
Servicemember and the individual State Department of Motor Vehicles. VA staff members must be aware of the State eligibility requirements, and cooperate with the State on behalf of the patient as much as possible
(7) Any Veteran or Servicemember eligible for VA medical care can be referred to the Driver Rehabilitation Program for training.
(1) It is necessary to assess effective utilization of the Driver Rehabilitation Program in an ongoing manner in order to determine the need to upgrade, advise, or possibly terminate programs at the designated VA medical facilities.
(2) Three categories of evaluation currently exist to provide the basis for productivity:
(a) Number of annual referrals to the program;
(b) Number of annual training hours provided in the program; and
(c) The amount of time each instructor gives to the program.
(3) New methods of measuring productivity including use of Current Procedural Terminology (CPT) Codes, and International Classification of Diagnoses, Clinical Modifications, 10th Edition (ICD-10-CM) Codes are being incorporated into the Decision Support System (DSS), the current system of record, as a new means for effectively measuring productivity and costs. All VA medical facilities with a driver rehabilitation program must have stop code 230 in the primary credit position. The secondary credit stop code should be devoted to the discipline providing the training, such as 214 for Kinesiotherapy, 206 for Occupational Therapy, 205 for Physical Therapy, etc. NOTE: The Coordinator of the Driver Rehabilitation Program, VHA Central Office, reviews the Annual Reports to assess existing workload and productivity. Consideration is given to those VA medical facilities in isolated geographic areas where Veteran activity is known to be low.
(4) Specific workload data must be maintained by the PM&RS Program Office (10P4R) staff assigned to coordinate the program.
d. Nonproductivity. The PM&RS Program office staff assigned to coordinate the program must review the annual report data from each VA medical facility, to determine which, if any, driver rehabilitation program does not meet the standards over an established period of time, and to recommend termination or intensive upgrading of delinquent centers. All such action is to be cleared through the appropriate VISN and the Office of PM&RS, VHA Central Office.
e. Accreditation. Driver Rehabilitation programs that are a part of a CARF accredited program must adhere to the applicable CARF Health and Safety standards. NOTE: The CARF Standards can be found at: http://vaww.oqsv.med.va.gov/functions/integrity/accred/carf.aspx. NOTE: This is an internal VA Web site and is not available to the public.
f. Transfers of Veterans to Driver Rehabilitation Centers. When the Veteran’s or Service member’s team indicates an applicant can be expected to satisfactorily complete a special driver rehabilitation course and the applicant accepts the plan offered, arrangements must be made to move the person to the nearest VA Driver Rehabilitation Center with authorized accommodations for completing the special training. The use of temporary lodging and/or hotel beds is encouraged for those patients who do not require overnight nursing care. Commuting from a patient’s home to the training facility may be utilized as an option when deemed necessary. Following completion or termination of the training, the patient is to be provided whatever return transportation the patient needs that is authorized. The referring facility must fund these transfers (see Appendix E). NOTE: Movement of patients between facilities is governed by VHA Directive 1601B.05, Beneficiary Travel, dated July 21, 2010, or subsequent policy.
g. Non-VA Training Programs.
(1) Certain situations may require that a Veteran or Servicemember seek driver training at some rehabilitation center other than an approved VA Driver Rehabilitation Program. Such situations could include:
(a) Inability to leave area of residence for family reasons;
(b) Inability to travel long distances to reach the nearest driver rehabilitation center;
(c) Unavailability of space.
(2) If any of these situations exist, it may be necessary to contract for these services at the nearest non-VA Driver Rehabilitation Program to meet the individual’s needs. It is the responsibility of a knowledgeable PM&RS specialist to review the non-VA facilities
to determine whether they meet VA standards for training of the disabled; e.g., adequate and safe adaptive equipment, a state-certified instructor, a respectable training record, etc., before the Veteran receives such training, or the contract is developed to authorize payment of such service.
h. Training in Veteran’s Personal Vehicle or Vendor Equipped Vehicle. It is permissible to teach adaptive driving skills to a Veteran or Servicemember in their personal vehicle, or in a vendor-equipped vehicle, as long as the Veteran, Servicemember or vendor can show documented proof that the vehicle is covered by the minimum State requirements for insurance. The vehicle must also have the required adaptive equipment already available in the vehicle if that equipment is necessary based on the disability of the individual. This situation may occur when the Veteran or Servicemember has a need for special adaptive equipment or structural
modifications of the vehicle not ordinarily utilized or available in the VA driver rehabilitation vehicle(s). NOTE: It is recommended that in such training situations, an instructor’s brake needs to be installed prior to beginning the training. Magnetic signs indicating student driver must be affixed to the vehicle by the Driver Rehabilitation Specialist.