Individual Supported Employment ISE New Planning and Payment

Individual Supported Employment (ISE) New Planning and Payment Structure January 9, 2012

Commissioner’s/Deputy Commissioner’s Remarks • Terrence W. Macy, Ph. D • Joseph Drexler, Esq.

Today’s Agenda: • • • Our Objectives for Today Employment First Initiative Background of ISE Work Group The Career Plan/Guide Payment Structure Wrap Up/Q&A

Today’s Objectives: • To provide an overview of the new ISE planning and payment structure • To review the new Career Plan and Guide • To review the new funding structure and protocols • To provide a starting point for the new ISE process and contacts for support • To respond to questions

Employment First Initiative • Employment is the first priority option to be explored in the service planning. • All future graduates and those with LON levels 1, 2, and 3 must have an employment goal which leads to individual supported or competitive employment. • All other individuals and their teams should consider individual supported or competitive employment options. • Annual Individual Plans should help people to secure employment and help people to pursue advancement in their chosen careers. • Employment is an ongoing path – it does not have an ending. http: //www. ct. gov/dds/lib/dds_manual/ic 5 po 001_employment_first. pdf

Background of ISE Work Group

ISE Work Group Transitioning from Traditional Payment Structure to Fee for Service

ISE Work Group – History and Outcomes • Established in February 2010 – Collaborative approach of DDS and Private Sector to address the following: • Conversion of traditional payment structure to attendance based payments dramatically reduced annualized (legacy) rates impacting agency infrastructure • Create a system which meets client needs and reimburses providers for work completed • Reinforce the value of ISE services • Sought and secured a cap on losses to be limited to 2% for ISE payments during the

ISE Work Group – History and Outcomes • Reviewed information on how other states pay for ISE services • Gathered information to identify direct and indirect costs/activities involved in job preparation, development, placement and retention • Collected analyzed information from 25 providers to determine aggregate data of above • Categorized ISE service components

ISE Work Group – History and Outcomes • Researched and re-designed available assessment and career planning tools to be consistently used within the system • Consistently reviewed CMS waiver guidelines for service delivery and documentation requirements • Solicited input from DDS CO Case Management Liaison

The Career Plan - Purpose • To gather information from the individual and stakeholders that is pertinent to obtaining/retaining employment • To identify and outline unique supports that will lead to employment • To be a roadmap for the individual and his/her support team that leads to successful competitive employment and career enhancement • To be a dynamic and flexible document that will accompany the individual throughout his/her personal

Structure of Career Plan • LON, IP and Client Summary Report (provided by case manager prior to or with service authorization) • Section 1: Background Information • Section II: Vocational Profile • Section III: Action Plan

Client Summary Report • The DDS Case Manager will provide this CAMRISbased report to the Private Provider • This will be in the referral package for a new consumer or forwarded to the provider in preparation for a career planning meeting • This summary captures pertinent consumer information currently stored in CAMRIS • This summary will be attached to the front of the Career Plan document

Section I – Background Information (Completed by Provider)

I. 1. Legal Status • Preparation for employment forms • Information to develop strategy for addressing criminal record and/or substance abuse issues

I. 2. Social Security • The start of a financial plan that meets the needs of the individual • Provides the basic information to project the impact, if any, competitive work may have on entitlements • Encourages link to benefits counselor

I. 3. Other Potential Funding/Resources for Employment Services and Supports • Identifying all pertinent resources to bring to the table

I. 4. Transportation • How will the person get to and from work ? • What are the options ? • What’s plan B, C and D ?

I. 5. - I. 7. Education, Training and Academic Skills/Work-Life Experience/ Advocacy Skills • What skills and experiences can be brought to bear for work? • What are the clues for matching skills for work?

I. 8. &I. 9. Paid Employment History & References • This is the start of a resume • Contact list for employment opportunities

Section II – Vocational Profile (Completed by Provider) This is the section that will incorporate observations, self-reports and results from established written assessments

II. 1. & II. 2. Vocational Preferences/Skills, Gifts and Strengths • Listening to individuals and stakeholders • Gathering information and perceptions

II. 3. - II. 7. Vocational Skills • Self reporting of individual • Information and perceptions of stakeholders • Opportunities for up to three (3) brief assessments or inventories (complete at least one) • Previous performance evaluations

II. 8. Communication Skills • How does the individual communicate? • Interaction with others

II. 9. Accommodations • What’s needed to make work possible, accessible, safe and successful ?

II. 10. Transportation/Safety Awareness • How will the individual safely and independently navigate to, from and around work ?

II. 11. Community Advantages/Disadvantages • Opportunities and risks ?

II. 12. - II. 15. Preparation for Job Development • Tools • Focus/Scope • Opportunities • Contacts

Section III – Action Plan • The Who – What – When – Where and How addressed? • What natural supports are in place to address some action steps? • Is everyone clear about what they are committing to do ? • Are there clear guidelines and timelines for completing tasks ?

Sign-Off “I’m committing to provide the support to the best of my ability. ” Individuals involved in the development and implementation of the plan are to sign off

Review and Approval of Career Plan • Submission of a copy of the completed Career Plan • Resource Manager Career Plan Completion Checklist • Approval/Authorization for Payment

Career Plan Guide • Purpose – Interpretive guideline for completing and submitting a person centered and meaningful career plan

10 Minute Break

ISE Payment Structure

Waiver Definition of Supported Employment • Supported Employment consists of intensive, ongoing supports that enable participants, for whom competitive employment at or above the minimum wage is unlikely absent the provision of supports, and who because of their disabilities, need supports to perform in a regular work setting. Supported employment may include assisting the participant to locate a job or develop a job on behalf of the participant.

Individual Supported Employment • Services will vary in the intensity of initial job development, intensive training, and decreasing periodic monitoring. • The individual, parent and/or guardian, and her/his team should discuss a support plan that addresses how and when the staff would begin to be fade direct supports. • Although there is no set time limit, a reasonable time frame from when an individual begins a job with staff supports to independently working on their own is generally 3 -6 months. • A few hours of ongoing weekly and/or monthly support is part of the Individual Supported Employment model.

Individual Supported Employment • This service is not for use to provide ongoing long-term 1: 1 support to enable an individual to complete work activities. • An individual who needs long-term 1: 1 on the job supports to maintain their job would utilize the Individualized Day model with a negotiated rate.

ISE Rates The new rate structure is for ISE supports only.

ISE Rates Service Hourly Payment # of hours Payment Process Annualized Authorization for follow -along support to include Face to Face hours with the participant at the work site, with the employer at the worksite or with the participant outside the worksite regarding work related issues $47. 00 per hour Based on LON allocationranges from 1 -5 hours per week POS Contract Web/res/day Individual Budgets Invoice to Fiscal Intermediary

ISE Rates Level of Need Hours of Follow Along Supports 1 Maximum of 3 hours per week 2 Maximum of 4 hours per week 3 Maximum of 5 hours per week 4 Maximum of 5 hours per week 5 Maximum of 5 hours per week 6 Maximum of 5 hours per week 7 Maximum of 5 hours per week

ISE Rates Service Hourly Payment Hours worked $4. 48 per each week by ISE hour worked Participant or paid vacation, (hours need to be sick, or verified – TBD) holiday time Payment Process POS Contract Web/res/day Individual Budgets Invoice to Fiscal Intermediary * Back up information maintained by the provider for potential audit

ISE Rates Service Benchmark Payment 1. Career Plan Direct Support – face to face 2. Career Plan Indirect Support $700 for completed product Hourly Payment # of hours Payment Process $47. 00 per hour Average of 10 hours for Career Plan POS Contract Web/res/day Individual Budgets Invoice to Fiscal Intermediary Completed acceptable Career Plan

ISE Rates Service Hourly Supports-Job development and intensive training Direct Face to Face Support provided during Working Interview Wage for consumer during the Working Interview Hourly Payment # of hours $47. 00 per hour Based on Team Recommendation Payment Process POS Contract Web/res/day Individual Budgets $47. 00 per hour up to 40 hours over a 2 week time period Invoice to Fiscal Intermediary POS Contract Web/res/day Individual Budgets $9. 00 per hour up to 40 hours over a 2 week time period Invoice to Fiscal Intermediary POS Contract One-time Documentation Individual Budgets Invoice to Fiscal Intermediary * Payroll Information submitted as one time documentation.

ISE Rates Service Benchmark Payment Process Start work 5 to 9. 99 hours = $400 10 to 14. 99 hours = $800 15 to 19. 99 hours = $1200 20 to 24. 99 hours = $1600 25 hours or more = $2000 POS Contract (payment based on hours worked per week) 5 to 9. 99 hours = $400 10 to 14. 99 hours = $800 Time begins with a full 15 to 19. 99 hours = $1200 calendar month of 20 to 24. 99 hours = $1600 employment 25 hours or more = $2000 3 months completion One-time documentation Individual Budgets Invoice to Fiscal Intermediary POS Contract Web/res/day Individual Budgets Invoice to Fiscal Intermediary

ISE Rates Service Benchmark Payment 6 months completion 5 to 9. 99 hours = $400 10 to 14. 99 hours = $800 15 to 19. 99 hours = $1200 20 to 24. 99 hours = $1600 25 hours or more = $2000 Time begins with a full calendar month of employment Transition to Natural Supports - Successful discharge Payment Documentation POS Contract Web/res/day Individual Budgets Invoice to Fiscal Intermediary 5 to 9. 99 hours = $400 10 to 14. 99 hours = $800 15 to 19. 99 hours = $1200 20 to 24. 99 hours = $1600 25 hours or more = $2000 Documentation of the discharge and plan for natural supports submitted as one time.

Implementation Details • Start Date - February 1, 2012 • All Individual Supported Employment (ISE) Authorizations for on-going support will be changed to the new rate of $47 hour. • All ISE authorizations will be changed to the LON based hours.

Implementation Details • It is important that we do not immediately reduce the total number of hours currently being received by the individual. • Unless a reduction in support hours is agreed upon by the team, any hours above the LON authorized Follow Along hours are to be authorized through the one-time process.

Implementation Details • The provider should submit a plan to decrease the support hours down to the LON Follow along hours. The plan must be approved by the region. • Individuals unable to maintain employment without the current authorized supports will be reviewed and, except for extreme circumstances, will have their authorization changed to Individual Day Supports.

Implementation Details • All individual budgets with ISE supports provided by a provider will be converted to the POS contract over the next few months. • All individual budgets with ISE supports provided by a provider and ADA transportation tickets purchased by the FI will be converted to the POS contract over the next few months. • Providers without a POS contract will be encouraged to sign a POS contract by 7/1/2012.

Implementation Details • Individual Budgets with ISE supports provided by a Self Hire will not change on 2/1/2012. • The individual budget will be reviewed to determine whether it is outside the ranges of the LON based authorization. • Teams will be asked to develop a plan to transition the supports to match the LON based authorizations or amend the authorization to a more appropriate support category.

Implementation Details • Providers will be reimbursed $ 4. 48 for each hour paid by the employer in a competitive employment setting. Hours worked include all paid time including sick, vacation and holidays. • The provider must have back-up documentation for all of the actual hours paid by the employer. • DDS is reviewing different back-up documentation but, in the meantime, only hours supported by the individual’s paychecks will be reimbursable. • Once additional back-up documentation has been identified, the provider may submit hours worked dating back to 2/1/2012.

How to determine hours worked • We did NOT want providers to need to calculate which hours were worked in which month • We did NOT want providers to need to calculate which hours happened on which day • We wanted an easy to audit system

How to determine hours worked • Consumers will get their “pay check and record the hours worked any paid leave sick/vacation” (that corresponds to the pay check). • The date of the check will determine which month to enter data into Web. Res. Day.

How to determine hours worked • Check dated 5/11/2012. Covers the period 4/27/2012 -to-5/3/2012: • Day by day hours: 4/27/2012 – 8 hours (32 units) 4/28/2012 – 8 hours (32 units) 4/29/2012 – off 4/30/2012 – 1 hours (4 units) 5/1/2012 – 8 hours (32 units) 5/2/2012 – off 5/3/2012 – off Total: 25 hrs (100 units) Enter “ALL 25 hours” of the pay period in Web. Res. Day in May 2012 (This includes any hours worked in April 2012).

How to determine hours worked • Check dated 5/18/2012. Covers the period 5/4/2012 -to-5/10/2012: • Day by day hours: 5/4/2012 – 4 hours (16 units) 5/5/2012 – 1 hour (4 units) 5/6/2012 – 8 hours (32 units) 5/7/2012 – 8 hours (32 units) 5/8/2012 – off 5/9/2012 – 4 hours (16 units) 5/10/2012 – off Total: 25 hrs (100 units) Enter “ALL 25 hours” in Web. Res. Day in May 2012.

How to record the hours worked by a Participant’s in WEBRESDAY Click on Hours Worked with SEI Supports

How to record the hours worked by a Participant’s in WEBRESDAY Unit equals 15 minutes. Do not need to put down daily work hours just the total for the month. The checks received by the participant in the month of May equaled 200 units ( 50 hours times 4 (fifteen minute units). The maximum number of units is 96 for each day.

How to record the hours worked by a Participant’s in WEBRESDAY • POS Contracted Providers should input January’s participant hours worked to become familiar with the process and to allow DDS to test the payment process for your agency. • Do not need to put down daily work hours just the total for the month. • Don’t forget to sign off on the attendance. • Attendance must be signed off by the 5 th of the month but no later than the 10 th.

Implementation Details • Benchmark payments will begin for all employment settings starting on 2/1/2012. • Provider will receive a one-time authorization for all benchmarks at the issuance of the Follow Along authorization for all new ISE participants.

Implementation Details • Benchmark payment for the acquisition of a competitive employment setting will be paid after the receipt of documentation of employment by the employer ( i. e. letter of employment, work schedule, etc. ) • Benchmark payments for continuous employment will be based on documentation of consecutive weekly working hours for the 3 and 6 month period. • Natural Supports benchmark will be paid at the termination of the Follow along authorization.

RATE GRID • Rate Grid was developed to visually portray ISE process and begin to delineate responsibilities in accessing supports.

Checklist Development • Began developing a checklist identifying responsibilities of all parties. • Struggling with best way to lay it out due to the many variables and possible scenarios. • Need input from end users as to what would be most helpful to you.

SCENERIO 1 • Existing ISE ▫ Revised annual authorization at new rate based on LON ▫ NO ACTION required by RM, CM, Provider or FI ▫ Authorizations will be revised by the Operations Center.

SCENARIO 2 • Existing ISE Lost Job after 2/1/12 ▫ Team knows what additional non-annualized supports are needed and requests additional hours through PRAT. Staff supports( ie. job development, intensive training ) need to be identified in writing. One Time Form needed for Benchmarks. If applicable, additional staff hours will be requested along with a onetime Form submitted for a Working Interview (Client Wages). RM completes Add Hours authorization or 1 x authorization as applicable for those receiving supports through the POS Contract. RM sends Authorization to Provider. CM amends budget to add non-annualized supports approved onto ISE 1 x line with CODES added into comments. FI would see once amendment was approved.

Scenario 3 • Existing ISE Lost Job after 2/1/12 ▫ Team unsure what direction to take and what supports are needed. One Time form for Career Plan submitted Other additional Staff hours needed for development of Career Plan and initial job development and training are requested. CM makes request to PRAT ▫ IP ▫ LON ▫ Client Summary

Scenario 3 (cont) • PRAT Makes Determination ▫ CM amends Individual Budget and sends service authorizations to Provider. ▫ RM completes any add hours or 1 x authorizations for individuals funded through a POS contract and sends service authorizations to Provider. ▫ Provider sends completed Career Plan to RM or FI Liaison. ▫ RM or FI Liaison reviews for completeness using the Career Plan checklist. ▫ For supports through POS contract, when complete RM does 1 x payment authorization. ▫ For supports through IP 6, FI liaison contacts appropriate FI via email to let them know Career Plan is completed and can be paid with a valid invoice.

Scenario 3 (cont) • If additional supports are identified through Career Plan CM submits request to PRAT Staff supports( ie. job development, intensive training ) need to be identified in writing. One Time Form needed for Benchmarks. If applicable, additional staff hours will be requested along with a onetime Form submitted for a Working Interview (Client Wages). RM completes Add Hours authorization or 1 x authorization as applicable for those receiving supports through the POS Contract. RM sends Authorization to Provider. CM amends budget to add non-annualized supports approved onto ISE 1 x line with CODES added into comments. FI would see once amendment was approved.

Scenario 4 • NEW PERSON to ISE after 2/1/12 ▫ Team knows what supports are needed. CM submits request for initial ISE supports as identified by team. CM does Annual authorization based on LON for IP 6 RM does Annual authorization based on LON for POS One Time Form needed for Benchmarks. If applicable, additional staff hours will be requested along with a onetime Form submitted for a Working Interview (Client Wages). RM completes Add Hours authorization or 1 x authorization as applicable for those receiving supports through the POS Contract. RM sends Authorization to Provider. CM amends budget to add non-annualized supports approved onto ISE 1 x line with CODES added into comments. FI would see once amendment was approved.

Scenario 5 • NEW PERSON to ISE after 2/1/12 ▫ Team unsure what direction to take and what supports are needed. One Time form for Career Plan submitted Other additional Staff hours needed for development of Career Plan and initial job development and training are requested. CM makes request to PRAT ▫ IP ▫ LON ▫ Client Summary

Scenario 5 (cont) • PRAT Makes Determination ▫ CM amends Individual Budget and sends service authorizations to Provider. ▫ RM completes any add hours or 1 x authorizations for individuals funded through a POS contract and sends service authorizations to Provider. ▫ Provider sends completed Career Plan to RM or FI Liaison. ▫ RM or FI Liaison reviews for completeness using the Career Plan checklist. ▫ For supports through POS contract, when complete RM does 1 x payment authorization. ▫ For supports through IP 6, FI liaison contacts appropriate FI via email to let them know Career Plan is completed and can be paid with a valid invoice.

Scenario 5 (cont) • If additional supports are identified through Career Plan CM submits request to PRAT Staff supports( ie. job development, intensive training ) need to be identified in writing. One Time Form needed for Benchmarks. If applicable, additional staff hours will be requested along with a onetime Form submitted for a Working Interview (Client Wages). RM completes Add Hours authorization or 1 x authorization as applicable for those receiving supports through the POS Contract. RM sends Authorization to Provider. CM amends budget to add non-annualized supports approved onto ISE 1 x line with CODES added into comments. FI would see once amendment was approved.

Hardship Adjustments • DDS will continue automatic hardship adjustments for Individual Supported Employment (ISE) services provided through a POS contract until June 30, 2012. • Since ISE supports on an individual budget were developed for the specific hourly needs of the participant, there is no hardship adjustment for individual budgets.

Hardship Adjustments • From February 1, 2012 through June 30, 2012, the hardship will be based on a loss limit of 10%. • This will not be an automatic calculation due to the combination of funding calculations that will be used to determine the total reimbursement for ISE. • The calculation will be completed once the fiscal year has ended.

Hardship Adjustments • The final reconciliation will be based on the utilization for each period and the loss limit to the month. The loss limit will be based on the difference between the total payments for follow along support, hours worked, career plan and benchmark payments with the current $58. 11 rate that is being replaced with the new ISE rate structure.

Hardship Adjustments • DDS will consider an interim payment for providers that can demonstrate a significant negative financial impact the delay in calculating the hardship adjustment will have on their organization.

Implementation Details • Contacts ▫ Client Summary Report, LON and IP – Case Manager ▫ Authorizations – Regional Resource Manager or FI Liaison ▫ General Technical Assistance – Self Determination Directors ▫ Career Plan Review – Regional Resource Manager or FI Liaison

Thank You and Enjoy the Flight