Individual Supported Employment (ISE) New Planning and Payment Structure

Individual Supported Employment (ISE)

New Planning and Payment Structure

January 9, 2012

Commissioner’s/Deputy Commissioner’s Remarks•Terrence W. Macy, PhD•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/dds_manual/ic5/ic5po001_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 transition period

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 and 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 career path

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

CAMRIS-based 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.

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

allocation- ranges from

1-5 hours per week

POS Contract Web/res/day

Individual Budgets

Invoice to Fiscal Intermediary

ISE Rates

ISE Rates

Level of Need Hours of Follow Along Supports

1 Maximum of 3 hours per week2 Maximum of 4 hours per week3 Maximum of 5 hours per week4 Maximum of 5 hours per week5 Maximum of 5 hours per week6 Maximum of 5 hours per week7 Maximum of 5 hours per week


Payment

Process

Hours worked each week by ISE

Participant

(hours need to be verified – TBD)

$4.48 per hour worked

or paid vacation, sick, or

holiday time


Individual Budgets


* Back up information maintained by the

provider for potential audit

ISE Rates

Service Benchmark Payment

Hourly Payment

# of hours

Payment Process

1. Career Plan

Direct Support – face to face

$47.00 per hour

Average of 10

hours for Career

Plan


Individual Budgets

Invoice to Fiscal

Intermediary2. Career Plan

Indirect Support

$700 for completed

product

Completed acceptable Career Plan

ISE Rates


# of hours Payment

Process

Hourly Supports-Job development and intensive training

$47.00 per hour

Based on Team Recommendation

POS Contract

Web/res/day

Individual Budgets


Direct Face to Face Support provided during Working Interview

$47.00 per hour

up to 40 hours over a 2 week time period

POS Contract

Web/res/day

Individual Budgets


Wage for consumer during the Working Interview

$9.00 per hour

up to 40 hours over a 2 week time period

POS Contract

One-time Documentation

Individual Budgets


* Payroll Information submitted as one time documentation.

ISE Rates

Service Benchmark Payment Payment Process

Start work

(payment based on hours worked per week)

5 to 9.99 hours = $40010 to 14.99 hours = $80015 to 19.99 hours = $120020 to 24.99 hours = $160025 hours or more = $2000

POS Contract

One-time documentation

Individual Budgets


3 months completion

Time begins with a full calendar month of employment


POS Contract

Web/res/day

Individual Budgets


ISE Rates

Service Benchmark Payment Payment Documentation

6 months completion

Time begins with a full calendar month of employment


POS Contract

Web/res/day

Individual Budgets


Transition to Natural Supports - Successful discharge


Documentation of the discharge and plan for natural supports submitted as one time.

ISE Rates

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.


•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.


•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 and any paid leave sick/vacation” (that corresponds to the pay check).

•The date of the check will determine which month to enter data into WebResDay.

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 WebResDay 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 WebResDay 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 5th

of the month but no later than the 10th.


•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 one-time Form submitted for a Working Interview (Client Wages).

RM completes Add Hours authorization or 1x 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 1x 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 1x 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

1x payment authorization.▫ For supports through IP6, 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 one-time Form submitted for a Working Interview (Client Wages).



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 IP6 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

one-time Form submitted for a Working Interview (Client Wages).



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 1x 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

1x payment authorization.▫ For supports through IP6, 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 one-time Form submitted for a Working Interview (Client Wages).



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.


•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

Wrap Up/Q&A

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Thank You and Enjoy the Flight

Individual Supported Employment (ISE) New Planning and Payment Structure

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