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

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Presentation on theme: "Individual Supported Employment (ISE) New Planning and Payment Structure January 9, 2012."— Presentation transcript:

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

2 Commissioner’s/Deputy Commissioner’s Remarks Terrence W. Macy, PhD Joseph Drexler, Esq.

3 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

4 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

5 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

6 Background of ISE Work Group

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

8 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

9 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

10 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

11 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

12 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

13 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

14 Section I – Background Information (Completed by Provider)

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

16 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

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

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

19 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?

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

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

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

23 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

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

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

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

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

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

29 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 ?

30 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

31 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

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

33 10 Minute Break

34 ISE Payment Structure

35 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.

36 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.

37 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.

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

39 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

40 Level of NeedHours of Follow Along Supports 1Maximum of 3 hours per week 2Maximum of 4 hours per week 3Maximum of 5 hours per week 4 5 6 7

41 Service Hourly Payment 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 POS Contract Web/res/day Individual Budgets Invoice to Fiscal Intermediary * Back up information maintained by the provider for potential audit ISE Rates

42 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 POS Contract Web/res/day Individual Budgets Invoice to Fiscal Intermediary 2. Career Plan Indirect Support $700 for completed product Completed acceptable Career Plan ISE Rates

43 Service Hourly Payment # 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 Invoice to Fiscal Intermediary 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 Invoice to Fiscal Intermediary 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 Invoice to Fiscal Intermediary * Payroll Information submitted as one time documentation. ISE Rates

44 ServiceBenchmark Payment Payment Process Start work (payment based on hours worked per week) 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 One-time documentation Individual Budgets Invoice to Fiscal Intermediary 3 months completion Time begins with a full calendar month of employment 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 Web/res/day Individual Budgets Invoice to Fiscal Intermediary ISE Rates

45 ServiceBenchmark Payment Payment Documentation 6 months completion Time begins with a full calendar month of employment 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 Web/res/day Individual Budgets Invoice to Fiscal Intermediary Transition to Natural Supports - Successful discharge 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. ISE Rates

46 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.

47 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.

48 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.

49 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.

50 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.

51 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.

52 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

53 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.

54 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).

55 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.

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

57 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.

58 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.

59 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.

60 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.

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

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65 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.

66 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.

67 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.

68 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

69 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.

70 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).  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.

71 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).  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.

72 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

73 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.

74 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).  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.

75 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.

76 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.

77 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.

78 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.

79 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

80 Wrap Up/Q&A ???????????????????????????????

81 Thank You and Enjoy the Flight


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