1. Exploring Community Based Prevocational Services LeAnn Moskowitz Program Manger Iowa Medicaid Enterprise, BLTC

2. What are Prevocational Services? Prevocational Services : Prepare clients for community or self employment Are not sheltered work services Are expected to occur over a defined period of time and with specific outcomes to be achieved, Teach general skills that are not job or task specific

3. CMS Requirements Prevocational Services are time limited. Three criteria in differentiating Prevocational Services and vocational services: Compensation for work is paid at less than 50% of minimum wage Provided to persons who are not expected to join the general work force or participate in a transitional sheltered workshop within one year of service initiation (excluding supported employment programs) Include activities that are not primarily directed at teaching job specific skills but at underlying habilitative goals (e.g., attention span, motor skills) 42 CFR § 440.180(c)(2)(i)

4. How Are They Different? Prevocational ServicesNon-Integrated Work Service Prepares the person for community employment. The service may last indefinitely. Teach general skills necessary to obtain and maintain community employment Teach skills required to perform steps associated with a specific job or task Goals are not specific to the job or task being performed Goals focus on areas such as increased productivity Purpose is not the production of goods or services Compensation is at less than 50% of minimum wage

5. Excerpts (Core Service Definition, page 150, January 2015 HCB Instructions, Technical Guide and Review Criteria) Intended outcome is to prepare an individual for competitive employment Core Service Definition

6. Excerpts (Core Service Definition, page 151, January 2015 HCB Instructions, Technical Guide and Review Criteria) The distinction between vocational and pre-vocational services is that pre-vocational services, regardless of setting, are delivered for the purpose of furthering habilitation goals that will lead to greater opportunities for competitive and integrated employment and career advancement at or above minimum wage. Core Service Definition

7. Excerpts (Core Service Definition, page 151, January 2015 HCB Instructions, Technical Guide and Review Criteria) Individuals participating in prevocational services may be compensated in accordance with applicable Federal laws and regulations and the provision of prevocational services is always delivered with the intention of leading to permanent integrated employment at or above the minimum wage in the community Core Service Definition

8. Is Prevocational Services the right Service? The client wants to work in the community And Prevocational Services are determined necessary to assist the person to enter the general workforce

9. Prevocational Services in Iowa Comprehensive functional assessment, indicates the needs supports to obtain and/or maintain employment Comprehensive Service plan identifies prevocational service needs and plan for employment Waiver Prior Authorization ensure the service is appropriate based on assessed need, employment goals of the member Annual re-assessment and review Goal is to obtain community employment Referral to the Division of Vocational Rehabilitation Services

10. Prevocational Goals Focus on general strengths and skills that are not specific to a job or task and that contribute to the ability to be employed in community settings, such as: Ability to communicate effectively Generally accepted workplace conduct Ability to follow directions Ability to attend to tasks Workplace problem solving skills General workplace safety

11. The Goal of Community Based Prevocational Services To determine, through community experience, whether an individual wishes to pursue integrated employment To make reasonable and continued progress toward achievement of an integrated employment outcome in the individual’s plan, and doing so engage in activities that will contribute to the individual’s success in securing and keeping an integrated job To contribute to an individual’s ability to maintain integrated employment by functioning as a wraparound support service during designated times when the individual is not working in integrated employment

12.  Employability skills training – Making good impressions, listening, personal care, interacting with coworkers, identifying skills, and self esteem  Job exploration  DVR assistance  Application assistance  Resume and cover letter assistance  Computer skills training  Guest speakers  Peer speakers  Touring employers  Job shadowing  Information interviews  Job try outs  Job retention skills  Volunteering  Learning transportation  Volunteer Work – volunteer learning and training that prepare a person for paid work Community Based Prevocational Services activities may include but are not limited to:

15. RESOURCES Please visit the Consumer Choice Option (CCO) homepage at: http://dhs.iowa.gov/ime/members/medicaid-a-to-z/consumer-choices-option http://dhs.iowa.gov/ime/members/medicaid-a-to-z/consumer-choices-option For information on increasing employment opportunities for people with disabilities and to read personal success stories from individuals who have used HCBS services and supports to successfully meet their employment goals, please visit the MHDS Employment homepage at: http://dhs.iowa.gov/mhds/disability-services/employment and, http://dhs.iowa.gov/mhds/disability-services/employment Iowa Vocational Rehabilitation Services Success Stories webpage at: http://www.ivrs.iowa.gov/SuccessStories/successstorieshome.html CMS 2015 1915 (c) HCBS waiver application and technical guidance: https://wms-mmdl.cdsvdc.com/WMS/faces/portal.jsp

16. RESOURCES SAMHSA Toolkit on Supported Employment as EBP, http://store.samhsa.gov/product/Supported-Employment-Evidence-Based- Practices-EBP-KIT/SMA08-4365 IVRS Website: http://www.ivrs.iowa.gov/ http://www.ivrs.iowa.gov/CustomizedEmploymentStrategies.html To learn more about ODEP’s Employment First initiatives visit: http://www.dol.gov/odep/topics/EmploymentFirst.htm http://www.dol.gov/odep/topics/EmploymentFirst.htm To learn more about the State Employment Leadership Network, visit: http://www.selnmembers.org/homepage

17. QUESTIONS??

18. Contact Information LeAnn Moskowitz, Program Manager Iowa Dept. Of Human Services Iowa Medicaid Enterprise, Policy Unit lmoskow@dhs.state.ia.us 515-256-4653