New Outcome based Payment System Maine Department of Labor Bureau of Rehabilitation Services Division of Vocational Rehabilitation May 2013

Background Coming Together with Rehabilitation Providers (CRP) project initiated in October 2011. Billing – Funding model, rates and fees was one area of focus Strong recommendation from work group to change CRP payment model to outcome based system. Reduce administrative steps Save time and effort for both CRP’s and VR staff Focus on employment outcomes Significant research and analysis Statewide input from VR staff and CRPs

What is an Outcome Based System? Also known as Results Based Funding Method of reimbursement for job placement services Not based on hours of service delivered Payments occur at specific employment milestones

What is the roll out plan? Implementation during SFY 2014 Phased in by regions (Augusta is first!) Statewide Presentation – May 28, 2013 Local Work Sessions Augusta – June 13 at 1 p.m.

New DVR CRP Payment System CRP Services and Fees Employment Placement Job Development (Outcome Milestone Payments) Job Coaching (Hourly Rate) Stand Alone Single Service Billed at hourly rate Only if not part of Employment Placement Examples – Trial Work Experience; Situational Assessment; Resume Writing

Job Development Services Tiered Payment System based upon significance of disability Four milestones for payment Bonus payment for higher earning levels Additional subsidy for CRPs contracted to serve remote areas Additional subsidy for CRPs contracted to serve populations requiring specific certification/competency

What are the Tiers? Tier I (Most Significantly Disabled) Determined by the VR Counselor to be in Order of Selection Priority Category #1 using existing rules/tool. Individuals who have a serious limitation in terms of an employment outcome in four or more functional capacity areas whose vocational rehabilitation can be expected to require multiple vocational rehabilitation services whose vocational rehabilitation can be expected to require an extended period of time

What are the Tiers? Tier II (Significantly Disabled or Disabled) Determined by the VR Counselor to be in Order of Selection Priority Category # 2 or Category # 3 using existing rules/tool Individuals who have a serious limitation in terms of an employment outcome in at least one functional capacity area whose vocational rehabilitation can be expected to require vocational rehabilitation services whose vocational rehabilitation may or may not be expected to require an extended period of time

Milestone Payments Milestone Tier I Tier II 1. Plan for Employment Services Written $ 900 $ 500 2. Placed in Employment - Completes 1 day 3. Maintains Employment – Completes 45 days $ 1,000 $ 500 4. Retains Employment – Eligible for VR closure $ 1,200 TOTAL $ 4,000 $ 2,500

Additional Fees $ 1,000 Bonus payment after Milestone 4 for SSI/SSDI beneficiaries employed at SGA earnings level. As part of CRP contract, select agencies will be provided an additional 15 percent for travel to serve individuals remote areas. As part of CRP contract, select agencies will be provided an additional 15 percent to serve populations requiring specific certification or competency, such as American Sign Language

An Anticipated Scenario What will happen with individuals who are already receiving job placement services when milestone payments go into effect? Funding will be transitioned immediately to the milestone system with consideration of the length of time that they have been receiving placement services: - In job development 0 to 3 months, issue confirming authorization to bring funding equal to Milestone 1. - In job development 3 to 6 months, review progress and if job development continues, issue authorization for Milestone 2. - In job development over 6 months, job development ceases until an updated comprehensive assessment of rehabilitation needs is completed. If it is determined that the client can benefit from renewed placement services, choices for CRP services should be offered and upon selection, the CRP will be eligible for Milestone 1.

Another Scenario What will happen with clients who are not placed after significant CRP time and effort? Even though there are no required written monthly reports, the CRP, VRC and client should be regularly communicating throughout the placement process. Other approaches, such as an O-J-T or vocational goal change, should be explored. In some instances, CRP job development services will end and the client will work with the VRC to determine next steps. Although the CRP will have received only Milestone 1, the rates set in this type of payment system take into consideration successful and unsuccessful placement efforts.

A Common Question Is there a minimum number of work hours per week? There is no minimum number of work hours required for milestone payments. However, the number of work hours must be consistent with what is identified in the IPE and the CRP employment search plan.

Important Things of Note Fee schedule provides incentive to serve individuals with the most significant disabilities. Referrals for Job Placement must be for individuals who have a defined vocational goal. Milestone payments can only be made for employment placements in the job goal identified on the Individualized Plan for Employment (IPE). Client responsibility and active engagement in the job search process is critical.

Supporting Documents CRP Description of Fees Contract Agreement CRP Referral Form CRP Payment Reporting Templates Common Scenarios Website: http://www.maine.gov/rehab/crp/index

Questions and Next Steps? Session on June 13 with Augusta - Rockland VR and CRP staff to work out the final details of implementation. Target date is July 1 in Augusta. Followed by August 1 in Rockland. Other regions stay tuned! Information will be shared through the BRS website and regional meetings. Questions?

Thanks to these Contributors! CRP Project Managers: Valerie Oswald and Elinor Weissman Billing Team Members: David Dwyer, Sally Sweeney, Robin Thayer, and Debbie Berry Josh Howe, Kevin Owen, Beth Lehning and Karen Fraser Steering Team Members: Debra Henderlong (Allies), Gayla Dwyer (Aroostook Mental Health Center), Laura Bolduc (B.E.S.T.), Diane Frigon (DBVI), Shannon Hartmann (Creative Works), Abigail Miller (Easter Seals ME), Bethany Campbell (Goodwill), Sally Sweeney (KFI), Deb Myers (KEWL ASL), Beth Lehning (VR – Augusta), Esther Ireland (VR-Bangor), Kevin Owen (VR – Lewiston), Robert Kennelly (Pathways), Gary McPherson (Progress Center), Wendy Warren (VR – Augusta), David Dwyer (WOU), Auta Main (MDOL-BES), Rachel Merriam (VR- Augusta), Terry Morrell (BRS-DDHHLD), Libby Stone-Sterling (BRS – CO), and Allison Bubier (VR-Augusta)