2016 Changes to Supported Employment & Prevocational Services For Brain Injury, Intellectual Disability, Habilitation Waivers

Transcription

1 2016 Changes to Supported Employment & Prevocational Services For Brain Injury, Intellectual Disability, Habilitation Waivers

2 Agenda: Supported Employment/Prevocational Services Overview Supported Employment /Prevococational Changes Workflow of Supported Employment Prevocational Training Changes Career Exploration Changes Individual Supported Employment Small Group Employment Services Job Coaching/Long-Term Job Coaching Integrated Health Home Providers 2

3 Supported Employment (SE) Services Overview UnitedHealthcare Community Plan members who are eligible for Brain Injury (BI), Intellectual Disability (ID) and Habilitation waivers can benefit from Iowa s Supported Employment and Prevocational Services (Prevoc), which cover: Prevocational training Career exploration Small group services Integrated individual employment Long-term job coaching 3

4 Supported Employment & Prevoc Changes Supported Employment and Prevocational Services changes better align with the Iowa Department of Vocational Rehabilitation (IVRS), Iowa Workforce Development, and the Home- and Community-Based waiver. Updates include: Developing consistent rates between services and waivers Increasing participation of Integrated Individual Employment providers through enhanced supports Promoting increased flexibility for contracted employment providers who assist members in finding employment with participating companies Covering activities to obtain a job under both individual and group employment supports 4

5 Supported Employment & Prevoc Changes Changes to Supported Employment Services are retroactive for dates of service starting May 4, Updated payments and rates include: Employment providers paid by the tier or by the hour New and added fee-for-service rate adjustments Coverage under both individual and group employment supports for activities done to obtain a job When billing for Supported Employment and Prevocational Services provided from April 1 to September 1, 2016, please reference the billing chart at UHCCommunityPlan.com > For Healthcare Professionals > IA > Bulletins > Changes to Supported Employment & Prevocational Services. 5

6 Prevocational Services 6

7 Prevocational Services There are two types of prevocational services activities task-oriented and classroom. The employment provider manages the services and the funds. Prevocational Services can: Be renewed/reauthorized when career exploration is authorized. Be renewed/reauthorized again if waiting for IVRS or when another support is authorized. Billing Information To bill for these services, please: Use HCPC code T2015. Include the number of hours needed in a 31-day month. Use an hourly rate of $

8 Prevocational Services Conversion Example Member is currently authorized for 20 daily units per month, and participates an average of six hours each day. The changes would convert this to T2015 for 120 hourly units per month. 8

9 Career Exploration 9

10 Career Exploration Career Exploration is a new, separate service managed by the prevocational service provider. Billing Information To bill for this service, please include the hours needed over three months to help with possible career choices and use: HCPC code T2015 Modifier U3 Maximum of 34 hours or three months, whichever comes first Hourly rate of $

11 Career Exploration Certified Job Coach Service Hour Guidelines Job coaching services can take place over 12 weeks, or 90 days, with three hours of face time per week. These estimates are a guideline for visits. Hour(s) Purpose 1 Initial meeting with member and family 2.5 Orientation for member and family about Supported Employment (SE), IVRS and basic benefits of these services 8 Discovery phase of job planning to coach the member on next steps 16 Three to five tours at prospective employer, informational interviews and job shadowing 2.5 Re-education or additional education for member on SE 4 Career plan report for the member 11

12 Supported Employment: Individual Supported Employment 12

13 Individual Supported Employment Individual Employment Supports assists members with disabilities to obtain and maintain employment. Individual Employment Supports now includes job development, employer development and enhanced job search activities. These tasks can now be billed separately. Supported Employment providers are paid at an hourly rate for each service. Job Development Employer Development Individual Supported Employment Enhanced Job Search 13

14 Individual Supported Employment Billing Information To bill, please: Use HCPC code T2018 UC. Include the number of hours needed in a 31-day month. Use an hourly rate of $66.13 Maximums 40 units/initial authorization 20 units/extended authorization $3, per month for ALL supported employment services 14

15 Individual Supported Employment Billing Activities* Career exploration tours, informational interviews, job shadowing, job seeking skills Employment or assistive technology assessment Person-centered employment planning Initial on-the-job training to stabilization activity Development of visual/traditional resumes Outreach to prospective employers on behalf of the member job development, negotiation with prospective employers, employer needs analysis Financial literacy and asset development Transportation of the member during service hours New Billing Activities: Career advancement services Reemployment services no longer a one year wait Other employment support services that can help our member receive Iowa Medicaid Enterprise-approved employment *This is not an all-inclusive list of billable activities 15

16 Supported Employment: Small Group 16

17 Small Group Employment Services Small Group Employment Supports include training and support in business or industry settings for groups of two to eight workers with disabilities. There are three tiers of services and payments, which are determined by your case manager. There s a $3, monthly maximum for ALL supported employment services. Tier 1: Groups of 2 4 members HCPC code H2023 Modifier U3 $2.84 per member; 15-minute unit Tier 2: Groups of 5 6 member HCPC code H2023 Modifier U5 $1.77 per member; 15-minute unit Tier 3: Groups of 7 8 members HCPC code H2023 Modifiers U7 $1.26 per member; 15-minute unit 17

18 Small Group Employment Services Billing Information Conversion Example Member is working in a small group with five other individuals for 12 hours per week, or 48 hours per month. Use HCPC code H2023 U5 for 192, 15-minute units per month. Please note: Member s tier remains the same day-to-day, regardless of whether one member of the work crew is off on a particular day. Other Important Information: Services can include parts of Career Exploration/Benefits Education Size of work crew must be evaluated during interdisciplinary team meetings with the employment provider to determine if tier level is appropriate or if adjustments should be made. 18

19 Supported Employment: Long-Term Job Coaching 19

20 Long-Term Job Coaching Long-Term Job Coaching supports our members with maintaining a job in the general workforce. It s considered the final stage of the Supported Employment program. Long-Term Job Coaching provides interaction with a job coach by phone or in person, and encourages less help as time goes on. 20

21 Long-Term Job Coaching Today, there are five tiers of payments based on the number of hours of job coaching provided to our members. All rates have increased. Services must be reauthorized every 90 days. There s a $3, monthly maximum for ALL supported employment services. The tiers, HCPC codes and rates are based on the hours in a month the job coach spends with the member. Tier 1: HCPC code H2025 Modifier U4 $67.67* per unit; 1 contact (hour) per month Tier 2: HCPC code H2025 Modifier U3 $361.58* per unit; 2-8 hours per month Tier 3: HCPC code H2025 Modifier U5 $722.15* per unit; 9-16 hours per month 21

22 Long-Term Job Coaching Long-term job coaching tiers continued. Tier 4: HCPC code H2025 Modifier U7 $1,129.18* per unit; hours per month Tier 5: HCPC code H2025 Modifier UC $45.16 paid per hour; 26+ hours per month * Only one unit for tiers 1-4 is authorized for payment. 22

23 Long-Term Job Coaching Billing Information Conversion Example, Tiers 1 4 Member is working four hours per week and receives five hours of support including transportation to and from work. The change in payment converts the hours to one unit of Tier 2 using HCPC code H2025 U3. Conversion Example, Tier 5 Member is working 12 hours per week and receiving 14 hours of job coaching support each week for 56 hours per month, including transportation to and from work. The change in payment converts the hours to 56 units each month of Tier 5 using HCPC code H2025 UC. 23

24 Integrated Health Home Providers 24

25 Integrated Health Home Providers Integrated Health Home providers who assist members with Supported Employment and Prevocational Services should take the following steps: Contact the Supported Employment/Prevocational provider, record all of member conversion information and update it in on our member s service plan. Forward the updated service plan to Optum Behavioral Health: Fax: uhc_iowa_healthhomes@uhc.com 25

26 Contact Information If you need to reach a case manager, please contact Provider Services at

27 Questions & Thank you. 27