Provider Service Expectations Supported Employment SPC 615 Provider Subcontract Agreement Appendix N

Transcription

1 Provider Service Expectations Supported Employment SPC 615 Provider Subcontract Agreement Appendix N Purpose: The provision of subcontracted, authorized and provided Prevocational Service shall be in compliance with the provisions of the Provider Subcontract Agreement and the service description and requirements of this section. 1.0 Service Definition WWC follows the definitions and guidelines as defined for Supported Employment in the DHS Family Care contract and the Medicaid Waivers manual, SPC 615. Supported employment individual employment support services are the ongoing supports provided to members who, because of their disabilities, need intensive ongoing support to obtain and maintain an individual job in competitive, customized or self-employment in an integrated work setting in the general workforce. A member receiving this service shall be compensated at or above the minimum wage, but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities. The outcome of this service is sustained paid employment at or above minimum wage in an integrated setting in the general workforce, in a job that meets personal and career goals. Payment for individual employment support services may be based on different methods including, but not limited to, co-worker support models, payments for work milestones, such as length of time on the job, or number of hours the member works. Supported employment - small group employment support services are services and training activities provided in a regular business, industry or community setting for groups of two (2) to eight (8) workers with disabilities. Examples include mobile crews and other business-based workgroups employing small groups of workers with disabilities in employment in the community. Small group employment support must be provided in a manner that promotes integration into the workplace and integration between members and people without disabilities in those workplaces. The outcome of this service is sustained paid employment and work experiences leading to further career development and individual integrated community-based employment for which a member is compensated at or above the minimum wage, but not less than the customary wage level of benefits paid by the employer for the same or similar work performed by individuals without disabilities. 2.0 Standards of Service Medicaid Waivers- Providers must follow Medicaid Waiver Standard for Supported Employment Services. 2.1 These Provider Service Expectations have been written to reflect the Waiver Standards. An asterisk* reflects reference to a Waiver Standard throughout the document. Service must be provided in a manner which honors member s rights such as consideration for member 2.2 preferences (scheduling, choice of provider, direction of work), and consideration for common courtesies such as timeliness and reliability. WWC subcontracted providers of long-term care services are prohibited from influencing members choice of long-term care program, provider, or Managed Care Organization (MCO) through communications that are misleading, threatening or coercive. WWC and/or the WI Department of Health Services may impose sanctions 2.3 against a provider that does so. Per Wisconsin Department of Health Services (DHS), any incidents of providers influencing member choice in a Family Care program must be reported to DHS immediately. 3.0 Service Description Individual employment support services may be provided by a co-worker or other job site personnel provided

2 * 3.3* 3.4* that the services are not part of the normal duties of the co-worker, supervisor or other personnel and these individuals meet the qualifications established below for individual providers of this service. Employers may be reimbursed for supported employment services provided by co-workers. Individual and Small Group employment support services may include any combination of the following activities: vocational/job-related discovery or assessment, person-centered employment planning, job placement, job development, meeting with prospective employers, job analysis, training and systematic instruction, job coaching, work incentive benefits analysis and counseling, training and work planning, transportation and career advancement services. Also included are other workplace support services not specifically related to job skill training that enable the member to be successful in integrating into the job setting. Additionally, individual employment support services are individualized and also include job supports. Both individual and small group supported employment services do not include vocational services provided in facility-based work settings or other types of vocational services furnished in specialized facilities that are not part of general community work places. Supported employment services may not include volunteer work. Members receiving individual or small group employment support may also receive educational, prevocational, and/or day services. However, different types of non-residential services may not be billed for the same period of time. Additionally, members receiving small group employment support may also receive career planning services. Workplace Personal Assistant The Workplace Personal Assistant (WPA) can provide assistance to a member in the member s employment setting in two ways: 1) The WPA may provide any personal care needs as directed on the Individual Service Plan (IPE), or 2) The WPA may be responsible for assisting individuals with disabilities in completing tasks, providing follow-along supports and promoting independence in their employment site. The specific services required will be individualized based on the person s personal care and long term support needs. Individuals receiving these services may have disabilities such that job coach fading to natural supports does not prove fully feasible and the individual is deemed to require on-site supports for a substantial portion of their work day. Overall Philosophy and Approach 1. This is the workplace of your consumer of services. Thus all questions and actions must be directed to the consumer whenever possible. 2. The individuals at the workplace are the coworkers of your consumer and not your own coworkers. Thus the relationship is quite unique in that they certainly may become acquaintances but they are not meant to be your primary contact at the workplace. The consumer is your customer. 3. You must blend into the workplace both in your overall communication style and dress. Every workplace has its own culture and determining how to the individual fits into that work culture is part of your role. Specific examples will be provided regarding this issue. 4. Respectful interactions with the individual that are age appropriate and blend into the workplace are important in your overall support at the workplace. Self-directed support is the approach with every member. Individuals with physical or cognitive disabilities will be part of the Individualized Plan. Components of services 1. Assessment and plan development The assessment is an evaluation of a member s functional abilities in a variety of settings. The provider must involve the member and as appropriate, the member s family and advocates. The assessment shall document the preferences, values and needs of the member. The assessment occurs in environments both familiar and unfamiliar to the member. The provider may use a current employment setting, or a work center setting up to 20% to complete the assessment. It is recommended the work center environment is not used during the assessment. The provider has 60 days to complete the assessment. This time frame may be extended on a case by case basis, based on the needs of the member, and provider must ask the Interdisciplinary Team (IDT)

3 * 3.10* prior to the 60 day due date for this extension. An automatic extension cannot be assumed. After the assessment is completed, the member, WWC team, and provider must meet to discuss findings of assessment. 2. Job development The job must be in accordance with the Employment Plan developed by member, WWC team, and provider. If a job is not found within three months for members receiving Supported Employment services, the WWC team and member should be contacted by the provider, the issues addressed, and the plan modified, if appropriate. 3. Job coaching This service may include any of the following activities: specific job skill teaching provided either on or off the job site, ensuring the availability of work related services such as transportation, providing assistive technology resources and other disability related accommodations and teaching the member about workrelated behavior and other employment standards. The cost of transportation for a member to get to and from a supported employment site may be included in the reimbursement paid to the supported employment provider, or may reimbursed under specialized (community) transportation, but not both. Personal care may be a component part of supported employment, but may not comprise the entire service. Personal care/assistance provided to a member during supported employment services may be included in the reimbursement paid to the supported employment provider, or may be reimbursed under the waiver service supportive home care or self-directed personal care. All providers of personal care/assistance shall meet the supportive home care provider qualifications. When personal care/assistance is a component of this service, payment may not be made for such assistance under another waiver service for the same period of time. Individual employment supports may include support to maintain self-employment, including home-based self-employment. Individual employment supports may also include services and supports that assist the member in achieving self-employment; however, Medicaid funds may not be used to defray the expenses associated with starting or operating a business. Assistance for self-employment may include: (a) aid to the member in identifying potential business opportunities; (b) assistance in the development of a business plan, including identifying potential sources of business financing and other assistance in developing and launching a business; (c) identification of the supports that are necessary in order for the member to operate the business; and (d) ongoing assistance, counseling and guidance once the business has been launched. For individual employment support services, coverage does not include incentive payments, subsidies or unrelated vocational training expenses such as the following: i. Incentive payment made to an employer to encourage or subsidize the employer's participation in supported employment; or ii. Wages or other payments that are passed through to users of supported employment services. Small group employment support does not include payment for supervision, training, support and adaptations typically available to other non-disabled workers filling similar positions in the business. Small group employment support services may be provided by a co-worker or other job site personnel provided that the 3.11* services that are furnished are not part of the normal duties of the co-worker or other personnel and these individuals meet the qualifications established below for individual providers of service. Employers may be reimbursed for supported employment services provided by co-workers. Fading the job coach is a best practice in Supported Employment; fading helps ensure that member is achieving optimum self-sufficiency and that Supported Employment is cost-effective over time. Where best practice Supported Employment is implemented, including a good job match and effective job coaching, 3.12 significant fading should be occurring. When job coaching has been faded to just a few hours a month, this is stabilization monitoring. At this point, the purpose of the job coaching is to ensure on-going stability and to prevent job loss Before authorizing supported employment services, documentation shall be maintained that the service has

4 already been utilized or is not available under a program funded under the section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act (IDEA) (20 U.S.C.1401 et seq). Supported employment services may be provided to supplement, but may not duplicate prevocational services or vocational futures planning services provided under the waiver. 4.0 Units of Service and Reimbursement Guidelines Supported Employment Assessment SPC 615 Procedure Code T2018, UN, U7 Payment for the assessment will be upon delivery of a written report, participation in an assessment staffing, 4.1 and development of a Member Job Development Plan. Rates for a job assessment will be set by Western Wisconsin Cares, and they will correspond to the rates set by DVR, although they will not necessarily match exactly. Supported Employment Job Development 4.2 SPC 615, Procedure Code T2018, UN, U7 Payable upon actual job hire and completion of two weeks of work. Supported Employment Job Coaching Billable per authorized quarter hour of service. Rates will be established for individuals or for a group setting. Job coaching funds may not be used to offset members wages. 1. Supported Employment Job Coaching- delivered to 1-2 members in an integrated setting SPC 615, Procedure Code T2019, UN A higher reimbursement rate will be considered for those members who are working in an individual integrated employment opportunity at minimum or prevailing wage in business or industry at an occupation of the member s choice hired directly by the employer. In this type of coaching, the member s employer of record is the business in which they are working. WWC will pay a lower reimbursement for those who are working in the community making subminimum wage and where the employer of record is the contracted supporting agency. 2. Supported Self Employment Job Coaching: Microenterprise/Supported Self Employment SPC 615, Procedure Code T2018, UN, U7 This type of job coaching is delivered to members who are working in a self-employment business, and includes the development of the business, along with ongoing support. Payable per the Supported Self Employment Payment Grid in collaboration with Division of Vocational Rehabilitation (DVR). Western Wisconsin Cares may authorize SE Job Development for 4.3 this service. 3. Supported Employment Job Coaching: to a group of 3-8 members who are working in the community making at least minimum wage SPC 615, Procedure Code T2019, UP This type of job coaching is delivered, but where the employer of record is the contracted supporting agency. Wage reporting is an expectation when providing this type of job coaching. This type of services should be viewed as transitional as the member moves to a more integrated setting. It is WWC s goal to see members are offered the opportunity to work in fully integrated, individualized employment that maximizes earning potential and opportunities for full inclusion, including employment by the community business in which they work. This service should not be long term in nature. 4. Supported Employment Job Coaching: delivered to a group of 3-8 members who are working in a community-based setting, earning below minimum wage (sub-minimum) SPC 615, Procedure Code T2019, UP, U9 Based on a time study/wage study. The employer of record in this type of job coaching is the contracted supporting agency. Wage reporting is an expectation when providing this type of job coaching. This type of services should be viewed as transitional as the member moves to a more integrated setting. It is WWC s

5 goal to see members are offered the opportunity to work in fully integrated, individualized employment that maximizes earning potential and opportunities for full inclusion, including employment by the community business in which they work. This service should not be long term in nature. 5. Supported Employment Job Coaching SPC 615, Procedure Code T2019, UN, U5 This type of job coaching is delivered through Self-Directed Supports (SDS). Customized Supported Employment (SPC s and Procedure Code correspond with above service): If Western Wisconsin Cares determines a member will benefit from the Customized Employment process, 4.4 WWC will authorize the provider to use the processes and documentation taught by Mark Gold and Associates. Fee Structure similar to Job Assessment and Supported Employment Job Development. 5.0 Staff Qualifications and Training Caregiver Background Checks- Providers will comply with all applicable standards and/or regulations related 5.1 to caregiver background checks as well as comply with the WWC Provider Policy on Caregiver Background Checks. There shall be a direct service staff person or persons who shall possess skills and knowledge that typically would be acquired through A course of study that would lead to a bachelor s degree on one of the human services, or A minimum of two years experience in the work to be supervised. 5.2 Members that wish to use a self-directed approach for employment will have member specific expectations and qualifications. Staff or consultants knowledgeable in adapting or modifying equipment, and the application of special equipment for persons with disabilities shall be available as needed* Individuals that provide employment services should possess skills and abilities in the areas of assessment, job development, job placement, job retention, evaluation, systematic instruction, job creation, customization or any combination of these. At a minimum, individual training should include these areas: safety 5.3 confidentiality respectful treatment knowledge of members provider performance measures abuse and neglect policy documentation and reporting requirements 6.0 Supervision and Staff Adequacy The provider agency shall maintain adequate staffing to meet the needs of members referred by WWC and 6.1 accepted by the agency for service. Provider agency will ensure: Staff are supervised and assessed to assure they are working effectively and collaboratively with members by conducting adequate on-site supervision and review. Performance issues with staff are addressed promptly, WWC teams are kept informed about 6.2 significant issues that affect the WWC member. Supervisory staff are involved in assessment, goal planning and tracking, and supervision for WWC members. Provider staff are working collaboratively and communicating effectively with WWC staff 7.0 Service Referral and Authorization The WWC team will provide a written service referral form to the provider agency that specifies the expected 7.1 outcomes, amount, frequency and duration of services. The provider agency will notify the WWC team within 2 business days of receiving a referral regarding the 7.2 ability to accept the member for services. If the referral is accepted, notification should also include the anticipated start date or any delays in staffing by the requested start date.

6 The provider agency must continue to report status of an open referral on a weekly basis to the WWC team until the referral is filled. The WWC team will issue a new written referral form when the tasks assigned, amount, frequency or duration 7.3 of the service changes. 7.4 The provider agency will retain copies of the WWC referral forms in the agency file as proof of authorization. Authorizations for Member Services Current and active authorizations are obtained by accessing the WWC Provider Portal. Providers must sign up with WWC to access the portal. The provider agency is responsible for ensuring only currently employed and authorized staff have access to 7.5 the WWC provider portal and using the member authorization information available on the portal to bill for services accurately. Questions on active authorizations should be directed to the WWC team. For authorization of services or products after WWC business hours, providers contact the After-Hours Authorization Line at (877) Communication, Documentation and Reporting Requirements WWC communicates with providers regularly in the following formats: Vendor forums Mass notifications via , fax, or mail Notices for expiring credentialing 8.1 Notices are sent to providers via when the provider has available to ensure timeliness of communication. Provider agencies are required to ensure WWC Provider Network, WWC teams, guardians and other identified members of the interdisciplinary team for a member have accurate and current provider contact information to include address, phone numbers, fax numbers, and addresses. The provider agency shall report to the WWC team whenever: 1. There is a change in service provider There is a change in the member s needs or abilities 3. The member is not available for scheduled services Member Incidents Provider agencies shall report all member incidents to the WWC team. Providers must promptly communicate with the WWC team regarding any incidents, situations or conditions that have endangered or, if not addressed, may endanger the health and safety of the member. 8.3 Acceptable means of communicating member incidents to the WWC team would be via phone, fax or within 24 hours. Additional documentation of incidents may be requested by the WWC team or WWC Quality Assurance Providers and WWC will comply with the WWC Incident Reporting Policy which is available on the WWC website at: > Providers > Provider Policy & Procedure. The provider agency shall give at least 30 days advance notice to the WWC team when it s unable to provide authorized services to an individual member. The provider agency shall be responsible to provide authorized services during this time period. The WWC team or designated staff person will notify the provider agency when services are to be discontinued. The WWC team will make every effort to notify the provider at least 30 days in advance. Behavior Support Plans The agency must develop and implement a positive, written behavioral support plan to assistant a participant that displays challenging needs or behaviors. Member Progress Reports Providers of supported employment services shall follow the WWC Provider Reporting Policy. The Supported Employment agency shall complete a written report that details the member s progress toward each of the outcomes outlined in the individual plan developed by the provider and, if indicated, recommendations for changes. This report shall be provided to the WWC team via submission instructions below. The WWC team may use these provider reports to evaluate the need for continuation or modification of

7 supported employment services. Submission Timeframes: Providers shall submit progress reports to WWC quarterly for the first full year of service (12 months). Thereafter, member progress reports shall be submitted as needed/requested by the WWC Team. Submission Instructions: Provider must use the WWC form provided titled; Supported Employment Progress Report. Providers may access the reporting forms at Providers are required to electronically submit progress reports via to or by faxing to Wage Reporting Supported employment providers are required to report monthly wages of Western Wisconsin Cares members receiving income to the local Social Security Office and the local county Economic Support office if the WWC member is on the payroll of the supported employment provider. See contact guide for local SSA/ES offices. Supported Employment Plan/Assessment Requirements This Employment Plan is required to include: Assessment Direct job placement Supported/customized employment, or self-employment Employment outcome (short and long term) Type of work the member is interested in Description how and to what degree the member will control their supports Physical or other limitations Number of days, hours, time of day the member prefers to work per week Description of member s strength and skills as well as barriers to employment Past work history Economic status and the impact of cash benefits and health insurance Transportation needs (walk, city bus, specialized transportation) Anticipated level of support needed both funded and non-funded supports Plan in developing natural supports and fading paid supports Description of the job coaching/training needs to be provided in conjunction with the supported employment services Identification of the providers and individuals that will provide each service Nature and intensity of services recommended. WWC requires that at least 80% of assessment must be completed in the community. Assessment must include documentation of WWC team s agreement with plan. Job Development Reporting Monthly documentation will include a description of strategies for member to be employed, methods, assets, and barriers. A listing of employer contacts including type of contact, date, and action related to contact will be included. Reporting is due by the 15 th of the following month for the month of service. WWC expects that the job found will offer minimum or commensurate wage, integration with non-disabled workers, employer of record is the business the member is working at, not the supporting agency. Exceptions may be made on a case by case basis. Approval of any exceptions must be obtained before job is offered to member. If not, WWC will not fund the unit of service. Job Coaching Reporting Provider s monthly documentation should include but not be limited to the following: Current rate of pay/commensurate rate of pay, Number of job coaching hours authorized per week, Employment related Issues/barriers, Role of job coach,

8 Assistive technology available if applicable, Member s job performance level and satisfaction of employer with the members job performance, Member s natural supports present, Description of efforts to develop greater natural supports and decrease paid supports, Anticipated date to fade paid job coaching supports. The monthly job coaching reports will be made available to the WWC team or other authorized WWC personnel for review upon request. Required Reporting for Member Receiving DVR Services It is expected that when a WWC member is receiving employment services through Division of Vocational 8.11 Rehabilitation (DVR), the supported employment provider submit copies of all documentation through report submission process as described in section 8.6. This is due to the WWC team by 15 th of the following month. State Reporting: Employment Outcome Data Collection and Reporting Measuring and evaluating outcomes associated with the purchase of employment services is an essential aspect of ensuring quality and cost-effectiveness. To this end, Employment Service Providers shall report employment outcome data in the Department of Health Services Program Participation System (PPS) in May and November of each year for pre-populated lists of members served. The pre-populated list of members, for whom employment outcome data must be reported, is visible upon login to the PPS system and navigation 8.12 to the Employment Outcomes page. The pre-populated list is updated prior to each data entry period. Data reported will be for the month prior to the reporting month: April data will be reported in May October data will be reported in November Employment service providers shall ensure that staff who are identified to do data entry take the steps necessary to gain security access to the PPS system and complete training on using the PPS system to report employment outcome data. The provider agency must maintain the following documentation; and make available for review by WWC upon request. Provider meets the required standards for applicable staff qualification, training and programming Verification of criminal, caregiver and licensing background checks as required. Policy and procedure related to supervision methods by the provider agency including frequency, 8.13 intensity and any changes in supervision. Policy and procedure for responding to complaints, inappropriate practices or matters qualifying as member-related incidents. The policy and procedure should also cover expectation of work rules work ethics and reporting variances to the program supervisor. Employee time sheets/visit records which support billing to the WWC. 9.0 Quality Assurance Purpose 9.1 WWC quality assurance activities are a systematic, departmental approach to ensuring and recognizing a specified standard or level of care expected of subcontracted providers. These methodologies are established to review and inspect subcontracted provider performance and compliance. WWC will measure a spectrum of outcomes against set standards to elicit the best picture of provider quality. WWC provider quality assurance practices: 1. establish the definition of quality services; 2. assess and document performance against these standards; and 3. detail corrective measures to be taken if problems are detected It is the responsibility of providers and provider agencies to maintain the regulatory and contractual standards as outlined in this section. WWC will monitor compliance with these standards to ensure the services purchased are of the highest quality. Resulting action may include recognition of performance at or above acceptable standards, working with the provider to repair and correct performance if it is below an acceptable standard, or action up to termination

9 of services and/or contract should there be failure to achieve acceptable standards and compliance with contract expectations. Quality Performance Indicators Legal/Regulatory Compliance- evidenced by regulatory review with no deficiencies, type of deficiency and/or effective and timely response to Statement of Deficiency Education/Training of staff- Effective training of staff members in all aspects of their job, including handling emergency situations. Established procedures for appraising staff performance and for effectively modifying poor performance where it exists. Performance record of contracted activitieso tracking of number, frequency, and outcomes of assigned WWC Quality Teams related to provider performance o tracking of successful service provision (member achieving goals/outcomes, increased member independence and community participation, etc) Contract Compliance- formal or informal review and identification of compliance with WWC contract terms, provider service expectation terms, applicable policies/procedures for WWC contracted providers Availability and Responsiveness- related to referrals or updates to services, reporting and communication activities with WWC WWC Sources and Activities for Measuring Provider Performance Member satisfaction surveys Internal or external complaints and compliments Onsite review/audits Statement of Deficiency (SOD)- state regulated entities Quality Teams- as assigned based on significant incidents, trend in quality concerns or memberrelated incidents, or issued Statement of Deficiency. Tracking of performance and compliance in relation to the subcontract agreement and appendices Statistical reviews of time between referral and service commencement Expectations of Providers and WWC for Quality Assurance Activities Collaboration: working in a goal oriented, professional, and team based approach with WWC representatives to identify core issues to quality concerns, strategies to improve, and implementing those strategies Responsiveness: actions taken upon request and in a timely manner to resolve and improve identified issues. This may include submitted documents to WWC, responding to calls, s, or other inquiries, keeping WWC designated staff informed of progress, barriers, and milestones achieved during quality improvement activities Systems perspective to improvement: approaching a quality concern, trend, or significant incident with the purpose of creating overall improvements that will not only resolve the issue at hand, but improve service and operations as a whole Member-centered solutions to issues: relentlessly striving to implement solutions with the focus on keeping services member-centered and achieving the goals and outcomes identified for persons served WWC is committed to interfacing with providers to collaboratively and proactively discuss issues identified with processes and assist with implementing improvements and reviewing the impact of the changes as a partner in the mission to serve members. PSE #: Date Issued January 1, 2012 DT Approval Date: Document Owner K Lubinski State Approval Date: N/A Contract Reference Subcontract Appendix N Next Review Date: 8/1/2016

10 Revision History: Revision # Date Description of Changes/Reason Requested By 0 11/6/09 Initial Formatting A. Bell 1 12/15/09 Final Revision, addition of waiver standard A. Bell 2 12/15/09 Corrections monthly from quarterly, daily living skills to S.E. Schmidt, Colvin 3 11/10 Review and Updates A. Bell 4 12/13/10 Updated Section 7.0 for Report submission requirements and updated Issue date to and review date to N Schmidt 5 10/13/11 Addition of 7.10 for State required Employment Outcome Data Collection and Reporting M Blaschke 6 1/25/12 Section made the changes to update/correct the SPC and procedure codes to the new State requirements. Removed the previous 4.4 (now appears within 4.3 as Microenterprise) and M Blaschke renumbered the remainder of section /18/12 Reviewed for inclusion with 2013 contract added 4.5 to add description for Workplace Personal Assistance, request Mary Kay Blaschke review in its entirety for accuracy and addition of Workplace Assistance if needed, reviewed and updates made to 4.1, 4.3, 4.5, and /20/13 Reviewed for inclusion with 2014 subcontract agreement, deleted 6.1(duplication), minor revision to 7.6 and /5/14 Updated service definitions in sections 1.0 and 3.0 per DHS contract language; added 3.4; Revision to 8.5 to update reporting process 10 10/15/15 Re-formatted to standard layout, standardized language used, updated to reflect new provider policies and contract language N. Schmidt, M Blaschke K. Lubinski K Lubinski S. Strittmater When Staff Instructed