HCBS Waiver Redesign Adult Day and Employment Services. September 7, 2016 Stacy A. Collins Division of Policy and Strategic Direction

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1 HCBS Waiver Redesign Adult Day and Employment Services September 7, 2016 Stacy A. Collins Division of Policy and Strategic Direction 1

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3 Priorities Person- Centered Planning Community Membership Community Employment 3

4 Targets Stronger Connections Develop abilities Better Benefits Expand Natural Supports Individual Improved Health Increased Self-Esteem Enhanced Quality of Life 4

5 Strategic Plan EMPOWER STAKEHOLDERS ALIGN POLICIES ENHANCE SUPPORTS PROVIDER CAPACITY ENGAGE BUSINESSES MEASURE SUCCESS 5

6 Proposed Adult Day and Employment Services Target: November 2016 Non-Medical Transportation 5123: Adult Day Support 5123: Vocational Habilitation 5123: Individual Employment Supports 5123: Career Planning 5123: Group Employment Supports 5123: SSA: TCM Employment Navigation Training 6

7 Proposed- Individual Employment Supports 5123: New Rate Modifications: Behavior Support Medical Services maintain/stabilize community employment Replaces SE- Community and Integrated Employment Unit-based reimbursement 1:1 7

8 Proposed- Individual Employment Supports 5123: Divided in 6 sections (A) Purpose (B) Definitions (C) Provider Qualifications (D) Requirements for service delivery (E) Documentation of Services (F) Payment Standards 8

9 Proposed- Individual Employment Purpose Supports 5123: Define individual employment support Set forth provider qualifications, requirements for service delivery, documentation, and payment standards for service Outlines outcome of individual employment support 9

10 What is Individual Employment Support? Service that provides support for an individual to maintain competitive, integrated employment Individualized Can be provided in conjunction with other services Services are not limited to Monday-Friday during normal business hours 10

11 Activities included Individual Employment Support Job coaching Personal Care can be included but can not be the entire service Activities Training in assistive technology or other technology Workplace support 11

12 Job Coaching Utilizes task analysis and systematic instruction that assists individuals to maintain employment or career advancement Outlines a plan to fade the job coaching Plan is in place within thirty days of the start of the service Can be support provided to the individual or their coworkers on behalf of the individual Can be in person or remotely via technology 12

13 Proposed- Individual Employment Outcome Supports 5123: The expected outcome of individual employment support is competitive integrated employment in a job that is wellmatched to the individual s interests, strengths, priorities, and abilities and that meets the individual s personal and career goals 13

14 Provider Qualifications: Individual Employment Supports Agency Independent Complete and submit application At least one year of full-time (or part-time) equivalent, paid work related to employment planning and support that provides assistance for individuals to attain competitive integrated employment OR Thirty hours of formal training related to employment planning and support that provides assistance for individuals to attain competitive integrated employment 14

15 Provider Qualifications: Individual Employment Supports Independent Provider- Complete 8 hours of annual training to enhance competencies Agency Provider- Orientation requirements, mentor, 8 hours of annual training, written training plan **Ensure to read rule to follow all provider qualification requirements Under-Development.aspx ** 15

16 Requirements for Service Delivery: Individual Employment Supports Expected Outcome- competitive integrated employment in a job that is well-matched to the individual s interests, strengths, priorities, and abilities, and that meets the individual s personal and career goals. Based on person centered planning Shall take place in a non-residential setting separate from any individual s home, except to maintain self-employment 1 on 1 ratio Services can be provided on behalf of an individual 16

17 Requirements for Service Delivery: Individual Employment Supports Complete reports and collect data via the department s employment tracking system SSA maintain documentation that this service (individuals enrolled in a waiver) is not otherwise available through VR A provider will recognize changes in an individual s condition and behavior and report to the SSA and maintain written records A provide will report any potential safety and sanitation hazards at the worksite to employers having the responsibility to remedy the condition **Ensure to read rule for all service delivery requirements. ** 17

18 Documentation Requirements Visit the link below for all documentation requirements: s-under-development.aspx 18

19 Payment Standards Visit the link below for all payment standards: s-under-development.aspx 15 minute billing units: Individuals may qualify for behavior support or medical assistance rate modification 19

20 Proposed Rate Modifications Rate modifications apply to this service Behavior Support Rate Modification (.63) Medical Assistance Rate Modification (.12) See proposed rule at Under-Development.aspx for outlined criteria for behavior support and medical assistance rate modification 20

21 Proposed- Group Employment Supports 5123: New Rate Modifications: Behavior Support Medical Clear outcome statement and expected activities Replaces SE- Community and Integrated Employment Base rate of SEenclave, include rate modifications Must comply with HCBS Settings Rule 21

22 Proposed- Group Employment Supports 5123: Divided in 6 sections (A) Purpose (B) Definitions (C) Provider Qualifications (D) Requirements for service delivery (E) Documentation of Services (F) Payment Standards 22

23 Purpose Proposed- Group Employment Supports 5123: Define group employment support Set forth provider qualifications, requirements for service delivery, documentation, and payment standards for service Outlines outcome of group employment support 23

24 What is Group Employment Support? Service and trainings activities provided in regular business, industry, and community settings for groups of two or more workers with disabilities Individualized Can be provided in conjunction with other services Services are not limited to Monday-Friday during normal business hours 24

25 What is Group Employment Support? Provided in two distinct service arrangements: Dispersed enclaves in which individuals work in a unit within a company or community site or perform multiple jobs in a company but are not integrated with other employees Mobile work crews comprised solely of individual operating as distinct units working several locations within the communtiy 25

26 Activities included Group Employment Support Job coaching Training in independent planning, arranging and using transportation Work adjustment Activities Training and Systematic instruction Person-centered employment planning Job analysis 26

27 Proposed- Group Employment Outcome Supports 5123: The expected outcome of group employment support is paid employment and work experience leading to further career development and competitive integrated employment 27

28 Provider Qualifications Agency Complete and submit application Direct service staff requirements (see rule) Complete orientation program of at least 8 hours, no late than ninety days after hire Must include the expectation that the vocational habilitation service will eventually lead to competitive integrated employment First year of employment- assign a mentor (except someone with one year of experience providing group employment support at time of hire) 8 hours of yearly training Specific on-the-job training specific to each individual served Written training plan 28

29 Provider Qualifications: Group Employment Supports **Ensure to read rule to follow all provider qualification requirements s-under-development.aspx ** 29

30 Requirements for Service Delivery: Group Employment Supports Expected Outcome- paid employment and work experience leading to further career development and competitive integrated employment Based on person centered planning SSA maintain documentation that this service (individuals enrolled in a waiver) is not otherwise available through VR Shall take place an integrated setting and support access to the greater community and is not furnished in the home of the individual receiving services 30

31 Requirements for Service Delivery: Individual Employment Supports Individuals receiving group employment support will be compensated in accordance with applicable federal and state laws and regulations Ensure appropriate staff are knowledgeable about the Workforce Innovation and Opportunity Act Provided in a manner that presumes all participants are capable of working in competitive integrated employment. Providers will encourage participants to explore their interests strengths and abilities and assist individuals to advance toward competitive integrated employment 31

32 Requirements for Service Delivery: Individual Employment Supports Complete reports and collect data via the department s employment tracking system A provide will report any potential safety and sanitation hazards at the worksite to employers having the responsibility to remedy the condition A provider will recognize changes in an individual s condition and behavior and report to the SSA and maintain written records **Ensure to read rule for all service delivery requirements. Development.aspx ** 32

33 Documentation Requirements Visit the link below for all documentation requirements: s-under-development.aspx 33

34 Payment Standards Visit the link below for all payment standards: s-under-development.aspx 15 minute billing units: Individuals may qualify for behavior support or medical assistance rate modification 34

35 Proposed Rate Modifications Rate modifications apply to this service Behavior Support Rate Modification (.63) Medical Assistance Rate Modification (.12) See proposed rule at Under-Development.aspx for outlined criteria for behavior support and medical assistance rate modification 35

36 DODD Website- Rules under Development s-under-development.aspx 36

37 Proposed General Requirements 5123: AAI Budget Limitations Increase AAI budget limitation- 260 days of service CODB Category Group A Group A- 1 Group B Group C $10,270 $10,270 $18,460 $10,335 $10,335 $18,655 $10,465 $10,465 $18,850 $10,595 $10,595 $19,045 $10,660 $10,660 $19,240 $10,790 $10,790 $19,435 $10,920 $10,920 $19,630 $10,985 $10,985 $19,760 $30,745 $31,070 $31,395 $31,720 $32,045 $32,370 $32,630 $32,955 Apply to adult day, career planning, group employment supports, individual employment supports, and vocational habilitation Proposed increase to NMT budgets to account for 260 days 37

38 Impact PCW MSS/PAWS MBS IDS Data Warehouse EF Outcome Tracking System 38

39 Training on Services and Applications Materials Webinars Live Chats 39

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41 Webinars- Service Rules October 18 November 14 Visit for more information 41

42 Community Integration Trainings Community Integration Trainings that align with Adult Day Support and Vocational Habilitation Date September 27 October 3 October 4 October 5 October 13 Time 12:00p-2:00p 1:00p-3:00p 9:00a-11:00a 4:30p-6:30p 10:30a-12:30p Registration will be available on Loop Ohio, 42

43 Next Steps Waiver and Rule approval Internal Systems Modification Training and guidance 43

44 For general questions about the proposed rule changes, please or call (614)