Individual Supported Employment (ISE) New Planning and Payment Structure

1. Individual Supported Employment (ISE) New Planning and Payment Structure

2. Commissioner’s/Deputy Commissioner’s Remarks • Terrence W. Macy, PhD • Joseph Drexler, Esq.

3. Today’s Agenda: • Our Objectives for Today • Employment First Initiative • Background of ISE Work Group • The Career Plan/Guide • Payment Structure • Wrap Up/Q&A

4. Today’s Objectives: • To provide an overview of the new ISE planning and payment structure • To review the new Career Plan and Guide • To review the new funding structure and protocols • To provide a starting point for the new ISE process and contacts for support • To respond to questions

5. Employment First Initiative • Employment is the first priority option to be explored in the service planning. • All future graduates and those with LON levels 1, 2, and 3 must have an employment goal which leads to individual supported or competitive employment. • All other individuals and their teams should consider individual supported or competitive employment options. • Annual Individual Plans should help people to secure employment and help people to pursue advancement in their chosen careers. • Employment is an ongoing path – it does not have an ending. http://www.ct.gov/dds/lib/dds/dds_manual/ic5/ic5po001_employment_first.pdf

6. Background of ISE Work Group

7. ISE Work GroupTransitioning from Traditional Payment Structure to Fee for Service

8. ISE Work Group – History and Outcomes • Established in February 2010 • Collaborative approach of DDS and Private Sector to address the following: • Conversion of traditional payment structure to attendance based payments dramatically reduced annualized (legacy) rates impacting agency infrastructure • Create a system which meets client needs and reimburses providers for work completed • Reinforce the value of ISE services • Sought and secured a cap on losses to be limited to 2% for ISE payments during the transition period

9. ISE Work Group – History and Outcomes • Reviewed information on how other states pay for ISE services • Gathered information to identify direct and indirect costs/activities involved in job preparation, development, placement and retention • Collected and analyzed information from 25 providers to determine aggregate data of above • Categorized ISE service components

10. ISE Work Group – History and Outcomes • Researched and re-designed available assessment and career planning tools to be consistently used within the system • Consistently reviewed CMS waiver guidelines for service delivery and documentation requirements • Solicited input from DDS CO Case Management Liaison

11. The Career Plan - Purpose • To gather information from the individual and stakeholders that is pertinent to obtaining/retaining employment • To identify and outline unique supports that will lead to employment • To be a roadmap for the individual and his/her support team that leads to successful competitive employment and career enhancement • To be a dynamic and flexible document that will accompany the individual throughout his/her personal career path

12. Structure of Career Plan • LON, IP and Client Summary Report (provided by case manager prior to or with service authorization) • Section 1: Background Information • Section II: Vocational Profile • Section III: Action Plan

13. Client Summary Report • The DDS Case Manager will provide this CAMRIS-based report to the Private Provider • This will be in the referral package for a new consumer or forwarded to the provider in preparation for a career planning meeting • This summary captures pertinent consumer information currently stored in CAMRIS • This summary will be attached to the front of the Career Plan document

14. Section I – Background Information (Completed by Provider)

15. I.1. Legal Status • Preparation for employment forms • Information to develop strategy for addressing criminal record and/or substance abuse issues

16. I.2. Social Security • The start of a financial plan that meets the needs of the individual • Provides the basic information to project the impact, if any, competitive work may have on entitlements • Encourages link to benefits counselor

17. I.3. Other Potential Funding/Resources for Employment Services and Supports • Identifying all pertinent resources to bring to the table

18. I.4. Transportation • How will the person get to and from work ? • What are the options ? • What’s plan B, C and D ?

19. I.5.- I.7. Education, Training and Academic Skills/Work-Life Experience/ Advocacy Skills • What skills and experiences can be brought to bear for work? • What are the clues for matching skills for work?

20. I.8.&I.9. Paid Employment History & References • This is the start of a resume • Contact list for employment opportunities

21. Section II – Vocational Profile (Completed by Provider) This is the section that will incorporate observations, self-reports and results from established written assessments

22. II.1. & II.2. Vocational Preferences/Skills, Gifts and Strengths • Listening to individuals and stakeholders • Gathering information and perceptions

23. II.3.- II.7. Vocational Skills • Self reporting of individual • Information and perceptions of stakeholders • Opportunities for up to three (3) brief assessments or inventories (complete at least one) • Previous performance evaluations

24. II.8. Communication Skills • How does the individual communicate? • Interaction with others

25. II.9. Accommodations • What’s needed to make work possible, accessible, safe and successful ?

26. II.10. Transportation/Safety Awareness • How will the individual safely and independently navigate to, from and around work ?

27. II.11. Community Advantages/Disadvantages • Opportunities and risks ?

28. II.12.- II.15. Preparation for Job Development • Tools • Focus/Scope • Opportunities • Contacts

29. Section III – Action Plan • The Who – What – When – Where and How addressed? • What natural supports are in place to address some action steps? • Is everyone clear about what they are committing to do ? • Are there clear guidelines and timelines for completing tasks ?

30. Sign-Off “I’m committing to provide the support to the best of my ability.” Individuals involved in the development and implementation of the plan are to sign off

31. Review and Approval of Career Plan • Submission of a copy of the completed Career Plan • Resource Manager Career Plan Completion Checklist • Approval/Authorization for Payment

32. Career Plan Guide • Purpose – Interpretive guideline for completing and submitting a person centered and meaningful career plan

33. 10 Minute Break

34. ISE Payment Structure

35. Waiver Definition of Supported Employment • Supported Employment consists of intensive, ongoing supports that enable participants, for whom competitive employment at or above the minimum wage is unlikely absent the provision of supports, and who because of their disabilities, need supports to perform in a regular work setting. Supported employment may include assisting the participant to locate a job or develop a job on behalf of the participant.

36. Individual Supported Employment • Services will vary in the intensity of initial job development, intensive training, and decreasing periodic monitoring. • The individual, parent and/or guardian, and her/his team should discuss a support plan that addresses how and when the staff would begin to be fade direct supports. • Although there is no set time limit, a reasonable time frame from when an individual begins a job with staff supports to independently working on their own is generally 3-6 months. • A few hours of ongoing weekly and/or monthly support is part of the Individual Supported Employment model.

37. Individual Supported Employment • This service is not for use to provide ongoing long-term 1:1 support to enable an individual to complete work activities. • An individual who needs long-term 1:1 on the job supports to maintain their job would utilize the Individualized Day model with a negotiated rate.

38. ISE Rates The new rate structure is for ISE supports only.

39. ISE Rates

40. ISE Rates

41. ISE Rates

42. ISE Rates

43. ISE Rates

44. ISE Rates

45. ISE Rates

46. Implementation Details • Start Date - February 1, 2012 • All Individual Supported Employment (ISE) Authorizations for on-going support will be changed to the new rate of $47 hour. • All ISE authorizations will be changed to the LON based hours.

47. Implementation Details • It is important that we do not immediately reduce the total number of hours currently being received by the individual. • Unless a reduction in support hours is agreed upon by the team, any hours above the LON authorized Follow Along hours are to be authorized through the one-time process.

48. Implementation Details • The provider should submit a plan to decrease the support hours down to the LON Follow along hours. The plan must be approved by the region. • Individuals unable to maintain employment without the current authorized supports will be reviewed and, except for extreme circumstances, will have their authorization changed to Individual Day Supports.

49. Implementation Details • All individual budgets with ISE supports provided by a provider will be converted to the POS contract over the next few months. • All individual budgets with ISE supports provided by a provider and ADA transportation tickets purchased by the FI will be converted to the POS contract over the next few months. • Providers without a POS contract will be encouraged to sign a POS contract by 7/1/2012.

50. Implementation Details • Individual Budgets with ISE supports provided by a Self Hire will not change on 2/1/2012. • The individual budget will be reviewed to determine whether it is outside the ranges of the LON based authorization. • Teams will be asked to develop a plan to transition the supports to match the LON based authorizations or amend the authorization to a more appropriate support category.