CHAPTER 3000 Supported Employment Services

CHAPTER 3000
SPECIFIC PROGRAM REQUIREMENTS
FOR
SUPPORTED EMPLOYMENT SERVICES
SCOPE OF SERVICES
3001 General
Supported Employment services are ongoing supports that enables participants, for whom competitive employment as 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 services are conducted in a variety of settings, particularly work sites where persons without disabilities are employed. Participants who receive Supported Employment services must require long-term, direct or indirect job-related support in job supervision, adapting equipment, adapting behaviors, transportation assistance, peer support, and/or personal care assistance during the work day. Supported Employment services consist of activities needed to obtain and sustain paid work by participants, including job location, job development, supervision, training, and services and supports that assist participants in achieving self-employment through the operation of a business, including helping the participant identify potential business opportunities, assisting in the development of a business plan, identifying the supports that are necessary for the participant to operate a business, and ongoing assistance, counseling and guidance once the business has been launched. These services do not include the supervisory activities rendered as a normal part of the business setting.
The planned outcomes of these services are to increase the hours worked by each participant toward the goal of forty hours per week and to increase the wages of each participant toward the goal of increased financial independence. Supported Employment services are based on the individual participant’s needs, preferences, and informed choice. These services allow for flexibility in the amount of support a participant receives over time and as needed in various work sites.
Supported Employment Group services are provided to groups of participants, with a staff to participant ratio of one to two or more. The staff to participant ratio for Supported Employment Group services cannot exceed one (1) to ten (10). Supported Employment Individual services are provided to an individual participant, with a
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one-to-one staff to participant ratio. Supported Employment Services Providers offer (or arrange when needed) any of the standard services listed in section 3005 – Covered Services that are needed by the participants served and specified in the participants’ Individual Service Plans.
3002 Special Requirements of Participation
3002.1 Individual Provider
In addition to those conditions of participation in the Medical Assistance Program as outlined in Part I, Policies and Procedures for Medicaid/PeachCare for Kids Manual applicable to all Medicaid providers, Section 106 (General Conditions of Participation), and Part II, Chapter 600 Policies and Procedures for the COMP Program, Supported Employment Services providers must meet the following requirements:
1. Individual providers of Supported Employment services must meet the following requirements for Supported Employment Specialists:
a. Be 18 years or older;
b. Have current CPR and Basic First Aid certifications;
c. Have the experience, training, education or skills necessary to meet the participant’s needs for Supported Employment services as demonstrated by:
(1) Direct Support Professional (DSP) certification, and at least six (6) months of experience in supported employment of individuals with disabilities; or
(2) Copy of high school diploma/transcript or General Education Development (GED) diploma and at least six (6) months of experience in supported employment of individuals with disabilities and fifteen (15) hours of training in providing supported employment of individuals with disabilities; or high school diploma or GED and one (1) year experience in providing supported employment to individuals with disabilities; or documented experience providing specific supports to individuals with disabilities related to the supported employment of those individuals.
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d. Have evidence of an annual health examination with signed statement from a physician, nurse practitioner, or physician assistant that the person is free of communicable disease;
e Agree to or provide required documentation of a criminal records check, prior to providing Supported Employment services.
f. Meet transportation requirements in COMP Part II Chapter 900 Section 905 if transporting participants.
2. Documentation Requirement: Providers, except for providers of participant-directed services, must document the following in the record of each participant receiving Supported Employment Services:
a. Specific activity, training, or assistance provided;
b. Date and the beginning and ending time when the service was provided;
c. Location where the service was delivered;
d. Verification of service delivery, including first and last name and title (if applicable) of the person providing the service and his or her signature;
e. Progress towards moving the participant towards independence by meeting the participant ISP, which includes person-centered goals, desired outcomes in the participant’s action plan, and the amount/type of assistance/support in the Current Service Summary and the Health and Safety sections of the ISP.
3. Participant-Directed Services Documentation and other Requirements: Documentation and other requirements for individual providers of participant-directed services are specified in Chapter Part II Policies and Procedures for COMP, Chapter 1200.
3002.2 Provider Agencies
In addition to those conditions of participation in the Medical Assistance Program as outlined in Part I, Policies and Procedures for Medicaid/PeachCare for Kids Manual applicable to all Medicaid providers, Section 106 (General Conditions of
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Participation), and Part II, Chapter 600 Policies and Procedures for the COMP Program, Supported Employment Services provider agencies must meet the following requirements:
1. Staffing Qualifications and Responsibilities
Provider agencies rendering Supported Employment Services must have staffing that meets the following requirements:
a. A designated agency director who must:
 Have either a bachelor’s degree in a human service field (such as social work, psychology, education, nursing, or closely related field) and five years of experience in service delivery to persons with developmental disabilities, with at least two of these years serving in a supervisory capacity; or
 Have an associate degree in nursing, education or a related field and six years of experience in service delivery to persons with developmental disabilities, with at least two of these years serving in a supervisory capacity; or
b. Duties of the Agency Director include, but are not limited to:
 Oversees the day-to-day operation of the agency;
 Manages the use of agency funds;
 Ensures the development and updating of required policies of the agency;
 Manages the employment of staff and professional contracts for the agency;
 Designates another agency staff member to oversee the agency, in his or her absence.
c. At least one agency employee or professional under contract with the agency must:
o Be a Developmental Disability Professional (DDP) (for definition, see Part II Policies and Procedures for COMP, Appendix I);
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o Have responsibility for overseeing the delivery of Supported Employment Services to participants.
d. The same individual may serve as both the agency director and the Developmental Disability Professional;
e. Duties of the DDP include, but are not limited to:
 Overseeing the services and supports provided to participants;
 Supervising the formulation of the participant’s plan for delivery of Supported Employment Services;
 Conducting functional assessments; and
 Supervising high intensity services.
f. Must have a minimum of one (1) employee that meets the Supported Employment Specialist experience, training, education or skills qualifications specified above for Individual Providers for every five (5) direct care staff members.
g. Duties of the Supported Employment Specialist include, but are not limited to:
1) Provides direct supervision of Direct Care Staff in their performance of Supported Employment services for participants;
2) Develops, acquires, and maintains work opportunities for participants;
3) Conducts necessary additional assessments at the work site;
4) Helps participants choose appropriate jobs or a specific employment option;
5) Applies training techniques which enhance the social and vocational functioning of participants;
6) Monitors wages, hours, and productivity of participants on an ongoing basis;
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7) Assists the participant, if applicable, in achieving self-employment through the operation of a business by:
i. Aiding the participant to identify potential business opportunities;
ii. Assisting in the development of a business plan, including potential sources of business financing and other assistance in developing and launching a business;
iii. Identifying the supports that are necessary for the participant to operate a business;
iv. Providing ongoing assistance, counseling and guidance once the business has been launched.
h. A minimum of one (1) direct care staff member or Supported Employment Specialist for every ten (10) participants served in Group Supported Employment Services and minimum of one (1) direct care staff member or Supported Employment Specialist for every one (1) participant served in Individual Supported Employment Services;
i. Direct Care Staff must:
 Be 18 years or older;
 Has high school diploma/equivalent (General Educational developmental or GED)
 Meet transportation requirements in COMP Part II Chapter 900, Section 905 in transporting participants.
 Be provided with a basic orientation prior to direct contact with participants and show competence in:
1) The purpose and scope of Supported Employment Services, including related policies and procedures;
2) Confidentiality of individual information, both written and spoken;
3) Rights and responsibilities of individuals;
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4) Requirements for recognizing and reporting suspected abuse, neglect, or exploitation of any individual:
i. To the DBHDD;
ii. Within the organization;
iii. To appropriate regulatory or licensing agencies; and
iv. To law enforcement agencies
j. Duties of the Direct Care Staff include, but are not limited to:
 Provides direct assistance in activities needed for the individual participant or a group of participants to sustain work, including job coaching, supervision and training;
 Provides direct assistance in training, retraining or improving the social and vocational functioning of the individual participant worker or groups of participant workers;
 Implements the behavioral support plans of participants to reduce inappropriate and/or maladaptive behaviors and to acquire alternative adaptive skills and behaviors;
 Provides active support and direct assistance in facilitating natural supports at the work site;
 Provides other support services at or away from the work site, such as transportation and personal assistance services.
k. The type and number of all other staff associated with the organization (such as contract staff, consultants) are:
1) Properly trained or credentialed in the professional field as required;
2) Present in numbers to provide services and supports to participants as required;
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3) Experienced and competent in the services and support they provide.
l. National criminal records check (NCIC) documentation for all employees and any volunteers who have direct care, treatment, or custodial responsibilities for participants served by the agency.
2. Agency Policies and Procedures – Each provider agency must develop written policies and procedures to govern the operations of Supported Employment services, which follow the Standards for the Department of Behavioral Health and Developmental Disabilities refer to Part II Policies and Procedures for COMP.
3. Documentation Requirement: Providers, except for providers of participant-directed services, must document the following in the record of each participant receiving Supported Employment Services:
 Specific activity, training, or assistance provided;
 Date and the beginning and ending time when the service was provided;
 Location where the service was delivered;
 Verification of service delivery, including first and last name and title (if applicable) of the person providing the service and his or her signature;
 Progress towards moving the participant towards independence by meeting the participant ISP, which includes person-centered goals, desired outcomes in the participant’s action plan, and the amount/type of assistance/support in the Current Service Summary and the Health and Safety sections of the ISP.
4. Participant-Directed Services Documentation and other Requirements: Documentation and other requirements for providers of participant-directed services are specified in Part II Policies and Procedures for COMP, Chapter 1200.
5. Providers must meet the following requirements for staff-to-participant ratios:
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a. Group Supported Employment Services: a staff to participant ratio of one to two or more, not to exceed one (1) to ten (10).
b. Individual Supported Employment Services: a one-to-one staff to participant ratio.
6. Providers must develop and plan Supported Employment services and supports:
a. Based on the individual participant’s needs, preferences, and informed choice;
b. To allow for flexibility in the amount of support a participant receives over time and as needed in various work sites;
c. With attention to the health and safety of the participant;
d. In accordance with the Fair Labor Standards Act, if applicable, to include documentation of sub-minimum wage;
e. With planned outcomes, which include:
1) Increases in hours worked by each participant toward the goal of 40 hours per week;
2) Frequent opportunities for each participant to interact with non-disabled peers during the normal performance of the job and/or during breaks, lunch periods, or travel to and from work;
3) Increases in wages of each participant toward the goal of increased financial independence.
7. DBHDD Contract/LOA and DBHDD Community Service Standards: Agency providers must adhere to DBHDD Contract/LOA, DBHDD Community Service Standards and all other applicable DBHDD Standards, including accreditation by a national organization (CARF, JCAHO, The Council, Council on Accreditation) or certification by DBHDD (see Part II Policies and Procedures for COMP, Chapter 603).
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3003 Special Eligibility Conditions
A. Supported Employment Services are available only for participants for whom the service is not available under a program funded under section 110 of the Rehabilitation Act of 1973 or the IDEA (20 U.S.C. 1401 et seq.). Documentation is maintained in the file of each participant receiving Supported Employment Services that these services are not available through any of these programs.
B. The need for Supported Employment Services must be related to the individual disability and tied to a specific goal in the Intake and Evaluation Team approved Individual Service Plan (ISP).
3004 Prior Approval
Supported Employment Services must be authorized prior to service delivery by the operating agency at least annually in conjunction with the Individual Service Plan (ISP) development and with any ISP revisions.
3005 Covered Services
Reimbursable Supported Employment Services include the following based on the assessed need of the participant and as specified in the approved ISP:
1. Assisting the participant to locate a job or develop a job on behalf of the participant.
2. Activities needed to sustain paid work by participants, including supervision and training.
3. Services and supports that assist the participant in achieving self-employment through the operation of a business and may include:
a. Aiding the participant to identify potential business opportunities;
b. Assistance in the development of a business plan, including potential sources of business financing and other assistance in developing and launching a business;
c. Identification of the supports that are necessary for the participant to operate the business; and
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d. Ongoing assistance, counseling and guidance once the business has been launched. Payment is not made to defray the expenses associated with starting up or operating a business.
4. Adaptations, supervision, and training required by participants receiving Supported Employment services as a result of their disabilities, when these services are provided in a work site where persons without disabilities are employed.
5. Transportation of two or more participants to community work sites is provided as specified in the ISP for participants receiving Supported Employment Group services.
6. Job Maintenance activities to maintain a participant in 60 to 80 or more hours of work per month.
3006 Non-Covered Services
1. Incentive payments, subsidies, or unrelated vocational training expenses such as the following:
a. Incentive payments made to an employer to encourage or subsidize the employer’s participation in Supported Employment program;
b. Payments that are passed through to users of Supported Employment programs; or
c. Payments for training that is not directly related to an individual’s Supported Employment program.
2. Supervisory activities rendered as a normal part of the business setting.
3. Supported Employment Services are distinct from and do not occur at the same time of the same day as Community Access, Prevocational or Transportation Services, with the exception of time-limited, non face-to-face Supported Employment job development. The exception for Supported Employment job development must be documented sufficiently to demonstrate no duplication of services for an individual participant and a service provided in preparation for transition of an individual participant to Supported Employment Services.
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4. Services that are available under a program funded under section 110 of the Rehabilitation Act of 1973 or the IDEA (20 U.S.C. 1401 et seq.).
5. Payment is not made, directly or indirectly, to members of the individual’s immediate family, except as approved as indicated in Part II Policies and Procedures for COMP, Chapter 900.
6. Supported Employment Services do not include sheltered work or other similar types of vocational services furnished in specialized facilities, such as service centers for individuals with intellectual/developmental disabilities
7. Payment is not made for those goods and services covered by the State Medicaid Plan except where a participant’s need exceeds State Plan coverage limits and exceptions to the coverage limits are not available.
3007 Basis for Reimbursement
The reimbursement rate for Supported Employment Services is found in Appendix A.
Transportation provided through these services is included in the cost of doing business and incorporated in the administrative overhead cost.
Separate payment for transportation only occurs when the COMP’s distinct Transportation Services are authorized.
A. A Unit of service is 15 minutes.
B. Supported Employment Individual Limits:
1. 40 fifteen-minute units per day.
2. 1,440 fifteen-minute units per year
C. Supported Employment Group Limits:
1. 320 fifteen-minute units per month.
2. 3,840 fifteen-minute units per year.
Self-Directed
Supported Employment Group Limits: 1 unit = $1.00
Annual limit is as authorized in the individual budget up to an annual maximum of $6,912.
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Supported Employment Individual Limits: 1 unit = $1.00
Annual limit is authorized in the individual budget up to an annual maximum of $10,454.
D. Supported Employment Job Maintenance
1. Supported Employment Job Maintenance is billed as actual hours worked from 60 hours up to a maximum of 80 hours per month, even if the participant works more than 80 hours.
2. Supported Employment Job Maintenance is billed under Supported Employment Group from 240 units up to a maximum of 320 units per month.
3. Supported Employment Group Services other than Job Maintenance can not be billed in any month in which Supported Employment Job Maintenance is billed.
4. Supported Employment Individual Services can not be billed in any month in which Supported Employment Job Maintenance is billed.
3008 Participant-Direction Options
A. Participants can choose the self-direction or co-employer options with Supported Employment Services.
B. An individual serving as a representative for a waiver participant in self-directed services is not eligible to be a participant-directed provider of Supported Employment Services.
C. For details on participant-direction, see Part II Policies and Procedures for COMP, Chapter 1200.
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