Commissioner Terrence W. Macy, PhD Overview of the GSE to SEI pilot Provider Panel Recommendations from Pilot SEI Rates Update Career Plan Pilot Update

DDS Employment First Initiative“Real Work for Real Pay”

1990-2007 Focus on Other Areas-Employment

Not Emphasized

1980’s DDS CT #1 in Supported Employment

It is time to refocus and re-energize our department efforts on

Employment

DDS Five Year Plan 6000

5000

4000

3000

2000

1000

FY 05 FY06 FY07 Fy08 Fy09 Fy10 Fy11

Sheltered Workshops & Day Support Options

Competitive and Individual Supported Employment

Employment numbers in CT are decreasing

The goal is to “turn the curve” and show that we can begin to change the direction of the bottom

trend line to turn upwards and change the direction of the top one to turn downwards..

DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Baltimore, Maryland 21244-1850

This guidance does not constitute new policy, but rather highlights the opportunities available to use waiver supports to increase employment opportunities for individuals with disabilities within current policy. Further, it underscores CMS’s commitment to the importance of work for waiver participants and provides further clarification of CMS guidance regarding several core service definitions

SUBJECT: Updates to the §1915 (c) Waiver Instructions and Technical Guide regarding employment and employment related services

Provider PanelProvider Panel

1. How were participants identified for the pilot?

2. How did you determine funding needs for each participant?

3. What organizational changes were considered or made to implement and staff the pilot?

4. How did you approach career planning and job development?

By the numbers…..•53 individuals engaged in the pilot

▫Range of 3-16 per agency

•17 (32%) have obtained an individual job▫3 have left their jobs, one is job seeking

Reasons for separation include economic lay off, health condition and desire to return to GSE

•Wage, hours, job type data will be forthcoming

What about those who are not yet employed?

•16 (30%) currently seeking a job

•1 is completing an on the job assessment

•4 are in the career planning process

•8 (15%) chose not to move forward with individual employment

Lessons learned…• Recruitment and engagement of individuals

▫Start with those seeking an individual job▫Engage the family and other team members early

• Career planning▫Engage the family and other team members early▫Address social issues as part of the planning

process▫Consider and plan for the impact of a part time

or non traditional work schedule ▫Consider how this job might be part of a career

ladder, not just a job

Lessons learned…

•Job development

▫Need to consider not just the individual job development, but also development of ongoing business relationships

▫Requires a professional approach▫Use the social and professional contacts of

the job seeker, family and other team members

Lessons learned….

•Organizational ▫Need to provide staff training▫Changes in job functions needed, different

approach to the work▫Need to work through the implications for

existing GSE programs Will they decrease over time? Can staff be reassigned to SEI? What will the transition look like?

▫Protect staff time devoted to SEI

Lessons learned…

•Funding▫Need to figure out how to manage the

funding process more efficiently and effectively Stay tuned for updates!

▫Everyone involved in making decisions about funding needs to understand all the options

▫Need to develop quick turn around process, particularly for those who experience job loss or when a great opportunity comes along quickly

The Career Planning Process for SEI

• History of the SEI Work Group and Career Plan Project• The Career Plan• Career Plan Pilot• Next Steps• Questions and Answers

History of the SEI Work Group and Career Plan Project

SEI Workgroup

Purpose was to Transition From Traditional Payment Structure (Contract) to Fee for Service Without Compromising the Agency Infrastructure and Ability to Provide Services

SEI Work Group – History and Progress• 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 SEI services• Sought and secured a cap on losses to be

limited to 2% for SEI payments during the transition period

SEI Work Group – History and Progress• Reviewed information on how other states

pay for SEI 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 SEI service components

SEI Work Group – History and Progress• Identified Service Gaps (i.e. no standardized

assessment tool/approach)•Researched and re-designed available

assessment and career planning tools to be consistently used within the system and developed Comprehensive Career Plan

•Consistently reviewed CMS waiver guidelines for service delivery and documentation requirements

•Solicited input from DDS CO Case Management Liaison

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 will lead into action steps

• To be a dynamic and flexible tool that will accompany the individual throughout his/her personal career path

Career Plan Pilot

•Met With SEI Providers•Sought Volunteers•10 Providers Participated•Completed 18 Career Plans•Received Feedback Forms •Consolidated Feedback and Data•Adjusted Career Plan Based on Feedback•Data Used to Develop Fee Structure

SEI Next Steps

•Seek to Formalize Service/Payment Structure

•Provide Training to SEI Providers in January•Subsequent Trainings to Other Partners

(Case Managers, Resource Managers, Other Providers)

• Implement in 2012•Periodic Feedback to SEI Work Group

Questions and Answers

Thank You

Joe Parente – Easter Seals GoodwillSandy Lavoy- CW ResourcesBeth Fisher – Kuhn EmploymentLou Alperowitz – MARC Community ResourcesRobin Wood - DDS

Service Hourly Payment

# of hours Payment Documentation

Annualized Authorization for

follow-along support to include Face to Face

hours with the participant at the work site, with the employer at the worksite or with the participant outside the worksite regarding

work related issues

$47.00 per hour

Based on LON

allocation- ranges from

1-5 hours per week

Web/res/day

Service Hourly Payment

Payment Documentation

Hours worked each week by ISE Participant

(hours need to be verified – TBD)

$4.48 per hour worked or paid vacation, sick, or holiday time

Web/res/day

Back up information

maintained by the provider for potential audit

Service Benchmark Payment

Hourly Payment

# of hours

Payment Documentation

1. Career Plan

Direct Support – face to face

$47.00 per hour

Average of 10 hours for Career Plan

Web/res/day

2. Career Plan

Indirect Support

$700 for completed product

Completed acceptable Career Plan

Service Benchmark Payment

Hourly Payment

# of hours Payment Documentation

Hourly Supports-

Job development and intensive

training

$47.00 per hour

Based on Team Recommendation

Web/res/day

Direct Face to Face Support provided during Working Interview

$47.00 per hour

up to 40 hours over a 2 week time period

Web/res/day

Wage for consumer

$9.00 per hour

up to 40 hours over a 2 week time period

Payroll Information submitted as one time documentation

Service Benchmark Payment Payment Documentation

Start work

(payment based on hours worked per week)

5 to 9.99 hours = $40010 to 14.99 hours = $80015 to 19.99 hours = $120020 to 24.99 hours = $160025 hours or more = $2000

Web/res/day

3 months completion

Time begins with a full calendar month of employment

5 to 9.99 hours = $40010 to 14.99 hours = $80015 to 19.99 hours = $120020 to 24.99 hours = $160025 hours or more = $2000

Web/res/day

Service Benchmark Payment Payment Documentation

6 months completion

Time begins with a full calendar month of employment

5 to 9.99 hours = $40010 to 14.99 hours = $80015 to 19.99 hours = $120020 to 24.99 hours = $160025 hours or more = $2000

Web/res/day Hours Worked section

Transition to Natural Supports - Successful discharge

5 to 9.99 hours = $40010 to 14.99 hours = $80015 to 19.99 hours = $120020 to 24.99 hours = $160025 hours or more = $2000

Documentation of the discharge and plan for natural supports submitted as one time.