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Supported Employment
Milestone Design FAQ
Why was the process delivery design changed for Supported Employment?
ACCES-VR has determined to emphasize employment outcomes and service time over
process. The cost of rehabilitations had risen during the study period while employment
outcomes had declined; thus prompting the need for research into other methods of
service delivery. The goals for improved quality, a new payment system and program
enhancements are all supported by a milestone design.
What are the goals for the milestone design?
There are three major goals:
1.
To focus on employment outcomes (product).
2.
To emphasis planning and consumer contact time over reporting and monitoring
(process).
3.
To utilize the expertise of all partners to achieve the quality employment
outcomes we most value.
Does the Milestone design focus on quality or production?
Quality job placement is the primary objective for the changed design. In support of this
objective, the design provides additional funding opportunities to the provider as
bonuses for employment with: 30 hours or more per week; and/or hourly wages at $9.50
upstate and $10.50 downstate. Hours and wages are indicators of quality employment
and an increase in hours is more likely to include the provision of additional employee
benefits, such as medical insurance. ACCES-VR has extended the time to 6 months
post rehab a provider may work with the consumer to help them attain the enhanced
hours or wages. This will reward both job retention and on going career growth for
consumers.
How was the milestone design developed?
This design was developed through a variety of research methods with emphasis on
program evaluation. Research included review of the literature (academic research on
previous programs); qualitative research (interviews with other states utilizing milestone,
outcome based systems); a review of archival information (collected from existing data
bases including CAMS & NYISER); and scientific research (survey of SE providers) with
triangulation of data to confirm validity. This data was used to design a milestone
outcome based system. The Center for Essential Management Services (CEMS)
provided assistance in running a variety of simulations which incorporated both ACCESVR’s budgetary and provider funding needs. All levels of service including the most
difficult to place individuals were factored into the development of both the rates and the
weighting of core milestones. This inclusion was important in order to assure that there
would be sufficient funding and a consistency of cash flow to cover all levels of services
to all individuals.
Will the milestone design improve the provision of SE services?
By moving the emphasis from monitoring of hours (fee for service) to planning & job
development, VRCs and providers can spend more time directly with the consumer.
This is expected to result in greater opportunities for success. The new reporting
(deliverables) emphasize communication between partners. Enhanced collaboration is
encouraged particularly for the referral and development of the Individual Service Plan.
Enhancement bonuses highlight and reinforce quality employment outcomes and
continued career growth rather than job retention alone.
When will the new design be implemented?
The new design is expected to become effective October 1, 2013 as part of the new
Core Rehabilitation Services (CRS) contract. SE will be one service group offered
under CRS. Current SE contracts will end early (09/30/2013 rather than 09/30/2014).
SE providers will need to apply under CRS to be considered for a new contract.
What does the new design look like?
The supported employment milestone design is described in the Core Rehabilitation
Services Guide along with information about payment rates, deliverables, staffing and
performance indicators.
What other changes are included in the Supported Employment Milestone
design?
The Core Rehabilitation Services Guide provides clarification regarding utilization of
Situational Assessment in the Assessment section of the guide. Situation Assessment
should not be routinely authorized for supported employment, but only when the VRC
determines it is needed to further assess the individual’s appropriateness for SE. Core
1 milestone: Pre-Employment Assessment/Job Development will also include an
assessment component.
Does the milestone design change any ACCES-VR procedure?
Changes include:
1. Stabilization and Transition - The 90 day clock for rehabilitation will begin on the
first day of employment. It will no longer be necessary to determine a date for
‘stabilization’ in order to ‘transition’ to employment. This change effectively
alleviates the inconsistencies encountered in defining and determining when
‘stabilization’ occurs. Stabilization will be defined as an ongoing process that
should be addressed through out employment. Ongoing assessment of ‘stability’
and satisfaction on the job should still include the input of employer, consumer,
provider and VRC.
2. Case Service Code - ACCES-VR will no longer use one CSC (569X) for SE.
Seven codes will be used to better identify components of the SE process; 571X
SE Intake, four core milestones: 572X Pre-Employment Assessment/Job
Development, 573X SE Job Placement (Day 5), 574XSE Job Placement (Day
45), 575X SE Job Retention; and two quality outcome bonuses: 576X SE Job
Retention Hours per Week, and 577X SE Job Retention Hourly Wage.
3. The Supported Employment Placement in Training Case Note will no longer be
required to capture the initial job placement date as the Status 22 In Employment
Case Note will be used.
4. Consumer progress will no longer be reported on the VR-416. New forms and
reports have been designed for each milestone that reflects the type of
information needed to review progress and identify needs. The focus of the new
reports in on planning and partner collaboration. It is less likely that waivers to
exceed 18 months of intensive service once placed in employment will be
required under this design.
Does the new design provide any time savings for providers and VRC’s?
There are a number of planned improvements that are expected to save time for both
providers of supported employment services and ACCES–VR VRCs by reducing paper
work.
1. Providers will no longer be required to list the hours utilized each month nor
explain how these hours are tied to their activities (or rewrite the 416 to expound
on the information). The new reporting will focus on mutual planning, job
development and identification of new resources and supports to assist the
consumer. Electronic reporting and billing will save time.
2. The VRC will no longer need to review the VR-416 monthly reports for hours
billed or draft justifications for additional hours.
3. SE Intake, four core SE services and two bonus enhancements will be
authorized with one Individual Plan for Employment.
4. Reauthorizing services (roll-overs) currently required at the beginning of each
contract year will no longer be necessary.
Were other states’ stakeholders satisfied after they changed to a performance
based, milestone system?
Providers, consumers and VR personnel, were extremely satisfied with the change.
One study in Oklahoma showed that SE providers chose the performance based design
over the fee for services by 80%. For all states reviewed, successful employment
outcomes increased from 3%-25% and averaged 15% in the first year after
implementing a performance, milestone based system.
How will ACCES-VR transition to the milestone design?
ACCES-VR is developing an implementation plan that will provide: guidelines on
transition; clarification regarding all core milestone services; early introduction of new
forms for reporting; and training which will occur prior to the implementation of the new
CRS contract in October 2013. Opportunities to provide feedback will be available after
the Pre-Bidders Informational sessions scheduled for late October 2012 and after the
Bidders Conference tentatively scheduled for late January 2013.
Are State Partner Agencies (OMH, OPWDD and CBVH) aware of the changes and
will it effect their involvement in the SE system?
ACCES-VR values the input of our State Partners and requested feedback from them
when research was initiated on the milestone design. The 515 Committee meetings
continue to provide regular input to obtain input. Extended services will be available in
the same manner under this design as is currently available under the hourly fee for
service payment system.
Will hard to place consumers be denied services under the milestone system?
Prioritizing or “creaming” was a critical consideration in the design of the new
performance, milestone system. The difficulty placing some individuals was factored
into the development of both the rates and the weighting of core milestones in order to
assure that there would be sufficient funding and a consistency of cash flow to cover all
levels of services to all individuals. Also a focus on individual planning was highlighted
as a key component to consistency in service. Programs from other states that
incorporated similar types of planning into their rate development and individualized
planning, reported that creaming was not been an issue.