FAQ Milestones Service Delivery (MSD) for Supported Employment May 24, 2012

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 ACCES- VR’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.