Supported Employment Supported Employment and Long Term Follow-and Long Term Follow-

AlongAlong for the for the

Counselor and Job CoachCounselor and Job CoachDecember, 2008December, 2008

Introductions:Introductions:

– Judy Hill - EES/LTESS CoordinatorJudy Hill - EES/LTESS Coordinator

OFFICE OF EMPLOYMENT SERVICES AND OFFICE OF EMPLOYMENT SERVICES AND SPECIAL PROGRAMSSPECIAL PROGRAMS

• JUDY HILLJUDY HILL 804-662-7108 804-662-7108• -- email email JUDY.HILL@DRS.VIRGINIA.GOVJUDY.HILL@DRS.VIRGINIA.GOV• FAX NUMBER FOR ESSP: 1-804-662-FAX NUMBER FOR ESSP: 1-804-662-

91409140 DRS TOLL FREE VOICEDRS TOLL FREE VOICE 1-800- 1-800-

552-5019552-5019WEBSITE: http://www.vadrs.org WEBSITE: http://www.vadrs.org then click on Employment and Vocational then click on Employment and Vocational

ServicesServices

The Supported Employment Guide can be The Supported Employment Guide can be found at:found at:http://vadrs.org/essp/downloads/http://vadrs.org/essp/downloads/seguide/pdfseguide/pdf

What’s in your resource What’s in your resource packetpacket??• Understanding Order of Selection BrochureUnderstanding Order of Selection Brochure

• Power point PresentationPower point Presentation• Enclave/Mobile Crew 101, Stability for Individual SEEnclave/Mobile Crew 101, Stability for Individual SE

Other SE Issues, Revised SE FormsOther SE Issues, Revised SE Forms• OESSP Information SheetOESSP Information Sheet• Appendices B & C - WAT, SA and Provisions for Extended Appendices B & C - WAT, SA and Provisions for Extended

Employment Services (EES)Employment Services (EES)• Appendix D - Guidelines for SE and JCTSAppendix D - Guidelines for SE and JCTS• Appendix E - Provision of Long Term Employment SupportAppendix E - Provision of Long Term Employment Support• LTESS GuidelinesLTESS Guidelines• LTESS forms - application, requisition, closureLTESS forms - application, requisition, closure• Policy on Integrated Settings-Employment Outcomes and Policy on Integrated Settings-Employment Outcomes and

Extended EmploymentExtended Employment• Successful ClosureSuccessful Closure• Definition of Most Significant Disability (MSD)Definition of Most Significant Disability (MSD)• Post EmploymentPost Employment• List of AcronymsList of Acronyms• List of DRS StatusesList of DRS Statuses• EES/LTESS FormsEES/LTESS Forms

Topics toTopics to Cover: Cover:• Insights into SE/Long Term Insights into SE/Long Term

PracticesPractices

• Brief Historical Background – EES Brief Historical Background – EES and LTESSand LTESS

• Key Service Requirements for Key Service Requirements for Long Term Follow-AlongLong Term Follow-Along

DRS IMPACT ON ESO DRS IMPACT ON ESO PROGRAMSPROGRAMS

• *DRS Field Spends almost 10 Million*DRS Field Spends almost 10 Million

• **DRS OESSP EES and LTESS Spends **DRS OESSP EES and LTESS Spends over 7.2 Millionover 7.2 Million* * State Fiscal Year 2008State Fiscal Year 2008

****This includes the 15% reduction in both programsThis includes the 15% reduction in both programs

Why are we here?Why are we here?• To stress the importance of To stress the importance of

communication and collaboration communication and collaboration among all partiesamong all parties

• Supported employment specificsSupported employment specifics

• Long Term Follow-along – LTESS Long Term Follow-along – LTESS specificsspecifics

THE KEYS TO SUCCESSTHE KEYS TO SUCCESSRRELATIONSHIPSELATIONSHIPS

- Frequent Contacts between VR and JCFrequent Contacts between VR and JC

- Getting info between VR and JC quicklyGetting info between VR and JC quickly

- VR and JC view themselves as part of a VR and JC view themselves as part of a teamteam

- Access to VR counselor or job coachAccess to VR counselor or job coach

THE KEYS TO SUCCESSTHE KEYS TO SUCCESSTRUSTTRUST

- VR and JC trust in each other to:VR and JC trust in each other to:

- Give sufficient hours to do jobGive sufficient hours to do job- Use hours given efficiently and effectivelyUse hours given efficiently and effectively

- Consumer Characteristics/Needs:Consumer Characteristics/Needs:

- Difficult vs. less difficult consumersDifficult vs. less difficult consumers- Full use of authorized hours vs request Full use of authorized hours vs request

cancellationscancellations

SUPPORTED SUPPORTED EMPLOYMENTEMPLOYMENT

• Collaboration and CommunicationCollaboration and Communication

• Roles of each of us from referral to Roles of each of us from referral to follow alongfollow along

• Clarification of servicesClarification of services– Individual SEIndividual SE– Group – Enclave, Mobile Work Crew, Group – Enclave, Mobile Work Crew,

EntrepreneurialEntrepreneurial– JCTSJCTS

What model to use?What model to use?• Does the consumer require ongoing Does the consumer require ongoing

extended support services in order to extended support services in order to maintain competitive employment?maintain competitive employment?

• Is it required that a job coach work Is it required that a job coach work individually with a consumer?individually with a consumer?

• Does the consumer require employment in Does the consumer require employment in a mobile work crew or enclave?a mobile work crew or enclave?

• Is employment integrated?Is employment integrated?

SE - Individual PlacementSE - Individual Placement• Single supported employee placed in an Single supported employee placed in an

integrated work setting in the communityintegrated work setting in the community

• employed by employeremployed by employer

• ongoing follow-along requiredongoing follow-along required

• most widely used SE modelmost widely used SE model

• Advantages: flexibility, max. integration, ease Advantages: flexibility, max. integration, ease in differentiating between training and LTFAin differentiating between training and LTFA

Enclave ModelEnclave Model• small group of supported employees placed small group of supported employees placed

in community-based employmentin community-based employment

• may work together or be dispersed with may work together or be dispersed with integrated settingintegrated setting

• may be employed by employer or ESOmay be employed by employer or ESO

• ongoing follow-along requiredongoing follow-along required

• advantage: higher level of supervision and advantage: higher level of supervision and supportsupport

Mobile Work Crew ModelMobile Work Crew Model• group of supported employees who travel group of supported employees who travel

together to one or more integrated work settings together to one or more integrated work settings in the community to perform contract workin the community to perform contract work

• employed by the ESOemployed by the ESO

• ongoing support requiredongoing support required

• advantage: higher level of supervision and advantage: higher level of supervision and supportsupport

Entrepreneurial ModelEntrepreneurial Model• supported employees producing a service supported employees producing a service

or product either on a sub-contract basis or product either on a sub-contract basis or as a prime manufactureror as a prime manufacturer

• SE employees, along with managers and SE employees, along with managers and others, comprise the businessothers, comprise the business

• advantages: integrated, public contact, advantages: integrated, public contact, PRPR

JCTSJCTS• Consumer receives initial situational assessment, job development, Consumer receives initial situational assessment, job development,

job skills training, transportation training, or other support services job skills training, transportation training, or other support services provided by an ESO; however long term follow-along is not provided by an ESO; however long term follow-along is not necessary after DRS case closure.necessary after DRS case closure.

• This is a separate service and requires applicable service category This is a separate service and requires applicable service category on vendor’s rate sheet.on vendor’s rate sheet.

• Service Item Codes are not the same as those for SE.Service Item Codes are not the same as those for SE.

• When service categories are open, cases can be coded as either When service categories are open, cases can be coded as either MSD or SD. MSD or SD.

• If a consumer receives JCTS services, no follow along is required so If a consumer receives JCTS services, no follow along is required so therefore, a LTESS application should not be completed. If the therefore, a LTESS application should not be completed. If the consumer demonstrates that LTFA is needed then the ESO can consumer demonstrates that LTFA is needed then the ESO can submit a LTESS application submit a LTESS application afterafter they have DRS counselor approval. they have DRS counselor approval. The counselor needs to document the change in the case notes and The counselor needs to document the change in the case notes and change the SI codes on any authorizations if necessary. change the SI codes on any authorizations if necessary.

DRS Counselor Roles DRS Counselor Roles and Responsibilitiesand Responsibilities• Once eligibility is Once eligibility is

established SE planning established SE planning begins.begins.

• Are long term supports Are long term supports needed? If yes, then SE needed? If yes, then SE case. If no, consider JCTS.case. If no, consider JCTS.

• Identify long term support.Identify long term support.• SE cases must be coded as SE cases must be coded as

MSD.MSD.• Share sufficient diagnostic Share sufficient diagnostic

information. information.

DRS COUNSELOR ROLEDRS COUNSELOR ROLE• Establish benchmarks regarding progress.Establish benchmarks regarding progress.• Stop the process if needed and discuss issues – Stop the process if needed and discuss issues –

Interrupt Failure if needed.Interrupt Failure if needed.• Clarify expectations.Clarify expectations.• Maintain a separate role with consumer from Maintain a separate role with consumer from

vendor.vendor.• Determine what services can be provided by DRS Determine what services can be provided by DRS

before asking a job coach to do them.before asking a job coach to do them.• Continue to communicate with consumer after Continue to communicate with consumer after

referral to job coach.referral to job coach.• Case statuses must be properly updated.Case statuses must be properly updated.• Communicate and collaborate!!!!!!!!!!!!!!!!Communicate and collaborate!!!!!!!!!!!!!!!!

HIPPA ISSUEHIPPA ISSUE• ESOs will not be able to reference SS #s in the ESOs will not be able to reference SS #s in the

new internet EES/LTESS system. As a result new internet EES/LTESS system. As a result you must use the consumer's participant ID # you must use the consumer's participant ID # rather than a case or Social Security # in all rather than a case or Social Security # in all communication regarding the consumer.communication regarding the consumer.

• The Certificate of Eligibility has the participant The Certificate of Eligibility has the participant #, therefore we recommend that a copy be #, therefore we recommend that a copy be sent to the ESO as a part of the referral sent to the ESO as a part of the referral package. package.

• The participant ID # should be reflected on The participant ID # should be reflected on all of the SE forms. It is not on the all of the SE forms. It is not on the authorizations generated by AWARE.authorizations generated by AWARE.

Job Coach Role:Job Coach Role:• Assist consumer Assist consumer

with locating with locating suitable job suitable job matches.matches.

• Assist in job Assist in job search efforts.search efforts.

• Provide timely Provide timely written reports written reports and phone and phone contacts with contacts with updates as updates as needed.needed.

• Provide job skills Provide job skills training as training as needed.needed.

• Ensure consumer Ensure consumer stability and job stability and job satisfaction on satisfaction on both consumer both consumer and employer and employer side.side.

• Provide extended Provide extended support services, support services, where where appropriate.appropriate.

Job Coach Job Coach ResponsibilitiesResponsibilities• Communicate and Communicate and

collaborate with collaborate with DRS Counselor DRS Counselor and consumersand consumers..

• Providing Providing information as to information as to fading plans, need fading plans, need for follow-along, for follow-along, funding options.funding options.

• Work as a teamWork as a team with DRS, case with DRS, case managers, managers, consumers, consumers, families, etc. to families, etc. to improve improve likelihood of likelihood of success.success.

Topics coming up:Topics coming up:Communication IssuesCommunication Issues

•Initial PlanningInitial Planning•Authorizing ServicesAuthorizing Services•Service ProvisionService Provision•Report WritingReport Writing•InvoicingInvoicing

Opportunities for Opportunities for Communication and Communication and

CollaborationCollaboration• Initial Planning ExpectationsInitial Planning Expectations

– Situational AssessmentSituational Assessment– SE vs. JCTSSE vs. JCTS– Job Goal/DevelopmentJob Goal/Development– Placement and TrainingPlacement and Training– Stability/FadingStability/Fading– Long Term Follow AlongLong Term Follow Along

WHO PAYS FOR SERVICES?WHO PAYS FOR SERVICES?

• Initial Planning for Services:Initial Planning for Services:

– DRS pays for situational assessment, job development DRS pays for situational assessment, job development and placement and training through stabilizationand placement and training through stabilization

– Long term support funds pay for extended services Long term support funds pay for extended services including post stabilization while the case is still open. including post stabilization while the case is still open. Examples-LTESS,CSBExamples-LTESS,CSB

– DRS pays for post employment, not LTESSDRS pays for post employment, not LTESS

Opportunities for Opportunities for Communication and Communication and

CollaborationCollaboration• Authorizing Services:Authorizing Services:

– All authorizations need to consider All authorizations need to consider individual consumer need.individual consumer need.

– Need to be in place Need to be in place priorprior to provision of to provision of service.service.

– Justification needed for requested hours Justification needed for requested hours and a timely response from counselors and a timely response from counselors including emergencies like post including emergencies like post employment.employment.

– DRS Counselor should keep in mind that DRS Counselor should keep in mind that there are there are no caps/no maximums.no caps/no maximums.

Opportunities for Opportunities for Communication and Communication and

CollaborationCollaboration• Service Provision:Service Provision:

– Job DevelopmentJob Development• Agreement of goals for consumer.Agreement of goals for consumer.• Provide sufficient service hours - No maximums Provide sufficient service hours - No maximums

or minimums, individually considered.or minimums, individually considered.• Monthly progress reports should contain Monthly progress reports should contain

information as to name, numbers and types of information as to name, numbers and types of contacts made, strategies applied, job contacts made, strategies applied, job development hours used, potential placement development hours used, potential placement possibilities or outcomes expected and request possibilities or outcomes expected and request for next month.for next month.

Opportunities for Opportunities for Communication and Communication and

CollaborationCollaboration• Service Provision:Service Provision:

– Job Placement/TrainingJob Placement/Training

• No maximum or minimum hours allowed for No maximum or minimum hours allowed for Placement/Training - has to be individually considered Placement/Training - has to be individually considered (18 month (18 month durationduration limitation). limitation).

• Training time is not standardized .Training time is not standardized .

• Monthly reports, including intervention percentage and Monthly reports, including intervention percentage and fading schedule along with progress made to date.fading schedule along with progress made to date.

• Last monthly SE P&T Report (SE Form 3) should indicate Last monthly SE P&T Report (SE Form 3) should indicate consumer is stable in employment before LTFA begins. consumer is stable in employment before LTFA begins.

INVOICING:INVOICING:Billable Services under SEBillable Services under SE

Expectation of Counselor – Complete, Timely, Individualized, and Accurate Expectation of Counselor – Complete, Timely, Individualized, and Accurate BillingBilling

• Work Site Activities:Work Site Activities:– Includes travel, training and intervention with consumer, employer, and Includes travel, training and intervention with consumer, employer, and

employees at work site employees at work site

• Job Development Activities: Job Development Activities: – Includes consumer specific job development with employers, Includes consumer specific job development with employers,

supervisors, and other personnel for purposes directly relating to supervisors, and other personnel for purposes directly relating to employment employment

• Off-Site Activities:Off-Site Activities:– Includes training in transportation, money handling, and advocacy for Includes training in transportation, money handling, and advocacy for

persons not directly affiliated with the work sitepersons not directly affiliated with the work site

Remember, if a DRS employee can provide Remember, if a DRS employee can provide the service, that should be the priority!the service, that should be the priority!

INVOICING:INVOICING:Billable Services under SEBillable Services under SE

• Assessment/Report Writing:Assessment/Report Writing:

– Includes provision of situational assessment Includes provision of situational assessment services and all task analysis, training and services and all task analysis, training and progress report writingprogress report writing

– Billing for report writing and telephone calls Billing for report writing and telephone calls should reflect should reflect actualactual and reasonable time spent, and reasonable time spent, not standardized timesnot standardized times

Fading:Fading:• Intervention percentage time Intervention percentage time

is the time the Job Coach is the time the Job Coach spends supporting the spends supporting the consumer on the job site consumer on the job site divided bydivided by the total number of the total number of hours worked.hours worked.

• Intervention declines over Intervention declines over time as a measure of time as a measure of progress.progress.

EMPLOYMENT STABILITY AND EMPLOYMENT STABILITY AND THE MOVEMENT FROM TIME THE MOVEMENT FROM TIME LIMITED TO LTESS FUNDINGLIMITED TO LTESS FUNDING

WHAT IS STABILITY?WHAT IS STABILITY?• Traditional guideline: job coaching support is 20% or less. Traditional guideline: job coaching support is 20% or less.

This may This may notnot always be the case. always be the case.

• Consumer is emotionally, behaviorally stable.Consumer is emotionally, behaviorally stable.

• Consumer will demonstrate stability for at least 30 days in Consumer will demonstrate stability for at least 30 days in “service” status before case is moved to “employed” status.“service” status before case is moved to “employed” status.

• Last placement and training form (SE Form 3) submitted to Last placement and training form (SE Form 3) submitted to DRS must note stability has been reached and when the DRS must note stability has been reached and when the case will begin long term follow along.case will begin long term follow along.

• Communication between the ESO and DRS is imperative for Communication between the ESO and DRS is imperative for this action to be successful.this action to be successful.

How to calculate How to calculate STABILITY?STABILITY? ““Stability” is the direct/indirect intervention hours Stability” is the direct/indirect intervention hours

by the employment specialist divided by the by the employment specialist divided by the number of consumer work hours for that time number of consumer work hours for that time period (usually calculated weekly and/or period (usually calculated weekly and/or monthly). monthly).

Example: 10 intervention hours divided by 20 consumer Example: 10 intervention hours divided by 20 consumer work hours is 50%. While DRS case service and LTESS work hours is 50%. While DRS case service and LTESS funds pay for employment specialist transportation and funds pay for employment specialist transportation and documentation, the hours spent providing these documentation, the hours spent providing these services do not enter into the calculation of “stability”. services do not enter into the calculation of “stability”.

DRS Individual SE Case DRS Individual SE Case MovementMovement• The DRS Counselor keeps the consumer in The DRS Counselor keeps the consumer in

“service”“service” status until stability for 30 days or status until stability for 30 days or more is achieved.more is achieved.

• The DRS counselor will then move the consumer The DRS counselor will then move the consumer to to “employed”“employed” status for at least 90 days. status for at least 90 days.

• Once the consumer has worked in Once the consumer has worked in “employed”“employed” status for a minimum of 90 days or more and status for a minimum of 90 days or more and remains stable on the job, the case is remains stable on the job, the case is successfully closed successfully closed “Closed - Rehab”.“Closed - Rehab”.

• LTESS funds begin supporting LTFA at the LTESS funds begin supporting LTFA at the beginning of beginning of “employed”“employed” status. status.

Stability in Group ModelsStability in Group Models• For persons in group models, “stability” is defined as For persons in group models, “stability” is defined as

the completion of a 60 day period in which intervention the completion of a 60 day period in which intervention is directed at maintaining a level of production and not is directed at maintaining a level of production and not at major barriers to successful integration into the job at major barriers to successful integration into the job site. In other words, the job coach/trainer is devoting site. In other words, the job coach/trainer is devoting the majority of time addressing training issues rather the majority of time addressing training issues rather than behavioral issues. The consumer is meeting a than behavioral issues. The consumer is meeting a level of production that is acceptable to the employer level of production that is acceptable to the employer (either the business or ESO itself). (either the business or ESO itself).

• The case remains in “service” status until the stability The case remains in “service” status until the stability period ends. The case then goes to “employed” status period ends. The case then goes to “employed” status at the end of a minimum 60 day period. At this point at the end of a minimum 60 day period. At this point the case is considered to be in LTFA. Funding could be the case is considered to be in LTFA. Funding could be from a number of sources. from a number of sources.

Ongoing Services Form (SE Ongoing Services Form (SE Form 4)Form 4)• The Code of Federal Regulations requires The Code of Federal Regulations requires

twice a month monitoring of the consumer twice a month monitoring of the consumer until DRS closes the case. The ESOs are until DRS closes the case. The ESOs are required to complete the Ongoing Services required to complete the Ongoing Services Form each month from the time the case Form each month from the time the case begins follow along until DRS case closure. begins follow along until DRS case closure. The job coach is required to send a copy to the The job coach is required to send a copy to the DRS counselor each month until the case is DRS counselor each month until the case is closed.closed.

ESO Action to Access LTESS ESO Action to Access LTESS • Before the 30 day stability period endsBefore the 30 day stability period ends, a , a

LTESS application must be received LTESS application must be received no laterno later than the than the 20 20thth of the month preceding the of the month preceding the start of follow along services. This ensures start of follow along services. This ensures that LTESS funds will support LTFA after time that LTESS funds will support LTFA after time limited services by the DRS counselor ends.limited services by the DRS counselor ends.

• All LTESS applications must be approved by All LTESS applications must be approved by a DRS counselora DRS counselor. The ESO must document . The ESO must document the approval in the case record. the approval in the case record.

Individual LTFA Definition Individual LTFA Definition • With the approval of the DRS counselor and With the approval of the DRS counselor and

ESO job coach either bimonthly or quarterly ESO job coach either bimonthly or quarterly contacts with the consumer would be contacts with the consumer would be acceptable to DRS provided that:acceptable to DRS provided that:           * the consumer and family understand            * the consumer and family understand the the frequency, frequency,           * the consumer is given access to            * the consumer is given access to follow along supports if needed sooner than follow along supports if needed sooner than the next scheduled contact, and the next scheduled contact, and            * the ongoing supports being provided            * the ongoing supports being provided are adequate to meet the client’s needs with are adequate to meet the client’s needs with respect to maintaining employment.respect to maintaining employment.   

LTFA VS POST EMPLOYMENT LTFA VS POST EMPLOYMENT SERVICESSERVICES

• LTFA is the maintenance of a person in LTFA is the maintenance of a person in employment.employment.

• LTFA does not mean case management.LTFA does not mean case management.

• LTESS does not fund training, retraining or LTESS does not fund training, retraining or job placement.job placement.

• If retraining, job placement or other services If retraining, job placement or other services

are needed, the DRS counselor should be are needed, the DRS counselor should be contacted contacted immediatelyimmediately. The consumer . The consumer probably will need services other than LTFA. probably will need services other than LTFA.

ONE LAST REMINDERONE LAST REMINDER LTESS funds vocational support services LTESS funds vocational support services

that are necessary and sufficient for that are necessary and sufficient for consumers to maintain employment. consumers to maintain employment. Case management, independent living or Case management, independent living or other services that are not vocational in other services that are not vocational in nature should not be billed to LTESS nature should not be billed to LTESS funds. Per the Code of Virginia, LTESS funds. Per the Code of Virginia, LTESS funds are not appropriated by the funds are not appropriated by the General Assembly to fund those services. General Assembly to fund those services.

QUESTIONS?????QUESTIONS?????

EES/LTESS BUDGETSEES/LTESS BUDGETSFISCAL YEARS 08-09FISCAL YEARS 08-09

• No new LTESS dollars in FY 08 or No new LTESS dollars in FY 08 or 09 09

• Total LTESS dollars after 3% Total LTESS dollars after 3% reductions in FY 2008 -- reductions in FY 2008 -- $5,184,044$5,184,044

• Total LTESS dollars after Total LTESS dollars after 15%15% reductions in FY 2009 -- reductions in FY 2009 -- $4,406,437$4,406,437

EES/LTESS BUDGETSEES/LTESS BUDGETSFISCAL YEARS 08-09FISCAL YEARS 08-09

• Total EES dollars after Total EES dollars after reductions in FY 2008 -- reductions in FY 2008 -- $3,200,104 -3%$3,200,104 -3%

• Total EES dollars after Total EES dollars after reductions in FY 2009 -- reductions in FY 2009 -- $2,720,088 -15%$2,720,088 -15%

Long Term Employment Long Term Employment Support Services Funding Support Services Funding

95-0895-08

$0

$1,000,000

$2,000,000

$3,000,000

$4,000,000

$5,000,000

$6,000,000

95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09

Extended Employment Extended Employment ServicesServices Funding Funding 95-0895-08

$0

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000

$3,000,000

$3,500,000

95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09

LTESS HISTORYLTESS HISTORY• Grassroots effort by ESOs with General Grassroots effort by ESOs with General

Assembly in FY 94Assembly in FY 94

• Success for FY 95 - $375,000 in State funds Success for FY 95 - $375,000 in State funds with primary target of Supported Employment with primary target of Supported Employment Follow Along for persons with severe disabilitiesFollow Along for persons with severe disabilities

• Incremental increases in past yearsIncremental increases in past years

• Funds have been reduced each year for the last Funds have been reduced each year for the last two years.two years.

EES/LTESS – What’s the EES/LTESS – What’s the difference?difference?

EES FundingEES Funding::- Services provided are onsite employment, enclave Services provided are onsite employment, enclave

and mobile crews – No individual SEand mobile crews – No individual SE- No counselor approvalNo counselor approval- Limited number of ESOs involvedLimited number of ESOs involved- No additional allocations – program not growingNo additional allocations – program not growing

LTESS FundingLTESS Funding::- Full array of services provided including Full array of services provided including individualindividual

supported employmentsupported employment, onsite employment, enclave , onsite employment, enclave and mobile crewand mobile crew

- Counselor must be involvedCounselor must be involved in the approval of in the approval of consumersconsumers

- Double the number of ESOs involved in LTESS fundingDouble the number of ESOs involved in LTESS funding- Concentrated efforts to “grow” the LTESS potConcentrated efforts to “grow” the LTESS pot

Extended Employment Extended Employment Services (EES) - HistoryServices (EES) - History

• First allocated from General Assembly for FY 84 and First allocated from General Assembly for FY 84 and 100% state funds.100% state funds.

• Current allocation is now over $2.7M distributed Current allocation is now over $2.7M distributed across the original 41 vendors providing Extended across the original 41 vendors providing Extended Employment Services to fund long term support to Employment Services to fund long term support to severely disabled consumers.severely disabled consumers.

• No additional funds allocated from the General No additional funds allocated from the General Assembly since 1989.Assembly since 1989.

• Numbers of consumers served have declined over Numbers of consumers served have declined over the years because of no increase in funds.the years because of no increase in funds.

EESEES• Half of ESOs provide community placement – enclaves Half of ESOs provide community placement – enclaves

and/or mobile crews.and/or mobile crews.

• Individuals served primarily have disabilities of MR (66%) Individuals served primarily have disabilities of MR (66%) or SMI (14%).or SMI (14%).

• EES is not restricted to DRS consumers.EES is not restricted to DRS consumers.

• Must be one of the original vendors to receive an EES Must be one of the original vendors to receive an EES allocation. allocation.

• Most recently funding has been lost to reductions.Most recently funding has been lost to reductions.

EESEES• Any consumer is eligible for EES funds as long as they are Any consumer is eligible for EES funds as long as they are

documented as having a severely disability.documented as having a severely disability.

• Counselors do not have to be contacted prior to an EES Counselors do not have to be contacted prior to an EES application.application.

• ESO must provide an integrated setting for a DRS/DBVI ESO must provide an integrated setting for a DRS/DBVI counselor to receive a closure. The counselor may still refer a counselor to receive a closure. The counselor may still refer a consumer to an ESO that is not integrated if that is the best consumer to an ESO that is not integrated if that is the best placement.placement.

• Bottom line is to do what is best for the consumer.Bottom line is to do what is best for the consumer.

• Due to limitations in the EES program, ESO community lobbied Due to limitations in the EES program, ESO community lobbied for additional follow along dollars which would be available to all for additional follow along dollars which would be available to all approved vendors….approved vendors….

LTESS - WHAT IS IT?LTESS - WHAT IS IT?

• LLong ong TTerm erm EEmployment mployment SSupport upport SServiceservices– 100% State dollars appropriated by the 100% State dollars appropriated by the

General Assembly for FY1995General Assembly for FY1995

– Intended as long term funding to support Intended as long term funding to support individuals with severe disabilities in individuals with severe disabilities in accessing and maintaining employmentaccessing and maintaining employment

– Not intended to supplant other funds Not intended to supplant other funds used for the same purpose.used for the same purpose.

LTESS BACKGROUNDLTESS BACKGROUND

• 1994 General Assembly appropriated 1994 General Assembly appropriated $375,000 for FY 95 and 201 $375,000 for FY 95 and 201 consumers were served.consumers were served.

• The LTESS program is currently The LTESS program is currently serving over 2,800 consumers a serving over 2,800 consumers a month in 77 ESOs around the state.month in 77 ESOs around the state.

• Individuals served primarily have Individuals served primarily have disabilities of MR (44%) or SMI (25%).disabilities of MR (44%) or SMI (25%).

LTESS GUIDELINESLTESS GUIDELINES• LTESS funds CANNOT be used to supplant planned or current LTESS funds CANNOT be used to supplant planned or current

funding for long term supports. funding for long term supports.

– If a consumer is being sponsored by a public source, it If a consumer is being sponsored by a public source, it should continueshould continue

- Generally, no split funding for employmentGenerally, no split funding for employment

• Vendors cannot charge DRS more than any other purchasers Vendors cannot charge DRS more than any other purchasers of the same services as specified on the vendor rate sheet. of the same services as specified on the vendor rate sheet.

• Exception: individual, private payException: individual, private pay

• Medicaid rates changed to be the same as DRS rates.Medicaid rates changed to be the same as DRS rates.

LTESS GUIDELINESLTESS GUIDELINES (continued)(continued)

• Individuals who have been sponsored for Individuals who have been sponsored for employment services by public funds must employment services by public funds must wait 12 months to become eligible forwait 12 months to become eligible for LTESS LTESS– A mechanism is established by DRS for A mechanism is established by DRS for

exceptions in the case of hardship.exceptions in the case of hardship.

• LTESS funding is not disability specific! LTESS funding is not disability specific!

• Organizations accepting LTESS funding must Organizations accepting LTESS funding must work with all DRS consumers and not work with all DRS consumers and not discriminate on the basis of disability.discriminate on the basis of disability.

LTESS GUIDELINESLTESS GUIDELINES (continued)(continued) • Services billed through LTESS must be Services billed through LTESS must be

employment related follow-along servicesemployment related follow-along services

– Job development, retraining, referral to DRS tp Job development, retraining, referral to DRS tp reopen the case and general case reopen the case and general case management services are NOT considered management services are NOT considered follow-alongfollow-along

– Provide the services needed to maintain Provide the services needed to maintain employment – not “nice to do” or “always employment – not “nice to do” or “always have done it that way” or “the employer likes have done it that way” or “the employer likes me to come every week”me to come every week”

– Spikes are expected-over 20% of hours Spikes are expected-over 20% of hours worked-send in documentationworked-send in documentation

– Email notification is sent to counselors Email notification is sent to counselors upon submission of LTESS applicationupon submission of LTESS application

LTESS GUIDELINES LTESS GUIDELINES (continued(continued))• As LTESS is the funding of last resort for As LTESS is the funding of last resort for

long term supports, vendors must document long term supports, vendors must document attempts to secure sponsorship and the attempts to secure sponsorship and the absence of alternative funding sources.absence of alternative funding sources.

• Each consumer is required to have an Each consumer is required to have an individualized service plan that is clear, individualized service plan that is clear, complete, and current following CARF complete, and current following CARF guidelines. guidelines.

LTESS GUIDELINES LTESS GUIDELINES (continued)(continued)• Monthly reports (including Monthly reports (including

intervention sheets) should be intervention sheets) should be maintained in the individual maintained in the individual consumer file except:consumer file except:

– if an individual is billed 20% or more if an individual is billed 20% or more of the total hours worked, the vendor of the total hours worked, the vendor must submit justification in the form must submit justification in the form of a monthly progress reportof a monthly progress report

GENERAL INFORMATIONGENERAL INFORMATION• Any consumer with a goal of receiving Supported Any consumer with a goal of receiving Supported

Employment or Extended Employment is a possible Employment or Extended Employment is a possible candidate for LTESS fundingcandidate for LTESS funding– Does Does NOTNOT have to be an open DRS case or a DRS have to be an open DRS case or a DRS

case at allcase at all

• DRS or DBVI counselor approval is required for use DRS or DBVI counselor approval is required for use of all LTESS dollarsof all LTESS dollars– Includes unfunded, on-site extended employmentIncludes unfunded, on-site extended employment– Includes closed DRS SE that may require Includes closed DRS SE that may require

additional follow along to maintain employmentadditional follow along to maintain employment– Includes JCTS if discovered consumer needs Includes JCTS if discovered consumer needs

support to maintain employmentsupport to maintain employment• Collaboration and Communication!!Collaboration and Communication!!

MAJOR LTESS ISSUESMAJOR LTESS ISSUES • Counselor approval must be obtained and Counselor approval must be obtained and documenteddocumented

before applications submitted.before applications submitted.

• Applications must be thoroughly completed.Applications must be thoroughly completed.

• Applications must be submitted by the 20Applications must be submitted by the 20th.th.

• Applications cannot be submitted for consumers Applications cannot be submitted for consumers receiving JCTS. receiving JCTS.

• Applications for consumers in wrong DRS status.Applications for consumers in wrong DRS status.

ALLOCATION ALLOCATION METHODOLOGYMETHODOLOGY

• Allocations are based on a 3-year rolling Allocations are based on a 3-year rolling average of expenditures utilizing a 125% average of expenditures utilizing a 125% rule.rule.

• One bad year will not “hurt” as much if One bad year will not “hurt” as much if averaged with two good years.averaged with two good years.

REALLOCATIONSREALLOCATIONS• DRS reviews expenditure patterns DRS reviews expenditure patterns

throughout the fiscal year and throughout the fiscal year and completes reallocations as needed.completes reallocations as needed.

• Reallocations are based on an Reallocations are based on an individual organization’s statistics-individual organization’s statistics-average hours billed, average average hours billed, average attendance, individual rates, attendance, individual rates, months/days remaining in fiscal months/days remaining in fiscal year.year.

REALLOCATIONS REALLOCATIONS (continued)(continued)

• Vendors need to monitor themselves on a Vendors need to monitor themselves on a monthly basis.monthly basis.

• If a vendor chooses to maintain more If a vendor chooses to maintain more individuals than their allocation can individuals than their allocation can support with hopes of receiving support with hopes of receiving additional dollars, that vendor is additional dollars, that vendor is committing to be responsible for those committing to be responsible for those individuals at the same level of service individuals at the same level of service regardless of future allocationsregardless of future allocations..

General Information for EES/LTESSGeneral Information for EES/LTESS• Vendor discretion as to how to apply their Vendor discretion as to how to apply their

EES/LTESS fundsEES/LTESS funds

– MAY choose to support individuals in SE, MAY choose to support individuals in SE, individual or group models, extended individual or group models, extended employment or a combinationemployment or a combination

– counselors may request certain consumers be counselors may request certain consumers be supported with EES/LTESS, but vendors have supported with EES/LTESS, but vendors have final say following their own policiesfinal say following their own policies

– overextending EES/LTESS funds is riskyoverextending EES/LTESS funds is risky• vendor discretionvendor discretion

• EES/LTESS allocations are public information.EES/LTESS allocations are public information.

THE FUTURETHE FUTURE

• Recommendations were made to Recommendations were made to update the 15+ year old update the 15+ year old computer systemcomputer system

• Web basedWeb based– No paperNo paper– Forms partially filled inForms partially filled in– Errors minimized with edits and Errors minimized with edits and

drop down help boxesdrop down help boxes

THE FUTURETHE FUTURE– Financial data available on demandFinancial data available on demand– Production data available on demandProduction data available on demand– Savings of paper, postage, phone bills Savings of paper, postage, phone bills

(faxes)(faxes)– Secured web site, password protectedSecured web site, password protected– Hipaa compliantHipaa compliantTimeframe – FY 08 Initiated SystemTimeframe – FY 08 Initiated SystemTraining for All in March 2009Training for All in March 2009

FORMSFORMS

• ApplicationsApplications

• ClosuresClosures

• Requisition/InvoicesRequisition/Invoices

Questions?Questions?