For the original publication, please click here. The following is a text version of the original publication.
To: General Public
Re: Final Vocational Rehabilitation Employment Services Rate Changes From: Kylee Hope, Director, Bureau of Rehabilitation Services
Date: January, 27, 2014
The Bureau of Rehabilitation Services (BRS) appreciates the public’s review and feedback of the proposed employment service model for Vocational Rehabilitation (VR). Based on the public comments received, the BRS adjusted the hourly rate, expanded the supported employment payment points, and provided additional clarification with respect to employment services.
BACKGROUND and PURPOSE:
BRS secures employment services through approved and accredited Community Rehabilitation Providers (CRP). In 2006, BRS fully implemented Results Based Funding (RBF) using a two-tiered consumer model. The majority of employment services provided by the CRPs are done through milestone payments, including completing an employment plan, five days after placement, four weeks after placement, and at case closure. While the RBF model has some effective components and incentivizes outcomes, there are some challenges that have developed over the years. The “one-size fits all” approach has presented unintended consequences that BRS has recognized and will attempt to address with the newly proposed Hybrid Model.
Upon review of the current RBF Model, BRS has identified several key areas that need to be addressed in the new model:
- A need to ensure that a full menu of VR services are options for consumers;
- A need to determine services on an individualized basis;
- A need to increase consumer access to assessment/discovery activities;
- A need to better serve individuals with the most significant disability (MSD), specifically through increased access to supported employment services;
- A need to improve the VR Counselor engagement in the employment service process to increase collaboration between consumer, VR, and employment consultant; and
- A need to determine appropriate rates to ensure reimbursement is appropriate for CRPs.
The purpose of the new model is to address the unintended consequences of the current model by adding flexibility into employment services, eliminating barriers for individuals with the most significant disabilities to receive appropriate services, and to ensure that employment plans are tailored to the unique needs of each consumer served. BRS is attempting to move employment services from a system-centric approach to a more consumer-centric approach.
BRS recognized the need for stakeholder input and asked INARF to create a workgroup to assist in the development of a new employment service model. The workgroup consisted of membership from CRPs (including Community Mental Health Centers), INARF, Indiana Institute on Disability and Community, and the Division of Disability and Rehabilitative Services (DDRS). In designing the new model, BRS and the workgroup reviewed Indiana’s VR data (fiscal and performance data), other state models, various CRPs’ data, and most importantly consumer needs. In addition, the workgroup worked from a core set of values and principles which included the following:
- Serve persons with varying disabilities, including those with the most significant disabilities;
- Focus on career pathways and development;
- System is individualized, strength-based, and flexible;
- System is responsive at the point of service delivery;
- An unsuccessful outcome does not necessarily result in elimination from services;
- Discovery process directs the employment path/plan/outcome;
- Promote economic self-sufficiency;
- Emphasize participation of the individual’s support network; and
- Recognize the need to support long-term employment outcomes.
In addition, the workgroup recognized the proposed employment service model should accomplish the following:
- Be responsive to all, including individuals with high support needs as well as consumers with minimal support needs;
- Refocus on discovery, especially for individuals with minimal/no prior work experience;
- Ensure that individuals with the most significant disabilities have access to adequate ongoing support services;
- Individuals should reach stabilization, or their highest level of independence, prior to VR case closure;
- Retain a system that focuses on outcomes, but also recognizes quality and individualization;
- Retain a system that is not difficult to administer; and
- Aim to improve the consumer experience.
CURRENT RBF MODEL:
The current model requires the VR Counselor to determine whether a consumer is considered a “Tier 1” or “Tier 2” consumer prior to the start of his/her employment services. Tier 1 individuals consist of those individuals with the most significant disabilities who are likely to need ongoing, intensive intervention to get and keep a job. The current rates for both Tier 1 and Tier 2 are as follows:
Job Placement and Supported Employment hourly services are currently paid at a rate = $34.00/hour.
PROPOSED HYBRID MODEL:
The proposed Hybrid Model continues to use three core milestones common for all employment services: 1) Placement, 2) Short-Term Retention (4 Weeks), and 3) Retention (minimum 90 days after consumer has achieved stabilization). In addition it has replaced RBF Milestone 1, Plan for Employment Supports, with specific VR discovery services and activities, billed outside of and in addition to the milestones to address consumer’s individualized needs. The Hybrid Model also increases access to appropriate supported employment services, including ongoing support services. The following are identified strengths with the Hybrid model:
- Re-emphasizes the importance of discovery for VR consumers. This allows for customization and flexibility for each consumer based on level of need.
- Sets a specific payment structure for Supported Employment Services by moving these services outside of the milestone payments. This again allows for customization and flexibility for each consumer based on the level of need. This idea provides for better assurance that fading occurs and that individuals with the most significant disabilities reach true stabilization before their case is closed.
- Moves to a 1-tiered approach and eliminates the confusion with assigning consumers to either Tier 1 or Tier 2 often prematurely.(Footnote 1)
- Reduces the incentive to move quickly to a milestone payment too early (i.e. movement to stabilization and retention before consumer has truly achieved stabilization).
- Requires more engagement from the VR Counselor to provide appropriate counseling and guidance and to collaborate with employment specialists and consumers in determining appropriate services.
FINAL RATES FOR THE HYBRID MODEL:
EMPLOYMENT SERVICES WORKFLOW:
*TENTATIVE* IMPLEMENTATION TIMELINE
Footnote 1: It is important to note that VR Counselors are still required to make severity determinations.