INARF
​​Home | login | contact us
  • About Us
    • About Us
    • Board of Directors
    • Staff
    • Corporate Committees
    • Professional Interest Sections
    • Awards & Recognition
  • Membership
    • Member Login
    • Membership
    • Member Benefits & Inquiries
    • Organizational Member Directory
    • Associate Member Directory
    • Member Job Postings
  • Events
    • Upcoming Events
    • INARF 2023 Pre-Conference
  • Professional Development
    • Professional Development
    • INARF DSP Series
    • INARF Leadership Academy
  • Technical Assistance
    • Technical Assistance
    • Resources
  • Governmental Affairs
    • Governmental Affairs
    • INARF PAC
    • Bills Being Watched
    • Statehouse News
    • Take Action Now With VoterVoice!
  • About Us
    • About Us
    • Board of Directors
    • Staff
    • Corporate Committees
    • Professional Interest Sections
    • Awards & Recognition
  • Membership
    • Member Login
    • Membership
    • Member Benefits & Inquiries
    • Organizational Member Directory
    • Associate Member Directory
    • Member Job Postings
  • Events
    • Upcoming Events
    • INARF 2023 Pre-Conference
  • Professional Development
    • Professional Development
    • INARF DSP Series
    • INARF Leadership Academy
  • Technical Assistance
    • Technical Assistance
    • Resources
  • Governmental Affairs
    • Governmental Affairs
    • INARF PAC
    • Bills Being Watched
    • Statehouse News
    • Take Action Now With VoterVoice!

Notice of Vocational Rehabilitation Employment Service Rate Changes

10/23/2014

 
For the original publication, please click here. The following is a text version of the original publication. 
--
To: General Public 
From: Bureau of Rehabilitation Services 
Date: October 23, 2014 

NOTICE OF VOCATIONAL REHABILIATION EMPLOYMENT SERVICE RATE CHANGES 

BACKGROUND and PURPOSE: 
The Bureau of Rehabilitation Services (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 Vocational Rehabilitation (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. 

WORKGROUP DEVELOPMENT: 
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. 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 and employment services are paid at a higher amount. The current rates are as follows:

RBF Milestone 1: Plan for Employment and Supports
Tier 1 Rate: $1080
Tier 2 Rate: $540

RBF Milestone 2: 5th Day of Placement
Tier 1 Rate: $1080
Tier 2 Rate: $810

RBF Milestone 3: Four-Week Placement
Tier 1 Rate: $1667.60
Tier 2 Rate: $1192.50

RBF Milestone 4: Eligibility for Case Closure
Tier 1 Rate: $3600
Tier 2 Rate: $2340

Job Placement Hourly Service Rate: $34.00

PROPOSED HYBRID MODEL: 
The proposed Hybrid Model continues to use three core milestones common for all employment services: 1) Placement, 2) Short-Term Retention (30 days), and 3) Retention (minimum 90 days after consumer is stable). In addition, it has replaced RBF Milestone 1 with specific VR discovery and assessment services that are billed outside of the model 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/assessment for consumers. This allows for customization and flexibility for each consumer based on level of need.
  • Sets 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 consumer to either Tier 1 or Tier 2 often prematurely.1
  • Reduces the incentive to move quickly to a milestone payment too early.
  • Requires more engagement from the VR Counselor to provide appropriate counseling and guidance and to be collaborative with employment specialists and consumers in determining appropriate services.
RATES FOR THE HYBRID MODEL:

Employment Service Activity: Discovery/Assessment Activities
Rate: Activities and costs will vary based on individual need. Standard Hourly Rate: $40.00/hour

Employment Service Activity: Core Employment Milestones: 1) Milestone 1 Placement (5 days)
Rate: $1300

Employment Service Activity: Core Employment Milestone 2 Short-Term Retention (30 days)
Rate: $1500

Employment Service Activity: Core Employment Milestone 3 Retention (90 days post stabilization)
Rate: $1300

Total Employment Milestones = $4100

Employment Service Activity: Supported Employment Services
Rate: Monthly rate based on number of Supported Employment hours.

DISCOVERY/ASSESSMENT: 
The employment services process begins with appropriate Discovery/Assessment. This important step will be individualized based on a consumer’s needs. These services are key in identifying an appropriate employment goal, the nature and scope of services needed to reach the goal, and preparation for the achievement of the goal. The discovery process is individualized and may including a wide range of services, including, but not limited to: 
  • Vocational assessments;
  • Community-Based Work Evaluations (CBEs);
  • Job Shadows;
  • Job Trials or Job Shadows;
  • Review of local job market;
  • Review of work history and transferable skills;
  • Work Experience;
  • Job Readiness activities (i.e., learning appropriate work behaviors);
  • Social skills Training or Soft Skills training; and
  • Other activities to assess unique strength, interests, and abilities
CORE EMPLOYMENT MILESTONES: 
A referral to employment services may occur after the employment goal and nature and scope of services are identified, any applicable preparation or training is completed and individual is ready to begin job development. As mentioned above, the core employment milestones include: 1) placement, 2) Short-Term Retention, and 3) Retention. 

SUPPORTED EMPLOYMENT SERVICES: 
Supported Employment Services (SE), including ongoing support services and other services necessary to support and maintain an individual with a most significant disability (MSD) in supported employment may be provided by VR for up to 18 months (or longer if extenuating circumstances). Stabilization and ongoing support services will no longer be part of the core milestone reimbursement payments; these payments will be funded at a monthly rate based on the number of SE hours provided each month (see table below). An ‘Ongoing Support and Fading Plan’ will be required to outline the specific support needs to be provided. The plan will likely include the information regarding the specific activities/strategies used to increase consumer independence, natural supports that will be explored, goals for fading and achievement of stabilization, identification of extended services needs and options for obtaining extended services, and other relevant information. Fading of employment supports occurs before the identification of stabilization and transition to extended services as appropriate. VR Counselor engagement is important during this process. The ‘Ongoing Support and Fading Plan’ will be updated at regular intervals. 

The total SE costs for each consumer will vary greatly depending on need. 

*Please see Attachment A Supported Employment Model.

SE Hours Per Month: 1-5
Rate:  $176

SE Hours Per Month: 6-10
Rate: $352

SE Hours Per Month: 11-15
Rate: $528

SE Hours Per Month: 16-20
Rate: $720

SE Hours Per Month: 21 - 25
Rate: $920

SE Hours Per Month: 26+
Rate: $1040

OVERALL COSTS: 
The workgroup reviewed sample cases to better understand the cost involved. The costs for Supported Employment cases ranged from $7300 to $9400, with an average per case cost of $8500. 
   o The Discovery costs ranged from $1000 to $2400 per individual. 
   o RBF cost was $4200 
   o SE Services (ongoing support services) ranged from $1700 to $3600 per individual

EMPLOYMENT SERVICES WORKFLOW: 
Below is a step-by-step overview of the employment service process: 
1. Start with Discovery; discovery is necessary for all individuals (SE or non-SE) though specific activities and scope and duration of activities will vary 
2. Determination as to whether the individual is ready to begin job development.
     YES --> referral to employment service core milestones 
     NO  -->what additional discovery is necessary? 
3. Referral to employment services under the Hybrid Model
4. Obtain employment in line with Individualized Plan for Employment (IPE) goal; if employment is not obtained identify whether there are additional job readiness activities necessary 
5. Milestone 1, 5 days Employment is achieved 
6. Milestone 2, 30-days Employment is achieved 
7. For SE cases, an ‘Ongoing Support and Fading Plan’ is developed 
8. After placement, ongoing support services and other appropriate SE services are provided by VR for individuals with MSD, and may continue for up to 18 months. 
9. For SE Cases, the ‘Ongoing Support and Fading Plan’ is reviewed and revised as necessary 
10. Stabilization is achieved (the point in time where the consumer has reached his/her highest level of independence on the job) 
11. Milestone 3, Retention is achieved (individual has maintained employment 90 days, or for SE, 90 days after reaching stabilization) 

NEXT STEPS:

  • Public comments due Friday November 7, 2014 to Theresa.Koleszar@fssa.in.gov
  • Model will be finalized by the end of November 2014.
  • Implementation of the model, including training and cross-training will occur in spring 2015.
  • Model will be implemented by July 1, 2015.
Please note that BRS has supplemented this document with a webinar that can be accessed by clicking this link: http://webinar.isl.in.gov/p5qav4t9wxf/.  

Thank you all for your time in reviewing the proposed model and providing feedback. 
Kylee Hope, Director of BRS
Theresa Koleszar, Director of Program Supports

Comments are closed.

    RSS Feed

    Archives

    September 2022
    August 2022
    July 2022
    June 2022
    May 2022
    April 2022
    March 2022
    February 2022
    January 2022
    December 2021
    November 2021
    October 2021
    September 2021
    August 2021
    July 2021
    June 2021
    May 2021
    April 2021
    March 2021
    February 2021
    January 2021
    December 2020
    November 2020
    October 2020
    September 2020
    August 2020
    July 2020
    June 2020
    May 2020
    April 2020
    March 2020
    February 2020
    January 2020
    December 2019
    November 2019
    October 2019
    September 2019
    July 2019
    June 2019
    May 2019
    April 2019
    March 2019
    February 2019
    January 2019
    December 2018
    November 2018
    October 2018
    September 2018
    August 2018
    July 2018
    June 2018
    May 2018
    April 2018
    March 2018
    February 2018
    January 2018
    December 2017
    November 2017
    October 2017
    September 2017
    August 2017
    July 2017
    June 2017
    May 2017
    April 2017
    March 2017
    February 2017
    January 2017
    December 2016
    November 2016
    October 2016
    September 2016
    August 2016
    July 2016
    June 2016
    May 2016
    April 2016
    March 2016
    February 2016
    January 2016
    December 2015
    November 2015
    October 2015
    September 2015
    August 2015
    July 2015
    June 2015
    May 2015
    April 2015
    March 2015
    February 2015
    January 2015
    December 2014
    November 2014
    October 2014
    September 2014
    August 2014
    July 2014
    June 2014
    May 2014
    April 2014
    March 2014
    February 2014
    January 2014
    December 2013
    November 2013
    October 2013
    September 2013
    August 2013
    July 2013
    June 2013
    May 2013
    April 2013
    March 2013
    February 2013
    January 2013
    January 2011
    September 2009
    December 2007

© Indiana Association of Rehabilitation Facilities, Inc. (INARF)
    615 North Alabama Street, Suite 410, Indianapolis, IN 46204
    (t) 317-634-4957 / (f) 317-634-3221 / Contact us by email
ANCOR Proud Member Small