What goes into determining support hours?

1. What goes into determining support hours? DDD Employment & Day program services

2. Goal of today’s training : • Process overview • Employment program services – Individual Employment (IE), Group Supported Employment (GSE), Prevocational support (PVS) • Community Access (CA) program services • Review the Rules – WAC revision • Employment rules effective September 1, 2012 • Change in language – In Training / Job Development • Community Access rules effective September 1, 2012 • Review the Assessment Process: • Communication • People • Case Resource Manager • County Staff • Client • Employment / Day Provider • System • Paperwork

3. Employment - IE,GSE,PVS Day - CA Process overview: • Rule- WAC 388-828-9325 through 9360 • DDD Assessment • Receive provider input • Client input • Acuity- WAC 388-828-9200 through 9280 • Develop ISP • Service Level • Classification auto populate in ISP • Employment Calculator • Employment Status These items are new – effective in Jan.: • Historical staff hours / site hours/ client paid hours (Highest , lowest and average number of hours) • County Service Authorization (CSA) / Maximum authorized hours • Communication of Service Level • Rule- WAC 388-828-9300 and 9310 • DDD Assessment • Receive provider input • Client input • Acuity - WAC 388-828-4165 through 4440 • Develop ISP • Service Level • Classification and hours auto populate in ISP

4. The RulesDSHS internet http://www.dshs.wa.gov./ddd/rules.shtml

5. Employment WAChttp://www.dshs.wa.gov/ddd/rules.shtml

6. Client Employment support hours WAC 388‑828‑9325 DDD determines the number of hours the client may receive for employment services by using the following information: • The employment support level (acuity) as described in WAC 388‑828‑9205; • The employment status described in WAC 388‑828‑9330; • The employment service type (IE, GSE and PVS); • The individual meets one of the conditions identified: • As described in WAC 388‑828‑9345 (fewer hours); or • As described in WAC 388‑828‑9350 (add‑on hours).

7. Employment statusWAC388‑828‑9330 DDD determines the client employment status to be: (1) "Working" when one of the following conditions are met: (a) In the past twelve months prior to the DDD assessment: (i) Client has been employed for nine consecutive months; and (ii) Earned at least minimum wage. or (b) Client is self‑employed (2) "In Training / Job Development"when you do not meet any of the conditions for "working."

8. Employment/ HCBS Waiver limits WAC 388-828-9335 and 9355

9. Reason for client to be authorized fewerhours- WAC 388‑828‑9345  The following factors detailed in your client’s employment plan: (1) Independent in finding and maintaining employment; (2) Employment is stable; (3) Natural supports are effective; (4) Job schedule does not require the full amount of support hours; (5) Client chooses to receive fewer hours; or (6) Other factors identified in the client’s employment plan.

10. Reasons for add-on hours - WAC 388‑828‑9350   The following factors detailed in the client’s employment plan: (1) Client’s work schedule; (2) The number of jobs; (3) The appropriateness of job match; (4) Natural supports available to on the job; (5) Health limitations; (6) Provider travel time and distance; (7) Behavioral or physical needs that may affect the safety of the person and others while at work; (8) Other factors detailed in your employment plan.

11. Employment/ HCBS Waiver limits WAC 388-828-9335 and 9355

12. Community Access – WAC’shttp://www.dshs.wa.gov/ddd/rules.shtml

13. Community Access WAC 388-828-9310 Based on Support Intensity Scale - percentile range/ band per level and support hours:

14. Assessment Process

15. Sources of Information & Communication

16. Activities : Client • Determines who attends their assessment • Participates in the DDD assessment • Provides input to their employment plan • Receives progress information / reports

17. Activities - Prior to Assessment: Case Manager Provider Make sure client’s employment plan is up to date. Review the support hours provided to the client during the pass months (year). Determine the amount of client support you are proposing. Ensure CRM has been provided with the most recent copy of client’s employment. plan/progress report or bring to assessment. Consider having a conversation with your County regarding client’s future support needs. • Provide notification to employment provider (minimum 2 weeks) prior to assessment date. • Review client’s employment plan and goals. • Use Employment Calculator to review data regarding: • Working status These items are new – effective in Jan.: • Historical hours of support: • staff hours/site hours • client paid hours • Highest number • Lowest number, and • Average hours • County Service Authorization (CSA) / Maximum authorized hours

18. EmploymentCalculator Enhancements:

19. Employment Calculator Enhancements:

20. Basic Elements of an Employment Plan • Client’s Employment plan must identify the following: • Their employment goal; • Their preferred job type they wish to obtain or maintain; • The wages and/or salary they wish to earn; • The number of hours they prefer to work; • Their preferred work shift; • Their skills, gifts, interests and preferred activities; • Measurable strategies (action steps and supports) to meet their employment goal. • Identification of persons and/or entities (such as family, Division of Vocational Rehabilitation) available to assist the client in reaching their employment goal. • Identification of other accommodations, adaptive equipment and/or supports critical to achieve employment goal.

21. Employment Plan should also include: • Indicate plan type: • Initial Plan, or • Plan update, or • Progress report; • The Plan date; • Client information: Name, ADSA ID; • Provider contact information including: • Provider Name, • Phone number, and • Staff person; • Authorized hours / maximum number of monthly support hours. Blank plans & instructions are located: http://www.dshs.wa.gov/ddd/counties.shtml

22. Activities: Counties • Ensure providers are completing and submitting employment plan(s) in a timely manner; • Ensure the providers Individualized plan meet minimum criteria; • Monitor that providers are providing services as indicated in client’s employment plan(s);

23. Activities - at the Assessment: Case Manager Provider Be prepare to talk about individual’s employment support needs. Discuss changes and/or continued support needs for client including: Movement towards employment goals (is the person stuck); Changes in job or job supports; Health limitations; Behavioral or physical needs that affect safety; Provider travel time or distance; Other items identified in client’s employment plan. • Conduct the DDD assessment • Complete the standardized Support Assessment = Support Intensity Scale (SIS) • Complete the Service Level Assessment • Use comment box to provide client specific details provided during the assessment. • If provider does not attend assessment, contact them to gain additional information regarding employment support needs

24. Developing Individual Support Plan (ISP) • CRM plan for the employment services, (IE, GSE, PVS), or • CRM plan for Community Access (CA) • Once, the service has been added in the client’s Individual Support Plan (ISP), the CARE system will automatically run the algorithm and display the client’s support level (shown on the next page). Please note: • For Employment services additional steps are required once the service level is identified to determine the number of hours the client is eligible for. • For Community access no additional steps are required to determine hours.

25. Individual Support Plan – Employment example

26. Individual Support Plan –Community Access Example

27. Next steps to determining the number of employment support hours • CRM will use the following information: • DDD assessment identifies needs of the individual (which includes providers input); • ISP identifies the client’s acuity; • Client’s Employment Plan identifies individuals goals and progress; • Employment calculator identifies: • Employment status • Pattern of employment support utilization; and • All of the items above are used to determine if client needs: • Add-on hours; • Short term support; or • ETR.

28. Communication Required • If the proposed employment support hours are not support by the documentation (the DDD assessment, employment plan, work history and WAC) then CRM is required to contact provider to come to agreement on employment support hours. • Once communication occurs: • CRM will initiate if necessary: • Prior Approval for agreed upon number of Short-term support; or • Exception to Rule request

29. Visio handout

30. Employment Calculator Enter information: • Assessment date • Acuity information from assessment • Work history - automatically populates • Service level - automatically populates • Employment support hours needed • CRM will assess if hours are within rule (based on information provided) and require: • Fewer hours • Add-on hours • Short-term hours (approval date required) • Exception to Rule (approval date required) Long-term hours • NOTE for GSE & PVS the monthly (Base) hours are adequate. For Add-on hours IN GSE & PVS talk with DDD County liaison.

31. Finalization/Communication Client Hours • CRM finalizes Employment calculator with all hours identified: • Add-on; • Short-term supports; or • Exception to Rule • Once calculator is finalized an automated e-mail will go to the county, • CRM will wait 3 business days for county response • If county agrees or there is no response, then complete ISP with hours identified in the employment calculator. • If county disagrees, then continue with conversation until hours are agreed upon. Revise employment calculator if needed complete ISP.

33. Associated processes County Service Authorization (CSA) • Communication from CRM and/or Employment calculator copy automatically sent via email to County • County updates CSA planned rates tab - maximum hours per month not to exceed amount indicated in the client’s Individual Support Plan (ISP) • CRM entered effective date on CSA – planned rates tab

34. County’s AWA system

37. Counties see Comment box:

38. Support changes –other than at Assessment timeWHAT TO DO? Provider must communicate to CRM as soon as possible (ASAP) if the client’s ISP hours do not continue to meet the client’s employment support needs or if the client has a change in program. Justification information must include: • Employment support hours change – proposed effective date and the proposed maximum number of hours and the current maximum number of hours • Employment change: • New Job including - employer name, start date, work schedule, hourly wage and job description; or • Current Job change – description of change (example - new task, job at risk, change in supervisor, etc.) start date of change OR job end date • Program change (IE, GSE, PVS) - current versus proposed;

40. What are short-term employment supports WAC 388-828-9360 • Additional service hours - above the base hours and add-on hours (base + add-on = maximum support hours) are to support a client with: • A new job; • A job change; or • Individualized technical assistance ( A third party to help a person who is stuck) • Short-term support is provided for a three month period of time that has been: • Recommended and supported by both the employment provider and County; and • Is identified as a need in the current employment work plan.

41. CRM Short-Term support process • Choose Prior Approval Type: • Prevocational Services – Emergency Assistance • Individual Employment – Emergency Assistance • Group Supported Employment - Emergency Assistance • Enter Information: • Start Date • End Date • Rate = the number of Short-Term hours requesting • Unit = Hour • Quantity = 3 or less (months) • Request Description • Justification for Request • Alternative explored • Provider Actions • Follow regional review process • Route to HQ

42. Short-Term support information - example • Request Description: The client’s high support level allows for 26 hrs./mo. Jerry will need an additional 14 hrs./mo. in his new job at the City of Olympia to support him in this 10 Hr./wk. job as a receptionist. • Justification for Request: Jerry needs support to continue to learn the new job tasks and to get a routine system down. The goal over the next three months is to help Jerry to be more independent as he masters each job task. • Alternative Explored: DVR was initially utilized. Provider is working to identify and build on natural supports.

43. Document Short-term support in Comment Box

44. Documentation of ITA Short-term support

45. Exception to Rule (ETR) process • Choose correct ETR Type – note label changes will occur for the following: Current label: • Waiver County Services– Exceed B/B+ employment up to $19,691 New label: • Waiver County Services – Exceed employment hour limit • Enter Information: • Date Range = Plan Period or enter Start Date & End Date • Hours = the number of ETR hours requesting • Unit – choose Month • Quantity = number of months • Request Description • Justification for Request • Alternative explored • Follow regional review process • Route to HQ

46. ETR example information • Request Description: Jerry’s high support level allows for 23 hrs./month. ABC Supporter is asking for 50 hrs./mo. of support for the plan period. • Justification for Request: Jerry has worked for Costco 4 years. Her employer requires 1:1 support to maintain safety. Jerry works 11 hrs./week M, W, F 12 – 2:30pm. ABC-S continues to work on travel training to and from Jerry’s work as she is resistive to getting on the bus as she has gotten lost several times. Approximately 1-2 hrs./month are spent on record keeping. • Alternative Explored: ABC-S has tried several prompting systems to address travel to work with no success to date.

47. Document ETRin Comment Box

48. The Tool Box • County Website on DDD intranet http://www.dshs.wa.gov/ddd/counties.shtml • Employment calculator (DDD SharePoint – right side of page) http://adsashare.dshs.wa.gov/DDD/default.aspx • ADSA reporting 0019 DDD Day Program Billing By Client • County Service Authorization – Planned Rates tab • DDD Assessment • Washington Administrative Code (WAC) http://www.dshs.wa.gov/ddd/rules.shtml • Employment Program Changes What to do now 2012? Power Point presentation (DDD SharePoint/Employment and Day Program Service/Training Materials)

49. Contacts • Branda Matson –Employment and Day Program manager Branda.Matson@dshs.wa.gov • Kris Pederson- Waiver Program manager Kris.Pederson@dshs.wa.gov • Region support: • R1 Diane Malmoe 509-329-2903 malmodr@dshs.wa.gov • R2 Rod Duncan 360-416-7268 DuncaRA@dshs.wa.gov • R3 Beth Krehbiel 360-725-4304 feebc@dshs.wa.gov • County Coordinator – for your County http://www.dshs.wa.gov/ddd/counties.shtml(bottom of page - see County Coordinators Contract List – link)