NC Department of Health and Human Services

1. NC Department of Health and Human Services Individual Placement and Support (IPS) Revised Service Definition Training Tara Alley MA, CESP Stacy A. Smith, LPC-S, NCC, LCAS April 25, 2019

2. Session Objectives • Identify key points from IPS stakeholder discussion groups that influenced the service definition revisions • Review changes made to the IPS service definition • Review future state/plans for IPS in Medicaid transformation

4. Some of the questions we asked…. • What would help IPS staff provide higher quality IPS services? • What is challenging about providing IPS? • What is going well with providing IPS? • What are some areas you feel you need training in?

5. Some feedback we received… • Tailoring to meet an individual’s needs in the moment helps people find employment • Paperwork is a burden • Teams were covering too much geographically • Need to increase exposure to employers to increase job types • Talking to a benefits counselor was beneficial

6. Some more feedback • Follow along supports are very helpful • Would like to cross walk authorizations between the LME-MCO and DVR • Authorizations can be difficult • Zero exclusion can be hard to do when there is no funding to support it • Behavioral health treatment team meetings are helpful but it can be difficult to get everyone in one place

7. Changes to the current service definition Collaboration with Vocational Rehabilitation All IPS providers are required to apply to become a DVR vendor, and actively collaborate with DVR in areas including but not limited to: referrals, shared clients, benefits counseling, shared outcomes, and access to funding.

8. Staffing Requirements • SOURCE: For the Team Lead, it is recommended rather than required to have at least 6 months of vocational experience and/or be a CESP. The team can serve no more than 210 individuals (8 ESP’s with caseloads of 25 each and a team lead with a caseload of 10). This is a change from when the team could serve no more than 200 individuals.

9. Staffing Requirements For the ESP, they can be certified in Individual Placement and Support (CIPS) through the IPS Employment Center.

10. Staffing Requirements Introduction of the Program Assistant 0.5 FTE Program Assistant to support the IPS team who has a minimum education of a HS/GED and who preferably has been employed in any capacity in the past.

11. Staffing Requirements Optional Work Incentive Benefits Counselor 0.3 FTE Benefits Counselor to support the IPS team who is a Certified Work Incentives Counselor (CWIC) or a credentialed Work Incentives Planner (WIP), who has a minimum of a HS/GED and who preferably has been employed in any capacity in the past.

12. Current Rates

13. Proposed Rates after adding 0.5 FTE Program Assistant

14. Proposed Rates after adding 0.3 FTE Benefits Counselor

15. Staff Responsibilities No changes with the Team Lead ESP: added teaching psychiatric rehabilitation skills to promote independent living EPM: changes include that EPMs do not function as an extension of ESP and/or case managers. Revised responsibilities to focus on wellness management.

16. Staffing Responsibilities Program Assistant The Program Assistant shall provide a full range of supports to the team, including but not limited to: • Organizing, coordinating, and monitoring all administrative operations of the team; • Record management; • Entering and tracking team performance beneficiary outcome data;

17. Staff Responsibilities Program Assistant cont. • Running reports; • Receiving calls and responding to referral sources; • Managing authorization requests; • Assisting with organizational record-keeping; • Managing human resources and continuing education files for ESPs; and • Scheduling activities.

18. Staffing Responsibilities Benefits Counselor • Work Incentive Benefits Analysis Services (WIBAS)is a service designed to inform the individual (and guardian, payee representative, and/or natural support) of the multiple pathways to ensuring individualized competitive and integrated employment or self-employment which results in economic self-sufficiency (net financial benefit) through the use of various work incentives.

19. Staffing Responsibilities- Benefits Counselor • Services are face-to-face, individualized, and are provided as the person needs and requests the interventions (i.e., daily, weekly, monthly, etc.). Individuals providing work incentive and benefits counseling must:

20. Staffing Responsibilities- Benefits Counselor • Possess a thorough understanding of all eligibility requirements (including local requirements), processes, and rules for all types of benefits, including, SSI/SSDI, Food Stamps, Veteran’s benefits, housing subsidies, etc. • Have the ability to complete benefits calculations. • Have knowledge of work incentives (how they work, how they are calculated, etc.).

21. Staffing Responsibilities- Benefits Counselor • Understand how to access work incentives (i.e., 1916b, Subsidies, IRWEs, PASS, etc.). • Possess the ability to develop IRWEs, Subsidies, Special Conditions, and PASS with individuals. • Gather and report accurate information about the individual’s benefits.

22. Staffing Responsibilities- Benefits Counselor • Support the individual to develop a better understanding in regard to the questions and concerns he/she has around his/her benefits and working. • As appropriate, help the individual develop a plan to maximize his/her earning potential, report his/her earnings, and navigate the benefit systems he/she is involved in or seeks to gain involvement in. • Provide the individual with a report explaining the results, including any changes to his/her benefits, of the work incentive benefit analysis.

23. Staffing Responsibilities- Benefits Counselor • Provide the individual a list of work incentives available to him/her (as applicable). • As appropriate, support the individual to access the work incentive he/she wants to use. • Create a Work Incentive Benefits Analysis and/or amend a Work Incentive Benefits Analysis in the event of the individual seeking changes in his/her income.

24. Training and Certification Requirements New training available for EPMs through UNC Springboard • Vocational Illness recovery Management (VIMR) (this is recommended not required) New training for Team Leads through UNC Springboard • Supervising NC Certified Peer Support Specialists (this is required)

25. Quarterly Outcome Tracking Quarterly Outcome Tracking Form. This is due quarterly (calendar year) on the 10th day of the following month i.e. the quarter July-Sept. is due October 10th.

26. Fidelity Evaluation

27. Fidelity Evaluation DMH/DD/SAS published Joint Communication Bulletin #J235 on February 14, 2017 provided guidance on the timeline and an option to contest up to 3 items by submitting supporting documentation.

28. Fidelity Evaluation One out of the four criteria for a re-evaluation has changed. In order to be eligible for a re-evaluation the score on the fidelity evaluation must be between a 65 and 73. *To note, all criteria must be in place at the time of the fidelity evaluation where the score fell below 74.

29. Service Type and Setting IPS staff should spend 65% or more of total scheduled work hours in the community (as opposed to 75% in the previous definition).

30. Program Requirements Face-to-face vocational unit meetings are preferable but accommodations for staff may be made by using a HIPPA compliant video teleconference/webinar if an ESP/EMP is located more than 30 miles from the main office to ensure they can consistently attend the team meeting. The long distance ESP/EPM must attend the meeting face-to-face at least monthly.

31. Program Requirements The behavioral health treatment team meeting is hosted by the behavioral health team. Guidance is provided in the Employment Behavioral health Team policy published November 25, 2017.

32. Eligibility Criteria The individual is working age 16+ (as opposed to 18+).

33. Utilization Management State funds shall not cover the following under IPS activities, and these activities may not be billed or considered the activity for which the IPS unit is billed: a) Services provided to teach academic subjects or as a substitute for educational personnel, including a: teacher, teacher’s aide, or an academic tutor; b) Pre-vocational classes; c) Supports and/or services to help individuals with volunteering;

34. Utilization Management d) Set-aside jobs for people with disabilities, such as enclaves; e) Group employment/work crews; f) Transitional employment; g) Group employment searches or classes; • Habilitative services for the adult to acquire, retain, and improve the self-help, socialization, and adaptive skills necessary to reside successfully in community settings;

35. Utilization Management i) Non-employment related transportation for the individual or family; j) Any services provided to family, friends, or natural supports of the individual receiving IPS to address problems NOT directly related to the individual’s issues and not listed on the Person-Centered Plan and/or Employment Plan; k) Clinical and administrative supervision of staff; or l) Time spent in meetings where the eligible individual is not present.

36. Utilization Management If an eligible individual is a shared case between DMH/DD/SAS and DVR, State funds will only reimburse for services not covered in a DVR milestone.

37. Utilization Management • For example, if an individual is working towards IPS Milestone 1- Job Development with Retention, State funds would not cover services related to consumer specific job development and placement, and time spent analyzing information relevant to a consumer’s job development and placement. State funds would reimburse for completion of the Intake and Career Profile (when working directly with the individual), and services provided by the Employment Peer Mentor.

38. Service Exclusions and Limitations • Service can only be billed when providing direct service to the individual, and cannot be billed for meetings, paperwork, documentation, or travel time.

39. IPS and Medicaid Transformation

40. IPS and Medicaid Transformation • AmeriHealth Caritas NC, Inc. • BCBS NC • Carolina Complete Health, Inc. • UnitedHealthcare of NC, Inc. • Wellcare of NC, Inc. • Standard Plans • Tailored Plans • Request for Proposals will be posting • Session Law requires that for the first four years of Tailored Plan implementation, Tailored Plan vendors must be LME-MCOs

41. IPS and Medicaid Transformation • Inpatient BH • Outpatient BH emergency room services • Outpatient BH services • Partial hospitalization • Mobile crisis management • Facility Based Crisis • Professional treatment services in facility-based crisis program • Peer supports • Outpatient opioid treatment • Ambulatory detoxification • Standard Plan and Tailored Plan Services • SA comprehensive outpatient treatment program (SACOT) • SA intensive outpatient program (SAIOP) • Social setting detoxification services • Research-based intensive behavioral health treatment • Diagnostic assessment • EPSDT • Non-hospital medical detox • ADATC treatment

42. IPS and Medicaid Transformation • Residential treatment facility services for children • Child/adolescent day tx. services • Intensive in-home services • MST • Psychiatric residential treatment facilities • ACT • CST • PSR • SA non-medical community residential treatment • Tailored plan ONLY services • SA Medically monitored residential tx. • Clinically managed low-intensity residential tx. services • Clinically managed population-specific high-intensity residential programs • ICF/IDD • Innovations waiver services • TBI waiver services • 1915 (b)(3) waiver services • State-funded BH and I/DD services • State-funded TBI services

43. What does this mean? • If a person is in a Standard Plan, they will not be eligible to receive IPS services, as it’s not a service covered by the Standard Plan

44. IPS and Medicaid Transformation • Tailored Plan Eligibility and Enrollment https://files.nc.gov/ncdhhs/BH-IDD-TP-FinalPolicyGuidance-Final-20190318.pdf • Proposed Program Design https://www.ncdhhs.gov/assistance/medicaid-transformation/proposed-program-design

45. Contact information • Tara Alley Tara.Alley@dhhs.nc.gov • Stacy A. Smith stacy.smith@dhhs.nc.gov