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Chapter 4: lrs technical assistance & guidanceCHAPTER 5, VENDORS
Federal Register, Volume 66, Department of Education, 34 CFR 361, Part VI, State Vocational
Rehabilitation Services Program, §361.48,361.50,361.51
Supported employment means competitive employment in an integrated setting with on-going support services for individuals with the most severe disabilities for whom competitive employment has not been traditionally available or for whom competitive employment has been interrupted or intermittent as a result of a severe disability; and who because of the nature and severity of their disabilities need intensive supported employment and extended services indefinitely in order to safely and independently perform essential job duties. Supported employment services are designed to provide community-based employment for LRS Consumers who are the most significantly disabled (Order of Selection Groups I and II) and require on-going support and extended services to maintain employment. Supported employment significantly expands the options available for persons with the most significant disabilities to achieve and maintain integrated, competitive employment in the community. Supported employment requires the ongoing services of other organizations or natural supports such as co-workers, family, friends, etc. and ongoing extended services when LRS services end. Therefore, it is important to consider and include the participation of other individuals and organizations beginning in the planning process. *The CRP must contact the consumer within 1-week of receiving the consumer’s referral documentation.** COMMUNITY-BASED SUPPORTED EMPLOYMENT ASSESSMENT AND
All Group Models for supported employment services follow the Supported Employment
Community-based Assessment and Narrative Report forms. CRP must provide counselor
with a copy of the Employment Assessment with Activities Form attached (SE1 & SE1 A).
All quality indicators for the supported employment assessment must be met for payment to
be authorized. After receipt of the assessment report, and prior to the development of the
IPE, a staffing must be held with the counselor, vendor and LRS counselor for Job Placement
SUPPORTED EMPLOYMENT MILESTONE OUTCOME PAYMENT SYSTEM
The Milestone Outcome Payment System is an outcome based payment system that allows
for greater flexibility by CRP’s by freeing them from hourly billing constraints and creates
financial incentives by encouraging the use of natural supports.
1. A “Milestone” is defined as the completion of a “step” in the supported employment process in assisting a Consumer to become competitively employed. *Milestone 1 Job Development / Placement Services Milestone 2 Job Stabilization / Transition to Follow-along 2. The CRP must receive prior written authorization (Individualized Plan for Employment (IPE) and/or AWARE Draft authorization, as appropriate) by the Counselor in order to provide the supported employment services. 3. The CRP receives payment after the Counselor receives documentation that services were delivered and completed, as per the LRS Supported Employment Guidelines and Quality Indicators for each Milestone. *(Counselor should refer to Chapter 4, Section 412.14)** 4. Each individual Milestone Payment can only be paid once the CRP providing the supported employment services to the Consumer, even if the Consumer loses a job after the completion of a Milestone and continues to receive services with that same CRP. 5. If the Consumer chooses a new CRP, then the Milestone the Consumer will begin at will be negotiated between the Counselor and the new CRP. In such situations, to start over at, the Supported Employment Community-based Assessment and Narrative Report, approval must be obtained from the Regional Manager. Work by the Consumer is considered cumulative during the span of each Milestone. If a Consumer loses a job, LRS will revert to the Milestone where the Consumer lost their job, and payment is authorized after the completion of that Milestone. Example: if the Consumer is at Milestone 2 (One - Month Job Retention), and works for three weeks and then loses a job, payment would not be made for Milestone 2 until the Consumer completes one week of employment on a new job (three weeks of employment on the first job plus one week of employment on the second job to equal a total of four weeks of employment, or the achievement of Milestone 2). NOTE: Additional fees for subsequent placements are not applicable in the Milestone
Outcomes Payment System. If a Consumer loses a job and is placed on another one, the
CRP will only be eligible for payments resulting from the milestones the Consumer has
not yet achieved, as noted above.
SUPPORTED EMPLOYMENT PLACEMENT MODELS
All group models for supported employment services follow the same assessment procedures
and payment as noted in the Individual Placement Model and the Milestone Outcome
Payment System for Supported Employment Services. Refer to Chapter 4, Section 412.14,
items V-XI, for the provisions for service delivery, quality indicators, and counselor responsibilities. A Group Model employment setting must comply with the definitions for supported employment as outlined in Chapter 4, Section 412.14, and includes: integrated setting, competitive employment, commensurate wages, on-going support and extended services. A. INDIVIDUAL PLACEMENT MODEL – A supported employment placement
Strategy, in which an employment specialist assists the individual with competitive employment by matching the unique abilities of the individual with unmet employer needs. A job coach then provides training and support and facilitates the use of natural supports (on-site and off-site) and then gradually reduces time and assistance. Supported Employment Milestone System for Individual Placement Model:
NOTE: CRP must complete the job match analysis prior to employment.
Documentation from the CRP must include:
Job Development activities reflect efforts to assure a good job match. (SE2) MILESTONE 1
That a job match analysis was completed before employment begins and *$1,000**
based upon assessment, reflects Plan Goal. (SE2A) *Documentation that the job coach accompanied the consumer to the employment A description of the consumer’s job duties; work hours and rate of pay. That the consumer has *maintained employment for seven (7) days** and reports satisfaction with the job to vendor. All Quality Indicators for this milestone must be met for payment to be That the consumer completed one (1) month of employment (as per check MILESTONE 2
stubs or other documentation) employment is cumulative but does not have
*$1,200** to be consecutive or on the same job with documented reason.
*Verification that job coaching was provided by the vendor on the job site (SE4).** That effective on and off site job supports and/or consultation to assist the consumer in adjusting to the demands of the integrated work environment, All Quality Indicators for this milestone must be met for payment to be That the consumer completed a minimum of 60-days of employment (as per *MILESTONE 3
check stubs or other documentation) employment is cumulative but does not
have to be consecutive or on the same job with documented reason.
*Verification that job coaching was provided by the vendor on the job site (SE4).** That the consumer is working the maximum number of hours they can as a That effective on and off site job supports and/or consultation to assist the consumer in adjusting to the demands of the integrated work environment were provided, and now only minimal support is necessary for the consumer *The Natural Supports Training Plan for on / off site long-term job supports / follow- along and / or consultation to be provided must be specified (SE5).** All Quality Indicators for this milestone must be met for payment to be That the consumer is working the maximum number of hours they can as a *MILESTONE 4
result of their disability as per check stubs or other documentation. *$2,826**
That the consumer has been satisfactorily employed for a minimum of 90 That effective on and off site job supports and/or consultation to assist the consumer in adjusting to the demands of the integrated work environment were provided, and now only minimal support is necessary for the consumer That minimal effective on and off site job supports and/or consultation were needed and provided in order for the consumer to maintain employment. Quality Indicators for this milestone must be met for payment to be MOBILE CREW PLACEMENT MODEL - A group of eight (8) or fewer workers with
disabilities who perform work in a variety of locations under the supervision of a job coach who
supervises the crew. These locations must be in an integrated setting. The mobile crew should
provide the workers with enough jobs that they have previously mastered in order to maximize
wages and productivity, increase the likelihood of individual choice in job selection and to have
workers continue to learn new jobs that will increase their marketable skills.
C. ENCLAVE PLACEMENT MODEL - An employment situation in competitive
employment in which a group of eight (8) or fewer workers with disabilities are working at a particular work setting. The disabled workers may be disbursed throughout the company among non-disabled workers or congregated as a group in one part of the business. The supervisor for the enclave is responsible for securing work assignments for the enclave from the employer, organizing the work to help enable job performance, training and supervising employees, managing workflow, and supporting the integration of enclave employees with other company employees. D. TRANSITIONAL EMPLOYMENT PLACEMENT MODEL for Individuals with
Chronic Mental Illness (CMI): This is a type of supported employment that is a series of time- limited positions in integrated settings to prepare individuals with chronic mental illness for permanent employment. On-going support services, including sequential job placement, are provided in order to gain confidence, interpersonal skills, and job references needed to secure and maintain integrated employment that matches the consumer’s interest and capabilities. Payment: $500 for each transitional placement with a limit of three (3).
K Hörmann1, A Plenker2, C Bachert3, B Hauswald4, L Klimek 5, G Rasp6 , C. Rudack 7, J Spaeth8, R Mösges9 1University Hospital Mannheim, Department of Otorhinolaryngology, Head and Neck Surgery, Mannheim, Germany, 2Essex Pharma GmbH, Munich Germany, 3University Hospital, Ghent, Belgium, 4University Hospital Dresden, Department of Otorhinolaryngology, Head and Neck Surgery, Dresden, Germany, 5R