1.  Commissioner Terrence W. Macy, PhD  Overview of the GSE to SEI pilot  Provider Panel  Recommendations from Pilot  SEI Rates Update  Career Plan Pilot Update

2. DDS Employment First Initiative “Real Work for Real Pay” 1990-2007 Focus on Other Areas-Employment Not Emphasized 1980’s DDS CT #1 in Supported Employment It is time to refocus and re-energize our department efforts on Employment

3. DDS Five Year Plan # of Individuals 6000 5000 4000 3000 2000 1000 FY 05 FY06 FY07 Fy08 Fy09 Fy10 Fy11 Sheltered Workshops & Day Support Options Competitive and Individual Supported Employment Employment numbers in CT are decreasing The goal is to “turn the curve” and show that we can begin to change the direction of the bottom trend line to turn upwards and change the direction of the top one to turn downwards..

4. DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Baltimore, Maryland 21244-1850 This guidance does not constitute new policy, but rather highlights the opportunities available to use waiver supports to increase employment opportunities for individuals with disabilities within current policy. Further, it underscores CMS’s commitment to the importance of work for waiver participants and provides further clarification of CMS guidance regarding several core service definitions SUBJECT: Updates to the §1915 (c) Waiver Instructions and Technical Guide regarding employment and employment related services

5. Provider Panel 1.How were participants identified for the pilot? 2.How did you determine funding needs for each participant? 3.What organizational changes were considered or made to implement and staff the pilot? 4.How did you approach career planning and job development?

6. By the numbers….. 53 individuals engaged in the pilot ▫Range of 3-16 per agency 17 (32%) have obtained an individual job ▫3 have left their jobs, one is job seeking  Reasons for separation include economic lay off, health condition and desire to return to GSE Wage, hours, job type data will be forthcoming

7. What about those who are not yet employed? 16 (30%) currently seeking a job 1 is completing an on the job assessment 4 are in the career planning process 8 (15%) chose not to move forward with individual employment

8. Lessons learned… Recruitment and engagement of individuals ▫Start with those seeking an individual job ▫Engage the family and other team members early Career planning ▫Engage the family and other team members early ▫Address social issues as part of the planning process ▫Consider and plan for the impact of a part time or non traditional work schedule ▫Consider how this job might be part of a career ladder, not just a job

9. Lessons learned… Job development ▫Need to consider not just the individual job development, but also development of ongoing business relationships ▫Requires a professional approach ▫Use the social and professional contacts of the job seeker, family and other team members

10. Lessons learned…. Organizational ▫Need to provide staff training ▫Changes in job functions needed, different approach to the work ▫Need to work through the implications for existing GSE programs  Will they decrease over time?  Can staff be reassigned to SEI?  What will the transition look like? ▫Protect staff time devoted to SEI

11. Lessons learned… Funding ▫Need to figure out how to manage the funding process more efficiently and effectively  Stay tuned for updates! ▫Everyone involved in making decisions about funding needs to understand all the options ▫Need to develop quick turn around process, particularly for those who experience job loss or when a great opportunity comes along quickly

12. The Career Planning Process for SEI History of the SEI Work Group and Career Plan Project The Career Plan Career Plan Pilot Next Steps Questions and Answers

13. History of the SEI Work Group and Career Plan Project

14. SEI Workgroup Purpose was to Transition From Traditional Payment Structure (Contract) to Fee for Service Without Compromising the Agency Infrastructure and Ability to Provide Services

15. SEI Work Group – History and Progress Established in February 2010 – Collaborative approach of DDS and Private Sector to address the following: Conversion of traditional payment structure to attendance based payments dramatically reduced annualized (legacy) rates impacting agency infrastructure Create a system which meets client needs and reimburses providers for work completed Reinforce the value of SEI services Sought and secured a cap on losses to be limited to 2% for SEI payments during the transition period

16. SEI Work Group – History and Progress Reviewed information on how other states pay for SEI services Gathered information to identify direct and indirect costs/activities involved in job preparation, development, placement and retention Collected and analyzed information from 25 providers to determine aggregate data of above Categorized SEI service components

17. SEI Work Group – History and Progress Identified Service Gaps (i.e. no standardized assessment tool/approach) Researched and re-designed available assessment and career planning tools to be consistently used within the system and developed Comprehensive Career Plan Consistently reviewed CMS waiver guidelines for service delivery and documentation requirements Solicited input from DDS CO Case Management Liaison

18. The Career Plan - Purpose To gather information from the individual and stakeholders that is pertinent to obtaining/retaining employment To identify and outline unique supports that will lead to employment To be a roadmap for the individual and his/her support team that will lead into action steps To be a dynamic and flexible tool that will accompany the individual throughout his/her personal career path

19. Career Plan Pilot Met With SEI Providers Sought Volunteers 10 Providers Participated Completed 18 Career Plans Received Feedback Forms Consolidated Feedback and Data Adjusted Career Plan Based on Feedback Data Used to Develop Fee Structure

20. SEI Next Steps Seek to Formalize Service/Payment Structure Provide Training to SEI Providers in January Subsequent Trainings to Other Partners (Case Managers, Resource Managers, Other Providers) Implement in 2012 Periodic Feedback to SEI Work Group

21. Questions and Answers

22. Thank You

23. Joe Parente – Easter Seals Goodwill Sandy Lavoy- CW Resources Beth Fisher – Kuhn Employment Lou Alperowitz – MARC Community Resources Robin Wood - DDS

24. Service Hourly Payment # of hours Payment Documentation Annualized Authorization for follow-along support to include Face to Face hours with the participant at the work site, with the employer at the worksite or with the participant outside the worksite regarding work related issues $47.00 per hour Based on LON allocation- ranges from 1-5 hours per week Web/res/day

25. Service Hourly Payment Payment Documentation Hours worked each week by ISE Participant (hours need to be verified – TBD) $4.48 per hour worked or paid vacation, sick, or holiday time Web/res/day Back up information maintained by the provider for potential audit

26. Service Benchmark Payment Hourly Payment # of hours Payment Documentation 1. Career Plan Direct Support – face to face $47.00 per hour Average of 10 hours for Career Plan Web/res/day 2. Career Plan Indirect Support $700 for completed product Completed acceptable Career Plan

27. Service Benchmark Payment Hourly Payment # of hours Payment Documentation Hourly Supports- Job development and intensive training $47.00 per hour Based on Team Recommendation Web/res/day Direct Face to Face Support provided during Working Interview $47.00 per hour up to 40 hours over a 2 week time period Web/res/day Wage for consumer $9.00 per hour up to 40 hours over a 2 week time period Payroll Information submitted as one time documentation

28. ServiceBenchmark Payment Payment Documentation Start work (payment based on hours worked per week) 5 to 9.99 hours = $400 10 to 14.99 hours = $800 15 to 19.99 hours = $1200 20 to 24.99 hours = $1600 25 hours or more = $2000 Web/res/day 3 months completion Time begins with a full calendar month of employment 5 to 9.99 hours = $400 10 to 14.99 hours = $800 15 to 19.99 hours = $1200 20 to 24.99 hours = $1600 25 hours or more = $2000 Web/res/day

29. ServiceBenchmark Payment Payment Documentation 6 months completion Time begins with a full calendar month of employment 5 to 9.99 hours = $400 10 to 14.99 hours = $800 15 to 19.99 hours = $1200 20 to 24.99 hours = $1600 25 hours or more = $2000 Web/res/day Hours Worked section Transition to Natural Supports - Successful discharge 5 to 9.99 hours = $400 10 to 14.99 hours = $800 15 to 19.99 hours = $1200 20 to 24.99 hours = $1600 25 hours or more = $2000 Documentation of the discharge and plan for natural supports submitted as one time.