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Questions & Answers

Additional Q & A Prior to May 2006

New Q & A - Posted May 2006

Summary of Comments to

Supported Employment “Provider Guidelines”-May 15, 2006

The following comments are from the recent statewide APSE meeting in Lake Placid. They represent comments and recommendations from four regional meetings which were held at that event. These are being circulated statewide for upcoming regional supported employment meetings which are being held during May and June. Responses from those meetings will be incorporated into this document in order to include all available input.

Global Issues:

1)   Training of Provider Guidelines when finished. Training sessions should be combined with CRP and VESID.

2)   Reporting systems from Albany, especially financial, should be easier to read and simplified so that reconciliation can done in quicker and more accurate way. A simper method to correct billing.

3)   Need a more centralized method to address problem cases, especially in billing.

4)   OMRDD delays eligibility decisions far too long. More coordination between DDSO and VESID at the beginning of referral process to Supported Employment.

5)   VESID counselors need to send more updated psychologicals and Adaptive scales. School psychologicals that are sent by VESID counselors are not sufficient for agency and especially OMRDD to make eligibility determination.

6)   More psychosocial reports should be sent by the VESID counselor at referral.

7)   OMRDD demands proof of onset disability before 22 years old, but consumers from other countries hard to gain information. Can VESID help with this process?

8)   Clear guideline procedures for eligibility from  VESID and OMRDD

9)   Agencies use many hours to obtain eligibility requirements of OMRDD. Is there a way to bill these hours to the VESID contract or to OMRDD? Agencies complain of a loss of money and manpower.

LOCAL ISSUES:

  1.  Need information on changes of VESID staff-
          their new phone #, etc

  2. Also waiver requests, especially for less than 20 hours, are a complaint from some agencies.

  3. When a consumer is not eligible for OMRDD extended the VESID extended contract is for much lower rate.

  4. There is no billing for family and parent guidance and counseling.

  5. Can hourly billing on SE contract be eliminated?

 RECOMMENDATIONS:

  1. Can VESID make a more seamless connection with the school system and aging out students and referral to VESID? Many schools districts, students and parents are not aware of VESID services.

  2. Can VESID open case before student graduates and need for VESID to provide summer jobs for disabled students.

  3. Annual conference- model 4201 conference- expand with VESID

  4. Increase understanding and staff of visually impaired consumers. CBVH is limited to agency they can refer to SE services due to lack of training, etc.
     

Payment Issues:

Major concern with the hourly billing methodology coupled with a request to replace it with another simpler method. 

Mention was made of the use of benchmarks or milestones similar to direct placement services as a payment method. 

It was suggested that the rate reflect the cost of program management.

It was also suggested that current data be used to make the reimbursement rates more accurate.  

Guidelines Concerns

Definition of stabilization needs to be clearer and therefore more able to train staff to use it.

The use of professional judgment was noted as a positive in the stabilization decision.

Need to rebuild fundamental elements of SE and restructure process around that basis.

Please get rid of NYISER!! (multiple requests!)

Transition

Much more support is needed to build a better system of transitioning from children’s entitlement services to adult volunteer services.  This support should focus on innovative programs and funding is needed. 

Students seem very unaware of what is happening to them and what their options/responsibilities are (readiness issues). 

The use of regional informational fairs involving BOCES was suggested. 

Concern was expressed about the children of families who do not participate in current planning activities.  How do we reach out to them and get them involved?

Similarly, there is a concern for those students who dropout and it was suggested that a connection be established sooner.

Can SED provide better data?

Can paid work experience be made available prior to graduation?

Can children in residential facilities be given some kind of work experience or vocational preparation?

Can resources be made available to identify hidden disabilities in the DSS population?

As no other funding is available for service coordination for the non-DD population and as there is insufficient funding for MH consumers VESID extended service is being used to provide this to many consumers.  These consumers do have a high level of need.  This is costly for the programs.

Ongoing training for staff is a high priority but the contracts do not reflect the need or the expense.  Staff time in training cost the program money and they are not reimbursed for it.  Additionally, staff time away from consumers reduces billable hours, so there is a double loss. 

Fast track is seen as a good option, with emphasis on school populations and the use of smaller groups.

A.   What Needs Fixing – How can we do supported employment better from the perspective of the Provider?

    1. Get rid of current hour/unit system.  Find a different way to pay for services.  Current system too costly in time and staff resources.

 
    1. Current system seems to have changed the dynamic significantly, and not for the better.

 
    1. Documentation needs have shewed process greatly

 
    1. Have to track, request, re-request – just takes a great deal of time.

 
    1. Staff are becoming overwhelmed and are leaving.  It is becoming increasingly difficult to keep quality staff.

 
    1. The check we get is just a check with out telling us who and what it’s for.

 
    1. The layering, the complexity is a great problem.

 
  1. Are you still serving the most significantly disabled?

 
    1. No, cannot serve MSD like we used to.  Have had to turn consumers away.

 
    1. Where before we would serve anybody, now we have to be concerned about units.

 
  1. Do you have to settle for jobs that are not optimal?

 
    1. No.  This does not seem to be a problem.

 
    1. But, we do have to make choices, especially for transition people and for those who need job carving.

 
  1. Would it be better to move to a set rate system?
     
    1. No.  we never get back the hours we put into a case.
    1. Too great a range of consumers.
    1. Do not believe that history was accurate in determining the rates.
  2. Is there anything you can suggest to gain efficiencies in the system?

     1.  Send referral and authorization together.
     
  3. Is the monitoring function fair and useful?

    1.      It feels like a team effort and is generally a positive experience.
     
  4. Comments on Provider Guidelines.

         1.     Differences in interpretation of Guidelines between Providers and VESID.
     
  5. Designing our Future

         1. NYISER report does not seem to co-ordinate with anything.

     

  6. Turnover – Any magic bullet?
    1.         Money.  What we pay.  In some cases consumers are being paid more than staff.

    2.    What we are asking of a job coach is too much.

    3.     Too much redundancy.

     

    7.
  7. General Comments

1.     Use a carrot at end of year, i.e., units plus a bonus.

2.     Need better communication between Providers and VESID.

3.     Would be nice if other funders were as involved as VESID in order to respond quicker to needs, especially billable and not billable issues.

 

Supported Employment issues:
  • How to deal with transportation issues in rural counties – the cost of extensive travel with rising fuel costs may become prohibitive Suggests increased hourly rate in rural areas (currently paid $40/hour vs $50 to $53 elsewhere in the state) to compensate for the transportation costs
  • Need to coordinate with other agencies – eg OMRDD may not honor a VESID issued off-site waiver and mandate on-site interventions
  • Need to update MOU
  • OMRDD drops people to VESID extended contract which pays a much lower rate
  • Problem of exceeding OMH slots and no access to VESID extended funding for the extra people with MI
  • What is life expectancy for the 416?
  • What is happening with PROS? How does it meet federal guidelines? How is transitioning working?
  • How does a provider track what it is being paid for when it is receives a lump check?
  • Need for original signature on the 416 as a billing document vs the 416 as a reporting document
  • What is happening to NYISERS?
  • OMH is not supporting job development/placement for individuals in extended service
  • VESID intensive contract hours are being used to determine eligibility for OMRDD extended funding rather than to provide direct intensive service to the consumer
  • We need to know what is working well as well as what the problems are

Would like to see more support for affirmative businesses

 

Transportation in Rural Areas

 

Investigate new ways of providing transportation services as rising fuel costs have impacted transportation services in rural counties.  Need to address how transportation services can be sustained over a period of time, i.e. after intensive services end. 

Suggestion:  Increase upstate’s hourly rate for SE services to downstate’s rate.  This would allow upstate providers to incorporate transportation costs.

Waiver services for OMRDD extended cover transportation services.

Some provider agencies have flexible funding that allows those agencies to transition consumers while getting their cars back on the road. 

Essex County has a transportation coordinator who coordinates transportation services to doctor’s appointments and employment situations.

Franklin/Clinton/Essex Counties are developing a DDPC grant that will fund transportation services for individuals with disabilities to employment situations. 

Suggestion:  Ask consumers to contribute towards the cost of transportation services. 
 

SE Off-Site Waivers (Inconsistency between VESID and OMRDD)

Question:  VESID approves off-site waiver.  OMRDD extended does not honor VESID waiver.  Can there be collaboration between VESID and OMRDD to honor VESID waiver?  To bill OMRDD for extended services, OMRDD requires two face-to-face on-site visits. 

Suggestion:  More collaboration between agencies (VESID, OMRDD, OMH).  Place this item on the agenda of the next MOU annual review meeting.  Note:  Chapter 515 requires that there be an annual review of the MOU. 

Suggestion:  Re-establish Interagency Council to foster discussion among agencies and address these types of issues. 

 

Extended Services

OMRDD places limits on eligibility for OMRDD extended services.  VESID has limited resources for VESID funded extended services and has established a differential cost for OMRDD transfers.  Concern over extended services payment model:  month-to-month payment system gives less flexibility than lump payment system did.  This strain is compounded by OMRDD limits on eligibility, placing more consumers in extended services under VESID’s lower reimbursement rate. 

What happens when OMH extended slots are exceeded.  Those eligible for OMH should be in OMH extended.  If agencies exceed OMH “slots”, VESID has picked them up. 

OMH will not fund job development in extended status.  Should be addressed in MOU.  VESID and partner agencies should seek provider input prior to annual MOU review.  This could be solicited under “topic” areas. 

 

RFA’s – Provider Input

Can providers assist VESID in developing RFA’s.

Look at increasing service rates.

 

Life Expectancy of VES-416’s

Electronic transmission needs to be implemented.  At upcoming regional sessions, VESID will discuss web-based systems.

VESID payment does not reflect specifics of what is being paid and doesn’t always correlate to John Cebula’s utilization report. 

If there is a question on the submitted VES-416 report, can VESID email or call rather than return the form to the Provider.  The reason the form is returned is that a change on the billing page requires an original signature.  However, one participant indicated that they phone the provider rather than return the form.  The provider then submits a new (corrected) signed form.  This does save some time. 

 

VESID’s Design our Future Project

VESID’s DOF Team realizes the importance of the role of provider in service delivery model and streamlining services.  However, there needs to be further discussion between VESID and providers. 

Provide joint training opportunities between VESID staff and providers to establish common beliefs, values and language. 

Would like to see more support for Affirmative Business model.

 

NYISER System

When the 416’s are automated, what is the future of the NYSIR system.  Concern over how HIPPA applies to an electronic system.

 

New Contract Language for Extended Services

Need clarification on the language being used in the Supported Employment Contracts regarding billing and payment of extended slots.  What defines a slot used?  This is scary to providers.

 

OMRDD Eligibility

Costs associated with obtaining psychological testing and tracking documentation aren’t covered by VESID.  Intensive hours are being used to determine OMRDD eligibility for extended services because of the complexity of the requirements. 

 

Status of PROS w/ OMH  (see Bill Deschenes)

-OMH expects roll-out to continue with changes and documentation.

-DOD is driving issue – can’t shift VESID contracts to meet OMH licensure; consumers may have to shift from one provider to another.

 

* Instructions for Downloading Files

Summary of VESID-Funded Supported Employment Extended Slots- As of February, 2006 - Download Word Document

VESID offices are currently reviewing contract needs for contracts which will begin 7/1/06. A part of that review is the establishment of the appropriate number of VESID-funded Extended slots for the coming year. A letter has been sent to all supported employment contracted agencies. That letter describes the use of the form which must be returned in response to the letter. Note that the form is downloadable into Word but it must not be returned electronically for confidentiality purposes. Please mail it as instructed in the letter or mail a disk with the data on the form. Note also that Extended reimbursement instructions will soon follow and will also be posted at this site.

Training for Supported Employment Providers

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