NYS VESID

July 25, 2007 - One of the recommendations of the VESID “Designing Our Future” initiative involved the redesign of the VESID Unified Contract Services (UCS) process. The existing UCS process had been described as cumbersome and archaic.

The first step in the design of a new system included the development of cohesive definitions for the array of services currently being purchased by VESID.

In January 2007 the New York State Rehabilitation Association (NYSRA) was awarded a competitive contract to convene a workgroup for the purpose of developing recommended definitions of VESID’s purchased services. The workgroup consisted of representatives from provider agencies, consumer groups and VESID. In their
final report the workgroup identified eight service categories which they believed encompassed the wide array of services available through VESID.

In our next step, we requested feedback from both internal and external stakeholders. The responses will be compiled and considered in the development of a new contract service process.

Office of Vocational and Educational Services for
Individuals with Disabilities
Unified Contract Services

WORKGROUP FINAL REPORT

March – June 2007

Sections of the Report:
Background for this Report
Present VESID UCS System
Rational for Changes to the UCS Codes and Services Description
The Workgroup Formation and Operation
Contract Requirement
Vocational Assessment Service
Work Readiness Service
Job Placement Service
Driver Rehabilitation Service
Fast Track - NYC
Assistive Technology Service
Deaf/Hard of Hearing Service
General Recommendations & Minority Opinions
Recommendation 10: EVIDENCE BASED TRIAL SERVICES
Other Minority Opinions expressed by the Workgroup or individual members of the Workgroup for consideration
by VESID in its redesign of the present UCS System
Rehabilitation Providers/Advocates
VESID Participants
GUIDELINES FOR REDESIGN of VESID UCS SERVICE SYSTEM

Background for this Report:

In December, 2006 the New York State Education Department issued a Request for Proposal (RFP #06-031) Coordination of Efforts to Review and Update Unified Contract Services (UCS) Definitions.  The resulting responses were evaluated and a contract was awarded to the New York State Rehabilitation Association (NYSRA) whose responsibility it was to convene a Workgroup appointed by the Office of Vocational and Educational Services for Individuals with Disabilities (VESID) and composed of a representative group from provider agencies, VESID Central Office and District Office staff, including Quality Assurance, and consumer groups.  In addition to four meetings of the larger Workgroups (two in Albany, and one each in New York City and Rochester), several subsequent teleconferences, with smaller teams from the larger Workgroup were to focus on selected program areas for the changes that were needed.

NYSRA was charged with convening and recording the meetings, including the smaller teleconference Workgroups.  NYSRA was to complete a final report for VESID with the recommendations of the Workgroups for program area changes and their implementation, including definitions of the services and unit of service to be utilized.  They were to be assisted by a consultant from Northeast Associates in Rehabilitation, LLC who had extensive experience with a provider agency with a VESID UCS contract, including working with the system when it was first developed as Hoisington, then as POSS, and had proposed a pilot several years ago to change the UCS services.

VESID was responsible for selecting the providers.  Over 20 providers unanimously responded to the invitation to be part of the Workgroup as did a sizable number of VESID staff, both representing all regions of the State, urban and rural.  Consumer groups were also represented.   Once the contract was awarded, NYSRA and this consultant met with VESID to finalize the membership of the Workgroup.  Forty-two representatives from provider agencies, advocacy groups, VESID Central Office and District Office staff were contacted and unanimously accepted the invitation to participate.

 Present VESID UCS System:

VESID provides a wide array of vocational rehabilitation services to over 100,000 disabled New Yorkers each year.  An important part of those services are purchased from community rehabilitation providers and include assessment/evaluation services, work adjustment/skill training and placement services.

VESID presently purchases the following services under its Unified Contract Services (UCS):

1. Diagnostic Vocational Evaluation (DVE)/Assessment – VESID purchases assessment services from a variety of organizations, most of which are not-for-profit community rehabilitation programs, based upon the needs of the individual VESID consumer.  Usually, assessments are short-term (one day up to three weeks) situation and pencil and paper tests which help the consumer to choose a likely job goal and also permit VESID to determine both consumer eligibility and goals.  Given the employment outcome expected of VESID services, particular emphasis is preferred for situational assessments or work tryouts conducted at an employment site in the community.  In most instances, assessment/evaluation services will be provided at the unit (daily) rate.  A unit is a five-hour program day.
2. Work Adjustment Training (WAT) – Given VESID’s broad mandate, training can be basic WAT or to learn how to work, including attendance, appropriate attitude, supervisor-subordinate relationships, etc. on up to more specialized vocations (described in III. Skills Training).  A unit is a five-hour program day.  WAT services are reimbursed at the unit (daily) rate.  It is assumed that WAT services will lead to successful employment with placement provided by the WAT services provider without an additional payment from VESID.
3. Skills Training – VESID purchases a variety of high-level skills training programs from both proprietary and not-for-profit providers.  These include, but are not limited to, occupations such as computer operation, business practices, home healthcare aide, building maintenance, and laboratory technician.  Skills Training, or Specialized Vocational Training (SVT), as it is also known, may be provided only via a curriculum approved by VESID.  That curriculum must include course content, duration, and expected levels of achievement which must be achieved by the student and at which points in the curriculum, in order to successfully complete.  In addition, Skills Training/SVT program requests must include projections of expected outcomes in terms of program completions and trainees employed.  Skills Training/SVT programs typically lead to employment in careers and not only in entry-level jobs, at wages which are beyond minimum wage.
4. Job Placement – VESID may purchase job placement as a stand-alone service.  Job placement, when purchased individually, is not provided as an add-on service to Training or Skills Training, as described above.  It is assumed that providers of Training and Skills Training services will provide placement and job follow-up services as part of those programs.  Job Placement may be purchased as an add-on service for assessment.  Job Placement must include follow-up services once an individual is placed with an employer and for a minimum of 90 days subsequent to the start of such employment.  Job Placement is provided as a performance-based service with three payments which are at referral, at the start of employment and after 90 days of continuous successful employment.
5. Other Specialized Services – UCS services include other services provided by UCS-eligible organizations.  These services include, but are not limited to travel training and other employment-related services.  Note that transportation services now included in UCS contracts as a support for other primary services are included at current rates.  The rates for these services may be continued for only the first year of these contracts, pending VESID review of transportation rates and services.  VESID cannot purchase transportation services which are not linked to one of the primary services.
6. Fast Track Assessment Services – UCS providers may assist VESID in the eligibility determination process via Fast Track Service.  Fast Track providers collect, and sometimes provide, the data which VESID counselors require in order to determine eligibility for VESID services and to complete the required Individual Plan of Employment (IPE).  The required information is provided via electronic or hard copy to VESID counselors.  In either arrangement, the Fast Track provider facilitates the referral and the eligibility determination for VESID and prospective VESID consumers by collecting diagnostic and other documentation required by Federal regulation.  Fast Track may lead directly to placement services for appropriate individuals.  The Fast Track provider may work with the consumer to develop an IPE for submission to VESID for approval or disapproval.  Rates will differ depending upon whether the Fast Track provider collects existing diagnostic documentation or actually arranges for the completion of and/or provides this documentation to VESID.  In every instance, only the VESID counselor is authorized to determine individual eligibility for VESID services and to approve or disapprove or recommend amendments to the completed IPE.  Payment is made to the provider of Fast Track services only if the individual is ultimately determined by VESID to be eligible for its services.  VESID may alter the structure of Fast Track services to adapt to changing service entry policies, procedures, and practices. 

Rationale for Changes to the UCS Codes and Services Description:

VESID, their vendors, consumers and advocates agree that the services system defined by UCS is in need of revision.  The definitions of service and the methodology of each respective unit for a service are problematic.  Inconsistency has resulted in serious disparities in what services were delivered and how providers were paid.  In addition, there have long been problems with the rates, which for some providers have been lower than the costs of providing services. 

Compounding these problems is the lack of statewide standardized documentation required for services.  Required documentation and unclear billing methods have resulted in additional administrative stress at all levels of the system, resulting in the need for VESID and providers to have bookkeeping staff to record and bill the hours and then check them against authorizations.  Over a period of time in the last few years, this has resulted in long delays in payments and reconciliations of full years of services.

Also contributing to the overall problem, was the proliferation of codes that were used to authorize services.  As the system evolved over time and new services were implemented, new codes were introduced to go along with the newly defined program.  Codes were introduced for certain specialty groups, and additional codes were introduced to refine certain areas and produce more clarity in the service provided.  This was particularly true in the area of Driver Assessment and Training where the largest number of codes was utilized.

Over time, in an attempt to address the above problems, new services were defined, approved and added within UCS to expand on the payment options and expand service delivery to specialized groups.  This partial solution, while well-intentioned and very successful in many areas, contributed to a widening of the inequity gap.  Attempts to resolve this through an RFP in 2005 were moderately successful, but inadvertently caused a further confusion of the system, as some providers did not understand the descriptions and/or did not bid on them.  Other off-contact approvals had to be given to address potential loss of services or address the needs of a particular group, creating a need for more codes and disparate services.

The Workgroup Formation and Operation:

Members of the full Workgroup met initially on March 13, 2007 to focus on the need for change in the system, the members’ role in the process, perspectives and endorsement from the VESID administration, how the system should look when redefined, and which area should initially get the most attention from the Workgroup.  Members were asked to sign a confidentiality agreement with VESID to participate in the Workgroup.  Each member was encouraged to share the upcoming agendas for Workgroup meetings from their respective constituent groups and or colleagues; however they were not allowed to discuss the decisions made.  The final report was to be posted by VESID to their website for public comment.

Guiding Principles were established as a result of the discussion. The Guiding Principles included key items such as:

• flexibility in the system;
• consumer driven;
• a “menu” approach to services, with core services for each program;
• service definitions are to be clear and meaningful;
• accountability and attendant methodology are to be clearly defined; and
• quality assurance is built around outcomes and consumer satisfaction with the services. 

The Workgroup also felt strongly that the parts of the system that are now working well for VESID, the provider community, and most importantly the person with a disability, should not be changed.  Each of the program areas listed below were fully discussed.  All work of the Workgroup was completed in a three-month time span as directed under the contract.

Contract Requirement:

 “Utilizing” VESID’s current listing of UCS services and the work of the advisory group provides a detailed final report that includes the following:

1. A recommended listing of services which, based upon their function, may be appropriately combined into a single, larger, category of services for purposes of the UCS-RFP and for the future provision of services.
2. A recommended listing of definitions of units of services which should be assigned to each revised service. For example, services are currently purchased on an hourly, daily outcome-based basis.
3. Justification for the units of service assigned to each service definition along with sufficient information regarding expected content of the services. Content, in this case, includes a description of the expected staffing required to provide each unit of service. VESID will utilize this information to determine rates for the services, as defined.

In the VESID RFP scheduled for release in the fall of 2007, the Workgroup recommends the following list of services for the new “VESID Service System,” formally known as the VESID UCS System:

Rehabilitation Technology was not discussed.  Evidence-Based Trial Services – Supported Education, Summer Youth Internships and other services not specifically defined in other categories were discussed.

Specific service recommendations are to be found in each respective section.  Each of these items listed above are set forth in a format that if acceptable to VESID can be incorporated as necessary into the RFA 2007. 

The Workgroup recommends the need for a full review of rates for all services.  Each service rate should factor in the value of the service to VESID and the consumer, the cost to the provider agency in using appropriately credentialed staff, and the amount of time needed for the service.  The authorization time frames recommended reflect the need to compensate providers who serve people with multiple disabilities that by the very nature of the challenges of their presenting disability require additional time for success.

Vocational Assessment Service
Final Draft

Purpose of the Service:

The purpose of a Vocational Assessment Service is to provide the information necessary to determine an individual’s eligibility for VR services and/or develop a vocational goal.  This information can be used to:

• Assess individual readiness to engage in the VR process in development of their plan.
• Identify skills, aptitudes, interests and behaviors.
• Evaluate and/or affirm a specific vocational goal or career choice(s).
• Assess the relevance of a choice to the current job market (local, regional, other).
• Evaluate or assess the individual’s traits/personality and learning styles.
• Determine the appropriate work environment for the individual.
• Review of background information, including social, educational and vocational history, and assessing the relevance of same for vocational planning; including in this the individual’s special interests, hobbies, participation in activities such as religious groups, clubs, etc.
• Determining the individual’s current benefits received and benefits needed in the determination of a good job placement match.
• Assessing a person’s work readiness/motivation (related to perceived and real challenges and disincentives) in pursuit of his/her vocational goal.
• Identify transferable work and social skills.
• Identify “reasonable accommodations” required, if any.

A vocational assessment of the individual will encompass all of the above purposes.  Specific needs will be stated in a referral document from the VR counselor.  It is expected that the VR counselor on referral will share, as available and appropriate, the most recent supporting documentation such as medical, psychological, psychiatric, and/or other specialty information on the individual requesting services to frame the context of the presenting disability.
It is expected that VR counselors should have access to state-of-the-art or “best practice” assessment tools and methodologies. For special-needs populations, where these are not already addressed, other such services can be utilized, with prior approval by Central Office, and incorporated into the Vocational Assessment purpose and definitions by referral.

Definition of the Service:
Vocational Assessment Service for the individual is a single service or group of services that is used to determine a suitable employment goal and plan or to determine eligibility for VESID services.  The services provided should identify an eligible individual’s unique strengths, resources, priorities, interests and needs, including the need for supported employment.  Vocational Assessment Service should be used for any approved purpose (as outlined above) and is used to make a determination of the goals, objectives, nature, and scope of vocational rehabilitation services to be incorporated in the Individual Plan of Employment (IPE).  Vocational Assessment Service is usually provided at the beginning of services but can be undertaken at any point in time, if it is recommended by the provider agency or requested by the consumer and upon approval of the VR Counselor.
Vocational Assessment Service is limited in its application to information necessary to identify the rehabilitation needs of the individual and to develop the individual’s IPE.  It uses existing information as a primary source of such information, to the maximum extent possible and appropriate and in accordance with confidentiality requirements.  Vocational Assessment Service relies on information provided by the individual, representative, school, individual as well as significant others and, where appropriate, by the family of the individual.  It may include, as needed, an assessment of the personality, interests, interpersonal skills, intelligence and related functional capacities, educational achievements, work experience, vocational aptitudes, personal and social adjustments, and employment opportunities of the individual, and the medical, psychiatric, psychological, and other pertinent vocational, educational, cultural, social, recreational, and environmental factors that affect the employment and rehabilitation needs of the individual.  It may include an appraisal of the patterns of work behavior of the individual and services needed for the individual to acquire occupational skills, and to develop work attitudes, work habits, work tolerance, and social and behavior patterns necessary for successful job performance.

Core Services and Methodology:

Present codes proposed for consolidation – The Workgroup achieved consensus that all the codes listed below could be replaced using new codes and the methodology described herein.  It represents an elimination of at least 14 codes:
DVE – 110, 113 (Deaf), 114 (TBI)
COMMUNITY BASED ASSESSMENT - 181
ASSESSMENT - 036 (Psych Ed.), 037, 038 (McCarron Dial), 100 (Special assessment),
101 (One day assessment), 102 (Two day assessment), 103 (Mobile), 104 (Substance Abuse)
166 (Rehab. Tech), 107 (In-school), 108 (Deaf), 147 (Cog. /Percept. Evaluation
148 (Performance Evaluation), 181 (Community Based Assessment), 821 (voice recorded), 822 (TBI); Specialized Assessment Rehab Tech Follow-up (no code listed), 111 (Transitional Work Assessment, Specialized Vocational Assessment for individuals with severe physical and or multiple disabilities, Transitional Work Program Assessment, TBI Placement Assessment & all other as well as off contract codes for Assessment, including Pre-placement evaluation)

The Vocational Assessment Service may include some, or all, of the following as determined by the referring VR Counselor:

• Record review and incorporation of findings from this review in the final report that addresses the above core services.
• Review of background information. This should include any social, educational and vocational history, and an assessment of the relevance of same for vocational planning.  It may also include the individual’s special interests, hobbies, participation in activities such as religious groups, clubs, etc.
• Evaluation of the individual’s work readiness, including motivation, e.g., use of Psych Rehab Readiness Assessment.
• Paper/Pencil Testing to include interest and aptitude inventories.
• Any standardized, computerized or other assessment system, including but not limited to work samples: CareerScope, OASYS, Apticom, JEVS, McCarron-Dial or any commonly recognized and validated system.
• Assessment of worker personal traits, learning styles.
• Assessment of work environments for the individual.
• Identification of work and social transferable skills.
• Situational Assessment – Community (Employer) Based or Facility Based.
• Initial assessment of needs in the area of assisted technology and other accommodations.
• Career or Vocational Counseling.
• Methods that help affirm or rule out specific vocational goal(s) or career choice(s) and their relevance to the current job market (local, regional, other).
• Assess the individual’s current benefits and the effect of these benefits on the person’s actual work readiness, as well as what benefits the individual will need in pursuit of his/her vocational goal.

The community rehabilitation provider has an ever increasing variety of methods available to provide the requested items in the Vocational Assessment Service.  Providers must use those which have validity and documented results, incorporating best practices into the assessments completed for the individuals with disabilities.

Unit of Service:

The Vocational Assessment Service report when delivered to VESID is what is paid for to the provider.  The time required to complete that report for any one individual will vary.  Based on the referral from the VR counselor the unit will be based on the amount of time needed to perform the required services in order to meet individual needs.  Time frames recommended by the Workgroup is proposed as follows:

1 Day
2 Day
3-5 Day
6-10 Day
11-15 Day
15 or more Days

The definition of a “day” is one hour or more of service in a normal workday operating schedule, some of which can be indirect, such as records review and data analysis.  The “day” is defined as business days, not calendar days.
         
A variety of “tools” will be expected to be utilized to provide the Vocational Assessment Services.  Since some “tools” for Vocational Assessment Service require particular expertise and training, the “tools” and staff necessary to provide the service must be considered.  The above definition and time frames for service delivery take into account that some individuals, particularly those who need special accommodations, may require extensive time to receive the service, while some require only a very short period of time, thereby no longer requiring different codes for different disability populations.

Process for Authorization:

1. The VR Counselor will select and/or a provider agency will recommend selected services and items specifically needed in Vocational Assessment Service (e.g. work tolerance, behaviors, equipment, etc.) for the individual.  In doing so, the VR Counselor will decide, based on consumer needs as identified in the plan for service or based on referral information, the authorization time frame required to achieve the final product.

2. The authorization will include the anticipated business days needed to complete the assessment.  This will include authorization of start and end dates for the assessment.  This initial authorization should provide for no less than 20 days to deliver the approved service.  There will be the ability to amend and extend the end delivery dates, as agreed upon between the VR Counselor and the provider, to adjust for the individual needs of the consumer.

3. There should be a standardized referral form or format utilized.  The VR Counselor should routinely provide supporting documentation to the provider, allowing ample time for provider receipt and review of the referral package prior to start of the Vocational Assessment Service.

4. The length of time to deliver the services will vary according to what is authorized.  The periods of time are only to be guidelines so that the provider and VESID have maximum flexibility in the provision of individualized services.  Delays and other challenges to complete the Vocational Assessment Service are to be noted in the Vocational Assessment report.

5. A formal VESID Authorization Voucher needs to be produced and in hand before service is rendered.

 
Rate: 

To be determined by VESID.     

Process of Service Accountability:

The provider will be paid based on completion of a Vocational Assessment Service report that incorporates all items requested in the authorization referral packet.  The provider agency will be paid effective the date of the report being received by VESID and approved by VR Counselor.

It is expected that the Vocational Assessment Service Final Report will be completed and delivered no later than within ten business days after the last contact with the individual.

Approval of the report by the VR Counselor will be granted after full review and acceptance of it as having met the stated purpose of the referral.  Review should ensure that the report conforms to a standardized reporting system (to be developed by VESID Quality Assurance) that will include areas covered in the report, such as background information, purpose of referral for the assessment, and other items in the purpose and definition.

Included in this review, the Workgroup recommends that the Vocational Assessment Service report conforms to other state and federal regulations.

Preparation for any individual’s Vocational Assessment Service requires provider time.  This preparation time is valued for any individual referred for the service.  The provider shall be paid for at least one day’s service, pending the completion and submission of a brief report which states what they have assessed, based on their review of any documents and/or reasons for the no-show.  It is expected that the provider will make every attempt to reschedule the person for at least a second appointment.  This provision would also apply to those referred individuals who do not complete the full Vocational Assessment Service authorized.  This is different if they disengage from service halfway through the service, in which case the provider should be paid for the full value of services provided.

The Workgroup recommends that VR Counselors statewide should be involved in the development of the design of a statewide standardized referral form.  It should be outcome driven, include the use of the timeframes described above and other required or suggested items.  The form already developed by Quality Assurance in its “fact-finding” stage may be more than adequate for this purpose.

Staffing Requirements: 

The current regulations for staffing use “Evaluator I and II” as the standards for Vocational Assessment Service.  VESID needs to review these for their continued relevance to this new service purpose and definition.  It is clear from the Workgroup comments that there needs to be more flexibility in the regulations to allow for a wider variety of credentials to be utilized.  The level of a Master’s Degree in Rehabilitation is preferred, but across the State, many providers may not be able to meet that standard due to the lack of availability of such credentialed professionals in areas where there is no college program or training for the techniques required. 

The Workgroup especially recommends the inclusion of a phrase in the standards that allows for those without the required credentials to perform the services under the direct supervision of a CRC or other approved credential.  There should also be a provision for granting said exemptions and allow providers to operate (e.g. for a period of one year) until they are able to obtain the necessary credentialing or training. 

Work Readiness Service
Final Draft

Purpose of the Service:

The purpose of Work Readiness Service is to prepare an individual through career skills practice and enhancement that is time-limited for job match and proper job development based on an individual’s approved Individual Plan for Employment (IPE).

Work Readiness Service is authorized as set forth by recommendations from a Vocational Assessment Service report and/or other existing indicators that prior employment preparation and adjustment is needed if a specific job goal is to be attained and training/skill enhancement in an identified area is needed. 
         
This means that the person presents the need to learn commonly accepted requirements for work, such as proper attendance, appropriate work and social attitudes, how to behave with a supervisor, or they need training or enhancement on specific work skills.

Work Readiness Service is considered transitional in nature for the individual, although it can be utilized at any time.  For example, if the individual leaves a job and it is determined that this type of program is needed prior to replacement efforts.

Definition of the Service:

Work Readiness Service is defined as a variety of individualized or group activities consisting of “career” orientation in a specific skill area.  This service also includes career training in the “soft skills” commonly required in the workplace.  The service may be delivered at the provider’s location (on-site) or at a real or simulated work site.  Work Readiness Service is a transitional program that typically takes place after Vocational Assessment, but prior to and/or in conjunction with actual job placement.  Job Placement Service is not included as an outcome and does not have to be provided as part of this transitional program.  Actual Job Placement Service by the provider would need to be authorized by the VR counselor.

Work Readiness Service shall be offered as facility-based and/or individual and group community situational-based services through which generic soft and tangible work skills are taught through instructive methodology and general practice.  These services will include but are not limited to; providing and increasing work motivation, entry level job skills set, and work hardening skills providing an individual with opportunity for proper job match and skill enhancement.  Services are provided on a prescriptive basis and their need is usually defined in the Vocational Assessment Service final report.

Core Services and Methodology:

Present codes proposed for consolidation – The Workgroup achieved consensus that all the codes listed below could be replaced using new codes and the methodology described herein. 
WAT – 600, 611 (Deaf); 480 (Learn & Earn), 663 (Word Processing – TBI), 351
(Adult Literacy Training - remedial), 563 (Job Coaching – deaf), Communication Skill Training for the Deaf, Sign Language Instruction

Work Readiness Service would consist of two sets of services (modules) which assist the individual to improve his/her career skills identified as necessary to meet his/her vocational goal.  They can be identified either through a VESID Vocational Assessment Service or other established means, such as an examination of the work history or other verifiable source.  It should include a means for the individual to work towards identifiable and measurable outcomes of personal achievement.  The service is short in duration, as defined above and must prepare the individual to pursue his/her identified vocational goal.

To achieve those purposes, the following modules are to be considered the Core Services for Work Readiness Service:

• Career Practice Session I is a defined set of activities that lead to a specific career outcome (e.g. training in retail sales, utility worker, or other more generic job area).  Career Practice Sessions must be designed to meet local employer needs primarily, but statewide employment needs need to be taken into consideration.  The Career Practice Session is short-term in duration, taking anywhere from a few days to several weeks to complete.  The sessions may be taught at the provider’s training facility or at the business site.  Internships at a future employer’s work site can be included.  The skills acquired must be transferable to other job areas.  The expected vocational service outcome must be defined in an individual’s IPE and the Career Practice Session I (or a close approximation for the Career Practice Session they will be involved with) should be listed on the authorization service line.

• Career Practice Session II is a defined set of activities that lead to the acquisition of specific “soft” skills by the individual.  They are primarily focused on tasks such as learning acceptable work and social conduct in the workplace, the culture of the workplace, “writing” a resume, motivation for work and maintaining a job, etc.

Under either module of Work Readiness Service can be short-term remediation (on specific tasks such as learning how to use a calculator, a checkbook, or other needs-based practical skill), short-term Job Coaching, Peer Mentoring/Training, Youth Summer Internships, and Self Esteem Enhancement.  Travel training of a brief and authorized prescriptive need may be provided.

Unit of Service:

The unit of service for Work Readiness Service is defined as a day, consisting of four hours or more of service.  A half day is any such time from two hours up to four hours.  Anything less than 2 hours does not count as attendance, except for purposes of the consumer receiving transportation reimbursement, if so authorized by the VR counselor.

In this discussion the Workgroup recognized that a work day “fatigue factor” is universally measured against a standard of a work day of four hours or more.  As such, it is then reasonable to reflect this as the goal of the work environment desired by the individual referred for Work Readiness Service.

Process for Authorization:

1. The VR Counselor should authorize the specific Career Practice Service Module(s) available from the provider’s approved contracted services.  These would be based on and should match the individual’s needs as identified in the plan for service.  VESID should have a standardized referral sheet for these services, based on the menu of such services available from the provider.
2. The VR Counselor would authorize the number of units based on categories selected.
3. Modules (Career Practice Session I and/or II) as outlined in IPE will be provided in a group setting and or in individual sessions.  Internships will generally be individualized.  Total time spent may range from 5 days to 120 days.
4. If an internship or individual service is required, this should be authorized as a separate line, specifying the number of days authorized.
5. A formal VESID Authorization Voucher needs to be produced and in hand before service is rendered.  The definition presumes that such services will be short-term in duration, not less than 5 days but not more than 120 days, although additional authorization may be given under certain situations depending on the individual’s needs.
6. Preparation for the provision of Work Readiness Service for any individual requires provider time and is valued for any individual referred for the service.  The provider shall be paid for one (1) unit of service, pending the completion and submission of a brief report which states what they have assessed, based on their review of any documents and/or specifying what transpired in the process.

Rate:

To be determined by VESID.  

Note: A group* rate could be set that is commensurate with the size of the group setting.  Internships are generally where the individual rate would be utilized, although individual facility settings are recommended for use by the Workgroup. 
*Group is defined as more than one person served, regardless of the setting and total number of persons served.

The Workgroup recommends that Transportation Fees be reimbursed any time the individual shows for service, even if he/she is present for less than two hours.

Process of Service Accountability:

The provider is required to report to the VR Counselor, using a statewide standardized format.  All providers would use the same format.

The frequency of reporting should be monthly, with a mid-term and final report detailing progress achieved.  The report by the provider, for purposes of accountability, should contain the individual’s attendance and progress made during the authorized service time.  Attendance sheets should be maintained by the provider but do not need to be submitted with the report.

VESID should provide a simple, standardized format for the reporting.  If not provided, VESID should allow flexibility to the provider, e.g. use of its own form, tracking of employer contacts, visits, etc.  Care should be taken not to require documentation that is not necessary.  Providers should submit their own method for documenting competency based skills and verification of achievement.

Staffing Requirements:

There are no current regulations for Provider staffing for WAT and therefore no required staffing for proposed Work Readiness Service.

VESID needs to review their staffing standards for compliance with proposed definition of Work Readiness Service.  The Workgroup recommends that the staffing standards reflect present practice that has resulted in quality outcomes from providers of WAT.  Specifically, the Workgroup recommends that there be a standard that specifies that the individual providing the activities within an authorized module have at least a minimum of one year experience working with individuals with disabilities and are directly supervised by someone with a BA and three years experience in the field of vocational rehabilitation.

Job Placement Service
Final Draft

Purpose of the Service:

The purpose of Job Placement Service is to assist the individual in obtaining, maintaining and retaining employment in an integrated work setting that meets his/her individual vocational goal. 

Definition of the Service:

Job Placement Service is defined as a variety of individualized service activities that culminate in an outcome where the individual obtains employment in a position of their choice, retains that employment, and/or obtains new employment after a job loss.

Core Services and Methodology:

Present codes proposed for consolidation – The Workgroup achieved consensus that all the codes listed below could be replaced using the methodology described herein:
931 (day 1), 932 (day 90), 186 (Deaf-Non-College), 187, 922, 923, 924, 925 (Deaf-College)
185, 926, 927, 928 (TBI)
Note:  Codes 929 and 959 are services widely used and effective and should remain; condensing the above 13 to 6 new codes.

Job Placement Service will include but not be limited to:

• The development of an actual Placement Plan for seeking employment as outlined in the agreed upon IPE.
• Job Development and Job Search - contacting prospective employers, as well as following up on actual or possible job leads through direct or indirect contact with the employer.
• Job Seeking Skills - resume preparation, personal conduct in the workplace (social skills), practicing job interviews, assisting with employment applications both on and offsite, and other needed soft skills for employment success.
• Job Interview Process - accompanying the individual to the job interview if required.  The activity assumes contact with the individual, as well as with family members, advocates, and the VR counselor and completion of required paperwork. 
• Community Employment Resources – assistance to the individual to identify, access and use community employment resources (for example local One-Stop).

Extra services, not inclusive of the above, which can be provided under Job Placement Service hourly include:

• Travel Training - on and off-site assistance as needed to start and retain employment
• Job Coaching - brief periods of interventions as needed to provide proper accommodations for the individual and their presenting disabilities.

It is proposed that Job Placement Service (as defined above) consist of Three Modules, each of which is a set of separate and distinct services.  They are:

Module 1 - Employment Preparation: Intake interview, Resume and interview skills development, interview application/completion, and Job Development (this is where the bulk of all man-hours are for most agencies).

Module 2 - Job Placement/Day 1 on the job

Module 3 - 90-day Rehabilitation

Module 1: Activities under this module consist of tasks necessary to assist the individual to develop a placement plan and to conduct job development activities.  Job Seeking skills, such as resume preparation, personal conduct in the workplace (social skills training), practicing job interviews and other needed soft skills are expected.  Job development and search activities include assistance with employment applications both on and offsite, and accompanying the consumer to a job interview.  This module anticipates that there will be contact with prospective employers, as well as following up on actual or possible job leads through actual direct or indirect contact with the employer.  This module anticipates that services are all based on a review of the vocational assessment; reflect the preferences of the consumer and the appropriate job market as well as other information available.  A report is generated and delivered to VESID signaling completion of the module and allowing for payment.

Module 2:  Activities under this module are consistent with tasks necessary to assist the individual to actually achieve placement on a job.  It is expected that an individual will be placed in employment and start work.  If the individual is placed at day one, billing can occur.  Replacement would require reauthorization, based on VR Counselor discretion and discussion with the consumer and the provider.

Module 3:  Activities under this module are consistent with tasks necessary to assist the individual to achieve 90 days placement on a job.  Activities within this module may include time limited Job Coaching Services.  Other activities conducted may include those to assist the individual in maintaining and retaining his/her job.

Extra Service:

It is recommended that the code 959X be retained, so that current usage of that code can be made by providers.  This will allow Job Coaching Services to be utilized for Job Save and other needed services outside of the scope of those to be authorized under the above Job Placement Services.  This code would only be utilized if such services cannot be provided under said authorizations.

Unit of Service:

Job Placement Service is defined as a set of three modules of activities each represented by its own code and unit of service which are required to produce a satisfactory job placement and promote retention.  Therefore the unit of service is not specified in hours or days, but represents the services to be provided which produce an outcome.  Within each module a wide variety of services are available and utilized to assist the individual in achieving job placement.

Process for Authorization:

1. The VR Counselor will choose from the modules which activities are needed, based on consumer needs as identified in the individualized Employment Plan for service.  VESID should have a standardized referral sheet for these services.
2. VR Counselor will authorize all services at the same time, unless one or more of the modules is clearly contraindicated by Individual Employment Plan or other available documentation.  It is possible that only a single code would be authorized, if only one service is needed.

Rate:

To be determined by VESID

Note: The Workgroup believes that an Outcome-based Model does work well with this service, as well as much of the current methodology in use.  The following breakdown is proposed so that as the modules and reports are completed and submitted, providers should be paid against that full rate as follows:

Module 1 – 40%
Module 2 – 35%
Module 3 – 25%

In addition - The Workgroup recommends that there be a specific, separate rate for providers who specialize in Job Placement Service for people who are Deaf/Hard of Hearing, but retain the same module system.

Process of Service Accountability:

The time frame for completion of the Job Placement Service will be no more than one year.  This takes into account that individuals with differing abilities require varying periods of time to achieve the outcome of satisfactory placement.  The provider will manage the provision of service to meet the needs of the individual job seeker.

Regular progress reports from the provider agency will be required.  These will document what activities have been provided and progress made toward the placement goal.  VESID should provide a statewide standardized format for the reporting, utilizing formats which are now in use and shown to be valuable communication tools for both VESID and the provider.  If not provided by VESID, they should allow flexibility to the provider, e.g. use of its own form, tracking of employer contacts, visits, etc.  Care should be taken not to require documentation that is not necessary.  Job Placement can be credited to the provider if the consumer obtains employment on his/her own.

Reports should be done and submitted monthly and/or at the end of each module, up through 90 days success on the job.
 
Providers of Job Placement Service should document the services in placement and include in the report their time allocated to the consumer, although it is not a requirement for payment.

If the consumer is a no-show, the provider should be paid for the module they are presently engaged in with a completed brief report stating what they have accomplished with the individual as well as a review of any documents and reasons for the no-show.

Staffing Requirements: 

The current regulations for staffing for Job Placement include Employment Counselor-Placement Specialist 1 (BA + 1 year experience, and supervision by an Employment Counselor-Placement Specialist 2), Employment Counselor-Placement Specialist 2 (BA + 3 years experience), and Job Coach (training and experience-no minimum requirements).  These standards should also be reviewed for their continued relevance. 

The Workgroup suggests retaining these standards, but VESID needs to review these for their continued relevance for Job Placement Services.  It is clear from the Workgroup comments that there needs to be more flexibility in the regulations to allow for a wider variety of credentials to be utilized.  Care should be taken, however, not to elevate the standards any higher than the current level, because of the difficulty in recruiting and retaining qualified individuals.  For Job Placement Services, many individuals who have worked in private employment can be as or even more successful than those whose background and training is in rehabilitation and their contribution is invaluable.  The Workgroup strongly recommends the inclusion of a phrase in the standards that allows for those without the required credentials to perform the services under the direct supervision of a CRC or other approved credential, for example, supervision by a Masters level person, or Rehabilitation Professional.  There should also be a provision for granting said exemptions and allowing providers to operate (e.g. for a period of one year) until they are able to obtain the necessary credentialing or training.

Driver Rehabilitation Service
Final Draft

Purpose of the Service:

The purpose of Driver Rehabilitation Services is to provide individuals with disabilities with evaluation to determine their potential to be safe drivers; training to allow for learning the skills necessary to be safe drivers with or without the use of adaptive technology and to provide evaluation and information to allow for the safe transportation of a passenger with a disability in a motor vehicle.

Definition of the Service:

The services defined and described require the provider to possess the skills, knowledge and competency with the appropriate certification and licensure described in the qualifications section.

Driver Evaluation – Driver Evaluation is an assessment of an individual’s functional and cognitive/perceptual abilities and their potential to become a safe driver. The driver evaluation is the initial phase of the driver rehabilitation program. Driver evaluation is used to recommended appropriate vehicle modifications, assistive devices and driving lessons to teach the client how to drive and to properly use recommended equipment.

Adapted Driver Education – Adapted Driver Education is provided to all individuals with a disability who successfully complete the drivers’ evaluation and require driving lessons to compensate for functional limitations and/or learn how to operate assistive devices and vehicle modifications. The program must provide a vehicle which meets the needs and functional capabilities of the driver. The program must provide the necessary skills to drive safely in a variety of road situations and provide the necessary skills for the driver to meet the requirements for securing a New York State license.

Vehicle Consultation - Vehicle Consultation and Vehicle Modification Recommendations
The driver rehabilitation personnel will serve as a source of expert professional opinion to the individual with a disability or family regarding the purchase of an appropriate vehicle that will accommodate the vehicle modifications and assistive devices required by the individual. In specific cases an additional evaluation and consultation may have to be provided if the individual’s functional capabilities change.

A prerequisite of this service is possession of a valid driver’s license or learner’s permit with the appropriate restrictions indicated. In cases where the vehicle is being modified as a transport vehicle a license or permit are not required. The driver rehabilitation personnel will conduct an assessment to determine what primary and secondary driving controls are required by the driver to operate the vehicle and to access and/or egress the vehicle independently.

The driver rehabilitation personnel must see the consumer’s vehicle or have sufficient literature and knowledge of the anthropometrics of the vehicle to recommend the appropriate assistive devices and/or vehicle modifications.

Vehicle Inspection (currently being provided by the VESID Independent Consultant) - Vehicle inspection is required when some types of adaptive equipment are installed as specified by VESID. Its function is to assure that the installation meets or exceeds VESID Modification Standards and that the vehicle modifier should be paid by VESID upon completion of final vehicle inspection.

Functional Inspection with Consumer (also known as Performance Assessment) - The functional assessment is required for all vehicle modifications and assistive devices. This service verifies that all modifications and equipment which were recommended comply with the recommendations provided by the Driver Rehabilitation personnel and meet the functional needs and capabilities of the driver. This inspection must include an evaluation and observation of the consumer operating all the assistive devices while accessing the vehicle, preparing to drive, and operating the vehicle on the road. This must be completed before releasing the vehicle to the consumer to drive. The VESID consumer and the Driver Rehabilitation personnel must sign the Vehicle Modification Adaptive Equipment Statement prior to releasing the vehicle to the consumer.

Core Services and Methodology:

Present codes proposed for consolidation – The Workgroup achieved consensus that all the codes listed below could be replaced using a new code and the methodology described herein. 
DRIVER & VEHICLE SERVICES - 137 (Driver Eval.-Car), 139, 142 (Travel-Driver Train),          877(Driver Training-Van), 144 (Vehicle Modification Assessment), 145, 146, 148, 875 (level II), 876 (level I), 877 (Driver Train–Car level III), 878 (level I), 879 (Driver Train – Van level III)

Driver Evaluation – required procedures for a driver evaluation will include review of the consumer’s medical history, evaluation  of functional capabilities and limitations as they pertain to the driving task, perceptual and visual assessment and where applicable cognitive assessment. An evaluation of wheelchair dimensions and seating as they pertain to operating a vehicle safely will be conducted. The pre-driver evaluation and in-vehicle evaluation must be completed by an appropriate Driver Rehabilitation personnel.  The cognitive perceptual evaluation must be administered by a registered, licensed professional such as an occupational therapist or clinical psychologist.

Successful performance on the driver evaluation will include an in-vehicle assessment of the individual utilizing equipment similar to that which will be recommended.

Driver evaluation is the only core service. The completion of the driver evaluation will determine whether or not additional services may be appropriate and recommended.

Unit of Service – Definition of a unit of service for all driver rehabilitation services is forty five minutes. A unit of service includes direct time and indirect time. Direct time is defined as time spent with the consumer or in conversation directly with the consumer. Indirect time includes record keeping, preparation  of evaluation/training vehicles for use by the consumer during the delivery of direct service, communication with collaterals including VESID staff, medical staff, vehicle modifiers, adaptive equipment suppliers, family members of the consumers, and others with whom conversation is necessary to support delivery of driving rehabilitation services. Indirect time shall also include travel time necessary to go to and return from the service point of delivery when service is delivered offsite.

Process for Authorization

1. All services will be authorized based on the specific code(s) assigned to the service requested. Distinct codes should be assigned for evaluation, driver education, vehicle consultation, vehicle inspection and functional inspection with the consumer. As previously noted, when a service is to be delivered “offsite”, the rate and code should be identified distinctively. It is recommended that: an Evaluation is authorized for no less than ten (10) units; Adaptive Driver Education for no less than twenty (20) units; Vehicle Consultation and Modifications assessment/recommendations for no less than ten (10) units. All other services should be authorized for not less than five (5) units. Authorization must include the start and end dates and proper coding of the services requested.

2. Request for units of service beyond the original authorization must be in writing and approved by VESID based on progress demonstrated and documented in the request by the provider. Every effort should be made to arrange for additional authorization to be made so as not to interrupt the continuity of the service. When termination of service is recommended prior to completion the provider will be entitled to payment for all services rendered. VESID will receive a report indicating the progress achieved through the last date of service. The decisions for termination should be discussed jointly between VESID and the provider.

Rate

To be determined by VESID.

Note: The Workgroup recommends that rates for Driver Rehabilitation Services should be determined by certain key factors. These factors include and are not limited to the following:

• The sophistication and cost of the vehicles utilized.
• The array and sophistication of adaptive technology utilized.
• The professional certification or licensure of the staff supervising and providing the service.
• The location from where the service is delivered. (If services are delivered from one or a central location to which VESID clients are sent, in contrast to when the service provider is requested to provide services outside the central location; rates should be established to accommodate this.)
• The specific nature of the service being delivered; rates for driver evaluation, cognitive perceptual evaluation, training and specialized services such as pre-licensing should be separately established.
• In recognition that this service is based on scheduled appointments requiring allocation of staff and equipment, providers should be entitled to bill VESID for missed appointments using a procedure and rate established by VESID and the provider.

Process of Service Accountability

Driving Evaluation – The evaluation report will be provided to VESID within ten business days of the completion of the evaluation. The final report will provide a summary and scores achieved for the evaluation, and an explanation summarizing the effects of the scores on the driving task. The report will indicate a recommendation of whether driving training is indicated. A preliminary checklist of vehicle modifications and assistive devices will be provided as appropriate.

Adapted Driver Training – Monthly progress reports will be generated throughout the course of training.

All Other Services – A report will be provided to VESID after the completion of the authorized service.

Staff Requirements

1. All Driver Rehabilitation personnel (DRS) must be certified or possess professional licensure and have a minimum of three (3) years qualifying experience. In lieu of qualifying years of experience a DRS may be supervised by a DRS who has been approved by VESID. Other professional credentials may include: licensed Occupational Therapist, Registered Physical Therapist, licensed Psychologist or Certified Teacher (in traffic safety) including NYS Driving School Instructor.
2. A practitioner may become certified as a DRS under the auspices of the Association of Driver Education for the Disabled (ADED) and Driver Rehabilitation personnel must be able to provide documentation of three (3) years experience providing driver rehabilitation services to individuals with disabilities consistent with the population they wish to serve.

Fast Track - NYC
Final Draft

Purpose of Service:

The purpose of Fast Track – NYC is to eliminate obstacles and unnecessary delays for participants in need of supported employment services due to an increasing number of referrals and a reduction in VR staff.  Further it is designed to increase the percentage of the harder to serve populations who would not necessarily “find” their way to VESID on their own.  It is a service that assures consumer choice.

Definition of Service:  
Present codes - 117, 118

Fast Track – NYC is an intake service provided by UCS contract providers in order to assist VR Counselors in their work to establish eligibility determination for individual referrals.  This service would include, but not be limited to, providers under contract to collect, and sometimes provide, the data and background information which VESID counselors require in order to determine eligibility for VESID services and to complete the required Individual Plan of Employment (IPE).

The Workgroup fully recommends that the process used in NYC District Offices is the service that was originally intended to be Fast Track.  In working to formulate a recommendation for statewide implementation it was clear that VESID District Offices have been allowed to institute a service that met their operation’s needs and there is no state standard.  Should Fast Track be included in the new RFA, the Workgroup recommends that the design be implemented as it is used in NYC and or some other solution be designed by VESID to meet the requirement of the eligibility function of the VR Service system in its respective offices.

Assistive Technology Service
Final Draft

Purpose of the Service:

The Assistive Technology Service was developed to provide greater independence for individuals with disabilities and to improve their overall quality of life through the use of assistive devices.  An assistive device is a device that has been custom built or purchased for a specific individual.  It is intended to help an individual do something they normally could not do.

Definition of Service:

811 (Assistive Technology Equipment Rental), 166 (Assistive Technology-TBI)

The menu of the Assistive Technology Service should include –

• Assistive Technology/Engineering Services
• Assistive Technology Evaluation
• Plant Engineering
• Job Accommodations
• Mobility/Sensory/Augmentative Communication
• Wheelchairs
• Consultation
• Special Service as defined by consumer need

Unit of Service:

The Workgroup recommends that the hourly rate continue; however, VESID needs to review the rates to determine if indeed these rates adequately cover the costs for completing the service needed.

Rate:

The Workgroup recommends that VESID review rates now provided to providers with services authorized off-contract to be certain that any new rates developed are no lower but at least 15% higher than the current rates.  Note: During the VESID “salary” survey, rates for these services were not reviewed and the Workgroup feels that they must be reviewed prior to the issuance of new RFA.

Deaf/Hard of Hearing Service
Final Draft

Recommendation:

Use of federally approved terminology - Lower Functioning Deaf (LFD). 
The Workgroup agreed that many of these people have other disabilities as well, but may not qualify under other State agency’s diagnosis requirements.  These individuals require more assistance and time to adjust.  It is more expensive to provide services to this group.  Other neighboring state’s rates were discussed and it was recommended that VESID review these rates when establishing new rates for the pending RFA.

Recommendation:

A higher rate could be collapsed here.  Perhaps it could be increased to at least $2,000 and still be outcome-based.  This is a group of consumers that needs some specialized soft-skills training.  Several ideas were tossed around including:

1. An add-on for enhanced services
2. Job Coaching (no less than 20 hours) must be authorized at time of placement/referral. 
3. There is a need to have employment staff/coaches that are ASL “qualified,” so rate must increase accordingly. 
4. Standards for staffing must be high enough to ensure qualifications can be met yet rate can be justified and still adequate to do the job.  Sign language skills are essential, some at various levels.  Rate is currently at about $20/hr. really not adequate for Job Coaching, as interpreters alone get considerably higher. 

Recommendation:

Individuals who are deaf/hard of hearing are not able to pick up peripheral cues on social/cultural norms and as such must learn about the “real world” to successfully function on the job.  Having a Job Coach with interpreter skills is critical to helping the individual adjust to their unique world of work.  The Workgroup recommends that to hire and keep quality Job Coaches who are skilled interpreters, providers must be able to pay an adequate salary.

Recommendation:

Working with people who are deaf/hard of hearing have few diversions from working with others with “special” needs from their own disability challenges.  The group felt it was necessary NOT to go back to creating separate “codes” by disability diagnosis.

The design should build into the authorization process parameters specific to serving the deaf/hard of hearing population as a directive yet allow flexibility to the discretion of the VR counselor to use this code to offer special assistance to all others needing specialized services.

Summary:

1. All current services are needed by the Deaf/HI
2. Set adequate standards for staffing by VR and providers
3. Authorizations to proper Assessment services is essential
4. Rates needs to increase
5. To assist the adjustment and acclimation of the person to the mainstream work world will require providing social and cultural counseling and supports now available under new service recommendation of Work Readiness Service.
6. However, the three levels of codes/rates in place now are not needed.  Upward adjusting and using the highest rate would eliminate that need. 

General Recommendations & Minority Opinions
The Workgroup’s Vision of the new “VESID Services System”

 Recommendation 1:
         
RATE DEVELOPMENT -

Rates for all services must be set high enough to cover the cost of the specific service.  Many Workgroup member providers reported that their reimbursement is lower for some services than what they pay their staff to do the service.  Providers do not have this capacity to continue to cover these unpaid costs.  It is clearly not possible to continue to provide any of these services with continued quality and consumer choice without adequate reimbursements in the future.

Supporting this, several District Office Workgroup reps expressed concern that they do not have sufficient provider resources available to them because when the rates are so low, providers can’t afford to provide the services and won’t bid.  This is a long-term problem that needs to be addressed.  Presently off-contract rates used in all service areas are logically more accurately paying providers.  The Workgroup asks that VESID look at these in making future determinations.

The Workgroup recommends in the new rate development, consideration be given to the economic differential throughout New York State, and not develop just an “Upstate or Downstate” rate.   

In addition, should the above rate process occur, the Workgroup felt strongly that there would no longer be a need for varying rates within service domains for specific populations.  A newly established rate paying the actual costs of the provision of services to the providers shall with proper management by the provider allow the provider to contract for services* with all the proper staff. 

(*Note: There is an exception to this statement - Placement Service for people who are deaf /hard of hearing must continue to  have a differential –see Placement Service description).

Recommendation 2:

STANDARDIZED METHODS –
         
There is a need to implement VESID standardized methods and VESID issued forms for referral, authorization, and reporting.  A consistent theme of all of the Workgroups’ discussions was the need for VESID to develop a standard format for referral for a specific program area and develop an information system that is more useful to individuals receiving services, providers and to VESID. 

The Workgroup also recommends that VR Counselors statewide should be involved in the development of the design of any statewide standardized referral form for all of the program areas.  It should be outcome driven, include the use of the timeframes described in the program areas and other service specific required or suggested items.  The form that has already been developed by the Quality Assurance team through its “fact finding” stage should be helpful and more than adequate for this purpose.

Recommendation 3:

FLEXIBILITY –

The new VESID Service System requires flexibility thereby allowing providers to customize their services to meet the needs of the consumer and the local District Office while responding to the RFA.  The system should to the extent possible be outcome driven.  There is a range of provider diversity across the State.  New and innovative approaches constantly are under design and then being utilized to provide quality services for VESID consumers.  The RFA and subsequent awarding of “VESID Service System” contracts should take into account the diversity of providers and allow programs to operate as freely as possible within the guidelines, keeping in mind that it is the outcomes which meet the needs of the eligible individuals that shall determine success.

Recommendation 4:

KEEP WHAT IS WORKING -

It was clear from the Workgroup discussions that many facets of the current VESID UCS system are working well. 
Examples of that were most evident are found in:

• Fast Track Service – NYC design,
• Job Development (929X), 
• Job Coaching (959X), and
• Vocational Assessment (the use of Situational Assessment). 

VESID should be certain that what is working well is not disrupted and some of those practices encouraged to be developed via the pending RFA.

Recommendation 5:

PROVIDER STAFFING & CREDENTIALS –

The full Workgroup and each of the individual program Workgroups discussed the issue of staffing and credentials needed to perform each specific vocational rehabilitation service authorized.  In each of the program write-ups as attachments, the recommendations particular to the program are included.
As a general statement, the Workgroup recommends that VESID make no major changes in the staffing requirements to providers which contract for services.  The new service descriptions that follow each have a section that describes the specific recommendation for that service.

It does not seem desirable to raise the standards at a time when it is difficult to recruit and retain credentialed staff to provide the services.  Highlighted in each section the reader will note the Workgroup recommends VESID consider adding a phrase to the staffing requirement about “adequate supervision” (for example, by a CRC) and also allow waivers or exemptions for defined periods of time and allowances for staff training.

Recommendation 6:

SYSTEM WIDE TRAINING –

The Workgroup feels very strongly that when the new “VESID SERVICE SYSTEM” is adopted by Central Office VESID, a plan must be implemented prior to the release of the new RFA for system wide training on the newly approved definitions and subsequent changes in authorization processes.  Failure to have a full understanding within the system network – VESID Central Office, VESID District office staff, Providers and individuals with disabilities – will result in confusion and an ineffective system altogether.

Recommendation 7:

SUPPORTED EMPLOYMENT –

It was the unanimous conclusion of the Workgroup that Supported Employment should not be included in the new “VESID Services System” and the contracts at this point in time.  Expressed were deep concerns about the rates and the hourly process, as well as the burden of reporting.  It was recommended that VESID first address the operational issues in Supported Employment as a stand alone contract and then engage providers again in a discussion of the feasibility of inclusion.  While inclusion makes sense from both the provider and VESID perspective in terms of administering both programs, combining them at this point would cause needless turmoil and disrupt the entire vocational rehabilitation service system.

Recommendation 8:

QUALITY ASSURANCE -

Quality Assurance review is necessary as well as required by the VR District Office to provide proper services to eligible individuals first and foremost and then to maintain a cadre of providers which offer high quality services and subsequently issue reports meeting all expectations of service requests authorized in a timely manner.   With standard methods in place, consistent referral and authorization forms issues and in use, eligible individuals will know what they are to expect in services.  Providers will be able to design and implement services accordingly.

Accountability measures looking at the value of outcome and consumer satisfaction with the services are needed.  Success in meeting these goals will ensure further referrals to an agency on a continuous basis by VR.

Recommendation 9: 

POST PLACEMENT STRATEGY (Note: May not be within VESID’s scope of services due to law and regulation.) –

The issue of how to support people achieving past 90 days employment, whose case has been closed, yet need additional supports to maintain employment was a major focus of discussion.  The Workgroup asks that VESID consider the development of a specific methodology to address this issue.  One suggestion registered as a minority opinion was to use an assigned code/rate added to Placement Service for this specific gap. 

Rationale: It makes sense to help ensure the success of efforts that have already been expended to give consumers assistance in maintaining that effort.

Recommendation 10:

EVIDENCE BASED TRIAL SERVICES -

Looking to maintain the Guiding Principle of Flexibility in the redesign, the Workgroup recommends that a new Service section be included in RFA that speaks to some of the findings from the Designing for the Future Best Practices and other Evidence based practices that drive VR success for individuals with disabilities. 

One such topic, Supported Education, was viewed as a needed service for driving success in employment and a part of many group discussions for people with disabilities especially those in psychiatric recovery.  The Supported Education model does not adequately nor neatly fit under any of the other service descriptions.  Since it was within the purview of this project to suggest ideas for needed services and programs to be included in the RFA, the Workgroup is recommending this process for the inclusion of this much needed service and others that VESID feels supports people with disabilities towards employment success.  If accepted, the Workgroup is prepared to assist in the design of a service description similar to the others contained in this report.

Other Minority Opinions expressed by the Workgroup or individual members of the Workgroup for consideration
by VESID in its redesign of the present UCS System

Consumer Developed IPE:

 VESID should develop and implement more forcefully the concept of consumer developed IPE.  This issue came up in the final Workgroup meeting, but time limited the discussion so it could not be fully developed.  It does appear to be an issue that should be addressed by the VESID Central Administration.

State Salary Parity:

Due diligence needs to be conducted by VESID on the issue of State salary parity with providers under contract.

“DROP-OUTS”:

Take a look at the prevalence of “drop-outs” to the VESID service system – “drop-outs” of services before initiating with an agency and “drop-outs” prior to completion of a program, once engaged.

The Workgroup, see list attached at the very end of report, is very pleased to present the above recommendations to VESID for consideration of the redesign of the present UCS system to the new VESID SERVICE SYSTEM.  We were pleased to serve as volunteers to this redesign effort and look forward to working with VESID it the implementation phase.

Rehabilitation Providers/Advocates

Andrew Karhan
Wildwood Programs, Inc.
1202 Troy-Schenectady Road, Bldg. 1
Latham, NY 12110
akarhan@wildwood.edu

Michael Sanders
Employment Options – Center for Disability Services
1164 Western Ave.
Albany, NY  12203
M_sanders@cftd.org

Timothy Pfohl
Suburban Adult Services
960 W. Maple Ct.
Elma, NY 14059
tpfohl@sasinc.org

William Schultz
People, Inc.
1219 North Forest Road
Williamsville, NY 14231
bschultz@people-inc.org

Adele Agin
Lexington VR Services Ctr. Inc.
30th Ave. and 75th St.
Jackson Heights, NY 11370
aagin@lexnyc.org

Daniel Tworek
UCP-NYS Inc.
90 State St., Suite 929
Albany, NY 12207
dtworek@CPOFNYS.ORG

Nancy Miller
The Rehab Center/Employment Connection
338 North 15th Street
Olean, NY 14760
nmiller@rehabcenter.org

Richard Bosch
InterAgency Council of MRDD Providers
150 30th St., 15th Fl.
NY, NY 10001
richard@iacny.org

Joseph Bravo
Westchester Ctr. for Independent Living
200 Hamilton Ave., 2nd Fl.
White Plains, NY 10601
Jbravo297@aol.com

Maureen Bentley
Fedcap Rehab Services, Inc.
211 W. 14th St.
NY, NY 10011
Mbentley@fedcap.org

Patricia Caso
UCP of Greater Suffolk, Inc.
250 Marcus Blvd.
Hauppauge, NY 11788
Pcaso@ucp-suffolk.org

Thomas Gibbons
Rochester Rehabilitation Center, Inc.
100 Elmwood Ave.
Rochester, NY 14620
T_gibbons@rochesterrehab.org

Stephen Towler
AHRC-NYC
200 Park Ave. South
NY, NY 10003
Steve.Towler@AHRCNYC.org

Gary McIlvain
Oswego Industries
7 Morrill Place
Fulton, NY 13069
gmcilvain@oswegoind.org

Frances Burnham
Madison-Cortland ARC
639 Lenox Ave.
Oneida, NY 13421
Fran.burnham@mcarc.us

Susan Reed
Adults and Children with Learning Disabilities, Inc.
807 S. Oyster Bay Road
Bethpage, NY 11714
ReedS@acldd.org

Maryann Hildebrandt
Gateway Community Industries, Inc.
One Amy Kay Parkway, PO Box 5002
Kingston, NY 12402
mahildebrandt@gatewayindustries.org

Edward O’Donnell
Goodwill Industries of NY and Northern NJ, Inc.
4-21 27th Ave.
Astoria, NY 11102
EODONNELL@goodwillny.org

Fredda Rosen
Job Path
22 W38th St.
NY, NY 10018
frosen@jobpathnyc.org

Sheri Muth
Jawonio, Inc.
260 Little Tor Road
New City, NY 10956
sheri.muth@jawonio.org

Kim Spahn
Westchester ARC
121 Westmoreland Drive, 3rd. Fl.
White Plains, NY 10606
Kspahn@westchesterarc.org

Francine Tishman
Abilities, Inc.
IU Willets Road
Albertson, NY 11507
ftishman@abilitiesinc.org

Ted Zupa
Education and Employment Consulting, Inc.
566 7th Ave., 6th Fl.
NY, NY 10018
Tzupa@aol.com

Margaret Wong
Contemporary Guidance Services, Inc.
156 William St., 7th Fl.
NY, NY 10038
Mwong@cgsnyc.org

Alysia Pascaris
New York Work Exchange
90 Broad St.
NY, NY 10004
apascaris@coalitionny.org

Matthew Mathai
NYAPRS
1 Columbia Place
Albany, NY 12207
Nyaprsmat.@aol.com

VESID Participants

Mark Ridgeway – Manager
White Plains DO
Mridgewa@mail.nysed.gov

Lisa Beers, Supervisor
Central Office Program Monitoring Unit
Lbeers@mail.nysed.gov

Betsy Hamel
Central Office Quality Assurance Unit
ehamel@mail.nysed.gov

John Cebula
Central Office Data Management
jcebula@mail.nysed.gov

Rich Bohman, Manager
Southern Tier DO
rbohman@mail.nysed.gov

Nicky Leathersich, Manager
Rochester DO
nleather@mail.nysed.gov

John Tracy, Regional Coordinator
Central NY
jtracy@mail.nysed.gov

Sheldon Brumberger
Central Office Program Monitoring Unit
sbrumber@mail.nysed.gov

Tom Guiffre, Senior VRC
Utica DO
tguiffre@mail.nysed.gov

John Seacord, AVRC
Albany, DO
jseacord@mail.nysed.gov

Barbara Weissberg, Senior VRC
Hempstead DO
bweissbe@mail.nysed.gov

Barbara Adler, Program Monitor
Manhattan DO
badler@mail.nysed.gov

Arnold Dorin, Senior Counselor
Manhattan DO
adorin@mail.nysed.gov

Fred Stechel, Senior Counselor
Brooklyn DO
Fstechel@mail.nysed.gov

Pat Dowse                                                      Michael Connelly
NYSRA                                                            Northeast Associates in Rehabilitation
155 Washington Avenue                             1721 Central Avenue
Albany, NY 12210                                         Albany, NY  12205
pat@nyrehab.org                                         northeastassociates@verizon.net

Fiscal Staff included Jack LaFrank, Tina Seda and Phil Kiernan.  These individuals participated in a number of meetings both in person and by phone.  The Contractor held a special meeting to discuss “re-design” topics to ensure that the Workgroup was reality based.  This supported the work of the full Workgroup throughout the process.

 GUIDELINES FOR REDESIGN of
VESID UCS SERVICE SYSTEM

NEW SYSTEM NEEDS

• Whatever is designed needs to be ADAPTABLE all along the way    
• Consistency statewide
• Target service group – Minority, especially Latino & Asian groups
• Work to help VR Define who is/isn’t “employable”        
• VR Counselors add value to the consumer’s plan and overall employment success
• Identify wider variety of tools available to assess interests of individuals with disabilities
• Establish baseline demographics of individuals being served for future planning
• UNIT – what is it for each service – same or different?
• Accountability measures throughout service delivery
• Reduce “wait time” for training start date
• Greater flexibility across system – stop the “boxes”
• Better communication/collaboration with and within VESID about what is needed for the people served
• Seamless/uninterrupted/faster service delivery that is not “felt” by consumer
• Remember that VESID serves a DIVERSE array of people with disabilities with a wide array of needs
• Develop a system that is “user friendly”

NEW SYSTEM EFFICIENCIES
IDENTIFIED ACROSS ALL STATE AGENCIES

• Better Performance Based Contract placement – look at milestone “weighting”
• Simplify the authorization process
• Community Information meetings regarding VR process
• Review other state agency’s forms for comparable uses– DOL, Parole
• Distinguish descriptions for actual delivery
• Don’t let the “contract” get in the way of consumer getting what they need
• Build “bridges” to VESID services for all state agencies – targeting case management and or service coordinator
• “Pilot projects” that include monitoring – goal is to add the “services” defined by pilot to the VR service “menu”
• VESID case flow process/integrate with CAMs – flexible and capacity to “back date” services
• Reflect business system of the FUTURE as well as NOW – job development/retention
• Service “codes” that define service timelines – BENCHMARK
• Take care not to create disincentives for the “most difficult” to serve
• Fund by person – think outside the present UCS box
• More contact time between consumers and providers
• Avoid “Contract Process Lock-ins” – change allocations by performance

COMPONENTS/CHARACTERISTCS
THAT NEED TO BE INCLUDED IN NEXT RFA –

Note:  the Workgroup provided one suggestion – Supported Education – under the heading “Evidence Based Trial Service” as a way to add new services for individuals with disabilities.  Any of these could be added or substituted.

• Academic Remediation
• Workplace Literacy/Reading, Writing,& Math
• Facilitated Application process - Psych test, MH screening, medical reports
• Consultant services – specific to specialty needs of consumers
• Customized employment
• Case Services for “replacement” supports for individuals already employed
• Peer monitoring
• Consumer prep/readiness/remedial training
• Transition Youth – pre-employment/work adjustment issues need to be addressed
• Rehab readiness tools –
• Summer Youth Employment
• Long Term Support services – when and where are they needed – post employment
• Transportation issues – bus passes, subway tokens where available
• Internships