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D.C. Municipal Regulations (Last Updated: September 13, 2017) |
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Title 29. PUBLIC WELFARE |
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Chapter 29-19. HOME AND COMMUNITY-BASED SERVICES WAIVER FOR INDIVIDUALS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES |
Section 29-1922. EMPLOYMENT READINESS SERVICES
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1922.1This section establishes standards governing Medicaid eligibility for employment readiness services for persons enrolled in the Home and Community-Based Services Waiver for Individuals with Intellectual and Developmental Disabilities (Waiver) and establishes conditions of participation for providers of employment readiness services.
1922.2 Employment readiness services occur over a defined period of time with specific outcomes to be achieved, and provide learning and work experiences, including volunteer work, where a person enrolled in the Waiver can develop general, non-job-task-specific strengths and new employment related skills that contribute to employability in paid employment in an integrated community setting. A person receiving employment readiness services may pursue employment opportunities at any time to enter the general work force.
1922.3 To be eligible for Medicaid reimbursable employment readiness services, the services shall be identified in the ISP, Plan of Care, and Summary of Supports for each person enrolled in Waiver, and each person shall:
(a) Demonstrate a need for employment readiness services; and
(b) Have employment related goals included in the ISP.
1922.4To be eligible for Medicaid reimbursement, employment readiness services shall support a person on his/her pathway to competitive, integrated employment and shall consist of the following:
(a) Providing opportunities for persons enrolled in the Waiver to develop general, non-job, task-specific strengths and skills that contribute to employability and are consistent with the person’s goals;
(b)Assessment activities that occur annually or more frequently based upon the needs of the person, which require, at a minimum, a Positive Personal Profile and Job Search and Community Participation Plan, and may also include a customized employment assessment, and/or conducting a person-centered vocational and situational assessment and employment readiness assessments provided at community businesses and other community settings;
(c)Social and soft skills training, including, but not limited to, the following:
(1)Following and interpreting instructions;
(2)Interpersonal skills, including building and maintaining relationships;
(3)Communication skills for communicating with supervisors, co-workers, and customers;
(4)Travel skills;
(5)Respecting the rights of others and understanding personal rights and responsibilities;
(6)Decision-making skills and strategies;
(7)Support for self-determination and self-advocacy; and
(8) Budgeting and money management;
(d)Developing work skills which shall include, at a minimum, teaching the person the following:
(1) Appropriate workplace attire, attitude, and conduct;
(2) Work ethics;
(3)Attendance and punctuality;
(4)Task completion;
(5)Job safety;
(6)Attending to personal needs, such as personal hygiene or medication management; and
(7)Interviewing skills;
(e)Coordinating transportation to community activities utilizing the Medicaid Non-Emergency Transportation Broker;
(f)Employment exploration and/ or employment preparation in the community; and
(g) Coordinating community-based, integrated, volunteer experiences as set forth in § 1922.5.
1922.5Volunteer experiences shall be time limited and must allow the person to develop experience and build skills to further the person’s employment goal, as identified in his or her ISP. A person enrolled in the Waiver may volunteer at a not-for-profit organization or an approved government agency, but may not volunteer for the provider agency or another business affiliated with the provider; if volunteering occurs at a for-profit business and the provider shall meet any requirements released by the U.S. Department of Labor. The guidance for those requirements can be found at:
http://www.dol.gov/whd/regs/compliance/whdfs71.pdf.
1922.6To be eligible for Medicaid reimbursement, a Positive Personal Profile and Job Search and Community Participation Plan shall be developed within thirty (30) days of the date when the person began receiving services. An additional vocational assessment, completed by a qualified professional, shall be conducted within the first ninety (90) days of participation, and shall include an assessment of the following:
(a)Employment-related goals based on a person’s strengths, interests, and areas for improvement;
(b)Available natural or community supports;
(c) Personal concerns and preferences, based upon what is important to and for the person;
(d) Work and career interests based on exploration and/or discovery; and
(e)Accommodations and supports, including an assessment of assistive technology, which may be required once the person is employed.
1922.7To be eligible for Medicaid reimbursement, a Positive Personal Profile, Job Search and Community Participation Plan, and additional vocational assessment shall be conducted at least annually by the provider to evaluate each person enrolled in the Waiver’s acquisition of employment-related skills based on the person's career preferences and goals as specified in their ISP and Plan of Care.
1922.8Each provider of Medicaid reimbursable employment readiness services shall develop an individualized service delivery plan described under Section 1909 (Records and Confidentiality of Information) of Chapter 19 of Title 29 DCMR reflecting the person enrolled in the Waiver’s interests, career preferences, choices, goals and prioritized needs. The plan shall:
(a) Define the specific outcomes to be achieved over a specified period of time;
(b) Describe the activities in the plan that are developed with the person and support the person on his or her pathway to competitive, integrated employment;
(c) Describe how the plan shall support a person in the development of employment related skills, including social skills such as interviewing skills, professionalism, building and maintaining relationships, self-determination and self-advocacy, and attending to the person’s needs; and
(d) Describe community-based employment preparation experiences that are related to the person’s employment goals.
1922.9Each provider of Medicaid reimbursable employment readiness services shall submit reports to Department on Disability Services (DDS) service coordinator on a quarterly basis, consistent with the record maintenance requirements described under Section 1909 (Records and Confidentiality of Information) of Chapter 19 of Title 29 DCMR. These reports shall also include the following information:
(a) Volunteer activities provided;
(b) Employment exploration and/or preparation in the community; and
(c)Other employment readiness service activities provided.
1922.10Each provider of Medicaid reimbursable employment readiness services shall develop, with the person, an individualized schedule of daily activities based upon the person’s goals and activities as identified in his or her ISP, and consistent with what is in his or her Person-Centered Thinking and Discovery tools, of meaningful adult activities that support the person on his or her pathway to integrated, competitive employment.
1922.11Each provider of Medicaid reimbursable employment readiness services shall maintain the following documents for monitoring and review, in addition to the record maintenance requirements described under Section 1909 (Records and Confidentiality of Information) of Chapter 19 of Title 29 DCMR:
(a) A copy of the Positive Personal Profile, Job Search and Community Participation Plan, and additional comprehensive vocational assessment; and
(b) A written daily schedule identifying the utilization of employment readiness services.
1922.12To receive Medicaid reimbursement, employment readiness services shall be provided in the community or in a facility-based setting that provides opportunities for community engagement, inclusion and integration.
1922.13To receive Medicaid reimbursement, each provider of employment readiness services shall be a Home and Community-Based Services (HCBS) Provider agency and shall meet the following requirements:
(a) Comply with the requirements described under Section 1904 (Provider Qualifications) and Section 1905 (Provider Enrollment Process) of Chapter 19 of Title 29 DCMR;
(b) Demonstrate, through experience or academic attainment of the executive staff, the ability and qualification to provide employment readiness services for persons with intellectual and developmental disabilities with varying habilitation needs; and
(c) Have at least one staff member with a bachelor’s degree in vocational rehabilitation or a similar discipline, and one (1) year of combined supervisory and “job coaching” experience or experience providing employment services to person with disabilities.
1922.14Each provider of Medicaid reimbursable employment readiness services shall comply with the requirements under Section 1938 (Home and Community-Based Settings Requirements) of Chapter 19 of Title 29 DCMR.
1922.15When employment readiness services are provided in a facility, each facility shall comply with all applicable federal, District, or state and local laws and regulations in order to receive Medicaid reimbursement.
1922.16All payment for employment related training services shall be in accordance with the United States Fair Labor Standards Act of 1985.
1922.17 The employment readiness Medicaid reimbursement rate shall include coverage for any personal care services provided by an employment readiness services provider.
1922.18To be eligible for Medicaid reimbursement, each Direct Support Professional shall meet the following requirements:
(a) Comply with Section 1906 (Requirements for Direct Support Professionals) of Chapter 19 of Title 29 DCMR; and
(b)Have at least one (1) year of experience working with people with intellectual and developmental disabilities, or one year of comparable experience.
1922.19Services shall be authorized for Medicaid reimbursement if:
(a) DDS provided a written service authorization before the commencement of services;
(b) The provider develops a Positive Personal Profile and Job Search and Community Participation Plan, conducts an additional initial vocational assessment and then an annual Positive Personal Profile and Job Search and Community Participation Plan and additional vocational assessment thereafter; and develops an employment readiness plan with training goals and techniques that will assist the person to achieve employment readiness goals and outcomes based upon the person’s interests and preferences. The initial Positive Personal Profile and Job Search and Community Participation Plan shall be completed within the first thirty (30) days of service delivery and the additional vocational assessment shall be completed within the first ninety (90) days of service delivery;
(c) The service name and provider delivering services are identified in the ISP and Plan of Care;
(d) The ISP, Plan of Care, and Summary of Supports and Services documents the amount and frequency of services to be received; and
(e) Services shall not conflict with the service limitations described under § 1922.20 (Service Limitations).
1922.20Medicaid reimbursement will only cover services furnished to a person enrolled in the Waiver for up to eight (8) hours per day, not to exceed forty (40) hours per week, which will not include reimbursement for travel time spent in transportation to and from the program.
1922.21Medicaid reimbursable employment readiness services shall not be provided, or billed for, during the same hours and on the same day as the following services:
(a) Day Habiliation;
(b) Supported Employment;
(c) In-Home Supports;
(d) Companion;
(e) Personal Care Services; and
(f) Individualized Day Supports.
1922.22Employment readiness providers may not pay a stipend to a person for attendance or participation in activities at the employment readiness program.
1922.23An employment readiness provider may not concurrently employ a person and be his or her provider of Medicaid employment readiness services.
1922.24Employment readiness services are not available to people who are eligible to participate in programs funded under Section 110 of the Rehabilitation Act of 1973, enacted September 26, 1973, as amended (Pub. L. 93-112; 29 U.S.C. §§ 720 et seq.), or Section 602 (16) and (17) of the Individuals with Disabilities Education Act, enacted April 13, 1970, as amended (Pub. L. 91-230; 20 U.S.C. §§ 1400 et seq.)
1922.25Each provider of employment readiness services shall maintain the required staff-to-person ratio, as indicated in the person’s ISP and Plan of Care, with a maximum staffing ratio of 1:4.
1922.26The billable unit of service for Medicaid reimbursable employment readiness services shall be fifteen (15) minutes. The reimbursement rate for employment readiness services shall be eighteen dollars and seventy-six cents ($18.76) per hour or four dollars and sixty-nine cents ($4.69) per billable unit. A provider shall provide at least eight (8) minutes of service in a span of fifteen (15) continuous minutes in order to be able to bill a unit of service.