1915c Waiver Employment

Billing Guidelines and

Payment Rates

Nehtra Davis

Program Specialist, HHSC

November 16, 2017

1915c Waiver Employment Services

• Employment Assistance (EA) services consist

of developing and implementing strategies for

achieving the individual’s desired

employment outcome, including more suitable

employment for individuals who are

employed.

• Supported Employment (SE) is assistance

provided in order to sustain competitive

employment or self-employment.2

Examples of Billable EA supports/activities

Services are individualized, person-directed, and

may include:• Exploring an individual's employment preferences

(where do I want to work?)

• Transportation needs for employment (going to

look for jobs)

• Filling out job applications

• Writing resumes

• How to dress for an interview

3

Examples of Non-Billable EA

supports/activities

• Face-to-face contact with an individual to

provide EA services simultaneously with Day

Habilitation services, Supported Employment,

CFC PAS/HAB or Respite.

• EA services accessed and/or funded through

other sources at no cost to the program

provider such as Employment Services

through Texas Workforce Solutions-

Vocational Rehabilitation Services formally

known as DARS.

• Life skills training such as hygiene/grooming

4

Examples of Billable SE supports/activities

• Employment adaptations (iPad to read totals

aloud to cashier)

• Transportation to and from work

• Communicating with managers to maintain

and sustain stable employment

• Assisting individual in reporting income to

Social Security

• Training or consulting in work-related tasks

5

Examples of Non-Billable SE

supports/activities

• Interacting with an individual prior to individual

obtaining employment (this could potentially be

billed as EA instead of SE)

• Face-to-face contact with an individual to

provide SE services simultaneously with Day

Habilitation services, Supported Employment,

CFC PAS/HAB or Respite.

• Any activity taking place in a sheltered work

environment or similar types of vocational

services in specialized facilities.

• Paying the individual as an incentive to 6

Service Log for EA

Must include information below that pertains to

individual’s progress toward employment

goals:• Name of individual

• Type of service

• Date of service

• Place of service

• Start and end time of each billable event

• Description of service event

• Name of service provider

• Signature of service provider 7

Written Documentation for SE

Program Providers must have written

documentation to support a service claim for

SE and that documentation must:

• Meet requirements set forth in Section 3800

(Written Documentation) https://hhs.texas.gov/laws-

regulations/handbooks/home-community-based-services-hcs-program-billing-guidelines/hcsbg-

section-3000-general-requirements-service-components-based-billable-activity

• Include start and end time of SE services provided

• Include evidence that SE services are not

available under a program funded under IDEA for

individuals under 22 yrs. old

• Include justification in the PDP reason(s) why

activities are simultaneously being performed by

8

Links for Billing Guidelines and Payment

Rates

• http://legacy-hhsc.hhsc.state.tx.us/rad/long-

term-svcs/index.shtml

• https://hhs.texas.gov/laws-

regulations/handbooks/home-community-

based-services-hcs-program-billing-

guidelines/hcsbg-section-4000-specific-

requirements-service-components-based-

billable-activity9

HHSC Employment Recruitment

Coordinator (ERC) Activities

Monty Chamberlain

Presentation to

Private Providers Association of Texas (PPAT)

November 17, 2017

Money Follows the Person (MFP) Employment Initiatives Project

In concert with other employment initiatives, DADS (now HHSC)

determined the need for Employment Recruitment Coordinator (ERC)

activities (project began January, 2015);

Development of materials, video, and initial website work in 2015;

Information Letter 15-72, November 16, 2015 introducing role;

Field based work statewide to reach beyond a state office based approach

with a direct face to face representative;

Ultimate goal is to increase employer awareness of the population we

serve and increase integrated employment opportunities.11

Goals for the role of the Employment Recruitment Coordinator

Pursue employment opportunities in

support of individuals who set

integrated employment as a goal;

Establish ongoing relationships with

businesses / employers;

Network and establish community

and civic organization relationships;

Promote Employment First

principles. 12

What is Employment First?

The philosophy that employment in the

general workforce should be the first and

preferred option for individuals with

disabilities receiving assistance from publicly

funded systems. Simply put, Employment

First means real jobs, real wages, earning

minimum wage or better.

13

Employment in the General Workforce

What does this mean?• Employment in the general workforce means regular jobs

like everyone else in society: in typical work settings,

working side-by-side with people without disabilities,

earning regular wages and benefits and being part of the

economic mainstream of our society.

• The individual sets employment as a goal with assistance

from the service provider. Not mandated on the individual

to become employed, but instead a goal set based on the

individual’s desire.

14

Employment First Assumption

Employment First starts with a presumption that a

person with a disability can work. Unlike other

individuals of working age in our society, where it’s

presumed they will become employed, people with

disabilities have too often had to demonstrate their

“readiness” for employment. Under Employment

First, it is assumed that individuals are capable of

working until proven otherwise, and employment in

the general workforce is the first option pursued.

15

HCS Billing Reimbursement Rate Comparison

Examples

Day Habilitation

• Based on Level of Need (LON) per day with Rate Enhancement

• Example - Intermittent Level 25 is $26.87 per day

Employment Assistance

• Per hour with Rate Enhancement

• Example – Participant Level 25 is $34.35 per hour

Supported Employment

• Per hour with Rate Enhancement

• Example – Participant Level 25 $34.35 per hour

16

Money Follows the Person (MFP) Employment Initiatives Project

The Big Goal:

Market to employers why

employing persons with

disabilities is a good business

decision!

17

A Focus on a Person’s Ability as Opposed to Disability

Individuals who desire to work in

integrated employment bring value

to the workplace as a productive

member of the organization;

Out of the box thinking with the

ability to meet the employers need

with difficult to fill or high turnover

positions;

Dedicated with excellent attendance

records, low turnover, and on-time!18

How is the message being delivered?

Direct interaction with employers in face to face settings

• Presentations

• Informal discussions

• Cold calls

Presentations at civic organization meetings;

Networking and expansion of employers (new participants and those

already employing persons with disabilities);

Networking with various TWC–Vocational Rehab staff;

Job Fairs;

ERC works throughout the state as a front line representative to educate

employers and pursue a commitment from employers.

19

Difference between the ERC and TWC – Voc Rehab Field Specialists

ERC focus is a more global focus with employers as

opposed to individual employment cases;

Focus is more statewide as opposed to local;

Open doors with employers that have a statewide

presence with intent of establishing large scale

initiatives;

Work in concert with TWC–Voc Rehab staff on

mutually beneficial projects such as job fairs and

encourage provider attendance.

20

Tools to Communicate

Packet of Information to remain with employers;

Handbill / Postcard selling employer benefits for hiring;

Better Bottom Line document;

Power Point employer focused presentation;

Employer Acknowledgement Form;

Employer list on HHSC website;

TWC “Guide for Hiring People with Disabilities”;

HHSC Employment Marketing video.

Provide employer contacts to LIDDA’s and Service

Providers

21

22

Employment Web Page Sample

23

CY 2016 Data

Initiated field outreach in April, 2016;

30 presentations made to civic organizations;

12 Presentations made to stakeholder organizations (ie;

provider organizations, providers, etc);

24 Direct one to one meetings with employers;

Participate in four (4) Disability Job Fairs where ERC was

one of the multi-agency team members for planning and

staffing;

5,500 people presented to in presentation settings during 2016

(civic presentations, conferences, stakeholders)

24

CY 2017

Continuing presentations to civic organizations

(estimate over 12,000 people reached by end of

2017);

Increased number of direct interactions with

employers and follow up;

Work with Local Authorities and Providers;

Training Opportunities; (July - Texas Panhandle

Centers, Starcare Specialty Health and Central

Plains… August – Texoma Community Centers…

October – Pecan Valley Centers)25

CY 2017 and Beyond

Webinar Training (Three target audiences - case

managers / employment specialists, Families;

Individuals);

ERC Web presence;

Civic presentations upon request with more specific

focus on direct employers;

Continue networking with TWC- Voc Rehab staff

and participate as team member in Job Fairs;

26

State Population

27

Dallas / Ft

Worth

25.1%

Houston 23.7%

San Antonio 8.6%

Austin 7.3%

Valley 6.1%

El Paso 3.2%

Employment Recruitment Coordinator Contact Information

Monty Chamberlain

701 W. 51st Street

Austin, Texas 78751

Mail Code: W-580

512-971-8839

monty.chamberlain@HHSCs.state.tx.us

erc@dads.state.tx.us

Video Link:

https://hhs.texas.gov/services/disability/employment/e

mployment-first28