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VR PROVIDER MANUAL(Revision 1 – Effective 01-01-18)

INTRODUCTIONThe VR Provider Manual offers VR Counselors, VR Contractors, VR Support Staff, and Providers guidance from Opportunities for Ohioans with Disabilities (OOD) about service delivery rates and requirements as defined in OAC 3304-2-52 (Appendix), as well as technical assistance and other non-service and/or rate requirements. The VR Provider Manual is updated periodically to address trends as identified by OOD and to respond to questions from Providers, VR Staff, and/or VR Contractors. Updates to the VR Provider Manual will be posted to the Provider Section of OOD’s website (www.ood.ohio.gov) and announced through the eGov Delivery email distribution list, also known as Granicus. Updates will be effective no less than thirty (30) days from the date posted on the website, unless specifically noted otherwise. It is implied by Providers continuing to accept authorizations and offering services to the VR Program that Providers accept and will adhere to the changes. Providers who do not wish to accept the updates to the VR Provider Manual may request to be removed from the approved VR Provider list by emailing [email protected].

Thank you.

Opportunities for Ohioans with Disabilities

NOTE: The last page of the VR Provider Manual contains a “Change Log” that summarizes the topics that were updated from the previous version.

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TABLE OF CONTENTSYou may press “Control” + Topic to go directly to that page. When finished you may select the “Control” + “Table of Contents” to be returned to this place.

TOPIC PAGECRPVENDOR Mailbox 4Provider Management Program Accounts 4Provider Applications 5Provider Accreditation & Standing 5Provider Contacts 5E-Gov Delivery Distribution List (Granicus) 5Confidentiality 6Ethics 7Conflicts of Interest 7Electronic Communications 7Signatures 8Marketing Materials & Activities 8VR Original Authorizations & Billings (OOD-0020) 10Electronic Submissions Of Reports & Invoices 10Invoices & Report Forms 11Service Requirements (Billable Definitions) 12Service Requirements (Non-Billable Definitions) 13Table 1: OAC 3304-2-52 Appendix - Individual Rates 14Table 2: OAC 3304-2-52 Appendix - Group Service Rates 16Table 3: Contracted Service Rates (Not In OAC 3304-2-52 Appendix) 16Fiscal Requirements 17Vocational Services 20Auxiliary Services 21Diagnostic & Assessment Services 26Disability & Augmentative Skills Training 34Job Readiness Services 36Job Related Services 44Contracted Services 57

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VR Forms Instructions & Examples 60Forms By Service Chart 60Forms – Invoice Section 62Form – CBA OJS WA JRT SYWE 65Form – Job Development – Monthly Tracking 72Form – Job Development Plan 78Form – Employment Verification 83Form – Job Seeking Skills Training 87Form – Career Exploration SYCX 91Form – ADL OM RT BLVS 95Form – Travel Training 99Form – Work Incentives Plan 102Form – Work Incentives Coordination 107Form – Vocational Evaluation 109Form – Vocational Consultation 113Form - Interpreting 114Form – Vocational Training Stipend 117Form – Transportation 118Appendix I: 80-VR-10 Provider Management Procedure 119Appendix II: 80-VR-10 Provider Meeting Summary 130Appendix III: New School-Based Job Readiness Training Program Protocol 130Appendix IV: Vocational Rehabilitation Supervisors & County Assignments 133Change Log 137

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TECHNICAL [email protected] MAILBOXThis is a monitored email account. The mailbox often receives a large volume of emails especially during periods of transition, during the summer, etc. OOD Staff check messages periodically and attempt to respond within three (3) business days. In some cases, OOD Staff may be out of the Office and there may be a delayed response. Providers should use this mailbox for all OOD business regarding the provision of fee schedule services. If you do not receive a response within three business days you may contact either James Gears at 419.861.8855 or Renee Kimbell at 614.438.1784.

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PROVIDER MANAGEMENT PROGRAM ACCOUNTSProviders may designate one individual to manage their information (e.g. contacts, services, and service delivery areas) in the Provider Management Program (PMP). New Providers who need access to PMP or existing Providers that need to change account access must email [email protected]. The email should include the Provider’s name, full name of the account holder, telephone number, and email address. They will be sent a link from [email protected] to set up a username and password. New Providers may use this username and password to login into PMP (SEE BELOW) to complete their initial application. Existing Providers should send the new account holder’s username (NOT PASSWORD) to [email protected]. The account access will then be transferred and the individual will be notified via email.

If an account holder forgets their password, they may use the “Forgot Password” option on the login screen to reset it. OOD does not have access to Provider’s PMP passwords and cannot reset them. If the account holder forgets their username they can email [email protected] and OOD can retrieve that as long as the initial application has been approved.

Providers shall not share usernames or passwords for PMP. Sharing of either usernames or passwords is a violation of the Department of Developmental Disabilities (DODD) security affidavit that Providers electronically sign as part of their Provider application. Violations of this requirement may result in suspension or revocation of Provider access to PMP.

Providers should access the Provider Management Program from the Opportunities for Ohioans with Disabilities (OOD) website (www.ood.ohio.gov ) under the Provider Services tab within the Provider Section. Providers should not bookmark the direct link.

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PROVIDER APPLICATIONSProviders and specific services offered through Providers must be approved through the Provider Management Program (PMP). Provider applications will be processed within forty-five (45) days. If more time is necessary to approve an application, OOD will notify the Provider and give an estimated date of completion of the approval process.

Providers submitting an application for a waiver of OAC 3304-1-12 Community Rehabilitation Program Standards are processed on the 15TH of the month in October, January, April, and July. Waiver applications will be processed within forty-five (45) days of these dates.

OOD, at its discretion, may approve and/or deny applications and services. OOD’s determination is final. OOD will send Providers a written verification of approval or denial of applications and/or services.

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PROVIDER ACCREDITATION & STANDINGPer OAC 3304-1-12 “Community Rehabilitation Program Standards,” specific services may require accreditation or certification from professional organizations. Providers are required to update their accreditation status through the Provider Management Program (PMP). If a Provider’s accreditation/certification lapses, the system will remove the Provider from the approved Provider list posted to OOD’s website. OOD may also set its case management software, AWARE, to prevent new authorizations from being issued until the accreditation status has been updated.

Providers who have been notified that their accreditation, certification, or licensure has been revoked or suspended by an accrediting or certifying body or another State/Federal authority shall notify OOD in writing to [email protected]. This includes situations that do not involve OOD Individuals. OOD will review the information and may request additional information and determine the next step. OOD, at its discretion, may temporarily suspend referrals and/or authorizations until the issue is resolved. Failure to notify OOD of an issue shall result in suspension from the OOD-approved Provider list until the issue has been resolved.

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PROVIDER CONTACTSProviders should ensure that they maintain updated and accurate contacts in the Provider Management Program (PMP). Changes should be made in PMP within thirty (30) days.

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E-GOV DELIVERY DISTRIBUTION LIST (GRANICUS)Provider Staff may register for VR Provider updates through the subscriptions option on OOD’s website (www.ood.ohio.gov.) Providers are responsible for maintaining and updating their current contact information through the e-Gov distribution list.

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CONFIDENTIALITYOpportunities for Ohioans with Disabilities (OOD) shares confidential information about Individuals with Providers in order to ensure quality and effective services. Confidential information includes, but is not limited to: Individual’s full name, address, Social Security Number, copies of identification, e.g. driver’s license, disability/medical history, or any combination of information that could potentially identify a specific Individual. This information and information created by Providers as part of service delivery remains the responsibility of OOD. Providers must develop internal policies and procedures to ensure that this information is kept in a secure and confidential manner. Providers should develop policies and procedures in regards to the following areas:

Storage of information, in either paper or electronic format, when not in use, e.g. locked in a file cabinet/office, not left unattended, visible on a desk when not being used, etc.

Storage of information on electronic media, e.g. secure and encrypted on computers and other mobile devices such as phones; encrypted storage devices (“jump drives”), etc. OOD does not recommend, but does not prohibit, the use of “jump drives” to store Individual’s information.

Transportation and use of data outside of the office, e.g. store information in the trunk of the vehicle or non-visible from the outside, policies against leaving information in vehicles overnight, etc.

Restrict access to Individual’s information, e.g. access must be for business related needs, Provider Staff should not be able to access records for family members/significant others, etc.

Electronic communications email or fax, to unintended recipients, e.g. information sent to the wrong fax number, emails containing Individual’s information sent to the wrong individual, etc.

Other areas as identified and required by accrediting, certification, or State/Federal agencies, e.g. Commission on Accreditation of Rehabilitation Facilities (CARF), Academy for Certification of Rehabilitation & Education Professionals (ACVREP), or Department of Developmental Disabilities (DODD), etc.

Upon request Providers shall share a copy of their confidentiality policies and procedures with OOD.

Breaches or loss of confidential information is of significant concern. Providers must notify OOD as soon as possible, but within one (1) business day, of any breaches or loss of confidential information. Providers shall report the incident in writing by emailing [email protected] using the subject line of “Confidentiality Incident.” The email shall include the following information: date of the incident, name(s) of the impacted Individual(s), description of what data was lost or accessed without authorization, and Provider’s response e.g. law enforcement reports, etc.

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Both OOD and the Provider shall provide a written notification to impacted Individuals with a description of the incident.

Providers shall be responsible for providing identity protection and/or monitoring for twelve (12) months from the time of the loss or breach of data. Failure to provide identity protection/monitoring may result in the removal from OOD’s approved Provider list.

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ETHICSProviders agree and understand that their business interactions with Opportunities for Ohioans with Disabilities (OOD) are governed by the Ohio Ethics Law (Ohio Revised Code §102) and any Executive Orders issued by the Governor of the State of Ohio in regards to State purchasing or doing business with the State of Ohio. Providers who would like more information on the Ohio Ethics Law and/or Executive Orders should contact the Ohio Ethics Commission, www.ethics.ohio.gov.

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CONFLICTS OF INTERESTProvider’s Staff may not work directly with or directly supervise Staff who will work directly with Individuals whom they may have a potential conflict of interest. Provider Staff may not work directly with immediate family members (including in-laws and step-relatives). Individuals may elect to work with a Provider where their family members work as long as the Provider has developed a procedure to maintain confidentiality and ensure that family members may not access records.

If a Provider has a question about a potential conflict of interest the Provider may email [email protected] for guidance.

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ELECTRONIC COMMUNICATIONSProviders shall use ZixMail or secure fax to communicate with VR Staff and/or VR Contractors. Provider Staff may request ZixMail access by emailing their name and email address to the [email protected] mailbox. This is a courtesy access to ZixMail based on interaction with OOD. Providers will not be able to email or “CC” other individuals outside of OOD through ZixMail. Providers are encouraged to use other secure email systems when contacting Individuals or other entities, e.g. County Boards of DD, mental health centers, etc. ZixMail messages are also maintained for thirty (30) days and then deleted by the system. Once deleted the messages are not retrievable. If the Provider needs to keep a record of the communication they should either print the message or make a

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screenshot of the “Sent” folder as documentation. ZixMail messages involving authorizations should include the authorization number in the subject line.

In cases where OOD is made aware that electronic communications are not sent via ZixMail or secure fax, OOD will notify the impacted Individual that the Provider has not followed OOD’s procedure for secure electronic communications. OOD, at its discretion, may also place the Provider on a Corrective Action Plan (CAP).

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SIGNATURESForms completed and submitted by Providers become part of the official case record and at times are used during appeals. Copies may be provided to Individuals upon request. Therefore, forms that must be signed by both the Participant and Guardian, if applicable, must provide an original hand written signature. This can be accomplished by printing the form and having the Participant sign the hard copy and/or having him/her sign their signature electronically via a signature/touch pad device.

Signatures should include a handwritten date. (SEE EXAMPLE) The date fields on forms may still be typed.

Providers must collect a signature each time a form is signed. Providers may not “save” an Individual’s signature and apply it to future documents.

Handwritten forms completed and signed in the field, then typed into a form are acceptable as long as the whole handwritten form is attached to the typed report.

Signatures that appear to be altered (e.g. cut and pasted onto forms) shall be considered falsification and will result in a Corrective Action Plan (CAP).

Signature Example

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MARKETING MATERIALS & ACTIVITIESOpportunities for Ohioans with Disabilities (OOD) is not a potential funding source for services or programs offered through Providers. OOD shall not be listed as a funding source in any marketing materials or on Providers’ websites. Provider services must be approved by OOD prior to purchasing.

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OOD is an eligibility-based program designed to assist Individuals with disabilities obtain, maintain, regain, or advance in competitive and integrated community employment. Services must be necessary, as determined by VR Staff and/or VR Contractors, to assist the individual to reach the employment goal as identified on the signed Individual Plan for Employment (IPE). Services may not be purchased unless they are listed on the approved IPE.

If Providers have recommendations for services they should be made to VR Staff and/or VR Contractors. VR Staff and/or VR Contractors will consider the service and, if appropriate discuss it with the Individual and add it to the IPE, as applicable. Providers should not discuss services with Individuals and refer them back to their assigned VR Staff and/or VR Contractor. This is potentially disruptive to the vocational counseling process.

Providers should not directly market services to potential referral sources if OOD will be funding services. Only VR Staff and/or VR Contractors may determine eligibility for VR services, determine vocational goals and services, enter into an Individualized Plan for Employment (IPE) with an eligible Individual, and authorize the purchase of services.

Providers should direct marketing materials and activities through the VR or Contract Supervisors. New and current Providers may request to attend a staff meeting to familiarize VR Staff and/or VR Contractors with the services that they offer or to introduce new services. Providers should not market directly to individual VR Staff and/or VR Contractors.

Providers who do not follow these guidelines may be placed on a Corrective Action Plan (CAP) and/or removed from the approved list of Providers.

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QUESTIONS?For questions about situations not addressed in the VR Provider Manual, Providers should email [email protected].

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PURCHASING SERVICES & FISCAL CYCLE

VR ORIGINAL AUTHORIZATIONS & BILLINGS (OOD-0020)Providers shall not deliver services until an authorization number has been issued as a part of a VR Original Authorization & Billing (OOD-0020). The authorization acts as a purchase order and defines what service is being purchased, how much of the service is being purchased, and the dates that the service must occur within.

VR Original Authorization & Billing (OOD-0020) forms will be sent to the Provider’s designated Fiscal Contact fax or email, as defined in the Provider Management Program (PMP).

Providers need to request and receive an approval from the assigned VR Counselor and/or VR Contractor for any increases in either the amount of the service (units) authorized or the dates of service. Requests for increases in Units and/or extension of service dates must be approved in advance by the VR Counselor and/or VR Contractor. Providers must plan accordingly if they are nearing the end of the dates or approaching the limit of units. OOD will issue and send the Provider an amended copy of the authorization with the new service amounts and/or dates.

For services authorized on a monthly basis, Providers should communicate their requests for units for the next month to VR Staff and/or VR Contractor at least ten days before the end of the month to ensure that there is sufficient time to create, issue, and send a copy of the authorization to the Provider, prior to the start of the next month of service.

OOD will not issue authorizations for services for more than two (2) months at a time. Providers must submit the report and invoice for the prior month before making a request for the following month.

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ELECTRONIC SUBMISSIONS OF REPORTS & INVOICESProviders shall submit a proper invoice and report via secure email (ZixMail) or secure fax. Proper invoices are defined as including an invoice and report that is free of errors and provides all required documentation in order for the payment to be released. Providers should submit the report and invoice to the respective mailbox for the Region that the VR Office is located.

Providers who opt to email invoices should include the authorization number for all the reports as part of the email subject line. Each email message may contain up to five (5) reports. Invoices and reports for the same service authorization should be submitted in one message and must contain all required documentation in order to release the payment.

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Providers who opt to fax should include a cover sheet with the list of authorizations contained in the fax. Each fax may contain up to five (5) reports or a maximum of twenty-five (25) pages, whichever is less. Invoices and reports for the same service authorization should be submitted in one transmission and must contain all required documentation in order to release the payment.

The preferred method of invoice and report submission is via secure email in its electronic format, e.g. Word or Excel document. Providers may convert Word and Excel documents into first generation PDF files. Providers should avoid printing/scanning documents, unless necessary e.g. form requires a signature, as scanned copies are converted to images and are typically not accessible.

CONTACT INFORMATION VR OFFICESNORTHEAST [email protected] (FAX)

Akron Regional OfficeCleveland Regional OfficeYoungstown Regional Office

NORTHWEST [email protected] (FAX)

Defiance Regional OfficeLima Regional OfficeMansfield Regional OfficeToledo Regional Office

SOUTHEAST [email protected] (FAX)

Athens Regional OfficeCanton Regional OfficeColumbus Regional OfficeZanesville Regional Office

SOUTHWEST [email protected]. 6982 (FAX)

Cincinnati Regional OfficeDayton Regional OfficeWheelersburg Regional Office

INDEPENDENT LIVING OLDER [email protected] (FAX)

STATEWIDE

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INVOICES & REPORT FORMSProviders shall use the report forms and invoices, as developed, by OOD. Providers may incorporate the report forms into their own case management systems or use third party software as long as the final document is the same as OOD’s form. Providers are not permitted to make changes to OOD’s report forms. (SEE FORMS INSTRUCTIONS & EXAMPLES ON PAGE ZXY OF THIS MANUAL)

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SERVICE REQUIREMENTSThis section defines when Providers may charge for services. These requirements apply to services defined in the VR Fee Schedule and/or approved as a VR Addendum or Miscellaneous Training service.

1. Provider Staff must be on-site (and in the same area) and actively providing direct services to Individuals in order to charge for the service. If Provider Staff are not on-site and/or actively providing direct services the time does not count towards the billable services and OOD shall not pay for the service.

EXAMPLES OF DIRECT SERVICES (BILLABLE) Successful telephone contacts and messages, left by Provider Staff, to Individuals, including

Parents/Legal Guardians, VR Counselors/VR Contractors, or potential Employers;

Correspondence, electronic and paper, created and sent by Provider Staff to Individuals, including Parents/Legal Guardians, VR Counselors/Contractors, or potential Employers;

Text messages created and sent by Provider Staff to Participants, including Parents/Legal Guardians, VR Counselors/Contractors, or potential Employers. ( NOTE: This is only permitted as a reasonable accommodation based on a disability related need, e.g. deaf/hard of hearing, speech impairments, or other disability related needs as documented in AWARE by the VR Counselor/VR Contractor.);

In person contacts/meetings with Participants and VR Counselors/VR Contractors, or potential Employers;

Instruction on how to perform job tasks, appropriate workplace behaviors, or to assist in the adjustment to the job site;

On-site observation of how the Participant is performing job tasks or is adjusting to the work environment;

Completion and submission of employment applications, paper or online, on behalf of an Individual, regardless of whether the Individual is present. ( NOTE: If the application includes any pre-employment tests the Individual must be present and answer questions themselves; however, Providers may assist in entering responses as need. Providers may not complete pre-employment tests on behalf of Individuals.); and

Online job searches, regardless of whether the Individual is present or not. ( NOTE: VR Counselors and/or VR Contractors may specify in the Referral to Facility their preferences on whether or how much time should be spent on online job searches.)

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EXAMPLES OF INDIRECT SERVICES (NON-BILLABLE) Missed appointments (except as allowed for Interpreters per Ohio Administrative Code §3304-

2-52 (E));

Unpaid meal periods are not counted for the purpose of determining billable time;

Listening to telephone messages and reading correspondence, electronic or paper, received by Provider Staff;

Telephone, correspondence, or in person contacts with third parties, other than potential employers, unless specifically authorized in advance by VR Counselor/VR Contractor;

Review of referral and collateral information to prepare for service delivery;

Provider internal communications, discussions (including staffing), fiscal, or program reviews;

Time spent developing programs and preparing materials, e.g. setting up classrooms, making copies of handouts, etc.;

Contacts for the purpose of managing authorizations, referrals, invoices, and payments e.g. calling to request an increase, checking on the status of a payment, etc.; and

Case management activities e.g. coordinating and scheduling services with third parties.

2. Providers may not charge administrative surcharges for pass through authorizations, e.g. purchase of fuel cards. (NOTE: If the Provider pays sales tax or shipping/handling charges, VR can reimburse them for those expenses as long as they are itemized on the receipt.)

3. Providers may not charge for services in excess of the amount authorized, that take place outside the range of dates on an authorization, or after the VR case has been closed. Providers shall receive an amended authorization if a VR Counselor/VR Contractor approves an increase or date extension.

4. VR Counselors/VR Contractors may not purchase equipment or supplies from Providers that perform evaluations and sell the recommended equipment or supplies, unless the purchase is awarded through a competitive bid process. (Exception: Providers who sell hearing aids and eyeglasses.)

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VR FEE SCHEDULE RATES & DESCRIPTIONS

TABLE 1: INDIVIDUAL FEE SCHEDULE RATES

SERVICE DESCRIPTION RATE PER UNIT UNIT (DURATION)

BILINGUAL SUPPLMENT SERVICE RATE + 10% VARIALBLE

SERVICE AREA MODIFIER – LEVEL I $36.50(UP TO 35 MILES ONE WAY) FLAT FEE

SERVICE AREA MODIFIER – LEVEL II $52.00(36 – 50 MILES ONE WAY) FLAT FEE

SERVICE AREA MODIFIER – LEVEL III $73.00(OVER 50 MILES ONE WAY) FLAT FEE

INTAKE $111.75 FLAT FEEINTERPRETER SERVICES(FOREIGN & SIGN LANGUAGE) $5.75 6 MINUTES

SITE DEVELOPMENT $6.50 6 MINUTESTRANSPORTATION $5.00 6 MINUTESVOCATIONAL TRAINING STIPEND OHIO MINIMUM WAGE + 15% 6 MINUTESWORK INCENTIVES PLANNING(NON-CREDENTIAL) $292.00 FLAT FEE

WORK INCENTIVES PLANNING(CREDENTIAL) $321.25 FLAT FEE

WORK INCENTIVES COORDINATION(NON-CREDENTIAL) $6.50 6 MINUTES

WORK INCENTIVES COORDINATION(CREDENTIAL) $7.00 6 MINUTES

COMMUNITY BASED ASSESSMENT $240.00 (HALF DAY) FLAT FEECOMMUNITY BASED ASSESSMENT $420.00 (FULL DAY) FLAT FEEVOCATIONAL EVALUATION $1,016.75 FLAT FEEVOCATIONAL CONSULTATION $6.50 6 MINUTESCAREER EXPLORATION $6.75 6 MINUTESTRAVEL TRAINING $6.00 6 MINUTESJOB READINESS TRAINING(SCHOOL BASED) $54.50 (HALF DAY) FLAT FEE

JOB READINESS TRAINING(SCHOOL BASED) $87.50 (FULL DAY)) FLAT FEE

JOB READINESS TRAINING(NON-SCHOOL BASED) $87.50 (HALF DAY) FLAT FEE

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JOB READINESS TRAINING(NON-SCHOOL BASED) $153.00 (FULL DAY) FLAT FEE

SUMMER YOUTH(CAREER EXPLORATION) $853.50 (WEEK) FLAT FEE

SUMMER YOUTH(WORK EXPERIENCE) $1,138.00 (WEEK) FLAT FEE

WORK ADJUSTMENT $230.00 (HALF DAY) FLAT FEEWORK ADJUSTMENT $402.50 (FULL DAY) FLAT FEEJOB SEEKING SKILLS TRAINING $6.00 6 MINUTESJOB DEVELOPMENT (UOS) $6.50 6 MINUTESPERFORMANCE BASED JOB DEVELOPMENT TIER I $1,167.50 FLAT FEE

PERFORMANCE BASED JOB DEVELOPMENT TIER II $1,110.25 FLAT FEE

PERFORMANCE BASED JOB DEVELOPMENT TIER III $1,580.50 FLAT FEE

PERFORMANCE BASED JOB DEVELOPMENT TIER IIIPREMIUM A (RAPID PLACEMENT)

$1,980.50 FLAT FEE

PERFORMANCE BASED JOB DEVELOPMENT TIER IIIPREMIUM B (SGA PLACEMENT)

$1,980.50 FLAT FEE

PERFORMANCE BASED JOB DEVELOPMENT TIER IIIPREMIUM C (RAPID & SGA)

$2,380.50 FLAT FEE

PERFORMANCE BASED JOB DEVELOPMENT SUBSEQUENT PLACEMENT

$339.50 FLAT FEE

SUPPORTED EMPLOYMENT JD TIER I $1,459.25 FLAT FEESUPPORTED EMPLOYMENT JD TIER II $1,387.75 FLAT FEE

SUPPORTED EMPLOYMENT JD TIER III $1,975.50 FLAT FEE

SUPPORTED EMPLOYMENT JD TIER IIIRETENTION PREMIUM A(RAPID PLACEMENT)

$2,375.50 FLAT FEE

SUPPORTED EMPLOYMENT JD TIER III

$2,375.50 FLAT FEE

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RETENTION PREMIUM B(SGA PLACEMENT)SUPPORTED EMPLOYMENT JD TIER IIIRETENTION PREMIUM C(RAPID & SGA PLACEMENT)

$2,775.50 FLAT FEE

SUPPORTED EMPLOYMENT SUBSEQUENT PLACEMENT $424.25 FLAT FEE

ON-THE-JOB SUPPORTS $6.00 6 MINUTES

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TABLE 2: GROUP FEE SCHEDULE RATES

SERVICE DESCRIPTIONNUMBER IN GROUP (#) UNIT

(DURATION)2 (50%) 3 (37.1%) 4 (31.4%)TRAVEL TRAINING $3.00 $2.23 $1.88 6 MINUTESSUMMER YOUTHCAREER EXPLORATION(WEEK)

$426.75 $316.65 $268.00 FLAT FEE

SUMMER YOUTHWORK EXPERIENCE)(WEEK)

$569.00 $422.20 $357.33 FLAT FEE

WORK ADJUSTMENT(HALF DAY) $115.00 $85.33 $72.22 FLAT FEE

WORK ADJUSTMENT(FULL DAY) $201.25 $149.33 $126.39 FLAT FEE

JOB SEEKING SKILLS TRAINING $3.00 $2.23 $1.88 6 MINUTESON-THE-JOB SUPPORTS $3.00 $2.23 $1.88 6 MINUTES

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TABLE 3: CONTRACTED SERVICE RATES (NOT INCLUDED IN OAC 3304-2-52)

SERVICE DESCRIPTION RATE PER UNIT UNIT (DURATION)ACTIVITIES OF DAILY LIVING TRAINING $7.40 UOSORIENTATION & MOBILITY TRAINING $9.60 UOSLOW VISION SERVICES $8.70 UOS

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REHABILITATION TECHNOLOGY $9.50 UOS

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FISCAL REQUIREMENTSFLAT FEESThe duration of Flat Fees shall be defined as a specific amount of time or a specific outcome as identified in the service description of the VR Fee Schedule. Flat Fees include services authorized on a daily, weekly, or specific milestone/outcome basis.

TECHNICAL GUIDANCE Half days are defined as up to, and including, four (4) hours of service. Full days are defined

as more than four (4) hours. Exception: Job Readiness Training (School Based) in which a half day is defined as up to, and including, two and a half (2 ½) hours and full day is more than two and a half (2 ½) hours.

Flat Fees are inclusive of all contacts required to provide and document the service, e.g. telephone contacts to set appointments, a case staffing, etc.

INDIVIDUAL AND GROUP RATESWhen OOD authorizes for VR services at rates identified in TABLE 1: INDIVIDUAL FEE SCHEDULE RATES, providers shall deliver services to participants on a 1:1 basis. This means that the one (1) provider staff to one (1) participant ratio must be maintained for the entire duration of the provided service.

When OOD authorizes for VR services at rates identified in TABLE 2: GROUP FEE SCHEDULE RATES, providers may deliver services in a group setting. Groups are defined as a single provider staff person dividing their time amongst multiple service recipients regardless of funding source. Groups shall have a maximum staffing ratio of 4:1, four (4) participants to one (1) staff person. Individualized services provided in a group setting shall not be considered 1:1 and shall be paid at the group rate. When group services are authorized, the provider shall bill the service based upon the actual staff to participant ratio when the service was provided.

When a provider delivers services not defined in the VR Fee Schedule through an approved addendum, services shall be provided on a 1:1 basis, unless the provider specifically has requested and OOD has approved a group rate.

TECHNICAL GUIDANCE Group sizes are based on the number of people that the Provider Staff is dividing their time

and attention, regardless of the funding source. For example, if a Provider Staff works with three (3) people funded by DD and two (2) people funded by OOD, this would be a group of five (5) and the Provider would need two (2) Staff.

Job Readiness Training, School Based and Non-School Based, is a group service by definition but is included in the Individual Rate Table due to the fact that the rate does not adjust with group size.

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SERVICE DELIVERY CYCLEVR authorizations for services that are purchased as UOS or Daily (Flat Fee) rates shall be issued for one calendar month with an allowable variance of seven (7) days into the previous or following month, e.g. February 22 to March 31 or March 1 to April 7. VR authorizations for UOS or Daily rates shall not exceed a total of five (5) weeks. Service dates of VR authorizations for other Flat Fee services, e.g. Week or Outcome, shall be determined by VR Counselors or VR Contractors, based on the expected date of completion, but shall not exceed the current Federal Fiscal Year (FFY). Providers may not bill for partial or incomplete services during the billing cycle.

UNITS OF SERVICE (UOS)Units of Service shall equal six (6) minutes increments. UOS shall be billed in accordance with the chart below. Providers may bill for time actively providing direct services to participants; for direct contacts with potential employers on behalf of specific participants; and for direct contacts with VR Counselors or VR Contractors on behalf of specific participants. Services can be billed for activities performed either in-person, via telephone, email, or other electronic media (such as completing an online electronic job application). Providers shall not bill for travel time between appointments. Provider staff must be physically present and/or actively performing a service for time to be billable. Providers may not bill for time providing indirect services which includes: reading email; listening to messages; internal communications between provider staff members; reading collateral documentation; conducting case/file reviews; and for the purpose of managing authorizations, invoices, and/or payments.

MINUTES UOSUP TO 6 17 – 12 213 – 18 319 – 24 425 – 30 531 – 36 637 – 42 743 – 48 849 – 54 955 – 60 10

VR AUTHORIZATIONSVR authorizations act as the agreement to purchase a maximum amount of a specific service within a specific range of dates and at what rate the provider will be compensated. Providers should not deliver services without a VR Original Authorization/Billing (OOD-0020) number or other OOD issued electronic version of the VR Original Authorization & Billing number. If there is a need to increase the

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amount of service or extend the dates of service from what has been authorized, the provider is responsible for contacting the assigned VR Counselor or VR Contractor to obtain approval of the increase or change of dates prior to delivering services. Providers will receive an amended authorization with the increase in the amount of service or extension of dates of service.

VR REPORTS & INVOICESProviders shall submit a written report, including the invoice, using the appropriate template for the specific service as defined in the VR Provider Manual. VR reports and invoices shall include all documentation and address all areas of the service definition and requirements section, even if previously submitted to VR Staff or VR Contractor (e.g. resume, placement report, etc.). VR Reports and invoices shall be submitted electronically within twenty-one (21) calendar days of the date of last service or the last day of the calendar month defined in the VR Original Authorization & Billing (OOD-0020), whichever comes first. The end of service shall be defined as the last direct contact with the participant and/or employer. OOD will not issue subsequent authorizations if the reports are not received within the 21 day timeframe. OOD shall return reports and invoices that contain errors and/or do not meet the requirements of the VR Fee Schedule. If returned, providers shall have twenty-one (21) calendar days from the date that the report and/or invoice was returned to the provider to make corrections and re-submit for payment.

TECHNICAL GUIDANCE The quality expectation is that Providers submit a correct and proper invoice/report within

twenty-one (21) days of the end of services; however, OOD will release payments beyond the twenty-one days, as long as a correct and proper invoice/report are submitted within ninety (90) days of the end of service as required in OAC 3304-1-13. Providers who submit an invoice and/or report that is denied will have twenty-one (21) days from time that OOD issues the denial to correct and re-submit the invoice, even if it falls outside of the ninety (90) days since the date of last service.

Providers must use the approved VR Form, as identified in the Report Instructions & Examples Section of the VR Provider Manual. Providers may use third party software to complete the reports but the final product generated must appear exactly as the VR form. Providers are not permitted to make any changes to the report forms.

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VOCATIONAL SERVICES


BILINGUAL SUPPLMENT SERVICE RATE + 10% VARIALBLE

SERVICE AREA MODIFIER – LEVEL I $36.50(UP TO 35 MILES ONE WAY) FLAT FEE

SERVICE AREA MODIFIER – LEVEL II $52.00(36 – 50 MILES ONE WAY) FLAT FEE

SERVICE AREA MODIFIER – LEVEL III $73.00(OVER 50 MILES ONE WAY) FLAT FEE

BILINGUAL SUPPLEMENTProviders with bilingual staff who have the ability to communicate with participants in their preferred mode of communication, either in foreign language or sign language, may charge an additional (10) percent supplement when utilizing those skills to provide vocational services. The bilingual supplement is applied to the specific service base rate as defined in the VR Fee Schedule. The bilingual supplement shall apply to all billing increments provided on behalf of the participant by the bilingual staff including contacts with VR Counselor or Contractors and businesses. The two (2) hour minimum for missed appointments for interpreting does not apply to the bilingual supplement. The supplement shall not be paid for Transportation.

SERVICE AREA MODIFIER (SAM)OOD may authorize the Service Area Modifier in situations where OOD specifically requests a provider to serve a participant outside of their designated service area. The SAM Fee shall only apply to services defined in the VR Fee Schedule. The SAM Fee shall be determined based upon the one way distance from the closest border of the Provider’s service delivery area to the participant’s residence. Service delivery areas are identified by County as indicated by Providers in the Provider Management Program (PMP). The SAM Fee may only be charged once per day by the Provider Staff Member. When serving more than one participant in a given day, the SAM Fee shall be determined based upon the mileage of the participant with the furthest residence from the Provider’s defined service delivery area. OOD shall establish the SAM Fee utilizing an electronic mapping tool, such as, navigation software or web based programs. OOD shall authorize the SAM Fee prior to service delivery.

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AUXILIARY SERVICESThese services are designed to complement the delivery of other services to ensure that participants may fully engage in diagnostic services or vocational services identified on their Individualized Plan for Employment (IPE).


INTAKE $111.75 FLAT FEEINTERPRETER SERVICES(FOREIGN & SIGN LANGUAGE) $5.75 6 MINUTES

SITE DEVELOPMENT $6.50 6 MINUTESTRANSPORTATION $5.00 6 MINUTESVOCATIONAL TRAINING STIPEND OHIO MINIMUM WAGE + 15% 6 MINUTES

INTAKE (I)Intakes are utilized to provide compensation for time associated with meeting accreditation requirements. Providers may charge the Intake fee when the following conditions are met: The provider is accredited by the Commission on Accreditation of Rehabilitation Facilities

(CARF), Joint Commission (JC) in the area of Behavioral Health, and/or the National Accreditation Council (NAC) for Blind and Low Vision Services;

The provider is initiating a service on the VR Fee Schedule that requires accreditation per OAC 3304-1-12;

The provider has not previously been paid an Intake fee for the participant, unless there has been a break of at least twelve (12) months since the date of last service provided to the participant.

REQUIREMENTSProvider shall ensure that the following components are addressed with the participant: Participant’s rights and responsibilities; Confidentiality, including limitations of confidentiality; Review of the referral information with the participant; and Providers shall notify VR Staff or VR Contractor of any updates and/or discrepancies to

the referral information.

Providers shall submit the invoice and the Provider Services Acknowledgement, signed by the participant and if applicable his/her parent or legal guardian, within 21 calendar days of the completion of service or the last date of service defined on the VR authorization, whichever comes first.

INVOICE & REPORT GUIDANCE*

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Providers shall submit a signed copy of the Provider Intake Acknowledgement with either the signed Original VR Authorization & Billing or the Provider may create their own invoice.

INTERPRETER SERVICES - FOREIGN LANGUAGE & SIGN LANGUAGE (INT)Interpreter Services are utilized to ensure effective communication for participants who are deaf, hard of hearing, deaf-blind, or speak English as a second language. Interpreting may be performed either in person, on the telephone, or online. Interpreting also includes similar services required to ensure effective communication such as Communication Access Real Time (CART), C-Print, etc. The outcome of the service is to provide effective communication assistance to deaf or hard of hearing participants and/or participants who are not fluent in English. Intake shall not be authorized with or as part of Interpreter Services

REQUIREMENTSThe written VR Report shall at a minimum address the following:

Date(s) and times of the interpreting assignment(s); and Signature of the participant who received the service.

Interpreters should arrive or connect at a minimum of five (5) minutes before the appointment to ensure that things are in place before the appointment.

Providers shall submit the invoice and report, on the appropriate template, within 21 calendar days of the completion of service or the last date of services defined on the VR authorization, whichever comes first.

INVOICE & REPORT GUIDANCE* Interpreter logs may be signed by the Participant (preferred), independent Provider staff

(e.g. Job Developer, Job Coach, etc.), and/or the VR Counselor/Coordinator.

SITE DEVELOPMENT (SD)Site Development services are utilized to secure a potential employment setting that may be used to help either assess or address a participant’s vocational barriers. Site Development shall not be billed in situations that the provider utilizes a readily available work site to conduct the assessment, e.g. the provider’s facility and/or a work crew (enclave) the provider operates within another business. Site Development may be authorized to secure an employment site for Community Based Assessments (CBA); school based internships, e.g. college internships; in cases where an individual needs an individualized site for Summer Youth (SY), not Summer Youth group sites; and Work Adjustment (WA). Service authorizations will not be issued until after the provider has notified the VR Counselor or VR Contractor of the dates and time of the service, e.g. CBA will not be authorized until after the provider has notified the VR Counselor or VR Contractor of the dates and times of the assessment. Site Development ends once the site has been secured and the dates and times of the assessment are determined.

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REQUIREMENTSThe written VR Report shall at a minimum address the following: Dates of contacts with the participant, his/her parent or legal guardian, VR

Counselors or VR Contractors, and businesses contacted on behalf of the participant and outcome of the contacts; and

Questions posed by VR Staff or VR Contractor in the Referral to Community Rehabilitation Program.

Providers shall submit the invoice and report, on the appropriate template, within 21 calendar days of the completion of service or the last date of services defined on the VR authorization, whichever comes first. Providers shall submit a report at a minimum of at least once per month.

TRANSPORTATION (T)Transportation services are utilized when providers transport participants to and from appointments for the following services: Community Based Assessment, Work Adjustment, On-The-Job Supports, Summer Youth, and for other services not included within the VR Fee Schedule, e.g. transportation to a psychological evaluation or medical appointment to determine eligibility. Providers may begin billing Transportation once the participant has been picked up and should end billing once the participants have been dropped off. Providers shall not bill wait time associated with Transportation. Providers shall divide the total amount of time for transportation, from the point when the first participant is picked up and the last participant is dropped off, amongst the total number of participants receiving transportation for the trip regardless of funding sources. The Bilingual Supplement shall not apply to Transportation. Intake shall not be authorized with or as part of Interpreter Services

REQUIREMENTSThe written VR Report shall at a minimum address the following: Date and times of transportation including address of pick-up and drop-off locations, as

well as the number of participants transported.

Providers shall submit the invoice and report within 21 calendar days of the completion of service or the last date of services defined on the VR authorization, whichever comes first.

TECHNICAL GUIDANCE Transportation may be utilized to reimburse Provider Staff time to purchase items for

Individual’s to be able to successfully participate in VR services e.g. clothes, work related equipment, etc., with the exception of Performance Based Job Development/Supported Employment Job Development. Performance Based Job Development/Supported Employment Job Development are inclusive of all activities required to achieve the milestone. Individual must be present in order for the service to be billable.

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Transportation is based on Provider Staff time and is inclusive of all Individuals in the vehicle and should be divided amongst the number of Individuals being transported during the trip, regardless of funding source.

VOCATIONAL TRAINING STIPEND (VTS)Providers should compensate participants for vocationally related work experiences (e.g. Community Based Assessment, Work Adjustment, Summer Youth work experiences, and non-school based Job Readiness Training services) at a rate equivalent to the current Ohio State Minimum Wage. OOD shall reimburse providers at a rate equivalent to the State of Ohio Minimum Wage plus an additional fifteen (15) percent (%) to include additional costs such as Worker’s Compensation, Federal Insurance Contributions (FICA), Medicare, and administrative costs.

Providers shall provide at least one fifteen (15) minute break for every four (4) hours of scheduled service. Providers shall provide an unpaid thirty (30) minute lunch period after six (6) hours of scheduled service. If a participant needs additional breaks, providers should provider as a reasonable accommodation but the time shall not be paid.

Participants are not intended to substitute for employees of a host business. Participants may request to waive the Vocational Training Stipend, the VR Counselor or VR Contract Liaison will make the final decision whether or not to authorize for the stipend.

REQUIREMENTS Providers shall submit a participant log that has been signed by the participant that

documents dates and start and end time of work performed and the start and end times of breaks.

Providers shall be required to cover participants under their Worker’s Compensation insurance policy.

Providers shall submit the invoice and participant log within 21 calendar days of the completion of service or the last date of services defined on the VR authorization, whichever comes first.

TECHNICAL GUIDANCE Unpaid meal periods are not counted for the purpose of calculating billable service time.

Minors shall be given a thirty (30) minute unpaid meal period after five (5) hours of work. Providers shall keep records to document the number of hours worked by such minor on each day of the week, the hours of beginning and ending work, the hours of beginning and ending meal periods, and the amount of wages paid each pay period to each minor. Records shall be kept for two years. (Source ORC §4109.11)

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Vocational Training Stipend is an independent service and may be invoiced and paid for separately from the corresponding service as long as the VTS form is completed and signed by the Individual.

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DIAGNOSTIC & ASSESSMENT SERVICESServices provided and activities performed to determine a participant’s eligibility for vocational rehabilitation services, to assign an individual to an Order of Selection priority, and/or to determine the nature and scope of services to be included in the Individualized Plan for Employment (IPE). Services may also include assistance to a participant that is interested in becoming employed, but is uncertain of the impact work income will have on benefits and/or is not aware of benefits, such as access to healthcare, that might be available to support any work efforts.


WORK INCENTIVES PLANNING(NON-CREDENTIAL) $292.00 FLAT FEE

WORK INCENTIVES PLANNING(CREDENTIAL) $321.25 FLAT FEE

WORK INCENTIVES COORDINATION(NON-CREDENTIAL) $6.50 6 MINUTES

WORK INCENTIVES COORDINATION(CREDENTIAL) $7.00 6 MINUTES

COMMUNITY BASED ASSESSMENT $240.00 (HALF DAY) FLAT FEECOMMUNITY BASED ASSESSMENT $420.00 (FULL DAY) FLAT FEEVOCATIONAL EVALUATION $1,016.75 FLAT FEEVOCATIONAL CONSULTATION $6.50 6 MINUTESCAREER EXPLORATION $6.75 6 MINUTES

WORK INCENTIVES PLANNING (WIP)Work Incentives Planning services are utilized to provide information on how participating in vocational rehabilitation services and returning to work can positively impact the participants earning potential. The Flat Fee shall include the time interviewing the participant, verifying benefits, analyzing data, and a review of the written report with the participant, his/her parent or legal guardian, and/or representative payee. WIP takes into consideration current benefits such as: Social Security Disability Insurance/Supplemental Income, Medicaid/Medicare coverage, Veteran’s benefits, housing assistance, Medicaid Buy-In for People with Disabilities, food stamps, and other public assistance programs. WIP services also provide participants information on work incentives such as: the Ticket to Work, Impairment Related Work Expenses (IRWE), Trial Work Periods (TWP), Student Earned Income Exclusions (SEIE), and Plan for Achieving Self-Sufficiency (PASS) plans. The outcome of the service is to give a participant a comprehensive overview of how working affects benefits and how work incentives can be

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utilized to maximize earnings. Intake shall not be authorized with or as part of Work Incentive Planning.

REQUIREMENTSThe written VR Report shall at a minimum address the following: Dates of contacts with the participant, his/her parent or legal guardian, and/or

representative payee; Social Security Administration; Department of Jobs & Family Services; or other organizations;

Verification of benefits received by participants and/or household members, e.g. SSI/SSDI (through written copy of the BPQY), medical, housing, cash assistance, and amounts the source organization, such as Social Security, Jobs & Family Services, Metropolitan Housing, etc.;

Demonstration of how returning to work may positively impact the participant’s overall income, including illustrations of how working can potentially increase earnings, e.g. SSI calculation sheets comparing current situation to at least two comparison points with different earnings;

Information about specific work incentives that the participant may be eligible to utilize, including a brief explanation of how the participant would implement the incentive; and


Provider shall review the report and BPQY, in a manner that is understandable, with the participant, his/her parent or legal guardian, and/or representative payee. VR Staff or VR Contractor may request to be present during the review of the report.

Provider shall provide the participant, his/her parent or legal guardian, and/or representative payee with a written copy of the report and BPQY.


TECHNICAL GUDIANCE Providers must only submit the invoice/report for the Work Incentives Plan once it

has been completed. Providers do not need to submit a monthly report for this service.

Providers with staff persons who are or become certified by either Virginia Commonwealth University (VCU) as a Community Work Incentives Coordinator (CWIC) or through Cornell University as a Work Incentives Practioner (WIP) shall be compensated at the certified rate when certified staff are providing the services. Providers who wish to charge the certified rate shall submit a copy of their certified staff person’s certificate to OOD. Effective July 1, 2018, provider staff

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persons shall be certified as either a CWIC or WIP in order to be able to provide this service.

WORK INCENTIVES COORDINATION (WIC)Work Incentives Coordination services are utilized to assist the participants in coordinating and resolving benefits issues such as, but not limited to, reporting income; applying for and documenting work incentives; applying for Medicaid Buy-In for People with Disabilities, resolving over-payments, etc. WIC may also be utilized to assist participants with developing and implementing a Plan for Achieving Self-Sufficiency (PASS). WIC services may not be utilized to assist a person in applying for Social Security benefits or completing a Continuing Disability Review (CDR). WIC services may not be utilized to supplant case management services already provided or available from other agencies. Intake shall not be authorized with or as part of Work Incentive Coordination.

REQUIREMENTSThe written VR Report shall at a minimum address the following: Dates of contacts with the participant, his/her parent or legal guardian, and/or

representative payee, VR Counselors or VR Contractors, Social Security Administration, Department of Jobs & Family Services, or other organizations;

How the information was provided to the participant, his/her parent or legal guardian, and/or representative payee in an understandable format; and



Providers with staff persons who are or become certified by either Virginia Commonwealth University (VCU) as a Community Work Incentives Coordinator (CWIC) or through Cornell University as a Work Incentives Practioner (WIP) shall be compensated at the certified rate when certified staff are providing the services. Providers who wish to charge the certified rate shall submit a copy of their certified staff person’s certificate to OOD. Effective July 1, 2018, provider staff persons shall be certified as either a CWIC or WIP in order to be able to provide this service.

COMMUNITY BASED ASSESSMENT (CBA)Community Based Assessments (CBA) are utilized to assess the participant’s job readiness and/or to provide information on an participant’s aptitudes, abilities, behaviors, and preferences to determine if a specific employment opportunity would be an appropriate match. CBA’s shall be authorized either as a half day, four (4) hours, or a full day, seven (7) hours. VR Counselors or VR Contractors may request a schedule a less than four (4) or seven (7) hours to

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accommodate a participant’s disability related needs. VR Counselors or VR Contractors must specifically communicate this to the provider at the time of the authorization. The Flat Fee includes provider staff time to assess the participant, any staffing that may be needed, and the report. CBA is not intended to teach specific work skills, provide work experience or adjustment services. CBA should not be standard practice for onboarding participants with disabilities or used as a hiring incentive in conjunction with or in lieu of Job Development services. CBA shall be conducted in competitive and integrated settings, except for limited circumstances when the VR Staff or VR Contractor determines that the participant’s needs cannot be met in the community. CBA provided in a non-integrated setting shall be transitioned to an integrated setting as soon as possible based upon the readiness of the participant. The outcome of the service is to assess the participant’s job readiness and make recommendations for future services.

REQUIREMENTSThe written VR Report shall at a minimum address the following: Dates of contacts with participants, his/her parent or legal guardian, VR Counselors

or VR Contractors, host businesses, and service; Information about the work environment and job tasks (job task analysis), including

employer or industry accepted performance (quantity and quality) standards; Initial assessment of the participant’s functioning at the beginning of the assessment

and final assessment to demonstrate the participant’s progress including but not limited to the following areas: attendance, interpersonal skills, work behaviors, work tolerance, quality and quantity of work, ability to stay on task, and responsiveness to supervision, etc.;

Explanation of instructional techniques and interventions that were used by provider staff or employer to facilitate learning and progress, including the effectiveness of the strategies in achieving desired results;

Input from the employer on participant’s performance and potential areas of concern;

Input from the participant on his/her vocational preferences; his/her assessment of his/her physical and mental capabilities to do the job; and his/her concerns;


Providers must be pre-authorized by VR Staff or VR Contractor to compensate participants for actual work performed utilizing the Vocational Training Stipend (VTS).

Providers shall submit a participant log that has been signed by the participant that documents dates of work performed, start and end times, and breaks 30 minutes or longer. VTS shall not be paid for breaks that last 30 minutes or longer.


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TECHNICAL GUIDANCE Since service is a Flat Fee (Half- or Full-Day), providers do not need to document all

contacts. Report only needs to document the activities delivered as part of the Half/Full Day of service.

Providers shall immediately notify the VR Counselor and/or Contractor if the Individual misses more than two (2) days during the service and/or when sufficient information has been obtained to answer the referral questions. VR Counselors and/or VR Contractors will then determine if services should continue.

Staffing is included in the service and when possible should be included on one of the last days of the service. It is encouraged that the staffing be scheduled after the site/dates/time have been identified and at the time of the authorization.

VOCATIONAL EVALUATION (VE)Vocational Evaluations are utilized to identify and evaluate a participant’s current and projected vocational functioning. The Flat Fee shall include the time associated with administering and analyzing test results and current local labor market analysis based on Ohio Means Jobs and other labor market resources, the report, and a staffing at the request of VR Staff or VR Contractor. Providers shall at a minimum perform standardized test batteries and/or work samples to document a participant’s abilities, interests, capabilities, aptitudes, and level of academic functioning.VE may include interviewing participants, family members, other involved service personnel (e.g. teachers, case managers, etc.). The outcome of the service is to identify and provide supporting data and documentation of viable employment options that the participant and VR Staff or VR Contractor may discuss as part of the vocational counseling process.

REQUIREMENTSThe written VR Report shall at a minimum address the following areas: Dates of contacts with participants, his/her parent or legal guardian, VR Counselors

or VR Contractors, and service; Summary of the participant’s abilities, interests, capabilities, aptitudes, and level of

academic functioning; Identification of realistic and viable employment options; Justification and explanation of why the identified employment options would be a

suitable match based on the testing results as well as the participant’s unique strengths, resources, capabilities, interests, aptitudes, and informed choice;

Current local labor market analysis based on Ohio Means Jobs and other labor market resources;

Identification of potential strengths and barriers, including recommendations for possible accommodations that may mitigate barriers; and


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VR Staff or VR Contractor may request specific test batteries be included in the service.

Providers shall use the most current version of test batteries that are currently supported by publishers and accepted by the professional community.


VOCATIONAL CONSULTATION (VC)Vocational Consultations are utilized when the participant has identified a potential employment option but VR Staff or VR Contractor needs additional information to determine the feasibility and appropriateness of the potential employment goal. Providers may charge for the time associated with administering and analyzing test results and current local labor market information. VC may be utilized in the following situations: To administer specific test instruments such as academics, interests, etc.; To complete a current local labor market or transferable skills analysis based on Ohio

Means Jobs and other labor market resources; To assess a participant’s computer skills and knowledge of software applications such as

Microsoft Office programs; or To review and update a previous vocational evaluation.

REQUIREMENTSThe written VR Report shall at a minimum address the following areas: Dates of contacts with participants, his/her parent or legal guardian, VR Counselors

or VR Contractors, and service; Identification of potential strengths and barriers, including recommendations for

possible accommodations that may mitigate barriers; and Questions posed by VR Staff or VR Contractor in the Referral to Community

Rehabilitation Program.

Computer skills and knowledge of software application assessments shall not exceed four (4) hours.

VR Staff or VR Contractor may request specific test batteries.

Providers shall use the most current version of testing batteries that are currently supported by publishers and accepted by the professional community.


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CAREER EXPLORATION (CX)Career Exploration is utilized to assist a participant in exploring specific employment option(s). CX involves the participant conducting informational interviews with individuals or employers who are actually performing the duties or hiring for the duties of the identified occupation (not academic/college programs) to ask questions about the job tasks, training required, salaries. The participant may also have the opportunity to job shadow and observe employees performing the job tasks associated with the identified occupation. If possible, the participant should be given an opportunity to attempt actual job tasks as well.

CX is also utilized for extended support planning and discovery activities in preparation for Supported Employment. Discovery activities may include activities such as interviewing participants, family members, other involved service personnel (e.g. teachers, case managers, etc.); observing participants in the community; and exploring participants interests, and identification of potential areas of vocational interest. Providers, at the request of VR Staff or VR Contractor, may participate in meetings to provide input on the development of the Individualized Plan for Employment (IPE), to determine supported employment services, and to determine benchmarks to transition services to the long term supported employment provider. Providers may be compensated up to a maximum of three (3) hours for these planning and discovery meetings.

The outcome of the service is to identify and provide supporting data and documentation of viable employment options that the participant and VR Staff or VR Contractor may discuss as part of the vocational counseling process.


or VR Contractors, host businesses, and service; Identification of a realistic and viable employment option(s) based on the

participant’s geographic location and labor market analysis; Justification and explanation of why the identified employment options would be a

suitable match for the participant based on his/her unique strengths, resources, capabilities, interests, and aptitudes;

Identification of potential strengths and barriers and suggested accommodations that may mitigate barriers;

Input from the participant on his/her experiences during the job shadowing activities; and



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TECHNICAL GUIDANCE Travel between businesses for the purpose of job shadowing and/or informational

interviews is billable as part of the service as long as the Individual is present.

Individual’s should be encouraged to make contacts with businesses with the support of Provider Staff; however, it is not required that the Individual is always present during contacts.

Career Exploration should be interactive and involve speaking and asking questions of businesses and individuals doing the actual work. Providers should limit the use of videos and only after consulting with the VR Counselor and/or VR Contractor.

Career Exploration may not be used to research academic (college) programs, complete college entrance applications, college visits, register for classes, etc. The activities are part of the vocational planning process and VR Counselor and/or VR Contractors should assist Individuals with these activities.

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DISABILITY & AUGMENTATIVE SKILLS TRAININGServices provided to assist participants to utilizing or enhancing their current functioning levels to be able to full participate in vocational rehabilitation services, secure and maintain employment, and/or enhance independence.


TRAVEL TRAINING $6.00 6 MINUTES


(DURATION)2 (50%) 3 (37.1%) 4 (31.4%)TRAVEL TRAINING $3.00 $2.23 $1.88 6 MINUTES

TRAVEL TRAINING (TT)Travel Training is utilized to teach participants how to travel independently on public transportation or in the community in their own private vehicle. The provider shall assess the needs of the participant and make recommendations to VR staff regarding in which areas the participant may have barriers and strengths as well as the service needs of the participant. Instruction should include topics such as: learning how to schedule transportation requests with transportation providers; reading bus schedules; purchasing tokens/bus passes, training on the public transportation rules; and contingency planning in the event of an unexpected issue (e.g. a missed bus, getting off at the wrong stop, or using GPS to navigate). Provider staff may provide instruction by demonstrating how to ride public transportation with the job seeker until the participant is independent. The outcome of the service is that the participant will be confident and independent in his/her ability to work and travel around in the community.


or VR Contractors, and service; Evaluation of the participant’s functioning at the beginning of the service and at the

end of each training period to document progress; Explanation of instructional techniques and interventions that were used by provider

staff or employer to facilitate learning and progress; Input from the participant on his/her self-assessment and progress during the

adjustment period; and potential concerns; Questions posed by VR Counselors or Contractors in the Referral to Community


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JOB READINESS SERVICESServices provided to prepare a participant for the world of work (e.g., appropriate work behaviors, getting to work on time, appropriate dress and grooming, increasing productivity).


JOB READINESS TRAINING(SCHOOL BASED) $54.50 (HALF DAY) FLAT FEE

JOB READINESS TRAINING(SCHOOL BASED) $87.50 (FULL DAY)) FLAT FEE

JOB READINESS TRAINING(NON-SCHOOL BASED) $87.50 (HALF DAY) FLAT FEE

JOB READINESS TRAINING(NON-SCHOOL BASED) $153.00 (FULL DAY) FLAT FEE

SUMMER YOUTH(CAREER EXPLORATION) $853.50 (WEEK) FLAT FEE

SUMMER YOUTH(WORK EXPERIENCE) $1,138.00 (WEEK) FLAT FEE

WORK ADJUSTMENT $230.00 (HALF DAY) FLAT FEEWORK ADJUSTMENT $402.50 (FULL DAY) FLAT FEE


(DURATION)2 (50%) 3 (37.1%) 4 (31.4%)SUMMER YOUTHCAREER EXPLORATION(WEEK)

$426.75 $316.65 $268.00 FLAT FEE

SUMMER YOUTHWORK EXPERIENCE)(WEEK)

$569.00 $422.20 $357.33 FLAT FEE

WORK ADJUSTMENT(HALF DAY) $115.00 $85.33 $72.22 FLAT FEE

WORK ADJUSTMENT(FULL DAY) $201.25 $149.33 $126.39 FLAT FEE

JOB READINESS TRAINING (JRT)Job Readiness Training is utilized to assist participants to develop the necessary skills and abilities to become successfully employed. JRT is a group based service in which OOD, the host

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business, and the provider have an established relationship which includes an OOD approved training curriculum to address vocational barriers while at the same time learn transferable skills. The outcome of the service is to prepare participants to be job ready and to secure permanent employment. JRT should include several short term rotations, or internships, within the business to allow participants to try and learn various job tasks. Providers shall conduct an assessment at the start of the service to identify training goals, develop benchmarks, and establish timeline for successful completion of the service. The primary emphasis of JRT is to eliminate or reduce vocational barriers such as: work behaviors; communication and interpersonal skills; build stamina and endurance; address attendance and timeliness issues, etc. JRT services must include a soft skills educational component, approved by OOD (e.g. “Skills to Pay the Bills”) to teach skills such as budgeting, time management, development of vocational interests, and job seeking skills training. The educational component may take place onsite at the host business or at an offsite location. Non-School Based JRT programs should include a bi-weekly staffing to discuss progress and additional updated goals. JRT should not be developed for a specific duration but should be based on participant’s progress. JRT includes the provider facilitating a potential job placement within the business partner once the participant approaches job readiness. VR Counselors or VR Contractors may refer the participant on for job development for a position outside the JRT host site if there is not an opening or if the participant is not going to be hired at the JRT business partner. Provider staff must remain on site and provide direct instruction and observation with participants during the full duration of the service.

OOD, as a source of funding, must approve Job Readiness Training programs in advance of the provider developing a program with a business partner. OOD should be engaged in all discussions with businesses partners about the design of potential programs. Providers must submit an educational curriculum to OOD for review and approval to demonstrate what and how soft skills training will be provided during the program.

REQUIREMENTS FOR SCHOOL BASED PROGRAMSSchool based JRT shall be authorized either as a half day, two and a half (2.5) hours, or a full day, four (4) hours. VR Counselors or VR Contractors may request a schedule a less than two and a half (2.5) or four (4)) hours to accommodate a participant’s disability related needs. VR Counselors or VR Contractors must specifically communicate this to the provider at the time of the authorization.

School based programs may occur for up to nine (9) months academic year during the participant’s last year of school.

The written VR Report shall at a minimum address the following: Dates of contacts with participants, his/her parent or legal guardian, VR Counselors

or VR Contractors, host businesses, and service; Information on the work environment and job tasks (job task analysis), including

employer or industry accepted performance (quantity and quality) standards;

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Initial assessment of the participant’s functioning at the beginning of the service and final assessment to demonstrate the participant’s progress;

Observations on the participant’s behavioral and job task performance; Explanation of instructional techniques and interventions that were used by provider

staff or employer to facilitate learning and progress; Input from the employer on performance and potential areas of concern; Input from the participant on his/her self-evaluation of progress on work skills,

behaviors, interpersonal skills, and other areas identified the VR staff and participant at the start of the service; and

Questions posed by VR Counselors or VR Contractors in the Referral to Community Rehabilitation Program.


TECHNICAL GUIDANCE Potential new Job Readiness Training (School Based) services shall follow the process

outlined in Appendix II: New School-Based Job Readiness Training Program Protocol.

Since service is a Flat Fee (Half- or Full-Day), providers do not need to document all contacts. Report only needs to document the activities delivered as part of the Half/Full Day of service.


Flat Fee includes a staffing as required or requested by the VR Counselor/VR Contractor. The staffing will discuss progress and need for continued services. For the purpose of staffing the term bi-weekly shall mean once every two weeks.

REQUIREMENTS FOR NON-SCHOOL BASED PROGRAMSNon-school based JRT shall be authorized either as a half day, four (4) hours, or a full day, seven (7) hours. VR Counselors or VR Contractors may request a schedule a less than four (4) or seven (7) hours to accommodate a participant’s disability related needs. VR Counselors or VR Contractors must specifically communicate this to the provider at the time of the authorization.

Non-school based programs may last as long as the participant is making progress towards achieving the specific goals as identified in their participant service plans. There is not a standard duration for non-school based programs. Participants should

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progress to other VR services (e.g. job development) as they approach completing their individualized plan goal and approach job readiness.



employer or industry accepted performance (quantity and quality) standards; Initial assessment of the participant’s functioning at the beginning of the service and

final assessment to demonstrate the participant’s progress; Observations on the participant’s behavioral and job task performance; Explanation of instructional techniques and interventions that were used by provider



Questions posed by VR Counselors or VR Contractor in the Referral to Community Rehabilitation Program.







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SUMMER YOUTH WORK EXPERIENCE (SY)Summer Youth Career Exploration and Work Experiences are intended to be group based services utilized to teach students and youth with disabilities vocational skills and appropriate work behaviors. SY services may be provided on an individual 1:1 (one provider staff to one participant) basis to accommodate disability related needs or based on a specific employment goal as identified by the VR Counselor or VR Contractor. The Flat Fee (Weekly) shall include all meetings with the participant or his/her parent or legal guardian prior to the service and include a staffing with the VR Counselor or VR Contractor at the end of the service. Group sites are defined as locations that are hosting more than one SY participant during the summer. SY shall be conducted in competitive and integrated settings, except for limited circumstances when the VR Staff or VR Contractor determines that the participant’s needs cannot be met in the community.

Both Career Exploration and Work Experience services must include a soft skills educational component approved by OOD (e.g. “Skills to Pay the Bills,” etc.) to teach independent living skills such as budgeting, time management, development of vocational interests, and job seeking skills training.

Career Exploration is designed for first-time or younger participants who have limited vocational experiences. CX shall be fifteen (15) hours per week for a total of three (3) weeks per summer. The soft skills educational component shall take place between two (2) to four (4) hours per week. The outcome of Summer Youth Career Exploration should be that the participant can articulate his/her desire to work; recognize different employment options through job shadowing, tours of businesses, discussion and presentations from employers, and informational interviewing; and awareness of his/her own personal strengths and weaknesses.

Work Experiences are designed for older participants or for participants who have successfully completed the Career Exploration track. Work Experiences shall be twenty (20) hours per week for a total of five (5) weeks. The first week shall be twenty (20) hours of soft skills education. The outcome of the service is that participants should be able to identify several vocational areas of interest; possess a general understanding of the job seeking process; the ability to meet employers expectations as far as quality and quantity of work, work behaviors, etc.; and; build upon communication and interpersonal skills; and/or address other potential vocational barriers.

REQUIREMENTSThe written VR Report shall at a minimum address the following:

Information on the work environment and job tasks (job task analysis), including employer or industry accepted performance (quantity and quality) standards.

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Initial assessment of the participant’s functioning at the beginning of the service and final assessment to demonstrate the participant’s progress;

Observations on the participant’s behavioral and job task performance; Explanation of instructional techniques and interventions that were used by provider



Questions posed by VR Counselors or VR Contractors in the Referral to Community Rehabilitation Program.




TECHNICAL GUIDANCE Provider staff must remain on site with youth at the job site for the full duration of

the service. Youth should be in the same area within the business and under the supervision of the Provider staff member at all times.

Since service is a Flat Fee ((Week) providers do not need to document all contacts. Report only needs to document the daily activities that take place during the service week.

Providers shall immediately notify the VR Counselor and/or Contractor if the Individual misses more than two (2) days during the week. Individuals will not be allowed to participate in the following week until the Individual has discussed the situation with their VR Counselor and/or VR Contractor. Providers should interrupt/suspend services and the authorization until the Provider hears from the VR Counselor or VR Contractor.

Summer Youth Work Experiences should be scheduled so that the Individual stays at the same job site for the full day for the entire week. Providers may change job sites at the end of the week once during the four (4) weeks in order to provide more job experiences. It is recommended that the job experiences should be at least two (2) full weeks each.

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Summer Youth Career Exploration should include contacts with three businesses per week, preferably in different employment sectors.

WORK ADJUSTMENT (WA)Work Adjustment services are utilized to assist participants in preparing for employment by improving their job readiness. WA is successfully completed once participants are job ready at which point WA should end and participants should progress into other vocational services, e.g. Job Development. WA shall be conducted in competitive and integrated settings, except for limited circumstances when the VR Staff or VR Contractor determines that the participant’s needs cannot be met in the community. Providers shall create a service plan that outlines what steps are required to be able to transition the participant into a competitive integrated setting.

Provider staff will provide the participant with an assessment at the start of the service to develop an objective and measurable service plan that includes training goals and benchmarks, outlines training techniques, and establish timeframes for adjustment. The service plan shall be submitted to VR Staff or VR Contractor within two weeks of the start of service. VR Staff and VR Contractor may not authorize additional time until the service plan has been received and reviewed. Providers should amend the service plan, as needed, with specific goals, modified instructional techniques, expected outcomes, and updated timeframes. Providers shall submit copies of updated plans to VR Staff and VR Contractor whenever they are updated. WA should not be used to teach position specific occupational or employer skills in order to get the participant hired or to develop a work history. The outcome of the service is to prepare the participant for permanent competitive integrated employment.

REQUIREMENTSWA shall be authorized either as a half day, four (4) hours, or a full day, seven (7) hours. VR Counselors or VR Contractors may request a schedule a less than four (4) or seven (7) hours to accommodate a participant’s disability related needs. VR Counselors or VR Contractors must specifically communicate this to the provider at the time of the authorization.



employer or industry accepted performance (quantity and quality) standards; Initial assessment of the participant’s functioning at the beginning of the service and

at the end of each adjustment period to document progress; Observations on the participant’s behavioral and job task performance; Explanation of instructional techniques and interventions that were used by provider

staff or employer to facilitate learning and progress; Input from the employer on performance and potential areas of concern;

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Input from the participant on his/her vocational preferences; his/her self-assessment of his/her physical and mental capabilities to do the job; and potential concerns.

Providers shall provide a participation log signed by the participant outlining dates, time started and ended, and any breaks, if applicable. And

Questions posed by VR Counselors or Contractors in the Referral to Community Rehabilitation Program.








TABLE OF CONTENTS

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JOB RELATED SERVICESServices which support and assist a participant in searching for and securing an appropriate employment outcome. Job Related Services also includes services provided to a participant who has been placed in employment in order to stabilize the placement and enhance job retention. Services may include, but are not limited to activities such as: resume preparation, identifying appropriate job opportunities, developing interview skills, making contacts with companies on behalf of participants, on the job supports, etc.


JOB SEEKING SKILLS TRAINING $6.00 6 MINUTESJOB DEVELOPMENT (UOS) $6.50 6 MINUTESPERFORMANCE BASED JOB DEVELOPMENT TIER I $1,167.50 FLAT FEE

PERFORMANCE BASED JOB DEVELOPMENT TIER II $1,110.25 FLAT FEE

PERFORMANCE BASED JOB DEVELOPMENT TIER III $1,580.50 FLAT FEE

PERFORMANCE BASED JOB DEVELOPMENT TIER IIIPREMIUM A (RAPID PLACEMENT)

$1,980.50 FLAT FEE

PERFORMANCE BASED JOB DEVELOPMENT TIER IIIPREMIUM B (SGA PLACEMENT)

$1,980.50 FLAT FEE

PERFORMANCE BASED JOB DEVELOPMENT TIER IIIPREMIUM C (RAPID & SGA)

$2,380.50 FLAT FEE


$339.50 FLAT FEE

SUPPORTED EMPLOYMENT JD TIER I $1,459.25 FLAT FEESUPPORTED EMPLOYMENT JD TIER II $1,387.75 FLAT FEE

SUPPORTED EMPLOYMENT JD TIER III $1,975.50 FLAT FEE

SUPPORTED EMPLOYMENT JD TIER IIIRETENTION PREMIUM A(RAPID PLACEMENT)

$2,375.50 FLAT FEE

SUPPORTED EMPLOYMENT JD TIER $2,375.50 FLAT FEE

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I I IRETENTION PREMIUM B(SGA PLACEMENT)SUPPORTED EMPLOYMENT JD TIER IIIRETENTION PREMIUM C(RAPID & SGA PLACEMENT)

$2,775.50 FLAT FEE

SUPPORTED EMPLOYMENT SUBSEQUENT PLACEMENT $424.25 FLAT FEE

ON-THE-JOB SUPPORTS $6.00 6 MINUTES


(DURATION)2 (50%) 3 (37.1%) 4 (31.4%)JOB SEEKING SKILLS TRAINING $3.00 $2.23 $1.88 6 MINUTESON-THE-JOB SUPPORTS $3.00 $2.23 $1.88 6 MINUTES

JOB SEEKING SKILLS TRAINING (JSST)Job Seeking Skills Training is utilized to assist a participant to successfully identify and respond to potential job opportunities. JSST is a component of Job Development; however, JSST may be provided outside Job Development for participants who are preparing to conduct their own independent job search (e.g. not receiving Job Development). The service may include: how to locate job opportunities through the newspaper, online, job boards, and ‘cold calling’ techniques (i.e. telephone script); how to develop a resume, cover letter; how to follow up with employers after completing an application or interview; how to address potential barriers such as breaks in employment history, criminal convictions, and need for reasonable accommodations; how to handle difficult interview questions, mock interviews, and to teach participants the importance of and how to manage their online/social media. The outcome of the service should be that the participant has the skills and resources to maximize his/her independence in conducting his/her own job search.


or VR Contractors, and service; Documentation of the topics and techniques used to teach the participant how to

prepare for his/her independent job search; Include input from the participant on his/her self-evaluation of his/her interviewing

skills; and Questions posed by VR Staff or VR Contractor in the Referral to Community


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Providers shall submit an electronic copy of the resume or mock application with the first report and invoice. The resume or mock application shall be professional in appearance and accurately reflect participant’s information, work and educational histories, and be free of spelling and grammatical errors.

Providers shall also assist the participant to register with Ohio Means Jobs (OMJ), if they are not already registered.


TECHNICAL GUIDANCE VR Counselors and/or VR Contractors shall have five business days to review and

approve the resume and/or mock application. Providers should follow up on the fifth (5TH) day and if there is no response, may assume that it has been approved. If an issue arises later, the Provider should work with the VR Counselor/VR Contractor, and Individual to make adjustments to the resume/mock application.

JOB DEVELOPMENT (JD)Job Development is utilized to prepare and assist participants to contact businesses, apply and interview with employers, and to secure employment. Job Development should include instruction and guidance about how to locate potential job opportunities (e.g. networking, use of OMJ and other electronic job boards, newspapers, online, and “cold” calling); development of a resume, cover letters and/or a mock application template; how to answer interview questions, including issues such as gaps in employment histories; requesting reasonable accommodations; addressing criminal histories; and managing online profiles/social media. This instruction and guidance should maximize the independence of the participant to conduct his/her own job search. Based upon the needs of the job seeker, Job Development may also include the job developer updating the job seeker’s resume/mock application, sending out cover letters and resumes to potential employers, providing job leads to the job seeker to follow up on, review of the job seekers interview skills, follow up contacts with employers when applications have been submitted or when a job seeker has an interview, discussion of hiring incentives and tax credits with the business, and providing support in requesting and implementing reasonable accommodations.

Performance Based (Tiers) is the preferred fee structure for job development and shall be paid upon the following deliverables:

Tier I (Job Seeking Skills Training & Planning): Upon completion of job seeking skills training, acceptance of the resume/mock application by the VR Staff or VR Contractor, registration of the participant with Ohio Means Jobs (OMJ), and completion of the job development plan;

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Tier II (Job Search Assistance): VR Counselor or VR Contractor’s approval of a job that meets the participant’s agreed upon wage and hours as identified in the IPE, a review of the position description, and successful completion of the second day of work;

Tier III (Retention): Upon 90 days and stabilization of employment after intensive On-The-Job Supports are removed as discussed and agreed upon by the VR Staff or VR Contractor and the provider; and

Subsequent Placement: In situations where a participant loses his/her job after Tier II has been paid but before Tier III has been paid VR Counselors and VR Contractors may authorize for a Subsequent Placement to locate a new job. The Subsequent Placement shall be paid upon meeting the same requirements of Tier II.

Job Development UOS services may be utilized in situations such as to locate Temporary Summer Jobs for Transitional Youth, to allow a provider to pursue a specific employment lead for participants who may be receiving JD services from another provider, and/or on a case by case basis as determined by OOD.

Job Development shall not be provided in instances where a job offer is extended as a result of other vocational services unless the Job Development was authorized prior to the other services. Providers may use on-the-job supports to complete the hiring process in these situations.

The outcome of the service is for the participant to obtain necessary supports to successfully obtain and maintain permanent employment.

REQUIREMENTSThe written VR Report shall at a minimum address the following: Include input from the participant on his/her self-evaluation of his/her interviewing

skills; Dates of contacts with the participant, his/her parent or legal guardian, VR



Providers and participants shall develop a Job Development plan that includes responsibilities for both the job developer and participant; identifies specific positions and employers that the job seeker would like to pursue, and establishes the frequency and method of contact between the job developer and participant. The Job Development plan must be submitted with the first month’s report and invoice. The Job Development plan shall be reviewed each month and new goals and lists of potential positions/employers shall be updated and documented on the monthly report.

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Providers shall submit an electronic copy of the resume or job application template for review and approval, by the VR Staff or VR Contractor, prior to sending it to potential employers or giving a copy to the participant;

Provider staff shall deliver services at an intensity as agreed upon in the job development plan and with sufficient attention to ensure the continued progress of the job seeker. Job Developers will be required to have weekly contact with the participant. The expectation is that the job developer and the participant are together regularly and actively job hunting together in the community, a minimal amount of time should be spent doing online job searches.

Providers shall assist participants to register with Ohio Means Jobs (OMJ), if they are not already registered.

Providers shall submit a placement report within five days of the job offer which includes, but not limited to, the job title, name of the employer, employer address, employer telephone, supervisor’s name, start date, wage, number of hours, if insurance is available, and summary of other benefits, if applicable. The placement report should include the name of the provider, name of the staff who verified the information, and date.


TECHNICAL GUIDANCE Performance Based Job Development includes all activities related securing

employment for the Individual, including but not limited to, transporting Individuals to fill out applications and complete interviews; assisting Individuals in purchasing interview clothing, etc.

Job Developers may assist individuals completing assessments, questionnaires, and surveys as part of the application and interview process e.g. person has difficulty using the computer the Job Developer can record the response. Participants must be present during the assessment, questionnaire, and/or survey and Job Developers may not complete them on behalf of the Participant.

VR Counselors and/or VR Contractors shall have five business days to review and approve the resume and/or mock application. Providers should follow up on the fifth (5TH) day and if there is no response, may assume that it has been approved. If an issue arises later, the Provider should work with the VR Counselor/VR Contractor, and Individual to make adjustments to the resume/mock application.

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Job stabilization is determined by the VR Counselor and/or VR Contractor after the Individual has learned their job tasks and has successfully adjusted to the work environment to the point that the Individual can independently perform the job tasks. VR Counselor and VR Contractor should include the Individual and Provider in the discussion about job stabilization. VR Counselors and/or VR Contracts shall notify the Provider once the Individual is placed in Employed Status (job stabilization date.)

Contacts during Tier III shall follow the same requirements as On-The-Job-Supports. Once per week for the first month, then every two weeks during the second month, and as determined by the VR Counselor/VR Contractor during the third and final month.

Final contact, between days eighty-three (83) and ninety (90) are required to be with the Individual. If the Provider has difficulty in contacting the Individual they should communicate that to the VR Counselor or VR Contractor.

Performance Based Job Development (Tier II) involves activities to assist the Individual in securing employment. If the Individual needs support on the job on the first day of paid work to learn job tasks or adjust to the work environment then On-The-Job Supports shall be authorized or, if the Individual does not need job coaching then Tier III shall be authorized.

The authorization process for Performance Based Job Development shall be as follows:

Tier I shall initiate the Job Development... VR Counselors/VR Coordinators should send a completed Referral to Facility to the Provider outlining the employment goal, expectations of wages/hours, and/or other instructions.

Tier II shall be issued once the Tier I invoice have been received and paid. Providers should not engage in an active job search (e.g. contacting potential employers) until the Tier II has been issued and received by them. If a potential opportunity becomes available the Provider should contact the VR Counselor and/or VR Contractor on a case by case basis for additional guidance.

Tier III shall be issued either 1) when the VR Counselor receives the placement report if there will not be On-The-Job Supports or 2) prior to the complete phase out of On-The-Job Supports. VR Counselors/VR Contractors shall an authorization in place prior to the need for retention services.

Placement premiums (Rapid or SGA Earnings) shall be authorized as part of Tier III based on the information available at the time of authorization. If it becomes known at a later date that a case is no longer eligible for the placement premium the Provider shall correct the invoice prior to submitting for payment. VR will then amend the authorization.

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Subsequent Placements shall be issued when the need arises to place the Participant back into Job Search prior to the Tier III being paid.

SUPPORTED EMPLOYMENT - JOB DEVELOPMENT (SE-JD)Supported Employment services are intensive, ongoing support services (including Customized Employment, the IPS Model and Employment First Model) that are needed to assist an individual with the most significant disabilities to work in an integrated employment setting. Supported Employment Job Development should not be utilized to place participants into sheltered work environments. Supported Employment services should be more intensive with more frequent and substantial contacts with the participant and his/her person centered employment team. Participants should be involved and included in the job search process to the fullest extent possible.

The Supported Employment job developer will take on a more active role in securing employment opportunities including: contacting businesses on behalf of the participants; negotiating possible customized employment options; job carving; completing applications on behalf of participants or support participants completing their own applications for employment; discussion of hiring incentives and tax credits with the business; and providing support in requesting and implementing reasonable accommodations. Providers shall also register participants with Ohio Means Jobs (OMJ), if they are not already registered. Providers, participants, and support professionals, and members of the participant’s person-centered planning team (e.g. family members, case managers, etc.) should develop a job development plan that includes vocational areas, or themes, for possible employment; specific employers where participants would like to apply; frequency and methods of communicating updates, but at a minimum of twice per week. Providers, participants, and support professionals, and involved other parties (e.g. family members, case managers, etc.) should meet as a team at a minimum of bi-monthly to review the supported employment/job development plan.

Performance Based (Tiers) is the preferred fee structure for Supported Employment Job Development and shall be paid upon the following deliverables:

Tier I (Job Seeking Skills Training & Planning): Upon completion of job seeking skills training, acceptance of the resume/mock application by the VR Staff or VR Contractor, registration of the participant with Ohio Means Jobs (OMJ), and completion of the job development plan;

Tier II (Job Search Assistance): VR Counselor or VR Contractor’s approval of a job that meets the participant’s agreed upon wage and hours as identified in the IPE, a review of the position description, and successful completion of the second day of work;

Tier III (Retention): Upon 90 days and stabilization of employment after intensive On-The-Job Supports are removed as discussed and agreed upon by the VR Staff or VR Contractor and the provider; and

Subsequent Placement: In situations where a participant loses his/her job after Tier II has been paid but before Tier III has been paid VR Counselors and VR Contractors may authorize for a Subsequent Placement to locate a new job. The Subsequent Placement shall be paid upon meeting the same requirements of Tier II.

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Supported Job Development shall not be provided in instances where a job offer is extended as a result of other vocational services unless the job development was authorized prior to the other services. Providers may use On-The-Job Supports to complete the hiring process in these situations.

The outcome of the service is for the participant to obtain necessary supports to successfully obtain and maintain permanent employment.

REQUIREMENTSThe written VR Report shall at a minimum address the following: Dates of contacts with the participant, his/her parent or legal guardian, VR



Providers and participants shall submit a job development plan that includes responsibilities for both the job developer and participant; identifies specific positions and employers that the participant would like to pursue, and establishes the frequency and method of contact between the job developer and participant. The job development plan must be submitted with the first month’s report and invoice. The job development plan shall be reviewed each month and new goals and lists of potential positions/employers shall be updated and documented on the monthly report.

Provider staff shall deliver services at an intensity as agreed upon in the job development plan and with sufficient attention to ensure the continued progress of the participant. Job Developers will be required to have contact with the participants at least twice per week. The expectation is that the job developer and the participant are together regularly and actively job hunting together in the community, a minimal amount of time should be spent doing online job searches.

Providers shall assist participants in registering with Ohio Means Jobs (OMJ), if they are not already registered.

Providers shall submit a placement report within five days of the job offer which includes, but not limited to, the job title, name of the employer, employer address, employer telephone, supervisor’s name, start date, wage, number of hours, if insurance is available, and summary of other benefits, if applicable. The placement report should include the name of the provider, name of the staff who verified the information, and date.

Providers shall submit the invoice and report, on the appropriate template, within 21 calendar days of the completion of service or the last date of services defined on the VR

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authorization, whichever comes first. Providers shall submit a report at a minimum of at least once per month.

TECHNICAL GUIDANCE Eligibility for the Supported Employment Job Development rate is determined by the

VR Counselor or VR Contractor based on the unique factors of the case. Both Providers and Individuals must meet specific criteria in order for the case to be considered eligible for the Supported Employment rate. Supported Employment Job Development must be placed on the Individual Plan for Employment (IPE) before it may be authorized.

Supported Employment Job Development includes all activities related securing employment for the Individual, including but not limited to, transporting Individuals to fill out applications and complete interviews; assisting Individuals in purchasing interview clothing, etc.

Job Developers may assist individuals completing assessments, questionnaires, and surveys as part of the application and interview process e.g. person has difficulty using the computer the Job Developer can record the response. Participants must be present during the assessment, questionnaire, and/or survey and Job Developers may not complete them on behalf of the Participant.

VR Counselors and/or VR Contractors shall have five business days to review and approve the resume and/or mock application. Providers should follow up on the fifth (5TH) day and if there is no response, may assume that it has been approved. If an issue arises later, the Provider should work with the VR Counselor/VR Contractor, and Individual to make adjustments to the resume/mock application.


Contacts during Tier III shall follow the same requirements as On-The-Job-Supports. Once per week for the first month, then every two weeks during the second month, and as determined by the VR Counselor/VR Contractor during the third and final month.

Final contact, between days eighty-three (83) and ninety (90) are required to be with the Individual. If the Provider has difficulty in contacting the Individual they should communicate that to the VR Counselor or VR Contractor.

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Performance Based Job Development (Tier II) involves activities to assist the Individual in securing employment. If the Individual needs support on the job on the first day then either On-The-Job Supports shall be authorized or, if the Individual does not need job coaching then Tier III shall be authorized.

The authorization process for Performance Based Job Development shall be as follows:

Tier I shall initiate the Job Development... VR Counselors/VR Coordinators should send a completed Referral to Facility to the Provider outlining the employment goal, expectations of wages/hours, and/or other instructions.

Tier II shall be issued once the Tier I invoice have been received and paid. Providers should not engage in an active job search (e.g. contacting potential employers) until the Tier II has been issued and received by them. If a potential opportunity becomes available the Provider should contact the VR Counselor and/or VR Contractor on a case by case basis for additional guidance.

Tier III shall be issued either 1) when the VR Counselor receives the placement report if there will not be On-The-Job Supports or 2) prior to the complete phase out of On-The-Job Supports. VR Counselors/VR Contractors shall an authorization in place prior to the need for retention services.

Placement premiums (Rapid or SGA Earnings) shall be authorized as part of Tier III based on the information available at the time of authorization. If it becomes known at a later date that a case is no longer eligible for the placement premium the Provider shall correct the invoice prior to submitting for payment. VR will then amend the authorization.

Subsequent Placements shall be issued when the need arises to place the Participant back into Job Search prior to the Tier III being paid.

Beginning in January 2019, providers that wish to offer Supported Employment Job Development services must use staff that have successfully passed the Certified Employment Support Professional (CESP) through the Association of People Supporting Employment First or are adhering with a high degree of fidelity to a professionally recognized evidence-based employment practice.

PERFORMANCE BASED JOB DEVELOPMENT RETENTION PREMIUM RATESTier III rates shall be paid based upon the nature of the outcome achieved. VR shall compensate providers for assisting participants in meeting specific job retention benchmarks. There shall be three job retention premium rates. Retention premium rates may be paid for Performance Based Job Development and Supported Employment Performance Based Job Development.

REQUIREMENTS: PREMIUM A (RAPID PLACEMENT) Participant is placed in an employment setting, in accordance with the requirements

of Tier II, that matches their desired wages, hours, and employment goal as

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identified on their IPE within ninety (90) days of the start of job development activities; and

Participant maintains a position within the same employer throughout Tier III (Retention).

TECHNICAL GUIDANCE Start of Job Development activities is defined as the first date of service on the Tier

I/Job Development Monthly Tracking Report.

Participant must maintain a position with the same business from the time of hire through the ninety (90) day retention period. Participants may change jobs within the same business and maintain eligibility for the premium payment.

VR shall deduct the time from the date that a proper invoice, e.g. an invoice/report that is technically and programmatically, from the date that the Tier II was issued from the 90 days when determining if the case is eligible for the Rapid Placement premium. If the invoice/report are denied/returned for correction the time shall still be counted until VR receives the proper invoice.

REQUIREMENTS: PREMIUM B (SGA EARNINGS PLACEMENT) Participant is placed in an employment setting, in accordance with the requirements

of Tier II, that pays earnings above the Substantial Gainful Activity (SGA) rate established by the Social Security Administration (SGA) at the time placement; and

Participant maintains a position above the SGA level throughout Tier III (Retention)

TECHNICAL GUIDANCE Provider must provide documentation from the Employer, either a letter or copy or

their payroll records, demonstrating that the Individual is earning over SGA at the time of the Tier III outcome.

Providers are eligible for the SGA Earnings enhancement regardless of whether the Individual receives Social Security benefits or not.

REQUIREMENTS: PREMIUM C (RAPID & SGA EARNINGS PLACEMENTS) Participant is placed in employment that meets the requirements of both Premium A

& B.

ON-THE-JOB SUPPORTS (OJS)On-The-Job Supports (OJS) (formerly known as Job Coaching and Job Retention) are utilized to provide assistance, such as, instruction to learn job tasks; to develop natural and peer supports; and adjusting to the work environment. OJS may occur on-site or off-site, an example of off-site job supports could be contacts with the participant before or after work to problem solve possible concerns that may impact employment. Providers shall perform a job task analysis for newly hired participants and develop a support plan that identifies specific qualitative and

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quantitative performance standards based on the employer’s expectations and industry standards. The plan should project a systematic decrease of the intensity of supports as the participant learns job tasks and adjusts to the work environment. OJS are also utilized to provide continued supports to the participant and/or employer after the participant has learned the job tasks and reached his/her expected level of independence to ensure stability of the placement and enhance retention. During the first month after job stabilization, at a minimum, the provider shall contact the participant and employer once per week; during the second month the contacts may decrease to bi-weekly; and during the third month, as needed. Providers must contact the participant within one week of the 90TH day after the job has been stabilized. The outcome of the service is that the participant will be able to perform job tasks within the employer’s accepted quality and quantity standards and that the participant will have successfully learned the job tasks and adjusted to the work environment.

REQUIREMENTSThe written VR Report shall at a minimum address the following: Information on the work environment and job tasks (job task analysis), including

employer or industry accepted performance (quantity and quality) standards. Initial assessment of the participant’s functioning at the beginning of the service and

final assessment to demonstrate the participant’s progress. Observations on the participant’s behavioral and job task performance. Explanation of instructional techniques and interventions that were used by provider

staff or employer to facilitate learning and progress. Input from the employer on performance and potential areas of concern. Input from the participant on his/her self-evaluation of progress on work skills,

behaviors, interpersonal skills, and other areas identified by the VR staff and participant at the start of the service.


Providers shall notify VR Counselor or VR Contractors as soon as possible, but no more than two business days, of any potential issues or areas of concern raised by the participant or employer.


TECHNICAL GUIDANCE Final contact, between days eighty-three (83) and ninety (90) are required to be with

the Individual. If the Provider has difficulty in contacting the Individual they should communicate that to the VR Counselor or VR Contractor.

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On-The-Job Supports shall be authorized when the Individual needs assistance in transitioning into the work environment, including the first day of work and/or paid orientation, or learning job tasks.


TABLE OF CONTENTS

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TABLE 3: CONTRACTED SERVICE RATES (NOT INCLUDED IN OAC 3304-2-52)


ACTIVITIES OF DAILY LIVING TRAINING $7.40 UOSORIENTATION & MOBILITY TRAINING $9.60 UOSLOW VISION SERVICES $8.70 UOSREHABILITATION TECHNOLOGY $9.50 UOS

DISABILITY & AUGMENTATIVE SKILLS TRAININGACTIVITIES OF DAILY LIVING (SELF) TRAINING (ADL)ADL (Self) Training, commonly referred to Rehabilitation Teaching, is utilized to teach individuals with visual impairments and other disabilities, such as cognitive disability or traumatic brain injury, to learn activities of daily living to enhance safety, independence, and employability. Provider will assess the needs of the individual and make recommendations to VR Counselor or Coordinator regarding in which areas the individual may have barriers as well as the individual’s strengths. Provider will develop a plan outlining benchmarks, instructional techniques, and estimated timeframes to achieve learning objectives. Provider staff can provide training on topics such as: selecting and organizing clothing, preparing meals, budgeting and managing money, and maintaining hygiene. Instructional techniques can include one-on-one demonstration, repetition, and development of natural supports and cues. The outcome of the service is that the individual develops the skills and confidence to be able to live and manage their activities of daily living independently. Providers shall use the appropriate report template as defined in the VR Provider Manual. VR Report and invoice shall be submitted electronically within 15 (fifteen) days of the date of last service or the last day of the calendar month defined in the VR Original Authorization & Billing (OOD-0020), whichever comes first.

REQUIREMENTS:The written VR Report shall at minimum address the following: Initial assessment of the individual’s functioning at the beginning of the service and at the end

of each adjustment period to document progress. Explanation of instructional techniques and interventions that were used by provider staff or

employer to facilitate learning and progress. Input from the individual on their self-assessment and progress during the adjustment period;

and potential concerns. Questions posed by VR Counselors or Coordinators in the Referral to Facility form.

ORIENTATION & MOBILITY (OM)Orientation & Mobility is utilized to assist individuals with visual impairments to familiarize themselves with their environment and to learn to navigate independently. Provider will assess the needs of the

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individual and make recommendations to VR Counselor or Coordinator regarding which areas the individual may have barriers as well as the individual’s strengths. Provider will develop a plan outlining benchmarks, instructional techniques, and estimated timeframes to achieve learning objectives. Providers may use instructional techniques, such as sighted-guide, cane, or use of service animals. The service may be provided in different settings, such as the workplace, home, educational setting, or the community-at-large. The outcome of the service is that the individual develops the skills and confidence to navigate independently. Providers shall use the appropriate report template as defined in the VR Provider Manual. VR Report and invoice shall be submitted electronically within 15 (fifteen) days of the date of last service or the last day of the calendar month defined in the VR Original Authorization & Billing (OOD-0020), whichever comes first.

REQUIREMENTS:The written VR Report shall at minimum address the following:

Initial assessment of the individual’s functioning at the beginning of the service and at the end of each adjustment period to document progress.

Explanation of instructional techniques and interventions that were used by provider staff or employer to facilitate learning and progress.

Input from the individual on their self-assessment and progress during the adjustment period; and potential concerns.

Questions posed by VR Counselors or Coordinators in the Referral to Facility form.

REHABILITATION TECHNOLOGYREHABILITATION TECHNOLOGY (RT)Rehabilitation Technology is a systematic application of technologies, engineering methodologies, or scientific principles to meet the needs of, and address the barriers confronted by, individuals with disabilities in areas that include education, rehabilitation, employment, transportation, and independent living. RT includes both assessment and services. The service should include home or employment site visits; measurements of the physical environment or equipment, developing technical drawings e.g. in the case of home modifications/physical accessibility modifications; researching potential modifications; fabrication and installation of modifications; and computer programming to provide for accessibility. Service may also include training on utilization and maintenance of accommodations. Providers should develop a plan for services that address the participant’s needs, training recommendations with specific and measurable benchmarks, and projected timeframes. The outcome of the service should be modifications to the physical environment or equipment that will enhance the individual’s independence and employment options. Providers shall use the appropriate report template as defined in the VR Provider Manual. VR Report and invoice shall be submitted electronically within 15 (fifteen) days of the date of last service or the last day of the calendar month defined in the VR Original Authorization & Billing (OOD-0020), whichever comes first.

REQUIREMENTSThe written VR Report shall at minimum address the following:

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Questions posed by VR Counselors or Coordinators in the Referral to Facility Form. Drawings and plans that clearly identify the current situation and proposed modifications. Input and feedback from the individual on the progress of the training, as applicable.

LOW VISION SERVICES (LVS)Low Vision Services includes an assessment, recommendation, and training on the appropriate selection and utilization of low vision equipment such as magnifiers, optics, and CCTV to address the functional impairments associated with vision loss. This may involve demonstrating and allowing individuals to use different types of equipment as part of the evaluation process. Provider may also provide recommendations on lighting to improve functional capabilities. Providers may also train individuals on the proper care and maintenance of selected equipment. The outcome of the service is to provide assistive technology devices and services to improve vision to promote employability and independence. Providers shall use the appropriate report template as defined in the VR Provider Manual. VR Report and invoice shall be submitted electronically within 15 (fifteen) days of the date of last service or the last day of the calendar month defined in the VR Original Authorization & Billing (OOD-0020), whichever comes first.

REQUIREMENTSThe written VR Report shall at minimum address the following: Questions posed by VR Counselors or Coordinators in the Referral to Facility Form. Input and feedback from the individual on the progress of the training, as applicable.

TABLE OF CONTENTS

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VR FORMS INSTRUCTIONS & EXAMPLES

This document is intended to demonstrate how Provider Staff should complete the VR Reports. It will document what information should be included in each form field and provide examples of narratives. This document is intended to be used as a guide and should not substitute training by Providers to their Staff on how to provide and document services.

Opportunities for Ohioans with Disabilities (OOD) may make additions and/or adjustments to these instructions based upon issues and concerns identified by VR Staff and/or Providers.

Specific questions or concerns about these instructions should be sent to [email protected]. Thank you.

FORMS BY SERVICE CHART

SERVICE DESCRIPTION REPORT FORMINTAKE PROVIDER INTAKE ACKNOWLEDGEMENTINTERPRETER SERVICES(FOREIGN & SIGN LANGUAGE) INTERPRETING

SITE DEVELOPMENT JOB DEVELOPMENT – MONTHLY TRACKINGTRANSPORTATION TRANSPORTATIONVOCATIONAL TRAINING STIPEND VOCATIONAL TRAINING STIPENDWORK INCENTIVES PLANNING WORK INCENTIVES PLANWORK INCENTIVES COORDINATION WORK INCENTIVES COORDINATIONCOMMUNITY BASED ASSESSMENT CBA OJS JRT WA SYWEVOCATIONAL EVALUATION VOCATIONAL EVALUATIONVOCATIONAL CONSULTATION VOCATIONAL CONSULTATIONCAREER EXPLORATION CAREER EXPLORATION SYCXTRAVEL TRAINING TRAVEL TRAININGJOB READINESS TRAINING(SCHOOL & NON-SCHOOL BASED) CAREER EXPLORATION SYCX

SUMMER YOUTH(CAREER EXPLORATION) CAREER EXPLORATION SYCX

SUMMER YOUTH(WORK EXPERIENCE) CBA OJS JRT WA SYWE

WORK ADJUSTMENT CBA OJS JRT WA SYWEJOB SEEKING SKILLS TRAINING JOB SEEKING SKILLS TRAININGJOB DEVELOPMENT (UOS) JOB DEVELOPMENT – MONTHLY TRACKINGPERFORMANCE BASED JOB JOB DEVELOPMENT – MONTHLY TRACKING &

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mailto:[email protected]

DEVELOPMENT TIER I JOB DEVELOPMENT PLANPERFORMANCE BASED JOB DEVELOPMENT TIER II

JOB DEVELOPMENT – MONTHLY TRACKING & EMPLOYMENT VERIFICATION

PERFORMANCE BASED JOB DEVELOPMENT TIER III




SUPPORTED EMPLOYMENT JD TIER I JOB DEVELOPMENT – MONTHLY TRACKING & JOB DEVELOPMENT PLAN

SUPPORTED EMPLOYMENT JD TIER II JOB DEVELOPMENT – MONTHLY TRACKING & EMPLOYMENT VERIFICATION

SUPPORTED EMPLOYMENT JD TIER III JOB DEVELOPMENT – MONTHLY TRACKING & EMPLOYMENT VERIFICATION

SUPPORTED EMPLOYMENT SUBSEQUENT PLACEMENT


ON-THE-JOB SUPPORTS CBA OJS JRT WA SYWE

GENERAL INSTRUCTIONS

VR Reports must be submitted to OOD via ZixMail to the electronic regional mailboxes or via fax. The preferred method of submission is as an Excel or Word document. Providers may also submit reports as PDF documents. PDF documents should be first generation, e.g. created from the original Excel or Word document. Printed and scanned copies of PDF documents are typically not accessible to screen reading software. (Exception: Forms that need to be signed may be scanned.)

Providers shall use and complete the fields in the VR Reports. Providers may not use reference statements such as “SEE ATTACHED” unless the report specifically states that is allowed, e.g. Providers shall complete the summary sections of the Vocational Evaluation form but attach the specific test results or Providers shall complete the Rehabilitation Technology report but attach home modification drawings and measurements, etc.

Providers may use the “Spell Check” function on Excel documents to make spelling corrections. “Spell Check” will not work on Word documents due to the “Form” protection.

Due to merged cells in the Excel documents Providers must manually expand rows to accommodate text fields by placing the cursor between the rows until it changes shape into a bar with an arrow pointing up and an arrow pointing down, and then press the left mouse button and drag the row down until all text is visible.

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Providers may also highlight the row, press the right mouse button, and select the “Row Height” option to manually enter a specific row height.

Double clicking between rows will shrink the row and not allow the full text to be displayed.

TABLE OF CONTENTS

INVOICE SECTION

Provider Staff should start to complete each form with the Invoice Section. Based on choices, e.g. “Service Description”, the report template will load the corresponding rates.

EXAMPLE 1: CBA OJS JRT WA SYWE INVOICE SECTION

PROVIDER NAMESTREET ADDRESSTELEPHONE

(MUST MATCH ORIGINAL VR AUTHORIZATION)

Placements ‘R US1 Main StreetHometown, OH 12345(614) 438-1200

AUTHORIZATION # 123456789-1PROVIDER INVOICE # ABC1234INDIVIDUAL'S NAME Noah BlakeDIRECT SERVICE STAFF NAME(S) Faith PhillipsPERSON COMPLETING REPORT(IF DIFFERENT THAN DIRECT SERVICE STAFF)

Ethan Deck (EJD)Madison Black (MEB)

VR COUNSELOR OR VR CONTRACTOR Samuel AdamsINVOICE DATE 10/07/17INVOICE STATUS FINALSERVICE START DATE 09/03/17SERVICE END DATE 09/16/17SERVICE DESCRIPTION (UOS SERVICES) SERVICE TOTAL $0.00SERVICE DESCRIPTION (HALF/FULL DAY SERVICES) SERVICE TOTAL $0.00

SERVICE DESCRIPTION (WEEKLY SERVICES) SERVICE TOTAL $0.00SERVICE AREA MODIFIER (SAM) TOTAL $0.00

LESS ADJUSTMENTS ADJUSTMENTS TOTALINVOICE TOTAL

FIELD ENTRY TYPE

INFORMATION

PROVIDER NAMESTREET ADDRESSTELEPHONE

TEXT

Providers should enter their business name and address as it is printed on the VR Original Authorization & Billing (OOD-0020) regardless if the service took place at a different business location. This information must match or the invoice will be denied and returned for correction.Providers should include the telephone number of the person to contact with questions about the report and/or invoice.

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FIELD ENTRY TYPE

INFORMATION

AUTHORIZATION # TEXT

Enter the authorization number from the VR Original Authorization & Billing (OOD-0020). If more than one service is included on the VR Original Authorization & Billing (OOD-0020) you can specify the Item # by using a dash between the authorization number and the item number. (SEE EXAMPLE ABOVE)

PROVIDER INVOICE # TEXT

Providers should create and enter a unique # for each invoice submitted to track payments. The number may be alpha, numeric, or a combination of alpha-numeric characters. OOD Staff will enter this # into AWARE when the invoice is processed and this reference will be included on the Remit Payment website.

INDIVIDUAL’S NAME TEXT Enter the full name, first and last, of the Individual who received the service.

DIRECT SERVICE STAFF NAME(S) TEXT

Enter the full name, first and last, and initials of the Direct Staff who provided the service. The initials will be recorded in the body of the report to document who provided services on which date.

PERSON COMPLETING REPORT(IF DIFFERENT THAN DIRECT SERVICE STAFF)

TEXTEnter the full name, first and last, of the Provider Staff completing the report, if different from the Staff who provided the direct service.

VR COUNSELOR OR VR CONTRACTOR TEXT

Enter the full name of the VR Counselor or VR Contractor assigned to manage services. The name can be located in the right-mid section of the VR Original Authorization & Billing (OOD-0020).

INVOICE DATE DATE FIELDMM/DD/YY

Enter the date that the invoice and report were sent via fax or ZixMail to the OOD electronic inbox. If there is a discrepancy between this date and the actual date received, OOD will use the date of the actual email or fax stamp for the purpose of determining if the invoice and report are submitted within the required timeframes.

INVOICE STATUS DROP DOWN

Enter “Final” or “Partial” in this field. Providers may only submit a “Partial” invoice for Summer Youth Work Experiences (SYWE) and/or the Vocational Training Stipend attached to SYWE. Providers should submit “Final” invoices for all other services and will be issued a new authorization if the service will extend beyond the current service cycle. (SEE SERVICE DELIVERY CYCLE IN OAC 3304-2-52 APPENDIX)

SERVICE START DATE DATE FIELDMM/DD/YY

Enter the date that the services actually started, e.g. if the first date of a CBA is September 3, 2017 that is the date that should be entered into the field. Not the date that the authorization was issued by OOD or received by the Provider.

SERVICE END DATE DATE FIELDMM/YY/DD

Enter the date that the services actually ended, e.g. if the last date of a CBA is September 16, 2017 that is the date that should be entered into the field. Not the date that the report was completed or the invoice/report was submitted to OOD.

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FIELD ENTRY TYPE

INFORMATION

SERVICE DESCRIPTIONS SEE SPECIFIC VR REPORT

TABLE OF CONTENTS

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CBA – OJS – JRT – WA – SYWE REPORTCOMMUNITY BASED ASSESSMENT (CBA)ON-THE-JOB SUPPORTS (OJS)JOB READINESS TRAINING (JRT) – SCHOOL & NON-SCHOOL BASEDWORK ADJUSTMENT (WA)SUMMER YOUTH WORK EXPERIENCE (SYWE)

INVOICE SECTIONSERVICE DESCRIPTION (UOS SERVICES) SERVICE TOTAL $0.00SERVICE DESCRIPTION (HALF/FULL DAY SERVICES) SERVICE TOTAL $0.00

SERVICE DESCRIPTION (WEEKLY SERVICES) SERVICE TOTAL $0.00SERVICE AREA MODIFIER (SAM) TOTAL $0.00

LESS ADJUSTMENTS ADJUSTMENTS TOTALINVOICE TOTAL

FIELD ENTRY TYPE INFORMATION

SERVICE DESCRIPTION(UOS SERVICES) DROP DOWN

Use this field for “On-Job Supports”. If the Bilingual Supplement has been approved and authorized for the case select the “Bilingual On-Job-Supports” option. This field will load the associated rates, individual and/or group, as applicable.

SERVICE DESCRIPTION(HALF/FULL DAY SERVICES) DROP DOWN

Use this field for “Community Based Assessment,” “Work Adjustment,” “Job Readiness (School Based),” or “Job Readiness (Non-School Based)”. If the Bilingual Supplement has been approved and authorized for the case select the “Bilingual CBA,” “Bilingual – Work Adjustment,” “Bilingual – JRT (School),” or “Bilingual – JRT (Non-School)” option. This field will load the associated rates, individual and/or group, as applicable.

SERVICE DESCRIPTION(WEEKLY SERVICES) DROP DOWN

Use this field for “Summer Youth Work”. If the Bilingual Supplement has been approved and authorized for the case select the “Bilingual SYWE” option. This field will load the associated rates, individual and/or group, as applicable.

SERVICE AREA MODIFIER TOTAL NON-EDITABLE Field is calculated based on information entered in the report form. Providers may not edit this field.

LESS ADJUSTMENTS DROP DOWN

Field is only used for “Summer Youth Work Experiences”. Use this field to explain the reason for a shortened week (less than 20 Hours), options include “Holiday” or “Other.’ OOD will provide more information during the annual Summer Youth trainings.

ADJUSTMENTS TOTAL TEXTEnter the total dollar amount that the service rate is being adjusted. OOD will provide more information during the annual Summer Youth trainings.

INVOICE TOTAL NON-EDITABLE Field is calculated based on information entered in the report form. Providers may not edit this field.

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SERVICE SECTION


REFERRAL QUESTIONS TEXT

Enter the questions that the VR Counselor or VR Contractor asked on the Referral to Facility. If the VR Counselor or VR Contractor did not ask specific questions, Provider should contact them to clarify the purpose for the referral and authorization. Providers must address all Referral Questions as part of the report, if Providers do not the report will be denied and returned to the Provider for correction.

BUSINESS NAME & LOCATION TEXT Enter the name and address of the business where the service was provided.

FIELD ENTRY TYPE INFORMATIONDOES THE EMPLOYER REQUIRE A MINIMUM AND/OR SPECIFIC EDUCATION OR TRAINING LEVEL? IF YES, PLEASE EXPLAIN.

TEXT

Enter any specific educational degree or training certificates that the business either requires or prefers for a successful job candidate.

DOES THE EMPLOYER REQUIRE WORK EXPERIENCE? IF YES, PLEASE EXPLAIN.

TEXTEnter any specific work experience that the business either requires or prefers for a successful job candidate.

DOES THE EMPLOYER CONDUCT A BACKGROUND CHECK AND/OR HAVE SPECIFIC LEGAL RESTRICTIONS? IF YES, PLEASE EXPLAIN.

TEXT

If the business conducts a criminal background check list any specific offenses that would preclude an applicant from being hired, e.g. theft, sexual offenses, etc.

DOES THE WORK SITE HAVE ANY ACCESSIBILITY CONCERNS? IF YES, PLEASE EXPLAIN.

TEXT

Is the business location physically accessible to meet the participants need? If not, explain which areas are not accessible and provide suggestions on potential accommodations, e.g. relocation of work areas, physical modifications to the job site, etc.

TASK

BRIEF DESCRIPTION

(LIMIT 25 CHARACTERS)

DESCRIBE THE PRIMARY TASKS, INCLUDING ANY PRODUCTIVITY AND/OR QUALITY REQUIREMENTS

TASK 1 Wash Dishes

Individual must collect dish tubs from dining stations located in the dining room and the general kitchen area. Individual must rinse off dishes and if necessary scrub food particles off of dishes. Individual must select the proper rack for the dishes, load the racks, and push them into the dishwasher opening. Once the rack is completed the Individual must open the dishwasher, remove the rack, and allow the dishes to air dry. While racks are drying Individual repeats the rinse, load, wash cycle. Individual must check chemical levels of dishwasher throughout the shift to ensure that the machine has soap. Quality standard is that dishes are clean at the end of the wash cycle or re-washed. Quantity standard is that clean dishes are always available on salad bar and stations.

TASK 2

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FIELD ENTRY TYPE INFORMATIONTASK # NON-EDITABLE This field is for reference and is not editable.

BRIEF DESCRIPTION(LIMIT 25 CHARACTERS) TEXT

Enter a brief description of the Job Task, e.g. “Wash Dishes.” Information entered into this field will be included in the Task portion of the job performance rating section.

DESCRIBE THE PRIMARY TASKS, INCLUDING ANY PRODUCTIVITY AND/OR QUALITY REQUIREMENTS

TEXTEnter an expanded description of the job tasks, including major task components and business expectations for quality and quantity of work performed.

DATE STARTTIME

ENDTIME UNITS SAM

LEVEL

HALF/FULL DAY

# OF IN

DIVIDUALS

HYGIENE/DRESS

ATTENDAN

CE

FOLLO

WS SU

PERVISION

SAFETY

INTERPERSO

NAL SKILLS

WO

RK BEHAVIORS

WO

RK TOLERAN

CE

SELF-STARTER/STAYS ON

TASK

COMMENTS

CONTACTS WITH

CONSUMER & VR STAFF

NARRATIVE IS REQUIRED FOR ANY

METRICS NOT MET ("-"),

ENCOURAGED FOR

METRICS THAT ARE MET ("+")

STAFFINITIALS

09/03/17 9:00 AM

11:00 PM 40 HALF 1 + + + - + + + + SEE BELOW EJD

09/04/17 9:00 AM

3:00 PM 60 FULL 1 - + - + + + + - SEE BELOW MEB

DATE INDICATORS

COMMENTS

CONTACTS WITH CONSUMER & VR STAFF

NARRATIVE IS REQUIRED FOR ANY METRICS NOT MET ("-"), ENCOURAGED FOR METRICS THAT ARE MET ("+")

09/03/17 SEE ABOVE

Noah was impatient and did not wait for the dishwasher cycle to completely end before trying to open the dishwasher doors. Noah burned himself on the steam and hot water dripping from the dishwasher door. Job Coach explained that if he waited 30 seconds after opening the door that he could still meet quantity expectations and allow the steam to dissipate before reaching into the machine.

09/04/17 SEE ABOVE

Noah had problems following instructions. He would watch Job Coach demonstrate task then do it his own way but that left food on the dishes. Noah had to be reminded of next tasks several times. Noah came to work in clothes that had dirt and stains on them. Job coach reminded him of the need to appear professional since he was seen by patrons when he entered the dining room to collect dishes.

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DATE DATE FIELDMM/DD/YY

Enter the date that the service took place. Date will also auto-populate the Job Task Section.(REQUIRED FIELD)

START TIME TIME FIELDAM/PM

Enter the time that the actual service started, not the scheduled start time.(REQUIRED FIELD FOR UOS & HALF/FULL DAY RATES)

END TIME TIME FIELDAM/PM

Enter the time that the actual service ended, not the scheduled end time.(REQUIRED FIELD FOR UOS & HALF/FULL DAY RATES)

UNITS NON-EDITABLE Field is calculated based on information entered in the report form. Providers may not edit this field.

SAM LEVEL DROP DOWN Enter the SAM Level if VR Counselor or VR Contractor has authorized SAM Level for the service.

HALF/FULL DAY DROP DOWN

Enter if the service is scheduled for a HALF or FULL DAY. Service time excludes unpaid meal periods, transportation, and educational sessions provided by external partners, e.g. school systems, etc.(REQUIRED FIELD FOR HALF/FULL DAY RATES)

# INDIVIDUALS DROP DOWN

Enter the number of Individuals that received the service. If an Individual service enter “1” if a Group service enter a number between “2” and “4.”

NOTE: Summer Youth Work Experience only enter the number of Individuals on the first day of the work week. Group sizes should not change during the week.(REQUIRED FIELD)

SOFT SKILLS HYGIENE/DRESS ATTENDANCE FOLLOWS SUPERVISION SAFETY INTERPERSONAL SKILLS WORK BEHAVIORS WORK TOLERANCE SELF-STARTER/STAYS ON TASK

DROP DOWN

Enter a “+” if the Individual meets the business expectations for the specific area. Enter a “-“if the Individual does not meet the business expectations for the specific area.

COMMENTS

CONTACTS WITH CONSUMER & VR STAFF

NARRATIVE IS REQUIRED FOR ANY METRICS NOT MET ("-"), ENCOURAGED FOR METRICS THAT ARE MET ("+")

TEXT

Enter an explanation of why the Individual did not meet a specific indicator, what interventions the Provider Staff used to address the issue, and outcome of interventions.

STAFF INITIALS TEXT Enter the initials of the Provider Staff who provided direct service to the Individual on the date.

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DATE

WASH DISHES

JOB TASK

JOB TASK

JOB TASK

JOB TASK

JOB TASK

JOB TASK

JOB TASK

JOB TASK

JOB TASK

NARRATIVE IS REQUIRED FOR ANY METRICS NOT MET("-"), OPTIONAL FOR METRICS THAT ARE MET ("+")

09/03/17 -

Noah had difficulty keeping up with the dishes in the tubs at various locations through the restaurant. They were often overfilled and several times servers helped bring tubs back so he could focus on washing dishes. Job Coach worked with Noah to set a pattern, e.g. three racks, check the dining room, three more racks, etc.

09/04/17 +

Noah was able to keep up with dishes and was able to collect dish tubs by himself. Job Coach congratulated him for his hard work and accomplishment.

FIELD ENTRY TYPE INFORMATIONDATE NON-EDITABLE Field is calculated based on information entered in the

report form. Providers may not edit this field.

JOB TASKS (1 – 10) NON-EDITABLE Field is calculated based on information entered in the report form. Providers may not edit this field.

NARRATIVE IS REQUIRED FOR ANY METRICS NOT MET ("-"),

OPTIONAL FOR METRICS THAT ARE MET ("+")ENCOURAGED

FOR METRICS THAT ARE MET ("+")

TEXT

Enter an explanation of why the Individual did not meet a specific indicator, what interventions the Provider Staff used to address the issue, and outcome of interventions.

FIELD ENTRY TYPE INFORMATIONPROVIDER'S COMMENTS (INCLUDES PERFORMANCE OBSERVATIONS, CONCERNS, INCIDENTS, INTERVENTION TECHNIQUES, & RECOMMENDATIONS FOR NEXT STEPS)

TEXT

Summary of the Providers assessment of the Individual to include comments on the Individual’s overall performance, specific issues and/or concerns, specific interventions used by the Job Coach, and recommendations for next steps. If Provider recommends continuation of service there should be information on what the Individual still needs to work on to be competitive with specific intervention techniques and benchmarks.

INDIVIDUAL'S COMMENTS TEXT

Summary of how the Individual feels that they performed during the service. Summary should be in the Individual’s own words; however, Provider Staff may have to ask clarifying questions. One word or simple phrases, e.g. “I did good.” are not acceptable.

EMPLOYER'S COMMENTS TEXTSummary of the Employer’s assessment of the Individual including any areas that they feel the Individual still needs to work on in order to be competitive.

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DATE SUMMER YOUTH WORK EXPERIENCE ONLYSUMMARY OF EDUCATIONAL TOPICS

06/05/17

Session included discussions on appropriate work place behavior. Participants were divided into small groups and given role playing scenarios. One Participant would enact the scenario and the other Participants would point out what was appropriate and inappropriate work place behaviors. Once the groups were done with scenarios the group gathered to discuss how Participants could have handled situations differently and turned inappropriate behaviors into appropriate ones. Noah participated in the scenarios, made comments during discussion, and was respectful of other Participants ideas.

FIELD ENTRY TYPE

INFORMATION


Enter the date that the service took place.

SUMMER YOUTH WORK EXPERIENCE ONLYSUMMARY OF EDUCATIONAL TOPICS TEXT

Enter a summary of the educational topic(s) covered that date and specific comments on Individual’s participation.

TRANSITIONAL YOUTH BENCHMARKS EXPECTATIONS

INDIVIDUAL CAN IDENTIFY SEVERAL AREAS OF Vocational INTEREST, UNDERSTANDS JOB SEEKING PROCESS, ETC. YES

INDIVIDUAL CAN MEET EMPLOYERS' EXPECTATIONS (E.G. FOLLOW RULES, BE ON TIME, MAINTAIN APPROPRIATE GROOMING/HYGIENE) YES

INDIVIDUAL IS AWARE OF HIS/HER STRENGTHS AND WEAKNESSES? YES

INDIVIDUAL HAS ABILITY TO PERFORM WORK TASKS WITH DECREASING LEVEL OF SUPPORT AND IS AT OR NEAR COMPETITIVE LEVEL, ABLE TO RETAIN INSTRUCTIONS, FOLLOW WORK PLACE RULES, AWARE OF SAFETY ISSUES, ETC.

YES

INDIVIDUAL IS ABLE TO DEMONSTRATE COMPETITIVE WORK BEHAVIORS (E.G. ACCEPTS CONSTRUCTIVE CRITICISM, RESPECTS RIGHTS OF OTHER AND PROPERTY EVEN WHEN UNSUPERVISED, IS ABLE TO COMMUNICATE NEEDS/QUESTIONS)

YES

INDIVIDUAL HAS ABILITY TO PERFORM WORK TASKS WITHOUT SUPPORT. YES

INDIVIDUAL DOES NOT HAVE SIGNIFICANT BARRIERS TO EMPLOYMENT (E.G. REFUSAL TO WORK, BEHAVIORAL ISSUES, INABILITY TO STAY ON TASKS, DISREGARD FOR SAFETY OF SELF, OTHERS, OR COMPANY PROPERTY)

YES

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INDIVIDUAL IS READY FOR COMPETITIVE & INTEGRATED EMPLOYMENT YES


EXPECTATIONSDROP DOWN Enter “Yes” if the Individual meets the specific

benchmark. Enter “No “if the Individual does not meet the specific benchmark.

TABLE OF CONTENTS

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JOB DEVELOPMENT – MONTHLY TRACKINGSITE DEVELOPMENT (SD)JOB DEVELOPMENT – UOS (JD-UOS)PERFORMANCE BASED JOB DEVELOPMENT (PBJD)SUPPORTED EMPLOYMENT JOB DEVELOPMENT (SEJD)

SPECIAL INSTRUCTIONSIf there is no billable service/outcome for the report, Providers should leave the “SERVICE DESCRIPTION” area blank. Providers should still indicate in the report if the Service Area Modifier (SAM) was authorized. This would apply in situations where the Provider is submitting a monthly report for Performance Based Job Development or Supported Employment Job Development in which an outcome was not billed but that there was an associated SAM rate. In cases where there is a billable outcome for Performance Based Job Development or Supported Employment Job Development then the Provider should select the appropriate “SERVICE DESCRIPTION” and attach either the Placement Plan or Job Placement – Verification Form.

INVOICE SECTIONSERVICE DESCRIPTION SERVICE TOTAL $0.00

SERVICE MODIFIER (SAM) TOTAL $0.00INVOICE TOTAL $0.00

FIELD ENTRY TYPE INFORMATIONSERVICE DESCRIPTION DROP DOWN Select the service from the drop down menu.

Site Development Job Development UOS Bilingual - Site Development Bilingual – Job Development UOS

Job Development - Tier I Job Development - Tier II Job Development - Tier III Job Development - Tier III Rapid Job Development - Tier III SGA Job Development - Tier III Rapid + SGA Job Development - Subsequent Placement Supported Employment - Tier I Supported Employment - Tier II Supported Employment - Tier III Supported Employment - Tier III Rapid Supported Employment - Tier III SGA Supported Employment - Tier III Rapid + SGA Supported Employment - Subsequent Placement Bilingual Job Development - Tier I Bilingual Job Development - Tier II Bilingual Job Development - Tier III

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FIELD ENTRY TYPE INFORMATION Bilingual Job Development - Tier III Rapid Bilingual Job Development - Tier III SGA Bilingual Job Development - Tier III Rapid + SGA Bilingual Job Development - Subsequent Placement Bilingual Supported Employment - Tier I Bilingual Supported Employment - Tier II Bilingual Supported Employment - Tier III Bilingual Supported Employment - Tier III Rapid Bilingual Supported Employment - Tier III SGA Bilingual Supported Employment - Tier III Rapid + SGA Bilingual Supported Employment - Subsequent Placement

SERVICE TOTAL NON-EDITABLE Field is calculated based on information entered in the report form. Providers may not edit this field.

SAM TOTAL NON-EDITABLE Field is calculated based on information entered in the report form. Providers may not edit this field.


EMPLOYMENT GOAL Dishwasher# OF MONTHS IN JOB DEVELOPMENT

2

# OF EMPLOYER CONTACTS JOB DEVELOPER MADE

2

# OF EMPLOYER CONTACTS JOB SEEKER MADE

1

# OF APPLICATIONSSUBMITTED TO EMPLOYERS 2

# OF INTERVIEWS 1

JOB SEEKER'S INPUTON JOB SEARCH

Noah indicated that he is satisfied with the progress of his job search. He indicated that he and his Job Developer meet regularly to discuss job leads and complete applications. Noah hopes to have a job within the next month.

POTENTIAL ISSUES/CONCERNSWITH PROGRESS

Noah indicated that he is having trouble with his car and is not sure that he can get to and from work. He indicated that he does not have the money to get it fixed right now until he starts working. Recommended Noah call his Counselor to discuss his transportation issue.

PLAN/GOALS FOR NEXTMONTH'S JOB SEARCH

Noah has identified five businesses (three restaurants, one nursing home, and one school) within walking distance of his home that he would like to apply too. Job Developer will contact businesses and collect applications. Noah and Job Developer will fill out applications together and Noah will deliver them to the businesses. Job Developer will follow up with businesses after Noah has dropped off applications.

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FIELD ENTRY TYPE INFORMATIONEMPLOYMENT GOAL TEXT Enter the employment goal as identified on the Referral to

Facility/Individualized Plan for Employment (IPE)# OF MONTHS IN JOB DEVELOPMENT TEXT Enter the number of months that Job Developer has searched

for jobs for the Individual.# OF EMPLOYER CONTACTS

JOB DEVELOPER MADETEXT

Enter the number of contacts that the Job Developer made with businesses during the month, including new and follow up contacts.

# OF EMPLOYER CONTACTS

JOB SEEKER MADETEXT

Enter the number of contacts that the Individual made with businesses during the month, including new and follow up contacts.

# OF APPLICATIONSSUBMITTED TO EMPLOYERS

NON-EDITABLEField is calculated based on information entered into the report form. Providers may not edit this field.

# OF INTERVIEWS NON-EDITABLE Field is calculated based on information entered into the report form. Providers may not edit this field.

JOB SEEKER'S INPUTON JOB SEARCH TEXT

Summary of how the Individual feels that their job search is progressing. Summary should be in the Individual’s own words; however, Provider Staff may have to ask clarifying questions. One word or simple phrases, e.g. “It’s going fine.” are not acceptable.

POTENTIAL ISSUES/CONCERNS WITH PROGRESS

TEXTEnter any potential barriers or issues that the VR Counselor or VR Contractor should be aware of that might impact the Individual’s ability to successfully participate in their job search.

PLAN/GOALS FOR NEXTMONTH'S JOB SEARCH TEXT

Enter the plan for the next month including tasks such as potential employers to contact within the next month, any planned follow up with specific employers, “homework” assignments, etc. Goals should be objective and measurable. Provider should also include any changes to the Placement Plan in this section.

EXAMPLE: JOB DEVELOPMENT – UNITS OF SERVICE OR SITE DEVELOPMENT

DATE START TIME END TIME UNITS SAM

LEVEL

LOCATION OF

CONTACT OR

BUSINESS NAME

(INCLUDE STREET AND

CITY FOR BUSINESSES

)

COMMENTS

(E.G. POSITION

TITLE, SALARY, HOURS,

BENEFITS, ETC.)

CONTACTTYPE

JOB SEEKER

PRESENTY/N

OUTCOME

STAFFINITIALS

10/01/17 9:00 AM 10:00 AM 10 SEE BELOW SEE BELOW TELEPHONE N EJD

0 SEE BELOW SEE BELOW TELEPHONE N EJD


10/02/17 9:00 AM 10:00 AM 10 SEE BELOW SEE BELOW Y MEB

20

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EXAMPLE: JOB DEVELOPMENT – PERFORMANCE BASED OR SUPPORTED EMPLOYMENT

DATE START TIME END TIME UNITS SAM

LEVEL

LOCATION OF

CONTACT OR

BUSINESS NAME

(INCLUDE STREET AND

CITY FOR BUSINESSES

)

COMMENTS

(E.G. POSITION

TITLE, SALARY,HOURS,

BENEFITS, ETC.)

CONTACTTYPE

JOB SEEKER

PRESENTY/N

OUTCOME

STAFFINITIALS

10/01/17 0 SEE BELOW SEE BELOW TELEPHONE N EJD



10/02/17 0 SEE BELOW SEE BELOW Y MEB

0

EXAMPLE: LOCATION & COMMENTS SECTION

DATE

LOCATION OF CONTACT ORBUSINESS NAME

(INCLUDE STREET AND CITY FOR BUSINESSES )

COMMENTS (E.G. POSITION TITLE, SALARY,

HOURS, BENEFITS, ETC.)OUTCOME

10/01/17 XYZ ProductionsMain Street, Columbus, OH

Application/Resume

ABC ServiceHigh Street, Columbus, OH Not Hiring

Middle ManagementBroad Street, Columbus, OH

Manager; Pay: $20.00/Hour; 40 Hours Week; Medical; No Vacation; Requires Bachelor’s Degree + 1 Year Supervisory Experience; No heavy lifting; Must be able to deal with difficult people

Hiring/Application

10/02/17Fast Track ServicesMain Street, Delaware, OH Not Hiring

FIELD ENTRY TYPE INFORMATIONDATE DATE

MM/DD/YYEnter the date that the service took place.(REQUIRED FIELD)


Enter the time that the actual service started, not the scheduled start time.(REQUIRED FIELD FOR JD-UOS & SITE DEVELOPMENT ONLY)


Enter the time that the actual service ended, not the scheduled end time.(REQUIRED FIELD FOR JD-UOS & SITE DEVELOPMENT ONLY)

UNITS NON-EDITABLE Field is calculated based on information entered into the report form. Providers may not edit this field.

SAM LEVEL DROP DOWN Enter the SAM Level if VR Counselor or VR Contractor has authorized SAM Level for the service.

LOCATION OF CONTACT OR NON-EDITABLE Enter the location of the contact with the Job Seeker or the

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FIELD ENTRY TYPE INFORMATIONBUSINESS NAME(INCLUDE STREET AND CITY FOR BUSINESSES )

name, street name, and city of the Business that was associated with the contact. Providers should list the Business contact information even if the contact was not made in person.

COMMENTS (E.G. POSITION TITLE, SALARY, HOURS, BENEFITS, ETC.)

TEXT

Enter information about possible job openings. Provider should list specific information that would assist in determining if the job opening is a suitable match for the Job Seeker as defined in their IPE.

CONTACT TYPE DROP DOWN

Enter the method of contact with the Business or Job Seeker, options include: Email Face/Face Internet Telephone Text Other

JOB SEEKER PRESENT (Y/N) DROP DOWN Enter “Yes” if the Job Seeker was present during the contact, if not enter “No.”

OUTCOME DROP DOWN

Enter the outcome of the contact, options include: Application/Interview

Application/Resume Follow-Up Hiring/Application In-Person App Interview Job Seeker Meeting Not Hiring Not Hiring/Interview Online - App Online - Search OMJ - Lead Placement Plan Review Staffing Other(SEE BELOW FOR DEFINITIONS)

STAFF INITIALS TEXT

OUTCOME DEFINITIONS

Application/Interview Provider or Job Seeker submitted an application and had an interview on the same date.

Application/ResumeProvider or Job Seeker submitted a paper application/resume to a Business in consideration of a potential future job opening. Job opening need not be currently open.

Follow-UpProvider or Job Seeker are following up with a Business in which an application/resume/interview was previously completed or Business indicated a future job opening.

Hiring/Application Business is hiring and Job Seeker had an interview on the same date.

In-Person App Job Developer or Job Seeker completed an application as part of

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OUTCOME DEFINITIONSthe contact.

Interview Job Seeker had an interview with a Business on this date.

Job Seeker Meeting Job Developer and Job Seeker meeting to discuss services and make plans for future job search.

Not Hiring Business is not hiring and does not plan to within the next three (3) months.

Not Hiring/Interview Job Seeker had an interview but was not hired.

Online - AppJob Developer or Job Seeker completed an online job application. Report should include the specific name of the Business where the Job Seeker applied.

Online - SearchJob Developer or Job Seeker completed an online job search. Report should list specific Businesses identified as part of the search.

OMJ - Lead Use this option if a job lead was the result of an Ohio Means Job match.

Placement Plan Review

Use this option to document the review and changes to the Placement Plan. Specific changes to the Placement Plan should be documented in the “PLAN/GOALS FOR NEXT MONTH'S JOB SEARCH” section.

Staffing Use this option for a meeting with the Job Developer, Job Seeker, and/or VR Staff/VR Contractor.

Other

Use this option for any type of outcome that does not fall within the scope of any of the other options. Job Developer should provide an explanation of the contact in the “COMMENTS” section.

TABLE OF CONTENTS

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JOB DEVELOPMENT – JOB DEVELOPMENT PLAN

SPECIAL INSTRUCTIONSProviders should attach the Job Development Plan to the Job Development Monthly Tracking Report. Providers should select the appropriate “SERVICE DESCRIPTION” in the invoice section of the Monthly Tracking Report, e.g. Job Development – UOS or Job Development – Tier I to bill for the service.

Providers must supply an editable copy of the Job Seeker’s resume or mock application to the VR Staff or VR Contractor for approval prior to the documents being provided to Businesses or the Job Seeker. Providers may email (using Zixmail) the resume and/or mock application directly to VR Staff and/or VR Contractor. VR Staff and/or VR Contractors will have five (5) business days to review the resume/mock application and provide feedback to the Provider. Provider must include an electronic copy of the approved resume or mock application with the proper report and invoice

Sample Job Development Plan will be included in the VR Forms folder available in the Provider Section of OOD’s website (www.ood.ohio.gov).

GENERAL INFORMATIONFIELD ENTRY

TYPEINFORMATION

PROVIDER NAME TEXTEnter the name of the Provider, as it appears on VR Original Authorization & Billing (OOD-0020).

JOB DEVELOPER(S) NAME(S) TEXT Enter the full name, first and last, and initials of the Direct Staff who provided the service.

JOB SEEKER NAME TEXT Enter the full name, first and last, of the Individual who received the service.

COUNSELOR/CONTRACTOR NAME TEXT


EMPLOYMENT NEEDSFIELD ENTRY

TYPEINFORMATION

EMPLOYMENT GOAL TEXT Enter the Employment Goal as identified on the Referral to Facility. Providers may not pursue job leads outside the Employment Goal area unless the VR Staff and/or VR Contractor amend the IPE and provide a written

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FIELD ENTRY TYPE

INFORMATION

notification to the Provider.

WAGE GOAL TEXT

Enter the specific wages that the Job Seeker has indicated as a requirement for a successful placement. Providers may not pursue job leads that are below this wage threshold.

HOURS GOAL TEXT

Enter the specific number of hours that the Job Seeker has indicated as a requirement for a successful placement. Providers may not pursue job leads that are below this number of hours.

BENEFITS (E.G. MEDICAL INSURANCE, ETC.) TEXT Enter preferred benefits that the Job Seeker

would like to obtain, e.g. medical, dental, etc.

JOB SEEKER’S PREFERRED EMPLOYERS TEXT

Enter the names of any specific Businesses that the Job Seeker would like to apply to as part of the job search.

POTENTIAL VOCATIONAL BARRIERSFIELD ENTRY

TYPEINFORMATION

TRANSPORTATION ARRANGEMENTS TEXT

Enter a summary of the Job Seekers plan on how they will get to and from work. Providers should get specific names and verify that the Job Seeker has talked to the Individual and that they have agreed.

CHILD/ELDER CARE ARRANGEMENTS TEXT

Enter a summary of the Job Seeker’s plan on who will provide child/elder care. Providers should get specific names and verify that the Job Seeker has talked to the Individual and that they have agreed. Enter “NA” if non-applicable.

CRIMINAL HISTORY TEXT

Enter a list and date of any criminal convictions. Providers should compare this against information received on the Referral to Facility. If the information does not match, the Provider should notify VR Staff or VR Contractor.

SUBSTANCE USE HISTORY TEXT Enter a summary of any substance use history including date of last use. Providers should compare this against information received on the Referral to Facility. If the information does not match, the Provider should notify VR Staff

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FIELD ENTRY TYPE

INFORMATION

or VR Contractor.

OTHER CONCERNS TEXTEnter any other concerns that the Job Developer identifies during the development of the Job Development Plan.

CONTACT & MEETING PREFERENCESFIELD ENTRY

TYPEINFORMATION

PREFERRED METHOD(S) OF CONTACT

TEXT

Enter the preferred method of how the Job Seeker wants to communicate with the Job Developer. (NOTE: Text is only an option to accommodate a disability related need, e.g. hearing or speech impairment, and must be pre-approved by VR Staff or VR Contractor.)

PREFERRED MEETING LOCATION(S) TEXT Enter the preferred location for meetings

between the Job Seeker and Job Developer.MEETING FREQUENCY(TIMES PER MONTH)

TEXT

Enter the preferred meeting frequency for contacts between the Job Seeker and Job Developer. (NOTE: Minimum contact as defined in the VR Fee Schedule is at least once per month.)

MEMBERS OF TEAM(IF SUPPORTED EMPLOYMENT)

TEXT

Enter the names of Individuals and/or Organizations that the Job Seeker wants involved as part of their Placement Team for Supported Employment. Team Members are optional, but not required for non-Supported Employment cases.

OTHER CONCERNSTEXT

Enter any other concerns that the Job Developer identifies during the development of the Job Development Plan.

JOB SEEKING SKILLS TRAININGFIELD ENTRY

TYPEINFORMATION

OMJ REGISTRATION VERIFICATION (DATE) TEXT Enter the date that the Job Seeker completed

their registration with Ohio Means Jobs.RESUME/MOCK APPLICATION REVIEWED WITH JOB SEEKER (DATE) TEXT

Enter the date that the resume or mock application was reviewed with the Job Seeker. (NOTE: Provider may not give a copy to the Job Seeker until it has been reviewed and approved by VR Staff or VR Contractor.)

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FIELD ENTRY TYPE

INFORMATION

RESUME/MOCK APPLICATION APPROVED BY VR COUNSELOR/CONTRACTOR (DATE) TEXT

Enter the date that the resume or mock application was approved by VR Staff and/or VR Contractor. (NOTE: If Provider does not receive a response within five business days of submitting it to VR Staff or VR Contractor it will be considered approved.)

JOB SEEKER SELF-ASSESSMENT OF INTERVIEWING SKILLS TEXT

Enter a summary of the Job Seekers self-assessment of their interviewing skills prior to the delivery of Job Seeking Skills Training.

SUMMARY OF JOB SEEKING SKILLS TRAINING (INCLUDING HOW TO ADDRESS SPECIFIC BARRIERS E.G. CRIMINAL HISTORY, GAPS IN EMPLOYMENT, REASONABLE ACCOMMODATION, ETC.)

TEXT

Enter a summary of the topics covered as part of the Job Seeking Skills Training. Providers should include a summary of instructional techniques, an evaluation of the Job Seeker’s progress, potential concerns/barriers, and recommendations.

SUMMARY OF INSTRUCTION ON HOW TO IDENTIFY POTENTIAL JOB LEADS (E.G. NETWORKING, NEWSPAPERS, ELECTRONIC JOB BOARDS, TELEPHONE BOOKS, ETC.)

TEXT

Enter a summary of the instruction on how the Job Seeker was taught to identify potential job leads. Providers should include a summary of instructional techniques and evaluation of Job Seeker’s progress.

SOCIAL MEDIA DISCUSSION(SUMMARY & DATE) TEXT

Enter the date of the discussion of how social media can impact the job search and discussion on how Job Seekers can reduce any potential adverse impact.

MOCK INTERVIEW(SUMMARY & DATE)

TEXT

Enter the date of and summary of the Job Seeker’s performance during their mock interview. The mock interview should take place after the Job Seeker has received their Job Seeking Skills Training.

RESPONSIBILITIESFIELD ENTRY

TYPEINFORMATION

JOB DEVELOPER RESPONSIBILITIES

TEXTEnter a summary of the Job Developer’s responsibilities during the job search to make sure that services progress.

JOB SEEKER RESPONSIBILITIES (E.G. JOB SEEKER WILL IDENTIFY THREE POTENTIAL EMPLOYERS PER WEEK, ETC.)

TEXT Enter a summary of the Job Seeker’s responsibilities, including any “homework assignments” during the job search to make

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FIELD ENTRY TYPE

INFORMATION

sure that services progress.SIGNATURES

FILL IN

Signatures must be original signatures, e.g. “wet ink” or image captured through a signature pad. Signatures may not be stored for future use.

TABLE OF CONTENTS

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JOB DEVELOPMENT – EMPLOYMENT VERIFICATIONSPECIAL INSTRUCTIONSProviders should attach the Job Development – Employment Verification Report to the Job Development Monthly Tracking Report. Providers should select the appropriate “SERVICE DESCRIPTION” in the invoice section of the Monthly Tracking Report, e.g. Job Development – UOS/Job Development – Tier I or with the final On-The-Job-Supports/Job Development – Tier III, to bill for the service.

Tier II Employment Verifications shall be signed by the Individual and Parent/Legal Guardian, if applicable. Tier III shall be signed by either the Individual and/ their Parent/Legal Guardian, if applicable, or Provider Staff person. Tier III verification must be completed between day 83 and day 90 after the successful placement. Successful placement is determined by VR Staff or VR Contractor after the Individual no longer needs supports to learn job tasks or adjust to the work environment or in the case of Supported Employment, as determined by VR Staff or VR Contractor that the Individual has reached their minimum level of ongoing supports.

EXAMPLE: EMPLOYMENT VERIFICATION

VR COUNSELOR’S OR VR CONTRACTOR’S NAME: Samuel Adams

EMPLOYMENT VERIFICATION

COMPANY NAME: Middle Management

COMPANY ADDRESS: 1 Broad Street

CITY: Columbus STATE: OH ZIP CODE: 12345 PHONE NUMBER: 614.438.1200

SUPERVISOR’S NAME: George Washington

FIRST DAY OF WORK (DATE): 10/15/17 JOB TITLE: Manager

JOB DUTIES: Supervises direct service workers in the delivery of customer service activities. Handles difficult customers. Provides technical assistance and guidance to direct service workers. Ensures that company policies are followed by direct service employees.

NUMBER OF HOURS WORKED PER WEEK: 40 WAGES (DOLLAR AMOUNT): $20.00

WAGE FREQUENCY: Weekly DATE OF FIRST PAYCHECK: 11/10/17

EMPLOYER PROVIDED MEDICAL INSURANCE AVAILABLE? YES NO

DATE OF FINAL EMPLOYMENT VERIFICATION (MUST BE BETWEEN DAY 83 AND DAY 90 AFTER JOB STABILIZATION AS DETERMINED BY THE VR COUNSELOR OR VR CONTRACTOR): 01/12/18

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SOURCE OF MEDICAL INSURANCE AT TIME OF FINAL EMPLOYMENT VERIFICATION: Employer Medical Insurance

COMMENTS: Noah has been on the job for several months now. Has adjusted to the environment. States he likes his Co-Workers but that his Supervisor is sometimes difficult to get along with. No significant issues. Noah is looking forward to advancing his career at the company.

To Bill for Placement: This form shall be signed by the Individual and their Parent/Legal Guardian, if applicable.

To Bill for Final On-The-Job Supports (OJS) or Tier III: This form shall be signed by either the Individual and their Parent/Legal Guardian, if applicable, or the Provider after the date of the final employment verification.

______Noah Blake______________________________ Date: ____11/08/17_______Individual’s Signature

__________________________________________________ Date: ________________Parent/Legal Guardian’s Signature (If applicable)

_________________________________________________ Date: ________________Provider Staff’s Signature

Provider’s Name: Placements ‘R US

GENERAL INFORMATIONFIELD ENTRY

TYPEINFORMATION

COUNSELOR/CONTRACTOR NAME TEXT


EMPLOYMENT VERIFICATIONFIELD ENTRY TYPE INFORMATION

COMPANY NAME TEXT Enter the full name of the Business that hired the Individual.

COMPANY ADDRESS TEXT

Enter the full street address of the Business that hired the Individual. This should be the location where the Individual works and not a corporate headquarters.

CITY TEXTEnter the city of the Business that hired the Individual. This should be the location where the Individual works and not a corporate headquarters.

STATE TEXT Enter the state of the Business that hired the Individual. This should be the location where the

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FIELD ENTRY TYPE INFORMATIONIndividual works and not a corporate headquarters.

ZIP CODE TEXTEnter the zip code of the Business that hired the Individual. This should be the location where the Individual works and not a corporate headquarters.

PHONE NUMBER TEXT

Enter the telephone number of the Business that hired the Individual. This should be the location where the Individual works and not a corporate headquarters.

SUPERVISOR’S NAME TEXTEnter the name of the Individual’s direct supervisor who will be responsible for oversight and evaluation of job performance.

FIRST DATE OF WORK TEXT

Enter the first date of work where the Individual will be on the Businesses payroll. This does not include any dates scheduled prior to the first date of work to complete background checks, set a schedule, etc.

JOB TITLE TEXT

Enter the job title for the position. It is possible that the job title may change between the time of placement and final check. Enter the name of the current job title at the time of the specific report.

JOB DUTIES TEXT

Enter the specific job duties for the position. It is possible that the job duties may change between the time of placement and final check. Enter the current job duties at the time of the specific report.

NUMBER HOURS WORKED TEXT

Enter the specific job duties for the position. It is possible that the job duties may change between the time of placement and final check. Enter the current job duties at the time of the specific report.

WAGES DOLLAR AMOUNT TEXT

Enter the amount of wages paid to the Individual. It is possible that the wage amount may change between the time of placement and final check. Enter the current wage amount at the time of the specific report.

WAGES FREQUENCY DROP DOWN

Enter the schedule or frequency of the Individual’s pay check.

Hourly Weekly Bi-Weekly Monthly Quarterly Annually

DATE OF FIRST PAYCHECK DATE Enter the date that the Individual received their first pay check.

EMPLOYER PROVIDED MEDICAL INSURANCE AVAILABLE? CHECK BOX

Check “YES” if the Employer makes Medical Insurance available, regardless of whether the Individual opts to accept the insurance or not. If no Employer provided health insurance is available, check “NO.”

DATE OF FINAL EMPLOYMENT VERIFICATION

DATE Enter the date of the final contact for the purpose of employment verification. Date must occur between

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FIELD ENTRY TYPE INFORMATIONday 83 and day 90 of successful employment. Start date of successful employment shall be determined by VR Staff or VR Contractor.

SOURCE OF MEDICAL INSURANCE AT TIME OF FINAL EMPLOYMENT VERIFICATION

DROP DOWN

Enter the source of the Individual’s medical insurance at the time of the final employment verification.

None Information Not Available Not Yet Eligible For Employer

Medical Employer Medical Insurance Medicaid Medicare State/Federal Affordable Care Act Other Public Insurance Other Private Insurance

COMMENTS TEXTEnter any information that was provided by the Individual that may be important for VR Staff or VR Contractor to be aware of.

SIGNATURES FILL INSignatures must be original signatures, e.g. “wet ink” or image captured through a signature pad. Signatures may not be stored for future use.

TABLE OF CONTENTS

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JOB SEEKING SKILLS TRAININGSPECIAL INSTRUCTIONSProviders must supply an editable copy of the Job Seeker’s resume or mock application to the VR Staff or VR Contractor for approval prior to the documents being provided to Businesses or the Job Seeker. Providers may email the resume and/or mock application directly to VR Staff and/or VR Contractor. VR Staff and/or VR Contractors will have five (5) business days to review the resume/mock application and provide feedback to the Provider.

INVOICE SECTIONSERVICE DESCRIPTION SERVICE TOTAL $0.00SERVICE MODIFIER (SAM) TOTAL $0.00INVOICE TOTAL $0.00


SERVICE DESCRIPTION

DROP DOWN

Select the service from the drop down menu. Job Seeking Skills Training Bilingual JSST

SERVICE TOTALNON-EDITABLE

Field is calculated based on information entered in the report form. Providers may not edit this field.

SAM TOTALNON-EDITABLE


INVOICE TOTALNON-EDITABLE




Enter the questions that the VR Counselor or VR Contractor asked on the Referral to Facility. If they VR Counselor or VR Contractor did not ask specific questions, Provider should contact them to clarify the purpose for the referral and authorization. Providers must address all Referral Questions as part of the report, if Providers do not the report will be denied and returned to the Provider for correction.

SERVICE PLAN(Include teaching techniques, frequency and location of meetings, homework assignments, etc.)

TEXT

Enter a brief description of how the service will be provided, e.g. instruction techniques, location and frequency of meetings, homework assignments, benchmarks for progress, tools for measurement, etc.

TASK BRIEF DESCRIPTION DATECOMPLETED INDIVIDUAL'S SELF-EVALUATION OF PERFORMANCE

1 How to complete job applications 10/02/17

Individual completed a sample job application. He indicated that he felt comfortable with answering

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questions and had a sheet with employment dates, employer’s addresses, etc. to help him complete the application. He indicated that he did have a question about a specific area of the application. Job Coach reviewed it with him and helped him formulate an acceptable response.

2 How to locate job openings

3 How to write a resume and cover letter

4 How to dress and appearance for interviews

5

How to interview for a job (e.g. 1:1, panel, telephone interview; how to address employment gals, reasonable accommodations, legal histories, etc.)

6How to follow up after an interview (e.g. thank you notes, follow up calls, etc.)

7 Mock Interview

8Impact of and how to manage social media and on-line profiles

9 Ohio Means Jobs Registration 10/02/17

Individual has his login name/password. He demonstrated how to log into OMJ. He was able to navigate independently to the job leads area.

10 Other



Enter the date that the Individual mastered the Task and could complete it independently, or with the minimum level of support required.

INDIVIDUAL'S SELF-EVALUATION OF PERFORMANCE

TEXT

Enter the Individual’s self-evaluation of how they feel that they are doing in the specific area, including their comfort level in performing the task on their own. Self-evaluation should be in the Individual’s own words; however, Provider Staff may have to ask clarifying questions. One word or simple phrases, e.g. “I did well.” are not acceptable.

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DATE STARTTIME

ENDTIME UNITS SAM

Level

# OF IN

DIVIDUALS

TASK TYPE OFCONTACT CONTACTS & ACTIVITY REPORT STAFF

INITIALS

10/02/17 9:00 10:00 10 1 9 Face/Face

Job Developer and Individual registered with Ohio Means Jobs. Individual will come back on 10/05 for a mock interview with Job Coaches Supervisor.

MEB

10/05/17 1:00 2:00 10 1 5, 7 Face/Face

Job Coach met with Individual to review interview skills. Individual participated in a mock interview with Job Coaches Supervisor. Job Coach reviewed the results with Individual. He did well with questions. Needed to take some time before answering to make answer was complete. He asked questions of Interviewer.

MEBEJD

FIELD ENTRY TYPE INFORMATIONDATE DATE FIELD



Enter the time that the actual service started, not the scheduled start time.(REQUIRED FIELD)


Enter the time that the actual service ended, not the scheduled end time.(REQUIRED FIELD)


SAM LEVEL DROP DOWN Enter the SAM Level if VR Counselor or VR Contractor has pre-authorized SAM Level for the service.


Enter the number of Individuals that received the service. If an Individual service enter “1” if a Group service enter a number between “2” and “4.” (REQUIRED FIELD)

TASK TEXT

Enter the number of the Task, as defined in previous table, associated with the purpose of the meeting, e.g. Ohio Means Jobs registration. If multiple Tasks are worked on during the meeting enter the number of all Tasks separated by commas.

CONTACT TYPE DROP DOWN Enter the method of contact, options include: Email Face/Face Internet Telephone

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FIELD ENTRY TYPE INFORMATION Text Other

CONTACTS & ACTIVITY REPORT TEXT

Enter a brief description of the contact. Information should include who was present, what was reviewed, any homework assignments, date/time of next meeting, etc.


IS INDIVIDUAL JOB SEARCH READY?IF NO, EXPLAIN

Individual is job search ready. He is able to answer interview questions, he has an approved editable resume and was shown how to make changes to highlight areas for specific job leads, he has a good understanding of where to find potential job leads and how to network, etc.

SUMMARY & RECOMMENDATIONS

Individual is ready to move on to his/her self-directed job search. If job search lasts more than a couple months, it is recommended that additional JSST be authorized to review concepts and possibly help Individual identify additional sources of job leads.


IS INDIVIDUAL JOB SEARCH READY? IF NO, EXPLAIN

TEXT

Enter “YES” and summarize how Individual is “Job Search Ready.’ Enter “NO” if the Individual is not “Job Search Ready” and needs additional supports or is recommended for Job Development instead of an independent job search. Be specific as to what barriers exist and provide a recommendation on how to eliminate and/or mitigate potential barriers.

SUMMARY & RECOMMENDATIONS

TEXT

Enter a summary of the Individual’s progress during the month and recommendations for additional or next services. Be specific, e.g. recommend 50 more UOS of JSST to work on improving responses to interview questions.

TABLE OF CONTENTS

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CAREER EXPLORATIONSUMMER YOUTH CAREER EXPLORATION

INVOICE SECTIONSERVICE DESCRIPTION (UOS SERVICES) SERVICE TOTAL $0.00SERVICE DESCRIPTION (WEEKLY SERVICES) SERVICE TOTAL $0.00

SERVICE AREA MODIFIER (SAM) TOTAL $0.00INVOICE TOTAL



Use this field for “Career Exploration”. If the Bilingual Supplement has been approved and authorized for the case select the “Bilingual Career Exploration” option. This field will load the associated rates, individual and/or group, as applicable.

SERVICE DESCRIPTION(WEEKLY SERVICES) DROP DOWN

Use this field for “Summer Youth Career Exploration”. If the Bilingual Supplement has been approved and authorized for the case select the “Bilingual Summer Youth Career Exploration” option. This field will load the associated rate, individual and/or group, as applicable.



STILL IN HIGH SCHOOL? IF YES, NAME OF SCHOOL.

Four County Joint Vocational School/Central Local (Fairview High School)

SERVICE IN AN INTEGRATED SETTING, IF NO, EXPLAIN.

YES

REFERRAL QUESTIONS

1) Identify three potential career fields based on interest.

2) Help Individual contact at least two people in each career field and conduct an informational interview that collects data on job duties, education levels, wages, hours, any special qualifications, etc.

3) Help Individual conduct one job shadowing experience in the field that they select based on the informational interview.

PROVIDERS RESPONSE TO REFERRAL QUESTIONS

1) Career fields identify: agriculture (animal farming), machine operation (plastics), and law enforcement (police or corrections.)

2) Completed two informational interviews this month: Arps Dairy and Plastics.

3) Site visit to Arps Dairy and observed operation of pasteurizing machines, milking

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machines, feeding animals, and maintaining a clean living area for animals (manure removal).


STILL IN HIGH SCHOOL? IF YES, NAME OF SCHOOL. TEXT

If the Individual is still in high school list the name of the school that they are attending, if they are attending a vocational school include the name of the vocational school and the home school. (This is to address Pre-Employment Transition Services.)

SERVICE IN AN INTEGRATED SETTING, IF NO, EXPLAIN. TEXT

Enter “YES” if the services take place in an integrated setting. Enter “No” if services are not in an integrated location and explain why integrated services are not a viable option. Reasons for non-integrated services should be disability related and not due to the lack of external factors such as lack of facilities, transportation, etc.


Enter the questions that the VR Counselor or VR Contractor asked on the Referral to Facility. If they VR Counselor or VR Contractor did not ask specific questions, Provider should contact them to clarify the purpose for the referral and authorization.

PROVIDERS RESPONSE TO REFERRAL QUESTIONS TEXT

Providers must address all Referral Questions as part of the report, if Providers do not the report will be denied and returned to the Provider for correction.

DATE

STAR

T TI

ME

END

TIM

E

UNITS

SAM

Y/N

# In

divi

dual

s

BUSINESS/JOBS

EXPLORED

CONTACTTYPE

LABOR MARKET DATA (INCLUDES:

JUSTIFICATION/EXPLANATION OF

SUITABLE JOB MATCH, STRENGTHS, BARRIERS, ACCOMMODATIONS)

INDIVIDUALS COMMENTS (INCLUDES: WHAT DID

THEY LEARN? WHAT DID THEY LIKE/DISLIKE? CAN

THEY SEE THEMSELVES IN THIS FIELD? DO THEY THINK

THEY CAN SUPPORT THEMSELVES ON THE

WAGE/HOURS? STAFFING/CONTACTS?

PERSONAL PREFERENCES?, ETC.)

INITIALS

06/12/17 9:00 10:00 10 4 Dairy Farmer Face/Face

Defiance County is a rural/agricultural community. There are numerous livestock farms in the area (cattle, chicken, turkey, pork, etc. Noah is physically capable of job duties and there are no accessibility issues. Job appears to be a suitable job match based on interest and availability of positions within the community.

I liked being outside, being around the animals, did not like the smell but could get used to it. I liked getting to feed the animals and lead them in and out of the barn. They pay is $15.00 Hour/40 + Hours per Week. I could support myself. Drawback is no medical insurance.

MEB



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Enter the number of Individuals that received the service. If an Individual service enter “1” if a Group service enter a number between “2” and “4.”

NOTE: Summer Youth Career Exploration only enter the number of Individuals on the first day of the work week. Group sizes should not change during the week.(REQUIRED FIELD)

BUSINESS/JOBS EXPLORED TEXTEnter the name of the Businesses, career field, and specific businesses contacted as part of the monthly exploration activities.

CONTACT TYPE DROP DOWN

Enter the method of contact, options include: Email Face/Face Internet Telephone Text Other

LABOR MARKET DATA (INCLUDES: JUSTIFICATION/EXPLANATION OF SUITABLE JOB MATCH, STRENGTHS, BARRIERS, ACCOMMODATIONS) TEXT

Enter a summary of the labor market information for the Individual’s location and/or explanation of where the Individual would need to go in order to secure employment. Labor market information should also explain why the job match is suitable based on the Individuals strengths, potential barriers, and/or need for potential accommodations.

INDIVIDUALS COMMENTS (INCLUDES: WHAT DID THEY LEARN? WHAT DID THEY LIKE/DISLIKE? CAN THEY SEE THEMSELVES IN THIS FIELD? DO THEY THINK THEY CAN SUPPORT THEMSELVES ON THE WAGE/HOURS? STAFFING/CONTACTS? PERSONAL PREFERENCES? ETC.)

TEXT

Enter a summary of the Individual’s thoughts about the job/work environment, wages, hours, required education/experience, and whether they feel that it would be a good job match for them. Summary should be in the Individual’s own words; however, Provider Staff may have to ask clarifying questions. One word or simple phrases, e.g. “I liked it.” are not acceptable.

INTIALS TEXT Enter the initials of the Provider Staff who provided direct service to the Individual on the date.

DATE

SUMMER YOUTH CAREER EXPLORATION ONLYEDUCATIONAL TOPIC (EDUCATION SHOULD BE INCLUDED DURING THE SERVICE WEEK,

MINIMUM 2 HOURS - MAXIMUM 4 HOURS PER WEEK)

06/05/17 Session included discussions on appropriate work place behavior. Participants were divided into

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small groups and given role playing scenarios. One Participant would enact the scenario and the other Participants would point out what was appropriate and inappropriate work place behaviors. Once the groups were done with scenarios the group gathered to discuss how Participants could have handled situations differently and turned inappropriate behaviors into appropriate ones. Noah participated in the scenarios, made comments during discussion, and was respectful of other Participants ideas.

FIELD ENTRY TYPE

INFORMATION


Enter the date that the service took place.

SUMMER YOUTH CAREER EXPLORATION ONLY SUMMARY OF EDUCATIONAL TOPICS TEXT

Enter a summary of the educational topic covered that date and specific comments on Individual’s participation.


INDIVIDUAL CAN ARTICULATE THE DESIRE TO WORK? YES INDIVIDUAL CAN ARTICULATE DIFFERENCES BETWEEN VARIOUS EMPLOYMENT OPTIONS? YES

INDIVIDUAL IS AWARE OF THEIR STRENGTHS AND WEAKNESSES? YES INDIVIDUAL HAS THE ABILITY TO DESCRIBE THEIR STRENGTHS AND WEAKNESSES? YES

INDIVIDUAL CAN ARTICULATE BASED EMPLOYER/EMPLOYMENT EXPECTATIONS? YES

INDIVIDUAL HAS ABILITY TO PERFORM WORK TASKS WITH SUPPORT? YES INDIVIDUAL CAN DEMONSTRATE BASIC WORK BEHAVIORS? (E.G. RESPECT FOR OTHERS, ABILITY TO COMMUNICATE NEEDS, ABILITY TO IDENTIFY APPROPRIATE WORKPLACE CONVERSATIONS, ETC.)

YES

INDIVIDUAL HAS SUCCESSFUL COMPLETED CAREER EXPLORATION AND IS RECOMMENDED TO MOVE FORWARD WITH A WORK EXPERIENCE? YES


EXPECTATIONSDROP DOWN Enter “YES” if the Individual meets the specific

benchmark. Enter “No“ if the Individual does not meet the specific benchmark.

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ACTIVITIES OF DAILY LIVINGORIENTATION & MOBILITY TRAININGREHABILITATION TECHNOLOGYLOW VISION SERVICES

SERVICE DESCRIPTION TOTAL $0.00MILEAGE TOTAL $0.00

INVOICE TOTAL $0.00

FIELD ENTRY TYPE

INFORMATION

SERVICE DESCRIPTION(UOS SERVICES)

DROP DOWN

Select the service from the drop down menu. ADL Self Skills - Individual ADL Self Skills - Group Orientation & Mobility - Individual Orientation & Mobility - Group Rehabilitation Technology Low Vision Services Bilingual ADL Self Skills - Individual Bilingual ADL Self Skills - Group Bilingual Orientation & Mobility - Individual Bilingual Orientation & Mobility - Group Bilingual Rehabilitation Technology Bilingual Low Vision Services

MILEAGE NON-EDITABLE

Field is calculated based on information entered into the report form. Providers may not edit this field.

INVOICE TOTAL NON-EDITABLE

Field is calculated based on information entered into the report form. Providers may not edit this field.

REFERRAL QUESTIONS AND/OR GOALS

Teach Individual how to use JAWS to be able to access and use a computer independently to perform general clerical skills.


REFERRAL QUESTIONSAND/OR GOALS TEXT


GOAL DESCRIPTION ENTER AN EXPLANATION HOW GOALS WILL BE MET, INCLUDING INSTRUCTIONAL TECHNIQUES AND/OR ADAPTIVE TECHNOLOGY

GOAL 1 Basic JAWS Teach Individual to load JAWS software with computer start up. How to

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Commands navigate software programs, desk top, locate computer files, etc. How to adjust JAWS settings such as voice, speech speed, etc.

GOAL 2 JAWS & WordTeach Individual how to create, edit/modify, save, and share MS Word documents using JAWS.

GOAL 3

GOAL 4

GOAL 5

GOAL 6

GOAL 7

GOAL 8

FIELD ENTRY TYPE INFORMATIONDESCRIPTION TEXT Enter a brief description of the goal or task to be accomplished as part

of the service.ENTER AN EXPLANATION HOW GOALS WILL BE MET, INCLUDING INSTRUCTIONAL TECHNIQUES AND/OR ADPATIVE TECHNOLOGY

TEXT

Enter a full explanation of instruction techniques, use of adaptive technology, and measurable benchmarks for goals.

NOTE: For Home Modifications a sketch with the general layout and measurement of rooms and also recommended changes must be submitted as an attachment to the report.

DATE STARTTIME

ENDTIME UNITS

STARTINGLOCATION

(CITY)

ENDLOCATION

(CITY)MILEAGE SUMMARY OF ACTIVITIES STAFF

INITIALS

10/02/17 9:00 10:00 10 Defiance Bryan 30 Installed JAWS software. Discussed how to locate, open, and save files with JAWS. Created a MS Word document, changed speech speed, and reviewed formatting commands with

MEB

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JAWS. Next session will continue to work on new Word commands and functions.

0 0








STARTING LOCATION (CITY) TEXT Enter the location (City) where Provider Staff’s travel originated.

ENDING LOCATION (CITY) TEXTEnter the location (City) where Provider Staff’s travel ended (where they met the Individual, the job site, etc.)

MILEAGE TEXT

Enter the total mileage allotted for the day in support of the service.

NOTE: Travel to meet with an Individual should be billed to the person being seen. Travel back to the Provider’s Office may be billed to the Individual after the appointment. Travel to a different Individual after an appointment should be billed to the new Individual. If Providers are seeing multiple Individuals with different funding sources, e.g. Waiver, BWC, etc. The travel to those Individuals should be billed to the other funding source not OOD.

SUMMARY OF ACTIVITIESTEXT

Enter a summary of what took place during the meeting making sure to document progress and future needs.

STAFF INTIALS TEXT Enter the initials of the Provider Staff who provided direct service to the Individual on the date.

INVIDUAL'S COMMENTS(SELF ASSESSMENT)

Noah feels that he is able to independently open a Word document, make formatting changes, and type into the document, save the document, and then return at a later time open the document and resume editing.

PROVIDERS RECOMMENDATION & SUMMARY

Noah could benefit from one more month/10 Hours of computer access training to review more functions in Word and to improve his ability to use JAWS. Goal is that Noah can prepare a series of Word documents that would be used in an office setting, e.g. newsletter, invoice, dictated letter, etc.

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TEXT

Summary of how the Individual feels that they performed during the service. Summary should be in the Individual’s own words; however, Provider Staff may have to ask clarifying questions. One word or simple phrases, e.g. “I got this.” are not acceptable.


TEXT

Discussion of progress with current benchmarks and recommendations for further services. Providers should be specific on what still needs to be accomplished, how it will be measured, and an estimated amount of time needed to accomplish the goal.

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TRAVEL TRAININGINVOICE SECTION

SERVICE DESCRIPTION (UOS) TOTAL $0.00

SERVICE AREA MODIFIER TOTAL $0.00

INVOICE TOTAL $0.00



Use this field for “Travel Training”. If the Bilingual Supplement has been approved and authorized for the case select the “Bilingual Travel Training” option. This field will load the associated rates, individual and/or group, as applicable.

SERVICE AREA MODIFIER NON-EDITABLE Field is calculated based on information entered in the report form. Providers may not edit this field.


REFERRAL QUESTIONS




GOAL DESCRIPTION LOCATION OF PATH OF TRAVEL &SUMMARY OF INSTRUCTIONAL TECHNIQUES

GOAL 1 Travel independently from Home to Work

Teach the Individual to use public transportation (the bus) to get from their home (1234 Main Street, Defiance, OH) to work (101 Clinton Street, Defiance, OH) and reverse trip.

GOAL 2

GOAL 3

GOAL 4

GOAL 5

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GOAL 6

GOAL 7

GOAL 8

FIELD ENTRY TYPE INFORMATIONDESCRIPTION TEXT Enter a brief description of the goal or task to be accomplished as part

of the service.ENTER AN EXPLANATION HOW GOALS WILL BE MET, INCLUDING INSTRUCTIONAL TECHNIQUES AND/OR ADPATIVE TECHNOLOGY

TEXT

Enter a summary in instructional techniques that will be used to teach the Individual the path of travel as well as how to use the maps and understand the bus routes. If adaptive technology will be used, e.g. GPS include a plan on what the Individual will need to know to be able to use it successfully, including benchmarks and estimated timeframes.

NOTE: Providers should describe or attach a rough sketch of the path of travel with the report.

DATE STARTTIME

ENDTIME UNITS SAM

Y/N

# INDIVIDU

ALS

GOALS

PROVIDER'S COMMENTS (INCLUDES PERFORMANCE OBSERVATIONS, CONCERNS, INCIDENTS, INTERVENTION TECHNIQUES, & RECOMMENDATIONS FOR NEXT STEPS)

STAFFINITALS

10/02/17 9:OO AM 12:00 AM 30 1 1

Noah was able to get on the bus independently. He remembered where he needed to get off and transfer to a different bus. Noah did start to get off at the wrong stop but caught himself and made the correction. Trainer discussed his performance once he got to his job site. He indicated that he is still not comfortable travelling by himself yet. Trainer recommends accompanying him on his path of travel four more times over the next week.

EJD





END TIME TIME FIELD Enter the time that the actual service ended, not the

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FIELD ENTRY TYPE INFORMATIONAM/PM scheduled end time.

(REQUIRED FIELD)

UNITS NON-EDITABLE Field is calculated based on information entered into the report form. Providers may not edit this field.



Enter the number of Individuals that received the service. If an Individual service enter “1” if a Group service enter a number between “2” and “4.” (REQUIRED FIELD)

GOALS TEXT

Enter the number of the Goal, as defined in previous table, associated with the purpose of the meeting, e.g. practice travel path. If multiple Goals are worked on during the meeting enter the number of all Goals separated by commas.

PROVIDER'S COMMENTS (INCLUDES PERFORMANCE OBSERVATIONS, CONCERNS, INCIDENTS, INTERVENTION TECHNIQUES, & RECOMMENDATIONS FOR NEXT STEPS

TEXT

Enter a summary of what took place during the service making sure to document progress, addressing any incidents, concerns, intervention techniques, and future needs.



Noah indicated that he is still not comfortable travelling alone. He would like to practice the route with Trainer a few more times.


Trainer will travel the route with Noah four more times over the next week. Trainer will then allow him to travel the route himself, with a cell phone, so he can call if there are any issues. Trainer will also review the emergency plan in case he gets off on the wrong stop or misses a connection.



TEXT

Summary of how the Individual feels that they performed during the service. Summary should be in the Individual’s own words; however, Provider Staff may have to ask clarifying questions. One word or simple phrases, e.g. “I got this.” are not acceptable.


TEXT

Discussion of progress with current benchmarks and recommendations for further services. Providers should be specific on what still needs to be accomplished, how it will be measured, and an estimated amount of time needed to accomplish the goal.

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WORK INCENTIVES PLANINVOICE SECTION

SERVICE DESCRIPTION INVOICE TOTAL $0.00



Use this field for “Work Incentives Plan” or “Work Incentives - Credential”. If the Bilingual Supplement has been approved and authorized for the case select the “Bilingual Work Incentives Plan” or “Bilingual Work Incentives – Credential” option. This field will load the associated rates, individual and/or group, as applicable.

BENEFITS SUMMARYBENEFIT PROGRAM BENEFIT AMOUNT VERIFIED BY WHOM & HOW

SOCIAL SECURITY DISABILITY INSURANCE (SSDI)

$540.00 BPQY from Social Security Administration

SUPPLEMENTAL SECURITY INCOME (SSI)

$200.00 BPQY from Social Security Administration

MEDICAL BENEFIT 1 (MEDICARE)MEDICAL BENEFIT 2 (MEDICAID)

Traditional Medicaid(e.g. not MBIPWD)

Telephone contact with Defiance County Jobs & Family Service.

HOUSING BENEFITBENEFIT 1BENEFIT 2BENEFIT 3BENEFIT 4BENEFIT 5


HOUSING BENEFIT TEXTEnter the name of the specific housing benefit or incentive.

BENEFIT 1, 2, 3, 4, or 5 TEXT Enter the name of the type of the benefit.

BENEFIT AMOUNT TEXT

Enter the cash dollar value of the benefit, if applicable, for other benefits mark “YES” if they have them, or provide a summary of the value of the benefit, e.g. reduce rent, housing voucher, etc.

VERIFIED BY WHOM & HOW TEXT Enter the name of the Organization that verified the benefit type and amount. Enter how the benefit was verified, e.g. telephone

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FIELD ENTRY TYPE INFORMATIONto Metropolitan Housing, etc.

OTHER BENEFITS OR CONSIDERATIONS FOR EMPLOYMENT1

2

3

4


OTHER BENEFITS OR CONSIDERATIONS FOR EMPLOYMENT TEXT

Planners may use this area to document other benefits that the Individual may receive that are not included above and/or financial in nature.

MEDICAL INSURANCE OPTIONS FOR INDIVIDUALS WITH DISABILITIES (SHOULD INCLUDE DISCUSSION ON OPTIONS SUCH AS MEDICAID BUY-IN FOR PEOPLE WITH DISABILITIES, MEDICAID/MEDICARE, AND OTHER SPECIAL PROGRAMS SUCH AS SLMB, QMB, 1619, ETC.

FIELD ENTRY TYPE INFORMATIONMEDICAL INSURANCE OPTIONS FOR INDIVIDUALS WITH DISABILITIES (SHOULD INCLUDE DISCUSSION ON OPTIONS SUCH AS MEDICAID BUY-IN FOR PEOPLE WITH DISABILITIES, MEDICAID/MEDICARE, AND OTHER SPECIAL PROGRAMS SUCH AS SLMB, QMB, 1619, ETC.

TEXT

Planner should review available medical insurance programs, such as 1619, QMB, SLMB, and Medicaid Buy In for People With Disabilities (MBIPWD) so that Individuals understand that they can work and still maintain some medical coverage.

WORK INCENTIVE WHEN IT IS USED HOW TO ISE IT

FIELD ENTRY TYPE INFORMATIONWORK INCENTIVE TEXT Enter the name of the specific work incentives

that the individual can use to maximize earnings and still provide security. Planners should not list work incentives that do not apply to the Individual’s situation, e.g. it is not

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FIELD ENTRY TYPE INFORMATIONappropriate to discuss Blind Work Expenses if the person does not have an allowed blindness condition through Social Security.

WHEN IT IS USED TEXT

Enter information on when a work incentive used, e.g. TWP available for SSDI recipients when earnings are above a specific level ($850 in 2018)

HOW TO ISE IT TEXT

Enter information on how to use the work incentive, e.g. is it automatic, do you have to be approved by Social Security beforehand, e.g. PASS, what documentation does Social Security need to approve it e.g. Impairment Related Work Expenses, etc.

ISSUES REQUIRINGIMMEDIATE ACTION

IMPORTANT DATES/DEADLINES

RECORD KEEPING REMINDERS

EMPLOYMENT SERVICES &SUPPORTS TO BE UTILIZED


ISSUES REQUIRINGIMMEDIATE ACTION TEXT

Enter important changes, e.g. marriage/divorce, births/deaths, change in health status, etc. that the Individual should notify Social Security.

IMPORTANT DATES/DEADLINES TEXT

Enter the date of the Individual’s next Medical Review or other important dates, e.g. 90 days to re-assign a Ticket to Work once taken out of use with VR, etc.

RECORD KEEPING REMINDERS TEXTEnter any specific reminders, e.g. report earnings monthly, etc.

EMPLOYMENT SERVICES &SUPPORTS TO BE UTILIZED TEXT

Enter potential employment supports that the Individual may be able to use, e.g. Ticket to Work, subsidies, etc.

SCENARIO (WAGE X HOURS)UNEARNED INCOME $0.00

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- GENERAL INCOME EXCLUSION (MAX $20.00) $0.00COUNTABLE UNEARNED INCOME $0.00

GROSS EARNED INCOME $0.00- STUDENT EARNED INCOME EXCLUION (SEIE)2017 = $1,1790?MONTH OR $7,200 YEAR) $0.00- GENERAL INCOME EXLUSION (IF NOT USED ABOVE) $20.00- EARNED INCOME EXLUSION (MAX $65.00) $0.00

- IMPAIRMENT RELATED WORK EXPENSES (MUST BE APPROVED) $0.00= REMAINDER EARNED INCOME $0.00$2-FOR-$1 EARNINGS DISREGARD (DIVIDE BY 2) $0.00- BLIND RELATED WORK EXPENSES $0.00= COUNTABLE EARNED INCOME $0.00TOTAL COUNTABLE UNEARNED & EARNED INCOME $0.00- PASS PLAN DEDUCATION $0.00= TOTAL COUNTABLE INCOME $0.00FULL SSI BENEFIT RATE - TOTAL COUNTABLE INCOME $0.00ADJUSTED SSI PAYMENT $0.00ADJUSTED SSI PAYMENT $0.00+ TOTAL EARNED & UNEARNED INCOME $0.00- PASS, BWE, & IRWE $0.00TOTAL FINANCIAL OUTCOME $0.00

SOCIAL SECURITY DISABILITY INSURANCE TRIAL WORK AND EXTENDED PERIOD OF ELIGIBILITY

(ONLY REQUIRED IF INDIDIVUAL RECEIVES SSDI)January February March April May June July August September October November December

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SSI CALCULATION SHEET TEXT

Provide three illustrations to Individual showing different earning levels.(ONLY REQUIRED FOR SSI OR DUAL BENEFICIARIES)

SSDI TWP/EPE TRACKER TEXT

Provide an illustration on how the Trial Work Period Level works.(ONLY REQUIRED FOR SSDI OR DUAL BENEFICIARIES)

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WORK INCENTIVES COORDINATIONINVOICE SECTION



INVOICE TOTAL $0.00



Use this field for “Benefits Coordination - Credential” or “Benefits Coordination – Non-Credential. If the Bilingual Supplement has been approved and authorized for the case select the “Bilingual Benefits Coordination - Credential” or “Bilingual Benefits Coordination – Non-Credential.” option. This field will load the associated rates, individual and/or group, as applicable.

SERVICE AREA MODIFIER NON-EDITABLE Field is calculated based on information entered into the report form. Providers may not edit this field.


SPECIFIC BENEFITS CONCERN(S) THAT VR STAFF OR VR CONTRACTOR WANTS THE PROVIDER TO WORK WITH THE INDIVIDUAL TO RESOLVE.

Individual has recently started work and needs assistance in reporting their income to Social Security. VR Staff wants Planner to work with the Individual to teach them how to report income and then also coach them while the Individual does it themselves to make sure they know the process.

FIELD ENTRY TYPE INFORMATIONSPECIFIC BENEFITS CONCERN(S) THAT VR STAFF OR VR CONTRACTOR WANTS THE PROVIDER TO WORK WITH THE INDIVIDUAL TO RESOLVE.

TEXT

Enter what you specially want the Provider to accomplish as part of the service. Consult the VR Fee Schedule to determine specifically what types of activities are allowed as part of the service.

DATE STARTTIME

ENDTIME UNITS SAM

LevelSUMMARY OF

ISSUE(S)/CONCERN(S)

CONTACTS & SUMMARY OF STEPS TAKENTO RESOLVE

ISSUE(S)/CONCERN(S)

STAFFINITIALS

0 0



START TIME TIME FIELD Enter the time that the actual service started, not the

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FIELD ENTRY TYPE INFORMATIONAM/PM scheduled start time.

(REQUIRED FIELD)





SUMMARY OF ISSUE(S)/CONCERN(S) TEXT Enter a summary of the issue that was worked on that specific date.

CONTACTS & SUMMARY OF STEPS TAKENTO RESOLVE ISSUE(S)/CONCERN(S) TEXT

Enter documentation of the type of contact or what actions were taken to resolve the issue on that specific date.


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VOCATIONAL EVALUATIONINVOICE SECTION

SERVICE DESCRIPTION (UOS SERVICES) SERVICE TOTAL $0.00SERVICE AREA MODIFIER (SAM) TOTAL $0.00

INVOICE TOTAL



Use this field for “Vocational Evaluation”. If the Bilingual Supplement has been approved and authorized for the case select the “Bilingual Vocational Evaluation” option. This field will load the associated rates, individual and/or group, as applicable.



INTEREST TEST(S) ADMINISTERED SUMMARY OF TEST RESULTS


INTEREST TEST(S) ADMINISTERED TEXT

Enter the name of any standardized vocational tests that were used to measure this characteristic. If no standardized tests were used to collect data explain how the conclusion was derived.

SUMMARY OF TEST RESULTS TEXT

Enter a summary of the information and explain how that it was used to formulate the identified vocational goal(s) as realistic and viable (e.g. within the Individuals interests, abilities, and capabilities.)

ACADEMIC TEST(S) ADMINISTERED SUMMARY OF TEST RESULTS


ACADEMIC TEST(S) ADMINISTERED TEXT




APTITUDE TEST(S) ADMINISTERED SUMMARY OF TEST RESULTS

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APTITUDE TEST(S) ADMINISTERED TEXT




CAPABILITIES TEST(S) ADMINISTERED SUMMARY OF TEST RESULTS


CAPABILITIES TEST(S) ADMINISTERED TEXT




ABILITIES TEST(S) ADMINISTERED SUMMARY OF TEST RESULTS


ABILITIES TEST(S) ADMINISTERED TEXT




MEMORY TEST(S) ADMINISTERED MEMORY TEST(S) ADMINISTERED


MEMORY TEST(S) ADMINISTERED TEXT




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OTHER TEST(S) ADMINISTERED SUMMARY OF TEST RESULTS


OTHER TEST(S) ADMINISTERED TEXT




STRENGTHS, BARRIERS, & POTENTIAL ACCOMMODATIONS


STRENGTHS, BARRIERS, & POTENTIAL ACCOMMODATIONS TEXT

Enter the strengths, barriers, and potential accommodations in order for the Individual to be successful in this type of employment. Example 1: Individual is highly motivated to enter a specific field but it requires a lot of reading and their reading comprehension is at the 2ND grade level, potential recommendations would be a remedial English course. Example 2: Individual wants to pursue a physically demanding occupation but has limited physical capacity, potential recommendation could be Work Adjustment to build stamina or Rehabilitation Technology to minimize physical requirements.

POTENTIAL JOB GOAL(S)


POTENTIAL JOB GOAL(S) TEXT

Enter the potential job goal(s) that have been identified as part of the evaluation. The goal(s) should be realistic, viable (within the interests, abilities, and capabilities), and available in the geographic that the Individual lives or define where the Individual would need to go in order to secure that type of employment.

LABOR MARKET ANALYSIS

FIELD ENTRY TYPE INFORMATIONLABOR MARKET ANALYSIS TEXT Enter labor market information that supports the job as

being “in demand” and have at minimum an average level of growth over the next few years. Labor market information should be based on the area where the

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FIELD ENTRY TYPE INFORMATIONIndividual resides (or where they plan to re-locate.)

DATE REVIEWED WITH INDIVIDUAL


DATE REVIEWED WITH INDIVIDUAL

TEXT

Information should be reviewed with the Individual, VR Staff, or VR Contractor. Information in the written report should be written at a level that is easily and clearly understandable by the Individual.

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VOCATIONAL CONSULTATIONINVOICE SECTION



INVOICE TOTAL $0.00



Use this field for “Vocational Consultation.” If the Bilingual Supplement has been approved and authorized for the case select or “Bilingual Vocational Consultation” option. This field will load the associated rates, individual and/or group, as applicable.


INVOICE TOTAL NON-EDITABLE Field is calculated based on information entered into the report form. Providers may not edit this field.

SPECIFIC TASKS THAT SHOULD BE COMPLETED AS PART OF THE SERVICE. IF SPECIFIC VOCATIONAL TESTS ARE USED THE SCORES & RESULTS SHOULD BE ATTACHED.

Need to measure academic skills to determine if vocational goal is appropriate. Please administer the TABE or WRAT to determine basic reading, writing, and mathematics levels.

FIELD ENTRY TYPE INFORMATIONSPECIFIC TASKS THAT SHOULD BE COMPLETED AS PART OF THE SERVICE. IF SPECIFIC VOCATIONAL TESTS ARE USED THE SCORES & RESULTS SHOULD BE ATTACHED.

TEXT

Information obtained from the Referral to Facility. VR Counselors/VR Contractors should enter what you specially want the Provider to do accomplish as part of the service. Consult the VR Fee Schedule to determine specifically what types of activities are allowed as part of the service.

DATE STARTTIME

ENDTIME UNITS SAM

LevelSUMMARY OF

ISSUE(S)/CONCERN(S)

CONTACTS & SUMMARY OF STEPS TAKEN

TO RESOLVE ISSUE(S)/CONCERN(S)

STAFFINITIALS

0 0



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SUMMARY OF ISSUE(S)/CONCERN(S) TEXT Enter a summary of the issue(s) that was worked on that specific date.

CONTACTS & SUMMARY OF STEPS TAKEN TO RESOLVE ISSUE(S)/CONCERN(S)

TEXTEnter documentation of the type of contact or what actions were taken to resolve the issue on that specific date.


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INTERPRETINGSPECIAL INSTRUCTIONSDue to the nature of the service, e.g. taking place in the community at different locations and needing the form to be signed, Interpreters can print off copies and hand write entries. Participants may have forms from various Interpreters if multiple staff were used to serve the individual throughout the month. Interpreters should bill all service at the end of the month or at the end of the billing cycle as defined on the Original VR Authorization & Billing (OOD-0020).

INVOICE SECTIONSERVICE DESCRIPTION (UOS) TOTAL $0.00


INVOICE TOTAL $0.00



Use this field for “Interpreting.” If the Bilingual Supplement has been approved and authorized for the case select the “Bilingual Benefits Coordination - Credential” or “Interpreting” option. This field will load the associated rates, individual and/or group, as applicable.


INVOICE TOTAL NON-EDITABLE Field is calculated based on information entered into the report form. Providers may not edit this field.

Date Start Time End Time Units SAM MEETING LOCATION INDIVIDUAL's SIGNATURE STAFFINITIALS

0

0








SAM LEVEL DROP DOWN Enter the SAM Level if VR Counselor or VR Contractor

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FIELD ENTRY TYPE INFORMATIONhas pre-authorized SAM Level for the service.

MEETING LOCATION TEXTEnter the name of the location where the interpreting took place, e.g. if at a business enter ABC Placements, Defiance, OH.

INDIVIDUAL’S SIGNATURE

TEXT

Enter the signature of the person receiving the service. If the Individual is unable to sign then the Job Developer/Job Coach, VR Counselor/VR Contractor, may sign to document that the service has been provided.

STAFF INTIALS TEXT Enter the initials of the Provider Staff (Interpreter) who provided direct service to the Individual on the date.

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VOCATIONAL TRAINING STIPENDDATE START TIME MEAL PERIOD (IN MINUTES) END TIME DAILY UNITS OF SERVICE (UOS)


DATE TEXTEnter the date that the service took place.(REQUIRED FIELD)

START TIME TEXTEnter the time that the actual service started, not the scheduled start time.(REQUIRED FIELD)

MEAL PERIOD (IN MINUTES) TEXT

Enter the meal period in minutes. For adults working over six (6) hours or minors working more than five (5) hours they must be provided a thirty (30) minute unpaid meal period. No service should take place during the meal period.

END TIME TEXTEnter the time that the actual service ended, not the scheduled end time.(REQUIRED FIELD)

DAILY UNITS OF SERVICE (UOS) NUMERIC

Calculate the number of Units of Service for each day. Refer to the UOS Table on the report form.(REQUIRED FIELD)

INDIVIDUALS SIGNATURE & DATE TEXT

Providers should have the form signed by Individuals at the end of each week in case the Individual stops participating. Providers should not have Individuals sign forms in advance.(REQUIRED FIELD)

PROVIDERS SIGNATURE & DATE TEXT

Providers must sign at the bottom of each side of the VTS form that is used. If the second page is not used to report any time, it does not need to be signed.(REQUIRED FIELD)

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TRANSPORTATIONINVOICE SECTION

Service End Date Service Description TRANSPORTATION INVOICE TOTAL $0.00


SERVICE DESCRIPTION NON-EDITABLEReport is only used for Transportation. There is only one rate for Transportation, no Bilingual option, and cost covers all people in the vehicle.



Date Start Time End Time Units

# IN VEHICLE

PER TRIP

START LOCATION END LOCATION STAFFINITIALS

10/02/17

9:00 AM 10:00 AM 10 1 Defiance, OH Bryan, OH MEB

FIELD ENTRY TYPE INFORMATIONDATE TEXT Enter the date that the service took place.

(REQUIRED FIELD)

START TIME TEXTEnter the time that the actual service started, not the scheduled start time.(REQUIRED FIELD)

END TIME TEXTEnter the time that the actual service ended, not the scheduled end time.(REQUIRED FIELD)

UNITS OF SERVICE (UOS) NON-EDITABLE Field is calculated based on information entered into the report form. Providers may not edit this field.

# IN VEHICLE TEXT

Enter the number of people in the vehicle during the Transportation service. NOTE: That field is set to “1” as default and will divide total time amongst the number in the vehicle.

START LOCATUION (CITY) TEXT Enter the location (City) where Provider Staff’s travel originated.

END LOCATION (CITY) TEXT Enter the location (City) where Provider Staff’s travel ended (where they met the Individual, the job site, etc.)


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PROCEDURE 80-VR-09-01TITLE Vocational Rehabilitation Provider Management ProcedureEFFECTIVE May 8, 2017REVIEW DATE 11-08-18

I. PURPOSEThe purpose of this procedure is to provide direction to ensure appropriate oversight and timely communication with vocational rehabilitation (VR) providers in accordance with appropriate federal (e.g. Code of Federal Regulations [CFR]) and state law (i.e. Ohio Revised Code, Ohio Administrative Code) governor directives and executive orders, other governing agency (e.g. DAS, OBM) policy or guidance, and/or executive director expectations.

II. APPLICABILITY1) This procedure applies to VR Staff and VR Contractors.2) In addition, it also applies as detailed below.

A. Individuals or entities who want to be considered to provide services listed in the VR Fee Schedule (OAC 3304-2-52 Appendix) or those who would like to offer specialized training (Refer to Section B).

B. Individuals or entities who want to be considered to provide medical, psychological and dental services shall follow all required guidance set forth in OOD’s Medical, Psychological and Dental Fee Schedules

III. DEFINITIONS

Approved Provider – individuals and entities who have met the requirements established by OOD and have been approved to provide vocational rehabilitation services to OOD individuals

OOD Representative – for the purposes of this policy, VR Staff person(s) designated by theExecutive Director, or designee, who will manage the Provider Management Program (PMP), the “Provider Search” tool and be responsible for oversight of the approved providers.

OOD Liaison – for the purposes of this policy, designated VR Staff person responsible for acting as an approved provider’s primary point of contact, their source of information and providing technical assistance.

Provider Management Program (PMP) – the electronic system that provides users to

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complete an application to be considered for the list of OOD’s approved providers or once approved, to make changes to their contact information, current services or service delivery areas.

Provider Search – an electronic search tool located on OOD’s website that allows VR Staff, VR Contractors and individuals with disabilities to access OOD approved provider information including, but not limited to, contact information, types of services offered, service delivery areas and areas of specialization.

Supply – goods or equipment.

Uniform Document System (UDS) – the system that is used to maintain individual provider records which includes, but is not limited to: accreditation award letters; insurance policies; quarterly review summaries; and scorecards.

VR Provider – individuals or entities that are approved by OOD to provide services defined in OOD fee schedules.

VR Provider Manual – a manual for OOD providers which contains OOD fee schedules, OOD policy and procedure and other information and requirements.

IV. PROCEDURES

A. General

1. OOD and its providers are required to provide information to individuals throughout the VR process as required by law (e.g. rights and duties). This information shall be provided to the individual and if applicable, the individual’s legal guardian, in writing and when appropriate, in their native language or through an appropriate mode of communication.

2. AWARE shall be updated, by VR Staff and VR Contractors, with pertinent conversations,recommendations, justifications, approvals and/or other actions taken in relation to this policy and subsequent procedures when appropriate.

3. OOD and approved providers shall not place an OOD individual in employment where they would be subject to a special wage certificate under the U.S. Department of Labor’s Fair Labor Standards Act (FLSA) which allows them to be employed at sub-minimum wage.

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4. In order for individuals or entities to be placed on OOD’s approved provider list, (i.e. be able to provide services as listed on OOD’s Fee Schedules) they must meet at least one (1) of the criteria listed below:

a. have the appropriate accreditation, certification or licensure as required by the State of Ohio; and/orb. successful completion necessary information/documentation in the Provider Management Program (PMP), if applicable (refer to Section B.).

5. Placement on OOD’s approved provider list does not:a. constitute a contractual relationship between OOD and the provider; orb. guarantee utilization of any or all of the services the provider offers.

6. After a provider’s placement on OOD’s approved provider list, OOD shall provide oversight of VR providers including, but not limited to, quality assurance measures.

a. OOD shall implement quality assurance measures to ensure quality VR services are being provided.b. Quality assurance measures shall include, but not be limited to, monitoring the provider’s process to protect an individual’s confidential personal information (CPI), successful placement rates and duration of services until placement.

7. At any time (i.e. prior to approval or after becoming an Approved Provider), OOD may request completion of a background check on any Approved Provider employee who delivers direct services to OOD individuals.

B. Process to be Considered for Providing Services to OOD Individuals

1. Individuals or entities who would like to be considered for providing services to OODindividuals, via OOD fee schedules (e.g. VR, psychological, medical, dental), are subject to the following:

a. provisions of the VR Provider Manual;b. state and federal laws;c. if applicable, completion of an application in OOD’s Provider Management Program(PMP) (refer to ood.ohio.gov/Providers/Provider-Services ); andd. once approved by OOD, registering with Ohio Shared Services (OSS) prior to being able to provide services (refer to http://obm.ohio.gov/suppliers.aspx for information).

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2. Prior to applying to become an approved provider, in addition to having appropriate State of Ohio accreditation, certification or licensure (if applicable), OOD requires potential providers to meet the following criteria:

a. be accredited or certified as required by OAC 3304-1-12 “Community Rehabilitation Program Standards”, or be granted a waiver of accreditation and/or certification by OOD’s Executive Director; andb. ensure that services will be provided in accordance with the definitions and requirements as outlined in the VR Provider Manual.

3. Once the above criteria have been met, potential providers may be required to complete one (1) of the applications listed below in OOD’s PMP in order to be placed on OOD’s approved list.

a. Traditional (Vocational Rehabilitation) Provider Applicationi. Providers who would offer at least one (1) service defined in the VR Fee Schedule shall complete this application.ii. Providers in this category shall be accredited or certified, as required, in specific areas as defined in OAC 3304-1-12 “Community Rehabilitation Program Standards” in order to provide:

a) vocational evaluations;b) work adjustment;c) job placement;d) on-the-job supports;e) community based assessment;f) orientation & mobility; andg) rehabilitation technology/low vision services.

iii. Providers shall consult the VR Provider Manual for information on OOD’s current accreditation standards (e.g. Commission on Accreditation of Rehabilitation Facilities [CARF], the Joint Commission (JC) in the area of Behavioral Health, the National Accrediting Council for Organizations Serving the Blind or Visually Impaired [NAC]).

b. Vision Services Provider Applicationi. This application is to be completed by providers offering vision services and meeting the appropriate accreditation requirements (e.g. Academy for Certification for Vision Rehabilitation and Education Professionals [ACVREP], the National Blindness Professional Certification Board [NBPCB], the National Accrediting Council for Organizations Serving the Blind or Visually Impaired [NAC], as defined in OAC 3301-1-12 “Community Rehabilitation Program Standards”.

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c. Employment First Provider Applicationi. Providers must be certified as required by Department of Developmental Disabilities (DODD) in the area of “Individual Employment Supports”. (Refer to the Ohio Department of Developmental Disabilities (DODD) website, http://dodd.ohio.gov/Providers/Pages/default.aspx for current certification requirements).

a) Providers in this category may request and be granted a waiver of OAC 3304-1-12 “Community Rehabilitation Program Standards” to provide services defined within the VR Fee Schedule (see d. below).

d. Waiver Provider Applicationi. Providers who are not accredited or certified in accordance with OAC 3304-1-12 “Community Rehabilitation Program Standards” but would still like to be approved to provide services listed in the VR Fee Schedule shall complete the Waiver Provider Application in order to request a waiver from OOD’s Executive Director.

a) In order to be granted a waiver, providers must submit additional informationabout their qualifications and experience to provide VR services.

ii. An OOD Representative shall review the applications for waivers four (4) times per calendar year on the 15th day of January, April, July and October. If the 15th falls on a non-business day, the review will be completed on the next business day.

a) After review, the OOD Representative shall submit a recommendation to the Executive Director, or designee.b) The Executive Director, or designee, may deny the waiver, in whole or in part, or conditionally grant a waiver of the accreditation or certification requirements.

1) The OOD Representative shall notify a provider of their waiver request within forty-five (45) days of the waiver review date (e.g. January 15th would be on or around March 1st).

iii. Providers who are granted a waiver are required to attend OOD’s training on fiscal requirements and service delivery.

e. Non-accredited Provider Applicationi. Providers that are not offering services defined in OOD Fee Schedules (e.g. occupational skills training) and are not subject to OAC 3304-1-12 “Community Rehabilitation Program Standards” shall complete the Non-accredited Provider Application.

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f. Subcontractor Applicationi. Providers who wish to provide services under another provider’s accreditation (e.g. CARF) shall complete the Subcontractor Application. Note: The subcontractor must then be associated to the OOD approved Provider in the PMP in order to be used to provide services.

a) In order for an approved subcontractor to be associated with an approved provider, the provider must be certified in the services in which the subcontractor is approved to provide.b) Providers may consult the VR Provider Manual for more information on subcontracting (refer to http://www.ood.ohio.gov/Providerss/ProviderServices/Provider-Manual).

4. Providers will be required to attach proof of the criteria in Section B.2 to their application in the PMP or submit, via email, to [email protected]

5. Applications which are not “submitted” within 90 days shall be removed from the PMP.

6. Providers and subcontractors shall be responsible for keeping their information (i.e. contact info, services offered and service delivery areas) current in the PMP.

a. Changes to a provider’s tax identification number, legal name, the addition of new services, changes to service delivery areas and/or the addition of subcontractors will require additional OOD approval.

C. Provider Approval Process

1. An OOD Representative shall review, approve or disapprove provider applications, submitted via PMP, within 45 days of submission unless a waiver (refer to Section B.3.d.) is required which may take longer.

a. If a provider application is submitted and additional information is needed, the OOD Representative shall notify the provider.

i. If the provider does not submit the requested information within forty-five (45) days of this notification, the application shall be removed from the PMP.

a) The provider may re-apply by completing and submitting a new application, via the PMP, at a later date.

b. The OOD Representative shall perform the following when reviewing a provider application:

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i. verification of required accreditation(s), certification(s) and/or licensure, if applicable;ii. for vision services, ensure that a copy of their professional liability insurance is received; andiii. review the provider’s experience in assisting individuals with disabilities in obtaining and maintaining competitive, integrated, community based employment.

c. Upon completion of review, the OOD Representative shall approve or disapprove the application and notify the provider.

D. Designation of OOD Area and Liaison

1. Approved providers shall be assigned to an OOD area based upon the location of theirprimary business (e.g. Northwest, Southeast).

2. Approved providers shall be assigned an OOD Liaison by the OOD Area Manager.a. An OOD AM may designate additional liaisons, as needed, for providers with service coverage territories that span multiple areas or contain satellite locations.

E. Meeting Requirements1. Providers shall participate in any meetings determined necessary by OOD. If a provider is unable to attend due to an extenuating circumstance, they are still responsible for understanding and adhering to VR Provider Manual and any other OOD requirements and for any items which may have been discussed or disseminated at the meeting.2. Local Meetings

a. Providers shall participate in local meetings as scheduled by OOD Liaisons.i. Providers, who received greater than $100,000 in revenue during the previous Federal Fiscal Year (FFY), shall meet at least quarterly with their OOD Liaison during the current FFY.ii. Providers who received less than $100,000 in revenue, during the previous FFY shall participate in a minimum of two (2) meetings with their OOD Liaison during the current FFY.iii. OOD Liaisons may require more frequent meetings with providers to address any issues (e.g. not following services as defined in the OOD Fee Schedules) that may arise during the course of providing services or, if applicable, as part of a Corrective Action Plan (CAP).

b. Topics for local meetings should include, but are not limited to:

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i. supervisor feedback;ii. referrals (e.g. current referral numbers);iii. provider updates;iv. fiscal review (e.g. compliance with timeliness of invoice submissions, accuracy of invoices, vouchered rates);v. service delivery (e.g. compliance with VR Fee Schedule, quality of services provided, outcomes and timeliness of services);vi. VR updates and technical assistance (e.g. VR Fee Schedule updates, policy updates).

c. The OOD Liaison shall document the meeting on the “Provider Meeting Summary” (80-VR-10-01.A).

i. The OOD Liaison shall provide a copy of the summary, within 10 days of the meeting, to the following:

a) provider;b) OOD Area Manager;c) VR Supervisors; andd) the OOD Representative.

ii. The OOD Representative shall be responsible for storing the record in the Uniform Document System (UDS) for the purpose of records retention.

3. Statewide Meetingsa. The OOD Representative may conduct statewide meetings with all provider directors and stakeholders to provide an overview of the strategic direction of the VR program and updates on related projects and/or initiatives.

F. Incident/Issue Reporting and Management1. The following incidents or issues fall under reporting requirements:

a. reports of abuse or neglect of an OOD individual;b. issues that would have an impact on the safety, health, or welfare of an OOD individual;c. issues of fiscal integrity, including but not limited to, charging for services not provided and charging multiple individuals for the same service/time; andd. breaches of confidential personal information (CPI).

2. If an incident or issue involves the physical or emotional safety of an OOD individual,providers shall immediately take steps to ensure the OOD individual’s safety, and thenimmediately provide notification to entities as required by law and OOD as detailed below.

a. Providers are required to immediately notify law enforcement, child protective services, county boards of developmental disabilities, or other agencies as required by law.

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b. Contact, via telephone, and provide notification to the OOD, and if applicable a VR Contractor as detailed below.

i. Call the VR Staff or VR Contractor who handles the OOD individual’s case, the designated OOD liaison, and the OOD Representative (in this order). The provider shall continue to attempt to reach all three (3) of the individuals until all are reached.

a) If none of these individuals are available, the provider shall contact an OOD VR Supervisor, Area Manager, or a VR Contractor’s supervisor or the OOD VR Contracts Unit Staff.b) Leaving a message (i.e. voice mail) is not acceptable, a provider shall speak directly to an individual or keep trying until an individual is reached.c) If the incident or issue takes place during the evening, weekend, or holiday, providers shall make contact on the next business day.

ii. Follow up the telephone call with an email to the individuals listed in Section F.2.a and if contact was made to an individual in Section 2.a.i., copy him/her.

a) The email shall include, at a minimum, the following information:

1) the OOD individual’s name;2) VR Staff or VR Contractor’s name assigned the OOD individual’s case;3) date of the incident or issue;4) detailed description of the incident or issue;5) where the incident or issue took place;6) who was involved;7) who witnessed the incident or issue; and8) what actions were taken.

3. The OOD Liaison shall be responsible for handling any incident or issued (e.g. performing an investigation, obtaining additional information or documentation from the OOD individual or the provider, development of a CAP) and sharing the information with the OOD Representative.

4. The OOD Representative will review and gather additional information, if necessary, and notify appropriate OOD management.

a. A formal review may be initiated if warranted (refer to Section H.).

G. Questions, Concerns, Complaints, & Issues

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1. Questions/concerns and minor issues with providers (e.g. correction of a report or invoice) should be handled by VR Staff or VR Contractors.

2. VR Staff and VR Contractors shall direct significant concerns, complaints and issues about providers to the OOD Liaison who will facilitate resolution.

a. Copy Requirementsi. VR Staff shall copy his/her VR supervisor.ii. VR Contractors shall copy their supervisor and a VR Contracts Unit designee.

b. Reporting Requirementsi. When reporting a significant concern, complaint or issue, VR Staff or VR Contractor shall provide the following information:

a) the OOD individual’s name;b) VR authorization number (if related to an invoice):c) type of service being provided; andd) date(s) and description of the concern, complaint or issue.

c. Resolution Facilitationi. The OOD Liaison shall facilitate resolution.a) In cases where the OOD Liaison is unable to facilitate resolution, it shall be forwarded to his/her immediate supervisor/manager for resolution.b) If resolution is still not able to be facilitated, it shall be forwarded to an OOD Representative for facilitation of final resolution.

3. The OOD Liaison shall review the information and documentation and discuss the issue with the provider and the Area Manager, if needed.

4. Necessary actions may be taken, if necessary, and may include, but are not limited to:a. providing training and/or technical assistance to address the concern, complaint or issue;b. developing a CAP; and/orc. recommending that a formal review be completed by an OOD Representative.

i. All documentation pertaining to a review (e.g. records, reports, findings, outcomes) shall be submitted to the OOD Representative.ii. The OOD Representative shall enter all in the Uniform Document System (UDS).

d. If the provider is unable to meet the requirements of the CAP or fails to continue to meet quality and/or compliance expectations after completion of the CAP, OOD may remove the provider from their list of approved providers

H. Formal Review

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1. If a formal review is recommended, OOD’s Monitoring & Compliance Unit (MCU), VRProgram Administration, and/or Legal will review the facts and determine the scope of the review if deemed necessary.

2. VR Staff and VR Contractors shall refer to “Internal and External Controls for Contractors and Providers” (40-MCU-03) for the review guidance.

I. Violation1. An employee who violates this procedure may be subject to discipline up to and including removal2. Providers who violate this procedure may be removed from the list of approved providers.

REVIEWIt is the responsibility of the Deputy Director, or designee, to annually review this procedure, on or before, the date listed in the header and if applicable, make any necessary revisions. The Deputy Director or designee shall document the annual review as required in OOD Policy 10-ADM-01 Policy and Procedure Development, Review, Dissemination and Acknowledgement”.

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Provider Management SummaryReview Date/Time:

Provider Name:

Provider’s OOD-VR Contact Name:

OOD Liaison:

Attendee Names:

Provider Management Program (PMP) Review (e.g. review of contacts, services, service areas)

No Changes Necessary Change in Contacts

Change in Services Change in Counties

Performance Review (Includes, but is not limited to, review of Scorecard data [e.g. comparison to previous version], referral capacity, VR Fee Schedule requirements, timeliness of services, and quality of services/reports.)

Fiscal Review (Includes, but is not limited to, review of timeliness of invoices, number of and reason for denials, and cancellations.)

Opportunities for Improvement (Include objective and measurable goals that the Provider and/or OOD can work towards before next meeting.)

Technical Assistance/Updates (May include, but not be limited to, discussion of current policy initiatives, change in rules/policies/procedures, best practices, and general guidance.)

Date/Time of Next Meeting:

FOR OOD USE ONLY

Copy sent to Provider on:

Copy sent to Area Manager and VR Supervisors on:

Copy sent to Central Office on:

Copies sent by:

Form 80-VR-09-01.A

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New School-Based Job Readiness Training Program Protocol

Initial Considerations of new School-Based Job Readiness Training ProgramsThe determination for the necessity of a School-Based Job Readiness Training program, (e.g. Project SEARCH, etc.), involves consideration of the following:

Is there a need for this program?1. Do other transition programs that provide School-Based Job Readiness Training services

(Project SEARCH or other) already exist in the area?2. Is there an unmet need in the area for a new or additional School-Based Job Readiness Training

program?3. What is the potential number of students with disabilities who have an identified need for the

intensity and duration of services offered by a School-Based Job Readiness Training program? Students who require such services include students who, based upon performance during the most recent summer work experience or other Pre-Employment Transition Services, are not expected to be job ready at graduation.

Is the host business an appropriate site for this program? 1. Does the identified host site have both the capacity and diversity of complex repetitive work

tasks to accommodate multiple internship rotations? 2. Are there employment opportunities with the host site that are in alignment with the

employment goals of students with disabilities? 3. Does OOD already have an existing relationship with the host business site? Is a Job Readiness

Training program the most effective way to source candidates with disabilities to the host site?4. What are the types of services and supports needed for the proposed host site?

When OOD staff are approached by a party (provider, business partner, etc.) interested in starting a Job Readiness Training program (staff should contact the OOD Supported Employment and Transition Unit supervisor to begin discussing the request with the Ohio Department of Education (ODE), Area Managers, Business Relations Specialists (BRSs) and local Vocational Rehabilitation Supervisor (VRS). If the initiation of a new School-Based Job Readiness Training site is deemed viable and appropriate by all parties, the OOD Area Manager identifies a VRS to take the lead with the interested party locally.

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Local Team Development If all parties determine that a School-Based Job Readiness Training program is needed in the area, OOD and ODE begin to assemble a local team. If the program is Project SEARCH, OOD and ODE would consult with Project SEARCH National, who can describe the licensing process and training requirements. This team includes:

OOD Area Manager, VRS, Business Relations Specialist (BRS) and assigned Liaison Counselor Career Technical Planning District (CTPD) or school district County Board of Developmental Disabilities (CBDD) Business Partner Community Rehabilitation Program (CRP) who is selected by the OOD and Business Partner

Planning Timelines and Advisory TeamIdeally, it takes at least one year for the planning team to work together for a successful implementation. This means that planning for a new School-Based Job Readiness Training should begin no later than August/September in order to implement a new program to begin the following school year. An ongoing Advisory Team should be identified and typically meets monthly while the School-Based Job Readiness Training program is being developed and implemented. Advisory Team members may be the same members as the initial local team, but should also include a family member, a young adult with a disability, and other community members such as the Workforce Investment Board, University Center for Excellence, etc.

OOD Quality AssuranceOOD remains part of the ongoing Advisory Team and typically participates in quarterly team meetings (as indicated in the OOD Provider Management Policy), monthly meetings to discuss participant progress, open houses, etc. In addition, OOD must be involved in the student selection process to ensure that students need the service to meet their employment goal. The VRS assigned to each Job Readiness Training host site meets with the CRP quarterly to discuss the program, including internship rotations, timing of job development, performance, and addresses any issues or concerns. This will include a semi-annual review of the scorecard to ensure the program is meeting minimum standards for performance.

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VOCATIONAL REHABILITATION SUPERVISORS & COUNTY ASSIGNMENTS

NOTE: In some cases a County may have more than one OOD Supervisor dependent on specialized services, e.g. BVR, BSVI, OTSP, Bridges, etc. VR Supervisor assignments are subject to change based on the needs of the VR Program. Information is current as of December 1, 2017.

AREA REGIONALOFFICE

CASETYPES

SUPERVISOR/EMAIL COUNTIES

NE Akron BVROTSP

Lynn [email protected]

Ashland (OTSP Only), Geauga, Holmes (OTSP Only), Lake, Lorain (OTSP Only), Medina, Portage, & Summit

NE Akron BVRRCD

Ashlee [email protected]

Columbiana (RCD Only), Lorain (RCD Only), Mahoning (RCD Only), Medina, Portage (RCD Only), Stark, Summit, & Trumbull (RCD Only)

NE Akron BVR James [email protected] Portage & Summit

NE Akron BSVIBVR

Nikki [email protected] Training Supervisor

NE AkronBSVIBVREF

Jennifer [email protected]

Lake, Medina, Portage (EF Only), & Summit

NE ClevelandBVREF

OTSP

Camille [email protected]

Ashtabula (EF Only), Cuyahoga, Geauga (EF Only), & Lake (EF Only)

NE Cleveland BVROTSP

Mallory [email protected] Cuyahoga

NE Cleveland BVR Nicholas [email protected] Cuyahoga

NE Cleveland BVRRCD

Carolyn O’ConnorCarolyn.o’[email protected] Cuyahoga

NE Cleveland BSVIBVR

Brandon [email protected]

Cuyahoga, Erie (BSVI Only), Huron (BSVI Only), Lake (BSVI Only), Lorain (BSVI Only),

NE YoungstownBSVIBVREF

Tina Copeland Columbiana, Mahoning, Trumbull

NE Youngstown BVROTSP

Brain Eskridge Ashtabula, Geauga (OTSP Only), Lake (OTSP Only),

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Mahoning, & Trumbull

NW Defiance BSVIBVR

Sherry [email protected]

Defiance, Fulton, Hancock (BSVI Only), Henry, Lucas (BSVI Only) Paulding, & Williams

NW Lima BSVIBVR

Kristen [email protected]

Allen, Auglaize (BSVI Only), Erie (BSVI Only), Hancock (BVR Only), Hardin (BSVI Only), Mercer (BSVI Only), Putnam, Seneca (BSVI Only), Wood, & Wyandot (BSVI Only)

NW Lima BVR Michelle [email protected]

Allen, Auglaize, Hardin, Mercer, & Van Wert

NW Mansfield BSVIBVR

Helen [email protected]

Ashland, Crawford (BSVI Only), Huron (BSVI Only) Knox, Marion (BSVI Only), Morrow (BSVI Only), & Richland

NW Mansfield BVR Nanette [email protected]

Crawford, Marion, Morrow, Sandusky, Seneca, & Wyandot

NW Toledo BSVIBVR

Jeanette [email protected] Training Supervisor

NW Toledo BSVIBVR

Merriam [email protected]

Fulton (BSVI Only), Lucas, Ottawa, Sandusky (BSVI Only), Williams (BSVI Only), & Wood

NW Toledo BVR Michael [email protected] Lucas

NW Toledo BVR Michelle [email protected] Lucas & Wood

NW Toledo BVR Sandra [email protected] Erie, Huron, & Lorain

SE Canton BVREF

OTSP

Cindy [email protected]

Ashland (EF Only), Carroll (EF Only), Columbiana (EF Only), Holmes (EF Only), Richland (EF Only), Stark, Tuscarawas (EF Only), & Wayne

SE Canton BVR Mark [email protected]

Carroll, Holmes, Jefferson, Start, Tuscarawas, & Stark

SE Columbus BSVIBVR

Beth [email protected]

Training Supervisor

SE Columbus BVROTSP

Jeremy [email protected]

Fairfield & Franklin

SE Columbus BVR Amanda Linard Franklin

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[email protected] Columbus BVR

EFRose [email protected]

Delaware & Fairfield

SE Columbus BVR Rob [email protected]

Franklin

SE Zanesville BVR Travis [email protected]

Belmont, Coshocton, Guernsey, Harrison, Licking, Muskingum, & Noble

SW Cincinnati BVROTSP

Teji [email protected]

Hamilton

SW Cincinnati BSVIBVREF

OTSP

Kim [email protected]

Adams, Brown, Clinton (BSVI & EF Only), Fayette (BSVI & EF Only), Clermont, &Highland

SW Cincinnati BVR Crystal [email protected]

Hamilton

SW Cincinnati BSVIBVR


Butler (BSVI Only), Hamilton, Preble (BSVI Only), & Warren (BSVI Only)

SW Cincinnati BVR Jerica [email protected]

Butler & Preble

SW Dayton BVR Sonya [email protected]

Clinton, Greene, & Warren

SW Dayton BSVIBVR

Crystal [email protected]

Training Supervisor

SW Dayton BSVIBVR

Lisa [email protected]

Champaign, Clark, Darke, Greene, Logan, Madison, Miami, Montgomery, Shelby, & Union

SW Dayton BVREF

OTSP


Clinton (OTSP Only), Darke, Fayette (OTSP Only), Greene (OTSP Only), Miami, Montgomery (OTSP Only), Preble (EF & OTSP Only) & Shelby

SW Dayton BVR Lisa [email protected]

Champaign, Clark, Logan, & Union

SW Dayton BVR David [email protected]

Montgomery

SW Wheelersburg BSVIBVR

Mary [email protected]

SW Wheelersburg BSVIBVR

Katherin [email protected]

Fayette, Lawrence (BSVI Only), Madison, Pickaway, Pike (BSVI Only), Ross, & Scioto (BSVI Only),

CASE KEYBSVI – Bureau of Services for the Visually Impaired

Page 136




mailto:Jerica.kruse@ood


mailto:rose.reed@ood


BVR – Bureau of Vocational RehabilitationEF – Employment FirstOTSP – Ohio Transition Support PartnershipRCD – Rehabilitation Counselor for the Deaf

TABLE OF CONTENTS

Page 137

Revision 1 Change Log (November 30, 2017)

Merged VR Forms Instructions & Examples into VR Provider Manual

Merged VR Provider Management Procedure & Summary into VR Provider Manual

Clarifications/Updated Topics: Service Requirements Examples Of Indirect Services (Non-Billable) Flat Fees Technical Guidance VR Reports & Invoices Technical Guidance Intake Technical Guidance Interpreter Technical Guidance Vocational Training Stipend Technical Guidance Job Readiness Technical Guidance Summer Youth Technical Guidance Work Adjustment Technical Guidance Job Development Technical Guidance Supported Employment Job Development Technical Guidance Repaid Placement Premium Technical Guidance

New Section: New School-Based Job Readiness Training Program Protocol

New Section: VR Supervisor Contacts & County Assignments

TABLE OF CONTENTS

Page 138

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