In Wisconsin, supported employment is funded by primarily three sources; DVR Title IB and VI funding and long-term funding directed by the Wisconsin Department of Health Service's, Division of Long Term Care (DHS/DLTC) and managed locally by regional managed care organizations or a self directed support system known as (56 counties) and by county human service agencies transitioning to Family Care (16 counties). To a much lesser extent, Social Security PASS plans, the Ticket to Work (TTW), natural supports and private party payments have been used to maintain a small number of individuals in long-term supported employment. DVR is promoting the TTWO Partnership Plus to ticket holders which has the potential to increase funding for long-term supports. All of these financial resources enhance the quality, scope, and extent of services proposed under the Title VI plan.
The quality of the DVR supported employment program includes the following components:
1. Use of DVR technical assistance to provide coordination, guidance, and consultation to counselors developing and implementing supported employment individualized plans for employment. DVR training and technical assistance is provided statewide for both service providers and DVR staff on the technical specifications for supported employment service agreements. These technical specifications are posted on the DVR public website.
http://dwd.wisconsin.gov/dvr/pdf_files/dpi_interagency_agreement.pdf
2. DVR staff are also involved with the planning and provision of supported employment training in collaboration with the Wisconsin Board for People with Developmental Disabilities (BPDD), the Association for Professionals in supported Employment (APSE) as well as the joint Wisconsin Rehabilitation Association (WRA) and Rehabilitation for Wisconsin (RFW) annual Rehabilitation and Transition Conference.
3. The DVR’s technical specifications for Supported Employment include strong outcome measures and statewide fee for service payment rates for supported employment services. The supported employment fee schedule is posted on the DVR public website: http://dwd.wisconsin.gov/dvr/service_providers/statewide_service_fee_structure_2009.pdf The fee structure is reviewed on a regular basis and will be reviewed again in FY11 in relation to the Division’s newly issued guidance related to defining the standards for competitive employment in an integrated setting.
4. DVR guidance pieces are provided to DVR staff as well as external stakeholder partners to assist in the provision of supported employment services. Guidance documents are designed to explain supported employment service and outcome policy as it relates to the Rehabilitation Act and its implementing regulations, and to provide best practice suggestions and answer common questions.
The scope and extent of supported employment is affected by the availability of extended services funding for ongoing employment supports available in integrated community settings. The expansion of support services for individuals seeking competitive employment in an integrated setting has been primarily achieved through the Department of Health Service (DHS) expansion of the Family Care system in Wisconsin. The expansion of Family Care eliminates wait lists over a 3-4 year period The plan by DHS is to have Family Care implemented statewide. DVR staff also identify and use other extended support service and funding resources such as employer and natural supports, Plans to Achieve Self-Support (PASS), Impairment Related Work Expenditures (IRWE), and family support. . The recently proposed 2011-13 State Budget, however, proposes a freeze for this program. The State Legislature would have to approve the freeze prior to enactment.
The Individual Plan for Employment (IPE) for DVR consumers, who select competitive employment in an integrated setting but may require long term employment support, usually begins with an assessment to help determine the employment goal related to the consumer’s interests and strengths. The assessment process may include trial work to help identify the extent of supports that may be necessary. If needed, the potential source(s) of funding for the long term employment supports must also be identified. If the source of extended services cannot be identified at the time of implementation of the employment plan, the plan must at least identify the services, activities and/or progress measures designed to identify the nature, type, scope, requirements and source of extended services. The DVR identifies extended services from private nonprofit organization, employers, and other appropriate resources for an individual with a most significant disability transitioning from employment supports provided by the DVR. Supported employment services funded by Title VI are provided only to those individuals with the most significant disabilities and who, as may be required, have an identified likely source of long term support.
The timing of the transition to extended services for consumers receiving supported employment services from the DVR as part of their approved employment plan occurs as soon as the plan services are completed and the consumer has achieved the employment outcome described, or after a period of time not to exceed 18 months whichever comes first. The DVR may, under special circumstances, extend supported employment services beyond 18 months if the eligible individual and the VR counselor agree to extend the time to achieve the employment outcome identified in the plan.
During FFY09 DVR provided a leadership role on the “Managed Care and Employment Task Force”, established by the Department of Health Services, Division of Long Term Care (DHS/DLTC). DVR’s also established an interagency Memorandum of Agreement for service coordination with the Department of Public Instruction (DPI) and DHS/DLTC. During FFY10, DVR provided substantive review and input into the definition of and technical guidelines for the DHS Prevocational Services in Family Care and Family Care Partnership Programs.
DVR also developed a white paper on the standard for a competitive, integrated employment outcome when extended supports are needed. The paper was shared with DVR staff and Community Rehabilitation Program partners. DVR has used and will continue to use the recommendations made by the Managed Care and Employment Task Force, the DHS Prevocational Services guidelines and the DVR standard for a competitive, integrated employment outcome for planning and implementation of statewide services in supported employment. The interagency Memorandum of Agreement with DPI and DHS/DLTC remains in place during FFY13 and will continue to inform efforts to include high school transition students as well as adults in supported employment and extended services.
Both the DHS Task Force and DVR’s interagency MOU are focused on developing coordinated services and funding mechanisms, within the context of the Family Care Managed Care service delivery system. In the next five years it is anticipated that extended employment supports for students in transition and adult consumers will be delivered on a statewide basis through the Family Care service delivery system. A successful deployment of Family Care services throughout Wisconsin will mean that DVR consumers who desire community employment and are in need of extended employment supports will be able to access those supports without a wait for extended employment support funding.
The DVR will continue to support collaborative efforts aimed at expanding integrated, competitive community employment opportunities for those in need of supported employment services. The Department of Health Services (Medicaid Agency), the Community Rehabilitation Program provider community, and the regional Managed Care Organizations are all current collaborative partners.
(the above is unofficial text for cross reference purposes)