Aligning CMS 1915 c Employment Services with State Policies to Achieve

Employment First OutcomesAUCD ConferenceWashington D. C.

November 10, 2014Susan Killam, M.Ed.; David Mank, Ph.D., Wendy

Parent-Johnson, Ph.D., & Philip Wilson, Ph.D.

Recent Events Providing Opportunities for UCEDD Involvement

• Policy and Legislative – 1915 (c) HCBS Waiver program rule changes– Workforce Innovation Opportunity Act (WIOA)– EEOC policy directing implementation of Section 503 of Rehab Act

• Court– Olmstead integration mandate

• Rhode Island settlement

• Initiatives– Employment First – State Employment Network (SELN) activities and collaborations

with NASDDDS– National Governor’s Association Conference – State’s as Model Employers– 6 by ‘15 Campaign

Changes in 1915 c HCBS Waiver Rule• Key Points of final rule:

– Establishes “quality of setting” requirements to ensure that services are being provided in Community; defines HCBS settings by:• “what they are not”• Nature and quality of settings

– Excludes certain provider owned and “institutional” (residential) settings• Opens the door to excluding provider owned & segregated

Employment/Day Rx settings from HCBS reimbursement

– Gives states 120 days from time of submitting 1915 c waiver renewals/amendments to submit plan with timeframes & benchmarks for ensuring waivers comply with new requirements• Additional guidance on how states should apply the

“community setting standards” to non-residential settings

Changes in 1915 c HCBS Waiver Rule(continued)

• For services provided under a 1915 c state plan:– State must complete a person centered plan (PCP)

annually– State must conduct an independent assessment of

the individual’s needs and strengths to determine specific services and supports required• Like VR requirement, individual must have access to support

during the assessment • If unpaid staff will be relied upon to implement the service

plan (natural support), a caregiver assessment must be done

– If the individual wishes to self-direct, information and supports needed to self-direct must be obtained

Workforce Innovation Opportunity Act• Increased VR role in Transition

– State VR required to maintain 15% of its allotment for youth transition services

• Limitations on subminimum wage– Restricts & defines when employers may pay sub-

minimum wage to workers under the age of 24– Prohibits schools from contracting with

providers/employers who pay subminimum wage

• Collaboration between state VR and I/DD agencies– Requires formal cooperative agreement between state

agency that administers the Medicaid plan and VR with respect to VR services, including extended services

WIOA (continued)

• WIOA Defines Competitive Integrated Employment– Full- or part-time work at minimum wage or higher, with wages and

benefits similar to those without disabilities performing the same work, and fully integrated with nondisabled co-workers

• Customized Employment an Available VR Service– Competitive integrated employment for an IWD based on an

individualized determination of the strengths, needs, and interests of the individual, and the business needs of the employer, carried out through flexible strategies

• Defines Supported Employment (SE)– New definition makes clear that SE is integrated competitive

employment, or an IWD working on a short-term basis in an integrated employment setting (with lower wage/benefits) in preparation for working in integrated competitive employment

– New definition extends “post-employment support services” from 18 to 24 months

WIOA (continued)

• Emphasis of SE state grants on youth– Requires 50% of money states receive under the

SE state grant program used to support youth with the most significant disabilities (up to 24 yrs old)

– *Youth receiving SE services under SE state grant may receive extended services to maintain the person in employment for up to four years

*”youth with most significant disabilities” has not yet been defined but could become a key issue and opportunity for UCEDD involvement

WIOA (continued)

• Changes in *Performance Measures– Entering and retaining employment– Median earnings– Obtaining an educational credential

• HS diploma, post-secondary credential

– Skill gains via post-secondary education/training– Effectiveness in serving employers

*These measures are new requirements; have not been defined nor has data collection/reporting procedures been operationalized- so good opportunity for UCEDDs to get involved in their state

WIOA (continued)

• Increased emphasis on serving job seekers with I/DD within the general workforce development system/One-Stop Centers– Workforce Development boards responsible for

developing strategies to support career pathways for IWD

– Local Workforce Development boards may now include community organizations that provide or support competitive integrated employment for IWD

– Employment Networks (EN) are specified as optional One-Stop partners

WIOA (continued)

• Opportunities for UCEDD involvement in post-secondary education– RSA commissioner may fund TA to “better

enable individuals with I/DD to participate in post-secondary ed. and obtain/retain competitive integrated employment

– Mandate for VR to maintain 15% of its allotment for youth Transition services

– New performance measures• “obtaining post-secondary credential” • “skill gains via post-secondary education/training”

EEOC Section 503 Implementation Policy

• Goal of 7% of employees of businesses/ organizations that receive federal funds will have disabilities (not a quota) – 7% goal applies to each job group or to the entire

workforce if there are fewer than 100 employees– Invite applicants and employees to voluntarily self-

identify as a person with a disability – Reach out to recruit individuals with disabilities

• Create partnerships with disability organizations. All outreach, partnerships and recruitment efforts should be documented

• Track and collect data – Document the number of individuals with disabilities

who applied, self-identified, were hired, and are currently employed

Olmstead Integration Mandate

• Principles of integration and choice established basis for much of the court, legislative and policy changes that undergird realignment of policies, funding and service delivery that supports meaningful employment outcomes for individuals with I/DD

Rhode Island Settlement• Illustrates DOJ’s commitment to enforcing ADA

provisions outlined in Olmstead – Services, programs & activities must be delivered in

*most integrated setting appropriate to the needs of IWD

– Established that civil rights of IWD are violated by unnecessary segregation in non-residential settings including: segregated employment, vocational & day programs (see pp 13-17 for description of characteristics and negative impacts of segregated settings)

*defined by DOJ as settings that enable IWD to interact with nondisabled persons to the fullest extent possible

SELN Collaboration with NASDDDS

• ICI Boston (UCEDD), Supported Employment Leadership Network (SELN) long history of providing TA and data collection/reporting regarding Supported Employment to Lead State I/DD agencies – Policy– Implementation– Outcomes

• State Data: The National Report on Employment Services and Outcomes

Employment First

• APSE– Resources– National map of activities– Employment First, Employment Now

(AFP vision)– Employment support professional

certification (CESP)

• State Efforts• Federal Initiatives

National Gov’nors Association Report by Gov. Markell

• Recommendations from the Framework proposed by Governor Markell to Governors in other States:– Make Employment First and States as Model

Employers principles integral to the state’s Workforce Development strategy

– Begin preparation for transition early– Ensure all stakeholders (educators, families, the

student, employers, service providers) have high expectations

– End “train and pray” practices by securing employer partners

States as Model Employers

• Initiative to remove barriers to employment and retain/advance qualified employees with disabilities. Recommended action steps:– Improve organizational readiness and create

more welcoming environment for employees with disabilities

– Proactive and targeted recruitment & outreach– Improve accessibility of employment

application and hiring process for IWD– Improve access to workplace accomodations

6 by ‘15 Campaign

• First goal identified by Senator Harkin– Initiative of AUCD and other partners– Goal is for 6 million individuals with

disabilities to have integrated competitive employment by 2015