DRAFT AND PRELIMINARY Employm… · Preliminary Framework for Supported Employment And Sheltered Employment Services State of Illinois Department of Human Services, Division of Developmental

Preliminary Framework for Supported Employment

And Sheltered Employment Services

State of Illinois Department of Human Services,

Division of Developmental Disabilities

June 29, 2007

DRAFT AND PRELIMINARY

State of Illinois Department of Human Services


Preliminary Framework for Supported Employment and Sheltered Employment Services

DRAFT 06/29/2007 2

Objective

To gather information from other states regarding their supported employment and sheltered

employment programs to assist in the development of a definition and fee-for-service rate

methodology for the Division of Developmental Disabilities’ (DDD) supported employment

services (i.e., Programs 390, 36G, 36U, 39G, 39U) and to provide recommendations on policy

and regulatory implications for claiming waiver funds (Title XIX) for sheltered employment

services, including potential provider training needed. Illinois provides supported employment

services through DDD’s Adult Home- and Community-based Services (HCBS) Waiver and the

Division of Rehabilitation Services (DRS).

Background

Division of Developmental Disabilities’ Supported Employment Program1

The Adult HCBS waiver defines supported employment as follows:

Supported employment services consist of intensive, ongoing supports that enable participants,

for whom competitive employment at or above the minimum wage is unlikely absent the

provision of supports, and who, because of their disabilities, need supports, to perform in a

regular work setting. Supported employment may include assisting the participant to locate a job

or develop a job on behalf of the participant. Supported employment is conducted in a variety of

settings; particularly work sites where persons without disabilities are employed. Supported

employment includes activities needed to sustain paid work by participants, including

supervision and training. When supported employment services are provided at a work site

where persons without disabilities are employed, payment is made only for the adaptations,

supervision and training required by participants receiving waiver services as a result of their

disabilities but does not include payment for the supervisory activities rendered as a normal part

of the business setting.

Supported employment may be provided in integrated and competitive work settings in a

business or industry that primarily employs people without disabilities. Supported employment

does not include sheltered work or other similar types of vocational services furnished in

specialized facilities.

Transportation will be provided between the participant's place of residence and the employment

site or between habilitation sites (in cases where the participant receives waiver services in more

than one place) as a component part of supported employment services. The cost of this

transportation is included in the rate paid to providers of supported employment services.

1 Illinois Division of Developmental Disabilities Adult Home- and Community-Based Waiver

Application, Section C-4, pages 55-57, draft dated February 28, 2007.




DRAFT 06/29/2007 3

Summary of Illinois’ Current Reimbursement Methodology

Supported employment services are currently reimbursed through grants and a fee-for-service

methodology. For grant supported employment, the individual must be determined to have a

developmental disability. For Programs 36U, 36G, 39U and 39G, the individual must be

enrolled in the Medicaid waiver. Funding for Programs 36U, 36G, 39U, and 39G will be made

available only if an individual is found ineligible to receive DRS funding.

For all waiver participants, the annual rate is spread over 1,100 hours for any combination of

day programs. Payment during any month is limited to 115 hours for any combination of day

programs.

Summary of Illinois’ Division of Rehabilitation Services

The Division of Rehabilitation Services (DRS) operates the Vocational Rehabilitation Services

Program that includes supported employment services to individuals with disabilities.

Through our research, we found that the “model” states that we researched and interviewed

had good working relationships between the DRS-type agency and the Medicaid DD agency.

The two agencies often worked closely to share the supported employment service costs, where

the DRS agency would provide the short-term job search, training and coaching and the

Medicaid DD agency would provide the long-term supports. However, this relationship is not

common in most states because of budget limits, priority of service (order of selection of

individuals served) and limitations on inter-agency communication. In our experience we have

found that typically the DRS agency would not provide services to most individuals referred by

the DD agency and who would qualify for the Medicaid waiver, because they would not meet

the DRS order of selection criteria since most individuals would likely need long-term supports.

The DRS generally serves individuals who are highly likely to have a successful outcome by the

time the DRS time limited services end, without needing long-term supports.

Based on the fiscal year 2007 State Plan for Illinois DRS, the agency had updated its order of

selection criteria in 2005, the first order includes individuals with a most significant disability

according to Title II (SSDI) or Title XVI (SSI). These are the individuals who will first receive

services from DRS. For fiscal year 2006, the agency expected to serve and employ 210 persons

in supported employment. DRS has a waitlist for services. For all of these reasons, at this time,

DRS may not be a resource for DDD for supported employment like in some of the model

states. However, since we have not interviewed Illinois’ DRS to date, we will be able to further

examine this relationship and opportunity as follow-up to this initial report.




DRAFT 06/29/2007 4

Rehabilitation Act of 19732

Title I of the Rehabilitation Act of 1973 provides Federal funding to states to assist in the

operation of vocational rehabilitation programs for individuals with disabilities. The main

objective of the Rehabilitation Act is to assist individuals with disabilities to “maximize

employment, economic self-sufficiency, independence, and inclusion and integration into

society.” In addition, this Act ensures that the Federal government plays a leadership role in

promoting the employment of individuals with disabilities by providing time-limited services

and supports.

Each state submits a State plan for vocational rehabilitation services to identify the State agency

that will administer the plan and to outline the state’s specific rules and regulations for

provision of services, such as:

• The development of an individualized plan for employment

• Eligibility and availability of services

• Reporting requirements

• Financial responsibility

• Referrals to other Federal or State programs

The State plan also includes an assurance that the Governor of the State will ensure that an

interagency agreement is made between the agency responsible for the plan and other

appropriate public entities, including the State Medicaid agency.

Medicaid Infrastructure Grant

The Medicaid Infrastructure Grant (MIG) Program is authorized by Section 203 of the Ticket to

Work and Work Incentives Improvement Act of 1999 and administered by the Centers for

Medicare and Medicaid Services (CMS). Funding for the MIG program is intended to facilitate

enhancements to State Medicaid programs and services, to promote linkages between Medicaid

and other employment-related service agencies, and to develop a comprehensive system of

employment supports for people with disabilities. The Act requires participating states to offer

personal assistance services through the State’s Medicaid program sufficient to support

individuals in employment.

The MIG program began in federal fiscal year 2001 and was authorized by Congress for 11

years. Congress appropriated $150 million in funding over the first 5 years of the program and

2 “Rehabilitation Act of 1973”, Title 1: Vocational Rehabilitation Services, found online at

http://www.access-board.gov/enforcement/Rehab-Act-text/title1.htm, downloaded on June 26, 2007.




DRAFT 06/29/2007 5

funding for subsequent years are appropriated by increasing the previous year by the consumer

price index. If grants are approved, states are appropriated $500,000 per year at a minimum

and neither state nor local matching funds are required.

This Act expands Medicare and Medicaid coverage for certain categories of employed

individuals with disabilities and tries to address the conflict many people with disabilities face

of returning to work or losing healthcare coverage.

The MIG program was created to provide financial assistance to States to facilitate the

competitive employment of people with disabilities through (a) Medicaid buy-in opportunities

under the Medicaid State plan, (b) significant improvements to Medicaid services that support

people with disabilities in their competitive employment efforts, and (c) providing

comprehensive coordinated approaches across programs to removing barriers to employment

for individuals with a disability.

Medicaid Buy-in

One component of the MIG program, the Medicaid Buy-In program, allows states to expand

Medicaid coverage to workers with disabilities whose income and assets ordinarily would

make them ineligible for Medicaid. Eligibility requires that the individual has a disability (as

defined by the Social Security Administration) and earned income, and must meet certain

financial eligibility requirements established by the state. Participants typically pay a monthly

premium based on income that allows them to “buy into” the Medicaid program.

The most recent report on MIG reported that 39 states were operating grants. All of the states

that we researched and interviewed have MIGs and all but one state adopted a Medicaid buy-

in. Illinois also has a Medicaid Infrastructure Grant operated through the Department of Health

and Family Services called Health Benefits for Workers with Disabilities.3

Sheltered Employment

The DDD Fiscal Year 2008 Program Manual4 defines Regular Work/Sheltered Employment as

follows:

Regular Work/Sheltered Employment provides long-term employment in a sheltered environment

for individuals whose functional levels require supervision but are not precluded from future

movement into a Supported Employment position or a competitive employment position.

3 The Health Benefits for Workers with Disabilities website can be found at: http://www.hbwdillinois.com/ 4 “FY08 Developmental Disabilities Program Manual,” Illinois Department of Human Services, Division

of Developmental Disabilities, Program Descriptions/Services, found online at

http://www.dhs.state.il.us/serviceProviders/grantsContracts/CSA08/DD/ProgramDescriptions.asp




DRAFT 06/29/2007 6

Regular Work/Sheltered Employment provides general work supervision, including direction and

on-the-job training in such areas as work expectations, workplace behavior, compliance to

workplace safety standards, production and task completion. This program provides the

opportunity to participate in productive work and to be compensated for that work in accordance

with the Fair Labor Act of 1938 (29 U.S.C. 208).

For the states in which we focused our research, “sheltered employment” types of services are

provided to individuals with developmental disabilities in all six states: Florida, Minnesota,

Missouri, Oregon, Washington and Wisconsin. The programs in Florida, Washington and

Wisconsin define these services consistent with the Home- and Community-based Services

(HCBS) waiver definitions thus enabling the claiming of Title XIX funds; “sheltered

employment” is not a waiver-coverable service so the service is defined consistent with the

waiver requirements. For example, Florida includes “sheltered employment” as an option

under the Adult Day Training service, and Wisconsin defines “sheltered employment” services

as Pre-Vocational Services in their waiver. Alternatively, Minnesota operates a “sheltered

employment” program that is 100 percent state-funded. The common theme for these states is

that they do not use the term “sheltered employment” in their waivers, but the actual services

provided are similar to those we believe are provided in Illinois.

The HCBS Waiver Application Instructions5, published by CMS, provide core definitions for

services covered under an HCBS waiver, and the core definition for prevocational services is as

follows:

Services that prepare a participant for paid or unpaid employment. Services include teaching

such concepts as compliance, attendance, task completion, problem solving and safety. Services

are not job-task oriented, but instead, aimed at a generalized result. Services are reflected in the

participant’s service plan and are directed to habilitative rather than explicit employment

objectives. Meals provided as part of these services shall not constitute a "full nutritional

regimen" (3 meals per day).

Massachusetts’ recently approved HCBS waiver defines their “sheltered employment”-type

services as follows:

Center-based work - Center-based work is a prevocational service delivered in settings that

provide supports that lead to the acquisition, improvement and retention of skills and abilities

that prepare an individual for work and community participation. Services are not job task

oriented, but intended to address underlying generalized habilitative goals, such as attention

span and task completion, that are associated with performing compensated work. Prevocational

5 “Instructions, Technical Guide and Review Criteria Application for a §1915(c) Home and Community-

Based Waiver [Version 3.4],” Centers for Medicare and Medicaid Services (CMS), Appendix C,

Attachment Core Service Definitions, page 140.




DRAFT 06/29/2007 7

services are provided to persons who are not expected to join the general workforce within one

year of service initiation (excluding supported employment). Documentation is maintained in

the file of each participant receiving this service that the service is not available under a program

funded under section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities

Education Act.

Day Services and Supports - Day Services and Supports provide for day activities typically for

participants with extensive and pervasive support needs. Supports are designed around the

preferences and choices of each participant and often include assistance to learn functional self-

help, academic, language, social, community integration and or prepare a participant for paid or

unpaid work.

Illinois DDD may want to consider incorporating one or a combination of these service

definitions into their Adult HCBS waiver to claim Title XIX funds for “sheltered employment”-

type services.

Summary of Other States’ Approaches to Supported Employment

Navigant Consulting, Inc. (NCI) has gathered information from six states through online

research and conference calls to understand how other states operate their Supported

Employment and Sheltered Employment programs.

We have summarized each of these states’ Supported Employment programs below. Please

refer to the appendices for more information.

Florida

The State of Florida offers employment services to persons with a developmental disability

through the Department of Education, Division of Vocational Rehabilitation (DVR) and through

its Agency for People with Disabilities (APD), which operates the Medicaid HCBS waiver

programs. These two State agencies work together to develop Individual Plans for

Employment (IPE) for Medicaid Waiver participants, and APD refers the waiver participants

interested in finding employment to DVR so the participant may begin the first phase of

supported employment.

Typically, the DVR provides the first phase of employment services to all persons interested in

supported employment including job search assistance, training, coaching and supplying

modifications that allow the person with a disability to perform their job (this is only true if they

find in their eligibility determination phase that the person is not going to or is likely to not

need ongoing supervision on the job). DVR provides supported employment services to both

Medicaid and non-Medicaid participants. There is a time limit on DVR services because these




DRAFT 06/29/2007 8

services are funded under the Rehabilitation Act of 1973, and DVR will close a case when a

person is successfully employed for 60 days.

Supports after the closure of DVR assistance for persons not on a Medicaid waiver can occur

through natural supports, e.g., at the work place, from family or friends. Persons on either the

Developmental Disabilities HCBS waiver or the Family and Supported Living Waiver may

choose supported employment services that would occur after the person was stabilized in a job

to help them maintain the job. There are no time limits on these waiver services; however the

individual must continue to qualify for the HCBSwaiver.

� Medicaid Infrastructure Grant - Basic

� Medicaid Infrastructure Grant - Comprehensive

� Medicaid Infrastructure Grant - Conditional

� Medicaid Buy-in

� Sheltered Employment




DRAFT 06/29/2007 9

Minnesota6

The Department of Human Services, Disability Services Division and the Department of

Employment and Economic Development (DEED) Vocational Rehabilitation provide supported

employment services to individuals with developmental disabilities through three Home- and

Community-based Services (HCBS) waivers and the Rehabilitation Act of 1973, respectively.

The Vocational Rehabilitation program within DEED identifies two avenues for individuals, i.e.,

placement with time-limited supports and placement with ongoing supports.

Minnesota is recognized as having one of the highest rates of employment of people with

disabilities in the United States. The State strives to bring together all aspects of the

employment spectrum: individuals with disabilities, employers, businesses, government and

providers. Minnesota’s statewide strategic plan “Pathways to Employment” is funded by its

Medicaid Infrastructure Grant from CMS and acts to coordinate the activities of DEED and

DHS. Minnesota’s Medicaid buy-in program, Medical Assistance for Employed Persons with

Disabilities has been in place since 1999 and has contributed to Minnesota’s success in

employing individuals with disabilities.

6 To date, we have not conducted follow-up interviews with Minnesota to complete this research.


� Medicaid Infrastructure Grant – Comprehensive


� Medicaid Buy-in





DRAFT 06/29/2007 10

Missouri

The Missouri Department of Mental Health, Division of Mental Retardation and Developmental

Disabilities (DMRDD) and the Department of Elementary and Secondary Education, Division of

Vocational Rehabilitation (MDVR) provide supported employment services to individuals with

developmental disabilities through two HCBS waivers and the Rehabilitation Act of 1973,

respectively. Individuals transition from MDVR services when they have reached a point of job

stability for a period of 90 days, and MDVR places an 18-month limit on service provision

through their agency. Individuals then begin to receive services through DMRDD on a long-

term basis with no time limitations on the support provided. Sheltered employment is not a

waiver service in Missouri, but waiver participants can access sheltered employment services

through the Division of Special Education. There are 92 sheltered workshops throughout the

State.

DMRDD negotiates rates with service providers; therefore, rates vary between providers.

MDVR uses an outcomes-based reimbursement methodology where providers receive a

payment upon completion of a full assessment, job coaching and job development and

placement.




� Medicaid Buy-in





DRAFT 06/29/2007 11

Oregon

The Department of Human Services, Office of Developmental Disability Services (ODDS) and

the Office of Vocational Rehabilitation Services (OVRS) provide supported employment

services to individuals with developmental disabilities through two HCBS waivers and the

Rehabilitation Act, respectively. OVRS’s primary supported employment responsibilities are

intensive training and support services during the first 18 months and stabilization of

supported employment. ODDS will provide the ongoing supports after the job has been

stabilized, however, the supported services offered through the two waivers are different in

each of the waivers. The primary differences in these waivers are in the individual budget

amounts, provider rates structures and service requirements.

ODDS stated that they are in the process of examining their supported employment program.

They had established a task force to develop a mission, vision and goals for supported

employment. Currently, individuals choose sheltered employment services more often than

supported employment. The sheltered workshops provide coaching, job development and

ongoing supports, much like the OVRS program. The State would like to have more people

using supported employment instead of sheltered workshops.




� Medicaid Buy-in





DRAFT 06/29/2007 12

Washington

In Washington State, the Department of Social and Health Services, Division of Developmental

Disabilities (DDD) and the Division of Vocational Rehabilitation (DVR) provide supported

employment services to individuals with developmental disabilities. DVR’s primary supported

employment responsibilities are intensive training and support services during the first 18

months as well as stabilization of supported employment. Once an individual is stabilized in

their employment, DVR assists them in the transition to extended services, which are provided

by another State agency. DDD provides both short-term and long-term services because

supported employment services are not time limited for waiver-eligible individuals.

While DDD covers supported employment through their four HCBS waivers, and DVR

operates their program under the Rehabilitation Act of 1973, both programs receive State and

Federal funding. Individuals generally begin receiving services through DVR, but are able to

begin receiving services through DDD if DVR funding is unavailable, the individual is ineligible

for DVR or if the individuals already have a job but need ongoing support (beyond the time-

limited support available through DVR).

The supported employment programs through DDD and DVR are county-based where the

providers contract with the county government to provide services. DDD allocates funding to

the counties based on an average amount per consumer per month, and the counties determine

service rates at their discretion. Alternatively, DVR reimburses providers using outcomes-

based payments where a payment is made upon completion of a particular task, such as the

completion of a plan of employment or job placement.




� Medicaid Buy-in





DRAFT 06/29/2007 13

Wisconsin

The State of Wisconsin provides supported employment programs through the Department of

Health and Family Services, Division of Disability and Elder Services (DDES) and the

Department of Workforce Development, Division of Vocational Rehabilitation (DVR). Waiver

services are generally accessed through DDES once funding has been exhausted through DVR.

Individuals with disabilities can receive services through DVR for up to 18 months, but services

are not time-limited through DDES as long as a person remains eligible.

DDES covers supported employment services under their five HCBS waivers, and DVR

operates their program under the Rehabilitation Act of 1973. Both of these programs in

Wisconsin operate at a county-level where individuals access services through county offices.

DDES allocates funding to the counties based on an average amount per consumer per day, and

allows the counties to determine provider licensing and rate setting rules and regulations. DVR

reimburses providers using an outcomes-based approach.

Wisconsin is in the process of transitioning to a managed care system. Once this transition is

complete, supported employment services through DDES and DVR will be accessed through

resource centers, which are region-based centers, rather than county-based agencies.

DDES also provides sheltered employment-type services through two of their HCBS waivers:

the Community Integration Program Waiver (CIP 1A/1B) and the Brain Injury Waiver (BIW).

These services are called Pre-Vocational Services and are defined as services to teach an

individual the skills necessary to succeed in employment (this service definition is consistent

with the CMS core definitions).




� Medicaid Buy-in





DRAFT 06/29/2007 14

Conclusions

Our research is summarized in the attached matrix, Appendix A, with sources listed in

Appendix B. Listed below are possible steps that IL DDD could take to review the supported

employment program in the State.

• DDD should ensure that there is a memorandum of understanding or an interagency

agreement with DDD or the Department of Health and Family Services (DHFS) and

DRS. This agreement would need to specify roles and responsibilities of each agency

as well as referral and documentation requirements. If desired, NCI could provide

examples of such agreements.

• DDD must examine the use of DRS supported employment services by individuals

on the HCBS waiver to ensure that the use of DRS federal funds are utilized prior to

HCBS waiver funding when possible.

• DDD should review service definitions, eligibility, provider requirements and

funding/service rates to determine what modifications and changes must be made.

• DDD should develop a plan to modify definitions and provide training to relevant

stakeholders.

Department of Health and Family Services


Appendix B: Sources

DRAFT 06/29/2007 1

Florida

1. “Developmental Disabilities Waiver Services Coverage and Limitations Handbook,”

Florida Agency for Health Care Administration, June 2005. Available on-line:

http://floridamedicaid.acs-inc.com/XJContent/DS_WaiverHB.pdf?id=000000843684

2. “Handbook to Services” State of Florida Department of Education, Division of

Vocational Rehabilitation, Revised 11/2006. Available on-line:

http://www.rehabworks.org/Files/DocumentsLinks/Handbook%20of%20Services%20200

6.pdf

3. “Resource Manual November 2006,” Florida Agency for Persons with Disabilities

Available on-line: http://apd.myflorida.com/about/docs/apd-resource-manual-

november-2006.pdf

4. “Family and Supported Living Waiver Quick Reference for Services” Florida Agency for

Persons with Disabilities, April 2007. Available on-line:

http://apd.myflorida.com/customers/docs/fsl-quick-reference-guide.pdf

Minnesota

1. State of Minnesota Department of Employment and Economic Development,

Rehabilitation Services webpage. http://www.deed.state.mn.us/rehab/

2. State of Minnesota Department of Human Services Disability Services Division

webpage.

http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&

RevisionSelectionMethod=LatestReleased&dDocName=id_000083

3. Pathways to Employment Program, State of Minnesota Department of Employment and

Economic Development, Rehabilitation Services. Available on-line:

http://www.deed.state.mn.us/pte/

4. “2006 Centers for Medicare and Medicaid Comprehensive Employment-Medicaid

Infrastructure Grant Submission – Pathways to Employment Strategic Plan for 2006-

2010,” State of Minnesota Department of Employment and Economic Development,

Rehabilitation Services. Available on-line:

http://www.deed.state.mn.us/pte/PDFs/MAEPDstratPl.pdf

5. “Review of Minnesota’s Vocational and Employment Services for Individuals with

Disabilities: Focus on Day Training and Habilitation,” The Lewin Group, February 2006.

6. Medical Assistance for Employed Persons with Disabilities (MA-EPD), Minnesota

Department of Human Services Disability Services Division webpage.

http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&

RevisionSelectionMethod=LatestReleased&dDocName=id_004088



Appendix B: Sources

DRAFT 06/29/2007 2

Missouri

1. “Supported Employment (SE) Agreement,” Vocational Rehabilitation, Missouri

Department of Elementary and Secondary Education. Available on-line at:

http://vr.dese.mo.gov/vr/co/VRWebsite.nsf/web/SESPAgreementPage?opendocument

2. “Vocational Rehabilitation General Administrative Policies,” Missouri Department of

Elementary and Secondary Education. Available on-line at:

http://www.dese.mo.gov/schoollaw/rulesregs/904200.htm

3. “Missouri Medicaid Manuals,” Missouri Division of Medical Services. Available on-line

at: http://manuals.momed.com/lpBin22/lpext.dll?f=templates&fn=main-j.htm&2.0

4. “Missouri’s Medicaid Waiver for Persons with Mental Retardation and Developmental

Disabilities,” Missouri Department of Mental Health. Available on-line at:

http://www.dmh.mo.gov/mrdd/progs/waiver/factsheet.htm

5. “Missouri’s Guide to Home and Community Based Services,” Missouri Department of

Social Services, Division of Medical Services. Revised September 2005. Available on-

line at: http://www.gcd.oa.mo.gov/pdf/GCDServices.pdf

6. “Senate Bill 40 Enabling Legislation,” The Missouri Association of County

Developmental Disabilities Services. Available on-line at:

http://www.macdds.org/senate_bill.html

Oregon

1. Oregon Department of Human Services, Office of Developmental Disabilities Services

Homepage, available on-line: http://www.oregon.gov/DHS/dd/

2. “Working Together To Reach Employment Goals For Persons with Developmental

Disabilities,” Oregon Department of Human Services, Office of Developmental

Disabilities Services, available on-line:

http://www.dhs.state.or.us/dd/supp_emp/se_basics_1.pdf

3. Oregon Department of Human Services, Office of Vocational Rehabilitation Homepage,

available on-line: http://www.oregon.gov/DHS/vr/

4. “Draft 2008 State Plan Update” Oregon Department of Human Services, Office of

Vocational Rehabilitation, available on-line:

http://www.oregon.gov/DHS/vr/publications/08stateplan_draft.pdf

5. “Oregon Competitive Employment Project: A systems change initiative to develop

comprehensive employment supports for persons with disabilities,” Oregon Department

of Human Services, Office of Vocational Rehabilitation

http://www.oregon.gov/DHS/vr/cep/docs/07_activitiesupdate.ppt



Appendix B: Sources

DRAFT 06/29/2007 3

Washington

1. “Washington Initiative for Supported Employment, A Corporate Initiative: Hiring

People With Disabilities”, Found online at:

http://www.theinitiative.ws/SupportedEmployment.asp

2. “Washington County Services for Working Age Adults”, Division of Developmental

Disabilities Policy Manual (Policy 4.11), Found online at:

http://www1.dshs.wa.gov/pdf/adsa/ddd/policies/policy4.11_07_04.pdf

3. Washington Administrative Code (WAC), Vocational Rehabilitation Services (Title 67),

Found online at: http://apps.leg.wa.gov/WAC/default.aspx?cite=67-25-436

4. Washington State Department of Social and Health Services, Division of Developmental

Disabilities, Home and Community Based Waiver Program, Found online at:

http://www1.dshs.wa.gov/ddd/waivers.shtml

5. “Fact Sheet: Division of Developmental Disabilities Waiver Plan”, Washington State

Department of Social and Health Services, July 2006. Found online at:

http://www.adsa.dshs.wa.gov/professional/factsheets/dd%20waivers%20plan%20fact%2

0sheet%207-06.pdf

Wisconsin

1. “Medicaid Home & Community-Based Waivers Manual for the Community Integration

Program IA (CIP IA), Community Integration Program IB (CIP IB), Brain Injury Waiver

(BIW) and Children's Long-Term Support (CLTS) waivers”, Department of Health and

Family Services, March 2005. Found online at:

http://dhfs.wisconsin.gov/bdds/waivermanual/

2. “Review of Minnesota’s Vocational and Employment Services for Individuals with

Disabilities: Focus on Day Training and Habilitation”, Prepared by the Lewin Group,

February 2006. Found online at:

http://www.dhs.state.mn.us/main/groups/disabilities/documents/pub/dhs_id_057670.pd

f

3. “Wisconsin DVR State Plan - Title VI Supported Employment”, Wisconsin Vocational

Rehabilitation Knowledgebase, found online at:

http://dwd.wisconsin.gov/dvr/knowledgebase508/wisconsin_dvr_state_plan_-

_title_vi_supported_employment.htm

4. “Wisconsin DVR State Plan - Supported Employment and Extended Services”,

Wisconsin Vocational Rehabilitation Knowledgebase, found online at:

http://dwd.wisconsin.gov/dvr/knowledgebase508/wisconsin_dvr_state_plan_-

_supported_employment_and_extended_services.htm



Appendix B: Sources

DRAFT 06/29/2007 4

5. Wisconsin Department of Workforce Development. Vocational Rehabilitation

Knowledgebase. Do the Regulations Restrict Individual Choice? Found online at:

http://dwd.wisconsin.gov/dvr/knowledgebase/federalregulations_appendix2.htm

6. “Long Term Care Program Options For Wisconsin’s Elderly and Disabled Adults –

2007,” Wisconsin Department of Health and Family Services. Available on-line at:

http://dhfs.wisconsin.gov/ltc_COP/ltcprograms-adults.pdf

7. “Integrating Employment into the Medicaid System: The Managed Care and

Employment Task Force, a project of the Wisconsin Pathways to Independence

Medicaid Infrastructure Grant,” Wisconsin Department of Health and Family Services.

Available on-line at:

http://www.nchsd.org/AccessDocument.cfm?document=WI_MCETF.doc