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1915c Waiver Employment
Billing Guidelines and
Payment Rates
Nehtra Davis
Program Specialist, HHSC
November 16, 2017
1915c Waiver Employment Services
• Employment Assistance (EA) services consist
of developing and implementing strategies for
achieving the individual’s desired
employment outcome, including more suitable
employment for individuals who are
employed.
• Supported Employment (SE) is assistance
provided in order to sustain competitive
employment or self-employment.2
Examples of Billable EA supports/activities
Services are individualized, person-directed, and
may include:• Exploring an individual's employment preferences
(where do I want to work?)
• Transportation needs for employment (going to
look for jobs)
• Filling out job applications
• Writing resumes
• How to dress for an interview
3
Examples of Non-Billable EA
supports/activities
• Face-to-face contact with an individual to
provide EA services simultaneously with Day
Habilitation services, Supported Employment,
CFC PAS/HAB or Respite.
• EA services accessed and/or funded through
other sources at no cost to the program
provider such as Employment Services
through Texas Workforce Solutions-
Vocational Rehabilitation Services formally
known as DARS.
• Life skills training such as hygiene/grooming
4
Examples of Billable SE supports/activities
• Employment adaptations (iPad to read totals
aloud to cashier)
• Transportation to and from work
• Communicating with managers to maintain
and sustain stable employment
• Assisting individual in reporting income to
Social Security
• Training or consulting in work-related tasks
5
Examples of Non-Billable SE
supports/activities
• Interacting with an individual prior to individual
obtaining employment (this could potentially be
billed as EA instead of SE)
• Face-to-face contact with an individual to
provide SE services simultaneously with Day
Habilitation services, Supported Employment,
CFC PAS/HAB or Respite.
• Any activity taking place in a sheltered work
environment or similar types of vocational
services in specialized facilities.
• Paying the individual as an incentive to 6
Service Log for EA
Must include information below that pertains to
individual’s progress toward employment
goals:• Name of individual
• Type of service
• Date of service
• Place of service
• Start and end time of each billable event
• Description of service event
• Name of service provider
• Signature of service provider 7
Written Documentation for SE
Program Providers must have written
documentation to support a service claim for
SE and that documentation must:
• Meet requirements set forth in Section 3800
(Written Documentation) https://hhs.texas.gov/laws-
regulations/handbooks/home-community-based-services-hcs-program-billing-guidelines/hcsbg-
section-3000-general-requirements-service-components-based-billable-activity
• Include start and end time of SE services provided
• Include evidence that SE services are not
available under a program funded under IDEA for
individuals under 22 yrs. old
• Include justification in the PDP reason(s) why
activities are simultaneously being performed by
8
Links for Billing Guidelines and Payment
Rates
• http://legacy-hhsc.hhsc.state.tx.us/rad/long-
term-svcs/index.shtml
• https://hhs.texas.gov/laws-
regulations/handbooks/home-community-
based-services-hcs-program-billing-
guidelines/hcsbg-section-4000-specific-
requirements-service-components-based-
billable-activity9
HHSC Employment Recruitment
Coordinator (ERC) Activities
Monty Chamberlain
Presentation to
Private Providers Association of Texas (PPAT)
November 17, 2017
Money Follows the Person (MFP) Employment Initiatives Project
In concert with other employment initiatives, DADS (now HHSC)
determined the need for Employment Recruitment Coordinator (ERC)
activities (project began January, 2015);
Development of materials, video, and initial website work in 2015;
Information Letter 15-72, November 16, 2015 introducing role;
Field based work statewide to reach beyond a state office based approach
with a direct face to face representative;
Ultimate goal is to increase employer awareness of the population we
serve and increase integrated employment opportunities.11
Goals for the role of the Employment Recruitment Coordinator
Pursue employment opportunities in
support of individuals who set
integrated employment as a goal;
Establish ongoing relationships with
businesses / employers;
Network and establish community
and civic organization relationships;
Promote Employment First
principles. 12
What is Employment First?
The philosophy that employment in the
general workforce should be the first and
preferred option for individuals with
disabilities receiving assistance from publicly
funded systems. Simply put, Employment
First means real jobs, real wages, earning
minimum wage or better.
13
Employment in the General Workforce
What does this mean?• Employment in the general workforce means regular jobs
like everyone else in society: in typical work settings,
working side-by-side with people without disabilities,
earning regular wages and benefits and being part of the
economic mainstream of our society.
• The individual sets employment as a goal with assistance
from the service provider. Not mandated on the individual
to become employed, but instead a goal set based on the
individual’s desire.
14
Employment First Assumption
Employment First starts with a presumption that a
person with a disability can work. Unlike other
individuals of working age in our society, where it’s
presumed they will become employed, people with
disabilities have too often had to demonstrate their
“readiness” for employment. Under Employment
First, it is assumed that individuals are capable of
working until proven otherwise, and employment in
the general workforce is the first option pursued.
15
HCS Billing Reimbursement Rate Comparison
Examples
Day Habilitation
• Based on Level of Need (LON) per day with Rate Enhancement
• Example - Intermittent Level 25 is $26.87 per day
Employment Assistance
• Per hour with Rate Enhancement
• Example – Participant Level 25 is $34.35 per hour
Supported Employment
• Per hour with Rate Enhancement
• Example – Participant Level 25 $34.35 per hour
16
Money Follows the Person (MFP) Employment Initiatives Project
The Big Goal:
Market to employers why
employing persons with
disabilities is a good business
decision!
17
A Focus on a Person’s Ability as Opposed to Disability
Individuals who desire to work in
integrated employment bring value
to the workplace as a productive
member of the organization;
Out of the box thinking with the
ability to meet the employers need
with difficult to fill or high turnover
positions;
Dedicated with excellent attendance
records, low turnover, and on-time!18
How is the message being delivered?
Direct interaction with employers in face to face settings
• Presentations
• Informal discussions
• Cold calls
Presentations at civic organization meetings;
Networking and expansion of employers (new participants and those
already employing persons with disabilities);
Networking with various TWC–Vocational Rehab staff;
Job Fairs;
ERC works throughout the state as a front line representative to educate
employers and pursue a commitment from employers.
19
Difference between the ERC and TWC – Voc Rehab Field Specialists
ERC focus is a more global focus with employers as
opposed to individual employment cases;
Focus is more statewide as opposed to local;
Open doors with employers that have a statewide
presence with intent of establishing large scale
initiatives;
Work in concert with TWC–Voc Rehab staff on
mutually beneficial projects such as job fairs and
encourage provider attendance.
20
Tools to Communicate
Packet of Information to remain with employers;
Handbill / Postcard selling employer benefits for hiring;
Better Bottom Line document;
Power Point employer focused presentation;
Employer Acknowledgement Form;
Employer list on HHSC website;
TWC “Guide for Hiring People with Disabilities”;
HHSC Employment Marketing video.
Provide employer contacts to LIDDA’s and Service
Providers
21
22
Employment Web Page Sample
23
CY 2016 Data
Initiated field outreach in April, 2016;
30 presentations made to civic organizations;
12 Presentations made to stakeholder organizations (ie;
provider organizations, providers, etc);
24 Direct one to one meetings with employers;
Participate in four (4) Disability Job Fairs where ERC was
one of the multi-agency team members for planning and
staffing;
5,500 people presented to in presentation settings during 2016
(civic presentations, conferences, stakeholders)
24
CY 2017
Continuing presentations to civic organizations
(estimate over 12,000 people reached by end of
2017);
Increased number of direct interactions with
employers and follow up;
Work with Local Authorities and Providers;
Training Opportunities; (July - Texas Panhandle
Centers, Starcare Specialty Health and Central
Plains… August – Texoma Community Centers…
October – Pecan Valley Centers)25
CY 2017 and Beyond
Webinar Training (Three target audiences - case
managers / employment specialists, Families;
Individuals);
ERC Web presence;
Civic presentations upon request with more specific
focus on direct employers;
Continue networking with TWC- Voc Rehab staff
and participate as team member in Job Fairs;
26
State Population
27
Dallas / Ft
Worth
25.1%
Houston 23.7%
San Antonio 8.6%
Austin 7.3%
Valley 6.1%
El Paso 3.2%
Employment Recruitment Coordinator Contact Information
Monty Chamberlain
701 W. 51st Street
Austin, Texas 78751
Mail Code: W-580
512-971-8839
Video Link:
https://hhs.texas.gov/services/disability/employment/e
mployment-first28
