I was excited to recently get a glimpse at the direction DODD is headed in regards to waiver based employment services. Having been a part of the state’s pilot project “Project Transformation” I have been aware of the direction the state has been leaning. During Project Transformation I had a few different conversations with state staff regarding the current service model and how providers would struggle with implementing change without regulatory and funding changes. Now, after a group of stakeholders have been meeting to try and sort out the steps for transformative change, we get a glimpse of the direction for employment services and day habilitation.
Day and Vocational Hab services will stay as a service for the moment, but there is every indication that this is only in order to allow time for other kinds of services (employment and community based) to come on line. In general there is real questioning as to whether this is a five day a week service, and how to account for more time in the community. It is very likely that definitions will be more detailed regarding the kinds of services and activities expected with a Voc Hab or Day Hab program. I reviewed a slide deck that made mention of a prior authorization process in the future which I suspect is meant to further curtail the authorization of this service without extensive conversation.
Community Inclusion, Job Readiness, and Supported Employment services are the direction the state looks to be moving the service model. Further more DODD is aligning its language with OOD requiring these new services to not exist in segregated environments. Having knowledge and experience with the OOD system it is critical that current providers recognize this specifically. Think about any current programming you might be doing as it pertains to job readiness, or skill development, or even a job itself. Then think of what it would mean if none of that was allowed to be provided in a segregated environment where only people with a disability could have access to it.
The final cut from the OOD cloth might be in the form of reimbursement as it pertains to supported employment. It appears that outcomes associated with the different stages of job obtainment – initial, stabilization, and maintenance (fairly common ways to talk about services at OOD) will also make their way into waiver services. The good news is that everyone is talking about transition as opposed to immediate implementation.
Everything written here does not have a lot of detail, so I look forward to more sharing from the stakeholder group in the future. What I have seen, and experienced tells me that providers need to be very cautious about expanding current models of service without flexible plans in place that will allow them to shift liabilities regarding their bricks and mortar buildings, as well as their current fleet services. Workforce development should be focused on community based job coach and job developer professionals, working out of the office and in their communities. If you are creating efficiencies through the use of rigid schedules, ratios, and consolidated locations you really need to look at building efficiencies using a flexible work model that make use of trained professionals and less on an unskilled workforce. Technology needs leveraged so that staff can follow the person into the community while still complying with documentation rules while also accessing important client information easily and securely.