Narrative: d. 2. Q. i.

In Wisconsin, supported employment is funded by primarily three sources; DVR Title I-B and long-term funding directed by DHS, Division of Long Term Care (DHS/DLTC) and Division of Care and Treatment Services (DCTS) Funds are managed locally by regional managed care organizations or a self-directed support system known as IRIS (Include, Respect, I Self-Direct)) and Managed Care Organizations (MCO's) Mental Health long term supports are managed locally by each county.

To a much lesser extent, Social Security Plans to Achieve Self-Support (PASS) plans, the 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 TTW Partnership Plus to ticket holders which has the potential to increase funding for long-term supports. 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.

2. DVR staff is also involved with the planning and provision of supported employment training including customized employment in collaboration with the Wisconsin PROMISE Grant

3. DVR’s technical specifications for Supported Employment include strong outcome measures and statewide fee for service payment rates for SES. The supported employment technical specifications are posted on the DVR public website.

4. The fee structure is reviewed on a regular basis and will be reviewed again in FFY 2018.

5. DVR guidance pieces are provided to DVR staff as well as external stakeholder partners to assist in the provision of SES. Guidance documents are designed to explain supported employment service and outcome policy as it relates to the Rehabilitation Act, WIOA and its implementing regulations, and to provide best practice suggestions and answer common questions.

6. In several counties in partnership with the DHS, Division of Care and Treatment Services, IPS are provided. The collaborative project has been in place since 2010 and is expected to expand and become a fee for service arrangement and typical practice following this evidence based model for common consumers in counties that offer IPS.

   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 DHS statewide expansion of the Family Care system in Wisconsin. DVR staff also identify and use other extended support services and funding resources such as employer and natural supports, PASS, Impairment Related Work Expenditures, and family support.

The IPE for DVR consumers, who select competitive employment in an integrated setting but may require long term employment support, usually begins with an assessment called a career Profile to help determine the employment goal related to the consumer’s interests and strengths. The assessment process may include trial work or other employment explorations 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. SES 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 SES 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. A meeting with the service provider, consumer, counselor and long-term support provider (as well as others invited by the consumer) should be conducted to discuss the timing and plan to facilitate the transfer.

SES may be provided by DVR for a period of time not to exceed 24 months unless under special circumstances an individual and DVR counselor agree to extend the time to achieve the employment outcome identified in the plan. This timeframe applies to all individuals with the most significant disabilities. Extended services are provided after supported employment services end and may be provided to youth with the most significant disabilities up to four years, or until the individual reaches the age of 25 and no longer meets the definition of a youth with a disability under (c)(5).

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 CRP partners. Link:

DVR has used and will continue to use the recommendations made by the Managed Care and Employment Task Force, the DHS Prevocational Services guidelines, the DHS Guiding Principles for Competitive Integrated Employment, 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 FFY 2013 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. Family Care has been expanded statewide beginning in January 2018. A successful deployment of Family Care services throughout Wisconsin means that DVR consumers who desire community employment and need extended employment supports will be able to access those supports without a wait for extended employment support funding.

DVR will also monitor the quality and availability of DVR supported employment service providers to reflect concern expressed by stakeholders and existing and common DVR/DHS service providers. Long-term care and managed care changes may impact job coaching and other SES due to DHS changes and issued guidance relating to payments for job coaching and other related support services such as transportation or personal attendant services.

DVR will continue to support collaborative efforts aimed at expanding integrated, competitive community employment opportunities for those in need of SES. The DHS (Medicaid Agency), the CRP provider community, and the regional Managed Care Organizations are all current collaborative partners. With the increased efforts for placing more individuals in employment through supported employment, DVR must also work with our long-term care partners to address transportation challenges faced by our common customers, especially those in rural areas with fewer public and private transportation resources.