Narrative: f.

The North Dakota Division of Vocational Rehabilitation (VR) purchases services from two for-profit and 18 nonprofit community rehabilitation providers (CRPs), for the provision of supported employment and extended services.

Outcome-based job placement rates and guidelines were implemented October 1, 2012.  In 2017, the supported employment guidelines and rates were updated to include a provision for extended services for youth.  The Division of Vocational Rehabilitation has 20 CRPs who provide supported employment services.  Several CRPs expressed concern regarding the outcome payment rate established in 2012.  One CRP discontinued providing supported employment services, and two larger providers considered discontinuing supported employment services in 2019.  In 2019, VR researched payment rates and service guidelines from various states; as well as, obtained rate information from North Dakota’s Developmental Disabilities division for individual employment services (IES).  In October 2019, VR implemented an hourly rate for job development and job coaching services for supported employment and customized employment services.

All units that purchase extended services fall under the administrative control of the North Dakota Department of Human Services and have developed a memorandum of understanding which includes Medicaid and the Developmental Disabilities division.  In addition, the Behavioral Health division manages a contract with Rocky Mountain Rehab for the provision of extended services for individuals with a serious mental illness, those with a traumatic brain injury, and others with diagnosis that are not able to access Medicaid services for extended services.  A workgroup that includes VR, the North Dakota Brain Injury Network, Aging Services, Medicaid, County Social Services and a CRP is currently working to improve the process for individuals with a traumatic brain injury to access extended services through the Medicaid Waiver for Home and Community Based Services (Elderly & Disabled). 

In cooperation with the Behavioral Health division, VR participated in a supported employment pilot project in two regional VR offices.  The project uses an individualized placement services (IPS) evidence-based supported employment model for consumers with the dual diagnosis of mental illness and substance abuse.  The project began March 2009 and continues in two out of eight regions of the state.  The VR state office program administrator responsible for supported employment is involved with the project.  Regional VR staffs are involved with the fidelity review teams.

During the 2019 legislative session, North Dakota lawmakers authorized the Department of Human Services to create a Medicaid 1915(i) state plan amendment, which allows North Dakota Medicaid to pay for additional home and community-based services to support individuals with specific behavioral health conditions like mental illness, an addiction or a brain injury.

For adults, these services could include, but are not limited to support for housing, employment, education, transition out of homelessness or institutional living and peer support.  Potential services for children and youth could include respite care, educational support and transition to adulthood support.  To be considered eligible for services, individuals must qualify for Medicaid or Medicaid Expansion.  Vocational Rehabilitation, the Behavioral Health division and Medical Services will work together to develop a process to braid funding for supported employment and extended services and ensure that services are not duplicated.

In the fall of 2015, VR began a three-year pilot project.  North Dakota VR established the three-year pilot to gather data, information and best practices the agency would need to consider when developing and implementing customized employment in the state.  In addition, the project was designed to build the capacity to deliver customized employment services for individuals with intellectual and developmental disabilities that lead to integrated and competitive employment opportunities for those currently receiving day support and segregated employment services.  North Dakota VR contracted with the North Dakota Center for Persons with Disabilities (NDCPD) to coordinate and provide training, in-field mentoring and technical assistance for customized employment training for four CRPs.  The four CRPs provide supported employment services in three of eight regions in North Dakota.  Fifty-seven individuals received customized employment services during the three-year pilot.  Of the 57 individuals served through the pilot 29 became employed in competitive integrated employment positions.  Additional outcomes from the pilot included; CRP staff and individuals presenting on customized employment at the 2017 and 2018 North Dakota Association of Community Providers (NDACP) annual conferences and the national APSE conference in 2018.  North Dakota VR collected data regarding customized employment, which was utilized to develop customized employment resources, three on-line customized employment training modules, a payment rate, policy and standardized procedure.

In 2018, VR contracted with NDCPD to coordinate training and technical assistance activities for a new cohort of CRPs to begin customized employment training.  This cohort would receive two years of training to include webinars, technical assistance and in-field mentoring.  North Dakota VR selected four rural CRPs for the new cohort.  Only CRPs who have participated or who are currently participating in VR’s customized employment training initiative, coordinated through Minot State University, are authorized to provide customized employment.  The eight CRPs provide customized employment services in six of eight regions in North Dakota.  A customized employment policy and payment rate were developed and implemented in October 2019.  In October 2019, VR implemented an outcome-based payment for discovery activities and an hourly rate for job development and job coaching services for customized employment services.

In the last legislative session, House Bill 1406, related to an income tax credit for the employment of individuals with developmental disability or severe mental illness, was passed.  The bill was signed by the governor in April 2019.  North Dakota Vocational Rehabilitation and the North Dakota Office of State Tax Commissioner will jointly administer this program which will foster employers to hire individuals who have consistently faced significant barriers to employment.  The Customized Employment Tax Credit Program provides a ND income tax credit to employers for hiring an individual in one of the following target groups:

• Individuals with a developmental disability
• Individuals with a severe mental illness

Vocational Rehabilitation is responsible for determining if an individual meets the targeted group criteria and meet the following:

• has a most significant developmental or mental disability,
• is eligible for Vocational Rehabilitation’s services,
• and requires customized employment in order to obtain competitive integrated employment

In partnership with the Department of Public Instruction, the Developmental Disabilities division and VR staff worked together to develop the “Transition Services Guide”.  The guide is meant to provide the Individualized Education Program (IEP) team with an overall understanding of the options available to transition aged students age 18-21, who are interested in competitive integrated employment and may require supported employment services.