Narrative: e. 3.

Supported employment means competitive integrated employment (CIE), including customized employment (CE), or employment in an integrated work setting in which an individual with a most significant disability, including a youth with a most significant disability, is working on a short-term basis toward competitive integrated employment that is individualized, and customized, consistent with the unique strengths, abilities, interests, and informed choice of the individual, including ongoing support services for individuals with the most significant disabilities. SE can be provided by VR for a period of time not to exceed 24 months, unless the VRC and customer jointly agree to extend the time to achieve the employment outcome identified in the IPE. 

SE services are restricted to those customers assigned to the Most Significant Disability (MSD) category. The Disability Priority Page in the Aware case management system is used to document the justification of priority category assignment. The category assignment is also displayed on the eligibility determination. A brief breakdown of severity categories follows:

Severity of Disability Priority Categories

Priority 1 – Most Significant Disability (MSD)

• Meets criteria for SD; AND
• Experiences severe physical or mental impairment that seriously limits three or more functional capacities (such as mobility, work tolerance, communication, self-care, interpersonal skills, self-direction, and work skills) in terms of an employment outcome; AND
• Requires multiple primary IPE services over an extended period of time. 

Priority 2 – Significant Disability (SD)

• Receives Social Security Disability Income or Supplemental Security Income.

OR all of the following:

• Meets criteria for Disability (D); AND
• Experiences severe physical or mental impairment that seriously limits one or more functional capacities (such as mobility, work tolerance, communication, self-care, interpersonal skills, self-direction, and work skills) in terms of an employment outcome; AND
• Requires multiple primary IPE services over an extended period of time. 

Priority 3 – Disability (D)

• Has a physical or mental impairment; AND
• Has a substantial impediment to employment as a result of the impairments; AND
• Who can benefit in terms of an employment outcome from the provision of vocational rehabilitation services. 

Furthermore, SE is indicated for individuals for whom CIE has not historically occurred, or for whom competitive integrated employment has been interrupted or intermittent as a result of a significant disability; and because of the nature and severity of their disabilities, need intensive supported employment services and extended services after the transition from support provided by IDVR in order to perform this work.

A Comprehensive Assessment of Rehabilitation Needs (CARN) must contain information supporting a need for SE and ES prior to engaging a customer in SE services.

Any additional assessments/evaluations purchased by IDVR to determine this need should be conducted in an integrated setting to the greatest extent possible.

SE refers to support services (like job coaching) provided after placement and before the individual reaches initial stability, and prior to utilization of extended services (long-term supports).

Extended Services (ES) are those services, including Youth Extended Services (YES), provided after the assessment of initial stabilization when required for an individual to maintain employment (to sustain employment stability). IDVR limits the provision of extended services exclusively to youth.

Youth Extended Services (YES): WIOA requires IDVR to make YES available when youth have no comparable ES resources available in the community. YES can continue to be provided until: Comparable benefits become available (External funders are identified) OR YES is provided for four years OR The individual reaches the age of 25 and no longer qualifies under the definition of ‘youth’. The Division does not provide Extended Services to customers 25 or over as this is an explicitly prohibited activity under WIOA. Youth extended services are only available to youth with most significant disabilities using Titles I and VI funding; and supported employment services are only available to individuals with most significant disabilities.

Supported Employment services under IDVR are only offered by qualified providers who meet the criteria to become CRPs for the Division under Idaho Administrative Procedure Act (IDAPA) 47.01.01.402: Provision of Community Rehabilitation Program Services:

The Division will purchase vocational services from the community rehabilitation programs that are accredited by the Commission on Accreditation of Rehabilitation Facilities, the Rehabilitation Services Accreditation System or from individuals who have employment related certificates from the Association of Community Rehabilitation Educators or who are Certified Employment Support Professional.

IDVR is committed to the advancement of opportunities for eligible individuals, including youth with the most significant disabilities, and encourages employment in the most integrated environments possible. IDVR has established and continues to maintain strong working relationships with pertinent state agencies such as the Department of Health and Welfare (H&W). Under H&W, Home, and Community Based Services (HCBS) Waiver and Aged and Disabled Waiver are the two main extended services funding sources for Idahoans in need of Supported Employment. The third funding source is the Extended Employment Services Program which has moved from under IDVR to IDH&W, eliminating any potential conflicts or perceived conflicts for serving individuals seeking non-CIE employment. This program is funded through State appropriations only. The primary service providers for long term supports (extended supports) under the three main funding sources are Idaho’s CRPs.

The Division will continue to work closely with each program overseeing these resources to provide appropriate referral and utilization of these external sources of extended services funding. The following provides more detail on the working relationship between each ES entity and IDVR:

IDH&W provides the following guidance on extended services under IDVR’s Health & Welfare banner:

The Supported Employment Agency Recommendation must be completed by the Idaho Division of Vocational Rehabilitation (IDVR) when transitioning from vocational rehabilitation services or by the Supported Employment Agency (Community Rehabilitation Provider) identified on the plan or addendum. Documentation must include:

• Amount of Service
• Level of Support Needed
• Employment Goals
• Transition Plan

IDVR provides funding for job development services and initial job coaching through a Community Rehabilitation Provider (CRP) agency. The length of time needed for job development varies depending on the individual. As soon as the person has become employed, it is critical to work quickly to ensure there is no gap in the individual’s job coaching support in the workplace. The CRP will communicate to the Service Coordinator/plan developer that the participant has been hired so planning for transition to Medicaid-funded Supported Employment services [extended services] can begin.

An Employment Agency Recommendation form has been developed to help with the transition process. It includes information from the CRP agency about the participant, their job tasks in the workplace, and a recommended level of service needed by the participant. This information will be used by the plan developer to complete an addendum to the ISP. A transition meeting will be called and facilitated by the Vocational Rehabilitation Counselor. This meeting should include the Service Coordinator/Plan Developer, guardian, and any other identified members of the Person-Centered Planning team to ensure all parties understand the shift to Medicaid Waiver Supported Employment and any signatures can be gathered as needed for addendum or plan development. IDH&W refers to CARF and RSAS (or equivalent) accreditation requirements to receive waiver funding.

EES extended services are provided under EES policy which requires the certification of an extended employment service provider. These providers are approved by the EES program administrator on a case-by-case basis. All EES approved providers are also CRPs which are initially approved as CRPs under IDVR’s accreditation requirement.

If a youth with a disability has been determined to need an SE strategy and an extended service funding source is not available yet, IDVR will utilize VR funds for the required timeframes or until the funding becomes available for the long-term support.

The Division has developed policies to ensure that Youth Extended Services (YES) can be provided up to four years as needed for IDVR customers under the age of 25 following the achievement of employment stability when comparable external sources of long-term extended support are unavailable. Upon exhaustion of Title VI funds reserved for youth supported employment, the Division will continue to support YES with Title I funds, as required by WIOA, and will continue to leverage other sources of extended services. YES funds are considered only when external sources of extended services funding are immediately unavailable and would unnecessarily interrupt the continuity of services.

IDVR supports the utilization of Natural Supports where available and encourages the development of Natural Supports for all SE customers. Natural Supports are supports and services typically available to other employees OR supports created to provide supports through people or other resources typically available in the work, home, and community environment.

Stakeholder commitment for Natural Supports include a Plan for change and the Division encourages a written commitment by the individual providing NS, including contact information for a soft handoff in the event a support loss is anticipated.

The following must be satisfied before VR can close an SE case successfully:

• The individual must have completed SE services and is no longer receiving VR funded services including extended services for youth under VR (those receiving YES remain an open case in the VR system).
• The individual has maintained employment stability for a period of 90 days after transitioning to extended services.
• The job meets the definition of CIE.
• The job is consistent with the vocational goal specified in the IPE.
• At the end of the 90 days the customer and VRC agree that the customer is performing well in employment (a lack of employer agreement would indicate instability).
• The individual is informed, through appropriate modes of communication, about the availability of Post-Employment Services.

The 2023 CSNA addresses the needs of individuals with the most significant disabilities in Idaho. Individuals survey results identified barriers to getting a job: Lack of training, lack of job skills, mental health concerns, and employer disability concerns were each cited by over 50 percent of respondents. Lack of job search skills was also a noted barrier for 38.7 percent of respondents. Concerns over loss of benefits was cited by 28.9 percent of respondents.

To address these needs, the Division has engaged in substantial quality improvement initiatives to impact Supported Employment services:

Job Ready Process:

IDVR developed the Job Ready process, which represents a significant update in our approach to ensuring VR customers are truly ready to seek employment, prior to engaging a CRP for services. The Job Ready process ensures individuals possess the necessary skills and qualities sought by employers to seamlessly transition into a job with appropriate support. It involves evaluating a customer's capabilities against job requirements, articulating job preferences, and understanding logistical needs. The primary aim is to enhance successful job outcomes by thoroughly preparing customers for their job search endeavors. This process engages VR customers ready for employment before initiating job searches. It begins by identifying prepared customers and documenting their readiness throughout the Job Ready process. Once the counselor determines the VR customer is “Job Ready,” customers commence their job search activities. Adaptations may be necessary, such as when vocational goals change significantly, prompting a re-initiation of the Job Ready process for the new goal. Personal changes impacting readiness require evaluation and potential restart of the Job Ready process to ensure readiness before proceeding with job-related activities.

Enhanced CRP Monitoring Protocol (Launching in PY 2023/24):

IDVR has developed a revised CRP monitoring protocol and included it in the updated CRP Manual. The CRP monitoring process by IDVR will occur every two years and comprises two key elements: an off-site field-based review and an on-site discussion and data review. The off-site review involves examining CRP data in the IDVR’s case record system. The CRP Manager initiates this review, requesting customer lists and developing case review samples. Center Managers (CMs) schedule staff time for the review, aiming to complete cases and address missing data by collaborating with CRPs. Results are discussed between CMs and the CRP Manager, shaping findings, recommendations, and observations for the monitoring report. The report quantitatively details findings, recommendations, and observations. Findings necessitate corrective action plans (CAPs) from CRPs within 90 days, addressing non-compliance issues. Recommendations suggest improvements, while observations note points of interest. Subsequently, discussions between the CRP Manager and CRPs ensue to address findings and CAP development. The on-site component occurs biennially, addressing the off-site report, CRP-specific data, customer satisfaction, service access, communication, and business issues. This meeting involves CRP representatives, the CRP Manager, and local CMs, facilitating virtual participation for CMs from distant regions if multiple centers are reviewed.

New Rate Methodology Study (Ongoing through 2024):

IDVR has contracted with Public Consulting Group (PCG) to complete a comprehensive rate study to assess service compensation and complexity, aiming to establish a rate methodology, incorporate innovative practices from other state VR agencies to redefine rates based on rehabilitation needs' complexity.

CRP WebEx Meetings:

IDVR hosts regular statewide CRP meetings via WebEx every odd number month to foster ongoing dialogue and information sharing between IDVR and CRPs. These sessions facilitate collaborative updates, feedback exchange, and dissemination of best practices, aligning with the evolving needs of the vocational rehabilitation landscape.

Updates to the CRP Manual (updated PY 2022):

CRPs were given the opportunity to provide feedback to the CRP Manual. Later, a workgroup of various IDVR staff worked to update the CRP Manual over several month. The updated CRP Manual was released in October 2024 and included numerous updates that aligned with current IDVR policy and procedures as well as updated the fee schedule.