Narrative: h. 1.

The State Medicaid plan under Title XIX of the Social Security Act; Medical Assistance, the state’s Medicaid program, is administered by the DHS Disability Services Division (DHS-DSD). Vocational Rehabilitation Services (VRS) and State Services for the Blind (SSB) collaborate closely with DHS in the provision of services for individuals who are on home and community-based waivers.  

In September 2019, DHS-DSD, VRS, and SSB signed a Memorandum of Understanding. The terms of the MOU are specific to individuals on a Medicaid waiver who want to pursue competitive, integrated employment. Employment First and Person-Centered principles form the basis of the shared vision for how our agencies can provide employment services for people with disabilities in a coordinated manner. The goal is to align systems so that common customers – those who receive home and community-based service disability waivers and vocational rehabilitation services from VRS or SSB – can get seamless and timely supports to make informed choices and meet their competitive integrated employment goals. The full implementation of the MOU is planned for January 2021 to allow time for communication, stakeholder involvement, and training.  

Under the MOU, the following coordination of services occurs: 

Payment of Services 

DEED-VRS/SSB is the primary payer for job-related services (services supporting job development, placement and employment stability) for common customers. DHS-DSD may fund services offered by VRS/SSB only when DHS-DSD documents that those services are not available through VRS/SSB. Once employment stability is established, DHS-DSD will continue to pay for long-term supports to maintain employment for customers of all ages. DHS-DSD will also pay for services that assist people in making informed choices and developing informed employment goals. 

Interagency Planning and Policy Development 

DHS-DSD and VRS/SSB will use strategic planning, troubleshooting, consultation and technical assistance to ensure successful implementation of this agreement. Key areas include goal setting, systems development, coordination of services, quality assurance and stakeholder involvement. We will:  

• Establish an interagency steering committee to provide MOU oversight, set goals, review program services and financing options, identify promising practices and resolve disputes 

• Identify program liaisons from VRS/SSB and DHS-DSD to coordinate joint efforts in communication, quality assurance, training, and coordination of services, policies and procedures 

• Create work groups as needed to provide advice and share expertise regarding practice enhancements 

• Hold periodic staff meetings across agencies to ensure coordinated communication and address policy issues 

• Establish an advisory committee that includes stakeholders from VRS/SSB, DHS-DSD, lead agency, and providers of both vocational rehabilitation services and waiver services to discuss progress and challenges with the MOU 

• Jointly meet with stakeholders to collect feedback and identify areas for improvement 

• Understand employment outcomes in our respective programs and develop a shared understanding of outcome measures and reporting procedures  

• Promote the use of evidence-based practices and/or promising approaches to create a more closely aligned employment service system, increase quality and gather shared data on employment outcomes  

• Identify common customers and practices that support positive employment outcomes  

Eligibility, Referrals, and Customer Flow 

We will establish a shared understanding of when and how eligibility will be determined by each agency and we will communicate eligibility requirements to stakeholders. This includes community rehabilitation partners, lead agency staff, waiver employment service providers, VRS/SSB staff, DHS-DSD staff, and the people served by our programs and their families. 

We will develop a shared referral process and provide clear instructions for referrals between programs when 1) a person indicates an interest to explore competitive, integrated employment through Minnesota’s Career Counseling Information and Referral Conversation in accordance with the Workforce Innovation and Opportunity Act (WIOA – 511 process), 2) a person receiving HCBS waiver services decides to pursue competitive, integrated employment and 3) when a person receiving vocational rehabilitation services achieves stable employment and needs supports to maintain employment. 

We will define a benefits planning model, determine how and when the model will be embedded into provided services, develop and coordinate training, and coordinate implementation through designated agency staff and a community of practice. 

We will develop guidance on how and when services may be provided as people move between programs and funding sources and when dual services are allowed. We agree that people may receive VRS/SSB and waiver services at the same time as long as those services are needed and not duplicative. 

Service Provider Networks 

We will work together to increase our statewide, shared network of employment service providers to improve access, support seamless transitions, and expand individuals’ choices to high quality employment services. As part of this work, we agree to: 

• Evaluate strategies for a common employment service provider pool. We will explore options for creating a shared job search service provider pool to support seamless service delivery and prevent unnecessary interruptions as people move between supports funded by VRS/SSB and supports funded by DHS-DSD. 

• Encourage dual enrollment of employment service providers. While DHS and DEED will continue to maintain separate employment service provider licensure/accreditation standards, we will make it easier for providers to understand our respective standards and develop strategies to provide ongoing communication and technical assistance to those interested in enrolling. 

• Align and streamline process and efforts. We will explore opportunities to better align and streamline each agency’s business processes and requirements to create consistency and efficiencies for dually enrolled employment service providers. 

• Coordinate communications and training. We will coordinate service provider communications and training to maintain consistent messaging and increase understanding of each agency’s respective system and the shared customer flow outlined in this agreement. 

• Measure and promote provider performance. We will explore methods to assess and provide information on service provider performance to people with disabilities and their families to support informed selection of service providers. 

• Develop new providers. We will analyze data, set goals and collaborate on the development of employment service providers in underserved populations and areas of the state.