HCBS Benefits Counseling Guidelines

SRT Guidance: HCBS Benefits Counseling May 16, 2024 1

SRT Guidance: HCBS Benefits Counseling One or more of the following situations has occurred: Participant expressed interest in benefits counseling to make informed decision about work and does not meet an eligibility category for WIPA Participant expressed interest in benefits counseling, does not meet a possible eligibility category for WIPA, and does not have an open case currently with OVR Participant is interested in benefits counseling and confirmed by Ticket to Work Helpline representative to not be eligible for WIPA Participant is exploring the possibility of self-employment April 25, 2024 2

SRT Guidance: HCBS Benefits Counseling When was the most current plan of care uploaded? Full assessment is not required with employment, however eligibility for Work Incentives Planning and Assistance (WIPA) program must be documented with the date in the SRT, as well as the Community Integration portion of the PCSP; it will also be reiterated in the email to Information@PaHealthWellness.com. Examples: o Not currently receiving SSDI and/or SSI 4/11/2024 o Not eligible for WIPA due to being over age 25 and not currently working 4/11/2024 o Ticket to Work Helpline rep confirmed ineligible for WIPA due to having exhausted Ticket 4/11/2024 NOTE: When Participant is eligible for WIPA services, the date and outcome must be immediately added to PCSP in the Community Integration section, as well as noted in the Service Plan. o Example of PCSP update: Ticket to Work Helpline called 4/11/2024 & rep referring to WIPA services 3

SRT Guidance: HCBS Benefits Counseling Date Enrollee/Enrollee s Authorized Representative made request? This is the date the request was noted on the PCSP, not necessarily uploaded. Is request standard or expedited? Waiver funded benefits counseling will always be a STANDARD request. What HCBS benefit is being requested? Currently, there s no option in the dropdown. Please select: OTHER Non- Covered Service Note: There are 3 types of HCBS Benefits Counseling What is the Request Type? Indicate NEW or INCREASE as applicable. Benefits Counseling is not a renewed service; at this time, we do not foresee reduction requests. o For INCREASE requests, be sure to complete all current authorization information and be very detailed in request regarding the need. o Units of Measure are always HOURS. 4

SRT Guidance: HCBS Benefits Counseling Initial Benefits Counseling Problem Solving Supplementary Up to 20hrs every 2 years Actively considering/ seeking employment or self- employment, or career advancement Up to 8hrs per situation Up to 4 times per year if necessary To maintain competitive integrated employment Up to additional 6hrs Evaluating a job offer/ promotion or self- employment opportunity WIPA eligibility status must be documented in PCSP with the date of determination. 5

SRT Guidance: HCBS Benefits Counseling THREE TYPES: Initial Benefits Counseling Due to current OLTL service definition, request 20 HOURS YEARLY. This will most likely be the (initial) request type of most HCBS Participants. o Example of eligibility PTP starts 4/25/2024 so they wouldn t be eligible to request this type again (under OLTL current service definitions) until 4/26/2026. Problem Solving - For Participant not eligible for WIPA services, this type is based on SITUATION. Due to this, be SPECIFIC to what the situation is because that will provide context regarding eligibility. Supplementary If someone has already exhausted Initial Benefits Counseling, Participant could then access this type for additional hours IF evaluating job offer, promotion, or self-employment opportunity UP TO additional 6 hours. 6

SRT Guidance: HCBS Benefits Counseling What s the reason for this request? Most often the following two boxes will be selected: Enrollee s Request Other What s the reason for this request? (elaborate using Enrollee s/Authorized Representative s words regarding what needs are not being met with the current plan of care) Specify the Participant s interest related to benefits counseling, curiosity in work, obtaining financial confidence, increasing financial literacy State if Participant has had previous experience (e.g. not eligible for WIPA services as of 4/11/2024, received Initial Benefits Counseling in 2022) Describe CC s findings Be sure to include the following: Current Employment Status (e.g. working, not working) Indicate if interest in self-employment, career advancement, promotion, job offer, raise WIPA eligibility status: if call made to Ticket to Work Helpline and rep stated ineligible, does not meet any of the possible WIPA eligible criteria Date (same as one noted in Community Integration portion of PCSP) Outcome of call/WIPA eligibility status Identify type of CHC Benefits Counseling: Initial, Problem Solving, Supplementary 7

Visual & Example - Initial Benefits Counseling Service Coordinator Date of PCSP upload that includes WIPA ineligibility date Will be the exact date the PTP makes request to the SC (ex. Call to SC 5/9/24; date here is 5/9/24) 8

Example - Initial Benefits Counseling (Cont.) Standard OTHER Non-Covered Service Enter IF APPLICABLE with INCREASE/reduction requests 9

Example - Initial Benefits Counseling (Cont.) HOURS (IF APPLICABLE) IF APPLICABLE NEW REQUEST / INCREASE would be primary reasons - 20 HOURS - (Specify again in CC findings that it s for 20 hours/80 UNITS for Initial Benefits Counseling YEARLY for Initial Benefits Counseling May be different if Problem Solving or Supplementary 10

Example - Initial Benefits Counseling (Cont.) x Ms. Wellness needs to understand financial part of what it could mean to work. She has not received benefits counseling before and isn t eligible for WIPA services (not currently working and aged 26+). I don t know how much I could make to afford possible rent changes and keep healthcare. Ms. Wellness needs help understanding financially how she could possibly work before she can feel comfortable in pursuing employment. She s not working and over age 26 so presumed to not meet eligibility criteria for WIPA; she is also figuring out if she could afford rent with her upcoming lease renewal. Needs Initial Benefits Counseling up to 20 hours. Once she feels confident in benefits, Ms. Wellness has shared she is interested in additional employment support (would need assistance with Office of Vocational Rehabilitation referral). 11

Initial Benefits Counseling Initial Benefits Counseling for someone actively considering or seeking individualized integrated employment or self- employment, or career advancement in these types of employment: up to twenty (20) hours. This service may be authorized no more than once every two (2) years (with a minimum of two 365-day intervals between services). 12

Guidance Example 1 Benefits Counseling 1. Participant aged 26+ and not currently working with no pending job offer 2. SC asks Participant if preferred benefits counseling provider. If no, SC will detail in SRT email. SC asks Participant the earliest they are willing to meet with the certified benefits counselor, providing at least 1 week from time the SC plans to submit the SRT. SC informs Participant that the request for benefits counseling will be made and they should expect a call within 2 weeks from the SRT submission date, unless the Provider needs additional time to meet. 3. SC adds date and details (why Ticket to Work Helpline call not made due to assumption not eligible for WIPA program): in Community Integration portion of PCSP, and in the SRT and email to Information@PaHealthWellness.com 4. SC creates/updates employment goal in PCSP accordingly. 5. SC completes SRT accordingly for Initial Benefits Counseling, up to 20HRS/YR. 6. SC submits SRT and email to PA Health & Wellness. 13

Guidance Example 2 Benefits Counseling 1. Participant aged 26+ and currently working (seeking advancement) 2. SC calls the Ticket to Work Helpline with the Participant and asks about referral to WIPA. Helpline representative says the Participant is not eligible for WIPA at this time. 3. SC adds date of call to Ticket to Work Helpline (MM/DD/YYYY) and details outcome (Helpline rep stated ineligible for WIPA at this time): in Community Integration portion of PCSP, and in the SRT and specified in email to Information@PaHealthWellness.com 4. SC creates/updates employment goal in PCSP accordingly. 5. SC asks Participant if preferred benefits counseling provider. If no, SC will detail in SRT email. SC asks Participant the earliest they are willing to meet with the certified benefits counselor, providing at least 1 week from time the SC plans to submit the SRT. SC informs Participant that the request for benefits counseling will be made and they should expect a call within 2 weeks from the SRT submission date, unless the Provider needs additional time to meet. o Note: If ACHIEVA is selected, there s a Google Form completion required prior to the Benefits Counselor is able to meet with the Participant. This is to ensure the most effective time between the Participant and Provider. 6. SC completes SRT accordingly for Initial Benefits Counseling, up to 20HRS/YR. 7. SC submits SRT and email to PA Health & Wellness. 14

Guidance Example 3 Benefits Counseling 1. Participant aged 26+ and currently working (evaluating job offer, has not received HCBS funded initial benefits counseling in the last 2 years) 2. SC calls the Ticket to Work Helpline with the Participant and asks about referral to WIPA. Helpline representative says the Participant is not eligible for WIPA at this time. 3. SC adds date of call to Ticket to Work Helpline (MM/DD/YYYY) and details outcome (Helpline rep stated ineligible for WIPA at this time): in Community Integration portion of PCSP, and in the SRT and specified in email to Information@PaHealthWellness.com 4. SC creates/updates employment goal in PCSP accordingly. 5. SC asks Participant if preferred benefits counseling provider. If no, SC will detail in SRT email. SC asks Participant the earliest they are willing to meet with the certified benefits counselor, providing at least 1 week from time the SC plans to submit the SRT. SC informs Participant that the request for benefits counseling will be made and they should expect a call within 2 weeks from the SRT submission date, unless the Provider needs additional time to meet. o Note: If ACHIEVA is selected, there s a Google Form completion required prior to the Benefits Counselor is able to meet with the Participant. This is to ensure the most effective time between the Participant and Provider. 6. SC completes SRT accordingly for Initial Benefits Counseling, up to 20HRS. 7. SC submits SRT and email to PA Health & Wellness. 15

Problem Solving Benefits Counseling Problem-Solving services for a participant to maintain competitive integrated employment: up to eight (8) hours per situation. This service may be authorized up to four (4) times per year if necessary for the individual to maintain individualized integrated employment or self-employment. 16

Guidance Example 4 Benefits Counseling 1. Participant aged 26+ and currently working (maintain job) 2. SC calls the Ticket to Work Helpline with the Participant and asks about referral to WIPA. Helpline representative says the Participant is not eligible for WIPA at this time. 3. SC adds date of call to Ticket to Work Helpline (MM/DD/YYYY) and details outcome (Helpline rep stated ineligible for WIPA at this time): in Community Integration portion of PCSP, and in the SRT and specified in email to Information@PaHealthWellness.com 4. SC creates/updates employment goal in PCSP accordingly. 5. SC asks Participant if preferred benefits counseling provider. If no, SC will detail in SRT email. SC asks Participant the earliest they are willing to meet with the certified benefits counselor, providing at least 1 week from time the SC plans to submit the SRT. SC informs Participant that the request for benefits counseling will be made and they should expect a call within 2 weeks from the SRT submission date, unless the Provider needs additional time to meet. o Note: If ACHIEVA is selected, there s a Google Form completion required prior to the Benefits Counselor is able to meet with the Participant. This is to ensure the most effective time between the Participant and Provider. 6. SC completes SRT accordingly for Problem-Solving Benefits Counseling, up to 8HRS per situation. SC details the situation (e.g., wants to ensure reporting properly). 7. SC submits SRT and email to PA Health & Wellness. 17

Supplementary Benefits Counseling Supplementary Benefits Counseling for a participant evaluating a job offer/promotion or self-employment opportunity: up to an additional six (6) hours. 18

Guidance Example 5 Benefits Counseling 1. Participant aged 26+ and currently working (evaluating job offer, received 20hrs HCBS funded benefits counseling last year) 2. SC calls the Ticket to Work Helpline with the Participant and asks about referral to WIPA. Helpline representative says the Participant is not eligible for WIPA at this time. 3. SC adds date of call to Ticket to Work Helpline (MM/DD/YYYY) and details outcome (Helpline rep stated ineligible for WIPA at this time): in Community Integration portion of PCSP, and in the SRT and specified in email to Information@PaHealthWellness.com 4. SC creates/updates employment goal in PCSP accordingly. 5. SC asks Participant if preferred benefits counseling provider. If no, SC will detail in SRT email. SC asks Participant the earliest they are willing to meet with the certified benefits counselor, providing at least 1 week from time the SC plans to submit the SRT. SC informs Participant that the request for benefits counseling will be made and they should expect a call within 2 weeks from the SRT submission date, unless the Provider needs additional time to meet. o Note: If ACHIEVA is selected, there s a Google Form completion required prior to the Benefits Counselor is able to meet with the Participant. This is to ensure the most effective time between the Participant and Provider. 6. SC completes SRT accordingly for Supplementary Benefits Counseling, up to 6HRS. SC details PTP s already maxed Initial Benefits Counseling use within last 2yrs. 7. SC submits SRT and email to PA Health & Wellness. 19

Questions? 20

THANK YOU! Much Appreciation! 21