Outcome-Based Payments for Individual Employment Support and Career Planning

S E P T 1 8 , 2 0 2 4 P R O V I D E R M T G . O U T C O M E - B A S E D P A Y M E N T S F O R I E S A N D C A R E E R P L A N N I N G : J O B D E V E L O P M E N T

AGENDA Outcome-based payments for Individual Employment Support (IES) and Career Planning (Job Development)

OUTCOME-BASED PAYMENTS I N D I V I D U A L E M P L O Y M E N T S U P P O R T S & C A R E E R P L A N N I N G ( J O B D E V E L O P M E N T )

WHAT IS AN OUTCOME -BASED PAYMENT? These are payments made to a provider that are in addition to the per-unit fee-for-service reimbursement for the service The payment is made once the provider demonstrates achievement of the desired outcome (community integrated employment)

CRITERIA FOR PAYMENTS Career Planning: Job Development First payment: The person receiving the support achieves competitive community integrated employment Individual Employment Support (IES) First payment: The person receiving the support retains competitive integrated employment for 90 calendar days following the date the provider was authorized for IES Additional payment: The person receiving the support earns $12 or more per hour OR the person works 30+ hours per week Additional payment: The person receiving the support retains competitive integrated employment for 180 calendar days following the date the provider was authorized for IES

LIMITS AND VERIFICATION No more than two outcome-based payments will be made during a person s eligibility span per eligible service (Career Planning: Job Development and Individual Employment Supports) To receive payment(s), the provider must submit both an attestation and for payments based on the individual s rate of pay or hours per week, a pay stub for the individual

PAYMENT RATES Payment rates are based on the outcome and the person s acuity Career Planning: Job Development Rates IES Payment Rates

PAYMENT CODES Individual Employment Support Outcome-Based Payment

PAYMENT CODES Career Planning: Job Development

BILLING FOR IES OUTCOME - BASED PAYMENT When you view the PAWS, you will see that the outcome-based payment for IES is authorized on a single day For the 90-day payment, it is authorized on the 91st day For the 180-day payment, it is authorized on the 181st day You must bill on this exact date or the billing will be rejected Review the PAWS prior to billing to be certain you re billing on the right date

C U R R E N T AU T H O R I Z AT I O N S People who already receive Career Planning: Job Development or Individual Employment Support will have the Outcome-Based Payment added to their Service Authorization in MSS SSAs will secure a signed statement from the person/guardian, indicating their understanding of the new Outcome-Based Payments Revisions will be completed by 9/30/24

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AUTHORIZATION PROCESS The provider is responsible to notify the SSA and revisions@hamiltondds.org mailbox that they qualify for the outcome- based payment. Using the new PROVIDER RELEASE OF OUTCOME BASED PAYMENT REQUEST FORM revisions@hamiltondds.org PROVIDER RELEASE OF OUTCOME BASED PAYMENT REQUEST FORM Funding will email the SSA and ask them to confirm that payment should be approved 1. Verify that the provider completed the attestation 2. Verify by reviewing the pay stub that the person is making at least $12/hour or working at least 30 hours per week (if applicable) The SSA will:

*This new revision request form will be used for providers to request outcome-based payments for all services that have an outcome-based payment associated with the service.

DODD ATTESTATION FORM * Form found here on DODD s site.

AUTHORIZATION PROCESS, CONT. Once the Funding Specialist receives the notification that the criteria are met, they will authorize the payment in MSS to allow the provider to bill the outcome-based payment The ISP does not need to be updated to allow the provider to bill the outcome-based payment

Question Answer What if the person does not want to allow the provider to bill the outcome-based payment? The payment is now a part of the service fee structure. If the person does not want the outcome-based payments to be paid, they will need to find another service to meet their needs. The earliest date the provider can request the payment is 90 days from 7/1/24 (9/29/24). YES regardless of how long the person has been employed or receiving the IES, the provider qualifies for the payment. Each service (Career Planning: Job Development) and IES both allow two, so potentially a provider could get four in one span (two for each service). What date do we use for people who have already been receiving IES (prior to July 2024)? Does the provider of IES qualify for the payment even if the person had the job for a long time prior to July 2024? How many payments can a provider get in a person s waiver span? F R E Q U E N T LY A S K E D Q U E S T I O N S

CORRECTION FROM 9/18/24 SESSION In our 9/18/24 session on this topic, we shared that for IES, the outcome-based payment for the 90- and 180-day milestones could be billed annually We noted that we wanted to verify this with DODD after we reached out to them, we learned that this is NOT CORRECT Once a person begins receiving IES, the provider only qualifies for the 90 and 180-day payments one time

RESOURCES DODD has a one-pager about the new outcome-based payments as well as an FAQ about the process. These can be found here. here