Supported Employment Program (SEP) Revalidation and Future Awards IB

Illinois Department of Human Services

Division of Developmental Disabilities

Information Bulletin

DD.21.022 FINAL

This Information Bulletin will replace DD.20.027: Supported Employment (Waiver Funded) upon CMS Federal Approval of the Waiver Amendment.

Purpose:

The Division of Developmental Disabilities (DDD) seeks to expand and enhance opportunities for individuals with intellectual and developmental disabilities (I/DD) to engage in, and sustain, competitive integrated employment (CIE). This Information Bulletin provides updated guidance on access and procedural changes to the primary funding source of long term, waiver funded employment supports and services - the Division of Developmental Disabilities Supported Employment Program (DDD SEP).

Background:

A Memorandum of Understanding was enacted on September 8, 2020 between the Division of Developmental Disabilities (DDD) and the Division of Rehabilitation Services (DRS) to fulfill a portion of CFR 361.24. A key component of the DDD/DRS MOU is the process to access/activate DDD SEP for individuals who are funded through the Adults with Developmental Disabilities Home and Community Based Services Waiver.

Per Federal rule, DRS VR is the first payor of Competitive Integrated Employment (CIE) Services for individuals with disabilities in Illinois. Referrals for Vocational Rehabilitation can be made via the DRS online portal: Visit the DRS referral page. DRS referrals are processed by the office in closest proximity to the individual's home address and barring exceptional or unforeseen circumstances, an eligibility determination must be made within 60 days. See Referral Processing Guidelines.

On January 1, 2021, the DDD clarified via Information Bulletin a number of topics related to the Supported Employment Program. Clarification at this time included the requirement that all related DDD SEP services and supports be associated with sustaining CIE and the specific requirements of new DDD SEP award requests (eligibility, documentation and authorization requirements). The DDD also communicated intent to develop a plan to address existing DDD SEP authorizations via a revalidation process.

Current Impact:

On October 15, 2021, the first DDD SEP revalidation process was initiated.

Effective January 1, 2022, or upon final waiver amendment approval from Federal CMS, all DDD SEP awards for Individual (39U) and Group (39G) issued prior to January 1 2021, will be deactivated and new program and bill codes, as identified below for each category, will be implemented.

DDD SEP Individual (39U) and Group (39G) will remain active and billable until such time as the waiver amendment is approved and initiated.

New program and billing codes associated with Federal CMS approval of the waiver ammendment:

  • SEP Individual (Billing Code: 36U)
    • Replaces 39U
    • Staff to individual ratio is 1:1
    • Hourly Maximum: 300 Annual, 50 Monthly, 8 Daily
  • SEP Small Group (Billing Code: 33G)
    • Replaces 39G
    • Staff to individual ratio is 1:3 or less
    • Hourly Maximum: 1,200 Annual, 115 Monthly, 5 Daily
  • SEP Large Group (Billing Code: 36G)
    • Replaces 39G
    • Staff to individual ratio is 1:4 to 1:6
    • Hourly Maximum: 1,200 Annual, 115 Monthly, 5 Daily

DDD SEP Group services should support a successful transition to competitive integrated employment or self-employment, or to supplement such employment and/or self-employment when it is only part-time.

To allow for the greatest flexibility while still supporting a distinction between the codes, DDD SEP Group will be awarded together (33G & 36G). Providers of DDD SEP Group must bill under the correct code based on the ratio of support staff to individuals served.

DDD SEP Eligibility Criteria:

All individuals approved for the Home and Community Based Support (HCBS) Waiver for Adults with Developmental Disabilities may access DDD SEP with prior approval. Requests for DDD SEP will only be considered for individuals who meet the following criteria:

  • enrolled in the Adults with Developmental Disabilities HCBS Waiver; and
  • require supportive services to work in an integrated employment environment; and
  • have a defined, related and ongoing/long term employment support need identified in his or her Personal Plan (Career and Income section); and
  • currently employed, either individually or in group employment, at competitive wages and in an integrated setting; and
  • supported within the proper ratio

Employment environments must meet the requirements of the HCBS Settings rule and allow ample opportunity for the individual receiving services and supports to engage in routine interactions with customers, co-workers and other individuals who do not have disabilities.

DDD SEP Forms:

All requests for DDD SEP (initial award and revalidation of existing) must include:

Initial Requests for DDD SEP Individual must also include DHS DRS Closure Form: IL 488-0717W

DDD SEP Request Categories:

  1. Initial (new) - for individuals who either never held a DDD SEP award or those whose award/s were deactivated and who found new CIE
  2. Revalidation - for individuals with an active DDD SEP award

Initial DDD SEP Requests:

Initial DDD SEP Individual (36U)

Individuals seeking initial awards for DDD SEP Individual (36U) must be successfully closed and transitioning from supports provided through DRS VR. Initial DDD SEP Individual (36U) requests will not be considered for individuals who have not achieved a successful DRS VR employment outcome or those who have been found ineligible (denied) for DRS VR services.

Initial requests for DDD SEP Individual (36U) must:

DDD SEP Individual is effective the day after the case closure as indicated on the DRS Closure Form.

Initial DDD SEP Group (33G, 36G)

DDD SEP Group is effective the day after request is processed.

DDD SEP Revalidation Requests:

To be considered for DDD SEP revalidation, an individual must meet the DDD SEP Eligibility Criteria noted earlier in this IB and have an active award for DDD SEP.

FY22 Revalidations:

Individuals authorized for DDD SEP prior to January 1, 2021, are eligible for continued authorization of DDD SEP program and bill codes through the revalidation process.

As of the end of October, 2021, DDD SEP Provider agencies were issued a list of all individuals for whom Individual and or Group DDD SEP billing was submitted State Fiscal Years 2020 and/or 2021. Accompanying the list was a provider letter which reinforced eligibility requirements, outlined timeframes and detailed the actions necessary to complete the FY22 DDD SEP Revalidation.

Similar to initial requests, to complete the FY22 DDD SEP revalidation, each provider agency must submit, for each eligible individual, complete and accurate versions of the following:

Individuals approved for initial DDD SEP (Individual and or Group) on or after January 1, 2021, and those who received initial (new) awards throughout the FY22 revalidation timeline, do not require revalidation FY22 Revalidation. These awards will be automatically authorized for the new, related, DDD SEP service and billing codes but will be included in future years revalidations.

Future Revalidations:

Will occur on a timeframe to be set forth and communicated by the DDD but will include a similar process and comparable requirements, including the submission of ADPRs and SEQs for all individuals requesting revalidation of the DDD SEP program and bill codes.

Revalidations pertain only to individuals who are authorized for DDD SEP.

Submission of Requests - Initial Award and or Revalidation:

Complete and accurate documentation (ADPR, SEQ and, as applicable for new Individual requests, the DRS closure) must be sent to the respective ISC agency. After review and approval at the ISC level, all documentation will be forwarded, by the ISC via Birdseye, to the applicable DDD staff.

DDD will:

  • review and log the documentation to verify eligibility and determine authorization of both initial and revalidation requests
  • work with staff from the provider, DDD Region/s and ISC Providers to address any processing concern
  • communicate authorization (initial and revalidation) of all awards
  • make necessary updates to state systems

DDD SEP Documentation Requirements:

DDD SEP provider agency employment support staff shall maintain records of the duration, nature and case specifics of employment supports for all units of DDD SEP, both Individual and Group, which are billed.

Permanent records of all individuals served in DDD SEP shall include:

  • Name of individual served
  • Job title of individual served
  • Hourly wage (or annual salary) of individual served
  • Name & address of employer
  • Name of direct employer supervisor
  • Start and, if applicable, end dates of employment
  • Employer benefits (Paid time off, 401K, donation match, insurance)
  • Documentation of services funded by DRS

Daily records, progress/case notes of all individuals served shall include:

  • Date of DDD SEP supports
  • Location(s) of DDD SEP supports
  • Start and end time of DDD SEP supports
  • Name of provider agency DDD SEP support staff
  • Description of the activities and nature of support provided (progress notes) which align to outcomes identified in the Personal Plan and Implementation Strategy
  • Staff signature and date (digital signature is acceptable)

Daily records shall be retained for a minimum of 5 years.

DDD SEP Billing

DDD SEP billing shall not exceed the state maximums (daily, monthly & annual) as described in the waiver for any combination of services under 31U, 31C, 31V, 35U and 37U.

If multiple supports that utilize the daily, monthly, and annual award combination are used, there must be Implementation Strategies which define exactly the hours for each type of service. This ensures the maximum award is divided appropriately. The ISC is responsible for ensuring all services are reflected and itemized appropriately. In cases where no ISC is assigned, the provider agency must reflect the number of hours and types of services in the Support Plan.

Service time should be rounded to the nearest 15 minutes.

Service payments (billing) for DDD SEP are made only for the adaptations, supervision and training required by individuals receiving waiver services, as a result of their disabilities, to sustain CIE. Adaptations, supervision and training under both DDD SEP may include non-person facing portions of time which support continued successful employment. However, a direct service benefiting the individual's employment outcomes must be provided in order to bill for DDD SEP.

DDD SEP Billing shall not be submitted for activities such as:

  • employment that does not meet the standard of CIE
  • general soft skill employment curriculum delivery
  • Non-paid, pre-vocational experiences (e.g. volunteerism or informational business tours)
  • supervisory activities rendered as a normal part of the business setting
  • transportation time, unless the individual's service plan indicates a need for transportation training and the transportation training is being provided
  • "stand-by" time when employment support staff is not actively supporting the individual(s) receiving DDD SEP supports.
  • time between arrival and the start of active DDD SEP support.

The specific DDD SEP program/service code, applicable statewide rate, total hours per month which can be billed and monthly total should be included on the Service Agreement prior to billing for any individual in Adult Home Based Services.

Notes:

  • Federal CMS approval of updated SEP service and bill codes will not impact the timeline for DDD SEP agencies to submit FY22 Revalidation documentation
  • At no time should 31U (Community Day Services On-Site), 31C (Community Day Services Off-Site) or 31V (Community Day Services Virtual) be used as a billing mechanism for services related to Supported Employment.
  • Activities conducted under Section 14c of the Fair Labor Standards act, commonly referred to as "Sheltered Work" or "Special Wage Certificates" are not billable under DDD SEP as they do not align with Medicaid Waiver guidelines.
  • Competitive Integrated Employment (CIE) is work performed on a full-time or part-time basis for which an individual is:
    • Paid at or above minimum wage; and
    • Not paid less than what other employees without disabilities are paid for the same or similar work; and
    • Eligible for the level of benefits provided to other employees without disabilities; and
    • Provided opportunities for advancement similar to those employees without disabilities who have similar positions; and
    • At a location where the employee interacts with other employees without disabilities, as well as regular interaction with persons without disabilities who are not paid care givers or service providers.
    • Self-employment or CIE at a location at which there are typically no other employees working, besides the individual, is acceptable.

The information contained herein should not be considered a substitute for the appropriate official statutes, rules, regulations, or the advice of legal counsel.

Effective Date:

January 1, 2022, or upon final waiver amendment approval from Federal CMS