Division of Developmental Disabilities Supported Employment Program (DDD SEP) FY23 Revalidation Guidelines Update
Purpose:
The Division of Developmental Disabilities (DDD) is committed to expanding and enhancing opportunities for individuals with intellectual and developmental disabilities (I/DD) to sustain Competitive integrated Employment (CIE). The DDD's commitment in this area includes periodic auditing and data collection efforts through the Revalidation of the DDD's Supported Employment Program (DDD SEP) awards.
The following is guidance on the process and procedure for FY23 DDD SEP Revalidation as well as the history and rationale of Revalidation, previous guidance on scope, eligibility, HCBS Settings, active service and billing codes, eligibility and records related to DDD SEP.
Background:
In October 2021, the DDD initiated the first Revalidation of all existing & active DDD SEP awards. Revalidation is built upon the foundation of the Memorandum of Understanding (MOU) entered into by the DDD and the Division of Rehabilitation Services (DRS) in September 2020, as well as guidance from a previous Information Bulletin regarding DDD SEP. Previous guidance related to DDD SEP included, but was not limited to:
- Scope: DDD SEP may only be associated with services and supports which sustain CIE.
- Eligibility: All individuals approved for the Adults with Developmental Disabilities Home and Community Based Services (HCBS) Waiver 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 sustain employment 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.
- New/initial requests for DDD SEP Individual require submission of documentation indicating successful closure from DRS within the preceding 90 days.
- HCBS Settings: Employment programs and environments must meet the requirements of the HCBS Settings rule and allow ample opportunity for the individual receiving services to optimize individual initiative, autonomy and independence in making life choices including choice of employment and environment as well as with whom to interact. DDD SEP must support engagement of routine interactions with customers, co-workers and other individuals who do not have disabilities.
- Service and Billing Codes:
- DDD SEP Individual (Billing Code: 36U)
- Staff to individual ratio is 1:
- Hourly Maximum: 300 Annually, 50 Monthly, 8 Daily
- DDD SEP Small Group (Billing Code: 33G)
- Staff to individual ratio is 1:3 or les
- Hourly Maximum: 1,200 Annually, 115 Monthly, 5 Daily
- DDD SEP Large Group (Billing Code: 36G)
- Staff to individual ratio is 1:4 to 1:6
- Hourly Maximum: 1,200 Annually, 115 Monthly, 5 Daily
Special Notes:
- Authorized individuals have an annual maximum of 1,200 hours per year for any combination of programs (i.e. Community Day Services and DDD SEP).
- DDD SEP Individual has different daily, monthly and annual maximums than DDD SEP Group (as noted above).
- DDD SEP Group services should support a successful transition to CIE 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 and revalidated together (33G and 36G).
- Providers of DDD SEP must bill under the correct code based on the type of award (Individual vs Group) and ratio of support staff to individuals served.
Current Impact:
Effective April 3rd, 2023, DDD will initiate the next round of DDD SEP Revalidation. 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.
All active DDD SEP awards authorized prior to April 3rd, 2023, are eligible for Revalidation of applicable DDD SEP program bill codes.
Agencies providing DDD SEP services and supports are expected to submit Revalidation documentation for all individuals with an active DDD SEP award and who require services and support to sustain currently active CIE. Unlike the first Revalidation, DDD SEP Providers will not be sent a list of active awards. Rather, DDD SEP Providers should reference their own active award records when considering Revalidation submission. Questions on the status of DDD SEP awards may be directed to the DDD SEP Unit personnel.
The FY23 Revalidation period will end on May 19th, 2023. DDD SEP Revalidation Requests that are submitted on time and which meet all criteria of DDD SEP, will be authorized for continued use into FY24. DDD SEP Revalidation requests which are received after May 19th, 2023, and those which do not meet DDD SEP criteria will be deactivated effective June 30th, 2023.
In the event of deactivation, a New/Initial Request for DDD SEP may be made, should the individual obtain employment.
Submission of Revalidation Requests
Complete and accurate documentation must be transmitted from the requesting DDD SEP Provider to the respective ISC agency. After review and approval by the ISC, all documentation will be forwarded by the ISC, via Birdseye, to DDD.
Submission of complete and accurate versions of the following documents are required for Revalidation of each DDD SEP award.
Upon receipt of complete and accurate ADPRs and SEQs, DDD SEP Unit Personnel will:
- Review and document the submission; and
- Verify eligibility and determine Revalidation status; and
- Work with staff from the DDD SEP provider agency, DDD Regions and ISC to address any processing concern/s; and
- Communicate the outcome of Revalidation to DDD Regions, DDD Rates, assigned ISC agencies and DDD SEP Providers.
- Revalidation will not result in issuance of an updated rate sheet.
Notes:
- Requests that include documents which are not fully completed and/or contain erroneous information are subject to denial.
- SEQs must be submitted for each employment opportunity supported by DDD SEP.
- DDD SEP Group programs and locations must be confirmed as compliant with HCBS Settings requirements.
- Revalidation applies only to DDD SEP Awards issued and active prior to April 3rd, 2023. Individuals approved for new/initial DDD SEP awards (Individual and or Group) on or after April 3rd, 2023, do not require Revalidation at this time. These awards will be automatically renewed for FY23 and will be included in future Revalidations.
Individuals whose DDD SEP award/s is/are not revalidated will have their current DDD SEP authorization(s) automatically deactivated for billing effective the end of the State's current Fiscal Year.
DDD SEP Documentation Requirements:
The DDD SEP provider agency shall maintain records of the duration, nature and case specifics of employment services and supports for all billed units of DDD SEP, both Individual and Group.
Permanent records of all individuals served in DDD SEP shall include:
- Name of individual served; and
- Job title of individual served; and
- Hourly wage (or annual salary) of individual served; and
- Name and address of employer; and
- Name of direct employer supervisor; and
- Start and, if applicable, end dates of employment; and
- Employer benefits (Paid time off, 401K, donation match, insurance); and
- Documentation of services funded by DRS.
Daily records, progress/case notes of all individuals served shall include:
- Date of DDD SEP supports; and
- Location(s) of DDD SEP supports; and
- Start and end time of DDD SEP supports; and
- Name of provider agency DDD SEP support staff; and
- Description of the activities and nature of support provided (progress notes) which align with outcomes identified in the Personal Plan and Implementation Strategy; and
- Staff signature and date (digital signature is acceptable).
DDD SEP Billing
DDD SEP billing shall not exceed the state maximums (daily / monthly / annually) for any combination of services under:
- Community Day Services On-Site (31U)
- Community Day Services Off-Site (31C)
- Virtual Day Services (31V)
- Adult Day Services (35U)
- Enhanced Residential (37U)
- DDD SEP Individual (36U)
- DDD SEP Group (33G and 36G)
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. Seven (7) minutes or less is to be rounded down and 7.5 minutes or above can be rounded up.
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 Individual and DDD SEP Group 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; and or
- General soft skill employment curriculum delivery; and or
- Non-paid, pre-vocational experiences (e.g. volunteerism or informational business tours); and or
- Job development or placement; and or
- Supervisory activities rendered as a normal part of the business setting; and or
- Transportation time, unless the individual's Personal Plan indicates a need for transportation training and the transportation training is being provided; and or
- "Stand-by" time when employment support staff is not actively supporting the individual(s) receiving DDD SEP supports; and or
- 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.
At no time should the following service and billing codes be used as a billing mechanism for services and supports related to DDD SEP:
- Community Day Services On-Site (31U)
- Community Day Services Off-Site (31C)
- Virtual Day Services (31V)
- Adult Day Services (35U)
- Enhanced Residential (37U)
- Intermittent CILA (61H, 62H and 63H)
- Personal Support (55D)
Activities conducted under the auspices of Section 14c of the Fair Labor Standards Act, commonly referred to as "Subminimum Wage", "Sheltered Work" or "Special Wage Certificates" are not billable under DDD SEP as they do not align with Medicaid guidelines.
Competitive Integrated Employment 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 DDD is offering a webinar training & Q/A session on the FY23 Revalidation on Tuesday, March 28th 12:00pm-1:00pm CST. The webinar's target audience is anyone who plays a role in, or wants to learn more about, DDD SEP then register for the webinar.
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:
March 20th, 2023
