Extended Services Added as New Medicaid Waiver Service – Replaces Supported Employment Follow Along

The Division of Disability and Rehabilitative Services (DDRS) has received approval from the Centers for Medicare and Medicaid Services (CMS) for the renewal of Indiana’s Family Supports Waiver (FSW).  This followed the earlier approval of the division’s request to amend the Community Integration and Habilitation (CIH) Waiver.  Both of the waiver documents are posted on BDDS’ webpage. 

Following is information edited from DDRS’ July 1 memo, “Extended Services for Family Supports and Community Integration and Habilitation Waivers.”  To read the complete memo, please visit: DDRS Memo: Extended Services for Family Supports and Community Integration and Habilitation Waivers

Effective July 1, 2015 Extended Services has been added as a new service to the Family Supports Waiver, Community Integration and Habilitation Waiver and the Money Follows the Person-CIH grant (MFP-CIH).  Extended Services replaces the Supported Employment Follow Along (SEFA) service.    

Extended Services – Service Definition

Extended Services are ongoing employment support services which enable an individual to maintain integrated competitive employment in a community setting.  Individuals must be employed in a community-based, competitive job that pays at or above minimum wage in order to access this service.

Initial job placement, training, and stabilization may be provided through Indiana Vocational Rehabilitation Services.

Extended Services provide the additional work related supports needed by the individual to continue to be as independent as possible in community employment. If an employed individual has obtained community-based competitive employment and stabilization without Vocational Rehabilitation’s services, the participant is still eligible to receive Extended Services, as long as the participant meets the qualifications noted below.

Ongoing employment support services are identified in the participants’ Individualized Support Plan and must be related to the participants’ limitations in functional areas (i.e. self-care, understanding and use of language, learning, mobility, self-direction, capacity for independent living, economic self-sufficiency), as are necessary to maintain employment.

Reimbursable Activities

  • Ensuring that natural supports at the worksite are secured through interaction with supervisors and staff. A tangible outcome of this activity would be a decrease in the number of hours of Extended Services an individual accessed over time.
  • Training for the participant, and/or the participant’s employer, supervisor or co-workers, to increase the participant’s inclusion at the worksite.
  • Regular observation or supervision of the participant to reinforce and stabilize the job placement.
  • Job-specific or job-related safety training.
  • Job-specific or job-related self-advocacy skills training.
  • Reinforcement of work-related personal care and social skills.
  • Training on use of public transportation and/or acquisition of appropriate transportation.
  • Facilitating, but not funding, driver’s education training.
  • Coaching and training on job-related tasks such as computer skills or other job-specific tasks.
  • Individual (one-on-one) services can be billed in 15-minute increments.

With the exception of 1:1 job coaching, support and observation, the potential exists for all components of the Extended Services’ definition to be applicable to either an individual waiver participant or to a group of participants.

Examples of activities that might be provided in a group setting include instructing a group of individuals on professional appearance requirements for various types of employment, reinforcement of work-related personal care or social skills, and knowing how to get up in time to get ready for and commute to work.  Groups could receive job specific or job-related safety training, self-advocacy training, or training on the use of public transportation.  A group could receive training on computer skills or other job-specific tasks when group participants have similar training needs.

Additional Information

  • Individuals may also utilize Workplace Assistance during any hours of competitive integrated employment in conjunction with their use of Extended Services.
  • Extended Services are not time limited.
  • Community settings are defined as non-residential, integrated settings that are in the community. Services may not be rendered within the same building(s) alongside other nonintegrated participants.
  • Competitive integrated employment is defined as full or part-time work at minimum wage or higher, with wages and benefits similar to those without disabilities performing the same work, and fully integrated with co-workers without disabilities.
  • Individuals may be self-employed, working from their own homes, and still receive Extended Services when the work is competitive and could also be performed in an integrated environment by and among persons without intellectual/developmental disabilities.

Note:  Only those waiver participants engaged in competitive community employment and actively utilizing a combination of Supported Employment Follow-Along (SEFA) and prevocational services as of June 30, 2015 (as reflected in their ISP, approved CCB and NOA) may utilize the combination of Extended Services and prevocational services on or after July 1, 2015. Group services may only be provided at the discretion of the IST and in group sizes no greater than four individuals to one staff. In addition, the provider must be able to provide appropriate documentation, as outlined in the DDRS Waiver Manual, demonstrating that the ratio for each claimed timeframe of services did not exceed the maximum allowable ratio determined by the IST for each group participant, and provide documentation identifying other group participants, by using the individuals’ HIPAA naming convention.

Activities Not Allowed

  • Reimbursement is not available under Extended Services for the following activities:
  • Any non-community based setting where the majority (51 percent or more) of the individuals have an intellectual or developmental disability.
  • Sheltered work observation or participation.
  • Volunteer endeavors.
  • Any service that is otherwise available under the Rehabilitation Act of 1973 or Public Law
    94- 142.
  • Public relations.
  • Incentive payments made to an employer to subsidize the employer’s participation in Extended Services.
  • Payment for vocational training that is not directly related to the individual’s Extended Service needs to be outlined in the ISP.
  • Extended Services do not include payment for supervisory activities rendered as a normal part of the business setting.
  • Extended Services provided to a minor by a parent(s), step-parent(s), or legal guardian, or spouse.
  • Waiver funding is not available for the provision of vocational services delivered in facility based or sheltered work settings, where individuals are supervised for the primary purpose of producing goods or performing services.
  • The provision of transportation is not a reimbursable activity within Extended Services.
  • Only those waiver participants engaged in competitive community employment and actively utilizing a combination of Supported Employment Follow-Along (SEFA) and prevocational services as of June 30, 2015 (as reflected in their ISP, approved CCB and NOA) may utilize the combination of Extended Services and prevocational services on or after July 1, 2015.
  • Effective July 1, 2015, for all other waiver participants, there is no longer an option to utilize this service combination as prevocational services and Extended Services are considered to be mutually exclusive and shall not overlap. The latter group of waiver participants includes all new enrollees to the waiver as well as other active participants not utilizing a combination of Extended Services and prevocational services as of June 30, 2015, whether or not they are/were engaged in competitive community employment. Going forward, individuals from the latter group of waiver participants who engage competitive community employment are no longer eligible for prevocational services.
  • Group supports delivered to individuals who are utilizing different support options. For example, one individual in the group is using Extended Services and another individual in the same group setting is using Facility-Based Habilitation. This type of activity would not be allowed.

NOTE: Supported employment services continue to be available under the Rehabilitation Act of 1973 through the Vocational Rehabilitation Services (VRS) program within FSSA/DDRS’s Bureau of Rehabilitation Services (BRS).

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