Community-Based Services Manual (CBSM)

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Community-Based Services Manual (CBSM)

CBSM Waiver programs

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Employment support services

Page posted: 6/27/18		Page reviewed:	Page updated: 2/5/21
Legal authority	Federally approved BI, CAC, CADI and DD waiver plans, 42 C.F.R 5302(a)(22), Minn. Stat. §245D.03
Definitions	Employment support services: Individualized services and supports that help people maintain paid employment in community businesses/settings. Employment support services occur in integrated community settings. Microenterprise business: A commercial business with five or fewer employees, including the owner(s) of the business.
Eligibility	To be eligible for employment support services, a person must both: · Receive BI, CAC, CADI or DD waiver services. · Have employment support service as an assessed need in their coordinated services and supports plan (CSSP).
Covered services	Employment support services consist of both job support services and self-employment/microenterprise support services. Job support services Requires direct contact Covered job support services that require direct contact with the person may include: · Job analysis. · Job re-design. · Coaching and supporting acceptable workplace self-care, proper dress, personal hygiene and grooming. · Job training and coaching to strengthen and maintain necessary work skills, behaviors and coworker relationships. · Job-related counseling and support, including help understanding earned wages and impact on benefits. · Training and coaching the person on job-related transportation. · Progress review and reporting meetings. · In-service transportation. Does not require direct contact Covered job support services that do not require direct contact with the person may include: · Arrangement for adaptive accommodations (e.g., modified work tasks or responsibilities, flexible schedules, telecommuting, etc.). · Arrangement for assistive technology (e.g., ergonomic workstations, magnifiers, speech-to-text or text-to-speech software, captioning, audio or visual cueing, etc.). · Advocacy, negotiation and liaison communication with the employer. · Development and strengthening natural work supports. · Research and coordination for job-related transportation. · Working with the employer to design and implement set schedules for ongoing follow-up support, job coach sharing, fading out and monitoring. · Formation of skilled, job-specific, work crews and job enclaves for group employment support service arrangements. · Data collection, documentation and progress reports on a person’s work performance. · Benefit(s) fact gathering, review and analysis to determine how a change in circumstances will affect benefits. Self-employment and microenterprise business support services Requires direct contact Covered self-employment and microenterprise business support services that require direct contact with the person may include: · Training, coaching and support services for helping with effective day-to-day operations of all aspects of the business (i.e., marketing, sales, production, order fulfillment, customer service, business technology, bookkeeping, file record maintenance, purchasing, inventory control, financial management, accounting, timely tax reporting and legal compliance). · Help with identifying other needed external business resources and services to assist with the continued development and support of the business enterprise. · Ongoing analysis and consultation to identify needed supports. · Design and implementation of set schedules for ongoing, follow-up support. · Business-related counseling and support, including help understanding earned wages and impact on benefits. Does not require direct contact Covered self-employment and microenterprise business support services that do not require direct contact with the person may include benefit(s) fact gathering, review and analysis to determine how a change in a person’s circumstances will affect benefits.
Limitations	Group size A person cannot receive employment support services in groups of more than six people. Settings A person cannot receive employment support services in a facility-based setting. Employment support services should involve opportunities and experiences for the people receiving the services to interact meaningfully with both coworkers and people in the community without disabilities. Compensation Wage and benefit compensation must be compliant with all applicable federal laws and regulations, as well as state statute and rules. Microenterprise businesses Microenterprise businesses are restricted to five or fewer people. Service providers cannot be owners, partners, shareholders, operators, employees, independent contractors, subcontractors or otherwise a financial beneficiary of the microenterprise businesses they assist, support and serve. Service provider-owned businesses Employment support services cannot be provided in businesses that are owned or operated by the same organization that is providing the person’s day and employment services.
Non-covered services	Employment support services do not cover: · Incentive payments (e.g., payments to an employer to encourage or subsidize the employer’s participation in a support program). · Payments for vocational training that is not directly related to the person’s support program. · Direct compensation to supplement a person’s wage. · Special education services available and funded under the Individuals with Disabilities Education Act (IDEA) (refer to CBSM – VRS, IDEA and HCBS employment services – Interim guidance). · Vocational services available and funded under Section 110 of the Rehabilitation Act of 1973 (refer to CBSM – VRS, IDEA and HCBS employment services – Interim guidance). · Vocational services in facility-based or sheltered workshop settings.
Remote support	Employment support services can be delivered through remote support. Services delivered through remote support must meet all the requirements listed on CBSM – Remote support.
Secondary information	Determining individual support versus group support A person can receive individual and/or group employment support services. Individual support Individual employment support services provide services to one person at a time who works at a full-time or part-time, paid job position in a community business (including self-employment). Group support Group employment support services provide support to 2–6 people in a group who work together and share the tasks, duties and responsibilities of a job position in a community business. The group receives support while they: · Perform and share the work tasks, duties and responsibilities of a full-time or part-time job position. · Divide work tasks, duties and responsibilities of the job position across group members. A service is not group support if a provider delivers job-coaching support to multiple people who work at their own distinct job positions at different or dispersed locations in a community business. In this situation, the service would be an individual support service with a shared, job-coaching arrangement. Connection with other services A person can receive exploration services when receiving group (1:6) employment support services, but they cannot receive exploration services when receiving individual (1:1) employment support services (refer to CBSM – Employment exploration services). A person can receive both employment support services and employment development services if they are seeking other competitive, integrated employment opportunities while currently employed. A person may return to development services if they lose their job (refer to CBSM – Employment development services).
Provider standards and qualifications	Employment support is a DHS enrollment-required service. Employment support service providers must: · Enroll with Minnesota Health Care Programs (MHCP). · Have a 245D license as an intensive support service provider. For more information, refer to CBSM – Waiver/AC provider enrollment standards. All providers of employment services must ensure staff competency. For more information, refer to DHS – Employment specialist competencies. Background study To provide employment exploration, providers must have a background study. For more information, refer to CBSM – Waiver/AC service provider overview – Required DHS background studies for direct-contact services. Reporting A provider licensed under 245D must report all uses of controlled procedures, emergency use of manual restraint and prohibited procedures according to Minn. Stat. §245D.06, subd. 5 to DHS via the Behavioral Intervention Report Form, DHS-5148.
Service authorization, rates and billing	Employment support is a framework service. The lead agency uses the Rate Management System (RMS) to determine rates. For more information, refer to CBSM – RMS. Employment services include in-service transportation. Transportation services occurring between the person’s place of residence and the site of service are not covered as part of this service and should be billed as waiver transportation (refer to CBSM – Transportation). Individual and group employment support should not be billed as DT&H day services, day support services, prevocational services, structured day services or adult day services. DT&H day services, day support services, prevocational services, structured day services and adult day services must be authorized and reimbursed on a 15-minute unit basis when employment support services are provided during the same day as these services.
Additional resources	Employment services CBSM – Employment exploration services CBSM – Employment development services DHS – Employment First Day services CBSM – Adult day services CBSM – Day support services CBSM – Prevocational services CBSM – Structured day program Waiver services CBSM – Waiver, AC and ECS general process and procedures CBSM – Waiver/AC provider enrollment and standards CBSM – Waiver programs overview CBSM – Transportation Other resources CBSM – Remote support CBSM – Resource: Guidance for employment services authorization CBSM – Resource: Lead agency employment liaisons CBSM – Resource: Transportation and day and employment services Disability Hub MN Disability Hub MN – Benefits planning toolkit Rate Management System (RMS) User Manual RMS User Manual – Quick reference guide on billable indirect time

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