D.C. Mun. Regs. tit. 29, r. 29-1922

Current through Register Vol. 71, No. 44, November 1, 2024

Rule 29-1922 - EMPLOYMENT READINESS SERVICES

1922.1

This section establishes standards governing Medicaid eligibility for employment readiness services for persons enrolled in the Home and Community-Based Services Waiver for Individuals with Intellectual and Developmental Disabilities (Waiver) and establishes conditions of participation for providers of employment readiness services.

1922.2

Employment readiness services occur over a defined period of time with specific outcomes to be achieved, and provide learning and work experiences, including volunteer work, where a person enrolled in the Waiver can develop general, nonjob-task-specific strengths and new employment related skills that contribute to employability in paid employment in an integrated community setting. A person receiving employment readiness services may pursue employment opportunities at any time to enter the general work force.

1922.3

To be eligible for Medicaid reimbursable employment readiness services, the services shall be identified in the ISP, Plan of Care, and Summary of Supports for each person enrolled in the Waiver, and each person shall:

(a) Demonstrate a need for employment readiness services;

(b) Have employment related goals included in the ISP; and

(c) Have services delivered through remote supports services to the extent the person is able to utilize equipment/technology needed for remote supports services as assessed and determined by the support team.

1922.4

To be eligible for Medicaid reimbursement, employment readiness services shall support a person on his/her pathway to competitive, integrated employment and shall consist of the following:

(a) Providing opportunities for persons enrolled in the Waiver to develop general, non-job, task-specific strengths and skills that contribute to employability and are consistent with the person's goals;

(b) Assessment activities that occur annually or more frequently based upon the needs of the person, which require, at a minimum, a Positive Personal Profile and Job Search and Community Participation Plan, and may also include a customized employment assessment, and/or conducting a person-centered vocational and situational assessment and employment readiness assessments provided at community businesses and other community settings;

(c) Social and soft skills training, including, but not limited to, the following:

(1) Following and interpreting instructions;

(2) Interpersonal skills, including building and maintaining relationships;

(3) Communication skills for communicating with supervisors, co workers, and customers;

(4) Travel skills;

(5) Respecting the rights of others and understanding personal rights and responsibilities;

(6) Decision-making skills and strategies;

(7) Support for self-determination and self-advocacy; and

(8) Budgeting and money management;

(d) Developing work skills which shall include, at a minimum, teaching the person the following:

(1) Appropriate workplace attire, attitude, and conduct;

(2) Work ethics;

(3) Attendance and punctuality;

(4) Task completion;

(5) Job safety;

(6) Attending to personal needs, such as personal hygiene or medication management; and

(7) Interviewing skills;

(e) Coordinating transportation to community activities utilizing the Medicaid Non-Emergency Transportation Broker;

(f) Employment exploration and/ or employment preparation in the community; and

(g) Coordinating community-based, integrated, volunteer experiences as set forth in § 1922.5.

1922.5

Volunteer experiences, as part of employment readiness, shall be time limited and must allow the person to develop experience and build skills to further the person's employment goal, as identified in his or her ISP. A person enrolled in the Waiver may volunteer at a for-profit private sector entity, a not-for-profit organization or an approved government agency, but may not volunteer for the provider agency or another business affiliated with the provider. Volunteering at a for-profit business shall meet any requirements released by the U.S. Department of Labor. Guidance for those requirements can be found at:http://www.dol.gov/whd/regs/compliance/whdfs71.pdf.

1922.6

To be eligible for Medicaid reimbursement, a Positive Personal Profile and Job Search and Community Participation Plan shall be developed within thirty (30) days of the date when the person began receiving services. An additional vocational assessment, completed by a qualified professional, shall be conducted within the first ninety (90) days of participation, and shall include an assessment of the following:

(a) Employment-related goals based on a person's strengths, interests, and areas for improvement;

(b) Available natural or community supports;

(c) Personal concerns and preferences, based upon what is important to and for the person;

(d) Work and career interests based on exploration and/or discovery; and

(e) Accommodations and supports, including an assessment of assistive technology, which may be required once the person is employed.

1922.7

To be eligible for Medicaid reimbursement, a Positive Personal Profile, Job Search and Community Participation Plan, and additional vocational assessment shall be conducted at least annually by the provider to evaluate each person enrolled in the Waiver's acquisition of employment-related skills based on the person's career preferences and goals as specified in their ISP and Plan of Care.

1922.8

Each provider of Medicaid reimbursable employment readiness services shall develop an individualized service delivery plan reflecting the person enrolled in the Waiver's interests, career preferences, choices, goals and prioritized needs. The plan shall:

(a) Define the specific outcomes to be achieved over a specified period of time;

(b) Describe the activities in the plan that are developed with the person and support the person on his or her pathway to competitive, integrated employment;

(c) Describe how the plan shall support a person in the development of employment related skills, including social skills such as interviewing skills, professionalism, building and maintaining relationships, selfdetermination and self-advocacy, and attending to the person's needs; and

(d) Describe community-based employment preparation experiences that are related to the person's employment goals.

1922.9

Each provider of Medicaid reimbursable employment readiness services shall submit reports to Department on Disability Services (DDS) service coordinator on a quarterly basis, consistent with the record maintenance requirements described under Section 1909 (Records and Confidentiality of Information) of Chapter 19 of Title 29 DCMR. These reports shall also include the following information:

(a) Volunteer activities provided;

(b) Employment exploration and/or preparation in the community; and

(c) Other employment readiness service activities provided.

1922.10

Each provider of Medicaid reimbursable employment readiness services shall develop, with the person, an individualized schedule of daily activities based upon the person's goals and activities as identified in his or her ISP, and consistent with what is in his or her Person-Centered Thinking and Discovery tools, of meaningful adult activities that support the person on his or her pathway to integrated, competitive employment.

1922.11

Each provider of Medicaid reimbursable employment readiness services shall maintain the following documents for monitoring and review, in addition to the record maintenance requirements described under Section 1909 (Records and Confidentiality of Information) of Chapter 19 of Title 29 DCMR:

(a) A copy of the Positive Personal Profile, Job Search and Community Participation Plan, and additional comprehensive vocational assessment; and

(b) A written daily schedule identifying the utilization of employment readiness services.

1922.12

To receive Medicaid reimbursement, employment readiness services shall provide opportunities for community engagement, inclusion and integration.

1922.13

To receive Medicaid reimbursement, each provider of employment readiness services shall be a Home and Community-Based Services (HCBS) Provider agency and shall meet the following requirements:

(a) Comply with the requirements described under Section 1904 (Provider Qualifications) and Section 1905 (Provider Enrollment Process) of Chapter 19 of Title 29 DCMR;

(b) Demonstrate, through experience or academic attainment of the executive staff, the ability and qualification to provide employment readiness services for persons with intellectual and developmental disabilities with varying habilitation needs; and

(c) Have at least one staff member with a bachelor's degree in vocational rehabilitation or a similar discipline, and one (1) year of combined supervisory and "job coaching" experience or experience providing employment services to person with disabilities.

1922.14

Each provider of Medicaid reimbursable employment readiness services shall comply with the requirements under Section 1938 (Home and Community-Based Settings Requirements) of Chapter 19 of Title 29 DCMR.

1922.15

When employment readiness services are provided in a facility, each facility shall comply with all applicable federal, District, or state and local laws and regulations in order to receive Medicaid reimbursement. Effective November 1, 2020, no increase in the number of facility-based settings shall be authorized. Current providers shall be prohibited from increasing the number of facility-based settings at which services are provided; and newly enrolling providers shall be prohibited from providing services at any facility-based settings.

1922.16

All payment for employment related training services shall be in accordance with the United States Fair Labor Standards Act of 1985.

1922.17

The employment readiness Medicaid reimbursement rate shall include coverage for any personal care services provided by an employment readiness services provider.

1922.18

To be eligible for Medicaid reimbursement, each Direct Support Professional shall meet the following requirements:

(a) Comply with Section 1906 (Requirements for Direct Support Professionals) of Chapter 19 of Title 29 DCMR; and

(b) Have at least one (1) year of experience working with people with intellectual and developmental disabilities, or one year of comparable experience.

1922.19

Employment readiness services shall be authorized for Medicaid reimbursement if:

(a) DDS provided a written service authorization before the commencement of services;

(b) The provider develops a Positive Personal Profile and Job Search and Community Participation Plan, conducts an additional initial vocational assessment and then an annual Positive Personal Profile and Job Search and Community Participation Plan and additional vocational assessment thereafter; and develops an employment readiness plan with training goals and techniques that will assist the person to achieve employment readiness goals and outcomes based upon the person's interests and preferences. The initial Positive Personal Profile and Job Search and Community Participation Plan shall be completed within the first thirty (30) days of service delivery and the additional vocational assessment shall be completed within the first ninety (90) days of service delivery;

(c) The service name and provider delivering services are identified in the ISP and Plan of Care;

(d) The ISP, Plan of Care, and Summary of Supports and Services documents the amount and frequency of services to be received; and

(e) Services shall not conflict with the service limitations described under Subsection 1922.20 (Service Limitations).

1922.20

Medicaid reimbursement shall only cover services furnished to a person enrolled in the Waiver for up to eight (8) hours per day, not to exceed forty (40) hours per week, which shall not include reimbursement for travel time spent in transportation to and from the program. Employment readiness services delivered through remote supports services shall be provided for a maximum of four (4) hours a day consecutively or in increments, not to exceed twenty (20) hours per week.

1922.21

Medicaid reimbursable employment readiness services shall not be provided, or billed at the same time as the following services:

(a) Day Habilitation;

(b) Supported Employment;

(c) In-Home Supports;

(d) Companion;

(e) Personal Care Services; and

(f) Individualized Day Supports.

1922.22

Employment readiness providers may not pay a stipend to a person for attendance or participation in activities at the employment readiness program.

1922.23

An employment readiness provider may not concurrently employ a person and be his or her provider of Medicaid employment readiness services.

1922.24

Employment readiness services are not available to people who are eligible to participate and are fully supported in programs funded under Section 110 of the Rehabilitation Act of 1973, enacted September 26, 1973, as amended (Pub. L. 93112; 29 USC §§ 720et seq.), or Sections 602(16) and (17) of the Individuals with Disabilities Education Act, enacted April 13, 1970, as amended (Pub. L. 91-230; 20 USC §§ 1400et seq.). However, employment readiness services may be used to provide additional supports for employment for persons eligible for and participating in those programs.

1922.25

Each provider of employment readiness services shall maintain the required staff-to-person ratio, as indicated in the person's ISP and Plan of Care, with a maximum staffing ratio of 1:4. For a person that requires 1:1 supports (behavioral and/or medical) in an Employment Readiness setting:

(a) The direct support professional (DSP) providing 1:1 employment readiness services shall be trained in physical management techniques, positive behavioral support practices and other training required to implement the person's health care management plan and behavioral support plan (BSP), in accordance with DDS's Training policy and procedure;

(b) There shall be an approved BSP or physician's order for 1:1 staffing support; and

(c) When required by a person's BSP, the DSP shall accurately complete the behavioral data sheets.

1922.26

The billable unit of service for Medicaid reimbursable employment readiness services shall be fifteen (15) minutes. A provider shall provide at least eight (8) minutes of service in a span of fifteen (15) continuous minutes in order to be able to bill a unit of service.

1922.27

No Employment Readiness setting may have a daily census that exceeds fifty (50) people who are in the setting for more than twenty (20) percent of the day, inclusive of people who receive supports through the Waiver and people who live in intermediate care facilities for individuals with intellectual disabilities and are engaged in active treatment at the setting.

1922.28

The following time limitations apply to the use of employment readiness services:

(a) For people who are not currently enrolled in employment readiness services, the service may only be authorized for up to one (1) year, except that DDS may approve up to a one-year extension if there is documentation that the person is making progress towards competitive integrated employment and would benefit from extended services;

(b) For people who are currently enrolled in employment readiness services, the service may only be reauthorized for up to one (1) year from the person's next ISP effective date, except that DDS may approve up to a one-year extension if there is documentation that the person is making progress towards competitive integrated employment and would benefit from extended services. For people who have an ISP meeting scheduled within ninety (90) days of the Waiver renewal effective date, DDS may authorize an additional ninety (90) days of employment readiness services if needed to ensure a smooth transition;

(c) If a person has exhausted employment readiness services and has had at least one (1) year since the end of that service; expresses an interest in employment; and the support team has identified specific goals around building employment skills that are reflected in the ISP, then DDS may authorize employment readiness services one time for up to one (1) year;

(d) Any time that a person loses his or her job, voluntarily leaves employment, or is employed and is seeking to learn new job skills, DDS may authorize employment readiness services for up to one (1) year; and

(e) For any person who is currently receiving employment readiness services who will be subject to a reduction in authorized service hours due to the service limitations listed above, DDS will provide timely and adequate due process notice of the change in services and the person's appeal rights in accordance with 29 DCMR § 1912 (Initiating, Changing, or Terminating Any Approved Service) and using the process described in the DDS Person-Centered Planning Process and Individual Support Plans policy and procedures, or the successor documents.

1922.29

As of the effective date of this regulation, any new Employment Readiness setting must be fully compliant with the requirements of the HCBS Settings Rule.

1922.30

Within one (1) year of the effective date of this Subsection 1922.30, all existing Employment Readiness providers must become enrolled as a provider for Rehabilitation Services Administration services. Any new Employment Readiness providers must become enrolled as a provider for Rehabilitation Services Administration services within one (1) year of becoming an HCBS Waiver Employment Readiness provider.

1922.31

Each provider of remote employment readiness services shall comply with the requirements under Section 1943 (Remote Supports Services) of Chapter 19 of Title 29 of DCMR.

1922.32

Remote employment readiness services shall be issued as a separate service authorization indicating the frequency of usage. A hybrid model may be used for in-person and remote supports services employment readiness hours where two (2) service authorizations are issued to cover the in-person service hours and the remote supports services hours.

1922.33

Remote employment readiness services staffing ratio is 1:6 and shall have active, continuous engagement and contact with the remote supports platform. Staff shall be available during the service hours and document that they are continuously engaged with the person or the remote supports responder platform to bill for hourly services rendered.

1922.34

HCBS waiver providers providing employment readiness through remote supports services shall meet the criteria, as specified at § 1943.

D.C. Mun. Regs. tit. 29, r. 29-1922

Final Rulemaking published at 61 DCR 2112 (March 14, 2014); amended by Final Rulemaking published at 62 DCR 15684 (12/4/2015); amended by Final Rulemaking published at 63 DCR 11653 (9/23/2016); amended by Final Rulemaking published at 69 DCR 10218 (8/12/2022); amended by Final Rulemaking published at 71 DCR 10372 (8/16/2024)

Authority: An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program, and for other purposes, approved December 27, 1967 (81 Stat. 744; D.C. Official Code § 1-307.02 (2012 Repl. & 2013 Supp.)) and Section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6) (2012 Repl.)).