Building a Bridge- Phase II (2015-2020)

Phase II (2015-2020)

1. Policy & Goals

  • Establish interagency agreements with Department of Medicaid and OOD
  • Develop Transition Vision for Ohio
  • Issue overarching home and community based services rule
  • Assess Ohio’s current state of employment and day services to align goals for Phase III (2021-2024)

2. Financing

  • Amend waivers to further incentivize community, including community employment, for ALL i. Include add-ons for those inividuals who require additional supports to be successful in the community ii. Include add-on to incentivize highly qualified staff
  • Grant funds to public and private providers to transform their systems, including Intermediate Care Facilities willing to focus on employment an integrated day services
  • Continue funding Employment First line item and partnership with OOD
  • Amend State Plan to clarify Employment Navigation is a function of Targeted Case Management
  • Fund technical assistance relative to Employment Navigation

3. Training & TA

  • Require competency-based training for employment providers
  • Build SSA Capacity that prioritizes person-centered planning, CIE and CLE.Employment Navigation training to all SSAs
  • Continue System Transformation efforts
  • Continue ODEP partnerships
  • Continue statewide training on Transition Framework
  • Develop additional tools, materials, resources and training specific to job seekers and families, including training advocates to discuss employment related topics around the state
  • Expand Employment First team to address Employment and Community Life Engagement. Bring on regional project managers
  • Build private provider capacity to provide person-centered community based services that prioritize CIE
  • Expand and build provider networks throughout Ohio.

4. Service Innovation

  • Continue Project: Transformation work
  • Launch Community of Practice
  • Fund innovation pilots (ICF employment pilots; Integrated Community Supports)
  • Work in conjunction with Financing and Contracting Goals and Objectives to develop services that allow flexible services that promote CIE and CLE

5. Outcome Tracking

  • Amend waivers in order to better track data
  • Remove ability to bill a “combo” rate for vocational habilitation and adult day supports – thereby allowing better tracking of who is receiving the discrete services
  • Collect data on add-on utilization o Divide all “prevocational” activity from “on-the-job supports” – thereby allowing better tracking of how long/how much someone is receiving a prevocational service prior to employment and allowing to track who is actually working rather than simply receiving an employment service
  • Refine Outcome Tracking System
  • Pilot provider software to collect outcome data on community integration

6. Interagency Collaboration

  • Expand Employment First Partnership with Opportunities for Ohioans with Disabilities (VR)
  • Continue work of Employment First Taskforce and Advisory Committee

Goals of Phase II:

1. Increase community presence and participation, including employment. Focus will be funding and otherwise supporting efforts to provide person-centered, individualized supports that result in community presence and participation, with community employment being the priority. Employment will be addressed in all plans. To reach a goal of 50% employment by 2024, we would expect to achieve 36% by the end of Phase II.

2. Increase capacity:

a. Private provider capacity. As Ohio addresses conflict free case management, more focus will be put on developing the number and capacity of private providers to deliver services.

b. SSA capacity. As we emphasize person-centered planning, community supports and employment, training and technical assistance will be offered to SSAs.

3. Substantial compliance with HCBS Settings Rule. Through the various efforts of Phase II, we expect to be in substantial compliance with the HCBS Settings Rule by the end of Phase II.

4. Make data informed decisions. Efforts will be made to collect outcome data to inform future financing and policy decisions and target training and technical assistance. By the end of Phase II, we would expect to have data to move us toward reality-based outcome payments in our employment services. We would also be in a position to further refine our service package to promote employment and community integration.

a. Combo rate. Our current data does not allow us to identify who is receiving adult day supports and/or vocational habilitation discretely, but rather combines the two, thus making it difficult to identify who is in a “prevocational” services and for how long. We will now be able to better monitor utilization of this service, and consider limitations/restrictions on it based on real data.

b. Community-based services. Our current data does not allow us to identify the extent to which services are community-based. By collecting data on the proposed “Community Integration” addon, we will be better able to identify who is receiving services in the most integrated manner, and work with those providers who are still providing “traditional” day services. Additionally, we will monitor utilization to determine if any additional changes are needed (i.e., if the field moves to all services being delivered in the community all the time, then this may no longer be an add-on, but rather we may consider bringing up a new service).

c. Employment Supports. By separating pre-employment supports (i.e., discovery, job development), from “on-the-job” supports (i.e., job coaching), we will be able to better track the average number of hours leading to employment, the average number of hours of job coaching needed initially, fading over time, etc. and move toward outcome-based payments.

As of July 2018, Ohio has seen a 36% increase in integrated employment services.