Vocational Rehabilitation Services Manual C-1200: Supported Employment Services

Supported Employment (SE) enables customers with the most significant disabilities to enter competitive integrated employment by:

• providing individualized assistance in finding an appropriate job match;
• providing Ongoing Support Services; and
• establishing Extended Services, sometimes called long-term supports, to help the customer to maintain a long-term competitive integrated employment.

Often customers in SE have been:

• excluded from community services;
• institutionalized; or
• in segregated work programs, such as sheltered workshops or enclaves, for extended periods of time.

SE providers often use the "place and train" model and customized employment practices to develop the best job match for the customer, using flexible strategies to meet the individual's needs and the employer's unmet business needs. The "place and train" model matches customers to jobs that are consistent with their unique strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choices. Providers then supply ongoing supports and training so that the customer can develop the skills needed to maintain the employment over the long term with the use of Extended Services.

SE can be used with customers with any disability, but it is most commonly used with customers who have a neurodevelopment disability, complex physical disabilities such as brain injury, cerebral palsy, etc., and significant behavioral health conditions that cause the customer to have severe limitations.

SE services may be used for customers with any type of disability, but a customer must:

• have a most significant disability (three or more functional limitations);
• require individualized assistance in finding an appropriate job match;
• require ongoing supports to learn the job and establish accommodations; and
• require extended services (long-term supports) to maintain the employment after VR closes the case.

A VR counselor can authorize the purchase of SE if the customer has a most significant disability and:

• will benefit from the Place, Then Train model of job placement;
• needs extensive comprehensive training and support to compete in the labor market;
• needs ongoing supports to maintain an employment outcome;
• requires considerable help competing in the open job market;
• has not had competitive integrated employment or has experienced interrupted or intermittent employment; and/or
• is likely to be able to find and keep a competitive integrated job when necessary supports are in place.

Supported Employment services are available for customers who are “youth with disabilities,” adults, and in trial work.

C-1202-1: Level of Significance for Supported Employment Cases

All VR customers who use SE services must be designated in ReHabWorks (RHW) as "most significant." The level of significance is determined at the time eligibility is determined. However, if additional information becomes available to support the change in the level of significance, this designation may be updated at any time thereafter.

SE can be used as a Trial Work activity.

For more information about determining the level of significance, refer to B-300: Determining Eligibility and B-309: Establishing the Level of Significance.

C-1202-2: Ongoing Supports

Ongoing supports are furnished by VR through SE from the time of job placement until the customer has achieved job stability and has been transitioned to Extended Services. Ongoing supports include the coordination or delivery of services at or away from the job site that are necessary for the customer to maintain stability in employment. Examples include:

• job skills training;
• social skills training;
• hard-skills training;
• development of job aids;
• education on disabilities with business; or
• establishing accommodation.

C-1202-3: Extended Services

Extended Services and supports assist the customer in maintaining employment long term, after the intensive ongoing supports and training have led to the stabilization of the customer's employment. Extended Services are comparable benefits that must be listed in the customer’s IPE.

Extended Services can be provided either at the employment site or off-site when necessary to maintain stable employment. Examples of Extended Services include, but are not limited to:

• job skills training (job coaching when provided by Home and Community-Based Services (HCBS) Waivers) to assist with development of soft and hard skills to ensure the customer is meeting the expectation of the employer;
• transportation;
• Social Security income reporting;
• medication management;
• assistance with dressing or toileting; and/or
• managing the customer's work schedule.

Extended Service Providers

Extended Services are funded by sources other than TWC-VR for as long as needed to ensure the customer remains stable in his or her employment. Extended Services begin when the customer achieves job stability. The Supported Employment Specialist coordinates and trains all Extended Service providers.

The only exception for Extended Services being provided by resources other than TWC-VR is for a VR customer who is a "youth with a disability" that does not have comparable benefits or resources available for Extended Services. VR can purchase Extended Services for VR customers who are "youth with disabilities" through Job Skills Training for only VR customers for a period of up to four years or until the youth reaches age 25, whichever occurs first.  When VR is providing Extended Services for a customer and is purchasing Job Skills Training the VR counselor must continually seek alternate resources for Extended Services and document the resources sought out in a case note. When comparable benefits or resources are found for Extended Services, VR must stop the purchase of Job Skills Training as an Extended Services.

Extended Services can be provided by:

• Medicaid Waiver Programs
• Local Intellectual Developmental Disabilities (LIDDA) and Local Mental Health Authorities (LMHA)
• public agencies and private nonprofit organizations
• natural supports:
  • supports from supervisors and coworkers such as mentoring, feedback on performance, and/or assistance in learning new skills
  • friends and family members can also provide natural supports such as arranging transportation, helping with medication management, and helping to solve work-related problems

Home and Community Based (HCBS) Waivers

Section 1915(c) Home and Community-Based Services (HCBS) Waivers provide opportunities for Medicaid beneficiaries to receive services in their own home or community rather than institutions or other isolated settings. These programs serve a variety of targeted populations groups, such as people with mental illnesses, intellectual disabilities, and/or physical disabilities. A person's services for HCBS waivers are determined on the person's preferences obtained through person-centered planning. Currently there is an interest list for all Texas HCBS waivers.  When a VR customer is eligible for a HBCS wavier the VR counselor should assist the customer in putting their name on the interest list.

People getting Medicaid HCBS have the right to:

• seek employment
• work in competitive or integrated settings
• engage in community life
• control their personal resources
• receive services in the community

Texas Home and Community Based (HCBS) Waivers include:

• Community Living Assistance and Support Services (CLASS)
• Home and Community-Based Service (HCBS)
• Texas Home Living (TxHmL)
• Youth Empowerment Services (YES)
• Deaf Blind with Multiple Disabilities (DBMD)
• STAR+PLUS
• STAR Kids

VR counselor's roles in coordinating a customer's Extended Services in a HCBS Wavier:

• VR counselor must make sure the customer's HCBS waiver budget has funds available for extended supports; and
• VR counselor must make sure the HCBS waiver provider includes the Extended Services in the customer's HCBS waiver person-centered/directed plan and individual service plan.

When HCBS services are coordinated in a VR customer's case:

• it is preferred and a best practice that the Extended Services, known as Supported Employment in the HCBS waiver, be identified before the VR counselor makes a referral for the VR Career Planning Assessment (CPA);
• units for HCBS waiver Supported Employment (aka VR Extended Services), must be approved in customer's HCBS waiver plan no later than the end of the final job retention benchmark in order for extended services to begin at job stability; and
• see TWS-VRS & HHS Waiver Sequencing of Services document.

This section applies only to customers who have a Medicaid waiver already available to them.

Supplemental Security Income and Social Security Disability Insurance Recipients

If a customer is eligible for Supplemental Security Income (SSI) and/or Social Security Disability Insurance (SSDI) benefits, the VR counselor must obtain a Benefits Planning Query (BPQY) in order for the Career Planning Assessment to be completed. Once the customer has an employment and earnings goal on the IPE, VR will arrange for the customer to receive a Benefits Summary and Analysis/Work Incentive Plan. VR works with the customer to facilitate use of Social Security work incentives when these resources are determined to benefit the customer. For more information about this process, refer to VRSM A-306-7: SSA Benefits and Work Incentives Supports and Services Planning Process.

Youth with Disabilities Customers and Extended Services

When all other available resources for extended services, such as Medicaid Waiver programs, natural supports, other public agencies, and/or private nonprofit organizations are not available to the customer, TWC-VRD can provide extended services to VR customers who are “youth with a disability.” Services can be provided for a period not to exceed four years or until the youth reaches the age of 25 and no longer meets the definition of a "youth with a disability," whichever occurs first. See the glossary for the definition of "youth with a disability." When VR sponsors extended services for youth with disabilities, the case must continue to maintain job stability status. Job skills training is how TWC-VRD purchases extended services for a customer. For information on how job skills training may be used as an extended service, refer to VR-SFP Chapter 17, Section 17.5.1.1 Purchasing Job Skills Training for Extended Services for Youth with Disabilities.

VR counselor must continue to seek out resources to fund the Extended Services until a resource for Extended Services is identified or the case is closed.

A case cannot be closed until 90 days after VR is no longer providing Extended Services for "youth with disabilities" customers.

For more information on services for youth with disabilities, refer to VRSM C-1300: Transition Services for Students and Youth with Disabilities.

For more information about using comparable benefits, refer to VRSM B-400: Completing the Comprehensive Assessment and B-504-6: Comparable Benefits.

Supported Employment Services are purchased through contracted providers only.

For more information on general purchasing policies and procedures, refer to D-200: Purchasing Goods and Services.

To ensure accountability and high-quality services to VR customers, VR staff must apply the contracting requirements as published in the Standards for Providers. For information about required outcomes for Supported Employment Services and the fee schedule, refer to VR Standards for Providers, Chapter 18: Supported Employment Services.

Any request to change to Supported Employment Service Description, Process and Procedure, or Outcomes Required for Payment must be documented and approved by the VR director using the VR3472, Contracted Service Modification Request form, before the change is implemented. Examples of when a VR3472 is necessary include when:

• requesting a change in providers in cases where the benchmarks previously achieved are not being paid;
• extending SE services beyond 24 months; and
• purchasing Supported Employment services after the purchase of a Bundled Job Placement Benchmark A-C.

C-1204-1: Premiums

The following premiums can be purchased with SE services:

• Autism
• Blind
• Brain Injury
• Criminal Background
• Deaf
• Mileage
• Professional Placement
• Wage

Refer to VR Standards for Providers, Chapter 20: Premiums, for service descriptions to determine whether a specific premium is applicable for a customer as well as the fee schedule.

SE services may not exceed 24 months from the time the customer is placed. When the customer needs SE for longer than 24 months to reach job stabilization, VR3472, Contracted Service Modification Request for Job Placement, Job Skills Training, and Supported Employment Services, must be completed and submitted for approval. The VR counselor and the customer must agree to extend services and must document the approved extension on the customer’s IPE.

When a change to an SE service description, process and procedure, or outcomes required for payment is required to meet a customer’s individual needs, the change must be documented and approved by the VR director using VR3472, Contracted Service Modification Request for Job Placement, Job Skills Training, and Supported Employment Services, before the change is implemented.

The following VR services may not be purchased while a customer is receiving SE services from an ESP:

• Bundled Job Placement
• Job Skills Training, except when the Job Skills Training is used to provide Extended Services as described in C-1202-3: Extended Services
• Non-bundled Job Placement
• On-the-Job Training (OJT)
• Personal Social Adjustment Training (PSAT)
• Vocational Adjustment Training (VAT)
• Environmental Work Assessment (EWA)
• Vocational Evaluation
• Project SEARCH
• Work Adjustment Training (WAT)
• Work Experience Services (WE)

For all benchmarks, the VR counselor:

• works in coordination with the customer and the SE specialist throughout the SE process to ensure the best possible employment outcome for the customer;
• facilitates the SE process, providing counseling and guidance throughout, to ensure successful employment for the customer;
• monitors the customer’s case;
• reviews all required documentation for accuracy and completeness prior to payment; and
• verifies that all deliverables have been achieved prior to authorizing payment of the invoice.

For all benchmarks, the rehabilitation assistant (RA):

• requests records;
• creates service records and issues SAs, ensuring SE funds are used when available;
• schedules and/or coordinates meetings with the customer, the customer’s circle of support, the SE specialist, and the VR counselor; and
• returns reports and invoices to the provider to correct errors using VR3460, Vendor Invoice Additional Data Request.

Refer to SFP Chapter 18 for additional information regarding SE service descriptions, processes and procedures, outcomes required for payment, the fee schedule, and SE resources.

C-1206-1: Supported Employment Plan

The SE Plan provides the framework for how the SE specialist will help the customer achieve competitive integrated employment. The SE Plan is completed during the SE Plan meeting by the VR counselor, using person-centered approaches, in collaboration with the customer, the customer’s circle of support, and the SE specialist. The SE Plan must align with the customer’s interests, preferences, potential job tasks, and identified employment conditions. The SE Plan also identifies the customer’s resources, support needs, extended services (both available and needed), potential employers, and any available premiums. VR1632, Supported Employment Plan and Employment Report, must be reviewed and agreed upon by the customer, the SE specialist, and the VR counselor.

When developing or amending the SE Plan, a meeting is conducted in person or remotely. The VR counselor, SE specialist, customer and, as appropriate, the customer’s representative and circle of support, must attend the SE plan meeting.

When developing the SE plan, the VR counselor must:

• review VR1630, Career Planning Assessment with the group, ensuring that the information recorded in the VR1632 represents the information in the CPA and/or EWA and the customer's best interests;
• complete VR1632 with the customer, SE specialist, and circle of support, recording the customer's identified:
  • interests, preferences, and potential job tasks;
  • employment conditions in measurable terms; and
  • extended services (funded, paid, and/or natural supports).
• maintain a signed version of VR1632 in the VR case file;
• provide a signed copy of VR1632 to the customer and SE specialist;
• provide an electronically fillable copy of VR1632 to the SE specialist; and
• request that VR staff issue SAs to the SE specialist for:
  • supported employment job development and placement benchmark;
  • two job retention benchmarks; and
  • any relevant premiums.

The SE Plan is amended when supported by the VR counselor and based on the customer’s informed choice and decision to change the preferences, interests, potential job tasks, and employment conditions listed on VR1632, Supported Employment Plan and Employment Report.

To amend the SE Plan, the VR counselor must:

• contact the customer to determine whether an update to the SE Plan is needed;
• request that VR staff issue an SA to the SE specialist for the SE Plan Update Meeting;
• schedule the meeting to update the SE Plan;
• revise VR1632 with the customer, SE specialist, and circle of support;
• obtain new signatures;
• file the updated, signed copy of VR1632 in the customer’s VR case file;
• provide an updated, signed copy of VR1632 to the customer and SE specialist;
• provide the updated, electronically fillable copy of VR1632 to the SE specialist; and
• ensure all required SAs are up to date.

C-1206-2: Supported Employment Job Development and Placement Benchmark

The job development and placement benchmark should be authorized and paid once during the life of the case. On a case-by-case basis, it may be necessary to purchase the Job Development and Placement benchmark more than once. When the VR counselor determines the customer needs the supports of a supported employment specialist for an additional Job Development and Placement benchmark, the VR counselor must obtain VR supervisor approval. Before obtaining VR supervisor approval, the VR counselor must document in a case note why the customer requires another placement and what interventions and/or services have been provided to the customer to address needs, circumstances, behaviors, and/or other employment barriers since the first purchase of the benchmark.

During the job development and placement benchmark, the VR counselor:

• reviews all documentation submitted by the provider for accuracy and completion;
• communicates with the provider and the customer regarding the job search and placement;
• reviews the employment placement to see if it meets the definition of competitive integrated employment (CIE) and requests that a CIE checklist be completed, when applicable;
• monitors the customer's employment to ensure that nonnegotiable employment conditions are met throughout the delivery of SE services;
• verifies that the extended services (funded, paid, and/or natural supports) have been identified and that the provider has arranged to train the long-term-support provider;
• verifies that the customer has received ongoing supports as necessary for the customer to learn the job and meet the employer's expectations;
• checks the SAs for premiums that are still open; and
• when requested by the SE specialist, schedules a job stability review meeting with the SE specialist, customer, and circle of support.

For information on how a CIE checklist is completed, refer to the Competitive Integrated Employment intranet page.

For more information, refer to SFP 18.5: Supported Employment Job Development and Placement Benchmark.

C-1206-3: Supported Employment Job Retention Benchmark

The VR counselor may approve and pay up to five job retention benchmarks. Six or more job retention benchmarks require the VR counselor to consult with the VR Supervisor prior to approval.

Each job retention benchmark consists of 28 cumulative calendar days during which the SE specialist must:

• visit the customer in person a minimum of two times at or away from the jobsite, however, the provider should visit multiple times to:
  • provide ongoing supports;
  • ensure that the customer is meeting the employer’s expectations; and
  • ensure that extended supports have been identified.
• make a minimum of one contact with the employer to ensure employer satisfaction; and
• verify that the customer has competitive integrated employment consistent with the preferences, interests, at least two potential job tasks, and all nonnegotiable employment conditions identified on VR1632.

The job retention benchmark may be purchased multiple times until the customer either achieves job stability or to reestablish job stability.

If a customer requires more than two job retention benchmark periods, the SE specialist must request a job stability review meeting.

During the job retention benchmark, the VR counselor:

• reviews all documentation submitted by the provider for accuracy and completion;
• requests VR staff issue SAs to the SE specialist for the job stability review meeting; and
• when requested by the provider, schedules the job stability review meeting with the SE specialist and the customer.

For more information, refer to SFP 18.6: Supported Employment Job Retention Benchmark.

C-1206-4: Supported Employment Job Stability Review

A job stability review is completed when the customer:

• appears he or she will be job stable at the completion of the current job retention benchmark; or
• appears to need additional job retention services after two 28-day job retention benchmark periods.

The customer must complete at least one 28-day job retention benchmark to be eligible for job stability. To establish job stability, the provider must be prepared to transition any remaining support needs to a funded, paid, and/or natural support extended service provider and notify the VR counselor.

The VR counselor and customer make the final determination about job stability and the purchase of any job retention benchmarks. The VR counselor must consult with the VR supervisor for six or more job retention benchmarks.

Refer to C-1202-3: Extended Services for information about extended services and for information about when a VR counselor can purchase extended services through job skills training for VR customers who are youth with disabilities.

The job stability meeting may be conducted remotely. During the job stability review meeting, the VR counselor, SE specialist, customer, and circle of support discuss and review the customer’s employment and whether the customer meets the service definition of “job stability” or needs one additional job retention benchmark.

During the job stability review meeting, the VR counselor:

• evaluates the customer’s job stability status, as defined in the service definition section in 18.7.1;
• reviews all documentation submitted by the provider;
• communicates with the provider and customer regarding the need for an additional job retention benchmark;
• provides counseling and guidance, per VRSM C-1206-4;
• documents:
  • one additional job retention benchmark, if approved; or
  • job stability status; and
• requests that VR staff issue SAs to the SE specialist for:
  • either one job retention benchmark before the next job retention benchmark begins or the SE closure benchmark; and
  • any relevant premiums.

When the VR counselor determines the customer needs the supports of a supported employment specialist for an additional Job Development and Placement benchmark, the VR counselor must obtain VR supervisor approval. Before obtaining VR supervisor approval, the VR counselor must document in a case note why the customer requires another placement and what interventions and/or services have been provided to the customer to address needs, circumstances, behaviors, and/or other employment barriers since the first purchase of the benchmark.

To reestablish job stability, the VR counselor:

• requests an SA for the provider to participate in another job stability review meeting;
• schedules a job stability review meeting; and
• follows the procedures for a job stability review meeting.

For more information on job stability, refer to SFP 18.7: Supported Employment Job Stability Review.

Counseling and Guidance for Job Stability

The VR counselor conducts counseling and guidance (C&G) with the customer during the job stability review meeting. After the job stability review meeting, a C&G case note must be entered documenting the customer’s job stability status. In addition to the C&G case note requirements in E-300: Case Note Requirements, the VR counselor must document in the C&G case note whether the customer:

• is satisfied with the employment;
• continues to work in a job that meets the definition of competitive integrated employment;
• is meeting the preferences, interests, at least two potential job tasks, and all nonnegotiable employment conditions on VR1632;
• has reliable transportation to and from the jobsite with a backup plan;
• is meeting the employer’s expectations regarding job performance;
• is meeting the physical and environmental demands of the job;
• has all necessary accommodations in place and working;
• has extended services (funded by other local or state agencies or Social Security, private pay, and/or natural supports) in place to ensure continued employment with this support; and
• has achieved all training goals, unless a goal has been determined to be “no longer applicable” or is scheduled to be transferred to extended services, on VR1634.

The job stability date is the day after the current job retention benchmark is completed.

Note: It is a best practice to schedule the SE closure meeting at the job stability review meeting when the job stability date is set.

For more information on job stability, refer to SFP 18.7: Supported Employment Job Stability Review.

C-1206-5: Supported Employment Closure Benchmark

The SE closure benchmark is completed when the customer has maintained job stability for 90 cumulative calendar days and the SE closure meeting has been completed.

To establish SE closure, the provider notifies the VR counselor, and the VR counselor arranges for the SE closure meeting. The VR counselor and customer make the final determination about SE closure.

The VR counselor schedules the SE closure meeting, which must occur after the customer’s 90th day of employment after job stability has been determined.

The SE specialist must provide the updated and complete VR1632 to the VR counselor without signatures before or at the meeting.

The VR counselor makes the determination that the case meets the SE closure benchmark by verifying that the customer has all extended services in place and is working in competitive integrated employment that meets the preferences, interests, at least two potential job tasks, and all nonnegotiable employment conditions identified in the SE Plan.

Counseling and Guidance for SE Closure

The VR counselor conducts counseling and guidance (C&G) with the customer during the SE closure meeting. After the SE closure meeting, a C&G case note must be entered. In addition to the C&G case note requirements in E-300: Case Note Requirements, the VR counselor must document in the C&G case note whether the customer:

• is satisfied with the employment;
• continues to work in a job that meets the definition of “competitive integrated employment”;
• is meeting the preferences, interests, at least two potential job tasks, and all nonnegotiable employment conditions on VR1632;
• has reliable transportation to and from the jobsite with a backup plan;
• is meeting the employer’s expectation regarding job performance;
• is meeting the physical and environmental demands of the job;
• has all necessary accommodations in place and working;
• has extended services (funded by other local or state agencies or Social Security, private pay, and/or natural supports) in place to ensure continued employment with this support; and
• verifies that the employment information, wages, and start date recorded on VR1632 is accurate.

Note: Signatures on VR1632 are obtained at the SE closure meeting.

For more information, refer to SFP 18.8 Supported Employment Closure Benchmark.