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 before the customer's achievement of SE Benchmark 5 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 Supported Employment Assessment (SEA);
• 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 Benchmark 4 in order for extended services to begin at Benchmark 5; and
• see Employment Services Medicaid Waiver Sequencing 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) before making a referral for SE services. The BPQY must be included in the SE referral packet when a customer is a recipient of Social Security.

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

VR must provide Extended Services, when no other resource can be identified for VR customers who are "youth with disabilities" for a period of up to four years or until the youth reaches the age of 25 and no longer meets the definition of a "youth with a disability" (see glossary for a definition);

When VR purchases Job Skills Training to provide Extended Services for "youth with disabilities" the Extended Services:

• must be in place and working prior to Benchmark 5 Job Stability, being achieved;
• may be purchased simultaneously with the Supported Employment Benchmark 6: Case Closure; and
• must be approved using a VR3472. 

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 information on how Job Skills Training can 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.

For more information on Extended Services for youth with disabilities, refer to VR-SFP 18.3.8 Extended Services.

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:

• purchasing an SE benchmark service more than once;
• 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
• 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, beginning with Benchmark 2. When the customer needs an SE longer than 24 months to reach job stabilization, a VR3472, Contracted Service Modification Request, 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 individualized plan for employment (IPE).

Any time a change to a Supported Employment 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 the VR3472, Contracted Service Modification Request, before the change is implemented.

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

• Job Development
• 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
• Nonbundled Job Placement
• On-the-Job Training (OJT)
• Personal Social Adjustment Training (PSAT)
• Vocational Adjustment Training (VAT)
• Environmental Work Assessment
• Vocational Evaluation
• 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 guidance and monitoring throughout, to ensure successful employment for the customer;
• monitors the customer's case;
• reviews all required documentation; and
• verifies all deliverables have been achieved prior to authorizing payment of the invoice.

For all benchmarks, the RA can:

• request records;
• create service records and issue service authorizations, ensuring that SE funds are used when available;
• schedule and/or coordinate meetings with the customer, the customer's circle of support, the provider, and the VR counselor;
• complete the primary review of provider forms by completing the "VRS Use Only" sections of the forms; and
• return reports and invoices to the provider to correct errors using the using VR3460, Vendor Invoice Additional Data Request.

 Refer to Employment Services on the VR Division intranet for the Supported Employment Diagrams.

C-1206-1: Benchmark 1A—Supported Employment Assessment

During Discovery, the meetings between the Supported Employment Specialist and the customer's circle of supports may be conducted remotely.

During Discovery the following cannot be conducted remotely:

• customer's interviews to observe skills and identify interests;
• home visits;
• work skills observations; and
• informational interviews.

When the Centers for Disease Control and Prevention (CDC), federal, state, and/or local governments issue health and safety protocols, such as social distancing, Discovery Process can be provided with a VR director approved VR3472, Contracted Service Modification Request. The VR3472 must include:

• how the service delivery will meet the customers individual training needs;
• how health and safety protocols will be followed; and
• the customer's agreement to participate.

For more information, refer to VR Standards for Providers (VR-SFP) 3.6.4.1 Remote Service Delivery for requirements and VR-SFP 3.6.4.2 Evaluation of Service Delivery.

Refer to VR-SFP 18.4 Benchmark 1A: Supported Employment Assessment and Supported Employment Assessment Review Meeting for information about the service description, process and procedure, outcomes required for payment, and the fee schedule for Benchmark 1A.

For Benchmark 1A, the VR counselor:

• reviews the SEA before the SEA meeting;
• returns the SEA when it is incomplete and/or inaccurate;
• facilitates the SEA review meeting, which takes place before the SESP Part 1 meeting, to determine whether an appropriate employment outcome for the customer can be achieved through SE services or Supported Self-Employment, or if no employment outcome will be pursued; and
• facilitates the identification of the next steps that must take place.

C-1206-2: Benchmark 1B—Supported Employment Service Plan (SESP)—Part 1

The SESP-1 meeting to develop the Supported Employment Service Plan may be conducted remotely. The customer and, as appropriate, the customer's representative must attend the SESP-1 meeting. Refer to VR-SFP 18.5 Benchmark 1B: Supported Employment Services Plan—1 for information about the service description, process and procedure, outcomes required for payment, and the fee schedule for Benchmark 1B.

For Benchmark 1B, the VR counselor:

• helps the employment services provider coordinate the SE service plan meeting, which is led by the customer and/or customer's representative;
• accurately completes the VR1642, Supported Employment Services Plan – 1 (SESP-1), recording the customer's identified:
  • interests, preferences, skills, job tasks;
  • employment conditions in measurable terms;
  • Extended Services (long-term supports); and
  • potential employers;
• ensures that the information on the VR1642 represents the information in the SEA and the customer's best interests;
• submits electronically a completed VR1642 to the employment services provider using encrypted e-mail;
• provides a printed copy of the completed signed VR1642 to the provider and customer, when applicable; and
• verifies that the service authorizations for Benchmark 2 and 3 are issued; and
• verifies that the service authorizations for premiums are issued.

C-1206-3: Benchmark 2—Job Placement and Supported Employment Service Plan (SESP)—Part 2

Refer to VR-SFP 18.6 Benchmark 2: Job Placement and Supported Employment Service Plan—2 for information about the service description, process and procedure, outcomes required for payment, and the fee schedule for Benchmark 2.

For Benchmark 2, the VR counselor:

• reviews the employment placement to see if it meets the definition of competitive-integrated employment and requests that a competitive integrated employment checklist be completed (refer to Competitive Integrated Employment), when applicable;
• monitors the customer's employment to ensure that 100 percent of nonnegotiable employment conditions, at least 50 percent of negotiable employment conditions, and at least one Targeted Job Task are maintained throughout the delivery of SE services;
• verifies that the customer worked five days and/or shifts in the job as required by the VR1642, Supported Employment Service Plan – 1;
• confirms with the customer that ongoing supports have been provided and that the customer is satisfied with the SE services;
• verifies that the Standards for Providers have been followed and that all deliverables have been achieved before authorizing payment;
• verifies that the Extended Services (long-term support) have been identified and 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;
• verifies that the service authorization for Benchmark 4 is issued; and
• checks the service authorizations for premiums that are still open.

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

C-1206-4: Benchmark 3—Four-Week Job Maintenance

Refer to VR-SFP 18.7 Benchmark 3: Four-Week Job Maintenance for information about the service description (including how services can be delivered), process and procedures, outcomes required for payment, and the fee schedule for Benchmark 3.

For Benchmark 3, the VR counselor:

• monitors the customer's employment to ensure that 100 percent of nonnegotiable employment conditions, at least 50 percent of negotiable employment conditions, and at least one Targeted Job Task are maintained throughout the delivery of SE services;
• verifies that the customer has maintained employment for 28 cumulative days without a seven-day or greater break within a workweek that is consistent with the requirements of the VR1642, Supported Employment Service Plan – 1;
• monitors and verifies that ongoing support services are provided at least twice monthly to monitor the customer at the work site and, as necessary, off-site to ensure that the customer maintains successful competitive integrated employment;
• confirms that the customer is satisfied with the SE services;
• verifies that the Standards for Providers have been followed and that all deliverables have been achieved before paying a provider;
• verifies that the Extended Services (long-term support) are arranged and that the individuals involved have been trained to support the customer in successful competitive integrated employment;
• verifies that the customer has received ongoing supports as necessary for the customer to learn the job and meet the employer's expectations;
• verifies that the service authorization for Benchmark 5 is issued; and
• checks the service authorizations for premiums that are still open.

C-1206-5: Benchmark 4—Eight-Week Job Maintenance

Refer to VR-SFP 18.8 Benchmark 4: Eight-Week Job Maintenance for information about the service description (including how services can be delivered), process and procedure, outcomes required for payment, and the fee schedule for Benchmark 4.

For Benchmark 4, the VR counselor:

• monitors the customer's employment to ensure that 100 percent of nonnegotiable employment conditions, at least 50 percent of negotiable employment conditions, and at least one Targeted Job Task are maintained throughout the delivery of SE services;
• verifies that the customer has maintained employment for 56 cumulative days without a seven-day or greater break within a workweek that is consistent with the requirements of the VR1642, Supported Employment Service Plan – 1;
• monitors and verifies that ongoing support services are provided at least twice monthly to monitor the customer at the work site and, as necessary, off-site to ensure that the customer maintains successful competitive integrated employment;
• confirms that the customer is satisfied with the SE services;
• verifies that the Standards for Providers have been followed and that all deliverables have been achieved before paying a provider;
• verifies that the Extended Services (long-term support) are arranged and that the individuals involved have been trained to support the customer in successful competitive integrated employment;
• verifies that the customer has received ongoing supports as necessary for the customer to learn the job and meet the employer's expectations;
• verifies that the service authorization for Benchmark 6 is issued; and
• checks the service authorizations for premiums that are still open.

C-1206-6: Benchmark 5—Job Stability

The Job Stability meeting may be conducted remotely. Refer to VR-SFP 18.9 Benchmark 5: Job Stability for information about the service description, process and procedure, outcomes required for payment, and the fee schedule for Benchmark 5.

Refer to C-1202-3: Extended Services for information about Extended Services and information about when a VR counselor can purchase Extended Services through Job Skills Training for VR customers who are youth with disabilities.

For Benchmark 5, the VR counselor:

• ensures the Extended Services provider(s) are identified on customer’s IPE and VR1646, Supported Employment, Job Stability Justification Summary;
• monitors the customer's employment to ensure that 100 percent of nonnegotiable employment conditions, at least 50 percent of negotiable employment conditions, and at least one Targeted Job Task are maintained throughout the delivery of SE services;
• verifies that the customer has maintained employment for at least 56 cumulative days without a seven-day or greater break within a workweek that is consistent with the requirements of the VR1642, Supported Employment Service Plan – 1 and that job stability status has been attained;
• conducts the stability meeting to:
  • confirm the customer is satisfied with the SE services;
  • confirm the employer is satisfied with the customer's performance;
  • verify the Extended Service providers are established and trained and that they understand their roles and responsibilities as identified on the VR1646;
• verifies that the Standards for Providers have been followed and that all deliverables have been achieved before paying a provider;
• verifies that the customer has received ongoing supports as necessary for the customer to learn the job and meet the employer's expectations;
• verifies that the service authorization for Benchmark 6 continues to be open; and
• checks the service authorizations for premiums that are still open.

The VR counselor makes the final decision in determining job stability status. A case is considered "job stable" once the job stability date is established in a job stability meeting.

If the customer finds a new position, a new job, or requires additional supports from the SE specialist or job skills trainer, at least 30 cumulative days of employment must occur before job stability is reestablished with a new stability meeting.

C-1206-7: Benchmark 6—Service Closure

Refer to VR-SFP 18.10 Benchmark 6: Service Closure for information about the service description, process and procedure, outcomes required for payment, and the fee schedule for Benchmark 6.

For Benchmark 6, the VR counselor determines whether the customer maintained the required 90 cumulative days of job stability from the most recently established job stability date without a seven-day or greater break within a workweek that is consistent with the requirements of the VR1642, Supported Employment Service Plan – 1. Ninety cumulative days of job stability are necessary to achieve Benchmark 6: Service Closure.