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The Menu of Services (MOS) Manual outlines employment services that Iowa Vocational Rehabilitation (VR) Services is able to purchase from a Community Rehabilitation Program (CRP) or an Independent Provider (IP) on behalf of the person receiving services, the VR job candidate (JC). The MOS Manual reflects the agreement between VR and a CRP/IP that ensures the JC’s needs drive the planning and service delivery process.
Memorandum of Agreements (MOAs) have been written by VR with the Iowa Department of Education (DE) and the Iowa Department of Health and Human Services (HHS) respectively to complement service provision. MOAs establish payer of first resort, agreements for long-term follow-up services, triage process for resolving differences, and roles and responsibilities required for state service providers.
A key component to the Menu of Services (MOS) is that it is driven by the needs of the JC - not the process. Services wrap-around the individual to create the necessary support and guidance to enhance employment for all JCs. Infused throughout each step of the rehabilitation process are opportunities for the JC and the rehabilitation team to explore and determine what support is needed for the JC in competitive integrated employment (CIE). This involves a continual process of communication, learning, applying, re-designing, and achieving.
The List of Services on the MOS can be found online at the VR website (https://workforce.iowa.gov/vr) under the Community Rehabilitation Programs (CRP) tab. The JC and the JC’s team are encouraged to refer to the purpose of the service to be used to guide expectations and responsibilities of VR, CRP/IP and the JC. VR forms can also be accessed at this same location to complete the documentation of services rendered. In order to accommodate the needs and the partnership of local offices with local CRPs/IP, VR forms are not required but documentations for services rendered are required and the information in that documentation, at minimum, must include the information requested on the VR forms.
Initiating Employment Services
The referral for CRP/IP services can be initiated by VR or the CRP/IP. Depending on the needs of the JC, not all services may be used.
Step 1: Whomever is initiating the request for services should complete the referral process. If the JC has not been determined eligible for VR that is the next step.
Step 2: VR calls for a meeting to develop the Individual Plan for Employment (IPE) which includes the decision for what services and support the JC may need to achieve CIE. The following forms are used based on the service that the JC uses:
Customized Discovery (CD) Staging Record (DSR) form is used to initiate the referral for Customized Employment services if the team feels that this is the most appropriate service from which the JC could benefit. This form is used solely for Customized Employment (CE) Services. This report is initiated, updated and submitted by the CRP as each stage of the CE phase is achieved. Upon completion of the CD phase, the team moves into Customized Job Development. Upon achieving a customized job, the team enters the final phase, Consultative Employment Support, where the JC is learning the job until stabilization is achieved. Sometimes a job in the market may already exist and customization is not needed.
Vocational Assessment/ Preparation/ Training Services form: This form is used for: Workplace Readiness Assessment (WRA), Job Seeking Skills Training (JSST), Job Shadow, Career Exploration, Work Adjustment Training (WAT), and Transportation Training. This form is completed by the CRP/IP.
Vocational Profile form: This form is used for Individual Placement and Support (IPS) Services only. This form is completed by the CRP.
Supported Employment Placement Agreement (SEPA) form - This form is used solely for Supported Employment Services (SES). The SEPA form or the information contained within it must be provided before VR is able to authorize any job development service. This form is completed by VR staff and the employment team. A copy should be provided to all team members upon signing. This is not a contract and does not automatically guarantee funding from partnering agencies at the time of signing. This is only used for planning and giving team members a notice for needs that the JC has to maintain long term success in CIE.
The JC and team select services that they believe will provide the type of experience and generate the quality of information necessary to develop an IPE. The JC and team may determine that only one specific service is necessary, or multiple services may be necessary to answer questions and identify outcomes needed to reach employment. A VR counselor and JC may select any combination of services to determine an employment goal. Employment services are authorized for and delivered one at a time in order to accurately assess the results of each service purchased, or with as little overlap as possible in order to validate the next step of action. A supervisor’s approval is needed to do two services at one time.
The maximum number of units allowed per service should not be authorized right away. The maximum number of units is for the life of the casefile. The life of the casefile is the period when a JC comes off the waitlist until the file is closed. If the JC ends services and returns for services later, that is a new casefile. VR staff will determine with guidance from the team the number of units necessary for each service. The max number of units may not always be needed in every scenario. However, the max number of units may be used if a service is used multiple times. An Exception to Policy (ETP) is required if additional units over the max number of units are needed for that case.
Reauthorization for the IPS milestone is dependent on service documentation verifying satisfaction of that milestone, team consultation and a plan to address improvements to support reauthorized activities. ETP is required for services exceeding the HHS monthly cap on the cost of services. The MOA between IVRS and HHS supports IPS fidelity as it clearly outlines the funding structure regarding long term support services within IPS.
Interpreter Services
VR job candidates may require an interpreter to participate in services. CRP/IP is responsible for ensuring that their programs are accessible as an entity agreeing to work with state and federal programs. Upon referral, VR staff will notify the CRP/IP what interpreter services are needed for the JC. VR will be responsible for arranging an interpreter for meetings initiated by VR.
Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. § 794, prohibits discrimination based on disability by programs and activities receiving federal funds. Both the Americans with Disabilities Act (ADA) and Section 504 require covered entities to ensure communications with individuals with disabilities are as effective as communications with others. They ensure equal opportunities to participate in and benefit from services and programs. In the performance of services, the CRP/IP understands that their services include all expenses associated with accommodations to access services. CRP/IP will not be reimbursed for additional expenses (such as interpreters).
In employment settings, interpreters are required for job interviews, training sessions, meetings, and performance reviews. Employers must provide these services to qualified deaf or hard of hearing applicants and employees to ensure equal opportunity and full participation in employment-related activities. This obligation applies to significant matters affecting the terms and conditions of employment.
In education and training settings, the education/training institution must provide interpreter services to qualified deaf and/or hard of hearing applicants/participants to ensure full access and participation in services for individuals with/without an open case with VR.
VR staff can assist the CRP/IP in connecting with interpreters and provide information on best practices when utilizing interpreters, if needed. Refer to the Native Language Incentive for CRPs/IPs that have providers that provide employment support services in the JC’s native language.
Services to Students and Youth
Students
VR partners with secondary and post-secondary schools, utilizing community and employment providers that may be needed to coordinate services for high school students ages 14 – 21 to facilitate a seamless transition to employment. Specific services can be provided to students with disabilities in a manner that will impact the broadest segment of students possible. This is done by working in collaboration to support students’ goals by providing Pre-Employment Transition Services (Pre-ETS) that enhance the student’s transition. VR staff collaborate with the Local Education Agency (LEA) to develop a plan to deliver Pre-ETS that maximizes staff resources, minimizes duplication and coordinates teams’ efforts.
Youth
VR staff work with local partners to ensure youth with disabilities ages 14 – 24 are provided transition services. These services may include job exploration, work readiness and opportunities to work in the community. Youth are limited from starting work that pays subminimum wage (SMW) unless they produce the necessary documentation showing the completion of specific service-related activities prior to entering settings where SMWs are paid.
Individuals Age 24 and Under Who Require Supported Employment
Since November 13, 2014, VR began funding services for JCs aged 24 and under who require SES. VR implemented the MOA with HHS to establish VR as the payer of first resort for JCs aged 24 and under who receive from both Waiver and VR support for SES.
The following Employment Services are considered SES:
If a supported employment outcome is not achieved by the time a JC turns 25, any remaining authorizations will be canceled by VR in order for HHS funds to be utilized. This should be done in collaboration with Case Managers and Care Coordinators for a smooth transition. Choreography of service and timing should be planned, not just immediate termination of funds by VR as an individual ages out. Extending VR funding for a brief time during the transition is acceptable, as long as VR staff documents the plan for a smooth transition. The goal is to achieve stabilized employment with long-term support funding thereafter (e.g. Waiver, Habilitation, Aging & Disability Services/ADS, and private pay).
SES funds for individuals age 25 or above who receive both VR and HHS are not affected and HHS remains the payer of first resort for individuals age 25 and above who receive SES.
Pre-Employment Transition Services (Pre-ETS)
When a high school student needs assistance in obtaining a paid part-time work experience (not job placement), the following two services can be considered:
- Instructional Training
- Pre-ETS Supported Short-Term Paid Work Experience
The need for these services must first be discussed with the student’s Individualized Education Program (IEP) team. Pre-ETS Supported Short-Term Paid Work Experience are for students who are Most Significantly Disabled (MSD) since they are considered career exploration services during the student’s transition process; thus, a component of the IEP. These services are most beneficial in the early stages of employment exploration during the transition process to employment.
With Pre-ETS Supported Short-Term Paid Work Experiences, Instructional Training is provided by an instructional trainer coordinated by the LEA. A student’s high school is responsible for funding costs associated with Instructional Training Services. These services can be provided through a CRP if the school agrees to fund services similar to Job Coaching Services through that entity.
Pre-ETS Supported Short-Term Paid Work Experiences are funded by VR when the IEP team agrees that these services are necessary. VR may support the development of the site in the community by partnering with a CRP. These services are not for students who have decided upon their career goal and are ready to begin SES.
SES Provisions for Students (14 – 21)
SES can begin when a student who requires intensive supports has identified their career goal and requires SES to achieve this goal. SES may last up to 24 months and be provided as early as is necessary for the student to achieve stability on the job by the time of graduation, as long as the long-term supports can be assured by the graduation date. For high school students, job coaching for SES is funded by VR once a student’s career goal is specified on their IPE. A student may be stabilized on the job prior to graduation, at which time the long-term supports are then provided, thereby allowing the case to be considered stabilized and then closed upon 90 days of the high school graduation date.
SES for post-high school youth under 25 without long-term funder
SES for Youth with Disabilities: A youth who requires extended services after achievement of a supported employment goal may require VR to fund Supported Employment Job Coaching services while awaiting services from a Waiver. If the job is stable and consistent with the IPE and the student/youth is on the Waiver waiting list, VR can fund the extended services on a time-limited basis. Said services are provided at a rate of up to two hours (8 units) per month and are only provided when the natural supports plan has been implemented and supervisory approval is obtained. In no circumstance may extended services be funded when the JC is age 25 and older. Additional hours beyond 8 units per month for Supported Employment Job Coaching services require an ETP.
After six months, the case must be reviewed and evaluated to determine if continued funding is necessary and supervisory approval is obtained each time it is evaluated. This process continues every six months until one of the following conditions is met:
- The service is no longer needed;
- Another funding source is identified;
- The service has been funded for four years; or
- The youth’s 25th birthday.
The VR case record may not be closed successfully, even if the employment stabilized, until the extended supports have transitioned to the Medicaid Waiver or other public/private funding for 90 days. A plan of natural supports should be implemented simultaneously with the extended services.
If they decide they do not want the other options for extended services, VR staff will provide the necessary information and referral to the youth and his/her representative, so they apply for Waiver funding. Assisting the youth to complete the application process is critical in these situations so that by the time the program of supported employment stabilizes, he/she will have the Waiver available. This discussion should occur as soon as it is clear that supported employment is a necessary service and written into the IPE.
The MOA between the Department of Education (DoE) and VR can be found at: https://public.powerdms.com/IVRS/tree/documents/1521471
Extended Supports
Long-term supports will be identified in SES cases for a JC age 24 and under to receive ongoing support through Waiver, DAP funds, Social Security Work Incentives, and/ or natural supports. Continued communication and collaboration with VR partners are still necessary for successful planning. A report identifying Natural Supports is required for any JC receiving SES.