Overview of Provider Service Agreements

Partnering with Community Rehabilitation Programs or Independent Providers

VR respects CRPs and IPs as valued partners in providing employment services to JCs. The “Menu of Services (MOS)” refers to various employment services that VR is able to purchase from a CRP/IP on behalf of a JC. VR, CRP staff and IPs work together to jointly coordinate services that will assist a JC in reaching a successful employment outcome. VR remains interested in expanding local CRP and IP partnerships and welcomes new and existing partners in the provision of quality employment services.

Accreditation Requirements

VR purchases various services from a CRP/IP that has been approved in advance to provide employment services. VR must verify that a CRP/IP partner has the necessary certification and/or accreditation requirements prior to purchasing services with state and federal funds. It is the policy of VR to use CRPs that are accredited by the appropriate accreditation organizations such as:

• the Commission on Accreditation of Rehabilitation Facilities (CARF);
• the Council on Quality and Leadership (CQL);
• the International Center for Clubhouse Development;
• Project SEARCH International;
• the Council on Accreditation (COA), and
• the Joint Commission on Accreditation of Health Organizations (JCAHO)

VR will apply its own standards to programs which are in the process of becoming accredited. A three-year period has been established to allow a CRP time to obtain the necessary certification required for certain employment services, unless the CRP has received approval to provide selected services through another state agency. VR also requires service providers to have at least 6 months of practical experience AND be trained in one of the following options:

• through Iowa APSE (Association of Persons Supporting Employment First); or
• DirectCourse; or
• through an Association of Community Rehabilitation Educators (ACRE) certified job development and/or job coaching program; or
• to have credentials as a licensed Special Educator in the State of Iowa; or
• to have worked as a Vocational Rehabilitation counselor; or
• is credentialed by the Commission on Rehabilitation Counselor Certification (CRCC).

CRP Staff and IP Credentials

Employment services providers have 24 months from the date of hire or from the date of providing services on the VR CRP Contract to meet the professional certification required to provide job development and job coaching services.

Providers delivering Customized Employment (CE) or Individual Placement and Support (IPS) services for Iowa Vocational Rehabilitation Services must complete the required service-specific certification and training before providing these services independently.

• For CE, providers must complete the required CE training and participate in CE fidelity reviews while delivering services.
• For IPS, providers must complete the Center of Excellence for Behavior Health (CEBH) IPS training and be willing to accept technical assistance (TA) from the state’s IPS TA provider as needed, including participation in fidelity review activities.

All providers must also complete the VR MOS training module within 6 months of the date of their hire or from the date of providing services on the VR CRP Contract and sign the Acknowledgement of Understanding (AOU) page upon completion of reviewing this MOS Manual. CRPs must receive approval from the VR CRP WPC for an exception if the expectation for each employment staff to review the MOS Manual will cause undue hardship for the CRP. This involves the CRP’s ability and commitment to ensure each staff complies with CRP Contract expectations. All direct employment support providers must complete a minimum of 4 CEUs per year to maintain the ability to serve JCs.

IVRS requires the following credentials for Employment Services from an individual who has a Certificate of Completion from an ES Training Program in:

• Job Development Training
• Job Coach Training

Job Coaching Qualifications:

VR requires Job Coaches to have a certificate of completion from either IA-APSE or College of Employment Services (CES) of required courses noted below; or staff have credentials as a licensed educator endorsement with the State of Iowa; or a degree in rehabilitation or closely related field with the approval of the VR Administrator. 

Certified Job Coaches are able to provide the following services on VR’s MOS:

• Supported Employment Job Coaching
• Non-Supported Employment Job Coaching
• Supported Short-Term Paid Work Experience
• Job Follow-Up
• Transportation Training

* Please Note: If new CRP staff or IP will be providing individual job development services and job coaching services, they would need to complete the job coach training requirements outlined above in addition to those courses listed under Job Development below.

Job Development

VR requires Job Developers to have at least a bachelor’s degree or commensurate experience preferably in human services, sociology, psychology, education, human resources, marketing, sales, or business; and a certificate of completion from either Iowa APSE or College of Employment Services (CES) of required courses noted below; or staff have credentials as a licensed educator or paraeducator with the State of Iowa; or a degree in vocational rehabilitation or closely related field with the approval of the VR Administrator. 

Certified Job Developers are able to provide the following services on VR’s MOS:

• Workplace Readiness Assessment (WRA)
• Job Shadow
• Career Exploration
• Work Adjustment Training (WAT)
• Job Seeking Skills Training (JSST)
• Job Development
• Natural Supports

Customized Employment (CE)

VR requires the ES providing Customized Employment (CE) services to hold a certificate of completion from one of the approved ACRE-certified programs that includes ACRE Competencies with an Emphasis on Customized Employment (ACRE + CE).Certified CE providers may deliver all services included in VR’s Menu of Services (MOS), with the exception of Individual Placement and Support (IPS) services.

Individual Placement and Support (IPS)

IPS Fidelity and Implementation Levels

IPS programs are subject to fidelity oversight at two levels:

1. Community-Level – focuses on IPS team formation, training, implementation, and participation in learning collaboratives.

Community-Level – IPS Requirements

New IPS teams must complete the following phases:

• Formation of an IPS team steering group and an initial meeting with an IPS trainer.
• Completion of the IPS Readiness Assessment.
• One-day IPS kick-off team training with the IPS trainer.
• Participation in team-level and leadership training, including:
  • In-person team training sessions.
  • Virtual team and leadership training.
  • Ongoing monthly technical assistance.

• Completion of a baseline fidelity review conducted by trained IPS review conducted by trained IPS reviewers.

  • Follow-up evaluation and planning with the IPS trainer to address next steps after the baseline fidelity review.

  Note: Teams may begin delivering IPS services provisionally following initial implementation, but full qualification requires achieving at least a “fair” score on the baseline fidelity review. Should a team not meet a “fair” rating, an improvement plan could be discussed and implemented to allow services to be paid by VR.

2. Direct Service Provider-Level – focuses on provider qualifications, training, and readiness to deliver IPS services.

Direct Service Provider Requirements

To deliver IPS services, providers must:

• Meet accreditation and experience standards for supported employment.
• Complete CEBH-approved IPS training.
• Participate in community-level IPS implementation activities.
• Accept technical assistance as needed to achieve and maintain fidelity.

Qualification: IPS teams are provisionally approved until achieving a minimum “fair” fidelity rating. Teams unable to meet fidelity standards within the required timeframe may lose the ability to bill and receive payments for IPS services until standards are met.

Payment Schedules & Timeframes

All VR purchased services require prior authorization from VR staff before services can be rendered and payment can be made. If the CRP/IP has a waiting list of more than 30 days, the option to explore an alternative CRP/IP provider may be presented to the JC. Written authorization for services will be issued to the CRP/IP with the expectation that the provider can serve the JC and comply with the timeframes indicated in the payment schedule. If a CRP/IP chooses not to accept a referral from VR for employment services, that information should be provided in writing to VR and include the following:

• A statement justifying the CRP’s/IP’s decision
• Information on appeal rights that may be available to a JC
• Documentation on what is needed for the JC to be reconsidered for acceptance by the CRP/IP.

VR is a process. We have forms that need to be completed in order to ensure data collection and proper documentation for the JC; however, these forms should be used as a PART of that process, not as THE process. So, in other words the process isn’t to complete the reports. The process is developing a full understanding of the JC’s goals, interests, strengths, and limitations to design a plan that best meets their service needs. The process allows the JC to identify what supports they need from different resources in order to be successful. As we meet with the JC, we learn more about those needs and can help them identify a clear picture of the steps they will take to reach their goals. The form such as the IPE and service authorizations is then completed to put that plan in writing for the JC & the team to follow as they move forward and the reports from our partners validate the decisions for various employment supports along the way. A monthly team meeting between VR staff and CRP staff/IP is recommended. At these informal joint meetings, authorizations, next steps, and some of the situations below are addressed.

All services must comply with the CRP Responsibilities outlined for each service or payment will not be made. No additional fees will be paid for administrative activities such as the following:

• Voice messages – reminder/requests regarding meeting with VR or other providers (unless pre-approved as a part of an authorized service)
• Meetings – requests for meeting with VR and team meetings
• Communication – updates regarding progress to VR and/or others on the JC’s team; and cancelling and rescheduling requests.
• Reports – documentation; case noting
• Travel – within normal area of service, unless negotiated and preapproved by VR local office supervisor.
• VR and CRP staff should read and refer to VR Responsibilities before initiating or authorizing from the Menu of Services.

Documentation

All claims need to be accompanied by a report justifying the service activity. All report forms can be accessed and downloaded online under each service tab at https://workforce.iowa.gov/vr/partners/community-rehabilitation-programs/menu-services. CRPs/IPs are encouraged to use VR forms downloaded from this site in order to ensure the most current form is used. In order to support local office autonomy and the relationship they have with their CRPs/IPs, VR has chosen not to mandate the requirement that VR’s forms are used but that the information on the reports MUST meet the minimum information that is required on the VR forms. The use of alternative forms requires the approval of the local VR supervisor.

A CRP/IP Contractor will submit claims and all associated reports and supporting documentation for services rendered to the IVRS local contact within 30 days following the month of service. The claims for VR to pay a vendor includes the VR authorization, along with the appropriate documentation required for services rendered. The authorization must be signed by the CRP/IP unless billings are completed and processed to the financial department within 10 working days of receipt from the vendor. Payment on claims will not be processed until the local office receives all of the required forms. Time may vary depending on the complexity of the claims, the Iowa Department of Administrative Services (DAS) has 60 days to process and pay claims.

One unit of authorization is equivalent to 15 minutes of service. The date of service rendered, start and end times for services are rounded to the minute. The following table outlines the units claimed based on the number of minutes for services to be rendered:

Virtual Services

Services that are completed under 6.5 minutes of service time and impromptu (e.g. text messages, chats, instant messaging, voice messages, and emails) are considered unscheduled encounters. Traditional services are scheduled encounters intended to last 15 minutes and/ or longer (e.g. in person, phone calls, and via any virtual platforms like Zoom, Google Meets, FaceTime, Teams, & etc.).

The decision to use virtual services is not only specific to the JC’s preference and ability but also to the specific event. In support of the Technology First (T1st), virtual services are supported unless the JC is best served in person and/or an alternative has been pre-approved by VR. If the JC is able to benefit from virtual services, the team should discuss when and how to use virtual services. Ongoing assessment for effectiveness of virtual and in person services enhance the success of the JC and the business needs. Virtual services can be used if:

1. JC is able to benefit from virtual services
   1. JC has the technology device and applications; and
   2. JC has reliable connectivity (e.g. device is properly charged, battery life is still at good capacity, good internet connection, & etc.); and
   3. JC demonstrates responsible behaviors surrounding technology use (e.g. frequency of checking voice messages, emails, instant messages, texts, social media accounts, & etc.).
2. Because VR acknowledges the value in text messages, emails and quick phone calls or voice messages yet the time it often takes to complete those transactions may not warrant an entire unit of payment, VR lumps services and actions together to justify their unit of work. In order for the service to be billable, the event must provide an approved direct service to the JC. Confirming appointments and other courtesy transactions, unless specifically approved as a part of the direct service needed by JC, are not billable transactions. For example,
   1. A JC struggles with memory, so the team agrees that JC would benefit from text reminders. This would be a billable transaction. If JC has no issues with memory, requested verification of an appointment and the employment specialist texted the appointment information. This would not be a billable transaction.
   2. The team agrees that JC would benefit from words of encouragement or pep talks so texts like “Good luck,” “You did your best,” and “Hang in there” would be billable. If JC is confident yet employment specialist texts “Good luck” to JC, that would not be billable.
3. Documentation details the event and rationale for direct service on claim for each virtual activity.

VR recognizes that many little efforts occur to keep service provision moving forward, it would not be applicable to bill one unit for each transaction, but certainly reasonable to lump all of the preapproved unscheduled encounters toward the authorized service. The following is an example of how to count the various types of encounters over the course of a month:

• 5/1/21 8:59am-10:02am (63 minutes) Met with JC at the library to complete applications to ABC and ZXY companies.
• 5/16/21 3:01pm-3:31pm (30 minutes) Completed MNM company's online application via Zoom for JC.
• 5/24/21 8am-8:01am (1 minute) Left voice message to remind JC of job interview at 10:30am.
• 5/24/21 11am-11:03am (2 minutes) Text JC to follow up on interview after JC did not respond to ES’s phone call & left supportive voice message.
• 5/27/21 9:05am-9:07am (2 minutes) Text “Hang in there” to JC in response to JC’s text about feeling down. Reminded JC that we will meet tomorrow via Zoom as requested.
• 5/28/21 11am-11:08am (8 minutes) Chatted on Google. JC did not want to do Zoom. JC is embarrassed to have overslept and does not want to be seen. JC continues to feel depressed not having heard from employer. Reminded JC of JC’s knowledge and skills to build JC’s confidence. We’ll meet via Zoom tomorrow.

5/1/21, 5/16/21, and 5/28/21 are considered scheduled encounters. The process remains in place for these types of services. Therefore, each of these are counted as individual appointments:

5/1/21 is 63 minutes or 4 units

5/16/21 is 30 minutes or 2 units

5/28/21 is 8 minutes or 1 unit

Total scheduled encounters are 7 units.

5/24/21 and 5/27/21 are considered unscheduled encounters. Therefore, each of these are lumped together:

5/24/21 1 minutes

5/24/21 2 minutes

5/27/21 2 minutes

Total unscheduled encounters are 5 minutes or 1 unit.

Total claimable units are scheduled encounter units + unscheduled encounter units = Total claimable units

Therefore, in the example above, the total claimable units for the month of May 2021 are 7 units + 1 unit = 8 units.

No Shows

No show occurrences are typically a natural expense incurred by the business and would not be billable. However, if a CRP/IP called and got prior confirmation of the appointment (for virtual/on-site appointments), waited for at least 10 minutes (called/text/emailed during the 10 minutes) and the individual did not respond and was a no show, then that would be billable for 1 unit.

If the ES sets the appointment and got a confirmation prior to driving to the in-person appointment and the JC is a no show, then VR will honor the time it took to drive to the appointment, but CRP/IP providers are to contact VR whenever there is a no show so that the counselor can address it with the JC prior to the CRP/IP making another appointment. If VR was not notified prior to a consecutive no show, then any following no show occurrence would not be billable.

It is best practice for the ES to call/ text to get confirmation before heading out to meet with the JC to make sure that the JC is ready to meet and/or can still meet. This would be the key to determining if the occurrence was preventable or not and therefore billable or a natural expense incurred by the CRP.

Report Out

Quarterly, a CRP/IP Quarterly Summary Report will be issued by VR to each CRP/IP which reflects programmatic data such as the number of JCs receiving authorizations for services; the dollar amount of services purchased by VR from that CRP/IP; the employment outcomes (including individuals closed successfully as well as those closed unsuccessfully); the average hours worked, hourly rate of pay; and the average cost per successful employment outcome. Additional data points were added to reports to help teams assess program effectiveness, quality, timeliness and outcomes. The general practice of VR is to utilize community partners to deliver items from the MOS based on the partners’ ability to meet the commitments of the CRP Contract with VR, to supply the quality of service desired, and to achieve expected outcomes resulting in CIE aligned with the JC’s IPE. Ongoing communication between VR and a local CRP/IP is encouraged to share additional information that may be relevant and reflective of the services each CRP/IP provides.

VR and local CRPs/IPs will review the partnership using quantitative and qualitative information. Though communication and reviews are encouraged as needed in order to address issues in real time, formal contractual reviews are completed on a quarterly, annually and every 3 years for monitoring site visits. These meetings may occur in person or via virtual meetings as needed by IVRS.

New Providers

If you are a new agency or person interested in serving VR JCs as an approved provider, you will need to arrange an interview with the area office supervisor at your local VR office to discuss services needed by that office. The VR supervisor will inform the CRP WPC if the office uses the service or not and the CRP WPC will provide information on next steps. VR providers may offer employment services by another name, but the service must be served under the purpose of one of the services on the MOS. Each potential provider will be asked to submit a W-9 and the proper credentials required to become a state vendor. All potential providers must go through the MOS Contracting process and all SES are rendered at rates comparable to that of Iowa Medicaid’s supported employment service rates. The process can vary depending on the type of employment service a potential vendor asks to provide.

Existing Providers

To continue services, you will need to arrange communication with the area office supervisor to discuss the past performance and future expectations. The area office supervisor will meet to go over any performance and outcome expectations and the progress to achieve for the upcoming year. The local office supervisor will let the CRP WPC know if the local VR team continues to want to work with the provider and the CRP WPC will complete a service gap analysis and present the request to the VR CORE Team for approval.

Ongoing contract is contingent upon local office needs and VR budget. Staff credentials will be automatically provided to VR within the required timeframes.

VR Office Locations

https://workforce.iowa.gov/vr/contact

Toll-Free: (800) 532-1486 

General Voice: 515.281.4211 TTY, call Iowa Relay at 711 or 1-800-735-2942

List of Area Offices (alphabetical order)

• Ames Area Office
• Burlington Area Office
• Cedar Rapids Area Office
• Council Bluffs Area Office
• Davenport Area Office
• Des Moines Area Office
• Dubuque Area Office
• Fort Dodge Area Office
• Iowa City Area Office
• Mason City Area Office
• Ottumwa Area Office
• Sioux City Area Office
• Waterloo Area Office

Contact Information

Questions may be directed to the respective WPC:

Vienna Hoang at vienna.hoang@iwd.iowa.gov or call/text at (515) 802-1460

Located at:
Iowa Vocational Rehabilitation Services 
1000 East Grand Avenue
Des Moines, IA 50319

For CE and IPS, contact Special Programs WPC:

Ashley Hazen at ashley.hazen@iwd.iowa.gov or call/text (319) 391-0347.