Case Management Strategies - PRO-10-05

Vocational Rehabilitation (VR) staff are responsible for providing cost-effective services that enable consumers to meet/obtain their employment goals. This memo will serve to clarify case management strategies previously discussed and outline procurement procedures to be used by staff in providing quality cost-effective services to meet the consumers' vocational and employment needs. It is critical that all staff share a clear understanding of these strategies and demonstrate a consistent application of these strategies across the State.

As we implement these strategies, we need to sustain the quality of VR services and outcomes. The VR Program is responsible for assuring that eligible individuals are able to participate in the full scope of VR services to meet their rehabilitation needs. Our purpose is to enable individuals with disabilities to achieve quality employment outcomes while using costeffective service options. The following are best practices incorporating counselor judgment with supervisor input.

Eligibility Determination

To the fullest extent possible, existing information should be reviewed to make an eligibility determination. Existing information will be considered adequate if, in the counselor's judgment, it provides sufficient information to document: the person's disability(ies); the ability to achieve employment consistent with their employment goals; impediments to employment; and the ability to benefit from services. VR policy allows for the use of Counselor observation and information provided by the applicant, family and/or advocate as a source of information in determining eligibility and should be considered.

Please refer to VR Policy: 202-Eligibility for Services for more information.

Assessments

When existing information is not sufficient to establish eligibility and/or develop the IPE, additional assessments may be authorized. In order to assure that VR staff are authorizing services in the most cost-effective manner, the following procedures have been established:

  1. If a DVE is determined necessary, the initial authorization should be for a maximum of 10 units.
  2. Assessment requests that exceed 10 units require Senior Vocational Rehabilitation Counselor (SVRC) approval.

Please refer to VR Policy: 204-Assessment Policy for further information.

Development of the Individual Plan for Employment (IPE)

When developing an IPE and planning for vocational rehabilitation services, consumers should be advised early in the process that VR:

  • may not necessarily be the sole source of support in achieving their goals;
  • will consider all comparable benefits;
  • will consider economic need for applicable services;
  • must consider cost-effective programs;
  • will state appropriate funding available for services on the consumer's IPE; and
  • will discuss all funding and choices with the consumer.

Additionally, when developing the IPE Counselors should consider the following factors:

  • level of integration, duration, effectiveness, timeliness, proximity and appropriateness of the service to meet the individual's needs;
  • consumer choice and interests; and
  • cost-effective options.

Cost-Effectiveness

When implementing a plan to meet the consumer's IPE employment goal, it is critical to consider the cost-effective options that are appropriate and available. Reports and quantifiable information may assist in determining cost-effective options (i.e. placement data for a particular employment field or assistance from VR's Integrated Employment Specialist (IES) etc.) The knowledge and experience of counselors and other district office staff are also critical elements to be used in determining appropriate, cost-effective service options for consumers. Once a determination is made, the consumer should be informed of their option to choose a more expensive alternative and their responsibility for personally incurring the additional costs of their choice. The IPE and IPE Development Case Note should clearly reflect this discussion and the consumer's decision. Only after considering all these factors should the authorization for the services required to assist the consumer in meeting their employment goal be processed.

Please refer to VR 100.00P -Consumer Involvement Procedure for further information.

Examples of applying cost-effective strategies:

  • When completing a comprehensive assessment for IPE development, the VRC should use existing information first and consider the purchase of assessment services only to fill in gaps in existing information regarding the individual's strengths, resources, priorities, concerns, abilities and capabilities;
  • When reviewing the cost of books for college, consumers should be encouraged to purchase used books or rent books, where available, as a way of maximizing resources;
  • When reviewing a culinary goal, determine if there is a more cost-effective alternative (i.e. community college vs. a culinary trade school.)

Supported Employment (SE)

In recent reviews of individuals in Supported Employment services, the appropriateness of some referred consumers has been questioned. Supported Employment should be used for consumers with the most significant disabilities who require on-going supports to become employed and maintain employment. Individuals requiring short-term supports and/or job coaching should be sponsored utilizing UCS services.

The VR Policy Unit is currently working on an updated policy with an expected completion date of May 2011. In the meantime we have implemented the following guidelines to ensure appropriate services are provided to consumers:

Supported Employment Authorization Guidelines

  1. Initial authorization can not exceed 50 units.
  2. If a second authorization is required, a justification must be provided in the case notes and the authorization can not exceed 50 units.
  3. If additional Supported Employment units are necessary, a justification must be provided by the vendor at a case conference, recorded in the official case notes and receive official approval from the Director of Counseling/District Office Manager prior to the authorization being written.
  4. The job development phase should not exceed nine months. If the consumer is moving towards placement and additional job development is needed, the provider must document the consumer's progress to-date and additional services needed. This documentation must be provided with the authorization to the Sr. Vocational Rehabilitation Counselor for approval.

Unified Contract Services (UCS)

Placement

UCS services should be applied in the most cost-effective manner and used consistently across New York State. Each placement service must meet the specified needs of the individual and required deliverables must be received prior to payment. In order to achieve better management of this service area, additional guidelines were developed in the following areas:

  1. Direct Placement Intake -Tier 1 -(Case Service Code 921X) -This service is designed to permit the individual referred for services and the service provider to evaluate the consumer's employability with respect to the vocational goal; the job search methodologies; and mutual expectations. It may be utilized as a placement service or as a pre-screening service relative to placement in a particular occupation. This UCS service can not be authorized if the placement vendor or the placement component of the vendor has:
    • served the consumer within the last 12 months; or,
    • the consumer has received training or work-readiness services from that vendor.
  2. Job Seeking and Job Development -Tier 2 (Case Service Code 929X) -These services are designed to equip the consumer with the necessary skills to participate, to the greatest degree possible, in the job search process and employment outcomes. A required deliverable for this service is the consumer's resume. Each DO will have a procedure for sharing the required deliverable (including the resume) with the VR Integrated Employment Specialist {IES) or designee and the tracking of consumers who are ready and available for employment.
  3. Job Retention Services -(Case Service Code 932X-Tier 4) -should not be authorized until after the consumer has been placed in employment; Job Placement -Tier 3 (Case Service Code 931X).

Complex/High Cost Services

The District Office Manager or their designee should be consulted prior to authorizing complex and/or potentially high-cost case services. High-cost services are when the total cost of the IPE is expected to exceed $10,000 including the following: home and vehicle modifications; adaptive technology cases (including closed captioning computer services for persons that are hearing impaired), and out-of-state training services when there is no in-state option. The $10,000 threshold does not apply to interpreter services. Please begin the implementation of these strategies immediately and if questions arise, discuss them with your District Office Manager.

EFFECTIVE DATE; Immediately

Date Issued: December 9, 2010