These services make the following three changes to Minnesota’s home and community-based services (HCBS) waivers:
These services allow us to:
No. We designed the employment services to help us better support competitive, integrated employment. They are about adding, not taking away options. Center-based services and subminimum wages will remain an option. Work crews will, however, have a maximum staffing ratio of 1:6.
Minnesota must meet the requirements of the federal HCBS Final Rule to ensure that people with disabilities are not isolated in the settings where services are provided. This means in future revisions of services (i.e., DT&H and prevocational services) DHS must decide how we can ensure these settings meet the integration requirements of the HCBS Final Rule. We will have these conversations and make these changes separately from the implementation of the employment services.
Here's how unpaid work experiences fit into the employment services and other options you might consider for supporting volunteer positions:
Employment exploration, employment development and employment support services are not an excluded time service because these services are not listed in the statutory language for excluded time services, Unitary Residence and Financial Responsibility, Minn. Stat. § 256G.02, subd 6.
The issue of excluded time services is broader than the scope of the three employment services. The entire array of services a person receives must be taken into consideration to make a determination about whether or not the person is in an excluded time status.
DHS has the statutory authority to resolve disputes between county human services agencies regarding financial responsibility for human services programs. DHS determines the facts in a particular case and uses Minn. Stat. § 256G, the law governing financial disputes, to make a determination. Read more on the County financial disputes webpage.
A list of excluded time facilities and services can be found on the Excluded Time Facilities and Services webpage.
The person may continue to receive extended employment services and is not required to change to waiver employment services.
Any services provided in a business owned or operated by the same organization that is providing the person’s day and employment services will continue to be considered a center-based service and would fall under DT&H/prevocational services rather than employment support services.
If someone works at a business or other organization in the community and is being paid through his or her service provider, this is a contracted work arrangement. Support for this employment may be provided under employment support services.
Authorize the hourly prevocational service for the days a person works in the community and receives one of the employment services (exploration, development or support). Use the daily rate for the days when the person does not receive any of the employment services and receives at least six hours of prevocational services.
The employment services affect DT&H services when both services are provided on the same day. Partial-day billing is available if no employment services are provided on the same day. DT&H day services, structured day services, and adult day services must be authorized and reimbursed on a 15-minute unit basis when exploration, development and support services are provided during the same day as these services. On days when an employment service is NOT provided, partial day DT&H services may be billed for people who received day services in 2013. DHS provided lead agency DWRS rate mentors with a partial-day DT&H spreadsheet with all eligible people’s specific partial-day rates. Only people listed on the spreadsheet may use the partial-day DT&H rate. Partial-day DT&H rates will remain the same even if the person changes his/her day provider.
When the employment services and DT&H services are provided on the same day, DT&H is billed in 15-minute units. A full DT&H day cannot be billed on the same day when any employment units are billed, even for indirect services that do not require direct contact with the person.
Yes, you may authorize both employment development service units and employment support service units at the same time. You may not authorize employment support services (1:1) and employment exploration services at the same time.
The Employment First website contains the most up-to-date information about and resources for the employment services. The Community-Based Services Manual (CBSM) contains policy guidance about employment-related HCBS waiver services. You'll find links to the policy pages for the services in the What’s new in the CBSM section of the CBSM homepage. If you would like to speak to someone about the services, please refer to the resources below:
No. DT&H day services, structured day services and adult day services must be authorized and reimbursed in 15-minute units when agencies provide the employment services during the same day. So, all units of DT&H would need to be in 15-minute units. On other days (when agencies do not provide employment services), the person might receive full-day or partial-day DT&H units.
The lead agency determines the service-delivery ratio for each service based on level of need and the given employment activity. Lead agencies authorize a single ratio for service delivery under each service:
To determine what average ratio to authorize and how many weekly units to authorize for each service, consider using the Employment and Day Services Individual Planning Tool (XLS) to find an average ratio based on a person’s weekly activities and supports.
Exploration and development may be provided at a location that also provides DT&H services, but we expect you to provide these services primarily in the community. You must provide employment support services in integrated community settings.
The requirements in Minn. Stat. 245D.071 that apply when a person begins to receive services (including the 45-day meeting) are not required when a person moves to or between any employment service (i.e., employment exploration, development or support). A provider must meet the 245D.071 requirements, however, when a person is new to the license-holder’s program and has not previously received an employment or day service from the license-holder. The license-holder must complete a service-plan review and evaluation according to the timelines in the person's coordinated service and support plan or addendum. The license-holder must complete these reviews at least annually or within 30 days of a written request from the person, his or her legal representative or case manager.
If a person participates in group employment support services and related services occur that do not require direct contact with the person, these services would be factored into the group employment support services ratio authorized by the lead agency. You would not do a separate authorizing of 1:1 employment support services for these services.
On any day when an employment service is provided, DT&H must also be authorized/provided in 15-minute units. This includes situations where someone may receive more than six hours of DT&H and an employment service on the same day. It is allowable to authorize/bill for more than six hours of DT&H services on a day in 15-minute units when an employment service is provided on that same day. If no employment service is provided on that day, then the DT&H would be authorized/provided as a daily unit.
Coordinated service and support plans are designed to meet the needs of the person. Authorize employment support services using your best estimate of how often this person may participate in work crews. You would also authorize accompanying 15-minute units of DT&H.
There are exceptions for gaps in service delivery. Lead agencies have the option to force the edit and start another 12 months of service. For more information, see the Employment Development Services CBSM page.
If there are multiple employer of records, each employer should have its own entry. This means using multiple 6790L forms and then multiple entries in the MnCHOICES Support Plan application. If the employment service provider NPI is the same across these different jobs, the staffing ratio should be averaged across all and use one 6790L.
Any employment service that takes place in a setting/business owned by a service provider will continue to be considered a center-based service and would fall under DT&H/prevocational services rather than the employment support service. Therefore, you do not need to complete RMS Worksheet 6790L for DT&H services. You need to complete the appropriate 6790 for either DTH or prevocational services.
If the employer of record is the same across all jobs, enter this as a single job even if the person is going to multiple sites to perform work tasks. If there are multiple employers of record, each employer of record should have its own entry. This means using multiple 6790L forms and then multiple entries in the MnCHOICES Support Plan application.
Yes, you need to complete a new RMS and 6790 when a person obtains a new position with a different employer. We expect the person to require additional support to learn and maintain this position.
Providers who pay subminimum wages must meet the requirements of WIOA Section 511 and its regulation, “Limitations on Use of Subminimum Wage.” A wait list for a VRS assessments does not change WIOA requirements. For more information, visit the Workforce Innovation and Opportunity Act (WIOA) page in the Community-Based Services Manual.
Employment First is a national movement supported by the federal government and Minnesota agencies. It means competitive, integrated employment is the first and preferred outcome for all working-age people with disabilities, including people with complex and significant disabilities. Minnesota adopted an Employment First policy (PDF) as part of our Olmstead Plan in September 2014.
Many people with disabilities want to work. A recent report published by the National Core Indicators© (PDF) showed the majority of Minnesotans with disabilities who are unemployed want a job but lacked a job goal in their service plans. Research, such as the NCI report, shows people with disabilities can be employed successfully in the general workforce given the right job match and supports. Employment offers people:
Competitive, integrated employment means a person:
No. Each person’s decision to work is personal. It should be an informed choice, based on accurate information and experiences. Informed choice means people with disabilities are fully able to explore employment as an option.
The Minnesota Olmstead Plan includes activities our state must accomplish to ensure people with disabilities live, learn, work and enjoy life in the most integrated setting. The Olmstead Plan requires the state to create opportunities to work, but it does not force people with disabilities to work. The Employment First approach to provide choice is consistent with Olmstead principles. We will use this strategy to meet Olmstead priorities.
The Minnesota Association of People Supporting Employment First published “Myths and Realities of Employment First and Olmstead (PDF)” to address misconceptions and questions about what the Olmstead Plan and Employment First policy mean for people with disabilities.
Informed choice about employment means that a person:
For a more information and resources, see the DB101 Informed Choice Toolkit (PDF).