NEW OUTCOME BASED
PAYMENT SYSTEM
Maine Department of Labor
Bureau of Rehabilitation Services
Division of Vocational Rehabilitation
May 2013
Background
• Coming Together with Rehabilitation Providers (CRP)
project initiated in October 2011.
• Billing – Funding model, rates and fees was one area of
focus
• Strong recommendation from work group to change CRP
payment model to outcome based system.
• Reduce administrative steps
• Save time and effort for both CRP’s and VR staff
• Focus on employment outcomes
• Significant research and analysis
• Statewide input from VR staff and CRPs
What is an Outcome Based
System?
• Also known as Results Based Funding
• Method of reimbursement for job
placement services
• Not based on hours of service delivered
• Payments occur at specific employment
milestones
What is the roll out plan?
• Implementation during SFY 2014
• Phased in by regions (Augusta is first!)
• Statewide Presentation – May 28, 2013
• Local Work Sessions
Augusta – June 13 at 1 p.m.
New DVR CRP Payment System
• CRP Services and Fees
• Employment Placement
• Job Development (Outcome Milestone Payments)
• Job Coaching (Hourly Rate)
• Stand Alone Single Service
• Billed at hourly rate
• Only if not part of Employment Placement
• Examples – Trial Work Experience; Situational
Assessment; Resume Writing
Job Development Services
• Tiered Payment System based upon significance of
disability
• Four milestones for payment
• Bonus payment for higher earning levels
• Additional subsidy for CRPs contracted to serve remote
areas
• Additional subsidy for CRPs contracted to serve
populations requiring specific certification/competency
What are the Tiers?
• Tier I (Most Significantly Disabled)
• Determined by the VR Counselor to be in Order of Selection
Priority Category #1 using existing rules/tool.
Individuals
• who have a serious limitation in terms of an employment
outcome in four or more functional capacity areas
• whose vocational rehabilitation can be expected to require
multiple vocational rehabilitation services
• whose vocational rehabilitation can be expected to require an
extended period of time
What are the Tiers?
• Tier II (Significantly Disabled or Disabled)
• Determined by the VR Counselor to be in Order of Selection
Priority Category # 2 or Category # 3 using existing rules/tool
Individuals
• who have a serious limitation in terms of an employment
outcome in at least one functional capacity area
• whose vocational rehabilitation can be expected to require
vocational rehabilitation services
• whose vocational rehabilitation may or may not be expected
to require an extended period of time
Milestone Payments
Milestone
Tier I
Tier II
1. Plan for Employment Services Written
$ 900
$ 500
2. Placed in Employment - Completes 1
day
$ 900
$ 500
3. Maintains Employment – Completes 45
days
$ 1,000
$ 500
4. Retains Employment – Eligible for VR
closure
$ 1,200
$ 1,000
$ 4,000
$ 2,500
TOTAL
Additional Fees
• $ 1,000 Bonus payment after Milestone 4 for SSI/SSDI
beneficiaries employed at SGA earnings level.
• As part of CRP contract, select agencies will be provided
an additional 15 percent for travel to serve individuals
remote areas.
• As part of CRP contract, select agencies will be provided
an additional 15 percent to serve populations requiring
specific certification or competency, such as American
Sign Language
An Anticipated Scenario
What will happen with individuals who are already receiving job
placement services when milestone payments go into effect?
• Funding will be transitioned immediately to the milestone system with
consideration of the length of time that they have been receiving
placement services:
- In job development 0 to 3 months, issue confirming authorization to
bring funding equal to Milestone 1.
- In job development 3 to 6 months, review progress and if job
development continues, issue authorization for Milestone 2.
- In job development over 6 months, job development ceases until
an updated comprehensive assessment of rehabilitation needs is
completed. If it is determined that the client can benefit from renewed
placement services, choices for CRP services should be offered and
upon selection, the CRP will be eligible for Milestone 1.
Another Scenario
What will happen with clients who are not placed after
significant CRP time and effort?
• Even though there are no required written monthly reports, the
CRP, VRC and client should be regularly communicating
throughout the placement process.
• Other approaches, such as an O-J-T or vocational goal
change, should be explored.
• In some instances, CRP job development services will end and
the client will work with the VRC to determine next steps.
• Although the CRP will have received only Milestone 1, the rates
set in this type of payment system take into consideration
successful and unsuccessful placement efforts.
A Common Question
Is there a minimum number of work hours per
week?
• There is no minimum number of work hours
required for milestone payments.
• However, the number of work hours must be
consistent with what is identified in the IPE and
the CRP employment search plan.
Important Things of Note
• Fee schedule provides incentive to serve individuals with
the most significant disabilities.
• Referrals for Job Placement must be for individuals who
have a defined vocational goal.
• Milestone payments can only be made for employment
placements in the job goal identified on the Individualized
Plan for Employment (IPE).
• Client responsibility and active engagement in the job
search process is critical.
Supporting Documents
• CRP Description of Fees
• Contract Agreement
• CRP Referral Form
• CRP Payment Reporting Templates
• Common Scenarios
Website: http://www.maine.gov/rehab/crp/index
Questions and Next Steps?
• Session on June 13 with Augusta - Rockland VR and CRP
staff to work out the final details of implementation.
• Target date is July 1 in Augusta.
• Followed by August 1 in Rockland.
• Other regions stay tuned!
• Information will be shared through the BRS website and
regional meetings.
• Questions?
Thanks to these Contributors!
CRP Project Managers: Valerie Oswald and Elinor Weissman
Billing Team Members:
David Dwyer, Sally Sweeney, Robin Thayer, and Debbie Berry
Josh Howe, Kevin Owen, Beth Lehning and Karen Fraser
Steering Team Members: Debra Henderlong (Allies), Gayla
Dwyer (Aroostook Mental Health Center), Laura Bolduc
(B.E.S.T.), Diane Frigon (DBVI), Shannon Hartmann (Creative
Works), Abigail Miller (Easter Seals ME), Bethany Campbell
(Goodwill), Sally Sweeney (KFI), Deb Myers (KEWL ASL), Beth
Lehning (VR – Augusta), Esther Ireland (VR-Bangor), Kevin
Owen (VR – Lewiston), Robert Kennelly (Pathways), Gary
McPherson (Progress Center), Wendy Warren (VR – Augusta),
David Dwyer (WOU), Auta Main (MDOL-BES), Rachel Merriam
(VR- Augusta), Terry Morrell (BRS-DDHHLD), Libby StoneSterling (BRS – CO), and Allison Bubier (VR-Augusta)