Arizona

Day Treatment and Training Services (Day Programs) provide training, supervision, and activities to a member to develop skills. This service is primarily offered in a community setting. It is intended to help members learn safety skills and socialize. Day Programs are available through DDD or local community resources and may include volunteer opportunities for members such as participation in a local senior activity.

Service Description This service engages Members in their communities to develop, or enhance skill development, for activities of daily living and employment while meeting their specialized sensorimotor, cognitive, communication, social interaction, and behavioral needs. Day Treatment and Training activities and environments are designed to foster the acquisition of skills, build community membership, increase independence, and expand personal choice. Members are provided with opportunities to engage in activities that are meaningful to them and that expand their skills and personal growth. Day Treatment and Training offers Members an opportunity to explore their communities, to learn about their interests, to engage with others, and to gain skills needed for greater independence. Outcomes 1. Members participate in Meaningful Days, are included in their communities, and fulfill valued community roles. 2. Members transition into employment activities and services when Members want employment. Members should be encouraged to seek desired employment and meaningful careers. Goals 1. To support Members, in accordance with their Planning Document: a. To participate in their community with the requisite socialization and adaptive skills they need to increase their potential for success: b. To strengthen relationships with family, friends, and community Members, develop desired relationships, and enhance their socialization, community participation, and knowledge of community resources, and:. c. For those Members who have been assessed and want to make a progressive move to employment, to develop or enhance their skills and abilities related to employment. Objectives The Qualified Vendor Shall ensure that the following objectives are met: 1. Identify and respect the Member’s cultural, racial, ethnic, linguistic, identified gender, sexual orientation, and religious or spiritual needs. 2. Provide services according to the Member’s preferences and needs, that recognize their strengths and promote their independence. 3. Provide support appropriate for the Member’s age and aligned with typical life experiences such as playing and making friends, navigating relationships and sexuality, having and raising children, exploring recreation and hobbies, using social media and technology, getting an ID card, learning to drive or accessing public transportation, going to college or vocational school, finding a career, engaging in civic life, seeking leadership or advocacy opportunities, living more independently or renting/buying a home, or transition into retirement. 4. Support the Member with activities that they, and their Responsible Person if applicable, have decided they need help with or that are documented in their Planning Document, such as: a. Participating in community activities and building community membership consistent with the Member’s interests, preferences, goals, and Outcomes; b. Developing and maintaining a meaningful social life, including social skill development, that offers opportunities for personal growth and development of Natural Supports through community participation and relationships; c. Providing opportunities that increase problem-solving skills to maximize the Member’s ability to participate in integrated community activities independently or with Natural Supports; d. Providing opportunities for Members to participate in a range of community activities and use community resources; e. Supporting Members in developing relationships of their choice, including enhancing social skills, confidence, and problem-solving for daily interactions; f. Supporting Members to develop or enhance independent functioning skills in sensory-motor areas, cognition, personal grooming, hygiene, dressing, eating, toileting, self-medication and first aid, recognizing symptoms of illness, and preventing accidents and illnesses; g. Providing exploration and learning opportunities related to work and volunteer experiences where Members develop knowledge related to general, non-job-specific skills and strengths that contribute to individual employment; h. Identifying barriers that limit progressive transitions to employment services; i. j. Offering specific teaching strategies to achieve identified Outcomes; Practicing daily living skills such as shopping, banking, money management, using community resources, navigating their community, and using public/community transportation; k. Assisting and training for personal, physical, mobility, or augmentative alternative communication needs; l. Implementing positive behavior support strategies, developing behavior intervention plans with the Planning Team, and coordinating with

behavioral health programs for proper review of medication treatment plans when needed; m. Ensuring that the Member’s health needs are met, including providing follow up as ordered by the Member’s Primary Care Provider or other medical specialist; n. Implementing all therapeutic recommendations including speech, occupational, and physical therapy, and assisting Members in following special diets, exercise routines, or other therapeutic plans; o. Providing for personal care needs; p. Providing general supervision; and q. Providing transportation necessary for community or Planning Document related activities. 5. Play an active role in ensuring that services with other involved entities, including other Home and Community-Based Service providers, health care providers, schools, and vocational rehabilitation are coordinated to best meet the Member’s needs. 6. Refer any identified issues or concerns related to the Member’s living situation, home and community-based services, health care providers, school services, or other community-based resources to the Support Coordinator in order to coordinate services to best meet the Member’s needs. 7. Identify and refer for issues that require social intervention (e.g., food insecurity, unsafe housing, needed interventions or medical care, neglect, abuse).

Limits on the amount, duration, or frequency of this service:

1. Qualified Vendors Shall assist in developing the Planning Document, including: a. Developing individualized, time-limited Outcomes based on the Member’s/Responsible Person’s vision for the future and assessed needs; b. Developing a specific teaching strategy for each habilitative outcome within twenty (20) Business Days after initiation of a new or a continuing service and whenever the Member has chosen a new Outcome. The specific teaching strategy for each Outcome Shall identify the schedule for implementation of the teaching strategies, frequency of services, data collection methods, and the steps to be followed to teach the member the new skill; and c. Changing specific Outcome(s) and strategies when requested by the Member or agreed upon by their Planning Team to support continued measurable progress toward the Member’s Outcome. 2. In collaboration with Members, Qualified Vendors are required to develop, at a minimum, a monthly on-site community-integrated schedule of daily activities. a. Daily activities and schedules are developed with member participation y, considering support needs, Planning Document goals, and enrichment of life experiences. Qualified Vendors Shall allow reasonable opportunities for Members to choose and offer alternative activities, as necessary. This schedule Shall be available to the Member/Responsible Person or others upon request. 3. Members that want to work should be informed of employment services that are available to them. Members who want to work or who demonstrate work-related skills Shall be referred to their Planning Team to develop an Outcome related to employment. 4. Day Treatment and Training activities Shall not include wage-related activities that would entitle the Member to earn wages. 5. This service Shall be provided in: a. A setting owned or leased by the Qualified Vendor that includes planned opportunities for interaction with community Members and resources and that home program allows for participation in community events; or b. A community setting that offers opportunities for interaction with community members and resources and that allows for participation in community events. 6. The service setting(s) shall: a. Be physically accessible and allow for movement between different areas; b. Allow for privacy in addressing personal care needs and storing personal belongings; and c. Allow for privacy for planning and discussing Member support needs, issues, and concerns. 7. This service Shall not be provided: a. In a Group Home, Nursing Supported Group Home, Behavioral-Supported Group Home, or a Vendor Supported Developmental Home; b. To Members living in non-state operated Intermediate Care Facilities or Level I or Level II behavioral health facilities; c. In the same room at the same time as another service (e.g., Center-Based Employment, Day Service, Child), except therapy services; or d. In a permanent residence, unless approved by the Department’s Network Operations Administrator/Designee. 8. Therapy services (occupational, physical, and speech) May be provided at Day Treatment and Training locations as identified on the Member’s Planning Document under the following circumstances: a. With the Day Treatment and Training Personnel present and learning how to implement activities to meet the Member’s Outcome(s) and in conjunction with the Home Program; or b. At the request of the Member or Responsible Person and with the agreement of the Day Service program, with a DSP or caregiver present and participating. 9. Members May use up to eight (8) service units per day. Direct service time associated with providing transportation to and from the program is included in the flat trip-rate for regularly scheduled daily transportation rate. 10. It is the responsibility of the Planning Team and the Qualified Vendor to determine the Member’s anticipated attendance and Member’s schedule as part of the initial service planning and referral. Members May choose to attend Day Treatment and Training for a few hours weekly or a full week when authorized. 11. Children through the age of fifteen (15) Shall be provided service separately from adults, except in situations where related Members have agreed to receive the service together. Upon age sixteen (16), transition plans May be individually developed and May permit the inclusion into services with adults with Responsible Person consent. The transition plan and consent Shall be available to the Department upon request. 12. Qualified Vendors Shall comply with monitoring activities as directed in the Provider Policy Manual(s), including collaboration and cooperation with the Division for all monitoring activities.

Provides on-the-job training and coaching. The member is hired by a company and paid just like any other employee. https://youtu.be/As6EWTaYapo?si=VGbEU2l8u7aNM9gD

Pre- and post-employment services including short-term and ongoing supports to assist members in obtaining and/or maintaining employment. Refer to ACOM Policy 447 and AMPM Policy 1240-J. Supported Employment services are also available for behavioral health services covered by the Contractor. To avoid duplication of efforts, the member’s Support Coordinator and Planning Team is responsible to decide if the Supported Employment service provider contracted with the Contractor or the Division best meets the member’s needs for employment support. This decision will be documented by the Support Coordinator in the member’s Planning Document. The Support Coordinator is responsible for Vocational Rehabilitation referrals for appropriate.

A service that supports Members to gain Competitive Integrated Employment or sustainable self-employment by providing job search and job coaching services. Job search provides job development, assistance in matching the individual with Competitive Integrated Employment, or support for finding meaningful self-employment. Job coaching provides support to help the Member develop the specific on-the-job skills necessary for employment as well as follow-along support to help the Member maintain employment. Job coaching is intended to be tapered to the extent possible to support the Member’s independence in their job. Outcomes 1. Members using this service gain or maintain meaningful, Competitive Integrated Employment based on their abilities, interests, and personal goals. Goals 1. To support Members, in accordance with their Planning Document and vision for employment to: a. Work in their community. b. Grow in their career. Service Objectives The Qualified Vendor Shall ensure that the following objectives are met: 1. Identify and respect the Member’s cultural, racial, ethnic, linguistic, identified gender, sexual orientation, and religious or spiritual needs. The Member will receive support aligned with these needs (e.g., work schedules that permit Members to express their religion or religious values, training about sexual harassment or discrimination). 2. Provide services according to the Member’s preferences and needs that recognize their strengths and promote their independence. 3. As applicable to the Member’s employment, provide support appropriate for the Member’s age and aligned with typical life experiences. This May include connecting the Member to a job that is appropriate for their age (e.g., summer jobs for youth, jobs that support transition into retirement) and their employment expectations (e.g., compensation, work culture, work schedules that promote parenting or other caregiving duties, work environments that allow for developing friendships with co-workers), and considers location (e.g., preference, convivence, available transportation). 4. In accordance with their Planning Document, support the Member in one or more of the following components of this service: a. Job Search – This time-limited component supports Members to find meaningful gainful employment in accordance with their vision for employment. i. This service includes job search activities that: 1. Are centered on the Member’s employment focus and interests; 2. Include a Job Search Agreement to: a. Identify the employment Outcome, job search strategy, and activities necessary to achieve that outcome; and b. Outline the activities needed to achieve the Outcome along with the amount of time needed to achieve the Outcome. 3. Assist the Member in preparing for a job search, including creating a job history and/or resume, preparing for interviews, and accompanying the Member on interviews, if needed; 4. Develop employment opportunities for the Member with local employers and provide education to potential employers about the Member’s strengths and skills, as well as proven benefits of hiring people with ID/DD; and 5. Provide other support necessary to help the Member obtain employment. b. Job Coaching – This component supports Members on the job to ensure that they begin their job with ample support that fades over time as Members become more comfortable and competent in engaging in work activities independently. This component also provides ongoing on-the-job support for Members who are well established in their competitive employment or self-employment and require routine ongoing support. This service includes, but is not limited to, the following employment activities: Ensuring that the Member has the opportunity to participate in Competitive Integrated Employment; Ensuring that the job is aligned with the Member’s capacities, capabilities, and interests; Providing orientation training and skill development to Members, in addition to those provided by Members’ employers, to support a strong transition into work; Orienting Members to health and safety aspects and requirements of their work; v. Providing ongoing training and education as needed to support Member’s independence in their work; Assisting Members in learning new skills necessary for maintenance or advancement in their employment; Identifying and referring for ongoing supports needed to assist Members in maintaining and advancing employment; Providing ongoing monitoring of the performance and general job-related skills of Members to identify both strengths and barriers to maintain and advance employment; Assisting the Member to understand and develop strategies to complete their work independently; Assisting the Member to identify and make use of Natural Supports on the job; Providing safety supports as needed for the Member and educating the Member about staying safe on the job; Providing contact and support in adherence with Member needs and preferences, including supporting Members to interact with co-workers in a positive and professional manner and to socialize with co-workers, as is common in the culture of their workplace, by offering direct support or minimizing support to allow for socialization opportunities during breaks and other appropriate non- work time; Maintain ongoing communication with Members’ employers to assess strengths, areas for improvement, and overall job performance; Assisting the Member in resolving work issues as well as any personal issues that interfere with their ability to engage in work; Providing intervention and Technical Assistance to an employer as needed to support the success of the Member; Providing ongoing onsite supervision and support; Consulting with each Member’s Planning Team to identify strengths and barriers to success and progressive movement; Developing and implementing strategies to capitalize on strengths and remove or minimize barriers; and Providing behavioral support, such as: 1. Shadowing the Member to assist him/her in maintaining positive workplace behaviors; 2. Providing behavioral support as needed by assisting in resolving inappropriate workplace behaviors; 3. Assisting the Member in resolving any life/personal concerns that May interfere with job performance; and 4. Communicating with all appropriate Persons or referring when the Member needs additional self-care, behavioral, and medical support. 5. Refer any identified issues or concerns related to the Member’s living situation, home and community-based services, health care providers, school services, or other community-based resources to the Support Coordinator in order to coordinate services to best meet the Member’s needs. 6. Identify and refer to the Support Coordinator issues that require social intervention (e.g., food insecurity, unsafe housing, needed interventions or medical care, neglect, abuse). 7. Cooperate with the Planning Team to develop plans to reduce service, as appropriate, and support Members as they transition to the maximum level of independence in Competitive Integrated Employment.

Limits on the amount, duration, or frequency of this service:

1. This service Shall be designed to promote community integration with people in the community workforce and provide paid work. This service Shall be: a. Used to search for, or to provide support to, Members to obtain and maintain competitive paid employment; b. Provided in integrated community work settings where people typically work and where Members interact with people without disabilities, other than DSPs providing support to the Member, to the same extent as people without disabilities; c. Provided in a one-to-one (1:1) ratio of Member to Personnel; d. Allowable for Members under eighteen (18) years of age when approved by the Network Operations Administrator/Designee; e. Allowable for Members who are in school who are seeking to obtain seasonal or temporary employment; and f. When using Job Search, provided individually in accordance with a Job Search Agreement developed on Department forms, between the Qualified Vendor and the Member’s Planning Team. 2. Members who use this service Shall at their annual planning meeting assess with their Support Coordinator whether: a. The service is still applicable for the Member, meeting their needs, and advancing their employment Outcomes or vision for employment; b. The Member’s employment needs could be better supported, or additionally coordinated, through other programs, such as school or with a referral to vocational rehabilitation for employment services;

c. The Member’s needs could be met in other ways, such as through Natural Supports; technology or adaptive equipment, or through other means; d. The Member Should be referred for other employment services; or e. The Member can maintain employment without the use of this service. 3. Qualified Vendors Shall maintain compliance with all applicable State and Federal law. 4. Comparable support services Shall not be available to the Member through Vocational Rehabilitation. 5. Qualified Vendors Shall comply with monitoring activities as directed in the Provider Policy Manual(s), including collaboration and cooperation with the Division for all monitoring activities.

Provides ongoing one-on-one support to a member to remain employed.

A service that provides members with the one-to-one supports needed for the member to remain in his/her employment. These supports could include one or more of the following three (3) options: personal care services, behavioral supports, and/or follow-along supports needed to maintain stable employment. The actual supports provided will be dependent upon member need; however, this service will primarily be used to provide on-the-job follow-along supports for members in competitive employment.

Service Goals To provide the necessary level of supports to empower the member to attain, maintain or advance in employment. Service Objectives The Qualified Vendor shall ensure that the following objectives are met, dependent upon the type of support being provided, per the member’s planning document [e.g., Individual Support Plan (“ISP”)]: Personal Care Services Provide assistance to meet the personal care needs of a member who would otherwise be excluded from employment, which may include but is not limited to: 1. 2. 3. 4. Assisting with lavatory use, Assisting at meal times and breaks, Assisting with self-medication or medication reminders, and/or Assisting with ambulation.

Behavioral Health Services

To support members with a co-occurring behavioral health diagnosis who would otherwise be excluded from employment. Comparable support services must have been denied by the relevant Regional Behavioral Health Authority (“RBHA”). It is expected services would fade or be provided only intermittently as the member’s workplace behaviors improve and/or the member stabilizes in his/her workplace performance. Services may include but are not limited to: 1. Shadowing the member in order to assist him/her in maintaining positive behaviors appropriate to the workplace, 2. Providing behavioral support as needed by assisting in resolving behaviors inappropriate for the workplace, 3. Assisting the member in resolving any life/personal concerns that may interfere with job performance, and/or 4. Communicating with all appropriate persons when the member presents any additional medical or social needs during the course of the service delivery in order to refer for or obtain additional needed supports.

Ongoing On-The-Job Supports

For members employed in the community and not receiving any other employment support services, the Employment Support Aide provides on-the-job, follow-along supports. It is expected that this will be the most frequently authorized use of this service/support option.

Limits on the amount, duration, or frequency of this service:

1. This service may be provided to Division members receiving Group Supported Employment, Individual Supported Employment, or members employed in the community who are not receiving other employment supports and services. 2. This service shall not be provided for a member during the time he or she is receiving a Center-Based Employment service.

Members using this service gain skills and explore interests to obtain meaningful, Competitive Integrated Employment based on their abilities, interests, and personal goals regardless of their journey along the employment pathway.

Pathways to Employment is designed for members with all skill levels and abilities to access employment options in such a way that takes into account the Member’s preferences and goals, and supports them to obtain Competitive Integrated Employment. Options available in this service will help the Member learn the skills necessary to increase the likelihood of employment, including:

Determining their interests in being competitively employed,

Providing experiences and employment opportunities,

Identifying the types of jobs the Member might be interested in or excel at,

Participating in work exploration to make an informed decision regarding interests/preferences and to understand skills needed to secure preferred jobs,

Achieving planning Outcomes or vision for employment and revising as needed,

Participating in work activities that support the Member on their pathway to employment, and

Providing flexible support as needed while the Member experiments with employment.

Members should be encouraged to find employment and meaningful careers. Consistent with Employment First!, the Department expects Members to consider Competitive Integrated Employment as the first option for day services. This service is designed for Members with all skill levels and abilities to access service and employment options in such a way that meets the Member’s preferences, goals, and needs for employment. Options available as part of the Pathways to Employment service are designed to be customizable, individualized, flexible, and person-centered so that each Member can develop their own pathway to employment based on their Outcomes in their Planning Document.

Outcomes 1. Members using this service gain skills and explore interests to obtain meaningful, Competitive Integrated Employment based on their abilities, interests, and personal goals regardless of their journey along the employment pathway. Goals to support Members in accordance with their Planning Document and vision for employment: 1. To receive instruction, and to develop abilities, skills, and behaviors that will enable them to realize their employment aspirations most fully; 2. To assess and explore their interests and aptitudes for work, and work possibilities; 3. To assess and experiment with different job types including opportunities for unpaid work exploration and job shadowing so that a good employment match can be made. Objectives The Qualified Vendor Shall ensure that the following objectives are met: 1. Identify and respect the Member’s cultural, racial, ethnic, linguistic, identified gender, sexual orientation, and religious or spiritual needs. The Member will receive support aligned with these needs (e.g., work schedules that permit Members to express their religion or religious values, training about sexual harassment or discrimination). 2. Provide services according to the Member’s preferences and needs, that recognize their strengths and promote their independence. 3. Provide support appropriate for the Member’s age and aligned with typical life experiences. This May include connecting the Member to a job that is appropriate for their age (e.g., summer jobs for youth, jobs that support transition into retirement) and their employment expectations (e.g., compensation, work culture, work schedules that promote parenting or other caregiving duties, work environments that allow for developing friendships with co-workers), and considers location (e.g., preference, convenience, available transportation). 4. In accordance with their Planning Document, support the Member in the following components of this service: a. Employment Skill Development – This is a flexible time-limited service focused on supporting the Member to gain skills necessary for employment. Qualified Vendors provide instruction to Members that is approved by the Department. i. RFQVA DDD-2024 The plan of instruction focuses on critical employment-related skill areas that may include, but are not limited, to: 1. Supporting the Member to understand their disability and accommodations they may need for employment; 2. Assessing learning style; 3. Identifying strengths, likes, dislikes, and interests; 4. Learning about careers of interest and the related requirements; 5. Creating a resume; 6. Applying for a job; 7. Enhancing self-determination; 8. Developing community safety skills; 9. Developing positive work behaviors; 10. Dressing for success; 11. Following the rules; 12. Getting along with your supervisor; 13. Getting along with your co-workers; 14. Responding to and resolving conflict at work; 15. Getting to work; 16. Receiving and using your paycheck; and ii. iii. 17. Understanding the impact of income on disability benefits. The Qualified Vendor will document the Member’s progress toward their goals and identify strategies to support the Member to develop the identified employment skills in a timely manner. Once the service component is complete, the Member will be supported in the next steps for their employment as identified by the Planning Team or in the Planning Document.

b. Assessment Exploring Job Possibilities and Skills – This is a time-limited service designed to assess Members and help them make an informed decision as to if and where they want to pursue Competitive Integrated Employment. The Member receives observation and assessment of their interpersonal skills, work habits, vocational skills while member is participating in practical experiential, community integrated volunteer experiences, and/or paid individualized, integrated work experiences that are uniquely arranged and specifically related to the interests, preferences and transferable skills of the job seeker as established through exploration or a similar process. This service will help to determine the Member’s aptitudes and interests for employment, when Members are interested in Competitive Integrated Employment or self-employment, but require more information about: Strongest employment interests, including the industry or type of work the Member is interested in; Skills, strengths, and other contributions likely to be valuable to employers or valuable to the community if offered through self-employment; and Conditions necessary for successful employment or self-employment. This component supports Members with the following activities: 1. Activities to identify a Member’s specific interests and aptitudes for paid work, including experience and skills transferable to Competitive Integrated Employment or self-employment. 2. Exploration of individualized Competitive Integrated Employment or self-employment opportunities in the local area that are specifically related to the Members’ identified interests, aptitudes, experiences, and skills most transferable to employment, and achieved through three or more uniquely arranged business tours, informational interviews, or job shadows. 3. Observation of Member in familiar places and activities, interviews with family, friends, and others who know the Member well, observation of the Member in an unfamiliar place and activity, identification of the Member’s strong interests and existing strengths and skills that are transferable to Competitive Integrated Employment or self-employment. 4. A comparison of the actual performance of the Member being assessed with core job competencies and duties required of a skilled worker to further determine the competencies and skills needed by the Member to be successful in environments similar to where the experience is taking place. 5. Identification of conditions for success based on experience shared by the Member and others who know the Member well, and observation of the Member during this process. 6. This assessment is used to provide the Member and their team with practical considerations and areas for improvement to support the Member to gain entry into employment. This assessment May also be used to determine support levels needed for employment and to inform an individual plan for employment. 7. The assessment is provided to the Member and their Planning Team so that the next step can be identified The Qualified Vendor will report on the progress with input from the Member that can be shared with the Planning Team to help determine next steps and submit with progress reports as referenced in the Division’s Policy Manual(s). 5. Support the Member with activities that they, and their Responsible Person, if applicable, have decided they need help with or that are documented in their Planning Document, such as: a. Offering specific teaching strategies to achieve identified Outcomes; b. Providing for personal care needs; c. Providing general supervision; d. Providing transportation necessary to support service components (e.g., to visit job sites);

Participating with the Member’s Planning Team in making a recommendation for referral to Vocational Rehabilitation for a progressive move to competitive employment; f. Participating with the Member’s Planning Team in making a recommendation for a progressive move to Competitive Integrated Employment; and g. Providing the Member support during the Rehabilitation Services/Vocational Rehabilitation process, including provision of relevant referral information, participation with the Member during the development of their Individual Plan for Employment, and other contacts as needed to support the outcome of Competitive Integrated Employment job placement. 6. Refer any identified issues or concerns related to the person’s living situation, home and community-based services, health care providers, school services, and other community-based resources to the Support Coordinator in order to coordinate services to best meet the Member’s needs. 7. Identify and refer to the Support Coordinator issues that require social intervention (e.g., food insecurity, unsafe housing, needed interventions or medical care, neglect, abuse).

Limits on the amount, duration, or frequency of this service:

1. This service Shall only be provided: a. To Members who have employment-related Outcomes identified in their Planning Document; b. For a maximum of four (4) hours a day for Members in high school while school is in session and for up to eight (8) hours a day when school is not in session (i.e., summers and holidays); and c. In a setting owned or leased by the Qualified Vendor and in community settings. 2. This service Shall not be provided: a. In a Group Home, Nursing Supported Group Home, Behavioral-supported group home, or a Developmental home; b. When the Member is hospitalized; c. To Members living in skilled nursing facilities, non-state operated Intermediate Care Facilities (ICFs), or Level I and Level II behavioral health facilities; or d. In a ratio exceeding one (1) DSP to four (4) Members (1:4). It is anticipated that all Members receiving the service may need intermittent one-to-one (1:1) assistance/supervision to meet individual needs. 3. If the service setting is co-located in a service setting which also provides other services, DSPs delivering Pathways to Employment services, Shall not concurrently deliver any other services. 4. This service May, or May not, include paid work. 5. The Member’s progress in this service will be reviewed by the Department’s District Employment Services Specialist for consideration for continued enrollment in the service beyond two (2) years. Continued enrollment beyond two (2) years requires the approval of the Department’s Network Operations Administrator or designee. 6. Members who use this service, Shall at their annual planning meeting, or upon completion of each component, assess with their Support Coordinator whether: a. The service is still applicable for the Member, meeting their needs, and advancing their employment Outcomes and vision for employment; b. The Member’s employment needs could be better supported, or additionally coordinated, through other programs, such as school or with a referral to Vocational Rehabilitation for employment services; c. The Member’s needs could be met in other ways, such as through Natural Supports, independent volunteer experiences, technology, or adaptive equipment; and whether d. The Member Should participate in other employment services to further advance their vision for employment. 7. Qualified Vendors Shall comply with monitoring activities as directed in the Provider Policy Manual(s), including collaboration and cooperation with the Division for all monitoring activities.

Provides on-site supervision to a small group of members working in a community setting. Groups can range from two to four individuals. Members may be paid by the DDD service provider or the employer.

This service provides employment and training activities to support a successful transition to Competitive Integrated Employment or to self-employment to Members in small groups of up to four (4) Members. Members are employed in integrated businesses and industries in the community where Members interact with people with and without disabilities. Group Supported Employment may include mobile crews, small enclaves, and other small groups participating in Community Integrated Employment. All Members in the group are paid by the Qualified Vendor or employer for work performed in accordance with State and Federal law and Shall at least receive minimum wage for their work. Outcomes 1. Members using this service gain employment skills needed to obtain meaningful, competitive employment based on their abilities, interests, and personal goals. Goals 1. To support Members, in accordance with their Planning Document and vision for employment to: a. Participate in gainful, productive, and paid work. b. Work in an environment that allows for maximum interaction among diverse populations. c. Acquire knowledge, skills, and experiences that facilitate career development and transition to Competitive Integrated Employment or self-employment, or that supplements part-time employment or self-employment. Objectives The Qualified Vendor Shall ensure that the following objectives are met: 1. Identify and respect the Member’s cultural, racial, ethnic, linguistic, identified gender, sexual orientation, and religious or spiritual needs. The Member will receive support aligned with these needs (e.g., work schedules that permit Members to express their religion or religious values, training about sexual harassment or discrimination). 2. Provide services according to the Member’s preferences and needs that recognize their strengths and promote their independence. 3. Provide support appropriate for the Member’s age and aligned with typical life experiences. This May include connecting the Member to a job that is appropriate for their age (e.g., summer jobs for youth, jobs that support transition into retirement) and their employment expectations (e.g., compensation, work culture, work schedules that promote parenting or other caregiving duties, work environments that allow for developing friendships with co-workers), and considers location (e.g., preference, convivence, available transportation). 4. Support the Member with activities that they, and their Responsible Person, if applicable, have decided they need help with or that are documented in their Planning Document, such as: a. Ensuring that the Member has the opportunity to participate in gainful, productive, and meaningful work; b. Ensuring that the job is aligned with Member’s abilities and interests; c. Providing orientation training and skill development to Members, in addition to those provided by their employers, to support a strong transition into work; d. Orienting Members to health and safety aspects and requirements of their work; e. Providing ongoing training and education as needed to support Members’ independence in their work; f. Assisting Members in learning new skills necessary for maintenance or advancement in their employment setting; g. Identifying and referring for ongoing supports needed to assist Members in maintaining and advancing in employment, including technology; h. Providing ongoing monitoring of the performance and general job-related skills of Members to identify both strengths and barriers to maintain and advance employment; i. j. Providing onsite supervision and support in alignment with Member needs and preferences, including supporting Members to interact with co-workers in a positive and professional manner and socialize with co-workers, as is common in the culture of their workplace, by offering direct support or minimizing support to allow for socialization opportunities during breaks and other appropriate non-work time; Maintain ongoing communication with Member’s employers to assess strengths, areas for improvement, and overall job performance; k. Assisting the Member in resolving work issues as well as any personal issues that interfere with their ability to engage in work; l. Providing intervention and Technical Assistance to an employer as needed to support the success of the Member; m. Consulting with each Member’s Planning Team to identify strengths and barriers to successful progressive move into Competitive Integrated Employment; n. Developing support strategies with the presumption that all Members can work in Competitive Integrated Employment with proper training and support; o. Developing and implementing strategies to capitalize on strengths and remove or minimize barriers; p. Providing transportation within the Member’s scheduled workday from worksite to worksite; and q. Providing behavioral support, such as: i. Shadowing the Member to assist him/her in maintaining positive workplace behaviors; ii. iii. iv. Providing behavioral support as needed by assisting in resolving inappropriate workplace behaviors; Assisting the Member in resolving any life/personal concerns that May interfere with job performance; and Communicating support needs with all appropriate Persons or informing the Support Coordinator when the Member needs additional self-care/behavioral/medical support. 5. Refer any identified issues or concerns related to the Member’s living situation, home and community-based services, health care providers, school services, or other community-based resources to the Support Coordinator in order to coordinate services to best meet the Member’s needs. 6. Identify and refer to the Support Coordinator issues that require social intervention (e.g., food insecurity, unsafe housing, needed interventions or medical care, neglect, abuse). 7. Refer Members at their request for a progressive move into integrated or Competitive Integrated Employment.

Limits on the amount, duration, or frequency of this service:

n. Developing support strategies with the presumption that all Members can work in Competitive Integrated Employment with proper training and support; o. Developing and implementing strategies to capitalize on strengths and remove or minimize barriers; p. Providing transportation within the Member’s scheduled workday from worksite to worksite; and q. Providing behavioral support, such as: i. Shadowing the Member to assist him/her in maintaining positive workplace behaviors; ii. iii. iv. Providing behavioral support as needed by assisting in resolving inappropriate workplace behaviors; Assisting the Member in resolving any life/personal concerns that May interfere with job performance; and Communicating support needs with all appropriate Persons or informing the Support Coordinator when the Member needs additional self-care/behavioral/medical support. 5. Refer any identified issues or concerns related to the Member’s living situation, home and community-based services, health care providers, school services, or other community-based resources to the Support Coordinator in order to coordinate services to best meet the Member’s needs. 6. Identify and refer to the Support Coordinator issues that require social intervention (e.g., food insecurity, unsafe housing, needed interventions or medical care, neglect, abuse). 7. Refer Members at their request for a progressive move into integrated or Competitive Integrated Employment.

3. A DSP employed by the Qualified Vendor Shall be onsite at the job site with the Member(s) at all times. 4. This service Shall be designed to promote integration with people in the community workforce and provide paid work. This service shall: a. Be provided in integrated community work settings where people typically work and where Members interact with people without disabilities, other than DSPs providing support to the Member, to the same extent as people without disabilities. Such settings May include: a community business, Qualified Vendor owned or leased facilities that are used primarily to serve the public and employ Members (e.g., retail stores, restaurants) or that also employ people from the community who are not Members, and mobile work crews (e.g., landscaping, manufacturing, custodial work) when Members are employed according to the norm for that industry. These work settings shall not be be Qualified Vendor owned, leased, or operated facilitates that do not employ people from the community who are not Members or that do not serve the public, and b. Be provided to Members who have competitive paid employment. Members participating in this service Shall be compensated according to State and Federal standards. i. ii. Members entering Group Supported Employment afterJanuary 1, 2025, Shall receive at least minimum wage for their work. Members who are receiving sub-minimum wage in Group Supported Employment before January 1, 2025, Shall have to plan that will allow them to progress towards earning at least minimum wage. Qualified Vendors Shall adhere to the Fair Labor Standards Act and the Workforce Innovation and Opportunity Act. Qualified Vendors who deliver Group Supported Employment Shall support Members in identifying and pursuing opportunities that will move the Member into Competitive Integrated Employment. 5. Qualified Vendors who deliver Group Supported Employment Shall support Members in identifying and pursuing opportunities that will move the Member into competitive integrated employment. The Qualified Vendors Shall provide recommendations to the Planning Team to support the Member with identifying and pursuing Competitive Integrated Employment. 6. Qualified Vendors Shall maintain compliance with all applicable State and Federal law. 7. Qualified Vendors Shall comply with monitoring activities as directed in the Provider Policy Manual(s), including collaboration and cooperation with the Division for all monitoring activities.

A time limited service that provides supervised work and vocational training for a member within a contracted vendor’s facility where most of the workers have a disability. Members are paid based upon their productivity.

A service that provides paid work and vocational skill building at a facility-based, non-integrated setting where members are supervised and paid by the provider. Paid work is typically at a sub-minimum wage rate. The service may be provided on a time-limited or on an ongoing basis.

This service provides a structured employment environment to support Members who choose to receive employment services that offer intensive supervision and support for paid work in a work center or in the community. This service provides a healthy, safe, and highly structured work environment to support Members to develop employment skills and refine their career focus. All Members using this service are paid by the Qualified Vendor or employer for work performed in accordance with State and Federal law. Center-Based Employment:

Introduces Members to work environments, including integrated work environments;

Supports Members to acquire knowledge, skills, and experiences that facilitate career development; and

Supports Members to develop skills and behaviors that help them achieve their employment goals.

Members who participate in Center-Based Employment Should increasingly need fewer and less intensive support to complete their work and Should transition to other employment services when they choose or Shall be referred for Vocational Rehabilitation services. Outcomes 1. Members using this service develop employment skills needed to obtain meaningful, competitive employment based on their abilities, interests, and personal goals. Goals 1. To support Members, in accordance with their Planning Document and vision for employment to: a. Participate in productive and paid work. b. Acquire knowledge, skills, and experiences that facilitate career development including transition to Competitive Integrated Employment or self-employment. c. Receive education or training and to develop abilities, skills, and behaviors that will enable them to realize their employment aspirations most fully. Objectives The Qualified Vendor Shall ensure that the following objectives are met: 1. Identify and respect the Member’s cultural, racial, ethnic, linguistic, identified gender, sexual orientation, and religious or spiritual needs. The Member will receive support aligned with these needs (e.g., work schedules that permit Members to express their religion or religious values, training about sexual harassment or discrimination). 2. Provide services according to the Member’s preferences and needs, that recognize their strengths and promote their independence. 3. Provide support appropriate for the Member’s age and aligned with typical life experiences. This May include connecting the Member to a job that is appropriate for their age (e.g., summer jobs for youth, jobs that support transition into retirement) and their employment expectations (e.g., compensation, work culture, work schedules that promote parenting or other caregiving duties, work environments that allow for developing friendships with co-workers), and considers location (e.g., preference, convenience, available transportation). 4. Support the Member with activities that they, and their Responsible Person, if applicable, have decided they need help with or that are documented in their Planning Document, such as: a. Providing Members with the opportunity to explore, observe, or participate in a variety of work opportunities, including integrated work environments to evaluate appropriateness for progressive moves; b. Ensuring that the Member has the opportunity to participate in productive and meaningful work; c. Ensuring that the job is aligned with the Member’s capacities and interests; d. Providing orientation, training, and skill development to Members, along with teaching general work skills; e. Orienting Members to health and safety aspects and requirements of their work; f. Providing ongoing training and education as needed to support the Member’s independence in their work; g. Assisting Members in learning new skills necessary to advance their employment interests; h. Providing ongoing monitoring of the performance and general job-related skills of Members to identify both strengths and barriers to maintain and advance employment; i. Providing onsite supervision and support in alignment with Member needs and preferences, including supporting Members to interact with co-workers in a positive and professional manner and to socialize with co-workers, as is common in the culture of their workplace, by offering direct support or minimizing support to allow for socialization opportunities during breaks and other appropriate non-work time; j. Maintaining ongoing assessments of strengths, areas for improvement, and overall job performance; k. Assisting the Member in resolving work issues as well as any personal issues that interfere with their ability to engage in work; l. Consulting with each Member’s Planning Team to identify strengths and barriers to success progressive movement toward integrated or Competitive Integrated Employment; m. Developing and implementing strategies to capitalize on the Member’s strengths and remove or minimize barriers in order to support a progressive employment move; n. Providing for the Member’s personal care needs; and o. Providing general supervision. p. Facilitating members of the general community to visit the setting and provide instruction on how to prepare for and be successful in the workplace (e.g., preparing for an interview, hygiene in the workplace, the use of natural supports, etc.) 5. Refer any identified issues and concerns related to the Member’s living situation, home and community-based services, health care providers, school services, and other community-based resources to the Support Coordinator in order to coordinate services to best meet the Member’s needs. 6. Identify and refer to the Support Coordinator issues that require social intervention (e.g., food insecurity, unsafe housing, needed interventions or medical care, neglect, abuse). 7. Refer Members at their request for a progressive move into integrated employment or Competitive Integrated Employment. 8. Provide rights information and resources in a location that anyone can access at any time for reference or in the event they feel their rights are being violated.

Limits on the amount, duration, or frequency of this service:

1. This service Shall: a. Only be provided to Members who have employment-related Outcomes identified in their Planning Document; b. Only be provided to Members twenty-two (22) years of age or older, unless otherwise approved by the District Program Manager or designee; c. Be provided in a work environment; and d. Primarily engage Center-Based Employment program participants in work and work-related activities. e. Be provided in accordance with Section 3 of the Standard Terms and Conditions, 8.4 Limited English Proficiency, 2. This service Shall not be provided: a. For more than eight (8) hours per day; b. In a Group Home, Nursing Supported Group Home, Behavioral-Supported Group Home, or a Developmental Home; c. In the same room at the same time as a Day Treatment and Training service; and d. At not less than an average ratio of one (1) DSP to six (6) Members (1:6). The work center Shall provide sufficient DSPs to support Members in accordance with their collective Planning Documents. 3. A Member beginning this service after March 17, 2023, Shall not be authorized for this service for more than one (1) year without the prior approval of the District Manager/Designee: a. Members who have started Center-Based Employment prior to March 17, 2023, are exempt from having an employment Outcome in their Planning Document and May continue Center-Based Employment for more than one (1) year so long as the service is reviewed at least annually. 4. Members who use this service Shall at their annual planning meeting assess with their Support Coordinator whether: a. The service is still applicable for the Member, meeting the Member’s needs, and advancing the Member’s employment Outcomes or vision for employment; b. The Member’s employment needs could be better supported, or additionally coordinated, through other programs, such as school or with a referral to vocational rehabilitation for employment services; c. The Member’s needs could be met in other ways, such as through Natural Supports, independent volunteer experiences, technology, or adaptive equipment; or d. The Member could participate in other employment services to further advance their vision for employment. 5. Any change in the type of employment services a Member receives Shall have the consent of the Member’s Planning Team and the Network Operations Administrator or Designee and have a current authorization prior to a change in service type. This also applies to moves to Day Treatment and Training services from Center-Based Employment services. The failure of the Qualified Vendor to secure a paid work opportunity is not a sufficient basis for making a move from Center-Based Employment services to Day Treatment and Training. 6. Qualified Vendors Shall cooperate and collaborate with the Department’s Qualified Vendors Shall comply with monitoring activities as directed in the Provider Policy Manual(s), including collaboration and cooperation with the Division for all monitoring activities.

Psychoeducational Services (when used for pre-vocational services and billing H2027) and Ongoing Support to Maintain Employment (job coaching/employment support) are designed to assist a member or group to choose, acquire, and maintain a job or other meaningful community activity (e.g., volunteer work) while managing their medical/mental health symptoms. These services may be used for members who are preparing to work and/or volunteer or are currently employed. These services shall be provided using tools, strategies, and materials that meet the member’s needs and are tailored to support members in a variety of settings. Psychoeducational Services/Pre-vocational services prepare members to engage in meaningful work-related activities, such as full- or part- time competitive employment. Psychoeducational Services/Prevocational services shall be provided in accordance with the member’s individualized treatment plan to support specific goals aimed at gaining meaningful employment; activities may include, but are not limited to, the following: 1. Career/educational counseling – Assisting members in making decisions about their careers and education by identifying strengths, knowledge, skills, and abilities, then developing a plan to achieve their goals. This process also includes assisting members overcome any barriers they may have in achieving their goals. 2. Job training – Services that help members develop skills necessary to enter the workforce, including volunteer work, where members develop general strengths and skills that contribute to employability in paid competitive employment in integrated community settings that are not specific to a given job, such as: a. Personal skills (e.g., self-discipline, time management, task prioritization, accountability, and integrity). b. Interpersonal skills (e.g., accepting supervision, following directions, and effective communication). c. Work-related skills and knowledge (e.g., workplace conduct, ethics, and dress code, safety skills in the workplace, and staying on task). d. The service is intended to be received on a time-limited basis as preparation for securing paid employment by an employer other than the service provider. 3. Assistance in the use of educational resources necessary to obtain employment – Assisting current or potential students in accessing programs to support educational goals (e.g., mentoring, scholarships, f inancial assistance). This also includes assistance in accessing learning materials designed to support gaining employment (e.g., locating articles on writing resumes or materials with potential interview questions). 4. Attendance to Rehabilitation Services Administration/Vocational Rehabilitation (RSA/VR) Orientations – RSA/VR Orientations are recommended for members to attend prior to deciding whether or not to participate in the RSA/VR program. Per the Statewide Collaborative Protocols that are tied to the Interagency Service Agreement (ISA) between AHCCCS and the Arizona Department of Economic Security (ADES), a minimum of one provider staff must be present during group RSA/VR Orientations and is expected to be actively engaged during the sessions. This service includes accompanying a member or group of members to an RSA/VR Orientation. As Orientations are mostly conducted by RSA/VR staff, billable time may only be counted for the time behavioral health staff are providing actual services. 5. Assistance in finding employment – A range of services and support offered to members seeking employment that is aimed at helping navigate the job market effectively. This assistance can include, but is not limited to, job counseling, developing/updating resumes with members, interview preparation, job search strategies, and access to job listings or networking opportunities, such as attending job fairs with members. 6. Other training – This may include developing study skills, budgeting skills (when it pertains to employment), appropriateness on the job, and time management, among others.

Ongoing support to maintain employment services are post-vocational services, often called job coaching, which enable members to maintain their current employment. Services are provided in accordance with the member’s individualized treatment plan to support specific goals aimed at maintaining employment or to assist a member in obtaining the skills needed for promotional opportunities. Ongoing Support to Maintain employment may be provided individually or in a group setting, as well as via telehealth. Ongoing support to maintain employment activities may include, but are not limited to, the following: 1. Monitoring and supervision – Monitoring job performance and satisfaction for both the worker and employer to track progress over time. 2. Assistance in performing job tasks – Helping employed members learn new job duties, relearn skills, and solve problems on the job. 3. Supportive counseling – Support aimed at assisting members in maintaining employment by providing emotional support, guidance, and practical strategies to overcome challenges related to workplace integration, such as acclimating to workplace culture and etiquette. This may also include addressing specific barriers related to a disability and/or behavioral health condition.

Limits on the amount, duration, or frequency of this service:

Billing Limitations 1. See general core billing limitations. 2. Transportation provided to members is not included in the rate and should be billed separately using the appropriate transportation procedure codes. 3. Psychoeducational services/Pre-vocational services28 and ongoing support to maintain employment services are provided only if the services are not available through the federally funded Rehabilitation Act program administered by Arizona Department of Economic Security Rehabilitation Service Administration (DES/RSA)29, which is required to be the primary payer for Title XIX/XXI eligible members. Members must be educated on the intended benefits of the ADES-RSA Vocational Rehabilitation program and decisions about participation must be documented accordingly, including in the service plan. 4. 30Service code H2026, Ongoing support to maintain employment, per diem, can only be billed for services over 5 hours and should be billed for the length of the service and cannot be billed on the same day as H2025. If providers are serving more than one member during the same time period, H2026 must be paired with the HQ modifier. 5. Service code H2027 – Psychoeducational service, per 15 minutes, may be billed for up to 8 hours when used to provide pre-vocational services. If providers are serving more than one member during the same time period, H2027 must be paired with the HQ modifier. 6. More than one provider agency may bill for psychoeducational services and ongoing support to maintain employment services provided to a behavioral health recipient during the same date span when the member’s clinical needs for this are clearly documented in the service plan or treatment plan.31 7. Costs associated with training an agency’s own employees are not reimbursable. 8. Billable time for psychoeducational services (including pre-vocational services) and ongoing support to maintain employment services may only be counted for the time a qualified behavioral health staff/professional is providing actual services.32 Observing a member while they are working is not reimbursable unless the observation is a part of an assessment of employment support interventions needed for the member. 9. H2025, H2026, and H2027 are not subject to the group limit specified in Core Billing Limitation #25 if group supported employment or pre-vocational services are provided in person at an AHCCCS registered provider service site or a member work site. Groups shall not exceed a 1: 20 ratio. 10. Only AHCCCS registered providers who render services to members may bill for and be reimbursed for the services provided. If an AHCCCS registered provider brings in a third-party entity, who is not an AHCCCS-registered provider, to deliver services to members, such as job training, that AHCCCS-registered provider may not bill for and be reimbursed for services rendered by that third-party entity. The AHCCCS-registered provider may bill for other services rendered to members during the course of the activity to support their active engagement and participation.

Transportation services are also available under this waiver to support access to community activities as identified through the individual’s person-centered plan.