Massachusetts

Prevocational Services comprises a range of learning and experiential type activities that prepare a participant for paid employment in an integrated, community setting. Services are not job-task oriented but instead, aimed at a generalized result (e.g. attention span, motor skills). The service may include teaching such concepts as attendance, task completion, problem solving and safety as well as social skills training, improving attention span, and developing or improving motor skills. Basic skill-building activities are expected to specifically involve strategies to enhance a participant’s employability in integrated, community settings. The amount, duration and scope of Prevocational Services provided to a participant is based on an assessment of the participant’s pre-employment needs that arise as a result of their functional limitations and/or conditions, including services that enable the participant to acquire, improve, retain/maintain, and prevent deterioration of functioning consistent with the participants interests, strengths, priorities, abilities and capabilities. Services are reflected in the participants individualized service plan and are directed to address habilitative or rehabilitative rather than explicit employment objectives. Prevocational services may be provided one-to-one or in a group format. This service may be provided as a site-based service, in community settings or in a combination of these settings and must include integrated community activities that support the development of vocational skills. This service may be provided remotely via telehealth based on the participant’s needs, preferences, and goals as determined during the person-centered planning process This service may be delivered remotely via telehealth 100% of the time. Meals provided as part of these services shall not constitute a “full nutritional regimen” (3 meals per day). Documentation is maintained in the file of each individual receiving this service that the service is not available under a program funded under section 110 of the Rehabilitation Act of 1973 or the IDEA (20 U.S.C. 1401 et seq.).

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

There is no limit on the duration of this service. Goals are reevaluated annually at the Person-Centered Planning meeting and more frequently if there is a changing need.

Supported employment services consists of intensive, ongoing supports that enable participants, for whom competitive employment at or above the minimum wage is unlikely absent the provision of supports, and who, because of their disabilities, need supports, to perform in a regular work setting. Supported employment may include assisting the participant to locate a job or develop a job on behalf of the participant. Supported employment is conducted in a variety of settings, particularly work sites where persons without disabilities are employed. This service may be provided remotely via telehealth based on the participant’s needs, preferences, and goals as determined during the person-centered planning process. This service may be delivered remotely via telehealth 100% of the time. Supported employment includes activities needed to sustain paid work by participants, including supervision and training. When supported employment services are provided at a work site where persons without disabilities are employed, payment is made only for the adaptations, supervision and training required by participants receiving waiver services as a result of their disabilities but does not include payment for the supervisory activities rendered as a normal part of the business setting. Documentation is maintained in the file of each participant receiving this service that the service is not available under a program funded under section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.). Federal financial participation is not claimed for incentive payments, subsidies, or unrelated vocational training expenses such as the following: 1. Incentive payments made to an employer to encourage or subsidize the employer’s participation in a supported employment program; 2. Payments that are passed through to users of supported employment programs; or 3. Payments for training that is not directly related to an individual’s supported employment program.

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

This service is not for use to provide continuous long-term 1:1 support to enable an individual to complete work activities.

This service has two components: Assistive Technology devices and Assistive Technology evaluation and training. These components are defined as follows: Assistive Technology devices – an item, piece of equipment, or product system that is used to develop, increase, maintain, or improve functional capabilities of participants, and to support the participant to achieve goals identified in their Plan of Care. Assistive Technology devices can be used to enable the participant to engage in telehealth. Assistive Technology devices can be acquired commercially or modified, customized, engineered or otherwise adapted to meet the individual’s specific needs, including design and fabrication. In addition to the cost of Assistive Technology device purchase, lease, or other acquisition costs, this service component covers maintenance and repair of Assistive Technology devices and rental of substitute Assistive Technology devices during periods of repair. This service includes device installation and set up costs but excludes installation and set-up and ongoing provision fees related to internet service. This service includes purchase, lease, or other acquisition costs of cell phones, tablets, computers, and ancillary equipment necessary for the operation of the Assistive Technology devices that enable the individual to participate in telehealth. These devices are not intended for purely diversional/recreational purposes. Assistive Technology evaluation and training – the evaluation of the Assistive Technology needs of the participant, i.e. functional evaluation of the impact of the provision of appropriate Assistive Technology devices and services to the participant in the customary environment of the participant; the selection, customization and acquisition of Assistive Technology devices for participants; selection, design, fitting, customization, adaption, maintenance, repair, and/or replacement of Assistive Technology devices; coordination and use of necessary therapies, interventions, or services with Assistive Technology devices that are associated with other services contained in the Plan of Care; training and technical assistance for the participant, and, where appropriate, the family members, guardians, advocates, or authorized representatives of the participant; and training or technical assistance for professionals or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of participants. Assistive Technology must be authorized by the Case Manager as part of the Plan of Care. The Case Manager will explore with the participant/legal guardian the use of the Medicaid State Plan. Waiver funding shall only be used for assistive technology that is specifically related to the functional limitation(s) caused by the participant’s disability. The evaluation and training component of this service may be provided remotely via telehealth based on the professional judgement of the evaluator and the needs, preferences, and goals of the participant as determined during the person-centered planning process. Assistive Technology must meet the Underwriter’s Laboratory and/or Federal Communications Commission requirements, where applicable, for design, safety, and utility. There must be documentation that the item purchased is appropriate to the participant’s needs. Any Assistive Technology item that is available through the State Plan must be purchased through the State Plan; only items not covered by the State Plan may be purchased through the Waiver. Participants may not receive duplicative devices through this service and either the Transitional Assistance Service or the Specialized Medical Equipment Service.

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

The Assistive Technology evaluation includes identification of technology already available and assesses whether technology modifications or a new device is appropriate based on demonstrated need.

Community Based Day Supports (CBDS) is designed to enable an individual to enrich their life and enjoy a full range of community activities by providing opportunities for developing, enhancing, and maintaining competency in personal, social interactions and community integration. The service may include career exploration, including assessment of interests through volunteer experiences or situational assessments; community integration experiences to support fuller participation in community life; development and support of activities of daily living and independent living skills, socialization experiences and enhancement of interpersonal skills and pursuit of personal interests and hobbies. The service is intended for individuals of working age who may be on a pathway to employment, a supplemental service for individuals who are employed part-time and need a structured and supervised program of services during the time that they are not working, and for individuals who are of retirement age. Using a small group model, CBDS provides a flexible array of individualized supports through community activities that promote socialization, peer interaction and community integration.

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

N/A

Day services/supports provide for structured day activity typically for individuals with pervasive and extensive support needs who are not ready to join the general workforce, or who are employed part-time and need a structured and supervised program of services during the time that they are not working, or who are of retirement age. Day Services are individually designed around consumer choice and preferences with a focus on improvement or maintenance of the person’s skills and their ability to live as independently as possible in the community. Day Services often include assistance to learn activities of daily living and functional skills; language and communication training; compensatory, cognitive and other strategies; interpersonal skills; recreational/socialization skills and other skills training to prepare the individual to undertake various community inclusion activities. This service may reinforce some aspects of other waiver and state plan services by allowing individuals to continue to strengthen skills, which are necessary for greater independence, productivity and community inclusion. Day Services are provided in a provider operated setting in the community and not in a participant’s residence, and do not duplicate any services under the state plan. This service is primarily delivered in person; telehealth may be used to supplement the scheduled in-person service based on the participant’s needs, preferences, and goals as determined during the person-centered planning process.

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

N/A

Orientation and Mobility (O&M) services teach an individual with vision impairment or legal blindness how to move or travel safely and independently in their home and community and include (a) O&M assessment; (b) training and education provided to Participants; (c) environmental evaluations; (d) caregiver/direct care staff training on sensitivity to blindness/low vision; and (e) information and resources on community living for persons with vision impairment or legal blindness. O&M Services are tailored to the individual’s need and may extend beyond the home setting to other community settings as well as public transportation systems.

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

N/A

Peer Support is designed to provide training, instruction and mentoring to individuals about self-advocacy, participant direction, civic participation, leadership, benefits, and participation in the community. Peer support may be provided in small groups or peer support may involve one peer providing support to another peer, the waiver participant, to promote and support the waiver participant’s ability to participate in self-advocacy. The one to one peer support is instructional; it is not counseling. The service enhances the skills of the individual to function in the community and/or family home. Documentation in the individual’s record demonstrates the benefit to the individual. This service may be self-directed. This service may be provided remotely via telehealth based on the participant’s needs, preferences, and goals as determined during the person-centered planning process . This service may be delivered remotely via telehealth 100% of the time.

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

Not to exceed 16 hours per week.

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

Prevocational Services comprises a range of learning and experiential type activities that prepare a participant for paid employment in an integrated, community setting. Services are not job-task oriented but instead, aimed at a generalized result (e.g. attention span, motor skills). The service may include teaching such concepts as attendance, task completion, problem solving and safety as well as social skills training, improving attention span, and developing or improving motor skills. Basic skill-building activities are expected to specifically involve strategies to enhance a participant’s employability in integrated, community settings. The amount, duration and scope of Prevocational Services provided to a participant is based on an assessment of the participant’s pre-employment needs that arise as a result of their functional limitations and/or conditions, including services that enable the participant to acquire, improve, retain/maintain, and prevent deterioration of functioning consistent with the participant’s interests, strengths, priorities, abilities and capabilities. Services are reflected in the participant’s individualized service plan and are directed to address habilitative or rehabilitative rather than explicit employment objectives. Prevocational services may be provided one-to-one or in a group format. This service may be provided as a site-based service, in community settings or in a combination of these settings and must include integrated community activities that support the development of vocational skills. This service may be provided remotely via telehealth based on the participant’s needs, preferences, and goals as determined during the person-centered planning process and reviewed by the Case Manager during each scheduled reassessment. This service may be delivered remotely via telehealth 100% of the time. Meals provided as part of these services shall not constitute a “full nutritional regimen” (3 meals per day). Documentation is maintained in the file of each individual receiving this service that the service is not available under a program funded under section 110 of the Rehabilitation Act of 1973 or the IDEA (20 U.S.C. 1401 et seq.).

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

There is no limit on the duration of this service. Goals are reevaluated annually at the Person-Centered Planning meeting and more frequently if there is a changing need.

Supported employment services consists of intensive, ongoing supports that enable participants, for whom competitive employment at or above the minimum wage is unlikely absent the provision of supports, and who, because of their disabilities, need supports, to perform in a regular work setting. Supported employment may include assisting the participant to locate a job or develop a job on behalf of the participant. Supported employment is conducted in a variety of settings, particularly work sites where persons without disabilities are employed. This service may be provided remotely via telehealth based on the participant’s needs, preferences, and goals as determined during the person-centered planning process and reviewed by the Case Manager during each scheduled reassessment. This service may be delivered remotely via telehealth 100% of the time. Supported employment includes activities needed to sustain paid work by participants, including supervision and training. When supported employment services are provided at a work site where persons without disabilities are employed, payment is made only for the adaptations, supervision and training required by participants receiving waiver services as a result of their disabilities but does not include payment for the supervisory activities rendered as a normal part of the business setting. Documentation is maintained in the file of each participant receiving this service that the service is not available under a program funded under section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.). Federal financial participation is not claimed for incentive payments, subsidies, or unrelated vocational training expenses such as the following: 1. Incentive payments made to an employer to encourage or subsidize the employer’s participation in a supported employment program; 2. Payments that are passed through to users of supported employment programs; or 3. Payments for training that is not directly related to an individual’s supported employment program.

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

This service is not for use to provide continuous long-term 1:1 support to enable an individual to complete work activities.

This service has two components: Assistive Technology devices and Assistive Technology evaluation and training. These components are defined as follows: Assistive Technology devices – an item, piece of equipment, or product system that is used to develop, increase, maintain, or improve functional capabilities of participants, and to support the participant to achieve goals identified in their Plan of Care. Assistive Technology devices can be used to enable the participant to engage in telehealth. Assistive Technology devices can be acquired commercially or modified, customized, engineered or otherwise adapted to meet the individual’s specific needs, including design and fabrication. In addition to the cost of Assistive Technology device purchase, lease, or other acquisition costs, this service component covers maintenance and repair of Assistive Technology devices and rental of substitute Assistive Technology devices during periods of repair. This service includes device installation and set up costs but excludes installation and set-up and ongoing provision fees related to internet service. This service includes purchase, lease, or other acquisition costs of cell phones, tablets, computers, and ancillary equipment necessary for the operation of the Assistive Technology devices that enable the individual to participate in telehealth. These devices are not intended for purely diversional/recreational purposes. Assistive Technology evaluation and training – the evaluation of the Assistive Technology needs of the participant, i.e. functional evaluation of the impact of the provision of appropriate Assistive Technology devices and services to the participant in the customary environment of the participant; the selection, customization and acquisition of Assistive Technology devices for participants; selection, design, fitting, customization, adaption, maintenance, repair, and/or replacement of Assistive Technology devices; coordination and use of necessary therapies, interventions, or services with Assistive Technology devices that are associated with other services contained in the Plan of Care; training and technical assistance for the participant, and, where appropriate, the family members, guardians, advocates, or authorized representatives of the participant; and training or technical assistance for professionals or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of participants. Assistive Technology must be authorized by the Case Manager as part of the Plan of Care. The Case Manager will explore with the participant/legal guardian the use of the Medicaid State Plan. Waiver funding shall only be used for assistive technology that is specifically related to the functional limitation(s) caused by the participant’s disability. The evaluation and training component of this service may be provided remotely via telehealth based on the professional judgement of the evaluator and the needs, preferences, and goals of the participant as determined during the person-centered planning process and reviewed by the Case Manager during each scheduled reassessment. Assistive Technology must meet the Underwriter’s Laboratory and/or Federal Communications Commission requirements, where applicable, for design, safety, and utility. There must be documentation that the item purchased is appropriate to the participant’s needs. Any Assistive Technology item that is available through the State Plan must be purchased through the State Plan; only items not covered by the State Plan may be purchased through the Waiver. Participants may not receive duplicative devices through this service and either the Transitional Assistance Service or the Specialized Medical Equipment Service.

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

The Assistive Technology evaluation includes identification of technology already available and assesses whether technology modifications or a new device is appropriate based on demonstrated need.

Community Based Day Supports (CBDS) is designed to enable an individual to enrich their life and enjoy a full range of community activities by providing opportunities for developing, enhancing, and maintaining competency in personal, social interactions and community integration. The service may include career exploration, including assessment of interests through volunteer experiences or situational assessments; community integration experiences to support fuller participation in community life; development and support of activities of daily living and independent living skills, socialization experiences and enhancement of interpersonal skills and pursuit of personal interests and hobbies. The service is intended for individuals of working age who may be on a pathway to employment, a supplemental service for individuals who are employed part-time and need a structured and supervised program of services during the time that they are not working, and for individuals who are of retirement age. Using a small group model, CBDS provides a flexible array of individualized supports through community activities that promote socialization, peer interaction and community integration.

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

N/A

Day services/supports provide for structured day activity typically for individuals with pervasive and extensive support needs who are not ready to join the general workforce, or who are employed part-time and need a structured and supervised program of services during the time that they are not working, or who are of retirement age. Day Services are individually designed around consumer choice and preferences with a focus on improvement or maintenance of the person’s skills and their ability to live as independently as possible in the community. Day Services often include assistance to learn activities of daily living and functional skills; language and communication training; compensatory, cognitive and other strategies; interpersonal skills; recreational/socialization skills and other skills training to prepare the individual to undertake various community inclusion activities. This service may reinforce some aspects of other waiver and state plan services by allowing individuals to continue to strengthen skills, which are necessary for greater independence, productivity and community inclusion. Day Services are provided in a provider operated setting in the community and not in a participant’s residence, and do not duplicate any services under the state plan. This service is primarily delivered in person; telehealth may be used to supplement the scheduled in-person service based on the participant’s needs, preferences, and goals as determined during the person-centered planning process and reviewed by the Case Manager during each scheduled reassessment.

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

N/A

Orientation and Mobility (O&M) services teach an individual with vision impairment or legal blindness how to move or travel safely and independently in their home and community and include (a) O&M assessment; (b) training and education provided to Participants; (c) environmental evaluations; (d) caregiver/direct care staff training on sensitivity to blindness/low vision; and (e) information and resources on community living for persons with vision impairment or legal blindness. O&M Services are tailored to the individual’s need and may extend beyond residential settings to other community settings as well as public transportation systems.

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

N/A

Peer Support is designed to provide training, instruction and mentoring to individuals about self-advocacy, participant direction, civic participation, leadership, benefits, and participation in the community. Peer support may be provided in small groups or peer support may involve one peer providing support to another peer, the waiver participant, to promote and support the waiver participant’s ability to participate in self-advocacy. The one to one peer support is instructional; it is not counseling. The service enhances the skills of the individual to function in the community and/or family home. Documentation in the individuals record demonstrates the benefit to the individual. This service may be self-directed. This service may be provided remotely via telehealth based on the participant’s needs, preferences, and goals as determined during the person-centered planning process and reviewed by the Case Manager during each scheduled reassessment. This service may be delivered remotely via telehealth 100% of the time.

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

Not to exceed 16 hours per week.

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

Group Supported employment services consist of the ongoing supports that enable participants, for whom competitive employment at or above the minimum wage is unlikely absent the provision of supports, and who, because of their disabilities, need support to perform in a regular work setting. The outcome of the service is sustained paid employment and work experience leading to further career development and individual community employment for which the participant is compensated at or above the minimum wage, but not less than the customary wage and level of benefit paid by the employer for the same or similar work performed by individuals without disabilities. Small group supported employment are services and training activities provided in regular business, industry and community settings for groups of two (2) to eight (8) workers with disabilities. Examples include mobile work crews, enclaves and other business-based workgroups employing small groups of workers with disabilities in employment in the community. Services must be provided in a manner that promotes engagement in the workplace and interaction between participants and people without disabilities including co-workers, customers, and supervisors. Group supported employment includes any combination of the following services: job-related discovery or assessment, assisting the participants to locate a job or develop a job on behalf of the participants, job analysis, training and systematic instruction, job coaching, negotiation with prospective employers, and benefits support. Typically group supported employment consists of 2-8 participants, working in the community under the supervision of a provider agency. The participants are generally considered employees of the provider agency and are paid and receive benefits from that agency. Group supported employment includes activities needed to sustain paid work by participants including supervision and training and may include transportation if not available through another source. Transportation between the participants’ place of residence and the employment site or between the provider site and the group employment site may be provided. Federal financial participation is not claimed for incentive payments, subsidies or unrelated vocational training expenses such as the following: 1. Incentive payments made to an employer to encourage or subsidize the employer’s participation in a supported employment program; 2. Payments that are passed through to users of supported employment programs; or 3. Payments for training that is not directly related to a participant’s supported employment program When supported employment services are provided at work sites where persons without disabilities are employed, payment is made only for the adaptations; supervision and training required for participants receiving the waiver service as a result of their disabilities but does not include payment for supervisory activities rendered as a normal part of the business setting. Documentation is maintained in the file of each participant receiving this service that the service is not available under a program funded under Section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.) Group supported employment does not include volunteer work or vocational services provided in facility based work settings. This service is primarily delivered in person; telehealth may be used to supplement the scheduled in-person service based on the participant’s needs, preferences, and goals as determined during the person-centered planning process and reviewed by the Service Coordinator during each scheduled reassessment.

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

N/A

This service has two components: Assistive Technology devices and Assistive Technology evaluation and training. These components are defined as follows: Assistive Technology devices – an item, piece of equipment, or product system that is used to develop, increase, maintain, or improve functional capabilities of participants, and to support the participant to achieve outcomes identified in their Individual Support Plan. Assistive Technology devices can be used to enable the participant to engage in telehealth. Assistive Technology devices can be acquired commercially or modified, customized, engineered or otherwise adapted to meet the individual’s specific needs, including design and fabrication. In addition to the cost of Assistive Technology device purchase, lease, or other acquisition costs, this service component covers maintenance and repair of Assistive Technology devices and rental of substitute Assistive Technology devices during periods of repair. This service includes device installation and setup costs but excludes installation and setup and ongoing provision fees related to internet service.

Assistive Technology evaluation and training – the evaluation of the Assistive Technology needs of the participant, i.e. functional evaluation of the impact of the provision of appropriate Assistive Technology devices and services to the participant in the customary environment of the participant; the selection, customization and, acquisition of Assistive Technology devices for participants; selection, design, fitting, customization, adaption, maintenance, repair, and/or replacement of assistive technology devices; coordination and use of necessary therapies, interventions, or services with assistive technology devices that are associated with other services contained in the Individual Support Plan; training and technical assistance for the participant, and, where appropriate, the family members, guardians, advocates, or authorized representatives of the participant; and training or technical assistance for professionals or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of participants. Assistive Technology must be authorized by the Service Coordinator as part of the Individual Support Plan. The Service Coordinator will explore with the participant/legal guardian the use of the Medicaid State Plan. Waiver funding shall only be used for assistive technology that is specifically related to the functional limitation(s) caused by the participant’s disability. The evaluation and training component of this service may be provided remotely via telehealth based on the professional judgement of the evaluator and the needs, preferences, and goals of the participant as determined during the person-centered planning process and reviewed by the Service Coordinator during each scheduled reassessment. Assistive Technology must meet the Underwriter’s Laboratory and/or Federal Communications Commission requirements, where applicable, for design, safety, and utility. There must be documentation that the item purchased is appropriate to the participant’s needs. Any Assistive Technology item that is available through the State Plan must be purchased through the State Plan; only items not covered by the State Plan may be purchased through the Waiver. This service includes purchase, lease, or other acquisition costs of cell phones, tablets, computers, and ancillary equipment necessary for the operation of the Assistive Technology devices that enable the individual to participate in telehealth. These devices are not intended for purely diversional/recreational purposes. Participants may not receive duplicative devices through both the Transitional Assistance Service and the Assistive Technology Service. The Assistive Technology evaluation includes identification of technology already available and assesses whether technology modifications or a new device is appropriate based on demonstrated need.

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

N/A

This program of supports is designed to enable an participant to enrich their life and enjoy a full range of (community) activities in a community setting by providing opportunities for developing, enhancing, and maintaining competency in personal, social and community activities. The service includes career exploration, including assessment of interests through volunteer experiences or situational assessments; community experiences to support fuller participation in community life; development and support of activities of daily living and independent living skills, socialization experiences and enhancement of interpersonal skills and pursuit of personal interests and hobbies. The service is intended for participants of working age who may be on a pathway to employment, a supplemental service for participants who are employed part-time and need a structured and supervised program of services during the time that they are not working, and for participants who are of retirement age. Community based day supports provides a structured and supervised program of services and supports in a group setting which promotes socialization and peer interaction and development of habilitative skills and achieve habilitative goals. This service is not eligible for delivery via telehealth.

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

N/A

Individual supported employment services consist of ongoing supports that enable a participant, for whom competitive employment at or above the minimum wage is unlikely absent the provision of supports, and who, because of their disabilities, need support to perform in a regular work setting. Individual supported employment includes assisting the participants to locate a job or develop a job on behalf of the participant. Individual supported employment is conducted in a variety of settings, particularly typical work sites where persons without disabilities are employed. Emphasis is on work in an environment with the opportunity for participants to have contact with co-workers, customers, supervisors and others without disabilities. In individual supported employment the participant has a job based on their identified needs and interests, located in a community business. It also includes self-employment or a small business, or a homebased self-employment, or temporary services which may assist a participant in securing an individual position within a business. Individual supported employment includes job-related discovery or assessment, person-centered employment planning, job placement, job development, negotiation with prospective employers, job analysis, training and systematic instruction, job coaching in the form or regular or periodic assistance; training and support are provided for the purpose of developing, maintaining and/or improving job skills and fostering career advancement opportunities. Job coaching at the job site is not designed to provide continuous on-going support; it is expected that as the participant develops more skill and independence the level of support will decrease and fade over time as the natural supports in the work place are established. Some on-going intermittent job related support may be provided to assist the waiver participant to successfully maintain their employment situation. Natural supports are developed by the provider to help increase participation and independence of the participant within the community setting. Participants are paid by the employer. It includes transportation if not available through another source. Transportation assistance between the participants’ place of residence and the employment site is included in the rate paid to providers of individual supported employment services. Ongoing transportation for a participant is excluded from the rate. Time-limited transportation for components of discovery, career exploration, job development is provided. Once the participant is hired, transportation ceases. Individual supported employment may be self-directed and paid through the Fiscal Intermediary.

Federal financial participation is not claimed for incentive payments, subsidies or unrelated vocational training expenses such as the following: 1. Incentive payments made to an employer to encourage or subsidize the employer’s participation in a supported employment program; 2. Payments that are passed through to users of supported employment programs; or 3. Payments for training that is not directly related to a participant’s supported employment program. When supported employment services are provided at work sites where persons without disabilities are employed, payment is made only for the adaptations; supervision and training required for participants receiving the waiver service as a result of their disabilities but does not include payment for supervisory activities rendered as a normal part of the business setting. Documentation is maintained in the file of each participant receiving this service that the service is not available under a program funded under Section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.) Individual supported employment excludes participants working in mobile crews or in small groups. It excludes volunteer work.

This service may be provided remotely via telehealth based on the participant’s needs, preferences, and goals as determined during the person-centered planning process and reviewed by the Service Coordinator during each scheduled reassessment . This service may be delivered remotely via telehealth 100% of the time.

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

N/A

Services and supports provided to participants tailored to their specific personal goals and outcomes related to the acquisition, improvement, and/or retention of skills and abilities to prepare and support a participant for work and/or community participation and/or meaningful retirement activities, and could not do so without this direct support. This service can only be participant-directed. A qualified family member or relative, independent contractor or service agency may provide services. This service originates from the home of the participant and is generally delivered in the community. This service is primarily delivered in person; telehealth may be used to supplement the scheduled in-person service based on the participant’s needs, preferences, and goals as determined during the person-centered planning process and reviewed by the Service Coordinator during each scheduled reassessment. Examples: • Develop and implement an individualized plan for day services and supports; • Assist in developing and maintaining friendships of choice and skills to use in daily interactions; • Provide support to explore job interests or retirement options; • Provide opportunities to participate in community activities, including support to attend and participate in post-secondary or adult education classes; • Provide support to complete work or business activities including supports for participants who own their own business; • Training and support to increase or maintain self-help, socialization, and adaptive skills to participate in own community; • Develop, maintain or enhance independent functioning skills in the areas of sensory-motor, cognition, personal grooming, hygiene, toileting, etc.

This service is not provided in or from a facility-based day program. This service is not provided from a provider-operated or state-operated group residence. This service may not be provided at the same time as Group or Individual Supported Employment, Community Based Day Supports, Individual Goods and Services or when other services that include care and supervision are provided. This service is only available to waiver participants who self-direct their own supports and must be pre-approved by the Team, subject to DDS rules stated above, and must be an identified need and documented in the service plan. The Individualized Day Supports must be purchased through a self-directed budget through either the Fiscal Intermediary or the Agency with Choice.

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

N/A

Peer support is designed to provide training, instruction and mentoring to participants about self-advocacy, participant direction, civic participation, leadership, benefits, and participation in the community. Peer support is designed to promote and assist the waiver participant’s ability to participate in self-advocacy through either a peer mentor or through an individual/agency peer support facilitator. Peer support may be provided in 1) small groups or 2) peer support may involve one individual who is either a peer or an individual peer support facilitator providing support to a waiver participant. The one to one peer support is instructional; it is not counseling. The service enhances the skills of the participant to function in the community and/or family home. Documentation in the participant’s record demonstrates the benefit to the participant. This service may be provided in small groups or as a one-to-one support for the participant. Peer support is available to participants who reside in 24 licensed settings, in the family home, a home of their own or receive less than 24 hours of support per day. This service may be self-directed. This service may be provided remotely via telehealth based on the participant’s needs, preferences, and goals as determined during the person-centered planning process and reviewed by the Service Coordinator during each scheduled reassessment. This service may be delivered remotely via telehealth 100% of the time.

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

N/A

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

Group Supported employment services consist of the ongoing supports that enable participants, for whom competitive employment at or above the minimum wage is unlikely absent the provision of supports, and who, because of their disabilities, need support to perform in a regular work setting. The outcome of the service is sustained paid employment and work experience leading to further career development and individual integrated community employment for which the participant is compensated at or above the minimum wage, but not less than the customary wage and level of benefit paid by the employer for the same or similar work performed by individuals without disabilities. Small group supported employment are services and training activities provided in regular business, industry and community settings for groups of two (2) to eight (8) workers with disabilities. Examples include mobile work crews, enclaves and other business-based workgroups employing small groups of workers with disabilities in employment in the community. Services must be provided in a manner that promotes engagement in the workplace and interaction between participants and people without disabilities including co-workers, customers, and supervisors. Group supported employment includes any combination of the following services: job-related discovery or assessment, assisting the participants to locate a job or develop a job on behalf of the participants, job analysis, training and systematic instruction, job coaching, negotiation with prospective employers, and benefits support. Typically group supported employment consists of 2-8 participants, working in the community under the supervision of a provider agency. The participants are generally considered employees of the provider agency and are paid and receive benefits from that agency. Group supported employment includes activities needed to sustain paid work by participants including supervision and training and may include transportation if not available through another source. Transportation between the participants’ place of residence and the employment site or between the provider site and the group employment site may be provided.

Federal financial participation is not claimed for incentive payments, subsidies or unrelated vocational training expenses such as the following: 1. Incentive payments made to an employer to encourage or subsidize the employer’s participation in a supported employment program; 2. Payments that are passed through to users of supported employment programs; or 3. Payments for training that is not directly related to a participant’s supported employment program When supported employment services are provided at work sites where persons without disabilities are employed, payment is made only for the adaptations; supervision and training required for participants receiving the waiver service as a result of their disabilities but does not include payment for supervisory activities rendered as a normal part of the business setting. Documentation is maintained in the file of each participant receiving this service that the service is not available under a program funded under Section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.)

Group supported employment does not include volunteer work or vocational services provided in facility based work settings. This service is primarily delivered in person; telehealth may be used to supplement the scheduled in-person service based on the participant’s needs, preferences, and goals as determined during the person-centered planning process and reviewed by the Service Coordinator during each scheduled reassessment.

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

N/A

This service has two components: Assistive Technology devices and Assistive Technology evaluation and training. These components are defined as follows: Assistive Technology devices – an item, piece of equipment, or product system that is used to develop, increase, maintain, or improve functional capabilities of participants, and to support the participant to achieve outcomes identified in their Individual Support Plan. Assistive Technology devices can be used to enable the participant to engage in telehealth. Assistive Technology devices can be acquired commercially or modified, customized, engineered or otherwise adapted to meet the individual’s specific needs, including design and fabrication. In addition to the cost of Assistive Technology device purchase, lease, or other acquisition costs, this service component covers maintenance and repair of Assistive Technology devices and rental of substitute Assistive Technology devices during periods of repair. This service includes device installation and set up costs but excludes installation and set-up and ongoing provision fees related to internet service. Assistive Technology evaluation and training – the evaluation of the Assistive Technology needs of the participant, i.e. functional evaluation of the impact of the provision of appropriate Assistive Technology devices and services to the participant in the customary environment of the participant; sthe selection, customization and acquisition of Assistive Technology devices for participants; selection, design, fitting, customization, adaption, maintenance, repair, and/or replacement of Assistive Technology devices; coordination and use of necessary therapies, interventions, or services with Assistive Technology devices that are associated with other services contained in the Individual Support Plan; training and technical assistance for the participant, and, where appropriate, the family members, guardians, advocates, or authorized representatives of the participant; and training or technical assistance for professionals or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of participants. Assistive Technology must be authorized by the Service Coordinator as part of the Individual Support Plan. The Service Coordinator will explore with the participant/legal guardian the use of the Medicaid State Plan. Waiver funding shall only be used for assistive technology that is specifically related to the functional limitation(s) caused by the participant’s disability. The evaluation and training component of this service may be provided remotely via telehealth based on the professional judgement of the evaluator and the needs, preferences, and goals of the participant as determined during the person-centered planning process and reviewed by the Service Coordinator during each scheduled reassessment. Assistive Technology must meet the Underwriter’s Laboratory and/or Federal Communications Commission requirements, where applicable, for design, safety, and utility. There must be documentation that the item purchased is appropriate to the participant’s needs. Any Assistive Technology item that is available through the State Plan must be purchased through the State Plan; only items not covered by the State Plan may be purchased through the Waiver. This service includes purchase, lease, or other acquisition costs of cell phones, tablets, computers, and ancillary equipment necessary for the operation of the Assistive Technology devices that enable the individual to participate in telehealth. These devices are not intended for purely diversional/recreational purposes. Participants may not receive duplicative devices through both the Transitional Assistance Service and the Assistive Technology Service. The Assistive Technology evaluation includes identification of technology already available and assesses whether technology modifications or a new device is appropriate based on demonstrated need.

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

N/A

This program of supports is designed to enable a participant to enrich their life and enjoy a full range of (community) activities in a community setting by providing opportunities for developing, enhancing, and maintaining competency in personal, social and community activities. The service includes career exploration, including assessment of interests through volunteer experiences or situational assessments; community experiences to support fuller participation in community life; development and support of activities of daily living and independent living skills, socialization experiences and enhancement of interpersonal skills and pursuit of personal interests and hobbies. The service is intended for participants of working age who may be on a pathway to employment, a supplemental service for participants who are employed part-time and need a structured and supervised program of services during the time that they are not working, and for participants who are of retirement age. Community based day supports provides a structured and supervised program of services and supports in a group setting which promotes socialization and peer interaction and development of habilitative skills and achieve habilitative goals. This service is not eligible for delivery via telehealth.

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

N/A

Individual supported employment services consist of ongoing supports that enable a participant, for whom competitive employment at or above the minimum wage is unlikely absent the provision of supports, and who, because of their disabilities, need support to perform in a regular work setting. Individual supported employment includes assisting the participants to locate a job or develop a job on behalf of the participant. Individual supported employment is conducted in a variety of settings, particularly typical work sites where persons without disabilities are employed. Emphasis is on work in an environment with the opportunity for participants to have contact with co-workers, customers, supervisors and others without disabilities. In individual supported employment the participant has a job based on their identified needs and interests, located in a community business. It also includes self-employment or a small business, or a homebased self-employment, or temporary services which may assist a participant in securing an individual position within a business. Individual supported employment includes job-related discovery or assessment, person-centered employment planning, job placement, job development, negotiation with prospective employers, job analysis, training and systematic instruction, job coaching in the form or regular or periodic assistance; training and support are provided for the purpose of developing, maintaining and/or improving job skills and fostering career advancement opportunities. Job coaching at the job site is not designed to provide continuous on-going support; it is expected that as the participant develops more skill and independence the level of support will decrease and fade over time as the natural supports in the work place are established. Some on-going intermittent job related support may be provided to assist the waiver participant to successfully maintain their employment situation. Natural supports are developed by the provider to help increase participation and independence of the participant within the community setting. Participants are paid by the employer. It includes transportation if not available through another source. Transportation assistance between the participants’ place of residence and the employment site is included in the rate paid to providers of individual supported employment services. Ongoing transportation for a participant is excluded from the rate. Time-limited transportation for components of discovery, career exploration, job development is provided. Once the participant is hired, transportation ceases. Individual supported employment may be self-directed and paid through the Fiscal Intermediary. Federal financial participation is not claimed for incentive payments, subsidies or unrelated vocational training expenses such as the following: 1. Incentive payments made to an employer to encourage or subsidize the employer’s participation in a supported employment program; 2. Payments that are passed through to users of supported employment programs; or 3. Payments for training that is not directly related to a participant’s supported employment program. When supported employment services are provided at work sites where persons without disabilities are employed, payment is made only for the adaptations; supervision and training required for participants receiving the waiver service as a result of their disabilities but does not include payment for supervisory activities rendered as a normal part of the business setting. Documentation is maintained in the file of each participant receiving this service that the service is not available under a program funded under Section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.) Individual supported employment excludes participants working in mobile crews or in small groups. It excludes volunteer work. This service may be provided remotely via telehealth based on the participant’s needs, preferences, and goals as determined during the person-centered planning process and reviewed by the Service Coordinator during each scheduled reassessment. This service may be delivered remotely via telehealth 100% of the time.

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

N/A

Services and supports provided to participants tailored to their specific personal goals and outcomes related to the acquisition, improvement, and/or retention of skills and abilities to prepare and support a participant for work and/or community participation and/or meaningful retirement activities, and could not do so without this direct support.

This service can only be participant-directed. A qualified family member or relative, independent contractor or service agency may provide services. This service originates from the home of the participant and is generally delivered in the community. This service is primarily delivered in person; telehealth may be used to supplement the scheduled in-person service based on the participant’s needs, preferences, and goals as determined during the person-centered planning process and reviewed by the Service Coordinator during each scheduled reassessment.

Examples • Develop and implement an individualized plan for day services and supports; • Assist in developing and maintaining friendships of choice and skills to use in daily interactions; • Provide support to explore job interests or retirement options; • Provide opportunities to participate in community activities, including support to attend and participate in post-secondary or adult education classes; • Provide support to complete work or business activities including supports for participants who own their own business; • Training and support to increase or maintain self-help, socialization, and adaptive skills to participate in own community; • Develop, maintain or enhance independent functioning skills in the areas of sensory-motor, cognition, personal grooming, hygiene, toileting, etc.

This service is not provided in or from a facility-based day program. This service is not provided from a provider-operated or state-operated group residence. This service may not be provided at the same time as Group or Individual Supported Employment, Community Based Day Supports, Individual Goods and Services or when other services that include care and supervision are provided. This service is only available to waiver participants who self-direct their own supports and must be pre-approved by the Team, subject to DDS rules stated above, and must be an identified need and documented in the service plan. The Individualized Day Supports must be purchased through a self-directed budget through either the Fiscal Intermediary or the Agency with Choice.

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

N/A

Peer support is designed to provide training, instruction and mentoring to participants about self-advocacy, participant direction, civic participation, leadership, benefits, and participation in the community. Peer support is designed to promote and assist the waiver participant’s ability to participate in self-advocacy through either a peer mentor or through an individual/agency peer support facilitator. Peer support may be provided in 1) small groups or 2) peer support may involve one individual who is either a peer or an individual peer support facilitator providing support to a waiver participant. The one to one peer support is instructional; it is not counseling. The service enhances the skills of the participant to function in the community and/or family home. Documentation in the participant’s record demonstrates the benefit to the participant. This service may be provided in small groups or as a one-to-one support for the participant. Peer support is available to participants who reside in 24 licensed settings, in the family home, a home of their own or receive less than 24 hours of support per day. This service may be self-directed. This service may be provided remotely via telehealth based on the participant’s needs, preferences, and goals as determined during the person-centered planning process and reviewed by the Service Coordinator during each scheduled reassessment. This service may be delivered remotely via telehealth 100% of the time.

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

N/A

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

Group Supported employment services consist of the ongoing supports that enable participants, for whom competitive employment at or above the minimum wage is unlikely absent the provision of supports, and who, because of their disabilities, need support to perform in a regular work setting. The outcome of the service is sustained paid employment and work experience leading to further career development and individual community employment for which the participant is compensated at or above the minimum wage, but not less than the customary wage and level of benefit paid by the employer for the same or similar work performed by individuals without disabilities. Small group supported employment are services and training activities provided in regular business, industry and community settings for groups of two (2) to eight (8) workers with disabilities. Examples include mobile work crews, enclaves and other business-based workgroups employing small groups of workers with disabilities in employment in the community. Services must be provided in a manner that promotes engagement in the workplace and interaction between participants and people without disabilities including co-workers, customers, and supervisors. Group supported employment includes any combination of the following services: job-related discovery or assessment, assisting the participants to locate a job or develop a job on behalf of the participants, job analysis, training and systematic instruction, job coaching, negotiation with prospective employers, and benefits support. Typically group supported employment consists of 2-8 participants, working in the community under the supervision of a provider agency. The participants are generally considered employees of the provider agency and are paid and receive benefits from that agency. Group supported employment includes activities needed to sustain paid work by participants including supervision and training and may include transportation if not available through another source. Transportation between the participants’ place of residence and the employment site or between the provider site and the group employment site may be provided.

Federal financial participation is not claimed for incentive payments, subsidies or unrelated vocational training expenses such as the following: 1. Incentive payments made to an employer to encourage or subsidize the employer’s participation in a supported employment program; 2. Payments that are passed through to users of supported employment programs; or 3. Payments for training that is not directly related to a participant’s supported employment program When supported employment services are provided at work sites where persons without disabilities are employed, payment is made only for the adaptations; supervision and training required for participants receiving the waiver service as a result of their disabilities but does not include payment for supervisory activities rendered as a normal part of the business setting. Documentation is maintained in the file of each participant receiving this service that the service is not available under a program funded under Section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.)

Group supported employment does not include volunteer work or vocational services provided in facility based work settings.

This service is primarily delivered in person; telehealth may be used to supplement the scheduled in-person service based on the participant’s needs, preferences, and goals as determined during the person-centered planning process and reviewed by the Service Coordinator during each scheduled reassessment.

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

N/A

This service has two components: Assistive Technology devices and Assistive Technology evaluation and training. These components are defined as follows: Assistive Technology devices – an item, piece of equipment, or product system that is used to develop, increase, maintain, or improve functional capabilities of participants, and to support the participant to achieve outcomes identified in their Individual Support Plan. Assistive Technology devices can be used to enable the participant to engage in telehealth. Assistive technology devices can be acquired commercially or modified, customized, engineered or otherwise adapted to meet the individual’s specific needs, including design and fabrication. In addition to the cost of Assistive Technology device purchase, lease, or other acquisition costs, this service component covers maintenance and repair of Assistive Technology devices and rental of substitute Assistive Technology devices during periods of repair. This service includes device installation and setup costs but excludes installation and set up and ongoing provision fees related to internet service. Assistive Technology evaluation and training – the evaluation of the Assistive Technology needs of the participant, i.e. functional evaluation of the impact of the provision of appropriate Assistive Technology devices and services to the participant in the customary environment of the participant; the selection, customization and, acquisition of Assistive Technology devices for participants; selection, design, fitting, customization, adaption, maintenance, repair, and/or replacement of Assistive Technology devices; coordination and use of necessary therapies, interventions, or services with Assistive Technology devices that are associated with other services contained in the Individual Support Plan; training and technical assistance for the participant, and, where appropriate, the family members, guardians, advocates, or authorized representatives of the participant; and training or technical assistance for professionals or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of participants. Assistive Technology must be authorized by the Service Coordinator as part of the Individual Support Plan. The Service Coordinator will explore with the participant/legal guardian the use of the Medicaid State Plan. Waiver funding shall only be used for assistive technology that is specifically related to the functional limitation(s) caused by the participant’s disability.. The evaluation and training component of this service may be provided remotely via telehealth based on the professional judgement of the evaluator and the needs, preferences, and goals of the participant as determined during the person-centered planning process and reviewed by the Service Coordinator during each scheduled reassessment. Assistive Technology must meet the Underwriter’s Laboratory and/or Federal Communications Commission requirements where applicable for design, safety, and utility. There must be documentation that the item purchased is appropriate to the participant’s needs. Any Assistive Technology item that is available through the State Plan must be purchased through the State Plan; only items not covered by the State Plan may be purchased through the Waiver. This service includes purchase, lease, or other acquisition costs of cell phones, tablets, computers, and ancillary equipment necessary for the operation of the Assistive Technology devices that enable the individual to participate in telehealth. These devices are not intended for purely diversional/recreational purposes. Participants may not receive duplicative devices through both the Transitional Assistance Service and the Assistive Technology Service. The Assistive Technology evaluation includes identification of technology already available and assesses whether technology modifications or a new device is appropriate based on demonstrated need.

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

N/A

This program of supports is designed to enable a participant to enrich their life and enjoy a full range of (community) activities in a community setting by providing opportunities for developing, enhancing, and maintaining competency in personal, social and community activities. The service includes career exploration, including assessment of interests through volunteer experiences or situational assessments; community experiences to support fuller participation in community life; development and support of activities of daily living and independent living skills, socialization experiences and enhancement of interpersonal skills and pursuit of personal interests and hobbies. The service is intended for participants of working age who may be on a pathway to employment, a supplemental service for participants who are employed part-time and need a structured and supervised program of services during the time that they are not working, and for participants who are of retirement age. Community based day supports provides a structured and supervised program of services and supports in a group setting which promotes socialization and peer interaction and development of habilitative skills and achieve habilitative goals. This service is not eligible for delivery via telehealth.

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

N/A

Individual supported employment services consist of ongoing supports that enable a participant, for whom competitive employment at or above the minimum wage is unlikely absent the provision of supports, and who, because of their disabilities, need support to perform in a regular work setting. Individual supported employment includes assisting the participants to locate a job or develop a job on behalf of the participant. Individual supported employment is conducted in a variety of settings, particularly typical work sites where persons without disabilities are employed. Emphasis is on work in an environment with the opportunity for participants to have contact with co-workers, customers, supervisors and others without disabilities. In individual supported employment the participant has a job based on their identified needs and interests, located in a community business. It also includes s elf-employment or a small business, or a homebased self-employment, or temporary services which may assist a participant in securing an individual position within a business. Individual supported employment includes job-related discovery or assessment, person-centered employment planning, job placement, job development, negotiation with prospective employers, job analysis, training and systematic instruction, job coaching in the form or regular or periodic assistance; training and support are provided for the purpose of developing, maintaining and/or improving job skills and fostering career advancement opportunities. Job coaching at the job site is not designed to provide continuous on-going support; it is expected that as the participant develops more skill and independence the level of support will decrease and fade over time as the natural supports in the work place are established. Some on-going intermittent job related support may be provided to assist the waiver participant to successfully maintain their employment situation. Natural supports are developed by the provider to help increase participation and independence of the participant within the community setting. Participants are paid by the employer. It includes transportation if not available through another source. Transportation assistance between the participants’ place of residence and the employment site is included in the rate paid to providers of individual supported employment services. Ongoing transportation for a participant is excluded from the rate. Time-limited transportation for components of discovery, career exploration, job development is provided. Once the participant is hired, transportation ceases. Individual supported employment may be self-directed and paid through the Fiscal Intermediary.

Federal financial participation is not claimed for incentive payments, subsidies or unrelated vocational training expenses such as the following: 1. Incentive payments made to an employer to encourage or subsidize the employer’s participation in a supported employment program; 2. Payments that are passed through to users of supported employment programs; or 3. Payments for training that is not directly related to a participant’s supported employment program. When supported employment services are provided at work sites where persons without disabilities are employed, payment is made only for the adaptations; supervision and training required for participants receiving the waiver service as a result of their disabilities but does not include payment for supervisory activities rendered as a normal part of the business setting. Documentation is maintained in the file of each participant receiving this service that the service is not available under a program funded under Section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.) Individual supported employment excludes participants working in mobile crews or in small groups. It excludes volunteer work.

This service may be provided remotely via telehealth based on the participant’s needs, preferences, and goals as determined during the person-centered planning process and reviewed by the Service Coordinator during each scheduled reassessment. This service may be delivered remotely via telehealth 100% of the time.

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

N/A

Services and supports provided to participants tailored to their specific personal goals and outcomes related to the acquisition, improvement, and/or retention of skills and abilities to prepare and support a participant for work and/or community participation and/or meaningful retirement activities, and could not do so without this direct support. This service can only be participant-directed. A qualified family member or relative, independent contractor or service agency may provide services. This service originates from the home of the participant and is generally delivered in the community. This service is primarily delivered in person; telehealth may be used to supplement the scheduled in-person service based on the participant’s needs, preferences, and goals as determined during the person-centered planning process and reviewed by the Service Coordinator during each scheduled reassessment.

Examples • Develop and implement an individualized plan for day services and supports; • Assist in developing and maintaining friendships of choice and skills to use in daily interactions; • Provide support to explore job interests or retirement options; • Provide opportunities to participate in community activities, including support to attend and participate in post-secondary or adult education classes; • Provide support to complete work or business activities including supports for participants who own their own business; • Training and support to increase or maintain self-help, socialization, and adaptive skills to participate in own community; • Develop, maintain or enhance independent functioning skills in the areas of sensory-motor, cognition, personal grooming, hygiene, toileting, etc.

This service is not provided in or from a facility-based day program. This service is not provided from a provider-operated or state-operated group residence. This service may not be provided at the same time as Group or Individual Supported Employment, Community Based Day Supports, Individualized Goods and Services Supports or when other services that include care and supervision are provided. This service is only available to waiver participants who self-direct their own supports and must be pre-approved by the Team, subject to DDS rules stated above, and must be an identified need and documented in the service plan. The Individualized Day Supports must be purchased through a self-directed budget through either the Fiscal Intermediary or the Agency with Choice.

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

N/A

Peer support is designed to provide training, instruction and mentoring to participants about self-advocacy, participant direction, civic participation, leadership, benefits, and participation in the community. Peer support is designed to promote and assist the waiver participant’s ability to participate in self-advocacy through either a peer mentor or through an individual/agency peer support facilitator. Peer support may be provided in 1) small groups or 2) peer support may involve one individual who is either a peer or an individual peer support facilitator providing support to a waiver participant. The one to one peer support is instructional; it is not counseling. The service enhances the skills of the participant to function in the community and/or family home. Documentation in the participant’s record demonstrates the benefit to the participant. This service may be provided in small groups or as a one-to-one support for the participant. Peer support is available to participants who reside in 24 licensed settings, in the family home, a home of their own or receive less than 24 hours of support per day. This service may be self-directed. This service may be provided remotely via telehealth based on the participant’s needs, preferences, and goals as determined during the person-centered planning process and reviewed by the Service Coordinator during each scheduled reassessment. This service may be delivered remotely via telehealth 100% of the time.

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

N/A

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

Prevocational Services comprises a range of learning and experiential type activities that prepare a participant for paid employment in an integrated, community setting. Services are not job-task oriented but instead, aimed at a generalized result (e.g. attention span, motor skills). The service may include teaching such concepts as attendance, task completion, problem solving and safety as well as social skills training, improving attention span, and developing or improving motor skills. Basic skill-building activities are expected to specifically involve strategies to enhance a participant’s employability in integrated, community settings. The amount, duration and scope of Prevocational Services provided to a participant is based on an assessment of the participant’s pre-employment needs that arise as a result of their functional limitations and/or conditions, including services that enable the participant to acquire, improve, retain/maintain, and prevent deterioration of functioning consistent with the participant’s interests, strengths, priorities, abilities and capabilities. Services are reflected in the participant’s individualized service plan and are directed to address habilitative or rehabilitative rather than explicit employment objectives. Prevocational services may be provided one-to-one or in a group format. This service may be provided as a site-based service, in community settings or in a combination of these settings and must include integrated community activities that support the development of vocational skills. This service may be provided remotely via telehealth based on the participant’s needs, preferences, and goals as determined during the person-centered planning process and reviewed by the Case Manager during each scheduled reassessment. This service may be delivered remotely via telehealth 100% of the time. Meals provided as part of these services shall not constitute a “full nutritional regimen” (3 meals per day). Documentation is maintained in the file of each individual receiving this service that the service is not available under a program funded under section 110 of the Rehabilitation Act of 1973 or the IDEA (20 U.S.C. 1401 et seq.).

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

There is no limit on the duration of this service. Goals are reevaluated annually at the Person-Centered Planning meeting and more frequently if there is a changing need.

Supported employment services consist of intensive, ongoing supports that enable participants, for whom competitive employment at or above the minimum wage is unlikely absent the provision of supports, and who, because of their disabilities, need supports, to perform in a regular work setting. Supported employment may include assisting the participant to locate a job or develop a job on behalf of the participant. Supported employment is conducted in a variety of settings, particularly work sites where persons without disabilities are employed. This service may be provided remotely via telehealth based on the participant’s needs, preferences, and goals as determined during the person-centered planning process and reviewed by the Case Manager during each scheduled reassessment. This service may be delivered remotely via telehealth 100% of the time. . Supported employment includes activities needed to sustain paid work by participants, including supervision and training. When supported employment services are provided at a work site where persons without disabilities are employed, payment is made only for the adaptations, supervision and training required by participants receiving waiver services as a result of their disabilities but does not include payment for the supervisory activities rendered as a normal part of the business setting.

Documentation is maintained in the file of each participant receiving this service that the service is not available under a program funded under section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.).

Federal financial participation is not claimed for incentive payments, subsidies, or unrelated vocational training expenses such as the following: 1. Incentive payments made to an employer to encourage or subsidize the employer’s participation in a supported employment program; 2. Payments that are passed through to users of supported employment programs; or 3. Payments for training that is not directly related to an individual’s supported employment program.

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

This service is not for use to provide continuous long-term 1:1 on the job support to enable an individual to complete work activities.

This service has two components: Assistive Technology devices and Assistive Technology evaluation and training. These components are defined as follows: Assistive Technology devices – an item, piece of equipment, or product system that is used to develop, increase, maintain, or improve functional capabilities of participants, and to support the participant to achieve goals identified in their Plan of Care. Assistive Technology devices can be used to enable the participant to engage in telehealth. Assistive Technology devices can be acquired commercially or modified, customized, engineered or otherwise adapted to meet the individual’s specific needs, including design and fabrication. In addition to the cost of Assistive Technology device purchase, lease, or other acquisition costs, this service component covers maintenance and repair of Assistive Technology devices and rental of substitute Assistive Technology devices during periods of repair. This service includes device installation and set up costs but excludes installation and set-up and ongoing provision fees related to internet service. This service includes purchase, lease, or other acquisition costs of cell phones, tablets, computers, and ancillary equipment necessary for the operation of the Assistive Technology devices that enable the individual to participate in telehealth. These devices are not intended for purely diversional/recreational purposes. Assistive Technology evaluation and training – the evaluation of the Assistive Technology needs of the participant, i.e. functional evaluation of the impact of the provision of appropriate Assistive Technology devices and services to the participant in the customary environment of the participant; the selection, customization and acquisition of Assistive Technology devices for participants; selection, design, fitting, customization, adaption, maintenance, repair, and/or replacement of Assistive Technology devices; coordination and use of necessary therapies, interventions, or services with Assistive Technology devices that are associated with other services contained in the Plan of Care; training and technical assistance for the participant, and, where appropriate, the family members, guardians, advocates, or authorized representatives of the participant; and training or technical assistance for professionals or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of participants. Assistive Technology must be authorized by the Case Manager as part of the Plan of Care. The Case Manager will explore with the participant/legal guardian the use of the Medicaid State Plan. Waiver funding shall only be used for assistive technology that is specifically related to the functional limitation(s) caused by the participant’s disability. The evaluation and training component of this service may be provided remotely via telehealth based on the professional judgement of the evaluator and the needs, preferences, and goals of the participant as determined during the person-centered planning process and reviewed by the Case Manager during each scheduled reassessment. Assistive Technology must meet the Underwriter’s Laboratory and/or Federal Communications Commission requirements, where applicable, for design, safety, and utility. There must be documentation that the item purchased is appropriate to the participant’s needs. Any Assistive Technology item that is available through the State Plan must be purchased through the State Plan; only items not covered by the State Plan may be purchased through the Waiver. Participants may not receive duplicative devices through this service and either the Transitional Assistance Service or the Specialized Medical Equipment Service.

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

The Assistive Technology evaluation includes identification of technology already available and assesses whether technology modifications or a new device is appropriate based on demonstrated need

Community Based Day Supports (CBDS) is designed to enable an individual to enrich their life and enjoy a full range of community activities by providing opportunities for developing, enhancing, and maintaining competency in personal, social interactions and community integration. The service may include career exploration, including assessment of interests through volunteer experiences or situational assessments; community integration experiences to support fuller participation in community life; development and support of activities of daily living and independent living skills, socialization experiences and enhancement of interpersonal skills and pursuit of personal interests and hobbies. The service is intended for individuals of working age who may be on a pathway to employment, a supplemental service for individuals who are employed part-time and need a structured and supervised program of services during the time that they are not working, and for individuals who are of retirement age. Using a small group model, CBDS provides a flexible array of individualized supports through community activities that promote socialization, peer interaction and community integration.

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

N/A

Day services/supports provide for structured day activity typically for individuals with pervasive and extensive support needs who are not ready to join the general workforce, or who are employed part-time and need a structured and supervised program of services during the time that they are not working, or who are of retirement age. Day Services are individually designed around consumer choice and preferences with a focus on improvement or maintenance of the person’s skills and their ability to live as independently as possible in the community. Day Services often include assistance to learn activities of daily living and functional skills; language and communication training; compensatory, cognitive and other strategies; interpersonal skills; recreational/socialization skills and other skills training to prepare the individual to undertake various community inclusion activities. This service may reinforce some aspects of other waiver and state plan services by allowing individuals to continue to strengthen skills, which are necessary for greater independence, productivity and community inclusion. Day Services are provided in a provider operated setting in the community and not in a participant’s residence, and do not duplicate any services under the state plan. This service is primarily delivered in person; telehealth may be used to supplement the scheduled in-person service based on the participant’s needs, preferences, and goals as determined during the person-centered planning process and reviewed by the Case Manager during each scheduled reassessment.

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

N/A

Orientation and Mobility (O&M) services teach an individual with vision impairment or legal blindness how to move or travel safely and independently in their home and community and include (a) O&M assessment; (b) training and education provided to Participants; (c) environmental evaluations; (d) caregiver/direct care staff training on sensitivity to blindness/low vision; and (e) information and resources on community living for persons with vision impairment or legal blindness. O&M Services are tailored to the individual’s need and may extend beyond the home setting to other community settings as well as public transportation systems

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

N/A

Peer Support is designed to provide training, instruction and mentoring to individuals about self-advocacy, participant direction, civic participation, leadership, benefits, and participation in the community. Peer support may be provided in small groups or peer support may involve one peer providing support to another peer, the waiver participant, to promote and support the waiver participant’s ability to participate in self-advocacy. The one to one peer support is instructional; it is not counseling. The service enhances the skills of the individual to function in the community and/or family home. Documentation in the individual’s record demonstrates the benefit to the individual. This service may be self-directed. This service may be provided remotely via telehealth based on the participant’s needs, preferences, and goals as determined during the person-centered planning process and reviewed by the Case Manager during each scheduled reassessment . This service may be delivered remotely via telehealth 100% of the time. .

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

Not to exceed 16 hours per week.

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

Prevocational Services comprises a range of learning and experiential type activities that prepare a participant for paid employment in an integrated, community setting. Services are not job-task oriented but instead, aimed at a generalized result (e.g. attention span, motor skills). The service may include teaching such concepts as attendance, task completion, problem solving and safety as well as social skills training, improving attention span, and developing or improving motor skills. Basic skill-building activities are expected to specifically involve strategies to enhance a participant’s employability in integrated, community settings. The amount, duration and scope of Prevocational Services provided to a participant is based on an assessment of the participant’s pre-employment needs that arise as a result of their functional limitations and/or conditions, including services that enable the participant to acquire, improve, retain/maintain, and prevent deterioration of functioning consistent with the participant’s interests, strengths, priorities, abilities and capabilities. Services are reflected in the participant’s individualized service plan and are directed to address habilitative or rehabilitative rather than explicit employment objectives. Prevocational services may be provided one-to-one or in a group format. This service may be provided as a site-based service, in community settings or in a combination of these settings and must include integrated community activities that support the development of vocational skills. This service may be provided remotely via telehealth based on the participant’s needs, preferences, and goals as determined during the person-centered planning process and reviewed by the Case Manager during each scheduled reassessment. This service may be delivered remotely via telehealth 100% of the time. Meals provided as part of these services shall not constitute a “full nutritional regimen” (3 meals per day). Documentation is maintained in the file of each individual receiving this service that the service is not available under a program funded under section 110 of the Rehabilitation Act of 1973 or the IDEA (20 U.S.C. 1401 et seq.).

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

There is no limit on the duration of this service. Goals are reevaluated annually at the Person-Centered Planning meeting and more frequently if there is a changing need.

Supported employment services consist of intensive, ongoing supports that enable participants, for whom competitive employment at or above the minimum wage is unlikely absent the provision of supports, and who, because of their disabilities, need supports, to perform in a regular work setting. Supported employment may include assisting the participant to locate a job or develop a job on behalf of the participant. Supported employment is conducted in a variety of settings, particularly work sites where persons without disabilities are employed. This service may be provided remotely via telehealth based on the participant’s needs, preferences, and goals as determined during the person-centered planning process and reviewed by the Case Manager during each scheduled reassessment. This service may be delivered remotely via telehealth 100% of the time. Supported employment includes activities needed to sustain paid work by participants, including supervision and training. When supported employment services are provided at a work site where persons without disabilities are employed, payment is made only for the adaptations, supervision and training required by participants receiving waiver services as a result of their disabilities but does not include payment for the supervisory activities rendered as a normal part of the business setting. Documentation is maintained in the file of each participant receiving this service that the service is not available under a program funded under section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.).

Federal financial participation is not claimed for incentive payments, subsidies, or unrelated vocational training expenses such as the following: 1. Incentive payments made to an employer to encourage or subsidize the employer’s participation in a supported employment program; 2. Payments that are passed through to users of supported employment programs; or 3. Payments for training that is not directly related to an individual’s supported employment program.

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

This service is not for use to provide continuous long-term 1:1 on the job support to enable an individual to complete work activities.

This service has two components: Assistive Technology devices and Assistive Technology evaluation and training. These components are defined as follows:

Assistive Technology devices – an item, piece of equipment, or product system that is used to develop, increase, maintain, or improve functional capabilities of participants, and to support the participant to achieve goals identified in their Plan of Care. Assistive Technology devices can be used to enable the participant to engage in telehealth. Assistive Technology devices can be acquired commercially or modified, customized, engineered or otherwise adapted to meet the individual’s specific needs, including design and fabrication. In addition to the cost of Assistive Technology device purchase, lease, or other acquisition costs, this service component covers maintenance and repair of Assistive Technology devices and rental of substitute Assistive Technology devices during periods of repair. This service includes device installation and set up costs but excludes installation and set-up and ongoing provision fees related to internet service. This service includes purchase, lease, or other acquisition costs of cell phones, tablets, computers, and ancillary equipment necessary for the operation of the Assistive Technology devices that enable the individual to participate in telehealth. These devices are not intended for purely diversional/recreational purposes. Assistive Technology evaluation and training – the evaluation of the Assistive Technology needs of the participant, i.e. functional evaluation of the impact of the provision of appropriate Assistive Technology devices and services to the participant in the customary environment of the participant; the selection, customization and acquisition of Assistive Technology devices for participants; selection, design, fitting, customization, adaption, maintenance, repair, and/or replacement of Assistive Technology devices; coordination and use of necessary therapies, interventions, or services with Assistive Technology devices that are associated with other services contained in the Plan of Care; training and technical assistance for the participant, and, where appropriate, the family members, guardians, advocates, or authorized representatives of the participant; and training or technical assistance for professionals or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of participants. Assistive Technology must be authorized by the Case Manager as part of the Plan of Care. The Case Manager will explore with the participant/legal guardian the use of the Medicaid State Plan. Waiver funding shall only be used for assistive technology that is specifically related to the functional limitation(s) caused by the participant’s disability. The evaluation and training component of this service may be provided remotely via telehealth based on the professional judgement of the evaluator and the needs, preferences, and goals of the participant as determined during the person-centered planning process and reviewed by the Case Manager during each scheduled reassessment. Assistive Technology must meet the Underwriter’s Laboratory and/or Federal Communications Commission requirements, where applicable, for design, safety, and utility. There must be documentation that the item purchased is appropriate to the participant’s needs. Any Assistive Technology item that is available through the State Plan must be purchased through the State Plan; only items not covered by the State Plan may be purchased through the Waiver. Participants may not receive duplicative devices through this service and either the Transitional Assistance Service or the Specialized Medical Equipment Service.

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

The Assistive Technology evaluation includes identification of technology already available and assesses whether technology modifications or a new device is appropriate based on demonstrated need.

Community Based Day Supports (CBDS) is designed to enable an individual to enrich their life and enjoy a full range of community activities by providing opportunities for developing, enhancing, and maintaining competency in personal, social interactions and community integration. The service may include career exploration, including assessment of interests through volunteer experiences or situational assessments; community integration experiences to support fuller participation in community life; development and support of activities of daily living and independent living skills, socialization experiences and enhancement of interpersonal skills and pursuit of personal interests and hobbies. The service is intended for individuals of working age who may be on a pathway to employment, a supplemental service for individuals who are employed part-time and need a structured and supervised program of services during the time that they are not working, and for individuals who are of retirement age. Using a small group model, CBDS provides a flexible array of individualized supports through community activities that promote socialization, peer interaction and community integration.

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

N/A

Day services/supports provide for structured day activity typically for individuals with pervasive and extensive support needs who are not ready to join the general workforce, or who are employed part-time and need a structured and supervised program of services during the time that they are not working, or who are of retirement age. Day Services are individually designed around consumer choice and preferences with a focus on improvement or maintenance of the person’s skills and their ability to live as independently as possible in the community. Day Services often include assistance to learn activities of daily living and functional skills; language and communication training; compensatory, cognitive and other strategies; interpersonal skills; recreational/socialization skills and other skills training to prepare the individual to undertake various community inclusion activities. This service may reinforce some aspects of other waiver and state plan services by allowing individuals to continue to strengthen skills, which are necessary for greater independence, productivity and community inclusion. Day Services are provided in a provider operated setting in the community and not in a participant’s residence, and do not duplicate any services under the state plan. This service is primarily delivered in person; telehealth may be used to supplement the scheduled in-person service based on the participant’s needs, preferences, and goals as determined during the person-centered planning process and reviewed by the Case Manager during each scheduled reassessment.

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

N/A

Orientation and Mobility (O&M) services teach an individual with vision impairment or legal blindness how to move or travel safely and independently in their home and community and include (a) O&M assessment; (b) training and education provided to Participants; (c) environmental evaluations; (d) caregiver/direct care staff training on sensitivity to blindness/low vision; and (e) information and resources on community living for persons with vision impairment or legal blindness. O&M Services are tailored to the individual’s need and may extend beyond residential settings to other community settings as well as public transportation systems.

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

N/A

Peer Support is designed to provide training, instruction and mentoring to individuals about self-advocacy, participant direction, civic participation, leadership, benefits, and participation in the community. Peer support may be provided in small groups or peer support may involve one peer providing support to another peer, the waiver participant, to promote and support the waiver participant’s ability to participate in self-advocacy. The one to one peer support is instructional; it is not counseling. The service enhances the skills of the individual to function in the community and/or family home. Documentation in the individual’s record demonstrates the benefit to the individual. This service may be self-directed. This service may be provided remotely via telehealth based on the participant’s needs, preferences, and goals as determined during the person-centered planning process and reviewed by the Case Manager during each scheduled reassessment. This service may be delivered remotely via telehealth 100% of the time.

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

Not to exceed 16 hours per week.

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

Supported Employment services consist of intensive, ongoing supports that clarify the skills that participants will need to strengthen ahead of job placement, determine if any specific skill training will be needed for successful job placement and retention, and enable participants who need supports to perform in a regular work setting to achieve successful placement in a competitive work setting, with such supports. Supported Employment may include assisting the participant to locate a job or developing a job on behalf of the participant, as well as post-placement intermittent support. Supported Employment is conducted in a variety of settings, particularly work sites where persons without disabilities are employed. This service may be provided remotely via telehealth based on the participant’s needs, preferences, and goals as determined during the person-centered planning process and reviewed by the Case Manager during each scheduled reassessment. This service may be delivered remotely via telehealth 100% of the time. Supported Employment includes activities needed to obtain and sustain paid work by participants, including assessment, education and skills training activities, job development and placement, support upon initial placement, and intermittent post-placement job supports. When supported employment services are provided at a work site where persons without disabilities are employed, payment is made only for the adaptations, supervision and training required by participants receiving waiver services as a result of their disabilities but does not include payment for the supervisory activities rendered as a normal part of the business setting. Documentation is maintained in the file of each participant receiving this service that the service is not available under a program funded under section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.). Federal Financial Participation is not claimed for incentive payments, subsidies, or unrelated vocational training expenses such as the following: 1. Incentive payments made to an employer to encourage or subsidize the employer’s participation in a supported employment program; 2. Payments that are passed through to users of supported employment programs; or 3. Payments for training that is not directly related to an individual’s supported employment program. This service does not include continuous, long-term 1:1 support to enable an individual to complete work activities.

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

N/A

Day Services provide structured day activities tailored to the participant’s specific personal goals and outcomes related to the acquisition, improvement, and/or retention of skills and abilities. Day Services are individually designed around consumer choice and preferences with a focus on improvement or maintenance of the person’s skills and their ability to live as independently as possible in the community. Day Services provide assistance to learn activities of daily living and functional skills; language and communication training; compensatory, cognitive and other strategies to compensate for functional limitations due to brain injury; interpersonal skills training; recreational/socialization skills training and skills training to negotiate and manage difficult or complex community relationships to prepare the individual to undertake various community inclusion activities. This service may reinforce, but not duplicate, other waiver and state plan services by allowing individuals to continue to strengthen skills, which are necessary for greater independence, productivity and community inclusion. Day Services/supports can be provided in a provider operated setting in the community, or, using a small group model, as individualized supports through a flexible array of community activities that promote socialization, peer interaction, and community integration. This service is primarily delivered in person; telehealth may be used to supplement the scheduled in-person services based on the participant’s needs, preferences, and goals as determined during the person-centered planning process and reviewed by the Case Manager during each scheduled reassessment. Day Services do not duplicate any services under the State Plan.

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

N/A

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