Section H – Interagency Cooperation SRC: The SRC supports and commends DVR in their efforts to foster collaborative relationships and coordinated services with the Office of Aging and Disability Services and the Office of Substance Abuse and Mental Health Services, as well as in connecting VR consumers with Benefits Counseling Services. However, the SRC recommends that DVR undertake outreach efforts with the Office of Family Independence, which is responsible for determining eligibility for MaineCare, Maine’s state Medicaid plan. All services from OADS and SAMHS flow from MaineCare eligibility, and OFI policy changes and initiatives greatly impact service provision and employment outcomes for VR consumers. As such, VR consumers would benefit greatly from education and involvement of OFI officials in the coordination of services to support employment for people with disabilities. (Page 226)
SRC: In section on “Interagency Support of Benefits Counseling”: Additionally through its collaboration with DHHS and specifically the coordination of Maine’s benefits counseling network DVR has been able to develop opportunities and overcome barriers to competitive integrated employment for individuals with visual impairments who are eligible for MaineCare, the State’s Medicaid program.” How are these individuals being served through DBVI? What role does DVR play?
AGENCY RESPONSE: Just as DVR clients are able to access Benefits Counseling Services and be served with provisions through MaineCare, DBVI clients are able to participate in and benefit from these services. Some examples of utilizing MaineCare to overcome barriers to employment are mental health counseling; low vision evaluations; personal support services. (Page 231)
AGENCY RESPONSE: The Maine Department of Health and Human Services (DHHS) is proposing to make changes to some MaineCare services through a 1915 (i) State Plan Amendment, also known as an iSPA. In this iSPA, Maine intends to streamline delivery systems and prioritize community and work–based habilitation support for adults. An iSPA provides states with greater autonomy and flexibility for providing services to Medicaid members while maintaining compliance with the federal Centers for Medicare and Medicaid Services (CMS). The proposed changes will affect the following sections of MaineCare policy: Section 2, Adult Family Care Services; Section 17, Community Support Services; Section 26, Day Health Services; Section 97, Private Non–Medical Institutions DHHS is also proposing to add the following services to the MaineCare Benefits Manual: Benefits Counseling; Career Planning; Psycho–Social Club House; Residential Habilitation; Supported Employment–Individualized (O) State’s Strategies (Goals 3, 4 and 5) (Page 234)
AGENCY RESPONSE: There are increases to spending in services provided to clients through the Milestone payment process; likewise, there are benefits and improvements noted. A more thorough evaluation of the costs and benefit analysis and a determination to make adjustments to the existing process will be forthcoming. (Page 235)
DVR continues to work closely with many other state partners to ensure that Maine’s benefits counseling services remain available to beneficiaries of SSI/SSDI, and specifically, DVR applicants and eligible clients. This allowed the services to remain intact while a resolution was determined on a federal level as to the continuation of this critical service in 2013. DVR currently administers a single contract with Maine’s approved WIPA provider, Maine Medical Center’s Department of Vocational Services, which includes funding from four sources of state and federal funds, including from the Division of Vocational Rehabilitation, Division for the Blind and Visually Impaired, Office of Substance Abuse and Mental Health Services, and Office of Aging and Disability Services. The contract’s scope of work includes direct service provision of benefits counseling, training of VR counselors and case managers, and service capacity building through quarterly system development network meetings, which include representatives from the Disability Rights Center’s Protection and Advocacy for Beneficiaries of Social Security (PABSS) and the Bureau of Employment Services’ Disability Employment Initiative (Page 241-242)
Through its collaboration with DHHS and specifically the coordination of Maine’s benefits counseling network DVR has been able to develop opportunities and overcome barriers to competitive integrated employment for individuals with visual impairments who are eligible for MaineCare, the State’s Medicaid program. DVR entered into the Ticket to Work Partnership Plus agreement with the Bureau of Employment Services in July 2014. The purpose of this agreement is to strengthen the partnerships within CareerCenters in the provision of vocational rehabilitation and employment and training services to individuals with disabilities seeking employment in Maine. This agreement expands service options and the overall capacity of Maine’s workforce investment activities and offers individuals the opportunity to achieve employment outcomes, decrease reliance on public benefits and increase personal economic assets and resources. (Page 251)
As outlined in Section 606 (Employment of Individuals with Disabilities) of the Individuals with Disabilities Education Improvement Act, Maine DVR continually makes "positive efforts to employ and advance in employment qualified individuals with disabilities in programs assisted under this title". Currently 25 Transition VR Counselors are assigned to work with the more than 200 Maine High Schools, as well as with out–of–school youth and youth attending private institutions. Transition–aged youth represent nearly one third of all DVR cases in Maine and one of the fastest growing populations served by DVR. Maine DVR has a Statewide Transition Counselor Advisory Group that meets quarterly to promote best practices in the provision of VR transition services. During the last year, this group heard from a number of guest speakers on disability and employment issues – including benefits counseling – and focused much of its efforts on WIOA (Page 260)
- In addition to providing ongoing employment support to more than 200 employed individuals with mental illness through contracts with CRP’s, the DHHS Office of Substance Abuse and Mental Health Services (SAMHS) has a number of initiatives currently underway to promote employment among the individuals they serve. SAMHS and OADS are coordinating the use of Balancing Incentive Program funds to increase system capacity to support individuals with disabilities on the path to employment. This initiative includes training for Work and Benefits Navigators, an Employment 101 curriculum, and training in Individual Placement and Support /Supported Employment (Page 262)
- In addition to providing ongoing employment support to more than 200 employed individuals with mental illness through contracts with CRP’s, the DHHS Office of Substance Abuse and Mental Health Services (SAMHS) has a number of initiatives currently underway to promote employment among the individuals they serve. SAMHS and OADS are coordinating the use of Balancing Incentive Program funds to increase system capacity to support individuals with disabilities on the path to employment. This initiative includes training for Work and Benefits Navigators, an Employment 101 curriculum, and training in Individual Placement and Support /Supported Employment. (Page 293)
REPORT ON PROGRESS: Monitoring of expenditures and employment outcomes is occurring; a detailed analysis is in early stages with the assistance of Management Analyst II hired during FFY 15. Using the Community Rehabilitation Provider (CRP) expenditures from SFY 2012 as a baseline and comparing it to SFY 2015 expenditures, there was an increase of total expenditures for CRP services of $655, 453; which equates to a 22.5% increase in spending. Using the same baseline data information, comparing SFY 2012 to SFY 2015, 263 less clients were referred to and received services from CRPs and there were 9 less CRP successful closures. Cost per successful closure was $11,345 in SFY 2012 and $14,412 in SFY 2015 or in an increase per client of $3,067. Costs for all clients served by CRPs in SFY 2012 were $1,169 and in SFY 2015 $1,602, an increase of $433 per client. Improvements were noted in service time length from Eligibility to Employment and from Eligibility to Closure during the same SFY comparison and closure trends showed an increase in the rehabilitation rate, comparing successful closures to unsuccessful closures, of 5.7% points. Another area of note is the number of authorizations created by Support Staff during the same time period decreased by 1,275; this demonstrates a decrease in workload for administrative staff within the agency and has implications for improvements throughout the State of Maine payment system and process. As noted above, there are increases to spending in services provided to clients through the Milestone payment process; likewise, there are benefits and improvements noted. A more thorough evaluation of the costs and benefit analysis and a determination to make adjustments to the existing process will be forthcoming. (Page 297)
Additionally, DBVI/DVR, OADS and SAMHS have developed and are implementing joint approaches to the workforce development of community rehabilitation providers and business engagement throughout the state.
- Interagency Support of Benefits Counseling DBVI/DVR continue to work closely with many other state partners to ensure that Maine’s benefits counseling services remain available to beneficiaries of SSI/SSDI, and specifically, DBVI applicants and eligible clients. This allowed the services to remain intact while a resolution was determined on a federal level as to the continuation of this critical service in 2013. DBVI/DVR currently administer a single contract with Maine’s approved WIPA provider, Maine Medical Center’s Department of Vocational Services, which includes funding from four sources of state and federal funds, including from the Division of Vocational Rehabilitation, Division for the Blind and Visually Impaired, Office of Substance Abuse and Mental Health Services, and Office of Aging and Disability Services. The contract’s scope of work includes direct service provision of benefits counseling, training of VR counselors and case managers, and service capacity building through quarterly system development network meetings, which include representatives from the Disability Rights Center’s Protection and Advocacy for Beneficiaries of Social Security (PABSS) and the Bureau of Employment Services’ Disability Employment Initiative.(Page 336)
- DHHS Office of Substance Abuse and Mental Health Services and DVR MOU (updated August 2013) “This Memorandum is intended to guide the Maine Department of Labor’s Bureau of Rehabilitation Services (BRS), through its Division for the Blind and Visually Impaired and the Division of Vocational Rehabilitation, and the Maine Department of Health and Human Services (DHHS), through its Office of Substance Abuse and Mental Health Services (SAMHS), in the course of planning and implementing an aligned service delivery system that promotes evidence–based practices. It contains information about policies and processes that pertain to maintaining and enhancing the relationship between these two entities.” Additionally through its collaboration with DHHS and specifically the coordination of Maine’s benefits counseling network with BRS, DBVI has been able to develop opportunities and overcome barriers to competitive integrated employment for individuals with visual impairments who are eligible for MaineCare, the State’s Medicaid program. (Page 345)
At this time, approximately 3,000 working-age MaineCare waiver recipients are not working but are being asked about their interest and desire to move toward employment. Additionally through its collaboration with DHHS and specifically the coordination of Maine’s benefits counseling network, DBVI has been able to develop opportunities and overcome barriers to competitive integrated employment for individuals with visual impairments who are eligible for MaineCare, the State’s Medicaid program. (Page 346)
BRS entered into the Ticket to Work Partnership Plus agreement with the Bureau of Employment Services in July 2014. The purpose of this agreement is to strengthen the partnerships within CareerCenters in the provision of vocational rehabilitation and employment and training services to individuals with disabilities seeking employment in Maine. This agreement expands service options and the overall capacity of Maine’s workforce investment activities and offers individuals the opportunity to achieve employment outcomes, decrease reliance on public benefits and increase personal economic assets and resources. (Page 346)
The worker receives the same pay and health benefits as other workers, but does not accumulate seniority time. If at any time during this year the supervisor deems the worker has performed their duties satisfactorily, he/she will be placed in the position as a new employee and the usual probationary period will begin. A unique feature of this initiative is that the Human Resources Department throughout all of state government is centrally connected to this process, which allows for people with disabilities from anywhere within the state to be contacted at the very first point the state becomes aware that there will be an open position. In this manner we can recruit from across a comprehensive network to fill vacancies within DBVI, as long as they meet the qualifications of our position. The Division has one employee that began state employment by utilizing the special appointment process. It has proven to be a very successful job match for this individual challenges. (Page 354)
The report discusses a variety of benefits related to local access to center–based, immersion model blindness rehabilitation as a key component of Maine’s overall delivery system. The most important of these advantages is the ability to provide immediate, comprehensive training and application with a wide variety of fundamental and essential blindness skills and devices. Being able to provide this comprehensive training in this fashion can increase the pace of acquisition of these basic blindness skills which then will decrease the time needed between eligibility for DBVI services to being prepared to integrate these newly learned skills into an employment setting. (Page 363)
Average cost per closure in FFY 2012–2014. The bottom–line in determining cost benefits with regard to rehabilitation services is what it costs an agency like DBVI to provide services and successfully close an individual who needed those services. The following table details average costs per closure based on information drawn from the DBVI case tracking system; (Page 377)
Limited transportation makes it hard to find and keep an appropriate job. In addition to contributing to the high poverty levels among people with disabilities, unemployment in its turn, combined with disability benefits that are too meager to provide discretionary income, make the available transportation unaffordable. Gaps in transportation also entail social costs, including reduced access to blindness services, especially for clients living in the more remote areas. (Page 385)
Six individuals were employed and they indicated their job income was the primary source they relied on to pay their daily living expenses. Four individuals received retirement benefits, five received SSDI benefits and six received SSI benefits that they used to contribute towards their living expenses. (Page 390)
Rehabilitation Counselor I (ILS) 2 1 Total Responses 42 Staff Perceptions of the Needs of People with Visual Impairments. The staff’s responses to a query about what they believed the greatest needs of people with visual impairments in Maine were unsurprisingly similar to responses received in the consumer and staff focus groups. They believed that access to transportation and employment were the greatest needs, followed closely by access to assistive technology. The next cluster of items were access to personal adjustment counseling, peer support, and disability–specific skills training. The third cluster of items included access to computer training, low vision device fitting and training, career development, education and training options, and job search skills training. The final cluster included access to information, housing, mental health counseling, benefits counseling, and medical interventions. Table 3.11 presents all of the staff responses concerning the greatest needs of people with visual impairments in Maine. Table 3.11 Greatest Needs of People with VI in Maine % n Access to transportation 83 39 Access to employment. (Page 397)