ARTICLE
QUESTION: Our question is about follow along services provided to individuals residing in Supervised Group Living (SGL) settings. Since there is no funding similar to what is provided for waiver recipients, how are other agencies capturing these costs? Are they having the SGL support staff provide the follow along services, the costs captured by Employment personnel and included during a re-basing year for the group home, or are the services provided as an unfunded service? Any feedback would be greatly appreciated. When our agency has an SGL individual that is ready for SEFA, they are successfully closed out of our Employment Services. SEFA is then provided by the SGL support staff, as the service is not a reimbursed service under that model. *** Although our agency does not operate any group homes, we do provide SEFA services to individuals who reside in group home settings operated by other agencies. We have contracts with those group homes and the group home (agency) reimburses us for providing those SEFA services. The rates built into these contracts are based on the waiver rates for SF10 and SF20. The group home pays for these services from the daily rate they receive for the individual(s). *** Our agency has addressed this scenario in two different ways: The residential/group home provider agrees to do the follow along after our agency has found the job and they are no longer in VR services. A clause is added in our contract with the residential/group home provider that if follow along is needed and our agency is to do it, the provider will pay us an agreed upon hourly fee for the service. This information must be explicitly stated in the individual’s ISP and the additional fee associated with the service is included in our monthly billing to the residential/group home provider. We have not had to address this often.
When our agency has an SGL individual that is ready for SEFA, they are successfully closed out of our Employment Services. SEFA is then provided by the SGL support staff, as the service is not a reimbursed service under that model.
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Although our agency does not operate any group homes, we do provide SEFA services to individuals who reside in group home settings operated by other agencies. We have contracts with those group homes and the group home (agency) reimburses us for providing those SEFA services. The rates built into these contracts are based on the waiver rates for SF10 and SF20. The group home pays for these services from the daily rate they receive for the individual(s).
Our agency has addressed this scenario in two different ways:
For individuals residing in a group home setting, group home and employment providers should negotiate a monthly reimbursement rate that would be part of their daily Medicaid per diem rate. This rate would most likely not exceed Tier 1 waiver rate, as this would allow the employment provider to provide 1-5 hours of monthly follow along services, which offers the individual the necessary supports to remain competitively employed.