RBF Vocational Rehabilitation Things to Answer or Consider
Q. In times past, VRC’s could decide NOT to authorize for retention under PBP. Could this happen under RBF? Could they decide to do it themselves and not pay the vendor?
A. No. All Milestones will be paid as they are achieved.
Q. If clients are put on hold and they eventually come back, do you have to do a new plan?
A. The plan may need to be amended to reflect changes needed.
Q. What is the difference between CBE and trial work? How does it show up differently on an authorization?For CBE as part of Milestone 1: is this only for assessing job skills under RBF so you can finish the plan or does this include VRC’s determination of whether the person can benefit from VR Services. If they are separate, do we bill hourly for the times when VR wants to determine if a person can benefit from their services?
A. The authorizations would be the same, but Trial Work is used by counselors to assess whether an individual may be too severe to benefit from VR services.
Q.Will VR still sponsor a CBE to determine a customer’s vocational goal? Will the CRP be paid an hourly rate? Is there a limit to the number of evals and hours?
A. CBEs will be a part of Milestone 1 when the team agrees that they have questions that a CBE will answer prior to job search. This is limited to three, 10 hour evaluations. If more is needed, it will be paid on an hourly basis.
Q. If the provider believes after working with someone in RBF that they aren’t employable—who decides when and if services should be stopped?
A. This needs to be discussed as a team. The counselor can determine whether services need to be terminated. The CRP should be able to explain why they feel that the person is unemployable.
Q. If VR requires us to do 2 or 3 trials/evals as a part of RBF, do we do the plan 1st to include those expected trials & then revise the plan once the trials are done or do we do the plan after the trials have been completed?
A. The evaluations would be done first and then the plan completed.
Q. Can someone be switched from Tier 2 to Tier 1 in the middle if we find they require more support than we initially thought?
A. This would be discussed with the counselor and if appropriate information shows that the individual will require on going supports to maintain employment, the Tier could be changed.
Q. Will there be extra incentives for people placed in jobs 30 or more hours per week or for placing extremely challenging clients?
A. Not at this time.
Q. Right now VR clients interview providers to choose who they want to work with—with RBF we would like to be more selective about who we want to work with. How can we make this happen since at times we get a referral without ever even having heard the client’s name?
A. You will need to work out a procedure with your local office. This information should also be presented to each customer that with this vendor they will be interviewed to determine whether they will be accepted.
Q. Is VR requiring a CBE on everyone in RBF?
A. No, only if the team agrees that there are questions that could be answered through an evaluation.
Q. If we have issues with something a VR Counselor is doing or not doing, and we follow the system VR encourages us to use to make a complaint, what assurances do we have that there will NOT be referral impacts from the counselor?
A. If you see that there is an impact on referrals this should be discussed with the Region Manager.
Q. I know VR says counselors cannot require meetings. We have already been told by a counselor that she would like to continue the monthly meetings. If we don’t think that is necessary, what is to keep her from using another provider that will have the monthly meetings?
A. If you feel that the counselor is not referring for this reason, the Region Manager needs to be contacted.
Q. Can we be given collateral information about consumer ability to obtain employment from VR Counselor?
A. VR should be sending collateral information at the time of referral.
Q. For a person you inherit from another provider who already has a plan (1st milestone): do you get “up to 6 hours” to get to know the person yourself or a “standard 6 hours” to get to know the person your self and is there a specific form that you fill out to get paid for this six hours?
A. VR will pay 6 hours. There is no standard form, but the CRP should send a report that they have reviewed the plan.
Q. VR says we can do CBEs and not pay people but is that legal?
A.INARF had distributed some information in the past few years concerning this. We would suggest that you contact them.
Q. Is there a way to get eligibility determined faster for CMH clients?
A. Providing the needed information to VR would help this process. Please consult with your local office.
Q. Will there be a standardized referral form for agencies to refer to VR? This will help alleviate discrepancies of Tiers and expedite eligibility if information is provided up front to VR.
A. We have not developed a form for agencies to refer individuals to VR.
Q. Can we receive back payment for Milestone 1 for a case that was transferred from Northern Indiana to West Central Indiana? The plan was poorly written and NOTHING except vocational goals was pertinent to this local. We received payment for 6 hours but since the plan was completely re-done, can we now receive Milestone 1 payment?
A. This change was one of the clarifications that came about for the start RBF for July 1, 2006. No, we can not go back and pay for this.
Q. Will VR consider decreasing the required times for VRC’s to complete intake process/eligibility—3 months is too long if information is provided up front from a vendor?
A. VR is committed to determining eligibility in the least amount of time as possible. Policy states that VRC is to complete certification within 10 days of having receipt of the needed documentation for eligibility. Actual referral for placement services can take longer than the determination of eligibility due to customer choice of vendor, etc.
Q.Will there be a standardized form for requesting authorizations or does email policy suffice? What needs to be included in the email?
A. The email needs to state what the authorization/supplement is needed for and for whom it is needed.
Q. What happens when you do NOT get an authorization in a timely manner and that impacts a payment point being paid or denied?
A. If you do not have an authorization for a service, contact the counselor and if not received in one week, contact the supervisor.
Q. Can you turn in a billing sheet without RS-1?
A. You should not be providing services without a current authorization.
Q. Clarify CBE folded into Milestone 1 v. a separate service that can be purchased.
A. If the assessment is to be short term then it is included in Milestone 1, but if it is expected to be longer than 3 - 10 hour assessments, then would be authorized on an hourly basis.
Q. Clarify use of the BIN. Is there a requirement to go through the BIN?
A. If there is a list of longer than 2 weeks for a customer to be seen by the BPAO specialist, then a referral and authorization for the service should be made to the BIN.
Q. What can we expect from VR regarding a timeframe from eligibility determination to issuing the RS-1 for Milestone 1 to begin working with the consumer on the assessment?
A. That varies according to the individual customer. As stated previously, the customer must make an informed choice of vendor for services.
Q. Who pays a CommunityMentalHealthCenter for the time to gather the required info to provide to VR so they can make an eligibility determination?
A. If a customer comes to VR and we need to obtain collateral information, we will send a release. If the agency charges for records, we can authorize for this.
Q. What happens when it takes a lot of time to gather requested info for DDRS application (i.e., written medical evidence) and that slows the Notification to FA and subsequent closure date payment?
A. Question is not understood. Please contact your local office so this can be discussed.
Q. There is no place for VRC names on forms. Also you have to add name and address for agency/vendor.
A. True, each agency must add their name and address to the form.
Q. What about the client who enters the program, gets to Tier, accepts job and then disappears! Do we receive payment for this? After all—there has been a great deal of time spent on this individual.
A. Does the question mean gets to MILESTONE? If so, VR pays for any Milestone that has been completed.
Q. Must you have a prior authorization before billing? What if they meet it beforehand (because it takes a long time to get the authorization)?
A. A CRP should not be providing services and can not bill VR without having an authorization for that service.
Q. Who will be paying for the interpreter services (hourly?).
A. VR will pay for needed interpreting services.
Q. When getting a referral, will it be sent directly to the program or the billing department?
A. Referrals will be sent to the program staff person who has been identified as the contact person for referrals.
Q. On the referral form, it would be helpful to have the name of the agency the counselor is referring to (we’ve had referrals go to one organization while the authorization went to another).
A. Will take this suggestion into consideration.
Q. Will VR provide authorizations in a timelier manner?
A. VR will process authorizations within 3-5 days from the time they are aware that a new authorization is needed.
Will individual counselor interpretations as to what can be authorized for be eliminated? Will this really address the VR inconsistency?
Can you standardize definitions for the goals (e.g., “service worker”) so we can know if a job meets the definition?How specific will job goals be? We need to make sure we’re on the same page so we aren’t blind-sided. Goals need to be specific. As stated, "service worker" as a dishwasher may be appropriate, yet service worker as a janitor, may not be. Everyone should agree as to what job titles are being pursued.
Could counselors include middle initials when referring (we have a number of people that share the same first and last initials). That will be suggested for common names.
If I (as a VRC) sends a person to a facility for a voc assessment and that assessment is much more detailed and time consuming than the “meet and write a plan” type, I can authorize on an hourly basis (vs the Milestone basis), correct? And, who decides that—me? The facility? The VRC decides if they need a longer assessment than is provided for under Milestone 1 and refers and authorizes as appropriate on an hourly basis.
Will there still be placement reports? If so, can it be emailed? There is no placement report, the information on the placement (wages, hours, etc.) are identified on the payment verification form.. When a job is found discussion should occur with the customer and VRC to ensure that this is an appropriate job.
To qualify for Tier I, must a need for follow along/extended services be determined to last 9 mos. Or more from plan to closure? To be Tier I, the customer must be MSD and require on going services to maintain employment.
I am concerned about not receiving authorizations in a timely manner. We need more timely authorizations.Are authorizations or supplements submitted automatically or is it the vendor’s responsibility to ask (beeeegggggg) for another authorization? We NEVER receive the supplements we request. If you have requested an authorization and not receiving it timely, please notify the supervisor.
Do employment consultants request authorizations & if so, is there a certain form you would like us to use? There is no form, email the counselor and the counselor's secretary and if no response in one week, contact the supervisor.
We need to document very well the time and # of job trials used to get the plan so we can justify getting authorized hours for assessment? Up to three 10 hour job trials are a part of Milestone 1.
How about VR hosting the billing site online & agencies input Milestones for payment with access code (like Med Waiver)? We can not do that at this point in time.
What if someone is promoted before closure? Do providers still get closure payment?
What is the difference between Tier I and Tier I Supported Employment?
On the referral form from VR there is no listing for emancipation. This is very awkward when making the initial contact as a vendor. Can this be included in the form? This should be included in concerns/issues.
Will clients be pre-screened for employment before referred to agencies (i.e. criminal background checks)? Needs to be consistent with referral packet. VR does not do criminal background checks on customers. If a customer has told the counselor of a prior criminal history that will impact placement, the counselor will note this on the referral form.
Why is closure recommended at 60 days for Tier I and 90 days for others? It is 60 days after stabilization for SE customers and stabilization can not occur prior to 30 days, but may be longer. These are Federal regulations.
“Arguments” between VR & CRP/CMHC will change. For example with RBF: What if customer gets own job? Perception of lack of time spent job developing…
There is lack of consistency among VRCs in being available for appointments.
I am concerned about the credibility of the profile.
Should the IEP be written before the profile is done?
We need a way to give feedback on problems with VR without a backlash and no more referrals.
I am concerned about inconsistency from VRC to VRC regarding the severity of disability for determination purposes.
What is the value of the profile if the provider is told plan is already written and there is no need for a profile?
What further analysis and problem solving is being done regarding 40% “drop out” before plans are written?
What about the two to three weeks it takes for a plan to be signed by an area supervisor? Supervisors have 5 days to turn around plans. If this is causing a delay, please notify the Region Manager.
Who determines the amount of hours/the amount of time allotted on an authorization? The VRC, with input from the CRP as to recommendations for time needed.
What if VRCs won’t refer to us because we won’t have monthly staffings? What if VRC’s won’t refer to us because we want to keep having monthly staffings? If you are aware that either situation is actually occurring, this needs to be discussed with the Area Supervisor.
Won’t we still have monthly staffing reports that are required? No
We need to have a CLEAR definition of when Milestone II is billable.
What will be the recommended range of hours for the development of the plan? There is no recommended range of hours because this is not billed on an hourly basis.
Has the MRO billing issue been resolved? Not sure what the billing issue is. Please consult with Area Supervisor and/or SECT.
I am concerned about our ability in this area to work as a team because VRCs treat employment consultants as their employees rather than as their colleagues. How can we turn around the rift between VRCs and ECs? VRC’s seem to have a very negative attitude toward ECs and lack professionalism and respect in their dealings with the ECs in this area.
Our clients are often steered away from their choice of EC or vendor by VRC who doesn’t like that particular EC or vendor. How will RBF insure client choice?
There can be over-involvement of VR in counseling/clinical issues of clients within our community mental health program but we are afraid of repercussions should we say something about it. What can we do?
With the plan being so important, will VRC be more available for intake to get the client started? Not sure how to address "more available". The CRP should contact the counselor and together work out a time that is also agreeable to the customer to meet to develop the PES.
- If someone is currently in the VR system under Community Based Work Evaluation and then VR moves them to JP or SE after July 1st, 2006, do they put them in hourly JP or hourly SE or do they put them in the tiers through RBF?
- Are multiple placements possible—1, 2, 3 people at one large company? Can one support person provide services to them?
- What are the follow along hours required per month on RBF?
- In a good economy, RBF works well in the early stages but in a slow economy, or in economically distressed areas, it looks like RBF will penalize vendors…The system looks like the payments are too bottom-loaded.
- What exactly is required in terms of daily, weekly, monthly documentation?
- How long will it take a client to come back through VR once he’s lost his job?
- Are you saying we don’t have to do one-on-one anymore? We can do group practice for interviewing and other JD training? Is this a breach in confidentiality?
- How long will a request for services take before VR makes it’s referral back to our agency?
Overall questions
Will there be instructional sheets for each form? There will be an instructional guide for the PES.