SECTION 340:100-17-25. Community integrated employment services

(a)   Community integrated employment (CIE) services promote independence through paid work and training activities. CIE services allow service recipients to engage in gainful integrated employment. CIE services are:

(1)   delivered in integrated settings in the community by contract providers;

(2)   provided to eligible service recipients 16 years of age or older who are not:

(A)   eligible for reimbursement by Oklahoma Health Care Authority (OHCA) through Home and Community-Based Services Waiver employment services; or

(B)   residing in a private intermediate care facility for persons with mental retardation (ICF/MR); and

(3)   available to service recipients 16 to 21 years of age who have not completed eligibility for services provided through Individuals with Disabilities Education Act (IDEA). The service recipient may receive CIE services when school is not in session, if the service recipient is not participating in an Individual Education Program (IEP) that includes extended school year services through his or her school.

(b)   Access to CIE services is contingent upon sufficient Oklahoma Department of Human Services (OKDHS) resources and written determination of eligibility per OAC 340:100-3-1.

(c)   The provider agency:

(1)   may use, prior to placement, up to 20 hours for assessment and up to 40 hours for job development;

(2)   after placement, provides, as needed, job site training, technical assistance to the employer, job adaptation, participation in Personal Support Team meetings, benefits planning, and transportation to and from the work site. These services are reimbursed when the job coach is with the service recipient;

(3)   ensures the service recipient is paid in accordance with United States Department of Labor (USDOL) wage and hour regulations for work performed;

(4)   ensures the service recipient's employment plan includes specific employment outcomes and action steps;

(5)   ensures all CIE services are provided by job coaches who complete required training per OAC 340:100-3-38;

(6)   may bill for CIE services rendered prior to determination of eligibility when CIE services are authorized in an employment plan and the service recipient is ultimately determined eligible; and

(7)   receives reimbursement for providing CIE services to only one service recipient at a given time.

(A)   This does not preclude CIE services from being provided to service recipients in group settings.

(B)   For example, one job coach simultaneously providing CIE services to three service recipients for three hours may only claim three units of reimbursement, not nine.

(d)   CIE services include reimbursement for securing individual gainful employment, individual follow-along, and group placements.

(1)   The provider agency must secure gainful employment in a job paying at least minimum wage for service recipients, in accordance with the current contract for CIE services.

(2)   Follow-along services are available to service recipients who were successfully placed in CIE services or who completed stabilization in Oklahoma Department of Rehabilitation Services supported employment program during the prior contract year. Reimbursement for follow-along services cannot exceed amounts specified in the contract for CIE services.

(3)   The provider agency may provide integrated group placements of two or more service recipients in gainful integrated group employment and claim in accordance with the contract for CIE services. Group placements:

(A)   may pay at or more than minimum wage or commensurate wages in accordance with USDOL wage and hour regulations; and

(B)   cannot exceed eight service recipients.

(e)   Payment for CIE services is only disbursed following the delivery of authorized CIE service to eligible service recipients.

(1)   To receive payment, the provider agency submits to the DDSD area office a claim for CIE services rendered and any supporting documentation required by OKDHS. Claims may be submitted on the provider agency's invoice or Form 10AD012E, Claim Form, and must include:

(A)   service recipient's:

(i)   legal name;

(ii)   case number;

(iii)   date of birth; and

(iv)   Social Security number; and

(B)   category, amount, rate, and date of CIE service delivered to the service recipient.

(2)   The provider agency maintains documentation available for review that documents:

(A)   service recipient's:

(i)   legal name;

(ii)   case number or Social Security number;

(iii)   date of birth;

(iv)   progress toward outcomes;

(v)   wages earned; and

(vi)   hours worked; and

(B)   type and date of CIE service

delivered to the service recipient.

(3)   Claims for reimbursement of CIE services must be submitted within 90 calendar days of service provision. Supporting encumbrances may be cancelled upon a lapse of six months from the actual provision of CIE services.

[Source: Added at 22 Ok Reg 882, eff 5-12-05; Amended at 25 Ok Reg 986, eff 5-15-08]