Employment Service Systems Transformation – a National

Perspective

Genni Sasnett National Subject Matter Expert

MARO Spring Leadership Conference 2019Friday June 7

Traverse City, Michigan

Introduction –Your Presenter

Genni Sasnett

Former COO of St. John’s Community Services Subject Matter Expert for the Office of Disability Employment Policy (ODEP), the Institute for Community Inclusion, U Mass Boston (ICI) and other Public and Private Agencies

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Michigan’s Status

Language from Executive Order:All state departments and agencies that provide services and support to persons with disabilities, and all state departments and agencies that provide employment, economic development, or other related services, shall implement Employment First in Michigan by coordinating efforts and collaborating to ensure that state programs, policies, procedures, and funding support competitive employment within an integrated setting as the first priority and optimal outcome for persons with disabilities

Provider Transformation National View

Where is the support for transformation coming from?

ODEP - active in several states

ICI – research, training, state performance data

SELN – membership organization providing TA to states

States – individual initiatives, local funds, DD Councils

APSE, ANCOR & other industry associations – training,

national/regional conferences, CESP certification

ACRE – training and certification of qualified staff

Provider Associations – like MARO!

Provider Collaboration – providers pooling resources for training, etc.

This Photo by Unknown Author is licensed under CC BY-SA

ODEP Support for Employment First Nationally

• Strategic Guidance on policy/funding reform, and training on effective practices from a pool of national subject matter experts.

• Practice & Policy Reform: policy analysis; strategic planning; rate restructuring and resource braiding; service delivery coordination; cross-agency collaboration; and provider contract reform.

• Provider Transformation: vision/mission statement drafting; staff restructuring/decentralization; financial diversification; executive leadership mentoring; communications/marketing; and performance benchmarking.

• Capacity Building: training and ongoing coaching supports for front-line direct support professionals and management in the use and successful implementation of evidence-based effective practices.

• Peer-to-peer mentoring: access to peer experts from other state governments who have demonstrated success in implementing one or more key components of an Employment First is a critical ingredient to the EFSLMP model.

ODEP Support to Michigan • Policy Alignment – School to

Work Transition MOU and Pilots

• Provider Transformation –Direct TA to provider agencies

• Capacity Building – ACRE training, CE train the trainer training

• Rate restructuring -Development of sustainable, outcomes-based funding –Pilots occurring now

SELN Support Nationally

• Leadership, policies and goals

• Training and TA, including workforce development • Interagency partnerships and collaboration• Provider level organizational changes

• Communication Strategies • Financing, Contracting and Funding Realignment • Performance Measurement and Quality Management

• Services and Service Innovation• On-line Events• Public Forums

SELN Support To Michigan

• Support in the development of BHTEDS Employment Data Reporting

• Update and review of Medicaid Provider Manual

• Participation in:• Employment vignettes highlighting CM role in increasing employment

outcomes• COP calls focused on pay-for-performance• Provision of national perspectives on HCBS & other CMS initiatives

State General Fund Budget Allocation–July 2017 and July 2018

• State invests $500,000 to support Employment First implementation for FY 18 and FY 19

• Statewide Capacity Building• Provider Transformation• Rate Restructuring• Blending and Braiding Resources• School-to-Work• Employer Engagement• Outreach• Benefits Coordination and Planning

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E1st First Results, Nationally• Numbers of people in CIE rising slightly – (note, varies state to state)

• Numbers of people in facility-based work declining slightly, though as we get closer to 2022 (CMS Settings Rule Implementation date) this will likely accelerate

• Issuance 14c certificate applications has been almost cut in half (2008 - 2,540; 2017 –1089)

• WIOA having a significant effect, states and providers seeing imperative to respond to new market

• Community-based day services growing rapidly (mixed bag)

• States setting their internal standards in some areas. Example, prohibiting payment of sub-min., closure of workshops, time-limiting work on crews/enclaves

Results Nationally

Michigan Results2011

17,096 people served

• 23% integrated employment• 39.5% CB non-work• 26% facility-based work • 25% facility-based non-work

2017

17,185 people served

• 26% integrated employment• 79% CB non-work• 26% facility-based work• 28% facility-based non-work

E1st Positive Trends – States

• State level investment in transformation to CIE (capacity building)

• Policy Statements (executive orders, laws, position papers)

• Waiver revisions (services and service definitions) revisions and consolidation

• New funding strategies are being piloted and implemented (rate restructuring, pay for performance)

• Some improved cooperation among state level departments

• MCOs – learning about health benefits of employment and supporting CIE more

• Major focus on HCBS Settings Rule implementation – strong ties to E1st

• Establishment of quality standards for personnel (required training, CESP certification)

• Great impact (though uneven implementation) of WIOA

This Photo by Unknown Author is licensed under CC BY-SA

E1st Positive Trends – Provider Agencies, Nationally

• Acceptance of changes, seeking assistance

• Enthusiasm increasing for both CIE and CBSB and CB pre-employment training

• Voluntary elimination of 14c certificates

• Reorganization of agencies to accommodate new service delivery paradigm

• Generation of leaders at retirement, new generation coming into leadership

• HCBS Settings Rule is causing agencies to look at employment differently

Employment 1st Positive Trends-Michigan

• On-going ODEP/SELN support

• State level support –employment first statement and implementation funds

• Seamless transition pilots

• Capacity building underway• Mentoring program• Training programs (CESP

certification and T-T-T)

• Rate structuring pilots

Variables Impacting E1st

Sub-Minimum Wage Activity

Transformation to Competitive Employment Act

• State Transformation Grants to develop CIE & transition from 14(c) usage

• Grant program for current 14(c) certificate holders to transition their business models to support CIE

• National TA center to support states and providers making this transformation.

• Supporting the development of “wraparound” services, to support integration and community participation during non-work hours

Subminimum Wage and 14(c)11 States Introducing Legislation:

MT (HB588) – Prohibits subminimum wages for workers with disabilities

IL (HB3340) – Develop plan to phase out subminimum wage for workers with disabilities by 2024

NC (HB 366) – Raises wages over 5 years and ends subminimum for workers with disabilities

CT (H6739) – Prohibits employers from paying workers with disabilities less than state minimum wage

NY (S4018) – Eliminates exemptions for workers with disabilities from state minimum wage

KY (SB76) – Phase out of sheltered workshops and 14(c) certificates by 2021

OR (HB2313) – Elimination of subminimum wage & tax credits

HI (SB349; SB789 SD2/HB1191 HD1) – Elimination of subminimum wage; tax credit to offset increase in wages (House bill includes language related to workers with disabilities)

WV (HB2902/S659) – Establish an E1 taskforce and elimination of subminimum wage

WA (SB 5753/HB 1706) – Elimination of subminimum wage

NV City of Reno (A-15) – Elimination of subminimum wage in Reno

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These States Have Legislation Banning or Phasing Out Sub-Minimum Wages

• Alaska eliminated subminimum wage through a regulatory change that went into effect on February 16, 2018.

• Maryland – HB 420 / SB 417 became law in May 2016 phasing out special wage certificates.

• New Hampshire – SB 47 passed in May 2015 banning employers from paying workers with disabilities less than the minimum wage

• Vermont – Vermont began moving toward integrated employment in the early 1980s. It closed its last sheltered workshop in 2002.

• The city of Seattle, WA passed CB 119220, removing the authority to pay subminimum wage. Washington state allows subminimum wage.

• The city of Reno, NV has passed resolution D. 1, that prohibits the payment of subminimum wages.

Recommendations of WIOA Advisory Committee on Increasing CIE

• Amend Section 14(c) of the FLSA to allow for a “well-designed, multi-year phase-out” that results in people with disabilities entering CIE

• Stronger enforcement of 14(c) certificates; strict standard for issuing and renewing certificates

• Federal agencies coordinate and provide technical assistance to states to assist with CRP/provider transformation from sheltered workshop to CIE

Recommendations Ability One

• SourceAmerica is fully committed to maximum pay for people with disabilities and supports the elimination of Section 14(c) of the Fair Labor Standards Act for all AbilityOne employees. As such, SourceAmerica will leverage the knowledge and experience of its nonprofit network and will invest significant resources toward a transition support program, which will include:

• Financial assistance to transitioning non-profits;

• Enhanced productivity engineering supports: and• Research and data collection that will inform

Congress about the implications of the transition for individuals and communities across the nation.

Dr. David Mank’s Article re: Funding E1st

http://thecpsd.org/its-time-to-help-states-build-capacity-to-provide-competitive-employment-for-all-people-with-disabilities

Michigan Status

No known action on sub-minimum wages

HCBS Settings Rule

Implementation Date, March 2022 The final rule requires that all home and community-based settings meet certain qualifications. These include:

• The setting is integrated in and supports full access to the greater community; • Is selected by the individual from among setting options; • Ensures individual rights of privacy, dignity and respect, and freedom from coercion and restraint; • Optimizes autonomy and independence in making life choices; and • Facilitates choice regarding services and who provides them.

This Photo by Unknown Author is licensed under CC BY-NC

Michigan’s Status

State Transition Plan was submitted August 2017

Initial Approval August 10 ‘17

Initial Approval Addendum August 14, 2018

No Final Approval to date

13 states with final approval currently (AK, AR, DE, DC, ID, KY, MN, ND, OK, OR, TN,WA, WY)

Workforce Innovation and Opportunity Act

• Increase employment of people with disabilities in integrated employment settings

• Significantly limit the use of 14(c), particularly for transition-age youth

• Defines and prioritizes integrated employment as work at or above minimum wage, with wages and benefits comparable to people without disabilities and fully integrated with co-workers without disabilities

• Limits entry into sheltered workshops: Anyone under 24 must try integrated employment before being placed in a subminimum wage setting; schools cannot contract with subminimum wage providers

Michigan Response Seamless Transition – FY 19

• TA to additional ISDs for more “seamless transition” sites

Four existing sites ‘refresher’ training & more TA

Two new pilot sites

• Field-based technical assistance to support team members In acquiring necessary skills

• Monthly conference calls and/or webinars for all existing and new pilots

Our Work Ahead

E1st Challenges

• Support Coordination (inadequate training and support for staff)

• Finance (dollars allocated don’t match services to be provided)

• State agency coordination (frustrations with lack of coordination and cooperation between VR and state MH and ID/DD agencies)

• Staffing shortages and availability of training

• Transportation

• Leadership grasping paradigm shift from making work to matching to work

Leadership

Change does not occur without strong and committed

leadership, period!

We must identify and develop a new generation of such leaders.

MI response – MARO leadership training, ODEP Vision Quest –Strategic Planning to move forward with EF implementation

This Photo by Unknown Author is licensed under CC BY-NC-ND

As we become more untethered to facilities through placements in community integrated employment and meaningful community integration, we need more staff in a time of national staff shortages.

We must find ways to adequately compensate and support in order to attract additional people to our field.

MI response: ODEP Provider Transformation DSP Focus -maximize retention and recruitment

Systems Alignment

Misalignment of systems, particularly vocational rehabilitation and ID/DD, MH agencies, is frustrating, costly, inefficient and ineffective

We must insist on better alignment and common cause among critical systems.

MI response: ODEP Vision Quest – Strategic Planning to move forward with EF implementation

External support to states for transformation may not be available forever.

We must develop internal capacity within our states for staff training and development, provider transformation, peer mentoring

MI Response: Statewide Capacity Building – FY 2019 (training, provider transformation, mentoring program)

Existing funds are often inadequate and outdated funding structures don’t always reward the outcome of CIE

We must continue to advocate for reasonable funding & rate restructuring that incentivizes CIE and meaningful community integration.

MI Response: Rate Restructuring & Provider Transformation Initiative –FY '19

Summary • A great deal is happening both nationally and at the state level to

forward E1st

• Results so far are showing some positive trends but there is more to do

• Many variables are at play in the transformation of employment services for people with disabilities, but all seem to be pushing in the same direction

• We must be vigilant in our advocacy to keep moving forward!

Questions ??