Determine the need for a Supported Employment Plan   

Once a person is eligible and in an open priority category (or comes off the waiting list), consult with them, their authorized representative (as applicable), referral source, and others involved in supporting the client, such as the DD service coordinator and other service providers, as applicable, to discuss the need for supported employment services to reach an employment outcome.  

Support the client in selecting a provider based on informed choice. 

If the client has not yet chosen a supported employment provider and there is more than one provider to choose, share the list of supported employment providers with the client.  Offer assistance in contacting the provider to arrange interviews or tours, as needed. Document in a task note how the client was provided the opportunity to make an informed choice of providers.

 Progressive Employment

Determine whether Progressive Employment (PE) activities (job shadowing, informational interviews, volunteer opportunities, individual and group business tours, mock Interviews with employers, or OJE) will be helpful in keeping the person engaged and obtaining important information for IPE development.  If the client needs on-site support to participate in these activities, discuss with the client’s chosen provider and authorize “Job Coaching” for the number of hours the client requires support for each PE activity.

Discuss and identify Assistive Technology (AT) needs: 

Refer, as applicable, for Assistive Technology Partnership (ATP) evaluation and services.  Such referral may occur anytime while the case is open, from assessment to job placement to identify and obtain needed accommodations. A referral may also be made after placement to support the resolution of problems that affect work performance or productivity in support of job maintenance and retention. 

See additional procedures in the Career Planning chapter

    Authorize Category: Career Planning – Support: Discovery

Discovery may be authorized when a customized employment (CE) plan is being considered.  Contact the Program Director for Supported Employment prior to proceeding with this service.  

Refer the client to the selected SE provider and authorize for Career Planning – Discovery ($1,464).  This service can be authorized for up to 60 days. 

Discovery requires completion of the VR Profile for Customized Employment. The profile includes a series of interviews, records review, and completion of progressive employment activities with three different employers. These activities need to reflect the client’s vocational interests and preferences. 

Once the VR Profile is obtained from the SE provider, make sure to review the document to ensure that it is completed.  Convene a team meeting including the client, authorized representative (as applicable), SE provider, DHHS service coordinator (as applicable), and any other relevant parties that support the client.  Review the information and recommendations of the VR Profile.  An IPE can be developed at this meeting if a customized job goal is identified. 

IPE Development:  

Develop the IPE based on the client’s strengths, needs, interests, abilities, preferences, and choices, and determine the number of hours the client plans to work.

Convene a meeting including the client and as applicable the authorized representative, staff from the individual’s chosen SE provider agency, DHHS service coordinator, and any other people selected by the individual to attend the meeting. 

Add applicable IPE services (QE2 Category/Service):

Job Search Assistance/Plan for Job Development (Milestone 1)

Job Search Assistance/Job Search and Placement (Milestone 2)

Supported Employment/Individual Supported Employment – or

Customized Supported Employment/Customized Employment

Extended Services (if the extended service plan is VR-funded extended services for youth)

Any other applicable IPE services

Identify the extended services plan, which may include:

Nebraska Health and Human Services, Division of Developmental Disabilities, for those eligible for ID/DD services/funding.

Nebraska Health and Human Services, Division of Behavioral Health, for those with behavioral health diagnoses and eligible for behavioral health services. 

Nebraska VR (for youth aged 14 through 24) for up to 4 years or age 25, whichever comes first when comparable benefits are not available.

SE Provider

Unknown (use when no other extended services are identified).

Complete the Extended Service section in QE2

Navigate to the IPE Data Entry screen. 

The Supported Employment panel will populate once the Work Type is selected as Competitive-Supported. 

The first data element will require a response to the DD Eligible data element (Yes/No). 

A response of 'Yes' will autogenerate a second data element of DD Funding Available (Yes/No). 

Confirm whether or not DD funding is available. 

Confirm the SE Type from the drop-drop menu option (MH/BH, ID/DD, ABI, Autism). 

Confirm the Extended Services Plan option (DHHS-DD Services, DHHS-MH/BH Services, SE Provider, Nebraska VR (funding for youth), or Unknown). 

*The Extended Services Plan can be updated at any time.  

See additional procedures in the Individualized Plan for Employment (IPE) chapter.

Plan for Job Development ($1,103 flat rate): Authorize Category: Job Search Assistance; Service: Plan for Job Development

Note: this service is not authorized if the client has a job; refer to the Job Coaching/Job Support process. 

Send the Supported/Customized Referral form, a copy of the IPE, authorization, and any other applicable documents (as noted on the referral form).  This service is authorized for two weeks. Authorizations may be extended as appropriate.  The reason for the extension needs to be documented in a task note.

Receive the Plan for Job Development Report, attachment(s), and invoice.  Review the report and documentation submitted to verify all activities were completed  Address any concerns with the report and document the resolution and receipt of all activities in a task note in QE2 before signing the invoice. Upload the report and attachment(s) to QE2.  Sign the invoice to approve payment when quality measures are met, all activities listed on the report are completed, and documentation is received. 

*Plan for Job Development may be authorized more than once, but subsequent authorizations require Office Director approval in QE2. Considerations for additional authorizations will include whether the job goal has changed, or other circumstances require a revised Plan for Job Search/Development, such as pursuing a customized employment approach, etc.

Job Search and Placement ($2586 flat rate): Authorize Category: Job Search Assistance; Service: Job Search and Placement

Note: this service is not authorized if the client has a job; refer to the Job Coaching/Job Support process. 

Authorize and send the authorization to the provider. This service is authorized for 90 days.

The SE provider is expected to meet with the client weekly to provide directed job search activities as outlined in the Plan for Job Development Report.  Meet with the provider monthly to staff the case and review what services were offered and what activities were completed, including; applications submitted, interviews completed, details of employer contacts/follow-up, and other any services provided to the client over the past month.  The Supported and Customized Employment Monthly Report can be used as a template to guide the conversation.  Problem-solve any issues that have interfered with conducting regular job search and placement activities.    

If job placement has not occurred in 90 days, a team meeting (involving the client, SE provider, authorized representative and DHHS service coordinator – as applicable) needs to be convened to identify the reasons why and to discuss any possible changes to the job search strategy.  This meeting is documented in a task note and the authorization can be extended for an additional 90 days. 

This process will continue until the client receives and accepts a job offer. 

Receive Job Search and Placement Outcome Report and invoice when a job offer is received and accepted by the client.

Approve payment of Job Search and Placement (as applicable) when: 

• The job is determined to be competitive and integrated
• Job Search and Placement Report Outcome Report is received and is complete
• The completed invoice is received
• For customized employment, the job description developed with the employer (including specific criteria outlined in the customized employment definition) is received. 

Upload the report to QE2.  Sign the invoice to approve payment when quality measures are met, all activities listed on the report are completed, and documentation is received. 

*Job Search and Placement may be authorized more than once, but subsequent authorizations require Office Director approval in QE2.  Considerations for additional authorizations include whether sufficient support was provided to maintain the job and whether job loss could have been prevented (an additional authorization would not be supported in such case.) Instances where additional authorization could be supported, include circumstances where the job did not meet the client’s needs, when sufficient support was provided but job loss occurred in spite of such support, or when other client-centered reasons for job loss have occurred.

Intellectual/Developmental Disability (ID/DD), Acquired Brain Injury (ABI), and Autism

Authorize Supported Employment; Service: Individual Supported Employment or Customized Employment; (Job Coaching/Job Support) ($61.00/hour rate or adjusted rate based on the job coaching/support level):  

Determine the number of hours the client is projected to work during the first 8 weeks/2 months. Each authorization will cover the span of 4 weeks (28 days). Initially, two separate authorizations will be created (Months 1 and 2) and sent to the SE provider.  Example: Client will work 25 hours per week x 4 weeks = 100 projected work hours. Each authorization amount will be $6,100 (100 projected hours x $61). 

The SE provider is required to meet with the client at least twice a month (minimum).  Meet with the SE provider monthly to review client progress towards meeting the stabilization criteria, and to problem-solve any issues that arise. 

At the end of each authorized month, the SE provider will submit the Job Coaching/Job Support Report and invoice which will include documentation of client progress, services provided, and client hours worked for the first 4 weeks.  This report provides information from the SE provider, employer (when applicable consent has been provided by client), employee (client), and authorized representative (as applicable).  SE provider will also attach verification of employee (client) hours worked.  Accepted forms of verification are: 

1) Verification of Employee Hours Worked form, signed by the client and the employer; OR

2) Documentation from the place of employment (e.g. paycheck stub, employee timesheet, email, etc.) that includes the client's name (pre-printed or signature) and number of hours worked per day.  If the documentation is not from the place of employment (e.g. client wrote down their hours), an employer signature is required.

*In the event the provider is unable to secure documentation that meets the above requirements, contact the Program Director for Supported Employment to discuss an exception.  

*Please note that while this service is authorized at the projected number of hours a client may work, it is only paid out at the actual number of hours a client works. 

The Job Coaching/Job Support report is reviewed, signed, and uploaded into QE2.

The Job Coaching/Support Level for subsequent authorizations will be auto-calculated in QE2 based on the actual hours worked by the client and actual hours of job coaching and job support by the provider during the initial period. Example: 100 client hours worked/75 job coaching/support hours = 75% Job Coaching/Support Level.

The Job Coaching/Support Level determines the percentage of the $61/hour rate that will be used for subsequent authorizations. Example: 75% falls between 62-80% in the matrix below, thus the hourly rate for Months 3 and 4 authorizations would be $48.80/hr. (80%), the hourly rate for Months 5 and 6 authorizations would $36.60 (60%) and the hourly rate for Months 7-24 would be $24.40 (40%).

Complete monthly Job Coaching/Job Support authorizations as needed. QE2 will only allow subsequent authorizations to be created as follows:

• Month 3 can only be authorized after receipt/payment of the invoice for Month 1. Month 4 can only be authorized after receipt/payment of the invoice for Month 2; and so on. 

Late authorizations require the approval of the Program Director for Supported Employment. 

This service continues until the job stabilization has been achieved, or job loss occurs. 

Behavioral Health (BH)

Authorize Supported Employment; Service: Individual Supported Employment or Customized Employment; (Job Coaching/Job Support) ($14.03/hour rate or adjusted rate based on the job coaching/support level):  

Determine the number of hours the client is projected to work during the first 8 weeks/2 months. Each authorization will cover the span of 4 weeks (28 days). Initially, two separate authorizations will be created (Months 1 and 2) and sent to the SE provider.  Example: Client will work 25 hours per week x 4 weeks = 100 projected work hours. Each authorization amount will be $1,403 (100 projected hours x $14.03). 

The SE provider is required to meet with the client at least twice a month (minimum).  Meet with the SE provider monthly to review client progress towards meeting the stabilization criteria, and to problem-solve any issues that arise. 

At the end of each authorized month, the SE provider will submit the Job Coaching/Job Support Report and invoice which will include documentation of client progress, services provided, and client hours worked for the first 4 weeks.  This report provides information from the SE provider, employer (when applicable consent has been provided by client), employee (client), and authorized representative (as applicable).  SE provider will also attach verification of employee (client) hours worked.  Accepted forms of verification are: 

1) Verification of Employee Hours Worked form, signed by the client and the employer; OR

2) Documentation from the place of employment (e.g. paycheck stub, employee timesheet, email, etc.) that includes the client's name (pre-printed or signature) and number of hours worked per day.  If the documentation is not from the place of employment (e.g. client wrote down their hours), an employer signature is required.

*In the event the provider is unable to secure documentation that meets the above requirements, contact the Program Director for Supported Employment to discuss an exception.  

*Please note that while this service is authorized at the projected number of hours a client may work, it is only paid out at the actual number of hours a client works. 

The Job Coaching/Job Support report is reviewed, signed, and uploaded into QE2.

The Job Coaching/Support Level for subsequent authorizations will be auto-calculated in QE2 according to the fee schedule listed below.  

Complete monthly Job Coaching/Job Support authorizations as needed. QE2 will only allow subsequent authorizations to be created as follows:

• Month 3 can only be authorized after receipt/payment of the invoice for Month 1. Month 4 can only be authorized after receipt/payment of the invoice for Month 2; and so on. 

Late authorizations require the approval of the Program Director for Supported Employment. 

This service continues until the job stabilization has been achieved, or job loss occurs. 

Determine Stabilization:

Stabilization is defined as the point when VR services end because the client is no longer in need of VR services and is able to remain stable in employment using the supports identified in the extended services plan.  Individualized stabilization criteria are identified initially and revised as the client gains experience on the job, and the client and provider develop a full understanding of the employer’s expectations for work performance. 

Stabilization is considered when the documentation indicates:

• the client’s work performance is satisfactory
• evidence of fading of job coaching/support; including the development of natural supports
• any identified need for/and plan to provide benefits counseling
• transportation plan has been implemented
• the employer reports adequate progress is being made
• the employee and their authorized representative report satisfaction with the job
• the client meets any additional individualized stabilization criteria
• and plan for extended services has been identified and agreed upon

When criteria are met, as noted above, the SE provider completes the Job Stability Report and submits it to the VR Specialist.  

• The VR Specialist reviews the form and convenes a team meeting (including the client and all applicable parties) to discuss the report and make a final determination about stabilization criteria being met and extended services being initiated.  
• The Job Stability Report is uploaded in QE2.
• The stabilization date is entered in QE2 on the Employment History record.
• If the Extended Service Plan was previously marked as 'Unknown' at the time of IPE development, this will need to be changed to one of the following options:
  • SE Provider
  • Natural Supports
  • DHHS-DD Services
  • DHHS-MH/BH Services

Once stabilization is achieved, Extended Services begins.  A case is eligible for a successful outcome 90 days after the Transition to Extended Services begins if no post-employment services are authorized during the 90-day period. The 90-day clock starts again once the post-employment service is complete (end date of authorization or payment).

For case closure procedures, see the Successful Outcome chapter.

Determine the number of hours the client is projected to work during the first 8 weeks/2 months.  Initially, two separate authorizations will be created for the first and second months and sent to the Extended Services provider.  QE2 will calculate the authorized amount using the hourly rate paid at the time of stabilization x the number of hours the client is projected to work.

The Extended Services provider will submit the Extended Services for Youth Report, a verification of client hours worked, and an invoice monthly. The provider will invoice VR for the actual number of hours the client works. 

Subsequent authorizations will be completed monthly.  As with the Job Coaching/Support service, subsequent authorizations (Months 3 and beyond) will not be made until the prior month’s report and invoice have been received.  Example(s): Month 3 cannot be authorized until the report and invoice for Month 1 have been received.  Month 4 cannot be authorized until the report and invoice for Month 2 have been received, and so on. Late authorizations require the approval of the Program Director for Supported Employment. 

While VR is funding extended services for youth, the VR Specialist meets with the client, authorized representative (as applicable), and Extended Services provider every 90 days to review documentation of the support provided. This discussion ensures services support job maintenance and, when other extended services are identified, transition to those resources can be achieved.

The case remains open while VR is funding extended services for a period not to exceed four years, or age 25, whichever comes first. If other funding options for extended services come available during that time, such as when a client is removed from the DD waiting list, the client transitions to extended services funded or provided by that resource. This service also can end if extended supports are no longer needed. 

An Independent Provider can be an alternative option for individuals who require supported employment, are in the Priority 1 category, and are eligible for funding and services from the Division of Development Disabilities of Nebraska Department of Health and Human Services. The client, authorized representative, and/or DD Service Coordinator will provide the name and contact information of the Independent Provider who provides developmental disabilities services under an agreement with Medicaid.  The Independent Provider will then be referred to the Program Director for Supported Employment to discuss a potential service agreement with VR.

Through a review of a resume of qualifications and completion of an interview with the Independent Provider, the Program Director will decide whether the Independent Provider has the necessary skills to provide supported employment services.  If the Program Director determines the Independent Provider does meet the general qualifications, they will proceed with completing a service agreement as outlined in the Service Agreement chapter.

If the Program Director determines that the Independent Provider does not meet general qualifications, the Program Director reserves the right to decline a service agreement.  The Independent Provider is notified of this decision, as are the DD Service Coordinator, client, and authorized representative, as applicable, so that another supported employment provider may be considered. 

Once the Independent Provider has been approved to provide supported employment services, they will receive training on the VR Supported Employment process. This training will either be provided by the Program Director for Supported Employment. 

If an Independent Provider's Medicaid provider enrollment is revoked at any time, Nebraska VR cannot maintain a service agreement with the Independent Provider.  The DD Service Coordinator is notified if a Medicaid Provider's enrollment is terminated and is responsible to notify Nebraska VR of the termination.  See the Service Agreement chapter for details about terminating a service agreement under such circumstances.