Categorized In: Case Services - Procurement
Approved Date: February 26, 2019
Owner: Carla Lasley
A Service Agreement is required for the following services: Job Coaching, Job Coaching/Placement, Job Coaching/Interpreting, Job Readiness Training, Work Site Skills Trainer, Self-Employment Consultation, Business Plan Implementation/Revision, Interpreter—Foreign Language, Interpreter – Hearing Impaired, Benefits Assessment, Benefits Planning, Benefits-PASS Development, Benefits Management, Rehab Technology – Rehab Engineering, Independent Living Training, Individual Supported Employment, and Customized Employment.
Background screens for specific types of providers are required prior to the provision of services unless the Exception Process is followed.
1. A VR Office Director may develop a Service Agreement when:
2. Identify the services to be provided. A Service Agreement is required for these services:
3. If the prospective provider will provide Individual Supported Employment Services, VR will check to ensure they are properly credentialed, as follows:
4. If the prospective provider must be licensed or certified in his or her profession (such as when providing interpreter or benefits services) obtain certification and / or licensure documentation. (Note that in the case of the Benefits services, this is done in conjunction with State Office Fiscal staff.) Documentation should be current and the expiration date of the license or certification noted for entry into QE2.
5. Complete top section of the Service Agreement:
6. If the provider is an individual or an Independent Provider, assess their training and experience by obtaining and reviewing a resume. Complete an interview, if necessary, to obtain clarification on qualifications. At this point, information about whether the individual or Independent Provider has lived or worked outside of the State of Nebraska may also be obtained. Make a decision about whether the individual or Independent Provider meets the general qualifications outlined on the Service Agreement form. Agency providers will have credentials or certification from DDD or DBH; verify as outlined in #1, above. See #8 below regarding background checks.
7. If the Service Agreement is for Individual Supported Employment or Customized employment, review and provide copies and instruction on how to complete the applicable Milestone Definition and Payment Schedule (BH, ABI/Autism, I/DD Supported Employment or I/DD Customized Employment), and required reporting forms.
8. Office Director reviews, discusses, and completes required documentation to obtain background checks applicable to the provider:
(A) Notify him/her that the background screen must be completed before a Service Agreement may be executed and that failure to authorize a background check will result in delay of Service Agreement processing. In order to have adequate processing time, forward the required information at least two weeks in advance of the proposed Service Agreement start date
(B) The prospective provider will need to provide a valid email address to complete the background screening process.
(C) Have the prospective provider complete page 1 of the Division of Children and Family Services Child Abuse/Neglect / Adult Protective Services Registry Form. Retain the form for submission with the signed Service Agreement to VR State Office
(D) The VR staff member will email Brenda Wid, email@example.com, in NDE Legal Services and provide her with the valid email address of the prospective provider. Brenda will initiate an email to NE DHHS providing NE DHHS with the prospective provider's valid email.
(E) DHHS will email the prospective provider a dedicated link to complete the NE DHHS Child Abuse/Neglect / Adult Protective Services Registry background. The prospective provider will be able to view their results following the submittal of the information and may print the findings. Legal Services will also track the progress of the request online, view the final status, and print the results for their use.
(F) NDE personnel may not enter the information for the prospective provider. This is a violation of Nebraska Revised Statute 28-725.
NOTE: When the Agreement is with a service provider employing individuals who will provide direct services, the authorized representative’s signature on the Agreement gives written assurance that the persons the service provider employs to provide the direct services have not been convicted of a felony or misdemeanor involving neglect or abuse of a child or vulnerable adult.
9. Using the State of Nebraska Substitute Form W-9 & ACH Enrollment Form, the Office Director has the prospective provider complete the W-9 information at the top, and, if applicable, the ACH portion of the form, to arrange for direct deposit of payments, then obtains 1 of the 4 documents from the list on the right-hand corner of the W9/ACH form.
10. The service provider completes the section to verify lawful presence in the US and completes/signs the applicable section of the agreement.
11. Office Director signs the Service Agreement, obtains the prospective provider’s signature, and explains that the Agreement is not in force until background checks are received. *
* Exception Requests: An Office Director may request an exception to policy in order to execute a Service Agreement before background check results are obtained. The rationale for the request will be made in writing to the VR Director. The decision to grant an exception will take into consideration whether there is potential that the client and provider will have unobserved one-to-one contact in the workplace or home as well as the need for services to begin immediately. Upon granting of an exception, the service provider will be entered into QE2.
12. Office Director scans the following documents to this dedicated VR State Office email address: firstname.lastname@example.org
13. Office Director enters provider in QE2 Create Provider, if applicable.
14. Upon receipt of scanned documents, VR State Office staff forwards Page 1 of the Division of CFS A/N / APS Registry Form to NDE Legal to complete background checks.
15. NDE Legal staff complete the following background checks and communicate the results to VR State Office:
16. When the prospective provider does not pass the background screen.
The VR State Office Staff:
The Office Director:
17. When the prospective provider has passed background checks the VR State Office notifies the Office Director and approves the provider in QE2.
18. The Office Director and other local VR staff, as applicable, meet with the service provider to complete arrangements to implement the Service Agreement, including monitoring service outcomes and effectiveness. The Office Director must review the Service Agreement annually with the service provider following the process outlined in #19 below.
19. Special note regarding the termination of Independent Providers: When an Independent Provider’s Medicaid enrollment is terminated the VR Office Director is notified by email from the DDD Service Coordinator. The email is printed and placed in the client’s VR case record for the client and is forwarded to the VR Fiscal Director who ensures the Independent Provider is notified of the termination of the Service Agreement.
20. Process to complete and document annual review of Service Agreements: The service agreement is reviewed annually.This review is intended to ensure continued understanding of and adherence to each requirement of the agreement and so that any questions about the tenets of the Agreement may be discussed to ensure continued compliance. For providers with multiple service agreements / multiple area programs / signers complete the review with each person who has signed the agreement, i.e., if an agency representative signs all agreements, the review of all is completed with that person or their local designee. If each area program’s agreement is signed by a different person, the agreement should be reviewed with the person who signed the agreement. Office Director completes the review using the following process: