8611 SUPPORTED EMPLOYMENT SERVICES FOR BENEFICIARIES WITH A SUBSTANCE USE DISORDER

8611.1 Supported employment services for beneficiaries with an SUD shall:

1. (a) Provide ongoing work-based vocational assessment, job development, job coaching, treatment team coordination, and vocational and therapeutic follow-along supports;
2. (b) Involve community-based employment, consistent with the strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice of the consumer;
3. (c) Provide services at various work sites; and
4. (d) Provide part-time and full-time job options that are:
5. (1) Diverse, competitive, and integrated with co-workers without disabilities;
6. (2) Based in business or employment settings that have permanent status rather than temporary or time-limited status; and
7. (3) Pay minimum wage, or greater, of the jurisdiction in which the job is located.

8611.2 Effective March 27, 2020, Medicaid reimbursable supported employment services for individuals with SUD are those set forth in Chapter 37 of Title 22-A DCMR.

8611.3 In accordance with the eligibility requirements set forth in Chapter 37 of Title 22-A DCMR, an individual eligible for supported employment services shall:

1. (a) Be a Medicaid beneficiary at least eighteen (18) years of age;
2. (b) Indicate an interest in employment;
3. (c) Have supported employment identified as a needed service on a current, person-centered plan of care that has been reviewed by DBH;
4. (d) Not be concurrently receiving Assertive Community Treatment (ACT) services, as defined in Chapter 34 of Title 22-A DCMR;
5. (e) Be receiving services in one of the following SUD levels of care, as defined in Chapter 63 of Title 22-A DCMR:

1. (1) Level: Opioid Treatment Program (OTP)
2. (2) Level 1: Outpatient;
3. (3) Level 2.1: Intensive Outpatient; or
4. (4) Level 2.5: Day Treatment;
5. (f) Be assessed as being able to benefit from and meaningfully engage in SUD supported employment services; and
6. (g) Be determined by DBH as meeting the following needs-based criteria set forth in Chapter 37 of Title 22-A DCMR.8611.4 Individuals shall be assessed for supported employment services by an entity designated by DBH.8611.5 The designated assessment entity shall conduct the needs-based assessment in accordance with the requirements set forth in Chapter 37 of Title 22-A DCMR and shall conduct a reassessment at least every one-hundred eighty (180) days or upon significant change in the beneficiary's condition.8611.6 The designated assessment entity shall also be responsible for developing the person-centered plan of care, as identified in § 8607.3(c), in accordance with federal regulations under 42 CFR § 441.725 and requirements set forth in Chapter 37 of Title 22-A DCMR.8611.7 The person-centered plan of care shall be reviewed and revised by the designated assessment entity in accordance with the requirements set forth in Chapter 37 of Title 22-A DCMR.8611.8 The designated assessment entity shall also assist the Medicaid beneficiary in identification and selection of a supported employment provider.8611.9 The assessment and the person-centered plan of care shall be reviewed by DBH, consistent with the requirements set forth in Chapter 37 of Title 22-A DCMR prior to initiation of supported employment services.8611.10 Following review and approval of the assessment information and person-centered plan of care, DBH shall issue an authorization for the initiation of supported employment services by the beneficiary-selected supported employment provider, in accordance with the requirements set forth in Chapter 37 of Title 22-A DCMR.

8611.11 The designated assessment entity shall inform the beneficiary of his or her eligibility for supported employment services.

8611.12 Supported employment providers shall be certified in accordance with the requirements set forth in Chapter 37 of Title 22-A DCMR.

8611.13 A supported employment provider shall develop an Individualized Work Plan for each Medicaid beneficiary receiving supported employment services, in accordance with the requirements set forth in Chapter 37 of Title 22-A DCMR.

8611.14 Medicaid reimbursement is not available for supported employment services provided to beneficiaries that reside in an institutional setting or any setting that is not in compliance with HCBS setting requirements consistent with 42 CFR § 441.301.

SOURCE: Final Rulemaking published at 68 DCR 5406 (May 21, 2021).