Day Services FAQ
Day Services are supports that help the person engage in community life do things they enjoy in their community and pursue opportunities for employment or retirement, depending on their age. Even though the name is “Day Services”, you can receive these supports any time of day or night, and on any day of the week. Day Services include support to help a person work at a job in the community, and the supports that help someone spend their time in ways that build on their interests and strengths, and help them reach their goals. For some people, Day Services can include using an agency day center as a base to access the community, learning skills for independence and learning skills to be used in community employment.
There are a few reasons why DIDD is making changes to Day Services. The department has heard feedback that people want to make sure they can change their plans during the day if they want to. Sometimes people have reported that they have to stay out of the house for longer than they would like, and we want to make sure people have the flexibility to go home during the day if they choose. The goal is for people to be able to use their home as their base for participating in their community. In addition, we want to give people the option to explore various opportunities for employment so they can make an informed choice about working in the community with supports from DIDD. There are many people who might want to work if they understood what was possible and how it could benefit them. There are also many people who know they want to work who have not yet had the opportunity to get a community job, so we want to make sure services and reimbursement rates will help providers create more paid job opportunities for people.
It’s also important to mention that there are federal rules to make sure people are not isolated. The rules also expect that people have opportunities to spend their days in their communities, and they have the opportunity to interact with people of all abilities who aren’t paid staff. These changes will help services comply with these new rules in order to continue to receive federal funding for these services.
There are several significant changes that are proposed for employment and day services, which are addressed throughout this FAQ document and in the documents posted on the DIDD website. One of the most important changes is the elimination of the 6-hour requirement. If the proposed waiver changes are implemented, persons supported will no longer be required to receive 6 hours of employment or day services in order for the provider to be reimbursed on that day. Instead, a person can choose to receive services in 15-minute increments—for any duration of time, at any time of day, and on any day of the week—as long as it does not exceed the limit of 60 hours of services during a 14-day billing cycle.
Another significant change is the addition of new employment services that will help people pursue their employment goals more effectively. The new services—including Exploration, Discovery, and Job Development—will help a person figure out if he or she wants to work, what kind of job he or she might like to have, and actually obtain the job. Persons supported will also have access to ongoing job coaching services to help them maintain their job and grow in the job over time.
A third significant change will impact how people receive services in their homes. All persons supported will have access to a wraparound service that allows them to start their day at home, use their home as their base (e.g. for lunch, rest, restroom, etc.) instead of going to a facility, and return to their home after spending time at work or in the community. Additionally, the service that is currently known as “in home day” will be impacted by the proposed waiver amendments. There will still be a homebound service (referred to as a residential special needs adjustment) for people who are not able to leave their homes for a period of time due to illness, injury, or sustained behavioral challenges. However, retirement will no longer be one of the criteria for this homebound service. Retired individuals can make an informed choice about spending time in the community and for what duration of time. They will have access to wraparound services in their homes before and after they spend time in the community.
Your Independent Support Coordinator (ISC) or Self-Determination Waiver (SD) Case Manager will help you understand if any of your services will be changing. We want to make sure people have the flexibility to spend their day in the community participating in the activities they select that help provide supports for valued and active participation in integrated activities and that help the person seek employment and work in competitive integrated settings. To assist in this, new services have been developed and will soon be available to help people explore the possibility of working a job in the community. Also, the services will allow for people to come home during the day if they want to rest or eat at their home, instead of staying out in the community for six hours. While we want to make sure home-based services are available when needed for people who are experiencing significant behavioral or medical challenges for a period of time, or for persons receiving hospice support, we also want to make sure everyone has maximum opportunities and support to leave home and explore their communities.
Your Independent Support Coordinator or Self-Determination Case Manager will discuss some of the new options designed to help you explore the potential of working in the community. Some people who may have spent many days at home will now be given new options to help them participate in more community activities with the support they need to do so.
Exploration and Discovery are two services that can help a person and his/her family explore what working a job in the community would look like.
Exploration helps a person explore different jobs in the community based on a person’s interests, and existing skills. It can include business tours, job shadows and/or informational interviews with employers for people to fully understand what a job in the community could mean for them and how it could benefit them both financially and otherwise. It also includes education about work incentives for people receiving Social Security, Medicaid, food stamps, etc. It also includes information on how employment services work. After participating in Exploration, a person can make an informed choice whether or not they would like to pursue community employment.
Discovery assists people who want to work in the community, but who need more information on the best kinds of job matches for them, before they pursue a job. This service helps a person identify strong interests that relate to employment, strengths and skills, and conditions for success that each person needs to be successful with employment.
No. A big benefit of the changes that are being made will be that people no longer need to spend six full hours outside of their home. Flexibility allows for people to spend some time at their home each day that they also get out in the community to focus on employment or other kinds of community involvement. Additionally, people can now use their home as a base. That means they can come home, instead of having to go to a day center during the day to rest, eat, or take care of their needs before going back out into the community. A person can choose to receive services in 15-minute increments—for any duration of time, at any time of day, and on any day of the week—as long as it does not exceed the limit of 60 hours of services during a 14-day billing cycle.
We understand that some people like to spend time at their homes during the day. A benefit of these changes is that people will have the option to come home during the day to rest, recharge, eat or take care of any personal needs. However, some people who may have needed to stay home part of their day have ended up staying home the entire day due to current day service billing rules. These people have not had the opportunities they should have to explore all of the options in the community. For people who truly cannot leave their home during the day on some days or for a period of time, there will be an approval process put in place to allow for these situations.
There will be two types of home-based services. One type, called ”Intermittent Employment and Community Participation Wrap-Around”, is available to everyone in services. It allows someone to use their home as their base instead of traveling to a facility before starting their day. If someone leaves their home to work or spend time in the community, they can come home to eat lunch, relax, change, and attend to personal needs. The other type of home-based support is designed for people who have significant challenges leaving the home for specific periods of time. This second type of home-based support is called “Residential Special Needs Adjustment – Homebound” for people who also receive residential services. For people not also receiving residential services, it is called “Non-Residential Homebound Adjustment.” People who are experiencing significant medical or behavioral challenges, or are receiving hospice care, will qualify to receive one of these Homebound Adjustments, which will be reviewed for need every three months and reauthorized if it continues to be needed.
People who are sick and cannot leave their home may stay at home. However, a provider cannot bill for a Day Service at that time.
The proposed waiver amendments do not include changes to DIDD’s policy for inclement weather days. DIDD will continue to encourage providers, individuals, and families to make a decision that ensures safety regarding whether or not to provide or receive services on inclement weather days. Reimbursement rates for services were calculated with the assumption there would be up to 17 inclement weather days throughout the year.
The changes do not mean that you have to work if you don’t want to. What they do mean is that people who aren’t sure about what employment means will now have opportunities to explore the various options in the community and will have help, that is not available through the waivers now, to pursue a community job. We want people to be able to see and experience the options so they have all of the information available to make the best choice for them. Exploration is a new service designed for people who are not sure if they want to work, but would like the opportunity to explore the option and decide if it’s right for them. After going through Exploration, a person can make the informed choice whether they would like to continue pursuing employment by engaging in Discovery services to learn more about their employment-related interests, strengths, skills, aspirations, and conditions that will help them be successful in working.
You will have the ability to make these decisions about these services with your ISC or SD Case Manager and your Circle of Support.
Right now we are planning on implementing these new options in October 2018. Your ISC or SD Case Manager will let you know when they will be available. The department will also keep everyone up to date through its Facebook and Twitter pages as well as its Open Line Newsletter.
It’s important that you discuss these changes with your independent support coordinator, case manager, family/natural support, and provider agency to make sure you are comfortable with the new options available. For some people that may mean having a Circle of Support meeting, but others may choose to discuss them over the phone or during a face-to-face visit with your ISC or SD Case Manager. Your ISC or SD Case Manager will help determine whether any changes need to be made to your ISP to accommodate your choice.
Disability MegaConference Session on Proposed Day Services Changes