Participant Name:
SAR #:
SAR Submit Date:
NC Innovations Waiver and B3 DI (with U4 modifier)
Supported Employment Services: Individual-H2025; Group-H2025HQ
Met
Not
Met
N/A
Criteria to Approve Service
The request includes services to provide assistance with choosing, acquiring, and maintaining a job
for participants ages 16 and older for whom competitive employment has not been achieved and /or
has been interrupted or intermittent.
Requests for Initial Supported Employment includes one or more of the following:
o Pre-job training/education and development activities to prepare a person to engage in
meaningful work-related activities which may include career/educational counseling, job
shadowing, assistance in the use of educational resources, training in resume preparation,
job interview skills, study skills, assistance in learning skills necessary for job retention.
o Assisting a participant to develop and operate a micro-enterprise. This assistance consists of:
a. Aiding the participant to identify potential business opportunities;
b. Assistance in the development of a business plan, including potential sources of
business financing and other assistance; and
c. Identification of the supports that are necessary in order for the participant to
operate the business.
o 3. Coaching and employment support activities that enable a participant to complete initial
job training or maintain employment such as monitoring, supervision, assistance in job tasks,
work adjustment training and counseling.
Services may include vocational evaluation, job development, intensive training, job placement, and
long-term support. Support services to participant’s families and consultation with the participant’s
employers and other involved agencies may also be provided.
Requests for Long Term Follow-Up Supports include one or more of the following:
o Coaching and employment support activities that enable a participant to maintain
employment in a group such as an enclave or mobile crew
o Ongoing assistance, counseling and guidance for a participant who operates a
microenterprise once the business has been launched;
o Assisting the participant to maintain employment through activities such as monitoring,
supervision, assistance in job tasks, work adjustment training and counseling; and
o Employer consultation with the objective of identifying work related needs of the participant
and proactively engaging in supportive activities to address the problem or need.
This request does not include incentive payments made to an employer to encourage or subsidize
the employer’s participation in a supported employment program. To clarify, Supported Employment
payments must not be used to pay an organization to hire a beneficiary. Also, work performed by the
beneficiary must be of direct benefit to the employer. Also, the job must be specific to the need of the
employer as it relates to hours and duties performed.
This request does not include payments that are passed through to users of supported employment
services. To clarify, Supported Employment payments must not be used to pay a beneficiary’s salary.
This request does not include costs for vocational training that is not directly related to a participant’s
supported employment program. To clarify, the individual is paid by the employer for the work
performed.
If the participant is employed by the Supported Employment Service provider, this job/position would
still exist if the provider agency was not being paid to provide the service.
The service involves paid work in a job which would otherwise be done by a non-disabled worker.
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If the participant is employed by the Supported Employment Service provider, this job/position would
not end if the beneficiary chose a different provider agency to provide service. To clarify, the
employer must not require that the individual choose a specific provider in order to obtain or maintain
a job.
If the participant is employed by the Supported Employment Service provider, the hours of
employment do not have a one to one correlation with the amount of hours of service that are
authorized. To clarify, hours and duties do not vary with regard to an individual/beneficiary’s
approved services but with regard to the need of the business/organization.
The Supported Employment Services occur in an integrated environment with non-disabled
individuals unless the business is owned by the beneficiary OR a small number of people with
disabilities work together. To clarify, all individuals employed at the business/organization have
opportunities to share common areas such as break rooms, rest rooms, and lunch rooms. This also
includes enclaves and mobile work crews.
The Supported Employment training activities occur in a separate location in the community, not in a
specialized facility maintained by the operator.
The Supported Employment Services do/will not occur in a licensed community day program.
The request for service is individualized, specific and consistent with the participant’s assessed
disability, specific needs.
The service can be safely furnished, and no equally effective and more conservative or less costly
treatment is available statewide.
Service is not requested to be furnished in a manner primarily intended for the convenience of the
participant, primary caregiver, the provider, employer of record, or the managing employer.
If there is a potential group and group is appropriate, this ISP includes a plan to move towards group
services. (Partners and CenterPoint)
Documentation is present that this service is not otherwise available under a program funded under
Section 110 of the Rehabilitation Act of 1973, or Individuals with Disabilities Education Act (20 U.S.C.
1401 et seq.) for this beneficiary.
Additional Criteria for QP Approval
No more than 40 hours/ week combined habilitative services requested.
Service has not been denied or partially denied this plan year.
Guidance: The SE activities should not occur in a work site immediately adjacent to another program providing services to
persons with disabilities.
Initial Review:
All Criteria Met:
YES – APPROVE
Reviewer Name, Credentials:
NO (Send to Clinical Reviewer)
Date:
Comments:
Clinical Review:
Approved
Send to Peer Review
Reviewer Name, Credentials:
Date:
Comments:
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