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CMS Announces Performance-Based Payment Options for Employment Services

September 25, 2015

At the annual Home and Community-Based Services (HCBS) Conference, hosted by the National Association of States United for Aging and Disabilities (NASUAD), the Centers for Medicare and Medicaid Services (CMS) announced new performance-based options for funding employment supports through a Medicaid §1915(c) waiver. These options reflect CMS’s goal of promoting integrated competitive employment outcomes for people who receive waiver services. The options will allow states to pay for employment outcomes based on the average amount of time the state expects it to take to reach that outcome, based on actual data, and the cost per hour determined by the state. This enables states to incentivize individual competitive integrated employment over other options. States could also provide milestone payments, which would reimburse service providers when a specific employment outcome is achieved, with the amount determined by data based on their past experiences. CMS would accept tiered outcome payments based upon the intensity of services an individual might require. Their guidance emphasizes the critical role of person-centered planning in achieving employment outcomes, and that Ticket to Work milestone and outcome payments still are not in conflict with Medicaid payments.

CMS notes that payment options require financial oversight measures to ensure that the amounts listed are accurate estimates based on data. Amounts of support would be expected to decrease the longer an employee works at a particular job.