Workplace Assistance FAQ | Colorado Department of Health Care Policy & Financing

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Page Updated: June 11, 2024

General Questions Who is Workplace Assistance For? Service Delivery Questions Service Authorization Questions

Provider Questions Other Questions

General Questions

What is Workplace Assistance?

Workplace Assistance is a Supported Employment service available in the Home and Community-Based Services (HCBS) Developmental Disabilities (DD) or Supported Living Services (SLS) Waivers and the State Supported Living Services (State SLS) Program.

This service supports Health First Colorado (Colorado’s Medicaid program) members who may need paid caregiver assistance to help with safety concerns in the workplace. Workplace Assistance meets a member’s safety needs to help the member maintain individual community employment or self-employment while promoting the member’s independence and integration at the worksite. This service is above and beyond what a workplace supervisor, co-workers, or technology offers.

Why does Workplace Assistance exist?

Colorado is an “Employment First” state. This means everyone, including people with significant disabilities, can work and should therefore have the opportunity to find employment in the general workforce. Employment in the community is the first and preferred option for individuals with disabilities receiving assistance from publicly funded systems.

In 2021, the state legislature passed Senate Bill 21-039 “Elimination of Subminimum Wage Employment” mandating the elimination of sub-minimum wage practices in Colorado. The bill also identified services that would support Competitive Integrated Employment (CIE) for adults with Intellectual and Developmental Disabilities (IDD). Specifically, the Workplace Assistance service was implemented in Colorado to support the creation of a less intensive and less expensive alternative to Job Coaching to address line-of-sight supervision needs, when appropriate.

The Workplace Assistance service was implemented in Colorado to support adults with IDD who may have historically not pursued employment due to elevated safety needs. This service will provide the opportunity for people who have previously been told, “You can’t work because you would need someone with you the entire time,” to access the level of support they would need at work.

How is Workplace Assistance different than Job Coaching?

Job Coaching teaches someone how to be successful at their job. A Job Coach may help with task analysis, intensive training, systematic instruction, integrating needed accommodations, and implementing job aides and/or technological supports. Job Coaches will also identify natural supports (such as co-workers) to help the member be successful at work. The Job Coaching support decreases as the person masters their job tasks, also referred to as “fading”.

Some members with Intellectual and Developmental Disabilities (IDD) may need longer-term Job Coaching. This continued support can help members maintain work quality, address issues or barriers that arise at work, request time off, interpret pay stubs, and navigate interpersonal relationships. The Job Coach may check in with the member and employer regularly but is not often present for the member’s shift. If there is a change in expectations or work process, the Job Coach can help the member learn or adjust. Job Coaching can be used to support individual jobs or jobs in group employment settings.

Workplace Assistance specifically supports individual jobs and is delivered one-on-one. A member may need Workplace Assistance to meet their safety needs while at work. It is only accessed after the member has mastered job tasks to the degree that the Job Coach would typically have faded out. Workplace Assistance staff are not teaching the member the job, but rather are keeping the member and others safe at the worksite.

What activities are included under Workplace Assistance?

Workplace Assistance may include:
- Promoting the member’s integration at work
- Encouraging the development and maintenance of natural support relationships
- Reinforcing and modeling safety skills
- Assisting with behavioral support needs and outlined supervision needs
- Reminding the member to follow work-related protocols and strategies as indicated by the member’s Job Coach, if needed
- Ensuring other identified needs are met (including attending to personal care, which cannot comprise the entirety of the service)

Isn’t an employer responsible for the training and supervision of their employees?

Yes, employers are responsible for providing the same level of training and supervisory support to employees with disabilities as they do to employees without disabilities.

All employees should have a supervisor who is responsible for activities such as setting schedules, directing work, providing feedback, and completing performance reviews. Workplace Assistance staff provide the additional oversight and support that members with IDD need when safety is a barrier to their success on the job.

Supported Employment services do not include payment for typical employer responsibilities, including training, general safety measures, or support and adaptations available to other workers without disabilities filling similar positions in the business.

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Who is Workplace Assistance For?

Is Workplace Assistance appropriate for all members with Intellectual and Developmental Disabilities (IDD)?

No, many people with IDD will not need a staff person with them after they have mastered the key elements of their job. These members can use Job Coaching to support their ongoing job-related needs but do not need a paid caregiver present on a consistent basis.
Having a paid caregiver watching over the member may draw attention to their disability, acting as a barrier to the member being fully accepted at work. Therefore, the member and their team should use a person-centered approach when determining whether Workplace Assistance is appropriate.

Can members with Line-of-Sight Supervision receive Workplace Assistance?

Yes! Workplace Assistance is a great option for members who want to work and require Intensive Supervision or have a documented need that warrants a Rights Modification requiring line-of-sight supervision. Workplace Assistance may also expand employment opportunities for members who have a court order or who meet Public Safety Risk or Extreme Risk-to-Self criteria.

Can a member without Line-of-Sight Supervision needs receive Workplace Assistance?

Yes, Workplace Assistance is not limited to members with Rights Modifications or other extensive supervision needs. In fact, a member’s supervision level is not the sole factor that justifies the need for this service. Workplace Assistance could be used if the member and their team agree that there is justification for a paid caregiver to be present at work due to safety concerns, and those needs are beyond what could be addressed through natural supports, technology, or intermittent Job Coaching. A professional experienced in Employment First concepts can help teams make this determination.

Where should a member’s Supervision Level be documented?

If a member is employed, the supervision the member needs while at work should be documented in their Person-Centered Support Plan. The supervision level must be based on the member’s specific needs at their worksite. The level of supervision by paid caregivers may be lower than in other community settings due to the support the member may receive by natural supports or the nature of the work environment.

What are some examples of safety concerns that would warrant Workplace Assistance?

Ultimately, the determination of safety needs at work will be up to the member and their team. However, some safety concerns that may warrant a paid caregiver to be present may include a member who demonstrates any of the following as described in 10 CCR 2505-10 8.7555.C.2:
- Behaviors that cause direct harm to themselves or others
- Intentionally or unintentionally puts themselves in unsafe situations
- Poor safety awareness or making poor decisions related to personal safety

Is Workplace Assistance only available to members with behavioral-related safety concerns?

No, Workplace Assistance is not limited to those with behavioral needs. If a member has a medical condition that needs regular or intermittent attention, Workplace Assistance could be leveraged. The team would still need to identify how the justification is safety-oriented.
- Example:
  Latasha is a young woman with Autism who is amazing at categorizing and organizing electronic materials. Latasha also has a condition called Pica, and she will compulsively attempt to swallow small non-food items. Latasha typically has a staff person by her side when she is not sleeping. Latasha has been offered a job at an advertising firm to help maintain their digital media and be an advisor regarding accessibility. Latasha, her team, and her employer agree that having a trained staff person with her for the entire shift will help keep her safe due to the concerns that Pica presents. The Workplace Assistance staff person will ensure that Latasha’s work area is free of any small items and will monitor her when she leaves her desk to take a break or when entering/leaving the building.

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Service Delivery Questions

Does the Division of Vocational Rehabilitation (DVR) cover Workplace Assistance?

No, Workplace Assistance is unique to the HCBS-DD and HCBS-SLS Medicaid Waivers, and State SLS Program. DVR does not reimburse solely for supervision or safety-related aid. DVR will cover job training, and other services needed to help a person achieve their employment goals.

Can a member receive Workplace Assistance while DVR is funding Job Coaching?

Yes! The intention of Job Coaching is to support someone in learning a job. As proficiency is achieved, the Job Coaching support fades and the member completes the job tasks as independently as possible. However, if there are valid safety reasons why a member cannot be without staff support at work, Workplace Assistance can be utilized for the portion of the member’s shift when Job Coaching is not occurring. In these cases, DVR can cover Job Coaching while the Waiver covers Workplace Assistance to assist with the member’s supervision and safety-related needs.
- Example:
  Paul is employed at a sporting goods store where he is responsible for stocking shelves and unloading the delivery trucks. His Job Coach has identified that he consistently unloads the trucks according to store protocol and considers him proficient at this task. Paul is still learning the labeling process and how to accurately display the merchandise. His Job Coach will continue to help him learn the labeling and display protocols. Paul has a Rights Modification in place regarding not having unsupervised alone time with women and meets the criteria of a Public Safety Risk. Paul’s situation warrants Workplace Assistance due to his supervision needs in community settings. DVR will continue to cover Job Coaching related to the labeling and learning to display merchandise. Workplace Assistance can be authorized to cover the portion of his shift when he is unloading the trucks and any other tasks or activities he no longer needs Job Coaching for. A trained staff person is present for the entirety of Paul’s shift; however, the nature of the support and the funding is different depending on whether he is still learning tasks or not. As Paul demonstrates competence with labeling and displaying merchandise, the Job Coaching time will decrease, and the Workplace Assistance time can increase.

Can a member receive both Workplace Assistance and HCBS Waiver-funded Job Coaching services?

Yes, Workplace Assistance and Job Coaching are two different, but complementary services, designed to address different needs. A member may have one or both services authorized in their Person-Centered Support Plan. As with all services, to receive both Workplace Assistance and Job Coaching, each service included in the Person-Centered Support Plan must be appropriate to meet the member’s identified needs. The unit cap for Supported Employment will apply, and the services may not be utilized simultaneously (i.e. they may not be provided at the same time on the same day).

Can the same staff member deliver Job Coaching and Workplace Assistance?

Yes. An agency that is an approved provider for Job Coaching and Workplace Assistance could have the Job Coach also deliver Workplace Assistance. This could make it seamless for the member and reduce the drive/transition time for staff. That said, there are a few considerations:
- If the member is being supported by DVR, then the agency would need to be a DVR vendor, as well as a Medicaid-approved provider for Supported Employment, which includes Workplace Assistance.
- The member can choose their Workplace Assistance service to be delivered by a different agency than their Job Coaching service.
- The agency may have someone besides the Job Coach provide the Workplace Assistance service so that the Job Coach (who likely has specialized training) can support more members learn their jobs.

Can Workplace Assistance be used outside of the member’s shift?

Yes, however, it should directly relate to supporting the member in their employment. Workplace Assistance will typically be delivered at the member’s place of employment and during the member’s work hours. Workplace Assistance can also be authorized for time immediately before or after the member’s shift, for activities such as setting up the member’s workstation or attending to personal needs.
Additionally, Workplace Assistance can be used to promote a member’s participation in work-related events at other locations e.g. attending an off-site training or a company holiday party.

Is Workplace Assistance only for supporting job-related tasks?

No, Workplace Assistance can also be used to support integration at work beyond job-related tasks for members with valid safety concerns. Workplace Assistance can support those members if they need assistance during breaks or lunches, or immediately before/after their shift. Supporting the member’s personal care needs may be a component of Workplace Assistance services. Workplace Assistance can also be leveraged to support the member in attending occasional informal employee gatherings and employer-sponsored events.
- Example:
  Taylor is employed at a small dental practice. He reminds patients of upcoming appointments by calling, texting, and/or emailing. When a patient is coming in for a procedure (rather than a cleaning) he provides instructions to them ahead of time. He also can reschedule appointments, if needed. Taylor has cerebral palsy and uses a wheelchair. He needs assistance in the bathroom, at lunchtime setting out food, and setting up his workstation for the day. He does not need help with his job tasks. Taylor’s Workplace Assistance staff person arrives with Taylor about 15 minutes before his 3-hour shift. The staff person ensures the workstation is set up in a way that is ergonomic and as Taylor wishes. Additionally, if Taylor needs to use the bathroom before his shift, the staff person assists him in the bathroom following identified protocols to minimize the chance of Taylor falling. The staff person is only onsite for about 30 minutes. Taylor’s co-workers set out his food at lunchtime and help put it away. Taylor has emergency contact information for various people in his support network in a notebook he keeps with him. His supervisor/co-workers know to access the notebook and contact the appropriate people if Taylor needs support beyond what they can assist him with. Between his co-workers and the Workplace Assistance staff, Taylor’s support needs at work are being addressed. The support he needs in the bathroom is related to preventing falls and is beyond the scope of what his co-workers can do.

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Service Authorization Questions

What is needed for Workplace Assistance to be authorized/ added to Person-Centered Support Plans?

Prior to Workplace Assistance being authorized, the member and their support team must determine if the member has a valid safety concern that requires having a paid caregiver present, and that alternatives to having a paid caregiver at work have been explored. The five factors for teams to consider are listed below, with a detailed explanation for each to follow:
- Necessary Job Coaching occurred
- Specific safety concern(s) are identified
- The member’s actual need is determined using an individualized, person-centered, process that highlights the member’s strengths and preferences
- Informed option from qualified Supported Employment Professional regarding the situation
- The member’s input
All factors should be addressed by the team and documented in the member’s Case Management record (e.g. Log Notes/ Service Goal) before Workplace Assistance units may be added to the member’s Person-Centered Support Plan. The Workplace Assistance provider should also have documentation reflecting what was attempted and discussed.

These factors do not need to be completed in a particular sequence; they are numbered in this FAQ for clarity. It is not intended to be a prioritization of the factors nor direction of the order in which they will be done. In fact, some of the factors may blend together e.g. getting the informed opinion from a qualified Supported Employment professional may inherently outline what Job Coaching has been completed.
Prior authorization factor #1: Necessary Job Coaching occurred
- Before authorizing Workplace Assistance, teams will consider if the member has had adequate support through Job Coaching to promote the member’s independence and minimize the need for the presence of a paid caregiver.
  
  The Job Coach should be able to speak to what has been attempted or provide explanations about why that avenue has not been pursued. Areas to be addressed are:
  - Has adequate job training occurred? Was the member given support in a way that they can learn/master the job? Were job aids developed, if necessary? Were individualized instruction techniques used?
  - Are appropriate accommodations in place? Did the member or Job Coach request accommodations from the employer? Do they seem to cover what the member needs?
  - Have efforts been made to promote natural supports? Have connections been made with supervisors/co-workers so that the member can be integrated into the work culture? Are people at the worksite supporting the member where appropriate?
  - Was technology considered as a support for the member/job? Should something be explored that could viably reduce the need for a paid caregiver?
    Note: this avenue does not have to be exhausted prior to approving Workplace Assistance, however, if there is viable technology it should be pursued, and the team can revisit how the implemented technology reduced the need for the paid caregiver at the annual Person-Centered Support Plan meeting (or sooner).
Prior authorization factor #2: Specific safety concerns are identified
- Before authorizing Workplace Assistance, teams will need to identify the safety concern(s) to be addressed. The team should also be able to articulate how the Workplace Assistance staff could support the member in addressing the safety concern(s) at work while facilitating integration and independence.
Prior authorization factor #3: Determine the member’s actual need
- Before authorizing Workplace Assistance, teams should take an individualized, person-centered, and strengths-based approach to review the member’s need for support at work. Specifically considering:
  - The nature of the job and work location
  - The member’s longevity with the employer
  - The degree of continuity at the member’s place of employment
  - The likelihood of the member putting themselves/others in harm’s way
Prior authorization factor #4: Informed opinion by qualified Supported Employment Professional
- Before authorizing Workplace Assistance, the need for the member to have paid caregiver support beyond intermittent Job Coaching should be established by a qualified Supported Employment Professional. This opinion should be grounded in Employment First concepts, as evidenced by:
  - The Supported Employment provider’s completion of a nationally recognized Supported Employment training certificate (Training Certificate) or a nationally recognized Supported Employment certification (Certification).
  - If the Supported Employment provider does not possess this credentialing, then the Supported Employment provider or the Case Manager may consult:
    - Someone who does possess either a Training Certificate or Certification (such as a supervisor), or
    - Someone on the Supported Employment team at the Department of Health Care Policy and Financing (HCPF) - HCPF_Supported.Employment@state.co.us
Prior authorization factor #5: Member’s input
- Before authorizing Workplace Assistance, the member must be part of the decision-making process, including identifying why the additional support is needed and exploring possible alternatives. If it is decided that Workplace Assistance is desired and needed, the member must be part of developing the plan outlining the role of the paid caregiver at work during the identified periods. The documentation of these discussions should include the member’s understanding of the need for the service and reflect what the Workplace Assistance staff would be doing to support the member at work. The member’s Person-Centered Support Plan should include the member’s preferences for how the service will be delivered.
  
  In cases where a member is required to have a certain level of supervision due to a court order or other serious concerns, that member’s team should engage in a thoughtful planning process to make an informed choice about having the continuous presence of a paid caregiver at work. In these instances, the supervision level would not be lowered solely because the member does not want to have a paid caregiver present. Rather there would be a conversation about how the Workplace Assistance staff engages at work and whether natural supports/ the work environment may be able to address the supervision needs.
  
  Conversely, if a member likes having a staff member at work but no longer has safety reasons for staff to be there, Workplace Assistance would not be appropriate to continue. Ideally, the Workplace Assistance staff would reduce their involvement and encourage the members' independence so the transition to not having a Workplace Assistance staff person present would not feel disruptive or abrupt. In this situation, the member can continue to receive intermittent Job Coaching to ensure that the employer and member are getting necessary support at work while not having staff present consistently.

Does Workplace Assistance have to be justified every year?

Yes, teams are expected to consider all of the outlined factors before adding Workplace Assistance to Person-Centered Support Plans initially and at the time of the annual renewal.

It is likely that the member has grown in their ability and experience and may not require the same level of support every year. Where possible, efforts should be made to reduce or eliminate the need for Workplace Assistance over time. Workplace Assistance staff should consistently seek to promote the member’s independence and integration at work.

Why do training, accommodations, technology, and natural supports need to be factored into Workplace Assistance authorization?

Community integration and independence is a core element of employment, it allows members to interact and build relationships with people beyond those they are related to or are served by, including coworkers and customers. There are many ways that members can be supported in the workplace while not relying on paid caregivers or family member. The intention of Supported Employment services is to have the minimal necessary support provided by a paid caregiver, so that the member can be as independent and integrated as possible within the workforce.

Supported Employment professionals should be well-versed in how to support members through training and engaging natural supports at the workplace. Accommodations and technology are also strategies that can be used to support members at work. Obtaining necessary support from the employer, such as accommodations, basic training, and supervisory responsibilities is also part of the equation. These less intrusive strategies should be maximized before relying on a paid staff person to meet those needs. Considering these other strategies will help teams determine if having a paid caregiver at work is the best and only way to support that member on the job.

Do Workplace Assistance service authorizations have to stay under the Service Plan Authorization Limit (SPAL)?

No, Workplace Assistance services, like other Individual Supported Employment services, are not subject to the SPAL in the Home and Community-Based Services Supported Living Services (HCBS-SLS) Waiver. Authorizations for Workplace Assistance along with other Supported Employment services must remain within specific unit limitations and under the Overall Spending Limit (Total Plan Spending).

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Provider Questions

Does the provider have to be a Program Approved Service Agency (PASA) to deliver Workplace Assistance?

Yes. Workplace Assistance falls under the umbrella of Supported Employment services and all provider enrollment/requirements apply. Existing Supported Employment providers do not need to take any additional steps to be approved to deliver Workplace Assistance.
For more information about becoming a Supported Employment provider, check out the “Supported Employment Provider Enrollment Instructions” on the Supported Employment Resources page.

Do Workplace Assistance staff need special training?

While Workplace Assistance staff do not need to possess a nationally recognized Supported Employment Training Certificate or Certification, it is expected that Workplace Assistance staff possess a basic understanding of Employment First principles. These staff should also have an awareness of how not to hinder the member’s interaction with co-workers, customers, and other community members at the worksite. These staff should be able to identify and implement ways that their presence will not be disruptive to the member’s place of employment. To learn more about Employment First, check out the Colorado Association of People Supported Employment First (APSE) website.

What is the reimbursement rate for Workplace Assistance?

Workplace Assistance is reimbursed in 15-minute increments (1 unit = 15 minutes). Rate and procedure codes are on the Department’s Provider Rates and Fee Schedule page.

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