Medicaid 1915i: Supported Employment (SE) and Individual Placement and Support (IPS)

• Clinical Coverage Policy 8H-1 Supported Employment for IDD and TBI
• Clinical Coverage Policy 8H-2 IPS for MH and SUD
• Alliance NC Core Milestone Structure

Submission Requirements

Care Managers (not the provider of the service) submit ALL requests for 1915i services.

Member must be determined eligible for 1915i services.

• Service Authorization Request (SAR)
• Person Centered Service Plan with incorporation of the Career Development Plan (CDP)
• Service Order

Service Definition Authorization Parameters

**Please note effective 2/19/2024, IPS Supported Employment for members with MHSUD diagnoses does not require Prior Authorizaiton.**

1 unit = 15 minutes of Supported Employment

3 Phases:

Pre-employment Phase and Employment Stabilization Phase

• A maximum of 20 hours/week (80 units/week) for up to 180 consecutive days for initial job development, training, and support services.
• Additional units can be requested If a beneficiary obtains employment and one’s schedule/support needs require more than 20 hours/week.
• If more than 180 consecutive days for initial job development is needed, additional days can be requested with justification.

Employment Stabilization Phase

• Services must be based on the beneficiaries work schedule and support needs, not to exceed 40 hours/week (160 units/week).
• 365 days can be authorized if the beneficiary’s work schedule and support needs are not anticipated to change.

Long-Term Supported Employment Phase

• For a beneficiary with ongoing support needs, Supported Employment may be authorized for the number of hours necessary to support the beneficiary to remain stable in their employment; not to exceed 40 hours/week (160 units/week).
• For a beneficiary who is stable in their employment and has minimal support needs, a maximum of 10 hours/month (40 units/month) may be approved annually for periodic long-term support. If the beneficiary has an increase in support needs, additional hours may be authorized to maintain employment stability.