Common use of Requirements for Exempt Temporary Assistance Participants Clause in Contracts

Requirements for Exempt Temporary Assistance Participants. ‌ (Reference 18 NYCRR 385.2 (e)) An exempt individual who has the potential to be restored to self-sufficiency through rehabilitation may be required to accept medical care to assist the individual in recovering from a mental or physical impairment, accept referral to and enrollment in a program of vocational rehabilitation, training, and/or other essential rehabilitation, and provide requested evidence that he/she is participating in the assigned program. a. Following is the district’s procedure for determining if an individual who is unable to work due to a mental or physical impairment has the potential through treatment or other rehabilitative activities to improve the ability to work. This determination is different from the determination of the individual’s disability exemption as covered in Section 6.1 of this plan. Included here is who (e.g., medical practitioner, employment worker, Temporary Assistance worker, local review team, etc.) makes or assists in this determination that an individual can restore or improve employability through treatment or other rehabilitative activities. Also included is the source and type of information used to make the determination (e.g., information from individual’s medical practitioner, district contracted provider, specialist evaluation obtained as result of district referral, etc.): Refer to section 6.1 - same process followed b. Following is the district’s procedure for developing a treatment plan and for referring the participant to appropriate treatment, etc. Please be specific: Employment unit staff reviews medical documentation provided by medical practitioner with recipient to develop a treatment plan based on practitioner’s recommendation to be added to his/her employment plan. c. Following is the district’s procedure for tracking the participant’s compliance with the treatment plan, including who in the district is responsible for monitoring compliance. Include elements such as monthly confirmation of attendance at rehabilitation or other factors to judge participation and progress, along with how often the treatment plan is updated: Each month, employment staff meets with exempt temporary assistance participants to discuss progress of treatment plan and review participants provided attendance timesheets of required treatment or other rehabilitative activities. Madison County Department of Social Services 7/1/13‌ 1 Deputy Commissioner– Financial Aid Commissioner 1 Deputy Commissioner– Administrative Services 1 Confidential Secretary 1 Deputy Commissioner– Family Services L egal: 2 Attorneys 1 Paralegal 1 OAII 1 Director of Child Support/ Financial Aid 1 Director of Temporary Assistance/ Financial Aid 1 Director of Admin. Serv. 1 PAC 1 Director of Admin. Serv. 1 PAC C PS/Adult 1 Senior CW 10 CW 1 Case B 5 XX X xxxxx Care/ Preventive/ P INS/Adult Services 2 Case B 2 Senior CW 3 OAII 1 FT Trans Aide 3 SSWE 11 SWE 1 OAII C xxxx Support: 3 Senior Inv. 5 Support Inv. 1 SWE 1 OAII 1 OAI H EAP/ 2 SWE 6 OAI 3 Energy Aides (seasonal) 2 SSWE 12 SWE Employment/ C xxxx Care: 2 Emp Rep 1 SWE 1 OAII 1 OAII 4 OAII

Requirements for Exempt Temporary Assistance Participants. ‌ (Reference 18 NYCRR 385.2 (e)) An exempt individual who has the potential to be restored to self-sufficiency through rehabilitation may be required to accept medical care to assist the individual in recovering from a mental or physical impairment, accept referral to and enrollment in a program of vocational rehabilitation, training, and/or other essential rehabilitation, and provide requested evidence that he/she is participating in the assigned program. a. Following is the district’s procedure for determining if an individual who is unable to work due to a mental or physical impairment has the potential through treatment or other rehabilitative activities to improve the ability to work. This determination is different from the determination of the individual’s disability exemption as covered in Section 6.1 of this plan. Included here is who (e.g., medical practitioner, employment worker, Temporary Assistance worker, local review team, etc.) makes or assists in this determination that an individual can restore or improve employability through treatment or other rehabilitative activities. Also included is the source and type of information used to make the determination (e.g., information from individual’s medical practitioner, district contracted provider, specialist evaluation obtained as result of district referral, etc.): Refer When an individual has indicated that they are unable to section 6.1 - same process followedengage in activities due to a physical or mental health issue the agency will request that the individuals doctor complete an LDSS-4526. On this form the physician will indicate the individuals condition, current treatment programs the individual is engaged in, limitations to work activities and how long they are expected to last and if the physician feels a referral to a rehabilitation program is appropriate. This information is used by the Employment Case Manager to determine if rehab should be part of an Employment Plan b. Following is the district’s procedure for developing a treatment plan and for referring the participant to appropriate treatment, etc. Please be specific: All exempt individuals are called in to do Employment unit staff reviews medical documentation provided by medical practitioner Plans. An individual who can improve their ability to engage in work activities through rehab will develope an Empoyment Plan along with recipient to develop a treatment plan based on practitioner’s recommendation their Employment Case Manager that spells out the steps the individual is too take. This would include actions such as contacting their primary care physician for appropriate referrals and time frames in which the action needs to be added to his/her employment planaccomplished. c. Following is the district’s procedure for tracking the participant’s compliance with the treatment plan, including who in the district is responsible for monitoring compliance. Include elements such as monthly confirmation of attendance at rehabilitation or other factors to judge participation and progress, along with how often the treatment plan is updated: Each month, employment staff meets with exempt temporary assistance participants to discuss progress of treatment plan and review participants provided attendance timesheets of required treatment or other rehabilitative activities. Madison County Department of Social Services 7/1/13‌ 1 Deputy Commissioner– Financial Aid Commissioner 1 Deputy Commissioner– Administrative Services 1 Confidential Secretary 1 Deputy Commissioner– Family Services L egal: 2 Attorneys 1 Paralegal 1 OAII 1 Director of Child Support/ Financial Aid 1 Director of Temporary Assistance/ Financial Aid 1 Director of Admin. Serv. 1 PAC 1 Director of Admin. Serv. 1 PAC C PS/Adult 1 Senior CW 10 CW 1 Case B 5 XX X xxxxx Care/ Preventive/ P INS/Adult Services 2 Case B 2 Senior CW 3 OAII 1 FT Trans Aide 3 SSWE 11 SWE 1 OAII C xxxx Support: 3 Senior Inv. 5 Support Inv. 1 SWE 1 OAII 1 OAI H EAP/ 2 SWE 6 OAI 3 Energy Aides (seasonal) 2 SSWE 12 SWE Employment/ C xxxx Care: 2 Emp Rep 1 SWE 1 OAII 1 OAII 4 OAII:

Requirements for Exempt Temporary Assistance Participants. ‌ (Reference 18 NYCRR 385.2 (e)) An exempt individual who has the potential to be restored to self-sufficiency through rehabilitation may be required to accept medical care to assist the individual in recovering from a mental or physical impairment, accept referral to and enrollment in a program of vocational rehabilitation, training, and/or other essential rehabilitation, and provide requested evidence that he/she is participating in the assigned program. a. Following is the district’s procedure for determining if an individual who is unable to work due to a mental or physical impairment has the potential through treatment or other rehabilitative activities to improve the ability to work. This determination is different from the determination of the individual’s disability exemption as covered in Section 6.1 of this plan. Included here is who (e.g., medical practitioner, employment worker, Temporary Assistance worker, local review team, etc.) makes or assists in this determination that an individual can restore or improve employability through treatment or other rehabilitative activities. Also included is the source and type of information used to make the determination (e.g., information from individual’s medical practitioner, district contracted provider, specialist evaluation obtained as result of district referral, etc.): Refer If a client claims to section 6.1 - be unable to participate in work activities due to medical and/or mental health barriers, the FIA worker at the Job Center will refer the client to the Wellness, Comprehensive Assessment, Rehabilitation and Employment (WeCARE) program for an assessment. HRA has been enhancing its efforts to identify clients with work limitations through our existing application and recertification processes. HRA will continue to work with its contractors to strengthen assessments in these areas in an effort to better identify and serve these clients based on their individual needs, including any needs for reasonable accommodations. HRA is increasing the portals of entry to the WeCARE program from the Job Centers. HRA will implement a process where HRA staff will review a client’s case for a history of federal Supplemental Security Income (SSI) applications and/or denial and a history of non-compliance. HRA will conduct a case review of all participants who were previously referred to WeCARE prior to implementing any adverse action. Physical and mental health issues that prevent someone from being successful in the labor market and/or lead to a history of non-compliance can go unnoticed by HRA staff. To address this problem and make a determination about whether a referral for additional services is required, HRA staff will review cases for SSI application history and non-compliance history and assess whether there is a previously unidentified physical and/or mental health limitation that may be contributing to non-compliance and whether the client could benefit from a referral for additional services. Additionally, HRA worker review of Social Security Application/Denial History will help to identify clients who may be potentially eligible for SSI. There will also be a review of history of non-compliance with HRA appointments to consider unidentified limitation/barriers. HRA is also enhancing its efforts regarding the screening of clients for reasonable accommodation needs with respect to travel, participation/engagement and workplace accommodations and uses a functional assessment in vocational services. The WeCARE vendors are contracted to provide a comprehensive Biopyschosocial (BPS) assessment, including a medical evaluation by a board certified physician. The individual is encouraged to submit his/her own medical documentation to the WeCARE vendor for consideration as part of the BPS assessment. Clients can be referred to board-certified specialty physicians for further evaluation when clinically indicated. Each WeCARE medical site has on-site psychiatrists. Upon completion of the BPS, a client’s Functional Capacity Outcome (FCO) is determined and includes: • Employable with no limitations to employment: these clients are referred back to their Job Center for engagement in work-activities, or • Employable with limitations that require vocational rehabilitation services and/or specialized job development and placement activities to ensure required work-place accommodations are provided, or • Temporarily Unemployable due to unstable medical and/or mental health conditions that require a Wellness Plan, or • Unable to work for 12 or more months and potentially eligible for federal disability, or • Unable to work due to unstable medical and/or mental health conditions that require a Wellness Plan and potentially eligible for federal disability. Additionally, if, within one year of completion of a BPS, a client develops a new or worsened medical and/or mental health condition, the client is referred to WeCARE’s Clinical Review Team (CRT) for assessment. The CRT review determines if changes to the client’s clinical condition result in a new FCO. CRT teams are staffed by social workers and nurses and overseen by physicians. Assist Clients with SSI Applications and Appeals As the reforms are phased in, HRA plans to strengthen the assessments performed by WeCARE vendors by implementing more comprehensive assessments for reasonable accommodation needs, to review cases for a history of SSI applications or denials, and to expand access to programs for clients with work limitations due to disabilities. Based on the results of these screens, vendors will be required to use this information to assess clients’ employability and better identify those clients who may be eligible for federal disability benefits. In the short term, this will entail strengthening the assessments for reasonable accommodation needs with respect to travel, participation/engagement by adding questions related to needed reasonable accommodations to the BPS and other assessment process currently conducted in WeCARE. Vendors will continue to identify workplace accommodations and the review of client history of applying for federal disability benefits to better identify clients who may be potentially eligible for SSI. (See above.) HRA will assist clients in filing SSI applications and appeals of denials of SSI applications, including federal court appeals. In the short term, HRA will also assist clients denied status due to citizenship status. Data indicate that approximately 5,000 clients are pending SSA decisions on disability applications or have been denied disability for citizenship reasons. As HRA data reflect that 84% of all Cash Assistance adults over age 60 with limited English proficiency were non-citizens who had an SSI application denied or were in pending status, it is unlikely their citizenship status will ever change and thus they will never be eligible for SSI benefits. HRA plans to move these clients who have been denied SSI due to citizenship status and who have been determined to be unable to work due to physical and/or mental health limitation that is expected to last six (6) months or more to the currently unused Employment Code 36 (Incapacitated six months or more – Exempt) to prevent unnecessary call-ins and the filing of multiple SSI applications that will only continue to be denied due to citizenship status. Currently, there are several thousand of these cases that appear as SSI pending on engagement reports when in fact these numbers reflect multiple unnecessary applications. HRA also intends to develop a plan, contingent upon OTDA approval, to implement biennial recertification periods and thereby reduce unnecessary appointments for these clients who are exempt from work requirements because of their disabilities. Additionally, HRA will implement a functional assessment in vocational services. Currently, clients who are determined work-limited participate in a Diagnostic Vocational Evaluation (DVE) that focuses on the vocational strengths of the client. In the medium term, HRA intends to apply aspects of the Social Security Administration’s (SSA) sequential evaluation and grid rules to identify those clients who may be “functionally disabled” due to a combination of clinical conditions, age, lack of education and work histories, and work- limitations. HRA will modify the current DVE process to better assess identified subgroups that may qualify for federal disability benefits and use the DVE to focus on their limitations to strengthen a SSI application based on the sequential evaluation and aspects of the grid rules. HRA intends to strengthen services around obtaining federal disability benefits for those clients for whom it is appropriate while at the same process followedtime reducing HRA appointments for this vulnerable population. HRA understands that assisting clients in obtaining SSI improves the quality of the client’s life while providing him or her with a better income source. HRA will also explore options for making referrals to community-based providers who will assist clients with federal court appeals of denials of federal disability benefits. Contingent upon OTDA approval, HRA will also pursue the possibility of biennial recertifications for all SSI-pending participants. HRA believes clients who are awaiting Social Security Administration decisions on disability applications or have been denied federal disability assistance for citizenship reasons should be allowed a biennial recertification for Cash Assistance, which HRA data suggests may involve approximately 3,000 clients. This will reduce the potential for unnecessary adverse actions of case closings or sanctions for these clients. In addition, in the short term, HRA intends to support the SSI application and appeal needs of clients who are determined to be homebound for more than one year, and will provide assistance to homebound New Yorkers with SSI applications and move toward biennial recertifications (in the medium-term and contingent upon OTDA approval) and home-based SSI application assistance. b. Following is the district’s procedure for developing a treatment plan and for referring the participant to appropriate treatment, etc. Please be specific: Employment unit staff reviews medical documentation provided by medical practitioner with recipient to develop Following the completion of the BPS or CRT, as described above, a treatment plan based on practitioner’s recommendation client may be determined to be added temporarily unemployable due to his/her employment unstable medical and/or mental health conditions that require a Wellness Plan At the initial Wellness Plan appointment, the WeCARE case manager a) reviews the results of the client’s BPS or CRT assessment and b) explains the Wellness Plan as well as the client’s and vendor’s roles and responsibilities in completing the plan. Clients leave the initial Wellness Plan appointment with a confirmed appointment with a medical provider. If a client does not have a medical provider, the case manager gives the client a choice of three providers. The vendor facilitates a timely treatment appointment. c. Following is the district’s procedure for tracking the participant’s compliance with the treatment plan, including who in the district is responsible for monitoring compliance. Include elements such as monthly confirmation of attendance at rehabilitation or other factors to judge participation and progress, along with how often the treatment plan is updated: Each monthThe WeCARE vendor is responsible for monitoring the applicant’s/participant’s compliance with treatment and for reporting noncompliance to HRA, employment as follows: Clients are scheduled to meet with WeCARE a minimum of once a month to review compliance with treatment in the community and monitor progress in stabilizing the medical and/or mental health conditions that are the focus of the Wellness Plan. Case managers also contact the client’s medical provider(s) to verify attendance at treatment appointments. Immediately after the initial Wellness Plan appointment, the vendors send the treating provider a copy of the Treating Physician’s Wellness Plan Report in addition to materials explaining WeCARE and the Wellness Plan. WeCARE vendors ask community-based physicians to complete this report at the end of the Wellness Plan in order to assess clinical progress and employability. Participants in a Wellness Plan are required to have a telephone or face-to-face appointment once a month with a vendor for the duration of their Wellness Plan. Use of telphone follow-up appointmetns allows clients with unstable clinical conditions to fulfill this requirement by telephone, reduce the number of face-to- face appointments, and decrease negative actions resulting from problems traveling to and from a vendor site. Wellness plans are completed when the vendor can make a determination that the client can now work with no limiations, partcipate in work-limited vocational rehabiliation settings, or is unable to work for 12 or more months and potentially eligible for federal disablity benefits. If a client does not comply with his Wellness Plan and attend required appointments at the vendor or at the treatment provider, the vendor provides escalating outreach to facilitate compliance before reporting noncompliance to HRA. Provide Client-Centered Services for those with Substance Use Disorders In addition, HRA plans to provide more client-centered services to clients with substance use disorders and other issues by evaluating the use of Harm Reduction services for clients with a history of non-compliance with intensive treatment and, with appropriate approvals, begin making referrals and monitoring compliance. Such an approach would not subject clients to a sanction for non-compliance with traditional treatment, and would give them an opportunity to begin to address their needs through Harm Reduction programs. This approach is consistent with what other states do, as well as with New York State’s Medicaid Redesign approach. In addition, it supports HRA’s goal of not harming those at risk of becoming homeless with sanctions that are linked with homelessness. HRA recognizes that these clients often cycle in and out of care and have histories of HRA imposed sanctions for failing to comply with mandates to substance use treatment. Harm Reduction is a well- recognized portal of entry to substance use services which recognizes that the engagement of these clients may require services that are client-centered and designed to decrease possible harm to themselves and the community through the clients’ activities when using substances. Providers work with clients on decreasing use and/or amounts of substances, safety, providing clean, positive space for clients to meet staff meets with exempt temporary assistance participants /other clients, decreasing unprotected sex and other high risk and criminal behaviors. They also use motivational interviewing and other techniques over time to discuss progress of treatment plan and review participants provided attendance timesheets of required treatment or other rehabilitative activitiesattempt to encourage the client to accept clinical substance use treatment. Madison County The New York State Department of Social Services 7/1/13‌ 1 Deputy Commissioner– Financial Aid Commissioner 1 Deputy Commissioner– Administrative Services 1 Confidential Secretary 1 Deputy Commissioner– Family Services L egal: 2 Attorneys 1 Paralegal 1 OAII 1 Director of Child Support/ Financial Aid 1 Director of Temporary Assistance/ Financial Aid 1 Director of AdminHealth supports this approach to reducing substance use. Serv. 1 PAC 1 Director of Admin. Serv. 1 PAC C PS/Adult 1 Senior CW 10 CW 1 Case B 5 XX X xxxxx Care/ Preventive/ P INS/Adult Services 2 Case B 2 Senior CW 3 OAII 1 FT Trans Aide 3 SSWE 11 SWE 1 OAII C xxxx Support: 3 Senior Inv. 5 Support Inv. 1 SWE 1 OAII 1 OAI H EAP/ 2 SWE 6 OAI 3 Energy Aides (seasonal) 2 SSWE 12 SWE Employment/ C xxxx Care: 2 Emp Rep 1 SWE 1 OAII 1 OAII 4 OAIIOctober 2015

Requirements for Exempt Temporary Assistance Participants. ‌ (Reference 18 NYCRR 385.2 (e)) An exempt individual who has the potential to be restored to self-sufficiency through rehabilitation may be required to accept medical care to assist the individual in recovering from a mental or physical impairment, accept referral to and enrollment in a program of vocational rehabilitation, training, and/or other essential rehabilitation, and provide requested evidence that he/she is participating in the assigned program. a. Following is the district’s procedure for determining if an individual who is unable to work due to a mental or physical impairment has the potential through treatment or other rehabilitative activities to improve the ability to work. This determination is different from the determination of the individual’s disability exemption as covered in Section 6.1 of this plan. Included here is who (e.g., medical practitioner, employment worker, Temporary Assistance worker, local review team, etc.) makes or assists in this determination that an individual can restore or improve employability through treatment or other rehabilitative activities. Also included is the source and type of information used to make the determination (e.g., information from individual’s medical practitioner, district contracted provider, specialist evaluation obtained as result of district referral, etc.): Refer If a client claims to section 6.1 - be unable to participate in work activities due to medical and/or mental health barriers, the FIA worker at the Job Center will refer the client to the Wellness, Comprehensive Assessment, Rehabilitation and Employment (WeCARE) program for an assessment. If after the BPS process described in Section 6.1, it is determined by WeCARE that the individual has an untreated or unstable mental or physical condition that would benefit from rehabilitative activities and further treatment from their own medical practitioner, the individual is engaged in a Wellness Plan as described below and catered to their specific conditions, lasting up to 90 days with extensions possible, based on progress. Additionally, if within one year of completion of a BPS a client develops a new or worsened medical and/or health condition, the client is referred to WeCARE’s Clinical Review Team (CRT) for assessment. The CRT review determines if changes to the client’s clinical condition(s) result in a new FCO. If the client is determined to need a Wellness Plan, the steps described below are carried out. The Clinical Review Teams are staffed by social workers and nurses and overseen by physicians. Assist Clients with SSI Applications and Appeals HRA has strengthened services around obtaining federal disability benefits for those clients for whom it is appropriate while at the same time reduced HRA appointments for this vulnerable population. HRA understands that assisting clients in obtaining SSI improves the quality of the client’s life while providing him/her with a better income source. XXX has done this in the following ways: HRA has strengthened the assessments performed by WeCARE by implementing more comprehensive assessments to better identify clients who are potentially eligible for SSI. Based on the results of the BPS, CRT, and Wellness completions, vendors are required to assess and better identify those clients who may be eligible for federal disability benefits. WeCARE will assist clients in filing SSI applications and appeals of denials of SSI applications, including federal court appeals. HRA has implemented the use of the Social Security Administration’s (SSA) sequential evaluation and grid rules to identify clients who may be “functionally disabled” due to a combination of clinical conditions, age, lack of education and/or work histories, and work-limitations. HRA has modified the vocational rehabilitation assessment process followedto better assess identified subgroups that may qualify for federal disability benefits and the use of the vocational assessment to focus on their limitations to strengthen an SSI application based on the sequential evaluation and aspects of the grid rules. HRA has improved services to clients denied SSI due to citizenship status. XXX has moved thousands of clients who have been denied SSI due to citizenship status and who have been determined to be unable to work due to physical and/or mental health limitation that is expected to last twelve (12) months or more to a previously unused Employment Status Code 36 (Incapacitated six months or more – Exempt) to prevent unnecessary call-ins and the filing of multiple SSI applications that will only continue to be denied due to citizenship status. HRA has implemented an SSI Maximization Program that assists clients who are determined to be homebound for one or more years apply for SSI. This same project also reviews clients whose SSI appeal after initial denial was unsuccessful, and when appropriate, files for an appeal of the denial all the way to the Federal Court level, if considered to have merit. b. Following is the district’s procedure for developing a treatment plan and for referring the participant to appropriate treatment, etc. Please be specific: Employment unit staff reviews medical documentation provided by medical practitioner with recipient to develop Following the completion of the BPS or CRT, as described above, a treatment plan based on practitioner’s recommendation client may be determined to be added temporarily unemployable due to his/her employment planunstable medical and/or mental health conditions that require a Wellness Plan. At the initial Wellness Plan appointment, the WeCARE case manager a) reviews the results of the client’s BPS or CRT assessment and b) explains the Wellness Plan as well as the client’s and vendor’s roles and responsibilities in completing the Plan. Clients leave the initial Wellness Plan appointment with a confirmed appointment with a medical provider. If a client does not have a medical provider, the case manager gives the client a choice of three providers. The vendor facilitates a timely treatment appointment. c. Following is the district’s procedure for tracking the participant’s compliance with the treatment plan, including who in the district is responsible for monitoring compliance. Include elements such as monthly confirmation of attendance at rehabilitation or other factors to judge participation and progress, along with how often the treatment plan is updated: Each month, employment staff meets with exempt temporary assistance participants to discuss progress of treatment plan and review participants provided attendance timesheets of required treatment or other rehabilitative activities. Madison County Department of Social Services 7/1/13‌ 1 Deputy Commissioner– Financial Aid Commissioner 1 Deputy Commissioner– Administrative Services 1 Confidential Secretary 1 Deputy Commissioner– Family Services L egal: 2 Attorneys 1 Paralegal 1 OAII 1 Director of Child Support/ Financial Aid 1 Director of Temporary Assistance/ Financial Aid 1 Director of Admin. Serv. 1 PAC 1 Director of Admin. Serv. 1 PAC C PS/Adult 1 Senior CW 10 CW 1 Case B 5 XX X xxxxx Care/ Preventive/ P INS/Adult Services 2 Case B 2 Senior CW 3 OAII 1 FT Trans Aide 3 SSWE 11 SWE 1 OAII C xxxx Support: 3 Senior Inv. 5 Support Inv. 1 SWE 1 OAII 1 OAI H EAP/ 2 SWE 6 OAI 3 Energy Aides (seasonal) 2 SSWE 12 SWE Employment/ C xxxx Care: 2 Emp Rep 1 SWE 1 OAII 1 OAII 4 OAII: