From Douglas Morton, from the Illinois Division of Rehabilitation Services:
Illinois VR has used a milestone payment system with CRP agencies for the last six years. We pay providers 25% of the total amount when an individual achieves 15 days of employment, another 25% at 45 days of employment, and the final 50% when the individual achieves employment stability after 90 days of employment. Milestone contracts account for about a third of our CRP contracts. We also continue to have contracts that pay a lump sum payment when an individual achieves employment stability after 90 days of employment. These types of performance-based contracts have reduced our spending on unsuccessful closures, compared to service-based contracts used in the past. While there was some initial resistance the milestone contracts have proven to be popular with providers. We believe that the interests of the VR agency, the customer and the provider are aligned in this system.
From LuAnn Summers, from WVDRS:
WVDRS implemented Milestone payments in 2008 when we closed our Rehabilitation Center and worked on moving CRP services back into the communities that clients reside. Below is feedback regarding benefits, potential issues and concerns. If you have additional questions please feel free to contact me.
Benefits:
• Ability to pay the CRP throughout the rehabilitation process
• Ensures follow up of services from the CRP
• Provides regular on-going updates to the counselor as the CRP must send in required paperwork with the invoice during the process
• Reimburses the CRP for services provided and does not punish them if through no fault of theirs if the client is not successful
• Better promotes the counselor being a part of the rehabilitation process making decisions along the way
Potential issues:
• During implementation there was initial confusion regarding making payments for services provided if the client was not successful
• Must ensure that time lines are reasonable for the CRP and the client to ensure that follow up is being done in a timely manner for the client and enables the CRP to provide the services within reasonable time frame
• Having the ability to train all new and existing staff prior to implementation/utilization of services and update on regular basis
• This milestone system does require the counselor to be on top of the case to be a part of the decision making throughout the rehabilitation process
Concerns:
We really did not have any major concerns. We researched how other states were implementing services along with fees for those services and utilized those aspects that would work well in WV. After implementation we reviewed utilization reports and met with each district to discuss utilization and determine why certain services were utilized more than other and made some tweaking along the way. We had one service, community based assessment, that we had made milestone that just did not seem to work well for milestone payment so we did go back and change it to an hourly rate. You will have to follow the process after implementation to ensure it is providing your clients and counselors with the type of outcomes you are hoping to obtain.
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From Tim Gravier, Missouri VR:
The benefit is that it’s “outcome based” and as an agency, you can define the outcome parameters. The issue faced is a third party verification of the outcome or a very reliable source of verification.
From Don Kay, WA-DVR:
WA-DVR has used an outcome-based CRP contract for a number of years. Here is a link to the current contract that is on our website:
http://www.dshs.wa.gov/pdf/HRSA/dvr/CRP/CRP_Sample_Contract.pdf
Let me know if youhave any questions.
From David Higginbotham, Louisiana Rehab Services:
For each Milestone: 1) Clearly define the parameters (e.g. related activities, time frame); 2) Specify the quality indicators for each Milestone (e.g. standards for service delivery, doucmentation of services; and 3) Specify the standard(s) that must be met for the CRP to recieve payment for services.
Posted in: Job Development and Placement Services