A Closer Look At Vocational Habilitation


The new modifications to Ohio Home and Community Based Services (HCBS) Adult Day and Employment Services that were effective April 1, 2017 support employment and community engagement for people accessing developmental disabilities services. 

Vocational Habilitation services are time limited and provide opportunities to learn and gain new experiences, including volunteering, in order to develop general and transferrable employment-related skills. The outcome of vocational habilitation is the advancement of an individual on his or her path to community employment and the individual's acheivement of competitive integrated employment..

Vocational Habilitation Webinars and Training Bites

Vocational Habilitation: HCBS Waiver Redesign Adult Day and Employment Services
In depth review of Vocational Habilitation (pdf)1/27/2017
The rule states no more than sixteen individuals may receive day services in one group irrespective of the funding source for the services provided to the individual participants. 

Does this mean a provider may use a facility model and divide total consumers by staff?  I have numerous providers who serve 30-40 people in one setting who are concerned with this wording.


It is not acceptable for a provider to default to the maximum group size allowable and to ensure only that one staff is available for every 16 people.  The provider must ensure that "sufficient" staff are available to support individuals with achieving outcomes and maintaining health and welfare.  This should be part of the person-centered planning process.  The team is responsible for considering the level of supervision/support a person may require in various environments. 

For example, Lori's AAI may reflect a ratio of 1:6.  Maybe during dance or exercise class she remains more focused and can be served in a group of 1:16, but during community-based activities she requires 1:1 support. 

While the plan doesn't necessarily have to detail the specific ratio for every anticipated activity/event, it should provide an overview of the level of support required in various settings. (Ref. The proposed new rule Ohio Administrative Code 5123:2-9-19 (E)(5))

What are the billing changes and when do I use daily vs fifteen minute units for adult day services and vocational habilitation?

Effective April 1, 2017 the Adult Day/ Vocational Habilitation Combo codes will no longer be a billable service (AXD, AXF, FXD, FXF, SXD, SXF). Services must be billed to reflect the specific service provided; either Adult Day or Vocational Habilitation.

The Adult Day daily codes and the Vocational Habilitation daily codes may be used if that service is provided in the period of 5-7 hours (defined day) and the individual does not qualify for the behavioral support rate modification or medical assistance rate modification, or when a qualified provider elects not to receive the community integration rate modification.

The service specific fifteen-minute unit code may be used to bill when the individual receives less than 5 or more than 7 hours of the service that day, when Adult Day services and Vocational Habilitation services are delivered on the same day, when the individual qualifies for the behavioral support rate modification or medical assistance rate modification, or when provider qualifies for and elects to receive the community integration rate modification.

*Please See the DODD Training Page for authorization details.

How do the add on rates work?

Behavioral support and medical assistance rate modifications apply

If a person qualifies for behavior add on rates, the state only pays for the behavior add on rate for adult day services including Vocational Habilitation.

If a person qualifies for the medical add on rate, the county pays for medical add-on rate for adult day services including Vocational Habilitation.

How can I access the DODD community integration training?

Proposed changes to Adult Day and Employment Services will be implemented on April 1, 2017. Here are archived versions of previous webinars, as well as information about upcoming training opportunities.

When do I use group size in billing community integration day services?

The community integration code requires a group size as part of its validation.
Group size is not required on claims for Adult Day Support or Vocational Habilitation
without the community integration component.

What are the changes to the combo code?

Although the combo code in CPT allows more flexibility in authorizing units/dollars, the expectation is that each ISP reflect the type(s) of services to be delivered by the provider and the related outcomes of these services. 

Providers will still be required to bill the correct Adult Day Support and/or Vocational Habilitation codes that accurately reflect the services delivered to the individual. 

Vocational Habilitation Facts List

Check_mark_.png Supports the individual's membership in the community

Check_mark_.pngEnhance general, transferrable employment-related skills

Check_mark_.pngRequire annual, individualized progress reports

Check_mark_.pngIs a step toward employment

Check_mark_.pngCan include volunteer opportunities

What activities can be included in Vocational Habilitation?
(See rule definition for full description)

  • Developing a systematic plan of instruction and support
  • Providing assistance to increase social integration
  • Support and training for individualized or community-based transportation services
  • Support to increase problem solving skills and meet job expectations
  • Assistance using natural supports and community resources
  • Education to maintain current skills (including hygiene, work skills, etc.)
  • Developing and implementing a transition plan 
  • Assistance with self-medication or medication administration

For complete overview of provider qualifications, please see the proposed rule, 5123:2-9-14.

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