DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, Maryland   21244-1850 
 
Center for Medicaid, CHIP and Survey & Certification 
 
CMCS Informational Bulletin  
 
DATE:   September 16, 2011 
 
FROM:   Cindy Mann, JD 
    Director  
                Center for Medicaid, CHIP and Survey & Certification (CMCS)  
 
SUBJECT:   Updates to the 1915 (c) Waiver Instructions and Technical Guide regarding  
    employment and employment related services  
 
This Informational Bulletin is intended to provide clarification of existing CMS guidance on 
development and implementation of 1915 (c) Waivers regarding employment and employment 
related services.  Specifically, this letter provides updates to several sections of the current Waiver 
Technical Guide Version 3.5, which was released in January of 2008, in advance of a future release 
of Technical Guide Version 3.6. 
 
This guidance does not constitute new policy, but rather highlights the opportunities available to use 
waiver supports to increase employment opportunities for individuals with disabilities within current 
policy.  Further, it underscores CMSs commitment to the importance of work for waiver participants 
and provides further clarification of CMS guidance regarding several core service definitions.   
 
While States have the flexibility to craft their own service definitions and modify CMS core service 
definitions, many States rely on CMS language for their waiver core service definitions.  We hope 
that by emphasizing the importance of employment in the lives of people with disabilities, updating 
some of our core service definitions, and adding several new core service definitions to better reflect 
best and promising practices that it will support States efforts to increase employment opportunities 
and meaningful community integration for waiver participants. 
 
The major changes in the Instructions and Technical Guide are summarized below: 
 
  Highlights the importance of competitive work for people with and without disabilities and 
CMSs goal to promote integrated employment options through the waiver program 
  Acknowledges best and promising practices in employment support, including self direction 
and peer support options for employment support 
  Clarifies that Ticket to Work Outcome and Milestone payments are not in conflict with 
payment for Medicaid services rendered because both Ticket to Work and Milestone  
payments are made for an outcome, not service delivery 
  Adds a new core service definition- by splitting what had previously been supported 
employment into two definitions- individual and small group supported employment   
  Includes a new service definition for career planning, that may be separate or rolled into the 
other employment related service definitions  2 | P a ge- CMCS Informational Bulletin 
 
 
  Emphasizes the critical role of person centered planning in achieving employment outcomes 
  Modifies both the prevocational services and supported employment definitions to clarify that 
volunteer work and other activities that are not paid, integrated community employment are 
appropriately described in pre-vocational, not supported employment services   
  Explains that pre-vocational services are not an end point, but a time limited (although no 
specific limit is given) service for the purpose of helping someone obtain competitive 
employment 
 
I hope that you will find this information helpful. States and other interested parties may also find 
information contained in the attachments at www.hcbswaivers.net.  If you have any additional 
questions about this guidance, please contact Ms. Nancy Kirchner, Health Insurance Specialist, 
Division of Long Term Services and Supports at 410-786-8641 or nancy.kirchner@cms.hhs.gov.   
 
 
 
 
Attachments (2): 
 
1 - Revisions to the Instructions and Technical Guide for 1915 (c) Waivers - Supported Employment            
and Prevocational Services  
 
2 - Revisions to the Core Service Definitions for Employment and Employment related services in 
the Instructions and Technical Guide for 1915 (c) Waivers 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  3 | P a ge- CMCS Informational Bulletin 
 
 
Attachment 1 
Revisions to the Instructions and Technical Guide for 1915 (c) Waivers for Supported 
Employment and Prevocational Services 
 
Work is a fundamental part of adult life for people with and without disabilities. It provides a sense of 
purpose, shaping who we are and how we fit into our community. Meaningful work has also been 
associated with positive physical and mental health benefits and is a part of building a healthy 
lifestyle as a contributing member of society.  Because it is so essential to peoples economic self 
sufficiency, as well as self esteem and well being, people with disabilities and older adults with 
chronic conditions who want to work should be provided the opportunity and support to work 
competitively within the general workforce in their pursuit of health, wealth and happiness. All 
individuals, regardless of disability and age, can work  and work optimally with opportunity, 
training, and support that build on each persons strengths and interests.   Individually tailored and 
preference based job development, training, and support should recognize each persons 
employability and potential contributions to the labor market.  
 
Peer support is a powerful best practice model for helping support people to be successful in the 
world of employment. Most specifically for people with mental illness, the evidenced based practice 
of peer support has been a critical component of successful community living, including 
employment.  Additionally, various types of employment and employment related supports may be 
provided by consumer operated service programs, independent nonprofit organizations that have a 
majority consumer board of directors. There is broader applicability for peer support and self 
advocacy for other disability population groups to ease the transition into community living and/or to 
develop stronger ties in those communities through the support and guidance from others who have 
navigated those situations and can now mentor others and offer mutual support.  States may wish to 
consider provider qualifications for employment supports that draw on peer support models.  
Additional information concerning peer support services is contained in the August 15, 2007 State 
Medicaid Director letter #07-011at http://www.cms.gov/SMDL/downloads/SMD081507A.pdf.  
Self directed service delivery models can also be used to provide employment supports.  In a self-
directed model, individuals may hire their own job coaches and employment support staff, rather than 
relying exclusively on agency based staffing models.  This may be particularly useful as individuals 
seek to expand the pool of people who can provide employment supports and services to include 
friends, family members, co-workers and other community members that do not view themselves as 
part of the traditional Medicaid provider employment supports workforce.  
Customized employment is another approach to supported employment. Customized employment 
means individualizing the employment relationship between employees and employers in ways that 
meet the needs of both. It is based on an individualized determination of the strengths, needs, and 
interests of the person with a disability, and is also designed to meet the specific needs of the 
employer. It may include employment developed through job carving, self-employment or 
entrepreneurial initiatives, or other job development or restructuring strategies that result in job 
responsibilities being customized and individually negotiated to fit the needs of individuals with a 
disability.  Customized employment assumes the provision of reasonable accommodations and  4 | P a ge- CMCS Informational Bulletin 
 
 
supports necessary for the individual to perform the functions of a job that is individually negotiated 
and developed. (Federal Register, June 26, 2002, Vol. 67. No. 123 pp 43154 -43149). 
Co-worker models of support to deliver on the job supports are effective service delivery methods 
that are often less expensive to provide and less intrusive to the flow of a business, helping the 
employee with a disability not just learn the task based elements of the job, but also the cultural 
norms and relationships within that job setting.  Co-worker models of support rely on regular 
employees within the work setting who provide on the job training and ongoing support to the waiver 
participant that is beyond what is typically provided as part of supervision or training to employees.  
Co-worker supports may be delivered on a volunteer basis or paid through a stipend or other 
statewide payment methodology and unit cost as described in the waiver application Appendices I 
and J. Importantly, payment for co-worker supports is not payment to the employer for hiring the 
individual. Instead, it is encouraging the forging of natural work relationships with individuals 
already present and participating in the work environment. These models are not intended to replace 
the support providers work, rather, it would be an additional mentoring/support role for which co-
workers could receive additional compensation above what they receive in the course of their typical 
job responsibilities.  
 
The Ticket to Work Program (TTW) is an employment support program offered through the Social 
Security Administration (SSA) which is available to SSA beneficiaries with disabilities who want to 
achieve and maintain their employment goals and can work in a complementary fashion with waiver 
services.  Ticket Outcome and Milestone payments do not conflict with CMS regulatory requirements 
and do not constitute an overpayment of Federal dollars for services provided since payments are 
made for an outcome, rather than for a Medicaid service rendered. Additional information regarding 
the receipt of Federal funds under the SSAs Ticket to Work program is contained in the January 28, 
2010  State Medicaid Director letter SMD# 10-002 at http://www.cms.gov/SMDL/SMD/list.asp. 
  
Supported employment and prevocational services may be furnished as expanded habilitation 
services under the provisions of 1915(c)(5)(C) of the Act. They may be offered to any target group 
for whom the provision of these services would be beneficial in helping them to realize their goals of 
obtaining and maintaining community employment in the most integrated setting. As provided in 
Olmstead Letter #3 (included in Attachment D), the provision of these services is not limited to 
waiver participants with intellectual or developmental disabilities, and can be a meaningful addition 
to the service array for any of the regulatorily identified target groups. 
 
It is important to note that such services may only be furnished to a waiver participant to the extent 
that they are not available as vocational rehabilitation services funded under section 110 of the 
Rehabilitation Act of 1973. When a state covers any category of supported employment services 
and/or prevocational services in a waiver, the waiver service definition of each service must 
specifically explain that the services do not include services that are available under section 110 of  
the Rehabilitation Act  of 1973 or, in the case of youth, under the provisions of the Individuals with 
Disabilities Education Act (IDEA), as well as assure that  such services are not available to the 
participant before authorizing their provision as a waiver service. 
  5 | P a ge- CMCS Informational Bulletin 
 
 
Waiver funding is not available for the provision of vocational services delivered in facility based or 
sheltered work settings, where individuals are supervised for the primary purpose of producing goods 
or performing services. The distinction between vocational and pre-vocational services is that pre-
vocational services, regardless of setting, are delivered for the purpose of furthering habilitation goals 
such as attendance, task completion, problem solving, interpersonal relations and safety, as outlined 
in the individuals person-centered services and supports plan. Prevocational services should be 
designed to create a path to integrated community based employment for which an individual is 
compensated at or above the minimum wage, but not less than the customary wage and level of 
benefits paid by the employer for the same or similar work performed by individuals without 
disabilities. 
 
Although this is guidance with respect to the 1915 (c) Waiver program, we note that states have 
obligations pursuant to the Americans with Disabilities Act, Section 504 of the Rehabilitation Act, 
and the Supreme Courts Olmstead decision interpreting the integration regulations of those statutes.  
Consistent with the Olmstead decision and with person centered planning principles, an individuals 
plan of care regarding employment services should be constructed in a manner that reflects individual 
choice and goals relating to employment and ensures provision of services in the most integrated 
setting appropriate.   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  6 | P a ge- CMCS Informational Bulletin 
 
 
 
 
 
 
 
 
 
 
 
 
Attachment 2  
 
Revisions to the Core Service Definitions for Employment and Employment related 
services in the Instructions and Technical Guide for 1915 (c) Waivers 
 
Day Habilitation 
Core Service Definition: 
Provision of regularly scheduled activities in a non-residential setting, separate from the participants 
private residence or other residential living arrangement, such as assistance with acquisition, 
retention, or improvement in self-help, socialization and adaptive skills that enhance social 
development and develop skills in performing activities of daily living and community living.   
Activities and environments are designed to foster the acquisition of skills, building positive social 
behavior and interpersonal competence, greater independence and personal choice.  Services are 
furnished consistent with the participants person-centered plan. Meals provided as part of these 
services shall not constitute a "full nutritional regimen" (3 meals per day). 
Day habilitation services focus on enabling the participant to attain or maintain his or her maximum 
potential and shall be coordinated with any needed therapies in the individuals person-centered 
services and supports plan, such as physical, occupational, or speech therapy.  
 
Instructions 
 Supplement or modify the core definition as appropriate to specify service elements/activities 
furnished as day habilitation under the waiver. 
 Day habilitation may be furnished in any of a variety of settings in the community other than the 
persons private residence.  Day habilitation services are not limited to fixed-site facilities. 
Supplement the core definition by specifying where day habilitation is furnished. 
 If transportation between the participant's place of residence and the day habilitation site, or other 
community settings in which the service is delivered, is provided as a component part of day 
habilitation services and the cost of this transportation is included in the rate paid to providers of day 
habilitation services, the service definition must include a statement to that effect in the definition. 
 
Guidance 
 Day habilitation may not provide for the payment of services that are vocational in nature (i.e., for 
the primary purpose of producing goods or performing services).  7 | P a ge- CMCS Informational Bulletin 
 
 
 Personal care/assistance may be a component part of day habilitation services as necessary to meet 
the needs of a participant, but may not comprise the entirety of the service. 
 Participants who receive day habilitation services may also receive educational, supported 
employment and prevocational services. A participants person-centered services and supports plan 
may include two or more types of non-residential habilitation services. However, different types of 
non-residential habilitation services may not be billed during the same period of the day. 
 Day habilitation services may be furnished to any individual who requires and chooses them 
through a person-centered planning process. Such services are not limited to persons with intellectual 
or developmental disabilities. 
 For individuals with degenerative conditions, day habilitation may include training and supports 
designed to maintain skills and functioning and to prevent or slow regression, rather than acquiring 
new skills or improving existing skills. 
 Day habilitation services may also be used to provide supported retirement activities.  As some 
people get older they may no longer desire to work and may need supports to assist them in 
meaningful retirement activities in their communities.  This might involve altering schedules to allow 
for more rest time throughout the day, support to participate in hobbies, clubs and/ or other senior 
related activities in their communities.  
 If States wish to cover career planning activities they may choose to include it as a component 
part of day habilitation services or it may be broken out as a separate stand alone service definition.  
 
Prevocational Services 
Core Service Definition: 
Services that provide learning and work experiences, including volunteer work, where the individual 
can develop general, non-job-task-specific strengths and skills that contribute to employability in 
paid employment in integrated community settings.  Services are expected to occur over a defined 
period of time and with specific outcomes to be achieved, as determined by the individual and his/her 
service and supports planning team through an ongoing person-centered planning process.   
 
Individuals receiving prevocational services must have employment-related goals in their person-
centered services and supports plan; the general habilitation activities must be designed to support 
such employment goals. Competitive, integrated employment in the community for which an 
individual is compensated at or above the minimum wage, but not less than the customary wage and 
level of benefits paid by the employer for the same or similar work performed by individuals without 
disabilities is considered to be the optimal outcome of prevocational services.   
 
Prevocational services should enable each individual to attain the highest level of work in the most 
integrated setting and with the job matched to the individuals interests, strengths, priorities, abilities, 
and capabilities, while following applicable federal wage guidelines. Services are intended to develop 
and teach general skills; Examples include, but are not limited to: ability to communicate effectively 
with supervisors, co-workers and customers; generally accepted community workplace conduct and 
dress; ability to follow directions; ability to attend to tasks; workplace problem solving skills and 
strategies; general workplace safety and mobility training.  
  8 | P a ge- CMCS Informational Bulletin 
 
 
Participation in prevocational services is not a required pre-requisite for individual or small group 
supported employment services provided under the waiver.  Many individuals, particularly those 
transitioning from school to adult activities, are likely to choose to go directly into supported 
employment. Similarly, the evidence-based Individual Placement and Support (IPS) model of 
supported employment for individuals with behavioral health conditions emphasizes rapid job 
placement in lieu of prevocational services.   
Documentation is maintained that the service is not available under a program funded under section 
110 of the Rehabilitation Act of 1973 or the IDEA (20 U.S.C. 1401 et seq.). 
 
Instructions 
 Supplement or modify the core definition as appropriate to incorporate the specific service elements 
furnished under the waiver. 
 Prevocational services may be furnished in a variety of locations in the community and are not 
limited to fixed-site facilities.  Specify in the service definition where these services are furnished. 
 If transportation between the participant's place of residence and the prevocational service site/s is 
provided as a component part of prevocational services and the cost of this transportation is included 
in the rate paid to providers of prevocational services, the service definition must include a statement 
to that effect. 
 Specify in the definition how the determination is made that the services furnished to the participant 
are prevocational rather than vocational in nature in accordance with 42 CFR 440.180(c)(2)(i). 
 
Guidance 
 Pre-vocational Services include activities that are not primarily directed at teaching skills to perform 
a particular job, but at underlying habilitative goals (e.g., attention span, motor skills, interpersonal 
relations with co-workers and supervisors) that are associated with building skills necessary to 
perform work and optimally to perform competitive, integrated employment.  Vocational services, 
which are not covered through waivers, are services that teach job task specific skills required by a 
participant for the primary purpose of completing those tasks for a specific facility based job and are 
not delivered in an integrated work setting through supported employment. The distinction between 
vocational and pre-vocational services is that pre-vocational services, regardless of setting, are 
delivered for the purpose of furthering habilitation goals that will lead to greater opportunities for 
competitive and integrated employment and career advancement at or above minimum wage.  These 
goals are described in the individuals person centered services and supports plan and are designed to 
teach skills that will lead to integrated competitive employment. 
 A person receiving pre-vocational services may pursue employment opportunities at any time to 
enter the general work force. Pre-vocational services are intended to assist individuals to enter the 
general workforce.   
 Individuals participating in prevocational services may be compensated in accordance with 
applicable Federal laws and regulations and the optimal outcome of the provision of prevocational 
services is permanent integrated employment at or above the minimum wage in the community.  
 All prevocational and supported employment service options should be reviewed and considered as 
a component of an individuals person-centered services and supports plan no less than annually, 
more frequently as necessary or as requested by the individual. These services and supports should be 
designed to support successful employment outcomes consistent with the individuals goals.  9 | P a ge- CMCS Informational Bulletin 
 
 
 Personal care/assistance may be a component of prevocational services, but may not comprise the 
entirety of the service. 
 Individuals who receive prevocational services may also receive educational, supported 
employment and/or day habilitation services. A participants person-centered services and supports 
plan may include two or more types of non-residential habilitation services. However, different types 
of non-residential habilitation services may not be billed during the same period of the day.   
If States wish to cover career planning activities they may choose to include it as a component part 
of pre-vocational services or it may be broken out as a separate stand alone service definition.  
 Prevocational services may include volunteer work, such as learning and training activities that 
prepare a person for entry into the paid workforce. 
 Prevocational services may be furnished to any individual who requires and chooses them through a 
person-centered planning process.  They are not limited to persons with intellectual or developmental 
disabilities. 
 
Supported Employment -Individual Employment Support  
Core Service Definition 
Supported Employment -Individual Employment Support services are the ongoing supports to 
participants who, because of their disabilities, need intensive on-going support to obtain and maintain 
an individual job in competitive or customized employment, or self-employment, in an integrated 
work setting in the general workforce for which an individual is compensated at or above the 
minimum wage, but not less than the customary wage and level of benefits paid by the employer for 
the same or similar work performed by individuals without disabilities. The outcome of this service is 
sustained paid employment at or above the minimum wage in an integrated setting in the general 
workforce, in a job that meets personal and career goals.  
 
Supported employment services can be provided through many different service models.  Some of 
these models can include evidence-based supported employment for individuals with mental illness, 
or customized employment for individuals with significant disabilities.  States may define other 
models of individualized supported employment that promote community inclusion and integrated 
employment.   
 
Supported employment individual employment supports may also include support to establish or 
maintain self-employment, including home-based self-employment. Supported employment services 
are individualized and may include any combination of the following services: vocational/job-related 
discovery or assessment, person-centered employment planning, job placement, job development, 
negotiation with prospective employers, job analysis, job carving, training and systematic instruction, 
job coaching, benefits support, training and  planning, transportation, asset development and career 
advancement services, and other workplace support services including services not specifically 
related to job skill training that enable the waiver participant to be successful in integrating into the 
job setting.   
Documentation is maintained that the service is not available under a program funded under section 
110 of the Rehabilitation Act of 1973 or the IDEA (20 U.S.C. 1401 et seq.). 
Federal financial participation is not claimed for incentive payments, subsidies, or 
unrelated vocational training expenses such as the following:  10 | P a ge- CMCS Informational Bulletin 
 
 
1. Incentive payments made to an employer to encourage or subsidize the employer's 
participation in supported employment; or 
2. Payments that are passed through to users of supported employment services. 
 
Instructions 
 Supplement or modify the core definition as appropriate to incorporate the specific service elements 
furnished in the waiver. 
 Supported employment individual employment supports is not intended for people working in 
mobile work crews of small groups of people with disabilities in the community.  That type of work 
support is addressed in the core service definition for Supported Employment Small Group 
employment support.   
 If transportation between the participant's place of residence and the employment site is a 
component part of supported employment individual employment supports services and the cost of 
this transportation is included in the rate paid to providers of supported employment individual 
employment supports services, the service definition must include a statement to that effect. 
 
Guidance 
 Statewide rate setting methodologies, which are further described in I-2-a of the waiver application 
may be used to embrace new models of support that  help a person obtain and maintain integrated 
employment in the community. These may include co-worker support models, payments for work 
milestones, such as length of time on the job, number of hours the participant works, etc.   Payments 
for work milestones are not incentive payments that are made to an employer to encourage or 
subsidize the employers hiring an individual with disabilities, which is not permissible.   
 Supported employment individual employment supports does not include facility based, or other 
similar types of vocational services furnished in specialized facilities that are not a part of the general 
workplace. 
 In addition to the need for an appropriate job match that meets the individuals skills and interests, 
individuals with the most significant disabilities may also need long term employment support to 
successfully maintain a job due to the ongoing nature of the waiver participants support needs, 
changes in life situations, or evolving and changing job responsibilities. 
 All prevocational and supported employment service options should be reviewed and considered as 
a component of an individuals person-centered services and supports plan no less than annually, 
more frequently as necessary or as requested by the individual. These services and supports should be 
designed to support successful employment outcomes consistent with the individuals goals. 
 Supported employment individual employment supports do not include volunteer work.  Such 
volunteer learning and training activities that prepare a person for entry into the paid workforce are 
addressed through pre-vocational services. 
 Supported employment individual employment supports do not include payment for supervision, 
training, support and adaptations typically available to other workers without disabilities filling 
similar positions in the business.  
  Supported employment individual employment supports may be provided by a co-worker or other 
job site personnel provided that the services that are furnished are not part of the normal duties of the 
co-worker, supervisor or other personnel and these individuals meet the pertinent qualifications for 
the providers of service.    11 | P a ge- CMCS Informational Bulletin 
 
 
 Personal care/assistance may be a component part of supported employment individual employment 
supports, but may not comprise the entirety of the service. 
 Supported employment individual employment supports may include services and supports that 
assist the participant in achieving self-employment through the operation of a business; however, 
Medicaid funds may not be used to defray the expenses associated with starting up or operating a 
business. Assistance for self-employment may include: (a) aid to the individual in identifying 
potential business opportunities; (b) assistance in the development of a business plan, including 
potential sources of business financing and other assistance in including potential sources of business 
financing and other assistance in developing and launching a business; (c) identification of the 
supports that are necessary in order for the individual to operate the business; and (d) ongoing 
assistance, counseling and guidance once the business has been launched. 
 Individuals receiving supported employment individual employment supports services may also 
receive educational, pre-vocational and/or day habilitation services and career planning services. A 
participants person-centered services and supports plan may include two or more types of non-
residential habilitation services. However, different types of non-residential habilitation services may 
not be billed during the same period of time. 
 If States wish to cover career planning they may choose to include it as a component part of 
supported employment individualized employment support services or it may be broken out as a 
separate stand alone service definition.  
 Supported employment individual employment supports may be furnished to any individual who 
requires and chooses them through a person-centered planning process. They are not limited to 
persons with intellectual or developmental disabilities. 
 
Supported Employment - Small Group Employment Support 
Core Service Definition 
Supported Employment Small Group employment support  are services and training activities 
provided in regular business, industry and community settings for groups of two (2) to eight (8) 
workers with disabilities. Examples include mobile crews and other business-based workgroups 
employing small groups of workers with disabilities in employment in the community. Supported 
employment small group employment support must be provided in a manner that promotes 
integration into the workplace and interaction between participants and people without disabilities in 
those workplaces. The outcome of this service is sustained paid employment and work experience 
leading to further career development and individual integrated community-based employment for 
which an individual is compensated at or above the minimum wage, but not less than the customary 
wage and level of benefits paid by the employer for the same or similar work performed by 
individuals without disabilities. Small group employment support does not include vocational 
services provided in facility based work settings. 
 
Supported employment small group employment supports may include any combination of the 
following services: vocational/job-related discovery or assessment, person-centered employment 
planning, job placement, job development, negotiation with prospective employers, job analysis, 
training and systematic instruction, job coaching, benefits support, training and planning 
transportation and career advancement services.  Other workplace support services may include  12 | P a ge- CMCS Informational Bulletin 
 
 
services not specifically related to job skill training that enable the waiver participant to be successful 
in integrating into the job setting.   
Documentation is maintained that the service is not available under a program funded under section 
110 of the Rehabilitation Act of 1973 or the IDEA (20 U.S.C. 1401 et seq.). 
 
Federal financial participation is not claimed for incentive payments, subsidies, or 
unrelated vocational training expenses such as the following: 
1. Incentive payments made to an employer to encourage or subsidize the employer's 
participation in supported employment services; or 
2. Payments that are passed through to users of supported employment services. 
 
Instructions 
 Supplement or modify the core definition as appropriate to incorporate the specific service elements 
furnished in the waiver. 
 If transportation between the participant's place of residence and the employment site is a 
component part of supported employment services small group employment support and the cost of 
this transportation is included in the rate paid to providers of supported employment small group 
employment supports services, the service definition must include a statement to that effect. 
 
Guidance 
 Supported employment small group employment support does not include vocational services 
provided in facility based work settings or other similar types of vocational services furnished in 
specialized facilities that are not a part of general community workplaces. 
 Supported employment small group employment supports do not include volunteer work.  Such 
volunteer learning and training activities that prepare a person for entry into the paid workforce are 
more appropriately addressed through pre-vocational services. 
 Supported employment small group employment support does not include payment for supervision, 
training, support and adaptations typically available to other workers without disabilities filling 
similar positions in the business.  
  Supported employment small group employment support services may be provided by a co-worker 
or other job site personnel provided that the services that are furnished are not part of the normal 
duties of the co-worker, supervisor or other personnel and these individuals meet the pertinent 
qualifications for the providers of service.  
 Personal care/assistance may be a component part of supported employment small group 
employment support services, but may not comprise the entirety of the service. 
 All prevocational and supported employment service options should be reviewed and considered as 
a component of an individuals person-centered services and supports plan no less than annually, 
more frequently as necessary or as requested by the individual. These services and supports should be 
designed to support successful employment outcomes consistent with the individuals goals. 
 Individuals receiving supported employment small group employment support services may also 
receive educational, prevocational and/or day habilitation services and career planning services. A 
participants person-centered services and supports plan may include two or more types of non-
residential habilitation services. However, different types of non-residential habilitation services may 
not be billed during the same period of time.  13 | P a ge- CMCS Informational Bulletin 
 
 
If States wish to cover career planning they may choose to include it as a component part of 
supported employment small group employment support services or it may be broken out as a 
separate stand alone service definition.  
 Supported employment small group employment support services may be furnished to any 
individual who requires and chooses them.  If a state offers both supported employment- individual 
and small group employment support services, individuals should be provided information to make 
an informed decision in choosing between these services.  Supported employment small group 
employment support services are not limited to persons with intellectual or developmental 
disabilities. 
 
Career Planning 
Core Service Definition 
Career planning is a person-centered, comprehensive employment planning and support service that 
provides assistance for waiver program participants to obtain, maintain or advance in competitive 
employment or self-employment. It is a focused, time limited service engaging a participant in 
identifying a career direction and developing a plan for achieving competitive, integrated 
employment at or above the states minimum wage. The outcome of this service is documentation of 
the participants stated career objective and a career plan used to guide individual employment 
support.   
 
Instructions 
 Supplement or modify the core definition as appropriate to incorporate the specific service elements 
furnished in the waiver. 
 Supplement the core service definition by specifying where in the community career planning may 
be furnished. 
  If transportation between the participant's place of residence and the site where career planning is 
delivered is provided as a component part of career planning services and the cost of this 
transportation is included in the rate paid to providers of career planning services, the service 
definition must include a statement to that effect in the definition. 
 
Guidance 
 For young people with disabilities transitioning out of high school or college into adult services, it is 
important to have the opportunity to plan for sufficient time and experiential learning opportunities 
for the appropriate exploration, assessment and discovery processes to learn about career options as 
one first enters the general workforce.   
 Individuals who receive career planning services may also receive educational, supported 
employment, pre-vocational and/or day habilitation services. A participants person-centered services 
and supports plan may include two or more types of non-residential habilitation services. However, 
different types of non-residential habilitation services may not be billed during the same period of the 
day.  
 If a waiver participant is receiving prevocational services or day habilitation services, career 
planning may be used to develop experiential learning opportunities and career options consistent 
with the persons skills and interests.    14 | P a ge- CMCS Informational Bulletin 
 
 
 If a waiver participant is employed and receiving either individual or small group supported 
employment services, career planning may be used to find other competitive employment more 
consistent with the persons skills and interests or to explore advancement opportunities in his or her 
chosen career.   
 All prevocational and supported employment service options, including career planning, should be 
reviewed and considered as a component of an individuals person-centered services and supports 
plan no less than annually, more frequently as necessary or as requested by the individual. These 
services and supports should be designed to support successful employment outcomes consistent with 
the individuals goals. 
 Career planning furnished under the waiver may not include services available under a program 
funded under section 110 of the Rehabilitation Act of 1973 or section 602(16) and (17) of the 
Individuals with Disabilities Education Act (20 U.S.C. 1401(16 and 17).   
 Career planning may include benefits support, training and planning, as well as assessment for use 
of assistive technology to increase independence in the workplace.  
 If a State wishes to cover career planning it may choose to include it as a component part of day 
habilitation, pre-vocational services or supported employment small group or individual employment 
support services or it may be broken out as a separate stand alone service definition.  
 Career planning services may be furnished to any individual who requires and chooses them. They 
are not limited to persons with intellectual or developmental disabilities.