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(10)Individual Employment staff hours must be attributed to the "Individual Employment and Billable <br />Activity Phase(s)". <br />(11)For Group Supported Employment (GSE),Clients must have paid work.The total number of <br />direct service staff hours provided to the group should be equal to or greater than the group's <br />collective amount of individual support monthly base hours.If the direct service staff hours are <br />less than the collective amount,then the provider will be reimbursed only for the number of hours <br />staff actually provided. <br />(a)The collective group's individual hours should be the minimum staff hours delivered to <br />support the group. <br />(b)A GSE Client must be on-sitelat work at least their base individual hours as a minimum per <br />month.If a Client is not on-sitelat work for all of their base hours,the county should verify <br />that the provider delivered the collective group's individual hours to the group (what was the <br />number of staff hours provided to the group during the month?If it was less than the <br />collective group's total the provider can only bill for the staff hours that were provided). <br />(c)A GSE agency may not bill for a GSE Client who does not receive services during an entire <br />service month. <br />(d)A GSE agency must have a record of which staff is supporting which Clients on any given <br />day. <br />(e)A GSE agency must have supportive documentation that provides clear evidence of support <br />helping with specific activities as identified in the Client plan to move a Client on their <br />pathway towards their employment goal(s). <br />(f)Running a GSE service is a part of the business operation and not billable to Clients <br />(contract procurement,contract maintenance,or administration functions associated with <br />GSE). <br />(g)Individual time in the community working towards the individual employment goal,separate <br />from the group time,must include phase information (refer to Employment Phases and <br />Billable Activities -see Phases 1 --4 for element /activity description). <br />(12)Employment and day services must adhere to the Home and Community Based settings <br />(HCBS)requirements of 42 C.F.R.Section 441.301(c)(4),including that: <br />(a)The setting is integrated in the greater community and supports Client's to have full access <br />to the greater community; <br />(b)Ensures the Client receives services in the community to the same degree of access as <br />individuals not receiving Medicaid HCBS; <br />(c)The setting provides opportunities to seek employment and work in competitive integrated <br />settings;and <br />(d)The setting facilitates individual choice regarding services and supports,and who provides <br />them. <br />I.Quality Assurance and Service Evaluation:The County shall develop and have available an <br />evaluation system to review services.The evaluation system must have both a Quality Assurance <br />and a Quality Improvement component,and both must include objective measures.The objective <br />measures at a minimum will include performance indicators,by acuity,that include the number of <br />DSHS Central Contract Services <br />1769CP Contract Amendment (12-10-21)Page 10