S-10000-00003770 Attachment E~2.pdf

ATTACHMENT E – CONTRACT TEMPLATE

Contract Number 000000

STATE OF OREGON

PERSONAL/PROFESSIONAL SERVICES CONTRACT

In compliance with the Americans with Disabilities Act, this document is available in alternate formats such as Braille, large print, audio recordings, Web-based communications and other electronic formats. To request an alternate format, please send an e-mail to dhs-oha.publicationrequest@state.or.us or call 503-378-3486 (voice) or 503-378-3523 (TTY) to arrange for the alternative format.

This Contract is between the State of Oregon, acting by and through its Oregon Department of

Human Services, hereinafter referred to as “ODHS,” and

Contractor

Address

Attention

Telephone

E-mail address hereinafter referred to as “Contractor.”

Work to be performed under this Contract relates principally to ODHS’

Office of Vocational Rehabilitation (VR)

500 Summer Street NE

Salem, Oregon 97301

Contract Administrator: Amy Rebiejo or delegate

Telephone: (503) 383-6439

E-mail address: VR.ContractInquiries@odhsoha.oregon.gov mailto:dhs-oha.publicationrequest@state.or.us mailto:dhs-oha.publicationrequest@state.or.us

RFA – OregonBuys Bid: S-10000-00003770 Attachment E

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ODHS PSK (reviewed by DOJ 8/30/2018) Updated: 3/1/2021

1. Effective Date and Duration.

a. This Contract shall become effective on the date this Contract has been fully executed by every party and, when required, approved by Department of

Administrative Services and Department of Justice, or on Date whichever date is later. Unless extended or terminated earlier in accordance with its terms, this

Contract shall expire on June 30, 2025. Contract termination shall not extinguish or prejudice ODHS' right to enforce this Contract with respect to any default by

Contractor that has not been cured.

b. Upon execution of this Contract, the parties mutually agree to terminate Contract

000000, as provided for in Exhibit B “Standard Terms and Conditions,” Section

10 “Termination,” Subsection e., Paragraph 4.

2. Contract Documents.

a. This Contract consists of this document and includes the following listed exhibits which are incorporated into this Contract:

(1) Exhibit A, Part 1: Statement of Work

(2) Exhibit A, Part 2: Payment and Financial Reporting

(3) Exhibit A, Part 3: Special Provisions

(4) Exhibit B: Standard Terms and Conditions

(5) Exhibit C: Insurance Requirements

(6) Exhibit D: Federal Terms and Conditions

There are no other contract documents unless specifically referenced and incorporated in this Contract.

b. This Contract and the documents listed in Section 2., “Contract Documents”, Subsection a. above, shall be in the following descending order of precedence:

this Contract less all exhibits, Exhibits D, B, A and C.

3. Consideration.

a. The maximum, not-to-exceed compensation payable to Contractor under this

Contract, which includes any allowable expenses, is $000,000.00. ODHS will not pay Contractor any amount in excess of the not-to-exceed compensation of this

Contract for completing the Work, and will not pay for Work performed before the date this Contract becomes effective or after the termination or expiration of this Contract. If the maximum compensation is increased by amendment of this

Contract, the amendment must be fully effective before Contractor performs

Work subject to the amendment.

b. Payments to Contractor shall be subject to ORS 293.462, and shall be made in accordance with the payment schedule and requirements in Exhibit A, Part 2., “Payment and Financial Reporting.”

c. ODHS will only pay for completed Work under this Contract. For purposes of this

Contract, “Work” means the tasks or services and deliverables accepted by ODHS as described in Exhibit A, Part 1, “Statement of Work.”

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ODHS PSK (reviewed by DOJ 8/30/2018) Updated: 3/1/2021

4. Contractor or Subrecipient Determination. In accordance with the State Controller’s

Oregon Accounting Manual, policy 30.40.00.104, ODHS’ determination is that:

Contractor is a subrecipient Contractor is a contractor Not applicable

Catalog of Federal Domestic Assistance (CFDA) #(s) of federal funds to be paid through this Contract: 84.126

5. Contractor Data and Certification.

a. Contractor Information. This information is requested pursuant to ORS

305.385 and OAR 125-246-0330(1).

PLEASE PRINT OR TYPE THE FOLLOWING INFORMATION

Contractor Name (exactly as filed with the IRS):

Street address:

City, state, zip code:

Email address:

Telephone: ( ) Fax: ( )

Is Contractor a nonresident alien, as defined in 26 U.S.C. § 7701(b)(1)?

(Check one box): YES NO

Business Designation: (Check one box):

Professional Corporation Nonprofit Corporation Limited Partnership

Limited Liability Company Limited Liability Partnership Sole Proprietorship

Corporation Partnership Other

Contractor Proof of Insurance. Contractor shall provide the following information upon submission of the signed Contract. All insurance listed herein and required by Exhibit C must be in effect prior to Contract execution.

Commercial General Liability Insurance Company: ____________________________________

Policy #: ______________________________________ Expiration Date: ________________

Professional Liability Insurance Company: ___________________________________________

Policy #: ______________________________________ Expiration Date: ________________

Automobile Liability Insurance Company: ___________________________________________

Policy #: ______________________________________ Expiration Date: ________________

Workers’ Compensation: Does Contractor have any subject workers, as defined in ORS

656.027? (Check one box): YES NO If YES, provide the following information:

Workers’ Compensation Insurance Company: ________________________________________

Policy #: ______________________________________ Expiration Date: ________________

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ODHS PSK (reviewed by DOJ 8/30/2018) Updated: 3/1/2021

b. Certification. Without limiting the generality of the foregoing, by signature on this Contract, the undersigned hereby certifies under penalty of perjury that:

(1) Contractor is in compliance with all insurance requirements in Exhibit C of this Contract, and notwithstanding any provision to the contrary, Contractor shall deliver to the ODHS Contract Administrator (see page 1 of this Contract) the required Certificate(s) of Insurance within 30 days of execution of this Contract. By certifying compliance with all insurance as required by this Contract, Contractor acknowledges it may be found in breach of the Contract for failure to obtain required insurance. Contractor may also be in breach of the Contract for failure to provide Certificate(s) of Insurance as required and to maintain required coverage for the duration of the Contract;

(2) Contractor acknowledges that the Oregon False Claims Act, ORS 180.750 to 180.785, applies to any “claim” (as defined by ORS 180.750) that is made by (or caused by) the Contractor and that pertains to this Contract or to the project for which the Contract work is being performed. Contractor certifies that no claim described in the previous sentence is or will be a

“false claim” (as defined by ORS 180.750) or an act prohibited by ORS

180.755. Contractor further acknowledges that in addition to the remedies under this Contract, if it makes (or causes to be made) a false claim or performs (or causes to be performed) an act prohibited under the Oregon

False Claims Act, the Oregon Attorney General may enforce the liabilities and penalties provided by the Oregon False Claims Act against the

Contractor;

(3) The undersigned is authorized to act on behalf of Contractor and represents and warrants that Contractor has complied with the tax laws of the State of Oregon and the applicable tax laws of any political subdivision of Oregon. Contractor shall, throughout the duration of this

Contract and any extensions, comply with all tax laws of this state and all applicable tax laws of any political subdivision of Oregon. For the purposes of this Section, “tax laws” includes: (i) All tax laws of Oregon, including but not limited to ORS 305.620 and ORS chapters 316, 317, and

318; (ii) Any tax provisions imposed by a political subdivision of Oregon that applied to Contractor, to Contractor’s property, operations, receipts, or income, or to Contractor’s performance of or compensation for any work performed by Contractor; (iii) Any tax provisions imposed by a political subdivision of Oregon that applied to Contractor, or to goods, services, or property, whether tangible or intangible, provided by

Contractor; and (iv) Any rules, regulations, charter provisions, or ordinances that implemented or enforced any of the foregoing tax laws or provisions.

Contractor acknowledges that the Oregon Department of Administrative

Services will report this Contract to the Oregon Department of Revenue

(DOR). The DOR may take any and all actions permitted by law relative to the collection of taxes due to the State of Oregon or a political

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ODHS PSK (reviewed by DOJ 8/30/2018) Updated: 3/1/2021 subdivision, including: (i) garnishing the Contractor’s compensation under this Contract; or (ii) exercising a right of setoff against Contractor’s compensation under this Contract for any amounts that may be due and unpaid to the State of Oregon or its political subdivisions for which the

DOR collects debts;

(4) The information shown in Section 5.a., “Contractor Information” above is

Contractor’s true, accurate and correct information;

(5) To the best of the undersigned’s knowledge, Contractor has not discriminated against and will not discriminate against minority, women or emerging small business enterprises certified under ORS 200.055 in obtaining any required subcontracts;

(6) Contractor and Contractor’s employees and agents are not included on the list titled “Specially Designated Nationals” maintained by the Office of

Foreign Assets Control of the United States Department of the Treasury and currently found at: https://www.treasury.gov/resource-center/sanctions/SDN-List/Pages/default.aspx;

(7) Contractor is not listed on the non-procurement portion of the General

Service Administration’s “List of Parties Excluded from Federal procurement or Non-procurement Programs” currently found at:

https://www.sam.gov/SAM;

(8) Contractor is not subject to backup withholding because:

(a) Contractor is exempt from backup withholding;

(b) Contractor has not been notified by the IRS that Contractor is subject to backup withholding as a result of a failure to report all interest or dividends; or

(c) The IRS has notified Contractor that Contractor is no longer subject to backup withholding; and

(9) Contractor’s Federal Employer Identification Number (FEIN) or Social

Security Number (SSN) provided is true and accurate. If this information changes, Contractor shall provide ODHS with the new FEIN or SSN within 10 days.

https://www.treasury.gov/resource-center/sanctions/SDN-List/Pages/default.aspx https://www.treasury.gov/resource-center/sanctions/SDN-List/Pages/default.aspx https://www.sam.gov/SAM

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ODHS PSK (reviewed by DOJ 8/30/2018) Updated: 3/1/2021

CONTRACTOR, BY EXECUTION OF THIS CONTRACT, HEREBY

ACKNOWLEDGES THAT CONTRACTOR HAS READ THIS CONTRACT,

UNDERSTANDS IT, AND AGREES TO BE BOUND BY ITS TERMS AND

CONDITIONS.

CONTRACTOR: YOU WILL NOT BE PAID FOR SERVICES RENDERED PRIOR TO

NECESSARY STATE APPROVALS.

6. Signatures. This Contract and any subsequent amendments may be executed in several counterparts, all of which when taken together shall constitute one agreement binding on all parties, notwithstanding that all parties are not signatories to the same counterpart.

Each copy of the Contract and any amendments so executed shall constitute an original.

Contractor Name

By:

(Non-Executable) Do Not Sign.

Authorized Signature Printed Name

Title Date

State of Oregon, acting by and through its Oregon Department of Human Services

By:

(Non-Executable) ODHS will NOT sign

Authorized Signature Printed Name

Title Date

Approved by the Department of Administrative Services:

Exempt per OAR 125-246-0170(2).

Authorized Signature Title Date

Approved for Legal Sufficiency:

Approved via email by:

Department of Justice Date

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ODHS PSK (reviewed by DOJ 8/30/2018) Updated: 3/1/2021

EXHIBIT A

Part 1

Statement of Work

1. Performance Standards

a. Contractor’s provision of the tasks or Services and deliverables described in this

Contract must meet the highest performance standards prevalent in the industry or business most closely involved in providing Vocational Rehabilitation (VR) Job

Placement Services. Contractor affirms Contractor is qualified to provide these

VR Job Placement Services and will provide the Competitive, Integrated

Employment (CIE) Services to Participants referred to Contractor by VR.

b. Contractor is prohibited from negotiating Services that are not in this Contract with VR branch managers, Vocational Rehabilitation Counselors (VRC), or VR support staff.

c. Conflict of Interest when working with VR Participants:

Contractor recognizes their own personal or professional relationships may interfere with their ability to provide Services ethically and professionally.

Contractor acknowledges they will not provide Services under this Contract to family or co-workers family.

d. If Contractor, Contractor’s employees, or a VR approved Subcontractor is an

Employment Network (EN) with the Social Security Administration or the VR

Ticket to Work (TTW) program, and Contractor has not signed the TTW General

EN Contract with VR, as stated in 20 CFR 411.400, Contractor must have the

TTW General EN Contract signed and in place before Contractor can provide Job

Placement Services under this Contract.

2. Definitions

For the purposes of this RFA, capitalized words are defined in OAR 125-246-0110 or as defined below.

a. “Authorization for Purchase” or “AFP” means a document created in the

Oregon Rehabilitation Case Automation (ORCA) system that allows expenditures to occur on behalf of a Participant. An AFP serves as Oregon VR’s guarantee of payment to a vendor or a Participant for the purchase of goods or Services.

b. “Career Exploration” means the activities that support the Participant for the purpose of identifying the job goal for development of the Individualized Plan for

Employment. It may include activities for the Participant to assess the feasibility of a job goal, strengths and concerns, job shadows, informational interviews, labor market surveys, vocational testing, and other job-related experiences.

c. “Community Based Work Assessments” or “CBWA” means the assessments utilized to determine a Participant’s work strengths, compensatory skills, types, and levels of support needs that cannot be identified through the Vocational

Rehabilitation Counselor’s comprehensive vocational assessment, eligibility

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ODHS PSK (reviewed by DOJ 8/30/2018) Updated: 3/1/2021 documentation, or any other means. CBWA’s are not vocational goal specific but must be completed in a Competitive Integrated Employment setting. The CBWA will provide information that supports the Vocational Rehabilitation Counselor’s ability to write a thorough and comprehensive IPE.

d. “Company” means as a singular business structure falling under one Federal

Employer Identification Number, regardless of subsidiary businesses or “doing business as” designations.

e. “Competitive Integrated Employment” or “CIE” means work that:

(1) Is performed on a full-time or part-time basis (including self-employment) and for which an individual is compensated at a rate that is not less than the higher of the rate specified in section 6(a)(1) of the Fair Labor

Standards Act of 1938 (29 U.S.C. 206(a)(1)) or the rate required under the applicable state or local minimum wage law for the place of employment;

and

(2) Is not less than the customary rate paid by the employer for the same or similar work performed by other employees who are not individuals with disabilities and who are similarly situated in similar occupations by the same employer and who have similar training, experience, and skills; and

(3) Is eligible for the level of benefits provided to other employees; and

(4) Is at a location typically found in the community; and

(5) Where the employee with a disability interacts for the purpose of performing the duties of the position with other employees within the particular work unit and the entire work site, and, as appropriate to the work performed, other persons (e.g., customers and vendors), who are not individuals with disabilities (not including supervisory personnel or individuals who are providing Services to such employee) to the same extent that employees who are not individuals with disabilities and who are in comparable positions interact with these persons; and

(6) Presents, as appropriate, opportunities for advancement that are similar to those for other employees who are not individuals with disabilities and who have similar positions.

f. “Contractor” means a person or business entity that agrees to legally enforceable terms and conditions under which the entity supplies products or performs

Services according to an agency’s specifications and for the purpose of accomplishing results the agency intends.

g. “Contractor Signee” means the authorized representative that holds the responsibility for delivering and signing any Solicitation and Contract documentation for the Contractor.

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ODHS PSK (reviewed by DOJ 8/30/2018) Updated: 3/1/2021

h. “Core Competency” means the foundation of an employment professional’s knowledge and are intended to be part of the larger organizational training and competency plan for individuals who deliver employment Services.

Demonstration of competency under this Contract must be achieved by completing 12 online Core Competency modules prior to providing Services under this Contract.

i. “Customized Employment” means competitive integrated employment for an individual with a significant disability, that is based on an individualized determination of the unique strengths, needs, and interests of the individual with a significant disability that is designed to meet the specific abilities of the individual with a significant disability and the business needs of the employer; and carried out through flexible strategies, such as:

(1) Working with an employer to facilitate placement, including -

(2) Customizing a job description based on current employer needs or on previously unidentified and unmet employer needs.

(3) Developing a set of job duties, a work schedule and job arrangement, and specifics of supervision (including performance evaluation and review) and determining a job location.

(4) Using a professional representative chosen by the individual, or if elected self-representation, to work with an employer to facilitate placement.

j. “Direct Placement” means the immediate placement of a Participant into

Competitive Integrated Employment, that aligns with the Participant’s job goal and the number of work hours requested, at any point prior to referral to the

Contractor.

k. “Employee Roster” means a form that lists the Contract signee, and Contract employees, or VR approved Subcontractors. This form is required to be resubmitted when additions to and removal of Contractor employees or VR approved Subcontractors working under the Job Placement Services Contract are made, within 30 days of the change, for the duration of the Contract. It is the

Contractor’s responsibility to maintain all required documents and submit this

Employee Roster to VR.ContractInquiries@odhsoha.oregon.gov for all changes in status of Contract signee, Contractor, Contractor’s employees or VR approved

Subcontractor working under the Contract.

l. “Employment Network” or “EN” is defined as either an agency or instrumentality of a State (or political subdivision of the State) or a private entity that assumes responsibility for the coordination and delivery of employment, vocational rehabilitation or other support services to those beneficiaries who have assigned their Tickets to the EN.

m. “Individualized Placement and Support” or “IPS” means the model of supported employment for people with serious mental illness. IPS supported employment helps people living with behavioral health conditions work at CIE opportunities that align with their informed choices. For purposes of this Contract, IPS is an evidence-based practice of supported employment.

mailto:VR.ContractInquiries@odhsoha.oregon.gov

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ODHS PSK (reviewed by DOJ 8/30/2018) Updated: 3/1/2021

n. “Individualized Plan for Employment” or “IPE” means a plan for attaining an individual's vocational objective. The IPE identifies Services necessary to assist the individual to prepare for, secure, retain, regain successful CIE, or advance in their career consistent with the individual's strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice. The IPE identifies the vocational goal, hours of work desired per week, required Services, approved service providers, costs, time frames, and the individual's responsibilities under the plan.

o. “Informed Choice” means that an individual, and any guardian or representative, who applies for Vocational Rehabilitation Services or is eligible to receive

Services, shall be an active and full partner throughout the vocational rehabilitation process as described in 34 CFR §361.52. Informed choice also means the counselor clarifies choices by using the preferred language of the applicant or participant and using rehabilitation counseling knowledge and skills;

and individuals receive sufficient information to make a decision concerning the rehabilitation process and CIE opportunities.

p. “IPS Career (Vocational) Profile” means a summary of information gathered from Participant’s support team and mental health treatment team. The summary information in the IPS Career (Vocational) Profile will indicate the support needs of the Participant on the job and will be used to help identify a job or career goal, for job searching, and for the on-the-job supports. It collects and stores information about a Participant’s workplace capabilities and limitations. An IPS

Career (Vocational) Profile goes beyond objective measures such as aptitude test scores to include notations regarding the Participant’s strengths, interests, needs, and goals.

q. “Job Coach” means the person who provides Job Coaching Services and who provides necessary prompts, develops natural supports for long-term success, and works with the employer toward a more effective working relationship with the

Participant.

r. “Job Coaching” means the direct Services authorized by the Vocational

Rehabilitation Counselor and provided to teach the Participant the essential skills necessary to complete required job tasks beyond what is normally provided by the employer. Job Coaching Services include onboarding activities, defined as necessary extensive assistance with activities such as attending new hire trainings, developing strategies to ensure comprehension of new hire expectations, and one-on-one review and study of employee manuals and job-related materials. Job

Coaching may also include job related tasks such as basic work etiquette, job related time management, hygiene, organization, task analysis, self-advocacy, and disclosure.

s. “Job Placement Plan” means the plan that defines the Participant’s documented work conditions and involvement for success on the job including number of hours and job type, addresses the information in the Referral form, and outlines the unique set of steps the Contractor will take for placement and retention in

CIE.

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ODHS PSK (reviewed by DOJ 8/30/2018) Updated: 3/1/2021

t. “Job Placement Services” means activities completed by the Contractor, after the acceptance of the Referral and the Job Placement Plan by the Vocational

Rehabilitation Counselor and Participant, that are needed to obtain CIE. Job

Placement Services include all work outlined and accepted in the Referral form, all strategies and methods outlined in the Job Placement Plan, as well as any additional meetings necessary to accomplish the work.

u. “Job Placement Services Contract Training” or “JPSCT” is a course intended to develop knowledge and skills for providing Services to VR participants under this Contract, as well as covering changes from the previous Contract.

v. “Job Retention Plan” means the plan that defines how Contractor will support the Participant’s needs in maintaining CIE.

w. “Job Search Assistance” is a direct service provided in place of Job Placement

Services when the Participant will need limited job search assistance. It includes helping facilitate the Participant’s use of community resources in their independent job search.

x. “Job Search Plan” means a plan created after completion of the IPS Career

(Vocational) Profile to plan for the barriers to Competitive Integrated

Employment that are identified in the Profile, with the help of the Participant’s mental health treatment team and natural supports. Employment goals and preferences are also identified, and job search strategies are developed.

y. “Job Stability” means the Participant, VRC, and employer agree that the job is satisfactory, Participant is adequately performing the duties of the job to the

Participant’s and employer’s satisfaction, job continues to match the vocational goal and number of hours as listed on the Individualized Plan for Employment and Job Placement Plan. Long-term supports have been defined and are in place, if needed.

z. “Licensed Mental Health Professional” or “LMHP” means an individual who is qualified by education, licensing, and training to meet the professional standards of conduct set forth by an Oregon state licensing authority.

aa. “Monthly Job Placement Report” means the Monthly Job Placement Reports describing the effectiveness and progress of the steps and expectations outlined in the Job Placement Plan for placement.

bb. “Monthly Job Retention Report” means the Monthly Job Retention Report outlining the expectations identified in the Job Retention Plan.

cc. “Oregon Forward” formerly known as a “Qualified Rehabilitation Facility” or

“QRF” means a qualified nonprofit agency as described in ORS 279.835 through

279.855.

dd. “Participant” means a reportable individual, sometimes also called a “client” has been determined eligible for VR Services and can benefit from rehabilitation

Services to assist in achieving CIE.

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ODHS PSK (reviewed by DOJ 8/30/2018) Updated: 3/1/2021

ee. “Placement” means obtaining CIE with the Participant’s agreed upon vocational goal and the hours the Participant requests to work as documented in the accepted

Referral Form and Job Placement Plan.

ff. “Portfolio” means a Portfolio individualized for a Participant that includes elements as requested by the Vocational Rehabilitation Counselor in the Referral form and during the Job Placement Plan Meeting, or as listed in the AFP for participants not referred to Job Placement Services.

gg. “Qualified Mental Health Associate” or “QMHA” means an individual delivering Services under the direct supervision of an QMHP. The QMHA is responsible for providing rehabilitative mental health and some treatment

Services to individuals suffering from severe emotional disorders.

hh. “Qualified Mental Health Professional” or “QMHP” means a clinician in the human-services field who is trained and experienced in providing psychiatric or mental health services to individuals who have a psychiatric diagnosis.

ii. “Referral” means the completed Referral form delivered to the Contractor. The

Referral will include the Participant’s vocational goal, amount of work hours per week desired by the Participant, disability barriers, predetermined Job Placement

Services Track, all required Services available under a Contract, and additional elements necessary for Contractor to make an informed decision whether to accept or deny the Referral.

jj. “Retention” means an array of individualized Services, provided by the

Contractor, while working with the Participant and employer, to determine issues, and solutions on the job, to ensure Participant’s employment success. It includes ongoing and routine engagement of employer and or Participant to identify issues affecting job performance and to establish a plan for remediation which will allow the Participant to make changes to maintain CIE. This will be based on

Participant’s preference of disclosure. Retention has been successfully achieved when the Participant has reached 90 days of successful CIE and Job Stability.

Retention is not Job Coaching. Refer to the definition for Job Coaching.

kk. “Self-Placement” means a Participant discovers a job lead, applies, interviews, and obtains CIE on their own without assistance from a Job Placement Services

Contractor. Self-Placement may occur at the same time as Job Placement

Services.

ll. “Subcontractor” means any individual who has an agreement with a Contractor to complete all or part of a service. Contractor must obtain ODHS written authorization prior to subcontracting.

mm. “Supported Employment” means CIE, including customized employment, or employment in an integrated work setting in which an individual with a most significant disability, including a youth with a most significant disability, working towards CIE that is individualized, and or customized, and consistent with the unique strengths, abilities, interests, and informed choice of the individual, including with ongoing support Services for individuals with the most significant disabilities for whom CIE has not historically occurred, or for whom CIE has

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ODHS PSK (reviewed by DOJ 8/30/2018) Updated: 3/1/2021 been interrupted or intermittent as a result of a significant disability; and for whom CIE has not historically occurred, or for whom CIE has been interrupted or intermittent as a result of a significant disability; and because of the nature and severity of their disabilities, need intensive supported employment Services and extended Services after the transition from support provided by the designated

State unit, in order to perform this work.

nn. “Targeted Vocational Assessment” or “TVA” means a community-based opportunity that evaluates specific vocational skills, tasks, and determines accommodations needed for success in the desired employment field.

oo. “Ticket To Work” or “TTW” means an employment program created in 1999 by the Ticket to Work and Work Incentives Improvement Act and administered by the Social Security Administration (SSA). The program is voluntary and offers beneficiaries, expanded opportunities to obtain the Services and supports that they need to work and to achieve their employment goals.

pp. “Vocational Rehabilitation” or “VR” means the State program within the

Oregon Department of Human Services, responsible for carrying out the responsibilities specified in ORS 344.511.(13).

3. Description of VR Job Placement Tracks

a. Job Placement Services Track 1 – Standard Employment

Track 1 Participants have the ability and motivation necessary to do the job but may experience employment barriers that impact their access to available jobs in the market, which may prevent the employer from recognizing them as viable candidates. Due to these barriers, Track 1 Participants will require third-party placement assistance but will not require long term supports.

b. Job Placement Services Track 2 – Supported Employment

Track 2 is designed for Participants with significant disabilities who demonstrate motivation but lack the ability to be competitive in the job market, such as difficulty multi-tasking -or- who demonstrate lower productivity levels than others who perform similar work tasks in a CIE environment. Track 2 Participants may require more flexible strategies, such as working with employers to facilitate placement, customizing a job description based on existing or unidentified employer needs, developing a set of job duties, modifying the work schedule, and arranging for provision of job supports.

c. Job Placement Services Track 3 – Customized Supported Employment

Track 3 is intended for supported employment Participants who exhibit the most significantly challenging functional limitations. There is no job description with intensive support and or customized employment. The Contractor must negotiate with the employer to create a job where the Participant can use their skills to benefit the employer. The employer will help the Participant develop their job description and support the development of supports at the worksite.

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ODHS PSK (reviewed by DOJ 8/30/2018) Updated: 3/1/2021

4. Services to be Provided

a. Referral

The VRC will provide the Contractor with a Referral form and AFP. The VRC, Participant and Contractor may meet to discuss the Referral with the objective to share information to assist in the development of the Job Placement Plan.

The VRC, Participant or the Contractor may agree that the Referral meeting is not necessary. The VRC will make the final decision about having the Referral meeting when there is a disagreement about its need.

Upon accepting the Referral, Contractor will not put a Participant on hold from

Job Placement Services without written acceptance from VR. Contractor will submit reasoning for a hold in writing to the VRC at least seven (7) days prior to the proposed hold beginning. VRC will respond in writing within seven (7) days.

(1) Referral Acceptance

The Contractor shall return a copy of the completed signed Referral form to the referring VRC within seven (7) days of receipt of the Referral.

Contractor shall also submit an invoice requesting payment for an accepted Referral to VR. For each accepted Referral, the Contractor will be paid a one-time Referral payment.

(2) Referral Rejection

If the Referral is rejected, Contractor will state the reasons for rejection on the VR Referral form within seven (7) days of the Referral.

When the Contractor attends the Referral meeting and the Contractor decides to reject the Referral, the Contractor will be paid for the Referral upon submission of an invoice to VR.

b. IPS Supported Employment Referral

For referral(s) to an IPS Supported Employment Contractor from VR the VRC will provide the Contractor with a Referral form and AFP.

When an IPS Supported Employment Contractor refers a potential participant to

VR, the IPS Supported Employment Contractor will submit a comprehensive IPS

Career (Vocational) Profile assessment at the Referral meeting.

An IPS Career (Vocational) Profile is necessary for all IPS Participants. The

Contractor shall submit a completed Profile. Examples of Profile elements are a resumé, an online application in print, profile page, interview skill building, and other job preparation activities deemed necessary by the VRC to reach a CIE outcome. Participant’s preferences, supports and benefits received should also be included in the Profile.

If the IPS Supported Employment Contractor refers a potential Participant to VR, the IPS Supported Employment Contractor will be paid a Referral fee.

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ODHS PSK (reviewed by DOJ 8/30/2018) Updated: 3/1/2021

c. Direct Referral

A Direct Referral form is not required when Contractor initiates Service with

VRC.

d. Portfolio

The Contractor will complete a Portfolio when requested by the VRC through the

Referral form and AFP, at the time of the Referral for Services. The Portfolio is not required for all Participants or all Job Placement Tracks.

The Contractor will also complete a Portfolio, if authorized through an AFP when the Participant does not need Job Placement Services, but requires assistance with resume´ building, interview skills, or application completion.

The Contractor will not provide a Portfolio in situations where Participant is receiving or has received Job Search Assistance. Job Search Assistance shall not be provided when a Portfolio was received. One exception may be made in extraordinary circumstances based on the VRC’s recommendation and the VR branch manager’s approval.

The completed Portfolio must be submitted to the VRC prior to or along with the first Monthly Job Placement Report, or within 30 days of AFP receipt by the

Contractor for Participants not referred for Job Placement Services.

The Portfolio must be individualized for each Participant. It must include elements as requested by the VRC in the Referral form and during the Job

Placement Plan Meeting; or as listed in the AFP for Participants not referred for

Job Placement Services. Examples of elements that may be requested include a resume´, an online application in print, a video profile, a profile page, mock interview skill building, and other job preparation activities deemed necessary by the VRC to reach CIE for the Participant.

The Portfolio is not provided by IPS Supported Employment Contractor’s due to completion of the IPS Career (Vocational) Profile.

(1) Portfolio Acceptance

Contractor will submit the Portfolio and invoice to the VRC prior to, or along with the first Monthly Job Placement Report, or within 30 days of

AFP receipt by Contractor for Participants not referred for Job Placement

Services. The VRC will determine if the Portfolio includes all required elements and is of acceptable quality. If acceptable, payment will be processed.

(2) Portfolio Rejection

The VRC will reject the Portfolio if the Portfolio does not include all required elements and is not of acceptable quality. The VRC will notify the Contractor in writing of the rejection within seven (7) days and may give the Contractor up to 14 days to revise and resubmit the Portfolio.

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e. Job Placement Plan

The Contractor will utilize the information included on the Referral form and the information provided by the VRC to prepare the Job Placement Plan. Contractor will conduct meetings with the Participant to discuss in detail the strengths, resources, priorities, concerns, abilities, legal issues, transportation needs, and interests, as related to the IPE goal listed on the Referral form, and how, if any functional limitations could impact work.

The Contractor will conduct the activities required to complete a comprehensive and individualized Job Placement Plan for a Participant. The Job Placement Plan must outline the strategies and methods the Contractor will use to achieve successful CIE.

Additional activities necessary to complete the Job Placement Plan may include job shadows with the Participant in the community to understand and observe behaviors and motivations, and the Participant’s CIE seeking abilities.

Contractor will submit the Job Placement Plan to the VRC within 45 days of

Contractor’s acceptance of the Referral.

The Job Placement Plan must be completed using the required form and must be individualized and comprehensive. The report will be submitted to VR after obtaining signatures from both the Contractor and Participant, prior to, or at the

Job Placement Plan meeting. When approved and signed by the VRC, the VRC will provide a copy of the Job Placement Plan to the Contractor and Participant.

The VRC, Contractor, and Participant will meet to review the Job Placement Plan and discuss the specific strategies outlined and determine if the Job Placement

Plan matches the information included in the Referral form to achieve a CIE outcome.

If Job Placement Services last 120 days without reaching successful CIE for the

Participant, the VRC, Contractor, and Participant will meet to determine if Job

Placement Services will continue. This meeting will determine what changes are needed to be made to reach a successful CIE outcome for the Participant. If the decision to continue Job Placement Services is agreed upon by the Participant, VRC and Contractor, the Contractor will then submit an updated Job Placement

Plan within 14 days.

If Participant’s vocational goal changes during Job Placement Services activities and the VRC and Participant agree that a new vocational goal is acceptable, the

Contractor will update the Job Placement Plan to reflect the goal change with the new or additional strategies that will be used to obtain and retain successful CIE.

VR will not make additional payments for Job Placement Plan updates required by the Contractor to reflect goal changes and new or additional strategies needed to obtain and retain successful CIE.

(1) Job Placement Plan Acceptance by the VRC

The Job Placement Plan will be accepted when the VRC, Contractor, and the Participant agree on the outlined strategies and Services, and when the

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Job Placement Plan has been signed by the VRC, Contractor, and the

Participant. Contractor may submit an invoice for payment upon acceptance.

(2) Job Placement Plan Rejection by the VRC

The VRC will reject the Job Placement Plan when outlined strategies do not match the Referral and are insufficient on meeting the Participants needs.

If the Job Placement Plan is rejected, the VRC will notify Contractor within seven (7) days of receiving the Job Placement Plan. The VRC will give the Contractor an additional 14 days from the date of rejection to revise the Job Placement Plan to meet the Participant’s needs.

Contractor may not invoice for the Job Placement Plan until the Job

Placement Plan has been accepted by the VRC.

f. Monthly Job Placement Report

The Contractor will submit the required Monthly Job Placement Report form, beginning with the first, full calendar month of Job Placement Services.

Only the first Monthly Job Placement Report will generate a payment. Contractor will submit an invoice requesting payment with the Contractor’s submission to

VR of the first Monthly Job Placement Report.

The Contractor will continue to submit the required Monthly Job Placement

Reports by the 5th day of each month to the VRC detailing the monthly progress for the Participant up to Retention.

If a Placement is achieved within the first, full calendar month of Job Placement

Services, Contractor will submit the Monthly Job Placement Report along with the Placement and Retention Verification form.

g. Placement

The VRC, Participant, and Contractor must agree that the placement is a match for the needs, job choice, and number of work hours for the Participant.

Contractor will place the Participant in a competitive, integrated employment setting that meets Participant’s vocational goal as outlined in the Referral, the Job

Placement Plan and is approved by the VRC and the Participant.

Contractor will not place Participants within the Contractor’s own place of business or Company, nor a Company substantially controlled by the Contractor’s

Company. Additionally, the Contractor will not place Participant within an

Oregon Forward facility, formerly known as a Qualified Rehabilitation Facility

(QRF).

If the placement does not meet the vocational goal as stated in the Referral but is acceptable and deemed a good fit by the Participant and VRC, Contractor will update the Job Placement Plan to reflect the new vocational goal. No additional payment will be made to Contractor for updates to the Job Placement Plan.

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Participant will be on the job for three (3) days prior to Contractor submitting the

Placement Verification form and requesting payment for an initial Placement.

Once the three (3) days of CIE is fulfilled, the Contractor is to complete the

Placement Verification form and request an AFP for the initial Placement within seven (7) days. Once received from VR, the Contractor shall then submit the required Placement Verification form and invoice to VR.

On the Job Training is considered training and part of the path to Placement.

Contractor will not be paid for the Placement until On the Job Training is complete, the Participant is hired, and requirements have been met for first or second Placement. Contractor will not be paid for On the Job Training.

If a second Placement occurs, the Participant will be on the job for 30 days prior to the Contractor submitting the Placement Verification form and requesting payment.

An updated Job Placement Plan shall be submitted to the VRC by the Contractor.

The Contractor is to complete the Placement Verification form and request an

AFP for the second Placement within seven (7) days of the Participant reaching the CIE milestone. The Contractor shall then submit the required Placement

Verification form and invoice to VR.

If a third placement occurs, the Participant will be on the job for 30 days prior to the Contractor submitting the Placement Verification form and requesting payment.

This is only allowable under extenuating circumstances. No placements will be paid to the Contractor beyond a third placement.

An updated Job Placement Plan shall be submitted to the VRC by the Contractor.

The Contractor is to complete the Placement Verification form and request an

AFP for the third Placement within seven (7) days of the participant reaching the

CIE milestone. The Contractor shall then submit the required Placement

Verification form and invoice to VR.

(1) Placement Acceptance by the VRC

VR accepts Placement when Participant, VRC, and Contractor agree the

Placement meets the vocational goal, or the revised vocational goal, as appropriate, and the Placement Verification form is signed. Contractor will ensure all monthly reports are submitted prior to submitting an invoice for the Placement payment.

(2) Placement Rejection by the VRC

If the Placement does not meet the vocational goal, or the Placement fails for any other reason, the VRC and the Participant will evaluate the reasons for the failed Placement and may request the Contractor to attempt an additional Placement.

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(3) Additional Placements

If a second Placement occurs, the Participant will be on the job for 30 days prior to the Contractor submitting the Placement Verification form requesting payment, and an updated Job Placement Plan shall be submitted to the VRC by the Contractor. The Contractor is to complete the

Placement Verification form and request an AFP for the second Placement within seven (7) days of the Participant reaching the CIE milestone. The

Contractor shall then submit the required Placement Verification form, and invoice to the VRC.

If a third Placement occurs, the Participant will be on the job for 30 days prior to the Contractor submitting the Placement Verification form, requesting payment, and an updated Job Placement Plan shall be submitted to the VRC by the Contractor. The Contractor is to complete the

Placement Verification form and request an AFP for the third Placement within seven (7) days of the Participant reaching the CIE milestone. The

Contractor shall then submit the required Placement Verification form, and invoice to the VRC.

(4) Cumulative Placements

Track 2 and 3 service levels may require a Participant to use more than one Placement to meet their required work hours at the same time as stated in their Job Placement Plan. The Placement for Track 2 and Track 3 service levels, as authorized by the Participant and the VRC, allows payments for multiple Placements using incremental steps of the standard

Placement payment levels.

VR will issue payments for Placements incrementally:

(a) 50% of the total payment is paid for the first Placement.

(b) A second payment of 50% of the total payment is paid for

Placement that reaches the total number of hours agreed upon in the Participant’s Job Placement Plan.

The VRC may authorize a third payment of 50% when the Track 2 or Track 3 Placement is to achieve the total number of hours in the

Participant’s Job Placement Plan, a previous job has been lost, and to reach Retention.

(5) Pay Stub Submission Requirements at time of Placement

Contractor shall submit a copy of the Participants first pay stub within 45 days of Placement date. The submission of the pay stub may be submitted separately from the Placement Verification form and invoice.

If Contractor is unable to obtain a copy of the participants pay stub, the

Contractor will document attempts on the Monthly Job Retention Report.

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Payment will not be withheld for Placement as long as the pay stub is received or attempts to obtain a pay stub is clearly documented on the

Monthly Job Retention Report.

h. Direct Placement

Direct Placement is the immediate placement of a participant into CIE that aligns with the Participants job goal and number of work hours, at any point prior to

Referral for Job Placement Services.

Contractor shall submit a Direct Retention Plan to specify the strategies to be used to successfully retain the Direct Placement.

The Direct Placement fee will be paid after the Participant has successfully completed 30 days of CIE.

VR will not pay the Direct Placement fee if the Participant’s CIE ends before 30 days.

(1) Direct Placement Acceptance

VR will accept the Direct Placement when Participant, VRC, and

Contractor agree the Direct Placement meets the vocational goal, and when the Direct Placement Verification form is signed. Contractor will ensure all monthly reports are submitted prior to submitting an invoice for the Direct Placement payment.

(2) Direct Placement Rejection

If the Direct Placement does not meet the vocational goal of the

Participant, the VRC will reject the Direct Placement in writing within seven (7) days.

i. Participant Self-Placement

If a Participant Self-Placement occurs within 45 days of Contractor’s acceptance of a Referral, Contractor will complete the Job Placement Plan and submit an invoice for payment, and the Contractor’s Job Placement Services will end. If

VRC determines Retention Services are needed, a new Referral will be submitted to Contractor for Retention Services.

j. Retention

When Retention is met, the Contractor will submit all Monthly Retention Report forms to the VRC.