State Agency Promising Practice: Oklahoma’s Outcomes-based Rate Setting System

Oklahoma’s Developmental Disabilities Services Division (DDSD) realized the need for increased attention towards the goal of community-based employment for individuals they served. Initially, rates were based on a vendor’s costs of providing direct services such as job development and job coaching. It became increasingly apparent that claims for vocational services oftentimes reflected staff activities (e.g., job development, client assessment, and service delivery documentation), which may have been occurring without the direct involvement of the service recipient. In some situations, this resulted in long-term job development with little success in actually acquiring a job. In 1995, DDSD elected to focus on outcome-driven rates. Reported costs were aggregated and divided to get the cost of the outcome for an hour of work with the consumer. Vendors providing supported employment services are paid an hourly rate based on the number of hours that an individual is employed, regardless of the number of hours that the individual receives support. This rate system provides higher funding for integrated employment settings versus segregated settings, and higher rates for individual versus group employment. The system also provides incentives for providers to develop jobs with more work hours and to fade job support as quickly as possible.

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