Community Residential Alternative
Community Residential Alternative (CRA) services are targeted for participants who require intense levels of
support. These services are a range of interventions with a particular focus on training and support in one or
more of the following areas: eating and drinking, toileting, personal grooming and health care, dressing,
communication, interpersonal relationships, mobility, home management, and use of leisure time. CRA
Services are individually planned and tailored to meet the specific needs of the participant and to
accommodate fluctuations in his or her needs for various services.
CRA services include assistance with and/or training in activities of daily living, such as bathing, dressing,
grooming, other personal hygiene, feeding, toileting, transferring, and other similar tasks. These services also
include training and/or assistance in household care, such as meal preparation, clothes laundering, bedmaking,
housecleaning, simple home repair, yard care, and other similar tasks. CRA services consist of
medically related services, such as basic first aid, arranging and transporting participants to medical
appointments, assisting with therapeutic exercises, and assisting with or supervising self-administration of
medication. These services also consist of implementing behavioral support plans designed for participants to
reduce inappropriate and/or maladaptive behaviors and to acquire alternative adaptive skills and behaviors.
CRA Services include transportation to all other waiver services specified in the Individual Service Plan and as
needed to facilitate the individual’s participation in personal shopping, recreation and other community
activities.
Participants receive CRA services in small group settings of four or less, in host home/life sharing situations for
adults 19 years and above, or foster home for participants under the age of 19 years through an approved
foster home operating under a licensed Child Placing Agency. CRA Services may not be provided to persons
living in their own or family homes.
Community Access
Community Access Services are designed to assist the participant in acquiring, retaining, or improving selfhelp,
socialization, and adaptive skills required for active community participation and independent
functioning outside the participant’s home or family home. These services are interventions in the areas of
social, emotional, physical, and intellectual development and may include training in the areas of daily
living skills (including leisure/recreation skills); communication training; mobility training; programming to
reduce inappropriate and/or maladaptive behaviors; and training in the use of common community
resources.
The emphasis of training will be on assisting the individual in increasing self help, socialization skills, skills
or daily living and adaptive skills required for active community participation and independent functioning
outside the participant’s home or family home. These activities include accompanying individuals to the
grocery store, or eating establishments; teaching an individual how to participate in appropriate social and
recreational activities; and assessing other activities of community living.
The services typically occur during the day but may also take place in the evenings and weekends.
Community Access services are individually planned to meet the participant’s needs and preferences for
active community participation. These services are provided in either community-based or facility-based
settings but not in the participant’s home or family home or any other residential setting.
The intended outcome of these services is to improve the participant’s access to the community through
increased skills and/or less paid supports.
Community Access Group services are provided to individual participants or to groups of individuals.
Community Access Group services are provided to groups of individuals, with a staff to individual ratio of
one to two or more. The staff to individual ratio for Community Access Group services cannot exceed one
(1) to ten (10). Community Access Individual services are provided to an individual participant, with a oneto-
one staff to participant ratio. Community Access Services Providers offer (or arrange when needed) any
of the Community Access Services that are needed by the participants served and specified in the
participants’ Individual Service Plans.
Supported Employment
Supported Employment services are ongoing supports that enable participants, for whom competitive
employment at or above the minimum wage is unlikely absent the provision of supports, and who, because
of their disabilities, need supports, to perform in a regular work setting. The scope and intensity of
Supported Employment supports may change over time, based on the needs of the participant. Supported
Employment services are conducted in a variety of settings, particularly work sites where persons without
disabilities are employed.
Participants who receive Supported Employment services must require long-term, direct or indirect jobrelated
support in job supervision, adapting equipment, adapting behaviors, transportation assistance,
peer support, and/or personal care assistance during the work day. Supported Employment services
consist of activities needed to obtain and sustain paid work by participants, including job location, job
development, supervision, training, and services and supports that assist participants in achieving selfemployment
through the operation of a business, including helping the participant identify potential
business opportunities, assisting in the development of a business plan, identifying the supports that are
necessary for the participant to operate a business, and ongoing assistance, counseling and guidance
once the business has been launched. These services do not include the supervisory activities rendered
as a normal part of the business setting.
The planned outcomes of these services are to increase the hours worked by each participant toward the
goal of forty hours per week and to increase the wages of each participant toward the goal of increased
financial independence. Supported Employment services are based on the individual participant’s needs,
preferences, and informed choice. These services allow for flexibility in the amount of support a participant
receives over time and as needed in various work sites.
Supported Employment Group services are provided to groups of participants, with a staff to participant
ratio of one to two or more. The staff to participant ratio for Supported Employment Group services cannot
exceed one (1) to ten (10). Supported Employment Individual services are provided to an individual
participant, with a one-to-one staff to participant ratio.
Pre-Vocational Training
Prevocational Services prepare a participant for paid or unpaid employment. These services are for the
participant not expected to be able to join the general work force within one year as documented in the
Individual Service Plan. If compensated, individuals are paid in accordance with the requirements of Part
525 of the Fair Labor Standards Act.
Prevocational Services occur in facility-based settings or at community sites outside the facility for small
groups of participants, called mobile crews, who travel from the facility to these community sites. Mobile
crews receive Prevocational Services by performing tasks, such as cleaning or landscaping, at community
sites other than the participant’s home or family home or any residential setting.
The emphasis of Prevocational Services is directed to habilitative rather than explicit employment
objectives. These services include teaching participants individual concepts necessary to perform
effectively in a job in the community. Activities included in these services are directed at teaching
concepts such as rule compliance, attendance, task completion, problem solving, endurance, work speed,
work accuracy, increased attention span, motor skills, safety, and appropriate social skills.
The intended outcome of these services is to prepare the participant for paid or unpaid employment
through increased skills. Prevocational Services are individually planned to meet the participant’s needs
for preparation for paid or unpaid employment. These services are provided either facility-based or at
community sites other than the participant’s home or family home or any other residential setting.
Prevocational Services are provided to groups of participants at a facility or to small groups of participants
who travel to sites outside the facility, referred to as mobile crews. The staff to participant ratio for facilitybased
Prevocational Services cannot exceed one (1) to ten (10). The staff to participant ratio for Mobile
Crew Prevocational Services cannot exceed one (1) to six (6).