1August 6, 2015

Applicant ForumFor Potential

Providers

Applicant ForumFor Potential

Providers State of Tennessee

Department of Intellectual and Developmental Disabilities (DIDD)

Objectives Objectives

• For Potential Providers

• To explain the DIDD Provider Application process

• Review some requirements

• To answer questions and facilitate discussion about the DIDD service delivery system

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Agenda OverviewAgenda Overview

• Welcome, Introduction, and Sign-In• Home and Community-Based Services Waivers• DIDD Application Process• Provider Agreement• Post Approval • Business Considerations• Subcontract• LEIE Requirements• Medicaid HCBS Rules & Settings• Resources• Questions and Answers

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IntroductionIntroduction

• Sandra Wise, Director of Staff and Provider Development (615) 615-741-6159 Sandra.Wise@tn.gov

• Linda Maurice, Provider Enrollment Coordinator (615) 532-6568 Linda.Maurice@tn.gov

• Regional Provider Development– West - Linda Hall

Linda.Hall@tn.gov– Middle – Lucretia Baxa Lucretia.Baxa@tn.gov– East – Katie K. Adcock Katie.K.Adcock@tn.gov

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Home and Community-Based Services WaiversHome and Community-Based Services Waivers

Vision, Mission, Values

• http://www.tn.gov/didd

State of TennesseeDEPARTMENT OF INTELLECTUAL AND

DEVELOPMENTAL DISABILITIES (DIDD)

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Home and Community-Based Services WaiversHome and Community-Based Services Waivers

• The Tennessee Department of Intellectual and Developmental Disabilities (DIDD) is the state agency responsible for providing services and supports to Tennesseans with intellectual and developmental disabilities.

• DIDD provides services directly or through contracts with community providers in a variety of settings. These settings range from in-home care to supported living in the community.

• DIDD services are paid for with a combination of state and federal funds.

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Home and Community-Based Services Waivers

• Funding system of Medicaid services is from the Federal Department of Health and Human Services (DHHS).

• Federal oversight is provided by the Centers for Medicare and Medicaid Services (CMS) which is a component of DHHS.

• In Tennessee, state oversight is provided by the Bureau of TennCare.

• The Bureau of TennCare has contracted with the State of Tennessee, Department of Intellectual and Developmental Disabilities (DIDD) to administer Medicaid Waiver services for persons who have Intellectual / Developmental Disabilities.

• DIDD currently manages three waiver systems.

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DIDD providers are approved to provide services for persons supported in either of the

three (3) Home and Community Based Waivers

DIDD providers are approved to provide services for persons supported in either of the

three (3) Home and Community Based Waivers

Provides upto $30,000 forIndividualized

services & supports.

Provides upto $30,000 forIndividualized

services & supports.

Provides additional services beyond

the statewide Waiver with an aggregate

cap on services

Provides additional services beyond

the statewide Waiver with an aggregate

cap on services

Provides comprehensive

individualized

services & supports with an individual cost

cap per year

Provides comprehensive

individualized

services & supports with an individual cost

cap per year

StatewideStatewide Comprehensive AggregateCap (CAC)

Comprehensive AggregateCap (CAC)

Self-Determination

Self-Determination

Home and Community-Based Services WaiversHome and Community-Based Services Waivers

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Waiver Services

Adult Dental Services (Statewide and Self-Determination Waiver only)Behavior RespiteBehavior Analyst & Behavior SpecialistCommunity Based DayIn-Home DaySupported EmploymentDentalEnvironmental Accessibility ModificationsFamily Model Residential SupportIndividual Transportation Intensive Behavioral Residential Medical Residential Nursing Nutrition Occupational Therapy

Home and Community-Based Services WaiversHome and Community-Based Services Waivers

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Orientation and Mobility Services for Impaired VisionPersonal AssistancePersonal Emergency Response SystemsPhysical TherapyResidential HabilitationRespiteSemi-Independent LivingSpecialized Medical Equipment and Supplies and Assistive TechnologySpeech, Language, and Hearing ServicesSupport CoordinationTransition Case Management

For Waiver Service definitions see:http://www.tn.gov/assets/entities/didd/attachments/Waiver_Service_Definitions.pdf

Waiver Services (continued)

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How to Start the Application Process How to Start the Application Process

• Business entities or individuals who want to provide and directly bill services within the DIDD system must undergo an approval and orientation process.

• This process involves submission of an application form accompanied by supplemental documentation demonstrating that all requirements are met for participation.

How to Start the Application ProcessHow to Start the Application Process

• DIDD Provider Applications are located on the DIDD website www.tn.gov/didd, on the home page see the Provider Information section and click the title How to Become a Provider.

• Completed applications must be typed, signed, scanned and sent in PDF form to DIDDProvider.Application@tn.gov .

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DIDD ApplicationsDIDD Applications

DIDD has four (3) types of application forms for different types of services:

1.NEW PROVIDER APPLICATION FOR LONG TERM SERVICES (Part 1 and Part 2) •New Provider Initial Screening Questionnaire for Long Term Services and for Support Coordination Services (PART 1)

• New Provider Application for Long Term Services• (PART 2)

• New Provider Application for Support Coordination • (PART 2)

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DIDD Applications (continued)DIDD Applications (continued)

2.Provider Application for Clinical and Ancillary Services

3.Credentialing Application for Dental Services and/or Anesthesia

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The Application Process Overview The Application Process Overview

5. The Provider DevelopmentCommittee submits its recommendationto the DIDD Commissioner for a decision.

3. The Provider Enrollment Coordinator submits the qualifying application to the Region(s) for a Recommendation

2. Applicant completes and submits Application to DIDD

1. Applicant obtains the appropriateApplication fromthe DIDD website

4. The applicable Region(s) submits its Recommendation to the Provider DevelopmentCommittee for Recommendation

The Application ProcessThe Application Process

General Requirements for all DIDD New Provider Applications; must have appropriate back ground checks:

• Tennessee Felony Offender Information• Tennessee Department of Health: Abuse Registry• Business Entity Search – Business Services Online

(Tennessee Secretary of State)• Tennessee Department of Health: Health Care Facilities• Tennessee Department of Health: Licensure Verification• Sex Offender Search – Tennessee Bureau of Investigation

Sex Offender Registry• Office of Inspector General US Department of Health &

Human Services (OIG)• DIDD Substantiated Investigation Record

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The Application ProcessThe Application Process

General Requirements for all DIDD New Provider Applications:The applicant must have acceptable qualifications to provide the services.

The applicant must not be terminated, barred or suspended from participation in the Medicare or Medicaid program.

There must be evidence of mechanisms to ensure that applicant staff are qualified to deliver the proposed services, including verification of licensure/certification for any licensed/certified staff employed.

There must be acceptable written policies submitted in accordance with DIDD requirements for provider policies. • 

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The Application ProcessThe Application Process

Requirements for Community Living Supports (CLS).

Providers of CLS services in the CHOICES program shall:

Be contracted with the Member’s MCO for the provision of CLS services, licensed by the DIDD in accordance with Title 33 of the T.C.A. and TDMHSAS Rule 0940-5-24, 0940-5-28 or 0940-5-32 as applicable, and contracted  by the DIDD to provide residential services pursuant to an approved Section 1915(c) waiver;

• For the  specific CLS services see the information : Community Based  Residential  Alternatives in CHOICES. Also reference CLS Rules Memo July 29, 2015

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DIDD Recruitment CyclesDIDD Recruitment Cycles

Recruitment Cycles: these cycles shall occur during Open Enrollment and during Targeted Enrollment as determined by DIDD.

•Open Enrollment shall mean a designated period of time, determined by DIDD during which entities may apply to become providers.

•Targeted Enrollment shall mean a designated period of time, determined by DIDD, during which DIDD seeks to enroll providers of specific services.

Targeted EnrollmentTargeted Enrollment

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Targeted Enrollment Application Time Line

Applications can be submitted at anytime throughout the year.

Targeted enrollment is open for:•Clinical & Ancillary Services•Dental Services and/or Anesthesia•Intensive Behavior Residential Services (IBRS)•Supported Employment Service•Semi-Independent Living Services

Targeted Enrollment (continued)Targeted Enrollment (continued)

• Applications which are rejected or incomplete are denied and applicants shall be notified electronically by the DIDD.

• Applicants which are denied are required to wait until the next Open Enrollment and/or Targeted Enrollment for the identified service before submitting another New Provider Application.

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Clinical & Ancillary ServicesClinical & Ancillary Services

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• Behavior Analyst • Behavior Specialist• Environmental Accessibility Modifications• Orientation and Mobility Services (O&M)• Individual Transportation Services with O&M only• Nursing Services• Nutrition Services• Occupational Therapy (OT)• OT Assistive Technology*• Personal Emergency Response Systems• Physical Therapy (PT)• PT Assistive Technology*• Specialized Medical Equipment and Supplies and Assistive Technology• Speech Language and Hearing Services (SLH)• SLH Assistive Technology**requires special approval for individuals/agencies with advance skills/experience with

assessment & intervention of Assistive Technology Devices

Long Term ServicesLong Term Services

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• Behavioral Respite• Community-Based Day• Family Model Residential Support• In-Home Day• Intensive Behavior Residential (IBRS)• Individual Transportation (Respite & Personal Assistance)• Medical Residential (requires Nursing Services)• Personal Assistance• Residential Habilitation• Respite• Semi-Independent Living• Support Coordination• Supported Employment• Supported Living

Open Enrollment for Long Term ServicesOpen Enrollment for Long Term Services

The applications being accepted during Open Enrollment are:

NEW PROVIDER APPLICATION FOR LONG TERM SERVICES (Part 1 and Part 2)

•New Provider Initial Screening Questionnaire for Long Term Services & for Support Coordination Services/PART 1• New Provider Application for Long Term Services/ PART 2• New Provider Application for Support Coordination

Services/PART 2

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Open Enrollment for Long Term Services (continued)

Open Enrollment for Long Term Services (continued)

The Open Enrollment period for Long Term Services occurs twice per year. Posted below is the Open Enrollment periods for the year 2015.

•March 1-March 31, 2015

•September 1-September 30, 2015

* The Supported Employment Service, Intensive Behavior Residential Service and the Semi-Independent Service is located on the Long Term Service Applications. Applicants may apply for these three services anytime throughout the year (see Targeted Enrollment).

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Open Enrollment for Long Term Services Time LineOpen Enrollment for Long Term Services Time Line

Open Enrollment Application Time Line for the March 2015 Applications:

Open Enrollment Application Time Line for the September 2015 Applications:

February 2015: Applicant Forum for Potential Providers is conducted in each DIDD region.

August 2015: Applicant Forum for Potential Providers is conducted in each DIDD region.

March 1, 2015: DIDD begins accepting the New Provider Initial Screening Questionnaire for Long Term Services and for Support Coordination Services (PART1).

September 1, 2015: DIDD begins accepting the New Provider Initial Screening Questionnaire for Long Term Services and for Support Coordination Services (PART1).

March 31, 2015: DIDD last day to accept the PART 1 application.

September 30, 2015: DIDD last day to accept the PART 1 application.

April 1, 2015: DIDD begins notification process: Approve or Deny or Reject Incomplete the Part 1 application .

October 1, 2015: DIDD begins notification process: Approve or Deny or Reject Incomplete the Part 1 application .

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Open Enrollment for Long Term Services Timeline (continued)

Open Enrollment for Long Term Services Timeline (continued)

Open Enrollment Application Time Line for the March 2015 Applications (continued):

Open Enrollment Application Time Line for the September 2015 Applications (continued):

May 2015: Upon approval of the New Provider Initial Screening Questionnaire (PART 1) The applicants shall be invited to the New Provider Pre- Application Activity, which is mandatory.

November 2015: Upon approval of the New Provider Initial Screening Questionnaire (PART 1) The applicants shall be invited to the New Provider Pre- Application Activity, which is mandatory.

May 30, 2015 Last day to submit the New Provider Application (Part 2) for Long Term Services and the last day to submit the New Provider Application for Support Coordination (PART 2).

November 30, 2015 Last day to submit the New Provider Application for Long Term Services (Part 2) and the last day to submit the New Provider Application for Support Coordination (PART 2).

June-July 2015: Applications Processed. December 2015-January 2016: Applications Processed.

July-August 2015: DIDD begins notification process: Approve or Deny.

January 2016-February 2016: DIDD begins notification process: Approve or Deny.

New Provider Orientation --The chief executive officer/executive director or Board Chairperson to attend within ninety (90) calendar days of assuming office, being appointed or beginning contracted services with DIDD.

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The Application Process For Long Term Services

The Application Process For Long Term Services

Requirements to approve the New Provider Initial Screening Questionnaire for Long Term Services and for Support Coordination Services (PART 1)The Department reserves the right to request any additional information deemed relevant to the qualification process.

• RESUMES AND REQUIREMENTS • For Chairperson of the Board• For Owner(s), and • For Executive Director

• FINANCIAL STABILITY for the past two years • For an Existing Agency • For a Start Up Agency

• ORGANIZATION STRUCTURE: • Provide an Agency Organizational Chart

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The Application Process For Long Term Services (Part 1)

The Application Process For Long Term Services (Part 1)

Requirements to approve the New Provider Initial Screening Questionnaire for Long Term Services and for Support Coordination Services (PART 1)

• ATTESTATION For each management position listed on the organizational chart

regarding their commitment of time and understanding of their obligation to the agency. Your provider approval is dependent upon the management positions within your organization. DIDD will need to be notified of any Executive Director changes.

• CERTIFICATION STATEMENT signed by the person authorized to submit the New Provider Initial Screening Questionnaire.

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The Application Process For Long Term Services (Part 2)

The Application Process For Long Term Services (Part 2)

New Provider Application for Long Term Services (PART 2)

The Department reserves the right to request any additional information deemed relevant to the qualification process.

• ORGANIZATIONAL CAPACITY

• FINANCIAL CAPACITY

• REQUIRED POLICIES

• CERTIFICATION STATEMENT

• STATEMENT OF UNDERSTANDING (IF APPLICABLE)

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The Application Process for Support Coordination (Part 2)

The Application Process for Support Coordination (Part 2)

New Provider Application for Support Coordination Services (PART 2)

The Department reserves the right to request any additional information deemed relevant to the qualification process.

• GENERAL INFORMATION• AGENCY MISSION AND FUTURE GOALS• AGENCY SUPERVISION PLAN• SERVICE PROVISION• PROTECTING PERSONS FROM HARM• FINANCIAL STABILITY/CAPACITY• AGENCY SELF ASSESSMENT PROCESS• INTERNAL GRIEVANCE AND APPEALS PROCEDURES

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The Application ProcessThe Application Process

Applicant receives a written decision:•Approved: Applicant is invited to complete the DIDD Provider Agreement. The DIDD Provider Agreement is generally approved for a designated time period. •Denied /Incomplete: Applicant not approved may apply at the next Recruitment Cycle (Open or Targeted Enrollment).

Refer to the 80.1.1 New Provider Application Policy for details about the application process  

Approved ApplicationApproved ApplicationAPPROVED APPLICATION:

•Before the approved Applicant can sign the DIDD Provider Agreement, the approved Applicant must obtain, the required license(s) for the approved service (s) Depending on the approved service (s). To obtain the license(s) the approved Applicant will contact: DIDD Licensure Division and/or Tennessee Department of Health. •After license is obtained, the DIDD Provider Agreement is signed by TennCare, DIDD, and the New Provider. •Once the New Provider receives a site code, the New Provider can provide the approved DIDD service(s).

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DIDD Provider Agreement

DIDD Providers may have a provider agreement in more than one of the three (3) regions :

West, Middle and East (see map by counties)

DIDD Provider Agreement

DIDD Providers may have a provider agreement in more than one of the three (3) regions :

West, Middle and East (see map by counties)

MiddleWest East

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DIDD Licensure RequirementsDIDD Licensure Requirements

• While there is no fee associated with applying to become a provider for DIDD, there is a fee required to obtain the DIDD license and to obtain the Tennessee Department of Health (DOH) license.

• Please note before the DIDD Provider Agreement can be finalized, agencies approved to provide Residential, Day, Respite, Family Model and/or Personal Assistant through Department of Intellectual and Developmental Disabilities (DIDD) are required to obtain the appropriate DIDD license(s).

For further details about DIDD licensure requirements and fees, contact the office in your DIDD region. •East Tennessee: (423) 434-6540          

•Middle Tennessee: (615) 231-5379

•West Tennessee: (731) 531-3754

•Department of Health: (615) 741-7300

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DIDD Licensure RequirementsDIDD Licensure Requirements

DIDD Licensure RequirementsDIDD Licensure Requirements

Department of Health License

•Please note before the DIDD Provider Agreement can be finalized, agencies approved to provide Occupational Therapy (OT), Physical Therapy (PT), Speech Language Hearing (SLH), and/or Nursing through the DIDD are required to obtain a Professional Support Services (PSS) license through the Department of Health. The PSS cannot be initiated until initial approval for the service is received from DIDD.

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Post ApprovalPost Approval

Regional Office Resources

BillingAssistance

Provider Supports

ProtectionFrom Harm

Marketing

RegionalOrientation

DIDDNEW

Provider

Technical Assistance Staff

Development

Quality Assurance

Initialconsult

Business ConsiderationsBusiness Considerations

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• Naming your Business (Person Centered Name); see the DIDD Provider Directory for a list of current business names.

• Persons supported with Intellectual/Developmental Disabilities and their families always have a choice in the selection of providers. Approval as a provider cannot be considered a guarantee of referrals or financial support.

• The DIDD Licensure requirement for most services is for agencies to have an office.

• DIDD requires an active license in order to maintain the Provider Agreement.

• Consider travel reimbursement versus gas cost.• Consider Start Up Cost versus Financial Capacity.

Business ConsiderationsBusiness Considerations

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• DIDD will communicate mainly with the applicant electronically at DIDDProvider.Application@tn.gov

• The applicant’s e-mail address specified on the application must be valid and able to accept e-mails from DIDD as this is the primary form of communication between DIDD and the applicant. It is the responsibility of the applicant that e-mails from DIDD are accepted by their e-mail system.

• The Applicant must have proof of 6 months start up cost when submitting the Long Term Service & Support Coordination Service Applications (referencing your budget).

Subcontract: How does it work?Subcontract: How does it work?

• You may decide instead to subcontract with an approved Provider instead of completing the DIDD application process for New Providers.

• To subcontract, contact an approved provider and if the two of you agree, the approved provider will contact DIDD to obtain approval to subcontract with you to provide the Waiver Service under their approved Provider Agreement.

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ResourcesResources

• www.tn.gov/didd and click the sections in Provider Information.  The Provider Information section gives access to lots of valuable information.

• Prospective providers should access, read, and be familiar with the DIDD Provider Manual, especially the service definitions.

• DIDD Policies.

  

LEIE RequirementsLEIE Requirements

What is the List of Excluded Individuals and Entities?

Office of Inspector General (OIG) List of Excluded Individuals/Entities (LEIE) provides information to the health care industry, patients and the public regarding individuals and entities currently excluded from participation in Medicare, Medicaid and all other Federal health care programs. Individuals and entities who have been reinstated are removed from the LEIE.”

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LEIE RequirementsLEIE RequirementsWhat are the current requirements for providers concerning LEIE?Existing requirement for providers to check their employees and subcontractors are in the current Provider Agreement (emphasis added):Provider Agreement in A.5. State and Federal Compliance (d) Provider Screening (ii): “The Provider and its subcontractors shall collect the disclosure of health care-related criminal conviction information as required by 42 CFR § 455.106 and establish policies and procedures to ensure that applicable criminal convictions are reported timely to DIDD. The Provider shall screen its employees and subcontractors initially and on an ongoing monthly basis to determine whether any of them has been terminated, debarred or excluded from participation in Medicare, Medicaid, SCHIP, or any Federal health care programs (as defined in Section 1128B (f) of the Social Security Act) and not employ or contract with an individual or entity that has been excluded. The provider shall immediately report to DIDD and the Program Integrity Unit of TennCare any exclusion information that the provider discovers.”

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LEIE ResourcesLEIE Resources

DIDD reference site for Office of Inspector General’s List of Excluded Individuals/Entities (LEIE): http://www.tn.gov/didd/provider_agencies/OIG/index.shtml has the following information:•Memo - LEIE Requirements (PDF) •LEIE Implementation Presentation (PDF)•LEIE Monthly Reporting Portal•LEIE Reporting Portal Training Document (PDF)

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Final Rule Medicaid HCBSFinal Rule Medicaid HCBS

What is the Final Rule Medicaid HCBS?

Final Rule CMS 2249-F and CMS 2296-F

Published in the Federal Register on January 16, 2014

Title:

Medicaid Program; State Plan Home and Community-Based Services, 5-Year Period for Waivers, Provider Payment Reassignment, and Home and Community-Based Setting Requirements for Community First Choice (Section 1915(k) of the Act) and Home and Community-Based Services (HCBS) Waivers (Section 1915(c) of the Act)

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Final Rule Medicaid HCBSFinal Rule Medicaid HCBS

Intent of the Final Rule•To ensure that individuals receiving long-term services and supports through home and community based service (HCBS) programs under the 1915(c), 1915(i) and 1915(k) Medicaid authorities have full access to benefits of community living and the opportunity to receive services in the most integrated setting appropriate •To enhance the quality of HCBS and provide protections to participants

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Final Rule Medicaid HCBS ResourcesFinal Rule Medicaid HCBS Resources

What are the current requirements for providers concerning the Final Rule?

All Providers need to know their requirements regarding compliance with the HCBS Final Rule. More

information about the final regulation is available:

http://www.medicaid.gov/medicaid-chip-program-information/by-topics/long-term-services-and-supports/home-and-community-based-services/

downloads/final-rule-slides-01292014.pdf

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Other Important ResourcesOther Important Resources

• The Code of Federal Regulations Title 42 Public Health Chapter IV Section 441.300

• Social Security Act: Section 1915 ( c ) Home and Community Based Waiver

• Tennessee Bureau of TennCare General Rules • Tennessee State Code Annotated: Title 33 • Title VI• Health Insurance Portability and Accountability Act (HIPAA)• Tennessee Department of Health Rules• Tennessee DIDD Regional and Central Office Personnel

QUESTIONS and ANSWERSQUESTIONS and ANSWERSThe floor is now open to answer questions you may have.

Can I only just provide In -Home Day service ? • In-Home Day Services cannot be the only Day Service requested for a person. DIDD expects people

to have the opportunity to receive their Day Services outside their home as much as possible.• If a person is approved for In-Home Day Services and any other Day Service, providers may bill

for the service provided for the majority of the day. For example, if a person has both In-Home Day

Services (e.g., for retirement) and Community-Based Day Services approved on their service plan and

they spend the majority of the day at the Senior Service Center, the provider may bill Community-

Based Day Services for that day.

What services do persons usually have with Personal Assistance Service ? • Personal Assistance, Respite and Individual Transportation

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Thank YouThank You

Thank you for attending the Applicant Forum. For applications and more

information regarding the New Provider Application Process, please go to

http://www.tn.gov/didd/provider_agencies/howto_prov.shtml

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