Applicant Forum for Potential Providers

Applicant Forum for Potential Providers

Agenda Overview Welcome, Introduction, and Sign-In TennCare and Managed Care Organization (MCO) programs: CHOICES & Employment & Community First (ECF) CHOICES DIDD Provider Development Contacts DIDD’s Vision, Mission and Values Home and Community-Based Services Waivers (HCBS Waivers) Final Rule Medicaid HCBS How to Start the Application Process Business Considerations Application Process Overview DIDD Types of Applications General Requirements Applicant Forum DIDD Recruitment Cycles Review of Long-Term Services (LTS) Part 1 application Application Status Licensure Requirements Provider Agreement Post Approval Subcontract Resources Questions and Answers 2

TennCare and Managed Care Organization (MCO) programs: CHOICES & Employment & Community First (ECF) CHOICES Please be advised: You do not need to be a DIDD approved provider if you wish to provide services only through the CHOICES or Employment & Community First (ECF) Choices programs. Unless you will be administering medication under the CHOICES program. In order to apply to provide services through these programs, please contact the MCO (Amerigroup, BlueCare, or United Health Care) and/or TennCare. 3

CHOICES, ECF, and HCBS How do the CHOICES & Employment & Community First (ECF) programs differ from the DIDD Home and Community-Based Services (HCBS) Waivers? TennCare has effectively closed all DIDD HCBS waivers to new enrollees. The only options for individuals with Intellectual and/or Developmental Disabilities to receive services is for them to enroll in the ECF or CHOICES programs. All persons currently enrolled in the DIDD waivers will continue to receive services. Please visit http://www.tn.gov/tenncare/section/long-term-services-supports for more information. 4

DIDD Provider Development Contacts Please submit all applications, supporting documents, and questions related to your application to: [email protected] Central Office: Sandra Wise, Director of Staff and Provider Development Phone: 615-741-6159 Email: [email protected] Linda Maurice, Provider Enrollment Coordinator Phone: 615-532-6568 Email: [email protected] Provider Development Coordinators: Middle Regional Office– Lucretia Baxa Phone: 615-884-4314 Email: [email protected] East Regional Office– Lori Kieffer Phone: 865-594-9296 Email: [email protected] West Regional Office - Linda Hall Phone: 901-745-7553 Email: [email protected] 5

DIDD’s Vision & Mission Vision Statement: The Department's vision is to support all Tennesseans with intellectual and developmental disabilities to live fulfilling and rewarding lives. Mission Statement: The Department's mission is to become the nation's most person centered and cost effective state support system for people with intellectual and developmental disabilities. 6

DIDD’s Values Values are the principles that apply to all levels of the service delivery system. Values guide the day to day decisions that are made in service delivery, as well as the decisions that are made related to the system as a whole. The following values are to be recognized and utilized by all partners in service delivery: 1. Honoring the individual rights of persons supported is crucial and must be maintained at all levels of the system. The Department is committed to assuring that the rights of persons using services are protected and promoted, including rights afforded by the United States Constitution and the United Nation’s Declaration of Human Rights. 2. Focus on persons supported must be maintained at all levels of the system. Persons supported are the most important participants in the system. 3. Effective service and support planning and coordination is crucial to the quality of life, health, and safety of persons supported. 4. Individual choices of persons are the foundation of service planning and delivery. It is incumbent on all individuals touching the lives of persons supported to ensure that they have the information needed to make informed decisions. 5. Opportunities to accomplish personal outcomes, live a meaningful life, and be included in the community are identified in the development and implementation of support plans. 7

DIDD’s Values Con’t 6. Safety and security are essential to a person being able to achieve personal outcomes. 7. Risk identification and planning are essential to achieving a balance between allowing personal choice and protection from harm. 8. Respect of persons and the staff involved in direct delivery of their services is crucial at all levels of the system. 9. Professionalism of state and provider employees is essential to ensure the level of collaboration (guiding, coaching, modeling and supporting rather than supervising, controlling and care-taking) in the provision of services that will result in achievement of personal outcomes. Expectations for achievement are high and it is expected that services are not intrusive or demeaning. 10. Person- and family-friendly information is necessary to promote understanding, choice, and ownership of the service delivery system. Training opportunities for persons supported and their families are needed to ensure understanding and appropriate utilization of services within the system. 11. Reliable and valid data and information must be easily accessible to all stakeholders to promote understanding of the system, identification of problems and issues and planning for effective ways of improving the system. 12. Stakeholder input is essential to developing and maintaining service delivery mechanisms that meet the needs of persons served from an operational standpoint and that ensure smooth implementation of changes in policy and operational procedure. 8

DIDD’s Values Con’t 13. Systems change and quality improvement (QI) opportunities that benefit persons must be identified and implemented on an ongoing basis. Systemic issues, provider compliance issues, and individual problems must be identified, analyzed, and resolved in an organized, timely manner. 14. Innovative approaches that ensure the best use of available public funds must be employed to ensure that the maximum number of people have access to needed services. 15. Compliance with applicable state and federal statutes, rules, regulations and policies is necessary to ensure that adequate funding is available to provide access to services. 16. Quality assurance (QA) monitoring must be focused on achieving desired outcomes and ongoing compliance. Changes in quality monitoring must be accomplished in an organized manner that ensures stability of the system. 17. Effective provider training and technical assistance opportunities are necessary to ensure that providers achieve and maintain desired outcomes and programmatic compliance. 18. Equity must be achieved and maintained in the provision of services and treatment of providers. 19. Provider payment rates must be such that an adequate provider network is maintained and quality services are possible within available State appropriations. 9

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 (please note: all DIDD waivers are closed to new enrollees): Statewide Statewide Provides Provides comprehensiv comprehensiv ee individualized individualized services services & & supports supports with with an individual an individual cost cost cap cap per per year year Comprehensive Comprehensive Aggregate Aggregate Cap Cap (CAC) (CAC) Provides Provides additional additional services services beyond beyond the the statewide statewide Waiver Waiver with with an an aggregate cap aggregate cap on on services services SelfSelfDetermination Determination Provides Provides individualize individualize dd services services & & supports. supports. 10

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. 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. 11

Final 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) Intent of the Final Rule: To ensure 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. 12

Final Rule Medicaid HCBS PLEASE NOTE: All incoming providers are required to be in compliance with the HCBS Final Settings Rule prior to application approval and thereafter. During Part two (2) of the application process, applicants are required to submit the following selfassessments and required documentation showing compliance with the Final Rule: TN Residential Provider Self-Assessment TN Non-Residential Provider Self-Assessment 13

Final 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-inform ation/by-topics/long-term-services-and-supports/homeand-community-based-services/downloads/final-rule-sli des-01292014.pdf 14

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 all requirements are met for participation. 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 and attachments must be typed, signed, scanned and sent in PDF form directly to: [email protected] 15

Business Considerations TennCare has effectively closed all DIDD HCBS waivers to new enrollees. Individuals and their families always have a choice in the selection of providers. Approval as a provider cannot be considered a guarantee of referrals or reimbursement for services rendered without prior/proper approval. . Study the online DIDD Provider Directory to see the services current DIDD providers are offering. 16

Business Considerations DIDD will communicate mainly with the applicant electronically at [email protected] Send the application directly to the DIDD email. DIDD will not retrieve the application from a third party. The applicant’s e-mail address specified on the application must be valid and able to accept emails 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. Naming your Business (Person Centered Name). Please see the DIDD Provider Directory for a list of current business names. To be discussed in the LTS- Part 2 application: – The Applicant must have proof of 6 months startup cost when submitting the Long Term Service & Support Coordination Service Applications (referencing your budget). – Consider travel reimbursement versus gas cost. – Consider Start Up Cost versus Financial Capacity. 17

The Application Process Overview 3. The Provider Enrollment Coordinator submits the application to the Region(s) for a recommendation. 2. Applicant completes and submits application and supporting documents to DIDD via email [email protected] 1. Applicant obtains the appropriate Application from the DIDD website. 4. The applicable Region(s) submits its recommendation to the Provider Development Committee for recommendation 5. The Provider Development Committee submits its recommendation to the DIDD Commissioner for a decision. 18

DIDD Types of Applications DIDD has three (3) types of application forms for different types of services: 1. Provider Application for Clinical and Ancillary Services 2. Credentialing Application for Dental Services and/or Anesthesia 3. New Provider Application for Long Term Services (LTS) (Part1 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) 19

General Requirements Supported Documentation The applicant must have acceptable qualifications to provide the services. The applicant must not be terminated, barred or suspended from participation in a Medicare or Medicaid program. There must be evidence of mechanisms to ensure 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. 20

General Requirements Background Checks * On the DIDD website at http://tn.gov/didd/topic/how-to-become-a-provider, study the Instructions for Submitting a National Background Check to DIDD Applicants must submit a National Background check for the following Owner(s) Executive Director(s) Chairperson of the Board For each applicant DIDD will also check the following online sites: Tennessee Felony Offender Information Tennessee Department of Health: Abuse Registry Business Entity Search Tennessee Secretary of State Tennessee Department of Health: Health Care Facilities Tennessee Department of Health: Licensure Verification Tennessee Bureau of Investigation Sex Offender Registry Office of Inspector General US Department of Health & Human Services (OIG) List of Excluded Individuals / Entities (LEIE) DIDD Substantiated Investigation Record 21

General 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.” What are the current requirements for providers concerning LEIE? Providers are required to perform initial and ongoing (monthly) employee screenings on all employees (including subcontractors). 22

General Requirements The DIDD website has links for the following information from the Office of Inspector General’s List of Excluded Individuals/Entities (LEIE): – – – – Memo - LEIE Requirements (PDF) LEIE Implementation Presentation (PDF) LEIE Monthly Reporting Portal LEIE Reporting Portal Training Document (PDF) To access this information, follow these instructions: 1. http://www.tn.gov/didd/section/providers 2. Resources & Manuals 3. OIG/LEIE 23

DIDD Recruitment Cycles Recruitment Cycles occur during both Open and Targeted Enrollment periods, 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. 24

Applicant Forum DIDD recommends that you attend an Applicant Forum prior to submitting a DIDD New Provider Application. Attendance is not mandatory, but it may be helpful to applicants seeking information about DIDD and clarification about the process for submitting a DIDD New Provider Application. The Applicant Forum is scheduled the month prior to Open Enrollment and will take place in each DIDD region (East, Middle and West). For your convenience, each DIDD Region presents the same agenda at each forum. The applicant is welcome to attend any forum on any date listed below. For Forum dates and times , Please see Schedule of Applicant Forums in the How To Become a Provider section of the DIDD website. 25

Open Enrollment for Long Term Services Open Enrollment shall mean a designated period of time, determined by DIDD during which entities may apply to become providers Posted below are the Open Enrollment periods for the year 2017: May 1 - May 31, 2017 October 1 - October 31, 2017 26

Open Enrollment for Long Term Services New Provider Initial Screening Questionnaire for Long Term Services and for Support Coordination Services (Part 1): Applicants whose Part 1 application is approved are invited to attend the Pre-application activity, which is mandatory. The activity shall review the continuation of the Part 2 application process for Long Term and Support Coordination services and DIDD guidelines for service provision. Once completed the applicant shall complete and submit the appropriate Part 2 application. 27

Open Enrollment for Long Term Services The New Provider Application for Long Term Services (Part 1 and Part 2) applications are accepted during Open Enrollment : New Provider Initial Screening Questionnaire for Long Term Services and for Support Coordination Services (Part 1) [Study each section of the Part 1 application, Disclosure forms and Substitute W-9 form]. New Provider Application for Long Term Services (Part 2) [Study each section of the Part 2 application, TN Residential and Non –Residential Self Assessments, Minimum Required Policies & Review Guidelines, Available Service Rates]. New Provider Application for Support Coordination (Part 2) 28

Open Enrollment for Long Term Services Long Term Services: Behavior Respite Day Services – Community-Based Day – In Home Day – Supported Employment Family Model Residential Support Individual Transportation (Respite & Personal Assistance) Medical Residential * For the Medical Residential service the applicant is required to apply for Nursing Services by submitting the Provider Application for Clinical & Ancillary Services. Personal Assistance Residential Habilitation Respite Semi-Independent Living Support Coordination Supported Living For Waiver Service definitions , please visit: http://www.tn.gov/assets/entities/didd/attachments/Waiver Service Definitions.pdf 29

Targeted Enrollment – Dental, Clinical & Ancillary Services Applications for Targeted Enrollment may be submitted at anytime throughout the year. Targeted Enrollment is open for: – Clinical & Ancillary Services – Dental Services and/or Anesthesia – Supported Employment Service* * The Supported Employment Service, is located on the Long Term Service Applications. Applicants may apply for the Supported Employment Service at any time. 30

Targeted Enrollment – Dental, Clinical & Ancillary Services Behavior Analyst Behavior Specialist Dental and/or Anesthesia 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 For Waiver Service definitions , please visit: http://www.tn.gov/assets/entities/didd/attachments/Waiver Service Definitions.pdf 31

Application Status Applicant receives a written decision Approved: For all application types. The Applicant is invited to complete the DIDD Provider Agreement. The DIDD Provider Agreement is generally approved for a designated time period. Denied: For all application types. The Applicant is not approved and may apply during the next Recruitment Cycle (Open and/or Targeted Enrollment). Refer to the 80.1.1 New Provider Application Policy for details about the application process 32

Application Status Approved Application Steps: 1. Once approved, the required license(s) for the approved service(s) must be obtained. To obtain the license(s) the approved Applicant will contact: DIDD Licensure Division and/or Tennessee Department of Health. 2. After license is obtained, the DIDD Provider Agreement is signed by the New Provider, DIDD, and TennCare. 3. Once the New Provider receives a site code, the New Provider may then provide the approved DIDD service(s). 33

Application Status – Obtaining License(s) DIDD 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(s) and/or the Tennessee Department of Health (DOH) license(s). 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). DIDD Licensure Regional Office Contacts East Tennessee: Heather Miles Phone: 423-787-6553 Email: [email protected] Middle Tennessee: Cheryl Jacobs Phone: 615-770-1004 Email: [email protected] West Tennessee: Gale Carter Phone: 731-426-1811 Email: [email protected] 34

Application Status – Obtaining License(s) 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 DIDD are required to obtain a Professional Support Services License (PSSL) through the Department of Health. Website: http://tn.gov/health/topic/hcf-licen sure Department of Health: (615) 741-7221 The PSSL may only be initiated once the agency receives an approval letter from DIDD. 35

DIDD Provider Agreement DIDD Providers may have a Provider Agreement in one , two, or all three (3) DIDD Regions : West Middle East 36

Post Approval DIDD NEW Provider Regional Orientation Regional Office Resources Marketing Billing Assistance Technical Assistance Provider Supports Quality Assurance Initial consult Protection From Harm Staff Development 37

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 and licensed service. 38

Resources 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 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 DIDD Provider Manual The Code of Federal Regulations Title 42 Public Health Chapter IV Section 441.300 39

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/topic/how-to-become-a-provider 40