1. Applicant Forum For Potential Providers
State of Tennessee
Department of Intellectual and Developmental Disabilities (DIDD)

2. 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

3. Agenda 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

4. Introduction
Sandra Wise, Director of Staff and Provider Development (615)
Linda Maurice, Provider Enrollment Coordinator
(615)
Regional Provider Development
West - Linda Hall
Middle – Lucretia Baxa
East – Katie K. Adcock

5. Home and Community-Based Services Waivers
State of Tennessee DEPARTMENT OF INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (DIDD)
Vision, Mission, Values
Reference the DIDD website to present : Vision , Mission and Values

6. Home 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.

7. 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.
Test emphasis: Waiver is a funding system, not a “program”, thus, funds are provided by the government so that provider agencies can develop the service within federal and state standards; the federal governing body is Centers for Medicare and Medicaid Services (CMS).
Clarification:
All states have a State Medicaid Agency that governs Medicaid Services.

8. DIDD providers are approved to provide services for persons supported in either of the three (3) Home and Community Based Waivers
Statewide
Comprehensive Aggregate
Cap (CAC)
Self-
Determination
Provides comprehensive individualized
services & supports with an individual cost cap per year
Provides additional services beyond
the statewide
Waiver with an aggregate cap on services
Provides up
to $30,000 for
Individualized
services & supports.

9. Home and Community-Based Services Waivers
Waiver Services
Adult Dental Services (Statewide and Self-Determination Waiver only)
Behavior Respite
Behavior Analyst & Behavior Specialist
Community Based Day
In-Home Day
Supported Employment
Dental
Environmental Accessibility Modifications
Family Model Residential Support
Individual Transportation
Intensive Behavioral Residential
Medical Residential
Nursing
Nutrition
Occupational Therapy

10. Home and Community-Based Services Waivers
Waiver Services (continued)
Orientation and Mobility Services for Impaired Vision
Personal Assistance
Personal Emergency Response Systems
Physical Therapy
Residential Habilitation
Respite
Semi-Independent Living
Specialized Medical Equipment and Supplies and Assistive Technology
Speech, Language, and Hearing Services
Support Coordination
Transition Case Management
For Waiver Service definitions see:

11. 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.

12. How to Start the Application Process
DIDD Provider Applications are located on the DIDD website 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 .

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

14. DIDD Applications (continued)
Provider Application for Clinical and Ancillary Services
Credentialing Application for Dental Services and/or Anesthesia

15. The Application Process Overview
3. The Provider Enrollment Coordinator submits the qualifying application to the Region(s) for a Recommendation
4. The applicable Region(s)
submits its Recommendation to the Provider Development
Committee for Recommendation
2. Applicant
completes and submits Application to DIDD
5. The Provider Development
Committee submits its recommendation
to the DIDD Commissioner for a decision.
1. Applicant obtains the
appropriate
Application from
the DIDD website

16. The 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

17. The 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.

18. The 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 , or 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

19. DIDD 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.

20. Targeted Enrollment 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

21. 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.

22. Clinical & Ancillary Services
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

23. Long Term Services 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

24. Open 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

25. 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).

26. Open 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 .

27. Open Enrollment for Long Term Services Timeline (continued)
Open Enrollment Application Time Line for the March Applications (continued):
Open Enrollment Application Time Line for the September 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.

28. 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

29. 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.

30. 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)

31. 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

32. The 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 New Provider Application Policy for details about the application process  

33. Approved Application APPROVED 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).

34. 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)
West
Middle
East

35. 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 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).

36. DIDD Licensure Requirements
For further details about DIDD licensure requirements and fees, contact the office in your DIDD region.
East Tennessee: (423)          
Middle Tennessee: (615)
West Tennessee: (731)
Department of Health: (615)

37. DIDD 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.

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

39. Business Considerations
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.

40. Business Considerations
DIDD will communicate mainly with the applicant electronically at
The applicant’s address specified on the application must be valid and able to accept s from DIDD as this is the primary form of communication between DIDD and the applicant. It is the responsibility of the applicant that s from DIDD are accepted by their 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).

41. 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.

42. Resources
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.

43. LEIE 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.”

44. LEIE Requirements
What 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 § 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.”

45. LEIE Resources
DIDD reference site for Office of Inspector General’s List of Excluded Individuals/Entities (LEIE): has the following information:
Memo - LEIE Requirements (PDF)
LEIE Implementation Presentation (PDF)
LEIE Monthly Reporting Portal
LEIE Reporting Portal Training Document (PDF)

46. 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)

47. Final 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

48. 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:

49. Other Important Resources
The Code of Federal Regulations Title 42 Public Health Chapter IV Section
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

50. The floor is now open to answer questions you may have.
QUESTIONS and ANSWERS
The 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

51. Thank You
Thank you for attending the Applicant Forum. For applications and more information regarding the New Provider Application Process, please go to