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Applicant Forum For Potential Providers

Applicant Forum For Potential Providers. State of Tennessee Department of Intellectual and Developmental Disabilities (DIDD). Objectives. For Potential Providers To explain the DIDD Provider Application process

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Applicant Forum For Potential Providers

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

  2. Objectives • For Potential Providers • To explain the DIDD Provider Application process • 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 • Resources • Questions and Answers

  4. Introduction • Tori Lindsey, Director of Staff and Provider Development (615) 615-741-6159 Tori.Lindsey@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 -Darlene Harris Darlene.Harris@tn.gov • East –Katie K. Adcock Katie.K.Adcock@tn.gov

  5. Home and Community-Based Services Waivers Vision, Mission, Values http://www.tn.gov/didd State of TennesseeDEPARTMENT OF INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (DIDD)

  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.

  8. DIDD providers are approved to provide services for persons supported in either of the three (3) Home and Community Based Waivers Self- Determination Statewide Arlington Providescomprehensive individualized services & supports Provides additional services beyond the statewide waiver and is only for Arlington Remedial Order Class members Provides up to $30,000 for Individualized services & supports.

  9. Home and Community-Based Services Waivers Waiver Services: • For service definitions reference: http://www.tn.gov/didd/provider_agencies/ServiceDefinitions/WaiverSrvcDefinitions.shtml Adult Dental Services (Statewide and Self-Determination Waiver only) Behavior Respite Behavior Analyst & Behavior Specialist Community Based Day Facility Based Day In-Home Day Supported Employment Dental Services (Arlington Waiver only) Environmental Accessibility Modifications Family Model Residential Support Individual Transportation Services Intensive Behavioral Residential Services Medical Residential Services Nursing Services

  10. Home and Community-Based Services Waivers Waiver Services (continued) • For service definitions reference: http://www.tn.gov/didd/provider_agencies/ServiceDefinitions/WaiverSrvcDefinitions.shtml Nutrition Services Occupational Therapy Orientation and Mobility Services for Impaired Vision Personal Assistance Personal Emergency Response Systems Physical Therapy Residential Habilitation Respite Semi-Independent Living Services (Self-Determination waiver only) Specialized Medical Equipment and Supplies and Assistive Technology Speech, Language, and Hearing Services Support Coordination Transition Case Management Vision Services (Arlington Waiver only)

  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 www.tn.gov/didd, on the home page click from the list on the left the word Provider Info then click How to Become a Provider. • Completed applications must be typed, signed, scannedand sent in PDF form to DIDDProvider.Application@tn.gov .

  13. DIDD Applications DIDD has four (4) different 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 (PART 2)

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

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

  19. Targeted Enrollment Targeted Enrollment Application Time Line: • Targeted Enrollment: Applications maybe submitted at anytime throughout the year for 2014. Targeted enrollment is open for: • Clinical & Ancillary Services • Dental Services and/or Anesthesia • Vision Services • Intensive Behavior Residential Services (IBRS) • Supported Employment Service

  20. Targeted Enrollment (continued) • Applications which are rejected or incomplete are denied and applicants shall be notified electronically by the DIDD within five (5) business days. • Applicants are required to wait until the next Open Enrollment and/or Targeted Enrollment for the identified service before submitting another New Provider Application. • Applicants shall be notified electronically within 90 business days, by the DIDD of approved or denied application

  21. 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

  22. Long Term Services

  23. 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

  24. Open Enrollment for Long Term Services (continued) The Open Enrollment period for potential providers occurs two times per year: • March 1-March 30, 2014 • September 1-September 30, 2014 * The Supported Employment service and Intensive Behavior Residential service is located on the Long Term Service applications. These two services will be accepted throughout the year of 2014 (see Targeted Enrollment).

  25. Open Enrollment for Long Term Services Time Line

  26. Open Enrollment for Long Term Services Timeline (continued)

  27. The Application Process For Long Term Services

  28. The Application Process For Long Term Services (Part 1)

  29. The Application Process For Long Term Services (Part 2)

  30. The Application Process for Support Coordination (Part 2)

  31. 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 five year period. • Denied /Incomplete: Applicant not approved may apply at the next Recruitment Cycle (Open or Target Enrollment). Refer to the 80.1.1 New Provider Application Policy for details about the application process

  32. Approved Application APPROVED APPLICATION: • Applicant must obtain, depending on the approved service(s), the required license(s) from DIDD Licensure Division and/or from Department of Health if applying for Clinical type services. • 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 services.

  33. DIDD Provider AgreementDIDD Providers may have a provider agreement in more than one of the three (3) regions : West, Middle and East (see map by counties) West East Middle

  34. 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 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).

  35. DIDD Licensure Requirements 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

  36. 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.

  37. 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

  38. Business Considerations • Naming your Business (Person Centered Name); see Provider directory for 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.

  39. Business Considerations • 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. • Proof of 6 months start up cost for applicants submitting the application: Long Term Services & Support Coordination Services.

  40. 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 provider will contact DIDD to obtain approval to subcontract with you to provide the Waiver Service under their approved Provider Agreement.

  41. Resources www.tn.gov/didd and click on the link labeled Provider Info.  The Provider Info page 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 • Central Office New Provider Orientation for Board Chairs and Executive Directors , it includes billing and the Available Services and Rates information.  • DIDD Provider Directory of approved providers and their approved services. Also, in this section are licensure links to the DIDD Licensure, the TN Department of Health Licensure and to TN Department of Mental Health and Substance Abuse. These verify the approved provider license for the specific DIDD approved service(s).

  42. Other 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

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