Wednesday, May 3, 2017

IL Centers exempted from Day Services License - Part 2

PART TWO: TennCare drops the requirement for Independent Living Centers to have a Day Services License

EDITOR’S NOTE: This is part two about advocate’s work to provide ECF Services in Tennessee. Please read PART ONE: Tennessee begins a stateprogram that leaves out the state’s Centers for Independent Living.

Josue of M C I L
The Tennessee Employment and Community First Program had a requirement that providers of Independent Living Skills Training must also be a “Licensed Day Habilitation Provider” in order to be credentialed. The burden of this license is one of the reasons that Tennessee CILs dropped the ECF services.

MCIL was approved by the two Managed Care Organizations to provide some ECF services, but the Center was informed that the Day Services License was essential to provide IL Skills Training. Since the ECF program began in July of 2016, no one was really clear on why the requirement existed. The MCO representatives agreed that IL Skills by regulation could not be provided in a facility.

The Day Habilitation license also has requirements on the staff who provide the services; however, the ECF requirements are more stringent. The Day Services requirement mandates at least one staff member is available for every six clients, while ECF is essentially a one-on-one skills training. Background and registry checks are also required by ECF so there is no material part of the Day Habilitation license that would be relevant.  

Activist speaking out with hands outstreached
Of course the purpose of the Day Services license is to approve the physical environment where services are provided. There is absolutely no need for the license where training is to be in the individual's home and community.  It is an absurd requirement.

“The odd requirement to be a ‘Licensed Day Habilitation Provider’ seems in contrast to the stated goals of the ECF CHOICES program and has no benefit for the state or individuals that may use the program,” MCIL said in a February letter to Dr. Wendy Long, the Director of TennCare. “Most importantly, please note that providing Independent Living Skills training according to the ECF CHOICES Guidelines would prohibit any provider from using a facility or adult day care center because the services are to be delivered in the community, in the least restrictive setting and in the individual’s home and community.”

On April 21, 2017 the state essentially changed the requirement. In a letter to the Program Director of MCIL, Patti Killingsworth, the Assistant Commissioner and Chief of Long Term Services and Supports wrote that the provider qualifications would be adjusted.

“A Center for Independent Living,” said Ms. Killingsworth in the April 21st letter, “as defined in federal law, that is receiving federal funding from [the] federal Department of HHS to operate as a Center for Independent Living is qualified to provide services in the Employment and Community First CHOICES program that would otherwise require an Adult Habilitation Day Facilities license.”

The state carved out an exemption for CILs, they did not get rid of the unnecessary requirement. The ECF services are to focus on individual integration and independence, the adult day services concentrate on safety. This is the contrast that MCIL noted in the letter to TennCare Director Wendy Long, the state grants approval for a program that has a license, even though the license has nothing to do with the services offered.
Person at M C I L

Nearly a year after the program rolls out, MCIL may offer Independent Living Skills training. However, the Center and other CILs in Tennessee cannot have a good feeling about the long-term viability of the program. Most importantly is how long it took to have the state recognize the problem with the day services license. For a year MCO’s and TennCare recognized the problem; facility license for non-facility services, and failed to act.

In my dealing with MCOs, they listened politely to our case, but simply agreed that the requirement did not make sense. Reason did not climb the ladder to action. For most CILs and small providers in the state, the unreasonable requirement to have a Day Habilitation license seems to be just another bureaucratic hurtle that made the overall program not worthwhile.

MCIL may provide IL Skills Training now because of the finding of the state, but the struggle of all the CILs, the SILC and small providers may say more about the future of the Employment and Community First Program.