Thursday, May 4, 2017

IL Centers exempted from Day Services License

PART ONE: Tennessee begins a state program that leaves out the state’s Centers for Independent Living

The MCIL Logo: stylized letters C I L to resemble a wheelchair climbing the letter M

The state of Tennessee developed a unique service with the new Employment and Community First initiative. Tennessee Amendment 27 was the first attempt in the U.S. to bring integration and independence to Americans that were often trapped on waiting lists for programs. All of the state’s six IL Centers were asked to be a part of providing the tools to help people with disabilities all over the state to live independently and to work for employment and self-sufficiency.

July 1, 2016 the program went live and MCIL had done the work to build our program and services from scratch. In the ECF program we offer: Peer-to-peer Self-Direction; Community support, development, organization and navigation; Health Insurance Counseling (Forms Assistance) and Independent Living Skills Training. At the time we were also offering Personal Attendant Services and Supportive Home Care through our existing PAS Services department.

MCIL desperately needed more service hours for our PAS program and those two ECF services seemed to be in demand. Increasing our capacity with ECF Personal Attendant Services and Supportive Home Care seemed just what the Center needed to continue consumer oriented home and community services. MCIL did not get any of the first ECF referrals and by October we had paid for all necessary training and background checks for our staff and we had been certified by both Managed Care Organizations.

To date, MCIL has not received a single appropriate referral. We have heard from five people and some “Support Coordinators” from the MCO’s, but none were looking for services that MCIL had agreed to provide. One referral may have included services we offer, but it was from a county outside our area.

Since the beginning of 2017, it has been very hard here at MCIL because our PAS program dipped below the hours needed to keep it sustainable and keep the dozens of Direct Support Professionals employed. In March MCIL had to end the program and two additional professionals who administered the program lost their jobs. The state’s ECF program said they had 1,700 slots in the first year but not one appropriate referral came to MCIL.

MCIL did not end its ECF program however, although clearly we could not offer Supportive Home Care and Personal Assistance services because we no longer had a PAS program. The MCOs did not call for any of the other services that MCIL had to offer.
Disability Rights activists

From the beginning, we had assumed the IL Skills would be our bread-and-butter. MCIL has more than 32 years of IL experience in the community and it is our calling-card, it is in our name.

The Memphis Center for Independent Living never removed the service “IL Skills Training” from our Policy and Procedure Manual but the Managed Care Organizations apparently could not approve us to provide IL Skills because, they claimed, an IL Skills provider must have be a “Licensed Day Habilitation Provider” in order to be credentialed by the Managed Care Organizations.

The MCO’s did not have any problem with us continuing to list IL Skills as a service we provide, because they could not coherently explain why we would need a Day Services license. It did not make any sense. The IL Skills according to the state regulations could not be provided in a facility and had to be one-on-one services offered in the least restrictive setting.

From early on in this process, the Statewide Independent Living Council and other CILs in the state were advocating to get rid of the Day Services license. The other Tennessee CILs were working on developing ECF programs of their own and saw the license as a barrier. One-by-one the CILs dropped out of the ECF program for a variety of reasons, including the burden of the unnecessary license.