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 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.

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.

PART TWO: Changing the license requirement

LETTER: Tim Wheat, Program Director Memphis Center for IndependentLiving to Dr. Wendy Long, Director of TennCare

LETTER: Patti Killingsworth, Assistant Commissioner and Chief of Long Term Services and Supports to Tim Wheat

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.

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.  

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.

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.  

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

LETTER: Tim Wheat, Program Director Memphis Center for IndependentLiving to Dr. Wendy Long, Director of TennCare

LETTER: Patti Killingsworth, Assistant Commissioner and Chief of Long Term Services and Supports to Tim Wheat

Tennessee Long-Term Care Program begins July 1

Employment and Community First Program offers options to institutions

June 30
Starting this Friday, individuals with intellectual disabilities and developmental disabilities not currently receiving Medicaid waiver services can apply for the new Employment and Community First program.

The new Employment and Community First program is an effort to serve more people and expand options in long-term services and supports with TennCare.

The ECF program opens for applications this Friday, July 1, 2016. Referrals for enrollment cannot be accepted before Friday. However, starting Friday, you can fill out a "self-referral online form" on the TennCare homepage to apply for the program. The form will be posted and available at:

https://tcreq.tn.gov/tmtrack/ecf/index.htm

You may apply by completing the self-referral form at the link above; but if you need help or have questions you can call the agencies listed below. Applicants who have Medicaid but are not sure who the MCO is may call the Tennessee Health Connection line 1-855-259-0701.

Applicants who already have Medicaid and are enrolled with Amerigroup or BlueCare should contact their Managed Care Organization with questions or if you need assistance completing the self-referral form. You can find the information about how to call your MCO on your insurance card.

Applicants who already have Medicaid and are enrolled with United HealthCare Community Plan should contact Dept. of Intellectual and Developmental Disabilities Regional Intake Offices with questions or if you need assistance completing the self-referral form.

Applicants who do not have Medicaid should contact Dept. of Intellectual and Developmental Disabilities Regional Intake Offices with questions or for assistance completing the self-referral form for both ECF CHOICES and applying for Medicaid. The DIDD contact information is below:

DIDD Regional Intake Office Contact information:

West Tennessee Regional Office Office of Intake (866) 372-5709
Middle Tennessee Regional Office Office of Intake (800) 654-4839
East Tennessee Regional Office Office of Intake (888) 531-9876 

If you are currently on the waiting list for home- and community-based services (HCBS) through the Medicaid waiver you should receive a letter about the new program the first week it begins. The letter should tell you to use the self-referral form on the TennCare website, starting July 1. Based on the information DIDD currently has about you they may automatically refer you to the ECF CHOICES program in an active or deferred category.