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Tennessee’s Bureau of TennCare and Department of Intellectual and Developmental Disabilities Release Memo Detailing Major Changes to Authorization of Facility-Based Day Services Under Its Section 1915(c) Intellectual Disability Waivers

June 29, 2016

On June 20, 2016, Tennessee’s Bureau of TennCare and the Department of Intellectual and Developmental Disabilities, released a memo detailing major changes to the way in which the state will authorize facility-based day services, including employment services, under Section 1915(c) waivers. The Bureau’s stated reason for the change, which will go into effect July 1, 2016, is to ensure the state’s compliance with its HCBS Transition Plan, CMS’ final rules for HCBS settings, and CMS’ 2011 guidance on employment or employment-related settings. The memo’s development was informed by the many technical resources that were provided by the Office of Disability Employment Policy (ODEP)’s Employment First State Leadership Mentoring Program.

TennCare has stated that facility-based day services may now only be provided in a non-community-based facility setting in one of two circumstances: (a) an individual needs pre-vocational training that is time-limited, when such training is not available at their job; or (b) an individual, through their person-centered planning process, chooses to participate in a facility-based setting and the training provided there is specifically designed to address the individualized, specific employment or community living skills detailed in the person’s individualized service plan (ISP). 

If an individual chooses to participate in a facility-based setting for the purpose of developing employment or community living skills, the person’s ISP must describe in detail the person’s employment or community living goals, the specialized skills the person will be working on developing in the facility-based day program, and how and when the skills the person is learning will help them prepare to move to the next steps in pursuing and achieving their employment or community living goals. Service notes and planning activities, submitted for review, must clearly document the progress being made towards the goals in the individual’s ISP. 

Pre-vocational training in a facility-based setting will now only be approved if the person’s final and ultimate goal is competitive, integrated employment in the community and if all facility-based training is designed to facilitate that goal. Employment in a sheltered workshop can, according to TennCare, never be authorized for these purposes and thus can no longer be funded using a Section 1915(c) intellectual disability waiver.