Tenn. Comp. R. & Regs. 0465-01-02-.07
Special Needs Adjustments
Effective Jan 5, 2020Authority: T.C.A. §§ 4-3-2701, 4-3-2707, 4-4-103, 4-5-201, et seq., 4-5-208, et seq. and its applicable regulations concerning emergency rules, 33-1-201, 33-1-202, 33-1-203(1) and (6), 33-1-204, 33-1-301, 33-1-302, 33-1-302(a)(3) and (a)(4), 33-1-303, 33-1-303(3) and (11), 33-1-304, 33-1-305(1), and 33-1- 309(d); Executive Order of the State of Tennessee No. 23, dated October 19, 1999; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; and the “Reimbursement Rate” for Medical Services under DIDD federal waiver(s) for provision of services as administered by TennCare. SERVICE PROVIDERS (RATE STRUCTURE)Tennessee Department of Intellectual and Developmental Disabilities/, Disability and Aging
- (1) An adjustment up to an additional thirty-five dollars ($35.00) per day is available to Residential Habilitation and Supported Living Levels 1-4 for homes with 1-4 persons.
- (2) An adjustment of twenty dollars ($20.00) per day is available to Residential Habilitation homes with 5 or more people except for reasons of a vacancy in the home.
- (3) This adjustment may be used for additional staff coverage or higher wages for staff.
(4) A special needs adjustment does not change the rate level designated for the waiver participant, but adjusts the rate level as a result of one or more of the following circumstances:
- (a) The waiver participant has a history of significant behavioral or psychiatric problems such as DSM-V diagnosis, violent acting out, serious self-injury or danger to others that are now not apparent due to the design or intensity of services being received or the person has a situation that is unique and results in the need for additional resources.
- (b) Less intensive services will likely result in recurrence of previous problems. The Regional Office must review the special adjustment at least annually.
- (c) The waiver participant is in circumstances that are time limited but that require support(s) at a higher level than described by the Level. (For example, the person has had a serious illness, injury, or surgery that requires more support while he/she is recovering than the Level describes.) A special adjustment may be approved for up to ninety (90) days and may be extended for an additional ninety (90) days.
Authority: T.C.A. §§ 4-3-2701, 4-3-2707, 4-4-103, 4-5-201, et seq., 4-5-208, et seq. and its applicable regulations concerning emergency rules, 33-1-201, 33-1-202, 33-1-203(1) and (6), 33-1-204, 33-1-301, 33-1-302, 33-1-302(a)(3) and (a)(4), 33-1-303, 33-1-303(3) and (11), 33-1-304, 33-1-305(1), and 33-1- 309(d); Executive Order of the State of Tennessee No. 23, dated October 19, 1999; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; and the “Reimbursement Rate” for Medical Services under DIDD federal waiver(s) for provision of services as administered by TennCare. SERVICE PROVIDERS (RATE STRUCTURE) Administrative History: Original rule filed December 12, 2013; effective March 12, 2014. Amendments filed October 7, 2019; effective January 5, 2020.