Rules & Regulations of the State of Tennessee
Title 0465 - Intellectual and Developmental Disabilities
Subtitle 0465-01 - General Rules
Chapter 0465-01-02 - Methodology Utilized to Determine Payments to Service Providers (Rate Structure)
Section 0465-01-02-.04 - RATE SETTING METHODOLOGIES FOR MEDICAL, RESIDENTIAL SERVICES

Universal Citation: TN Comp Rules and Regs 0465-01-02-.04

Current through September 24, 2024

(1) Medical Residential Services.

(a) For residential services that are shift-staffed, staff coverage is calculated as follows:

1. 168 hours per week - 7 days at 24 hours per day.

2. The unit of service for these residential services is a day.

(b) The calculation of the daily cost per person for a Full Time Equivalent (FTE) is:

1. Allowable Hourly direct support staff wages plus % for benefits for the hourly cost for direct support staff.

2. Annual allowable salary for direct supervision plus % for benefits divided by four residents equals the cost per person per year.

3. Divide the cost per person per year by 52 weeks and by 168 hours to arrive at the hourly cost for supervision.

4. Add together the hourly cost for direct support staff and the hourly cost for supervision.

5. Multiply the result from Step four by one and the % allowed for non-direct program costs.

6. Multiply the result from Step five by one and the % allowed for administrative costs to arrive at the hourly cost for coverage.

7. Multiply the hourly cost for an FTE by 168 hours to arrive at the weekly cost for coverage.

8. Divide the weekly cost by 7 days to arrive at the daily cost for coverage.

9. Divide the daily cost by allowable FTEs to arrive at the daily FTE cost per person.

1. For each Rate Level and Home Size, multiply the daily per person FTE cost by the rate level factor.

2. Divide the result of Step one by the facility size.

3. Multiply the result of Step two by 385 (to allow for 20 absent days).

4. Divide the result of Step three by 365 to arrive at the daily rate.

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.

Disclaimer: These regulations may not be the most recent version. Tennessee may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.

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