Current through September 24, 2024
(1) Calculation for Semi-Independent Living
Services is:
(a) The unit of service for
these residential services is a day.
(b) The rate is calculated on a monthly
basis. For purposes of billing, the monthly rate is converted to a per diem
amount. The per diem rate will be billed for each day of the month that the
person is enrolled in the services, regardless of whether any direct assistance
was provided that day.
(c) The rate
is calculated using the following factors:
1.
Average monthly hours, inclusive of on-call services;
2. Personal Assistant services quarter hour
reimbursement rate as defined in
0465-01-02-.18;
3. Transportation cost.
(d) Semi-Independent Living Incentive: is a
one-time payment of $2,500 per waiver participant per provider. The waiver
participant must have transitioned directly into Semi-Independent Living from a
twenty-four hour residential service following at least thirty consecutive paid
residential days. The waiver participant must then participate in
Semi-Independent Living for six (6) consecutive months immediately following
the transition to be eligible for the incentive payment.
(e) Semi-Independent Living Transition Rate:
is double that of the semi-independent living daily rate and limited to waiver
participants who require additional hours of support during the period
immediately following transition. This rate is only available for up to thirty
days following the initial transition from a twenty-four hour residential
service to Semi-Independent Living and requires thirty consecutive paid
residential days immediately prior and adjacent to the claim for the transition
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.
