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-.08 - VALUE-BASED RATE SETTING METHODOLOGY FOR SUPPORTED EMPLOYMENT-INDIVIDUAL EXPLORATION

Universal Citation: TN Comp Rules and Regs 0465-01-02-.08

Current through September 24, 2024

(1) Supported employment-individual exploration is paid for on an outcome basis.

(2) The unit is a complete episode of the service as defined in the approved Section 1915(c) waiver application and includes all of the service required to deliver the expected outcome.

(3) The outcome-based rate is calculated using the following factors:

(a) Average cost of job coach hour of service (as described in 0465-01-02-.11(3)(a) ), including these component costs:
1. DSP reimbursement rate;

2. Employee-related expenses;

3. Administrative costs;

4. Productivity assumptions; and

5. Travel costs;

(b) A value-based incentive of $4.30/hour above actual cost (rate model) to reward provision of services expected to result in the person identifying a goal of competitive integrated employment;

(c) Average number of job coach hours required to complete service; and

(d) Billable service adjustment for percentage of waiver participants that do not complete the service due to reasons beyond the purview of the provider's control.

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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