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-.11 - VALUE-BASED RATE SETTING METHODOLOGY FOR SUPPORTED EMPLOYMENT-INDIVIDUAL JOB COACHING

Universal Citation: TN Comp Rules and Regs 0465-01-02-.11

Current through September 24, 2024

(1) Supported employment-individual job coaching is reimbursed on a fee-for-service basis.

(2) The unit of service is 15 minutes.

(3) The fee-for-service rate is calculated using the following factors:

(a) Average cost of job coach hour of service divided by four (4), including these component costs:
1. DSP reimbursement rate;

2. Employee-related expenses;

3. Administrative costs;

4. Productivity assumptions, including projected average waiver participant absentee rate of 12 percent; and

5. Travel cost; and

(b) A value-based incentive of $3/hour above actual cost (rate model) to reward the provision of services to support waiver participant success in competitive, integrated employment - so long as fading expectations are met (see below);

(c) Value-based adjustments beginning six months after initiation of individual job coaching to incentivize fading of services, based on a combination of: the intensity of support needs of the waiver participant, the length of time the waiver participant has held the current job or self-employment position, and the effectiveness of job coaching services as demonstrated by fading achieved.

(4) Additionally, where an waiver participant has a need for job coaching that is equal to or less than one hour per week, a monthly "Stabilization and Monitoring" payment will be used to encourage ongoing, effective monitoring of the waiver participant's employment situations, with minimum monthly contact requirements that will allow for prevention of otherwise avoidable job losses or reductions in work hours.

(5) Quality Payment for Hours Worked Milestone under Supported Employment-Individual Employment Support: Payment earned and paid for additional/atypical effort of provider that results in a waiver participant working in competitive integrated employment achieving above average hours worked in a six-month period. There are two quality payment levels available:

(a) The base tier payment is $1,500 and is made based on the waiver participant working in competitive integrated employment between three-hundred ninety (390) and five-hundred nineteen (519) hours in the prior six (6) calendar month period. This is average hourly employment that is at least 15 but less than 20 hours/week.

(b) The top tier payment is $2,000 and is made based on the waiver participant working five-hundred and twenty (520) or more hours in the prior six (6) calendar month period. This is average hourly employment that is 20 hours/week or more.

(c) A provider may earn the quality payment up to twice a year.

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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