Day Services shall mean individualized services and supports that enable a person to acquire, retain, or improve skills in the area of self-care, sensory/motor development, socialization, daily living skills, communication, community living, employment, and social skills. Day Service therapeutic objectives and action steps are outlined in the Individual Support Plan (ISP)/plan of care during the person-centered planning process. With the exception of employment that is staff supported, Day Services shall be provided only on weekdays during the day between the hours of 7:30 a.m. and 6:00 p.m. as specified in the ISP/plan of care. Day Services may be provided to persons as a separate service where permitted under service specifications described in this waiver.
Community-based Day Services are designed to enable the person to become more independent, integrated, and productive in the community as well as assist the person to build relationships and natural supports. Community-based Day Services are designed such that the person spends the majority of his/her time, while participating in this service, actively engaged in activities in the community (i.e., not facility-based or in-home day services). Supervision, monitoring, training, education, demonstration, or support is provided to assist with the acquisition of skills in the following areas: leisure activities and community/public events, utilizing community resources (e.g. public transportation), acquiring and maintaining employment, educational activities, hobbies, unpaid work experiences (e.g. volunteer opportunities), and maintaining contact with family and friends.
Facility-based Day Services are provided in a licensed day habilitation facility. A facility-based provider may provide services in community locations such as community recreation centers or job sites on occasion.
Supported Employment Day Services are provided in accordance with the following requirements:
a. A job coach employed by the Day Services provider shall be on-site at the work location and shall supervise the person; or
b. The Day Services provider shall oversee the person’s supported employment services including on-site supervisors, and shall have a minimum of three contacts per week with the person including at least one contact per week at the work site, and shall have a job coach employed by the Day Services provider who is available on-call if needed to go to the work site.
In-home Day Services are provided in the person’s residence if there is a health, behavioral, or other medical reason or if the person has chosen retirement or is unable to participate in services outside the home: such as, community-based, facility-based, and supportive employment.
Transportation of the person to and from the person’s place of residence to the location where Day Services will be provided shall be the responsibility of the Day Services provider. With the exception of transportation to and from medical services covered through the Medicaid State Plan/TennCare Program, transportation that is needed during the time that the person is receiving
Day Services shall be the responsibility of the Day Services provider, and the cost of such transportation shall be considered to be included within the Day Services reimbursement rate.
Day Services shall not be provided in inpatient hospitals, nursing facilities, and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID).
Day Services are not intended to replace services available through the Medicaid State Plan/TennCare program. Services provided by natural supports are not reimbursable and are excluded.
Day Services shall not replace services available under a program funded by the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act. Day Services shall not be provided during the same time period that the person is receiving Personal Assistance Services, Respite Services, or services under a 504 Plan or Individual Education Program (IEP), is being homeschooled, or any combination thereof, or as a substitute for education services which are available pursuant to the Individual with Disabilities Education Act (IDEA), but which the person or his/her legal representative has elected to forego.
The reimbursement for Supported Employment Day Services shall not include incentive payments, subsidies, or unrelated vocational training expenses: such as,
a. Incentive payments made to an employer to encourage or subsidize the employer's participation in a supported employment program.
b. Payments that are passed through to users of supported employment programs.
c. Payments for vocational training that is not directly related to a person's supported employment program.
Day Services shall be limited to a maximum of 5 days per week up to a maximum of 243 days per person per year. Family members who provide Day Services are required to implement services as specified in the Individual Support Plan (ISP). Reimbursement to family members shall be limited to forty (40) hours per week per family member for self-directed services as well as those delivered by contracted provider agencies. The person’s Circle of Support is responsible for determining if the use of family members to deliver paid care is the best choice for the person supported and shall ensure that paid services do not supplant natural supports that would otherwise be provided at no cost to the Medicaid program.
Day Services shall be reimbursed in accordance with the requirements set forth herein.
The provider may receive the per diem reimbursement for Day Services if:
a. The person receives 6 hours of direct services comprised of any combination of Community-based, Facility-based, and or Supported Employment Day Services.
b. The person receives 6 hours of In-home Day Services. The reimbursement shall be the per diem rate for In-home Day Services.
c. The person receives at least 2 hours of Day Services and there is documentation that the person was unable to complete the full 6 hours of Day Services for reasons beyond the provider’s control (e.g., sickness of the person).
Reimbursement for a combination of different Day Services (e.g., community-based, facility-based, and or supported employment) provided on the same day shall be made in accordance with the following:
a. If the person receives up to or in excess of 6 hours of a combination of Community-based and Facility-based Day Services, the reimbursement shall be the per diem reimbursement rate for the type of service provided for the greatest amount of time that day.
b. If the person receives up to or in excess of 6 hours of a combination of Day services that includes Supported Employment, the reimbursement shall be the per diem reimbursement rate for Supported Employment Day Services.
Applicable limits, if any, on the amount, frequency, or duration of this service:
Day Services shall be limited to a maximum 5 days per week up to a maximum of 243 days per service recipient per year.