- 1915(c) Appendix K COVID-19 Addendum
- Appendix K- revised 5/2/20 per CMS 5/1/20 review
- Appendix K WebEx PowerPoint
- Appendix K - submitted 6/6/20 based on CMS review 6/6/20
- Appendix K - Emergency Preparedness & Response, COVID-19 Addendum (5/7/2020)
- Appendix K - Approval Letter (5/7/2020)
- Medical Equipment and Enabling Technology Memo (5/27/2020)
Temporary Rate Increase and COVID+ Special Needs Adjustments
DIDD and TennCare are providing additional detail regarding conditions of payment for temporary COVID-related payment flexibilities approved through Appendix K for the 1915c waivers.
The attachment below includes additional information regarding billing processes and further describes how attestations will be accomplished. Please review this information carefully. Note in particular that submission of claims and/or acceptance of payment for these COVID-related payment flexibilities constitutes the provider’s attestation that all applicable conditions of payment will be met.
All COVID-related payments are subject to audit and recoupment if it is determined that conditions of payment were not met.
We are working very quickly to begin processing these payments, and we are appreciative of the collaboration, insight and patience of the provider community. We are especially thankful for the way entire community mobilized during these unprecedented and challenging times to continue to provide high-quality services to the people we support.
- Provider Funding Relief and Conditions of Payment
- COVID+ Residential Special NeedsAdjustment and Personal Care Rate Differential Memo
Update 8/7/2020 - DIDD will begin entering approvals into Titan for the RSNA and PCRDs for people who are confirmed to be COVID19+ and who require dedicated staff. From there, Providers will bill via PCP and payment will be made through the typical process.
For the RSNA, providers may bill the $300 rate:
- When the person is confirmed Covid19+ and requires a dedicated staff 24/7
- If there is a 2nd person in the same home who is also Covid19+ and shares this same staff with person #1, the provider may not bill an additional RSNA for the 2nd person.
- If there is a 3rd person in the home who subsequently tests positive, and the provider brings in a 2nd dedicated staff person for person # 3, the provider can bill the $300 RSNA for that 2nd dedicated staff for 24/7.
This same methodology applies to the $200 rate when the provider is supporting a person who requires a dedicated staff for less than 24 hours/day.
For each person reported to be COVID19+, Regional Office staff will reach out to providers to determine if the person is eligible for the RSNA and for which rate.
For more information on the rate criteria, please refer to Appendix K located above.
As you are aware, the Centers for Disease Control and Prevention (CDC) is currently recommending social distancing to minimize risk of contracting the disease if COVID-19 is spreading in your community. This is especially important for people who are at higher risk from the disease, including persons age 60 and older and those with chronic health conditions.
This does not mean that persons supported should be restricted from all community activities. It does mean, however, that providers should help persons supported and their families or conservators, as applicable, understand the potential risk of exposure so they can make informed decisions about participation in community activities.
In the event that persons supported or their conservators decide to forego community-based activities in the short-term, DIDD and TennCare want to make sure that options are available to provide supports at home, where the risk of COVID-19 infection is reduced.
As you are aware, there is currently a special needs adjustment (i.e., an additional payment) that providers may be authorized to receive for persons supported who are receiving residential services when the person is not able to participate in community activities for certain reasons (Residential Special Needs Adjustment - Homebound). These reasons include “significantly health compromised,” which is defined as “a chronic health issue, supported by current medical records that restricts the person from leaving their home under certain pre-determined circumstances, including…exposure (geographically) to high incidences of communicable disease etc., that would further compromise the individual’s health and physical well-being.” While this provision would typically apply only to individuals with specifically diagnosed chronic diseases, based on the current COVID-19 pandemic and the State of Emergency declared by Governor Lee, we believe this provision can be reasonably applied to any individual supported in the waiver at this time. TennCare will follow up with CMS to pursue additional authority for this short-term use, if determined to be needed. Please note, this should not be confused with the Residential Special Needs Adjustment that has been in place for several years.
A comparable benefit, called Non-Residential Homebound Support Service, is available to persons in the same circumstances that do not receive residential services.
While both the Residential Special Needs Adjustment - Homebound and the Non-Residential Homebound Support Service typically cannot be billed until the homebound requirement is met—unable to participate in any employment or day service OR to leave the home except for medical treatment or medical appointments and for at no more than 2 hours a day for at least 5 days in the billing period, due to the chronic nature of the threat of exposure to COVID-19, effective Friday, March 13, 2020, the homebound definition shall be met on any day when a person does not participate in employment or community activities.
All other limitations pertaining to this benefit (and other employment and day services, as applicable) shall continue to apply.
In order to make these benefits available, DIDD will be adding the Residential Special Needs Adjustment—Homebound or Non-Residential Homebound Support Service, as applicable, to the cost plan of each person currently receiving any day service effective Friday, March 13, 2020, through December 31, 2020. For persons receiving residential services, Level 4 or Level 6 payment for the Residential Special Needs Adjustment – Homebound will be authorized only when this level of payment is also authorized for Community Participation. The level of reimbursement for Non-Residential Homebound Support Service shall be based on the level of payment currently authorized for Community Participation. The addition of the applicable Homebound service will be made by the Department and will not require submission of an amended ISP at this time.
Again, this is not a mandate by the department to discontinue all community participation; the expectation is, as always, providers should support persons to make informed decisions regarding their choice to participate in community activities.
Further Guidance on Homebound:
To follow up on the recent Open Line and guidance from our Central office, please do not send amended ISPs into the regional offices to add the temporary, COVID-19-related Homebound service. As stated, this service will be added, by DIDD, to all current cost plans with an approved Day service. The applicable Homebound service will be effective March 13, 2020, through December 31, 2020.
Please note that we will be matching the applicable Homebound service to the provider of residential services or, for those persons who do not have a residential provider, we will assign the applicable Homebound service to his/her current Day service provider. For any exceptional circumstances (ex – person will be getting Homebound from PA provider rather than Day provider,), please email the regional administrative services office directly and we will do our best to get the cost plans adjusted accordingly.
Please be aware that, in order to bill for the homebound services, 6 hours of service must be provided.
Homebound Update (8/13/2020):
Based on the continuing public health emergency caused by COVID-19, DIDD and TennCare are extending the availability of Homebound Services through December 31, 2020. DIDD has used the past two months to gather feedback from persons supported and families, providers, and advocates. While many persons and/or families have indicated a strong desire to safely return to community participation and/or employment, there are still a large number who desire to remain at home during this ongoing pandemic. In an effort to honor those choices and balance the health and safety of the people supported, we believe it is necessary to make available Homebound Services through the end of the year. While Homebound and other Day Services cannot be used on the same day, this does not preclude the use or availability of other employment and day services when people desire to safely engage in their communities. As a reminder, DIDD has issued guidance as well as a risk-benefit tool that can help guide people, families, and support teams in making those decisions.
The Department of Intellectual and Developmental Disabilities (DIDD) would like to provide the following guidance to help support providers in the successful reinitiating of Community Participation Services and the reopening of Day Service Centers if a closure has occurred. This guidance document and recommendations apply to services and providers across the HCBS Waiver service system to include both the 1915(c) and 1115(a) programs. Additionally, this information is designed to support individuals and families as they continue to contemplate their individual Day Service choices.
While DIDD has not mandated closure or suspension of any services offered through the DIDD Waiver programs and continues to value and support the requirements set forth by the HCBS Settings Rules, it is important to recognize that state and local authorities have issued guidance related to the pandemic. As Stay-at-Home orders have been lifted across the state, businesses have begun reopening in phases and concurrent with their local conditions. This observation of local conditions, combined with informed decision-making related to individual preferences and health, should continue to drive service decisions for both our provider network as well as those receiving services. Employment and Day Service providers are strongly encouraged to develop and share their specific plans and procedures with their staff, persons supported, and families.
The guidance document is below "Reopening Responsibly - Day Services".
DIDD is providing the following guidance to Independent Support Coordinators (ISC) and Self-Determination Case Managers in regard to face-to-face visit requirements and Circle of Support Meetings.
DIDD is permitting ISCs and SD Case Managers to conduct visits and Circle of Support Meetings remotely; using phone or video conferencing solutions. When either of these responsibilities are completed in place of a required face-to-face meeting, the ISC or SD Case Manager should document the occurrence in a corresponding service note.
For Individual Support Coordinator and SD Case Manager meetings that require signature sheets, ISCs and CMs should write down people’s names (the name of everyone who participates in the meeting) on the signature sheet. The ISC/CM should sign and date the form and identify somewhere on the signature sheet the phone call was held in lieu of a face-to-face meeting due to COVID 19 precautions.
Independent Support Coordinators (ISC’s)/Case Managers (CM’s) can get verbal consent of the person/conservator, they must document thoroughly. ISC’s/CM’s need to document the full name of the person who gave consent verbally, date, time, and ensure that they cover what each consent means. ISC’s/CM’s need to document that the consents are being processed in this manner due to COVID-19.
Update: We have received feedback that ISCs and other stakeholders are having difficulty reaching people in their homes via phone currently. Please make sure staff know that phone conversations and FaceTime conversations are extremely important at this time. As we continue to practice social distancing, digital communication is often the only contact people are having outside of their staff and roommates. ISCs and Case Managers are still required to conduct their visits through phone or Facetime to ensure the wellbeing of persons supported. If the person is unavailable for a phone conversation at the time, please have staff make every effort to return calls as soon as possible.
DIDD has implemented a no visitors policy at the state-run community homes (ICF/IIDs) and is requiring an inobtrusive temperature check of employees before entering the home. Further guidance from TennCare and CMS related to Long Term Care Facilities is below.
Families should be encouraged to utilize electronic means of visitation. Meetings and other appointments that are typically done face-to-face should be done using an electronic means of communication.
At this time, investigators will be permitted to conduct direct witness interviews via FaceTime. If an investigator or witness requests a FaceTime interview, the investigator shall provide them this opportunity. As always, it is better to get the details timely so if a witness states that they do not have that capability to conduct a FaceTime interview, note this on the statement form and continue a telephonic interview. As already required, a witness will be asked to review and verify the information provided.
We have also revised in-person response guidance to investigators of abuse, neglect and exploitation to limit exposure to people supported without compromising quality of investigations.
All urgent situations, including adhering to PFH timeframes, should still be communicated to DIDD through the proper channels. DIDD reserves the right to appear in-person for case management, Protection from Harm visit or any other operational procedure if necessary.
Various operational changes and guidance issued by DIDD over the state of emergency will remain in effect for the time being and be available for use during the period of time that the department operates under the Appendix K as submitted to CMS. While the Department has not accessed all available measures provided in the document we will continue to assess program and network needs in this changing environment and, when warranted, will determine the appropriate policy response.
- Homebound services are currently approved through June 30, 2020. As DIDD continues to survey the impacts of the COVID-19 crisis we plan to communicate with our network on any future plans for extending this service.
- Staffing Ratio Relaxation
- Enabling Technology Utilization via Appendix K, but Enabling Technology will be added as an ongoing waiver service
- Suspension of Provider Contacts and Meetings
- Suspension of Provider Support Visits
- Suspension of Family Support Programmatic Reviews
Provider Contacts and Meetings
As a response to our continued efforts to minimize community spread in accordance with CDC guidance, DIDD will allow providers to complete home visits by phone or FaceTime until further notice. Supervisory contacts should be made with their staff on the regular schedule (3 times/month for SL and 2 times/month for FMRS) to go over applicable items on the supervisory checklist. Documentation should reflect responses on the form.
In regards to required meetings as dictated by the provider manual (i.e. IMC or Human Rights meetings), these meetings may be conducted either telephonically or through electronic means.
Housing Inspections and Transitions
DIDD’s Program Operations Division has made the determination to resume the 30-month housing inspections. This process will involve a phased re-entry to begin effective 9/14/2020 and includes housing inspection for supported living and semi-independent living homes.
In an attempt to reduce any chances of cross-contamination between agencies, Home Inspectors will plan to inspect one agency per day, where possible.
Additionally, with the permission of the person supported and when possible, the housing inspectors will plan to inspect homes when people supported are away from the home participating in Community Based Day activities. However, the provider agency must ensure someone is available to meet the inspector at the home so they are able to gain access to the home.
You may continue to email the DIDD Inspections mailbox (DIDD.INSPECTIONS@tn.gov) with initial inspection requests as well as any other housing inspections needs. Be sure to copy the appropriate housing inspector on your requests and questions during this time. Contact information is as follows:
Crissonya Phillips, Statewide Director of Residential Services Crissonya.Phillips@tn.gov
Ronnie Taylor, DIDD Housing Inspector, East TN Ronnie.R.Tarlor@tn.gov
Karla Hall, DIDD Housing Inspector, Middle TN Karla.F.Hall@tn.gov
Sandra Clamp, DIDD Housing Inspector, West TN Sandra.Clamp@tn.gov
CPR/1st Aid Certifications
CPR and 1st Aid expirations will be linked to Appendix K. Information regarding Appendix K can be found in the "Appendix K" section above. Information regarding the duration of Appendix K can be found in the Appendix K WebEx PowerPoint on the slide Tennessee’s Appendix K -duration. Once the effective date of Appendix K ends, DIDD will allow up to 90 days to renew CPR and 1st Aid certifications.
It should be noted that these are temporary flexibilities to address COVID-19 related needs. As the risk of exposure and spread of COVID-19 are reduced, and as providers are able to safely resume provision of services as described in the currently approved waiver applications, these flexibilities will be discontinued.
Additionally, DIDD has been provided the following information on the Training Entities:
American Red Cross
- ARC web site indicates classroom courses are currently available. Class sizes are limited to no more than 6 individuals.
- Trainers who call ARC and talk to the Instructor Support team will be trained on the current ARC guidelines during the COVID-19 outbreak and, will then be allowed to resume training.
American Heart Association
- AHA has reported an extension on expirations.
- AHA web site indicates classroom courses are currently available.
ASHI and Medic Frist Aid (HIS)
- ASHI has reported an extension on expirations.
- The web site indicates training locations with contact information, however no current class dates available.
Please contact Karen Chambers for questions or assistance with 1st Aid and CPR. Karen.Chambers@tn.gov
All of the various operational changes and guidance DIDD has issued over the state of emergency will remain in effect for the time being and be available for use during the period of time that the department operates under the Appendix K as submitted to CMS.
- Suspension of On-site QA Surveys
- Suspension of On-site FAR Reviews
- Suspension of On-site ECF Surveys
Regarding ICF/IID surveys, all suspension information has been provided to state-operated and private ICF/IID providers via the CMS memo system which can be accessed at the following links:
QA Surveys Update (7/21/2020)
Due to the pandemic, QA surveys cannot be completed using the same procedures as in previous years. In an effort to keep persons supported, agency staff, and QA personnel safe, QA surveyors will be completing an initial desk review of a limited number of records, with plans to complete additional tasks and visit people supported later this year, if conditions allow. For additional information, please see the guidance below.
Seating and Positioning Clinics:
The Seating and Positioning Clinics began a phased re-opening on July 1, 2020, with limited clinic appointments. Please see the letter below being sent out once an appointment is scheduled regarding what to expect when visiting one of our clinics. This information applies to all visitors to the clinic, including DIDD employees. We appreciate everyone's cooperation as we work to provide a safe and healthy environment and experience for those using our services.
Community Providers of Clinical Services
Tennessee has begun a phased re-opening of community settings. In order to begin a phased approach to resuming face-to-face services that were recommended to be provided via telehealth, community providers of clinical service need to ensure that they have up to date policies addressing COVID-19 precautions in accordance with guidance issued by the CDC and guidance issued by the Tennessee Department of Health.
Community providers of clinical services should continue to utilize telehealth to conduct services whenever possible*. Until further notice, telehealth services will be billable under the 1915(c) waivers as outlined in Appendix K**.
An exception to the recommendation to utilize telehealth services may occur if all persons in the home and the clinical service provider staff conducting the visit are free of COVID-19 symptoms or recent exposure (see Script for Pre-visit Health Questions below) and any of the following apply:
- Telehealth services are not possible or not appropriate for the service being provided for the person supported and the person or their legal representative agrees to resume face-to-face services.
- Telehealth services alone are not sufficient to provide the level of service needed for the person supported and the person or their legal representative agrees to resume face-to-face services.
- A situation involves an imminent risk that cannot be managed without a face-to-face visit. Imminent risk is one that outweighs the risk of a COVID-19 infection to the person supported or the staff.
If a face to face visit is made, it is recommended that community providers of clinical service follow current CDC guidance regarding COVID-19 prior to, throughout, and following the visit. This includes, but is not limited to the following:
- Wash your hands often with soap and water for at least 20 seconds especially after being in a public place, blowing your nose, coughing, or sneezing.
- Use hand sanitizer containing at least 60% alcohol when soap and water are not readily available.
- Avoid touching your eyes, nose, and mouth with unwashed hands.
- Avoid close contact with people, staying at least 6 feet apart.
- Cover your mouth and nose with a cloth face cover when around others. This includes wearing a cloth face cover throughout the face-to-face visit.
- Cover coughs and sneezes. Throw used tissues in the trash and immediately wash your hands or use hand sanitizer if soap and water aren’t available.
- Clean and disinfect frequently touched surfaces daily. Use detergent or soap and water prior to disinfection and use an EPA-registered household disinfectant.
- Monitor your health. Be alert for symptoms of COVID-19. If symptoms are present, leave the face-to-face visit immediately and follow CDC guidance.
For full CDC guidance and to stay abreast of any changes to the guidance, please visit: https://www.cdc.gov/coronavirus/2019-ncov/index.html
- Avoid bringing unnecessary items into the setting where the face-to-face visit is conducted that are not essential. Ensure that any items brought into the home that are essential for service are cleaned and disinfected prior to and following the face-to-face visit.
- Clinical Service Providers should also comply with policies pertaining to face-to-face visits during COVID-19 put in place by community providers of residential and day services.
- CDC guidance regarding the appropriate use of personal protective equipment (beyond cloth face coverings) can be found at https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control.html
* Community providers of residential and day services should ensure persons supported by their agency have access to means to receive telehealth services as recommended by clinical service providers and determined medically necessary for the person. For assistance, providers may contact the DIDD Enabling Technology Champion in their region.
** The clinician is responsible for staying aware of current licensure laws and regulations pertaining to telehealth for their discipline.
To determine if persons are free of symptoms or have had recent exposure, ask questions according to the script entitled Clinical Appointment Health Questions
Most of the licenses expiring at the end of March and April have already received a licensure survey to complete the renewal process. For licenses which have not received a licensure survey, the current license will be placed in “Extended Status” until such time as surveys can be completed. An extension letter will be emailed to each licensee when a license is placed in “Extended Status”.
Risk Management visits to provider agencies have also been suspended, though auditors are available to make visits for any urgent situations which may arise.
Update: All of the various operational changes and guidance DIDD has issued over the state of emergency will remain in effect for the time being and be available for use during the period of time that the department operates under the Appendix K as submitted to CMS.
- Suspension of Licensure Visits unless urgent - "Urgent" could include new construction licenses or alligation of licensure violations. Additionally, virtual licensure visits are being conducted in select non-residential settings.
- Suspension of Risk Management Visits unless urgent
Providers and service coordinators will be in close communication with families to discuss upcoming visits and to make sure services are provided in a safe environment. Below are links provided by the U.S. Department of Education to guide decisions in the days and weeks ahead. You will find guidance on providing services whether at home or in a clinical setting.
- Direct link to guidance for serving children with disabilities (Section B of the document relates specifically to Part C): Questions and Answers on Providing Services to Children with Disabilities During the COVID-19 Outbreak (March 12, 2020)
- Previously issued guidance documents including questions and answers applicable to school closings and distance learning (includes Part C ) Non-Regulatory Guidance on Flexibility and Waivers for Grantees and Program Participants Impacted by Federally Declared Disasters
- The Department’s COVID-19 webpage, which includes information and a number of additional resources: https://www.ed.gov/coronavirus
There is nothing more important than the well-being of our TEIS employees, providers and families. We will continue to monitor this situation closely with help from the U.S. Centers for Disease Control (CDC), Tennessee Department of Health, as well as other agencies. As the situation evolves, we may revisit these policies.
Please reach out Joan Kennedy at firstname.lastname@example.org if you have any further questions or concerns.
DIDD has received revised guidance from TEMA about provider acquisition of PPE. In coordination with TEMA, DIDD will collect provider PPE requests and submit them for consideration.
It’s important you understand that these supplies are very limited and in extremely high demand. Therefore, DIDD will consolidate the requests from providers, but cannot guarantee any fulfillment of orders. Additionally, DIDD will not be coordinating delivery of requests. All fulfillment of these requests will be at the discretion of Emergency Management Supply Chain priorities. By submitting a request, you are being placed into a queue with all other competing priorities within the state at this time. This by no means guarantees that you will be a recipient or can we promise a projection of when you will receive those supplies.
Please be mindful and responsible in making these requests as supplies are extremely limited. The form to request these supplies can be found here: https://stateoftennessee.formstack.com/forms/supply_request
We do want to make people aware that those who have requested items through the department will receive a receipt confirmation from the TEMA Logistics Unit once DIDD has submitted the request to them. This confirmation is connected to your original DIDD request.
Please note: this receipt is not a guarantee that the request will be fulfilled, just that it has been submitted and placed in line with all other statewide PPE requests. The Emergency Supply Chain Management is still processing requests based on prioritization as determined by regulatory authorities.
The Tennessee Department of Health has issued the following guidance on exposure, healthcare facilities and group settings:
What to Expect of You Were Possibly Exposed to COVID-19
How do I know if I was exposed?
You generally need to be in close contact with a sick person to get infected. Close contact includes:
- Living in the same household as a sick person with COVID-19
- Caring for a sick person with COVID-19
- Being within 6 feet of a sick person with COVID-19 for about 10 minutes or longer
- Being in direct contact with secretions from a sick person with COVID-19 (e.g., being coughed on, kissing, sharing utensils, etc.)
What to Expect After Being Tested for COVID-19 (see attached CaseGuidance.pdf)
- While waiting for results, you should strictly isolate yourself at home.
- Stay in a specific room and away from other people in your home to the extent possible. Use a separate bathroom, if available. Household members can consider staying in a separate location, if available, to decrease their risk of exposure.
- Where possible, ask others such as friends or family, to get food or necessities for you.
- If you must leave home, such as to seek medical care, wear a surgical mask if available.
Guidance for Healthcare Providers Diagnosed with COVID-19
Communicate with your Employer
- Immediately notify all of your employers if you are having symptoms and/or if you are being tested for COVID-19.
- Identify any times that you were at work during the 2 days before you began feeling ill and any days you worked while ill.
- You should strictly isolate yourself at home for at least 7 days after you became ill or until you are feeling well and without a fever (without fever reducing medication) for three consecutive days (whichever is longer).
- If you are asymptomatic, you should self-isolate and not work until for at least 7 days after testing was conducted.
- Stay in a specific room and away from other people in your home to the extent possible. Where possible, ask others such as friends or family, to get food or necessities for you.
Guidance for Healthcare Facilities with a HCP Diagnosed with COVID-19
- Determine all the days the employee worked on or after symptom onset.
- If the employee did not report any symptoms, determine all the days they worked on/after date of COVID-19 testing.
- Identify any patients and other employees who had close contact with the employee. Close contact is defined as spending more than a few minutes within 6 feet of the employee with confirmed COVID-19.
- Patients who have been discharged should be notified and instructed to quarantine for 14 days after their exposure.
- Patients who remain hospitalized should be isolated and placed on Standard, Contact, and Droplet Precautions with Eye Protection for 14 days after their last exposure.
- Consider work exclusion of asymptomatic employees determined to be close contacts of a known COVID-19 case. If this is not possible, the employees who continue to work should wear surgical masks for their entire shift for 14 days after the exposure and should undergo daily symptom and temperature monitoring while continuing to work.
- Employees who become symptomatic during monitoring should be excluded from work.
Guidance for Group Care Settings (see attached GroupCareGuidelines.pdf)
- Prevent the introduction of respiratory germs INTO your facility
- Prevent the spread of respiratory germs WITHIN your facility
- Prevent the spread of respiratory germs AMONG facilities
Case Counts by Region or County
We have previously provided guidance about adjusting community engagement based on how COVID-19 is spreading with the community. This resource can help agencies make decisions based on data within their county or region.
As you are all aware, the rapid spread of COVID-19 throughout the nation and our communities is presenting new staffing and support challenges for HCBS service providers across Tennessee. Through opportunities presented in the recent waiver language changes, as outlined in Memo 212 and Guidance Pertaining to Relaxed Staffing Requirements in Response to COVID-19 that expanded flexibility regarding staffing standards for the time-limited period where there is a declared Federal or State emergency, the Department of Intellectual and Developmental Disabilities and TennCare are working in collaboration to immediately expand access to Enabling Technology through its Appendix K proposal.
Update: The Enabling Technology team reports significant interest from the provider and ISC networks in pursuing Enabling Technology options for people. Thirty-five referrals have been received over the last 8 business days. Additional meetings have been held, in some cases to formulate comprehensive Enabling Technology plans.
DIDD wants to express its support and encouragement to those of you who recognize the importance of this step. Please remember that DIDD and each region's Plans Review Unit are exercising maximum flexibility in reviewing and approving Enabling Technology plans. Most importantly, no person is at risk of losing their selected Enabling Technology as a waiver service as DIDD and TennCare are committed to adding it to all three 1915c waivers for longterm funding and utilization past the state of emergency.
Guidance and Utilization Steps
DIDD Vendor Resources
DIDD COVID-19 Testing Numbers
Testing as of December 2, 2020
|# of COVID Tests Reported||7350|
|# of Positive COVID Results||805|
Data collected through 8/21/2020
|Rate of Infection
Proportion of the overall population that has tested positive for COVID-19
|2.10%(140,844/6.77 million)||2.51% (62/12,500)|
Proportion of those tested who are positive for COVID-19
|7.12% (140,844/1.98 million)||7.10% (62/3179)|
|Symptom/Exposure-Based Confirmation Rate
Proportion of persons tested based on the presence of symptoms or exposure to persons testing positive who are positive for COVID-19
|Mass Testing Confirmation Rate
Proportion of those who were tested in mass testing who tested positive
Proportion of the total population who have been tested
|29.22% (1.98 million/6.77 million)||35.39% (4424/12,500)|
Death rate among those testing positive for COVID-19
|1.10% (1549/140,844)||4.45% (14/314)|
|Overall Death Rate
Proportion of the overall population who have died from symptoms caused by COVID-19
|2.86 per 12,500 (1549/6.77 million)||14 per 12,500 (14/12,500)|
Update (12/2/2020): Enhanced Reporting Process for Positive COVID Questionnaires
Providers will have the option to complete the Covid Questionnaire in lieu of calling the Investigation Hotline.
DIDD is offering Providers the opportunity to complete the Covid Questionnaire Form and send it into the Investigations production box for their respective region. By submitting the completed Covid Questionnaire, the Provider will no longer be required to call the Investigations Hotline.
The questionnaire is below.
Questionnaires shall be submitted to the following production boxes that are managed by the Investigations Units:
[All reports need to be submitted as soon as possible during business hours in order for contact tracing to begin.]
This is not the account for the submission of REFs by providers. Providers will continue to submit all REFs to DIDD.Incidentmgmt@tn.gov.
This would reduce the time spent by the Provider waiting on a return call as a result of the volume of calls into the Hotline and time spent on the phone with an investigator.
The provider would have an opportunity to collect all the needed information for the questionnaire prior to reporting and eliminate the need for follow-up calls for reporting.
Allow flexibility in filing the Questionnaire by collecting all the necessary data before reporting, reporting available 24 hours a day and not dependent upon business hours or Investigator availability.
Update (8/21/2020): Effective Immediately, COVID-19 Reporting Update
In an effort to help alleviate Provider burden during the pandemic, Providers will now only have to submit COVID-19 REFs for test results (positive and negative) for persons' supported. This means that Providers will NO LONGER submit pending COVID-19 Test REFs. Please remember to continue to include all information regarding what led to the person supported being tested.
Additionally, any updates related to COVID-19 positive persons supported, such as retesting, hospitalizations, trips to the ER/Urgent Care, and death, must continue to be reported via REF.
Please remember, REFs are not submitted for positive staff. Providers are to continue following the protocol for reporting positive persons supported and staff to the DIDD Investigations Hotline (888-633-1313).
Effective March 18th, 2020, DIDD is tracking all COVID-19 testing for persons supported. Reporting requirements shall include the reporting of COVID-19 testing for any person supported. The Reportable Event Form (REF) is required to be completed as soon as possible, but no later than by the following business day. The provider completing the REF shall select “Other Type of Event” and specify “COVID-19 Testing” in the space provided. Details of the person’s status and test results would be expressed in the narrative section. “COVID-19” needs to be included in the subject line of the REF email.
All positive test results shall be reported to the Abuse Hotline (1-888-633-1313) as soon as possible but no later than 4 hours of discovery.
DIDD is utilizing this hotline because of its availability to receive and respond to calls 24 hours a day. DIDD will not be classifying positive cases of COVID-19 as abuse or neglect, rather this is an effort for providers to have a channel to report any positive cases to the department immediately.
When positive COVID-19 tests are reported to the Department through the 24-hour on-call hotline, we are requesting that names and last four digits of social security numbers for staff that have been exposed to the infected person be provided. The Department will use this information to cross-reference the staff member in the Relias training system to see if there are any other provider agencies the person may work for. Once DIDD has gathered this information a call will be made to any provider agencies the person may work for other than the provider agency that reported the positive test. If you are contacted regarding a staff person who may have been exposed to COVID-19 at another provider agency, please follow the processes in place for your agency.
For Persons Supported:
A person supported whose test results come back negative:
- A REF should be submitted through the normal reporting process with COVID-19 listed in the subject line of the email.
A person supported whose test results come back positive
- The investigations hotline must be contacted as soon as possible, but within 4 hours, of the positive results being reported to the provider.
- A REF or an amended REF must be submitted through the normal reporting process with COVID-19 listed in the subject line of the email.
DIDD will not require a REF for staff who test positive, just the report to the on-call hotline as described below.
Staff person who has been tested and results are pending:
- No action is required
Staff person whose test results come back negative:
- No action is required
Staff Person whose test results come back positive:
- The investigations hotline must be contacted as soon as possible, but within 4 hours, of the positive results being reported to the provider.
If there is any confusion over the reporting requirements, please contact Vicki.Loveday@tn.gov or call 615-532-5974. If there is any doubt over whether or not to report, please report. These reporting requirements are the mechanism being utilized by the department to inform provider agencies when staff and persons supported may have been exposed to a person who has tested positive for COVID-19.
- Data Collection for Positive COVID Reports to the Hotline
- COVID Reporting Guidelines for Persons Supported and Staff (coming soon)
Testing for Persons Supported
- COVID Testing Letter 5.12.2020
- West HIPAA Compliant Patient Authorization
- Middle HIPAA Compliant Patient Authorization
- East HIPAA Compliant Patient Authorization
DIDD has heard that there are many who are uncomfortable with the “deep nasal” swab that is commonly used to perform COVID-19 tests. Having heard those concerns, the department is pleased to announce that it will be using a different type of COVID nasal swab test. For all further DIDD-sponsored testing, our lab has supplied us with a test called Aptima Nasal Collection, which is an anterior nasal swab that is less invasive than nasopharyngeal method that is commonly used. With the Aptima Nasal Collection, the swab is only inserted approximately a half-inch into the front part of the nose versus the two inches used for the nasopharyngeal collection method. You can view an animation of the test at this link under the “Testing and Results Guidance” tab.
DIDD hopes this new collection method will help ease fears about the test. We are strongly encouraging everyone who receives services to get a test so we can better understand how the virus is impacting the Tennessee IDD community and help contain the spread.
DIDD has recommended guidance on testing provider staff for COVID-19. Please see the attached guidance, the Everlywell Standard Operating Procedure, and DOH guidance specific to DIDD residential homes.
This staff testing guidance applies to all IDD services, including those in the 1915c waivers, ECF CHOICES and private ICF/IIDs.
New Testing Recommendation for Intermediate Care Facilities
COVID-19 continues to spread at a high rate within the IDD community. Much of this spread has occurred in Intermediate Care Facilities (ICF). For this reason, the Department of Health is now recommending that ICFs test their staff weekly rather than monthly as previously recommended. DIDD will submit a list of the ICFs to the Department of Health so that they can be authorized for weekly testing. All other providers will continue with monthly testing as planned.
Updates on Testing Options
As staff testing ramps up in IDD systems, there are some additional pieces of information that may help providers.
- Those who may not have been able to make the Everlywell webinar on Wednesday may receive the training by reviewing the presentation found at this link.
- You may also learn more about Everylywell testing by visiting their FAQ page.
- IDD agencies are also eligible to order P23 self-test kits which do not require training prior to ordering.
- The Everylywell training describes the swab used in their test kits as a “short nasal swab.”
Questions may be directed to DIDD.Covid19@tn.gov.
Medication Administration Classes
Medication Administration expiration dates have been extended until December 31st, 2020. Classes and/or test outs conducted by the Regional Office are being scheduled. Agencies are encouraged to get their staff recertified as soon as possible to avoid being unable to find a class prior to the end of the extension.
Agency and Independent Trainers are encouraged to follow the CDC, State, and Local Health Department guidelines when conducting in-person Medication Administration Classes and in-person Test-Outs. Web-based classes with in-person testing are encouraged to limit potential exposure.
Remote Medication Administration
Due to the state of emergency caused by the COVID-19 pandemic, DIDD has cancelled in-person Medication Administration classes to reduce the risk of exposure and spread of the virus. However, these cancellations are creating a shortage of direct support professionals who are certified to administer medications. Therefore, in an effort to maintain the continuity of care while reducing contact between staff members and persons served during the current state of emergency due to the COVID-19 pandemic, DIDD will allow staff who are currently certified under the Medication Administration for Unlicensed Personal program to direct unlicensed staff who have not yet been certified through the program to administer medications via a live remote connection. The certified staff directing the uncertified staff will retain responsibility for the administration of the medications.
- Staff not certified in Medication Administration will be required to take an online course in Relias and confirm that they have reviewed the PowerPoint presentation and watched the videos on medication administration. The test completion will not certify the staff member to independently administer medications but will simply acknowledge the individual reviewed the required documents and video.
- The certified staff must be able to connect via a video and voice connection, i.e. FaceTime or a similar app, to the uncertified staff located with the person supported and maintain the connection until the administration is complete.
- The certified staff must be able to direct the uncertified staff to perform all the steps required to administer medications.
- The certified staff must be able to perform the 3 checks prior to administration.
- The certified staff must be able to verify the correct dose of the medication is being administered such as volume of liquid or number of pills prior to administration.
- The certified staff must be able to verify that the medication supply is secured after administration.
- The certified staff must be able to verify that the uncertified staff has documented correctly on the MAR and include the name of the certified staff that directed the administration of the medication.
- The certified staff must maintain separate documentation of the encounter to include a statement that administration of medications was completed with assistance of (name of the uncertified staff member).
- The certified staff will retain responsibility for the administration of medications as if they had administered the medications in-person.
- If, at any time during administration, the certified staff feels that the uncertified staff cannot safely administer medications in this manner, they are to instruct the uncertified staff not to administer the medications and find another means to have the medications administered.
- Controlled substance counts will be completed according to agency policy and may include the remote certified staff as needed.
- Certified staff may direct uncertified staff to transcribe a new order on the MAR if needed.
- Certified staff working in one home may direct uncertified staff in another home if the certified staff can still fulfill their obligations while doing so.
Upon the request of DIDD, and in order to ensure there are sufficient staff members to care for persons supported, the Governor’s Office has granted the authority to suspend until after the state of emergency is over the criminal background check requirement in T.C.A. 33-2-1201 and 33-2-1202. What this means for providers is that, during the ongoing state of emergency, you do not need to have a criminal background check performed before hiring employees or volunteers who will be in a position that involves providing direct contact with or direct responsibility for persons supported as outlined in TCA 33-2-1202. This suspension is only for the criminal background check report not reference or registry checks. The registries that must be checked are:
Tennessee Department of Health Elderly and Vulnerable Abuse Registry - Copies of the printed page that contains the name of the person and the term “Search Results” are accepted for this registry.
Tennessee Sexual Offender Registry – For this registry, the screen should be printed with the name of the person being checked before submitting the name. Then after the name is submitted, the “No Records Returned” page with the signature of the provider’s human resource staff (or other appropriately designated person) and the date of the check should be stapled to the printed name screen.
Tennessee Felony Offender List (FOIL) - Copies of the printed page that contains the name of the person and the term “Search Results” are accepted for this registry.
Link - https://apps.tn.gov/foil/
Office of Inspector General List of Excluded Individuals and Entities (LEIE) – Copies of the printed page that contains the name of the person and the term “Search Results” are accepted for this registry.
Important - Most registries include the date that the search was run; however, for some, this date is at the bottom of the search page and if the printer used is not adjusted correctly, the date can be omitted. If there is no date of search, a designated agency staff must sign and date the search page. This is accepted by DIDD.
All of the above registry checks can be completed by the agency at no charge to the agency since they are all available as online databases. Under law anyone on the Tennessee Abuse Registry or the LEIE is prohibited from working for a provider agency. However, during this time DIDD is also restricting any person on the Tennessee Felony Registry or Tennessee Sexual Offender Registry from working at a provider agency, as without a background check report, the Department has no knowledge of what conviction led to the placement.
The suspension of this requirement will remain active through the life of Appendix K. If you have already submitted a request to the department through the Exemption Process that request will now be considered withdrawn based upon this new information. Once the state of emergency has expired, providers will have 90 days to submit criminal background checks to the TBI or private investigation company to conduct a criminal background check for all persons hired under this suspension. Any criminal background checks that come back with a potentially prohibited conviction should be submitted through the DIDD exemption process. If you have any questions, please submit them through the COVID-19 mailbox and they will be answered promptly.
Governor Lee has extended the state of emergency and issued Executive Order 63, which extended certain targeted provisions of previous Executive Orders. Listed below are the provisions in previous Executive Orders applicable to DIDD providers that were not extended:
- EO15 ¶36 Provides that Tenn. Comp. R. & Regs. 0465-01-03.04(4)(a) and (b) are suspended to the extent necessary to grant DIDD discretion to extend the medication administration certification of unlicensed personnel when necessary to provide for continuity of care.
- EO32 [amending EO15] ¶36.1 Suspends provisions of TCA, Title 33, Chapter 2, Part 12 and related rules in order to give the Commissioner of DIDD the discretion to suspend any requirement for the hiring or retention of an employee or the participation of a volunteer whose function would include direct contact with or direct responsibility for persons supported by DIDD, if necessary to address staffing shortages resulting from the impact of COVID-19 to ensure continuity of care for persons supported by DIDD. Any such suspended requirements must be completed within ninety (90) days after the termination of Paragraph 36.1.
What does the expiration of these provisions mean to you as a provider? It means that any waiver of the cited rule or regulation granted will no longer be in effect as of midnight on September 30, 2020. DIDD has previously issued guidance that all medication administration certificates have been extended to June 30, 2021. The expiration of this provision of the Executive Order will not change that date, what it means is that the June 30, 2021 date cannot be extended. The expiration of the suspension of 33-2-1202 means that providers will need to begin to submit employee background checks to either the TBI or a private investigation company. The provision allows for a 90 day period after the termination of the Executive Order provision, this means that for all employees who have not had a background check upon hire, as a result of the Executive Order suspension of the requirement, the provider must submit the information for a background check to be conducted by either the TBI or a private investigation company within 90 days. Please note this does not mean that you must have a completed background checks within 90 days just that they requests must be submitted. Also, please note that if there are potentially prohibited convictions on any background check reports and exemption request must be submitted to the appropriate regional office per DIDD’s exemption request policy.
If you have any questions or need additional clarification please contact Theresa Sloan at Theresa.C.Sloan@tn.gov
- DIDD’s Clinical Services Team continues to provide resources to assist persons supported, DIDD providers and other stakeholders in better understanding COVID-19 and its impact on the population we support.
Articles Written by Deputy Commissioner Bruce Davis about COVID-19
- Don’t Go Viral
- We’re All a Part of this Community
- Telehealth Now
- COVID-19 Response Plan
- COVID-19 Response Plan Update
- Mental Health Considerations COVID-19
- Testing the Waters
All Open Lines and Special Editions since March 13, 2020 (by date)
- March 13, 2020 - Open Line
- March 16, 2020 - Special Edition Open Line
- March 18, 2020 - Special Edition Open Line
- March 19, 2020 - Special Edition Open Line
- March 20, 2020 - Open Line
- March 27, 2020 - Open Line
- March 30, 2020 - Special Edition Open Line
- April 2, 2020 - Special Edition Open Line
- April 3, 2020 - Open Line
- April 6, 2020 - Special Edition Open Line
- April 7, 2020 - Special Edition Open Line
- April 9, 2020 - Open Line
- April 14, 2020 - Special Edition Open Line
- April 17, 2020 - Open Line
- April 22, 2020 - Special Edition Open Line
- April 24, 2020 - Open Line
- April 30, 2020 - Special Edition Open Line
- May 1, 2020 - Open Line
- May 7, 2020 - Special Edition Open Line
- May 8, 2020 - Open Line
- May 12, 2020 - Special Edition Open Line
- May 15, 2020 - Open Line
- May 18, 2020 - Special Edition Open Line
- May 22, 2020 - Open Line
- May 29, 2020 - Open Line
- June 5, 2020 - Open Line
- June 12, 2020 - Open Line
- June 17, 2020 - Special Edition Open Line
- June 19, 2020 - Open Line
- June 24, 2020 - Special Edition Open Line
- June 26, 2020 - Open Line
- July 2, 2020 - Open Line
- Additional editions of Open Line can be found at tndidd.tumblr.com
Commissioner Turner's Office Hours
- Watch Commissioner Turner's Office Hours
- COVID-19 Crisis and Community Provider Response Efforts - May 21, 2020
A summary of all guidance issued thus far from CMS can be found here:
DIDD COVID-19 INQUIRIES
DIDD has established an inbox for community and provider inquiries about COVID-19 at DIDD.Covid19@tn.gov. We will work to answer all questions in the inbox as quickly as possible.