COVID-19

Vaccine Resources

COVID-19 mRNA Vaccine Dosing Allowances for Certain Immunocompromised Individuals

TDH COVID-19 Vaccine Update Memo

COVID-19 Monoclonal Antibodies

TDH COVID-19 mAB Update Memo

 

All Tennesseans 12 and over are now eligible to receive a vaccine.

Find a vaccine near you: https://vaccinefinder.org/search/

For more resources, please visit: https://www.tn.gov/health/cedep/ncov/covid-19-vaccine-information.html

A plain language guide for persons with disabilities who might need assistance learning about the COVID-19 vaccine can be found at the following link: https://www.tn.gov/cdd/training-and-news/covid-resources-disability.html

Vaccine Consents

First, we have received multiple questions from providers regarding receiving informed consent from persons supported who do not have court-appointed conservators but who the provider or others believe are unable to communicate or to comprehend information about the COVID-19 vaccine in order to provide informed consent. 

ANSWER: Unless a court has declared an individual to lack capacity to make a decision on providing medical consent, and has definitively given the authority to make that decision to another legal representative/conservator through an order of the court, those individuals legally retain the right to make that decision to provide medical consent.  While people who work and interact with those individuals may believe these individuals lack capacity to provide informed consent, unless a court has determined that they lack capacity, legally those individuals have the right and authority to sign those forms without having to have it discussed by anyone else.

Secondly, there has been a lot of confusion regarding different versions of the consent forms to receive the COVID-19 vaccine.

ANSWER: It must first be noted that the Tennessee Department of Health has oversight for 89 of the 95 counties in Tennessee- the exemptions being Davidson, Hamilton, Knox, Madison, Shelby, and Sullivan counties which each have their own standalone health departments.  Each of these 7 health departments have their own forms and procedures for administration of the COVID-19 vaccine.  On the afternoon of January 4, 2021, the Tennessee Department of Health finalized their consent form, which is attached (under the name “COVID Consent- TN Department of Health”).  While other versions of the TDOH consent form have been used in the past, the attached form should be the only form used going forward.   Also attached please find the forms provided by the Hamilton County Department of Health (“COVID-19 Consent- Hamilton County”) and Shelby County Department of Health (“COVID-19 Vaccine Consent Form – Shelby County Health Department").  In Hamilton County and Shelby County, please use the above consent forms.  Knox County, Metro Public Health (Davidson), and Madison County stated they were accepting the same forms as the Tennessee Department of Health, even though some of these departments have their own consent forms.  We will send an update regarding the use of consent forms in Sullivan County as soon as possible.

Third, DIDD has currently worked out procedures for conservators to provide informed consent for the COVID-19 vaccine with (1) the Tennessee Department of Health; (2) the Metro Public Health Department (Davison County); (3) the Knox County Health Department; and (4) the Madison County Health Department.  Each of these processes includes a process for conservators to provide consent through email, text and/or telephone if they are unable to return a signed consent form.  DIDD is currently finalizing procedures with the Hamilton County Department of Health, the Shelby County Department of Health, and the Sullivan County Department of Health and will provide information regarding these procedures once they are finalized. 

ANSWER: Please see the processes for the four health departments listed above (TN, Davison, Knox, and Madison).

Instructions for the administration of the COVID-19 vaccine by: (a) the 89 Tennessee Counties with oversight from the Tennessee Department of Health [all Tennessee Counties except Davison, Hamilton, Knox, Madison, Shelby, and Sullivan], (b) Metro Public Health Department (Davidson County), (c) the Knox County Health Department, and (d) the Madison County Health Department:

If the person supported has a conservator with authority to make decisions related to medical treatment, please see the instructions below:

1.      Has a Tennessee Department of Health consent form (see attached) already been received from the conservator which was signed by the conservator?  If yes, then please present that signed consent form to the Health Department administering the vaccine prior to vaccination.  If not, proceed with the consent procedures as outlined below. 

2.      If there is not already a signed consent form from the conservator, contact the conservator for the person supported to obtain consent either: (a) through a signed consent form to be received prior to vaccination; or (b) over email, text, or phone stating that you may authorize the form by signing the conservator’s name with permission.  Whenever possible, the consent form signed by the conservator is preferred.  These are the steps for obtaining informed consent if the conservator cannot deliver a signed consent form by the day of vaccination:

a.      Prior to vaccination, the conservator must be provided the Tennessee Department of Health consent form and accompanying documents to be able to provide informed consent.  So please first check whether the conservator has received and had a chance to read the TDH consent form, the Notice of Privacy Practices, and the Vaccine Information Statement or Emergency Use Authorization Information Sheet.  If they have not, please either send the forms to the conservator or, if necessary, read them to the conservator over the phone so that informed consent can be obtained.  The documents which need to have been reviewed by the conservator are:

                                          i.     Notice of Privacy Practices.

                                         ii.     Vaccine Information Statement

                                        iii.     Emergency Use Authorization Information Sheet.

                                        iv.     The consent form of the Tennessee Department of Health.

b.      After checking that the conservator has received and had a chance to read the TDH consent form, the Notice of Privacy Practices, and the Vaccine Information Statement or Emergency Use Authorization Information Sheet, ask whether you may sign the form for the conservator with permission. If this can be accomplished through email, text, or other written format, where there is proof of the conservator’s permission to sign his/her name, that is preferred.  However, if this is not possible, you may obtain permission to sign the conservator’s name over the phone. If the consent must be provided over the phone, have another individual witness that consent being given over the phone.

c.      If the conservator provides that consent, whether on the phone or through email or other means, sign the form in the following way: “[signature of name of the conservator] w/p [name of the employee signing the form]. [Phone/text/or email] consent obtained from [print name of conservator] on [date] at [time] by [employee’s initials].” 

d.      If consent was provided through the process outlined in section (c) above, please continue to follow-up with the conservator to attempt to receive a consent form signed by the conservator his/herself.  Once those signed consent forms are received, please send them to the County Health Department which administered the vaccine for that person supported. If you are not sure who to send the signed form to at the County Health Department, please contact the DIDD Regional Office in your Region.

e.      If the conservator refuses to provide that consent:

                                       i.     Tell the conservator that if they later decide that the person supported should receive the vaccine, even after the scheduled vaccination date, to contact the DIDD Regional Office in your Region to                                               let them know.

f.       If you have any questions about the DIDD consent procedures, please contact Seth Wilson, Associate Counsel for DIDD, at Seth.Wilson@tn.gov or (615) 982-0106.

Update (3/11/2021) - CMS has approved the extension of the Appendix K Documents covering the state’s three 1915(c) HCBS waivers.  More information and the updated documents can be found below.
 
 
 
 
 
 

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.[1] 

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 June 30, 2021.  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. 

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 (2/26/2021):

Based on the continuing circumstances surrounding COVID-19, DIDD and TennCare are extending the availability of Homebound Services through June 30, 2021.  In an effort to honor those choices and balance the health and safety of the people supported, we believe it is necessary to continue to make available Homebound Services. 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.

Reopening Responsibly:

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.

We have seen a dramatic decrease in the number of positive COVID-19 cases among both persons supported by DIDD and staff. As more people across Tennessee have received vaccinations and cases have declined, many people are now able to safely gather with their loved ones. 
 
This includes at our homes. Everyone who lives at the homes who chose to receive a vaccine has been fully vaccinated, and this has put us in a position to resume full visitation at our homes. This includes the ability for people in the homes to visit their loved ones offsite, including overnight visits and visits in the family home. 
 
The options of contacting loved ones through telephone or FaceTime will continue to be available, even with expanded in-person visitation.
Investigations

At this time, investigators will be permitted to conduct direct witness interviews via Microsoft Teams, with the exception of the alleged victim and alleged perpetrator, which will require face-to-face interviews. If an investigator or witness requests a face-to-face interview, the investigator shall provide them this opportunity. If a witness states that they do not have the capability to conduct a Microsoft Teams interview, a face-to-face interview will need to be arranged for direct witnesses. Circumstantial witness interviews may be conducted telephonically. 

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.

Resumption of Face-to-Face Visits

With COVID-19 cases rapidly declining in the state of Tennessee and the increasing number of vaccinations, the Department of Intellectual and Developmental Disabilities (DIDD) is resuming onsite provider visits.

While there will be business practices in some areas that will continue to be performed remotely, beginning in May 2021 many of the types of visits conducted onsite prior to March 2020 will resume. This includes Quality Assurance surveys, ECF quality surveys, licensure & risk management visits, provider support teams visits, protection from harm, accreditation (POMs, BA reviews, and PCO/PCP meetings), and other Central or Regional Office functions. Please note that DIDD staff are also resuming in-person visits in intake, case management, and TEIS service coordination.

As in the past, we will notify you of our impending visits except for traditionally unannounced visits, such as licensure and some risk management visits. Providers must make arrangements to accommodate DIDD staff.

Please send questions regarding the resumption of face-to-face visits to DIDD.Covid19@tn.gov.

 

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 flexibilities, as afforded within the authority granted by the approved Appendix K Amendment and as indicated in the guidance document issued on April 1, 2020, titled "Relaxing Staffing Requirements in Limited Circumstances in Response to COVID-19" will continue to remain in place until further notice.
  • Current availability and utilization of the Enabling Technology benefit remains viable under the authority provided through the approved Appendix K Amendment. However, it is anticipated that availability of Enabling Technologies will become a permanent available benefit as described and submitted in the most recent 1915(c) Waiver Amendment submitted to CMS in April of 2021.
  • The previous suspension of DIDD Units engaging in provider contacts and direct meetings has been officially lifted on May 14, 2021, and normal business practices have resumed.
  • The previous suspension of Provider Support Visits has been officially lifted on May 14, 2021, and normal business practices have resumed.
  • The previous suspension of Family Support Programmatic Reviews has been officially lifted on May 14, 2021, and normal business practices have resumed.
     

Provider Contacts and Meetings

In continued response to the potential concerns spurred by the Public Health Emeregency and out of an abundance of caution, DIDD will continue to 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 continue to be conducted either telephonically or through electronic means until further notice.

 

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. 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

The following is a summary of DIDD’s plan for future on-site activities for the Office of Quality Management.

Fiscal Accountability Reviews (FAR) – We have determined that the FAR process can continue to be conducted remotely going forward. With the availability of the Cloud for electronic submission and storage of provider documentation to be reviewed, we have been able to adjust the review process to being an almost totally remote one. One possible exception to this might be if there are significant findings from a review that would be better discussed face-to-face.

ICF/IID Certification Surveys – Surveys of the private ICF/IID facilities by DIDD would resume at the direction of the Department of Health since we operate under a contract with DOH and abide by the stipulations of that contract. Of note is that CMS has already indicated that states can go back to on-site surveys for ICF/IID facilities, but DOH has chosen to continue to limit on-site activities in Tennessee in accordance with the current state of emergency order. It should be noted that throughout the pandemic, DIDD has conducted complaint investigations in the private ICF/IIDs, as directed by DOH. As we receive additional information from DOH, we will be in contact with providers as to a re-start date for the certification surveys.

Employment and Community First Choices (ECF) Quality Reviews – As approved by TennCare, the initial consultative surveys for ECF providers were deferred since these are required to be on-site visits. As of May 3, 2021, we have been able to restart the ECF consultative surveys. This allows us to make a determination as to the appropriateness of services and supports provision by newly approved ECF providers. For the annual surveys, we will resume on-site reviews by July 1, 2021. Providers will be notified of their survey dates in advance, as was done prior to the pandemic.

Quality Assurance (QA) Reviews – The QA survey process was reconfigured in August 2020 to address the need for a remote model of review. Since that time, QA reviews have addressed a portion of the quality indicators that are usually reviewed in full surveys. We will be continuing the methodology we adopted for the pandemic; however, for providers of Residential, Day, and PA services, we plan to add a brief on-site visit that will allow us to interview persons supported, if they agree to be interviewed, and provider staff. Optimally, we would like to have these visits in the persons’ homes. However, to ensure that interviews are conducted in an environment where the person is most comfortable, we can conduct visits at an alternative site rather than in the person’s home if she/he prefers. We anticipate that these on-site visits will require QA staff to be physically present on-site for one to two days, depending on the size of the agency. For comparison, our typical time in an agency prior to the pandemic was anywhere from two to seven days, so we are adjusting our on-site time significantly downward. The addition of on-site visits to QA reviews will begin by July 1, 2021. As is the usual process, agencies have already been notified of their QA review dates prior to the beginning of 2021 and will be provided specific information about our upcoming activities in the pre-review letter.

 

Community Providers of Clinical Services

Tennessee is continuing re-open community settings and resume face-to-face services that were recommended to be provided via telehealth during the state of emeregency. Community providers of clinical service should continue to update 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 can continue to utilize telehealth to conduct services as necessary or requested by persons supported or their conservators and as appropriate; however, face-to-face services may resume.

All persons in the home and the clinical service provider staff conducting the visit are free of COVID-19 symptoms or recent exposure (see Clinical Appointment Health Questions below).

When face-to-face visits are made, it is recommended that community providers of clinical service follow current CDC guidance (https://www.cdc.gov/coronavirus/2019-ncov/index.html) 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 when possible. 
  • Face Mask Usage:
  • 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: https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html

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. 

Additional Guidance:

  • 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. Please note that community providers of residential and day services policies are not permitted to deny a person's access to medically necessary services, but the person supported or their conservator can request services be provided via telehealth.
  • 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. 
** 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

By mid-March 2020, most April licenses had been renewed, but most licenses since that time have been placed in extended status du to the pandemic. Some licenses have been reissued utilizing virtual visit technology and this practice will continue for certain settings and situations going forward. All Residential Habilitation and ICF-IID licenses will continue to require in-person, unannounced licensure visits resuming in May 2021.

Risk Management audits have predominately been conducted remotely since March 2020. Providers should anticipate the resumption of onsite audits in May 2021.

TEIS remains committed to providing services in a setting that protects everyone's health and safety.  Staff and providers are preparing to resume in-person visits.  The following guidance documents will help families and service providers as we continue through this process. 

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.

Over the past year DIDD has worked diligently with TEMA and the Dept of Health to support and ensure that adequate supplies and PPE were available to combat the spread of COVID-19 to vulnerable populations across the state. Supply shortages from the onset of the pandemic strained the healthcare networks and supply chains across the globe. Today, the PPE supply chain has bounced back in a manner that now affords providers the ability to independently seek and sustain adequate supplies as needed. Effective on June 1, 2021 DIDD will be suspending its support of PPE requests through the Formstack Portal for the DIDD provider network.

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.)

Close Contact Guidance

 

What to Expect After Being Tested for COVID-19 (see attached CaseGuidance.pdf)

Isolate Yourself

  • 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.

Case Guidance

 

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.

Isolate Yourself

  • 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.

HCW Case Guidance

 

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

Group Care Guidelines

Releasing Cases and Contacts from Isolation and Quarantine

 

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.

https://www.tn.gov/health/cedep/ncov/data/epi-curves.html

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 approval of Appendix K and expansion of Enabling Technology has greatly benefited people supported to maintain their independence and ensure their health and safety through the Public Health Emergency. As of May 2021, 144 people supported have been able to request waiver funding for Enabling Technology services and solutions through Appendix K.

Furthermore, the Innovation Team reports that more than 90 people have already embarked on a pre-employment process using Enabling Technology software applications, thereby giving people a chance to re-start their job searches in a safe manner.

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.

StationMD Information

Guidance and Utilization Steps

Enabling Technology - Waiver funding request procedures

Telemedicine - Waiver funding request procedures

COVID-19 Enabling Technology Expansion

COVID-19  Enabling Technology Utilization Steps

DIDD Vendor Resources

CreateAbility COVID Solutions

Mozzaz - COVID-19 Solution

SafeinHome Emergency Development Options 2020

SimplyHome.ReSET for Tech First Organizations 2020

THS RSS Service Plans

Spencer COVID-19 Flyer

NOSS Quick Deploy During COVID-19

WebEx Recordings

Enabling Technology Expansion WebEx 04.08.20

Enabling Technology StationMD Telehealth WebEx

DIDD COVID-19 Testing Numbers

Testing as of January 7, 2022

# of COVID Tests Reported 11,190
# of Positive COVID Results 2567

 

Data collected through 12/22/2020

  Typical Population DIDD
Rate of Infection 
Proportion of the overall population that has tested positive for COVID-19		 7.88% (534,019/6.77 million) 8.28% (1035/12,500)
Overall Death Rate
Proportion of the overall population who have died from symptoms caused by COVID-19		 11.57 per 12,500 (6,269/6.77 million; .09%) 38 per 12,500 (38/12,500; .30%)

Reporting Requirements

2021 Positive COVID reporting for persons supported and staff:

As the COVID Pandemic continues, DIDD continues to enhance the reporting process and reduce the reporting impact on Providers. DIDD has created a new COVID Quesionnaire Form for Providers that will be more user friendly and reduce the amount of information required for completing. The report should be submitted as soon as possible after the requested information is available.

To enhance security for Protected Health Information (PHI), DIDD is moving the COVID Questionnaire production box to TNCloud. Providers will upload forms to the respective region. The Investigation Abuse Reporting production boxes will no longer be utilized for COVID reporting beginning January 11, 2021.

The COVID Questionnaire, is available below and is attached to this Open Line. All reports must be submitted as a word document.

Questionnaires shall be submitted to the following production boxes:

Once your document is uploaded, it will no longer be viewable.

[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.ReportableEvents@tn.gov .

If there is any confusion over the reporting requirements, please contact Elizabeth Duhack at Elizabeth.Duhack@tn.gov or call (615) 231-5547.  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.

Testing for Persons Supported

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.
 


Staff Testing

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.  

Guidance--Staff Testing

DIDD Guidance

Everlywell Self-Collection COVID-19 PCR Testing--Standard Operating Procedure

COVID-19 Testing Supplies MOU

P23 Laboratories Self-Collection COVID-19 PCR Testing Standard Operating Procedure

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, 2021. Classes and/or test outs are being conducted by the Regional Offices.  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 may continue to be utilized.

Remote Medication Administration

In an effort to maintain continuity of care until the end of the medication administration certification extension on December 31, 2021, DIDD will continue to 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 and non-certified staff must complete the remote medication administration training in Relias.

Requirements:

  1. 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.  
  2. 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.
  3. The certified staff must be able to direct the uncertified staff to perform all the steps required to administer medications.
  4. The certified staff must be able to perform the 3 checks prior to administration.
  5. 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.
  6. The certified staff must be able to verify that the medication supply is secured after administration.
  7. 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.
  8. 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).
  9. The certified staff will retain responsibility for the administration of medications as if they had administered the medications in-person.
  10. 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.
  11. Controlled substance counts will be completed according to agency policy and may include the remote certified staff as needed.
  12. Certified staff may direct uncertified staff to transcribe a new order on the MAR if needed.
  13. 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.
  • 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

All Open Lines and Special Editions since March 13, 2020 (by date)

Commissioner Turner's Office Hours

 

A summary of all guidance issued thus far from CMS can be found here:

https://www.cms.gov/newsroom/press-releases/cms-publishes-faqs-ensure-individuals-issuers-and-states-have-clear-information-coverage-benefits

Patients with Disabilities in Hospital Settings

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.