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Office of ICF/IID Survey Operations and Information

The Quality Improvement (QI) section of the Office of Quality Management consists of one (1) administrator for ICF/IID operations, one (1) director of DIDD ICF/IID survey operations and nine (9) members of the ICF/IID survey team.

The ICF/IID administrator and survey operations director are assigned to the DIDD Central Office in Nashville. The ICF/IID surveyors operate in three regions of the state (four (4) staff in East Tennessee, three (3) staff in Middle Tennessee, and two (2) staff in West Tennessee) under the supervisory oversight of the administrator and supervisor of the ICF/IID survey operations. The DIDD ICF/IID survey team is responsible for the initial and annual Medicaid re-certification of all privately operated home/facilities operated by eleven (11) privately operated ICF/IID providers. The Tennessee Department of Health/Health Care Facilities retains the ICF/IID survey responsibilities for the DIDD state operated ICF/IID providers (Greene Valley Developmental Center, Middle Tennessee Homes, East Tennessee Homes, West Tennessee Homes and the Day One unit operated by the Harold Jordan Center).

The ICF/IID administrator and the survey operations director provide technical assistance on ICF/IID certification, best practices and the communication of current memos and information issued by the Centers for Medicare and Medicaid Services (CMS) to ICF/IID providers and survey agencies. 

The DIDD ICF/IID state operated providers evaluate themselves utilizing quality key indicators of services and supports in the major areas of health, individual support planning/person centered planning and implementation, safety and security, rights and respect, community integration, choices and decision making, opportunities for work and day services, and training. These indicators are also reflective of the outcome measures sought from the Council of Quality Leadership / CQL Accreditation as well as the ICF/IID federal regulations. These reports are ultimately analyzed by the ICF/IID administrator for trends related to the quality of services and supports. Guidance is also provided in the development, revision, and/or implementation of policies, procedures and operations in regards to ICF/IID requirements and person centered practices.

ICF/IID Regulations:

Question: ICF/IID regulations state in order for a person to qualify for admission to an ICF/IID provider, they must have an intellectual disability and be in need of active treatment. What does it mean to be in need of active treatment services?

Answer:  The CMS federal regulations specifically require that each and every individual who receives ICF/IID benefits have an intellectual disability and be in need of and receiving active treatment. The phrase active treatment can be interpreted as intensive specialized supports, services and supervision designed to assist individuals with intellectual disabilities to develop increased skills and independence in functional life areas which are preventing the individual from living in a more independent setting. Individuals with intellectual disabilities who are able to function independently without training, supervision or support from staff would not meet the definition of being in need of active treatment.


Question: How are ICF/IID requirements different from HCBS waiver requirements?

Answer: The ICF/IID regulations were developed first by CMS over forty five (45) years ago to use as a method to verify States serving individuals with intellectual disabilities complied with regulations for best practices and qualified for Medicaid funds. At that time the majority of persons with ID also lived in institutions.  Fast forward several decades as States and individuals with ID expressed a wish to live in homes located in community settings and to have more choices.  Best practices were evolving. The ICF/IID regulations were then “waivered” to allow more choices in residential community homes, services and supports.