Long-Term Services and Supports
Tennessee will implement quality- and acuity-based payment and delivery system reform for Long-Term Services and Supports, including Nursing Facility services and Home and Community Based Services (HCBS) for seniors and adults with physical, intellectual and developmental disabilities (I/DD). The initiative's approach will combine a quality measure framework focused on measures that most impact the member experience, regardless of care setting.
Quality- and Acuity-Based Payment for Nursing Facilities and Home and Community Based Services: Under the Quality Improvement in Long-Term Services and Supports (QuILTSS) initiative, Nursing Facility payment is based in part on residents' assessed levels of need and adjusted based on quality metrics. Home and Community Based Services payments will also be adjusted to incorporate the same quality metrics when they apply across service delivery settings, along with modified and additional quality metrics specific to Home and Community Based Services. These changes will reward providers that improve the member's experience of care and promote a person-centered care delivery model. For individuals with intellectual and developmental disabilities, Tennessee will apply quality and acuity-based payments to address inequities in the system, encourage appropriate high-quality and efficient care, and increase the number of people who can be served. These include value-based reimbursement strategies in the new Employment and Community First CHOICES program that align payment with key program outcomes including integrated competitive employment. For more details regarding the QuILTSS initiative, please visit Value Based Purchasing.
Value-Based Purchasing Initiative for Enhanced Respiratory Care (ERC): As part of a comprehensive quality improvement initiative for care provided in a Nursing Facility to individuals with enhanced respiratory care needs, TennCare revised its reimbursement structure, using a point system to adjust rates based on the facility's performance on key performance indicators. The initiative combined the new reimbursement approach with strengthened standards of care to promote quality and best practices, and improve member outcomes. A comprehensive overview of the initiative is available at ERCQualityImprovementPlan .
Workforce Development: Through its extensive stakeholder input processes, Tennessee has identified that one of the most critical aspects of Long-Term Services and Supports value pertains to the level of training and competency of professionals delivering direct supports—whether in a Nursing Facility or in the community. Therefore the initiative will invest in the design and implementation of a comprehensive competency-based workforce development program and credentialing registry for individuals paid to deliver Long-Term Services and Supports. Since staff training will be an important quality measure and will also impact a provider's success across other measures, agencies employing better trained and qualified staff will be appropriately compensated for the higher quality of care experienced by individuals they serve.
More information on Long-Term Services and Supports reform please visit Long-Term Services & Supports