LTSS Quality and Accountability

The HCBS Final Rule was issued by the Centers for Medicare and Medicaid Services (CMS) on January 10, 2014. The Rule guarantees that elderly adults and individuals with physical, intellectual, and developmental disabilities receiving long-term care services outside of an institutional setting—such as a nursing or intermediate care facility—have the same rights and freedom of choice as non-disabled individuals living in the community.

States were required to develop a transition plan for bringing existing HCBS providers into—and maintaining—compliance with the rule’s requirements. TennCare received final CMS approval of its Statewide Transition Plan on April 13, 2016 and was in full compliance with the HCBS Final Rule requirements by March 17, 2019.

The State’s Statewide Transition Plan can be found in the LTSS Documents.

TennCare monitors ongoing compliance through data collection and member feedback, using the following tools:

• Individual Experience Assessment (IEA)
• Individual and Family Experience Assessment (IFEA)
• Employment Data Survey (EDS)
• Member Record Review (MRR)

The HCBS Final Rule requires that service coordinators and providers use a person-centered approach to develop service plans for TennCare members receiving HCBS through the CHOICES, ECF CHOICES, and Katie Beckett programs. This approach recognizes the individual (and their family member, guardian, or legal representative, if applicable) as the primary decision maker regarding the services they receive, where services are provided, and who provides them. The individual’s choices are reflected in their service plan, also known as the Person-Centered Support Plan (PCSP). The PCSP also includes detailed information about the individual’s strengths and interests, goals, risks, and support needs.

The rule also ensures that the individual is able to receive HCBS supports in an accessible, integrated setting with non-disabled individuals, and that their service coordinator and providers respect their independence, beliefs, freedoms, and choices.

TennCare conducts National Core Indicators (NCI) surveys directly with individuals and families receiving services through the CHOICES and Katie Beckett programs. NCI surveys are nationally recognized tools used by many states to measure program outcomes related to service planning, community inclusion, individual rights and choice, health, safety, and relationships. Responses to the NCI surveys help TennCare ensure that 1) programs and services are meeting individuals’ needs, 2) individuals are being treated with respect and dignity, and 3) individuals’ rights to freedom and choice are being respected.

TennCare uses different versions of the NCI survey for each program, as follows:

• NCI-Aging and Disabilities (NCI-AD) Survey – For individuals receiving nursing facility care in CHOICES Group 1 and HCBS in CHOICES Groups 2 and 3 and the PACE program.
• NCI-Child and Family Survey (NCI-CFS) – For individuals and families receiving services through Katie Beckett Part A or B.

In 2024, TennCare began using the Personal Outcome Measure® (POM®) tool to assess quality of life and services for individuals receiving services through the ECF CHOICES and 1915(c) waiver programs. During a POM® interview, individuals define the personal outcomes related to security, community, relationships, choices, and goals that are important to them and provide insights into whether the outcomes are being achieved.

Each year, TennCare will randomly select a group of individuals from each LTSS program for a list of potential survey participants.

• For NCI-AD, surveyors from the state’s nine Area Agencies on Aging and Disability (AAADs) will contact the selected individuals and ask if they are willing to provide feedback about their services. If the individual agrees to participate, the surveyor will schedule either a phone call or in-person meeting with  at a time and location convenient to the individual to conduct the survey.
• For NCI-CFS surveys, families will be mailed a copy of the survey that can either be filled out and sent back using a postage-paid return envelope or completed online using the provided link.
• For POM, interviewers from the managed care organizations (for individuals in ECF CHOICES) or the TN Department of Disability and Aging (for individuals in 1915(c) waivers) will contact the selected individuals and ask if they are willing to participate. If the individual agrees to participate, the interviewers will schedule and in-person or virtual meeting at a time and location convenient to the individual to conduct the interview.

Yes, participants may have family members, friends, or other support persons with them during the NCI survey or POM interview to help them understand and answer questions. When scheduling the meeting, the surveyor or interviewer will ask if you need or want any communication supports during the meeting, including presence of a support person, use of a communication aid/device, or an interpreter, and will work with you to coordinate any requested supports.

TennCare uses NCI survey and POM interview results to improve program quality for everyone receiving services, so we encourage you to participate and provide honest feedback if contacted by a surveyor or interviewer. Your individual responses will not be shared and your services will not be affected by your decision to participate or the quality of your responses.