Self Determination Waiver Program
The Self-Determination Waiver (0427.R03.02) offers supports to children and adults with intellectual disabilities and children under age six with developmental delay who qualify for and, absent the provision of services provided under the Self-Determination waiver, would require placement in a private Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID).
In the Self-Determination Waiver Program, people have the opportunity to directly manage selected services, including the recruitment and management of service providers. Participants and families (as appropriate) electing self-direction are empowered and have the responsibility for managing, in accordance with waiver service definitions, a self-determination budget affording flexibility in service design and delivery. The Self-Determination Waiver Program serves persons who have an established non-institutional place of residence where they live with their family, a non-related caregiver or in their own home and whose needs can be met effectively by the combination of waiver services through this program and natural and other supports. The Self-Determination Waiver does not include residential services such as supported living, with the exception of Semi-Independent Living services.
The Self-Determination Waiver offers a continuum of services that are selected by the person pursuant to a person-centered planning process and support each person’s independence and full integration into the community, including opportunities to seek employment, work in competitive integrated settings, and engage in community life. Services are delivered in a manner which ensures each individual’s rights of privacy, dignity, respect and freedom from coercion and restraint; optimizes individual initiative, autonomy, and independence in making life choices; and are delivered in a manner that comports fully with standards applicable to HCBS settings delivered under Section 1915(c) of the Social Security Act, including those requirements applicable to provider-owned or controlled homes, except as supported by the individual’s specific assessed need and set forth in the person-centered Independent Support Plan.
The Department of Intellectual and Developmental Disabilities (DIDD) serves as the Operational Administrative Agency for this waiver, which is administered under the administrative oversight of TennCare.
Consistent with the special terms and conditions of the State’s approved 1115 demonstration and the June 2015 guidance issued by CMS, Tennessee utilizes tiered standards in its HCBS programs, working to ensure minimum compliance across settings in its Section 1915(c) waivers while closing all new enrollment into these waivers and directing all new HCBS enrollment into the Employment and Community First CHOICES program. The Tennessee Self-Determination Waiver remains available to Tennessee residents in the target population already enrolled in the waiver who:
a. Meet TennCare ICF/IID level of care criteria (TennCare Rule 1200-13-1-.15) and financial eligibility criteria and have a Pre-Admission Evaluation approved by TennCare;
b. Have been assessed and found to:
Have an intellectual disability manifested before eighteen (18) years of age, as specified in Tennessee State law (Tennessee Code Annotated, Title 33-1-101); or,
Have a developmental disability, which is defined as a condition of substantial developmental delay or specific congenital or acquired conditions with a high probability of resulting an intellectual disability and be a child five (5) years of age or younger; and
c. Do not require residential waiver services (e.g., family model, residential habilitation, supported living) and have an established non-institutional place of residence where they live with their family, a non-related caregiver or in their own home.
Accordingly, a person must need at least one waiver service in addition to case management on an ongoing basis—at a minimum, quarterly. If you qualify for care in an ICF/IID, you have the right to choose between receiving supports in home and community-based settings (HCBS) or receiving supports in institutional ICF/IID care. If you choose to receive HCBS waiver program services, you will still be eligible to receive your regular TennCare benefits. The following waiver services are available based on assessed participant need:
- Adult Dental Services
- Behavior Services
- Behavioral Respite Services
- Community Participation Supports
- Environmental Accessibility Modifications
- Facility-Based Day Supports
- Individual Transportation Services
- Intermittent Employment and Community Integration Wrap-Around Supports
- Non-Residential Homebound Support Services
- Nursing Services
- Nutrition Services
- Occupational Therapy Services
- Orientation and Mobility Services for Impaired Vision
- Personal Assistance
- Personal Emergency Response Systems
- Physical Therapy Services
- Semi-Independent Living Services
- Specialized Medical Equipment & Supplies & Assistive Technology
- Speech, Language, & Hearing Services
- Supported Employment-Individual
- Job Development
- Job Coaching
- Supported Employment-Small Group