Tenn. Comp. R. & Regs. 0465-01-02-.06 - RATE SETTING METHODOLOGIES FOR SEMI-INDEPENDENT LIVING SERVICES

(1) Calculation for Semi-Independent Living Services is:
(a) The unit of service for these residential services is a day.
(b) The rate is calculated on a monthly basis. For purposes of billing, the monthly rate is converted to a per diem amount. The per diem rate will be billed for each day of the month that the person is enrolled in the services, regardless of whether any direct assistance was provided that day.
(c) The rate is calculated using the following factors:
1. Average monthly hours, inclusive of on-call services;
2. Personal Assistant services quarter hour reimbursement rate as defined in 0465-01-02-.18;
3. Transportation cost.
(d) Semi-Independent Living Incentive: is a one-time payment of $2,500 per waiver participant per provider. The waiver participant must have transitioned directly into Semi-Independent Living from a twenty-four hour residential service following at least thirty consecutive paid residential days. The waiver participant must then participate in Semi-Independent Living for six (6) consecutive months immediately following the transition to be eligible for the incentive payment.
(e) Semi-Independent Living Transition Rate: is double that of the semi-independent living daily rate and limited to waiver participants who require additional hours of support during the period immediately following transition. This rate is only available for up to thirty days following the initial transition from a twenty-four hour residential service to Semi-Independent Living and requires thirty consecutive paid residential days immediately prior and adjacent to the claim for the transition rate.

Notes

Tenn. Comp. R. & Regs. 0465-01-02-.06
Original rule filed December 12, 2013; effective March 12, 2014. Amendments filed October 7, 2019; effective 1/5/2020.

Authority: T.C.A. ยงยง 4-3-2701, 4-3-2707, 4-4-103, 4-5-201, et seq., 4-5-208, et seq. and its applicable regulations concerning emergency rules, 33-1-201, 33-1-202, 33-1-203(1) and (6), 33-1-204, 33-1-301, 33-1-302, 33-1-302(a)(3) and (a)(4), 33-1-303, 33-1-303(3) and (11), 33-1-304, 33-1-305(1), and 33-1-309(d); Executive Order of the State of Tennessee No. 23, dated October 19, 1999; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; and the "Reimbursement Rate" for Medical Services under DIDD federal waiver(s) for provision of services as administered by TennCare.

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