Tenn. Comp. R. & Regs. 0465-01-02-.12 - VALUE-BASED RATE SETTING METHODOLOGY FOR SUPPORTED EMPLOYMENT-SMALL GROUP

(1) Supported employment-small group is reimbursed on a fee-for-service basis.
(2) The unit of service is 15 minutes.
(3) The fee-for-service rate is calculated using the following factors:
(a) Average cost of job coach hour of service divided by four (4), including these component costs:
1. DSP reimbursement rate;
2. Employee-related expenses;
3. Administrative costs;
4. Productivity assumptions, including projected average waiver participant absentee rate of 8.23 percent; and
5. Travel costs;
(b) Participant transportation cost per unit per person;
(c) Administrative adjustment based on the number of waiver participants in the small group and the expected job coach-to-waiver participant staffing ratio (one job coach for a group of two, three, or four waiver participants); and
(d) Value-based adjustment to incentivize smaller group size.

Notes

Tenn. Comp. R. & Regs. 0465-01-02-.12
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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