July 13, 2012
Below, are various items I would like to share:
- Nursing Home Administrators Public Meeting: On July 12th, a public meeting was held in Jackson, Tennessee to support and assist class members residing in West Tennessee nursing homes. Other objectives were to foster a collaborative effort among the Department of Finance and Administration, Department of Health, DIDD, TennCare, and other entities including Q Source, The Arc Tennessee, and the Tennessee Health Care Association.
CJ McMorran, West Regional Director, facilitated and presented. Mrs. McMorran provided an overview of the Arlington Lawsuit as it pertains to class members, discussed community-based options available, as well as explained available resources DIDD has to offer for class members.
Commissioner Mark Emkes (Department of Finance and Administration), Commissioner John Dreyzehner (Department of Health), and I also attended. We stressed to the audience the importance of supporting persons residing in nursing homes to make informed choices concerning their care and quality of life.
The meeting was informative and generated a lot of feedback and questions. We appreciate those who took time out of their schedules to attend. This matter is a high priority for the Department and one we will continue to work on diligently.
- Disability Law and Advocacy Center (DLAC): DIDD will enter into a memorandum of understanding with the Disability Law and Advocacy Center as a commitment to work together to ensure the safety and full participation of Tennesseans with intellectual and developmental disabilities. The signing between DIDD and DLAC, a federally-funded agency, will take place on Monday, July 16th, and will signify the cooperation of the two agencies in protection from harm and advocacy issues for individuals. The agreement will also express the intent to share resources and information that will assist individuals with intellectual and developmental disabilities in securing meaningful and productive lives.
- The Arc Tennessee: On Wednesday, I visited with the staff of The Arc Tennessee at their office in Nashville. I had the opportunity to observe their integrated workforce on the job and share an informal lunch where I turned the tables and asked each one of them what they would do to change DIDD if they could be “Commissioner for a Day,” but the change couldn’t cost money.
I visited two people who self-direct their supports, one through the Self-Determination Waiver and one through the Personal Assistance Supports and Services Grant (PASS). I first met Jeremy, a young man who successfully self-directs his services in the Self-Determination Waiver and his brother Chris, who is currently on the waiting list. Both men have significant disabilities but thrive in their environment. While sitting at the kitchen table, I listened to the concerns of his family as well as the achievements and obstacles both men face in the system. The Self-Determination Waiver program allows for John, the boys’ father, to serve as the primary support staff and assist them with outcomes established in the ISP.
Shortly after, I met Martin, an original pilot member of the PASS grant. Please see attached photo. Martin has cerebral palsy and uses a wheelchair for mobility. He is a lively guy with a big heart. His uncles have always provided natural supports but recently his last remaining uncle moved into a nursing home because of his own health needs. Martin requires 24/7 but is not currently eligible for TennCare or CHOICES and does not want to live in a nursing home. He has actively hired, trained, managed, and paid his support staff with the modest budget PASS provides and also pays staff out of his own pocket for the remaining support he requires. He wrote me a letter sharing how self-direction improved his overall quality of life and allowed him to remain in his home with the help of a personal assistant.
In both cases, The Arc Tennessee Supports Brokers assist the self-directing individual and their family with all staffing and budgeting issues that come with the individual being the “employer of record.” Special thanks to Executive Director Carrie Guiden and her staff for an enjoyable visit.
- Greene Valley Developmental Center: The week of April 30, 2012, the Quality Review Panel conducted its Annual Systems Review of Sections IV, V, and IX of the Settlement Agreement at Greene Valley Developmental Center. On July 2, 2012, the formal report of the findings was published. Of the paragraphs reviewed, 21 were found to be in compliance, 6 were in partial compliance, 2 were in non-compliance, and 1 was listed as not applicable. Prior to this review, the Quality Review Panel had not conducted an on-site review of GVDC since 2006, when the Court dismissed GVDC from Sections VI and VII of the Settlement Agreement. Congratulations to the staff of Greene Valley for another great survey this year. The ICF survey in March was the best GVDC has had in many years.
- College of Direct Support: New training modules are now available through the College of Direct Support. These new modules were created in response to the revisions recently made to Chapter 18 of the DIDD Provider Manual. As you are aware, Chapter 18 addresses Protection from Harm and the revisions made to the chapter went into effect on June 1, 2012.
DIDD recommends that management staff, including Incident Management Coordinators, complete the new training. Please contact Stephanie Butler, Director of Incident Management or Jodi Simmons, Director of Investigations for questions concerning training content at Stephanie.Butler@tn.gov or Jodi.L.Simmons@tn.gov.
- Volunteer State: A few weeks ago, we let you know that we were building a list of persons in the community who were interested in volunteering to serve on committees that DIDD is involved with. The response has been incredible and we have some exceptionally talented and experienced individuals on our resource list. As vacancies come available or new workgroups are created, we will look to this list and make contact with people whose interests or experience match with the issues at hand to see if they can serve on that particular group. Thank you to everyone who has volunteered. Your time and insight are valued.
- HIPAA Compliance Reminder: DIDD would like to remind all providers and DIDD staff that Protected Health Information (PHI) should be secure when sent electronically through e-mail.
It is imperative that persons served SSNs, names, medical information, and ISPs are not linked together. To review the entire HIPAA Rule, please visit the OCR website: http://www.hhs.gov/ocr/hipaa. Please be aware that any time Protected Health Information is not safeguarded or is shared inappropriately, sanctions may be imposed. In lieu of a secure network, an easy way to secure PHI, is to password protect Word and Excel documents just like it is done when agencies send reportable incident information. For more information, please visit: http://office.microsoft.com/en-us/word-help/password-protect-a-file-HP005186090.aspx.
It is imperative that the user send the password in a separate e-mail. It is also important to note that even users of the free OpenOffice Word Processor can open and edit these files. Please direct any questions to Simone Cuarino, HIPAA Compliance Director, at (615) 532-6511.
- Voided Claims Reports: As part of the new billing processes, DIDD has begun sending out a Voided Claims Report. This report is used to identify claims that have been voided when a cost plan is errored out in DIDD’s billing system. When a cost plan is errored out, typically a new cost plan is entered and any billing that was submitted under the pre-existing cost plan is voided and can be resubmitted under the new cost plan. This report was designed to notify providers when this has occurred.
The report is broken out into two sections. The first section shows voided claims that have been submitted to DIDD, but have not yet been swept and submitted to TennCare. In this case, the claims have not been sent to TennCare, so there is no recoupment. The claims will need to be rebilled once a new cost plan is entered in order for providers to receive payment. The second section shows voided claims that have been submitted to TennCare, and may or may not have already been paid. If a claim has already been paid by TennCare at the time of the voided transaction, it could result in a recoupment of the claim amount unless there is a rebilled transaction to offset it.
Currently, providers have access to bill for dates of service from 5/1/2012 forward. If a cost plan is errored out resulting in a voided claim for dates of service prior to 5/1/2012, and a new cost plan has been entered, then providers should treat this as a late bill submission and follow the normal late bill and adjustment process of sending the information either to the Special Services Group or the Regional Office based on past procedures. If a cost plan is errored out resulting in a voided claim for dates of service on or after 5/1/2012, and a new cost plan has been entered, then a new billing calendar will be available for these claims, and the rebilling will take place in PCP. Currently, all rebilled claims should be treated the same as Late Bills and Adjustments and should be sent to the Special Services Group or the Regional Office. Once the development effort is completed and tested, providers will be given access to submit their own rebilling, along with Late Bills and Adjustments. Instructions and training on this new process will be made available to providers before implementing the new functionality.
DIDD is aware that some of the reports that were initially sent out did not include information for all of the voided claims. DIDD has corrected this issue and now sends two Voided Claims Reports; one that details voided claims for Waiver services, and one that details voided claims for state-funded services. These reports are sent in both PDF and Excel format.
- Performance Issues with Provider Claims Processing (PCP) System: DIDD continues to receive reports of issues with system performance in our provider claims processing (PCP) system. While it is not possible for us to implement a long-term solution for these issues at this time, due to a lack of available programming resources, we have identified one of the likely causes and will be taking steps to correct this issue over the coming week. While we hope that this will alleviate some of the performance issues, we are aware that there are other steps that will need to be taken in order to ensure proper performance. We will continue to address these issues as the needed resources become available.
- Project Titan Update: DIDD continues to make great progress towards replacing its computer information systems. Late last month, DIDD received approval and budget authority to purchase the framework that the new system will be built upon. DIDD is now moving forward with a Request for Proposal (RFP) to secure an implementation vendor for the project. We expect the RFP to be released early next week. Detailed planning and design sessions are expected to begin in October, and DIDD will be reaching out to the provider community for participation in many of these sessions. We look forward to working with many of you as we move forward with this effort.
DIDD has hired a new Business Analyst who will be working on this project. Please join me in welcoming Phillip Smith. Phillip is an integral member of the project team and given his skill sets, he will be working closely with the Health Services Division to ensure that their business requirements are met.
- Clarification for Memo #0173 Policy Publication Distributed July 10, 2012: Policies numbered P.80.3.7 Request for Emergency Service Authorization, P.80.4.1 Program Participants Experience Surveys, and P.80.4.3 Personal Funds Management are renumbering and reformatting of policies and not new or revised policies. We will ensure this is clear in future policy publications. Finally, policy P.100.1.5 applies only to DIDD operated ICF/ID facilities and does not apply to waiver providers.