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November 9, 2012

Open Line

This edition of Open Line includes information I want to share with you:

State Director of Employment and Day Services:  In last week’s edition, DIDD announced an opening for the State Director of Employment and Day Services position.  A complete job description is available at http://www.tn.gov/didd/vault/newsroom/announcements/DirectorofDayServices.shtml.  Interested applicants should submit their resume to Karen Haynes, DIDD Director of Human Resources, at Karen.Haynes@tn.gov.

State Director of Investigations: I am pleased to announce Stephanie Butler will serve as the new Director of Investigations for the department.  She will continue to serve as the interim Director of Incident Management until that position is filled.  Ms. Butler can be contacted at Stephanie.Butler@tn.gov or at 615-532-3060 with concerns and/or questions related to Incident Management and Investigations.

Transition NOW:  This week, DIDD, along with the Department of Health (DOH) met with the Board of Examiners for Nursing Home Administrators to discuss the placement of persons residing in nursing homes and the responsibility of the Department to offer choice to the at-risk class members to receive care in the community.  Following the presentation, DIDD and DOH met with representatives from the Tennessee Health Care Association (THCA), who have agreed to assist the Department with this endeavor.  As a result of the meeting with the legal and legislative arm of THCA, THCA’s Government Affairs Department immediately issued a notice in their weekly newsletter encouraging nursing homes with class members to cooperate with DIDD’s efforts to offer informed choice.  THCA representatives agreed to continue working with the Department in its Transition NOW initiative. 

Additionally, with continuing efforts to streamline our processes to ensure improved quality of care and conditions for at-risk class members residing in nursing facilities, Dr. Nancy Ray offered training to members of the At-Risk team and the Arc Tennessee this week.  The entire group also discussed ways to collaboratively work together and better define each entity’s role when working with nursing homes on behalf of class members.

1619(b):  Many people supported by DIDD and who receive TennCare are concerned about the effects work could have on their eligibility for these programs.  There is a unique provision that helps people address this concern called 1619(b).  For 2012, the Social Security Administration has determined that in Tennessee, by using 1619(b) a person can earn as much as $31,464* and still continue to be supported by DIDD and receive TennCare.  Of course, certain conditions apply.  To find out how or if 1619(b) might benefit you, visit http://tndisability.org/coalition_programs/benefits_work.  In the meantime, please help us spread the word about 1619(b).  Together, let’s get Tennessee to work.

* This amount often changes on an annual basis, so we encourage you to call 1-888-839-5333 for the most up-to-date information.

Discovery:  Providers have to be creative in structuring effective outcomes which lead to meaningful Community-Based Day Services.  Discovery is the guiding strategy in pursuit of the Day Services principles of productivity, inclusion, and independence.  It provides a way for people to discover their skills, interests, talents and the world around them.


Discovery is achieved in Community-Based Day Services when documentation demonstrates the person’s week encompassed at least four of the following:

Supported Employment

•   The person’s time is spent exploring employment.
•   The person’s time in Discovery has led to an interest in pursuing employment.
•   The person spent their time doing job shadowing.
•   The person is currently employed and is using their time in Discovery to explore         career advancement opportunities.


•   The person’s time is spent exploring volunteering opportunities.
•   The person regularly contributes to their community by volunteering.

Community Connections

  • The person has developed hobbies or interests as a result of Discovery.
  • The person is an active member of their community (examples are being a member of a garden club, neighborhood organization, local gym, etc.)
  • The person is taking a class in the community to learn a new skill.

2013-2014 Budget Hearing:  On November 8, the department presented its Fiscal Year 2013-2014 budget before Governor Haslam.  This year, along with other state departments, DIDD was instructed to submit a 5% reduction plan.  To view the complete hearing, please visit www.tn.gov and click on the link, “View Archived and Live Hearings.”

Continuing Education Opportunities:  From my time spent in the community, I have learned a great deal from experts in the intellectual and developmental disabilities field.  Since education is vital and enhances our practices, I would like to implement a quarterly program where renowned speakers in the field come to share their knowledge and expertise.  Although this program is not a requirement for DIDD employees, they are highly encouraged to attend, as well as anyone else who may be interested.  We are still in the planning stages of this process, but further details are forthcoming.

Presentation:  At the Comcare Conservatorship Conference this week, Dr. Cheetham did a presentation on “Working with the Primary Care Provider,” and Dr. Victor Schueler, DIDD East Region and Greene Valley Developmental Center Medical Director, presented on “Working with a Psychiatrist.”  They also participated in a panel discussion on artificial nutrition and hydration with Mr. Bill Barrick from Comcare.

LEAD Tennessee:  Please join me in congratulating Elverna Cain, interim WTRO Transition Director; Pixie Duncan, CBDC Director of Nursing; Kellie McCain, CO QM Special Projects Coordinator; and Theresa Sloan, CO General Counsel, for being selected to participate in LEAD Tennessee next year.  We had a great group of nominees to choose from and were glad for the enthusiasm of staff wanting to improve their leadership skills.

clip 1Creative Housing Ideas: Earlier this year, I shared how identifiable markers such as ramps outside of community homes, can signify that persons with disabilities reside there.  As persons have a right to complete inclusion within communities, their homes should also be reflective of those that surround them.  Pictured at the right and below, are two photos of a home with a ramp.  The ramp is located on the side of the house, but from a frontal view, the porch resembles others in the neighborhood.  These photos are great examples of how a person’s home should look in any community.

clip2An Ounce of Prevention:   This week’s topic is Tennessee’s False Claims Act.  Per this statute, those who knowingly submit, or cause another person or entity to submit, false claims for payment of government funds are liable for three times the government's damages plus civil penalties of $5,500 to $25,000 per false claim.  The Program Integrity unit within TennCare manages and guides the Bureau’s efforts pertaining to this Act.

Providers have the responsibility and opportunity to perform self-audits and report overpayments.  When applicable overpayments must be returned to TennCare within 60 days from the date the overpayment is identified.  Overpayments that are not returned within 60 days from the
date the overpayment was identified can trigger a liability under the False Claims Act.
For more information, please see the Program Integrity page within the TennCare website at: http://www.tn.gov/tenncare/programintegrity.shtml.

IDD Standards of Practice and Performance:  Paula Cushing, RD, LDN, regional dietitian with DIDD, served as Chair of a workgroup in the development and publication of the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for Registered Dietitians (RDs) in Intellectual and Developmental Disabilities (IDD) in the September 2012 issue of the Journal of the Academy of Nutrition and Dietetics.  The SOP and SOPP are guidelines for RDs in IDD that promote safe, effective, and efficient food and nutrition services, facilitate evidence-based practice, and serve as a professional evaluation resource.  The publication includes an overview of nutrition service provision that balances nutrition needs with individual desires, abilities, and supports to achieve quality of life for persons supported. 

SIS® Appeals:  Earlier this year, DIDD began implementation of the Supports Intensity Scale® (SIS®).  The SIS® represents a huge leap forward for the IDD field in the way it emphasizes supports rather than deficits.  Information for the SIS® is captured through an interview with the individual and at least two knowledgeable respondents.  Unlike the ICAP, the SIS® interview is conducted with all respondents together at one time.  Because the SIS® interview is time-intensive and integrates information from all respondents at once, it is vital that providers assure that staff members who are knowledgeable about the person’s support needs attend the scheduled SIS® interview.

We have been given very strict requirements for the interview process and data collection by the American Association of Intellectual and Developmental Disabilities (AAIDD), the publishers of the SIS®.  As a result, assessment procedures no longer allow for a phone interview with Ascend nor allow for submission of supplementary documents as we have done for the ICAP.  Assessors will clearly and transparently indicate scoring criteria and decisions for each item.  Consequently, scores from the SIS® will not be appealable.  If an individual experiences a significant change in condition, a request will need to be made for a new SIS® assessment.

Personal Outcome Measure:  This week’s Personal Outcome Measure focuses on People Live in Integrated Environments.  To have this outcome present, we should ensure people have the right to access the same environments as anyone else.  Integration increases exposure to, and acceptance of wide diversity in people.  Opportunities for building social capital are increased when people live within their community.  Organizations should ensure that environments where people spend time are determined by their preference and provide supports so that an array of options about where people work and live is available.  People's use of social capital should also be promoted.

Certification:  Congratulations to Dana Scott of the East accreditation team.  Ms. Scott has completed the process to be certified as inter rater reliable for Personal Outcome Measures.

clip3Person-Centered Practices in Action: This has been an exciting election year nationally and in Jane Tate’s local community.  Jane had never voted in the community, but wanted to this year.  However, a new law requiring voters to produce photo identification presented a slight problem.  Since Jane doesn’t drive, she needed to apply for an identification card.  The steps began in the process to obtain photo identification.  Jane’s mother located her birth certificate and Jane’s support team gathered other documents needed to prove her identity.  She arrived at the local driver’s license center with papers in hand to obtain her identification card.  Jane gave the center staff her documentation, sat for her photograph to be taken, and was handed her brand new photo identification card.

Jane participated in early voting and is pictured at the Greene County Election Commission Office with her new wallet and photo identification card in hand.  She proudly stood in line, signed her name to the voting documents, and cast her vote via electronic booth just like everyone else.