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DIDD Policies and Procedures

    Effective
Date
Summary
of
Revisions
P-003 Recoupment and Sanctions Policy (PDF) 10/06  
Human Resources
10.1.2 Background Checks For Department Of Intellectual And Developmental Disabilities Employees, Contract Workers And Volunteers (PDF, WORD) 10/22/13 WORD FILE
  Authorization For Release of Information (PDF, WORD) 10/22/13  
10.2.7 Title VI Compliance (PDF, WORD) 10/1/2012 WORD FILE
  Title VI Complaint Form (WORD )    
10.4.1 Internship Policy (PDF, WORD) 5/15/13 WORD FILE
  A Student Internship Application Form (PDF, WORD)    
  B Student Internship Program Plan (PDF, WORD)    
  C Student Internship Service Agreement (PDF, WORD)    
  D Student Internship Evaluation (PDF, WORD)    
Policy & Innovation
30.1.2 Policy Committee (PDF, WORD) 7/1/12 WORD FILE
30.1.6 Exemption Policy (PDF, WORD) 1/15/14 WORD FILE
  Exemption Request Form (PDF)    
Quality Management
70.1.1 Fiscal Accountability Review Policy (PDF, WORD) 8/3/12 WORD FILE
70.2.1 Reporting Fraud Waste and Abuse of Government Funds and Property (PDF, WORD) 8/3/12 WORD FILE
Program Operations
80.1.1 New Provider Application Policy 80.1.1 (PDF) 6/9/14 WORD FILE
  Credentialing Application for Dental Services Anesthesia (PDF)    
  Credentialing Application for Vision Services (PDF)    
  Disclosure from Entities (PDF)    
  Disclosure from Person (PDF)    
  New Provider Application for Support Coordination (PDF)    
  New Provider Initial Screening Questionnaire for LTA Support Coordination (PDF) Part 2 (PDF)    
  Provider App for Clinical and Ancillary Services (PDF)    
  Substitute W-9 Form (PDF)    
80.2.1 Abuse Neglect Prevention Committee (PDF, WORD) 8/3/12 WORD FILE
80.2.2 Abuse Registry Review Committee (PDF, WORD) 5/2/13 WORD FILE
80.2.3 Investigation Review Committee (PDF, WORD) 10/22/13 WORD FILE
  Request for Investigation Review Form (WORD)    
80.2.4 Abuse Registry Advisory Group (PDF) 6/13/14 WORD FILE
  Application for Removal from Abuse Registry (PDF)    
80.3.2 Level of Care Reevaluations Policy (PDF, WORD) 8/3/12 WORD FILE
  Guidelines LOC Reevaluations & Annual Reevaluation LOC (PDF, WORD)    
80.3.4 Authorization of Services (PDF, WORD) 3/15/13 WORD FILE
  ISP with Person Centered Prompts (WORD)    
  Annual ISP Review and Update Documentation (WORD)    
  ISC/CM Monthly Documentation Form (PDF)    
80.3.5 Continued Stay for Children Enrolled in Waiver Before Age Six (PDF, WORD) 8/3/12 WORD FILE
80.3.6 Amending the Initial Plan of Care Before Development of the ISP (PDF, WORD) 8/3/12 WORD FILE
  Amending the Initial Plan of Care Form (PDF, WORD)    
80.3.7 Requests for Emergency Service Authorization (PDF, WORD) 7/6/12 WORD FILE
  Request for Emergency Service Authorization form (PDF, WORD)    
80.3.8 Termination of Participant Direction of Waiver Services (PDF, WORD) 10/10/12 WORD FILE
80.3.10 Individual Rights and Responsibilities (PDF, WORD) 6/27/13 WORD FILE
  Acknowledgement of Intake Process and Individual Rights (WORD)    
80.3.11 Case Management Services While on DIDD Waiver Waiting List (PDF, WORD)

6/27/13

WORD FILE
  Case Manager Contact Log (WORD)    
  Wait List Status Change Form (WORD)    
  Wait List Status Change Letter (WORD)    
  New Case Manager Letter (WORD)    
  Certified Unable to Locate Letter (WORD)    
80.4.1 Program Participant Experience Surveys (PDF, WORD) 7/6/12 WORD FILE
80.4.2 Medicaid HCBS Waiver Personal Assistance Services (PDF, WORD) 10/10/12 WORD FILE
80.4.3 Personal Funds Management (PDF, WORD) 9/17/12 WORD FILE
80.4.4 Electronic Records and Signatures (PDF, WORD) 10/10/12 WORD FILE
80.4.6 Sanctions (PDF, WORD) 3/15/13 WORD FILE
  Examples of Violations (PDF, WORD)    
80.4.7 Community Transition Policy (PDF, WORD) 6/1/12 WORD FILE
  Community Transition Planning Form (PDF, WORD)    
  Community Transition Notify Form (PDF, WORD)    
80.4.8 Limited English Proficiency Policy (PDF, WORD) 10/1/12 WORD FILE
80.5.1 Establishment Funds (PDF, WORD) 10/1/12 WORD FILE
80.5.2 Housing Costs Subsidy (PDF, WORD) 4/15/14 WORD FILE
  Request for Housing Costs Subsidy Form (EXCEL) 4/15/14  
  Instructions for Request for Housing Costs Subsidy Form (PDF, WORD) 4/15/14  
80.5.3 Vehicle Protective Barrier Subsidy (PDF, WORD) 10/10/12 WORD FILE
  Vehicle Protective Barrier Subsidy Form (PDF, WORD)    
80.5.4 Transportation Cost Subsidy (PDF, WORD) 10/1/12 WORD FILE
  Transportation Subsidy Cost Form (WORD)    
80.5.5 Transition Allowance for Money Follows the Person (PDF) 6/30/14 WORD FILE
Health Services
90.1.1 Nursing Health Care Management (PDF, WORD) 3/23/12 WORD FILE
90.1.2 Death Review Policy (PDF, WORD) 3/23/12  
  Reportable Incident Forms
Reportable Incident Form Instructions and Definitions (PPT)
West Region (WORD)
Middle Region (WORD)
East Region (WORD)
   
  Death Review Attendance Form (PDF, WORD)    
  Notice of Death Form (PDF)    
  Initial Agency Death Review Form (PDF, WORD)    
  Links
End-of-Life Planning ResourcesTennessee Department of Health for Advance Directives, Physician Orders Scope of Treatment (POST),Do-Not-Resuscitate Orders (DNR's)
Last Passages
   
Intermediate Care Facilities for Individuals with Intellectual Disabilities
100.1.1 Protection From Harm (PDF, WORD) 9/1/13 WORD FILE
100.1.2 Governing Bodies in Public Intermediate Care Facilities for Individuals with Intellectual Disabilities (PDF, WORD) 11/15/13 WORD FILE
100.1.5 Personal Property (PDF, WORD) 7/6/12 WORD FILE
100.1.8 Individual Support Planning Process (PDF, WORD) 3/15/13 WORD FILE
  ISP with Person Centered Prompts Form (WORD)    
100.1.11 Trust Fund Accounts (PDF, WORD) 11/8/13  
100.1.15 Staff Development (PDF, WORD) 11/27/12 WORD FILE
100.1.16 Leave and Attendance (PDF, WORD) 11/27/12 WORD FILE
100.1.18 Complaint Resolution (PDF, WORD) 3/15/13 WORD FILE
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