Quality Assurance

The Quality Assurance section of the DIDD is responsible for surveying contracted community-based providers to determine quality of services provided and performance in regard to meeting DIDD requirements.  The types of providers surveyed include day and residential, independent support coordinator agencies and clinical service providers.

The survey instruments that are used have been developed by the DIDD in conjunction with TennCare, the federal Centers for Medicare and Medicaid Services (CMS) and other stakeholders and are based on a set of quality domains, outcomes and indicators that measure performance based on DIDD requirements. Generally providers are surveyed annually with the exception of independent clinical services providers who are surveyed every three years. Regional Quality Assurance surveyors conduct the surveys. Data is collected from the survey results and used to determine the level of quality across the service system. This data is also incorporated into the DIDD quality management reports for distribution to interested persons.

Quality Management survey instruments are revised annually prior to the beginning of each calendar year or when special circumstances create a need for revision.


All providers must have an ongoing self-assessment process.  Why is a self-assessment process critical to a provider’s success in the provision of services and supports?

A provider’s self-assessment ensures that an internal mechanism exists for ongoing review of the effectiveness of services provided.  Self-assessment allows a provider to identify systemic issues and initiate corrective actions.  The process also allows the provider to incorporate results of external monitoring reports into its self-assessment processes.  Each provider is responsible for completion of self-assessment activities and for evaluation of revision of self-assessment processes. 

To fulfill the requirement for a self-assessment process, a provider must include at least the following components in its self-assessment activities:

  • Review of all documentation regarding the implementation of a person’s plan and his or her progress toward meeting outcomes;
  • Review of trends related to persons supported and family satisfaction with services provided;
  • Review of incident trends, including those related to medication variances and errors and other health and safety factors;
  • Review of external monitoring reports for the previous twelve (12) month period;
  • Review of any sanctions imposed during the previous twelve (12) month period;
  • Review of personnel practices, including staff recruitment and hiring, staff training, staff retention and turnover;
  • Review of processes intended to ensure timely access to health-related interventions, such as health care appointments and follow-up activities;
  •  Review of policies to ensure continuing alignment with current DIDD requirements;
  • Application of the current DIDD QA survey tool to a sample of persons supported.

To fulfill the requirement for a self-assessment process, a provider may use the Council on quality and Leadership (CQL) Basic Assurances® Self-Assessment.

All providers must have an internal quality improvement plan.  What is the purpose of this plan?

The internal quality improvement plan picks up where the self-assessment ends.  This plan is the mechanism for addressing the issues identified during the self-assessment process.  The plan is to be focused on resolution of systemic issues at the provider level.  Systemic issues are those that affect or have the potential to affect a number of persons supported.  All provider staff should have access to the quality improvement plan.  The plan specifies how any necessary systemic improvements will be made through a process which includes:

  • Analysis of the cause of any serious issues and problems identified.  Serious issues and problems are those that impact multiple persons supported or those that have health and safety consequences requiring medical treatment of one or more person supported;
  • Development of observable and measurable quality outcomes related to resolving the causal factors;
  • Establishment of reasonable timeframes for implementation of quality initiatives;
  • Assignment of staff responsible for completion of actions and achievement of quality outcomes;
  • Modification of policies, procedures and/or the agency management plan (possibly including the quality improvement plan) to prevent recurrence of issues and problems that were resolved.

All day, residential, personal assistance and support coordination providers are required to have a management plan.  What is a management plan?

The management plan describes how the provider conducts business to ensure successful operation and compliance with applicable program requirements.  The plan describes how the provider implements policies and procedures to assure the health, safety and welfare of person using services.  The management plan includes:

  • The provider’s mission statement and philosophy of service delivery;
  • An organizational chart;
  • A description of service(s) offered by the provider;
  • Complaint resolution procedures for persons supported, family members and legal representatives;
  • Any policies that are required by DIDD;
  • For providers of transportation services or providers of services that include transportation as a component of the service, a description of the provider’s transportation system, including the person’s access to transportation, e.g., a description of how people will be provided adequate access to transportation for medical appointments and other activities that may be specified in the Individual Support Plan.

What are consultation surveys? 

For new agencies that have not yet been involved in a Quality Assurance survey, the regional QA survey team will conduct an initial consultation survey between 90 days and six months after service provision begins. Although this is considered an informal survey process, the provider must correct any serious health and safety issues identified during the consultation survey.  After the initial consultation survey, the provider with be added to the regular survey schedule.

What is the purpose of the entrance conference (initial meeting) for the quality assurance survey?

Surveys begin with a meeting between key provider staff and the survey team. During the initial meeting (sometimes called an entrance conference), participants will discuss the logistics of the survey. The provider may utilize the initial meeting to provide general information about the organization, including management and QI strategies that have been implemented since the last survey.  Following the initial meeting, survey activities begin.

What is purpose of the exit conference for the quality assurance survey?

The survey will conclude with an exit conference. During the exit conference, the survey team will review major findings and entertain questions from the provider staff about those findings.  Under some circumstances, the written survey report will be made available during the exit conference. When circumstances require further review of specific issues, the survey report will be issued when review is completed. A copy of the final report will be sent to the provider agency’s board chair or chief officer.

If a provider is dissatisfied or disagrees with the results of a quality assurance survey, what recourse is there for the provider?

Providers may request a review of findings cited during a survey and included in the written survey report. Review requests are submitted to the appropriate DIDD Regional Director of QA.

If the provider is dissatisfied with the results of the regional review, a second review may be initiated by submitting a written request to the DIDD Commissioner stating the reason a second level review is being requested. The Commissioner or designee will respond to the request as expeditiously as possible, in most cases, within 30 days. Response times will vary depending upon the number and complexity of issues presented with the review request.

All review requests must specify findings to be reviewed and must be accompanied by any documentation available to support requested changes in survey findings. For each step, the provider will have ten (10) days from the date of receiving the survey report or written notification of a determination to initiate or continue the review process.