System Transformation

TennCare promotes person-centered principles, supported decision-making, inclusion, and self-advocacy within our long-term services and supports (LTSS) service delivery system. We call this work “System Transformation.”

TennCare continues to work alongside many stakeholders including Disability and Aging, other state agencies, health plans, providers, advocacy groups, people supported through LTSS programs, and family members to advance System Transformation initiatives, including:

  • Workforce Development
  • Money Follows the Person (MFP)
  • Value-Based Purchasing (which includes Nursing Facility QuILTSS and Enhanced Respiratory Care)

The infographic below illustrates the core values of System Transformation. We believe that our System Transformation efforts will help to achieve a broader culture transformation where people with disabilities are better supported to enjoy the rights, valued roles, and quality of life that other citizens are afforded. For greater insight into System Transformation, view the System and Culture Transformation Infographic.

Pillars of Transformation

LTSS Workforce Development

TennCare continues to support workforce development efforts to address workforce challenges for direct support professionals (DSPs) in Tennessee. These workforce development programs and partnerships are supported through collaboration with multiple partners including the Disability and Aging, Managed Care Organizations (MCOs), advocacy agencies, and other state departments. Workforce Development is the foundation for our Pillars of System Transformation. Find out more information below.

TennCare supports provider organizations achievement of a more stable and highly trained workforce over time. Please checkout the following resources for providers and/or stakeholders.

The goal of TN’s Quality Improvement in Long Term Services and Supports (QuILTSS) Workforce Initiative and Statewide Strategy is to:

  • Support provider organizations to see a more stable and highly trained workforce overtime
  • Support the direct care workforce through high-quality competency-based training, progressive certifications, professionalization, and creating additional career development opportunities.

To meet the goals, TN is focusing on

  • Continued Survey and Data Collection,
  • Offering Competency Based Training and Wage Incentives,
  • Supporting Organizations with recruitment and retention efforts, and
  • Evaluating Workforce Efforts.

Consistent with CMS's value-based programs, one of TN’s strategies is to provide financial incentives for implementing evidence-based best practices in workforce recruitment and retention, as well as financial incentives for specific workforce and quality of life outcomes.

  • TennCare produced a Tennessee-Specific Realistic Job Preview (RJP) and corresponding marketing materials. The RJP focuses on Employment and Community First services and supports. Additionally, there are five Public Service Announcements (PSAs) with aligned targeted marketing flyers based on target audiences identified by TN key stakeholders.
  • TennCare YouTube Page

TennCare partnered with the University of Minnesota and the MCOs to conduct the annual statewide survey about the caregiver and direct support workforce in Tennessee. The survey is a key component of a comprehensive workforce strategy. Data gathered from the surveys are informing ongoing discussions and efforts to improve the recruitment, selection, and retention of high-quality employees to enhance home and community-based services in Tennessee. More information including the QUILTSS Survey results for each year can be found by clicking link below.

https://tenncare.ici.umn.edu/

Tennessee LTSS Workforce Quality Improvement 2022 Survey Results Presentation

2023 data collection begins June 1, 2024. Survey Results Coming Soon.

  • TN Regional Workforce Development Community of Practices

To continue to support the ongoing development, implementation and evaluation of workforce strategies that improve workforce stability across the state of Tennessee at the organizational, regional and state levels.

  • Statewide Workforce Development Stakeholder Committee

From this committee, we are looking to glean insight into the current workforce development climate in Tennessee as well as increase the effectiveness and focus of strategies to address issues facing Tennessee provider agencies.

  • Provider Workforce Development Series

Providers are invited to join virtual quarterly workforce development workshops planned with providers in mind.

To learn more about any of these resources or be included in these meetings, please email LTSS.WorkforceDevelopment@tn.gov

TennCare supports the direct care workforce through high-quality competency-based training, progressive certifications, professionalization, and creating additional career development opportunities. This training is accessible through the following initiatives:

Leaders in Inclusive Services (LINCS) is a program for high-achieving university students and high school seniors in the state of Tennessee who are interested in impacting the lives of others, while preparing for a future in healthcare, human services, social services and more.

The following link is to a brochure for download that can be used as an example or customized to promote the LINCS program: Downloadable LINCS Trifold Brochure

The Tennessee Direct Support Professional Training and Apprenticeship Program is a competency-based, 12-course program that provides training to enhance the skills of direct support professionals (DSPs). The program's goals include advancing health equity in medically underserved communities by expanding the number of DSPs in these areas, enhancing the skills of current DSPs, and increasing the workforce by offering practical on-the-job training apprenticeships.

The National Alliance for Direct Support Professionals (NADSP) has launched The NADSP E-Badge Academy, which offers Direct Support Professionals (DSPs) and Frontline Supervisors (FLSs) the ability to earn national certification through stackable electronic badges. These badges demonstrate the knowledge, skills, and values that direct care professionals in Tennessee utilize every day.

National Alliance for Direct Support Professionals (NADSP) Metrics and Incentives:

Metrics

DSP Bonus and Training Time

Provider Incentive

DSP – 1 Certification

(15 total NADSP E-Badges, which include 50 hours of accredited education)

$500 bonus

$500 training time

$1,000 (reimbursed for training if needed)

$250 per DSP - 1

DSP – 2 Certification

(30 total NADSP E-Badges, which includes 100 hours of accredited education (50 hours of which were previously earned as DSP-I)

$1000 bonus

$500 training time

$500 per DSP - 2

DSP – 3 Certification (50 total NADSP E-Badges)

$1500 bonus

$150 training time

$750 per DSP - 3

FLS Certification 2 total NADSP E-Badges, which include 25 hours of accredited education)

$750 bonus

 

*approved by CMS

E-Badge Academy Information and Dashboard

Questions, suggestions, comments? Contact us at LTSS.WorkforceDevelopment@tn.gov

Money Follows the Person (MFP)

Money Follows the Person (MFP) is a federally funded grant awarded to TennCare with the purpose of assisting the state to transition people from qualified institutions (i.e., ICF/IID) to home and community based care, and to also assist the state to rebalance their long term care expenditures.

  • Financial Support for Transition: MFP pays for a participant’s care in the community. It also pays for other expenses that come when a person moves into a more independent situation. Based on participant’s needs, they may be eligible to receive more help. MFP may help with home modifications, short term rent assistance and security deposits, along with one-time setup costs for a new apartment.
  • Care Coordination: An MFP participant’s care plan depends on their needs. The care management team will help assess each person’s needs. They will assess what level of care will provide a safe transition to the community. They will also look at how many hours need to be covered in any given day.
  • Transition Support: A Transition Coordinator will work with MFP participant’s and the care team to help find a place to live. They will also help find service providers such as nurses, physical therapists, or home health aides in the community.
  • To be eligible for Money Follows the Person an individual must:
    • Be enrolled in Medicaid
    • Be 18 years of age or older
    • Reside in a qualified institution (i.e. Intermediate Care Facilities for Individuals with Intellectual Disabilities, Regional Mental Health Institute, or Nursing Home) for sixty (60) days
    • Have care needs that can be adequately met in a community setting
    • Transition to the community in the CHOICES program, Employment and Community First (ECF) CHOICES program, or other waiver Home and Community Based Services (HCBS).

Questions? Contact us at the LTSS Help Desk 1-877-224-0219

Aaron's Story

Growing up in the warm embrace of Memphis, Tennessee, Aaron, the youngest of six siblings, experienced the joys of childhood sports and video games. He attended the Kirby School in Special Education, overcoming early challenges to find happiness in his activities.

In his late teens, life took a challenging turn. His aggressive behavior resulted in Aaron’s hospitalization at the psychiatric unit of the Children’s Institute, diagnosed with Prader-Willi Syndrome (PWS) and cognitive deficits. Ultimately, Aaron moved to Prader-Willi Homes (PWH) at Hanson House in Wisconsin, where his diagnoses evolved to include Personality Change Secondary to Prader-Willi Syndrome, Intermittent Explosive Disorder, Conduct Disorder, and Mild Intellectual Developmental Disorder. Although he continued to experience aggressive episodes, these incidents gradually decreased.

A significant transition occurred for Aaron in 2023 when he moved to TrustPoint Hospital in Murfreesboro, TN. Aaron spent 10 months in the inpatient unit at TrustPoint. With support from BlueCare, Employment and Community First (ECF) CHOICES, the Money Follows the Person (MFP) program and his father, Aaron was able to return to living in the community with Reflection Care, marking a pivotal moment in his life.

Through Reflection Care’s Community Living Supports (CLS) program, Aaron has thrived. He has found his voice and confidence, and he is starting to advocate for his own needs and desires. He participates in the Special Olympics, enjoys walks with staff members, plays video games, and attends his day program, where he has made many friends. He walks at the gym every day and continues to be encouraged to get into shape for the Special Olympics, which will also lead to better health outcomes. He is even exploring employment opportunities, showcasing his growth and determination.

The staff at Reflection Care have worked tirelessly to create a safe and trusting environment, empowering Aaron to take charge of his life while ensuring his specific needs related to PWS are appropriately managed. Aaron’s behaviors are stable in this structured environment, where he is advancing his daily living skills and receiving support to maintain a healthy lifestyle.

One of Aaron’s most significant opportunities has been his involvement with The ARC Tennessee, using the LifeCourse Exploring Decision-Making Support tool available to Aaron as an MFP participant. This experience has taught Aaron the importance of making decisions for himself. With his team’s support, he now confidently communicates his goals and plans for the future, standing up for himself and others.

Aaron’s journey is a powerful lesson in resilience and the transformative power of compassionate support. His life has undergone remarkable changes, and he continues to inspire those around him with his courage and determination.

Tiffany's Story

In Tennessee, the "Money Follows the Person" (MFP) demonstration is designed to support individuals transitioning from institutional settings to community-based settings, emphasizing independence and quality of life. Below is one member’s story of how they utilized the MFP funding.

Following a four-month long hospital stay, Tiffany McCauley, age 24, found herself at a crossroads. She had limited family support and few community resources to rely on to help her. She faced the challenge of starting over without an income or adequate support for rent, household items, or food.

Using MFP funding, Tiffany was able to transition to a Community Living Support- Family Model (CLS-FM) residence. Although the transition to her new living situation was challenging, the MFP funding and resources provided the crucial support she needed. Tiffany received assistance with essential items for her new home, including food and hygiene products. This support was instrumental in helping her settle in and begin anew. The program’s support allowed Tiffany to focus on her personal goals and embrace her independence. Tiffany explains, “I now have access to what I need in my life, and I’m able to work on achieving the goals that are important to me.” Her advice to others considering a big transition like hers is to stay positive and recognize the value of the resources available. “It will help you restart your life and stay on track.”

Tiffany’s story showcases her courage and the profound impact of supportive care. Her growth and independence continue to inspire those around her.

Value Based Purchasing

Value Based Purchasing is the effort to link systems of payment to a value-based system in order to improve the quality of care provided.

  • The TennCare QuILTSS Initiative (Quality Improvement in Long-Term Services and Supports) includes outcomes-based reimbursement for services such as Nursing Facility Care and Enhanced Respiratory Care provided in nursing facilities.
  • The Nursing Facility QuILTSS program is a voluntary program open to nursing facilities that provide services to TennCare Members. This program evaluates facilities based on clinical outcomes, satisfaction, member family satisfaction, alongside several other quality related measures.
  • The Enhanced Respiratory Care program permits participating nursing facilities to report the clinical measures of residents that require ventilator or tracheotomy management.

Enhanced Respiratory Care services in nursing facilities are reimbursed using a system that measures quality outcomes to adjust rates based on the facility’s performance on key performance indicators.

  • If you have questions about the Nursing Facility QuILTSS program, please contact us at: QUI.LTSS@tn.gov
  • If you have questions about the Enhanced Respiratory Care Program, Please contact us at: ERC.LTSS@tn.gov