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 DIDD, 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 Department of Intellectual and Developmental Disabilities (DIDD), 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.

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

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:


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


Questions, suggestions, comments? Contact us at

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

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:
  • If you have questions about the Enhanced Respiratory Care Program, Please contact us at: