Section 0465-01-02-.08 - VALUE-BASED RATE SETTING METHODOLOGY FOR SUPPORTED EMPLOYMENT-INDIVIDUAL EXPLORATION(1) Supported employment-individual exploration is paid for on an outcome basis.(2) The unit is a complete episode of the service as defined in the approved Section 1915(c) waiver application and includes all of the service required to deliver the expected outcome.(3) The outcome-based rate is calculated using the following factors:(a) Average cost of job coach hour of service (as described in 0465-01-02-.11(3)(a) ), including these component costs:1. DSP reimbursement rate;2. Employee-related expenses;4. Productivity assumptions; and(b) A value-based incentive of $4.30/hour above actual cost (rate model) to reward provision of services expected to result in the person identifying a goal of competitive integrated employment;(c) Average number of job coach hours required to complete service; and(d) Billable service adjustment for percentage of waiver participants that do not complete the service due to reasons beyond the purview of the provider's control.Tenn. Comp. R. & Regs. 0465-01-02-.08
Original rule filed December 12, 2013; effective March 12, 2014. Amendments filed October 7, 2019; effective 1/5/2020.Authority: T.C.A. §§ 4-3-2701, 4-3-2707, 4-4-103, 4-5-201, et seq., 4-5-208, et seq. and its applicable regulations concerning emergency rules, 33-1-201, 33-1-202, 33-1-203(1) and (6), 33-1-204, 33-1-301, 33-1-302, 33-1-302(a)(3) and (a)(4), 33-1-303, 33-1-303(3) and (11), 33-1-304, 33-1-305(1), and 33-1-309(d); Executive Order of the State of Tennessee No. 23, dated October 19, 1999; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; and the "Reimbursement Rate" for Medical Services under DIDD federal waiver(s) for provision of services as administered by TennCare.