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August 9, 2013

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August 9, 2013

This week's edition includes important information I want to share with you:

CMS Quality Initiative: Over the past two years, the Centers for Medicare and Medicaid Services (CMS) has worked with several national organizations to review and evaluate quality expectations for State waiver services. These expectations were established several years ago. In 2011, CMS convened a group that included representatives from the National Association of Medicaid Directors (NAMD), the National Association of State Directors of Developmental Disabilities Services (NASDDDS) and the National Association of States United for Aging and Disabilities (NASUAD), along with representatives from 10 states, including Tennessee. The mission of this group was to review the current waiver requirements for a Continuous Quality Improvement (CQI) System and make recommendations as to how the requirements might be changed for the future. During the two-year period, the group convened via conference call approximately once each month to review and evaluate State concerns that the established quality process was overly laborious, had omitted some important areas for measurement of performance and could be made more effective. A set of specific recommendations was formulated this past spring; CMS is proceeding to make changes in its expectations based on those recommendations. In the near future, CMS will provide the timeline for implementing these changes and the options states will have available to them to continue to improve their CQI systems.

Employment Network: As Tennessee continues with our advancement as a protege state for Employment First, Subject Matter Expert Nancy Gurney conducted a meeting on August 5 with Tennessee Community Organizations (TNCO). The purpose of the meeting was to discuss the Ticket to Work program and how becoming an Employment Network (EN) can provide a significant amount of revenue. Tennessee currently only has 19 Employment Networks. If your agency becomes an EN, you will be one of the few agencies within the state that can generate revenue by accepting tickets. The meeting was productive and several important factors were taken into consideration such as persons meeting Substantial Gainful Activity (SGA) and the amount of time a person needs to work to meet SGA. Another important topic centered on the Employment Network application process. Although it is lengthy, agencies will not have to spend much time on the application. Further, it contains a checklist with required information needed. If your agency is interested in becoming an Employment Network, please contact the DIDD State Director of Employment and Day Services at or (615) 532-6119.

An Ounce of Prevention: This week's topic on leases for persons receiving Supported Living services was addressed almost a year ago, but it impacts many providers and persons so it is worth repeating. The waiver definition for Supported Living begins with: "Supported Living shall mean a type of residential service having individualized services and supports that enable an enrollee to acquire, retain, or improve skills necessary to reside in a home that is under the control and responsibility of the enrollee."

Chapter 9.5.c of the Provider Manual specifies that: "Supported living services are provided in a home owned or leased by the service recipient." When a person leases his or her home, there are four important elements.

  • The lease is signed by the person or legal representative.
  • The lease amount does not exceed fair market value for similar property in the same general location.
  • The owner of a supported living home may not be an employee or board member employed or appointed by the supported living provider.
  • The lease agreement shall not exceed one (1) year unless specified in the ISP and in the best interests of the person supported for purposes of obtaining a home with accessibility modifications.

To review all requirements applicable to supported living leases, please refer to Chapter 9.5.d. of the Provider Manual.

The above requirements also apply for persons receiving medical residential services in a home licensed as a supportive living facility.

DIDD Training Update: Almost 200 agency bulk downloads of learners into Relias have been completed. The College of Direct Support (CDS) historical training records have started appearing in Relias and are listed in the transcript as External Courses with the score and completion date. The DIDD Office of Staff and Provider Development has received several inquiries they wish to address. Providers are also reminded to click here for recorded webinars and a list of Frequently Asked Questions (FAQs).

When learners cannot log into Relias, it is often due to an incorrect URL. Tennessee agencies in the hierarchy structure should login at while learners working at an agency with their own sub-portal have an agency specific URL with the agency name imbedded as part of the address. When a learner completes the course, but is unable to access the exam (receiving a message that the learner has to finish the course first), the learner needs to ensure all items in the course have been clicked, including all interactive screens to view videos or additional material before the course will mark as "completed" and release the test.

If a course freezes and the learner is unable to move past a certain page, at the bottom of the course window, there should be a button that says "View ADA/HTML Version." Clicking that button will disable the Flash content of the course which should allow the learner to click through all pages and complete the course. Additionally, compatibility is sometimes a problem using Internet Explorer 10 (IE 10). Please click here for a compatibility document explaining how to change computer settings in IE 10. Some compatibility can be fixed by clicking the icon that looks like a torn sheet of paper or by turning off the pop-up blocker. To avoid these problems, Internet Explorer can be removed as a server and other free browsers such as Google Chrome or Mozilla Firefox, may be downloaded for opening Relias.

Trainers have noted that when entering a new hire, the record would not save. If a required field (ex: date of hire) is missing, the system will display a red notice near the incomplete field and the box must be completed before the record will save. We hope this information is helpful to agency personnel as they continue to learn and navigate the Relias system.

Tennessee Government Executive Institute (TGEI): The Department of Human Resources (DOHR) provides oversight to maintain integrity of the overall distinct vision of leadership initiatives that individually and collectively serve the state's purposes. TGEI is a two-week executive institute that provides senior-level leaders in state government the opportunity for academic study and learning in executive responsibility and cross-agency networking designed to enhance the individual skills of senior leaders. Congratulations to Sherrie Artman, Human Resources Director and Linda Sain, Deputy Regional Director of the West Tennessee Regional Office (WTRO) on their selection to participate in this year's institute!

Human Resources Certification Achievement: Lisa Kent, HR Manager in Central Office, has attained Professional Human Resources (PHR) certification. The preparation for this certification, sponsored by the Society for Human Resource Management, is very strenuous and quite an achievement. Congratulations Lisa on this outstanding accomplishment!

Ovarian Cancer Walk: MillarRich is sponsoring their "Second Annual Elaine's Walk" on September 13 at Centennial Park-Events Shelter in honor of Elaine, who passed away from Ovarian Cancer in 2012. Elaine received services from MillarRich and is sorely missed by their entire team. For further details, please click here. The event is open to everyone.

Have a great weekend!