These videos give an overview of the various Home and Community-Based Services (HCBS) available in Tennessee for providers who want to learn how to start or operate an HCBS agency in the state. Each video explains the purpose of the service, provider requirements, licensing process, and how the program functions. Use these videos to better understand the responsibilities, standards, and steps involved in becoming or working with approved HCBS providers in Tennessee. Explore each section to find the service that best matches your goals or area of interest.
Respite Care
RESPITE CARE SERVICES PROVIDER IN TENNESSEE
OFFERING TEMPORARY, COMPASSIONATE RELIEF TO CAREGIVERS WHILE SUPPORTING INDIVIDUALS WITH DISABILITIES AND MEDICAL NEEDS
Respite Care Services in Tennessee provide short-term, substitute caregiving to individuals with disabilities or complex medical needs, allowing family caregivers to rest, attend to other responsibilities, or prevent burnout. These services are available under the Employment and Community First (ECF) CHOICES, 1915(c) Waivers, and certain State Plan Medicaid programs, supporting both in-home and facility-based care.
1. GOVERNING AGENCIES
Agency: Tennessee Division of TennCare
Role: Administers Medicaid waivers including ECF CHOICES and oversees respite care as a reimbursable service.
Agency: Department of Intellectual and Developmental Disabilities (DIDD)
Role: Certifies and monitors providers offering respite to individuals with intellectual and developmental disabilities (I/DD).
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Regulates federal standards for HCBS waiver services including temporary care and caregiver relief models.
2. RESPITE CARE SERVICES OVERVIEW
Respite Care offers temporary relief to primary caregivers by providing direct care to individuals in their home, in a licensed facility, or at a provider-operated location.
Covered services include:
In-Home Respite: Provided in the individual’s home by trained staff
Out-of-Home Respite: Delivered in licensed homes or facilities
Emergency Respite: For unexpected caregiver emergencies or crises
Planned Respite: Scheduled in advance to support family well-being
Supervision & Personal Assistance: Help with bathing, toileting, meals, and mobility
Documentation & Reporting: Shift logs, incident reports, and health monitoring
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register business with the Tennessee Secretary of State
Obtain EIN and Type 2 NPI
Apply through TennCare and DIDD to provide Respite Care under HCBS waivers
If offering out-of-home respite, acquire a DIDD residential license
Comply with safety, training, and staff ratio requirements
Develop a Respite Care Services Policy & Procedure Manual
4. TENNESSEE PROVIDER ENROLLMENT PROCESS
Step 1: Register business and obtain EIN/NPI
Step 2: Apply to become a Respite Care provider via TennCare or DIDD, depending on the waiver
Step 3: Submit staff qualifications, training records, and policies
Step 4: If out-of-home care, complete licensing of the facility or group setting
Step 5: Pass compliance checks and begin receiving referrals through the participant’s care team
5. REQUIRED DOCUMENTATION
Articles of Incorporation, EIN, NPI
Proof of insurance (liability, workers’ comp)
Staff background checks and training certifications
Respite Care Policy & Procedure Manual including:
Intake and caregiver relief scheduling process
Emergency response and crisis support protocols
Participant supervision logs and health monitoring
Medication assistance (if applicable)
Abuse prevention, HIPAA compliance, and participant rights documentation
Billing templates for waiver reimbursement
6. STAFFING REQUIREMENTS
Role: Respite Care Worker / Direct Support Professional (DSP)
Requirements: High school diploma/GED, CPR/First Aid, abuse prevention training, clean background
Role: Program Supervisor / Respite Coordinator
Requirements: Experience in disability support or healthcare coordination
All staff must complete:
Person-centered planning and ISP training
HIPAA and privacy standards
Documentation and billing procedures
Emergency and safety protocol drills
HCBS compliance education (via DIDD or TennCare)
7. MEDICAID WAIVER PROGRAMS
Respite services are available through:
ECF CHOICES – For individuals with intellectual and developmental disabilities
1915(c) Waivers – For children and adults with I/DD and other support needs
State Plan EPSDT (for children under 21) – May include medically necessary respite when ordered by a physician
Tennessee Family Support Program – Non-Medicaid-funded respite for individuals with developmental disabilities (via DIDD)
8. TIMELINE TO LAUNCH
Phase: Business Formation & Licensing
Timeline: 1–2 months
Phase: TennCare/DIDD Enrollment & Documentation Submission
Timeline: 2–3 months
Phase: Staff Recruitment & HCBS Training
Timeline: 30–60 days
Phase: Begin Respite Care Delivery
Timeline: Upon provider approval and service authorization
9. CONTACT INFORMATION
TennCare (Tennessee Medicaid Program)
Website: https://www.tn.gov/tenncare
Tennessee Department of Intellectual and Developmental Disabilities (DIDD)
Website: https://www.tn.gov/didd
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TN RESPITE CARE PROVIDER
WCG supports professionals, DSP agencies, and family-focused organizations in launching or expanding high-quality respite services across Tennessee's Medicaid waiver ecosystem.
Scope of Work:
TennCare and DIDD enrollment for Respite Services
Policy & Procedure Manual tailored for in-home or out-of-home respite
Staff orientation forms, checklists, and compliance logs
Shift documentation, incident reports, and scheduling templates
HCBS Final Settings Rule guidance for residential respite
Family engagement tools and participant safety plans
Residential Habilitation
RESIDENTIAL HABILITATION SERVICES PROVIDER IN TENNESSEE
DELIVERING 24-HOUR SUPPORT AND LIFE SKILLS TRAINING TO EMPOWER INDEPENDENT LIVING FOR INDIVIDUALS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES
Residential Habilitation Services in Tennessee are part of the Employment and Community First (ECF) CHOICES and 1915(c) Waiver Programs, designed for individuals with intellectual and developmental disabilities (I/DD). These services provide round-the-clock assistance in licensed homes or supported apartments and help participants acquire daily living skills, achieve personal goals, and fully engage in their communities.
1. GOVERNING AGENCIES
Agency: Tennessee Division of TennCare
Role: Administers the Medicaid program and oversees waiver services, including Residential Habilitation under ECF CHOICES and 1915(c) waivers.
Agency: Department of Intellectual and Developmental Disabilities (DIDD)
Role: Licenses, certifies, and monitors providers delivering services to individuals with I/DD.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Sets federal HCBS waiver requirements for Residential Habilitation.
2. RESIDENTIAL HABILITATION SERVICES OVERVIEW
Residential Habilitation provides 24/7 supervised care in small group homes or individual living settings. The goal is to maximize independence through consistent support and hands-on skill development.
Services include:
Daily Living Support: Bathing, grooming, cooking, toileting, dressing
Household Management: Budgeting, cleaning, laundry, safety
Community Integration: Attending events, volunteer work, shopping
Medication Administration and Health Monitoring
ISP Implementation: Direct support aligned with the person-centered plan
Behavior Support Implementation (if applicable)
Skill Development in Communication, Socialization, and Self-Advocacy
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Tennessee Secretary of State
Obtain EIN and Type 2 NPI
Apply through DIDD Provider Enrollment and TennCare CHOICES
Secure DIDD Residential License for each home
Ensure compliance with the HCBS Final Settings Rule
Maintain liability insurance and workers’ compensation
Develop a Residential Habilitation Policy & Procedure Manual
4. TENNESSEE PROVIDER ENROLLMENT PROCESS
Step 1: Form business entity and acquire EIN/NPI
Step 2: Apply to DIDD and TennCare as a Residential Habilitation provider
Step 3: Undergo DIDD site inspection and staffing review
Step 4: Submit policy manuals, emergency plans, and staff training records
Step 5: Obtain license for each home and receive participant referrals
5. REQUIRED DOCUMENTATION
Articles of Incorporation, EIN, NPI
DIDD Residential Home Licenses
Staff background checks, CPR/First Aid, training certifications
Policy & Procedure Manual including:
ISP implementation protocols
Medication and health documentation logs
Emergency response and fire safety plans
Participant rights, privacy, and behavioral safeguards
HCBS settings compliance measures
Progress tracking and documentation forms
6. STAFFING REQUIREMENTS
Role: Direct Support Professional (DSP)
Requirements: High school diploma or GED, clean background, CPR/First Aid, HCBS training
Role: Residential House Manager
Requirements: Supervisory experience, knowledge of HCBS regulations
Role: Nurse (if required)
Requirements: Licensed RN or LPN for delegated medical tasks or high-needs clients
All staff must complete:
DIDD Core Training Modules
Person-Centered Planning and ISP Implementation
Behavior Support and Incident Reporting
Infection Control and Emergency Procedures
HCBS Settings Rule Training
7. MEDICAID WAIVER PROGRAMS
Residential Habilitation Services are offered through:
Employment and Community First (ECF) CHOICES
1915(c) Waivers (Statewide and Legacy programs)
State Plan Medicaid (for select nursing services within the home)
8. TIMELINE TO LAUNCH
Phase: Business Formation & NPI Registration
Timeline: 1–2 months
Phase: Provider Enrollment & Site Licensure (DIDD)
Timeline: 3–4 months
Phase: Staff Recruitment & Training
Timeline: 30–60 days
Phase: Participant Admission & Service Delivery
Timeline: Begins after license approval and ISP authorization
9. CONTACT INFORMATION
TennCare (Tennessee Medicaid Program)
Website: https://www.tn.gov/tenncare
Tennessee Department of Intellectual and Developmental Disabilities (DIDD)
Website: https://www.tn.gov/didd
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TN RESIDENTIAL HABILITATION PROVIDER
WCG partners with providers across Tennessee to develop fully licensed, person-centered residential support programs that meet HCBS standards and serve individuals with intellectual and developmental disabilities.
Scope of Work:
Business formation and DIDD licensing
Residential Habilitation Policy Manual development
Staffing plan templates and onboarding guides
Participant daily routines, emergency drills, and shift documentation
ISP implementation tracking and billing documentation
HCBS settings compliance and site readiness walkthroughs
Intermittent Employment
INTERMITTENT EMPLOYMENT SERVICES PROVIDER IN TENNESSEE
EMPOWERING INDIVIDUALS WITH DISABILITIES THROUGH FLEXIBLE, PERSON-CENTERED SUPPORT TO GAIN AND MAINTAIN EMPLOYMENT IN THE COMMUNITY
Intermittent Employment Services in Tennessee support individuals with intellectual and developmental disabilities (I/DD) who have obtained a job or are participating in employment training but require on-call or occasional assistance to remain successful in competitive or supported employment. These services are authorized under TennCare’s Employment and Community First (ECF) CHOICES Waiver and certain 1915(c) Waivers.
1. GOVERNING AGENCIES
Agency: TennCare (Tennessee Medicaid)
Role: Funds and regulates waiver-based employment services and ensures they are aligned with person-centered goals.
Agency: Department of Intellectual and Developmental Disabilities (DIDD)
Role: Approves providers, monitors service quality, and oversees compliance with employment-related service standards.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Establishes federal guidelines for employment supports within Medicaid Home and Community-Based Services (HCBS) waivers.
2. INTERMITTENT EMPLOYMENT SERVICES OVERVIEW
Intermittent Employment Services are flexible supports provided to individuals who do not need daily job coaching but may require assistance occasionally to maintain employment success.
Supports may include:
On-call job coaching during schedule changes, new tasks, or workplace conflicts
Intermittent travel training or assistance with transportation coordination
Employer communication support (problem-solving, accommodations, advocacy)
Coaching on time management, workplace safety, or customer service as needed
Troubleshooting performance issues or transitions in job duties
Coordination with Vocational Rehabilitation, Supported Employment, and the ISP team
These services must be linked to a specific employment outcome and documented in the Individual Support Plan (ISP).
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register business with the Tennessee Secretary of State
Obtain EIN and Type 2 NPI
Apply to become an approved provider with DIDD under Employment Services
Maintain liability insurance and data privacy compliance
Develop a Policy & Procedure Manual for Employment Services, including intermittent support documentation standards
4. TENNESSEE PROVIDER ENROLLMENT PROCESS
Step 1: Register business entity and secure EIN/NPI
Step 2: Apply for provider enrollment with DIDD under ECF CHOICES
Step 3: Submit staffing qualifications, documentation systems, and incident response plan
Step 4: Complete required DIDD and employment support training
Step 5: Begin accepting referrals once participant ISPs include employment goals requiring intermittent supports
5. REQUIRED DOCUMENTATION
Articles of Incorporation, EIN, NPI
Insurance coverage and staff background checks
Employment Services Policy & Procedure Manual including:
Job coaching protocols and engagement criteria
ISP collaboration and employment goal alignment
Support documentation forms (intermittent log sheets, contact notes)
Employer coordination procedures and workplace confidentiality
Incident and progress reporting policies
Service utilization tracking and outcome documentation
6. STAFFING REQUIREMENTS
Role: Employment Support Professional / Job Coach
Requirements: HS diploma or higher; prior experience in vocational support, soft skills coaching, or workforce development; abuse prevention training
Role: Employment Program Coordinator (optional)
Requirements: Experience managing waiver-based employment services; coordinates with ISP teams and employers
All staff must complete:
DIDD Employment Services Training
Person-Centered Planning and HCBS documentation
HIPAA, workplace etiquette, and abuse prevention
Employer engagement and advocacy skills
Safety and emergency protocols related to job sites
7. MEDICAID WAIVER PROGRAMS
Intermittent Employment Services are covered under:
ECF CHOICES – For individuals actively employed or preparing for employment who need non-continuous support
1915(c) Waivers (Comprehensive or SD) – For individuals requiring job retention or minimal support to maintain employment
Katie Beckett (in rare cases) – When employment is a goal in the transition from youth to adult services
8. TIMELINE TO LAUNCH
Phase: Business Registration & Policy Manual Development
Timeline: 1–2 months
Phase: DIDD Enrollment & Training Completion
Timeline: 2–3 months
Phase: Staff Recruitment & Documentation Setup
Timeline: 30–60 days
Phase: Participant Assignment & Service Activation
Timeline: Begins once ISP approval is secured and intermittent support is authorized
9. CONTACT INFORMATION
Tennessee Department of Intellectual and Developmental Disabilities (DIDD)
Website: https://www.tn.gov/didd
TennCare (Tennessee Medicaid Program)
Website: https://www.tn.gov/tenncare
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TN INTERMITTENT EMPLOYMENT SERVICES PROVIDER
WCG assists job coaches, vocational agencies, and employment programs in becoming approved TennCare providers for intermittent job support.
Scope of Work:
DIDD provider enrollment guidance
Employment Services Policy Manual and ISP alignment tools
Intermittent service tracking logs and contact documentation
Employer communication guides and support request templates
Billing readiness checklist and outcome documentation resources
Staff onboarding packet and waiver documentation workflow
Non-Residential Homebound
NON-RESIDENTIAL HOMEBOUND SERVICES PROVIDER IN TENNESSEE
DELIVERING IN-HOME PERSONALIZED SUPPORT FOR INDIVIDUALS UNABLE TO PARTICIPATE IN COMMUNITY OR DAY PROGRAMS
Non-Residential Homebound Services in Tennessee provide individualized care and life skills support to people with disabilities or complex medical needs who are unable to safely or consistently participate in community-based or congregate settings. This service is typically available through the Employment and Community First (ECF) CHOICES Program, particularly under benefit groups that allow for alternative day service delivery models in the home.
1. GOVERNING AGENCIES
Agency: TennCare (Tennessee’s Medicaid Agency)
Role: Oversees the ECF CHOICES program and authorizes services like Community-Based Day Services or their in-home alternatives for homebound individuals.
Agency: Tennessee Department of Intellectual and Developmental Disabilities (DIDD)
Role: Regulates provider qualifications and ensures services for individuals with I/DD meet person-centered and HCBS standards.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Provides federal oversight of Medicaid-funded in-home habilitative services and waiver flexibility.
2. NON-RESIDENTIAL HOMEBOUND SERVICES OVERVIEW
These services offer meaningful daytime support and engagement for individuals who cannot attend traditional day programs due to health, behavioral, or mobility-related barriers.
Core activities may include:
Skill-Building at Home: Personal hygiene, cooking, household management, communication
Habilitation & Cognitive Development: Memory games, routine planning, therapeutic exercises
Remote or In-Home Community Engagement: Music, reading, virtual socialization, or adapted outdoor activities
Health & Wellness Routines: Medication reminders, stretching, walking with support
ISP Implementation: Delivery of goal-based interventions from the individual’s person-centered plan
Documentation of Progress and Daily Activity Logs
These services must be individualized, habilitative, and not duplicative of other services like Personal Assistance or Respite.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Tennessee Secretary of State
Obtain EIN and Type 2 NPI
Apply to TennCare and DIDD as an ECF CHOICES Community-Based Day Service Provider
Clearly indicate your ability to serve homebound individuals in service descriptions
Develop a Non-Residential Homebound Services Policy & Procedure Manual
4. TENNESSEE PROVIDER ENROLLMENT PROCESS
Step 1: Form legal business entity and secure EIN/NPI
Step 2: Apply for enrollment via DIDD and TennCare as a Community-Based Day Services provider
Step 3: Submit a service description outlining your approach to in-home habilitation
Step 4: Provide staff training records and documentation tools
Step 5: Receive referrals for eligible homebound participants through managed care organizations
5. REQUIRED DOCUMENTATION
Articles of Incorporation, EIN, and NPI
Liability and workers’ comp insurance
Staff resumes, background checks, and training certifications
Policy & Procedure Manual including:
In-home habilitation session plans
Participant supervision and engagement strategies
Health and safety protocols for home environments
Documentation templates (daily logs, ISP goal progress, activity summaries)
Person-centered delivery approach
Emergency protocols and risk mitigation plans
6. STAFFING REQUIREMENTS
Role: Direct Support Professional (DSP)
Requirements: High school diploma/GED, CPR/First Aid, background clearance, experience with home-based care
Role: Habilitation Coordinator (optional)
Requirements: Supervisory experience in person-centered planning and ISP delivery
All staff must complete:
Person-centered planning and documentation training
Infection control and home safety training
HIPAA and participant rights education
ISP-specific skill-building instruction
Emergency response for in-home settings
7. MEDICAID WAIVER PROGRAMS
Non-Residential Homebound Services are typically covered under:
ECF CHOICES (Benefit Groups 4, 5, 6, and 7) – For individuals with significant needs or who are medically fragile and cannot access traditional day services
1915(c) Waiver (limited or pilot use cases) – For persons with I/DD requiring in-home habilitation as part of their ISP
State Plan EPSDT (under 21) – May allow home-based habilitation as a medically necessary alternative to day programs
8. TIMELINE TO LAUNCH
Phase: Business Registration & Staffing
Timeline: 1–2 months
Phase: TennCare/DIDD Provider Enrollment
Timeline: 2–3 months
Phase: Staff Training & Policy Manual Finalization
Timeline: 30–60 days
Phase: Service Initiation
Timeline: Begins after receiving authorization and participant referrals
9. CONTACT INFORMATION
TennCare (Tennessee Medicaid Program)
Website: https://www.tn.gov/tenncare
Tennessee Department of Intellectual and Developmental Disabilities (DIDD)
Website: https://www.tn.gov/didd
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TN NON-RESIDENTIAL HOMEBOUND PROVIDER
WCG helps providers design, enroll, and implement high-quality home-based habilitation services for participants unable to attend community programs across Tennessee.
Scope of Work:
Provider enrollment with TennCare and DIDD
Homebound-specific service description development
Policy & Procedure Manual creation for in-home habilitation
ISP goal tracking tools and daily documentation forms
Staff orientation modules for home-based service delivery
Risk mitigation, emergency protocols, and scheduling templates
Specialized Medical Equipment
SPECIALIZED MEDICAL EQUIPMENT SERVICES PROVIDER IN TENNESSEE
SUPPLYING CUSTOMIZED MEDICAL EQUIPMENT AND SUPPORTIVE TECHNOLOGIES TO PROMOTE HEALTH, MOBILITY, AND INDEPENDENCE
Specialized Medical Equipment (SME) Services in Tennessee provide individuals with disabilities or complex medical needs access to essential devices and assistive technologies that support daily functioning, health maintenance, and safety. These services are available under TennCare’s State Plan Medicaid, Employment and Community First (ECF) CHOICES, 1915(c) Waivers, and the Katie Beckett Program.
1. GOVERNING AGENCIES
Agency: TennCare (Tennessee Medicaid)
Role: Oversees State Plan Durable Medical Equipment (DME) and waiver-based Specialized Medical Equipment services.
Agency: Tennessee Department of Intellectual and Developmental Disabilities (DIDD)
Role: Monitors and certifies providers under 1915(c) and ECF CHOICES Waivers for SME delivery and training.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Establishes federal rules and medical necessity criteria for SME and DME coverage.
2. SPECIALIZED MEDICAL EQUIPMENT SERVICES OVERVIEW
Specialized Medical Equipment refers to medically necessary devices, adaptations, and equipment that:
Are not available through standard DME coverage
Improve functional capabilities, independence, or health outcomes
Are used in the home or community and not solely for recreation
Covered items may include:
Adaptive Seating and Wheelchairs
Portable Ramps or Lifts
Specialized Beds or Pressure-Relief Mattresses
Communication Devices (AAC)
Adaptive Utensils, Toileting Equipment, or Bath Aids
Medical Alert and Safety Monitoring Devices
Environmental Controls (e.g., voice-activated switches, remote lighting)
Custom Prosthetics or Orthotics (non-standard)
Services may also include delivery, setup, maintenance, and participant training.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Tennessee Secretary of State
Obtain EIN and Type 2 NPI
Apply to TennCare as a DME/SME provider OR enroll via DIDD for waiver programs
Secure a DME License (if dispensing medical devices under State Plan Medicaid)
Maintain insurance (liability, equipment coverage, workers’ comp)
Develop a Specialized Medical Equipment Policy & Procedure Manual
4. TENNESSEE PROVIDER ENROLLMENT PROCESS
Step 1: Form legal entity and acquire EIN/NPI
Step 2: Apply as a TennCare DME/SME Provider or DIDD-certified Waiver SME Provider
Step 3: Submit catalog of equipment, medical necessity criteria, and order procedures
Step 4: Verify delivery protocols and return/replacement policies
Step 5: Receive referrals based on ISP/physician orders and begin delivery
5. REQUIRED DOCUMENTATION
Articles of Incorporation, EIN, NPI
TennCare or DIDD provider approval
Product list and manufacturer certifications
SME Policy & Procedure Manual including:
Medical necessity review and documentation process
Delivery, setup, and participant training protocols
Maintenance and warranty tracking
Participant education and safe use materials
HIPAA compliance and incident response procedures
Billing templates and prior authorization forms
6. STAFFING REQUIREMENTS
Role: SME Delivery Technician
Requirements: Background check, product-specific training, CPR/First Aid recommended
Role: Equipment Specialist or ATP (Assistive Technology Professional)**
Requirements: ATP Certification or relevant clinical background (e.g., OT/PT) preferred for complex devices
Role: Program Coordinator or Billing Specialist
Requirements: Knowledge of TennCare claims and HCBS documentation
All staff must complete:
HIPAA and privacy training
Product-specific operation and safety protocols
Documentation and incident reporting procedures
Infection control (for equipment entering homes)
7. MEDICAID WAIVER PROGRAMS
Specialized Medical Equipment is available under:
TennCare State Plan (as Durable Medical Equipment) – For items meeting standard DME definitions with physician orders
ECF CHOICES (Group 4, 5, 6) – Includes SME as part of the Individual Support Plan
1915(c) Waivers – For children or adults with I/DD and specific assistive device needs
Katie Beckett Program – For medically complex children not eligible for Medicaid through income alone
EPSDT (under 21) – Covers medically necessary equipment for children under physician recommendation
8. TIMELINE TO LAUNCH
Phase: Business Registration & Licensing
Timeline: 1–2 months
Phase: TennCare/DIDD Enrollment & Product Documentation
Timeline: 2–3 months
Phase: Vendor Agreements & Staff Training
Timeline: 1–2 months
Phase: Begin Referrals & Equipment Delivery
Timeline: Upon approval and receipt of ISP/doctor’s orders
9. CONTACT INFORMATION
TennCare (Tennessee Medicaid Program)
Website: https://www.tn.gov/tenncare
Tennessee Department of Intellectual and Developmental Disabilities (DIDD)
Website: https://www.tn.gov/didd
Tennessee Department of Health – Health Licensure
Website: https://www.tn.gov/health
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TN SPECIALIZED MEDICAL EQUIPMENT PROVIDER
WCG helps equipment suppliers and assistive technology startups enroll with Medicaid and waivers to deliver meaningful, personalized SME services across Tennessee.
Scope of Work:
Provider enrollment through TennCare and DIDD
SME Policy Manual creation (equipment ordering, delivery, training)
Authorization templates and billing guidance
Maintenance logs, participant instruction handouts, and documentation tools
ATP credentialing assistance and vendor sourcing strategies
Compliance readiness and safety planning
Skilled Nursing
SKILLED NURSING SERVICES PROVIDER IN TENNESSEE
DELIVERING CLINICALLY NECESSARY CARE IN THE HOME OR COMMUNITY TO SUPPORT HEALTH, STABILITY, AND INDEPENDENCE
Skilled Nursing Services in Tennessee are medically necessary, licensed nursing services provided in a participant’s home or community setting. These services are authorized under TennCare’s State Plan Home Health Benefit, the Employment and Community First (ECF) CHOICES program, and certain 1915(c) Waivers for individuals with chronic conditions, disabilities, or complex medical needs. Services must be performed by a licensed nurse (RN or LPN) and are generally ordered by a physician or incorporated into a person-centered support plan.
1. GOVERNING AGENCIES
Agency: TennCare (Tennessee Medicaid)
Role: Administers Medicaid reimbursement for Skilled Nursing through the State Plan, ECF CHOICES, and other HCBS waiver programs.
Agency: Tennessee Department of Health (DOH)
Role: Licenses home health agencies and regulates nursing scope of practice.
Agency: Tennessee Department of Intellectual and Developmental Disabilities (DIDD)
Role: Oversees providers serving people with I/DD under waivers such as ECF CHOICES and legacy 1915(c) waivers.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Ensures compliance with federal Medicaid guidelines for Skilled Nursing Services.
2. SKILLED NURSING SERVICES OVERVIEW
These services must be medically necessary and provided by licensed professionals under a plan of care or Individualized Service Plan (ISP). Services are typically intermittent, though continuous nursing may be authorized in exceptional cases.
Covered services include:
Medication Administration (oral, injectable, IV)
Wound and Ostomy Care
Tube Feeding and Tracheostomy Suctioning
Vital Signs Monitoring and Chronic Disease Management
Catheter Care and Skin Integrity Monitoring
Health Assessments and Nursing Documentation
Coordination with Physician or Care Team
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Form a legal business entity with the Tennessee Secretary of State
Obtain EIN and Type 2 NPI
Apply through TennCare for Medicaid provider status
If providing under a home health model, obtain DOH Home Health Agency License
For waiver programs, register with DIDD as a Skilled Nursing provider
Maintain professional liability and general insurance
Develop a Skilled Nursing Services Policy & Procedure Manual
4. TENNESSEE PROVIDER ENROLLMENT PROCESS
Step 1: Form business and acquire EIN/NPI
Step 2: Apply to TennCare for State Plan Medicaid enrollment or to DIDD for waiver-based skilled nursing
Step 3: If applicable, obtain DOH license as a Home Health Agency
Step 4: Submit staffing rosters, credentials, and service descriptions
Step 5: Begin services after authorization and care plan approval
5. REQUIRED DOCUMENTATION
Articles of Incorporation, EIN, NPI
DOH Home Health License (if applicable)
RN/LPN licensure and current CPR/BLS certification
Skilled Nursing Services Policy Manual including:
Physician order process and care coordination
Medication administration protocols
Infection control and emergency procedures
Documentation and billing logs
Participant rights and HIPAA protections
Delegation (LPN) and supervision (RN) protocols
6. STAFFING REQUIREMENTS
Role: Registered Nurse (RN)
Requirements: Tennessee RN license, experience in home/community care, CPR/BLS certification
Role: Licensed Practical Nurse (LPN)
Requirements: Tennessee LPN license; must operate under RN supervision
Optional Role: Clinical Supervisor or Director of Nursing
Requirements: RN with administrative oversight of care planning and quality assurance
All clinical staff must complete:
HIPAA, infection control, and documentation training
Emergency and medication error protocols
Participant-specific orientation and plan of care review
Annual license verification and CEU tracking
7. MEDICAID WAIVER PROGRAMS & COVERAGE OPTIONS
Skilled Nursing is available under:
TennCare State Plan Home Health Services – For acute or chronic needs with physician orders
ECF CHOICES – Skilled nursing tasks may be part of a participant’s ISP
1915(c) Waivers – For children and adults with disabilities or complex care needs
EPSDT (under 21) – May authorize extended skilled care for medically fragile youth
Katie Beckett Program – For medically complex children not otherwise Medicaid-eligible
8. TIMELINE TO LAUNCH
Phase: Business Formation & Licensure (if applicable)
Timeline: 1–2 months
Phase: Medicaid/DIDD Enrollment
Timeline: 2–3 months
Phase: Nurse Credentialing & Compliance Documentation
Timeline: 1–2 months
Phase: Service Delivery Start
Timeline: Upon referral and care plan authorization
9. CONTACT INFORMATION
TennCare (Tennessee Medicaid Program)
Website: https://www.tn.gov/tenncare
Tennessee Department of Health (DOH)
Website: https://www.tn.gov/health
Tennessee Department of Intellectual and Developmental Disabilities (DIDD)
Website: https://www.tn.gov/didd
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TN SKILLED NURSING PROVIDER
WCG partners with nurses, home health entrepreneurs, and community providers to launch Medicaid-approved skilled nursing operations tailored for waiver and home health models.
Scope of Work:
TennCare and/or DIDD provider enrollment
Home Health Agency licensing support (if required)
Skilled Nursing Policy & Procedure Manual development
Clinical supervision setup, RN/LPN credentialing logs
Nursing visit documentation templates and medication administration forms
Plan of care tracking tools and Medicaid billing guides
Facility-Based Day Support
FACILITY-BASED DAY SUPPORT SERVICES PROVIDER IN TENNESSEE
DELIVERING STRUCTURED, SKILL-BUILDING, AND COMMUNITY-READY PROGRAMS FOR ADULTS WITH DISABILITIES IN LICENSED FACILITY SETTINGS
Facility-Based Day Support Services in Tennessee offer structured activities in licensed, non-residential settings to help adults with intellectual and developmental disabilities (I/DD) develop skills for greater independence, social interaction, and community inclusion. These services are primarily offered through 1915(c) Waivers, Employment and Community First (ECF) CHOICES, and other TennCare-supported programs for individuals with significant support needs.
1. GOVERNING AGENCIES
Agency: TennCare (Tennessee Medicaid)
Role: Manages reimbursement and service authorizations under State Plan and waiver-based programs.
Agency: Tennessee Department of Intellectual and Developmental Disabilities (DIDD)
Role: Licenses and certifies Facility-Based Day Support providers, monitors safety and compliance, and approves staffing models and program content.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Establishes federal Home and Community-Based Services (HCBS) settings requirements and quality standards.
2. FACILITY-BASED DAY SUPPORT SERVICES OVERVIEW
Facility-Based Day Services are designed to support individuals who may not yet be ready for integrated employment or full community participation. These services must be person-centered and promote:
Skill Development: Daily living skills, communication, self-care, problem-solving
Social Engagement: Peer interactions, teamwork, games, role-playing
Pre-Vocational Readiness: Sorting, assembling, following schedules or simple routines
Health & Wellness Activities: Light exercise, nutrition education, hygiene reminders
Community Preparation: Simulated activities like bus navigation, budgeting, and safety skills
All services must align with the participant’s Individual Support Plan (ISP) and be delivered in compliance with HCBS Final Settings Rule expectations.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register business with the Tennessee Secretary of State
Obtain EIN and Type 2 NPI
Secure licensure through DIDD as a Facility-Based Day Services provider
Ensure facility meets health, fire, safety, and accessibility codes
Obtain zoning approval and occupancy permit
Develop a Facility-Based Day Services Policy & Procedure Manual
4. TENNESSEE PROVIDER ENROLLMENT PROCESS
Step 1: Form legal entity and obtain EIN/NPI
Step 2: Apply for certification through DIDD Provider Enrollment Unit
Step 3: Submit facility layout, safety plan, staff credentials, and curriculum outline
Step 4: Pass DIDD facility inspection and policy manual review
Step 5: Receive referrals through ISP teams and begin service delivery
5. REQUIRED DOCUMENTATION
Business registration documents, EIN, and NPI
Proof of commercial general liability and workers’ comp insurance
Facility licensure documents and inspection approvals
Staff rosters, background checks, and training records
Facility-Based Day Services Policy & Procedure Manual including:
Daily activity and skill-building curriculum
Participant supervision and emergency procedures
Behavior support plan implementation
Staff-to-participant ratio guidelines
Documentation protocols for progress, attendance, and incident tracking
Infection control and abuse prevention plans
Transportation policies (if applicable)
6. STAFFING REQUIREMENTS
Role: Direct Support Professional (DSP)
Requirements: Background clearance, training in ISP implementation, CPR/First Aid
Role: Program Coordinator or Day Services Manager
Requirements: Experience in adult education or I/DD services, administrative oversight
Role: Behavior Specialist (if needed)
Requirements: Experience implementing Positive Behavior Supports
All staff must complete:
HCBS person-centered training
Documentation and data tracking instruction
Behavior management and de-escalation techniques
Safety and emergency drills
Ongoing in-service trainings and competency checks
7. MEDICAID WAIVER PROGRAMS
Facility-Based Day Support Services are authorized under:
1915(c) Statewide and Self-Determination Waivers – For adults with I/DD in structured habilitation settings
ECF CHOICES (certain benefit groups) – As a temporary or transitional day service
State-Funded Services via DIDD – If waiver capacity is full or pending
Katie Beckett or EPSDT (under rare conditions) – If deemed necessary and non-duplicative
8. TIMELINE TO LAUNCH
Phase: Business Formation & Facility Readiness
Timeline: 1–2 months
Phase: DIDD Enrollment & Facility Licensing
Timeline: 2–3 months
Phase: Staff Hiring & Policy Manual Development
Timeline: 30–60 days
Phase: Service Delivery Start
Timeline: After ISP team authorization and safety approval
9. CONTACT INFORMATION
Tennessee Department of Intellectual and Developmental Disabilities (DIDD)
Website: https://www.tn.gov/didd
TennCare (Tennessee Medicaid Program)
Website: https://www.tn.gov/tenncare
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TN FACILITY-BASED DAY SUPPORT PROVIDER
WCG equips providers with the tools and strategies needed to build structured, engaging, and compliant day programs for individuals with I/DD in Tennessee.
Scope of Work:
DIDD enrollment and facility setup consulting
Facility-Based Day Support Policy & Procedure Manual creation
Staff training packets and HCBS settings compliance tools
Curriculum samples for skill-building and community prep
Documentation templates (daily logs, ISP progress reports, attendance sheets)
Behavior support tracking tools and emergency preparedness plans
Adult Dental Services
ADULT DENTAL SERVICES PROVIDER IN TENNESSEE
PROMOTING ORAL HEALTH, FUNCTIONAL WELLNESS, AND QUALITY OF LIFE FOR TENNESSEE’S MEDICAID-ELIGIBLE ADULTS
Adult Dental Services in Tennessee offer critical preventive, diagnostic, and restorative oral health care to low-income adults through TennCare Medicaid, including enrollees in Employment and Community First (ECF) CHOICES, 1915(c) Waivers, and Katie Beckett programs. As of 2023, TennCare now covers routine and emergency dental care for most adult enrollees, expanding access and improving whole-person health outcomes.
1. GOVERNING AGENCIES
Agency: TennCare (Tennessee Medicaid)
Role: Oversees the adult dental benefit under State Plan Medicaid and waiver programs.
Agency: DentaQuest (TennCare Dental Benefits Administrator)
Role: Manages the TennCare dental provider network, claims processing, credentialing, and member education.
Agency: Tennessee Board of Dentistry (under the Department of Health)
Role: Licenses dentists and dental hygienists, regulates scope of practice, and ensures compliance with professional standards.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Approves State Plan amendments and oversees federal Medicaid program compliance.
2. ADULT DENTAL SERVICES OVERVIEW
Covered dental services for adults include both preventive and restorative care, as well as emergency and medically necessary procedures.
Typical covered services:
Preventive Care: Exams, x-rays, cleanings, fluoride
Restorative Services: Fillings, crowns, partial and full dentures
Periodontal Services: Scaling and root planing, deep cleanings
Oral Surgery: Extractions, infection drainage
Emergency Dental Care: Pain management, infection control
Dental Services for Waiver Participants: Related to safety, nutrition, or communication (e.g., dental appliances)
All services must be medically necessary, prescribed or approved by a licensed dentist, and meet TennCare or waiver-specific clinical coverage guidelines.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Dental practice must be registered with the TN Secretary of State
Active license from the Tennessee Board of Dentistry (for dentists and hygienists)
Register with DentaQuest as a participating TennCare dental provider
Obtain an NPI (Type 2 for organizations) and EIN
Maintain liability/malpractice insurance
Develop an Adult Dental Services Policy & Procedure Manual
4. TENNESSEE PROVIDER ENROLLMENT PROCESS
Step 1: Form dental entity or verify existing licensure and EIN/NPI
Step 2: Apply to DentaQuest via the TennCare Dental Provider Portal
Step 3: Complete credentialing (licensure, malpractice, DEA number, etc.)
Step 4: Enroll with TennCare if delivering waiver-specific services
Step 5: Begin accepting TennCare-covered adults and receive referrals
5. REQUIRED DOCUMENTATION
Business registration, EIN, NPI
Tennessee dental license, DEA registration, malpractice insurance
Credentialing documents for DentaQuest
Adult Dental Services Policy & Procedure Manual including:
Intake and treatment planning process
Emergency dental protocols and pain management
Infection control and OSHA procedures
Consent, privacy, and HIPAA compliance
TennCare billing templates and pre-authorization guides
Participant education and dental care maintenance tools
6. STAFFING REQUIREMENTS
Role: Dentist (DDS or DMD)
Requirements: Tennessee license, DEA registration, malpractice insurance
Role: Dental Hygienist
Requirements: Tennessee hygiene license, radiology certification if applicable
Role: Dental Assistant
Requirements: X-ray certification if taking radiographs, trained in OSHA and infection control
All staff must complete:
HIPAA and TennCare compliance training
Infection prevention and cross-contamination protocols
Emergency response drills
Documentation and claims submission procedures
7. MEDICAID WAIVER PROGRAMS
Adult Dental Services may be covered under:
TennCare Medicaid (State Plan) – Preventive and restorative services for most adults as of 2023
ECF CHOICES – Dental services to improve nutrition, communication, or general health
1915(c) Waivers – Based on ISP and individual needs (e.g., dentures to improve oral intake)
Katie Beckett Part B – May include dental supports tied to medically necessary interventions
EPSDT (under 21) – Offers full pediatric dental coverage
8. TIMELINE TO LAUNCH
Phase: Business Formation & Licensure
Timeline: 1–2 months
Phase: TennCare & DentaQuest Credentialing
Timeline: 2–3 months
Phase: Staff Training & System Setup
Timeline: 30–60 days
Phase: Accepting TennCare Adults & Billing
Timeline: Upon approval and patient scheduling
9. CONTACT INFORMATION
TennCare (Tennessee Medicaid Program)
Website: https://www.tn.gov/tenncare
Tennessee Board of Dentistry (Health Licensure)
Website: https://www.tn.gov/health/health-program-areas/health-professional-boards
DentaQuest (TennCare Dental Provider Portal)
Website: https://www.dentaquest.com
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TN ADULT DENTAL PROVIDER
WCG assists dental providers, mobile dental clinics, and multi-specialty clinics in enrolling with TennCare and designing dental care pathways for Medicaid and waiver-eligible adults.
Scope of Work:
DentaQuest credentialing and TennCare enrollment
Adult Dental Services Policy Manual development
Consent forms, SOAP note templates, and progress tracking logs
Dental billing support and authorization toolkits
Staff orientation on waiver service coordination and claims
Participant communication and preventive care education materials
Assistive Technology
ASSISTIVE TECHNOLOGY SERVICES PROVIDER IN TENNESSEE
ENABLING FUNCTIONAL INDEPENDENCE THROUGH CUSTOMIZED DEVICES, TRAINING, AND SUPPORT FOR INDIVIDUALS WITH DISABILITIES
Assistive Technology (AT) Services in Tennessee help individuals with disabilities gain or maintain functional independence through specialized devices, environmental modifications, and hands-on training. These services are available through TennCare’s State Plan, Employment and Community First (ECF) CHOICES, 1915(c) Waivers, and the Katie Beckett Program, and are often tied to functional goals in a participant’s Individual Support Plan (ISP).
1. GOVERNING AGENCIES
Agency: TennCare (Tennessee Medicaid)
Role: Oversees the authorization and reimbursement of AT services through State Plan Medicaid and waiver programs.
Agency: Tennessee Department of Intellectual and Developmental Disabilities (DIDD)
Role: Certifies AT service providers under ECF CHOICES and other Medicaid waivers.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Approves state waivers and sets federal standards for Medicaid-covered AT services.
2. ASSISTIVE TECHNOLOGY SERVICES OVERVIEW
AT services include assessment, acquisition, customization, delivery, setup, maintenance, and participant training for a wide range of supportive technologies. Services must be medically necessary, functionally appropriate, and tied to the participant’s ISP or plan of care.
Covered devices and supports may include:
Communication Devices (AACs)
Screen Readers, Voice-Activated Tech, or Switches
Smart Home Automation (lights, doors, alarms)
Adaptive Keyboards, Mice, and Computer Access Tools
Environmental Control Units (ECUs)
Mounting Systems and Device Holders
Mobility or Positioning Aids with Tech Components
Training in Use, Safety, and Troubleshooting of Devices
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Tennessee Secretary of State
Obtain EIN and Type 2 NPI
Apply to TennCare or DIDD for AT service provider enrollment
If providing physical devices, obtain appropriate vendor certification or partner with a DME supplier
Maintain liability and general insurance
Develop an Assistive Technology Policy & Procedure Manual
4. TENNESSEE PROVIDER ENROLLMENT PROCESS
Step 1: Form business and acquire EIN/NPI
Step 2: Apply to TennCare (for State Plan AT) or DIDD (for waiver-based AT)
Step 3: Submit AT assessment protocols, training tools, and inventory list (if applicable)
Step 4: Participate in ISP meetings and submit documentation of medical necessity
Step 5: Begin referrals, device procurement, delivery, and training services
5. REQUIRED DOCUMENTATION
Articles of Incorporation, EIN, NPI
Liability insurance certificate
Proof of AT training or vendor authorization
AT Policy & Procedure Manual including:
Assessment and recommendation protocols
Coordination with the participant's care team
Delivery, installation, and maintenance procedures
Participant instruction and caregiver training plans
Safety, risk management, and HIPAA compliance
Billing and warranty documentation templates
6. STAFFING REQUIREMENTS
Role: Assistive Technology Specialist
Requirements: Background in rehab, therapy, or special education; ATP certification preferred
Role: AT Trainer / Device Technician
Requirements: Hands-on experience with device setup and user training
Optional Role: Speech-Language Pathologist or Occupational Therapist
Purpose: To recommend and configure communication or sensory-based devices
All staff must complete:
HIPAA and person-centered planning training
ISP participation procedures
Documentation and progress tracking
Troubleshooting and safe use protocols
Equipment maintenance procedures
7. MEDICAID WAIVER PROGRAMS
AT services are available through:
ECF CHOICES – As part of a participant’s ISP to support communication, safety, and independence
1915(c) Waivers – When needed to achieve developmental or daily living goals
Katie Beckett Program – For children with medical complexity needing customized devices
EPSDT (under 21) – Covers medically necessary assistive tech when ordered by a doctor
State Plan DME – May include basic AT if deemed medically necessary and durable
8. TIMELINE TO LAUNCH
Phase: Business Registration & Credentialing
Timeline: 1–2 months
Phase: TennCare or DIDD Enrollment
Timeline: 2–3 months
Phase: Staff Training & Tool Development
Timeline: 30–60 days
Phase: Begin Service Delivery
Timeline: Once referrals and device authorizations are approved
9. CONTACT INFORMATION
TennCare (Tennessee Medicaid Program)
Website: https://www.tn.gov/tenncare
Tennessee Department of Intellectual and Developmental Disabilities (DIDD)
Website: https://www.tn.gov/didd
Tennessee Department of Health – Health Licensure
Website: https://www.tn.gov/health
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TN ASSISTIVE TECHNOLOGY PROVIDER
WCG supports entrepreneurs, disability-focused providers, and technology specialists in building AT service models aligned with Medicaid and waiver guidelines.
Scope of Work:
TennCare or DIDD provider enrollment support
AT Policy & Procedure Manual development
Assessment templates and documentation tools
Participant training forms and satisfaction tracking
Device tracking logs, maintenance checklists, and risk protocols
Guidance for coordinating with ISPs and interdisciplinary teams
Behavioral Health
BEHAVIORAL HEALTH SERVICES PROVIDER IN TENNESSEE
DELIVERING MENTAL HEALTH AND SUBSTANCE USE SUPPORT TO EMPOWER INDIVIDUALS THROUGH RECOVERY-ORIENTED, PERSON-CENTERED CARE
Behavioral Health Services in Tennessee provide therapeutic interventions and clinical support for individuals facing mental health conditions, behavioral challenges, and/or substance use disorders. These services are covered under TennCare (Medicaid), Employment and Community First (ECF) CHOICES, 1915(c) Waivers, and specialized programs such as Crisis Services and Children's Behavioral Health Safety Net.
1. GOVERNING AGENCIES
Agency: TennCare (Tennessee Medicaid)
Role: Manages behavioral health benefits, authorizations, and reimbursements through managed care organizations (MCOs).
Agency: Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS)
Role: Regulates community mental health providers, crisis response programs, and certifies providers of substance use treatment.
Agency: Department of Intellectual and Developmental Disabilities (DIDD)
Role: Coordinates behavioral services under HCBS waivers for individuals with I/DD.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Oversees Medicaid-funded behavioral health and waiver compliance standards.
2. BEHAVIORAL HEALTH SERVICES OVERVIEW
Behavioral Health services are provided in-home, in-clinic, or via telehealth and are tailored to each person’s needs, diagnosis, and functional goals. Covered services may include:
Diagnostic Assessments & Treatment Planning
Individual, Group, and Family Therapy
Behavioral Support & Functional Behavioral Assessments (FBA)
Psychiatric Services & Medication Management
Crisis Intervention & Stabilization
Substance Use Treatment & Recovery Support
Positive Behavior Support Plan (PBSP) Development
Skills Training, Peer Recovery Support, and Community Integration Counseling
All services must align with the participant’s Individual Support Plan (ISP) or treatment plan and meet medical necessity criteria.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register business with the TN Secretary of State
Obtain EIN and Type 2 NPI
Apply as a behavioral health provider through TennCare MCOs (e.g., Amerigroup, BlueCare, UnitedHealthcare)
If serving waiver participants, enroll through DIDD as a Behavioral Services provider
For substance use treatment, obtain licensure through TDMHSAS
Maintain liability and professional insurance
Develop a Behavioral Health Services Policy & Procedure Manual
4. TENNESSEE PROVIDER ENROLLMENT PROCESS
Step 1: Business registration and licensure (clinical/organizational)
Step 2: Enroll with one or more TennCare MCO networks
Step 3: Submit staff credentials, licensure, insurance, and service descriptions
Step 4: If serving individuals under DIDD waivers, complete DIDD Behavioral Services application and meet additional training standards
Step 5: Begin service delivery upon approval and referral
5. REQUIRED DOCUMENTATION
EIN, NPI, business license
Clinical licensure and credentials of staff
Liability insurance and malpractice coverage
Behavioral Health Services Policy & Procedure Manual including:
Clinical documentation standards
Crisis de-escalation and response protocols
PBSP implementation and staff training process
HIPAA, safety, and emergency planning
Consent forms, intake assessments, and progress note templates
Incident reporting and outcome tracking tools
6. STAFFING REQUIREMENTS
Role: Licensed Mental Health Professional (LPC, LCSW, LMFT, etc.)
Requirements: Active TN license, experience in Medicaid billing preferred
Role: Behavior Analyst / Behavior Support Specialist (for waiver programs)
Requirements: BCBA or master's-level behaviorist trained in PBSP and FBA
Role: Psychiatric Nurse Practitioner / Psychiatrist (if offering med mgmt)
Requirements: DEA number, prescriptive authority, psychiatric background
Role: Peer Recovery Specialist or Case Manager (optional)
Requirements: State certification for peer role or training in care coordination
All staff must complete:
HIPAA and person-centered care training
Trauma-informed care and crisis intervention training
ISP and PBSP implementation standards
TennCare documentation and billing protocols
7. MEDICAID WAIVER PROGRAMS
Behavioral Health Services are supported through:
TennCare State Plan – Mental health and substance use disorder services for Medicaid-eligible individuals
ECF CHOICES – Behavior services for individuals with I/DD (behavior support, PBSP)
1915(c) Waivers – Specialized behavior services as part of habilitation and safety planning
Children’s Behavioral Health Safety Net – For non-Medicaid children in crisis
School-based Behavioral Health – Through partnership with TDMHSAS and LEAs
8. TIMELINE TO LAUNCH
Phase: Business Formation & Licensure
Timeline: 1–2 months
Phase: TennCare MCO & DIDD Enrollment
Timeline: 2–3 months
Phase: Staff Credentialing & Compliance Setup
Timeline: 30–60 days
Phase: Start of Services
Timeline: Upon plan approval or referral receipt
9. CONTACT INFORMATION
TennCare (Tennessee Medicaid Program)
Website: https://www.tn.gov/tenncare
Tennessee Department of Mental Health & Substance Abuse Services (TDMHSAS)
Website: https://www.tn.gov/behavioral-health
Tennessee Department of Intellectual and Developmental Disabilities (DIDD)
Website: https://www.tn.gov/didd
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TN BEHAVIORAL HEALTH PROVIDER
WCG supports behavioral health clinics, solo practitioners, and interdisciplinary teams with entry into Tennessee’s Medicaid and waiver networks for integrated mental health support.
Scope of Work:
TennCare MCO and DIDD provider enrollment
Behavioral Health Policy Manual creation
Consent forms, clinical documentation templates, and PBSP tools
Crisis response protocols and staff training resources
Medicaid billing and authorization packet guidance
Outcomes tracking and satisfaction survey templates
Environmental Modification
ENVIRONMENTAL MODIFICATION SERVICES PROVIDER IN TENNESSEE
CREATING SAFE, ACCESSIBLE, AND FUNCTIONAL LIVING ENVIRONMENTS FOR INDIVIDUALS WITH PHYSICAL, MEDICAL, OR DEVELOPMENTAL NEEDS
Environmental Modification Services in Tennessee support individuals with disabilities or chronic health conditions by funding and implementing physical changes to their homes. These modifications help individuals remain safe, independent, and integrated within their communities. Covered under TennCare Waivers such as ECF CHOICES, 1915(c) Waivers, and the Katie Beckett Program, these services must be medically necessary and directly related to the individual’s functional limitations.
1. GOVERNING AGENCIES
Agency: TennCare (Tennessee Medicaid)
Role: Authorizes and reimburses Environmental Modifications as part of waiver programs.
Agency: Department of Intellectual and Developmental Disabilities (DIDD)
Role: Approves provider qualifications, ensures project alignment with the participant’s ISP, and monitors service delivery.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Provides federal regulatory guidance for waiver-covered home modifications.
2. ENVIRONMENTAL MODIFICATION SERVICES OVERVIEW
Environmental Modifications must support health, safety, or functional independence in the home. Projects are reviewed and authorized on a case-by-case basis and are subject to caps and scope limits.
Examples of allowable modifications include:
Ramps and Widened Doorways for wheelchair access
Roll-in Showers, Grab Bars, and Bathroom Renovations
Lowered Countertops or Accessible Sinks
Non-slip Flooring or Flooring Replacement
Stair Lifts or Vertical Platform Lifts (VPLs)
Smart Home Accessibility Devices (if tied to functional need)
Fencing (for safety when justified in ISP)
Fire Alarms with Visual or Vibration Alerts
Unallowable modifications typically include: general home repairs, remodeling not tied to function, or upgrades for aesthetics.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register business with the Tennessee Secretary of State
Obtain EIN and Type 2 NPI
Enroll with TennCare and/or DIDD as a Medicaid waiver provider under the Environmental Modification category
Maintain contractor licensure in Tennessee (e.g., Home Improvement or Residential Contractor license, if required for project type)
Carry general liability and workers’ compensation insurance
Develop an Environmental Modification Policy & Procedure Manual
4. TENNESSEE PROVIDER ENROLLMENT PROCESS
Step 1: Form business entity and acquire EIN/NPI
Step 2: Apply to DIDD or TennCare for enrollment as an Environmental Modification provider
Step 3: Submit required credentials, contractor licenses, insurance, and policies
Step 4: Participate in ISP meetings or home assessments with support coordinators
Step 5: Upon authorization, complete projects per Medicaid guidelines and submit for reimbursement
5. REQUIRED DOCUMENTATION
Articles of Incorporation, EIN, NPI
Proof of contractor licensure (if applicable)
Certificates of liability and workers’ comp insurance
Environmental Modification Services Policy & Procedure Manual including:
Scope of allowable projects
Pre- and post-installation inspection protocols
Participant rights, safety policies, and consent forms
Cost estimating and documentation procedures
Billing and reimbursement standards
Communication procedures with support coordinators and ISPs
6. STAFFING REQUIREMENTS
Role: Project Manager / Coordinator
Requirements: Construction or home modification experience, project oversight, Medicaid documentation knowledge
Role: Licensed Contractor / Installer
Requirements: State license or trade certification based on project (e.g., plumber, electrician)
Optional Role: Occupational Therapist (for assessments)
Requirements: State licensure; may assist in determining needs or recommending modifications
All staff must complete:
HIPAA and person-centered planning training
ISP coordination training
Safety, hazard assessment, and documentation standards
TennCare compliance procedures
7. MEDICAID WAIVER PROGRAMS
Environmental Modifications are covered under:
ECF CHOICES Waiver – Based on safety, accessibility, or independence needs
1915(c) Waivers – For adults with I/DD or medically fragile conditions
Katie Beckett Program – For children with complex needs requiring home adaptation
EPSDT (under 21) – When medically necessary and prescribed by a physician
8. TIMELINE TO LAUNCH
Phase: Business Registration & Credentialing
Timeline: 1–2 months
Phase: TennCare/DIDD Enrollment
Timeline: 2–3 months
Phase: Staff Hiring, Policy Manual Finalization
Timeline: 30–60 days
Phase: Service Start & Project Implementation
Timeline: Upon authorization and service plan inclusion
9. CONTACT INFORMATION
TennCare (Tennessee Medicaid Program)
Website: https://www.tn.gov/tenncare
Tennessee Department of Intellectual and Developmental Disabilities (DIDD)
Website: https://www.tn.gov/didd
Tennessee Board for Licensing Contractors
Website: https://www.tn.gov/commerce
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TN ENVIRONMENTAL MODIFICATION PROVIDER
WCG helps contractors, construction professionals, and community organizations become Medicaid-approved providers for home modifications supporting waiver participants.
Scope of Work:
TennCare and DIDD enrollment assistance
Contractor compliance checklist and licensure guidance
Environmental Modification Policy & Procedure Manual
Project bidding, invoicing, and documentation templates
Collaboration tools for ISP and support coordinators
Safety checklists, consent forms, and participant satisfaction tracking
Therapy Services
THERAPY SERVICES PROVIDER IN TENNESSEE
EMPOWERING INDIVIDUALS THROUGH OCCUPATIONAL, PHYSICAL, AND SPEECH THERAPIES DESIGNED TO PROMOTE FUNCTION, COMMUNICATION, AND INDEPENDENT LIVING
Therapy Services in Tennessee are critical components of care plans for individuals with developmental disabilities, chronic health conditions, or functional limitations. These services are covered under TennCare’s State Plan, Employment and Community First (ECF) CHOICES, 1915(c) Waivers, and the Katie Beckett Program, and must be provided by licensed professionals within their scope of practice.
1. GOVERNING AGENCIES
Agency: TennCare (Tennessee Medicaid)
Role: Manages therapy coverage through State Plan and waiver programs, including authorization and reimbursement.
Agency: Tennessee Department of Health (DOH)
Role: Licenses Physical Therapists (PT), Occupational Therapists (OT), and Speech-Language Pathologists (SLP) through its health licensure boards.
Agency: Department of Intellectual and Developmental Disabilities (DIDD)
Role: Coordinates provider certification and participant ISP implementation under 1915(c) and ECF CHOICES Waivers.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Establishes federal Medicaid coverage standards for therapy services.
2. THERAPY SERVICES OVERVIEW
Therapy services may be delivered in-home, in-clinic, or in community settings, depending on the individual’s need and plan of care.
Covered therapies include:
Occupational Therapy (OT)
Daily living skill training (e.g., dressing, grooming, toileting)
Fine motor development, sensory processing, adaptive equipment use
Physical Therapy (PT)
Mobility, balance, muscle strength, postural control
Adaptive movement and gait training
Speech-Language Pathology (SLP)
Verbal communication, feeding and swallowing, AAC device use
Social pragmatics and articulation development
Feeding & Swallowing Therapy
Often provided by SLPs with specific training
Supports safety, nutrition, and mealtime function
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register business with the TN Secretary of State (if billing as an agency)
Obtain EIN and Type 2 NPI
Ensure all therapists are individually licensed through the Tennessee Board of Health Licensure
Apply to TennCare as a Medicaid Therapy Services provider
Register with DIDD if delivering therapy under waiver programs
Maintain liability and malpractice insurance
Develop a Therapy Services Policy & Procedure Manual
4. TENNESSEE PROVIDER ENROLLMENT PROCESS
Step 1: Business registration and NPI acquisition (individual and group, if applicable)
Step 2: Apply to TennCare or MCOs as an OT, PT, or SLP provider
Step 3: Submit licensure verification and credentialing documents
Step 4: If serving waiver participants, enroll with DIDD and participate in ISP planning
Step 5: Begin delivering therapy upon authorization
5. REQUIRED DOCUMENTATION
Business entity documents, EIN, NPI
Licensure verification for each therapist
Proof of liability/malpractice insurance
Therapy Services Policy Manual including:
Documentation standards and progress notes
Session tracking and Medicaid billing logs
Treatment plan development and ISP coordination
Participant rights and confidentiality policies
Infection control and emergency procedures
Discharge planning and re-evaluation protocols
6. STAFFING REQUIREMENTS
Role: Occupational Therapist (OT)
Requirements: TN OT license, relevant experience, CPR/First Aid certification
Role: Physical Therapist (PT)
Requirements: TN PT license, experience with waiver populations, safety training
Role: Speech-Language Pathologist (SLP)
Requirements: TN SLP license, ASHA certification preferred
All therapists must complete:
TennCare/DIDD orientation if applicable
HIPAA and abuse prevention training
Documentation and goal tracking procedures
Plan of care implementation training
Emergency and safety protocols for home/community settings
7. MEDICAID WAIVER PROGRAMS
Therapy Services are authorized through:
TennCare State Plan – With physician orders, therapy may be provided for rehabilitation or habilitation
ECF CHOICES – Therapy can be built into an ISP to promote independence and skill development
1915(c) Waivers – Used for habilitative therapy for individuals with I/DD
Katie Beckett Program – Offers therapy for medically complex children
EPSDT (under 21) – Provides medically necessary therapy to children and adolescents with documented needs
8. TIMELINE TO LAUNCH
Phase: Business Registration & License Verification
Timeline: 1–2 months
Phase: TennCare Enrollment & Credentialing
Timeline: 2–3 months
Phase: DIDD Enrollment & Staff Orientation
Timeline: 30–60 days
Phase: Service Authorization & Start
Timeline: Upon plan approval and service referral
9. CONTACT INFORMATION
TennCare (Tennessee Medicaid Program)
Website: https://www.tn.gov/tenncare
Tennessee Department of Health – Health Professional Boards
Website: https://www.tn.gov/health
Tennessee Department of Intellectual and Developmental Disabilities (DIDD)
Website: https://www.tn.gov/didd
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TN THERAPY SERVICES PROVIDER
WCG helps therapy agencies, solo practitioners, and multidisciplinary clinics enter Tennessee’s Medicaid ecosystem to provide high-impact rehabilitative and habilitative care.
Scope of Work:
TennCare and DIDD provider enrollment
Policy & Procedure Manual tailored to OT, PT, or SLP services
Evaluation, progress note, and session tracking templates
ISP participation training and documentation
Medicaid billing logs and treatment planning forms
Staff compliance checklists and CEU tracking tools
Family Model Residential
FAMILY MODEL RESIDENTIAL SERVICES PROVIDER IN TENNESSEE
CREATING STABLE, SUPPORTIVE HOME ENVIRONMENTS FOR INDIVIDUALS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES THROUGH FAMILY-BASED CARE
Family Model Residential Services (also known as Host Home or Companion Care) provide adults with intellectual and developmental disabilities (I/DD) the opportunity to live in a private home setting with a trained caregiver or family, rather than in a group facility. These services are authorized under TennCare’s Employment and Community First (ECF) CHOICES program and select 1915(c) Waivers, ensuring individuals receive person-centered support in the least restrictive setting possible.
1. GOVERNING AGENCIES
Agency: TennCare (Tennessee Medicaid)
Role: Manages waiver services and provider reimbursement for family model supports.
Agency: Department of Intellectual and Developmental Disabilities (DIDD)
Role: Certifies Family Model providers, conducts home inspections, matches participants with host families, and ensures compliance with ISP requirements.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Approves and oversees Medicaid waivers and federal HCBS setting requirements.
2. FAMILY MODEL RESIDENTIAL SERVICES OVERVIEW
These services allow an adult with I/DD to reside in the private home of a trained caregiver (host family) who provides supervision, personal care, skill-building, and community involvement. Unlike traditional group homes, family model care offers a more intimate, individualized support structure.
Core services provided by host families include:
24/7 supervision and companionship
Personal care (bathing, hygiene, dressing, medication reminders)
Meal preparation and nutrition support
Community access and recreational activities
Daily living skill development
Participation in ISP and coordination with the support team
Behavioral support and safety monitoring (when applicable)
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register business with the Tennessee Secretary of State (if operating as an agency)
Obtain EIN and Type 2 NPI
Apply for provider approval through DIDD as a Family Model Residential Services provider
Develop a screening, training, and monitoring system for host families
Maintain liability insurance
Develop a Family Model Services Policy & Procedure Manual
4. TENNESSEE PROVIDER ENROLLMENT PROCESS
Step 1: Register as a provider or business entity and acquire NPI/EIN
Step 2: Apply to DIDD for certification under Family Model Residential Services
Step 3: Submit home study procedures, host family screening criteria, training materials, and sample documentation
Step 4: Complete initial inspection of potential host homes and host training
Step 5: Upon ISP team approval, begin accepting referrals and providing services
5. REQUIRED DOCUMENTATION
Business registration, EIN, NPI (if applicable)
Host family application, home inspection checklist, and training records
Participant-caregiver matching process
Family Model Services Policy & Procedure Manual including:
Participant safety and emergency response protocols
ISP integration and daily activity documentation
Behavior intervention protocols and de-escalation plans
Transportation policies and supervision guidelines
Incident reporting, grievance resolution, and quality assurance standards
Host family support, monitoring, and respite coverage procedures
6. STAFFING REQUIREMENTS
Role: Host Family / Primary Caregiver
Requirements: Background check, home inspection, completion of DIDD training, CPR/First Aid, abuse prevention
Role: Program Coordinator (if agency-based)
Requirements: Experience in residential care, ISP coordination, and provider monitoring
Role: Behavioral Specialist or Nurse (optional)
Purpose: To support individuals with complex needs requiring behavioral or medical oversight
All host families must complete:
DIDD-approved training and certification
HIPAA, abuse prevention, and emergency preparedness training
Ongoing competency evaluations and ISP participation
Home inspections and health/safety compliance
7. MEDICAID WAIVER PROGRAMS
Family Model Residential Services are approved under:
ECF CHOICES – For adults with I/DD needing supportive, non-institutional residential options
1915(c) Waivers (Comprehensive or SD Waiver) – Based on participant’s level of need and support model preferences
Katie Beckett (limited settings for youth) – Only when paired with extensive oversight and approved through the ISP team
8. TIMELINE TO LAUNCH
Phase: Business Formation & Initial Training
Timeline: 1–2 months
Phase: DIDD Enrollment & Home Study Setup
Timeline: 2–3 months
Phase: Host Family Recruitment & Documentation
Timeline: 30–60 days
Phase: Service Launch & Participant Matching
Timeline: Begins once ISP authorizations and compatibility are confirmed
9. CONTACT INFORMATION
Tennessee Department of Intellectual and Developmental Disabilities (DIDD)
Website: https://www.tn.gov/didd
TennCare (Tennessee Medicaid Program)
Website: https://www.tn.gov/tenncare
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TN FAMILY MODEL RESIDENTIAL PROVIDER
WCG helps new providers and established agencies design, license, and operate Family Model Residential programs that meet waiver standards and provide meaningful community-based living options.
Scope of Work:
DIDD certification and documentation support
Family Model Services Policy Manual and host family handbook
Sample forms (host screening, home inspections, ISP logs)
Daily activity logs, health monitoring forms, and grievance tools
Behavior support and training coordination
Staff and host family compliance checklists and documentation templates
Homemaker
HOMEMAKER SERVICES PROVIDER IN TENNESSEE
SUPPORTING DAILY LIVING AND INDEPENDENT LIFESTYLES FOR INDIVIDUALS WITH DISABILITIES AND CHRONIC CONDITIONS IN THEIR OWN HOMES
Homemaker Services in Tennessee help individuals with disabilities, the elderly, and those with chronic illnesses maintain their independence by providing assistance with household tasks that they cannot complete on their own. These non-medical services are available through TennCare’s Employment and Community First (ECF) CHOICES, 1915(c) Waivers, and other home and community-based service (HCBS) programs for Medicaid-eligible individuals.
1. GOVERNING AGENCIES
Agency: TennCare (Tennessee Medicaid)
Role: Administers funding and oversight for Homemaker Services under Medicaid State Plan and waiver programs.
Agency: Department of Intellectual and Developmental Disabilities (DIDD)
Role: Approves homemaker service providers and monitors service delivery under relevant waiver programs.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Establishes federal guidelines for Medicaid-funded homemaker services and HCBS compliance.
2. HOMEMAKER SERVICES OVERVIEW
Homemaker Services focus on non-medical assistance with routine household tasks necessary to maintain a clean, safe, and supportive home environment. These services are tailored to the participant’s functional limitations and outlined in their Individual Support Plan (ISP) or care plan.
Covered tasks may include:
Light housekeeping (vacuuming, dusting, sweeping)
Laundry and linen changing
Dishwashing and kitchen cleaning
Meal preparation (non-specialized diets)
Grocery shopping and errand running (with or on behalf of the participant)
Trash removal and organizing living spaces
Mail and appointment organization
These services do not include hands-on personal care unless the provider is also approved for Personal Care Services.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register business with the Tennessee Secretary of State
Obtain EIN and Type 2 NPI
Apply for provider approval through DIDD or TennCare (depending on waiver type)
Maintain general liability insurance and workers' compensation (if employing staff)
Develop a Homemaker Services Policy & Procedure Manual
4. TENNESSEE PROVIDER ENROLLMENT PROCESS
Step 1: Form business entity and acquire EIN/NPI
Step 2: Submit provider application to DIDD or through the TennCare MCO portals
Step 3: Provide documentation of staff training, service procedures, and risk protocols
Step 4: Participate in ISP team meetings and service planning (if applicable)
Step 5: Receive service authorizations and begin providing support in participants’ homes
5. REQUIRED DOCUMENTATION
Articles of Incorporation, EIN, NPI confirmation
Proof of liability insurance and staff background checks
Homemaker Services Policy & Procedure Manual including:
Scope of tasks and service delivery limits
Emergency procedures and safety protocols
Participant consent and service agreement templates
ISP coordination and documentation standards
Staff training procedures (cleaning, infection control, boundaries)
Billing and scheduling logs
Incident reporting and satisfaction tracking
6. STAFFING REQUIREMENTS
Role: Homemaker / Housekeeping Support Worker
Requirements: Must pass background checks, complete TennCare-approved training, and demonstrate understanding of infection control and respectful boundaries
Optional Role: Supervisor or Coordinator (for agencies)
Requirements: Experience managing in-home support services and coordinating with care teams
All staff must complete:
Orientation on HCBS rights and person-centered service
Safety and infection control training
Confidentiality and HIPAA compliance
ISP documentation procedures
Abuse prevention and mandatory reporting training
7. MEDICAID WAIVER PROGRAMS
Homemaker Services are available under:
ECF CHOICES Waiver – For individuals with I/DD requiring support to maintain a clean and safe home
1915(c) Waivers (Comprehensive or SD Waiver) – For adults with disabilities or aging-related needs
Katie Beckett Program (Part B) – If services support continued in-home living
TennCare CHOICES (Aging & Disability Program) – For eligible older adults needing assistance with IADLs
8. TIMELINE TO LAUNCH
Phase: Business Registration & Policy Manual Development
Timeline: 1–2 months
Phase: TennCare or DIDD Provider Enrollment
Timeline: 2–3 months
Phase: Staff Hiring & Compliance Training
Timeline: 30–60 days
Phase: Service Delivery Begins
Timeline: Once authorizations are received and ISP participation begins
9. CONTACT INFORMATION
TennCare (Tennessee Medicaid Program)
Website: https://www.tn.gov/tenncare
Tennessee Department of Intellectual and Developmental Disabilities (DIDD)
Website: https://www.tn.gov/didd
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TN HOMEMAKER SERVICES PROVIDER
WCG provides comprehensive support for launching Homemaker Services in Tennessee, from enrollment to documentation.
Scope of Work:
Provider enrollment support through DIDD or TennCare
Homemaker Services Policy Manual development
Staff training packets and scheduling templates
Client service logs, consent forms, and emergency response plans
Compliance guidance and incident tracking tools
HCBS documentation and billing worksheets
Case Management
CASE MANAGEMENT SERVICES PROVIDER IN TENNESSEE
EMPOWERING PARTICIPANTS WITH INTELLECTUAL, DEVELOPMENTAL, AND MEDICAL NEEDS THROUGH PERSONALIZED COORDINATION OF SERVICES, RESOURCES, AND SUPPORT SYSTEMS
Case Management Services in Tennessee are essential for helping Medicaid waiver participants access the care, services, and supports they need to thrive in the community. Case managers act as advocates and service coordinators, ensuring the participant’s needs are met through proper planning, monitoring, and collaboration. These services are reimbursed under TennCare, Employment and Community First (ECF) CHOICES, and 1915(c) HCBS Waiver Programs.
1. GOVERNING AGENCIES
Agency: TennCare (Tennessee Medicaid)
Role: Oversees the reimbursement and performance standards for case management activities.
Agency: Department of Intellectual and Developmental Disabilities (DIDD)
Role: Approves and monitors Support Coordinators and Case Management agencies under waiver programs like ECF CHOICES and 1915(c).
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Sets federal regulations for conflict-free case management, care coordination, and participant rights in HCBS programs.
2. CASE MANAGEMENT SERVICES OVERVIEW
Case Management (also referred to as Support Coordination) involves assessing, planning, coordinating, monitoring, and advocating for an individual's services and supports across medical, behavioral, and social needs.
Core functions include:
Comprehensive needs assessments
Development and maintenance of Individual Support Plans (ISP)
Monitoring of service delivery and participant satisfaction
Crisis and incident response coordination
Transition planning (e.g., from school, hospital, or institutional settings)
Resource linkage (housing, employment, therapy, transportation)
Documentation and compliance reporting
All services must be person-centered, outcome-driven, and aligned with Medicaid standards for conflict-free case management.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register business with the Tennessee Secretary of State
Obtain EIN and Type 2 NPI
Enroll with TennCare and/or DIDD as a case management or support coordination provider
Ensure conflict-free status (i.e., not delivering direct HCBS services to the same individual)
Maintain liability insurance and data security protocols
Develop a Case Management Services Policy & Procedure Manual
4. TENNESSEE PROVIDER ENROLLMENT PROCESS
Step 1: Form a legal entity and obtain EIN/NPI
Step 2: Apply for certification with DIDD or TennCare depending on target population
Step 3: Submit documentation for key staff (e.g., resumes, licensure, background checks)
Step 4: Demonstrate system for ISP development, tracking, and reporting
Step 5: Complete any required trainings and begin receiving participant referrals
5. REQUIRED DOCUMENTATION
Business registration, EIN, NPI
Staff credentials, degrees, background checks, CPR/First Aid
Liability insurance and HIPAA compliance policies
Case Management Policy & Procedure Manual including:
Assessment tools and eligibility documentation
ISP template and planning protocols
Crisis planning and risk mitigation
Participant rights, grievance procedures, and informed consent
Incident reporting and quality improvement
Progress notes, monitoring forms, and visit logs
6. STAFFING REQUIREMENTS
Role: Case Manager / Support Coordinator
Requirements: Bachelor’s or master’s degree in social work, psychology, or related field; experience with HCBS or behavioral health preferred
Role: Clinical Supervisor (optional but recommended)
Requirements: Master’s-level credential (LCSW, LPC, etc.); provides guidance and plan oversight
All staff must complete:
DIDD or MCO-approved case management training
ISP development and HCBS documentation training
HIPAA, person-centered planning, and abuse prevention
Incident management and emergency response training
Annual competency assessments and quality reviews
7. MEDICAID WAIVER PROGRAMS
Case Management Services are funded under:
ECF CHOICES – For individuals with I/DD needing person-centered service coordination
1915(c) Waivers – For individuals requiring targeted case management as part of their home and community-based services
Katie Beckett Program – Coordination for children with medical complexity
TennCare MCOs – May also offer medical case management services under State Plan benefits
8. TIMELINE TO LAUNCH
Phase: Business Formation & Manual Development
Timeline: 1–2 months
Phase: Provider Enrollment & Training
Timeline: 2–3 months
Phase: Staff Onboarding & Compliance Readiness
Timeline: 30–60 days
Phase: Participant Assignment & Service Start
Timeline: Upon ISP approval and DIDD/MCO authorization
9. CONTACT INFORMATION
TennCare (Tennessee Medicaid Program)
Website: https://www.tn.gov/tenncare
Tennessee Department of Intellectual and Developmental Disabilities (DIDD)
Website: https://www.tn.gov/didd
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TN CASE MANAGEMENT PROVIDER
WCG helps independent care coordinators and case management agencies build systems to comply with Tennessee’s HCBS and TennCare requirements.
Scope of Work:
Provider enrollment with DIDD and TennCare
Case Management Services Policy & Procedure Manual
ISP templates, progress notes, and tracking forms
Risk assessment and crisis plan samples
Staff onboarding tools and quality assurance checklists
Conflict-free case management compliance toolkit
Transportation
TRANSPORTATION SERVICES PROVIDER IN TENNESSEE
CONNECTING INDIVIDUALS WITH DISABILITIES AND HEALTH NEEDS TO ESSENTIAL SERVICES, DAY PROGRAMS, AND COMMUNITY LIFE THROUGH SAFE, RELIABLE MEDICAID-APPROVED TRANSPORTATION
Transportation Services under TennCare support individuals with disabilities, chronic conditions, or mobility limitations by providing non-emergency, medically necessary or community-based rides to and from appointments, day programs, work, and other essential activities. These services are available through TennCare’s Medicaid State Plan, ECF CHOICES, 1915(c) Waivers, and Katie Beckett waivers for eligible children.
1. GOVERNING AGENCIES
Agency: TennCare (Tennessee Medicaid)
Role: Administers transportation services through managed care organizations (MCOs) and waiver programs.
Agency: Department of Intellectual and Developmental Disabilities (DIDD)
Role: Oversees transportation supports for waiver participants with I/DD and ensures service inclusion in ISPs.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Regulates Medicaid reimbursement standards for non-emergency transportation (NEMT) and community supports.
Vendor Partner (Brokered): ModivCare (formerly LogistiCare)
Role: Manages Non-Emergency Medical Transportation (NEMT) under the TennCare State Plan for routine healthcare visits.
2. TRANSPORTATION SERVICES OVERVIEW
Transportation services under Medicaid waivers may fall into two categories:
Non-Emergency Medical Transportation (NEMT): Covered under the State Plan for rides to physician appointments, dialysis, therapy, etc.
Community-Based Transportation (Waiver-Based): Covered under waivers for day programs, employment, habilitation, and other ISP-related activities.
Approved transportation supports may include:
Individual or shared rides to and from day services, therapy, work, or approved social/recreational events
Wheelchair-accessible transportation
Mileage reimbursement (if family or informal supports provide transport under a waiver)
Transportation with trained staff accompanying the participant (if required)
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register business with the Tennessee Secretary of State
Obtain EIN and Type 2 NPI
Enroll with TennCare MCOs and/or DIDD as a Transportation Services provider
Ensure vehicle(s) meet safety, insurance, and accessibility requirements
Drivers must pass background checks and complete required training
Develop a Transportation Services Policy & Procedure Manual
4. TENNESSEE PROVIDER ENROLLMENT PROCESS
Step 1: Form legal entity and acquire EIN/NPI
Step 2: Apply as a transportation provider with DIDD and/or TennCare MCOs
Step 3: Submit documentation for each vehicle (registration, inspection, insurance) and each driver (license, training, background)
Step 4: Complete initial compliance review and vehicle inspection
Step 5: Begin accepting ride authorizations and delivering services per ISP or NEMT assignment
5. REQUIRED DOCUMENTATION
Business registration, EIN, NPI
Driver’s license, MVR report, background check, and First Aid/CPR certification
Vehicle registration, liability insurance, inspection documents
Transportation Services Policy & Procedure Manual including:
Safety protocols and emergency response
Rider assistance and wheelchair lift procedures
No-show and cancellation policies
Mileage logs and billing templates
Passenger incident reporting process
HIPAA and confidentiality policies
6. STAFFING REQUIREMENTS
Role: Driver / Transportation Support Staff
Requirements: Valid driver’s license, clear MVR, CPR/First Aid certification, abuse prevention training
Role: Transportation Coordinator (for agencies)
Requirements: Scheduling, dispatch experience, Medicaid compliance knowledge
Optional Role: Attendant / Aide (if rider requires in-vehicle assistance)
Requirements: Background clearance, ability to manage behavior or assist mobility
All transportation staff must complete:
TennCare/DIDD-required training on safety, abuse prevention, and participant rights
Emergency procedures, HIPAA training, and proper documentation practices
Periodic vehicle and skills evaluations
7. MEDICAID WAIVER PROGRAMS
Transportation services are offered under:
TennCare State Plan (via ModivCare) – Medical appointment rides for Medicaid enrollees
ECF CHOICES – Rides for employment, day services, ISP-driven activities
1915(c) Waivers – Community integration and habilitation-related transportation
Katie Beckett Program (Part B) – Rides for essential therapies, activities, or school-day supports
8. TIMELINE TO LAUNCH
Phase: Business Formation & Fleet Readiness
Timeline: 1–2 months
Phase: TennCare/DIDD Enrollment & Credentialing
Timeline: 2–3 months
Phase: Driver Onboarding & Vehicle Inspections
Timeline: 30–60 days
Phase: Service Activation
Timeline: Once contracts are signed and ride authorizations are received
9. CONTACT INFORMATION
TennCare (Tennessee Medicaid Program)
Website: https://www.tn.gov/tenncare
Department of Intellectual and Developmental Disabilities (DIDD)
Website: https://www.tn.gov/didd
ModivCare (NEMT Broker for TennCare)
Website: https://www.modivcare.com
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TN TRANSPORTATION SERVICES PROVIDER
WCG helps transportation companies, solo drivers, and HCBS agencies get approved to offer Medicaid-funded rides under waiver and State Plan programs.
Scope of Work:
TennCare and DIDD transportation provider enrollment
Transportation Services Policy Manual and safety training packet
Driver onboarding tools and mileage log templates
Vehicle compliance checklist and incident response forms
ISP coordination forms and ride authorization trackers
HIPAA and participant rights orientation materials
Home Health
HOME HEALTH SERVICES PROVIDER IN TENNESSEE
DELIVERING SKILLED NURSING AND THERAPEUTIC CARE IN THE COMFORT OF HOME FOR TENNESSEANS WITH COMPLEX MEDICAL NEEDS
Home Health Services in Tennessee provide short-term, intermittent, or ongoing medical care at home for individuals recovering from illness, managing chronic health conditions, or requiring support for functional limitations. These services are authorized under TennCare’s Medicaid State Plan, 1915(c) HCBS Waivers, ECF CHOICES, and the Katie Beckett Program for children with medical complexity.
1. GOVERNING AGENCIES
Agency: TennCare (Tennessee Medicaid)
Role: Oversees Medicaid coverage, reimbursement, and prior authorization for home health services.
Agency: Tennessee Department of Health (TDH) – Board for Licensing Health Care Facilities
Role: Licenses home health agencies and monitors clinical compliance and safety standards.
Agency: Department of Intellectual and Developmental Disabilities (DIDD)
Role: Coordinates home-based health supports under waiver programs.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Sets federal standards for home health under Medicaid and Medicare.
2. HOME HEALTH SERVICES OVERVIEW
Home Health Services provide clinical care in a home setting for individuals who require skilled medical support, typically under physician orders or as part of an ISP.
Services may include:
Skilled Nursing Care: Medication administration, wound care, injections, catheter care, chronic condition management
Therapy Services: Physical, occupational, or speech therapy (by licensed therapists)
Medical Social Work: Support with psychosocial needs and community resources
Home Health Aide Services: Assistance with ADLs under the supervision of a licensed nurse
Care Coordination & Documentation: Development of care plans, shift documentation, Medicaid billing
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register business with the Tennessee Secretary of State
Obtain EIN and Type 2 NPI
Apply for licensure as a Home Health Agency through the Tennessee Department of Health
Enroll as a TennCare provider through applicable MCOs
Apply to DIDD or Katie Beckett (as needed) for home health authorization
Maintain liability, workers’ comp, and malpractice insurance
Develop a Home Health Services Policy & Procedure Manual
4. TENNESSEE PROVIDER ENROLLMENT PROCESS
Step 1: Form business entity, obtain EIN and NPI
Step 2: Apply for Home Health Agency licensure through TDH
Step 3: Complete agency site inspections and submit required documentation
Step 4: Enroll with TennCare MCOs and/or DIDD depending on your target population
Step 5: Begin receiving referrals and service authorizations from case managers and physicians
5. REQUIRED DOCUMENTATION
Articles of Incorporation, business license, EIN, NPI
TDH Home Health license and inspection results
Staff credentials and clinical supervision plan
Liability and malpractice insurance
Home Health Services Policy & Procedure Manual including:
Admission protocols and physician order tracking
Infection control and clinical documentation standards
Medication management and nursing plan templates
Emergency preparedness and patient safety protocols
Discharge planning, quality assurance, and participant rights
Medicaid billing forms and audit readiness tools
6. STAFFING REQUIREMENTS
Role: Registered Nurse (RN)
Requirements: Active Tennessee license; develops care plans, supervises HHAs
Role: Licensed Practical Nurse (LPN)
Requirements: Licensed; provides direct skilled care under RN direction
Role: Certified Home Health Aide (HHA)
Requirements: Training certification, CPR/First Aid, supervised by RN
Role: Physical/Occupational/Speech Therapist (as applicable)
Requirements: TN licensure and physician-ordered service plan
Role: Clinical Director / Administrator
Requirements: Oversight of all clinical and operational services
All staff must complete:
HIPAA and infection control training
Documentation and Medicaid compliance procedures
Abuse prevention and emergency response training
Annual competencies and background checks
7. MEDICAID WAIVER PROGRAMS
Home Health Services are covered under:
TennCare Medicaid State Plan – For short-term skilled nursing and therapy at home
1915(c) Waivers – For individuals needing long-term, clinically supervised care
Katie Beckett Program (Part A) – For medically fragile children needing in-home skilled care
ECF CHOICES – When home health is necessary to support the ISP goals for individuals with I/DD
8. TIMELINE TO LAUNCH
Phase: Business Formation & Licensure Application
Timeline: 2–3 months
Phase: Facility Inspection & TennCare Enrollment
Timeline: 2–3 months
Phase: Staff Hiring, Policy Manual Completion
Timeline: 1–2 months
Phase: Referral Acceptance & Service Start
Timeline: Begins after licensure approval and MCO/DIDD authorizations
9. CONTACT INFORMATION
Tennessee Department of Health (TDH) – Health Care Facilities Licensure
Website: https://www.tn.gov/health
TennCare (Tennessee Medicaid Program)
Website: https://www.tn.gov/tenncare
DIDD (Department of Intellectual and Developmental Disabilities)
Website: https://www.tn.gov/didd
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TN HOME HEALTH PROVIDER
WCG supports solo nurses, nurse entrepreneurs, and licensed home health agencies in entering the TennCare ecosystem and meeting clinical compliance standards.
Scope of Work:
Home Health Agency licensure application support
TennCare MCO and DIDD provider enrollment
Custom Home Health Services Policy & Procedure Manual
Clinical documentation templates (nursing, therapy, HHA logs)
Audit readiness tools and HIPAA compliance kits
Staffing tools, supervision logs, and quality assurance resources
Meal & Nutriiton
MEAL & NUTRITION SERVICES PROVIDER IN TENNESSEE
PROMOTING HEALTH AND INDEPENDENCE THROUGH HOME-DELIVERED AND SPECIALIZED MEAL SUPPORT FOR INDIVIDUALS WITH DISABILITIES, THE ELDERLY, AND MEDICALLY COMPLEX POPULATIONS
Meal and Nutrition Services in Tennessee are essential supports offered under various Medicaid programs, including the Employment and Community First (ECF) CHOICES, 1915(c) Waivers, and the Tennessee Commission on Aging and Disability (TCAD). These services ensure that individuals with limited ability to shop for or prepare meals can maintain their health, meet dietary requirements, and continue living independently at home or in the community.
1. GOVERNING AGENCIES
Agency: TennCare (Tennessee Medicaid)
Role: Oversees Medicaid waiver programs including ECF CHOICES and reimburses for meal and nutrition supports when authorized in the participant's service plan.
Agency: Tennessee Department of Intellectual and Developmental Disabilities (DIDD)
Role: Certifies waiver providers who deliver meal services to individuals with I/DD under Medicaid waivers.
Agency: Tennessee Commission on Aging and Disability (TCAD)
Role: Provides State-funded home-delivered meals and nutrition education for older adults.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Approves waiver-based nutritional services under federal HCBS regulations.
2. MEAL & NUTRITION SERVICES OVERVIEW
Meal services are individualized and may be provided in a participant’s home or a congregate setting, depending on the participant’s needs and service plan. Services can include:
Home-Delivered Meals – Frozen, shelf-stable, or hot meals delivered to the participant’s home
Congregate Meals – Meals served at adult day programs or community centers
Specialized Diets – Diabetic, renal, gluten-free, mechanically altered, or culturally preferred meals
Feeding Assistance – Physical help with eating, drinking, or mealtime positioning
Nutrition Counseling (optional) – By licensed dietitians for health condition-specific meal plans
Grocery Support Services (when part of the waiver plan)
Documentation of Meal Delivery and Participant Feedback
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Tennessee Secretary of State
Obtain EIN and Type 2 NPI
Apply through TennCare/DIDD or TCAD depending on the program
If preparing food, obtain appropriate Food Establishment Permit from the Tennessee Department of Health
Maintain food safety certifications and staff training
Develop a Meal & Nutrition Services Policy & Procedure Manual
4. TENNESSEE PROVIDER ENROLLMENT PROCESS
Step 1: Register as a legal entity and acquire EIN/NPI
Step 2: Apply through TennCare or DIDD to become a waiver-approved nutrition services provider
Step 3: Submit menus, dietary protocols, and meal delivery plan
Step 4: Obtain food safety license if preparing meals
Step 5: Receive participant referrals and begin meal service per ISP or care plan
5. REQUIRED DOCUMENTATION
Articles of Incorporation, EIN, NPI
Proof of insurance (liability, workers' comp)
Food handling certifications and DOH permit (if applicable)
Meal & Nutrition Services Policy & Procedure Manual including:
Nutrition standards and meal prep guidelines
Delivery scheduling and confirmation logs
Client feedback and complaint response protocols
Meal modification procedures for special diets
Feeding assistance and choking prevention procedures
HIPAA compliance, emergency contact forms, and billing documentation
6. STAFFING REQUIREMENTS
Role: Meal Prep/Delivery Staff
Requirements: Food handler certification, background check, CPR/First Aid recommended
Role: Nutrition Coordinator / Licensed Dietitian (if offering nutrition education or special meal planning)
Requirements: TN license, knowledge of waiver nutrition needs, diet formulation experience
All staff must complete:
HIPAA and participant confidentiality training
Infection control and food safety training
Participant rights and non-discrimination education
Documentation and incident reporting procedures
7. MEDICAID WAIVER PROGRAMS
Meal and Nutrition Services are available under:
ECF CHOICES – As part of a person-centered plan to support individuals with I/DD
1915(c) Waivers – When needed for health or support goals (e.g., elderly or medically fragile adults)
EPSDT (under 21) – Meals may be covered for children with medical necessity
State Aging Services via TCAD – For seniors age 60+ in partnership with local Area Agencies on Aging
8. TIMELINE TO LAUNCH
Phase: Business Formation & Menu Planning
Timeline: 1–2 months
Phase: TennCare or DIDD Enrollment & Safety Compliance
Timeline: 2–3 months
Phase: Staff Hiring, Training & Meal Prep Readiness
Timeline: 1–2 months
Phase: Launch of Meal Services
Timeline: After participant plan approval and referrals
9. CONTACT INFORMATION
TennCare (Tennessee Medicaid Program)
Website: https://www.tn.gov/tenncare
Tennessee Department of Intellectual and Developmental Disabilities (DIDD)
Website: https://www.tn.gov/didd
Tennessee Department of Health – Food Safety & Licensure
Website: https://www.tn.gov/health
Tennessee Commission on Aging and Disability (TCAD)
Website: https://www.tn.gov/aging
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TN MEAL & NUTRITION PROVIDER
WCG helps organizations build scalable, compliant meal and nutrition programs across Tennessee’s Medicaid and aging services landscape.
Scope of Work:
Provider enrollment and waiver program navigation (TennCare, DIDD, TCAD)
Menu design templates and special diet protocols
Food delivery route planning and verification logs
Staff training packets and compliance checklists
Policy Manual tailored to in-home or congregate meal services
HIPAA documentation tools and participant satisfaction tracking
Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements.