ECF CHOICES Opens 2 New Groups for Those with IDD and Significant Mental/Behavioral Health Concerns

By Amber Cockings

About the Author

Amber Cockings is the director of Employment and Community First CHOICES program at TennCare. She has worked with individuals with intellectual and developmental disabilities since her college days, and she has been a case manager, a van driver, a direct support professional, a program director for various services, as well as an administrator of a community provider agency.

Our hope is that this weekly blog will offer information you want to know, so if you have a question you want answered about employment for people with disabilities or other mysteries of the world of work, please email me at janet.shouse@vumc.org.

When Tennessee unveiled its new waiver program, Employment and Community First CHOICES, in 2016, the program offered three groups of services based on age and need.

  • Essential Family Supports (Group 4) –Services for families caring for a child under the age of 21 who has an intellectual or developmental disability. The child must live at home with their family (not a foster family). Adults age 21 with IDD living at home with their family can also choose to enroll in this group, if they qualify.
  • Essential Supports for Employment and Independent Living (Group 5) — Services for adults age 21 and older who have an IDD but don’t qualify for the level of care in a nursing home. A person age 18-21 with IDD may be enrolled in this group if they can’t live with their family anymore.
  • Comprehensive Supports for Employment and Community Living (Group 6) – Services for adults age 21 and older who would qualify to get care in a nursing home. A person age 18-21 with IDD may be enrolled in this group if they can’t live with their family anymore.

As individuals enrolled in Employment and Community First CHOICES, it became clear that a small group of children and adults with very significant behavioral health needs needed a different approach to help them be successful in community living. TennCare has now created Group 7 and Group 8, which will focus exclusively on this new approach to serving these children and adults.

The Centers for Medicare and Medicaid Services approved these additional two groups in July, and people could begin to apply as of Sept. 3, 2019.

Group 7 will provide Intensive Behavioral Family-Centered Treatment, Stabilization and Supports for children under the age of 21 who live at home with family caregivers and have an intellectual or developmental disability and severe co-occurring behavioral health and/or psychiatric conditions.

In order to qualify, these co-occurring conditions must:

  • Place the child/youth or others at significant risk of serious physical harm;
  • Significantly strain the family’s ability to adequately respond to the needs of the child/youth;
  • Threaten the sustainability of the family living arrangement; and
  • Place the child/youth at imminent and significant risk of placement outside the home (e.g., state custody, hospitalization, residential treatment, incarceration)

As a condition of enrollment, the child’s family must provide informed consent, including a commitment to actively participate in a family-centered therapeutic approach to treatment and support.

Group 8 provides Comprehensive Behavioral Supports for Employment and Community Living for adults age 21 and older, unless otherwise specified by TennCare, with IDD and severe behavioral and/or psychiatric conditions, who are:

  • Transitioning out of a highly structured and supervised environment, such as jail or a hospital;
  • Meet nursing facility level of care; and
  • Need and are receiving specialized services for IDD.

To qualify for enrollment in Group 8, a person’s psychiatric symptoms or behaviors must place the person or others at imminent and significant risk of serious physical harm and require continuous monitoring and supervision by 24-hour staff to ensure the person’s safety and/or the safety of others.(The intensity of supports needed is expected to lessen as the person achieves stabilization in the community and readies for transition to a different benefit group.)

Only people in the following target groups can qualify:

1) adults with severe psychiatric or behavioral symptoms whose family is no longer capable of supporting the individual due to the severity and frequency of behaviors;

2) emerging young adults (age 18-21) with IDD and severe psychiatric or behavioral symptoms aging out of the foster care system;

3) adults with IDD and severe psychiatric or behavioral symptoms following a crisis event and/or psychiatric inpatient stay and/or transitioning out of the criminal justice system or a long-term institutional placement (including residential psychiatric treatment facility).

Janet, as always, had some additional questions for me now that the two groups have been approved.

What is different about the approach to serving these individuals in these new groups?

For the first time in any TennCare Long-Term Services and Supports program, the new benefits in each group will integrate behavioral health treatment into the day-to-day delivery of home and community based services.  Agencies providing the service will be licensed to provide mental health treatment (directed by master’s degree level clinicians) as well as home and community based services.

Benefits in Group 7 will provide supportive services in a way that helps to engage, strengthen, support and build the capacity and confidence of the family in the consistent and effective implementation of the child’s behavior support plan in all aspects of daily lifein order to help ensure safety, well-being and permanency.

In Group 8, intensive therapeutic support and intervention will be provided up to 24 hours a day, as needed, across the person’s life, including home, school, work and community, in order to achieve stability, support the person in building healthy relationships, and successfully plan and transition to other long-term services and supports with appropriate behavioral health treatment services.

How many slots are available in each group?

Up to 50 people may be served in each group.

What are the expenditure caps per person for each group?

For both groups, the cost limit is based on the comparable cost of institutional care.

For Intensive Behavioral Family-Centered Treatment, Stabilization and Supports/Group 7, this is the average annual cost of services in a private ICF/IID—currently $169,300.

For Intensive Behavioral Comprehensive Treatment, Stabilization and Supports/Group 8, it is the same, except for the first year.  During the first year, the average annual cost could be higher—up to the average annual cost of services in a public (state) ICF/IID.

What are the services that will be available in each group?

 Many of the services available in other Employment and Community First CHOICES Groups will also be available in Groups 7 and 8. Because these services require specialized training and expertise, these services cannot be consumer directed.

Group 7 benefits include:

  • Intensive Behavioral Family-Centered Treatment, Stabilization and Supports
  • Employment services/supports, as follows:

− Exploration

− Benefits counseling

− Discovery

− Situational observation and assessment

− Job development plan or self-employment plan

− Job development or self-employment start up

− Job coaching for individualized, integrated employment or self-employment

− Co-worker supports

− Career advancement

− Supported employment—small group

− Integrated employment path services

  • Community integration support services
  • Community transportation
  • Independent living skills training
  • Assistive technology, adaptive equipment and supplies
  • Minor home modifications
  • Community support development, organization and navigation
  • Family caregiver education and training
  • Family-to-family support
  • Decision-making supports counseling and assistance
  • Health insurance counseling/forms assistance

Group 8 benefits include:

  • Intensive Behavioral Community Transition and Stabilization Services
  • Employment services/supports, as follows:

− Exploration

− Benefits counseling

− Discovery

− Situational observation and assessment

− Job development plan or self-employment plan

− Job development or self-employment start up

− Job coaching for individualized, integrated employment or self-employment

− Co-worker supports

− Career advancement

− Supported employment—small group

− Integrated employment path services

Assistive technology, adaptive equipment and supplies

  • Minor home modifications
  • Decision making supports and options
  • Individual education and training
  • Peer-to-peer person-centered planning, self-direction, employment and community support and navigation
  • Specialized consultation and training
  • Adult dental services

Do the managed care organizations have an adequate number of providers and agencies equipped to provide the needed services?

TennCare has been working closely with each MCO on contracting and training for providers to serve individuals within Groups 7 and 8. The MCOs are required to maintain an adequate network of providers and have identified providers throughout the state and continue to work on contracting with additional providers. As a part of implementation and ongoing oversight TennCare will continue to require and receive updates from the MCOs related to network adequacy, additional providers and where they are in the contracting phases, as well as staffing and training. Importantly, DIDD is now partnering with TennCare and with the MCOs to support a successful rollout of these two new groups and to help develop the capacity of the system to serve individuals in these groups and people with I/DD and co-occurring behavior support needs more broadly.

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I want to thank Amber for taking the time, as TennCare is rolling out these two new ECF CHOICES group, to provide additional information on these supports and services. If you have questions or concerns, please email me at janet.shouse@vumc.org, and I will see if I can get answers. Thanks, as always, for reading!