Tenn. Comp. R. & Regs. 0465 — Intellectual and Developmental Disabilities/Disability and Aging

Chapter 0465-01-01 Statewide Admission Review Committee Rules (Rule renumbered from 0940-04-01)

Tenn. Comp. R. & Regs. 0465-01-01-.01 PURPOSE

The purpose of these rules is to amend the former rules pertaining to Voluntary Admissions to Development Centers and establish new rules in light of the Department of Intellectual and Developmental Disabilities current organization, structure and resources.

History

Authority: T.C.A. § 33-5-301, et seq., 4-3-2708, and Public Acts of 2012, Chapter No. 636.
Administrative History: Original rule filed February 11, 2013; effective July 29, 2013.

Tenn. Comp. R. & Regs. 0465-01-01-.02 DEFINITIONS

(1) “Department” means the Tennessee Department of Intellectual and Developmental Disabilities;

(2) “Regular Voluntary Admission” means an admission authorized by the statewide admission review committee for a specified period of time;

(3) “Statewide Admission Review Committee” means a committee established by the Tennessee Department of Intellectual and Developmental Disabilities in accordance with T.C.A. § 33-5- 301 et seq., appointed by the Commissioner of the Department, to review, consider and, when appropriate, approve admissions to the Department’s developmental center(s);

(4) “Short-term training admission” means an admission authorized by a written agreement between a developmental center and an applicant that the center provide services and supports for a person with intellectual or developmental disability to learn how to perform a certain function or functions for a specified period of time, not exceeding six (6) months, at the end of which the center will discharge the person with intellectual or developmental disability to the care, custody, and control of the applicant.

(5) “Respite Admission” means an admission for up to forty-five (45) days authorized solely for the purpose of providing a respite for the person having responsibility for the care, custody, and control of a person with intellectual or developmental disability;

(6) “Emergency respite admission” means an admission for up to forty-five (45) days authorized due to an emergency situation that results in the temporary inability of the person who has the care, custody, and control of a person with intellectual or developmental disability to provide proper care, custody, and control;

(7) “ICF/ID” means an Intermediate Care Facility for persons with Intellectual Disabilities which is operated by the Department;

July, 2013 2 (8) “Class member” means an individual meeting the requirements of the definition of the class in one of the following: People First vs. Clover Bottom Developmental Center or United States of America vs. State of Tennessee, et al (Arlington Developmental Center);

History

Authority: T.C.A. § 33-5-301, et seq., 4-3-2708, and Public Acts of 2012, Chapter No. 636.
Administrative History: Original rule filed February 11, 2013; effective July 29, 2013.

Tenn. Comp. R. & Regs. 0465-01-01-.03 STATEWIDE ADMISSION REVIEW COMMITTEE

(1) The purpose of the Statewide Admission Review Committee (“Committee”) is to consider and approve or disapprove applications for voluntary admission to the centers operated by the Department including the Harold Jordan Center.

(2) The Committee shall maintain at all times as its highest priority the best interest of the person with intellectual or developmental disabilities who is applying for admission. The Committee is expected to exercise it’s powers and duties with the goal of matching the best available services and supports to the needs of the applicant consistent with departmental resources and funding.

(3) The voting membership of the Committee shall consist of the persons in the following Departmental positions:

(a) Health Services Director (who will serve as chairperson of the Board)

(b) Deputy Commissioner of Program Operations (c) The Regional Director or designee from the referring grand region (d) Director of Person Centered Practices (4) The Chief Officer (or appointed designee) of the center to which an admission is proposed shall serve as a non-voting member.

(5) The voting membership of the Committee shall also include the following individuals who are Tennessee residents and not employed by the department:

(a) an Independent Support Coordinator (ISC) for persons with intellectual or developmental disabilities;

(b) a person who is employed by The ARC of Tennessee as an advocate for persons with intellectual or developmental disabilities; and (c) a person who is a parent, child or sibling of a person with intellectual or developmental disabilities currently receiving services and supports from the State of Tennessee.

(d) Two member(s) from the community, service providers and/or other individuals interested in and supportive of the persons with disabilities.

(6) The non-departmental members of the Committee shall serve for a term of three (3) year(s).

(7) The Committee shall meet as often as necessary to carry out its functions. Members may participate by telephonic or video conferencing. There is no minimum advance notice requirement for a meeting; however, notice shall be given as soon as practicable.

(8) A quorum for a meeting shall consist of a majority of voting members.

July, 2013 3 (9) Decisions by the Board shall be subject to review by the Department in accordance with T.C.A. § 33-5-304.

History

Authority: T.C.A. § 33-5-301, et seq., 4-3-2708, and Public Acts of 2012, Chapter No. 636.
Administrative History: Original rule filed February 11, 2013; effective July 29, 2013.

Tenn. Comp. R. & Regs. 0465-01-01-.04 VOLUNTARY ADMISSIONS

(1) To be eligible for regular voluntary admission to a center, a person must be a resident of the State of Tennessee with intellectual or developmental disabilities who applies for voluntary admission and does not lack capacity to apply under T.C.A. § 33-3-218, or an adult whose conservator or legal representative applies for voluntary admission.

(2) Consistent with T.C.A. § 33-1-204, there is no right or entitlement to admission to a departmental facility of a person with intellectual or developmental disabilities. If suitable accommodations are not available, there is a less restrictive alternative available, or admission is not otherwise appropriate for an individual, alternative services should be considered by the applicant. The Department will develop admission criteria and specify what types of services are offered at such facility.

(3) Applications.

(a) An application or request for voluntary admission shall be submitted to the center or to the appropriate Regional Director on behalf of the applicant. A complete package of information conforming to the criteria specified by the Committee shall accompany the application. The information submitted shall include, but is not limited to, the reason for the referral and the specific needs that can be met in the facility for which admission is sought.

(b) Upon receipt of an application, the Department shall undertake an evaluation of the applicant to assess the person’s need for services and supports. In making this assessment, the Department shall also consider the least restrictive alternatives available to provide appropriate services and supports and whether suitable accommodations are available at the Department’s facilities based upon the above criteria.

(c) The application and the Department’s findings, reports and recommendations shall be forwarded to the Director of Person Centered Practices, and if complete, it shall be reviewed by the Health Services Director, who shall determine when and whether to convene a Statewide Admission Review Committee meeting.

History

Authority: T.C.A. § 33-1-204, 33-5-301, et seq., 4-3-2708, and Public Acts of 2012, Chapter No. 636.
Administrative History: Original rule filed February 11, 2013; effective July 29, 2013.

Tenn. Comp. R. & Regs. 0465-01-01-.05 EMERGENCY RESPITE ADMISSIONS

(1) In an emergency when time does not permit consideration by the Statewide Admissions Review Committee, suitable accommodations are available, and all other feasible solutions have been considered, the Health Services Director and the Deputy Commissioner of Program Operations may, in their discretion, authorize an admission to a Department facility not to exceed forty-five (45) calendar days.

(2) To initiate a request for an emergency respite admission, the Regional Director shall contact the Health Services Director and the Deputy Commissioner of Program Operations and furnish appropriate information as requested by them to support an Emergency Respite Admission.

July, 2013 4 (3) The Statewide Admission Review Committee shall informally review a person’s emergency respite admission within seven (7) days after the person is admitted. If this review is not done, then a called meeting shall be held by the Committee to review the propriety of the admission as in the case of regular voluntary admissions and shall make its decision within twenty-five (25) days after admission as to whether it should be continued, modified or terminated.

(4) If an extension of the admission beyond forty-five (45) days is sought, the Health Services Director shall convene a meeting of the Statewide Admission Review Committee to review the admission. Provided that in no event shall any admission under this section exceed two hundred twenty-five (225) days within a twelve-month period from the first day of an emergency respite admission.

History

Authority: T.C.A. § 33-5-301, et seq., 4-3-2708, and Public Acts of 2012, Chapter No. 636.
Administrative History: Original rule filed February 11, 2013; effective July 29, 2013. 0465-01-01-06 SHORT-TERM TRAINING ADMISSIONS. (1) In an emergency when time does not permit consideration by the Statewide Admissions Review Committee, suitable accommodations are available, and all other feasible solutions have been considered, the Health Services Director and the Deputy Commissioner of Program Operations may, in their discretion, authorize an admission to a Department facility not to exceed six (6) months. (2) The purpose of an admission under this section is for training in specific skills needed for integration of the individual admitted into the community. Authority: T.C.A. § 33-5-301, et seq., 4-3-2708, and Public Acts of 2012, Chapter No. 636.

Tenn. Comp. R. & Regs. 0465-01-01-.07 OTHER PROVISIONS

(1) In all admissions except short-term training and emergency respite admissions, the Statewide Admission Review Committee shall determine in which region of the State and in which facility the person’s need can best be served consistent with the resources of the Department and the availability of services.

(2) A respite admission, emergency respite admission, short-term training admission, or combination of such admissions shall not be used to circumvent appearance before the Committee when regular voluntary admission is actually sought or appropriate.

(3) Consistent with T.C.A. § 33-1-204, there is no right or entitlement of a person with intellectual or developmental disabilities to any category of admission, as defined or referred to in these Rules, to any departmental facility.

History

Authority: T.C.A. § 33-1-204, 33-5-301, et seq., 4-3-2708, and Public Acts of 2012, Chapter No. 636.
Administrative History: Original rule filed February 11, 2013; effective July 29, 2013.

Chapter 0465-01-02 Methodology Utilized to Determine Payments to Service Providers (Rate Structure)

Tenn. Comp. R. & Regs. 0465-01-02-.01 PURPOSE

(1) This chapter establishes a rate setting methodology for Residential Day and other Services that are provided through the Department of Intellectual and Developmental Disabilities.

History

Authority: T.C.A. §§ 4-3-2701, 4-3-2707, 4-4-103, 4-5-201, et seq., 4-5-208, et seq. and its applicable regulations concerning emergency rules, 33-1-201, 33-1-202, 33-1-203(1) and (6), 33-1-204, 33-1-301, 33-1-302, 33-1-302(a)(3) and (a)(4), 33-1-303, 33-1-303(3) and (11), 33-1-304, 33-1-305(1), and 33-1- 309(d); Executive Order of the State of Tennessee No. 23, dated October 19, 1999; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; and the “Reimbursement Rate” for Medical Services under DIDD federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Original rule filed December 12, 2013; effective March 12, 2014. Amendments filed October 7, 2019; effective January 5, 2020.

Tenn. Comp. R. & Regs. 0465-01-02-.02 SCOPE

(1) All of the rate methodologies used to determine payments to service providers set forth in these rules are subject to the availability of appropriations established in the TennCare budget for home and community based services provided under the State’s approved HCBS waivers for individuals with intellectual disabilities and may be adjusted by the Department or by TennCare as necessary to assure that expenditures for these services are within and do not exceed the budgeted amount for waiver services that year; and also the provisions of Ti tle 33 and 34 of the Tennessee Code Annotated; and, Executive Order of the State of Tennessee No. 23, dated October 19, 1999, and Executive Order No. 28, dated June 19, 2013, which established the Tennessee Employment First Initiative which directs state agencies to “coordinate to increase opportunities for integrated and competitive employment for individuals with intellectual and developmental disabilities.”

History

Authority: T.C.A. §§ 4-3-2701, 4-3-2707, 4-4-103, 4-5-201, et seq., 4-5-208, et seq. and its applicable regulations concerning emergency rules, 33-1-201, 33-1-202, 33-1-203(1) and (6), 33-1-204, 33-1-301, 33-1-302, 33-1-302(a)(3) and (a)(4), 33-1-303, 33-1-303(3) and (11), 33-1-304, 33-1-305(1), and 33-1- 309(d); Executive Order of the State of Tennessee No. 23, dated October 19, 1999; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; and the “Reimbursement Rate” for Medical Services under DIDD federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Original rule filed December 12, 2013; effective March 12, 2014. Amendments filed October 7, 2019; effective January 5, 2020.

Tenn. Comp. R. & Regs. 0465-01-02-.03 DEFINITIONS

(1) As used in these rules:

(a) “Administrative Costs” are the allowable percentage of the service rate that includes, for example, the costs for administrative salaries and benefits, home office costs, office supplies and printing, phone and other communication, travel and conference, advertising, professional services, licensure and dues, legal and accounting fees, interest, depreciation, occupancy, general liability insurance, equipment and administrative vehicles.

(b) “Costs” are estimated calculations of the average expense incurred by a provider in 2004 based on information available at that time and are not intended to fully account for every expense that may have been incurred by any particular provider at or since that time in delivering a waiver service. Costs include adjustments based on funding approved by the General Assembly to increase certain components of these calculations, including primarily, wages for direct support staff. Costs may be adjusted as determined by DIDD and TennCare, subject to the availability of funding in each year’s Appropriation Bill.

(c) “Direct Service Costs” are the costs for direct service such as staff salaries and benefits, overtime, direct supervision wages and benefits, contracted direct service/temporary help, training, recruiting/advertising, drug testing, background checks, Hepatitis B and TB tests, and other costs for direct service staff bonuses and employee appreciation events.

(d) “Direct Support Professional (DSP) Reimbursement Rate” means the estimated calculation of the cost of wages paid to DSPs employed by providers to deliver services requiring hands-on assistance and supervision including adjustments based on funding approved by the General Assembly to increase DSP wages.

(e) “Fading” is an essential component of the provision of job coaching services. Fading uses a combination of strategies such as job and task analysis, on-the-job training, including systematic instruction, use of assistive technology or other adaptive aids, and engagement of natural supports (assistance from co-workers or others) to allow the waiver participant to independently perform as much of his/her employment or selfemployment roles and responsibilities as possible, without the engagement of paid support. Fading is possible when a waiver participant achieves greater independence and/or inter-dependence performing his/her job, thereby reducing the need for the job coach.

(f) “Full Time Equivalent (FTE)” means the total cost for one direct support staff for forty hours. It includes direct service costs, non-direct program costs, administrative costs, and twenty (20) annual days of payment to cover waiver participant absences.

(g) “Job Coach” is a person employed by a provider agency who meets the additional qualifications specified by DIDD or TennCare and has the skills and competencies needed to identify and provide services and supports that assist a waiver participant in maintaining individualized integrated employment that pays at least minimum wage, but ideally not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities, or in maintaining self-employment, and that supports the development of the waiver participant’s independence in performing employment or self-employment job functions using a fading plan.

(h) “Job Developer” is a person employed by a provider agency who meets the additional qualifications specified by DIDD or TennCare and has the skills and competencies needed to support a waiver participant in obtaining an individualized competitive or customized job in an integrated employment setting in the general workforce, for which the waiver participant is compensated at or above the minimum wage, but ideally not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities or achievement of individualized self-employment consistent with the waiver participant’s personal and career goals.

(i) “Non-Direct Program Costs” is the allowable percentage of the service rate that includes the costs for multi-site supervisors and benefits, training, off site computer/file storage, depreciation/amortization, internal monitoring, agency case management, personal funds management, healthcare oversight, specific assistance to waiver participants-room and board, specific assistance to waiver participants-non-room and board, transportation of waiver participants, staff travel, facility maintenance, facility supplies, habilitation supplies.

(j) “Productivity Assumptions” is a calculation which takes into account the amount of a paid job coach or job developer’s time that will not be spent providing direct services, including administrative tasks (e.g. documentation, staff meetings), training, holidays, vacation, sick leave, and other emergencies, as well as the absentee rate of waiver participants receiving services which impact the billable hours of support in a typical day.

(k) “Rate” is the amount paid per person to approved service providers for each unit of a DIDD service that is provided. A rate unit may be a portion of an hour, a day, a month, an item or a job, depending on the type of service.

(l) “Rate Levels” are the series of rates for residential, day and other services that are based on a waiver participant’s needs and the size or site of the service setting.

(m) “Rate Level Factor” is the multiplier applied to the FTE daily cost that reflects intensity of support need and number of persons receiving services. Rate level factors were based on licensure requirements for staffing and professional judgment of estimated hours of direct support staff assistance required for waiver participants at each rate level.

(n) “Rate Setting Methodology” is the manner in which the rates for residential, day and other services are calculated or determined.

(o) “Special Needs Adjustment” is an additional payment that may, within the discretion of the Department and subject to resource availability, be added to the residential rate for a waiver participant in appropriate circumstances (e.g. periodic crisis that require additional support).

(p) “Usual and customary” is the amount paid for a service in a geographic area based on what providers in the area usually charge for the same or similar service.

(q) “Value-based adjustment” is an adjustment made to a rate of reimbursement or to one or more components used to calculate a rate of reimbursement that is intended to incentivize (and reward) certain qualitative aspects of the delivery of services or service outcomes (e.g. fading in the provision of job coaching or smaller group size in the provision of supported employment-small group).

(2) Waiver services (for which rate setting methodologies are set forth in these rules) shall be defined as set for the in the Section 1915(c) waiver application approved by the federal Centers for Medicare and Medicaid Services.

History

Authority: T.C.A. §§ 4-3-2701, 4-3-2707, 4-4-103, 4-5-201, et seq., 4-5-208, et seq. and its applicable regulations concerning emergency rules, 33-1-201, 33-1-202, 33-1-203(1) and (6), 33-1-204, 33-1-301, 33-1-302, 33-1-302(a)(3) and (a)(4), 33-1-303, 33-1-303(3) and (11), 33-1-304, 33-1-305(1), and 33-1- 309(d); Executive Order of the State of Tennessee No. 23, dated October 19, 1999; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; and the “Reimbursement Rate” for Medical Services under DIDD federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Original rule filed December 12, 2013; effective March 12, 2014. Amendments filed October 7, 2019; effective January 5, 2020.

Tenn. Comp. R. & Regs. 0465-01-02-.04 RATE SETTING METHODOLOGIES FOR MEDICAL, RESIDENTIAL SERVICES

(1) Medical Residential Services.

(a) For residential services that are shift-staffed, staff coverage is calculated as follows:

168 hours per week - 7 days at 24 hours per day.
The unit of service for these residential services is a day.

(b) The calculation of the daily cost per person for a Full Time Equivalent (FTE) is:

Allowable Hourly direct support staff wages plus % for benefits for the hourly cost for direct support staff.
Annual allowable salary for direct supervision plus % for benefits divided by four residents equals the cost per person per year.
Divide the cost per person per year by 52 weeks and by 168 hours to arrive at the hourly cost for supervision.
Add together the hourly cost for direct support staff and the hourly cost for supervision.
Multiply the result from Step four by one and the % allowed for non-direct program costs.
Multiply the result from Step five by one and the % allowed for administrative costs to arrive at the hourly cost for coverage.
Multiply the hourly cost for an FTE by 168 hours to arrive at the weekly cost for coverage.
Divide the weekly cost by 7 days to arrive at the daily cost for coverage.
Divide the daily cost by allowable FTEs to arrive at the daily FTE cost per person.

For each Rate Level and Home Size, multiply the daily per person FTE cost by the rate level factor.
Divide the result of Step one by the facility size.
Multiply the result of Step two by 385 (to allow for 20 absent days).
Divide the result of Step three by 365 to arrive at the daily rate.

History

Authority: T.C.A. §§ 4-3-2701, 4-3-2707, 4-4-103, 4-5-201, et seq., 4-5-208, et seq. and its applicable regulations concerning emergency rules, 33-1-201, 33-1-202, 33-1-203(1) and (6), 33-1-204, 33-1-301, 33-1-302, 33-1-302(a)(3) and (a)(4), 33-1-303, 33-1-303(3) and (11), 33-1-304, 33-1-305(1), and 33-1- 309(d); Executive Order of the State of Tennessee No. 23, dated October 19, 1999; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; and the “Reimbursement Rate” for Medical Services under DIDD federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Original rule filed December 12, 2013; effective March 12, 2014. Amendments filed October 7, 2019; effective January 5, 2020.

Tenn. Comp. R. & Regs. 0465-01-02-.05 RATE SETTING METHODOLOGIES FOR RESIDENTIAL AND SUPPORTED LIVING

SERVICES.

(1) Residential Habilitation and Supported Living (Shift-Staffed) Model.

(a) For residential services that are shift-staffed, staff coverage is calculated as follows:

138 hours per week - 5 days at 18 hours per day and 2 days at 24 hours per day is equal to one week.
The unit of service for these residential services is a day.

(b) The calculation of the daily cost per person for a Full Time Equivalent (FTE) is:

Hourly direct support staff wages plus % for benefits for the hourly cost for direct support staff.
Annual salary for direct supervision plus % for benefits divided by four residents equals the cost per person per year.
Divide the cost per person per year by 52 weeks and by 138 hours to arrive at the hourly cost for supervision.
Add together the hourly cost for direct support staff and the hourly cost for supervision.
Multiply the result from Step four by one and the % allowed for non-direct program costs.
Multiply the result from Step five by one and the % allowed for administrative costs to arrive at the hourly cost for coverage.
Multiply the hourly cost for an FTE by 138 hours to arrive at the weekly cost for coverage.
Divide the weekly cost by 7 days to arrive at the daily cost for coverage.
Divide the daily cost by all owable FTEs to arrive at the daily FTE cost per person.

For each Rate Level and Home Size, multiply the daily per person FTE cost by the rate level factor.
Divide the result of Step one by the facility size.
Multiply the result of Step two by 385 (to allow for 20 absent days).
Divide the result of Step three by 365 to arrive at the daily rate.

(2) Supported Living-Companion Model.

(a) For non-shift staffed, companion model the unit of service is a day. The calculations are as follows:

(b) Calculate the daily rate per person.

Multiply the annual stipend by one and the % for benefits.
Add the companion room and board allowance.
Add the number of hours per year at the hourly rate for relief staff divided by 365 days.
Add costs in steps one through three.
Multiply the result of step four by one and the % for non-direct program costs.
Multiply the result of step five by one and the % for administrative costs.
Divide the result of step six by 365.
Multiply the result of step seven by 385 (to allow for 20 absent days).
Divide the result of step eight by 365 to arrive at the daily rate.

(3) Family Model for Residential Services.

(a) Family Model Residential Services are those provided in a family home under the supervision of a residential services agency. The unit of service is a day.

(b) Calculate the daily rate per person.

Multiply the annual stipend by one and the % for benefits.
Add the number of hours per year at the hourly rate for relief staff divided by 365 days.
Add direct supervision at annual salary plus % for benefits divided by 10 waiver participants divided by 365 days.
Add costs in steps 1 through 3 above.
Multiply the result of step four by one and the percent for non-direct program costs.
Multiply the result of step five by one and the percent for administrative costs.
Divide the result of step six by 365 days.
Multiply the result of step seven by 385 days (to allow for 20 absent days).
Divide the result of step eight by 365 days to arrive at the daily rate.

History

Authority: T.C.A. §§ 4-3-2701, 4-3-2707, 4-4-103, 4-5-201, et seq., 4-5-208, et seq. and its applicable regulations concerning emergency rules, 33-1-201, 33-1-202, 33-1-203(1) and (6), 33-1-204, 33-1-301, 33-1-302, 33-1-302(a)(3) and (a)(4), 33-1-303, 33-1-303(3) and (11), 33-1-304, 33-1-305(1), and 33-1- 309(d); Executive Order of the State of Tennessee No. 23, dated October 19, 1999; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; and the “Reimbursement Rate” for Medical Services under DIDD federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Original rule filed December 12, 2013; effective March 12, 2014. Amendments filed October 7, 2019; effective January 5, 2020.

Tenn. Comp. R. & Regs. 0465-01-02-.06 RATE SETTING METHODOLOGIES FOR SEMI-INDEPENDENT LIVING SERVICES

(1) Calculation for Semi-Independent Living Services is:

(a) The unit of service for these residential services is a day.

(b) The rate is calculated on a monthly basis. For purposes of billing, the monthly rate is converted to a per diem amount. The per diem rate will be billed for each day of the month that the person is enrolled in the services, regardless of whether any direct assistance was provided that day.

Average monthly hours, inclusive of on-call services;
Personal Assistant services quarter hour reimbursement rate as defined in 0465- 01-02-.18;
Transportation cost.

(d) Semi-Independent Living Incentive: is a one-time payment of $2,500 per waiver participant per provider. The waiver participant must have transitioned directly into Semi-Independent Living from a twenty-four hour residential service following at least thirty consecutive paid residential days. The waiver participant must then participate in Semi-Independent Living for six (6) consecutive months immediately following the transition to be eligible for the incentive payment.

(e) Semi-Independent Living Transition Rate: is double that of the semi-independent living daily rate and limited to waiver participants who require additional hours of support during the period immediately following transition. This rate is only available for up to thirty days following the initial transition from a twenty-four hour residential service to Semi-Independent Living and requires thirty consecutive paid residential days immediately prior and adjacent to the claim for the transition rate.

History

Authority: T.C.A. §§ 4-3-2701, 4-3-2707, 4-4-103, 4-5-201, et seq., 4-5-208, et seq. and its applicable regulations concerning emergency rules, 33-1-201, 33-1-202, 33-1-203(1) and (6), 33-1-204, 33-1-301, 33-1-302, 33-1-302(a)(3) and (a)(4), 33-1-303, 33-1-303(3) and (11), 33-1-304, 33-1-305(1), and 33-1- 309(d); Executive Order of the State of Tennessee No. 23, dated October 19, 1999; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; and the “Reimbursement Rate” for Medical Services under DIDD federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Original rule filed December 12, 2013; effective March 12, 2014. Amendments filed October 7, 2019; effective January 5, 2020.

Tenn. Comp. R. & Regs. 0465-01-02-.07 SPECIAL NEEDS ADJUSTMENTS

(1) An adjustment up to an additional thirty-five dollars ($35.00) per day is available to Residential Habilitation and Supported Living Levels 1-4 for homes with 1-4 persons.

(2) An adjustment of twenty dollars ($20.00) per day is available to Residential Habilitation homes with 5 or more people except for reasons of a vacancy in the home.

(3) This adjustment may be used for additional staff coverage or higher wages for staff.

(4) A special needs adjustment does not change the rate level designated for the waiver participant, but adjusts the rate level as a result of one or more of the following circumstances:

(a) The waiver participant has a history of significant behavioral or psychiatric problems such as DSM-V diagnosis, violent acting out, serious self-injury or danger to others that are now not apparent due to the design or intensity of services being received or the person has a situation that is unique and results in the need for additional resources.

(b) Less intensive services will likely result in recurrence of previous problems. The Regional Office must review the special adjustment at least annually.

(c) The waiver participant is in circumstances that are time limited but that require support(s) at a higher level than described by the Level. (For example, the person has had a serious illness, injury, or surgery that requires more support while he/she is recovering than the Level describes.) A special adjustment may be approved for up to ninety (90) days and may be extended for an additional ninety (90) days.

History

Authority: T.C.A. §§ 4-3-2701, 4-3-2707, 4-4-103, 4-5-201, et seq., 4-5-208, et seq. and its applicable regulations concerning emergency rules, 33-1-201, 33-1-202, 33-1-203(1) and (6), 33-1-204, 33-1-301, 33-1-302, 33-1-302(a)(3) and (a)(4), 33-1-303, 33-1-303(3) and (11), 33-1-304, 33-1-305(1), and 33-1- 309(d); Executive Order of the State of Tennessee No. 23, dated October 19, 1999; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; and the “Reimbursement Rate” for Medical Services under DIDD federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Original rule filed December 12, 2013; effective March 12, 2014. Amendments filed October 7, 2019; effective January 5, 2020.

Tenn. Comp. R. & Regs. 0465-01-02-.08 VALUE-BASED RATE SETTING METHODOLOGY FOR SUPPORTED

EMPLOYMENT-INDIVIDUAL EXPLORATION.

(1) Supported employment-individual exploration is paid for on an outcome basis.

(2) The unit is a complete episode of the service as defined in the approved Section 1915(c) waiver application and includes all of the service required to deliver the expected outcome.

(3) The outcome-based rate is calculated using the following factors:

(a) Average cost of job coach hour of service (as described in 0465-01-02-.11(3)(a)), including these component costs:

DSP reimbursement rate;
Employee-rel ated expenses;
Administrative costs;
Productivity assumptions; and 5. Travel costs;

(b) A value-based incentive of $4.30/hour above actual cost (rate model) to reward provision of services expected to result in the person identifying a goal of competitive integrated employment;

(c) Average number of job coach hours required to complete service; and (d) Billable service adjustment for percentage of waiver participants that do not complete the service due to reasons beyond the purview of the provider’s control.

History

Authority: T.C.A. §§ 4-3-2701, 4-3-2707, 4-4-103, 4-5-201, et seq., 4-5-208, et seq. and its applicable regulations concerning emergency rules, 33-1-201, 33-1-202, 33-1-203(1) and (6), 33-1-204, 33-1-301, 33-1-302, 33-1-302(a)(3) and (a)(4), 33-1-303, 33-1-303(3) and (11), 33-1-304, 33-1-305(1), and 33-1- 309(d); Executive Order of the State of Tennessee No. 23, dated October 19, 1999; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; and the “Reimbursement Rate” for Medical Services under DIDD federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Original rule filed December 12, 2013; effective March 12, 2014. Amendments filed October 7, 2019; effective January 5, 2020.

Tenn. Comp. R. & Regs. 0465-01-02-.09 VALUE-BASED RATE SETTING METHODOLOGY FOR SUPPORTED

EMPLOYMENT-INDIVIDUAL DISCOVERY.

(1) Supported employment-individual discovery is paid for on an outcome basis.

(2) The unit is a complete episode of the service as defined in the approved Section 1915(c) waiver application and includes all of the service required to deliver the expected outcome.

(3) The outcome-based rate is calculated using the following factors:

(a) Average cost of job developer hour of service, including these component costs:

DSP reimbursement rate;
Adjustment of $2.75/hour to increase DSP reimbursement rate to account for additional qualifications required for discovery;
Employee-related expenses;
Administrative costs;
Productivity assumptions; and 6. Travel costs;

(b) Average number of job developer hours required to complete service; and (c) Billable service adjustment for percentage of waiver participants that do not complete the service due to reasons beyond the purview of the provider’s control.

History

Authority: T.C.A. §§ 4-3-2701, 4-3-2707, 4-4-103, 4-5-201, et seq., 4-5-208, et seq. and its applicable regulations concerning emergency rules, 33-1-201, 33-1-202, 33-1-203(1) and (6), 33-1-204, 33-1-301, 33-1-302, 33-1-302(a)(3) and (a)(4), 33-1-303, 33-1-303(3) and (11), 33-1-304, 33-1-305(1), and 33-1- 309(d); Executive Order of the State of Tennessee No. 23, dated October 19, 1999; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; and the “Reimbursement Rate” for Medical Services under DIDD federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Original r ule filed December 12, 2013; effective March 12, 2014. Amendments filed October 7, 2019; effective January 5, 2020.

Tenn. Comp. R. & Regs. 0465-01-02-.10 VALUE-BASED RATE SETTING METHODOLOGY FOR SUPPORTED

EMPLOYMENT-INDIVIDUAL JOB DEVELOPMENT.

(1) Supported employment-individual job development is paid for on an outcome basis.

(2) The unit is a complete episode of the service as defined in the approved Section 1915(c) waiver application and includes all of the service required to deliver the expected outcome.

(3) The outcome-based rate is calculated using the following factors:

(a) Average cost of job developer hour of service, including these component costs:

DSP reimbursement rate;
Adjustment of $2.75/hour to increase DSP reimbursement rate to account for additional qualifications required for job developer;
Employee-related expenses;
Administrative costs;
Productivity assumptions; and 6. Travel costs;

(b) Rate level factor based on average number of job developer hours required to complete service and secure outcome adjusted for intensity of support needs of the individual; and (c) Billable service adjustment for percentage of waiver participants that do not complete the service due to reasons beyond the purview of the provider’s control.

History

Authority: T.C.A. §§ 4-3-2701, 4-3-2707, 4-4-103, 4-5-201, et seq., 4-5-208, et seq. and its applicable regulations concerning emergency rules, 33-1-201, 33-1-202, 33-1-203(1) and (6), 33-1-204, 33-1-301, 33-1-302, 33-1-302(a)(3) and (a)(4), 33-1-303, 33-1-303(3) and (11), 33-1-304, 33-1-305(1), and 33-1- 309(d); Executive Order of the State of Tennessee No. 23, dated October 19, 1999; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; the “Reimbursement Rate” for Medical Services under DIDD federal waiver(s) for provision of services as administered by TennCare; and. Tennessee Public Chapter 1100, June 23, 2010.
Administrative History: Original rule filed December 12, 2013; effective March 12, 2014. Amendments filed October 7, 2019; effective January 5, 2020.

Tenn. Comp. R. & Regs. 0465-01-02-.11 VALUE-BASED RATE SETTING METHODOLOGY FOR SUPPORTED

EMPLOYMENT-INDIVIDUAL JOB COACHING.

(1) Supported employment-individual job coaching is reimbursed on a fee-for-service basis.

(2) The unit of service is 15 minutes.

(3) The fee-for-service rate is calculated using the following factors:

(a) Average cost of job coach hour of service divided by four (4), including these component costs:

DSP reimbursement rate;
Employee-related expenses;
Administrative costs;
Productivity assumptions, including projected average waiver participant absentee rate of 12 percent; and 5. Travel cost; and (b) A value-based incentive of $3/hour above actual cost (rate model) to reward the provision of services to support waiver participant success in competitive, integrated employment - so long as fading expectations are met (see below);

(c) Value-based adjustments beginning six months after initiation of individual job coaching to incentivize fading of services, based on a combination of: the intensity of support needs of the waiver participant, the length of time the waiver participant has held the current job or self-employment position, and the effectiveness of job coaching services as demonstrated by fading achieved.

(4) Additionally, where an waiver participant has a need for job coaching that is equal to or less than one hour per week, a monthly “Stabilization and Monitoring” payment will be used to encourage ongoing, effective monitoring of the waiver participant’s employment situations, with minimum monthly contact requirements that will allow for prevention of otherwise avoidable job losses or reductions in work hours.

(5) Quality Payment for Hours Worked Milestone under Supported Employment-Individual Employment Support: Payment earned and paid for additional/atypical effort of provider that results in a waiver participant working in competitive integrated employment achieving above average hours worked in a six-month period. There are two quality payment levels available:

(a) The base tier payment is $1,500 and is made based on the waiver participant working in competitive integrated employment between three-hundred ninety (390) and fivehundred nineteen (519) hours in the prior six (6) calendar month period. This is average hourly employment that is at least 15 but less than 20 hours/week.

(b) The top tier payment is $2,000 and is made based on the waiver participant working five-hundred and twenty (520) or more hours in the prior six (6) calendar month period.

This is average hourly employment that is 20 hours/week or more.

History

Authority: T.C.A. §§ 4-3-2701, 4-3-2707, 4-4-103, 4-5-201, et seq., 4-5-208, et seq. and its applicable regulations concerning emergency rules, 33-1-201, 33-1-202, 33-1-203(1) and (6), 33-1-204, 33-1-301, 33-1-302, 33-1-302(a)(3) and (a)(4), 33-1-303, 33-1-303(3) and (11), 33-1-304, 33-1-305(1), and 33-1- 309(d); Executive Order of the State of Tennessee No. 23, dated October 19, 1999; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; and the “Reimbursement Rate” for Medical Services under DIDD federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Original rule filed December 12, 2013; effective March 12, 2014. Amendments filed October 7, 2019; effective January 5, 2020.

Tenn. Comp. R. & Regs. 0465-01-02-.12 VALUE-BASED RATE SETTING METHODOLOGY FOR SUPPORTED

EMPLOYMENT-SMALL GROUP.

(1) Supported employment-small group is reimbursed on a fee-for-service basis.

(2) The unit of service is 15 minutes.

(3) The fee-for-service rate is calculated using the following factors:

(a) Average cost of job coach hour of service divided by four (4), including these component costs:

DSP reimbursement rate;
Employee-related expenses;
Administrative costs;
Productivity assumptions, including projected average waiver participant absentee rate of 8.23 percent; and 5. Travel costs;

(b) Participant transportation cost per unit per person;

(c) Administrative adjustment based on the number of waiver participants in the small group and the expected job coach-to-waiver participant staffing ratio (one job coach for a group of two, three, or four waiver participants); and (d) Value-based adjustment to incentivize smaller group size.

History

Authority: T.C.A. §§ 4-3-2701, 4-3-2707, 4-4-103, 4-5-201, et seq., 4-5-208, et seq. and its applicable regulations concerning emergency rules, 33-1-201, 33-1-202, 33-1-203(1) and (6), 33-1-204, 33-1-301, 33-1-302, 33-1-302(a)(3) and (a)(4), 33-1-303, 33-1-303(3) and (11), 33-1-304, 33-1-305(1), and 33-1- 309(d); Executive Order of the State of Tennessee No. 23, dated October 19, 1999; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; and the “Reimbursement Rate” for Medical Services under DIDD federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Original rule filed December 12, 2013; effective March 12, 2014. Amendments filed October 7, 2019; effective January 5, 2020.

Tenn. Comp. R. & Regs. 0465-01-02-.13 RATE SETTING METHODOLOGY FOR COMMUNITY PARTICIPATION SERVICES

(1) Community participation services are reimbursed on a fee-for-service basis.

(2) The unit of service is 15 minutes.

(3) The fee-for-service rate is calculated using the following factors:

(a) DSP reimbursement rate.

(b) Non-direct program costs;

(d) Transportation costs per unit per person;

(e) Projected average waiver participant absentee rate of 8.23 percent; and (f) Rate Level Factor as defined in 0465-01-02-.03.

History

Authority: T.C.A. §§ 4-3-2701, 4-3-2707, 4-4-103, 4-5-201, et seq., 4-5-208, et seq. and its applicable regulations concerning emergency rules, 33-1-201, 33-1-202, 33-1-203(1) and (6), 33-1-204, 33-1-301, 33-1-302, 33-1-302(a)(3) and (a)(4), 33-1-303, 33-1-303(3) and (11), 33-1-304, 33-1-305(1), and 33-1- 309(d); Executive Order of the State of Tennessee No. 23, dated October 19, 1999; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; and the “Reimbursement Rate” for Medical Services under DIDD federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Original rule filed December 12, 2013; effective March 12, 2014. Amendments filed October 7, 2019; effective January 5, 2020.

Tenn. Comp. R. & Regs. 0465-01-02-.14 RATE SETTING METHODOLOGY FOR INTERMITTENT EMPLOYMENT AND

COMMUNITY PARTICIPATION WRAPAROUND.

(1) Intermittent employment and community participation wraparound services are reimbursed on a fee-for-service basis.

(2) The unit of service is 15 minutes.

(3) The fee-for-service rate is calculated using the following factors:

(a) DSP reimbursement rate;

(b) Non-direct program costs;

(d) Projected average waiver participant absentee rate of 8.23 percent; and (e) Rate Level Factor as defined in 0465-01-02-.03.

(f) This service is provided in a waiver participant’s home and has no transportation cost included.

History

Authority: T.C.A. §§ 4-3-2701, 4-3-2707, 4-4-103, 4-5-201, et seq., 4-5-208, et seq. and its applicable regulations concerning emergency rules, 33-1-201, 33-1-202, 33-1-203(1) and (6), 33-1-204, 33-1-301, 33-1-302, 33-1-302(a)(3) and (a)(4), 33-1-303, 33-1-303(3) and (11), 33-1-304, 33-1-305(1), and 33-1- 309(d); Executive Order of the State of Tennessee No. 23, dated October 19, 1999; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; and the “Reimbursement Rate” for Medical Services under DIDD federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Original rule filed December 12, 2013; effective March 12, 2014. Amendments filed October 7, 2019; effective January 5, 2020.

Tenn. Comp. R. & Regs. 0465-01-02-.15 RATE SETTING METHODOLOGY FOR FACILITY-BASED DAY SERVICES

(1) Facility-based day services are reimbursed on a fee-for-service basis.

(2) The unit of service is 15 minutes.

(3) The fee-for-service rate is calculated using the following factors:

(a) DSP reimbursement rate;

(b) Non-direct program costs;

(d) Transportation costs per unit per person;

(e) Projected average waiver participant absentee rate of 8.23 percent; and (f) Rate Level Factor as defined in 0465-01-02-.03.

History

Authority: T.C.A. §§ 4-3-2701, 4-3-2707, 4-4-103, 4-5-201, et seq., 4-5-208, et seq. and its applicable regulations concerning emergency rules, 33-1-201, 33-1-202, 33-1-203(1) and (6), 33-1-204, 33-1-301, 33-1-302, 33-1-302(a)(3) and (a)(4), 33-1-303, 33-1-303(3) and (11), 33-1-304, 33-1-305(1), and 33-1- 309(d); Executive Order of the State of Tennessee No. 23, dated October 19, 1999; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; and the “Reimbursement Rate” for Medical Services under DIDD federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Original rule filed December 12, 2013; effective March 12, 2014. Amendments filed October 7, 2019; effective January 5, 2020.

Tenn. Comp. R. & Regs. 0465-01-02-.16 RATE SETTING METHODOLOGY FOR RESIDENTIAL SPECIAL NEEDS

ADJUSTMENT-HOMEBOUND AND NON-RESIDENTIAL HOMEBOUND SUPPORT SERVICES.

(1) Residential special needs adjustment-homebound and non-residential homebound support service are reimbursed on a fee-for-service basis.

(2) The unit of service is a day, constituting staff coverage for 6 hours each day.

(3) The fee-for-service rate is calculated using the following factors:

(a) DSP reimbursement rate;

(b) Non-direct program costs at the allowable percentage;

(d) Projected average waiver participant absentee rate percentage based on 20 leave days per year; and (e) Rate level factor as defined in 0465-01-02-.03.

(f) This setting is provided in a waiver participant’s home and has no transportation cost included.

History

Authority: T.C.A. §§ 4-3-2701, 4-3-2707, 4-4-103, 4-5-201, et seq., 4-5-208, et seq. and its applicable regulations concerning emergency rules, 33-1-201, 33-1-202, 33-1-203(1) and (6), 33-1-204, 33-1-301, 33-1-302, 33-1-302(a)(3) and (a)(4), 33-1-303, 33-1-303(3) and (11), 33-1-304, 33-1-305(1), and 33-1- 309(d); Executive Order of the State of Tennessee No. 23, dated October 19, 1999; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; and the “Reimbursement Rate” for Medical Services under DIDD federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Original rule filed December 12, 2013; effective March 12, 2014. Amendments filed October 7, 2019; effective January 5, 2020.

Tenn. Comp. R. & Regs. 0465-01-02-.17 RATE SETTING METHODOLOGIES FOR CLINICAL SERVICES

(1) The unit for all types of therapy services and nursing services is a quarter hour.

(2) The unit for behavioral services is one quarter (1/4) of an hour.

(3) The rate for clinical services is based on comparison with national rates of payment and comparable rates of payment within the State for like services.

History

Authority: T.C.A. §§ 4-3-2701, 4-3-2707, 4-4-103, 4-5-201, et seq., 4-5-208, et seq. and its applicable regulations concerning emergency rules, 33-1-201, 33-1-202, 33-1-203(1) and (6), 33-1-204, 33-1-301, 33-1-302, 33-1-302(a)(3) and (a)(4), 33-1-303, 33-1-303(3) and (11), 33-1-304, 33-1-305(1), and 33-1- 309(d); Executive Order of the State of Tennessee No. 23, dated October 19, 1999; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; and the “Reimbursement Rate” for Medical Services under DIDD federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Original rule filed December 12, 2013; effective March 12, 2014. Amendments filed October 7, 2019; effective January 5, 2020.

Tenn. Comp. R. & Regs. 0465-01-02-.18 RATE SETTING METHODOLOGIES FOR RESPITE AND PERSONAL ASSISTANCE

SERVICES.

(1) The unit for respite services may be one quarter (1/4) of an hour or daily rates as determined by DIDD based on the duration of services provided. The unit for personal assistance services is a quarter hour.

(2) The determination of rates in this section (.18) is calculated based on units of one quarter (1/4) of an hour for one (1) staff person or of one day of allowable direct service costs for one (1) staff person and a percentage of administrative costs. Reimbursement for two (2) staff to deliver services to one (1) waiver participant at the same time is not covered under any circumstances.

(3) There will be one (1) maximum rate for one-quarter (1/4) of an hour of Personal Assistance.

(4) There will be one (1) maximum rate for one-quarter (1/4) of an hour of Respite services.

History

Authority: T.C.A. §§ 4-3-2701, 4-3-2707, 4-4-103, 4-5-201, et seq., 4-5-208, et seq. and its applicable regulations concerning emergency rules, 33-1-201, 33-1-202, 33-1-203(1) and (6), 33-1-204, 33-1-301, 33-1-302, 33-1-302(a)(3) and (a)(4), 33-1-303, 33-1-303(3) and (11), 33-1-304, 33-1-305(1), and 33-1- 309(d); Executive Order of the State of Tennessee No. 23, dated October 19, 1999; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; and the “Reimbursement Rate” for Medical Services under DIDD federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Original rule filed December 12, 2013; effective March 12, 2014. Amendments filed October 7, 2019; effective January 5, 2020.

Tenn. Comp. R. & Regs. 0465-01-02-.19 RATE SETTING METHODOLOGIES FOR DENTAL SERVICES

(1) Dental Services rates are those set by TennCare for reimbursement of Medicaid funded dental care.

Authority T.C.A. §§ 4-3-2701, 4-3-2707, 4-4-103, 4-5-201, et seq., 4-5-208, et seq. and its applicable regulations concerning emergency rules, 33-1-201, 33-1-202, 33-1-203(1) and (6), 33-1-204, 33-1-301, 33-1-302, 33-1-302(a)(3) and (a)(4), 33-1-303, 33-1-303(3) and (11), 33-1-304, 33-1-305(1), and 33-1- 309(d); Executive Order of the State of Tennessee No. 23, dated October 19, 1999; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; and the “Reimbursement Rate” for Medical Services under DIDD federal waiver(s) for provision of services as administered by TennCare.

Administrative History: Original rule filed December 12, 2013; effective March 12, 2014. Amendments filed October 7, 2019; effective January 5, 2020.

Tenn. Comp. R. & Regs. 0465-01-02-.20 RATE SETTING METHODOLOGIES FOR PERSONAL EMERGENCY RESPONSE

SYSTEMS.

(1) Rates paid are the usual and customary rates for installation and monitoring set by the company providing the service.

Administrative History: Original rules filed October 7, 2019; effective January 5, 2020.

Tenn. Comp. R. & Regs. 0465-01-02-.21 RATE SETTING METHODOLOGIES FOR SPECIALIZED MEDICAL EQUIPMENT

AND SUPPLIES.

(1) Rates paid are the usual and customary costs for the equipment or supplies.

Administrative History: Original rules filed October 7, 2019; effective January 5, 2020.

Tenn. Comp. R. & Regs. 0465-01-02-.22 RATE SETTING METHODOLOGIES FOR ENVIRONMENTAL MODIFICATIONS

(1) Rates paid are the usual and customary costs for the modification.

Administrative History: Original rules filed October 7, 2019; effective January 5, 2020.

Tenn. Comp. R. & Regs. 0465-01-02-.23 RATE SETTING METHODOLOGIES FOR INDEPENDENT SUPPORT

COORDINATION SERVICES.

(1) Current rates were derived after consideration of provider input, resource availability as well as system service requirements. Future changes in amounts paid for this service will be made utilizing such tools as: consultation with stake-holders (e.g. Independent Support Coordinators, Independent Support Coordination Agencies/Organizations), review of similar services in other states, market conditions, and system needs.

Administrative History: Original rules filed October 7, 2019; effective January 5, 2020.

Tenn. Comp. R. & Regs. 0465-01-02-.24 RATE SETTING METHODOLOGIES FOR SERVICES FUNDED EXCLUSIVELY BY

THE STATE [NON-WAIVER; STATE FUNDED (NWSF) SERVICES].

(1) Rates paid are discretionary and based upon waiver participant need, limited by system and service requirements and subject to DIDD funding and resource availability.

Administrative History: Original rules filed October 7, 2019; effective January 5, 2020.

Chapter 0465-01-03 Administration of Medication By Unlicensed Personnel

Tenn. Comp. R. & Regs. 0465-01-03-.01 PURPOSE

(1) The purpose of these rules is to amend the former rules pertaining to Administration of Medication by Unlicensed Personnel and establish new rules in light of the Department of Intellectual and Developmental Disabilities’ current organization, structure and resources.

History

Authority: Tenn. Code Ann. (T.C.A.) §§ 4-5-202, 33-1-302, 33-1-303, 33-1-305, 33-1-309 and 68-1-904.
Administrative History: Original rule filed August 28, 2015; effective November 26, 2015. Rule renumbered from 1200-20-12.

Tenn. Comp. R. & Regs. 0465-01-03-.02 DEFINITIONS

(1) “Administration of Medications” shall mean providing for the ingestion, application, injection of medications allowed by these rules; inhalation or rectal or vaginal insertion of medication, including over the counter and prescription drugs, according to the written or printed directions of the prescribing practitioner; and making a written record thereof with regard to each medication administered, including the time and amount taken. Administration does not include judgment, evaluation or assessment.

(2) “Certification” shall mean the period of time an unlicensed staff is authorized to administer medications in accordance with these rules.

(3) “Certified Personnel” authorized to administer medications shall mean an employee who:

(a) Is at least 18 years of age;

(b) Has met all requirements to be an employee of a provider agency;

(c) Is able to effectively read, write and communicate verbally in English as well as read and understand instructions, perform record-keeping duties and write reports;

(d) Has successfully completed the DIDD medication administration training program; and (e) Holds current certification to administer medications according to the provision of these rules.

(4) “Competency Testing” shall mean a written examination and a practical demonstration of skills that measure basic proficiency in medication administration.

November, 2015 (5) “Curriculum” shall mean the current course training program ‘Medication Administration for Unlicensed Personnel’.

(6) “Department” shall mean the Tennessee Department of Intellectual and Developmental Disabilities, also referred to as DIDD.

(7) “Drugs or Medications” shall mean substances intended for use in diagnosis, care, mitigations, treatment or prevention.

(8) “Employee” shall mean an individual who is unlicensed and is employed or receives payment through a provider agency contracting with the Department.

(9) “Medication Variance” shall mean any time a medication is given in a way that is inconsistent with how it was ordered by the prescribing practitioner and in accordance with the “Eight Rights” (i.e. right dose, right drug, right route, right time, right position, right texture, right person and right documentation).

(10) “Injectable Medications” shall mean medications given by intradermal, subcutaneous, intramuscular or intravenous routes. Injectable medications that may be given by certified unlicensed personnel are limited to routine insulin injections that are pre-drawn/prepared by the pharmacy and ordered on a regular basis (with additional training) or injectable epinephrine (i.e.EpiPen).

(11) “Monitoring” shall mean periodic review, observation, direction, and evaluation of a certified unlicensed staff’s knowledge, skills and performance related to the functions and activities provided for in these rules.

(12) “Participant Record” shall mean the official record from the Department containing all information relative to class participation. Participant record is the only acceptable documentation for proof of certification to administer medications under the exemption.

(13) “RN Trainer” shall mean a registered nurse holding an unencumbered license in the State of Tennessee and who is trained by the Department to provide medication administration training in accordance with the curriculum and these rules.

(14) “Person (receiving services)” shall mean any person with intellectual and/or developmental disabilities who is enrolled in a DIDD home and community based waiver program and any person served by an agency that is both licensed under Title 33 and under contract with DIDD to provide residential or day services for people with intellectual and/or developmental disabilities, including persons served in the CHOICES program.

(15) “Provider Agency” shall mean private non-profit or for-profit entity under agreement/contract with the Department to provide services to individuals with intellectual and/or developmental disabilities.

(16) “Termination” shall mean the permanent revocation of certification and authority for:

(a) Unlicensed staff to administer medication or (b) RN trainer to train the curriculum.

History

Authority: Tenn. Code Ann. (T.C.A.) §§ 4-5-202, 33-1-302, 33-1-303, 33-1-305, 33-1-309 and 68-1-904.
Administrative History: Original rule filed August 28, 2015; effective November 26, 2015. Rule renumbered from 1200-20-12. November, 2015

Tenn. Comp. R. & Regs. 0465-01-03-.03 MEDICATION ADMINISTRATION TRAINING PROGRAMS

(1) Medication Administration Curriculum developed and administered by the Department.

The course curriculum should cover, at a minimum, the following:

(a) Legal and ethical aspects of medication administration;

(b) State and federal regulations regarding medications;

(d) Administration of medications;

(e) Types of medications, indications, actions, side effects and appropriate emergency response;

(f) Documentation; and (g) Storage of medications.

(2) Certified RN Trainers (a) The instruction of medication administration shall be performed by a Registered Nurse licensed and registered in the State of Tennessee who has:

(1) A minimum of two (2) years RN experience;

(2) A minimum one of (1) year experience in the provision of services to people within the DIDD system; and (3) Experience as a direct supervisor responsible for oversight and management of staff.

(b) RN Trainer shall maintain security of all testing materials.

(d) The Department shall maintain a current database of certified RN trainers who are eligible to provide the instruction of medication administration under the exemption.

(e) The RN Trainer’s authority to provide training in Medication Administration for Unlicensed Personnel may be terminated by the Department for failure to conform and perform to the standards set forth in these rules and the curriculum. Notice shall be provided to the RN Trainer by certified mail and he/she shall have the right to request an appeal hearing of decision to terminate his/her authority to provide training, pursuant to the Tennessee Uniform Administrative Procedures Act.

(3) The Department shall keep abreast of current standards and practices in the field and update the program accordingly.

(4) Competency Based Medication Administration Program:

November, 2015 (a) The Department shall ensure that training sessions are held in accordance with these rules;

(b) Provider agencies shall develop and maintain a system for ensuring that any certified personnel administering medications have current certification in Medication Administration for Unlicensed Personnel;

(c) The Department shall maintain course material for one (1) year and participant records for five (5) years; and (d) The Department shall provide the agency with a participant record for each participant registered for class.

History

Authority: Tenn. Code Ann. (T.C.A.) §§ 4-5-202, 4-5-301, 33-1-302, 33-1-303, 33-1-305, 33-1-309 and 68-1-90.
Administrative History: Original rule filed August 28, 2015; effective November 26, 2015. Rule renumbered from 1200-20-12.

Tenn. Comp. R. & Regs. 0465-01-03-.08 TERMINATION OF AUTHORITY TO ADMINISTER MEDICATION

(1) The provider agency shall submit a recommendation to the Department for termination of

authority to administer medications in the event a certified personnel is determined to be unable to safely administer medications due to:

(a) The use of drugs, alcohol or controlled substances which could impair judgment; or (b) Performance of unsafe or unacceptable care of people receiving medications; or (c) Failure to conform to the essential and prevailing standards of medication administration.

The Department shall review the recommendation and provide a decision to the provider agency.

Termination of certification notice shall be provided to the certified personnel by certified mail and the he/she shall have the right to request an appeal hearing on his/her termination of authority to administer medications, pursuant to the Tennessee Uniform Administrative Procedures Act.

November, 2015

History

Authority: Tenn. Code Ann. (T.C.A.) §§ 4-5-202, 4-5-301, 33-1-302, 33-1-303, 33-1-305, 33-1-309 and 68-1-904.
Administrative History: Original rule filed August 28, 2015; effective November 26, 2015. Rule renumbered from 1200-20-12.

Tenn. Comp. R. & Regs. 0465-01-03-.04 APPROVAL OF UNLICENSED PERSONNEL

(1) Any contracted DIDD provider agency employing staff who are not otherwise authorized by law to administer medications shall be allowed to perform such duties only after passing competency testing. Certified personnel who administer medications within the provision of this paragraph shall be exempt from the licensing requirements of the Nurse Practice Act and the Rules of the Board of Nursing.

(2) Before administering medications, an employee shall successfully complete a medication administration program consisting of not less than twenty (20) hours of classroom instruction as set forth in these rules.

(3) To successfully complete a medication administration training program, an employee shall achieve a score of at least 80 percent (%) for the course based on a written, objective test on the components set forth in these regulations. Demonstrated proficiency in the practicum of medication administration shall also be required with a score of at least 80 percent (%).

(4) Certification shall be renewed every three (3) years by:

(a) Successfully completing the Medication Administration for Unlicensed Personnel program or (b) Test-out; by completion of online review followed by successfully passing the written and practical tests administered by a certified RN Trainer.

(5) DIDD shall allow employees who failed under the previous system to start fresh under the new system. DIDD shall remove any limit on the number of times an employee may take the exam with no waiting period between attempts. After the second failure of the employee to pass the examination, the cost of further testing shall be shifted to the provider.

History

Authority: Tenn. Code Ann. (T.C.A.) §§ 4-5-202, 33-1-302, 33-1-303, 33-1-305, 33-1-309 and 68-1-904. A d m i n i s t r a t i v e H i s t o r y : Original rule filed August 28, 2015; effective November 26, 2015. Rule renumbered from 1200-20-12. November, 2015

Tenn. Comp. R. & Regs. 0465-01-03-.05 CERTIFICATION OF UNLICENSED PERSONNEL

(1) The provider agency shall obtain proof of certification (participant record) for new employees from the Department before they are allowed to administer medications.

(2) The Department shall verify an employee’s current status and date of last successful completion of the medication administration training program.

History

Authority: Tenn. Code Ann. (T.C.A.) §§ 4-5-202, 33-1-302, 33-1-303, 33-1-305, 33-1-309 and 68-4-904.
Administrative History: Original rule filed August 28, 2015; effective November 26, 2015. Rule renumbered from 1200-20-12.

Tenn. Comp. R. & Regs. 0465-01-03-.06 LIMITATIONS OF FUNCTIONS OF UNLICENSED PERSONNEL

(1) The following may be performed by certified personnel under the scope of these regulations and in accordance with the training curriculum:

(a) Medication administration via the following routes: oral, rectal, vaginal, eye, ear, nasal and topical; and (b) Administration of medications by subcutaneous route for routine insulin (with additional training) and injectable epinephrine (i.e. EpiPen).

(2) This regulation does not preclude the performance of procedures by certified personnel pursuant to individual delegation by licensed personnel in accordance with the Nurse Practice Act and the Rules of the Board of Nursing.

(3) Administration of medications included in this exemption cannot be delegated.

History

Authority: Tenn. Code Ann. (T.C.A.) §§ 4-5-202, 33-1-302, 33-1-303, 33-1-305, 33-1-309 and 68-1- 904.
Administrative History: Original rule filed August 28, 2015; effective November 26, 2015. Rule renumbered from 1200-20-12.

Tenn. Comp. R. & Regs. 0465-01-03-.07 PROVIDER AGENCY REQUIREMENTS

(1) A provider agency employing certified personnel shall have a written policy demonstrating compliance with these rules. This policy shall be accepted by the Department and shall include, at a minimum, the following elements:

(a) Medication prohibitions;

(b) Security;

(d) Medication storage and labeling;

(e) Editing of medication records;

(f) Medication refusal;

(g) Medication Administration Record (MAR);

(h) Controlled substances;

(i) Medication variances;

November, 2015 (j) Medication disposal;

(k) Family visit; and (l) Self-Administration.

(2) A provider agency shall have a separate Medication Administration Record (MAR) of ordered medications for each person. The MAR must include at least the following:

(a) Name of person receiving the medication;

(b) Name of medication, indication, dosage and route of administration;

(d) Name of prescribing practitioner;

(e) Start date and stop date, if applicable; and (f) Any specific directions.

(3) A provider agency shall maintain a side effects sheet and practitioner orders with the MAR for each medication ordered. Such records shall be subject to review by the Department.

(4) Storage, security and disposal of medications shall be maintained in accordance with State and Federal laws and DIDD regulations.

(5) The agency shall have certified personnel available to administer medications as ordered and at a place and time convenient for the person.

History

Authority: Tenn. Code Ann. (T.C.A.) §§ 4-5-202, 33-1-302, 33-1-303, 33-1-305, 33-1-309 and 68-1- 904.
Administrative History: Original rule filed August 28, 2015; effective November 26, 2015. Rule renumbered from 1200-20-12.

Tenn. Comp. R. & Regs. 0465-01-03-.09 MONITORING OF UNLICENSED PERSONNEL

(1) The Department shall monitor the administration of medications by certified personnel.

Monitoring shall be completed by Registered Nurses employed by the Department.

(2) The provider agency shall monitor, at a minimum, the first medication pass of the certified personnel upon successful completion of his/her original certification, provide ongoing monitoring in accordance with agency policy and maintain documentation of such.

History

Authority: Tenn. Code Ann. (T.C.A.) §§ 4-5202, 33-1-302, 33-1-303, 33-1-305, 33-1-309 and 68-1- 904.
Administrative History: Original rule filed August 28, 2015; effective November 26, 2015. Rule renumbered from 1200-20-12.

Chapter 0465-01-04 Public Records

Tenn. Comp. R. & Regs. 0465-01-04-.01 PURPOSE AND APPLICATION

The purpose of these rules is to establish a process and procedures, pursuant to T.C.A. §§ 10-7-503(g) and 10-7-504, to provide economical and efficient access to public records of the Department of Intellectual and Developmental Disabilities (“DIDD” or “department”), in compliance with the Tennessee Public Records Act (“TPRA”), except as otherwise provided by law. These rules apply to employees of DIDD and any citizen of Tennessee requesting public records of DIDD.

History

Authority: T.C.A. §§ 4-3-2708, 10-7-503, 10-7-504, 33-1-303, and 45 C.F.R. Part 164, Subpart E.
Administrative History: Original rules filed January 2, 2019; effective April 2, 2019. Repealed by Chapter 653, § 1 of the 2020 Public Acts, effective April 2, 2020. New rules filed September 3, 2020; effective December 2, 2020.

Tenn. Comp. R. & Regs. 0465-01-04-.02 EFFECTIVE DATE

The effective date of the rules set forth in this chapter shall be December 2, 2020.

History

Authority: T.C.A. § 4-5-207.
Administrative History: Original rules filed January 2, 2019; effective April 2, 2019. Repealed by Chapter 653, § 1 of the 2020 Public Acts, effective April 2, 2020. New rules filed September 3, 2020; effective December 2, 2020.

Tenn. Comp. R. & Regs. 0465-01-04-.03 LEGAL BASIS

As directed by the Legislature, by January 1, 2019, state agencies and departments shall promulgate rules regarding public records in compliance with T.C.A. § 10-7-503(g).

History

Authority: T.C.A. § 10-7-503(g).
Administrative History: Original rules filed January 2, 2019; effective April 2, 2019. Repealed by Chapter 653, § 1 of the 2020 Public Acts, effective April 2, 2020. New rules filed September 3, 2020; effective December 2, 2020.

Tenn. Comp. R. & Regs. 0465-01-04-.04 DEFINITIONS

(1) The following terms as used in these rules shall have the meanings described below:

(a) “Office of Open Records Counsel” (OORC) means the office of the Tennessee Comptroller of the Treasury serving citizens, media, and governmental entities as a resource for issues concerning Tennessee’s public records laws.

(b) “Public Records” means all documents, papers, letters, maps, books, photographs, microfilms, electronic data processing files and output, films, sound recordings, or other material, regardless of physical form or characteristics, made or received pursuant to law or ordinance or in connection with the transaction of official business by DIDD.

(c) “Public Records Request Coordinator” (PRRC) means the DIDD employee who has the responsibility to ensure public record requests are routed to the appropriate records custodian and are fulfilled in accordance with the TPRA and these rules. The Public Records Request Coordinator may also be a records custodian.

(d) “Records Custodians” means the employees of DIDD lawfully responsible for the direct custody and care of public records. The records custodians are not necessarily the original preparers or receivers of the records.

(e) “Requestor” means a person seeking access to a public record, whether it is for inspection or duplication.

(f) “Tennessee Public Records Act” (TPRA) means the statutes codified at T.C.A. §§ 10-7- 501, et seq.

History

Authority: T.C.A. § 10-7-503.
Administrative History: Original rules filed January 2, 2019; effective April 2, 2019. Repealed by Chapter 653, § 1 of the 2020 Public Acts, effective April 2, 2020. New rules filed September 3, 2020; effective December 2, 2020.

Tenn. Comp. R. & Regs. 0465-01-04-.05 ACCESS TO PUBLIC RECORDS

(1) DIDD public records shall, at all times during business hours, be open for personal inspection by any citizen of this state, and those in charge of the records shall not refuse such right of inspection to any citizen, unless otherwise provided by state or federal law.

(2) Personnel of DIDD shall timely and efficiently provide access and assistance to persons requesting to view or receive copies of public records. No provisions of these rules shall be used to hinder access to open public records. However, the integrity and organization of public records, as well as the efficient and safe operation of DIDD, and the persons it supports, shall be protected as provided by current law.

(3) These rules shall be applied consistently throughout the various offices, departments, and/or divisions of DIDD, except that records requests directed to DIDD’s Office of General Counsel will be handled in accordance with applicable law and procedural rules pertaining to privileged communications.

History

Authority: T.C.A. §§ 10-7-503, 33-1-303, and 45 C.F.R. Part 164, Subpart E.
Administrative History: Original rules filed January 2, 2019; effective April 2, 2019. Repealed by Chapter 653, § 1 of the 2020 Public Acts, effective April 2, 2020. New rules filed September 3, 2020; effective December 2, 2020.

Tenn. Comp. R. & Regs. 0465-01-04-.06 REQUESTING ACCESS TO PUBLIC RECORDS

(1) Public record requests shall be made to the PRRC or his/her designee in order to ensure that public record requests are routed to the appropriate records custodian and fulfilled in a timely manner.

(2) A request to view public records may be made to the PRRC orally or in writing using the “DIDD Public Records Request Form” found on the DIDD website at https://www.tn.gov/didd/about/public-records-requests.html. The form may be sent to the PRRC by: 1) mailing it to 315 Deaderick Street, UBS Tower, 8 th Floor, Nashville, Tennessee 37243; or 2) faxing it to 615-532-9940; or 3) emailing it to the email address listed on the records request webpage and/or the request form. The PRRC may request contact information from the requestor for the purpose of providing any written communication required under the TPRA.

(3) Requests for copies, or requests for inspection and copies, shall be made to the PRRC in writing using the form referred to above.

(4) Proof of Tennessee citizenship by presentation of a valid Tennessee driver’s license (or, in the discretion of the PRRC, alternative acceptable form of ID showing the requestor’s address) is required as a condition to inspect or receive copies of DIDD public records.

History

Authority: T.C.A. § 10-7-503.
Administrative History: Original rules filed January 2, 2019; effective April 2, 2019. Repealed by Chapter 653, § 1 of the 2020 Public Acts, effective April 2, 2020. New rules filed September 3, 2020; effective December 2, 2020.

Tenn. Comp. R. & Regs. 0465-01-04-.07 RESPONDING TO PUBLIC RECORDS REQUESTS

(1) Public Records Request Coordinator (PRRC)

(a) DIDD’s designated PRRC is the person whose name and contact information appears on the DIDD Public Records Request Form. Contact information for the PRRC may also be found on DIDD’s website.

(b) The PRRC shall review public record requests and make an initial determination of the following:

If the requestor provided evidence of Tennessee citizenship;
If the records requested are described with sufficient specificity to identify them; and 3. If DIDD is the custodian of the requested records.

(c) The PRRC shall acknowledge receipt of a records request by appropriate means and take any of the following appropriate actions:

Advise the requestor of these rules and requirements regarding:

(i) Evidence of Tennessee citizenship;

(ii) The form required to request copies;

(iii) Fees; and (iv) Aggregation of multiple or frequent requests.

If appropriate, deny the request in writing within seven (7) business days of receipt of the request, using the “DIDD Public Records Request Response Form”, found on the DIDD website, providing the grounds for the denial, such as one or more of the following:

(i) The requestor has not presented evidence of Tennessee citizenship;

(ii) The request lacks specificity;

(iii) A specified exemption, or state or federal law makes the record not subject to disclosure under the TPRA;

(iv) DIDD is not the custodian of the requested records; or (v) The records do not exist.

If appropriate, contact the requestor to see if the request can be narrowed.
Forward the records request to the appropriate DIDD records custodian.
If requested records are in the custody of a different government department or agency, and the PRRC knows the correct governmental entity, the PRRC will provide that information to the requestor with contact information for the PRRC for that entity, if known.

History

Authority: T.C.A. §§ 10-7-503, 33-1-303, and 45 C.F.R. Part 164, Subpart E.
Administrative History: Original rules filed January 2, 2019; effective April 2, 2019. Repealed by Chapter 653, § 1 of the 2020 Public Acts, effective April 2, 2020. New rules filed September 3, 2020; effective December 2, 2020.

Tenn. Comp. R. & Regs. 0465-01-04-.08 RECORDS CUSTODIAN

(1) Upon receiving a public records request, a DIDD records custodian shall promptly make requested public records not specifically exempt from disclosure available as required by T.C.A. § 10-7-503(a)(2). The custodian may notify the requestor of the time and place of inspection or availability of copies of the records for pickup using the DIDD Public Records Request Response Form or by other means. The custodian may also furnish copies of the requested records, subject to the payment of fees and charges, by sending them to the requestor along with the Public Records Request Response Form.

(2) If the records custodian is uncertain that an applicable exemption or state or federal law prohibiting disclosure applies, the custodian may consult with the PRRC or DIDD’s Office of General Counsel.

(3) If it is not practicable to promptly make available for inspection or furnish copies of requested records, because additional time is necessary to determine whether the requested records exist, to search for, retrieve, or otherwise gain access to records, to determine whether the records are protected from disclosure, to redact records, or for other similar reasons, then the PRRC or records custodian shall, within seven (7) business days from receipt of the request by the PRRC, send the requestor the Public Records Request Response Form indicating the reason for the delay and an estimate of the time that will be necessary to produce the records or determine the proper response to the request.

(4) A denial by the records custodian shall be in writing using the Public Records Request Response Form.

(5) If a records custodian, in consultation with the PRRC and/or Office of General Counsel, reasonably determines that production of requested records should be segmented because the records request is for a large volume of records, or that additional time is necessary to prepare the records for access, the records custodian shall use the Public Records Request Response Form to notify the requestor that production of the records will be in segments or groups and that a records production schedule will be provided as expeditiously as practicable. If appropriate, the PRRC or records custodian should contact the requestor to see if the request can be narrowed.

(6) If a records custodian discovers records responsive to a prior records request were omitted, he/she should contact the requestor concerning the omission and produce the records as soon as practicable.

History

Authority: T.C.A. §§ 10-7-503, 33-1-303, and 45 C.F.R. Part 164, Subpart E.
Administrative History: Original rules filed January 2, 2019; effective April 2, 2019. Repealed by Chapter 653, § 1 of the 2020 Public Acts, effective April 2, 2020. New rules filed September 3, 2020; effective December 2, 2020.

Tenn. Comp. R. & Regs. 0465-01-04-.09 REDACTION

(1) If a DIDD record contains confidential information or information that is not open for public inspection, the records custodian shall prepare a redacted copy prior to providing access or copies. If questions arise concerning redaction, the records custodian should coordinate with the PRRC or Office of General Counsel regarding review and redaction of records. If necessary, DIDD’s attorneys may consult with the Office of Open Records Counsel (OORC) or with the Office of Attorney General and Reporter regarding this or other issues concerning records requests.

(2) Whenever a redacted record is provided, a records custodian should provide the requestor with the basis for redaction. The basis given for redaction shall be general in nature and not disclose confidential information.

History

Authority: T.C.A. §§ 10-7-503, 33-1-303, and 45 C.F.R. Part 164, Subpart E.
Administrative History: Original rules filed January 2, 2019; effective April 2, 2019. Repealed by Chapter 653, § 1 of the 2020 Public Acts, effective April 2, 2020. New rules filed September 3, 2020; effective December 2, 2020.

Tenn. Comp. R. & Regs. 0465-01-04-.10 INSPECTION OF RECORDS

(1) There shall be no charge for inspection of open public records.

(2) The location for inspection of DIDD records shall be determined by the PRRC or the records custodian.

(3) The PRRC or a records custodian may require an appointment for inspection or may require inspection of records at an alternate location.

(4) During the inspection, the requestor shall have the right to make copies and take photographs or photostats of complete or partial records. However, DIDD will not certify the accuracy of copies, photographs, or photostats made with the requestor’s personal equipment, such as a printer, a cell phone, or a copy machine.

History

Authority: T.C.A. §§ 10-7-503 and 10-7-506.
Administrative History: Original rules filed January 2, 2019; effective April 2, 2019. Repealed by Chapter 653, § 1 of the 2020 Public Acts, effective April 2, 2020. New rules filed September 3, 2020; effective December 2, 2020.

Tenn. Comp. R. & Regs. 0465-01-04-.11 COPIES OF RECORDS

(1) The PRRC and/or records custodian shall promptly respond to a public record request for copies in the most economic and efficient manner practicable.

(2) Copies will be available for pickup at a location specified by the PRRC or records custodian.

(3) Copies will be mailed to the requestor’s address by U.S. Mail on request, and upon payment by the requestor of estimated postage charges and fees for copies and labor, unless other arrangements have been made in advance for billing the requestor for such fees or charges.

Copies may also be emailed to the requestor on request, and upon payment of fees for copies and labor. If electronic copies are provided on a flash drive or other storage device, the requestor may be charged the department’s out-of-pocket cost for such device.

History

Authority: T.C.A. § 10-7-503.
Administrative History: Original rules filed January 2, 2019; effective April 2, 2019. Repealed by Chapter 653, § 1 of the 2020 Public Acts, effective April 2, 2020. New rules filed September 3, 2020; effective December 2, 2020.

Tenn. Comp. R. & Regs. 0465-01-04-.12 FEES AND CHARGES

(1) Excessive fees and charges for copies of public records should not be used to hinder access to public records.

(2) Records custodians shall provide requestors with a good faith estimate of the fees and charges prior to producing the requested records.

(3) When fees and charges for copies and labor do not exceed $50, the fees may be waived at the discretion of the PRRC. When fees and charges for copies and labor exceed $50, the fees may be waived at the discretion of the PRRC upon written request to the PRRC. Fees associated with aggregated records requests will not be waived.

(4) Fees and charges for copies and labor are as follows:

(a) $0.15 per page for letter and legal size black and white copies.

(b) $0.50 per page for letter and legal size color copies.

(c) Labor charges, when time exceeds one (1) hour for time reasonably necessary to produce requested records, including the time spent locating, retrieving, reviewing, reproducing, redacting, or scanning records, will vary depending on the hourly rates of the employee(s) doing the work and may include the time of an attorney reasonably necessary to review records and redactions to ensure compliance with confidentiality requirements of state and federal law.

(d) If an outside vendor is used, the actual costs assessed by the vendor.

(e) No duplication costs will be charged for requests resulting in ten (10) or fewer pages of records. No duplication costs will be charged for records provided electronically except when paper copies that did not already exist are required to be created in responding to the request, such as when a record must be printed to be redacted.

(f) Payment is to be made by check or money order payable to DIDD and mailed or hand delivered to DIDD Fiscal and Administrative Services.

History

Authority: T.C.A. § 10-7-503.
Administrative History: Original rules filed January 2, 2019; effective April 2, 2019. Repealed by Chapter 653, § 1 of the 2020 Public Acts, effective April 2, 2020. New rules filed September 3, 2020; effective December 2, 2020.

Tenn. Comp. R. & Regs. 0465-01-04-.13 AGGREGATION OF FREQUENT AND MULTIPLE REQUESTS

(1) DIDD will aggregate records requests in accordance with the “Reasonable Charges for Frequent and Multiple Requests” policy promulgated by the OORC, which may be found on the DIDD website, when four or more requests are received within a calendar month either from a single individual or a group of individuals deemed working in concert.

(2) Requests for any DIDD records, regardless of the type of records requested or whether the request is directed to, or specifies that the records requested pertain to, a local, regional or central office of the department, may be aggregated.

(3) The PRRC is responsible for making the determination that a group of individuals is working in concert. The PRRC or the records custodian must inform the individuals that they have been deemed to be working in concert and that they have the right to appeal the decision to the OORC.

(4) Once the aggregation threshold is reached, the exemption for labor charges up to one hour specified in Rule 0465-01-04-.12(4) above does not apply for the second and subsequent requests.

History

Authority: T.C.A. § 10-7-503.
Administrative History: Original rules filed January 2, 2019; effective April 2, 2019. Repealed by Chapter 653, § 1 of the 2020 Public Acts, effective April 2, 2020. New rules filed September 3, 2020; effective December 2, 2020.

Chapter 0465-02-01 Definitions

Tenn. Comp. R. & Regs. 0465-02-01-.01 DEFINITIONS OF TERMS USED IN ALL RULES

Unless the context indicates otherwise, terms have the following meaning:

(1) “Adaptive Behavior” means the effectiveness or degree with which a person supported meets the standard of personal independence, maturation, learning, and social responsibility expected for his/her age and cultural group.

(2) “Agency” means a sole proprietorship, partnership, corporation, limited liability company or limited liability partnership providing personal support services or support coordination as defined below. Agency includes all entities that employ or subcontract with individuals who provide personal support services or support coordination for persons supported.

(3) “Applicant or Licensee Applicant” means the proprietorship, partnership, association, governmental agency, or corporation which makes, or is required to make, application for the licensure of a facility/service determined to be under the licensure jurisdiction of the Department.

(4) “Assessment” means a documented evaluation of a person supported for the purpose of determining prevention, treatment, and/or rehabilitation needs. An assessment may, but does not necessarily, include examinations and tests determined to be necessary by the service staff based on the presenting problems and symptoms of the person supported.

(5) “Aversive Stimuli” means painful or noxious stimuli, which are employed to reduce the frequency of or to eliminate problem behaviors.

(6) “Behavior Management Drugs” means a drug or medication used for the purpose of modifying, limiting, or eliminating problem behaviors. Included are antipsychotic drugs/antipsychotics, antianxiety drugs, and antidepressants. Excluded are drugs that may have behavior-modifying effects, but are not prescribed or administered for that purpose, such as anticonvulsants.

(7) “Capable of Self-Preservation” means that a person supported is capable of responding to an approved emergency signal, including prompting by voice, by following a pre-taught evacuation procedure within a reasonable time limitation whether or not he/she is fully aware of the reasons for the action. A person supported is capable of self-preservation if they are able to transfer unassisted from a bed or another fixed position to an individualized means of mobility, which is continuously available, and able to demonstrate the ability to transverse a pre-defined means of egress from the facility or dwelling within a reasonable time limitation.

Persons supported who have security measures imposed upon them beyond their control, which prevent their egress from the facility or dwelling, are not capable of self-preservation.

October, 2016 2 (8) “Caregiver” means a temporary care-giving adult individual with power of attorney or form provided by the Department of Children Services for care of minor child as defined by T.C.A. § 34-6-302.

(9) “Case Management” means support provided for obtaining eligibility for service, assessment, development and evaluation and revision of the plan of care and the assistance with the selection and coordination of services and providers for persons who are supported, including those in the Self-Determination Waiver.

(10) “Center Based Environment” means a congregate setting where services are rendered. This setting is subject to life safety inspections, which vary dependent upon the applicable occupancy classification.

(11) “Chief Executive Officer or Director” means the individual appointed, designated, or hired by the governing body to be responsible for the licensee’s day-to-day operation.

(12) “Civil Rights” means the rights of personal liberty guaranteed to citizens by the Constitutions of the United States and the State of Tennessee, and by federal and state statutes.

Licensees are encouraged to adopt the principles contained within the Universal Declaration of Human Rights found at www.un.org.

(13) “Community/Home Based Environment” means a non-congregate setting where services are rendered. This environment is not subject to life safety inspections, as the corporate office is the licensed setting.

(14) “Community Living Skills” means the array of skills which enables a person supported to live independently in the community. These include, but are not limited to, skills in the following areas:

(a) Independent living;

(b) Educational/Vocational;

(d) Social;

(e) Problem solving;

(f) Financial;

(g) Leisure time;

(h) Mobility in the community; and (i) Use of community resources.

(15) “Conservator” means an individual or individuals or a corporation appointed by the court to exercise the decision-making rights and duties of a person with a disability in one or more areas in which he/she lacks capacity as determined and required by the orders of the court.

(16) “Corporal Punishment” means the application of painful stimuli to the body in an attempt to terminate behavior or as a penalty for behavior, but does not mean aversive stimuli.

(17) “Chronic Condition” means a mental and/or physical impairment that is expected to last indefinitely.

October, 2016 3 (18) “Department” or “DIDD” means the Tennessee Department of Intellectual and Developmental Disabilities.

(19) “Direct Support Staff” means licensee personnel who have, face-to-face contact with persons supported, excluding administrators, bookkeepers, accountants, secretaries, typists, clerks, or other clerical personnel, doctors, nurses, psychologists, speech and language therapists, pharmacy and other professional support personnel, maintenance, groundskeepers, cooks, bus drivers, or other personnel, teachers, trainers, social workers, and other professional personnel, unless such personnel are under specific assignment to direct services staff duties and then only for that amount of time devoted to direct support staff duties.

(20) “DSM” means the current version of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, a handbook for mental health professionals listing different categories of mental disorders and the criteria for diagnosing them.

(21) “Education Services” means consultation provided by a licensed nurse to the person supported or primary family caregiver concerning a chronic condition.

(22) “Emergency Procedures” means the use of procedures necessary to control severely aggressive or destructive behaviors that could not have been anticipated and that place the person supported or others in imminent danger.

(23) “Emotional Abuse” means any threatening behavior or statement directed toward a person supported that causes emotional trauma or fear including, but not limited to, humiliation, harassment, threats of punishment or deprivation, intimidation or demeaning or derogatory communication (vocal, written, gestures), including verbal abuse, directed to or within eyesight or audible range of the person supported.

(24) “Emotional Harm” means psychological distress which may include; fear, anxiety, stress, trauma, humiliation, depression or grief. Such a response may or may not be visible in people with intellectual or developmental disabilities.

(25) “Exploitation” means any act intended to exploit, extort, or defraud a person supported including, but not limited to deliberate misplacement, misappropriation or wrongful temporary or permanent use of belongings or money (the loss of $50.00 or more within a 60 day calendar period) with or without the consent of the person supported. The illegal or improper use of the resources or status of the person supported for another’s benefit or advantage.

(26) “Facility” means an institution, treatment resource, group residence, boarding home, sheltered workshop, activity center, rehabilitation center, hospital, or other entity by these or other names, providing intellectual and/or developmental disabilities services.

(27) “Governing Body” means an individual or individuals with primary legal authority and responsibility for the overall operation and to whom a director/chief executive officer is responsible. Depending upon the organizational structure, this body may be an owner or owners, a board of directors or other governing members of the licensee, or state, city, or county officials appointed by the licensee, etc.

(28) “Grievance Procedure” means a procedure for responding to an expression of a cause of distress believed by a person supported, or by acting on behalf of a person supported, to constitute a reason for complaint.

October, 2016 4 (29) “Guardian” means an individual or individuals appointed by a court to provide partial or full supervision, protection and assistance of the person or property, or both, of a minor as defined by T.C.A. § 34-1-101(9).

(30) “Habilitation or Habilitative Services” means the structured process by which the service provider assists a person supported to acquire and maintain those life skills which enable them to cope more effectively with the demands of his/her disability and the environment, and to raise the physical, mental, and social skills. This process includes programs of formal, structured education and training as described in the ISP.

(31) “Hold Out to the Public” means asserting expertise and availability through advertising, public notice, self-promotion, etc.

(32) “Human Rights Committee” means a designated group of people which consists of at least three (3) members, one (1) of whom must be independent of the licensee. The committee's function is to review the licensee’s activities to ensure that the rights of the person supported are not suppressed, neglected, or abused.

(33) “ICD” means the current version of the International Statistical Classification of Diseases and Related Health Problems, published by the World Health Organization. The ICD provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease.

(34) “Independent Living Skills” means the complete continuum of skills involved in increasing independence. These include, but are not limited to, the following areas: grooming/personal hygiene, selection/care of clothing, responsible self-medication, personal safety, housekeeping, nutritional/meal preparation, eating/table manners, use of telephone, and money/budgeting concepts.

(35) “Individual Support Plan” (ISP) means a document developed by the ISP team/circle of support and the person supported, which identifies the needs of the person supported and specifies goals to be addressed in treatment and the interventions used to accomplish these goals. ISPs may also be referred to as a Plan of Care, Person Centered Support Plan, Support Plan, Individual Family Support Plan, etc.

(36) “Intellectual and Developmental Disabilities Professional” means an individual with a bachelor's degree in a field related to developmental disabilities or an individual with a bachelor's degree and two (2) years of supervised work in the field of intellectual or developmental disabilities.

(37) “Intellectual Disabilities / Developmental Disabilities Services” means all services pertaining to and incidental to the prevention, diagnosis, evaluation, treatment, domiciliary care, training, habilitation, counseling, or supervision of a person supported with intellectual and/or developmental disabilities.

(38) “Legend Drugs” mean any item that federal law prohibits dispensing without a prescription from a licensed doctor, dentist, optometrist, or veterinarian, as defined in T.C.A. § 53-10-101.

(39) “Licensed Clinical Psychologist” means a psychologist licensed to practice psychology in Tennessee with the certified competency in clinical psychology determined by the Board of Examiners in Psychology.

(40) “Licensed Practitioner” means an individual who is licensed by the Tennessee Health Related Boards as a:

(a) Physician (medical doctor or doctor of osteopathy);

October, 2016 5 (b) Certified nurse practitioner;

(d) Nurse with a master’s degree in nursing who functions as an Advanced Practice Nurse (APN);

(e) Psychologist with health service provider designation;

(f) Licensed professional counselor;

(g) Senior psychological examiner;

(h) Licensed marriage and family therapist;

(i) Licensed clinical social worker;

(j) Licensed psychological examiner; or (k) Licensed alcohol and drug abuse counselor.

(41) “Licensee” means the proprietorship, partnership, association, governmental agency, or corporation which provides a service under the licensure jurisdiction of the Department.

(42) “Major Life Activities” means:

(a) Self-care;

(b) Receptive and expressive language;

(d) Mobility;

(e) Self-direction;

(f) Capacity for independent living; or (g) Economic self-sufficiency.

(43) “Medication” means drug, either prescribed or available over the counter, intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease or condition.

(44) "Medication Administration" means giving the person supported injections or any form of medication or administration that would only be appropriate and acceptable for individuals who are authorized to do so by T.C.A., Title 63 or rules and regulations of the Tennessee Board of Medical Examiners or the Tennessee Board of Nursing and in a manner prescribed under Departmental Rules.

(45) “Medication Assistance” means providing medication reminders and opening medication packaging, but does not mean giving the person supported injections or any form of medication or medication administration that would only be appropriate and acceptable for individuals who are authorized to do so by Title 63, Chapter 7 of the T.C.A. Medication assistance includes, but is not limited to, any of the following:

October, 2016 6 (a) Loosening the cap on a pill bottle for oral medication;

(b) Opening a pill reminder box if the box is filled by the person supported, authorized representative, or licensed medical personnel practicing within the scope of his/her license;

(d) Holding the hand steady of the person supported, to help him/her with drinking liquid medication;

(e) Guiding the hand of the person supported, when he/she is applying eye/ear/nose drops and wiping the excess liquid;

(f) Helping the person supported with a nasal cannula or mask for oxygen, plugging the machine in and turning it on;

(g) Applying non-prescription creams and lotions purchased over-the-counter to external parts of the body of the person supported.

(46) “Mobile Non-Ambulatory” means a person who is able, without other assistance, to transfer to and move about only with the aid of a wheelchair, walker, crutch, wheeled platform, or similar device.

(47) “On-Duty and On-Site” means a staff person who is on the premises and has the obligation to carry out any job responsibilities designated in his/her job description.

(48) “On-Site” means a staff person who is on the premises, but is only required to be on duty during an emergency.

(49) “Person Supported” means a service recipient defined under T.C.A. § 33-1-101(23) as a person who is receiving services, has applied for services, or for whom someone has applied for or proposed services because the person has intellectual and/or developmental disabilities.

(50) “Person Who is Ambulatory” means a person who is physically and mentally capable under emergency conditions of finding a way to safety without physical assistance from another person. A person who is ambulatory may use a cane, wheelchair or other supportive device and may require verbal prompting.

(51) “Personal Care” means services provided to a person supported who does not require chronic or convalescent medical or nursing care. Personal care may include, but are not limited to, any of the following services:

(a) Responsibility for the safety of the person supported;

(b) A daily awareness by the management and staff of the needs of the person supported;

(d) Reminding a person supported of appointments;

(e) The ability and readiness to intervene if a crisis arises for a person supported;

(f) Supervision of major life activities, self-care, self-direction, capacity for independent living, or economic self-sufficiency for the person supported;

October, 2016 7 (g) The safekeeping and supervision of the self-administration of prescription medication of the person supported; and/or (h) Medication administration in a home and community based setting where the licensee is contracted with the Department and the staff are appropriately certified.

(52) “Personal Support Services” means one or more of the following are services provided at the regular or temporary residence of the person supported to assist with activities of daily living.

Personal support services include, but are not limited to:

(a) Self-care assistance with tasks such as eating, dressing, toileting, bathing, mobility, transfer assistance and other services and supports to maintain health and wellness;

(b) Household assistance with tasks such as housekeeping, laundry, meal planning, meal preparation, shopping, bill paying, and use of telecommunication devices;

(c) Personal assistance to access community activities such as transportation, social, recreational or other personal activities; and (d) Education services.

(53) “Personal Support Services Agency” means a sole proprietorship (someone who owns an unincorporated business by him/herself), partnership, corporation, limited liability company, or limited liability partnership providing personal support services.

(54) “Personal Support Services Worker” or “Worker” means a person licensed as a personal support services agency, or an employee for an individual subcontracted by a personal support services agency who is providing personal support services under an arrangement between a person supported and a personal support services agency.

(55) “Physical Abuse” means actions including, but not limited to, any physical motion or action by which physical harm, pain or emotional harm. Also included is the use of excessive force when restraining a person supported (e.g., using methods to restrain them which are not outlined in staff training) and acts which constitute sexual activity.

(56) “Physician” means a graduate of an accredited medical school authorized to confer upon graduates the degree of Doctor of Medicine (M.D.) who is duly licensed in Tennessee or an osteopathic physician who is a graduate of a recognized osteopathic college authorized to confer the degree of Doctor of Osteopathy (D.O.) and who is licensed to practice osteopathic medicine in Tennessee.

(57) “Physician Assistant” means an individual who renders services, whether diagnostic or therapeutic, which are acts constituting the practice of medicine and, but for the provisions of T.C.A. § 63-6-204, could only be performed by a licensed physician.

(58) “Policies and Procedures Manual” means a document that describes the philosophy, services, organization, policies, and procedures for the provision and implementation of services for the person supported provided by the licensee.

(59) “PRN” means an order which is written to allow a medication or a treatment to be given on an as-needed basis.

(60) “Psychiatrist” means a physician who specializes in the assessment and treatment of persons diagnosed with psychiatric disorders; is certified by the American Board of Psychiatry and October, 2016 8 Neurology or has the documented equivalent in education, training and/or experience; and who is fully licensed to practice medicine in the State of Tennessee.

(61) “Psychotropic Drug/Medication” means a drug which exercises a direct effect upon the central nervous system and which is capable of influencing and modifying behavior. Drugs covered by these rules include but are not limited to:

(a) Anti-depressants;

(b) Anti-psychotics;

(d) Anti-anxiety agents;

(e) Psychomotor stimulants; and (f) Hypnotics.

(62) “Qualified Dietician” means a person licensed as a dietician/nutritionist by the Tennessee Board of Dietician/Nutritionist Examiners.

(63) “Qualified Food Service Manager” means a qualified dietician, a graduate of a dietetic technician or assistant training program approved by the American Dietetic Association, or a graduate of a state-approved course that provides ninety (90) or more hours of classroom instruction in food service supervision, who has experience as a supervisor in a health care institution with consultation from a qualified dietician.

(64) “Qualified Medical Records Practitioner” means a record technician (ART) currently accredited by the American Medical Records Association, or a registered record administrator (RRA) currently registered by the American Medical Record Association, or others qualified by work experience.

(65) “Qualified Prescribers” means individuals authorized to prescribe medications by the State of Tennessee Board of Medical Examiners or the Tennessee Board of Nursing.

(66) “Quality Assurance” means a systematic procedure for the review and evaluation of the agency's functions, quality of services, and the utilization of resources in the provision of services.

(67) “Reputable and Responsible Character” means having a personal and/or business history which suggests that the licensee can be trusted with responsibility for persons supported who are particularly vulnerable to neglect, and financial and sexual exploitation. Personal and/or business histories involving operation of substandard facilities and/or services and an arrest record resulting in a conviction for offense relating to theft, larceny, embezzlement, rape, assault, homicide, drugs, and pornography, are inherently inconsistent with "reputable and responsible character."

(68) “Restraint” means measures taken to restrict the freedom of movement of a person supported, including:

(a) “Chemical Restraint” - a medication that is prescribed to restrict the freedom of movement of the person supported for the control of extreme violent physical behavior.

Chemical restraints are medications used in addition to, or in replacement of, his/her regular drug regimen to control extreme violent behavior. The medications that comprise the regular medical regimen (including PRN medications) of the person October, 2016 9 supported are not considered chemical restraints, even if the purpose of the medication is to control ongoing behavior;

(b) “Mechanical Restraint” - the application of a mechanical device, material, or equipment attached or adjacent to the body of the person supported, including ambulatory restraints, which he/she cannot easily remove and that restricts freedom of movement or customary access to his/her body. Mechanical restraint does not include the use of:

Restrictive devices or manual methods employed by a law enforcement agent or other public safety officer to maintain custody, detention, or public safety during the transport of an individual under the jurisdiction of the criminal justice system or juveniles with charges in the juvenile justice system;
Restraints for medical immobilization, adaptive support, or medical protection; or 3. Restrictive devices administratively authorized to ensure the safety of the person supported or others when a person supported who is involuntary committed person must be transported.

(c) “Physical Holding” - the use of bodily contact by staff with a person supported in order to restrict his/her freedom of movement or customary access to his/her body to prevent the behavior of the person supported from becoming dangerous to him/herself, others, or property. Physical holding does not include the use of:

Physical touch associated with prompting, comforting, or assisting that does not prevent freedom of movement or customary access to the body of the person supported;
Physical escort, which means the temporary touching or holding of the hand(s), wrist(s), arm(s), shoulder, or back for the purpose of inducing the person supported to walk to a safe location; or 3. Physical intervention for the temporary holding of the hand(s), wrist(s), arm(s), shoulders(s), or leg(s), which does not otherwise restrict freedom of movement or access to the body of the person supported, for the purpose of terminating unsafe behavior.

(69) “Restrictive Procedure” means a treatment or procedure that limits the rights of the person supported for the purpose of controlling or modifying problem behavior, including but not limited to, time-out and restraint, and seeks to replace them with behaviors that are adaptive and appropriate.

(70) “Schedule II Drugs” means drugs and other substances, by whatever name (official, common, usual, chemical, or brand) as defined in T.C.A. § 39-17-407 or listed in T.C.A. § 39-17-408.

(71) “Seclusion” means the confinement of a person supported alone in a room or an area where he/she is prevented from leaving. This definition is not limited to instances in which a person supported is confined by a locked or a closed door. Seclusion does not include:

(a) The segregation of a person supported for the purpose of managing biological contagion consistent with the Centers for Disease Control Guidelines;

(b) Confinement to a locked unit where other persons supported are present. Seclusion is not solely confinement of a person supported to an area, but separation of the person supported from other individuals; or October, 2016 10 (c) Time-out, a behavior management procedure in which the opportunity for positive reinforcement is withheld, contingent upon the demonstration of undesired behavior.

Time-out may involve the voluntary separation of a person supported from others.

(72) “Self-Administration of Medication” means the ability of a person supported to take prescribed or over-the-counter medications without assistance from another individual.

(73) “Shall or Must” means a mandatory provision.

(74) “Should or May” means a suggestion or recommendation.

(75) “Standard Precautions” means an approach to infection control based on the principle that broken skin and mucus membranes, as well as all blood, bodily fluids, and secretions (except sweat) may contain transmittable infectious agents. Standard precautions apply to all people regardless of suspected or confirmed infection status in any setting where care is provided.

Current guidelines for standard precautions are published by the Centers for Disease Control and Prevention (CDC).

(76) “Support Coordination” means the assessment, planning, implementation coordination and monitoring of services and supports that assist persons with intellectual and developmental disabilities to develop personal relationships, participate in their community, increase control over their own lives and develop the skills and abilities needed to achieve these goals as specified in the person-centered ISP of the person supported.

(77) “Support Coordination Agency” means a sole proprietorship (someone who owns an unincorporated business by him/herself), partnership, corporation, limited liability company or limited liability partnership providing support coordination.

(78) “Support Coordinator” means a person licensed as a support coordination agency, or an employee or an individual subcontracted by a support coordination agency who is providing support coordination under an arrangement between a person supported and a support coordination agency.

(79) ““Time-Out” means a behavior management procedure in which the opportunity for positive reinforcement is withheld, contingent upon the demonstration of undesired behavior. Timeout may involve the voluntary separation of a person supported from individuals.

(80) “Treatment” means a therapeutic process to reduce or eliminate the symptoms and side effects of mental illness, alcohol and/or drug abuse, or dependency disorders through direct observation, assessment, examination, and therapeutic intervention. Treatment services include: screening; clinical assessment; diagnostic evaluation; treatment planning; therapeutic interventions, including individual, family, and group therapy; medication prescription and monitoring; and discharge planning and referral.

(81) “Treatment Review Committee” means a committee to make decisions for a person supported who lacks capacity as defined by T.C.A. § 33-3-218. The composition, duties and responsibilities of Treatment Review Committees are defined by T.C.A. § 33-6-107.

(82) “Vocational Services” means the services provided to persons supported, which involve remunerative work experiences and the provision of vocational activities.

(83) “Volunteer” means an individual who is not paid by the licensee and whose varied skills are used by the licensee to support and supplement the efforts of the paid staff.

(84) “Written” means, as applied to a licensee’s records, any generally accepted format, including electronic or paper, used for retaining business or client records.

October, 2016 11

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-01-.02 DEFINITION OF DISTINCT CATEGORIES OF INTELLECTUAL AND

DEVELOPMENTAL DISABILITIES FACILITIES/SERVICES.

(1) “Intellectual Disabilities Adult Habilitation Day Facility/Services” means a non-residential facility or service which offers a variety of habilitative activities to adults with intellectual disabilities. Such habilitative activities may range from training activities in independent living to vocational skills depending on the needs of the person supported. This includes adult developmental training, work activity, and sheltered workshop programs, but does not include job placement and supported employment programs. This category is provided in either a center based or a community/home based environment. Each setting requires a separate license.

(2) "Developmental Disabilities Adult Habilitation Day Facility/Service" means a non-residential facility or service which offers a variety of habilitative activities to adults with developmental disabilities. Such habilitative activities may range from training activities in independent living to vocational skills depending on the needs of the person supported. This includes adult developmental training, work activity, and sheltered workshop programs, but does not include job placement and supported employment programs. This category is provided in either a center based or a community/home based environment. Each setting requires a separate license.

(3) “Intellectual and Developmental Disabilities Boarding Home Facility” means a residential facility that offers personal care services to persons with intellectual and/or developmental disabilities, including room, board, and supervision to two (2) or more persons supported unrelated by blood or marriage to the owner or operator. People living in such facilities are capable of self-preservation, able to care for basic self-help needs with minimal assistance, able to care for personal possessions, able to maintain personal living areas in a state of orderliness, able to recognize danger or threat to personal safety, able to maintain behavior which is generally tolerable to the community, and able to attend to minor health care needs.

(4) “Intellectual and Developmental Disabilities Diagnosis and Evaluation Facility” means a nonresidential service, which provides personnel and testing resources to perform diagnosis and evaluation of persons supported having, or suspected of having, intellectual and/or developmental disabilities.

(5) “Intellectual and Developmental Disabilities Institutional Habilitation Facility” means a facility which offers, on a regular basis, health-related services for persons supported with intellectual and/or developmental disabilities who do not require the degree of care and treatment which a hospital or skilled nursing facility is designed to provide but, because of physical, intellectual, and/or developmental disabilities, require residential care and services (more than room and board) that involve health-related care under the supervision of a physician. Such a facility also offers an intensive program of habilitative services.

(6) “Intellectual and Developmental Disabilities Placement Services” means a program which provides or arranges regular residential placements, for persons with intellectual and/or developmental disabilities, in the individual home of care providers who are recruited, trained, and supervised by the program. The entity licensed is the program delivering such services rather than the individual homes of the program's care providers. No more than three (3) persons supported may receive services in an individual care provider's home. Such programs are known as foster care, sponsor care, or family model residential care.

October, 2016 12 (7) “Developmental Disabilities Preschool Facility/Service” means a non-residential service which offers a program of training, habilitation, or care for children with developmental disabilities, or children at risk of developmental disabilities, not of the chronological mandatory age to be enrolled in services of the Department of Education, and which is designed to teach self-help, socialization, communication, or school readiness skills, or designed to train parents or surrogates in methods and techniques of habilitation. This category of service is provided in either a center based or community based environment. Each setting requires a separate license.

(8) “Intellectual and Developmental Disabilities Residential Habilitation Facility” means a residential facility which provides room and board, and assistance in acquiring, retaining and improving self-help, socialization, adaptive skills, and any other services necessary for a person supported with intellectual and/or developmental disabilities to live in a community setting. No more than four (4) persons supported shall reside in the home unless the home was licensed on or before June 23, 2000. The facility shall provide training in the acquisition of, and assistance in completing skills related to, daily living, personal grooming, cleanliness, household chores, eating, meal preparation, and any other skills necessary based on the needs of the person supported. Any of these services shall be specified in the ISP with specific therapeutic goals. Any professional services delivered in the facility shall be provided by duly licensed staff and specified in the ISP.

(9) “Intellectual and Developmental Disabilities Respite Care Services” means a program which provides or arranges for the temporary support of persons supported with intellectual and/or developmental disabilities in the care of staff recruited, trained, and supervised by the licensee for the purpose of giving relief to the regular caregiver or to provide other assistance to the person supported, his/her family, guardian, or care giver. The licensed entity is the program delivering such services rather than the individual homes of the program's providers.

No more than three (3) people can receive this service in one (1) home.

(10) “Intellectual Disabilities Semi-Independent Living Services” means a program which provides services for persons supported with intellectual disabilities, who are able to reside in a housing situation without program staff residing on site. The services of program staff support the home life style of the person supported in order to reside in such housing situations. The program offers and provides regular, and as needed, support services in procuring or monitoring adequate housing for persons supported, supervising home life styles, and assisting in development of higher-order independent living skills. The entity licensed is the program delivering the services rather than the individual dwellings for persons supported.

(11) “Developmental Disabilities Semi-Independent Living Services” means a program which provides services for persons supported with developmental disabilities, who are able to reside in a housing situation without program staff residing on site. The services of program staff support the home life style of the person supported in order to reside in such housing situations. The program offers and provides regular, and as needed, support services in procuring or monitoring adequate housing for persons supported, supervising home life styles, and assisting in development of higher-order independent living skills. The entity licensed is the program delivering the services rather than the individual dwellings for persons supported.

(12) “Intellectual and Developmental Disabilities Supported Living Services” means a service entity which provides support and assistance to individuals with intellectual and/or developmental disabilities, who live in their own homes or apartments but require staff support and assistance to reside in such housing situations. Service entity staff provides support and assistance on a regular basis in accordance with the needs of the person supported living in the home. No more than three (3) persons supported shall reside in the October, 2016 13 home. The service entity delivering the support is licensed rather than the homes of the person supported.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Chapter 0465-02-02 Licensure Administration and Procedures

Tenn. Comp. R. & Regs. 0465-02-02-.01 STATEMENT OF AUTHORITY

The Department of Intellectual and Developmental Disabilities (“DIDD” or “Department”) is authorized to license facilities and services operated for the provision of intellectual and developmental disabilities, and personal support services in the State of Tennessee by T.C.A. title 33, chapter 2, part 4.

(1) Notwithstanding any law or rule to the contrary, a residential facility or provider licensed by DIDD to provide residential services to persons with intellectual or developmental disabilities shall not be prohibited from providing residential services to the elderly or adults with physical disabilities, so long as the services are adequate to ensure the health, safety, and welfare of each resident.

(2) Medicaid-reimbursed home and community based service (HCBS) providers are required to comply with the federal home-based and community-based setting final rule, published in the Federal Register at 79 FR 2947 (January 16, 2014).

(a) HCBS providers and facilities licensed on or before March 31, 2015, shall have performed the required Self-Assessment and shall have submitted the same to the respective DIDD Regional Office. Providers who self-reported or were assessed to be non-compliant with the HCBS Settings Rule shall have a completed and validated Provider Transition Plan on file with the respective DIDD Regional Office.

(b) HCBS providers and facilities receiving an initial license on or after April 1, 2015, shall have on file with the DIDD Provider Enrollment Coordinator acceptable policies addressing quality assessment, assurance, and improvement, including a description of how the provider meets compliance with the HCBS Settings Rule (these are required elements which must be submitted with a New Provider Application For Long Term Services).

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016. October, 2016

Tenn. Comp. R. & Regs. 0465-02-02-.02 TYPES AND CONDITIONS OF LICENSES

(1) Initial License - An initial license is issued to a facility or service to give the licensee an opportunity to implement minimum program requirements and to give DIDD an opportunity to evaluate the facilities’ or service’s compliance performance. Initial licenses will not exceed a period of twelve (12) months.

(2) Full License - A full license is valid for up to one (1) year from the date of issuance and is issued to a facility or service when the licensee demonstrates compliance with the licensure law and applicable rules as determined by DIDD.

(3) Provisional License - A provisional license may be issued to a facility or service when it does not meet all of the requirements for a full license. The Department may grant a provisional license, for a period not to exceed six (6) months, if all of the conditions below are satisfied:

(a) The facility or service is making a diligent effort to comply with the licensure law and rules. A “diligent effort to comply with rules" is determined by past performance of the facility or service in meeting rules and correcting deficiencies and by commitments to correct existing deficiencies within time frames agreed to by the Department;

(b) The continued operation of the facility or service will not endanger the health or safety of persons supported.

(c) The facility or service has submitted an acceptable compliance plan specifying how and when deficiencies will be corrected. The Department will consider the seriousness of the deficiencies and the past performances of the facility or service in determining whether the compliance plan is acceptable; and (d) The facility or service has substantially met the commitments made in the preceding year's compliance plan, if any.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-02-.03 UNLAWFUL OPERATION

No organization may begin the provision of service delivery until the Department issues a license.

Providing intellectual and developmental disability, or personal support services without a license is unlawful and may result in civil and/or criminal sanctions pursuant to T.C.A. §§ 33-2-405 and 33-2-412.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-02-.04 APPLICATION FORMS

(1) The application for a license is to be made on forms prepared and supplied to the applicant by the Department.

(2) Each application for a license must be submitted in a legible format with all the information requested on the application. The information gathered by the Department on the application is needed pursuant to T.C.A. § 33-2-406 to determine the applicant’s responsible and reputable character and the applicant’s ability to meet the minimum standards for the operation of a facility or service.

October, 2016 (3) The information to be supplied to the Department is as follows:

(a) The name, address, and other background and identifying information of the applicant;

(b) A description of the location, design, and type of facility or service to be licensed;

(c) The name, address, and other background and identifying information of the individual or individuals responsible for the operation of the facility or service to be licensed, including social security number, date of birth, place of residence during the past five (5) years, place of birth, proof of citizenship or evidence of legal immigration status, and criminal background check;

(d) Personal character references;

(e) The signature of the licensee applicant or of the individual charged by the licensee applicant for certifying the correctness and completeness of the application and for ensuring compliance with the licensure rules; and (f) Any such other information as the Department may require.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-02-.05 FEES

(1) The applicant must submit fees for the processing of the application prior to the Department’s determination to grant or to deny licensure. Each initial and renewal application for licensure must be submitted with the appropriate fees. All fees submitted are non-refundable. The fee rate is based on the number of distinct categories of service or facility, as applicable, to be operated at each site. For a residential site, the fee rate is based on the number of beds to be licensed. A fee must be submitted for each facility and/or service for which licensure is being sought under the following schedule:

Non-Residential Facility Fees Per Site :

One (1) Distinct Category of Service or Facility $ 810.00 Two (2) Distinct Categories of Services and/or Facilities $ 1,010.00 Three (3) Distinct Categories of Services and/or Facilities $ 1,220.00 Four (4) Distinct Categories of Services and/or Facilities $ 1,420.00 More Than (4) Distinct Categories of Services and/or Facilities $ 1,620.00 Residential Facility Fees Per Site :

Institutional Habilitation Facilities (per bed) $ 175.00 All Other Residential Facilities: 2-3 Beds $ 200.00 4-10 Beds $ 280.00 11-15 Beds $ 410.00 16-50 Beds $ 810.00 more than 50 Beds $ 1,220.00 October, 2016 (2) In addition to the fees associated with initial and renewal applications outlined above, other fees may be charged as follows:

(a) Inspection - a fee of fifty dollars ($50.00) for the inspection or re-inspection of any facility or service.

(b) Change of Status - a fee of one hundred dollars ($100.00) for changes in:

Organization Name;
Executive Director;
Bed Capacity; or 4. Life Safety Occupancy/Classification.

(3) The Department shall invoice the applicant or licensee the appropriate fee(s). The applicant or licensee shall pay the fee(s) within thirty (30) days after receipt of the invoice, unless the current license expires before the end of the thirty (30) day period. If the current license expires before the end of the thirty (30) day period, the licensee shall pay the fee(s) before the expiration of the current license.

(4) The Department may withhold the issuance of a license or suspend an existing license pending the payment of fees.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-02-.06 APPLICATION PROCESS FOR INITIAL LICENSE

(1) The applicant must submit application forms as required by the Department.

(2) The applicant must submit the required fees for application processing.

(3) The applicant is responsible for any fees charged by other regulatory agencies whose inspection of the facility or service is necessary for the issuance of licenses.

(4) Upon receipt of the completed application and the required fees, the Department will arrange for needed inspections of the proposed site or sites, when applicable.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-02-.07 APPLICATION PROCESS FOR LICENSE RENEWAL

(1) Prior to the expiration of an initial, full, or provisional license, the Department will notify the licensee of the need to submit an application for license renewal. The Department will advise the licensee of the information, fees, and the documents needed to process the renewal application.

October, 2016 (2) The applicant must submit the renewal application, fees, and other information required by licensure.

(3) The applicant is responsible for any fees charged by other regulatory agencies whose inspection of the facility or service is necessary for the issuance of licenses.

(4) The Department, when applicable, will conduct or arrange for inspections of the facility’s or service’s current life safety and environmental conditions, and review the facility's or service’s program performance history. Dates for unannounced inspections will be random and will vary from year to year.

(5) Upon receipt of the application material and the required fees, the Department will review the application material, the current life safety and environmental conditions, when applicable, and the performance history of the facility or service and take one of the following actions:

(a) If the Department determines that all facilities or services operated by the licensee are in compliance with the applicable licensure law and rules, then a full license will be issued;

(b) If the Department determines that all facilities or services operated by the licensee do not comply with the applicable licensure law and rules, a provisional license may be issued covering the facility or service not in full compliance; or (c) If the Department determines that a license should not be issued to one (1) or more facilities or services operated by the licensee, the licensee shall be notified of the denial of licensure. Within fifteen (15) calendar days of such notification of denial of licensure, the licensee may file a written request for a hearing before the Licensure Review Panel on the denial.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-02-.08 DISTINCT CATEGORIES OF FACILITIES AND SERVICES

The licensure rules identify and define distinct categories of facilities or services. These facilities and services must meet applicable life safety and environmental rules, as well as minimum program rules based on the type of program services and the needs of the persons supported.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-02-.09 NUMBER OF LICENSES REQUIRED

Each licensee will be issued one (1) license for each site at which the licensee is operating a facility or service. The license for each site will indicate what category or categories of facility and/or service is authorized to be operated at that site. However, when a licensee operates more than one (1) category at a single site, two (2) licenses may be issued if one (1) or more of the categories at the site require an initial or a provisional license, and one (1) or more are eligible for a full license.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016. October, 2016

Tenn. Comp. R. & Regs. 0465-02-02-.10 CHANGE OF OWNERSHIP OR LOCATION

Licenses are not assignable or transferable except as provided by law. A new application must be made and a new license issued before services are provided when there is a change in the ownership of a facility/service or a change of location.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-02-.11 TIME LIMITS

Upon inspection of any facility or service making application for or holding a license, the Department may allow a reasonable time period for the facility or service to correct any deficiencies that are found by inspection.

History

Authority: T. C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-02-.12 DEEMED COMPLIANCE

(1) A facility or service which is accredited or certified by any of the following may be deemed by the Department to be in compliance (“deemed compliance status”) with applicable licensure program requirements:

(a) The Joint Commission (TJC), formerly Joint Commission on Accreditation of Health Care Organizations (JCAHO);

(b) Council on Accreditation of Rehabilitation Facilities (CARF);

(c) Social Security Act, Title XIX, Public Law 89-98, as amended (Medicaid) for Intermediate Care Facilities for the Mentally Retarded (ICF/IID) only;

(d) The Accreditation Council on Services for People with Disabilities;

(e) Council on Accreditation for Children and Family Service;

(f) National Commission on Accreditation for Special Education Services (NCASES);

(g) Council on Quality and Leadership (CQL); or (h) Department of Education Early Intervention (Certification for center based facilities, Approval for community based facilities).

(2) In addition, a licensee that received a rating of Fair or above (or their equivalents) from their most recent survey by the DIDD Quality Assurance unit may be deemed to be in compliance (“deemed compliance status”) with applicable licensure program requirements.

(3) To be considered for a deemed compliance status determination under this section, the licensee must submit written and official evidence of accreditation, certification, and/or acceptable survey results to the Department including any cited deficiencies with a plan of correction.

(4) Licensees receiving deemed compliance status must also demonstrate compliance with the life safety and environmental rules. Deemed compliance status of the licensee does not alter October, 2016 the operator's obligation to correct any deficiencies cited during the unannounced inspections required by T.C.A. § 33-2-413, or to cooperate with investigations conducted by the Department of reports of abuse, dereliction, or deficiency in the operation of the facility or service. Notwithstanding deemed compliance of the licensee is subject to the suspension or revocation of its license under the terms and procedures established in T.C.A. § 33-2-407 and the rules of this chapter.

(5) Pursuant to T.C.A. § 33-2-403(c), a facility or service which can demonstrate compliance with regulations and standards by a previously acquired license from another state agency is considered in compliance with rules promulgated by the Department to the extent that duplicate inspection and enforcement is necessary.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-02-.13 ACCESS TO PREMISES AND INFORMATION

With or without giving notice, representatives of the Department shall have the right to enter upon or into the premises of any facility or service providing intellectual and/or developmental disabilities or personal support services in order to make inspections deemed necessary to determine compliance with licensure law and rules. The licensee must comply with all reasonable requests of the Department and allow it to obtain information from third parties, including, but not limited to, the person supported, and/or to review all records of the facility or service.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-02-.14 GROUNDS FOR DENIAL, REVOCATION, OR SUSPENSION

(1) The maintenance and renewal of a license is contingent upon evidence of continued compliance with rules and regulations. The Department may deny, suspend, or revoke a license on any of the following grounds:

(a) Violation of licensure law or rules;

(b) Permitting, aiding, or abetting the commission of any illegal act in a licensed facility or service;

(d) The submission of false information to the Department; or (e) The use of subterfuge (e.g., filing through a second party after an individual has been denied a license).

(2) Unless the Department finds that summary suspension of a license is necessary, the procedure for revocations, suspension, and denials is as follows:

(a) The licensee shall be notified in writing of the basis for the revocation, suspension or denial.

October, 2016 (b) Within fifteen (15) days of the notification the licensee may file a written request for review by the Licensure Review Panel appointed under T.C.A., Title 33 Part. 2.

Review shall be held at the earliest possible date.

(c) The Licensure Review Panel shall report its recommendations to the Commissioner of the Department. The Commissioner shall determine whether the original action shall remain effective and notify the licensee.

(d) Within fifteen (15) days of notification the licensee may file a written request for hearing before the Department. The hearing shall be conducted under the U.A.P.A. Title 4

Chapter 5.

(3) Summary suspension may only occur when the Department determines that continued operation of a licensed facility or service presents an immediate threat to the health, safety or welfare of persons supported. When a summary suspension occurs, proceedings for revocation or other action against the licensee shall be promptly instituted and determined in accordance with the Uniform Administrative Procedures Act.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-02-.15 EXPIRATION OF LICENSES

The expiration date of all licenses issued by the Department will be indicated on the face of the license.

However, when a licensee has made timely and sufficient application for a new license (including payment of the required fees), the existing license does not expire until the status of the application has been determined by the Department. When the application is denied or the terms of the new license limited, the existing license does not expire until the last day for seeking review of the order or a later date fixed by an order of the reviewing court.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-02-.16 POSTING OF LICENSES

The license certificate must be posted for public viewing in a conspicuous place at the facility or service.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-02-.17 SURRENDER REQUIREMENTS

The license certificate must be surrendered to the Department upon revocation or suspension of the license, upon transfer of ownership of the facility or service, or when the facility or service otherwise ceases to operate.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016. October, 2016

Tenn. Comp. R. & Regs. 0465-02-02-.18 EXCLUSIONS FROM LICENSURE

(1) The following facilities or services are excluded from the licensure jurisdiction of the Department:

(a) A facility that is appropriately licensed by the Department of Health, and whose primary

purpose is not the provision of intellectual and/or developmental disability services.

(b) A satellite hospital, as defined by rules of the Department of Health, whose primary

purpose may be the provision of intellectual, mental, or developmental disability services, and other facilities appropriately licensed by the Department of Health pursuant to T.C.A. § 68-11-201, et. seq.

(c) A facility which is operated by the Department of Education, the Department of Correction, the Department of Human Services, or the Department of Children’s Services, and that affirmatively states that its primary purpose is not the provision of intellectual and/or developmental disabilities services or personal support services.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-02-.19 WAIVER AUTHORITY

The Department may waive any rule determined to be irrelevant or to pose a hardship. A hardship waiver may be granted only when strict enforcement of a particular requirement would not be in the best interest of persons supported. All waivers granted will be made in writing and entered in the official record of the licensed service or facility. This written document shall include the justification for the waiver. All waivers will be reviewed by the Department and the Licensure Review Panel.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-02-.20 INVESTIGATION OF ABUSE, DERELICTION, OR DEFICIENCY IN OPERATION OF

A FACILITY OR SERVICE.

(1) The Department will investigate reports or suspicion of abuse, dereliction, or deficiency in the operation of a licensed service or facility in accordance with T.C.A. § 33-2-416.

(2) The licensee shall post a sign in the facility or service displaying the Department’s regional toll-free telephone number which informs persons supported, families, and the public that they may file a complaint with the Department. Any exemptions to posting signs will be determined by the Department.

(3) The licensee must report to the Department any serious allegations or suspicion of abuse, dereliction, or deficiency in the operation of the facility or service.

(4) The licensee must report to the Department any significant occurrences involving the facility/service or person supported and staff. “Significant occurrences” may include, but is not be limited to, occurrences such as accidents, injuries, or death regarding the person supported; fires, loss of heat/air conditioning, and/or other structural problems with the building(s).

October, 2016

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-02-.21 NOTICE OF NON-COMPLIANCE AND PLAN OF COMPLIANCE

(1) The Department will give a Notice of Non-Compliance to the licensee on a form prepared and provided by the Department when an inspection or investigation of a licensee reveals noncompliance with licensure law or rules.

(2) The licensee must submit, by the date specified on the Notice of Non-Compliance, a written Plan of Compliance in response to the Notice of Non-Compliance.

(3) The licensee's written Plan of Compliance shall include a description of the action taken or to be taken in correcting deficiencies, and the date by which each corrective action is completed or to be completed.

(4) The Department will notify the licensee in writing whether the Plan of Compliance is acceptable and the basis for the decision. When the Plan of Compliance is not acceptable, the Department and licensee may continue to seek agreement. If agreement cannot be reached in a reasonable time, as determined by the Department, the Department may institute sanctions against the license.

(5) The licensee shall maintain copies of the most recent compliance plans in a central location.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-02-.22 UNANNOUNCED INSPECTION

The Department shall make at least one (1) unannounced inspection of each licensed facility/service yearly.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-02-.23 ASSISTANCE TO PERSONS SUPPORTED WHEN A LICENSE IS DENIED,

SUSPENDED, OR REVOKED.

When a license is to be denied, suspended, or revoked, the Department will notify the appropriate state and local agencies, which may be able to provide assistance to persons supported by coordinating placement and/or services.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-02-.24 CIVIL PENALTIES FOR LICENSEES

(1) The Department may, in addition to or in lieu of any other lawful disciplinary action, assess a civil penalty for each separate violation of a licensure law or rule.

(2) The procedure for imposing a civil penalty shall be as follows:

October, 2016 (a) Department staff shall verbally notify a licensee that a civil penalty may be imposed due to the licensee’s violation of a licensure law or rule.

(b) Within six (6) business days of the verbal notification, the licensee shall be notified in writing of the basis for the civil penalty and the amount imposed.

(c) Within fifteen (15) days of the notification the licensee may file a written request for review by the Licensure Review Pane appointed under T.C.A., Title 33 Part. 2. Review shall be held at the earliest possible date.

(d) The Licensure Review Panel shall report its recommendations to the Commissioner of the Department. The Commissioner shall determine whether the original action shall remain effective and notify the licensee.

(e) Within fifteen (15) days of notification the licensee may file a written request for hearing before the Department. The hearing shall be conducted under the U.A.P.A. Title 4

Chapter 5.

(f) The civil penalty shall be effective beginning on the date the written notification of the decision is issued.

(g) The Department may impose a penalty for each day a licensee remains in violation of a licensure rule, regulation, ordinance or law. Each licensure law, rule, regulation or ordinance violated shall constitute a separate offense.

(3) In determining the amount of the daily penalty, the commissioner may consider the following:

(a) The severity of the violation and the harm or risk of harm to a person supported;

(b) The willfulness of the violation;

(d) The efforts made by the licensee to attain compliance;

(e) Any extraordinary enforcement cost incurred by the Department;

(f) The interest of the public; and (g) Whether the civil penalty imposed will be an economic deterrent to the non-compliant activity.

(4) The Department may impose a civil penalty in accordance with the following schedule:

(a) First Offense 1. Priority 1/Critical Offenses - $500.00 2. All other offenses - $250.00 (b) Second or subsequent offense of same type within a twelve (12) month period:

Priority 1/Critical Offense - $2,500.00 to $5,000.00 October, 2016 2. All other offenses - $500.00 to $2,500.00 (5) The Department may continue to work with a licensee to seek compliance with any licensure law or rule. The Department may waive any penalty determined by the Department to impose a hardship. A hardship waiver of a civil penalty may be granted only when strict enforcement of a particular requirement would not be in the best interest of persons supported.

(6) A “Priority 1 offense,” for the purposes of these rules is defined as a substantiated investigation involving the death of a person supported; neglect, physical or sexual abuse of the person supported by the licensee or staff; and/or a serious injury to a person supported.

A “critical offense,” for purposes of these rules, is defined as those Department-designated administrative rules whose violation could result in serious harm to the person supported.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-3-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Chapter 0465-02-03 Application of Rules for Distinct Service Categories

Tenn. Comp. R. & Regs. 0465-02-03-.01 INTELLECTUAL DISABILITIES ADULT HABILITATION DAY

FACILITIES/SERVICES.

(1) The governing body of a center based Intellectual Disabilities Adult Habilitation Day Facility/Service, which provides services for four (4) or more persons who are not capable of self-preservation must provide services and facilities, which comply with the following rules:

(a) Rule 0465-02-04-.02(2) Health Care Occupancies;

(b) Chapter 0465-02-05 Adequacy of Environment and Services;

(c) Chapter 0465-02-06 Minimum Program Requirements for All Facilities/Services; and (d) Chapter 0465-02-07 Minimum Program Requirements for Intellectual Disabilities Adult Habilitation Day Facilities/Services.

(2) The governing body of a center based Intellectual Disabilities Adult Habilitation Day Facility/Service must provide services and facilities which comply with the following rules:

(a) As determined by the Department’s Office of Licensure:

Rule 0465-02-04-.03 Educational Occupancies;
Rule 0465-02-04-.05 Industrial Occupancies; and 3. Rule 0465-02-04-.09 Daycare Occupancies.

(b) Chapter 0465-02-05 Adequacy of Environment and Services;

(d) Chapter 0465-02-07 Minimum Program Requirements for Intellectual Disabilities Adult Habilitation Day Facilities/Services; and (e) If services are to be provided to one (1) or more mobile non-ambulatory person, Rule 0465-02-04.07 Mobile Non-Ambulatory.

October, 2016 (3) The governing body of a community/home based Intellectual Disabilities Adult Habilitation Day Facility/Service must provide services, which comply with the following rules:

(a) Rule 0465-02-04-.04 Business Occupancies;

(b) Chapter 0465-02-05 Adequacy of Environment and Services;

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-03-.02 DEVELOPMENTAL DISABILITIES ADULT HABILITATION DAY

FACILITIES/SERVICES.

(1) The governing body providing Developmental Disabilities Adult Habilitation Day under this

chapter shall comply with the following rules:

(a) Chapter 0465-02-08 Minimum Program Requirements for Developmental Disabilities Adult Habilitation Day Facilities/Services;

(b) Applicable Life Safety Rules for Educational Occupancies found in Chapter 0465-02- 04;

(d) Rule 0465-02-04-.07 Mobile Non-Ambulatory Rule, if applicable; and (e) Applicable rules in Chapter 0465-02-05 Adequacy of Environment and Services.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-03-.03 DEVELOPMENTAL DISABILITIES PRESCHOOL FACILITIES/SERVICES

(1) The governing body of a center based Developmental Disabilities Preschool Facility/Service must provide services and facilities, which comply with the following rules:

(a) Rule 0465-02-04-.03(2) Educational Occupancies;

(b) Chapter 0465-02-05 Adequacy of Environment and Services;

(c) Chapter 0465-02-06 Minimum Program Requirements for All Facilities/Services; and (d) Chapter 0465-02-20 Minimum Program Requirements for Developmental Disabilities Preschool Facilities/Services.

(2) The governing body of a community based Developmental Disabilities Preschool Facility/Service must provide services and facilities which comply with the following rules:

(a) Rule 0465-02-04-.04 Business Occupancies;

October, 2016 (b) Chapter 0465-02-05 Adequacy of Environment and Services;

(c) Chapter 0465-02-06 Minimum Program Requirements for All Facilities/Services; and (d) Chapter 0465-02-20 Minimum Program Requirements for Developmental Disabilities Preschool Facilities/Services.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-03-.04 DIAGNOSIS AND EVALUATION FACILITIES

(1) The governing body of an Intellectual and Developmental Disabilities Diagnosis and Evaluation facility must provide services and facilities, which comply with the following rules:

(a) Rule 0465-02-04-.04(2) Business Occupancies;

(b) Chapter 0465-02-05 Adequacy of Environment and Services;

(c) Chapter 0465-02-06 Minimum Program Requirements for All Facilities/Services; and (d) Chapter 0465-02-09 Minimum Program Requirements for Intellectual and Developmental Disabilities Diagnosis and Evaluation Facilities.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-03-.05 INSTITUTIONAL HABILITATION FACILITIES

(1) The governing body of an Intellectual and Developmental Disabilities Institutional facility must provide services and facilities, which comply with the following rules:

(a) Rule 0465-02-04-.02(2) Health Care Occupancies;

(b) Chapter 0465-02-05 Adequacy of Environment and Services;

(c) Chapter 0465-02-06 Minimum Program Requirements for All Facilities/Services; and (d) Chapter 0465-02-10 Minimum Program Requirements for Intellectual and Developmental Disabilities Institutional Habilitation Facilities.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-03-.06 RESIDENTIAL HABILITATION FACILITIES

(1) The governing body of an Intellectual and Developmental Disabilities Residential Habilitation facility which provides services for four (4) or more persons who are not capable of selfpreservation must provide services and facilities, which comply with the following rules:

(a) Rule 0465-02-04-.02(2) Health Care Occupancies;

October, 2016 (b) Chapter 0465-02-05 Adequacy of Environment and Services;

(c) Chapter 0465-02-06 Minimum Program Requirements for All Facilities/Services; and (d) Chapter 0465-02-11 Minimum Program Requirements for Intellectual and Developmental Disabilities Residential Habilitation Facilities/Services.

(2) The governing body of an Intellectual and Developmental Disabilities Residential Habilitation facility which provides services for one to three (1-3) persons who are not capable of selfpreservation must provide services and facilities, which comply with the following rules:

(a) Rule 0465-02-04-.11 Residential Occupancies;

(b) Chapter 0465-02-05 Adequacy of Environment and Services;

(3) The governing body of an Intellectual and Developmental Disabilities Residential Habilitation facility which provides services to one to three (1-3) persons must provide services and facilities, which comply with the following rules:

(a) Rule 0465-02-04-.11 One and Two-Family Dwellings Occupancies;

(b) Chapter 0465-02-05 Adequacy of Environment and Services;

(d) Chapter 0465-02-11 Minimum Program Requirements for Intellectual and Developmental Disabilities Residential Habilitation Facilities; and (e) If services are to be provided to one (1) or more persons who are mobile nonambulatory, Rule 0465-02-04.07 Mobile Non-Ambulatory.

(4) The governing body of an Intellectual and Developmental Disabilities Residential Habilitation facility providing services to four (4) or more persons must provide services and facilities, which comply with the following rules:

(a) Rule 0465-02-04-.06(2) Residential Occupancies - Board and Care;

(b) Chapter 0465-02-05 Adequacy of Environment and Services;

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016. October, 2016

Tenn. Comp. R. & Regs. 0465-02-03-.07 BOARDING HOME FACILITIES

(1) The governing body of an Intellectual and Developmental Disabilities Boarding Home facility which provides services to two (2) or three (3) persons must provide services and facilities, which comply with the following rules:

(a) Rule 0465-02-04.10 One and Two-Family Dwellings Occupancies;

(b) Chapter 0465-02-05 Adequacy of Environment and Services;

(2) The governing body of an Intellectual and Developmental Disabilities Boarding Home facility providing services to four (4) or more persons must provide services and facilities, which comply with the following rules:

(a) Rule 0465-02-04-.06(2) Residential Occupancies - Board and Care;

(b) Chapter 0465-02-05 Adequacy of Environment and Services;

(c) If services are to be provided to one (1) or more persons who are mobile nonambulatory, Rule 0465-02-04.07 Mobile Non-Ambulatory.

(d) Chapter 0465-02-12 Minimum Program Requirements for Intellectual and Developmental Disabilities Boarding Home Facilities; and (e) If services are to be provided to one (1) or more persons who are mobile nonambulatory, Rule 0465-02-04.07 Mobile Non-Ambulatory.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-03-.08 PLACEMENT SERVICES

(1) The governing body of an Intellectual and Developmental Disabilities Placement Services must provide services, which comply with the following rules:

(a) Rule 0465-02-04-.04 Business Occupancies, for the location from which the licensed program services are to be delivered. The licensed program services may be delivered from a location which is used for other purposes, such as a facility licensed by the Department, if such facility meets the provisions of Rule 0465-02-04-.01 Life Safety Requirements for the primary use of the building;

(b) Chapter 0465-02-06 Minimum Program Requirements for All Facilities/Services; and October, 2016 (c) If services are to be provided to one (1) or more persons who are mobile nonambulatory, Rule 0465-02-04-.07 Mobile Non-Ambulatory.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-03-.09 RESPITE CARE SERVICES

(1) The governing body of an Intellectual and Developmental Disabilities Respite Care Services facility must provide services which comply with the following rules:

(b) Chapter 0465-02-.06 Minimum Program Requirements for All Facilities/Services;

(c) Chapter 0465-02-.14 Minimum Program Requirements for Intellectual and Developmental Disabilities Respite Care Services; and (d) If services are to be provided to one (1) or more persons who are mobile nonambulatory, Rule 0465-02-04.07 Mobile Non-Ambulatory.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-03-.10 SEMI-INDEPENDENT LIVING SERVICES

(1) The governing body of an Intellectual and Developmental Disabilities Semi-Independent Living services provider must provide services and facilities which comply with the following rules:

(b) Chapter 0465-02-.06 Minimum Program Requirements for All Facilities/Services;

(c) Chapter 0465-02-.15 Minimum Program Requirements for Intellectual Disabilities Semi- Independent Living Services; and (d) If services are to be provided to one (1) or more persons who are mobile nonambulatory, Rule 0465-02-04.07 Mobile Non-Ambulatory.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016. October, 2016

Tenn. Comp. R. & Regs. 0465-02-03-.11 PERSONAL SUPPORT SERVICES AGENCIES

(1) The licensee providing personal support services under this chapter shall comply with and provide services that comply with the following rules:

(a) Chapter 0465-02-06 Minimum Program Requirements for All Facilities/Services;

(b) Chapter 0465-02-02 Licensure Administration and Procedures;

(c) Chapter 0465-02-17 Minimum Program Requirements for Intellectual and Developmental Disabilities Personal Support Services Agencies; and (d) Chapter 0465-02-06-.03 Minimum Program Requirements for All Facilities/Services, Financial Management.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-03-.12 SUPPORTED LIVING SERVICES

(1) The governing body of an Intellectual and Developmental Disabilities Supported Living Services provider must comply with and provide services, which comply with the following rules:

(a) Rule 0465-02-04-.04 Business Occupancies, for the location from which the licensed program services are to be delivered. The licensed program services may be delivered from a location which is used for other purposes including, but not limited to a facility licensed by the Department, if such facility meets the provisions of Rule 0465-02-04- .01, Life Safety Requirements for the primary use of the building;

(b) Chapter 0465-02-06 Minimum Program Requirements for All Facilities/Services;

(c) Chapter 0465-02-18 Minimum Program Requirements for Intellectual and Developmental Disabilities Supported Living Services; and (d) If services are to be provided to one (1) or more persons who are mobile nonambulatory, Rule 0465-02-04-.07 Mobile Non-Ambulatory.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-03-.13 SUPPORT COORDINATION AGENCIES

(1) The licensee providing support coordination shall comply with and provide services that comply with the following rules:

(a) Chapter 0465-02-02 Licensure Administration and Procedures;

(b) Chapter 0465-02-04-.04 Life Safety Licensure Rules, Business Occupancy;

October, 2016 (d) Chapter 0465-02-06 Minimum Program Requirements for All Facilities/Services; and (e) Chapter 0465-02-19 Minimum Program Requirements for Intellectual and Developmental Disabilities Support Coordination Agencies.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Chapter 0465-02-04 Life Safety Licensure Rules

Tenn. Comp. R. & Regs. 0465-02-04-.01 LIFE SAFETY REQUIREMENTS

For purposes of life safety, licensees of the Department of Intellectual and Developmental Disabilities are required to meet the appropriate standards of the edition of the National Fire Protection Association Life Safety Code currently in use by the Office of the State Fire Marshal as set forth in Rule 0780-02-02-.01 of the Rules of the Department of Commerce and Insurance. In addition, all residential settings must be physically accessible to persons supported.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-04-.02 HEALTH CARE OCCUPANCIES

(1) Definition – Health Care Occupancies are used for purposes such as medical or other treatment or care of persons with physical, intellectual, or developmental disabilities, disease, or infirmity, and for the care of children, persons recovering from an illness or operation, or persons of advanced age. Health Care Occupancies provide sleeping facilities for the occupants or are occupied by persons who are mostly incapable of self-preservation because of age, physical or intellectual disability, or because of security measures not under the occupants’ control. Examples of licensees required to meet health care occupancy standards are the following:

(a) Intellectual and Developmental Disabilities Institutional Habilitation Facility.

(b) Any residential facility serving four (4) or more persons who are not capable of selfpreservation and any non-residential facility serving four (4) or more persons six (6) years of age or older who are not capable of self-preservation.

(2) Criteria - For the purpose of life safety, licensees required to meet Health Care Occupancies must comply with the applicable standards of the Life Safety Code of the National Fire Protection Association, Health Care Occupancies, or equivalent standards hereafter adopted by the Office of the State Fire Marshal.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016. October, 2016

Tenn. Comp. R. & Regs. 0465-02-04-.03 EDUCATIONAL OCCUPANCIES

(1) Definition - Educational Occupancies include all buildings used for gathering of groups of persons supported for purposes of instruction. An example of a facility required to meet educational occupancy standards is a Pre-School Facility-Center Based.

(2) Criteria - For the purpose of life safety, licensees required to meet educational occupancies must comply with the following:

(a) The applicable standards of the Life Safety Code of the National Fire Protection Association, Educational Occupancies, or equivalent standards hereafter adopted by the Office of the State Fire Marshal; and 1. Document fire-safety drills which shall be conducted:

(i) Monthly at unexpected times and under varying conditions; and (ii) Under direct staff supervision.

Document that all smoke-detection devices are tested at least every six (6) months.
Document that all fire extinguishers are properly maintained and serviced.
Document instruction to staff upon employment and to persons supported upon admission in fire evacuation procedures.
Adopt and post a policy on smoking in specified areas.
Suspended unit electric heaters may be used, except in means of egress, provided such heaters are located high enough to be out of the reach of persons using the area and are approved for use by the Office of Licensure.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-04-.04 BUSINESS OCCUPANCIES

(1) Definition - Business Occupancies are used for the transaction of business (other than that covered under Mercantile), for the keeping of accounts and records, and similar purpose.

Examples of a facility required to meet business occupancy standards are the following:

(a) Adult Habilitation Facility/Services-Community/Home Based;

(b) Developmental Disability Pre-School Facility/Services-Community Based;

(d) Respite Care Services;

(e) Supported Living Services; and (f) Semi-Independent Living Services.

October, 2016 (2) Criteria - For the purpose of Life Safety, licensees required to meet business occupancies must comply with the applicable standards of the Life Safety Code of the National Fire Protection Association, Business Occupancies, or equivalent standards hereafter adopted by the Office of the State Fire Marshal.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-04-.05 INDUSTRIAL OCCUPANCIES

(1) Definition - Industrial Occupancies include factories making products of all kinds and properties devoted to operations such as processing, assembling, mixing, packaging, finishing or decorating, and repairing. An example of facilities required to meet industrial occupancy standards is an Adult Habilitation Facility/Services-Center Based.

(2) Criteria - For the purpose of Life Safety, licensees required to meet industrial occupancies must comply with the following:

(a) The applicable standards of the Life Safety Code of the National Fire Protection Association, Industrial Occupancies, or equivalent standards hereafter adopted by the Office of the State Fire Marshal; and 1. Document fire-safety drills which shall be conducted:

(i) Monthly at unexpected times and under varying conditions, and (ii) Under direct staff supervision.

Document that all smoke-detection devices are tested monthly and that the batteries are changed when no longer functional.
Document that all fire extinguishers are properly maintained and serviced.
Document instruction to staff upon employment and to persons supported upon admission in fire evacuation procedures.
Adopt a policy on smoking and ensure designated areas are posted.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-04-.06 RESIDENTIAL OCCUPANCIES - BOARD AND CARE

(1) Definition - Board and Care facilities include a building or part thereof that is used for the lodging and boarding of four (4) or more persons supported, not related by blood or marriage to the owner or operator, to provide care services. Examples of facilities required to meet board and care occupancy standards are an Intellectual and Developmental Disabilities Boarding Home Facility and an Intellectual and Developmental Disabilities Residential Habilitation Facility.

(2) Criteria - For the purpose of Life Safety, licensees required to meet Board and Care occupancy must comply with the following:

October, 2016 (a) Applicable standards of the Life Safety Code of the National Fire Protection Association, Residential Board and Care Occupancies, or equivalent standards hereafter adopted by the Office of the State Fire Marshal; and 1. Provide at least two hundred (200) square feet, gross, of occupiable space per person.

Provide at least:

(i) Eighty (80) square feet per person of bedroom space for single occupancy; or (ii) Sixty (60) square feet per person of bedroom space for multiple occupancy.

Not allow multiple occupancy which exceeds four (4) persons per bedroom.
Equip any stairways with emergency lighting.
Provide emergency lighting in any corridors used as means of egress.
Not use unvented gas heaters.
Use portable electric space heaters only in emergency situations and only under conditions specified by the Office of Licensure.
Allow the use of fireplaces only under the following conditions:

(i) For recreation or therapy only;

(ii) Not used as a primary source of heat;

(iii) Used in activity or living rooms;

(iv) Under proper supervision and in accordance with specific written fire safety procedures; and (v) Fireplaces may be installed and used only in areas other than sleeping areas of persons supported, provided the fireplace is equipped with a heattempered glass fireplace enclosure guaranteed against breakage up to a temperature of six hundred and fifty (650) degrees Fahrenheit.

Allow the use of portable cooking devices in the kitchen only.
Document fire-safety drills which shall be conducted:

(i) Monthly at unexpected times and under varying conditions; and (ii) Under direct staff supervision.

Provide a functioning UL rated battery-operated smoke detector in each bedroom occupied by a person supported and document that all smoke-detection devices are tested monthly and that batteries are changed when no longer operating, but at least yearly.

October, 2016 12. Provide operable 2A-10B, C multi-purpose fire extinguishers in a fixed location and readily accessible for use in the facility, and document that all fire extinguishers are properly maintained and serviced. The Office of Licensure will determine the number of fire extinguishers required in a particular facility.

Document instructions to staff upon employment and persons supported upon admission in fire evacuation procedures.
Adopt a policy on smoking and ensure designated areas are posted.
Suspended unit electric heaters may be used, except in means of egress and sleeping areas of persons supported, provided such heaters are located high enough to be out of the reach of persons supported using the area and provided the heaters are equipped with appropriate safety devices and are approved for use by the Office of Licensure.
Use extension cords only on a limited basis and under the conditions acceptable to the Office of Licensure of the Department.

(b) Provide services only for persons who require no greater level of care than personal care as defined at 0465-02-01(51).

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-04-.07 MOBILE NON-AMBULATORY

(1) For the purpose of Life Safety, licensees required to meet the Mobile Non-Ambulatory Rule must comply with the following:

(a) People that use mobility devices only be located on the level of exit discharge;

(b) Provide approved ramps;

(d) Provide doors and exits of at least thirty-two (32) inches clear opening; and (e) Provide bathrooms approved by the Office of Licensure.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-04-.08 CAPABLE OF SELF-PRESERVATION

All residential facilities serving four (4) or more persons supported who are not capable of selfpreservation and all non-residential facilities serving four (4) or more persons supported six (6) years of age or older who are not capable of self-preservation are required to meet the criteria for Health Care Occupancies.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016. October, 2016 6

Tenn. Comp. R. & Regs. 0465-02-04-.09 DAY CARE OCCUPANCIES

(1) Definition - Day Care Occupancies include all buildings used for gathering of groups of persons supported for purposes of instruction. Adult Day Care occupancies are for facilities serving more than twelve (12) persons. Group Day Care Homes are for facilities serving seven to twelve (7-12) persons. Family Day Care Homes are for facilities serving less than seven (7) persons. An example of a facility required to meet day care occupancy standards is an Adult Habilitation Facility/Services-Center Based.

(2) Criteria - For the purpose of Life Safety, licensees required to meet Day Care Occupancies must comply with the following:

(a) Applicable standards of the Life Safety Code of the National Fire Protection Association, Day Care Occupancies, or equivalent standards hereafter adopted by the Office of the State Fire Marshal; and 1. Document fire-safety drills which shall be conducted:

(i) Monthly at unexpected times and under varying conditions; and (ii) Under direct staff supervision.

Document that all smoke-detection devices are tested at least every six (6) months.
Document that all fire extinguishers are properly maintained and serviced.
Document instruction to staff upon employment and to persons supported upon admission in fire evacuation procedures.
Adopt a policy on smoking and ensure designated areas are posted.
Suspended unit electric heaters may be used, except in means of egress, provided such heaters are located high enough to be out of the reach of persons using the area and are approved for use by the Office of Licensure.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-04-.10 RESIDENTIAL OCCUPANCIES - ONE- AND TWO-FAMILY DWELLINGS (ONE TO

THREE PERSONS SUPPORTED).

(1) Definition - One- and Two-Family Dwellings (One to Three persons supported) includes buildings in which each living unit is occupied by members of a single family or licensee staff with no more than three (3) persons supported. Examples of dwellings required to meet oneand two-family dwelling occupancy standards are an Intellectual and Developmental Disabilities Boarding Home Facility and an Intellectual and Developmental Disabilities Residential Habilitation Facility.

(2) Criteria - For the purpose of Life Safety, licensee required to meet one and two-family dwelling occupancy must comply with the following:

October, 2016 (a) Applicable standards of the Life Safety Code of the National Fire Protection Association, One and Two-Family Dwellings, or equivalent standards hereafter adopted by the Office of the State Fire Marshal; and 1. Provide at least two hundred (200) square feet, gross, of occupiable space per person supported.

Provide at least:

(i) Eighty (80) square feet per person of bedroom space for single occupancy; and (ii) Sixty (60) square feet per person of bedroom space for multiple occupancy.

Maintain proper storage and safeguards for all flammable materials.
Not use unvented gas heaters or portable electric space heaters.
Not allow the use of portable cooking devices in rooms other than the kitchen.
Use extension cords only on a limited basis and under the conditions acceptable to the Office of Licensure of the Department.
Provide a functioning UL rated battery-operated smoke detector in each bedroom occupied by a person supported, in the living rooms, and in other such rooms or areas as the Office of Licensure of the Department may require.
Provide an operable 2A-10B, C multi-purpose fire extinguisher in a fixed location and readily accessible for use.
Identify areas where smoking is permitted - smoking in bedrooms must not be allowed.
Not allow persons supported requiring mobility aids to sleep above or below ground floor.
Document fire-safety drills which shall be conducted:

(i) Monthly at unexpected times and under varying conditions; and (ii) Under direct staff supervision.

Document that all smoke detectors are tested monthly and that batteries are changed when no longer operating but at least yearly.

(b) Provide services for only persons supported who require no greater level of care than personal care as defined at Rule 0465-02-01-(49).

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016. October, 2016

Tenn. Comp. R. & Regs. 0465-02-04-.11 RESIDENTIAL OCCUPANCIES - ONE- AND TWO-FAMILY DWELLINGS (ONE TO

THREE PERSONS SUPPORTED).

(1) Definition - One- and two-family dwellings include buildings containing not more than two (2) dwelling units in which each dwelling unit is occupied by members of a single family with not more than three (3) unrelated persons supported who are unable to respond to an approved emergency signal, including voice prompt, and evacuate the dwelling without physical assistance, in three (3) minutes or less. A dwelling required to meet one- and two-family dwelling occupancy with persons supported unable to evacuate without physical assistance, in three (3) minutes or less, includes an Intellectual Disability and Developmental Disability Residential Habilitation Facility.

(2) Physical Assistance - Includes, but is not limited to, staff leading the person supported by the hand, and guiding and helping him/her transfer to a wheelchair.

(3) Criteria - For the purpose of Life Safety, dwellings accommodating persons supported unable to evacuate without physical assistance, in three (3) minutes or less and are required to meet one- and two-family dwelling occupancies must comply with the following:

(a) The applicable standards of the Life Safety Code of the National Fire Protection Association, or equivalent standards hereafter adopted by the Office of the State Fire Marshal; and 1. All staff should be able to assist each person supported in evacuation from the dwelling. This may be accomplished, for example, by assigning responsibility for a particular person supported to a particular staff member, especially where he/she needs complete physical assistance to evacuate. Persons supported who use a wheelchair for evacuation purposes need not be assigned a specific staff person to assist them as long as they are able to transfer from a fixed position to a wheelchair without physical assistance, and evacuate the dwelling in three (3) minutes or less.

Evacuation procedures shall be sufficient so that it is not necessary for a staff person to re-enter the building after once leaving.
A risk assessment must be completed for each person supported admitted within five (5) calendar days of admission on a form prepared by the Department.
If the risk assessment indicates that the person supported is able to evacuate without physical assistance within three (3) minutes or less, then it is not necessary to assign a specific staff person to assist him/her in evacuating.
If the risk assessment indicates that the person supported is not able to evacuate without physical assistance within three (3) minutes or less, then a specific staff person must be assigned to assist him/her in evacuating. Such staff assignment is required at all times when the person is inside the dwelling.
The risk assessment must be repeated when the circumstances of the person supported change.
Staff assigned to persons supported needing assistance must be trained in evacuation procedures specific to the service recipient(s) being assisted.
Persons supported who are ambulatory who cannot evacuate independently within three (3) minutes must receive education and information needed to improve their ability to evacuate the dwelling more independently. When October, 2016 documented attempts at education fail the licensee need not continue training efforts.
Provide at least two hundred (200) square feet, gross, of occupiable space per service recipient.
Provide at least:

(i) Eighty (80) square feet per person of bedroom space for single occupancy; or (ii) Sixty (60) square feet per person of bedroom space for multiple occupancy.

Maintain proper storage and safeguards for all flammable materials.
Not use unvented gas heaters or portable electric heaters.
Use extension cords only on a limited basis and under the conditions acceptable to the Office of Licensure.
Provide a smoke detector in each bedroom occupied by a person supported, in the living rooms, and in other such rooms or areas as the Office of Licensure may require. Smoke detectors must be hardwired into the electrical system.
Provide operable, type 2A-10B, C, multipurpose fire extinguishers in a fixed location and readily accessible for use, and document that all fire extinguishers are properly maintained and serviced.
Identify areas where smoking is permitted; smoking in bedrooms must not be allowed.
Persons supported who use mobility aids shall not sleep above or below ground floor.
Document fire-safety drills which must be conducted:

(i) Monthly at unexpected times and under varying conditions, ensuring each shift holds one (1) per quarter; and (ii) Under direct staff supervision.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Chapter 0465-02-05 Adequacy of Environment and Services

Tenn. Comp. R. & Regs. 0465-02-05-.01 STANDARD FOR NEW CONSTRUCTION

The licensee or applicant for licensure must ensure that new construction for licensees subject to the licensure standards of the Department meets the appropriate standards of the edition of the Standard Building Code currently in effect as adopted by the Office of the State Fire Marshall in rule 0780-02-02- .01 of the promulgated rules of the Department of Commerce and Insurance.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-05-.02 ENVIRONMENTAL REQUIREMENTS FOR ALL LICENSEES

(1) The environment must be maintained in a safe manner and a continuing effort made to eliminate potential hazards.

(2) The environment must be maintained in a sanitary and clean condition, free from all accumulation of dirt and rubbish, well-ventilated, and free from foul, stale, or musty odors.

(3) The environment must be kept free of mice, rats, and other rodents.

(4) Housekeeping practices and standards must be maintained which will ensure the eradication of flies, roaches, and other vermin.

(5) All interior and exterior stairs and steps must be equipped with securely and safely installed handrails.

(6) All interior and exterior stairways, halls, porches, walkways, and all other means of egress and areas of exit must be maintained free of any obstacles, including furniture or other stored items.

(7) A heating system must be provided which is capable of maintaining a comfortable humidity level at all times within the environment and a minimum temperature of sixty-five (65) degrees Fahrenheit.

(8) A cooling, natural ventilation or air conditioning system must be provided which is capable of maintaining a comfortable humidity level at all times within the environment and a maximum temperature of eighty-five (85) degrees Fahrenheit.

October, 2016 (9) Operable windows for ventilation must be provided unless the requirement for operable windows is otherwise exempted by the licensee’s life safety occupancy classification and the environment is equipped with an air conditioning system.

(10) All operable windows used for ventilation must be equipped with screens which do not render the window unusable if the windows are also required for escape or emergency rescue purposes.

(11) A telephone system must be provided which is capable of ensuring prompt notification in cases of emergencies and which is capable of meeting the needs of persons supported.

(12) Emergency telephone numbers must be posted for the most local available agencies for fire protection, police or sheriff, ambulance or medical intervention, and poison control.

(13) An adequate first aid kit must be provided as recommended by the local chapter of the American Red Cross or the licensee’s medical staff, as applicable.

(14) Drinking water must be provided from a source approved by the Tennessee Department of Health.

(15) A system for the disposal of sewage must be provided which is connected to a public sewage system or which is connected to a private sewage system (septic tank and field system), which has the approval of the local public health agency having jurisdiction.

(16) Natural or artificial lighting must be provided, which is adequate for the needs of persons supported.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-05-.03 ENVIRONMENTAL REQUIREMENTS FOR RESIDENTIAL LICENSEES

(1) The governing body must ensure that each person supported is provided with the following:

(a) A separate bed of proper size and height for the convenience and comfort of the person supported;

(b) A mattress and springs, or a mattress foundation, both of which are clean, comfortable, and in good repair;

(c) Clean linens consisting of both a top and bottom sheet, which are clean, in good repair, and are changed as often as needed, but at least weekly;

(d) Bedding, such as blankets, which are clean, in good repair, and appropriate to the weather;

(e) A clean and comfortable pillow, unless contra-indicated by the choice of the person supported or for health reasons;

(f) Space in a dresser or chest of drawers, which is adequate for the storage of the clothing of the person supported;

(g) Closet or wardrobe space, which is adequate for the hanging storage for the clothing of the person supported; and October, 2016 (h) Access to a mirror at an appropriate height.

(2) Unless the licensee is required to meet Health Care Occupancy standards, or unless the room has a door which leads directly to the outside, each bedroom must be provided with a window which meets the following criteria:

(a) Is operable from the inside without the use of special keys, tools, or knowledge;

(b) Provides a clear opening of not less than twenty (20) inches in width, twenty-four (24) inches in height, and five and seven-tenths (5.7) square feet in area; and (c) The bottom of the opening is not more than forty-four (44) inches from the floor.

(3) Each bedroom must be decorated in an appropriate manner including bedspreads, window coverings, and wall hangings.

(4) Bathrooms must be provided, which are equipped as follows:

(a) One (1) private toilet for each six (6) persons, including staff;

(b) One (1) lavatory with hot water for each six (6) persons, including staff, (c) One (1) private tub or shower with hot water for each eight (8) persons, including staff,;

(d) Slip-resistant tub and shower floor surfaces;

(e) Adequate and sanitary, soap and towels provided in each lavatory; and (f) Adequate and sanitary, toilet paper provided at each toilet.

(5) A dining area and dining furniture must be provided, which are sufficient, appropriate, and in good repair for meeting the needs of the persons supported.

(6) A combined living and activity area and furnishings must be provided, which are sufficient in size, in good repair, and appropriate for meeting the needs of the persons supported. The area must contain one (1) seating area, including items such as chairs or sofas, for each person, and other residential furniture such as tables, lamps, wall hangings, a television, and a clock.

(7) An outdoor area must be provided which is neat, free of potential hazards, and is appropriate to meeting the needs of the persons supported.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-05-.04 ENVIRONMENTAL REQUIREMENTS FOR NON-RESIDENTIAL LICENSEES

(1) If persons supported are regularly scheduled to be in the facility for extended periods of time which encompass recognized mealtimes, then the facility must provide a dining area with tables and chairs sufficient for the persons supported to take their meals, whether meals are provided by the facility, the person supported, or other source.

(2) Provide one (1) lavatory and one (1) private toilet for each fifteen (15) persons supported.

October, 2016 (3) Equip each lavatory with adequate and sanitary, hand soap and hand towels.

(4) Equip each toilet with adequate and sanitary, toilet paper.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-05-.05 LICENSEE PROVIDING FOOD SERVICES AND NUTRITION

All residential licensee required to meet this chapter of rules must comply with the requirements of this rule. Any non-residential licensee required to meet this chapter of rules, which provides food and nutrition on a regular basis to persons supported must comply with the requirements of this rule.

(1) Food and nutrition must be provided in as typical a fashion as possible.

(2) Records must be maintained which document the content of all meals served for, at least, the previous thirty (30) days.

(3) Food must be served in appropriate quantity, at appropriate temperatures, and in a form consistent with customary situations.

(4) All Persons supported, including those individuals with physical handicaps, shall be provided the opportunity to eat meals at a table in a dining area unless temporarily contra-indicated for medical reasons.

(5) Provisions must be made for following special diets for persons supported when such diets are prescribed for medical or health reasons, and encouragement given to the person supported to follow such special diets.

(6) In residential settings, provisions must be made for three (3) well-balanced meals at recognized mealtimes with no more than fourteen (14) hours elapsing between the evening meal and the breakfast meal the following morning.

(7) In residential settings, a forty-eight (48) hour supply of food must be maintained, which is sufficient for meeting the needs of the persons supported.

(8) Appropriate equipment and utensils for cooking food and serving meals must be provided in sufficient quantity to serve all persons supported. Such equipment and utensils must be in good repair and washed and sanitized after each use.

(9) Kitchens must be equipped with appliances and fixtures, which are sufficient and appropriate for cooking meals, refrigerating food, washing utensils and dishes, and the sanitary disposal of waste.

(10) Foods requiring cold storage must be maintained at a temperature of forty-five (45) degrees Fahrenheit or below.

(11) Foods requiring frozen storage must be maintained at a temperature of ten (10) degrees Fahrenheit or below.

(12) All dry foods and goods must be stored in a manner to prevent possible contamination and must be stored a minimum of six (6) inches above the floor.

(13) Garbage (food waste) must be stored in secure containers with tight-fitting lids and liners or discharged through a properly installed food waste disposal system.

October, 2016 (14) Garbage (food waste) containers must be emptied daily into secure containers located outside.

(15) Provisions must be made for the regular removal or disposal of garbage (food waste) from the premises.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-05-.06 LICENSEES PROVIDING TRANSPORTATION SERVICES

If the licensee, or employees of the licensee, provides transportation to persons supported in vehicles owned either by the licensee or by the employee, the governing body must ensure that the following requirements are met:

(1) All vehicles must be maintained and operated in a safe manner;

(2) All staff providing transportation must possess an appropriate driver’s license.

Documentation of such license must be maintained in the licensee’s records;

(3) All licensee-owned and staff-owned vehicles used for the transportation of persons supported must be adequately covered by vehicular liability insurance for personal injury to occupants of the vehicle. Documentation of such insurance must be maintained in the licensee’s records; and (4) Appropriate safety restraints must be used as required by state and federal law.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-05-.07 LICENSEES SERVING CHILDREN

Any licensee required to meet this chapter of rules, which provides services to children six (6) years of age or younger must comply with these requirements.

(1) Non-toxic, lead-free paint must be used on all painted surfaces.

(2) Electrical wall outlets which are accessible to children must be protected with covers.

(3) Poisonous and toxic materials must be identified, stored, and used only in such manner and under such conditions as not to pose any threat of poisoning of persons supported or contaminating of food.

(4) All sources of heat must be protected by screens or other protective barriers to prevent burns or injury to children.

(5) Furnishings and other equipment must be free of sharp or projecting objects or surfaces and not pose any potential harm or injury to children.

(6) Steps or stairs which pose a fall hazard to children must be protected by barriers.

(7) Outside play areas must be fenced or otherwise situated to protect children from hazards such as open drainage ditches, adjacent streets, and traffic.

(8) Outside play areas must provide fifty (50) square feet of play area for each child present.

(9) Grass, bark, sand, rubber mats, or other resilient surfaces must be used under play equipment used for climbing or swinging.

October, 2016 (10) Furniture, equipment, and bathroom fixtures must be sized or adapted for meeting the needs of the children supported.

(11) Equipment must be provided that is sufficient and appropriate for active and quiet play needs and for implementing program activities for each child.

(12) Non-residential facilities must provide nap facilities if the children are scheduled to remain in the facility for as long as six (6) hours.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-05-.08 LICENSEES PROVIDING VOCATIONAL SERVICES

(1) Activities of an industrial or productive vocational nature such as assembling, packaging, painting, stripping, wood or metal working, or manufacturing must be conducted in a designated area or room which is separated by fire-rated construction, as required by the applicable Life Safety rules under Chapter 0465-02-04 of these rules, from any other part of the building not used for vocational purposes such as classrooms, residential areas, offices, or storage rooms.

(2) Permanent aisles and passageways which provide the most direct route of egress to exits must be clearly identified within open work areas, and such aisles and passageways must be maintained free of obstacles and in good repair.

(3) All floor surfaces, platforms, and other walking surfaces must be maintained in a clean manner and free of holes or projections which constitute hazards.

(4) All materials must be stored in tiers which are stacked, racked, blocked, inter-blocked, or otherwise secured to prevent sliding, collapsing, or falling.

(5) All powered equipment, machinery, and powered hand tools must be equipped and maintained with the safety guards, shields, and other devices necessary to protect the health and safety of the operators and others in the work area.

(6) All exposed rotating parts, motor shafts, drive belts, chains, cables, gears, cutting blades, wheels, and other moving parts of machinery must be adequately guarded.

(7) Personal protective equipment and clothing must be provided to persons supported and employees, when appropriate, when handling dangerous materials or working at hazardous operations.

(8) All interior floor and wall openings, open-sized mezzanine areas or platforms, which are six (6) feet or more above the adjacent ground level, must be guarded by standard railing.

(9) Natural or adequately-powered ventilation which conforms to ventilation rates of the stateadopted building codes must be provided for all working areas.

(10) Equipment, conductors, controls, and signaling devices which are necessary to provide a complete electrical system must be provided. All specifications and materials must meet state-adopted standards of the building codes and of the Underwriters’ Laboratories, Inc., or similarly established standards.

October, 2016

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-05-.09 LICENSEES SERVING PERSONS WITH VISION LOSS

The governing body of any residential or non-residential licensee, which is required to admit only persons supported who are capable of self-preservation, and which also provides services to one (1) or more persons supported who have vision loss, must ensure compliance with the following requirements:

(1) The person supported must be able to demonstrate independent familiarity with the physical design and layout of the environment and be able to initiate and complete evacuation without physical assistance;

(2) The environment design and placement of furnishings are consistent, free of special hazards, and made known to the person supported, especially when changes occur in the design or placement of furnishings; and (3) Prior notice of the admission of such persons supported must be given to the Office of Licensure.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-05-.10 RESIDENTIAL LICENSEES SERVING PERSONS WITH HEARING LOSS

The governing body of any residential licensee, which is required to admit only persons who are capable of self-preservation, and which also admits one (1) or more persons who have loss of hearing, must ensure that when the sounding of the standard fire alarm is not sufficient to notify a sleeping person who has hearing loss of the need to evacuate, must then provide a means of such notification which:

(1) Is independent of personal, physical contact, or notification by staff or other persons during sleep;

(2) Provides some mechanical means of sensory notification during sleep;

(3) Is consistent in notifying the person supported of the need to evacuate; and (4) Has the prior approval of the Office of Licensure.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-05-.11 NON-RESIDENTIAL LICENSEES SERVING PERSONS WITH HEARING LOSS

Non-residential licensees which serve persons supported with hearing loss must ensure that the means of notifying the person supported, which may include personal contact by staff, is consistent, is always available, and has the approval of the Office of Licensure.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Chapter 0465-02-06 Minimum Program Requirements for All Facilities/Services

Tenn. Comp. R. & Regs. 0465-02-06-.01 GOVERNANCE

(1) The governing body must ensure that the licensee complies with all applicable federal, state, and local laws, ordinances, rules, and regulations.

(2) The governing body must ensure that the facility/services are administered and operated in accordance with written policies and procedures.

(3) The governing body must exercise general direction over the facility/services and establish policies governing the operation of the facility/services and the welfare of the person supported.

(4) The governing body must designate an individual responsible for the operation of the facility/services.

(5) The governing body must ensure that the licensee serves only persons whose placement will not cause a violation of its licensed status and capacity based on the distinct licensure category, the life safety occupancy classification, and the required staffing ratios, if any.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-06-.02 POLICIES AND PROCEDURES

(1) The governing body must ensure that a written policies and procedures manual is maintained. The manual must include the following elements:

(a) A description of each facility/service provided by the licensee. The description must include the hours of operation and admission and discharge criteria;

(b) An organizational chart which clearly shows or describes the lines of authority between the governing body, the chief executive officer, and the staff;

(c) Policy and procedures which ensure that someone is delegated the authority to act in the absence of the individual responsible for the operation of the facility/service;

(d) A schedule of fees, if any, currently charged to persons supported for all services provided by the licensee;

October, 2016 2 (e) A statement of person supported rights and the grievance procedures to be followed when a suspected violation of person supported rights has been reported;

(f) Policy and procedures which ensure the confidentiality of the information of a person supported, and which include the following provisions:

Staff must comply with applicable confidentiality laws and regulations, (e.g., T.C.A. § 33-3-104(10); federal alcohol and drug regulations, which is found at 42 CFR, Part 2); the Health Insurance Portability and Accountability Act (HIPAA), which is found at 45 CFR, Part 160, Part 162, and Part 164);
The person supported must not be required to make public statements, which acknowledge gratitude to the licensee or for the licensee’s facility/services;
The person supported must not be required to perform in public gatherings; and 4. Identifiable photographs of the person supported must not be used without the written and signed consent of the person supported or his/her legal representative (conservator, parent, guardian, or legal custodian).

(g) A medication administration policy and control procedures for licensees involved in the administration of medication to persons supported;

(h) The plans and procedures to be followed in the event of fire evacuation and natural disaster emergencies;

(i) The plans and procedures to be followed in the event of an emergency involving care of persons supported, which will provide for emergency transportation, emergency medical care, and staff coverage in such event;

(j) A policy which prohibits persons supported from having any of the following responsibilities:

Care of other persons supported;
Supervision of other persons supported, unless on-duty/on-site staff are present; and 3. Responsibilities requiring access to confidential information.

(k) Policy and procedures to be followed in the reporting and investigation of suspected or alleged abuse, or neglect of persons supported, or other critical incidents. The procedures must include provisions for corrective action, if any, to be taken as a result of such reporting and investigation;

(l) Policy and procedures which ensure that volunteers, if used by the licensee, are in a supportive capacity and are under the supervision of appropriate designated staff members;

(m) Policy and procedures which govern the use of behavior-management techniques, if used by the licensee;

(n) Policy regarding the use of human subjects in research, if the licensee is involved in, or planning to be involved in, such research, which includes procedures for the following:

Identification of subjects, projects, and staff;

October, 2016 3 2. Provisions to protect the personal and civil rights of the subjects;

Obtaining the consent of the subjects involved;
Assurance that all research projects are conducted under the direction and supervision of professional staff qualified by education and experience to conduct research;
Emergency guidelines for problems that may develop during research activities; and 6. Appointment of a licensee representative to act as coordinator of the research activities.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-06-.03 FINANCIAL MANAGEMENT

(1) The licensee holding or receiving funds or property for the person supported as trustee or representative payee will adhere to all laws, state and federal, that govern their position and relation to persons supported.

(2) The licensee must prohibit staff and proprietors from borrowing money from persons supported.

(3) The licensee must ensure that all money held and disbursed on behalf of persons supported is for the strict, personal benefit of the person supported.

(4) The licensee must not mix its funds with those of the person supported.

(5) The licensee must not take funds or property of the person supported for the licensee’s own use or gain.

(6) The licensee must provide an annual reporting of the funds of the person supported, which are being held and disbursed by the licensee to the person supported or his/her legal representative (conservator, parent, guardian, or legal custodian).

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-06-.04 PERSONNEL AND STAFFING

(1) A job description must be maintained, which includes the employment requirements and the job responsibilities for each staff position.

(2) A personnel record must be maintained which verifies that each employee meets the respective employment requirements for the staff position held.

(3) Training and development activities, which are appropriate in assisting the staff in meeting the needs of the persons supported, must be provided for each staff member. The provision of such activities must be evidenced by documentation in the records.

October, 2016 4 (4) Training and development activities, which are appropriate in assisting volunteers (if used by the licensee) in implementing their assigned duties, must be provided for each volunteer.

The provision of such activities must be evidenced by documentation in the licensee’s records.

(5) Direct Support Staff members must be competent persons aged eighteen (18) years of age or older.

(6) The personnel records for each employee must contain the following:

(a) Evidence of a criminal background check, as required by T.C.A. § 33-2-1202;

(b) Evidence of the staff’s status on the Tennessee registry of persons who have abused, neglected, or misappropriated the property of vulnerable individuals (“Abuse Registry”) maintained by the Department of Health;

(c) Evidence of the staff’s status on the State’s sexual offender registry (After January 1, 2016, no individual or volunteer who is listed on the State’s Sex Offender Registry may be hired or otherwise permitted to provide services); and (d) Evidence of the staff’s status the Tennessee Felony Offender Information Lookup (FOIL). The information available on this list pertains to Tennessee felony offenders who are or who have been in the custody of the Tennessee Department of Correction or under the Supervision of the Tennessee Board of Probation and Parole. The information is submitted by various jurisdictions within Tennessee. Confirmation and/or elaboration should be obtained from the originating jurisdiction.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-06-.05 PERSON SUPPORTED RECORDS

(1) The governing body must ensure that an individual record for each person supported is maintained which, at a minimum, includes the following information:

(a) The name of the person supported;

(b) The address of the person supported;

(d) The gender of the person supported;

(e) The date of birth of the person supported;

(f) The date of admission of the person supported;

(g) The source of referral to the licensee of the person supported;

(h) The name, address, and telephone number of an emergency contact person for the person supported;

(i) If the licensee charges fees for its services, a written fee agreement dated and signed by the person supported or his/her legal representative (conservator, parent, guardian, October, 2016 5 or legal custodian) prior to provision of any services other than emergency services.

This agreement must include, at least, the following information:

The fee or fees to be paid by the person supported;
The services covered by such fees; and 3. Any additional charges for services not covered by the basic service fee.

(j) Appropriate informed, signed, and dated consent and authorization forms for the release or obtainment of information about the person supported; and (k) Written acknowledgement that the person supported and his/her legal representative (conservator, parent, guardian or legal custodian) has been informed of the rights and responsibilities of the person supported and the licensee’s general rules affecting persons supported.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-06-.06 PERSON SUPPORTED RIGHTS

(1) The following rights must be afforded to all persons supported by all licensees and are not subject to modification.

(a) Persons supported have the right to be fully informed before or upon admission about their rights and responsibilities and about any limitation on these rights imposed by the rules of the licensee. The licensee must ensure that the person supported is given oral and written rights information that includes, at least, the following:

A statement of the specific rights guaranteed the person supported by these rules and applicable state laws;
A description of the licensee’s grievance procedure;
A listing of available advocacy services; and 4. A copy of all general licensee rules and regulations for persons supported.

(b) The information shall be presented in a manner that promotes understanding by persons supported of his/her rights, and the person supported shall be given an opportunity to ask questions about the information. If the person supported who was unable to understand the information at the time of admission later becomes able to do so, the information shall be presented to the person supported at that time. If a person supported is likely to continue indefinitely to be unable to understand the information, the licensee must promptly attempt to provide the required information to his/her legal representative (conservator, parent, guardian, or legal custodian) or other appropriate person or agency responsible for protecting the rights of the person supported;

(c) Persons supported have the right to voice grievances to staff, to the licensee, and to outside representatives of their choice, with freedom from restraint, interference, coercion, discrimination, or reprisal;

(d) Persons supported have the right to be treated with consideration, respect, and full recognition of their dignity and individuality;

October, 2016 6 (e) Persons supported have the right to be protected by the licensee from neglect, mistreatment from physical, verbal, and emotional abuse (including corporal punishment), and from all forms of misappropriation and/or exploitation;

(f) Persons supported have the right to be assisted by the licensee in the exercise of his/her civil rights;

(g) Persons supported have the right to be free of any requirement that they perform services which are ordinarily performed by staff; and (h) If residential services are provided, persons supported must be allowed to send personal mail unopened and to receive mail and packages, which may be opened in the presence of staff when there is reason to believe that the contents thereof may be harmful to the person supported or others.

(2) Medicaid-reimbursed individuals receiving HCBS services shall be afforded the rights referenced in 42 C.F.R. § 441.301(c)(4) of the HCBS Settings Rule.

(3) The following rights must be afforded to all persons supported by all licensees, unless modified in accordance with Rules 0465-02-06-.07 and/or 0465-02-06-.08:

(4) Appropriate safety restraints must be used as required by state and federal law.

(a) Persons supported have the right to participate in the development of their ISP, and to receive sufficient information about proposed and alternative interventions and program goals to enable them to participate effectively;

(b) Persons supported have the right to participate fully, or to refuse to participate, in community activities including cultural, educational, religious, community services, vocational, and recreational activities;

(c) If residential services are provided, persons supported must be allowed to have free use of common areas with due regard for privacy, personal possessions, and the right of others;

(d) If residential services are provided, persons supported have the right to furnish and decorate their bedroom/sleeping area, within the lease or other agreement;

(e) If residential services are provided, persons supported have the right to be given privacy and freedom for the use of bathrooms at all hours;

(f) If residential services are provided, persons supported have the right to be given privacy and freedom in the use of their bedroom/sleeping area. If residential services are provided and if married persons are residents, privacy for visits by spouses must be ensured, and if both spouses are residents, they must be permitted to share a room; and (g) If residential services are provided, persons supported have the right to associate and communicate privately with persons of their choice including receiving visitors at any time.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016. October, 2016 7

Tenn. Comp. R. & Regs. 0465-02-06-.07 MODIFICATION OR LIMITATION OF PERSON SUPPORTED RIGHTS BY

FACILITY/SERVICES RULES, POLICIES, OR PROCEDURES.

(1) The rights of all persons supported by a licensee may only be modified or limited under the following conditions:

(a) The licensee is not a Medicaid-reimbursed home and community based service (HCBS) provider required to comply with the federal home-based and communitybased setting final rule, published in the Federal Register at 79 FR 2947 (January 16, 2014).

(b) It is demonstrated and documented that a legitimate purpose cannot reasonably be achieved without such modification or limitation;

(c) No modification or limitation may be made solely for the convenience of staff or be more stringent than is necessary to achieve the demonstrated purpose;

(d) Persons supported or representatives of persons supported, as appropriate, must be fully informed of proposed rules, policies or procedures modifying or limiting the rights of the person supported, and of the reasons therefore, and must be given an opportunity to object, propose alternatives, and consult with family, friends, and/or advocacy agencies prior to their implementation; and (e) Rules, policies, or procedures which modify or limit the rights of the person supported must be in writing and posted in a conspicuous place.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-06-.08 MODIFICATION OR LIMITATION OF PERSON SUPPORTED RIGHTS

(1) The rights of a person supported may only be modified or limited under the following conditions:

(a) It is demonstrated and documented that such modification or limitation is necessary to achieve a legitimate goal in the ISP of the person supported;

(b) No modification or limitation may be made solely for the convenience of staff or be more stringent than is necessary;

(c) The person supported or his/her legal representative (conservator, parent, guardian, or legal custodian), as appropriate, must be fully informed of the proposed limitation or modification and must be given an opportunity to object, propose alternatives, and consult with family, friends, and/or advocacy agencies prior to implementation of the modifications or limitations; and (d) Any modifications or limitations must be documented in the ISP of the person supported in accordance with the following requirements:

Identify a specific and individualized assessed need;
Document the positive interventions and supports used prior to any modifications to the person-centered service plan;

October, 2016 8 3. Document less intrusive methods of meeting the need that have been tried but did not work;

Include a clear description of the condition that is directly proportionate to the specific assessed need;
Include regular collection and review of data to measure the ongoing effectiveness of the modification;
Include established time limits for periodic reviews to determine if the modification is still necessary or can be terminated;
Include the informed consent of the person supported; and 8. Include an assurance that interventions and supports will cause no harm to the person supported.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Chapter 0465-02-07 Minimum Program Requirements for Intellectual Disabilities Adult Habilitation Day Facilities/Services

Tenn. Comp. R. & Regs. 0465-02-07-.01 POLICIES AND PROCEDURES

The licensee must maintain a written policies and procedures manual which includes procedures for tuberculosis control and reporting of infectious and communicable diseases to the Tennessee Department of Health.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, and 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-07-.02 PROFESSIONAL SERVICES

(1) The licensee must provide or procure assistance for persons supported in locating qualified dental, medical, nursing, and pharmaceutical care, including care for emergencies during hours of the facility’s operation.

(2) The licensee must ensure that an annual physical examination is provided or procured for each person supported (unless less often is indicated by the physician of the person supported). Such examinations should include routine screenings (such as vision and hearing) and laboratory examinations (such as Pap smear and blood work), as deemed necessary by the physician and special studies where the index of suspicion is high.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, and 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-07-.03 PERSONNEL AND STAFFING

(1) The licensee must provide two (2) direct support staff members for the first twenty (20) persons supported. One (1) additional direct support staff member must be provided for each additional increment of twenty (20) persons supported present.

(2) The licensee must ensure that employees practice infection control procedures that will protect persons supported from infectious diseases.

(3) Employees shall be screened or tested for tuberculosis according to the procedures of the Tennessee Department of Health. Documentation of such screening or testing shall be maintained in the employee's personnel file.

October, 2016 2 (4) Employees must be provided with a basic orientation in the proper techniques and strategies for the support of persons supported with seizure disorders, prior to being assigned to work with them.

(5) A staff member must be on duty who is trained in First Aid and Cardiopulmonary Resuscitation (CPR).

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, and 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-07-.04 PERSON SUPPORTED RECORDS

(1) The record of each person supported must contain the following information:

(a) A recent photograph and a description of the person supported;

(b) The social security number of the person supported;

(d) The sources of financial support of the person supported, including social security, veteran’s benefits and insurance;

(e) The sources of coverage for medical care costs of the person supported;

(f) The name, address and telephone number of the physician or healthcare agency providing medical services of the person supported;

(g) Documentation of all drugs/medications prescribed or administered by the licensee to the person supported, which indicates the date prescribed, type, dosage, frequency, amount, and reason for prescription;

(h) A discharge summary of the person supported, which states the date of discharge, reasons for discharge, and referral for other services, if appropriate;

(i) Report of medical problems, accidents, seizures and illnesses, and treatments for such medical problems, accidents, seizures and illnesses for the person supported;

(j) Report of significant behavior incidents and of actions taken for the person supported; and (k) Report of the use of restrictive behavior management techniques for the person supported.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, and 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-07-.05 MEDICATION ADMINISTRATION

(1) When medications are administered by certified staff to persons supported the licensee must:

October, 2016 3 (a) Consider the ability and training of the person supported, when supervising the selfadministration of medication;

(b) Ensure that prescription medications are taken only by the person supported for whom they are prescribed, and in accordance with the directions of a physician;

(c) Provide storage for medications in a locked container, which ensures proper conditions of security and sanitation, and prevents accessibility to any unauthorized individual;

(d) Assure the disposal of discontinued and outdated medications and containers with worn, illegible or missing labels; and (e) Report all medication variance (errors), medication reactions, or suspected side effects to the practitioner who prescribed the medication.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, and 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-07-.06 VOCATIONAL SERVICES

(1) The licensee must ensure that work provided is dignified and not demeaning or degrading to the person supported. Vocational Service activities provided must be challenging to the capabilities of the person supported yet result in a sense of accomplishment and productivity.

(2) Day services shall be provided or procured in accordance with the age level, interests, and abilities of the person supported as specified in the ISP.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, and 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-07-.11 USE OF RESTRICTIVE BEHAVIOR MANAGEMENT

(1) No procedures shall be used for behavior management which results in physical or emotional harm to the person supported.

(2) Corporal punishment, seclusion, aversive stimuli, chemical restraint, and denial of a nutritionally adequate diet shall not be used.

(3) Restraint (physical holding, mechanical restraint), medications for behavior management, time-out rooms, or other techniques with similar degrees of restriction or intrusion must not be employed except as an integral part of an ISP.

(4) Restrictive or intrusive behavior management procedures must not be used until after less restrictive alternatives for dealing with the problem behavior have been systematically tried or considered and have been determined to be inappropriate or ineffective.

(5) Prior to the implementation of a written program or behavior support plan incorporating the use of a highly restrictive or intrusive technique, the program plan must be reviewed and approved by the person supported or his/her legal representative (conservator, parent, guardian, or legal custodian), with documentation of such approval. A Human Rights Committee must also review and approve the written program.

(6) When procedures such as physical holding, mechanical restraint, and time-out are used in emergency situations to prevent the person supported from inflicting bodily harm, more than three (3) times within six (6) months, a behavioral assessment shall be conducted by an appropriate professional. Recommendations shall be incorporated into a written plan that is

part of the ISP.

(7) Behavior management medications may be used only when authorized in writing by a physician for a specific period of time.

(8) The program plan for the use of a mechanical restraint must specify the extent and frequency of the monitoring schedule according to the type and design of the device and the condition of the person supported.

(9) A person supported who is placed in a mechanical restraint must be released for a minimum of ten (10) minutes at least every two (2) hours and provided with an opportunity for freedom of movement, exercise, liquid intake/refreshment, nourishment, and use of the bathroom.

(10) Physical restraint/physical holding may be used only until the person supported is calm.

October, 2016 6 (11) A person supported who is placed in time-out must be released after a period of not more than sixty (60) minutes.

(12) The ability of a person supported to exit from time-out must not be prevented by means of keyed or other locks, and locations used for time-out must allow for the immediate entry of staff.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, and 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-07-.07 ASSESSMENTS

(1) The following assessments of the person supported must be completed prior to the development of an ISP:

(a) An assessment of current capabilities in such areas as adaptive behavior and independent living skills;

(b) A basic medical history, information, and determination of the necessity of a medical evaluation, and a copy, where applicable, of the result of the medical evaluation;

(c) A six (6) month history of prescribed medications, frequently used over-the-counter medications, alcohol, and/or other drugs; and (d) An existing psychological assessment on file which is updated as recommended by the ISP team.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, and 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016. October, 2016 4

Tenn. Comp. R. & Regs. 0465-02-07-.08 INDIVIDUAL SUPPORT PLAN (ISP) TEAM

(1) The licensee must ensure that an ISP team known as the Circle of Support is identified and provided for each person supported. The team may include the following as determined by the person supported:

(a) The person supported;

(b) The legal representative (conservator, parent, guardian, or legal custodian) of the person supported, if applicable, unless their inability or unwillingness to attend is documented;

(d) Relevant professionals or individuals, unless their inability to attend is documented;

(e) Friends, advocates and other non-paid supports, if applicable, and (f) The Independent Support Coordinator/Case Manager.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, and 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-07-.09 INDIVIDUAL SUPPORT PLAN (ISP) DEVELOPMENT AND IMPLEMENTATION

(1) The licensee must ensure that a written ISP is provided and implemented for each person supported. The ISP must meet the following requirements:

(a) Developed within thirty (30) days of the admission of the person supported;

(b) Developed by the ISP team of the person supported;

(d) Includes signatures of the person supported, appropriate staff, and, if applicable, the legal representative (conservator, parent, guardian, or legal custodian) of the person supported;

(e) Specifies the needs identified by assessment of the person supported and addresses those needs within the particular service/program component;

(f) Includes personal goals and objectives of the person supported, which are related to the specific needs identified, and specifies which goals and objectives are to be addressed by a particular service/program component; and (g) Includes methods or activities by which the goals and objectives of the person supported are to be implemented.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, and 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016. October, 2016 5

Tenn. Comp. R. & Regs. 0465-02-07-.10 INDIVIDUAL SUPPORT PLAN (ISP) MONITORING AND REVIEW

(1) Written progress notes must be maintained, which include at least quarterly reviews of progress or changes occurring in the ISP.

(2) Changes relative to health, safety, and implementation of outcome based services must be assessed on an ongoing basis and reflected within the quarterly reviews.

(3) The ISP team must review the ISP annually and revise, as necessary.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, and 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Chapter 0465-02-08 Minimum Program Requirements for Developmental Disabilities Adult Habilitation Day Facilities/Services

Tenn. Comp. R. & Regs. 0465-02-08-.01 POLICIES AND PROCEDURES

(1) The licensee shall maintain a written policy and procedures manual which includes:

(a) A policy ensuring that employees and volunteers practice infection control procedures and standard precautions that will protect the persons supported from infectious diseases;

(b) Procedures for tuberculosis control and reporting of infectious and communicable diseases to the Tennessee Department of Health; and (c) Requirements that each employee or volunteer comply with procedures for detection, prevention, and reporting of communicable diseases according to procedures of the Tennessee Department of Health.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-08-.02 PROFESSIONAL SERVICES

The licensee shall provide or procure assistance for people in locating qualified dental, medical, nursing, and pharmaceutical care, including care for emergencies during hours of operation.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-08-.03 PERSONNEL AND STAFFING

(1) The licensee shall provide: one (1) Direct Support Staff member for the first ten (10) persons supported; two (2) Direct Support Staff members for eleven (11) to fifteen (15) persons supported; three (3) Direct Support Staff members for sixteen (16) to twenty (20) persons supported. When more than twenty (20) persons are supported, one (1) additional Direct Support Staff member shall be provided for each additional twenty (20) persons supported present.

October, 2016 (2) The licensee shall ensure that employees practice infection control procedures that will protect persons supported from infectious diseases.

(4) Prior to contact with a person supported, employees shall receive documented orientation to the specific needs of any person supported to whom the employee is assigned.

(5) At least one (1) staff member shall be on duty who is trained in First Aid, cardiopulmonary resuscitation (CPR), and the Heimlich Maneuver.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-08-.04 PERSON SUPPORTED RECORDS

(1) Each record of the person supported shall contain the following:

(a) A recent photograph and a description of the person supported;

(b) Report of the use of restrictive behavior management techniques, as defined under

Rule 0465-02-08-.11, if used;

(c) The name, address and telephone number of the physician or healthcare agency providing medical services of the person supported; and (d) A discharge summary of the person supported, which states the date of discharge, reasons for discharge, and referral for other services, if appropriate.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-08-.05 MEDICATION ASSISTANCE

(1) When medications are taken by persons supported under the supervision of staff, the staff must:

(a) Consider the ability and training of the person supported, when supervising the selfadministration of medication;

(b) Ensure that prescription medications are taken only by the person supported for whom they are prescribed, and in accordance with the directions of a physician;

(c) Provide storage for medications in a locked container, which ensures proper conditions of security and sanitation, and prevents accessibility to any unauthorized individual;

October, 2016

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-08-.06 VOCATIONAL SERVICES

(1) The licensee shall ensure that work provided is dignified and not demeaning or degrading to the person supported. Work activities provided shall be challenging to the capabilities of the person supported yet can result in a sense of accomplishment and productivity.

(2) Day services shall be provided or procured in accordance with the age level, interests, and abilities of the person supported as specified in the ISP.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-08-.11 USE OF RESTRICTIVE BEHAVIOR MANAGEMENT

(1) No procedures shall be used for behavior management which results in physical or emotional harm to the person supported.

October, 2016 (2) Corporal punishment, seclusion, aversive stimuli, chemical restraint, and denial of a nutritionally adequate diet shall not be used.

part of the ISP.

(7) Behavior management medications may be used only when authorized in writing by a physician for a specific period of time.

(10) Physical restraint/physical holding may be used only until the person supported is calm.

(11) A person supported who is placed in time-out must be released after a period of not more than sixty (60) minutes.

(12) The ability of a person supported to exit from time-out must not be prevented by means of keyed or other locks, and locations used for time-out must allow for the immediate entry of staff.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-08-.07 ASSESSMENTS

(1) The following assessments of the person supported must be completed prior to the development of an ISP:

(a) An assessment of current capabilities in such areas as adaptive behavior and independent living skills;

(b) A basic medical history, including a list of current medications, and documentation of the necessity for a medical evaluation. If a medical evaluation is necessary, documentation of the result of the medical evaluation; and (c) A six (6) month history of prescribed medications, frequently used over-the-counter medications, alcohol, and/or other drugs.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-08-.08 INDIVIDUAL SUPPORT PLAN (ISP) TEAM

(1) The governing body must ensure that an ISP team known as the Circle of Support is identified and provided for each person supported. The team may include the following as determined by the person supported:

(a) The person supported;

(b) The legal representative (conservator, parent, guardian, or legal custodian) of the person supported, if applicable, unless their inability or unwillingness to attend is documented;

(d) Relevant professionals or individuals, unless their inability to attend is documented;

(e) Friends, advocates and other non-paid supports, if applicable; and October, 2016 (f) The Independent Support Coordinator/Case Manager.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-08-.09 INDIVIDUAL SUPPORT PLAN (ISP) DEVELOPMENT AND IMPLEMENTATION

(1) The licensee must ensure that a written ISP is provided and implemented for each person supported. The ISP must meet the following requirements:

(a) Developed within thirty (30) days of the admission of the person supported;

(b) Developed by the ISP team of the person supported;

(d) Includes signatures of the person supported, appropriate staff, and, if applicable, the legal representative (conservator, parent, guardian, or legal custodian) of the person supported;

(e) Specifies the needs of the person supported which have been identified by assessment and to be addressed within the particular service/program component;

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-08-.10 INDIVIDUAL SUPPORT PLAN (ISP) MONITORING AND REVIEW

(1) Written progress notes must be maintained, which include at least quarterly reviews of progress or changes occurring in the ISP.

(2) Changes relative to health, safety, and implementation of outcome based services must be assessed on an ongoing basis and reflected within the quarterly reviews.

(3) The ISP team must review the ISP annually and revise, as necessary.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Chapter 0465-02-09 Minimum Program Requirements for Intellectual and Developmental Disabilities Diagnosis and Evaluation Facilities

Tenn. Comp. R. & Regs. 0465-02-09-.01 POLICIES AND PROCEDURES

(1) The governing body must ensure compliance with rule 0465-02-06-.02 Minimum Program Requirements for All Facilities/Services, Policies and Procedures.

(2) An ongoing system must be provided for the collection and recording of accurate data about the person supported.

(3) A procedure must be provided for allowing the person supported or his/her legal representative (conservator, parent, guardian, or legal custodian) a method of challenging any information entered into the record of the person supported. The procedure must also allow for the subsequent removal of successfully challenged information.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-09-.02 ASSESSMENTS

(1) Assessments must be completed by using empirically reliable and valid instruments of diagnosis and evaluation.

(2) Diagnosis and evaluation services must be capable of assessment in the following areas:

(a) Intellectual development;

(b) Sensorimotor development;

(d) Social development;

(e) Communicative development; and (f) Physical development.

(3) Assessment of physical development must be completed by the following:

(a) Physical examination;

(b) Review of Medication history;

October, 2016 (c) Visual screening;

(d) Audiological screening;

(e) Nutritional screening; and (f) If determined necessary, a genetic evaluation.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-09-.03 ASSESSMENT TEAM

(1) The licensee must ensure that an assessment team is identified and provided for each person supported. The team must minimally include:

(a) A designated individual who is responsible for each assessment;

(b) The active participation of each staff member or consultant who is responsible for the completion of the assessment; and (c) The person supported or his/her legal representative (conservator, parent, guardian, or legal custodian).

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-09-.04 ASSESSMENT RECORDS

(1) The licensee must ensure that an individual record of the assessments is maintained for each person supported which includes the following:

(a) The reports of completed evaluations including the names and disciplinary status of the evaluating team members;

(b) The initial recommendations of the assessment team including the services needed for the person supported without consideration of the actual availability of such services;

(c) The availability of needed services and recommended service providers; and (d) The documentation of efforts made in exploring resources for meeting the needs of the person supported identified by the team’s recommendations.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-09-.05 PERSONNEL AND STAFFING

(1) Professional staff must be provided who are capable of performing assessments and who are duly licensed, eligible for licensure, or duly certified to practice their profession in the State of Tennessee. The duties assigned in the performance of diagnosis and evaluation services October, 2016 must be commensurate with the level of competence, training and experience of the staff so assigned.

(2) Each employee must be provided with an initial orientation upon employment and with an annual in-service training activity which must be commensurate with the assigned duties of each employee.

(3) Employees with serious infectious diseases must not be permitted contact with persons supported.

(4) Employees shall be screened or tested for tuberculosis according to the procedures of the Tennessee Department of Health. Documentation of such screening or testing shall be maintained in the employee's personnel file.

(5) The licensee must be sufficiently staffed to the extent that they are not dependent upon volunteers or person supported in the delivery of services.

(6) The licensee must be sufficiently staffed to the extent that assistance is available from another staff member in the event of an emergency.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Chapter 0465-02-10 Minimum Program Requirements for Intellectual and Developmental Disabilities Institutional Habilitation Facilities

Tenn. Comp. R. & Regs. 0465-02-10-.01 POLICIES AND PROCEDURES

The written policies and procedures manual must include procedures for tuberculosis control and reporting of infectious and communicable diseases to the Tennessee Department of Health.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-10-.02 PROFESSIONAL SERVICES

(1) The facility must ensure that each person supported receives an annual physical examination (unless less often is indicated by the physician of the person supported), which includes routine screenings (such as vision and hearing) and laboratory examinations (such as Pap smear and blood work) as determined necessary by the physician and special studies where the index of suspicion is high.

(2) The facility must ensure that all persons supported receive social services including liaison between the person supported, his/her family, the facility and the community.

(3) The facility must ensure that each person supported receives a medical exam within ninety (90) days before or thirty (30) days after admission.

(4) The facility must ensure that each person supported receives an annual dental screening.

(5) The facility must ensure that each person supported receives qualified dental, medical, nursing, pharmacy, physical and occupational therapy, social, psychological, speech pathology and audiology services in accordance with his/her ISP.

(6) The facility must ensure that each person supported is provided with immunizations as required by the Tennessee Department of Health unless prohibited by a physician’s order.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016. October, 2016

Tenn. Comp. R. & Regs. 0465-02-10-.03 PERSONNEL AND STAFFING

(1) All professional services must be provided by individuals duly licensed or certified to practice their profession in the State of Tennessee, or by individuals who are eligible for licensure or certification and under the supervision of duly licensed or certified personnel, as appropriate.

(2) The facility must provide an overall ratio of one (1) Direct Support Staff member for each two and one-half (2 ½) persons supported present.

(3) The facility must ensure that employees practice infection control procedures that will protect persons supported from infectious diseases.

(4) Employees must have a regular tuberculosis skin test or screening within thirty (30) days of employment and as required thereafter by current Tennessee Department of Health guidelines.

(5) Employees must be provided with a basic orientation in the proper management of persons supported with seizure diagnoses prior to being assigned to work with persons supported with such disorders.

(6) Persons supported must never be left unattended during customary sleeping hours.

(7) A staff member must be on duty in the facility who is trained in First Aid and the Heimlich maneuver.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-10-.04 PERSON SUPPORTED RECORDS

(1) The record for each person supported must contain the following information:

(a) A recent photograph and a description of the person supported;

(b) The social security number of the person supported;

(c) The legal competency status of the person supported, including the name of his/her legal representative (conservator, parent, guardian, or legal custodian), if applicable;

(d) The sources of financial support of the person supported, including social security, veteran’s benefits and insurance;

(e) The sources of coverage of medical care costs of the person supported;

(f) The name, address, and telephone number of the physician or healthcare agency providing medical services for the person supported;

(g) Documentation of all medications prescribed or administered by the facility to the person supported, which indicates date prescribed, type, dosage, frequency, amount and reason for the prescription;

(h) A discharge summary of the person supported, which states the date of discharge, reasons for discharge, and referral for other services, if appropriate;

October, 2016 (i) Report of medical problems, accidents, seizures, and illnesses of the person supported, and treatments for such medical problems, accidents, seizures, and illnesses;

(j) Report of significant behavior incidents and of actions taken for the person supported;

(k) Report of the use of restrictive behavior-management techniques for the person supported;

(l) A list of each individual article of personal property of the person supported valued at fifty dollars ($50.00) or more, including its disposition, if no longer in use; and (m) Written accounts of all monies received and disbursed on behalf of the person supported.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-10-.05 MEDICATION ADMINISTRATION

(1) When medications are administered by certified staff to persons supported the licensee must:

(a) Consider the ability and training of the person supported, when supervising the selfadministration of medication;

(b) Ensure that prescription medications are taken only by the person supported for whom they are prescribed, and in accordance with the directions of a physician;

(c) Provide storage for medications in a locked container, which ensures proper conditions of security and sanitation, and prevents accessibility to any unauthorized individual;

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-10-.06 HEALTH, HYGIENE, AND GROOMING

(1) The facility must provide the person supported with assistance and training, as needed, with health, hygiene, and grooming practices.

(2) The facility must provide the person supported with assistance and training in the use of dental appliances, eyeglasses, and hearing aids.

(3) The facility must encourage the person supported to maintain a well-groomed and clean appearance that is age and activity appropriate and within reason of current acceptable styles of grooming and dressing and appearance.

October, 2016 (4) Facility staff must be responsible for the implementation of the orders of a physician concerning recuperative procedures subsequent to an illness or injury of the person supported.

(5) The facility must ensure that each person supported bathes or receives a bath daily and that hair and nails are clean and groomed weekly.

(6) Facility staff must immediately clean persons supported who are incontinent, including a change of clothing and linen, as necessary.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-10-.07 CLOTHING FOR PERSONS SUPPORTED

(1) Each person supported must be provided the least restrictive level of support and assistance needed in the selection and purchase of clothing.

(2) The facility must allow each person supported to dress him/herself in his/her own clothes and to change clothes at appropriate times, according to his/her abilities.

(3) The facility must assist each person supported in securing an adequate allowance of personally owned, individualized, customary, clean, and seasonal clothes.

(4) Any marking of clothing belonging to the person supported for the purposes of identification must be done in an inconspicuous manner.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-10-.08 RECREATIONAL ACTIVITIES

The facility must ensure that opportunities are provided for recreational activities, which are appropriate and adapted to the needs, interests, and age of the person supported.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-10-.09 DAY ACTIVITIES

(1) The facility must ensure that day activities are provided or procured. Such day activities must be in accordance with the age level, interests, and abilities of the person supported, and in accordance with an ISP.

(2) If the person supported attends a school or day program provided outside of the facility, the facility’s staff must participate with the school personnel in developing an individual education plan or with the day program staff in developing an ISP, as appropriate.

(3) The facility must ensure the participation of the person supported and direct support staff in developing and implementing daily activity schedules for each person supported.

October, 2016 (4) Activity schedules of persons supported must not have more than three (3) hours of unscheduled time daily.

(5) The facility must ensure that each person supported who has significant disabilities and uses a wheelchair, unless contraindicated by a physician’s order:

(a) Is assisted by a direct support staff member in spending at least three (3) hours of his/her waking day out of bed;

(b) Is assisted by a direct support staff member in spending a portion of their waking day out of his/her bedroom area;

(c) Is assisted by a direct support staff member in an exercise period daily; and (d) Is assisted in being mobile whenever possible by the use of wheelchairs or other mobility devices.

(6) The facility must ensure that each person supported is provided with a planned period of outdoor activity on a daily basis except during inclement weather.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-10-.10 ASSESSMENTS

(1) The following assessments of the person supported must be completed prior to the development of his/her ISP:

(a) An assessment of current capabilities in such areas as adaptive behavior and independent living skills;

(b) A basic medical history, information, and determination of the necessity of a medical evaluation, and a copy, where applicable, of the results of the medical evaluation;

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-10-.11 INDIVIDUAL SUPPORT PLAN (ISP) TEAM

(1) The facility must ensure that an ISP team known as the Circle of Support is identified and provided for each person supported. The team may include the following as determined by the person supported:

(a) The person supported;

October, 2016 (b) The legal representative (conservator, parent, guardian, or legal custodian) of the person supported, if applicable, unless their inability or unwillingness to attend is documented;

(d) Relevant professionals or individuals, unless their inability to attend is documented;

(e) Friends, advocates and other non-paid supports, if applicable; and (f) The QIDP (Qualified Intellectual Disabilities Professional).

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-10-.12 INDIVIDUAL SUPPORT PLAN (ISP) DEVELOPMENT AND IMPLEMENTATION

(1) The facility must ensure that a written ISP is provided and implemented for each person supported. The ISP must meet the following requirements:

(a) Developed within thirty (30) days of the admission of the person supported to the facility;

(b) Developed by the ISP team of the person supported;

(d) Includes signatures of the person supported, appropriate staff, and, if applicable, the legal representative (conservator, parent, guardian, or legal custodian) of the person supported;

(e) Specifies the needs identified by assessment of the person supported and addresses those needs within the particular service/program component;

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-10-.13 INDIVIDUAL SUPPORT PLAN (ISP) MONITORING AND REVIEW

(1) Written progress notes must be maintained, which include at least quarterly reviews of progress or changes occurring in the ISP.

(2) Changes relative to health, safety, and implementation of outcome based services must be assessed on an ongoing basis and reflected within the quarterly reviews.

(3) The ISP team must review the ISP annually and revise, as necessary.

October, 2016

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-10-.14 HUMAN RIGHTS COMMITTEE

The facility must provide a Human Rights Committee to ensure the rights of the person supported and provide advocacy for the person supported. The committee must consist minimally of at least three (3) members, including one (1) member who is independent of the facility. The committee’s meetings and decisions must be documented.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-10-.15 USE OF RESTRICTIVE BEHAVIOR MANAGEMENT

(1) No procedures shall be used for behavior management which results in physical or emotional harm to the person supported.

(2) Corporal punishment, seclusion, aversive stimuli, chemical restraint, and denial of a nutritionally adequate diet shall not be used.

part of the ISP.

(7) Behavior management medications may be used only when authorized in writing by a physician for a specific period of time.

October, 2016 (10) Physical restraint/physical holding may be used only until the person supported is calm.

(11) A person supported who is placed in time-out must be released after a period of not more than sixty (60) minutes.

(12) The ability of a person supported to exit from time-out must not be prevented by means of keyed or other locks, and locations used for time-out must allow for the immediate entry of staff.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Chapter 0465-02-11 Minimum Program Requirements for Intellectual and Developmental Disabilities Residential Habilitation Facilities/Services

Tenn. Comp. R. & Regs. 0465-02-11-.01 HEALTH, SAFETY, AND WELFARE SAFEGUARDS

(1) The facility must provide or procure assistance for the person supported in locating qualified dental, medical, nursing, and pharmaceutical care including care for emergencies.

(2) The facility must ensure that each person supported receives an annual physical examination (unless less often is indicated by the physician of the person supported), which includes routine screenings (such as vision and hearing) and laboratory examinations (such as Pap smear, mammogram, prostate screening, and blood work) as determined necessary by the physician and special studies where the index of suspicion is high.

(3) The facility must ensure that each person supported receives dental examinations and treatment as prescribed by the physician.

(4) The facility must require that a person supported receives immunizations as required by the Department of Health, unless contraindicated by a doctor’s written orders.

(5) The facility must ensure that each person supported has a physical examination within the twelve (12) months prior to admission or within thirty (30) days after admission.

(6) The facility must ensure that employees practice infection control procedures that will protect the person supported from infectious diseases.

(7) The facility must enable the person supported or his/her legal representative (conservator, parent, guardian, or legal custodian) to choose a personal physician for routine services.

(8) The facility must insure that appropriate corrective actions have been taken in response to substantiated abuse or neglect.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-11-.02 PERSONNEL AND STAFFING

(1) The facility must provide one (1) direct support staff member for every ten (10) persons supported present in the facility.

October, 2016 (2) Employees shall be screened or tested for tuberculosis according to the procedures of the Tennessee Department of Health. Documentation of such screening or testing shall be maintained in the employee's personnel file.

(3) The facility must document that the Hepatitis B vaccine is made available to direct support staff.

(4) Employees must be provided with a basic orientation in the specific needs of a person supported prior to being assigned to work with him/her.

(5) The facility must provide at all times at least one (1) on-duty staff member who is certified in First Aid and Cardiopulmonary Resuscitation (CPR).

(6) All employees must receive training in detection, reporting, and prevention of abuse. This training must be documented in the employee’s record.

(7) All professional services must be provided by individuals duly licensed or certified to practice their profession in the State of Tennessee.

(8) Persons supported must never be left unattended unless otherwise specified in his/her ISP.

Approval by appropriate staff must be documented in the record of the person supported.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-11-.03 PERSON SUPPORTED RECORDS

(1) The record of each person supported must contain the following information:

(a) A recent photograph and a description of the person supported;

(b) Social security number of the person supported;

(c) The legal competency status of the person supported, including the name of his/her legal representative (conservator, parent, guardian, or legal custodian), if applicable;

(d) The sources of financial support of the person supported, including social security, veteran’s benefits, and insurance;

(e) The sources of coverage for medical care costs of the person supported;

(f) The name, address and telephone number of the physician or health agency providing medical services for the person supported;

(g) Documentation of all medications prescribed or administered by the facility to the person supported, which indicates date prescribed, type, dosage, frequency, amount, reason, and side effects;

(h) Documentation of medical problems, accidents, seizures and illnesses of the person supported and treatments for such medical problems, accidents, seizures and illnesses while the person supported is in the care of the facility;

October, 2016 (i) Documentation of significant behavior incidents and of actions taken while the person supported is in the care of facility staff;

(j) Documentation of the use of restrictive behavior-management techniques while the person supported is in the care of facility staff;

(k) A list of each individual article of personal property of the person supported, valued at one hundred dollars ($100) or more including its disposition, if no longer in use;

(l) Written accounts of all monies received and disbursed on behalf of the person supported; and (m) A discharge summary of the person supported, which states the date of discharge, reasons for discharge, and referral for other services, if appropriate.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-11-.04 MEDICATION ADMINISTRATION

(1) When medications are administered by certified staff to persons supported the licensee must:

(a) Consider the ability and training of the person supported, when supervising the selfadministration of medication;

(b) Ensure that prescription medications are taken only by the person supported for whom they are prescribed, and in accordance with the directions of a physician;

(c) Provide storage for medications in a locked container, which ensures proper conditions of security and sanitation, and prevents accessibility to any unauthorized individual;

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-11-.05 SUPPORTS AND SERVICES

(1) The facility must provide supports and services that comply with the following:

(a) Activities available to persons supported throughout the day must be based on the preferences and interests of each person supported;

(b) Activities have an identifiable purpose and are of meaningful activity;

(d) Persons supported who have eating/swallowing diagnoses are identified and the identified diagnoses are addressed;

October, 2016 (e) Special diets and mealtime practices are implemented as needed;

(f) Persons supported must have access to prescribed adapted equipment and/or assistive technology;

(g) Equipment is monitored to determine proper fit, working order and need for repair;

(h) Equipment storage is available if needed; and (i) Persons supported must be provided assistance in the use and protection of money.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-11-.06 PERSONAL SUPPORT AND ASSISTANCE

(1) The facility must provide persons supported with the level of support and assistance needed in a private and dignified manner.

(2) The facility must provide persons supported with the level of support and assistance needed in the use of dental appliances, eyeglasses, and hearing aids.

(3) The facility must be responsible for the implementation of all physicians’ orders.

(4) The facility must assist each person supported in securing an adequate amount of personally owned, clean and seasonal clothes that are of correct size.

(5) Each person supported must be provided the level of support and assistance needed to purchase and select his/her own clothes.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-11-.07 RECREATIONAL ACTIVITIES

The facility must ensure that opportunities are provided for recreational activities, which are appropriate and adapted to the needs, interests, and age of the persons supported.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-11-.08 DAY ACTIVITIES

(1) The facility must ensure that day activities are provided or procured. Such day activities must take into account the age, interests, abilities and needed supports of the person supported and be provided in accordance with an ISP.

October, 2016 (2) If the person supported attends a school or day program provided outside of the facility, the facility’s staff must participate with the school personnel in developing an individual education plan or with the day program staff in developing an ISP, as appropriate.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-11-.09 ASSESSMENTS

(1) The following assessments of the person supported must be completed prior to development of the ISP:

(a) An assessment of current capabilities in such areas as adaptive behavior and independent living skills;

(b) A basic medical history, information, and determination of the necessity of a medical evaluation, and a copy, where applicable, of the results of the medical evaluation;

(c) A six (6) month history of prescription and non-prescription medications, and an alcohol and substance abuse history; and (d) An existing psychological assessment on file which is updated as recommended by the ISP team.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-11-.10 INDIVIDUAL SUPPORT PLAN (ISP) TEAM

(a) The person supported;

(b) The legal representative (conservator, parent, guardian, or legal custodian) of the person supported, if applicable, unless their inability or unwillingness to attend is documented;

(d) Relevant professionals or individuals, unless their inability to attend is documented;

(e) Friends, advocates and other non-paid supports, if applicable; and (f) The Independent Support Coordinator/Case Manager.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016. October, 2016

Tenn. Comp. R. & Regs. 0465-02-11-.11 INDIVIDUAL SUPPORT PLAN (ISP) DEVELOPMENT AND IMPLEMENTATION

(1) The facility must ensure that a written, ISP is provided and implemented for each person supported within thirty (30) days of admission. The ISP must include the following:

(a) The name of the person supported;

(b) The date of plan development;

(d) Interventions that address specific goals and outcomes, identify staff responsible for interventions and planned frequency of contacts;

(e) The facility must maintain documentation that supports the implementation and results of the ISP of the person supported;

(f) Signature(s) of staff who develop the ISP and the primary staff responsible for its implementation; and (g) Signature of the person supported (and/or legal guardian or documentation of reasons for refusal to sign and/or inability to participate in ISP development.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-11-.12 INDIVIDUAL SUPPORT PLAN (ISP) MONITORING AND REVIEW

(1) Written progress notes must be maintained, which include at least quarterly reviews of progress or changes occurring in the ISP.

(2) Changes relative to health, safety, and implementation of outcome based services must be assessed on an ongoing basis and reflected within the quarterly reviews.

(3) The ISP team must review the ISP annually and revise, as necessary.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-11-.13 USE OF RESTRICTED BEHAVIOR INTERVENTIONS

(1) The facility must ensure that restricted behavior interventions are not provided until unrestricted interventions have been systematically tried or considered and have been determined to be inappropriate or otherwise contraindicated.

(2) The facility must ensure that restricted behavior interventions are only provided through an approved written intervention plan.

(3) If restricted interventions are provided, the written intervention plan must:

(a) Be based upon a functional assessment;

October, 2016 (b) Utilize the least intrusive effective intervention that supports the person supported in developing alternative behaviors;

(c) Include procedures to reinforce the person supported for interacting in more adaptive, effective ways so that the need for the challenging behavior is reduced;

(d) Include information on the functional assessment, treatment rationale, procedures, generalization and maintenance strategies, data collection, and schedule for progress review;

(e) Include measurable criteria for fading or removing the restricted intervention based on progress;

(f) Clearly define all responsibilities for implementing components of the plan;

(g) Clearly describe for staff:

The description of the behavior;
Situations in which the behavior is likely to occur;
Signs and signals that occur prior to the behavior and what staff should do to reduce the likelihood of the behavior occurring;
How staff should respond when the behavior occurs;
What staff should do to encourage appropriate responses;
What information staff should document; and 7. Crisis intervention or emergency procedures, as applicable;

(4) The facility must ensure that the written intervention plan is reviewed and approved by appropriately constituted Behavior Support and Human Rights Committees prior to its implementation.

(5) The facility must ensure that staff who implement the written intervention plan are trained to competency on implementing the plan.

(6) The facility must ensure that staff implementation of the plan is monitored regularly and reported as part of progress notes at least monthly.

(7) The facility must ensure that in the provision of behavior services, restraint or protective equipment is used only to protect the person supported or others from harm and when other less intrusive methods have been ineffective or are contraindicated.

(8) The facility must ensure that in the provision of behavior services, the programmatic restraint or protective equipment is used only as part of any approved intervention plan for which consent has been obtained.

(9) The facility does not employ the following devices or practices in the provision of behavior services:

October, 2016 (a) Restraint vests, camisoles, body wraps;

(b) Devices that are used to tie or secure a wrist or ankle to prevent movement;

(d) Removal of mobility aids, such as a wheelchair or walker, of the person supported;

(e) Protective equipment that restricts or prevents movement or the customary use/functioning of the body or body part to which it is applied;

(f) Protective equipment that impairs or inhibits visual or auditory capabilities or prevents or impairs speech or other communication modalities;

(g) Any actions, including seclusion or restraints imposed as a means of coercion, discipline, convenience or retaliation;

(h) Corporal punishment, denial of a nutritionally balanced diet or any other procedures that may result in physical or emotional harm to the person supported;

(i) Restraint rooms; and (j) Aversive stimuli.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-11-.14 USE OF RESTRICTIVE BEHAVIOR MANAGEMENT

(1) No procedures shall be used for behavior management which results in physical or emotional harm to the person supported.

(2) Corporal punishment, seclusion, aversive stimuli, chemical restraint, and denial of a nutritionally adequate diet shall not be used.

part of the ISP.

October, 2016 (7) Behavior management medications may be used only when authorized in writing by a physician for a specific period of time.

(10) Physical restraint/physical holding may be used only until the person supported is calm.

(11) A person supported who is placed in time-out must be released after a period of not more than sixty (60) minutes.

(12) The ability of a person supported to exit from time-out must not be prevented by means of keyed or other locks, and locations used for time-out must allow for the immediate entry of staff.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-11-.15 USE OF PSYCHOTROPIC MEDICATIONS

(1) The facility must obtain the following when psychotropic medications are used:

(a) A diagnosis that is based on a comprehensive psychiatric assessment; and (b) Reasons for prescribing medications.

(2) The facility must ensure that there is informed consent from the person supported or his/her legal representative (conservator, parent, guardian, or legal custodian) prior to utilizing psychotropic medications.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Chapter 0465-02-12 Minimum Program Requirements for Intellectual and Developmental Disabilities Boarding Home Facilities

Tenn. Comp. R. & Regs. 0465-02-12-.01 POLICIES AND PROCEDURES

The written policies and procedures manual must include policies and procedures regarding tuberculosis control and the reporting of infectious and communicable diseases, as required by the Tennessee Department of Health.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-12-.02 PROFESSIONAL SERVICES

(1) The facility must provide or procure assistance for persons supported in locating qualified dental, medical, nursing and pharmaceutical care including care emergencies during hours of the facility’s operation.

(2) The facility must ensure that an annual physical examination is provided or procured for each person supported (unless less often is indicated by the physician of the person supported).

Such examinations should include routine screenings (such as vision and hearing) and laboratory examinations (such as Pap smear and blood work) as determined necessary by the physician and special studies where the index of suspicion is high.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-12-.03 PERSONNEL AND STAFFING

(1) The facility must provide one (1) direct support staff member for each ten (10) persons supported present in the facility.

(2) Persons supported are never to be left unattended in the facility.

(4) The facility must ensure that employees practice infection control procedures that will protect persons supported from infectious diseases.

October, 2016 (5) Employees must be provided with a basic orientation in the proper management of seizure disorders for persons supported prior to being assigned to work.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-12-.04 PERSON SUPPORTED RECORDS

(1) The record of each person supported must include the following information:

(a) A recent photograph and a description of the person supported;

(b) The social security number of the person supported;

(c) The legal competency status of the person supported, including the name of his/her legal representative (conservator, parent, guardian, or legal custodian), if applicable;

(d) The sources of financial support including social security, veteran’s benefits and insurance of the person supported;

(e) Sources of coverage for the medical care costs of the person supported;

(f) The name, address and telephone number of the physician or of the healthcare agency providing medical services for the person supported;

(g) Documentation of all medications administered to the person supported by the facility, which indicates the date prescribed, type, dosage, frequency, amount and reason;

(h) A discharge summary of the person supported, which includes the date of discharge, reasons for discharge and referral for other services, if appropriate;

(i) A list of each individual article of personal property owned by the person supported valued at fifty dollars ($50) or more, including its disposition if it is no longer in use;

(j) Written accounts of all monies received and disbursed on behalf of the person supported;

(k) Report of medical problems, accidents, seizures and illnesses of the person supported, and treatments for such medical problems, accidents, seizures and illnesses while the person supported resides in the facility;

(l) Report of significant behavior incidents of the person supported and the actions taken; and (m) Report of the use of restrictive behavior-management techniques on the person supported.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016. October, 2016

Tenn. Comp. R. & Regs. 0465-02-12-.05 MEDICATION ASSISTANCE

(1) When medications are taken by persons supported under the supervision of staff, the staff must:

(a) Consider the ability and training of the person supported, when supervising the selfadministration of medication;

(b) Ensure that prescription medications are taken only by the person supported for whom they are prescribed, and in accordance with the directions of a physician;

(c) Provide storage for medications in a locked container, which ensures proper conditions of security and sanitation, and prevents accessibility to any unauthorized individual;

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-12-.06 HEALTH, HYGIENE AND GROOMING

(1) The facility must assist and encourage the person supported in the use of dental appliances, eyeglasses, and hearing aids.

(2) The facility must assist and encourage the person supported in maintaining a well-groomed and clean appearance, which is age and activity appropriate, and which is within reason of currently acceptable styles of grooming, dressing, and appearance.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-12-.07 CLOTHING FOR PERSONS SUPPORTED

(1) Each person supported must be provided the least restrictive level of support and assistance needed in the selection and purchase of clothing.

(2) The facility must allow each person supported to dress him/herself in his/her own clothes and to change clothes at appropriate times according to his/her abilities.

(3) The facility must assist each person supported in securing an adequate allowance of personally-owned, individualized, customary, clean, and seasonal clothes.

(4) Any marking of clothing belonging to the person supported for identification purposes must be done in an inconspicuous manner.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016. October, 2016

Tenn. Comp. R. & Regs. 0465-02-12-.08 RECREATIONAL ACTIVITIES

The facility must ensure that opportunities are provided for recreational activities, which are appropriate to and adapted to the needs, interests, and age of the person supported.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-12-.09 DAY ACTIVITIES

The facility must ensure that appropriate day activity programs, vocational placements, school placements, or other such appropriate day activities are provided or procured for all persons supported by the facility. Such day activities should be in accordance with the age level, interests, and abilities of the person supported.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-12-.10 ADMISSIONS

(1) The governing body must ensure that all persons supported admitted to and residing in the facility meet the following criteria:

(a) Capable of self-preservation;

(b) Able to care for basic self-help and minor health care needs with minimal assistance;

(c) Able to recognize danger or threat to personal safety; and (d) Able to maintain appropriate behavior generally tolerable to the community.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-12-.11 USE OF RESTRICTIVE BEHAVIOR MANAGEMENT

(1) No procedures shall be used for behavior management which results in physical or emotional harm to the person supported.

(2) Corporal punishment, seclusion, aversive stimuli, chemical restraint, and denial of a nutritionally adequate diet shall not be used.

October, 2016 (5) Prior to the implementation of a written program or behavior support plan incorporating the use of a highly restrictive or intrusive technique, the program plan must be reviewed and approved by the person supported or his/her legal representative (conservator, parent, guardian, or legal custodian), with documentation of such approval. A Human Rights Committee must also review and approve the written program.

part of the ISP.

(7) Behavior management medications may be used only when authorized in writing by a physician for a specific period of time.

(10) Physical restraint/physical holding may be used only until the person supported is calm.

(11) A person supported who is placed in time-out must be released after a period of not more than sixty (60) minutes.

(12) The ability of a person supported to exit from time-out must not be prevented by means of keyed or other locks, and locations used for time-out must allow for the immediate entry of staff.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Chapter 0465-02-13 Minimum Program Requirements for Intellectual and Developmental Disabilities Placement Services

Tenn. Comp. R. & Regs. 0465-02-13-.01 POLICIES AND PROCEDURES

(1) The written policies and procedures manual must include the following:

(a) Procedures for tuberculosis control and reporting of infectious and communicable diseases to the Tennessee Department of Health;

(b) Policies and procedures establishing minimum requirements in all placement providers’ homes for ensuring safety to life in the event of fire. These policies and procedures minimally must ensure:

Fire safety features of smoke detectors, fire extinguishers and two (2) alternate means of escape from sleeping rooms in each provider’s home; and 2. Training for all providers in developing and implementing evacuation procedures within each provider’s home; and (c) Policies and procedures establishing minimum requirements in all placement providers’ homes regarding environmental conditions and services. The policies and procedures must address minimum standards for health and sanitation, adequate furnishings, facilities/services, and food/nutrition for meeting the needs of the person supported in providers’ homes.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-13-.02 PROFESSIONAL SERVICES

(1) The licensee must provide or procure assistance for persons supported in locating qualified dental, medical, nursing and pharmaceutical care including care for emergencies during hours of the facility’s operation.

(2) The licensee must ensure that an annual physical examination is provided or procured for each person supported (unless less often is indicated by the physician of the person supported). Such examinations should include routine screenings (such as vision and October, 2016 hearing) and laboratory examinations (such as Pap smear and blood work) as determined necessary by the physician and special studies where the index of suspicion is high.

(3) The licensee must ensure that an annual dental screening is provided or procured for each person supported.

(4) The licensee must ensure that each person supported is provided with immunizations as required by the Tennessee Department of Health unless contraindicated by a physician’s order.

(5) The licensee must ensure that each person supported receives a medical exam within ninety (90) days before or thirty (30) days after admission.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-13-.03 PERSONNEL AND STAFFING

(1) The governing body must ensure that no more than three (3) persons supported are residing in an individual home at any given time.

(2) The governing body must ensure that employees and providers practice infection control procedures that will protect persons supported from infectious diseases.

(4) Employees and providers must be provided with a basic orientation in the proper management of seizure disorders for persons supported prior to being assigned to work.

(5) Persons supported must never be left unattended during customary sleeping hours.

(6) Employees and providers must be trained in First Aid and Cardiopulmonary Resuscitation (CPR).

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-13-.04 PERSON SUPPORTED RECORDS

(1) Each record of the person supported must contain the following information:

(a) A recent photograph and a description of the person supported;

(b) The social security number of the person supported;

(c) The legal competency status of the person supported, including the name of his/her legal representative (conservator, parent, guardian, or legal custodian), if applicable;

(d) The sources of financial support including social security, veteran’s benefits and insurance of the person supported;

October, 2016 (e) The sources of coverage for medical care costs of the person supported;

(f) The name, address and telephone number of the physician or healthcare agency providing medical services for the person supported;

(g) Documentation of all medications prescribed or administered by the licensee to the person supported, which indicates date prescribed, type, dosage, frequency, amount and reason;

(h) A discharge summary of the person supported, which states the date of discharge, reasons for discharge and referral for other services, if appropriate;

(i) Report of medical problems, accidents, seizures and illnesses of the person supported, and treatments for such medical problems, accidents, seizures and illnesses;

(j) Report of significant behavior incidents of the person supported, and actions taken;

(k) Report of the use of restrictive behavior management techniques on the person supported;

(l) A list of each individual article of personal property of the person supported valued at fifty dollars ($50.00) or more, including its disposition if it is no longer in use; and (m) Written accounts of all monies received and disbursed on behalf of the person supported.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-13-.05 MEDICATION ADMINISTRATION

(1) When medications are administered by certified staff to persons supported the licensee must:

(a) Consider the ability and training of the person supported, when supervising the selfadministration of medication;

(b) Ensure that prescription medications are taken only by the person supported for whom they are prescribed, and in accordance with the directions of a physician;

(c) Provide storage for medications in a locked container, which ensures proper conditions of security and sanitation, and prevents accessibility to any unauthorized individual;

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016. October, 2016

Tenn. Comp. R. & Regs. 0465-02-13-.06 HEALTH, HYGIENE AND GROOMING

The governing body must ensure that the person supported receives assistance and training, as needed, with health, hygiene, and grooming practices.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-13-.07 CLOTHING FOR PERSONS SUPPORTED

(1) The licensee must assist each person supported with the least restrictive level of support and assistance needed in the selection and purchase of clothing.

(2) Each person supported must be allowed to dress him/herself in his/her own clothes and to change clothes at appropriate times according to his/her abilities.

(3) The licensee must assist each person supported in securing an adequate allowance of personally owned, individualized, clean, and seasonal clothes.

(4) Any marking of clothing belonging to the person supported for identification purposes must be done in an inconspicuous manner.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-13-.08 RECREATIONAL ACTIVITIES

The governing body must ensure that opportunities are provided for recreational activities, which are appropriate to and adapted to the needs, interests, and age of the person supported.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-13-.09 DAY ACTIVITIES

(1) The governing body must ensure that day activities are provided or procured. Such day activities must be in accordance with the age level, interests, and abilities of the person supported and in accordance with an ISP.

(2) If the person supported attends an outside school or day program the governing body must ensure that the staff participates with the school personnel in developing an individual education plan or with the day program staff in developing an ISP, as appropriate.

(3) The governing body must ensure that each person supported with significant disabilities, and who uses a wheelchair:

(a) Is assisted by a Direct Support Staff member in spending at least three (3) hours of their waking day out of bed, unless contraindicated by a physician’s order;

(b) Is assisted by a Direct Support Staff member in spending a portion of their waking day out of their bedroom area;

October, 2016 (c) Is assisted by a Direct Support Staff member in an exercise period daily; and (d) Is assisted in being mobile whenever possible by the use of wheelchairs or other mobility devices.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-13-.10 ASSESSMENTS

(1) The following assessments of the person supported must be completed prior to the development of his/her ISP:

(a) An assessment of current capabilities in such areas as adaptive behavior and independent living skills;

(b) A basic medical history, information, and determination of the necessity of a medical evaluation, and a copy, where applicable, of the results of the medical evaluation;

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-13-.11 INDIVIDUAL SUPPORT PLAN (ISP) TEAM

(a) The person supported;

(b) The legal representative (conservator, parent, guardian, or legal custodian) of the person supported, if applicable, unless their inability or unwillingness to attend is documented;

(d) Relevant professionals or individuals, unless their inability to attend is documented;

(e) Friends, advocates and other non-paid supports, if applicable; and (f) The Independent Support Coordinator/Case Manager.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016. October, 2016

Tenn. Comp. R. & Regs. 0465-02-13-.12 INDIVIDUAL SUPPORT PLAN (ISP) DEVELOPMENT AND IMPLEMENTATION

(1) The governing body must ensure that a written ISP is provided and implemented for each person supported. The ISP must meet the following requirements:

(a) Developed within thirty (30) days of the admission of the person supported;

(b) Developed by the ISP team of the person supported;

(d) Includes signatures of the person supported, appropriate staff, and, if applicable, the legal representative (conservator, parent, guardian, or legal custodian) of the person supported;

(e) Specifies the needs identified by assessment of the person supported and addresses those needs within the particular service/program component;

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-13-.13 INDIVIDUAL SUPPORT PLAN (ISP) MONITORING AND REVIEW

(1) Written progress notes must be maintained, which include at least quarterly reviews of progress or changes occurring in the ISP.

(2) Changes relative to health, safety, and implementation of outcome based services must be assessed on an ongoing basis and reflected within the quarterly reviews.

(3) The ISP team must review the ISP annually and revise, as necessary.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-13-.14 USE OF RESTRICTIVE BEHAVIOR MANAGEMENT

(1) No procedures shall be used for behavior management which results in physical or emotional harm to the person supported.

(2) Corporal punishment, seclusion, aversive stimuli, chemical restraint, and denial of a nutritionally adequate diet shall not be used.

October, 2016 (4) Restrictive or intrusive behavior management procedures must not be used until after less restrictive alternatives for dealing with the problem behavior have been systematically tried or considered and have been determined to be inappropriate or ineffective.

part of the ISP.

(7) Behavior management medications may be used only when authorized in writing by a physician for a specific period of time.

(10) Physical restraint/physical holding may be used only until the person supported is calm.

(11) A person supported who is placed in time-out must be released after a period of not more than sixty (60) minutes.

(12) The ability of a person supported to exit from time-out must not be prevented by means of keyed or other locks, and locations used for time-out must allow for the immediate entry of staff.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Chapter 0465-02-14 Minimum Program Requirements for Intellectual and Developmental Disabilities Respite Care Services

Tenn. Comp. R. & Regs. 0465-02-14-.01 POLICIES AND PROCEDURES

(1) The written policies and procedures manual must include the following:

(a) Policies and procedures regarding tuberculosis control and the reporting of infectious and communicable diseases as required by the Tennessee Department of Health;

(b) Policies and procedures establishing minimum requirements in all respite care services for ensuring safety to life in the event of fire. These policies and procedures must minimally ensure:

Fire safety features of smoke detectors, fire extinguishers and two (2) alternate means of escape from sleeping rooms in each home; and 2. Training for all providers in developing and implementing fire safety precautions and evacuation procedures within each home.

(c) Policies and procedures establishing minimum requirements for environmental quality in each home. Such requirements must include minimum standards for health, sanitation, and adequate furnishings, and equipment for meeting the needs and food/nutrition of the person supported.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-14-.02 PERSONNEL AND STAFFING

(1) The governing body must ensure that no more than three (3) persons are in an individual respite care placement at a time.

(2) Persons supported are never to be left unattended during customary sleeping hours.

(4) The governing body must ensure that employees and providers practice infection control procedures that will protect persons supported from infectious diseases.

October, 2016 (5) Employees and providers must be provided with a basic orientation in the proper management of seizure disorders for persons supported prior to being assigned to work.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-14-.03 PERSON SUPPORTED RECORDS

(1) The governing body must ensure that the record of each person supported includes the following:

(a) The social security number of the person supported;

(b) The legal competency status of the person supported, including the name of his/her legal representative (conservator, parent, guardian, or legal custodian), if applicable;

(d) The name, address and telephone number of the physician or healthcare agency providing medical services for the person supported;

(e) Documentation of all medications administered to the person supported by the licensee, which indicates the date prescribed, type, dosage, frequency, amount and reason;

(f) Written accounts of all monies received and disbursed on behalf of the person supported;

(g) Report of medical problems, accidents, seizures and illnesses of the person supported, and treatments for such medical problems, accidents, seizures and illnesses while the person supported is in respite care;

(h) Report of significant behavior incidents of the person supported, and actions taken; and (i) Report of the use of restrictive behavior management techniques on the person supported.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-14-.04 MEDICATION ADMINISTRATION

(1) When medications are administered by certified staff to persons supported the licensee must:

(a) Consider the ability and training of the person supported, when supervising the selfadministration of medication;

(b) Ensure that prescription medications are taken only by the person supported for whom they are prescribed, and in accordance with the directions of a physician;

(c) Provide storage for medications in a locked container, which ensures proper conditions of security and sanitation, and prevents accessibility to any unauthorized individual;

October, 2016 (d) Assure the disposal of discontinued and outdated medications and containers with worn, illegible or missing labels; and (e) Report all medication variance (errors), medication reactions, or suspected side effects to the practitioner who prescribed the medication.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-14-.05 HEALTH, HYGIENE AND GROOMING

The governing body must ensure that all persons supported receive assistance with health, hygiene, and grooming.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-14-.06 DAY ACTIVITIES

The governing body must ensure that appropriate day activities are provided or procured, which are in accordance with the age level, interest, and ability of the person supported, and relevant to the length and

purpose of his/her stay.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-14-.07 USE OF RESTRICTIVE BEHAVIOR MANAGEMENT

(1) No procedures shall be used for behavior management which results in physical or emotional harm to the person supported.

(2) Corporal punishment, seclusion, aversive stimuli, chemical restraint, and denial of a nutritionally adequate diet shall not be used.

(6) When procedures such as physical holding, mechanical restraint, and time-out are used in emergency situations to prevent the person supported from inflicting bodily harm, more than three (3) times within six (6) months, a behavioral assessment shall be conducted by an October, 2016 appropriate professional. Recommendations shall be incorporated into a written plan that is

part of the ISP.

(7) Behavior management medications may be used only when authorized in writing by a physician for a specific period of time.

(10) Physical restraint/physical holding may be used only until the person supported is calm.

(11) A person supported who is placed in time-out must be released after a period of not more than sixty (60) minutes.

(12) The ability of a person supported to exit from time-out must not be prevented by means of keyed or other locks, and locations used for time-out must allow for the immediate entry of staff.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Chapter 0465-02-15 Minimum Program Requirements for Intellectual Disabilities Semi-Independent Living Services

Tenn. Comp. R. & Regs. 0465-02-15-.01 POLICIES AND PROCEDURES

(1) The written policies and procedures manual must include the following:

(a) Procedures for tuberculosis control and reporting of infectious and communicable diseases to the Tennessee Department of Health.

(b) Policies and procedures establishing minimum requirements ensuring reasonable safety to life in the event of fire for all dwellings in which persons supported reside.

These policies and procedures must require:

Fire safety features of smoke detection, fire extinguishers and two (2) alternative routes of escape in each dwelling of the person supported; and 2. Training for each person supported at the time of admission in the proper evacuation of his/her respective dwelling and the use of fire safety features.

(c) Policies and procedures establishing minimum standards of environmental quality in the dwelling of each person supported. These policies and procedures must ensure:

The health of the person supported is not threatened by the standard of environmental quality maintained in his/her dwelling; and 2. Each dwelling of the person supported is furnished and equipped in an adequate manner for meeting his/her individual needs and personal life style.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-15-.02 PROFESSIONAL SERVICES

(1) The licensee must provide or procure assistance for persons supported in locating qualified dental, medical, nursing, and pharmaceutical care including care for emergencies during hours of the licensee’s operation.

October, 2016 (2) The licensee must ensure that an annual physical examination is provided or procured for each person supported (unless less often is indicated by the physician of the person supported). Such examinations should include routine screenings (such as vision and hearing) and laboratory examination (such as Pap smear and blood work), as determined necessary by the physician and special studies where the index of suspicion is high.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-15-.03 PERSONNEL AND STAFFING

(1) A primary staff member must be assigned to each person supported. The primary staff member is to be responsible for monitoring and assisting the person supported in the semiindependent living arrangement. A primary staff member must not be responsible for more than twenty (20) persons supported at one time.

(2) Primary staff members or other assigned support staff must be available on call to persons supported on a twenty-four (24) hour per day basis.

(3) The governing body must ensure that employees practice infection control procedures that will protect persons supported from infectious diseases.

(5) Employees must be provided with a basic orientation in the proper management of seizure disorders for persons supported prior to being assigned to work.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-15-.04 PERSON SUPPORTED RECORDS

(1) The record of each person supported must contain the following:

(a) A recent photograph and a description of the person supported;

(b) The social security number of the person supported;

(c) The legal competency status of the person supported, including the name of his/her legal representative (conservator, parent, guardian, or legal custodian), if applicable;

(d) The sources of financial support including social security, veteran’s benefits and insurance of the person supported;

(e) The sources of coverage for medical care costs of the person supported;

(f) The name, address and telephone number of the physician or healthcare agency providing medical services for the person supported;

October, 2016 (g) Documentation of all medications prescribed or administered to the person supported by the licensee, which indicates the date prescribed, type, dosage, frequency, amount and reason;

(h) A discharge summary of the person supported, which states the date of discharge, reasons for discharge and referral for other services, if appropriate;

(i) Report of medical problems, accidents, seizures and illnesses of the person supported, and treatments of such medical problems, accidents, seizures and illnesses;

(j) Report of significant behavior incidents of the person supported, and actions taken;

(k) Report of the use of restrictive behavior-management techniques on the person supported; and (l) Written accounts of all monies received and disbursed on behalf of the person supported.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-15-.05 MEDICATION ADMINISTRATION

(1) When medications are administered by certified staff to persons supported the licensee must:

(a) Consider the ability and training of the person supported, when supervising the selfadministration of medication;

(b) Ensure that prescription medications are taken only by the person supported for whom they are prescribed, and in accordance with the directions of a physician;

(c) Provide storage for medications in a locked container, which ensures proper conditions of security and sanitation, and prevents accessibility to any unauthorized individual;

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-15-.06 DAY ACTIVITIES

(2) If the person supported attends an outside school or day program the governing body must ensure that the staff participate with the school personnel in developing an individual education plan or with the day program staff in developing an ISP, as appropriate.

October, 2016

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-15-.07 ASSESSMENTS

(1) The following assessments of the person supported must be completed prior to the development of an ISP:

(a) An assessment of current capabilities in such areas as adaptive behavior and independent living skills.

(b) A basic medical history, information, and determination of the necessity of a medical evaluation, and a copy, where applicable, of the results of the medical evaluation.

(c) A six (6) month history of prescribed medications, frequently used over-the-counter medications, alcohol, and/or other drugs.

(d) An existing psychological assessment on file, which is updated as recommended by the ISP team.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-15-.08 INDIVIDUAL SUPPORT PLAN (ISP) TEAM

(a) The person supported;

(b) The legal representative (conservator, parent, guardian, or legal custodian) of the person supported, if applicable, unless their inability or unwillingness to attend is documented;

(d) Relevant professionals or individuals, unless their inability to attend is documented;

(e) Friends, advocates and other non-paid supports, if applicable; and (f) The Independent Support Coordinator/Case Manager.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-15-.09 INDIVIDUAL SUPPORT PLAN (ISP) DEVELOPMENT AND IMPLEMENTATION

(1) The governing body must ensure that a written ISP is provided and implemented for each person supported. The ISP must meet the following requirements:

October, 2016 (a) Developed within thirty (30) days of the admission of the person supported;

(b) Developed by the ISP team of the person supported;

(d) Includes signatures of the person supported, appropriate staff, and, if applicable, the legal representative (conservator, parent, guardian, or legal custodian) of the person supported;

(e) Specifies the needs identified by assessment of the person supported and addresses those needs within the particular service/program component;

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-15-.10 INDIVIDUAL SUPPORT PLAN (ISP) MONITORING AND REVIEW

(1) Written progress notes must be maintained, which include at least quarterly reviews of progress or changes occurring in the ISP.

(2) Changes relative to health, safety, and implementation of outcome based services must be assessed on an ongoing basis and reflected within the quarterly reviews.

(3) The ISP team must review the ISP annually and revise, as necessary.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-15-.11 ADMISSIONS

(1) The governing body must ensure that all persons supported in semi-independent living services must meet the following criteria:

(a) Capable of self-preservation;

(b) Able to care for basic self-help and minor health care needs without assistance;

(c) Able to care for personal possessions and to maintain personal living area in a state of orderliness and cleanliness to the extent it does not constitute a health hazard;

(d) Able to travel independently or secure assistance in traveling to work, training, community activities, or to generic services;

(e) Able to recognize danger or threat to personal safety;

October, 2016 (f) Able to plan and cook simple meals; and (g) Able to secure assistance in crisis situations by such means as the telephone or contacting neighbors or staff.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-15-.12 SUPPORTIVE SERVICES

(1) The governing body must ensure that the following support services are provided for each person supported:

(a) Transportation or assistance with transportation for non-routine events, special appointment, or long distance travel;

(b) Liaison for making appointments and obtaining consultation with professional services;

(c) Maintenance of a current list of the names and telephone numbers, within each dwelling of the person supported, for emergency services and the Direct Support Staff available and on-call;

(d) Counseling for each person supported as needed on the utilization of professional, social and community services, and assistance in the referral process and in making appointments for such services;

(e) Monitoring of food and nutrition to ensure that the person supported is able to plan, shop for, store, and prepare appropriate food and meals;

(f) Counseling, training, and other assistance in procuring and taking prescription and non-prescription drugs;

(g) Aid in the development of homemaking, money management, and socialization skills;

(h) Counseling/Assistance in the use and protection of money; and (i) Assistance in applying for financial benefits for which the person supported may be eligible.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-15-.13 USE OF RESTRICTIVE BEHAVIOR MANAGEMENT

(1) No procedures shall be used for behavior management which results in physical or emotional harm to the person supported.

(2) Corporal punishment, seclusion, aversive stimuli, chemical restraint, and denial of a nutritionally adequate diet shall not be used.

October, 2016 (3) Restraint (physical holding, mechanical restraint), medications for behavior management, time-out rooms, or other techniques with similar degrees of restriction or intrusion must not be employed except as an integral part of an ISP.

part of the ISP.

(7) Behavior management medications may be used only when authorized in writing by a physician for a specific period of time.

(10) Physical restraint/physical holding may be used only until the person supported is calm.

(11) A person supported who is placed in time-out must be released after a period of not more than sixty (60) minutes.

(12) The ability of a person supported to exit from time-out must not be prevented by means of keyed or other locks, and locations used for time-out must allow for the immediate entry of staff.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Chapter 0465-02-16 Minimum Program Requirements for Developmental Disabilities Semi-Independent Living Services

Tenn. Comp. R. & Regs. 0465-02-16-.01 POLICIES AND PROCEDURES

(1) The written policies and procedures manual must include the following:

(a) Procedures for tuberculosis control and reporting of infectious and communicable diseases to the Tennessee Department of Health.

(b) A policy ensuring that employees and volunteers practice infection control procedures and standard precautions that will protect people from infectious diseases.

(c) Policies and procedures establishing minimum requirements ensuring reasonable safety to life in the event of fire for all dwellings in which persons supported reside.

These policies and procedures must require:

Fire safety features of smoke detection, fire extinguishers, and two (2) alternative routes of escape in each dwelling of the person supported; and 2. Training for each person supported at the time of admission in the proper evacuation of his or her respective dwelling and the use of fire safety features.

(d) Policies and procedures establishing minimum standards of environmental quality in the dwelling of each person supported. These policies and procedures must ensure:

The health of the person supported is not threatened by the standard of environmental quality maintained in his/her dwelling; and 2. Each dwelling of the person supported is furnished and equipped in an adequate manner for meeting his/her individual needs and personal life style.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016. October, 2016

Tenn. Comp. R. & Regs. 0465-02-16-.02 PROFESSIONAL SERVICES

(2) The licensee must ensure that an annual physical examination is provided or procured for each person supported (unless less often is indicated by the physician of the person supported). Such examinations should include routine screenings (such as vision and hearing) and laboratory examination (such as Pap smear and blood work), as determined necessary by the physician and special studies where the index of suspicion is high.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-16-.03 PERSONNEL AND STAFFING

(2) Primary staff members or other assigned support staff must be available to persons supported on call on a twenty-four (24) hour per day basis.

(3) The governing body must ensure that employees practice infection control procedures that will protect persons supported from infectious diseases.

(5) Employees must be provided with a basic orientation in the proper management of seizure disorders for persons supported prior to being assigned to work.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-16-.04 PERSON SUPPORTED RECORDS

(1) The record of each person supported must contain the following:

(a) A recent photograph and a description of the person supported;

(b) The social security number of the person supported;

(c) The legal competency status of the person supported, including the name of his/her legal representative (conservator, parent, guardian, or legal custodian), if applicable;

(d) The sources of financial support including social security, veteran’s benefits and insurance of the person supported;

October, 2016 (e) The sources of coverage for medical care costs of the person supported;

(f) The name, address and telephone number of the physician or healthcare agency providing medical services for the person supported;

(g) Documentation of all medications prescribed or administered by the licensee to the person supported, which indicates the date prescribed, type, dosage, frequency, amount, and reason;

(h) A discharge summary of the person supported, which states the date of discharge, reasons for discharge, and referral for other services, if appropriate;

(i) Report medical problems, accidents, seizures and illnesses of the person supported, and treatments of such medical problems, accidents, seizures and illnesses;

(j) Report of significant behavior incidents of the person supported, and actions taken;

(k) Report of the use of restrictive behavior-management techniques on the person supported; and (l) Written accounts of all monies received and disbursed on behalf of the person supported.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-16-.05 MEDICATION ASSISTANCE

(1) When medications are taken by persons supported under the supervision of staff, the staff must:

(a) Consider the ability and training of the person supported, when supervising the selfadministration of medication;

(b) Ensure that prescription medications are taken only by the person supported for whom they are prescribed, and in accordance with the directions of a physician;

(c) Provide storage for medications in a locked container, which ensures proper conditions of security and sanitation, and prevents accessibility to any unauthorized individual;

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016. October, 2016

Tenn. Comp. R. & Regs. 0465-02-16-.06 DAY ACTIVITIES

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-16-.07 ASSESSMENTS

(1) The following assessments of the person supported must be completed prior to the development of an ISP:

(a) An assessment of current capabilities in such areas as adaptive behavior and independent living skills;

(b) A basic medical history, information, and determination of the necessity of a medical evaluation, and a copy, where applicable, of the results of the medical evaluation of the person supported; and (c) A six (6) month history of prescribed medications, frequently used over-the-counter medications, alcohol, and/or other drugs.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-16-.08 INDIVIDUAL SUPPORT PLAN (ISP) TEAM

(a) The person supported;

(b) The legal representative (conservator, parent, guardian, or legal custodian) of the person supported, if applicable, unless their inability or unwillingness to attend is documented;

(d) Relevant professionals or individuals, unless their inability to attend is documented;

(e) Friends, advocates and other non-paid supports, if applicable; and (f) The Independent Support Coordinator/Case Manager.

October, 2016

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-16-.09 INDIVIDUAL SUPPORT PLAN (ISP) DEVELOPMENT AND IMPLEMENTATION

(1) The governing body must ensure that a written ISP is provided and implemented for each person supported. The ISP must meet the following:

(a) Developed within thirty (30) days of the admission of the person supported;

(b) Developed by the ISP team of the person supported;

(d) Includes signatures of the person supported, appropriate staff, and, if applicable, the legal representative (conservator, parent, guardian, or legal custodian) of the person supported;

(e) Specifies the needs identified by assessment of the person supported and addresses those needs within the particular service/program component;

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-16-.10 INDIVIDUAL SUPPORT PLAN (ISP) MONITORING AND REVIEW

(1) Written progress notes must be maintained, which include monthly documentation of progress or changes occurring within the ISP.

(2) The ISP team must review the ISP annually and revise, as necessary.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-16-.11 ADMISSIONS

(1) The governing body must ensure that all persons supported in semi-independent living services meet the following criteria:

(a) Capable of self-preservation;

(b) Able to care for basic self-help and minor health care needs without assistance;

October, 2016 (c) Able to care for personal possessions and to maintain personal living area in a state of orderliness and cleanliness to the extent it does not constitute a health hazard;

(d) Able to travel independently or secure assistance in traveling to work, training, community activities, or to generic services;

(e) Able to recognize danger or threat to personal safety;

(f) Able to plan and cook simple meals; and (g) Able to secure assistance in crisis situations by such means as the telephone or contacting neighbors or staff.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-16-.12 SUPPORTIVE SERVICES

(1) The governing body must ensure that the following support services are provided for each person supported:

(a) Transportation or assistance with transportation for non-routine events, special appointments, or long distance travel;

(b) Liaison for making appointments and obtaining consultation with professional services;

(c) Maintenance of a current list of the names and telephone numbers, within each dwelling of the person supported, for emergency services and the Direct Support Staff available and on-call;

(e) Monitoring of food and nutrition to ensure that the person supported is able to plan, shop for, store, and prepare appropriate food and meals;

(f) Counseling, training, and other assistance in procuring and taking prescription and non-prescription drugs;

(g) Aid in the development of homemaking, money management, and socialization skills;

(h) Counseling/Assistance in the use and protection of money; and (i) Assistance in applying for financial benefits for which the person supported may be eligible.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016. October, 2016

Tenn. Comp. R. & Regs. 0465-02-16-.13 USE OF RESTRICTIVE BEHAVIOR MANAGEMENT

(1) No procedures shall be used for behavior management which results in physical or emotional harm to the person supported.

(2) Corporal punishment, seclusion, aversive stimuli, chemical restraint, and denial of a nutritionally adequate diet shall not be used.

part of the ISP.

(7) Behavior management medications may be used only when authorized in writing by a physician for a specific period of time.

(10) Physical restraint/physical holding may be used only until the person supported is calm.

(11) A person supported who is placed in time-out must be released after a period of not more than sixty (60) minutes.

(12) The ability of a person supported to exit from time-out must not be prevented by means of keyed or other locks, and locations used for time-out must allow for the immediate entry of staff.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Chapter 0465-02-17 Minimum Program Requirements for Intellectual and Developmental Disabilities Personal Support Services Agencies

Tenn. Comp. R. & Regs. 0465-02-17-.01 SCOPE

(1) These rules apply to all agencies or personal support services coordinator who provide personal support services in the permanent or temporary residence of persons supported who meet the criteria specified in Rule 0465-02-01(47).

(2) The following are exempt from licensure under this chapter:

(a) An individual who provides personal support services to only one (1) person supported and who is not in a business arrangement to provide personal support services to any other person supported. This exception shall not apply to an individual who holds themselves out to the public as being in the business of personal support services for compensation;

(b) An individual who provides personal support services only to members of the individual’s own family;

(c) An individual who provides only housekeeping services to a person supported and no other assistance with major life activities;

(d) An individual who provides only transportation services and no other assistance with major life activities;

(e) An individual who provides services in homeless shelters;

(f) An individual who provides only delivery services, such as dry-cleaning, food, medication delivery, or medical equipment; and (g) Home care organizations licensed under T.C.A., Title 68, Chapter 11, Part 2 as a home care organization.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016. October, 2016

Tenn. Comp. R. & Regs. 0465-02-17-.02 APPLICATION FOR LICENSURE

(1) To provide personal support services, an agency needs a license from either the Department of Mental Health and Substance Abuse Services or the Department of Intellectual and Developmental Disabilities.

(2) An agency licensed by either Department listed in Rule 0465-02-17-.02(1) may provide personal support services to individuals with physical or other disabilities.

(3) An agency seeking an initial license as a personal support service agency must submit a written attestation at the time of application acknowledging the categorization of the majority of its client population base, as described in (a) and (b) below. The written attestation shall be on a form developed by the department to whom application for a license is made.

(a) An agency with 50% or more of its client base being aged and/or having a diagnosis of mental illness and/or substance abuse should obtain a license from the Department of Mental Health and Substance Abuse Services.

(b) An agency with 50% or more of its client base having a diagnosis of developmental disability or intellectual disability should obtain a license from the Department of Intellectual and Developmental Disabilities.

(4) After January 1, 2016, any agency seeking renewal of a personal support services license need only make application with the department that licenses 50% or more of its client base, as described in sections (3)(a) and (b) above. The renewing agency shall submit with the renewal application a written attestation acknowledging the categorization of the majority of its client population base.

(5) No license shall be issued until the appropriate fee or fees are submitted by the agency seeking an initial or renewal license, as set forth in Rule 0465-02-02-.05 Licensure Administration and Procedures, Fees. All fees submitted are non-refundable.

(6) The agency should submit to the licensing department a list of the counties in which they provide services and the address at which the agency maintains its employee and service recipient records.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-17-.03 GOVERNANCE

(1) The licensee shall comply with all federal, state, and local laws, ordinances, rules, and regulations.

(2) The licensee shall ensure that the agency is administered and operated in accordance with written policies and procedures including, but not limited to, those specified in Rule 0465-02- 17-.04.

(3) The licensee shall exercise general direction over the agency and establish policies governing the operation of the agency and the welfare of the person supported.

(4) The licensee shall designate an individual responsible for the operation of the agency.

October, 2016 (5) The licensee shall ensure that the licensed agency supports only persons supported who will not cause the agency to violate its licensed status based on the distinct licensure category.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-17-.04 PERSONNEL AND STAFFING

(1) The governing body must ensure that appropriate support and assistance are provided in accordance with the needs of persons supported.

(2) Employees shall be screened or tested for tuberculosis according to the procedures of the Tennessee Department of Health. Documentation of such screening or testing shall be maintained in the employee's personnel file.

(3) Support staff must be provided with a basic orientation in the proper management of seizures for persons supported prior to being assigned to work.

(4) The governing body must ensure that support staff are trained in First Aid and Cardiopulmonary Resuscitation (CPR).

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-17-.05 PERSON SUPPORTED RECORDS

(1) The governing body must ensure that each record of the person supported contains the following:

(a) A recent photograph and identifying information of the person supported;

(b) The social security number of the person supported;

(c) The legal competency status of the person supported, including the name of his/her legal representative (conservator, parent, guardian, or legal custodian), if applicable;

(d) The sources of financial support of the person supported, including social security, veterans benefits, and insurance;

(e) The sources of coverage for medical care of the person supported;

(f) The name, address, and telephone number of the physician or healthcare agency providing medical services for the person supported;

(g) Report of medical problems, accidents, seizures, and illnesses of the person supported, and treatments for such medical problems, accidents, seizures, and illnesses as they occur;

(h) Report of significant behavior incidents of the person supported, and of actions taken;

(i) Report of restrictive behavior-management techniques used on the person supported; and October, 2016 (j) Written accounts of all monies received and disbursed on behalf of the person supported.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-17-.06 MEDICATION ADMINISTRATION

(1) When medications are administered by certified staff to persons supported the licensee must:

(a) Consider the ability and training of the person supported, when supervising the selfadministration of medication;

(b) Ensure that prescription medications are taken only by the person supported for whom they are prescribed, and in accordance with the directions of a physician;

(c) Provide storage for medications in a locked container, which ensures proper conditions of security and sanitation, and prevents accessibility to any unauthorized individual;

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-17-.07 ASSESSMENTS

(1) The following assessments of the person supported must be completed prior to the development of an ISP:

(a) An assessment of current abilities and preferences; and (b) A review of relevant medical, medication, and health information.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-17-.08 INDIVIDUAL SUPPORT PLAN (ISP) TEAM

(a) The person supported;

October, 2016 (b) The legal representative (conservator, parent, guardian, or legal custodian) of the person supported, if applicable, unless their inability or unwillingness to attend is documented;

(d) Relevant professionals or individuals, unless their inability to attend is documented;

(e) Friends, advocates and other non-paid supports, if applicable; and (f) The Independent Support Coordinator/Case Manager.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-17-.09 INDIVIDUAL SUPPORT PLAN (ISP) DEVELOPMENT AND IMPLEMENTATION

(1) The licensee must ensure that a written ISP is provided and implemented for each person supported. The ISP must meet the following requirements:

(a) Developed within thirty (30) days of the admission of the person supported;

(b) Developed by the ISP team of the person supported;

(d) Includes signatures of the person supported, appropriate staff, and, if applicable, the legal representative (conservator, parent, guardian, or legal custodian) of the person supported;

(e) Specifies the needs identified by assessment of the person supported and addresses those needs within the particular service/program component;

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-17-.10 INDIVIDUAL SUPPORT PLAN (ISP) MONITORING AND REVIEW

(1) Written progress notes must be maintained, which include at least quarterly reviews of progress or changes occurring in the ISP.

(2) Changes relative to health, safety, and implementation of outcome based services must be assessed on an ongoing basis and reflected within the quarterly reviews.

(3) The ISP team must review the ISP annually and revise, as necessary.

October, 2016

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-17-.11 USE OF RESTRICTIVE BEHAVIOR MANAGEMENT

(1) No procedures shall be used for behavior management which results in physical or emotional harm to the person supported.

(2) Corporal punishment, seclusion, aversive stimuli, chemical restraint, and denial of a nutritionally adequate diet shall not be used.

part of the ISP.

(7) Behavior management medications may be used only when authorized in writing by a physician for a specific period of time.

(10) Physical restraint/physical holding may be used only until the person supported is calm.

(11) A person supported who is placed in time-out must be released after a period of not more than sixty (60) minutes.

(12) The ability of a person supported to exit from time-out must not be prevented by means of keyed or other locks, and locations used for time-out must allow for the immediate entry of staff.

October, 2016

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Chapter 0465-02-18 Minimum Program Requirements for Intellectual and Developmental Disabilities Supported Living Services

Tenn. Comp. R. & Regs. 0465-02-18-.01 POLICIES AND PROCEDURES

(1) The governing body of the entity providing support and assistance must maintain policies and procedures for control of infectious and communicable diseases.

(2) The governing body of the entity providing support and assistance must maintain policies and procedures establishing minimum requirements ensuring reasonable safety to life in the event of fire for all dwellings in which persons supported reside. These policies and procedures must require:

(a) Fire safety features of smoke detection, fire extinguishers, and two (2) alternative means of escape in each dwelling; and (b) Training for support staff and persons supported in the proper evacuation from the home and the use of fire safety features.

(3) The governing body must maintain policies and procedures establishing standards ensuring environmental quality in the home of each person supported.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-18-.02 PERSONNEL AND STAFFING

(1) The governing body must ensure that appropriate support and assistance are provided in accordance with the needs of persons supported living in the home.

(2) Support staff must be available on call to persons supported living in the home on a twentyfour (24) hour per day basis.

October, 2016 (4) Support staff must be provided with a basic orientation in the proper management of seizures for persons supported prior to being assigned to work.

(5) The governing body must ensure that support staff are trained in First Aid and Cardiopulmonary Resuscitation (CPR).

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-18-.03 PERSON SUPPORTED RECORDS

(1) The governing body must ensure that each record of the person supported contains the following:

(a) A recent photograph and identifying information of the person supported;

(b) The social security number of the person supported;

(c) The legal competency status of the person supported, including the name of his/her legal representative (conservator, parent, guardian, or legal custodian), if applicable;

(d) The sources of financial support of the person supported, including social security, veterans benefits, and insurance;

(e) The sources of coverage for medical care of the person supported;

(f) The name, address, and telephone number of the physician or healthcare agency providing medical services for the person supported;

(g) Report of medical problems, accidents, seizures, and illnesses of the person supported, and treatments for such medical problems, accidents, seizures, and illnesses as they occur;

(h) Report of significant behavior incidents of the person supported, and of actions taken;

(i) Report of restrictive behavior-management techniques used on the person supported; and (j) Written accounts of all monies received and disbursed on behalf of the person supported.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-18-.04 MEDICATION ADMINISTRATION

(1) When medications are administered by certified staff to persons supported the licensee must:

(a) Consider the ability and training of the person supported, when supervising the selfadministration of medication;

(b) Ensure that prescription medications are taken only by the person supported for whom they are prescribed, and in accordance with the directions of a physician;

October, 2016 (c) Provide storage for medications in a locked container, which ensures proper conditions of security and sanitation, and prevents accessibility to any unauthorized individual;

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-18-.05 DAY ACTIVITIES

(1) The governing body must ensure that daily activities are provided or procured in accordance with the age level, interests, and abilities of the person supported as specified in the ISP.

Such daily activities may include, but are not limited to, part-time and full-time employment, attendance at a day activity center, participation in a vocational rehabilitation program, senior citizens involvement, and regularly scheduled recreational activities.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-18-.06 ASSESSMENTS

(1) The following assessments of the person supported must be completed prior to the development of an ISP:

(a) An assessment of current abilities and preferences; and (b) A review of relevant medical, medication, and health information.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-18-.07 SUPPORTIVE SERVICES

(1) The governing body must ensure that the following support services are provided for each person supported:

(a) Transportation or assistance with transportation for non-routine events, special appointments, or long distance travel;

(b) Liaison for making appointments and obtaining consultation with professional services;

(c) Maintenance of a current list of names and telephone numbers for emergency services and the direct support staff within each dwelling;

October, 2016 (d) Assistance to each person supported in the utilization of professional, social, and community services, and assistance in the referral process and in making appointments for such services;

(e) Assistance to ensure that a nutritionally adequate diet is available to the person supported;

(f) Counseling, training, and other assistance in procuring and taking prescription and non-prescription drugs;

(g) Assistance in the use and protection of money of the person supported; and (h) Assistance in applying for financial benefits for which the person supported may be eligible.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-18-.08 PROFESSIONAL SERVICES

(1) The governing body must ensure that persons supported are assisted in locating qualified dental, medical, nursing, and pharmaceutical care, as needed, including care for emergencies.

(2) The governing body must ensure that each person supported receives an annual physical examination (unless less often is indicated by the physician of the person supported), which includes routine screenings (such as vision and hearing) and laboratory examinations (such as Pap smear and blood work) as determined necessary by the physician and special studies where the index of suspicion is high.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-18-.09 INDIVIDUAL SUPPORT PLAN (ISP) TEAM

(a) The person supported;

(b) The legal representative (conservator, parent, guardian, or legal custodian) of the person supported, if applicable, unless their inability or unwillingness to attend is documented;

(d) Relevant professionals or individuals, unless their inability to attend is documented;

(e) Friends, advocates and other non-paid supports, if applicable; and (f) The Independent Support Coordinator/Case Manager.

October, 2016

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-18-.10 INDIVIDUAL SUPPORT PLAN (ISP) DEVELOPMENT AND IMPLEMENTATION

(1) The licensee must ensure that a written ISP is provided and implemented for each person supported. The ISP must meet the following requirements:

(a) Developed within thirty (30) days of the admission of the person supported;

(b) Developed by the ISP team of the person supported;

(d) Includes signatures of the person supported, appropriate staff, and, if applicable, the legal representative (conservator, parent, guardian, or legal custodian) of the person supported;

(e) Specifies the needs identified by assessment of the person supported and addresses those needs within the particular service/program component;

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-18-.11 INDIVIDUAL SUPPORT PLAN (ISP) MONITORING AND REVIEW

(1) Written progress notes must be maintained, which include at least quarterly reviews of progress or changes occurring in the ISP.

(2) Changes relative to health, safety, and implementation of outcome based services must be assessed on an ongoing basis and reflected within the quarterly reviews.

(3) The ISP team must review the ISP annually and revise, as necessary.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-18-.12 USE OF RESTRICTIVE BEHAVIOR MANAGEMENT

(1) No procedures shall be used for behavior management which results in physical or emotional harm to the person supported.

(2) Corporal punishment, seclusion, aversive stimuli, chemical restraint, and denial of a nutritionally adequate diet shall not be used.

part of the ISP.

(7) Behavior management medications may be used only when authorized in writing by a physician for a specific period of time.

(10) Physical restraint/physical holding may be used only until the person supported is calm.

(11) A person supported who is placed in time-out must be released after a period of not more than sixty (60) minutes.

(12) The ability of a person supported to exit from time-out must not be prevented by means of keyed or other locks, and locations used for time-out must allow for the immediate entry of staff.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Chapter 0465-02-19 Minimum Program Requirements for Intellectual and Developmental Disabilities Support Coordination Agencies

Tenn. Comp. R. & Regs. 0465-02-19-.01 APPLICATION FEES

The applicant shall submit a fee or fees with the application to the Office of Licensure and Review of the Department. Each initial and renewal application for licensure shall be submitted with the appropriate fee or fees as set forth in Rule 0465-02-02-.05 Licensure Administration and Procedures, Fees. All fees submitted are non-refundable.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-19-.02 GOVERNANCE

(1) The licensee shall comply with all federal, state, and local laws, ordinances, rules, and regulations.

(2) The licensee shall ensure that the agency is administered and operated in accordance with written policies and procedures including, but not limited to, those specified in Rule 0465-02- 19-.03.

(3) The licensee shall exercise general direction over the agency and establish policies governing the operation of the agency and the welfare of person supported.

(4) The licensee shall designate an individual responsible for the operation of the agency.

(5) The licensee shall ensure that the licensed agency supports only persons supported who will not cause the agency to violate its licensed status based on the distinct licensure category.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-19-.03 POLICIES AND PROCEDURES

(1) The licensee shall maintain a written policies and procedures manual which includes:

(a) An organizational chart which clearly shows or describes the lines of authority;

(b) A policy and procedure which ensure the confidentiality of the information of the person supported, and which includes the following provisions:

October, 2016 1. The staff must comply with applicable confidentiality laws and regulations. (e.g., T.C.A. § 33-3-104) and the Health Insurance Portability and Accountability Act (HIPAA), found at 45 CFR, Part 160, Part 162, Part 164;

Persons supported shall not be required to make public statements which acknowledge gratitude to the licensee or for the licensee’s services;
Persons supported shall not be required to perform in public gatherings; and 4. Identifiable photographs of persons supported shall not be used without the written and signed consent of the person supported or his/her legal representative (conservator, parent, guardian, or legal custodian);

(c) Policy and procedures to be followed in the reporting and investigation of suspected or alleged abuse or neglect of persons supported, or other critical incidents. The procedures shall include provisions for corrective action, if any, to be taken as a result of such reporting and investigation, and reporting to the Office of Risk Management and Licensure of the Department and any authority as required by law;

(d) Policy and procedures to address caseload assignments and the maintenance of caseloads, including at times of a staff vacancy;

(e) Policy and procedures that ensure the staff receive effective guidance, mentoring, and training including all training required by the Department. Effective training must include opportunities to practice support coordination duties in a manner that promotes development and mastery of essential job skills.

(f) The licensee must ensure the person supported or his/her legal representative (conservator, parent, guardian, or legal custodian) is provided information and education regarding:

The types of services and programs available in the DIDD system;
Rights and responsibilities of persons supported;
Resolution processes including reporting abuse/neglect/exploitation, provider conflict resolution, DIDD and TennCare complaint resolution processes, and appeals processes.

(g) A policy ensuring that employees practice infection control procedures and standard precautions that will protect the person supported from infectious diseases; and (h) Requirements that each employee comply with procedures for detection, prevention, and reporting of communicable diseases according to procedures of the Tennessee Department of Health.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-19-.04 PROFESSIONAL SERVICES

(1) The licensee must ensure the support coordinator/case manager arranges and secures all services and supports as described in the ISP; the support coordinator/case manager provides information to potential and current providers, completes service authorization October, 2016 requests, assists with appeals and monitoring and follow-up to ensure that issues and problems are resolved so that the ISP can be implemented as written or amended as necessary.

(2) The assessment process/information gathering must be completed prior to the development of the ISP.

(3) Assessment information to be compiled by the independent support coordinator/case manager in preparation of the ISP for the Planning Meeting consists of the following:

(a) Information about the services a person supported is receiving through all resources, such as DIDD programs, Managed Care Organization, Medicare, or other organizations;

(b) Ideas and suggestions about what things the person supported can and cannot do, what things are important to the person supported, and what things are liked and disliked by the person supported;

(c) Uniform Assessments- Information about the capabilities and support needs of the person supported. Assists in identifying needed services and supports and the activities for which a person may need assistance;

(d) Risk Assessments;

(e) Clinical Assessments;

(f) Medical Assessments; and (g) Vocational Assessments and Desire for Employment.

(4) Assessments are to assist in identifying the strengths, interests and desired outcomes of the person supported, and aid in determining how to best meet those desired outcomes.

(5) The licensee must ensure that an ISP team known as the Circle of Support is identified and provided for each person supported. The team may include the following as determined by the person supported:

(a) The person supported, unless contraindicated by the ISP team;

(b) The legal representative (conservator, parent, guardian, or legal custodian) of the person supported, if applicable, unless their inability or unwillingness to attend is documented;

(d) Relevant professionals or individuals, unless their inability to attend is documented;

(e) Friends, advocates and other non-paid supports, if applicable, and (f) The Independent Support Coordinator/Case Manager.

(6) The licensee must ensure that a written ISP is provided and implemented for each person supported. The ISP must meet the following requirements:

October, 2016 (a) Developed within sixty (60) calendar days from the date of initial service provision as determined by TennCare.

(b) Developed by the ISP team of the person supported;

(d) Includes the signatures of the person supported or his/her legal representative (conservator, parent, guardian, or legal custodian), and the appropriate staff;

(e) Specifies the needs of the person supported, identified by assessments and to be addressed within the particular service/program component;

(f) Includes outcomes and action steps of the person supported, which are related to his/her specific needs and desires identified, and which are to be addressed by the particular service/program component; and (g) Includes methods or activities by which the outcomes and action steps of the person supported are to be implemented.

(7) The licensee must ensure that contacts with persons supported include:

(a) One (1) contact shall be completed each calendar month;

(b) One of the contacts each quarter must be face-to-face (pending CMS approval of 1915(c) HCBS waiver amendment, expected in January 2017);

(8) Monthly reviews shall be documented by the licensee. Information contained within the monthly review shall include: ISP implementation status, including progress in completing action steps and achieving outcomes; information gathered from the monthly contact, interviews with the person supported, his/her family members, conservators or guardians.

The monthly review shall also contain information from the quarterly progress notes submitted by the residential, day, or personal assistance providers of the person supported.

(9) The Annual ISP meeting must be held prior to the ISP expiration date. The effective date of a new plan can be no more than one (1) year from the effective date of the previous plan.

(10) The ISP must be amended when any of the following occur:

(a) The action steps and outcomes change;

(b) Services or service providers change;

(d) The person supported has made major changes to his/her preferred lifestyle.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016. October, 2016

Tenn. Comp. R. & Regs. 0465-02-19-.05 PERSONNEL AND STAFFING

(1) The licensee shall maintain a personnel file for each support coordinator with the following:

(a) A job description including the employment requirements and job responsibilities for each staff position held; and (b) Individuals employed as ISC’s must meet at least one (1) of the following educational and relevant experience requirements:

A Bachelor’s degree from an accredited college or university in a human services field;
A Bachelor’s degree from an accredited college or university in a non-related field, plus one (1) year of relevant experience;
An Associate degree, plus two (2) years of relevant experience;
A high school diploma or general educational development (GED) certificate, plus four (4) years of relevant experience;
Relevant experience is defined as experience in working directly with persons with intellectual disabilities, other developmental disabilities, or mental illness; or 6. Support Coordinators who do not have a Bachelor’s degree in a human services field must be supervised by someone who does meet that qualification.

(2) The licensee must ensure a staff member is available to people receiving services at all times, including evening, nights, weekends, and holidays when provider offices are generally closed.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-19-.06 PERSON SUPPORTED RECORDS

(1) The record of a person supported must contain the following:

(a) A Uniform Assessment;

(b) Reports from medical and other consultants (e.g. therapy consultation reports, specialty physician consult report, psychiatric consult report, etc.);

(d) Medicaid medical eligibility documentation (the PAE packet);

(e) Emergency contact information;

(f) A current photograph of the person supported;

October, 2016 (g) The current ISP;

(h) The current BSP, if applicable;

(i) The Individual Education Plan, if applicable;

(j) Support coordination monthly reviews;

(k) Correspondence, as applicable;

(l) Discharge summaries, if applicable;

(m) Plans of care or treatment for nursing, therapeutic, therapy-related, or dental services; and (n) Health Care Surrogates, POA, Guardianships (for minors if applicable), Supported Decision Maker forms, and Orders of Conservatorship.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Chapter 0465-02-20 Minimum Program Requirements for Developmental Disabilities Preschool Facilities/Services

Tenn. Comp. R. & Regs. 0465-02-20-.01 POLICIES AND PROCEDURES

The licensee must ensure that the written policies and procedures manual include procedures for tuberculosis control and reporting of infectious and communicable diseases to the Tennessee Department of Health.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-20-.02 PROFESSIONAL SERVICES

(1) The licensee must provide or procure assistance for the child supported in locating qualified dental, medical, nursing and pharmaceutical care including care for emergencies during hours of the facility’s operation.

(2) The licensee must ensure that an annual physical examination is provided or procured for each child supported (unless less often is indicated by the physician of the child supported).

Such examinations should include routine screenings (such as vision and hearing) and laboratory examinations (such as blood work), as deemed necessary by the physician and special studies where the index of suspicion is high.

(3) The licensee must require each child supported to show proof of current immunization status within thirty (30) days after admission.

(4) The licensee must require that each child supported receives immunizations as required by the Tennessee Department of Health unless contraindicated by a doctor’s written order.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-20-.03 PERSONNEL AND STAFFING

(1) The licensee must provide one (1) direct support staff member for every six (6) children present unless a more stringent staffing ratio is required by applicable life safety rules.

October, 2016 (2) The licensee must ensure that employees practice infection control procedures that will protect the child supported from infectious diseases.

(3) Employees must have a regular tuberculosis skin test or screening within thirty (30) days of employment and as required thereafter by current Tennessee Department of Health guidelines.

(4) Employees must be provided with a basic orientation in the proper management of seizure disorders prior to being assigned to work with children with such disorders.

(5) A staff member must be on duty in the facility who is trained in First Aid and Infant/Child Cardiopulmonary Resuscitation (CPR).

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-20-.04 CHILD SUPPORTED RECORDS

(1) The record of each child supported must contain the following information:

(a) A recent photograph and a description of the child supported;

(b) The social security number of the child supported;

(d) The sources of financial support of the child supported, including social security, veteran’s benefits and insurance;

(e) The sources of coverage for medical care costs of the child supported;

(f) The name, address and telephone number of the physician or healthcare agency providing medical services of the child supported;

(g) Documentation of all drugs prescribed or administered by the licensee to the child supported, which indicates date prescribed, type, dosage, frequency, amount and reason;

(h) A discharge summary of the child supported, which states the date of discharge, reasons for discharge and referral for other services, if appropriate;

(i) Report of medical problems, accidents, seizures and illnesses; and treatments for such medical problems, accidents, seizures and illnesses of the child supported;

(j) Report of significant behavior incidents and of actions taken for the child supported; and (k) Report of the use of restrictive behavior management techniques for the child supported.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016. October, 2016

Tenn. Comp. R. & Regs. 0465-02-20-.05 RECREATIONAL ACTIVITIES

The licensee must ensure that opportunities are provided for recreational activities, which are appropriate and adapted to the needs, interests, and age of the child supported.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-20-.06 CHILD SUPPORTED ASSESSMENTS

(1) The following assessments of the child supported must be completed prior to the development of an IFSP:

(a) An assessment of current capabilities in such areas as adaptive behavior;

(b) A basic medical history, information, and determination of the necessity of a medical evaluation, and a copy, where applicable, of the result of the medical evaluation;

(c) A six (6) month history of prescribed medications and/or frequently used over-thecounter medications; and (d) An existing developmental assessment on file which is updated as recommended by the IFSP team.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-20-.07 INDIVIDUAL SUPPORT PLAN (IFSP) TEAM

(1) The licensee must ensure that an IFSP team is identified and provided for each child supported. The team may the following:

(a) The parent or guardian of the child supported, if appropriate, unless their inability or unwillingness to participate is documented;

(b) Direct support staff, as appropriate;

(d) An intellectual and developmental disabilities specialist; and (e) Other person(s) invited by the legal representative (conservator, parent, guardian, or legal custodian) of the child supported.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016. October, 2016

Tenn. Comp. R. & Regs. 0465-02-20-.08 INDIVIDUAL FAMILY SUPPORT PLAN (IFSP) DEVELOPMENT AND

IMPLEMENTATION.

(1) The licensee must ensure that a written IFSP is implemented for each child supported. If the IFSP is not provided by TEIS (Tennessee Early Intervention System), then the licensee must develop an IFSP, which meets the following requirements:

(a) Developed within forty-five (45) days of the admission of the child supported to the facility;

(b) Developed by the IFSP team of the child supported;

(d) Includes the signatures of the legal representative (conservator, parent, guardian, or legal custodian) of the child supported and the appropriate staff;

(e) Specifies the needs identified by assessment of the child supported and addresses those needs within the particular service/program component;

(f) Includes personal goals and objectives of the child supported, which are related to the specific needs identified, and specifies which goals and objectives are to be addressed by a particular service/program component; and (g) Includes methods or activities by which the goals and objectives of the child supported are to be implemented.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-20-.09 INDIVIDUAL SUPPORT PLAN (IFSP) MONITORING AND REVIEW

(1) Written progress notes must be maintained, which include monthly documentation of progress or changes occurring within the IFSP.

(2) The IFSP team must review the IFSP annually and revise, as necessary.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Tenn. Comp. R. & Regs. 0465-02-20-.10 USE OF RESTRICTIVE BEHAVIOR MANAGEMENT

(1) When a parent or legal guardian is present licensee staff shall not implement restrictive behavior management. In the absence of a parent or legal guardian advanced written permission must be on file before licensee staff implement any of the below:

(a) No procedures should be used for behavior management which results in physical or emotional harm to the child supported;

(b) Corporal punishment, seclusion, aversive stimuli, chemical restraint, and denial of a nutritionally adequate diet must not be used;

October, 2016 (c) Restraint (physical holding, mechanical restraint), medications for behavior management, time-out rooms, or other techniques with similar degrees of restriction or intrusion must not be employed except as an integral part of his/her IFSP;

(d) Restrictive or intrusive behavior management procedures must not be used until after less restrictive alternatives for dealing with the problem behavior have been systematically tried or considered and have been determined to be inappropriate or ineffective;

(e) Prior to the implementation of a written program incorporating the use of a highly restrictive or intrusive technique, the program must be reviewed and approved by the child supported or his/her legal representative (conservator, parent, guardian, or legal custodian), with documentation of such approval. A Human Rights Committee must also review and approve the written program;

(f) When procedures such as physical holding, mechanical restraint, and time-out are used in emergency situations to prevent the person supported from inflicting bodily harm, more than three (3) times within six (6) months, a behavioral assessment shall be conducted by an appropriate professional. Recommendations shall be incorporated into a written plan that is part of the IFSP;

(g) Behavior management medications may be used only when authorized in writing by a physician for a specific period of time;

(h) The program plan for the use of a mechanical restraint must specify the extent and frequency of the monitoring schedule according to the type and design of the device and the condition of the child supported;

(i) A child supported who is placed in a mechanical restraint must be released for a minimum of ten (10) minutes at least every two (2) hours and provided with an opportunity for freedom of movement, exercise, liquid intake/refreshment, nourishment, and use of the bathroom;

(j) Physical restraint/physical holding may be used only until the child supported is calm;

(k) A child supported who is placed in time-out must be released after a period of not more than sixty (60) minutes; or (l) The ability of the child supported to exit from time-out must not be prevented by means of keyed or other locks, and locations used for time-out must allow for the immediate entry of staff.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-201, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33- 2-302, 33-2-404, 33-2-407.
Administrative History: New rules filed July 6, 2016; effective October 4, 2016.

Chapter 0465-02-21 Minimum Program Requirements for Tier 1-Homes for the Aged

Tenn. Comp. R. & Regs. 0465-02-21-.01 LICENSING PROCEDURES

(1) No person, partnership, association, corporation, or state, county or local government unit, or any division, department, board or agency thereof, shall establish, conduct, operate, or maintain in the State of Tennessee any Tier 1 Home for the Aged, as defined in T.C.A. § 68- 11-201 and Chapter 0465-02-01, without having a license. A license shall be issued only to the applicant named and only for the premises listed in the application for licensure. Licenses are not transferable or assignable and shall expire and become invalid annually on the anniversary date of their original issuance. The license shall be conspicuously posted in the Home for the Aged.

(2) In order to make application for a license:

(a) The applicant shall submit an application on a form prepared by the department.

(b) Each applicant for a license shall pay an annual license fee in accordance with Rule

Tenn. Comp. R. & Regs. 0465-02-21-.02 POLICIES AND PROCEDURES

(1) The Tier 1 Home for the Aged must maintain written policies and procedures in a manual. The manual must include the following:

(a) Procedures for infection control, including as provided in subsections (1) and (2) and as required by federal law:

Employees shall be screened or tested for tuberculosis according to the procedures of the Tennessee Department of Health. Documentation of such screening or testing shall be maintained in the employee’s personnel file.
No employee who has a reportable communicable disease is permitted to reside or work in a Home for the Aged unless the Home for the Aged has a written protocol approved by the Department of Disability and Aging.

(b) Requirements for ensuring safety in the event of fire as referenced in Chapter 0465-02- 04. These policies and procedures minimally must ensure:

Fire safety features of smoke detectors, fire extinguishers and two (2) alternate means of escape from sleeping rooms in the home; and 2. Training for all staff in developing and implementing evacuation procedures within the home.

Tenn. Comp. R. & Regs. 0465-02-21-.03 PROFESSIONAL SERVICES

(1) The licensee must provide or procure assistance for residents in the home in locating qualified dental, medical, nursing and pharmaceutical care including care for emergencies, to the extent desired by the person.

(2) The licensee must ensure that an annual physical examination is provided or procured for each resident, to the extent desired by the person. Such examinations should include routine screenings (such as vision and hearing) and laboratory examinations (such as Pap smear and blood work) as determined necessary by the physician and special studies where the index of suspicion is high.

(3) The licensee must ensure that an annual dental screening is provided or procured for each resident to the extent desired by the person.

(4) The licensee must ensure that each resident is assisted in procuring immunizations as required by the Tennessee Department of Health unless contraindicated by a physician’s order or to the extent desired by the person.

History

Authority: T.C.A. §§ 4-4-103, 52-1-104, 52-1-105, 52-1-107, 52-2-301, 52-2-302, 52-2-403, 52-2-404, 52- 2-406, 52-2-407, and 68-11-201.
Administrative History: Emergency rules filed August 22, 2025; effective through February 18, 2026. New rules filed November 18, 2025; effective February 16, 2026.

Tenn. Comp. R. & Regs. 0465-02-21-.04 PERSONNEL AND STAFFING

(1) Each Home for the Aged shall:

(a) Have an identified responsible attendant and a sufficient number of employees to meet the needs of the residents. The responsible attendant must be at least eighteen (18) years of age and able to comply with these rules;

(b) Maintain documentation of the background and registry checks described in 0465-02- 06-.04 and as required by T.C.A. § 52-2-1002 prior to hiring any employee;

(d) A personnel record must be maintained which verifies that each employee meets the respective employment requirements for the staff position held, in accordance with 0465- 02-06-.04; and (e) Training and development activities, which are appropriate in assisting the staff in meeting the needs of the residents, must be provided for each staff member. The provision of such activities must be evidenced by documentation in the personnel records.

History

Authority: T.C.A. §§ 4-4-103, 52-1-104, 52-1-105, 52-1-107, 52-2-301, 52-2-302, 52-2-403, 52-2-404, 52- 2-406, 52-2-407, and 68-11-201.
Administrative History: Emergency rules filed August 22, 2025; effective through February 18, 2026. New rules filed November 18, 2025; effective February 16, 2026.

Tenn. Comp. R. & Regs. 0465-02-21-.05 RESIDENT RIGHTS

Each resident has at least the following rights:

(1) To privacy in treatment and personal care;

(2) To be free from mental and physical abuse. Should this right be violated, the facility must notify the Office of Licensure within five (5) working days of each instance. The Tennessee Department of Human Services, Adult Protective Services shall be notified immediately;

(3) To refuse treatments as outlined in Rule 0465-02-21-.03. The resident must be informed of the consequences of that decision, and the refusal and its reason must be reported to the physician and documented in the resident’s record;

(4) To have his or her file kept confidential and private. Written consent by the resident must be obtained prior to release of information except to persons authorized by law;

(5) To be fully informed of the Resident’s Rights, of any policies and procedures governing resident conduct, any services available in the home, and the schedule of all fees for all services;

(6) To participate in drawing up the terms of the admission agreement, including providing for the resident’s preferences for physician care, hospitalization, assisted living facility care, nursing home care, acquisition of medication, emergency plans and funeral arrangements;

(7) To be given thirty (30) days written notice prior to transfer or discharge, except when ordered by any physician because a higher level of care is required;

(8) To voice grievances and recommend changes in policies and services of the home with freedom from restraint, interference, coercion, discrimination or reprisal. The residents shall be informed of procedures for registering complaints confidentially and to voice grievances;

(9) To manage his or her personal financial affairs, including the right to keep and spend his or her own money. If the resident requests assistance from the home in managing his or her personal financial affairs, the request may be verbal or in writing and may be terminated by the resident at any time. If the resident makes a verbal request the request must be documented in writing and signed by the resident or signed by two (2) witnesses. The home must separate such monies from the home’s operating funds and all other deposits or expenditures, submit a written accounting to the resident at least quarterly, and immediately return the balance upon transfer or discharge. A current copy of this report shall be maintained in the resident’s file maintained by the licensee;

(10) To have free access to day rooms, dining and other group living or common and to come and go from the home, unless such access infringes upon the rights of other residents;

(11) To be treated with consideration, respect and full recognition of his or her dignity and individuality;

(12) To be accorded privacy for sleeping and for storage space for personal belongings;

(13) To wear his or her own clothes, to keep and use his or her own toilet articles and personal possessions;

(14) To send and receive unopened mail;

(15) To associate and communicate privately with persons of his or her choice, including receiving visitors at any time unless such access infringes upon the rights of other residents; and, (16) To participate or to refuse to participate in community activities, including cultural, educational, religious, community services, vocational and recreational activities.

History

Authority: T.C.A. §§ 4-4-103, 52-1-104, 52-1-105, 52-1-107, 52-2-301, 52-2-302, 52-2-403, 52-2-404, 52- 2-406, 52-2-407, and 68-11-201.
Administrative History: Emergency rules filed August 22, 2025; effective through February 18, 2026. New rules filed November 18, 2025; effective February 16, 2026.

Tenn. Comp. R. & Regs. 0465-02-21-.06 RESIDENT RECORDS

(1) An individual resident file shall be maintained for each resident in the home. Personal information, as defined in T.C.A. § 71-4-812(b), shall be confidential and shall not be disclosed, except by a court order or subpoena, to the resident, or to the department and others with written authorization from the resident. These files shall be retained for one (1) year after the resident is transferred or discharged. The resident file shall include:

(a) Name, Social Security Number, veteran status and number, marital status, age, sex, previous address and any health insurance provider and number, including Medicare and Medicaid numbers;

(b) Name, address and telephone number of next of kin, legal guardian and any other person identified by the resident to contact on his/her behalf;

(d) Date of admission, transfer, discharge and any new forwarding address;

(e) Name and address of the resident’s preferred physician, hospital, pharmacist, assisted care living facility and nursing home, and any other instructions from the resident to be followed in case of emergency;

(f) Record any personal property of the resident valued at over $50, with appropriate updates;

(g) Health information including all current prescriptions, major changes in resident’s habits or health status, results of physician’s visits, and any health care instructions; and (h) A copy of the admission agreement signed and dated by the resident.

History

Authority: T.C.A. §§ 4-4-103, 52-1-104, 52-1-105, 52-1-107, 52-2-301, 52-2-302, 52-2-403, 52-2-404, 52- 2-406, 52-2-407, and 68-11-201.
Administrative History: Emergency rules filed August 22, 2025; effective through February 18, 2026. New rules filed November 18, 2025; effective February 16, 2026.

Tenn. Comp. R. & Regs. 0465-02-21-.07 CLOTHING FOR RESIDENTS

(1) The licensee must assist each resident with the least restrictive level of support and assistance needed in the selection and purchase of clothing.

(2) Each resident must be allowed to dress him/herself in his/her own clothes and to change clothes at appropriate times according to his/her abilities.

(3) The licensee must assist each resident in securing an adequate allowance of personally owned, individualized, clean, and seasonal clothes.

(4) Any marking of clothing belonging to the resident for identification purposes must be done in an inconspicuous manner.

History

Authority: T.C.A. §§ 4-4-103, 52-1-104, 52-1-105, 52-1-107, 52-2-301, 52-2-302, 52-2-403, 52-2-404, 52- 2-406, 52-2-407, and 68-11-201.
Administrative History: Emergency rules filed August 22, 2025; effective through February 18, 2026. New rules filed November 18, 2025; effective February 16, 2026.

Tenn. Comp. R. & Regs. 0465-02-21-.08 PERSONAL SERVICES

(1) Personal services must include protective care of the resident, responsibility for the safety of the resident when in the facility and the ability and readiness to intervene if crises arise.

Personal services do not include nursing or medical care. Personal services must be provided by employees of the home.

(2) Assistance in reading labels, opening bottles, reminding residents of their medication, observing the resident while taking medication and checking the self-administered dose against the dosage shown on the prescription are permissible in the self-administration of medications.

(3) All medications shall be stored so that no resident can obtain another resident’s medication.

(4) Each Tier 1 Home for the Aged shall provide access to laundry arrangements for linens for the home and for residents’ clothing.

(5) Residents shall have free access to the kitchen area and at least three (3) meals per day.

(6) Assigned storage space for each resident to store their foods and ingredients for both perishable and non-perishable foods.

(7) Sufficient food provision capabilities and dining space shall be provided.

(8) Appropriate equipment and utensils for cooking and serving food shall be provided in sufficient quantity to serve all residents and must be in good repair.

(9) The kitchen shall be maintained in a clean and sanitary condition.

(10) The home must have a telephone accessible to all residents, which is capable of meeting the needs of the resident, to make and receive personal telephone calls twenty-four (24) hours per day.

(11) Should the licensee admit a resident who has loss of hearing, the licensee must ensure that when the sounding of the standard fire alarm is not sufficient to notify a sleeping person who has hearing loss of the need to evacuate, the licensee must then provide a means of such notification which:

(a) Is independent of personal, physical contact, or notification by staff or other persons during sleep;

(b) Provides some mechanical means of sensory notification during sleep; and (c) Is consistent in notifying the resident of the need to evacuate.

History

Authority: T.C.A. §§ 4-4-103, 52-1-104, 52-1-105, 52-1-107, 52-2-301, 52-2-302, 52-2-403, 52-2-404, 52- 2-406, 52-2-407, and 68-11-201.
Administrative History: Emergency rules filed August 22, 2025; effective through February 18, 2026. New rules filed November 18, 2025; effective February 16, 2026.

Tenn. Comp. R. & Regs. 0465-02-02-.05 for a residential site of three (3) or fewer beds.

(c) The issuance of an application form is in no way a guarantee that the completed application will be accepted or that a license will be issued by the department. Residents shall not be admitted to the home until a license has been issued. Applicants shall not hold themselves out to the public as being a Home for the Aged until the license has been issued. A license shall not be issued until the facility is in substantial compliance with these rules.

(d) The applicant must prove the ability to meet the financial needs of the facility.

(e) The applicant shall not use subterfuge or other evasive means to obtain a license, such as filing for a license through a second party when an individual has been denied a license or has had a license disciplined or has attempted to avoid inspection and review process.

(f) The applicant shall allow the residential Home for the Aged to be inspected by a Department of Disability and Aging Licensure surveyor. In the event that deficiencies are noted, the applicant shall submit a plan of corrective action to the Office of Licensure that must be accepted by the Office of Licensure. Once the deficiencies have been corrected, then the department shall consider the application for licensure.

(3) Renewal.

(a) In order to renew a license, each residential Home for the Aged shall submit to periodic inspections by Department of Disability and Aging Licensure surveyors for compliance with these rules. If deficiencies are noted, the licensee shall submit an acceptable plan of corrective action and shall remedy the deficiencies. In addition, each licensee shall submit a renewal form approved by the Office of Licensure and applicable renewal fee prior to the expiration date of the license.

(b) If a licensee fails to renew its license prior to the date of its expiration but submits the renewal form and fee within sixty (60) days thereafter, the licensee may renew late by paying, in addition to the renewal fee, a late penalty of one hundred dollars ($100) per month for each month or fraction of a month that renewal is late; provided that the late penalty shall not exceed twice the renewal fee.

(c) In the event that a licensee fails to renew its license within the sixty (60) day grace period following the license expiration date, then the licensee shall reapply for a license by submitting the following to the Office of Licensure:

A completed application for licensure; and 2. The license fee provided in Rule 0465-02-02-05.

(d) Upon reapplication, the licensee shall submit to an inspection of the facility by Department of Disability and Aging Licensure surveyors.

(4) A license shall be issued only for the location designated and the licensee named in the application. If a Tier 1 Home for the Aged moves to a location not noted on the currently operating license, a new license will be required before residents are admitted. A licensee who plans to relocate must contact the department to inspect the new building prior to relocation.

(5) The governing body must ensure that no more than three (3), unrelated residents are residing in an individual home at any given time. Each resident must be aged 55 or older. Any admission in excess of the licensed bed capacity is prohibited.

(6) A separate license shall be required for each Home for the Aged when more than one home is operated under the same management or ownership.

History

Authority: T.C.A. §§ 4-4-103, 52-1-104, 52-1-105, 52-1-107, 52-2-301, 52-2-302, 52-2-403, 52-2-404, 52- 2-406, 52-2-407, and 68-11-201.
Administrative History: Emergency rules filed August 22, 2025; effective through February 18, 2026. New rules filed November 18, 2025; effective February 16, 2026.

Tenn. Comp. R. & Regs. 0465-02-05-.02 and 0465-02-05-.03.

(d) Information for the resident related to his/her rights and how to register grievances and complaints.

(e) A written statement of policies and procedures outlining the responsibilities of the licensee to the resident and any obligation of the resident to the facility.

(f) A written statement prohibiting an owner, responsible attendant, employee or representative thereof to act as a court-appointed guardian, trustee, or conservator for any resident of the home or any of such resident’s property or funds.

(g) A policy that the licensee cooperate in the department’s inspections, including allowing entry at any hour and providing all required records.

(h) A policy prohibiting retaliation against or, in any manner, discrimination against any person because of a complaint made to the department, Adult Protective Services, the Comptroller of the State Treasury, the Long Term Care Ombudsman Program, or any other local, state, or federal government entity. A home shall neither retaliate nor discriminate because of information lawfully provided to these authorities, because of a person’s cooperation with them or because a person is subpoenaed to testify at a hearing involving one of these authorities.

(i) A policy requiring the licensee comply with all local laws, rules or ordinances, and with this chapter and all other applicable Office of Licensure chapters.

History

Authority: T.C.A. §§ 4-4-103, 52-1-104, 52-1-105, 52-1-107, 52-2-301, 52-2-302, 52-2-403, 52-2-404, 52- 2-406, 52-2-407, and 68-11-201.
Administrative History: Emergency rules filed August 22, 2025; effective through February 18, 2026. New rules filed November 18, 2025; effective February 16, 2026.

Chapter 0465-03 Office of Administrative Appeals

Tenn. Comp. R. & Regs. 0465-03-.01 APPEALS GENERALLY

(1) When a person who has been substantiated at the Class I level for abuse, neglect, misappropriation of property of, or exploitation of, a vulnerable person (“A/N/E”); or who has three (3) or more Class II substantiations in separate investigations for incidents occurring or discovered within a twenty-four (24) month period, whether or not that substantiation(s) resulted in a referral for placement on the State’s registry of persons who have abused, neglected, exploited or misappropriated the property of vulnerable individuals (“Abuse Registry”), is dissatisfied with any action taken or intended to be taken by the Department of Intellectual and Developmental Disabilities (hereinafter referred to as “DIDD” or “department”), that person has the right to appeal to have the matter decided by a department official in a file review proceeding, or if a hearing is requested, by an administrative judge of the Administrative Procedures Division of the Office of Secretary of State.

(2) Administrative actions taken by the department pursuant to judicial or administrative order or which are the subject of pending or concluded judicial or administrative proceedings shall not be subject to review by the processes described herein.

History

Authority: T.C.A. §§ 4-3-103; 4-3-2708; 4-5-101, et seq.; 4-5-217; 4-5-301, et seq.; 33-1-302; 33-1-303; 33-1-305; and 33-1-309.
Administrative History: Original rule filed August 6, 2018; effective November 4, 2018.

Tenn. Comp. R. & Regs. 0465-03-.02 EFFECTIVE DATE

The effective date of the rules set forth in this chapter shall be November 4, 2018. Appeal rights provided for in these rules are available for those substantiations described herein resulting from incidents occurring or discovered on or after the effective date.

History

Authority: T.C.A. §§ 4-5-207 and 4-5-208.
Administrative History: Original rule filed August 6, 2018; effective November 4, 2018. November, 2018 2

Tenn. Comp. R. & Regs. 0465-03-.03 LEGAL BASIS

The commissioner of DIDD has the authority to make and enforce rules that are necessary for the lawful operation of the department’s programs and services. The commissioner, and any employee of the department to whom such responsibility has been delegated, has the authority to review decisions made by DIDD employees, including decisions regarding substantiations of persons who were the subject of DIDD administrative investigations. The commissioner may also utilize administrative judges employed by the Secretary of State to conduct contested case hearings of departmental matters.

History

Authority: T.C.A. §§ 4-3-103; 4-3-2708; 4-5-101, et seq.; 4-5-208; 4-5-217; 4-5-301, et seq.; 33-1-302; 33-1-303; 33-1-305; and 33-1-309.
Administrative History: Original rule filed August 6, 2018; effective November 4, 2018.

Tenn. Comp. R. & Regs. 0465-03-.04 SCOPE

(1) Subject to any superseding federal or state law, these rules apply to and establish procedures for administrative appeals of Class I substantiations; three (3) or more Class II substantiations in separate investigations for incidents occurring or discovered within a twenty-four (24) month period; and referrals by DIDD of substantiated persons to the State’s Abuse Registry. Contested case hearings of such matters, when requested, will be conducted by administrative judges of the Administrative Procedures Division of the Secretary of State and will be governed by the rules of the Tennessee Department of State, Administrative Procedures Division, Chapter 1360-04 “Uniform Rules of Procedure for Hearing Contested Cases Before State Administrative Agencies.”

(2) The Office of Administrative Appeals (OAA) is a unit of DIDD. The OAA is responsible for receiving appeals of those adverse administrative actions by the department which are defined below, conducting file reviews when requested, and arranging for, coordinating and prosecuting on behalf of DIDD contested case hearings before administrative judges of the Administrative Procedures Division (APD). Attorneys from DIDD’s Office of General Counsel may also prosecute contested case hearings for the department. The APD is a division of the Secretary of State and is not a part of DIDD.

(3) Nothing in these rules shall be construed to restrict the department from releasing any information about an alleged perpetrator of A/N/E to any state or federal law enforcement agency investigating a report of known or suspected abuse, neglect, exploitation of, misappropriation of money or property of, or crimes involving vulnerable persons; any state or federal District Attorney, Attorney General or U.S. Attorney, or his/her authorized assistants, of judicial districts or agencies involved in investigating or prosecuting crimes against vulnerable adults; any grand jury, criminal or civil court or administrative tribunal or body in response to a valid subpoena; any DIDD-contracted provider that is a full or part-time employer, or potential employer, of the alleged perpetrator or is responsible for providing care or services to victims or potential victims of the alleged perpetrator; or any state or federal agency or official investigating allegations of abuse, neglect, exploitation or misappropriation of money or property of vulnerable adults or the alleged perpetrator(s) thereof.

History

Authority: T.C.A. §§ 4-3-103; 4-3-2708; 4-5-101, et seq.; 4-5-301, et seq.; 33-1-302; 33-1-303; 33-1-305; 33-1-309; 33-3-105; 33-3-107; 33-3-108; 33-3-110; and Rules of the Department of State, Chapter 1360- 04.
Administrative History: Original rule filed August 6, 2018; effective November 4, 2018.

Tenn. Comp. R. & Regs. 0465-03-.05 DEFINITIONS

(1) The following terms as used in these rules shall have the meanings described below:

(a) “Abuse” means the knowing infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain or mental anguish.

November, 2018 3 (b) “Abuse Registry” means the Registry maintained by the Department of Health which contains the names of persons who have abused, neglected, exploited or misappropriated property of a vulnerable person as defined in T.C.A. § 68-11-1002(8).

The registry is established by T.C.A. §§ 68-11-1001, et seq.

(c) “Abuse Registry Review Committee” or “ARRC” means the DIDD committee that reviews the cases of persons who have been substantiated at the Class I level for A/N/E, or persons who have three (3) or more Class II substantiations for A/N/E in separate investigations for incidents occurring or discovered within a twenty-four (24) month period, to make decisions regarding referrals for placement on the Abuse Registry.

(d) “Administrative Judge” means an employee of the Administrative Procedures Division of the Office of the Secretary of State who conducts contested case hearings.

(e) “Administrative Procedures Division” or “APD” means the division of the Secretary of State which is responsible for conducting contested case hearings.

(f) “Adverse Administrative Action” means one or more of the following determinations by the department affecting an individual:

Class I substantiation of a person for allegations of A/N/E following an administrative investigation conducted by DIDD and proposed placement of the perpetrator’s name on DIDD’s Substantiated Investigations Records Inquiry (SIRI) database;
Three (3) or more Class II substantiations of a person in separate investigations for incidents occurring or discovered within a twenty-four (24) month period of an individual for allegations of A/N/E following administrative investigations conducted by DIDD and proposed placement of the perpetrator’s name on DIDD’s SIRI database; and 3. Proposed placement of an individual on the State’s Abuse Registry, by decision of DIDD’s Abuse Registry Review Committee, for either of the above.

(g) “A/N/E” means abuse, neglect, misappropriation of money or property of, or exploitation of, a person supported by DIDD.

(h) “Appeal” means the process by which an appellant requests review of one or more adverse administrative actions, as defined herein, in accordance with procedures set forth in these rules. Except as otherwise specified herein, an appeal may consist of a file review or a contested case hearing or both. An Initial Order issued by an administrative judge of the APD following a contested case hearing may also be appealed to the Commissioner’s Designee pursuant to T.C.A. § 4-5-315 and/or to the appropriate Chancery Court pursuant to T.C.A. § 4-5-322.

(i) “Appellant” means a person who has filed an appeal challenging an adverse administrative action, as defined herein, against that person. Under the circumstances described in Rules 0465-03-01-.12(11) and 0465-03-01-.18(1), the department may also be an appellant.

(j) “Class I” and “Class II” are categories utilized by DIDD investigators in classifying a substantiation, with Class I being the more egregious.

November, 2018 4 1. Class I means the wrongful conduct affecting the person supported constituted abuse, neglect, exploitation, or misappropriation of money or property, and resulted in one or more of the following consequences to the person supported: death, serious injury or physical harm; physical or sexual abuse; significant pain, intimidation or mental anguish; probable risk of serious harm; loss of funds or property of greater than $500 in value or prescription controlled medications regardless of value; or, through supervision neglect, harming a citizen in the community or engaging in criminal acts resulting in arrest and confinement.

Wrongful conduct in this category is of a nature serious enough to call into question whether the offender should be entrusted with the care of vulnerable persons.

Class II means the wrongful conduct affecting the person supported constituted abuse, neglect, exploitation, or misappropriation of money or property, but resulted in minimal or no physical harm or injury, pain or mental anguish; minimal risk of serious harm; loss of funds or property of up to $500 in value; or violations of plans of care with minimal or no adverse consequences. Wrongful conduct in this category is of a nature that disciplinary action and/or additional training may reasonably be deemed sufficient to address.

(k) “Commissioner” means the commissioner of the Tennessee Department of Intellectual and Developmental Disabilities.

(l) “Commissioner’s Designee” means a person authorized by the commissioner to review Initial Orders issued by administrative judges of the APD and to enter Final Orders pursuant to T.C.A. § 4-5-315. Reviewing officials of the OAA are also designees of the commissioner.

(m) “Contested Case” or “Contested Case Hearing” means an administrative proceeding in which the legal rights, duties or privileges of a party are required by any statute or constitutional provision to be determined after an opportunity for a hearing. The department may commence a contested case at any time with respect to a matter within its jurisdiction. Contested case hearings are conducted by administrative judges of the APD in accordance with the APD’s rules and procedures.

(n) “Department” or “DIDD” means the Tennessee Department of Intellectual and Developmental Disabilities.

(o) “Exploitation” means actions including but not limited to the deliberate misplacement, misappropriation or wrongful temporary or permanent use of belongings or money with or without the consent of a person using services. The illegal or improper use of a person’s resources or status for another’s benefit or advantage is considered exploitation.

(p) “File Review” is a proceeding requested by an appellant and conducted by DIDD’s Office of Administrative Appeals (OAA) in which the matter is decided by a reviewing official based on the department’s records or file material and any written submissions by the appellant. The reviewing official may uphold, overturn, or modify the adverse administrative action.

(q) “Final Order” means an Initial Order of an administrative judge of the APD which has become a Final Order, or an order issued by the Commissioner’s Designee after review of an Initial Order, concerning a contested case. An Initial Order becomes a Final Order in accordance with T.C.A. § 4-5-314.

November, 2018 5 (r) “Hearing” means a contested case proceeding before an administrative judge of the APD.

(s) “Initial Order” means the written decision of the administrative judge issued after a contested case hearing.

(t) “Misappropriation of property” means the deliberate misplacement, exploitation, or wrongful, temporary or permanent use of belongings or money without consent.

(u) “Neglect” means failure to provide goods or services necessary to avoid physical harm, mental anguish, or mental illness, which results in injury or probable risk of serious harm.

(v) “Party” means each person or entity participating in an appeal.

(w) “Reviewing official” means an employee of the OAA who is designated by the commissioner to conduct file reviews.

(x) “Substantiated” means that following a DIDD administrative investigation, a person has been determined, by a preponderance of the evidence, to have committed an act(s) against a person supported by DIDD that meets the definitions of abuse, neglect, misappropriation of property or exploitation.

(y) “Substantiated Investigation Records Inquiry” or “SIRI” means a database maintained by DIDD containing information regarding substantiations of perpetrators of A/N/E.

History

Authority: T.C.A. §§ 4-3-103; 4-3-2708; 4-5-101, et seq.; 4-5-301, et seq.; 4-5-314; 4-5-315; 4-5-322; 33- 1-302; 33-1-303; 33-1-305; 33-1-309; 33-2-402; and 68-11-1001, et seq.
Administrative History: Original rule filed August 6, 2018; effective November 4, 2018.

Tenn. Comp. R. & Regs. 0465-03-.06 RIGHT TO APPEAL; CONTACT INFORMATION OF APPELLANT

(1) An appellant may appeal an adverse administrative action, as defined in Rule 0465-03-01- .05(f), by following the procedures set forth in these rules.

(2) It is the responsibility of the appellant to provide the Office of Administrative Appeals with his or her current mailing address and other contact information and to keep that information current at all times.

History

Authority: T.C.A. §§ 4-3-103; 4-3-2708; 4-5-101, et seq.; 4-5-301, et seq.; 33-1-302; 33-1-303; 33-1-305; and 33-1-309.
Administrative History: Original rule filed August 6, 2018; effective November 4, 2018.

Tenn. Comp. R. & Regs. 0465-03-.07 INFORMATION REGARDING RIGHT TO APPEAL

(1) Every person against whom an adverse administrative action, as defined in Rule 0465-03-01- .05 (f), has been taken by the department shall be provided a written notice, sent to the last known address of the recipient, which contains the following information:

(a) Notice of the department’s adverse administrative action and any intended action as a consequence thereof;

(b) A notice of the right to appeal;

(c) A description of the appeal options available and the steps by which an appeal can be perfected; and November, 2018 6 (d) A statement of the deadline(s) for the taking of appropriate steps to perfect the appeal and that failure to timely request an appeal will result in a waiver of appeal rights.

(2) For a Class I substantiation or three (3) or more Class II substantiations in separate investigations for incidents occurring or discovered within a twenty-four (24) month period, the items listed in subsection (1) above will be included in a letter or notice issued by the department within ten (10) business days following the Class I substantiation, or, if applicable, within ten (10) business days after the determination by DIDD that the third Class II substantiation has occurred.

(3) For a referral for placement on the Abuse Registry, the items listed in subsection (1) above will be included in a letter or notice issued by the department within ten (10) business days following the meeting of the Abuse Registry Review Committee at which the substantiated perpetrator’s case was considered.

(4) For a Class I substantiation or three (3) or more Class II substantiations in separate investigations for incidents occurring or discovered within a twenty-four (24) month period for which a referral for placement on the Abuse Registry was not made, the items listed in subsection (1) above will be included in a letter or notice issued by the department within ten (10) business days following the meeting of the Abuse Registry Review Committee at which the substantiated perpetrator’s case was considered.

(5) The notifications required by subsections (2), (3) and (4) of this rule shall be sent by certified and regular mail to the last known address of the recipient. The notifications will be accompanied by an appropriate response or election form for use by the recipient in responding to the department and exercising or declining his/her rights to appeal.

History

Authority: T.C.A. §§ 4-3-103; 4-3-2708; 4-5-101, et seq.; 4-5-301, et seq.; 33-1-302; 33-1-303; 33-1-305; and 33-1-309.
Administrative History: Original rule filed August 6, 2018; effective November 4, 2018.

Tenn. Comp. R. & Regs. 0465-03-.08 TIME LIMITATIONS APPLICABLE

(1) Requests for appeals will be accepted only if submitted in writing, in compliance with Rule

Tenn. Comp. R. & Regs. 0465-03-.09 REQUESTS FOR FILE REVIEWS CHALLENGING SUBSTANTIATIONS

(1) An appellant requesting a file review challenging a Class I substantiation or three (3) or more Class II substantiations in separate investigations for incidents occurring or discovered within a twenty-four (24) month period and who has received a notice of the type specified in Rule 0465-03-01-.07(2) may request a file review of the substantiation(s).

(2) A person who elects to take no action, or who fails to respond timely to the notice, waives the right to a file review but does not waive the right to request a hearing challenging the substantiation(s) and/or referral by the ARRC for placement of the person’s name on the Abuse Registry after the ARRC meeting at which that substantiation(s) was considered.

(3) An appellant requesting a file review may submit any documentation or other evidence that he/she wishes to have considered by the reviewing official. Such material should be submitted no later than fifteen (15) calendar days following the date of the notice containing the information required by Rule 0465-03-01-.07(2), unless a longer period is requested by the appellant prior to the expiration of the deadline and is approved by the reviewing official.

History

Authority: T.C.A. §§ 4-3-103; 4-3-2708; 4-5-101, et seq.; 4-5-301, et seq.; 33-1-302; 33-1-303; 33-1-305; and 33-1-309.
Administrative History: Original rule filed August 6, 2018; effective November 4, 2018.

Tenn. Comp. R. & Regs. 0465-03-.10 REQUESTS FOR HEARINGS CHALLENGING REFERRALS FOR PLACEMENT ON THE

ABUSE REGISTRY AND/OR SUBSTANTIATIONS.

(1) A person who has received a notice of the type specified in Rule 0465-03-01-.07 (3) may:

(a) Request a hearing challenging only the referral for placement on the Abuse Registry, in which case the substantiation is not at issue, and the person’s name will be placed on the SIRI database for the underlying substantiation(s); or (b) Request a hearing challenging both the referral for placement on the Abuse Registry and the substantiation(s) on which the referral was based.

(2) A person who elects to take no action, or who fails to respond timely to the notice, waives all appeal rights. The person’s name will be placed on the Abuse Registry as well as on the SIRI database for the underlying substantiation(s).

History

Authority: T.C.A. §§ 4-3-103; 4-3-2708; 4-5-101, et seq.; 4-5-301, et seq.; 33-1-302; 33-1-303; 33-1-305; 33-1-309; and 68-11-1001, et seq.
Administrative History: Original rule filed August 6, 2018; effective November 4, 2018.

Tenn. Comp. R. & Regs. 0465-03-.11 REQUESTS FOR HEARINGS CHALLENGING SUBSTANTIATION(S) FOR WHICH A

REFERRAL TO THE ABUSE REGISTRY WAS NOT MADE.

(1) A person who has received a notice of the type specified in Rule 0465-03-01-.07(4) may request a hearing challenging the substantiation.

(2) A person who elects to take no action, or who fails to respond timely to the notice, waives all appeal rights. The person’s name will be placed on the SIRI database.

History

Authority: T.C.A. §§ 4-3-103; 4-3-2708; 4-5-101, et seq.; 4-5-301, et seq.; 33-1-302; 33-1-303; 33-1-305; and 33-1-309.
Administrative History: Original rule filed August 6, 2018; effective November 4, 2018. November, 2018 8

Tenn. Comp. R. & Regs. 0465-03-.12 FILE REVIEWS

(1) A file review is an informal proceeding in which the reviewing official reviews the department’s files, which may include the investigation report and file and any submissions by the appellant, and then makes a determination, reflected in a decision letter, whether to uphold, modify or overturn the adverse administrative action.

(2) Submissions by the appellant relating to file reviews of substantiations shall be made available by the OAA to DIDD’s Director of Investigations or designee within three (3) business days of receipt thereof. The Director of Investigations or designee shall, within three (3) business days of receipt of these documents, notify the OAA in writing if the investigation(s) will be reopened with respect to the appellant’s substantiation(s). If so, Rule

Tenn. Comp. R. & Regs. 0465-03-.13 REOPENED INVESTIGATIONS

(1) If, as a result of documents or other evidence submitted by an appellant in support of his/her request for a file review of a substantiation(s), or if for any other reason an investigation is reopened under circumstances which could affect the substantiation(s) of an appellant with a November, 2018 9 pending file review request, the appellant will be notified in writing that the file review is suspended pending outcome of the additional investigation.

(2) If the pending file review request was for a Class I substantiation, upon the closing of the additional investigation, the appellant will be notified in writing of the outcome as it pertains to him or her. If the Class I substantiation was overturned, and there was no other Class I substantiation against the appellant resulting from that investigation, he/she will be notified that the file review proceeding is closed. If the appellant remains substantiated at the Class I level following the additional investigation, he/she will be notified in writing that the file review will be resumed. The thirty (30) day period specified in Rule 0465-03-.12(8) for completion of the file review will commence following the date of the notification specified in this paragraph.

(3) If the pending file review request was for three (3) or more Class II substantiations in separate investigations for incidents occurring or discovered within a twenty-four (24) month period, upon the closing of the additional investigation, the appellant will be notified in writing of the outcome as it pertains to him or her. If the Class II substantiation was overturned, and there was no other Class II substantiation against the appellant resulting from that investigation, he/she will be notified that the file review proceeding is closed. If the appellant remains substantiated at the Class II level following the additional investigation, he/she will be notified in writing that the file review will be resumed. The thirty (30) day period specified in Rule 0465-03-.12(8) for completion of the file review will commence following the date of the notification specified in this paragraph.

History

Authority: T.C.A. §§ 4-3-103; 4-3-2708; 4-5-101, et seq.; 33-1-302; 33-1-303; 33-1-305; and 33-1-309.
Administrative History: Original rule filed August 6, 2018; effective November 4, 2018.

Tenn. Comp. R. & Regs. 0465-03-.14 HEARINGS GENERALLY

(1) A hearing is a contested case proceeding conducted by administrative judges of the APD in accordance with the APD’s rules and procedures. Parties should refer to Tennessee Department of State, Administrative Procedures Division Chapter 1360-04 “Uniform Rules of Procedure for Hearing Contested Cases Before State Administrative Agencies.”

(2) Initial Orders issued by administrative judges, stays of effectiveness of Initial Orders, or petitions for reconsideration of Initial Orders are governed by T.C.A. §§ 4-5-314, 4-5-316 and 4-5-317, respectively.

History

Authority: T.C.A. §§ 4-3-103; 4-3-2708; 4-5-101, et seq.; 4-5-301, et seq.; 33-1-302; 33-1-303; 33-1-305; and 33-1-309.
Administrative History: Original rule filed August 6, 2018; effective November 4, 2018.

Tenn. Comp. R. & Regs. 0465-03-.15 SEPARATION OF FUNCTIONS

A person who has served as, or is subject to the authority, direction, or discretion of one who has served as, an investigator, or who has otherwise participated in a determination made in an administrative investigation or related proceeding which is the subject of an appeal, or who has had any direct or indirect involvement in the adverse administrative action under consideration prior to the filing of the appeal, may not serve as a reviewing official, attorney representative or Commissioner’s Designee in the same or related proceeding. No reviewing official may serve as an attorney representative in a hearing if he or she has previously conducted a file review in the same or related proceeding.

History

Authority: T.C.A. §§ 4-3-103; 4-3-2708; 4-5-101, et seq.; 33-1-302; 33-1-303; 33-1-305; and 33-1-309.
Administrative History: Original rule filed August 6, 2018; effective November 4, 2018. November, 2018 10

Tenn. Comp. R. & Regs. 0465-03-.16 FILING OF DOCUMENTS

(1) To be considered timely filed, all documents required to be filed by a date certain with the OAA shall be filed by delivering such materials in person or in any other manner, including mail or hand delivery, fax or email, provided they are actually received by the OAA during normal business hours and within the required time period. For purposes of these rules, normal business hours are between 8:00 a.m. and 4:30 p.m. C.S.T. Monday through Friday, excluding state and federal holidays.

(2) All documents required to be filed with the OAA shall be stamped with the date of receipt; provided, however, that if a document is hand delivered or sent by fax or email after hours or on a weekend or holiday, it shall be deemed received on the date of the next business day and will be date-stamped with that date. A copy of any document sent by fax or email for filing will be deemed an original document and maintained in the file.

(3) All requests for appeals received by the OAA shall be acknowledged in writing. The acknowledgement shall be sent, within three (3) business days of receipt of the request, by mail or by email to the address(es) provided by the appellant.

(4) For documents required to be filed with the APD in a contested case, the APD’s rules and procedures are applicable.

History

Authority: T.C.A. §§ 4-3-103; 4-3-2708; 4-5-101, et seq.; 4-5-301, et seq.; 33-1-302; 33-1-303; 33-1-305; and 33-1-309.
Administrative History: Original rule filed August 6, 2018; effective November 4, 2018.

Tenn. Comp. R. & Regs. 0465-03-.17 AGENCY RECORD

(1) The department’s official record of each appeal shall be maintained for not less than five (5) years from the date a decision letter is issued in a file review, an Initial Order becomes a Final Order, or a Final Order is issued, whichever is later.

(2) The record shall include paper or electronic copies of:

(a) All documents submitted by the appellant in a file review;

(b) Correspondence between the reviewing official and the parties, including the decision letter issued upon completion of a file review;

(c) All pleadings, orders, transcribed testimony, recordings, or other record of oral proceedings, and correspondence filed, issued, or generated in a contested case proceeding; and (d) All pleadings, orders, and correspondence filed, issued, or generated in a proceeding before the Commissioner’s Designee.

(3) Except to the extent otherwise provided by law, the agency record, including the record of oral proceedings, shall constitute the exclusive basis for agency action in contested cases, departmental review, and judicial review thereof.

History

Authority: T.C.A. §§ 4-3-103; 4-3-2708; 4-5-101, et seq.; 10-7-501, et seq.; 33-1-302; 33-1-303; 33-1- 305; and 33-1-309.
Administrative History: Original rule filed August 6, 2018; effective November 4, 2018. November, 2018 11

Tenn. Comp. R. & Regs. 0465-03-.18 REVIEW OF INITIAL ORDERS ISSUED BY ADMINISTRATIVE JUDGES

(1) Except in circumstances described in T.C.A. § 4-5-315(a)(1) and (2), the department may review, and upon petition for appeal submitted to the OAA within fifteen (15) calendar days after entry of an Initial Order by an administrative judge, shall review the Initial Order. If the department on its own motion decides to review an Initial Order, it shall file its petition with the OAA and give written notice of its intention to review the Initial Order within fifteen (15) calendar days after its entry. Reviews of Initial Orders shall be conducted by the Commissioner’s Designee.

(2) Pursuant to T.C.A. § 4-5-315(b), the fifteen (15) calendar day periods referred to in the preceding paragraph shall be tolled by the submission of a timely petition for reconsideration of the Initial Order pursuant to T.C.A. § 4-5-317 and a new fifteen (15) calendar day period shall start to run upon disposition of the petition for reconsideration. If an Initial Order is subject both to a timely petition for reconsideration and to a petition for appeal or to review by the agency on its own motion, the petition for reconsideration shall be disposed of first, unless the agency determines that action on the petition for reconsideration has been unreasonably delayed.

(3) The petition for appeal shall state the grounds upon which the appeal is based. If the department on its own motion gives notice of its intent to review an Initial Order, it shall identify the issues that it intends to review.

(4) The Commissioner’s Designee shall exercise all the decision-making power that the agency would have had to render a final order had the agency presided over the hearing, except to the extent that the issues subject to review are limited by rule or statute or by the agency upon notice to all parties.

(5) Each party shall be afforded the opportunity to present briefs in accordance with a schedule established by the Commissioner’s Designee, who may, but is not required to permit oral argument.

(6) The department may cause a transcript to be prepared at its expense of such portions of the proceeding under review as are deemed necessary.

(7) The Commissioner’s Designee may render a Final Order disposing of the proceeding or may remand the matter for further proceeding with instructions to the administrative judge who rendered the Initial Order. Upon remanding a matter, the Commissioner’s Designee may order such temporary relief as is authorized and appropriate.

(8) A Final Order or an order remanding the matter for further proceedings shall be rendered and entered in writing within sixty (60) days after receipt of briefs and oral argument, if permitted, unless that period is waived or extended with the written consent of all parties or for good cause shown. The Final Order or an order remanding the matter for further proceedings shall be delivered to each party and to the administrative judge who conducted the contested case.

(9) A Final Order, or an order remanding the matter for further proceedings, shall identify any difference between such order and the Initial Order, and shall include, or incorporate by express reference to the Initial Order, all requirements of T.C.A. § 4-5-314(c).

History

Authority: T.C.A. §§ 4-3-103; 4-3-2708; 4-5-101, et seq.; 4-5-315; 4-5-317; 33-1-302; 33-1-303; 33-1- 305; and 33-1-309.
Administrative History: Original rule filed August 6, 2018; effective November 4, 2018. November, 2018 12

Tenn. Comp. R. & Regs. 0465-03-.19 RECONSIDERATION OF INITIAL OR FINAL ORDER

(1) Any party, within fifteen (15) calendar days after entry of an Initial or Final Order may file a petition for reconsideration, stating the specific grounds upon which relief is requested. A petition for reconsideration of an Initial Order shall be filed with the APD. A petition for reconsideration of a Final Order shall be filed with the OAA.

(2) The petition for reconsideration shall be disposed of by the same person who rendered the Initial or Final Order, if he or she is available.

(3) The person who rendered the Initial or Final Order that is the subject of the petition shall, within twenty (20) calendar days of receiving the petition, enter a written order either denying the petition, granting the petition and setting the matter for further proceedings, or granting the petition and issuing a new order in accordance with T.C.A. § 4-5-314.

(4) If no action has been taken on the petition within twenty (20) calendar days of filing, the petition shall be deemed to have been denied.

(5) An order granting the petition and setting the matter for further proceedings shall state the extent and scope of the proceedings, which shall be limited to argument upon the existing record. No new evidence shall be introduced unless the party proposing such evidence shows good cause for the failure to introduce the evidence in the original proceeding.

(6) The sixty (60) calendar day period for a party to file a petition for judicial review of a Final Order pursuant to T.C.A. § 4-5-322 shall be tolled if a petition for reconsideration is granted, and a new sixty (60) calendar day period shall begin to run upon disposition of the petition for reconsideration by issuance of a Final Order by the Commissioner’s Designee.

History

Authority: T.C.A. §§ 4-3-103; 4-3-2708; 4-5-101, et seq.; 4-5-314; 4-5-317; 4-5-322; 33-1-302; 33-1-303; 33-1-305; and 33-1-309.
Administrative History: Original rule filed August 6, 2018; effective November 4, 2018.

Tenn. Comp. R. & Regs. 0465-03-.20 STAY OF EFFECTIVENESS OF FINAL ORDER

A party may file with the OAA a petition for stay of effectiveness of a Final Order issued by the Commissioner’s Designee within seven (7) calendar days after its entry, unless otherwise provided by statute or stated in the Initial or Final Order. The department may take action on the petition for stay, either before or after the effective date of the Initial or Final Order.

History

Authority: T.C.A. §§ 4-3-103; 4-3-2708; 4-5-101, et seq.; 4-5-316; 33-1-302; 33-1-303; 33-1-305; and 33- 1-309.
Administrative History: Original rule filed August 6, 2018; effective November 4, 2018.

Tenn. Comp. R. & Regs. 0465-03-.21 JUDICIAL REVIEW OF FINAL ORDER

A person who is aggrieved by a final decision by the department in a contested case is entitled to judicial review by the appropriate Chancery Court by filing a petition with that court within sixty (60) calendar days after the entry of a Final Order by the department. Procedures for judicial review are governed by T.C.A. § 4-5-322.

History

Authority: T.C.A. §§ 4-3-103; 4-3-2708; 4-5-101, et seq.; 4-5-322; 33-1-302; 33-1-303; 33-1-305; and 33- 1-309.
Administrative History: Original rule filed August 6, 2018; effective November 4, 2018.

Tenn. Comp. R. & Regs. 0465-03-.22 CLERICAL MISTAKES

(1) Prior to any appeal being perfected by either party to the Commissioner’s Designee or to the Chancery Court, clerical mistakes in orders or other parts of the record, and errors arising November, 2018 13 from oversight or omissions may be corrected at any time on motion of any party and after such notice, if any, as the reviewing official or administrative judge may require.

(2) The entry of a corrected order will not affect the dates of the original appeal time period.

History

Authority: T.C.A. §§ 4-3-103; 4-3-2708; 4-5-101, et seq.; 33-1-302; 33-1-303; 33-1-305; and 33-1-309.
Administrative History: Original rule filed August 6, 2018; effective November 4, 2018.

Tenn. Comp. R. & Regs. 0465-03-01-.16 , and within the time limits set forth below.

(a) For a request for a file review challenging a Class I substantiation or three (3) or more Class II substantiations in separate investigations for incidents occurring or discovered within a twenty-four (24) month period: within fifteen (15) calendar days following the date of the notice containing the information required by Rule 0465-03-01-.07(2).

(b) For a request for a hearing challenging a referral for placement on the Abuse Registry: within sixty (60) calendar days following the date of the notice containing the information required by Rule 0465-03-01-.07(3).

(c) For a request for a hearing challenging a Class I substantiation or three (3) or more Class II substantiations in separate investigations for incidents occurring or discovered within a twenty-four (24) month period: within sixty (60) calendar days following the date of the notice containing the information required by Rule 0465-03-01-.07(4).

(2) In computing any period of time prescribed or allowed by statute, rule, or order, the time within which any act provided by law is to be done shall be computed by excluding the first day and including the last, unless the last day is a Saturday, a Sunday, or state or federal holiday, in which event the period runs until the end of the next day which is neither a Saturday, a Sunday nor a holiday.

History

Authority: T.C.A. §§ 4-3-103; 4-3-2708; 4-5-101, et seq.; 4-5-301, et seq.; 33-1-302; 33-1-303; 33-1-305; November, 2018 7 and 33-1-309.
Administrative History: Original rule filed August 6, 2018; effective November 4, 2018.

Tenn. Comp. R. & Regs. 0465-03-01-.13 will be applicable.

(3) Formal pleadings or affidavits are not required, but all written submissions shall be filed and become part of the record of the proceeding.

(4) Discovery procedures do not apply to file reviews.

(5) The party requesting the file review shall be designated as the “Appellant,” and DIDD shall be designated as the “Department” or “DIDD.”

(6) In consideration of materials reviewed, the reviewing official shall not be constrained by rules of evidence but shall give the items considered the weight that he or she deems appropriate.

(7) The reviewing official will consider the information available and make a determination whether, based on a preponderance of the evidence, the adverse administrative action taken by the department was or was not justified in light of applicable statutes and other authorities, including but not limited to other rules and policies.

(8) The decision letter will be issued by the reviewing official not later than thirty (30) calendar days following receipt of the appellant’s request for a file review unless circumstances exist which make a delay unavoidable.

(9) The decision letter will be mailed to the appellant and distributed to DIDD personnel as appropriate.

(10) If the decision of the reviewing official is to modify or overturn the substantiation(s), an addendum will be issued by the investigations unit in accordance with the decision letter or, if a hearing is conducted, with the Initial or Final Order.

(11) Following any file review authorized by these rules in which the other party has not requested a hearing, DIDD may, if dissatisfied with the decision of the reviewing official, within fifteen (15) calendar days following the expiration of the other party’s right to request a hearing, file with the OAA and serve on the other party a notice of intention to commence a contested case hearing challenging that decision. Thereafter, DIDD must file a notice of charges with the APD within thirty (30) calendar days of the date of said notice.

History

Authority: T.C.A. §§ 4-3-103; 4-3-2708; 4-5-101, et seq.; 33-1-302; 33-1-303; 33-1-305; and 33-1-309.
Administrative History: Original rule filed August 6, 2018; effective November 4, 2018.

Chapter 0465-04-01 Tennessee's Early Intervention System (Transferred from 0520-01-10)

Tenn. Comp. R. & Regs. 0465-04-01-.01 GENERAL REGULATIONS

ADOPTION BY REFERENCE.

The State Department of Intellectual and Developmental Disabilities adopts by reference the Compilation of Federal Regulations at 34 C.F.R. Part 303 in their entirety unless otherwise provided herein as the policies and procedures for administration of special education early intervention programs and services in the state. The regulations are available from Tennessee’s Early Intervention Systems (TEIS), Tennessee Department of Intellectual and Developmental Disabilities, UBS Tower, 8 th Floor, 315 Deaderick Street, Nashville, Tennessee 37243, or on the internet by accessing the Department of Intellectual and Developmental Disabilities’ website at http://tn.gov/DIDD/teis.

History

Authority: T.C.A. §§ 4-3-2708, 33-1-303, and 49-10-702; 20 U.S.C. §§ 1431, et seq.; and Exec. Order No. 10 (Dec. 2, 2019).
Administrative History: Transfer from chapter 0520-01-10 and amendments filed March 15, 2021; effective June 13, 2021.

Tenn. Comp. R. & Regs. 0465-04-01-.02 DEFINITIONS

(1) Developmental Delay for Infants and Toddlers.

(a) General.

Infants and toddlers with disabilities eligible for TEIS services shall be those children from birth to age three, inclusive, who:

Have been evaluated in accordance with appropriate procedures for early intervention services; and 2. As a result of the evaluation, a multidisciplinary team has determined that the child meets the criteria for Tennessee’s definition of Developmental Delay.

(b) Developmental Delay Criteria. The infant or toddler must meet one of the following:

The child is experiencing developmental delays, as measured by appropriate diagnostic instruments, administered by qualified professionals, indicating that the child is:

(i) Functioning at least twenty-five percent (25%) below his/her chronological age in two or more of the following developmental areas:

(I) Cognitive development;

(II) Physical development, including vision and hearing;

(III) Communication development;

June, 2021 2 (IV) Social/emotional development; and/or (V) Adaptive development; or (ii) Functioning at least forty percent (40%) below his/her chronological age in one of the developmental areas listed in subparagraph 1.(i)(I)-(V) above; or (iii) The child has a diagnosed physical or mental condition that has a high probability of resulting in developmental delay, i.e., known, obvious, or diagnosable condition such as sensory losses and severe physical impairments. Examples include, but are not limited to:

(I) Hearing loss that can be verified or estimated to be significant as indicated through an audiological evaluation;

(II) Visual loss, which can be verified or estimated to be significant; for example, cataracts, retinopathy of prematurity, or dysfunction of the visual cortex;

(III) Neurological, muscular, or orthopedic impairment which prevents the development of other skills; for example, spina bifida, cerebral palsy, autism, epilepsy;

(IV) Organic conditions or syndromes which have known significant consequences; for example, tuberous sclerosis, hydrocephalus, muscular dystrophy, fetal alcohol syndrome;

(V) Chromosomal, metabolic, or endocrine abnormalities; for example, Down Syndrome; Klinefelter Syndrome, Turner Syndrome, hypothyroidism; or (VI) Prematurity, as defined by Tennessee’s eligibility criteria for premature infants; or (iv) The child has been determined eligible based on informed clinical opinion because the use of standardized instruments does not accurately reflect the child’s developmental status and the child does not have a diagnosed physical or mental condition that has a high probability of resulting in developmental delay.

(2) Developmental Therapy.

Developmental therapy for infants and toddlers with disabilities eligible for TEIS services includes:

(a) Family training, counseling, and home visits, as appropriate, by social workers, psychologists, and other qualified personnel to assist the family of an infant or toddler with a disability in understanding the special needs of the child and enhancing the child’s development; and (b) Special instruction including:

(i) The design of learning environments and activities that promote the infant’s or toddler’s acquisition of skills in a variety of developmental areas, including cognitive processes and social interaction;

June, 2021 3 (ii) Curriculum planning, including the planned interaction of personnel, materials, and time and space, that leads to achieving the outcomes in the Individualized Family Service Plan (IFSP) for the infant or toddler with a disability;

(iii) Providing families with information, skills, and support related to enhancing the skill development of the child; and (iv) Working with the infant or toddler with a disability to enhance the child’s development.

History

Authority: T.C.A. §§ 4-3-2708, 33-1-303, 49-10-702, and 68-5-905; 20 U.S.C. §§ 1431, et seq.; and Exec. Order No. 10 (Dec. 2, 2019).
Administrative History: Transfer from chapter 0520-01-10 and amendments filed March 15, 2021; effective June 13, 2021.

Tenn. Comp. R. & Regs. 0465-04-01-.03 LEAD AGENCY

(1) The Tennessee Department of Intellectual and Developmental Disabilities is designated by the Governor as lead agency for TEIS and is responsible for the administration of the State’s early intervention system.

(2) The Tennessee Department of Intellectual and Developmental Disabilities, in accordance with Individuals with Disabilities Education Act (IDEA), 20 U.S.C.A. §§ 1431 (Part C), et seq. and state interagency agreements, shall be responsible for:

(a) The general administration and supervision of programs that receive funding under IDEA

Part C to provide services to eligible infants and toddlers and their families; and (b) Assigning financial responsibility among appropriate agencies for early intervention services.

(3) The Tennessee Department of Intellectual and Developmental Disabilities shall be responsible for the supervision and monitoring of programs including:

(a) Supervising and monitoring programs and activities that comprise the early intervention system, including agencies, institutions, and organizations which provide early intervention services to children eligible under Part C and their families, for compliance with IDEA Part C and the provisions of federal and state regulations, policies and procedures, whether or not the programs or activities receive financial assistance under

Part C of IDEA;

(b) Providing, or facilitating the provision of, technical assistance to those agencies, institutions, and organizations including self-evaluation, program planning and implementation;

(c) Enforcing obligations imposed on those agencies, institutions and organizations as required under these regulations; and (d) Directing that deficiencies identified through monitoring be corrected.

(4) Each agency receiving assistance under IDEA Part C shall:

(a) Submit financial and other written reports at the time and manner specified by TEIS; and (b) Participate in periodic on-site monitoring visits conducted by TEIS.

June, 2021 4 (5) The Tennessee Department of Intellectual and Developmental Disabilities shall utilize funds provided under IDEA Part C that are reasonable and necessary for administering the state early intervention system.

(6) TEIS shall ensure that traditionally underserved groups, including minority, low-income, and rural families, are meaningfully involved in the planning and implementation of all components of the early intervention system and that these families have access to culturally competent services within their local geographical areas.

(7) The lead agency shall utilize contractual arrangements as a method of securing required early intervention services for children and families. Each contractor will be required by the terms of its contract to adhere to all applicable state and federal requirements for the provision of services to Part C eligible children and their families.

(a) All early intervention services provided for eligible children and their families shall meet the definition of early intervention services and shall be provided in a manner that is consistent with state and federal standards for services under IDEA Part C.

(b) Procurement of early intervention services by service providers shall conform to the applicable agency procurement policies.

(c) Individuals or organizations seeking to provide early interventions services shall meet the requirements and standards established by the lead agency.

History

Authority: T.C.A. §§ 4-3-2708, 33-1-303, and 49-10-702; 20 U.S.C. §§ 1431, et seq.; and Exec. Order No. 10 (Dec. 2, 2019).
Administrative History: Transfer from chapter 0520-01-10 and amendments filed March 15, 2021; effective June 13, 2021.

Tenn. Comp. R. & Regs. 0465-04-01-.04 DATA COLLECTION AND RECORDS

(1) The Tennessee Department of Intellectual and Developmental Disabilities shall maintain a data system that contains the early intervention records of infants and toddlers served by TEIS. The department shall maintain a process for collecting, managing, analyzing, and reporting statewide data regarding the operational status of TEIS.

History

Authority: T.C.A. §§ 4-3-2708, 33-1-303, and 49-10-702; 20 U.S.C. §§ 1431, et seq.; and Exec. Order No. 10 (Dec. 2, 2019).
Administrative History: Transfer from chapter 0520-01-10 and amendments filed March 15, 2021; effective June 13, 2021.

Tenn. Comp. R. & Regs. 0465-04-01-.05 INDIVIDUALIZED FAMILY SERVICE PLAN (IFSP)

(1) IFSP Meetings.

(a) The service coordinator shall communicate with the family and other IFSP team members in scheduling the IFSP meeting. Once scheduled, written notice of the meeting shall be provided to the family and other participants, no later than then (10) days prior to the scheduled meeting date to ensure that they will be able to participate.

(b) Participants’ involvement in the IFSP meeting shall be reflected on the IFSP document by personal signature or by noting the method of participation.

History

Authority: T.C.A. §§ 4-3-2708, 33-1-303, and 49-10-702; 20 U.S.C. §§ 1431, et seq.; and Exec. Order No. 10 (Dec. 2, 2019).
Administrative History: Transfer from chapter 0520-01-10 and amendments filed March 15, 2021; effective June 13, 2021. June, 2021 5

Tenn. Comp. R. & Regs. 0465-04-01-.06 PROCEDURAL SAFEGUARDS

(1) Mediation.

(a) Mediations shall be conducted by mediators employed by the secretary of state and in accordance with Tennessee Department of Intellectual and Developmental Disabilities policy.

(b) TEIS shall provide an appropriate location for the mediation and shall be responsible for the administrative costs of the mediation.

(2) Due Process.

(a) Due process cases shall be heard by administrative law judges employed by the secretary of state and in accordance with Tennessee Department of Intellectual and Developmental Disabilities policy.

(b) Due process cases shall be conducted pursuant to 34 C.F.R. §§ 303.440 – 449.

(c) TEIS shall provide an appropriate location for the hearing, a court reporter, an original copy of the transcript for the administrative law judge, a copy of the transcript for the parents, and shall be responsible for the administrative costs of the hearing.

(d) Any party aggrieved by the findings and decision of a due process hearing has the right to bring a civil action with respect to the complaint presented. The action may be brought in any state court of competent jurisdiction in accordance with Tenn. Code Ann. § 4-5- 322 or in a district court of the United States without regard to the amount in controversy.

History

Authority: T.C.A. §§ 4-3-2708, 33-1-303, and 49-10-702; 20 U.S.C. §§ 1431, et seq.; and Exec. Order No. 10 (Dec. 2, 2019).
Administrative History: Transfer from chapter 0520-01-10 and amendments filed March 15, 2021; effective June 13, 2021.