On Limiting Services to Those With Intellectual Disabilities

NASHVILLE, Tenn. (AP) — Tennessee is limiting the amount of home nursing and personal assistance services for people with intellectual and developmental disabilities to reduce budget costs, which could push more people into community-based homes.
The Tennessee Department of Intellectual and Developmental Disabilities has been notifying families who use the at-home waiver programs of the new limits since March. The department has been looking to make the changes for two years and got approval in February from the Centers for Medicare and Medicaid.
Under the changes, one-on-one nursing services will be limited to 12 hours a day and personal assistance services limited to 215 hours a month. Previously, these services were provided on a case-by-case basis, but the programs were never intended to be used 24 hours, every day, said department spokeswoman Missy Marshall.

Personal assistance services are generally for people who are physically or mentally limited, but who don’t require medical care, as opposed to nursing services. Personal assistance services are designed to keep people with developmental disabilities living at home, with the expectation that they would be independent part of the day or have family members contributing to their care.
But in some cases, people had two personal assistants providing care 24 hours a day, which the department said could cost more than $230,000 a year per person.
“DIDD proposed to stop providing this level of reimbursement because it is extremely expensive, and the department could find no other state in the country that provides payment for two assistants to support one person at a time,” the department said in a news release this week.
Marshall said they couldn’t continue providing that level of care when there were 6,800 people in the state on waiting lists for these services. There are about 7,500 people who currently get support through the department’s waiver programs.
Marshall said the department has estimated that about 680 people who are over the news limit for personal assistant services and they will be meeting with case managers to determine other options.
“We are trying to give families time to be able to sit down and look at the providers that offer services,” Marshall said.
One of those options for some people might be community-based homes, which can provide constant care for people with intellectual disabilities, as well as employment and recreational activities. In the $30.8 billion spending plan approved by the Tennessee General Assembly this year, about $5 million has been allocated to the Department of Intellectual and Developmental Disabilities to restore recurring rates paid to providers who operate these group homes.

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