The department is making changes in billing for SIL services that apply to all three HCBS waivers as well as two new provisions that apply to the Statewide (SW) and Comprehensive Aggregate Cap (CAC) Waivers. If you have any questions, contact [email protected] or [email protected].
o Change in SIL billing that applies to the SDW, SW and CAC Waivers:
1. The regular monthly rate for SIL of $927.98 will be pro-rated to a daily rate of $30.93 per day. This will allow for more accurate billing and accountability for audit purposes as well as allow two different providers to bill if someone changes SIL providers in the midst of a month. Providers are reminded that a minimum of two face-to-face direct service visits in the home per week are required for each person receiving SILS. Providers delivering this service are required to implement provisions for availability of provider staff on a 24 hour basis in case emergency supports are needed. The effective date of this billing change will be communicated prior to implementation.
o Changes that apply to the SW and CAC Waivers only:
In response to public comment and stakeholder feedback, the state added Semi-Independent Living (SIL) as a service to the Statewide and CAC Waivers. The state agrees with the input from the public that SIL is an important option for individuals. The state recognizes that individuals transitioning from 24 hour residential services to SIL may need extra support during the transition period to adjust to the change in services provided. Therefore, the state is proposing two new financial supports for providers who transition individuals from 24 hour residential services into SIL.
Note: To reiterate, these changes do not apply to the Self Determination Waiver.
2. A SIL transition enhanced rate of $1,855.96 is available to assist in the increased support required during the first 30 days of a transition from 24-hour residential services to SIL. This enhanced rate is billable as a daily pro-rated amount of $61.87 per day for up to 30 days. As stated above, the intent of the enhanced rate is to reimburse providers for the amount of support that will be needed during someone's period of initial transition from 24 hour services to SIL. We anticipate providers will be providing more than the average amount of SIL support while someone adjusts to a new level of support. Edits in the TennCare billing system will check for at least 30 consecutive days of a 24 hour residential service being provided prior to permitting payment of the SIL transition enhancement rate. Providers may bill the enhanced rate for up to 30 days post transition to SIL.
Note: For individuals in the Statewide Waiver, the SIL transition enhanced rate will count against the annual cost neutrality cap.
3. A one-time SIL transition incentive payment of $2500.00 is available (one-time per recipient per provider) to providers who successfully transition someone from 24-hour residential services to SIL services. This one-time payment shall be made after six consecutive months of SIL services. Prior to permitting payment for the SIL incentive payment, the TennCare billing system will check for a 24 hour residential service being provided prior to the six consecutive months of SIL required for an incentive payment. This six months must be six consecutive calendar months and can be comprised of one of the two following:
• A combination of SIL enhanced transition services and adjacent, consecutive months of SIL that equate to six consecutive months of service; OR
• Six consecutive calendar months of SIL (in the event someone transitions to SIL and did not need enhanced services)
Note: For individuals in the Statewide Waiver, the incentive payment will not count towards the cost neutrality cap.
