Participant-Directed Services in Managed Long-Term Services and Supports Programs: A Five State Comparison. Appendix C. Tennessee Enrollment Targets and Pd-mltss Performance Measures

08/23/2013

Tennessee developed distinct benchmarks, standards, and quality outcomes for PD-MLTSS programs. Quality benchmarks specified in Tennessee's contract18 require the three MCOs (United HealthCare, Amerigroup, and Volunteer State Health Plan) to increase the number of participant-directing members each year over the life of the contract. The contract specifies the level of increase from one year to the next. For example, Tennessee's United Healthcare contract specifies that the MCO is measured against the following goals:

  Year     # Participant-Directing  
2011 450
2012 750
2013 1,000
2014 1,250
2015 1,400
2016 1,500

In Tennessee, the FMS and MCO routinely forward the following reports to the state: (1) number of members electing the participant-directed option including their name, social security number, and phone number; (2) number of members who disenrolled and reason for the action; (3) reports and investigations of critical incidents and results of follow-up; (4) number of fair hearings requested; (5) number of scheduled visits with self-directing members; (6) number of late or missed home assessment visits; (7) maximum and average time from FMS referral to commencement of participant direction, including the date the member was referred to the FMS; (8) number and percent of members enrolled in participant direction who appointed a representative to manage the program on their behalf; (9) number and percent of members receiving participant -directed services by type of service (attendant care, companion care, homemaker, in-home respite, or personal care); (10) total number of members who do not wish to receive traditional home and community-based services from contract providers pending enrollment into participant direction; and (11) the total number of days per member that home and community-based services have not been received.19

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