Help! My Services have been cut by DMRS

The Division of Mental Retardation Services (DMRS) has announced it will review all cost plans and make recommendations for reductions in services to individuals in the Medicaid Waiver program. This website includes current information from DMRS, your right to appeal the changes in your or your family member’s services and a form to use to file that appeal.

NOTE: YOU MUST FILE AN APPEAL WITHIN 10 DAYS OF WHEN THE LETTER OF DENIAL OR CHANGE OF SERVICES WAS SENT IN ORDER TO CONTINUE RECEIVING SERVICES WHILE YOUR APPEAL IS BEING HEARD.

This website includes information on how to submit an appeal and a place for you to tell your story so that The Arc will be able to share with legislators how these cuts are impacting you.

1. Introduction
2. Formal Appeal Notice
3. Bulletpoints on how to Appeal
4. Form to use for Appeal
5. Submit your stories

Introduction

The Tennessee Division of Mental Retardation Services (DMRS) has implemented two actions in an effort to lower the cost of services in its Statewide Home and Community Based Services Waiver. Both actions can have an effect on people receiving supports either by eliminating a service that is needed to assure the safety and wellbeing of the individual or by reducing the quality of services currently being realized by the individual being supported. This review does not apply to the Self-Determination Waiver or the Arlington Waiver.

The first action involves review by the DMRS Regional Office of each Individual Support Plan (ISP) to evaluate what services can be reduced or eliminated entirely. This may include (but not limited to) the reduction or elimination of specific therapy services such as Physical Therapy, Occupational Therapy, Speech Therapy or Nursing services. To read the first letter to all providers of services on October 24, 2007 regarding the cost review initiative click here [Memorandum - Cost Review Initiative 10-2007.pdf]. To review the protocol utilized by the regional office staff click here [letter,1-9-08.pdf]

The second action involves an across the board reduction in rates paid to the providers of services in the statewide Home and Community Based Services Waiver. This rate reduction began at 5.7% through a memorandum from Steve Norris on December 6, 2007 [Payment Reduction Memo From SN120607.pdf]making these rate reductions retroactive to services provided in October, 2007.

Subsequently a series of letters from The Arc of Tennessee [SN Letter on Payment Reductions 121707], the Court Monitor in West Tennessee [Donald.nkr.020108], the Quality Review Panel in Middle, East, and West Tennessee [dec 20], People First Attorneys [People First Demand Ltr to Dycus and Lakey 0102080001], TNCO, and various other advocacy organizations caused DMRS to rethink their position and another memorandum was issued on December 26, 2007 [Main Waiver Rate adjustment 12-26-07] reversing the decision to reduce rates retroactively and instead reducing rates by 6.1% each month from January 1, 2008 through June 30, 2008.

As a response to the reduction in rates and the reduction or elimination of services through the DMRS cost plan reviews, People First of Tennessee attorneys sent a letter on January 23, 2008 [People First ltr 012308 to Dycus and Lakey0001] asking for a meeting to discuss the effect on people. DMRS did not respond to the request.

As a result People First has entered contempt motions in the Arlington Case to stop both the payment reductions and the cost plan reviews currently being used by DMRS.

Formal Appeal Notice

When your family member’s Individual Support Plan (ISP) has been reviewed and a decision to reduce or eliminate a service is made, DMRS will send a letter either to the person or their legal representative (conservator) and the Independent Support Coordinator (ISC). This letter will state the intent to reduce or eliminate a service. It is very important for you as a family member to alert your ISC, the Service Provider, and the staff at your family member’s home that you want to be informed immediately if a service is going to be reduced or eliminated. You must review the service reduction and make a decision if this reduction will have a negative effect on the supports that are currently being received.

The Arc of Tennessee has advocated for individuals and families to be involved in the cost plan review process but to date has had no success in having this included. DMRS is meeting with provider agencies in Middle Tennessee and most likely will be doing the same in East and West soon. The purpose of these meetings is to review the services a person is receiving and determine if a person can do with out a service, a reduction in the frequency of the service, or if living alone, could live with someone else (either in the home they currently live or to move to another home of another person receiving services).

If your family member receives a letter stating that services are going to be eliminated or reduced you will have only 10 days to file an Appeal [DMRS Grier APPEAL FORM] of this decision and keep services in place until the appeal is heard. While you do have up to 30 days to actually file the appeal, after the 10 days your family member’s will be terminated while you are waiting for the appeal hearing.

You will not receive a notice when the rates are reduced. It will be up to you and your family member’s Circle of Support to determine if the reduction has reduced the intensity (such as the staffing utilized in a residential service), the frequency (such as how often a person may receive Occupational Therapy), or duration (such as limiting the time frame that Speech Therapy may be authorized to only 90 days).

Should you and your family members Circle of Support determine that the intensity, frequency, or duration will adversely affect their health and well being an Appeal [DMRS Grier APPEAL FORM] should be filed within 10 days so as to keep the service in place!

Bullet points on how to Appeal

• An appeal may be filed if a person’s Medicaid Waiver services have been denied, terminated, reduced, delayed or are not being provided as needed. Anyone may submit an appeal on the person’s behalf. You do not have to use this form to file an appeal. You may make your appeal in a letter or you may call in your appeal. The appeal must be made within 10 days of the date of the adverse action notice (letter) from the Division of Mental Retardation Services (DMRS)
• Question #1 - Complete this section
• Question #2 - This is the person that DMRS or TennCare should call for more information. Leave blank if same as the person submitting the appeal
• Question #3 - If DMRS denied, terminated, suspended, or reduced a service, only check Need care or medicine with an X. You may request that the service be continued as currently authorized while the appeal is being considered and until a final decision is made by the TennCare Solutions Unit. To request a continuation, you must submit the appeal within 10 days of the date of the adverse action notice from the DMRS
• Fill out Part B on Page 2
• Question #4 - DO NOT MARK the box for an EMERGENCY APPEAL.
• Question #5 - If desired, you may state below the reasons for this appeal OR attach additional information. However, you may leave this section blank if you wish. You are not required to provide any additional information at the time that you file the appeal. You will have a chance to provide more information about your appeal to the DMRS or TennCare after you file the appeal. Someone may call and ask you for more information about your appeal. If there is a hearing about your appeal, someone will contact you to schedule the hearing. During the hearing, you will have an opportunity to tell your reasons to administrative law judge
• How to File Your Medical Appeal - You may fax, mail or call-in your appeal. The appeal goes to the Bureau of TennCare’s Solutions Unit. TennCare Solutions handles all Medicaid Waiver and TennCare appeals. You may also send a copy to the Regional Office of the Division of Mental Retardation Services. Keep a copy of your appeal and a record of when you submitted the appeal.

Fax TennCare:
1 – 888 – 345 – 5575
(Toll Free)

Mail:
TennCare Solutions
P.O. Box 000593
Nashville, TN 37203 – 0593

Call TennCare:
1 – 800 – 878 – 3192
(Toll Free)

DMRS Regional Office Fax Numbers:

West
Attention: CJ McMorran
901-867-7809

Middle
Attention: Kathleen Clinton
615-231-5150

East
Attention: John Craven
865-594-5180

Submit your stories

The Arc of Tennessee is asking you to submit information about your family member and you and the effects that either the Funding Rate Reduction or the Cost Plan Review (and ultimate reduction or elimination of a service) has had on your family member receiving Medicaid Waiver funded services. It will be utilized to track what is happening to people as a result of the actions by DMRS. If you provide us with permission to do so we will post this information on our website without identifying information. We will tally all information and provide the information to legislators and the administrators of the Division of Mental Retardation Services when advocating for change in the process of reducing costs of services.

If you would like to share your story, email it to cuts@thearctn.org. Please provide:

• the name of your family member
  
• your name
  
• contact information including the county your family member lives
  
• the agency providing the supports to your family member
  
• the reduction or elimination of a service
  
• the effect that this has had on your family member's quality of services being provided to them
  
• whether or not you give us permission to post your story on our website