Independent Support Coordination
Frequently Asked Questions
What is the Medicaid Waiver Program?
The Medicaid Waiver Program is also known as the Home and Community Based Services (HCBS) Waiver or the Waiver. It is called the Waiver because some requirements are “waived” or set aside so people with mental retardation and developmental disabilities can receive the support they need to live in the community instead of a developmental center. Medicaid funds these supports.
What is an Independent Support Coordinator?
An Independent Support Coordinator (also known as an ISC) is a person who works with you to help you meet your personal goals. The ISC helps locate resources, develops appropriate supports and services, helps you make informed choices so you can decide what is important to you, and monitors implementation of your plan. The ISC will visit with you each month to get to know you well and share information about services and supports so you can live successfully in the community. Once every third month, the ISC will visit you in your home if you receive services there. Everyone receiving services through the Medicaid Waiver program has an ISC.
What is a Circle of Support (COS)?
The Circle of Support (also called the COS) is the group of people who helps you with the planning process. The person supported and his/her legal representative, if applicable, directs the COS. The person supported and/or the person’s legal representative determines who participates in the COS. Because the mission of the COS is to support the person in developing an ISP that will guide the achievement of the person’s outcomes, the person may change the membership of the group at any time. For example, the COS includes the person supported, his/her legal representative, the person’s family member(s), ISC or CM, and any providers of supports and services the person receives. Friends, advocates, and all other non-paid supports are included at the invitation of the person supported.
What is an Individual Support Plan and who writes it?
The Individual Support Plan (ISP) is a form that tells everyone what is important to you, what your goals are for the future, how you want your life to look, the help you need to accomplish those goals, the paid services you are receiving now, the services you need and the people who help you. The ISC will ask you during regular monthly visits about your interests, goals, wants, needs, etc. and will make changes when needed to the ISP. You or your legal representative can also ask for changes to be made in your ISP as needed. Once a year, the ISC meets with you, your legal representative and others that you choose to invite (or not invite) to write the ISP based on what you and your legal representative want, any suggestions your friends may give and any information your doctors provide about your needs. You should be involved in scheduling the meeting, directing the plan, etc. If you need to change the time or location of the meeting, just let your ISC know. Your ISC will contact everyone to reschedule the meeting. Before the meeting, your ISC will write up a draft ISP that should be a good example of what you have told the ISC you want. The draft is sent to you, your legal representative and all other members of your circle of support, unless you’ve told the ISC not to send it to someone. It is very important that you and your legal representative look over the draft and tell the ISC if there are things that need to be changed or if it’s written in a way that you can’t understand. During the year, as you think of things you would like to try or things you would like to do differently or changes that need to be made, let your ISC know so changes can be made in your ISP as needed. The ISP should be a reflection of what is important to you! As soon as the ISP is written, it will be mailed to you and everyone who came to the meeting, unless you told the ISC not to send it to someone. Make sure you look over it again to be sure everything is clear. Ask your ISC about any questions you may have. The ISC will make sure that everyone gets an updated copy when significant changes occur. Every time you get an updated ISP, look through it to make sure it’s correct and be sure you don’t have any questions. Ask your ISC about any questions you may have. If you are not satisfied with your services or supports, let your ISC know right away. The ISC will work with the provider to resolve any concerns and will notify the Department of Intellectual and Developmental Disabilities (DIDD) of any problems as needed.
What if there are things in my plan that I don’t agree with or don’t think should be in there?
The ISC makes every effort to write the plan in a respectful way but still provide the information that the staff working with you will need to know to keep you safe and help you live the life you want to live. Sometimes it can be difficult to find the best way to share information. That’s why it’s important that you and the people you have invited to be part of your circle of support work together to make sure the information is accurate and respectful. Your plan of care should respect your wishes about how your care is delivered. If you feel that something is written wrong in your plan, could be said in a better way or if something has changed and your plan needs to be updated, contact your ISC and talk about it. Sometimes your plan may stop you from doing something you want to do but that should not happen without talking with you and your circle of support about ways to minimize risks and plan to remove the restrictions as soon as possible.
What if I don’t understand the things I’ve been told?
You should have the information you need so you can make decisions, help develop your ISP and make choices about things that are important to you. If you are not sure you know what something means, you should ask your ISC, your circle of support or your staff anything you want to know more about. If you still aren’t sure what something means, keep asking questions. Answers should be provided in a way that makes sense for you.
Will the Medicaid Waiver pay for everything I need?
No. The Medicaid Waiver Program is designed to help people continue to live at home with their families and to help people move out of Institutions so they can live in the community. The Waiver provides a variety of services but will not pay for a service that is covered by other insurance. It is not a “sure thing.” Your ISC must try to find a way to get the things you need through some other source in the community before he or she can ask the waiver to pay for them.
How do you help me get the things I need?
First you tell the ISC what you need. The ISC will try to find a way to get it by looking for community programs to pay for it or by asking TennCare to pay for it. If there are no community programs and / or TennCare denies it, we can fill out the services and supports section of your ISP to ask for the funding. The ISC can appeal if TennCare denies it and will send the denial letters with the paperwork asking the waiver to pay for the things you need. The ISC updates your ISP to include information showing why you need the things or services you are requesting and sends it, along with other required information (your budget, bank statements, etc. as needed) to the DIDD Regional Office. Once there, the Plans Review staffs look at it and decide if the request will be approved, denied or partially approved. This process may take up to 21 days. Services cannot begin and items cannot be purchased until the approved paperwork has been received from the Regional Office. Everyone in your circle has to work together to explain why you need these things and get any additional paperwork needed to the ISC so it can all be sent in. It takes teamwork to get services approved for you.
Why does it take so long for the ISC to get funding for things I need?
Many things can slow down the process of getting funding. ISCs cannot submit any requests to the waiver without going through TennCare or looking for community programs to pay for the things you need. When information is sent to TennCare, they will decide if you need the thing we asked for. TennCare has up to 21 days to make a decision. If they approve it, you get it pretty soon. If they deny it, we have to appeal within 30 days to TennCare Solutions. TennCare Solutions looks at all the information and will take up to 14 days to make a decision. If they deny it again, we have to go on to a hearing and have a judge decide. TennCare sets the dates based on when the court can review the information and will tell you and your ISC so you can give the judge more information. Once the judge makes a final decision, the court will send the ISC paperwork to show what the judge decided. If the judge denied the request, the ISC will send the court paperwork and other information to DMRS for review. The review process starts over at this point and follows the process described in the question above.
What do I do if a service I need is denied?
You have the right to appeal! An appeal can help you get the answer you need. If you appeal, someone else will take a look at what you need. They will try to fix it quickly. If they cannot, you will get a chance to tell your side of the story to someone who does not work for the DIDD. If you are already getting the service, you may be able to keep getting it during the appeal. To do this, you must appeal by the date your service will be stopped. You must say you want to keep getting the service during the appeal. If the appeal is decided against you, you might have to repay the Medicaid Waiver program for the service you got during the appeal. To appeal, call your ISC for assistance. He or she will call the TennCare Solutions unit to appeal for you and can answer any questions you may have. The ISC Supervisors and Director of Support Coordination are available to the ISCs to answer questions about the appeals process and provide any help needed.
What do I do if I am supposed to get a service but I haven’t started receiving it yet?
Call your ISC. Your ISC will find out the date the service is supposed to start. Sometimes the service has to start on the first day of the next month; the date may have been changed, etc. The ISC will check the date for you and contact the agency that is supposed to be providing the service. It is your choice whether you want to wait and see if the service starts in a couple of days or you want the ISC to appeal the delay to the DIDD Regional Office. The ISC will have to let the Regional Office know that the service has not started and tell them what you want to do (wait or appeal.) You should not go without the service you need for very long and your ISC needs to know right away if you are not getting the support you need.
What should I do if I don’t agree with the ISC about something?
It is extremely important to The Arc of Davidson County & Greater Nashville that all people are valued, treated with respect, dignity and fairness and have positive interactions with others. Your ISC should advocate for you to be treated appropriately in all settings. If you do not feel you are being treated respectfully by your ISC or if you don’t agree with the ISC about something, please notify the appropriate ISC Supervisor (Kristi Lane 615-321-5699 ext. 215, Shannon Arrington 615-321-5699 ext. 225 or Anna Flatt, 615-321-5699 ext. 238) as quickly as possible. The supervisors will follow up on your complaint right away. If you do not feel comfortable discussing your concerns, please ask a trusted family member, your legal representative, or someone else that you trust to call one of the supervisors for you. You can also make a complaint without giving your name.
What if I have already complained to the ISC Supervisors but I’m not satisfied with the results?
If the ISC Supervisors have not been able to help you, please contact Sheila Moore, Executive Director, at 615-321-5699 ext. 216 to talk about your complaint. You can make a complaint without giving your name.
If you still feel that you need more help and that the problem was not solved, please call the DIDD Customer Focus Unit (615-231-5492) and let them know the problem you are having. You can talk to them without giving your name. They will follow up to make sure that the problem is resolved.
Can I change to a different service provider if I want to?
Yes! You can choose from any of the service providers who work in your area. This includes all providers, whether residential, day, nursing, Independent Support Coordination (ISC), etc. If you would like a change in ISC agency, you should contact Kelly Hyde, DIDD Regional Office to let her know you want to do this. Only you or your legal representative can make this change. If you want to change any of your other services, let your ISC know. He or she will work with you to try to find another agency that meets your needs. It is best if we try to work with the provider to fix any problems you are experiencing before asking for a change in provider and we will be asked to explain all the things that have been tried to fix the problem but, ultimately, the choice is up to you.
Can I change from one doctor to another?
Yes, and your ISC can help you do this. Just let your ISC know and he or she can get a list of names of doctors (or other TennCare providers) that accept your TennCare plan. Once you choose the doctor (or provider) you want to change to, the ISC can call to see if they are accepting new patients and help you make the change to the new doctor.
I have heard about something called TENNderCARE. What is it?
TennCare’s TENNderCARE is a program of scheduled checkups and screenings for children 21 and under to find and treat health problems. These checkups are free for all children who have TennCare. Checkups include physicals, eye tests, hearing tests, shots, growth and development checks, nutrition checks and facts on healthy eating, referrals to a dentist for regular checkups and many include other tests or referrals to specialists such as Physical Therapists, Occupational Therapists, Speech Therapists, etc. Before your ISC is able to ask for any therapy services through the Medicaid Waiver (for children 21 and under), he or she will have to see if TENNderCARE will pay for it first. If TENNderCARE decides not to pay for it, the ISC can send in a request (called a service plan) asking for Medicaid Waiver funds for the service you need.
What should I do if I don’t feel safe at home or at work?
Call your ISC right away to let the ISC know that you don’t feel safe and why. The ISC will call the agency who helps you to tell them about your concerns and will make sure steps are taken to resolve them. The ISC will keep talking to the agency about your concerns until they are resolved. As your ISC visits each month, he or she will ask you if you feel safe and help make sure you are as safe as possible by ensuring your environment poses no risk to you.
What should I do if someone has tried to hurt me (abuse), isn’t taking care of me (neglect) or has tried to take advantage of me (exploitation)?
Preventing and reporting abuse, neglect and exploitation is everyone’s job. You should notify someone you trust right away, such as a family member, the staff who works with you or your ISC. You or the person you trust should call the DIDD Investigators (1-888-633-1313) and let them know you believe that you have been abused, neglected or exploited. You do not have to tell them your name. If you or your family member do not feel safe calling the Investigator yourself, contact your ISC or a trusted staff who works with you right away and ask them to report the information to the Investigator. DIDD requires anyone who provides services to you to quickly report allegations of abuse, neglect and exploitation. When a person has been harmed or abused, State law requires reporting to Child Protective Services if the person is a child (1-877-237-0004) or Adult Protective Services if the person is an adult (1-888-277-8366.)
Will someone get mad at me if I report an incident of abuse, neglect or exploitation?
The DIDD makes sure that no one at any provider agency will retaliate against any person for reporting, witnessing, or participating in the incident management and investigation process. If you feel that someone has retaliated against you, you should contact Levi Harris, DIDD Regional Director and let him know this happened. The provider agency can be fined up to $500.00 per event.
Who decides what I can and cannot do each day?
YOU do! our ISC, family and friends will help you decide what is important to you by telling you about options that are available so you can make an informed decision and have a meaningful life. Some of these choices include who comes to your meetings, which agencies you want to work with you, where and with whom you want to live, how to spend your money, activities you want to participate in, where you want to work, and many others. Your circle of support will make sure you have the information and support you need to make choices about your life and will advocate for you to be an active participant in community life and hold a valued role in the community.
What if I don’t like where I live or don’t get along with my housemate?
If you don’t like where you live or are having problems with your housemate, let your ISC know. The ISC will contact your circle of support and set up a meeting to figure out what is working and not working and try to fix the problems. If the problems can’t be worked out, you can choose to move to a different home with a different housemate. Depending on your needs and budget, it may be possible for you to live without a housemate or to purchase a home of your own. You have the right to choose where you live and receive services and visit several places before making a choice or homes, housemates or providers. Once you have chosen the home you want to live in and the agency who will provide the services, the ISC will get your circle of support together so a transition plan can be developed to show how you will safely move from one home to another and the date the circle of support expects you to move. The plan has to be approved by DIDD before you can move.
Can I work if I want to?
Yes! There are many jobs available in the community to choose from. Let your ISC know if you are interested in working. The COS will meet to talk about the kinds of work you are interested in, jobs that you’ve done before, things you liked or didn’t like about other jobs, etc. and then come up with a plan to get a work assessment through Vocational Rehabilitation. Once the paperwork is completed, Vocational Rehabilitation will help you find an agency that will help you look for a job.