TDC's 2025 Policy Priorities
Paid Family Caregiving: Part 1
For years, TennCare has effectively prohibited the payment of family caregivers for the care they provide to their loved one with a disability – both through formal and informal means – even when the state has failed to provide promised home- and community-based services. This discriminatory practice has exacerbated the workforce crisis, heaped substantial responsibility for care onto family members and actively harmed Tennesseans with disabilities and their loved ones.
This bill would prohibit TennCare from creating policies that discriminate against family caregivers in the ability for local provider agencies to hire them as Direct Support Workers (DSP’s). The bill also requires TennCare to compile and publicly share a document that outlines the procedure for provider agencies to hire and supervise family caregivers. Essentially, the bill creates a reliable pathway for a family member – including parents – to be paid for providing care to a loved one with a disability.
The goal of this legislation is to provide some degree of financial relief to family caregivers, while ending a discriminatory hiring prohibition. This also sets the stage for “Part 2” legislation next year, which would provide opportunities for family caregivers to gain care skills, or certify existing care skills, and receive appropriate compensation for that work.
TennCare Network Reporting Reform
Currently, TennCare must report the quality of their provider network – doctors and specialists who treat patients enrolled in a TennCare program – based on several outdated and misleading indicators. These data points are things like the amount of time it takes a person to drive to a providers office or the distance between a TennCare enrollee and a TennCare provider. These statistics do not account for the actual care, supports and services that a person receives, only whether or not a provider is within the required time and distance standard.
This means that many TennCare members – those in ECF CHOICES or CHOICES or Katie Beckett, for example – may live in an area where they cannot access necessary care or home-and community-based services. However, because TennCare reports network adequacy using outdated metrics, it appears as though TennCare has done enough to ensure that member has access to care. This leads to long wait times for appointments, services promised by the state that never arrive and negative outcomes for people with disabilities.
This bill would change the network adequacy reporting standard from the supply side – time and distance between members and providers – to the demand side – if people are actually able to receive the care and services that are promised to them. The bill would require TennCare to publicly report percent service utilization (what percent of promised services did members actually get), time between approval for a service and delivery of that service, and appointment wait times. The data is also required to be broken down by county, TennCare program and demographics.
The goal of this legislation is to highlight the fact that many TennCare enrollees do not actually receive the extent of services promised to them by the state. By bringing to light what we anecdotally know to be an inadequate provider network, the disability community and our allies can push TennCare to do more to improve the provider network and thus, improve access to care and services.
Katie Beckett Part A HRA
As part of its design, the Katie Beckett program is broken into two parts: Part A and Part B. Part B is considered a “Medicaid Diversion” program, which offers enrollees $10,000 to help pay for home- and community-based services (HCBS). These funds are utilized via a Health Reimbursement Account (HRA) – a member buys and item under the program, sends in a receipt, and is reimbursed for the expense, up to $10,000.
Part A enrollees receive up to $15,000 in home- and community-based “wraparound” services, but these are administered differently from the funds in Part B. Part A enrollees must go through a Managed Care Organization (MCO) like Blue Cross Blue Shield, Wellpoint or UnitedHealthCare to purchase HCBS items. Since the beginning of the Katie Beckett program in Tennessee, this process has shown itself to be difficult, wasteful and unhelpful.
This bill would change how Part A enrollees are able to utilize their HCBS funding, from MCO to HRA. We believe that this would allow families far greater flexibility in making choices about the care of their loved one with a disability, and would allow them to use their HCBS funds in more effective and efficient ways. It is also possible that this bill contains other “fixes” for issues in both Part A and Part B of the Katie Beckett program. Any further policies included in this bill would be at the discretion of the legislative sponsors.
Academic and Behavioral Specialist Teaching License
As TDC reported in a white paper published this summer, students with behavior needs are struggling to succeed in Tennessee schools. One of the reasons for this issue is because teachers do not know how to effectively work with this population of students. In fact, they tell us this: according to the 2023 Tennessee Educator Survey, 59% of teachers in the state say they do not know how to support students’ behavioral success. It is possible that teachers say this because their Teacher Preparation Programs (TPP’s) do not offer enough coursework on how to foster success for students with behavior needs.
This bill would establish a new category of teaching license meant to prepare special education teachers to successfully teach students with behavior needs. This license – called an Academic and Behavioral Specialist (ABS) – would place additional focus on behavioral interventions, Behavior Intervention Plans, Functional Behavior Assessments and other strategies for effectively working with students with behavior needs.
Disability Accommodations in the Open Meetings Act
There are dozens and dozens of councils, advisory groups, commissions and boards across the state that do the hearty work of local governance. Those bodies are made up of Tennesseans from all walks of life, including those with disabilities. The inclusion of people with disabilities is vital to ensuring that the needs of our community are considered when decisions are being made.
All public accommodations, including boards and commissions, are required to abide by the Americans with Disabilities Act. However, there have been numerous instances across the state in which Tennesseans with disabilities who are participating as members of these governing bodies have not received reasonable accommodations for their participation. In some instances, this has meant that they could not participate virtually, in others, it has meant that meeting activities are inaccessible.
This bill would clarify that all “governing bodies” subject to the Open Meetings Act must indeed offer and provide reasonable accommodations, as defined in the Americans with Disabilities Act, for the participation of Tennesseans with disabilities.
Threats of Mass Violence Protections
During the 2024 General Assembly session, legislators passed a new law that would make levying a threat of mass violence directed at a school a felony. The law also requires school personnel to report any and all threats, regardless of validity, to law enforcement. Initially, the law had protections only for people with intellectual disabilities, but this protection is limited by an error in the code.
This has led hundreds of Tennessee students across the state to be arrested and investigated by law enforcement for purported threats. However, many of these threats are clearly unviable threats, and many have been functions of a disability. We understand that students with disabilities manifest behaviors, including words, that are functions of that disability. Our school system accommodates this fact through accommodations and modifications found in an IEP. However, this law does not account for this same consideration, which misaligns protections for people with disability in schools and a lack of protections under the law.
This bill would expand protections for people with disabilities and provide a level of discretion for school personnel to judge the viability of a threat before contacting law enforcement. This would better align what we know about disability and what we practice in the public school system to the degree of culpability for manifestations of a disability under the law.
ECF Resolution
The state’s Employment and Community First CHOICES program, which serves Tennesseans with intellectual and developmental disabilities, has become outdated and ineffective. This is especially true for those with higher levels of need, including complex medical cases and behavioral health needs. Further, its hyper-focus on employment exists to the detriment of all other forms of independence, including adequate home- and community-based services (HCBS) and residential options.
It is time for TennCare to reevaluate the priorities inherent in ECF CHOICES and to rebuild a modern waiver program that meets the needs of Tennesseans with disabilities. This resolution is the opening salvo to what is likely to be a difficult change to instigate. The resolution will urge Tennessee modernize ECF CHOICES to ensure that Tennesseans with disabilities – which manifest across the spectrum of need – have access to vital home- and community-based services, including more intensive residential support, to allow them to live and thrive in lives of their choosing.
Get Breaking Disability Policy Updates in Tennessee
Fill out the form below to join our email list and stay connected.
Text TEAMWORK to 72690
to get policy updates and alerts sent straight to your phone.
*Msg and Data rates may apply. Avg 1-4/msg per week. Reply HELP for help or STOP to cancel.