Tennessee Employment Application

The Company, Advantage Home Care (includes Advantage In-Home Services, LLC , Advantage Consumer Directed Services, LLC and TPC Advantage, LLC) will obtain background checks as a consideration of employment that may include, but not limited to: employment and education verifications, social security verification, criminal history, civil history, consumer reports that include nationwide background checks, sex offender registry, highway patrol records, Department of Motor Vehicle (DMV) records, finger prints, Division of Homeland Security, public records of any kind, personal interviews and other screenings. As required by regulation, Advantage Home Care requires applicants to be registered with various state registrars prior to an employment offer being made. As allowed by law, applicants and employees are required to disclose all aliases, social security numbers and criminal convictions, findings of guilt, pleas of guilt and pleas of nolo contendere except in minor traffic violations. Applicants applying to work in the state of Illinois are not obligated to disclose sealed or expunged records of conviction or arrest, nor if they exist. All employees are required to complete an I-9 at hire and provide proof of identity. Advantage Home Care participates in E-Verify through the Division of Homeland Security. Employment is contingent upon the results of thorough background checks pursuant to federal and state regulations and Company policy. Persons found guilty of a prohibited offense as defined by regulation, regardless of adjudication or a plea of nolo contender, are not eligible for employment. Other offenses and findings may require a formal waiver to be obtained before employment will be considered as defined by regulation or make a person ineligible for employment per company policy and/or company discretion. Background checks are conducted prior to hire and throughout employment.

CONFIDENTIALITY, NON-DISCLOSURE AND NON-SOLICITATION AGREEMENT

This Confidentiality, Non-Disclosure and Non-Solicitation Agreement (“Agreement”) is made and entered into in the State of Tennessee by and between Advantage Home Care and all related companies (or “Employer”) and the “Employee” named in this application as of the date the “Employee” provided their acknowledgment of the agreement contract terms.

WHEREAS, Employee acknowledges Employer is engaged in a specialized and highly competitive business providing, among other services,

WHEREAS, Employer desires to employ (or continue to employ) Employee and Employee desires to be employed (or continue to be employed) by Employer as an In Home aide and/or Consumer Directed Services Attendant and

WHEREAS, Employee acknowledges that the execution of this Agreement is an express condition of Employee’s employment (or continued employment) with Employer; and

WHEREAS, no contract regarding the length of employment is created by this Agreement and the employment relationship between Employer and Employee is terminable at the will of either party.

NOW, THEREFORE, in consideration of Employee’s employment (or continued employment) with Employer, and for other good and valuable consideration, the receipt and adequacy of which are hereby acknowledged, Employer and Employee hereby agree to execute and be bound by this Agreement as follows:

1. DEFINITIONS: In this Agreement:
Client or Clients means any individual, couple, group of individuals, or other entity that has been solicited, contacted, or served by Employer at any time during the twenty-four (24) month period prior to the discontinuation of Employee’s employment with Employer.
Referral Source means any individual, proprietorship, partnership, corporation, association or other entity that has referred Clients to Employer at any time during the twenty-four (24) month period prior to the discontinuation of Employee’s employment with Employer.
Competing Business means any individual, proprietorship, partnership, corporation, association or other entity other than Employer which: (i) is engaged in, or is about to be engaged in, non-medical home care service, skilled nursing visits, personal care services, attendant services, companion services, pediatric care, consumer directed care, house cleaning, grooming, meal preparation, respite care, and medication assistance and reminders.

Trade Secrets mean any technical information and business information that generally facilitates the sale and performance of Employer’s services, increases revenues, or provides an advantage over Employer’ competitors and is not generally known.
Know-How means all factual knowledge and information related to Employer’ business which is not capable of precise, separate description but which, in accumulated form, after being acquired as a result of trial and error, gives to the one acquiring it the ability to produce and market something which one would otherwise not have known how to produce and market with the same accuracy or precision necessary for commercial success, provided, however, that such knowledge and information is not in the public domain or readily available to any third party other than a limited number of persons who have agreed to keep that information secret.
Confidential Information is information acquired by Employee in the course and scope of his or her activities for Employer or to which Employee is, was or will be exposed to by Employer that is designated by Employer as “confidential” or that Employer indicates through its policies, procedures, or other instructions, or by this Agreement, should not be disclosed to anyone outside Employer except through controlled means. Confidential Information need not be a Trade Secret, Intellectual Property, or Know-How to be protected under this Agreement. The parties to this Agreement specifically agree that, regardless of its affect on trade secret status, the controlled and limited disclosure of Confidential Information to third parties for legitimate business purposes and the availability of the Confidential Information to others outside Employer through independent investigation and effort will not remove it from protected status as Confidential Information under this Agreement if Employee was first entrusted with the Confidential Information while employed by Employer. “Confidential Information” includes, but is not limited to, any and all trade secrets and/or confidential, financial or business information of Employer, or any of its direct or indirect subsidiaries or affiliates, including, but not limited to, (i) names, addresses, phone numbers, e-mail addresses, w-2 information, work history, qualifications, work performance and contact information for Employer’s employees, (ii) names, addresses, telephone numbers and e-mail addresses of customers/clients (and key contacts related to customers/clients), and other business information concerning the level of business provided to any such customer/client, the business preferences and requirements of any such customer/client, prices charged such customer/client, or other business information which otherwise would be of assistance in marketing, serving and/or retaining any such customer/client, (iii) financial statements or reports, marketing or business plans, marketing or business techniques, market analysis, marketing or business plan development material, management information system material, Employer’s statistical information, prices charged customers, quality assurance data, financial status, profits, profit margins, accounts receivable and payment information, and other financial information of or concerning Employer, or any of its respective direct or indirect subsidiaries or affiliates, (iv) marketing and bidding information, rates, price and quotation techniques and methods, sales volumes and profits, margins, marketing plans, strategies and projections, business methods, forms and procedures, (v) operating procedures and manuals, forms, policy manuals, customer/client evaluation procedures, standard of care and outcome measurement data, and companies and contacts from whom Employer, or any of its respective direct or indirect subsidiaries or affiliates obtains various products for sale, resale and marketing, (vi) lists of customers/clients, including but not limited to, any such information maintained on any computer system or data base, (vii) computer software or other data, (viii) accounting information, cost information, discount information, pricing and pricing structure, source codes and/or object codes, technical data, product specifications (of Employer, or any of its respective direct or indirect subsidiaries or affiliates and of any customer of any such business or entity), sales and other records, process technology, lists of customers, and computer software systems and programs, (ix) trade secrets, software, object code, manuals, product design, plans, financial information, software designs and programs, sales and customer information, and other information of Employer, (x) personnel and internal business records and plans, and other information that may not be known generally or publicly outside Employer, or any of their respective direct or indirect subsidiaries or affiliates which gives such business or entity an advantage over its competitors who do not have access to or know or use it, and (xii) other information concerning Employer and customer projects, proposals, financial and operating data.
Company Information means Trade Secrets, Know-How, and Confidential Information (recognizing that certain information and material will fall into multiple categories).

2. CONFIDENTIALITY AND NON-DISCLOSURE AGREEMENT: Employee recognizes and acknowledges that Employer has a legitimate business interest to keep certain information confidential at all times. Employee further acknowledges that Employer’s Confidential Information, including, but not limited to, referral sources, clients, and customers of Employer who utilize or are serviced by Employer’s programs as well as the employees and staff who are employed by Employer, are valuable and unique assets of the Employer’s business and were acquired and developed at considerable expense to the Employer. Effective immediately and at all times thereafter, Employee shall hold in strictest confidence and shall not disclose to any person, firm, corporation, partnership, agency, commission, institution or other entity, without the express prior written authorization of the President of Employer, or any other designee selected by the President of Employer, any Confidential Information, Trade Secrets, Know How and/or Company Information relating to any business of Employer.
(a) By virtue of Employee’s employment by Employer, Employee will become familiar with and possess documents and information which are Confidential Information, Trade Secrets, Intellectual Property and/or Company Information, as defined in this Agreement, and Employee will become personally acquainted with certain Referral Sources and Clients of Employer. Employee further acknowledges that Employee will acquire a special relationship with many of the Employer’s Clients and Customers through this employment. Employer and Employee specifically agree and acknowledge that any and all Confidential Information or Trade Secrets provided by Employer or otherwise obtained by Employee during the term of this Agreement is proprietary, unique and commercially sensitive in nature, represents in many instances advanced and state of the art technology, and has been developed over time and reflects a substantive investment by Employer. Employee further acknowledges that Confidential Information and Trade Secrets provided by Employer are not matters of public or general knowledge in the industry and that Employer derives economic value (whether actual or potential) from such information. Employee acknowledges Employer has maintained substantial secrecy concerning the Confidential Information and Trade Secrets and that absent disclosure by Employer to Employee, Employee could not otherwise have readily ascertained by proper means, and/or have acquired knowledge of such confidential or proprietary information and trade secrets.
(b) In the event of termination of employment for any reason, Employee shall immediately deliver to Employer all of Employer’s property, including, but not limited to, all copies and electronically stored versions of any Employer’s property, containing or relating to any Confidential Information, Trade Secrets, and/or Company Information, as defined in this Agreement, and all other business records as well as all other Employer’ property in Employee’s possession and over which Employee has control.
(c) Employee will not, without the prior written consent of Employer, during or at any time after the period of his/her employment by Employer, use for his/her own use or any other’s use or benefit, any Confidential Information, Trade Secrets, and/or Company Information obtained during, after or as a result of employment by Employer.
(d) Employee acknowledges and agrees that Employee will have access to Confidential Information (including the information contained in this Agreement) and that Employee shall not in any manner, directly or indirectly, disclose or divulge Confidential Information to any other person, firm, corporation or other third party for any use or purpose, except as required by law or with the express written authorization of Employer.
(e) The Confidentiality and Non-disclosure obligations and covenants expressed herein shall remain in full force and effect during Employee’s employment with Employer and during or at any time after the period of Employee’s employment with Employer.
(f) Employee understands and acknowledges that any violation of this Section 2 is grounds for immediate termination.

3. NON-SOLICITATION AGREEMENT:
(a) Employee acknowledges that, along with access to Employer’s Confidential Information, Employee will acquire a special relationship with many of the Employer’s Clients, Customers, and employees through employment with the Employer.
(b) During Employee’s employment by Employer and for a period of two years (730 days) after discontinuation of Employee’s employment with Employer, for whatever reason and whether the discontinuation of such employment was voluntary or involuntary, Employee shall not, without the prior written consent of Employer, in any manner, directly or indirectly, either individually or as an employee, owner, partner, consultant, shareholder, director, officer or agent of another, for his/her own benefit or on behalf of any person, firm, partnership, entity or corporation, solicit, recruit, hire, retain, employ, create a business relationship with, or endeavor to solicit, recruit, hire, retain, employ or create a business relationship with any current employee of Employer or any former employee of Employer who was employed by Employer at any time during the one year period (365 days) immediately prior to the discontinuation of Employee’s employment with Employer.
(c) Employee further agrees that during his/her employment with Employer and for a period of two years (730 days) after discontinuation of Employee’s employment with Employer, for whatever reason and whether the discontinuation of such employment was voluntary or involuntary, Employee will not directly or indirectly, on Employee’s own behalf or on behalf of any third party, or as a sole proprietor, joint venture, partner, employee, officer, director, consultant, shareholder, investor, or otherwise solicit the business of any of Employer’s Clients, customers or referral sources, or contact such Clients, customers, or referral sources for any business purpose that is competitive with Employer’s business.
(d) Employee further agrees that during his/her employment with Employer and for a period of two years (730 days) after discontinuation of Employee’s employment with Employer, for whatever reason and whether the discontinuation of such employment was voluntary or involuntary, Employee will not directly or indirectly, on Employee’s own behalf or on behalf of any third party, or as a sole proprietor, joint venture, partner, employee, officer, director, consultant, shareholder, investor, or otherwise encourage any of Employer’s Clients, customers or referral sources (i) to modify their business relationship with Employer or (ii) not to establish or not renew their business relationship with Employer.
(e) Employee understands and acknowledges that any violation of this Section 2 is grounds for immediate termination.

4. ACKNOWLEDGEMENTS. Employee acknowledges and agrees that Employee has the experience, knowledge and capabilities to obtain employment notwithstanding the restrictions in Section 2 and Section 3 and thus Employee has a means to support himself or herself and Employee’s dependents other than by engaging in the activities restricted by the terms of Section 2 and Section 3 and that the terms of Section 2 and Section 3 will not impair such ability. Employee further acknowledges and agrees that enforcement of this Agreement through an injunction will not prevent Employee from earning a living and supporting himself or herself. Employee also acknowledges and agrees that this Agreement does not constitute a contract of employment, Employee’s engagement with Employer is at-will and may be terminated at any time for any or no reason, and nothing herein shall be interpreted as providing Employee the right to continued employment by Employer or provide Employee any right to any compensation or payment upon Employee’s termination.

5. GOODWILL. Employee acknowledges that Employer has developed, over a period of time, and will continue to develop, significant relationships and goodwill between itself and its Clients and Referral Sources by providing superior services. Employee further acknowledges that these relationships and this goodwill are a valuable asset belonging solely to Employer. Employee further acknowledges that any business relationship that he or she brings or has brought to Employer will belong to and will inure to the benefit of Employer after Employee begins his or her employment. Finally, Employee acknowledges that the responsibility to build and maintain business relationships and goodwill with current and prospective Clients and Referral Sources creates a special relation¬ship of trust and confidence between him or her, Employer, and its Clients and Referral Sources. Employer promises to permit Employee to use its goodwill with its current and prospective Clients and Referral Sources to enable Employee to perform his or her duties for Employer.

6. RETURN OF EMPLOYER PROPERTY Employee acknowledges that all written records, databases, CDs, DVDs, disks and other electronic storage media containing information relating to Employer business, including, without limitation, memoranda, notes, correspondence, reports, manuals, books, papers, letters, Client profile data, Client lists, contracts, software programs, drafts, and other documentation (whether in draft or final form, and whether in paper or electronic format), marketing plans, and other sales, financial or technical information relating to Employer’s business, and any and all other documents containing Company Information furnished to Employee by any representative of Employer or otherwise acquired or developed by him or her in connection with his or her association with Employer (collectively, "Recipient Materials") shall at all times be Employer’s exclusive property. Within twenty-four (24) hours of the termination of his or her employment, Employee promises to return any Recipient Materials that are in his or her possession, custody or control, regardless of whether such materials are located in Employee’s office, home, automobile, personal computer, electronic storage media or elsewhere. Employee also shall authorize and permit Employer to inspect all computer drives and electronic storage media used or maintained by Employee during his or her employment and, if necessary, to permit Employer to delete any Recipient Materials or Company Information contained on such drives or storage devices. Additionally, within twenty-four (24) hours of the termination of his or her employment, Employee agrees to return to Employer any equipment or other tangible property which Employee received from Employer during his or her employment, including, but not limited to, desktop and laptop computers, printers, monitors, cellular telephones, pagers or other personal com¬munication devices, credit cards, access cards, security cards, keys and employee manuals which are in Employee’s possession, custody or control, and shall disclose to Employer any and all passwords or codes required to gain access to such devices.

7. REMEDIES FOR VIOLATION: Employee acknowledges that the damages which will be suffered by Employer by a breach of any term or provision of this Agreement may be continuing and irreparable, but will also be difficult or impossible to ascertain in money or money’s worth. Consequently, in addition to any action at law for damages, Employee agrees that Employer may have equitable relief, including specific performance and injunctive relief, including temporary restraining orders and preliminary, permanent and mandatory injunctions, to ensure and enforce his/her performance of such obligations. If such action becomes necessary, Employee further agrees to pay the attorneys’ fees and costs incurred by Employer in the enforcement of these contract provisions, whether or not litigation is initiated.

8. NON-WAIVER: Employer’ failure to exercise any of its rights in the event Employee breaches any of the separate and distinct promises in this Agreement shall not be construed as a waiver of such breach or prevent Employer from later enforcing strict compliance with any and all promises in this Agreement.

9. BINDING EFFECT: This Agreement shall be binding upon and shall inure to the benefit of Employer, its successors and assigns.

10. ASSIGNMENT: This Agreement can only be assigned by Employer.

11. MODIFICATION: This Agreement contains the parties’ complete understanding regarding the subject matters contained herein, and there are no other agreements, oral or written, pertaining to the subject matters of this Agreement. Any amendments to this Agreement must be in writing and signed by the parties.

12. DISCLOSURE OF EXISTENCE OF AGREEMENT: In order to preserve Employer’s rights under this Agreement, Employer may advise any third party of the existence of this Agreement and of its terms and may provide such third party copies hereof, and Employer shall have no liability for doing so. Employee shall notify each subsequent employer or person or entity using the services of Employee at any time within two (2) years following the termination of Employee’s employment with Employer of the existence and provisions of this Agreement. Employee shall also notify Employer in writing of the name, principal business address, primary area of business, and any area of business competitive with the business of Employer of each person or entity by whom Employee is employed or otherwise engaged to provide services at any time within two (2) years following the termination of Employee’s employment with Employer.

13. PRIOR AND/OR PRESENT EMPLOYMENT: Employee represents and warrants to Employer that Employee is not a party to any agreement containing a noncompetition provision or other restriction with respect to (a) the services or business that Employee is required to perform or conduct for Employer or (b) the disclosure or use of any information which directly or indirectly relates to the nature of the business of Employer or the services to be rendered by Employee to Employer. Employee further certifies that he/she has not disclosed or used, and will not disclose or use, during Employee’s employment by Employer, any confidential information that Employee acquired as a result of any previous employment or under a contractual obligation of confidentiality before Employee’s Employment by Employer.

14. INTERPRETATION, JURISDICTION & VENUE: This Agreement shall be interpreted, governed and construed according to the laws of the State of Missouri without reference to conflict of law principles and notwithstanding the place of execution hereof or the performance of any acts under this Agreement in any other jurisdiction. Employee agrees that the State of Missouri bears a substantial relationship to the parties and the transaction between the parties under this Agreement and each party consents to the personal jurisdiction of the state and federal courts located in the State of Missouri for purpose of any suit, action or other proceeding arising out of this Agreement. Employee waives any argument that venue in any such forum is not convenient. Employee and Employer each agrees that the venue of any litigation initiated by either of them in connection with this Agreement shall be in either the Circuit Court of St. Louis County, Missouri, or the United States District Court for the Eastern District of Missouri.

15. HEADINGS: Paragraph headings are for reference purposes only and do not restrict or limit in any way any subject matters contained in this Agreement.

16. ACKNOWLEDGEMENT: BY SIGNING THIS AGREEMENT, EMPLOYEE ACKNOWLEDGES THAT HE/SHE HAS READ THE AGREEMENT, THAT HE/SHE UNDERSTANDS THE AGREEMENT AND INTENDS TO FULFILL EACH AND EVERY ONE OF THE PROMISES IN THIS AGREEMENT, THAT EMPLOYEE UNDERSTANDS THAT THIS IS A LEGALLY BINDING AGREEMENT, THAT EMPLOYEE HAS RECEIVED A COPY OF THIS AGREEMENT AND THAT EMPLOYEE UNDERSTANDS, ACKNOWLEDGES AND AGREES THAT THE PROMISES MADE HEREIN ARE REASONABLE AND NECESSARY TO PROTECT EMPLOYER’ LEGITIMATE BUSINESS INTERESTS.

IN WITNESS WHEREOF, this Agreement has been executed as of the date the employee acknowledged their agreement.

EMPLOYEE: I understand that by acknowledging this agreement in the online onboarding paperwork, I am agreeing to the terms listed in the agreement.

I acknowledge that I have a duty to report any alleged or suspected violation of the Standards of Conduct or the Corporate Compliance Program to the Administrator. Unless otherwise noted, I am not aware of any possible violation of the Standards of Conduct or the Corporate Compliance Program. I also certify that I have not been convicted of or charged with a criminal offense related to health care, nor have I been listed by a federal agency as debarred, excluded or otherwise ineligible for participation in federally funded health care programs.

Further, I certify that I am not aware of any additional circumstances, other than those disclosed above, that could represent a potential violation of the Corporate Compliance Program, the Standards of Conduct. I will report any potential violation of which I become aware promptly to the Compliance Officer. I understand that any violation of the Corporate Compliance Program, the Standards of Conduct or any other corporate compliance policy or procedure is grounds of disciplinary action, up to and including discharge from employment.

Definitions
Reportable Event: Any event involving alleged wrongful conduct affecting the person by acts or omissions
of abuse, neglect, exploitation, or misappropriation of money or property, and resulted in one or more of
the following consequences to the person: death, Serious injury, or physical harm; physical or sexual
abuse; significant pain, intimidation or mental anguish that required medical intervention or loss of funds
or property greater than $1,000 in value.
Tier 1 Events
1) All allegations of sexual abuse.
2) Allegations of physical, emotional, or psychological abuse required medical intervention or
treatment.
3) Allegations of neglect that required medical intervention or treatment, and all neglect that is
potentially felonious in nature when there is not an injury.
4) All unexplained or unexpected deaths including suicide.
5) A suspicious injury where abuse or neglect is suspected requires medical treatment or
intervention, and the nature of the injury does not coincide with explanation of how the injury was
sustained.
6) Serious Injury of an unknown cause. For purposes of this section, Severe injury shall mean an injury
that requires assessment and treatment beyond first aid that can be administered by a lay person.
Assessment and treatment for a Serious injury is in a hospital emergency room, in an urgent care center, or
from a physician, nurse practitioner, or physician's assistant and/or nurse. Includes, but not limited to
decubitus ulcers, fractures, dislocations, concussions, cuts, or lacerations requiring sutures, staples,
Dermabond torn ligaments (e.g., severe sprain) or torn muscles or tendons (e.g., severe strain) requiring
surgical repair, 2nd and 3rd degree burns, and loss of consciousness. Serious injuries can be both known
and unknown.
7) Exploitation by provider personnel (employees or volunteers) of more than $1,000 (Class E felony).
Timelines
1) Verbal notice is given to the DDA Investigations Hotline as soon as possible but within 4 hours.
2) Advantage Home Care Event Management Coordinator (ADVANTAGE HOME CARE), or designer,
shall submit a Reportable Event Form (REF) via DDA’s REM Focus system to DDA and the MCO by close
of the next business day after the telephonic report to DDA is made. Advantage Home Care and the MCO
shall not move forward with their own “reviews” once a Tier 1 Reportable Event has been reported.
3) Suspected abuse, neglect, and exploitation of members who are adults is immediately reported in
accordance with TCA 71-6-103 and suspected brutality, abuse, or neglect of members who are children is
immediately reported in accordance with TCA 37-1-403 or TCA 37-1-605 as applicable. (APS/CPS
reporting)
Immediate Actions1) ADVANTAGE HOME Care will immediately (which shall not exceed twenty-four hours) take steps
to prevent further harm to all members and respond to any emergency needs of members.
2) Excluding when an exception is granted by DDA, Advantage Home Care are required to
immediately remove an employee or volunteer alleged to have acted in a manner consistent with sexual
abuse or physical abuse resulting in medical treatment, named in a Tier 1 Reportable Event that DDA
opens for investigation, from providing direct support to any person(s) supported until DDA has completed
their investigation, either by placing the named employee or volunteer on administrative leave or in another
position in which he or she does not have direct contact with, or supervisory responsibility for, a person(s).
Advantage Home Care may, pursuant to agency policies, choose to remove staff concerning other events
at their discretion, pending completion of the investigation.
3) If a Tier 1 Reportable Event, or any other event that poses an immediate threat to the health and
safety of a person occurs, provider staff must be on site with the person, and in addition to reporting this
event, such staff shall be required to remain with the person until the threat is removed or the person
receives needed medical treatment, if appropriate.
4) ADVANTAGE HOME Care will cooperate with any investigation conducted by the CONTRACTOR or
outside agencies (e.g., TENNCARE, APS, CPS, and law enforcement).
Follow Up Actions
1) For any Reportable Event, Advantage Home Care has supervisory staff (including clinical staff, as
applicable) review the Reportable Event and determine appropriate follow-up.
2) Send all information related to the investigation to DDA as soon as possible upon request.
3) Advantage Home Care shall instruct all staff that the facts and circumstances being investigated
are not to be discussed with anyone except the DDA Investigator, law enforcement officers, or other state
investigative entities (APS, Department of Children’s Services, Disability Rights TN, etc.).
4) All waiver program Advantage Home Care, persons supported, legal representatives, case
managers/support coordinators, MCO, DDA, or TennCare representatives may request a review of an
investigative report within fifteen (15) days of an investigation closing. Requests must be based on new or
additional information, evidence not considered during the investigative process, raise matters that bring
into question the integrity of an investigation, or provide a basis for disputing the investigative conclusion.
All Investigation Review requests must be submitted in writing, express the reason for the disagreement,
and include additional evidence if applicable. The Committee will not review any file requests that are
incomplete or not submitted within the allotted timeframe. (Process for requesting an Investigation
Review)
5) Advantage Home Care will complete the Action Plan for all substantiated Class 1 and Class 2
investigations. The Action Plan shall address each informational finding and late reporting discovered as a
means of provider self-improvement.
6) Upon acceptance of the Final Investigative Report, Advantage Home Care will have an additional
ten (10) days to complete the Action Plan, which will be tracked by the date on which the Final
Investigative Report was closed. Advantage Home Care will continue to discuss the outcome of the
investigation with the person(s) supported and invite the person’s legal representative and/or primary
contact, if any, to participate in this discussion.
7) If the Action Plan submitted does not sufficiently address the identified concerns, Advantage
Home Care has ten (10) calendar days to provide additional information.
8) If allegations are not substantiated, an Action Plan is not required. For both substantiated and
unsubstantiated investigations, Advantage Home Care must ensure that informational findings are made
upon in a timely manner. DDA or the MCO can request follow-up action to unsubstantiated informational
findings, to include Late Reporting.Policies and Procedures
1) All Reportable events P&P are updated to include the One Alignment process and provider
demonstrates knowledge for accessing REM website/resources.
2) Demonstrates knowledge of Reportable Event Management process as it related to the Quality
Monitoring Tool through identified processes and implementation of those processes. (Completed
guidance of OUTCOME 7 of QMT)
Training
1) All ECF CHOICES provider agreements shall require that all direct support staff (i.e., provider staff
collaborating directly with people in ECF CHOICES) complete the required training as prescribed by
TENNCARE within thirty (30) days of hire and prior to providing direct support to members.
Non-Compliance
1) The MCO will be notified and responsible for ensuring provider cooperation with the investigation if
provider staff does not send the requested information to DDA by the following business day. ECF
CHOICES and CHOICES will maintain their current processes for imposing progressive disciplinary action
(e.g., monetary sanctions).
Required Elements for Policies/Procedures - Reportable Events Tier 2
Tier 2 Events
1) Allegations of physical abuse, emotional/psychological abuse, or neglect that do not require
medical intervention or treatment, including allegations that provider personnel (e.g., employees,
volunteers) engaged in disrespectful or inappropriate communication about a person [e.g., humiliation,
harassment, threats of punishment or deprivation, intimidation or demeaning or derogatory
communication (vocal, written, gestures)], or any other similar acts that do not meet the definition of
emotional or psychological abuse and which are directed to or within eyesight or audible range of the
person supported (the CONTRACTOR shall include such complaints in the CONTRACTOR’s nondiscrimination reporting pursuant to A.2.30.22.3.2.1).
2) Suspicious Injury in which abuse/neglect is suspected but did not require medical treatment or
intervention.
3) The deliberate misplacement, exploitation, wrongful, temporary, or permanent use of belongings or
money valued between $250 and
$1,000, i.e., less than the threshold for misappropriation.
Timelines
1) Advantage Home Care will submit a REF to both DDA and MCO by close of the next business day
after the occurrence or discovery of occurrence of a Tier 2 Reportable Event via the DDA REM Focus
system.
2) Advantage Home Care are responsible for conducting investigations of Tier 2 Reportable Events
and submitting an investigation report via the DDA REM Focus system for each Tier 2 allegation. A
completed investigation report and attachments shall be entered in the DDA REM Focus system within
twenty-five (25) calendar days of the anchor date.
Immediate Actions
1) Advantage Home Care, after seeking the victim/person’s preference and/or that of the legal
representative (if applicable), shall determine at their discretion and in accordance with their policy, whether to remove an employee or volunteer named in a Tier 2 Reportable Event from any or all direct
support until Advantage Home Care has completed their investigation.
2) Should the Advantage Home Care Investigator discover evidence that would result in the allegation
rising from Tier 2 to a Tier 1, the Advantage Home Care Investigator stop the investigative process
immediately and notify the Investigations Specialist (if during normal business hours), or the DDA Abuse
Hotline. Advantage Home Care must forward the investigation immediately back to DDA to investigate.
Follow Up Actions
1) For any Reportable Event, Advantage Home Care has supervisory staff (including clinical staff, as
applicable) review the Reportable Event and determine appropriate follow-up.
2) If the allegation is substantiated as a Class 2, the employee or volunteer may be terminated or
removed until the completion of any action plan (e.g., training) deemed appropriate by the provider. In lieu
of removing an employee or volunteer named in a Tier 2 Reportable Event from any or all direct support,
Advantage Home Care may opt to utilize a modified assignment or increased supervision. Advantage
Home Care is expected to ensure that adequate steps are taken for the protection and safety of all people
during the investigation process.
3) Advantage Home Care will complete the Action Plan for all substantiated Class 1 and Class 2
investigations. The Action Plan shall address each Informational Findings and late reporting discovered as
a means of provider self-improvement.
4) Upon acceptance of the final investigative report, Advantage Home Care will have an additional ten
(10) days to complete the Action Plan, which will be tracked by the date on which the Final Investigative
Report was closed. Advantage Home Care will continue to discuss the outcome of the investigation with
the person(s) supported and invite the person’s legal representative and/or primary contact, if any, to
participate in this discussion.
5) If the Action Plan submitted does not sufficiently address the identified concerns, Advantage
Home Care has ten (10) calendar days to provide additional information.
6) If allegations are not substantiated, an Action Plan is not required. For both substantiated and
unsubstantiated investigations, Advantage Home Care must ensure that informational findings are made
upon in a timely manner. DDA or the MCO can request follow-up action to unsubstantiated Informational
Findings, to include Late Reporting.
Policies and Procedures
1) All Reportable events P&P are updated to include the One Alignment process, and provider
demonstrates knowledge for accessing REM website/resources.
2) Demonstrates knowledge of Reportable Event Management process as it related to the Quality
Monitoring Tool through identified processes and implementation of those processes. (Completed
guidance of OUTCOME 7 of QMT)
Training
1) All ECF CHOICES provider agreements shall require that all direct support staff (i.e., provider staff
collaborating directly with people in ECF CHOICES) complete the required training as prescribed by
TENNCARE within thirty (30) days of hire and prior to providing direct support to members.
Additional Medical Reportable Events and Interventions:
Definitions
Additional Medical Reportable Events and Interventions: Additional Reportable Events and Interventions,
which are not related to abuse, neglect, or exploitation, are events and interventions that the provider, MCO, or FEA staff shall be responsible for reporting to the MCO and/or DDA as specified in TENNCARE
protocol. Reporting and reviewing of such Reportable Events and Interventions is secondary to any
medical attention required by the person supported.
1) Reportable Medical Events require assessment and treatment at an emergency room or urgent
care facility (except for 2.12.20.1.3 below, which may or may not be performed by a medical professional
at an emergency room or urgent care facility). This is an event that occurs during the delivery of services or
discovered during the delivery of services, outside of a diagnosed chronic condition, which requires
assessment and treatment in an emergency room or urgent care facility. It is not a reportable event when
assessment and treatment result from the discovery of a medical event occurring outside the provision of
services, nor when referred to the emergency room for assessment or treatment by the primary care
provider.
"2) Reportable Medical Events include:
a) Deaths (other than those that are unexpected/unexplained).
b) Cellulitis.
c) Choking episode requiring physical intervention (e.g., use of abdominal thrust or Heimlich
maneuver; d) Fall with injury (including minor or Serious)
e) Insect or animal bite requiring treatment by a medical professional.
f) Pressure ulcer/Decubitus Ulcer.
g) MRSA.
h) Fecal impact.
i) Severe dehydration requires medical attention.
j) Seizure progressing to status epilepticus.
k) Pneumonia.
l) Severe allergic reaction requiring medical attention.
m) Influenza.
n) Sepsis.
o) Skin Infection (other than Cellulitis and MRSA).
p) Urinary Tract Infection.
q) Serious Injury of Known Cause. Serious injury shall mean an injury that requires assessment and
treatment beyond first aid that can be administered by a lay person. Assessment and treatment for a
Serious injury is in a hospital emergency room, in an urgent care center, or from a physician, nurse
practitioner, or physician’s assistant and/or nurse. Includes, but not limited to decubitus ulcers, fractures,
dislocations, concussions, cuts, or lacerations requiring sutures, staples, or Dermabond, torn ligaments
(e.g., severe sprain) or torn muscles or tendons (e.g., strain) requiring surgical repair, 2nd and 3rd degree
burns, and loss of consciousness; and
r) Other (CONTRACTOR to explain on REF). "
3) Additional Behavioral Reportable Events and Interventions: Reportable Behavioral Events include
Reportable Psychiatric Events. A Reportable Behavioral Event is an event in which a person presents a
challenging action(s) which requires the use of a behavior safety intervention or a restrictive behavioral
procedure (with the exception of 2.12.20.2.2, 2.12.20.2.3, 2.12.20.2.6, 2.12.20.2.8, and 2.12.20.2.12
below, which may or may not involve the use of such interventions/procedures) that is not captured as an
appropriate response in a plan(s) of care (ex. PCSP, BSP, Behavioral Health Plan of Care, etc.) that
pertain(s) to that person. A Reportable Psychiatric Event is an event in which a person present evidence of
psychiatric destabilization which requires the use of a psychiatric intervention or crisis services (with the
exception of 2.12.20.2.2, 2.12.20.2.3, 2.12.20.2.6, 2.12.20.2.8, and 2.12.20.2.12 below, which may or
may not involve the use of such intervention/services) that is not captured as an appropriate response in a
plan(s) of care (ex. PCSP, BSP, Behavioral Health Plan of Care, etc.) that pertain(s) to that person."4) Reportable Behavior and Reportable Psychiatric Events include:
a) Criminal conduct/probable criminal conduct. Criminal Conduct/Probable Criminal Conduct shall
mean acts which violate existing criminal codes which lead to or can be expected to lead to police
involvement, arrest, or incarceration of a person using services or an employee, during the provision of
services.
b) Engagement of law enforcement.
c) Sexual aggression.
d) Physical aggression.
e) Reportable Behavior involving physical aggression and/or self-injurious behavior resulting in injury
to another person (housemate, staff, private citizen, etc.).
f) Suicide attempt.
g) Self-injurious behavior (SIB) (For SIB to be reportable via REF, there must be an injury that requires
assessment and treatment beyond basic first aid that can be administered by a lay person).
h) Property destruction is greater than $100.
i) Behavioral crisis requires protective equipment, manual or mechanical restraints, regardless of
type or time used or approved by PCSP (all take-downs and prone restraints are prohibited).
j) Behavioral crisis requiring emergency psychotropic medication.
k) Behavioral crisis requiring crisis intervention (i.e., call).
l) Psychiatric admission (or observation), including in acute care hospital; "
"5) Other Additional Reportable Events include:
a) Administration of Routine Psychotropic Medication without consent.
b) Emergency Situations, including fire, flooding, and Serious property damage, which result in harm
or risk of harm to persons supported.
c) Fall with Injury – Minor (an injury that is treatable by a lay person) and Serious (resulting in medical
intervention and treatment).
d) Medication Variance and Omission.
e) Victim of fire.
f) Enabling Technology Remote Supports: failure to implement Emergency Back-up Plans.
g) Unsafe Environment (lack of cleanliness/hazardous conditions not otherwise expected to normally
exist in the environment.
h) Vehicle Accident – Minor (not resulting in an injury; treatable by a lay person) and Serious (resulting
in medical intervention and treatment);
Vehicle Accident – Minor (not resulting in an injury; treatable by a lay person) and Serious (resulting in
medical intervention and treatment).
i) Missing Person> (greater than) 1 hour; “““6) Reportable Interventions include:
a) Abdominal Thrust/Back Blows/Heimlich Maneuver.
b) Administration of PRN Psychotropic Medication.
c) Admission to: Assisted Care Living Facility, Skilled Nursing Facility, ICF/IID, Incarceration, Planned
and Unplanned Medical Hospitalization, and Psychiatric Hospitalization.
d) CPR or Automated External Defibrillator (AED).
e) Crisis Services: 911 Call, EMT, ER Visit, Fire, Mobile Crisis Services, Police, and Urgent Care
Facility.
f) Discharge from: Assisted Care Living Facility, Skilled Nursing Facility, ICF/IID, Incarceration,
Planned and Unplanned Medical Hospitalization, and Psychiatric Hospitalization.
g) Manual Restraint.
h) Mechanical Restraint; I) Protective Equipment; and
j) X-Ray (to rule out fracture. " Follow Up Actions1) For any Reportable Event, Advantage Home Care has supervisory staff (including clinical staff, as
applicable) review the Reportable Event and determine appropriate follow-up. For Additional Reportable
Events and Interventions, this may include follow up with the member’s PCP or behavioral health provider,
as applicable, to provide information and determine any needed treatment adjustments, follow up with the
person’s Support Coordinator regarding any needed adjustments in the PCSP, and targeted training or
assistance for agency staff who support the person. All Reportable Additional Reportable Events and
Interventions, any medical attention provided, and follow-up shall be documented in the member’s
record.
2) Advantage Home Care shall be responsible for tracking and trending all Additional Reportable
Events and Interventions as outlined above and evaluating such events to determine how to prevent or
reduce similar occurrences in the future whenever possible. Such efforts may be targeted at an individual
person supported, a particular service setting or location, a particular type of Reportable Event, a
particular provider, or system wide.
Policies and Procedures
1) All Reportable events P&P are updated to include the One Alignment process and provider
demonstrates knowledge for accessing REM website/resources.
2) Demonstrates knowledge of Reportable Event Management process as it related to the Quality
Monitoring Tool through identified processes and implementation of those processes. (Completed
guidance of OUTCOME 7 of QMT)
3) Advantage Home Care will be responsible for documenting, performing data collection and trend
analysis, and addressing Non- Reportable Events.
Training
1) All ECF CHOICES provider agreements shall require that all direct support staff (i.e., provider staff
collaborating directly with people in ECF CHOICES) complete the required training as prescribed by
TENNCARE within thirty (30) days of hire and prior to providing direct support to members.
Non-Compliance
Non-Reportable Events Definitions
Non-Reportable Event: Events which do not rise to the level of Reportable Events as defined by
TENNCARE.
Non-Reportable Events
"1) Any instance of disrespectful or inappropriate communication, e.g., humiliation, harassment,
threats of punishment or deprivation, intimidation or demeaning or derogatory communication (vocal,
written, gestures) or any other acts pertaining to a person supported that is not directed to or within
eyesight or audible range of the person supported and that does not meet the definition of emotional or
psychological abuse (the CONTRACTOR shall require Advantage Home Care under this Section to report
such complaints to the CONTRACTOR and the CONTRACTOR shall include such complaints in the
CONTRACTOR’s non-discrimination reporting pursuant to A.2.30.22.3.2.1); "
2) Minor injury not requiring medical treatment beyond first aid by a lay person and is not associated
with abuse or neglect.
3) Staff misconduct that falls outside the definition of Reportable Events (see Section A.2.15.7.6) or
actions or inactions by staff of contracted Advantage Home Care, contracted employees, volunteers or
others associated with or providing care for the persons supported, that are contrary to sound judgement
and/or training and related to the provision of services and/or the safeguarding of the person’s health,
safety, general welfare and/or individual rights. Staff misconduct includes events that do not rise to the level of abuse, neglect, or exploitation, and do not result in injury or adverse effects, and the risk for harm
is minimal.
Timelines
1) Advantage Home Care shall immediately contact DDA by appropriate hotline number or the MCO and
DDA within twenty-four (24) hours if during a provider’s review of a Non-Reportable Event Advantage
Home Care discovers the Non-Reportable Event should be classified as a Tier 1 or Tier 2 Reportable
Event.
Follow Up Actions
1) All contracted Advantage Home Care will be responsible for documenting, performing data collection
and trend analysis, and addressing Non-Reportable Events, which do not rise to the level of Reportable
Events as defined by TENNCARE. Advantage Home Care shall immediately contact DDA by appropriate
hotline number or the MCO and DDA within twenty-four (24) hours if during a provider’s review of a NonReportable Event Advantage Home Care discovers the Non-Reportable Event should be classified as a
Tier 1 or Tier 2 Reportable Event.
Policies and Procedures
1) Advantage Home Care will be responsible for documenting, performing data collection and trend
analysis, and addressing Non- Reportable Events.
2) All Reportable events P&P are updated to include the One Alignment process, and provider
demonstrates knowledge for accessing REM website/resources.
3) Demonstrates knowledge of Reportable Event Management process as it related to the Quality
Monitoring Tool through identified processes and implementation of those processes. (Completed
guidance of OUTCOME 7 of QMT)
Provider Reportable Event Review Team (PRERT)
Definitions
Provider Reportable Event Review Team (PRERT): The purpose of the PRERT is to review and evaluate the
provider’s reportable events, investigations, and trends to inform internal prevention strategies. ECF
CHOICES and CHOICES provider agencies that provide day, residential, and personal assistance services
will develop Provider Reportable Event Review Teams (PRERT).
Timelines
1) The PRERT shall meet regularly, but no less than monthly, and membership and representation are
specific to each provider’s Event Management policy.
2) PRERT meetings will be documented and will reflect discussion and follow up actions concerning
reported events and investigations, their causes, actions taken, and recommendations made by the review
team.
Definitions: Event Management Coordinator
1) Each contracted provider is responsible for the designation of an Event Management Coordinator .
2) Provider should have an identified back up to the EMC and P&P for back process/implementation.
Certified Provider Investigator (CPI)
1) Advantage Home Care shall ensure that all Tier 2 investigations are conducted by a certified
Provider Investigator. As part of the certification, provider Investigators must complete the required
training as determined by TennCare in collaboration with DDA.2) Advantage Home Care may have multiple DDA certified Provider Investigators or may contract with
a DDA certified Provider Investigator. Advantage Home Care shall notify the Investigations Specialist, via
the DDA REM Focus system, the identity of the Investigator.
"3) If Advantage Home Care requests not to investigate an allegation and shall result in a DDA Investigator
conducting the investigation. Advantage Home Care shall be responsible for submitting an Exception to
Investigation form to the Director of Investigations or designee within two (2) business days of the anchor
date with an explanation related to one or more of the following:
• Conflict of interest associated with the investigation.
• The complexity of the investigation impedes the provider’s ability to investigate.
• When the alleged perpetrator has three prior substantiations with that agency within a 24-rolling
month period, Advantage Home Care can request the state to investigate any subsequent investigation."