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Remote Support in Tennessee: Every Service It Fits, and How It Is Paid

Tennessee screens every person receiving home and community-based services in CHOICES, ECF CHOICES and its 1915(c) waivers for enabling technology at enrollment and at least once a year. Any Tennessee provider agency can get Vista Enterprise™, the remote support solution, the way it gets an EHR or payroll system, with no state approval. Billing is separate. The agency’s own trained team responds and decides.

Can any Tennessee agency buy a remote support solution?

Yes. Any Tennessee provider or agency can get Vista Enterprise™, the remote support solution, which includes VistaLink™, the technology. Like an EHR or payroll system, getting it needs no approval from TennCare, the Department of Disability and Aging (DDA), a managed care organization (MCO), or anyone else.

Billing is a separate question. It depends on the program, the service, your agency’s provider status, and each person’s plan. The rest of this page walks through every place remote support fits in Tennessee.

Where does remote support fit in Tennessee?

Setting or programHow technology is usually paidWhat to know
HCBS in CHOICES, ECF CHOICES and the 1915(c) waiversThe ET benefit, per person, by purchase or lease, including remote support systemsScreened at enrollment and at least annually; each program sets its own limit
Above the program limitET, only as a cost-effective alternativeCompared with facility care, more HCBS hours or a higher residential rate
ICF/IIDThe facility’s own costFederal staffing floor stays
Nursing homes and assisted livingThe facility’s own costResident privacy rules apply
Home care agenciesThe agency’s own cost, or the person’s ET benefit where it appliesSupport between visits
Any agency, any settingThe agency’s own budgetNo approval needed to buy

What does Tennessee’s Enabling Technology Protocol say?

The TennCare ET Protocol, effective February 1, 2026, sets how enabling technology is screened for, bought and reported in home and community-based services. Under the protocol:

  • ET supports independence. TennCare defines enabling technology as equipment or methodologies that support increased independence in the home, community and workplace.
  • Remote support systems are covered. The ET benefit covers the purchase or lease of technology systems that let the person receive remote supports from support staff, coaches and natural supports. In the protocol’s words, “Utilization of remote supports enables service providers to adjust staffing levels and provide individuals with increased independence, while also ensuring their health and safety.”
  • Need comes first. Purchases must rest on a need found through the comprehensive needs assessment and person-centered planning, and the benefit cannot buy devices or systems for the purposes of monitoring, tracking, or restricting the person’s activities.
  • Coordinators lead. Independent Support Coordinators and DDA Case Managers use DDA tools for the 1915(c) waivers. MCO Care Coordinators in CHOICES and Support Coordinators in ECF CHOICES use TennCare-approved tools.
  • People can learn first. Coordinators offer demonstration videos and success stories on DDA’s Enabling Technology page, the TN Tech Connect page on the TN Disability Pathfinder website, an in-person or virtual demonstration with an enabling technology provider, a tour of one of the Enabling Technology Model Homes, and a DDA or MCO Technology Champion.

What has to happen before remote support starts in Tennessee?

  1. Screening with the person. The coordinator screens or assesses for ET with the person and their Circle of Support at enrollment and at least annually.
  2. The person and their Circle of Support decide. The Circle of Support determines whether ET belongs in the person-centered support plan, based on the person’s assessed needs, goals, budget and other relevant factors. If the person needs and is interested in ET, the coordinator follows the referral, authorization and procurement process. A denial comes with a Notice of Adverse Benefit Determination and appeals information.
  3. It goes in the plan. ET is listed in the Services section of the person-centered support plan (PCSP). Leased devices and subscriptions stay on the PCSP for as long as they are used.
  4. Backup is written down. For remote supports, the PCSP holds a backup and emergency preparedness plan: a 24-hour emergency contact for remote support equipment that is damaged or not working properly, paid or unpaid backup supports if the equipment is not working or remote support staff are not available, and a plan for moving equipment and telling the remote support provider if the person must evacuate.
  5. The provider is ready. Remote support providers follow the Reportable Event Management Operational Protocol, where a failure to implement Emergency Back-up Plans is itself a reportable event. Coordinators complete the Enabling Technology Fundamentals training in Relias, and providers complete the trainings on DDA’s Enabling Technology Training Requirements for Staff Categories grid.

How does Tennessee pay for remote support?

From the agency’s own budget. Any agency can get Vista Enterprise™ as its own remote support solution, whether or not it bills a service. This is the route for ICFs, nursing homes, assisted living and home care agencies.

Your agency gets Vista Enterprise™ directly, as its own remote support solution. Tennessee then has three ways to pay for or obtain the enabling technology a person uses:

1. The ET benefit, per person. ET can be bought or leased, and the benefit also covers shipping, installation, training and repair. Each program, CHOICES, ECF CHOICES and the 1915(c) waivers, sets its own benefit limit.

2. Above the limit, as a cost-effective alternative. ET spending can go past a program limit only when it is a cost-effective alternative to care in a nursing facility or ICF/IID, if the person meets the requirements for that care; to additional hours of personal assistance or other HCBS that would otherwise be covered and medically necessary, including covered home health services; or to a higher level of reimbursement that would otherwise be provided for residential services.

3. Through the managed care organization. The February 2026 update added language allowing MCOs to directly acquire ET for members.

Sources, checked October 25, 2026: TennCare LTSS Operational Protocol for Enabling Technology Screening, Acquisition, and Reporting for Home- and Community-Based Service Programs (ET Protocol), effective February 1, 2026; DDA Memo 2026-2, Updated Enabling Technology Protocol, January 26, 2026; TennCare and DDA Reportable Event Management Definitions, March 16, 2026; DDA Memo 2024-3, Human Rights Guidance, October 16, 2024.

How do consent and privacy work in Tennessee?

The person supported decides whether remote support is used and where devices go, with help from the people they choose. The person-centered support plan (PCSP) is led by the person with their coordinator and their Circle of Support. When the person has a conservator or other legal representative, that person takes part in consent, in line with the authority they hold. Having a conservator does not mean the person cannot make choices or give consent; each person’s decision-making is looked at individually. Consent is informed, voluntary and written down: for the 1915(c) waivers, federal home and community-based services rules require the plan to be finalized and agreed to with the person’s written informed consent, and signed by everyone responsible for carrying it out. Any rights restriction must be reviewed and approved by the Human Rights Committee (1915(c) waivers) or the MCO’s HCBS Settings Committee, and is used only in response to a risk to the health, safety or welfare of the person or others. The person can say no or withdraw consent at any time, and consent is revisited whenever the plan changes. The agency’s own trained team responds and decides, following the plan.

Tennessee’s ET Protocol lists live or on-demand audio and video technology systems among the equipment the ET benefit can cover. No cameras are required in bedrooms, bathrooms or other personal spaces.

What if our staffing stays the same, as in an ICF or a fully staffed group home?

An agency in Tennessee can keep every in-person shift and still use remote support, because technology can raise quality even with full staff.

Even a fully staffed overnight shift cannot be in every room at once, stay fully alert through every hour of the night, or carry every detail from one shift to the next. When nothing answers those human limits, they quietly become limits on the outcomes people supported can reach. That is a limit of people, not a failing of staff.

Enabling technology for human services helps with those gaps without replacing anyone. It gives trained people better information and more of their time for the moments that need a person in the room.

  • Fewer night checks that wake people up. For people whose plans do not call for hands-on checks through the night, a door opening on a schedule interrupts sleep and privacy. Non-wearable sensors the person agreed to can let overnight staff know when something may need a person. Whether a plan moves away from scheduled checks is decided through the person’s plan, by the person and their team, with input from the agency’s own nurse or clinician. In Tennessee, DDA has said bed checks are not required under the 1915(c) waivers or ECF CHOICES. Bed checks for reasons other than physician-ordered treatments are reviewed as a rights restriction with the person, their legal representative and their Circle of Support, and a disagreement goes to a human rights committee or, in ECF CHOICES, the MCO’s settings committee (DDA Memo 2024-3, October 16, 2024).
  • Better information. Plain-language daily reports on sleep, activity and safety events give nurses and the team a fuller picture than a shift note alone.
  • Closing gaps in data and judgment. A steady record across shifts means handoffs rest on more than memory, and a change that is hard to read in the middle of the night comes to a trained person with the facts in front of them.

Know the limits.

  • Federal ICF rules set the staffing floor. In an intermediate care facility for individuals with intellectual disabilities (ICF/IID), federal rules require responsible direct care staff on duty around the clock when people are present, awake in some living units, plus minimum direct care staff ratios. Remote support adds to on-site staff. It does not replace them.
  • Privacy comes first. Federal rules require ICFs to give each person the opportunity for personal privacy. CMS guidance for surveyors says video or audio never takes the place of staff. No cameras are required in bedrooms, bathrooms or other personal spaces. Non-wearable sensors fit that approach.
  • The facility pays. An ICF/IID is paid as a facility, not through a person’s waiver plan, so an ICF that uses Vista Enterprise™ pays for it as its own operating cost.
  • ICF terms apply. In an ICF/IID, the person’s plan is the Individual Program Plan (IPP), developed by an interdisciplinary team that includes the person and the qualified intellectual disability professional (QIDP). A move away from scheduled night checks is decided by that team, including the person and their legal guardian where they have one (in Tennessee, a conservator), with input from the facility’s own nurse, and written into the IPP. If the change could affect the person’s protection or rights, the facility’s specially constituted committee reviews it, and it goes ahead only with written informed consent from the client, their legal guardian or conservator, or a parent if the client is a minor.
  • In Tennessee, the ET benefit is part of home and community-based services in CHOICES, ECF CHOICES and the 1915(c) waivers, so an ICF does not bill it.
  • Group homes and privacy. Federal home and community-based settings rules give each person privacy in their sleeping or living unit. Any limit on that must be based on a specific assessed need, written into the person’s plan, and agreed to with informed consent.

Can nursing homes and assisted living in Tennessee use remote support?

Yes. Nursing homes and assisted living communities get Vista Enterprise™ the same way any agency does, and the facility’s own trained team responds and decides.

  • Nursing homes. Federal rules give each resident a right to personal privacy and to be free from restraints that are not needed to treat medical symptoms, and require the facility to give each resident adequate supervision and assistance devices to prevent accidents. Better information can help staff see who needs them without waking everyone. Each resident decides whether devices go in and can say no, and a resident representative decides for the resident only as far as the resident, a court or state law gives them that role. CMS guidance for surveyors treats devices that alert staff when a resident moves as position change alarms, so the facility’s care team checks, in each care plan, that a device does not keep a resident from moving freely or disturb their sleep. Remote support does not prevent falls, and it is not a promise that every fall will be noticed. A trained person on the facility’s own team decides each step. Nursing homes are paid as facilities, so Vista Enterprise™ is the facility’s own purchase. In-person staffing rules do not change.
  • Assisted living. Assisted living is licensed by each state, not under the federal nursing home rules, so each community follows its own state’s licensing rules for resident rights, privacy and consent. Where Medicaid home and community-based services (HCBS) pay for a resident’s services there, the federal HCBS settings rules also apply, including privacy in the person’s sleeping or living unit, a door they can lock, and a say in choosing any roommate. Technology placed with each resident’s consent gives staff better information between scheduled visits.
  • In Tennessee, nursing homes and assisted living communities follow the state’s own licensing rules alongside the federal ones.

How does remote support help home care agencies in Tennessee?

Home care agencies send aides into people’s homes for set hours. Between visits, no one from the agency is there. Remote support helps with that gap: the person keeps their privacy, and the agency’s own trained team can learn when something may need attention and decide who should go.

  • Better visits. Aides arrive knowing how the night went.
  • Earlier notice. Changes in routine can show up before they become a crisis.
  • In Tennessee, ET can go past a program limit when it is a cost-effective alternative to additional hours of personal assistance or other HCBS that would otherwise be covered and medically necessary, including covered home health services.

Who else can remote support help in Tennessee?

It is not all about disability. Remote support is enabling technology for human services as a whole. It works for people with intellectual and developmental disabilities (IDD), older adults, people with physical disabilities, people recovering from an illness or injury, faith-based organizations that run health ministries, and the staff and families who support them.

How does VistaLink™ fit Tennessee’s rules?

VistaLink™ uses non-wearable sensors and a display in the home to send events to your agency’s own trained team, and it never acts alone. The agency’s own trained team responds and decides, following each person’s plan.

Your agency stays the provider. It confirms that its full setup meets Tennessee’s rules for the service it bills, or the rules for its license if it bills nothing. For ET, that includes the screening, the PCSP and its backup plan, and Tennessee’s reportable event rules.

Vista is not the direct service provider. The agency or facility is. Vista Enterprise™ supports the people who plan and give support: the person, their family or guardian where they have one, the provider’s own team, and any case manager or coordinator. It helps them follow the rights, privacy and consent rules that apply in that setting and state, and build each person’s plan around their own wants and needs. The agency’s own trained team responds and decides.

For states and government agencies

Vista can also work with TennCare, the Tennessee Department of Disability and Aging (DDA), and with other state and government agencies, for example through a procurement or a contract. Any single agency, in any state or anywhere in the world, can already get Vista Enterprise™ with no state approval.

Remote support for states and government agencies

What does remote support look like for a Tennessee agency? (composite example)

This is a composite example built from common situations. It is not a real person.

A woman in ECF CHOICES lives in her own apartment and wants to do more on her own. At her yearly screening, she, her Circle of Support and her Support Coordinator talk about enabling technology, and she chooses non-wearable sensors and a display in the home, listed in the Services section of her PCSP. Her plan names her brother as unpaid backup support. When an event comes in, a trained staff member at her provider agency checks in the way her plan says, and calls her brother when she needs someone in person.

Questions and answers

Can any Tennessee agency buy a remote support solution?

Yes. Any Tennessee provider or agency can get Vista Enterprise™, which includes VistaLink™. Like an EHR, it needs no TennCare, DDA or managed care approval. Billing follows each program’s rules.

Which Tennessee programs cover enabling technology?

Enabling technology (ET) is a benefit for people receiving home and community-based services in CHOICES, Employment and Community First (ECF) CHOICES and the 1915(c) waiver programs, and it can cover technology systems that let a person receive remote supports.

How often is a person screened for enabling technology in Tennessee?

At program enrollment and at least annually after that, with the person and their Circle of Support, as part of the comprehensive needs assessment and person-centered planning.

Can ET spending go past the program limit in Tennessee?

Only when it is a cost-effective alternative to care in a nursing facility or ICF/IID, if the person meets the requirements for that care; to additional hours of personal assistance or other HCBS that would otherwise be covered and medically necessary, including covered home health services; or to a higher level of reimbursement that would otherwise be provided for residential services.

What must a Tennessee PCSP include for remote supports?

A backup and emergency preparedness plan: a 24-hour emergency contact for remote support equipment that is damaged or not working properly, paid or unpaid backup supports, and a plan for moving equipment and telling the remote support provider if the person must evacuate.

What happens if enabling technology is denied in Tennessee?

DDA or the managed care organization, as applicable, follows the Notice of Adverse Benefit Determination requirements in TennCare Rule 1200-13-13-.11, including giving appeals information.

Can a Tennessee ICF, nursing home or assisted living facility use remote support?

Yes, as its own tool alongside on-site staff. Federal and state staffing rules still apply in full, and the facility pays for Vista Enterprise™ as its own cost. No cameras are required in bedrooms, bathrooms or other personal spaces.

Who responds when remote support is in place?

Your agency’s own trained team responds and decides, following each person’s plan. VistaLink™ never acts alone.

Is remote support in Tennessee only for disability services?

No. It fits any human service where staff cannot be everywhere at once: disability services, older adults, assisted living, nursing homes, home care and faith-based health ministries.

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