§ 71-5-1420. Veterans Education Benefits
Notwithstanding any other provision of this chapter, to the extent permitted by federal law, the value of federal veterans education benefits received by an applicant shall not be included as any form of income when making eligibility determinations for assistance under this part.
§ 71-5-1421. Prompt Payment of Claims and Liability for Bad Faith Failure to Pay Claims Promptly
Any managed care organization shall comply with § 56-32-126 and any prompt pay provisions within the MCO contractor risk agreements with TennCare. In addition, the MCO shall ensure that ninety percent (90%) of clean claims for nursing facility services shall be processed and paid within fourteen (14) calendar days and ninety-nine and one half percent […]
§ 71-5-1422. Pilot Project for Disabled Individuals and Family Members to Self-Direct Supports and Services
The commission on aging and disability shall develop a pilot project proposal in accordance with this section. The long-term care services planning council shall be responsible for evaluating the implementation of the project. If funded in the general appropriations act, the pilot project shall be implemented and shall continue for three (3) years. The commission […]
§ 71-5-1423. Hearing on Resident’s Appeal of Involuntary Discharge From Facility — Timeframe for Hearing and Final Order
If a resident appeals the facility’s notice of involuntary discharge to that resident and a hearing is requested pursuant to 42 C.F.R. § 431.220(a)(3) before the bureau of TennCare: The hearing shall be conducted and a final order rendered within ninety (90) days from the date of the resident’s appeal of the facility’s involuntary discharge […]
§ 71-5-1424. Hearing on Appeal of Tenncare’s Initial Determination of Ineligibility for Nursing Facility Services — Motion to Intervene by Facility
If an individual appeals TennCare’s initial determination that they are not eligible for TennCare nursing facility services: The hearing on any appeal of an initial determination that the individual is not financially eligible shall be conducted and a final order rendered within ninety (90) days from the date of the individual’s appeal; provided, however, that […]
§ 71-5-1425. Guidance Regarding Whether Temporary Family Healthcare Structures Are Covered — Federal Approval of Waiver Amendment to Offer Benefit — Applicability of Waiver
As part of the plan to expand cost-effective community-based residential alternatives to institutional care as required pursuant to § 71-5-1411(a), the bureau of TennCare shall seek written guidance from the centers for medicare and medicaid services regarding whether a temporary family healthcare structure, as defined in § 13-7-501, may be covered in whole or in […]
§ 71-5-1412. Transition Period Following Implementation of Managed Long-Term Care Service Delivery System
A managed care organization (MCO) shall contract with any nursing facility licensed under title 68, chapter 11, part 2, and certified by the centers for medicare and medicaid services, that provides medicaid nursing facility services pursuant to an approved preadmission evaluation (PAE) and is willing to contract with the MCO to provide that service under […]
§ 71-5-1413. Acuity-Based Reimbursement Methodology for Nursing Facility Services
The commissioner shall develop and implement an acuity-based reimbursement methodology for nursing facility services, based on an individualized assessment of need, as an alternative to the current cost-based nursing facility reimbursement system. The methodology may include, but is not limited to, the development of enhanced rates for specified chronic care services that may encourage the […]
§ 71-5-1414. Self-Directed Health Care
The commissioner shall, upon approval of a waiver amendment granting authority from the federal government, develop and make available consumer-directed options for persons receiving home and community-based long-term care services under the long-term care program, which may include, but are not limited to, the ability to select, direct or employ persons delivering unskilled hands-on or […]
§ 71-5-1415. Quality Assurance and Quality Improvement Strategies
The commissioner shall develop and implement quality assurance and quality improvement strategies to ensure the quality of long-term care services provided pursuant to this part and shall specify in contractor risk agreements with contractors responsible for coordination of medicaid primary, acute and long-term care services requirements related to the quality of long-term care services provided. […]