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What's New With TennCare



Information on Health Plan Transition Click here



Are You Waiting for a Decision on Your Application for Medicaid?

TennCare can help. Some people applied at healthcare.gov but have still not gotten a decision.  Have you waited for a decision for more than 45 days (or more than 90 days if you applied for long-term care)? You can now ask for a “delay hearing”. To ask for a delay hearing, call us at 1-855-259-0701. OR click here. If you click on the link, fill out the page and follow the instructions. That page tells you how to send it to us by mail or fax. Click here to find out more.

Do you have a new baby (12 months old or less) that you’re trying to enroll?

You may be able to enroll your baby right now. TennCare and CoverKids have made it easy to enroll newborns over the phone:

  • • Do you already have TennCare? Call 1-855-259-0701 when your baby is born.
  • • Do you have CoverKids? Call 1-866-620-8864 when your baby is born.
  • • If you don’t have TennCare or CoverKids, you can apply for your baby over the phone. Call 1-855-259-0701.

 

Eligibility Assistance for Pregnant Women and Newborns

The Bureau of TennCare implemented a newborn presumptive eligibility (NPE) program on August 18, 2014. This new program allows participating hospitals and birthing centers to enroll in TennCare newborns whose mothers (a) are not enrolled in TennCare at the time of delivery but (b) have self-reported incomes at or below the TennCare income limit. In addition, TennCare is streamlining the reporting of births among mothers who are enrolled in TennCare and CoverKids at the time of their deliveries. More information is available at www.tenncaretopics.com.

 

Federal Processing Delays and New Appeal Process

Many Tennessee residents have applied for TennCare at the federally-facilitated marketplace (FFM, otherwise known as healthcare.gov or the Marketplace) since January 1, 2014. While the FFM has issued TennCare approvals for over 125,000 applicants in Tennessee through August 2014, the federal government has not been able to make a timely determination of eligibility in some cases. Because of these processing delays at the FFM, a group of applicants has not gotten a timely eligibility decision from the federal government. More information about TennCare’s experience since January 1, 2014, federal processing delays, and the new appeals process is available here.

 

Transition Plan Documents for New Federal Home and Community Based Services Rules

Each state must submit a proposed Transition Plan in accordance with requirements set forth in the Centers for Medicare and Medicaid Services (CMS) Home and Community Based Services Setting and Person Centered Planning Rule released on January 16, 2014. ...more

 

Home and Community Based Services for Individuals with Intellectual and Developmental Disabilities:

TennCare and the Department of Intellectual & Developmental Disabilities (DIDD) have released a Concept Paper about the future of the state's Home and Community Based Services for people with intellectual and developmental disabilities. ...more

 

Quality Improvement in Long Term Services and Supports

Quality Improvement in Long Term Services and Supports or QuILTSS is a TennCare initiative to promote the delivery of high quality Long Term Services and Supports for TennCare members, including Nursing Facility services as well as Home and Community Based Services.  TennCare intends to create a new payment system (aligning payment with quality) for Nursing Facilities and certain Home and Community Based Services based on performance on those measures. ...more

 

What is TennCare?

TennCare is the state of Tennessee's Medicaid program that provides health care for 1.3 million Tennesseans and operates with an annual budget of approximately $10 billion. More information is available here.

...More TennCare News

Increased Medicaid Payment for Primary Care

Effective January 1, 2013, qualified Primary Care Physicians as detailed by CMS regulation are to receive a rate increase effective until 12/31/14. This rate increase is also referred to as the “PCP Bump”. This rate increase also includes payments for services furnished by Primary Care Physicians under the Vaccines for Children program. Payments to Primary Care Physicians are being made to designated providers for current claims from the Managed Care Contractors. Managed Care Organizations are also beginning the process of making retroactive rate adjustments for qualified providers. Increased payment for physician crossover services from TennCare will begin once required system changes are complete. Physician crossover payments related to these rate increases are currently targeted for January 2014 and will include retroactive payments for eligible providers for eligible services back to January 2013. more...

Public Notices

New Website for Families: www.kidcentraltn.com

As a participating member of the Governor’s Children’s Cabinet, the Division of Health Care Finance and Administration is proud to support the launch of www.kidcentraltn.com 

This new website provides information on health, education, development and support to Tennessee families, as well as a searchable State Services Directory. Families will also be able to create their own private profiles on the kidcentral tn site, which will allow them to receive information that matters to the specific needs of their families.

In alignment with the TENNderCARE program, kidcentral tn reinforces the department’s goal to promote good health in children from birth until age 21.

Visit www.kidcentraltn.com to explore the site and share it with the Tennessee families you serve every day.

kidcentral

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