The Commissioner of the Tennessee Department of Finance and Administration is providing official notification, pursuant to 42 CFR § 447.205 and 59 Fed. Reg. 49249, concerning intent to file an amendment to the TennCare II Demonstration. The amendment will be filed with the Centers for Medicare and Medicaid Services (CMS), a federal agency located in Baltimore, Maryland.
The State is required to meet certain advance notice obligations whenever an amendment to the TennCare demonstration is filed. This demonstration amendment, which will be known as “Amendment 18,” is being filed with a proposed effective date of July 1, 2013.
Amendment 18 makes certain modifications in the benefits available under the CHOICES program, which is the portion of TennCare that serves the elderly and adults with physical disabilities requiring long-term services and supports (LTSS). There are three CHOICES program components. CHOICES 1 serves individuals living in Nursing Facilities (NFs). CHOICES 2 serves individuals who qualify for NF care but who are able to benefit from home and community-based services (HCBS) that provide an alternative to NF care. CHOICES 3 serves individuals who are “at risk” for institutional placement. People in CHOICES 2 and CHOICES 3 are eligible for an array of HCBS that provide a safe and cost-effective alternative to institutional placement.
At present Community Based Residential Alternatives (CBRA) to institutional care are covered only for persons in CHOICES 2. CBRAs include, but are not limited to, assisted care living facilities (ACLFs), adult care homes, and companion care.
The purpose of Amendment 18 is to make ACLF services available to persons in CHOICES 3 as well as CHOICES 2 under certain circumstances. ACLF services will be provided for CHOICES 3 members only when the cost is no more than the cost of CHOICES HCBS that would otherwise be needed by the individual to be safely served in the community and to delay or prevent nursing facility placement. The definitions of ACLF services and community based residential alternatives are modified consistent with this change.
It is our intention to submit this amendment to CMS with the request that it be approved in time for implementation to occur on July 1, 2013. We estimate that implementation of the amendment will not have a significant impact on aggregate annual expenditures.Copies of this notice will be available in each county office of the Tennessee Department of Human Services. Written comments may be submitted by email here or may be mailed to Mr. Darin Gordon, Director, Bureau of TennCare, 310 Great Circle Road, Nashville, Tennessee 37243. Persons wishing to review copies of written comments received may submit their requests to the same email and/or physical address.