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Notice of Change in TennCare II Demonstration
Amendment 24

The Commissioner of the Tennessee Department of Finance and Administration is providing official notification, pursuant to 59 Fed. Reg. 49249, of intent to file an amendment to the TennCare II Demonstration.  The demonstration amendment will be filed with the Centers for Medicare and Medicaid Services (CMS), a federal agency located in Baltimore, Maryland, with a Regional Office in Atlanta, Georgia. 

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 24,” is being filed with a proposed effective date of January 1, 2015.

Amendment 24 pertains to TennCare CHOICES, the program operated by the Health Care Finance and Administration that furnishes two key types of services: (1) Nursing Facility (NF) services to eligible individuals of all ages and (2) home and community-based services (HCBS) that are alternatives to NF services for eligible adults who are aged or who have physical disabilities. 

The purpose of Amendment 24 is to add two service definitions to the menu of services covered by the TennCare CHOICES program, and set forth in Attachment D of the TennCare Demonstration.  These two service definitions describe models that have been evaluated and found to be consistent with the objectives of the CHOICES program, and they will be implemented in a manner that comports with new HCBS settings rules applicable to services provided under a Section 1915(c) HCBS waiver.  The development and implementation of a plan to expand appropriate cost-effective community-based residential alternatives to institutional care is required pursuant to the Long-Term Care Community Choices Act, which authorized the CHOICES program in 2008 (see TCA 71-5-1411).  These definitions are as follows:

Community living supports (CLS).  A community-based residential alternative service for seniors and adults with disabilities encompassing a continuum of support option for up to four individuals living in a home that supports each resident’s independence and full integration into the community, ensures each resident’s choice and rights, and comports fully with standards applicable to HCBS settings delivered under Section 1915(c) of the Social Security Act, including those requirements applicable to provider-owned or controlled homes, as applicable, except as supported by the individual’s  specific assessed need and set forth in the person-centered plan of care.

Community living supports–family model (CLS-FM).  A community-based residential alternative service for seniors and adults with disabilities encompassing a continuum of support option for up to three individuals living in the home of trained family caregivers (other than the individual’s own family) in an “adult foster care” arrangement.  In this type of shared living arrangement, the provider allows the individual(s) to move into his or her existing home in order to integrate the individual into the shared experiences of a home and family, provides the individualized services that support each resident’s independence and full integration into the community, ensures each resident’s choice and rights, and supports each resident in a manner that comports fully with standards applicable to HCBS settings delivered under Section 1915(c) of the Social Security Act, including those requirements applicable to provider-owned or controlled homes, except as supported by the individual’s  specific assessed need and set forth in the person-centered plan of care.

Implementation of the amendment is not expected to result in additional program costs.  These services would be covered only when an MCO determines that the cost of CLS or CLS-FM services, as applicable, will not exceed the cost of CHOICES HCBS that would otherwise be needed by the member to 1) safely transition from a nursing facility to the community; or 2) to continue being safely served in the community and to delay or prevent nursing facility placement.  This will allow the state to make this change without requiring a new appropriation to support an expansion of program benefits, which would not be possible at this time. Existing individual and expenditure caps will continue to apply.   

Copies of this notice will be available in each county office of the Tennessee Department of Health.  Written comments may be submitted by email to Susie.Baird@tn.gov 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.