TennCare Pausing Terminations durning COVID-19

TennCare also stopping involuntary disenrollments from LTSS

TennCare Advocates,

We wanted to take an opportunity to update our advocacy partners on a few decisions TennCare has made in light of the COVID-19 emergency.  To start, for the duration of the emergency, TennCare is pausing terminations for both Medicaid and CoverKids with exceptions for voluntary terminations and cases where a member is no longer a resident. Redeterminations will continue only to the extent a member can be automatically renewed through the ex parte process. The effective date for this pause is March 18 so anyone who was enrolled as of that date will maintain coverage through the end of the national emergency.  This includes members who received continuation of benefits pending appeal as of that date. Regarding the 90-day termination period, this pause will not impact that process currently. If an individual who submits information during the 90-day reconsideration period is ultimately approved, we will continue to fill any gap in coverage back to the date of termination, just as we have done voluntarily for the last several years.

We have also implemented several Long-Term Services and Supports (LTSS) policy changes including the pause of all involuntary disenrollments from LTSS programs. To ensure continued access to these important services, we are allowing all assessments (PAEs, PASRRs) to be performed remotely. We continue to work closely with our partners and have issued guidance to MCOs, AAADs, and providers, and have worked with DIDD to issue guidance to their support coordination and provider agencies. All of these updates are available on the TennCare Coronavirus webpage at  https://www.tn.gov/tenncare/information-statistics/tenncare-information-about-coronavirus.html.

TennCare has always encouraged anyone who thinks they may be eligible to apply and TennCare Connect will remain open and accessible to anyone seeking to do so.  As you know, online, phone, mail, and in person are all options to apply and we will closely monitor the availability of each of those options as we move forward.  Specific to the application process, TennCare will begin taking self-attestation of eligibility criteria, including income and resources, on a case-by-case basis when documentation is not available due to the coronavirus pandemic.  We have also temporarily simplified the presumptive eligibility process so that applications and signatures can be completed by phone during this emergency; however, anyone who gains or has recently gained eligibility through the presumptive process will still need to apply in order to maintain their eligibility status.

On the medical side, we are also in constant contact with provider groups and stakeholders on ways to support impacted providers and have already taken steps to ensure services are not disrupted.  For example, we have already significantly expanded telehealth policies and guidance regarding services is updated on our website as soon as it becomes available.  Additionally, we have authorized automatic reauthorizations for ongoing home health and private duty nursing services for at least 60 days.  This authorization is temporary and will be reevaluated as we continue to work with our health plans during this period.    

Finally, to secure additional flexibilities related to the COVID-19 emergency, TennCare has submitted an 1135 waiver to CMS.  If approved, TennCare will gain several regulatory flexibilities targeted toward providers and designed to ensure sufficient health care services are available to serve our members.

Again you can find up-to-date information on the TennCare Coronavirus webpage at https://www.tn.gov/tenncare/information-statistics/tenncare-information-about-coronavirus.html.

Please don’t hesitate to reach out if you have any questions.

Thanks

Sarah

Sarah Tanksley Stockton

Director of Communications

310 Great Circle Rd., Nashville, TN 37243

p. 615-507-6457 c.615-767-4109

sarah.tanksley@tn.gov tn.gov/tenncare

Take Action on Work Requirments

Tennessee is asking the Federal Government to allow it to have monthly work requirements put in place for folks to receive healthcare thru TennCare.  

Please use the survey put together by the Tennessee Justice Center as an easy means to submit comments. By taking this short survey and adding your comments after you answer each survey question, your comments will be sent anonymously. 

Survey on work reporting requirements. 

February 7th is the last day to submit comments on this proposal. To learn more about this and to submit comments take this survey on work reporting requirements.

The responses to this survey would generate at least 5 separate comments (depending on how you answer) for the federal comment period. The Tennessee Justice Center submit those comments on your behalf anonymously. All you have to do is the survey. 
 
Please pass this on to your friends, even people outside of Tennessee can do it. 



https://www.surveymonkey.com/r/tenncaresurvey

A robust federal comment period helped Kentucky defeat work reporting requirements in their state.

A federal district court decided to vacate a plan from the Kentucky government to implement work requirements for able-bodied adults in the state Medicaid program. That decision calls into doubt an initiative strongly favored by the Trump administration and several Republican governors across the country. It also challenges a larger administration plan to refashion all federal welfare and means-tested poverty programs, and should kick off a flurry of court activity on the issue.

Kentucky created the work requirement in its Medicaid program back in January, after the Centers for Medicare and Medicaid Services issued official guidance encouraging “state efforts to test incentives that make participation in work or other community engagement a requirement for continued Medicaid eligibility.” Formerly, federal administrations had never approved state restrictions in Medicaid like work requirements or drug-testing that constrained base eligibility for the program. After expanding Medicaid to all low-income adults in participating states, President Obama’s CMS was particularly stringent about this, approving state waivers that restructured elements of Medicaid programs and even reduced benefits, but never approving a waiver from a state involving work requirements.

IL Centers exempted from Day Services License

PART ONE: Tennessee begins a state program that leaves out the state’s Centers for Independent Living

The state of Tennessee developed a unique service with the new Employment and Community First initiative. Tennessee Amendment 27 was the first attempt in the U.S. to bring integration and independence to Americans that were often trapped on waiting lists for programs. All of the state’s six IL Centers were asked to be a part of providing the tools to help people with disabilities all over the state to live independently and to work for employment and self-sufficiency.

July 1, 2016 the program went live and MCIL had done the work to build our program and services from scratch. In the ECF program we offer: Peer-to-peer Self-Direction; Community support, development, organization and navigation; Health Insurance Counseling (Forms Assistance) and Independent Living Skills Training. At the time we were also offering Personal Attendant Services and Supportive Home Care through our existing PAS Services department.

MCIL desperately needed more service hours for our PAS program and those two ECF services seemed to be in demand. Increasing our capacity with ECF Personal Attendant Services and Supportive Home Care seemed just what the Center needed to continue consumer oriented home and community services. MCIL did not get any of the first ECF referrals and by October we had paid for all necessary training and background checks for our staff and we had been certified by both Managed Care Organizations.

To date, MCIL has not received a single appropriate referral. We have heard from five people and some “Support Coordinators” from the MCO’s, but none were looking for services that MCIL had agreed to provide. One referral may have included services we offer, but it was from a county outside our area.

Since the beginning of 2017, it has been very hard here at MCIL because our PAS program dipped below the hours needed to keep it sustainable and keep the dozens of Direct Support Professionals employed. In March MCIL had to end the program and two additional professionals who administered the program lost their jobs. The state’s ECF program said they had 1,700 slots in the first year but not one appropriate referral came to MCIL.

MCIL did not end its ECF program however, although clearly we could not offer Supportive Home Care and Personal Assistance services because we no longer had a PAS program. The MCOs did not call for any of the other services that MCIL had to offer.

From the beginning, we had assumed the IL Skills would be our bread-and-butter. MCIL has more than 32 years of IL experience in the community and it is our calling-card, it is in our name.

The Memphis Center for Independent Living never removed the service “IL Skills Training” from our Policy and Procedure Manual but the Managed Care Organizations apparently could not approve us to provide IL Skills because, they claimed, an IL Skills provider must have be a “Licensed Day Habilitation Provider” in order to be credentialed by the Managed Care Organizations.

The MCO’s did not have any problem with us continuing to list IL Skills as a service we provide, because they could not coherently explain why we would need a Day Services license. It did not make any sense. The IL Skills according to the state regulations could not be provided in a facility and had to be one-on-one services offered in the least restrictive setting.

From early on in this process, the Statewide Independent Living Council and other CILs in the state were advocating to get rid of the Day Services license. The other Tennessee CILs were working on developing ECF programs of their own and saw the license as a barrier. One-by-one the CILs dropped out of the ECF program for a variety of reasons, including the burden of the unnecessary license.

PART TWO: Changing the license requirement

LETTER: Tim Wheat, Program Director Memphis Center for IndependentLiving to Dr. Wendy Long, Director of TennCare

LETTER: Patti Killingsworth, Assistant Commissioner and Chief of Long Term Services and Supports to Tim Wheat

SAVE MY CARE!

Save My Care Bus Tour in Memphis this Monday

The Save My Care Bus Tour is a two-month, cross-country tour focused on telling the stories of the more than 30 million Americans who will lose their health care under Congress’ dangerous repeal plan. 

So far, the bus has held 31 rallies in 14 states and traveled 7,457 miles telling the stories of the more than 30 million Americans who will lose their health care under Congress’ dangerous repeal plan.

Memphis Stop: February 27, 2017 12:00pm-2:00pm

Navy Park South Second Street and GE Patterson
Memphis, TN 38103

SAVEMYCARE.ORG

Tennessee Set to Redetermine TennCare Eligibility

What You Need to Know About TennCare Redetermination Process  

By Tim Redd and Allison Donald
The TennCare Redetermination Process is tedious to say the least. The packet comes in two formats. The standard packet is 98 pages long and if you assert a disability you will fill out a total of 119 pages.

Several challenges have been revealed in the wake of this process like the extensive questioning.  Also the packets are not being mailed to the right address and each packet includes an individualized bar-code, so every page is related to an individual recipient. Explaining and communicating with diverse populations and some people are prevented from reapplying. Failure to complete the process in a timely fashion will leave many TennCare recipients with no health insurance.

The most important thing you need to do is call the Tennessee Health Connection 1-855-259-0701 to verify your address and inquire if you are scheduled to receive a redetermination packet. You have 90 days to submit your completed form. If you receive any mail that requires you to send in more information you have 10 days to respond.

The catch is, you really only have only 50 days to return the redetermination packet, which is based on the day the packet is mailed out. Please keep a copy of the information you receive.  You may produce a paper trail so nothing is lost by sending a fax to the Tennessee Health Connection is 1-855-315-0669.

“The most vital part of this entire equation,” said Michael Heinrich a volunteer with the Tennessee Health Care Campaign, “is to make sure your correct address is on file with the state of Tennessee, and ask if you are supposed to receive a redetermination packet.”

You should be able to get help with your packet from the Department of Health and Human Services and Tennessee Health Connection. Enrollees do not have a case worker that will fill out the redetermination packet, you must call the Department of Health and Human Services (901) 320-7200 to get assistance.

Tennessee finally closing the Medicaid Gap?

The Three-Star Healthcare Taskforce Pilot Program for Tennessee

The Three-Star Healthcare Taskforce released an outline of a Medicaid expansion plan today. The process has taken far too long and has been costly for the state of Tennessee, but finally our state may have an insurance proposal that could close the coverage gap.

The Taskforce was created by Speaker Beth Harwell to address the Legislature overlooking the issue of Medicaid Expansion in the state of Tennessee. The Three-Star Healthcare Taskforce has been hearing from the federal Center for Medicare and Medicaid Services about the proposal.

The proposal is called a “Pilot” program and may be adopted as soon as April of next year. The first phase of the plan would be to cover about 140,000 people in Tennessee without insurance by diagnosis, and expand the program if it meets goals set for the first six months. The proposal includes employment and job training services for enrollees.

Phase two would be rolled out in January of 2018 at the earliest. The second phase will close the coverage gap and be paid for by the federal government through the Affordable Care Act and the Tennessee Hospital Association will pick-up the balance.