TBA.org > Sections > Section Home
TBA Elder Law Section resources
New TennCare Medicaid Policy Manual
The link below will enable you to download and review the Manual from the State's web site.
• Tennessee Department of Human Services: TennCare Medicaid Policy Manual
Qualified Income Trust Information
Department of Human Services policy regarding the use of Qualified Income Trusts in establishing financial eligibility for Medicaid in a long-term care setting.
• Letter from IRS to a state DHS (Texas) regarding tax ID number for Miller Trust
• Introduction to the Qualified Income Trust (or Miller trust).
Compiled by Pam Wright, March 2005.
• Legal Issues in PAE Contested Case Hearings
Poster’s note (Pam Wright): ALJ Ann Young wrote “Legal Issues in PAE Contested Case Hearings” in November 1994. It was published in the Administrative Procedures Reports (APR), a loose-leaf compilation on file in the Administrative Procedures Division of the Office of the Secretary of State. Since 1994, the regulations at 1200-13-1-.13(3) have been re-written. At the time those regulations were re-written, the Department of Health staff stated that the regulations were being re-written for clarity not to reflect changes in policy (based on a conversation between Dr. Louis Moore and Gordon Bonnyman and me). Gradually, issues arising out of PAE determinations have gone on to review in the state courts (Shupe v. Rudolph, 1995 Tenn. App. LEXIS 613 and Conner v. Rudolph, 1995 Tenn, App. LEXIS 649). The Administrative Procedures Division no longer publishes a digest (http://www.state.tn.us/sos/forms/digest.pdf) or other public record of precedence. So, it is impossible for me to know how much of this article reflects current APD precedence. Therefore, researcher needs to keep in mind the age of this article. Still, in my limited experience with contested PAE cases in the past ten years, I have found that the legal precedence and issues stated in this article are consistent with the decisions with which I am familiar and give the practitioner insight as to how PAEs are decided. I consider the article to be the best available overview of PAE legal issues in Tennessee.
OPTIONS for Community Living
The Tennessee Commission on Aging and Disability now has responsibility for administering two programs that provide home and community-based services. The first program, called OPTIONS for Community Living, is funded primarily with state dollars. The Options Program is designed to enable adults with disabilities who do not have services available to them from other programs to live independently in their own home by providing long- term care information and assistance, homemaker, personal care and home delivered meal. Options are offered in all counties, to persons not eligible for institutionalized Medicaid. For more information on these services call 1- 866-836-6678.
The regulations can be found at http://www.state.tn.us/sos/rules/0030/0030-02-01.pdf
Medicaid-waiver program
The second program is a Medicaid-waiver program (statewide 1915) which is beginning to provide services during the winter of 2003-2004.
The regulations for this program start at page 119 of http://www.state.tn.us/sos/rules/1200/1200-13/1200-13-01.pdf.
Additional proposed rules for the TCAD program can be found, beginning on page 41, at http://www.state.tn.us/sos/pub/tar/2003-09.pdf, and the final rules are expected to be listed as Rules 0030-2-2.
Click here to download a .pdf file that may be more descriptive of the services. This file contains the components of the waiver application that was submitted to CMS and approved in 2002. These services will also be offered statewide.
To be eligible, a person must have an approved Medicaid Pre-Admission Evaluation (establishing medical eligibility), meet the financial criteria for Medicaid and have a full-time caregiver.
DHS Bulletin on new hearings and appeals procedures
This bulletin describes implementation of new hearings and appeals procedures for Medicaid and other "family assistance" cases (effective 01/04/05). These procedures apply to eligibility and patient liability determinations, not Pre-Admissions Evaluations (PAE) determination.
Medicaid Assistance Manual Appendix K
Appendix K of the Medicaid Assistance Manual lists the Home and Community Based Services programs that are funded through a Medicaid waiver and describes the eligibility criteria for receipt of services under these programs.
DHS - Waiver fact sheet
Desk Guide for Home and Community Based Services (HCBS)
Medicaid bulletin on eligibility for Medicaid and TennCare (pdf)
This Medicaid bulletin explains how income for self-employed persons is counted in making the determination of eligibility for Medicaid and TennCare.
Other TennCare related documents
DHS Bulletin No. 10 outlining residency policy for Medicaid/Tenncare (pdf)
- Bureau of Tenncare memo on construction of the term "Principal Residence"
"The Out-of-State Former Home: Federal Law Requires That Intent to Return in the Indefinite Future Not, by Itself, Preclude a Finding of Residence in the New State"
Open Medicaid Categories for Adults Who Have Received TennCare Disenrollment Notices
Department of Human Services bulletin on the closing of the Adult Medically Needy category of Medicaid
If you do not have a copy of Adobe Acrobat Reader you can download one free here.
© Copyright 2007 Tennessee Bar Association
|
|
