For Department of State Use Only

Department of State Division of Publications

Sequence Number:

;312 Rosa L. Parks, 8th Floor Snodgrass/TN Tower Nashville, TN 37243 Phone: 615.741.2650 Email: [email protected]

Notice ID(s): File Date: _

O{p-13- 1'] 2710 _.,~~ q/.fL-' 12 _L ,_,_'J--" 7_ _

Notice of Rulemaking Hearing Hearings will be conducted in the manner prescribed by the Uniform Administrative Procedures Act, T.C.A. § 4-5-204. For questions and copies of the notice, contact the person listed below.

A~ency/Board/Commission: Division: Contact Person:

Address: Phone: Email:

--------------Tennessee Department of Finance and Administration

Bureau of TennCare George Woods Bureau of TennCare 310 Great Circle Road Nashville, TN 37243 615) 507-6446 george [email protected]~ov

Any Individuals with disabilities who wish to participate in these proceedings (to review these filings) ·and may require aid to facilitate such participation should contact the following at least 10 days prior to the heal ing:

ADA Contact:

Address: Phone: Email:

Talley A. Olson, Director HCFA Office of Civil Riqhts Compliance Bureau of TennCare 310 Great Circle Road Nashville, TN 37243 (855) 857-1673 TTY dial 711 and ask for 855-857-1673 [email protected]

_

Hearing Location(s) (for additional locations, copy and paste table) Address 1: Citv: Zip: Hearing Date : Hearinq Time:

Bureau of TennCare 310 Great Circle Road, Conference Room 1 East A Nashville, TN 37243 August4,2017 EST/EDT 9:00 a.m. i XCST/CDT

I

Additional Hearing Information:

Revision Type (check all that apply): X Amendments New Repeal

Rule(s) (ALL chapters and rules contained in filing must be listed. If needed, copy and paste additional tables to accommodate more than one chapter. Please enter only ONE Rule Number/Rule Title per row.)

SS-7037 (December 2015)

RDA 1693

~hapter Number 1200-13-13 Rule Number 1200-13-13-.03 1200-13-13-.10

·-----··--·--- ·-·------- ·-----------------~-

-··--·-·---·-----··------

Chapter Title ----~-·-·---··- .. ----------- ---- ··· ··-------·--·-------·-----~-TennCare Medicaid Rule Title Enrollment, Reassiqnment, and Disenrollment with Managed Care Contractor (MCCS) Exclusions -----------. ,,,,

(Place substance of rules and other info here. Statutory authority must be given for each rule change. For information on formatting rules go to http://sos.tn.gov/sites/default/files/forms/Rulemaking Guidelines August2014.pdf) Subparagraph (c) of Paragraph (2) of Rule 1200-13-13-.03 Enrollment, Reassignment, and Disenrollment with Managed Care Contractor (MCCS) is amended by naming the title of Subparagraph (c) as "Members receiving long-term services and supports .", by numbering the current content as Part 1, and adding a new Part 2 so as amended Subparagraph (c) shall read as follows: (c)

Members receiving long-term services and supports . 1.

In the event that a CHOICES member is determined, based on an assessment of needs, to require a long-term care service that is not currently available under the MCO in which he is currently enrolled, but that is available through another MCO, the Bureau shall work with the current MCO to arrange for provision of the required service, which may involve providing such service out-of-network. It shall be considered to be a hardship reason to change MCO assignment only if the current MCO, after working with the Bureau, is unable to provide the required service. In such cases, the MCO that is unable to provide the required service after working with the Bureau may be subject to sanctions.

2.

A CHOICES or ECF CHOICES member may request and shall have cause to change MCO assignment if all of the following are met: (i)

The member receives institutional, residential, or employment support services in the ML TSS program in which he is enrolled;

(ii)

The member's institutional, residential, or employment support services provider has stopped participating in the member's MCO network and has refused continuation of care to the member in his current MCO assignment;

(iii)

The member's current MCO has been unable to negotiate continued services for the member with the current provider;

(iv)

The member would have to change his residential, institutional, or employment supports provider based on that provider's change in status from an in-network to an out-ofnetwork provider with the MCO;

(v)

As a result, the member would experience a disruption in his residence or employment;

(vi)

The current institutional, residential, or employment support services provider is in the network of one or more alternative MCOs; and

(vii)

The alternative MCO the member has selected is available to enroll members (i.e., has not given notice of withdrawal from the TennCare Program, is not in receivership, and is not at member capacity for the member's region) .

Statutory Authority: T.C.A. §§ 4-5-202 , 4-5-203, 71-5-105, and 71-5-109. The introductory sentence of Part 29 of Subparagraph (b) of Paragraph (3) of Rule 1200-13-13-.10 Exclusions is amended by capitalizing the "R" in "rule" and deleting the "12 ." at the end of "1200-13-13- .10(3)(a)12." and replacing it with "1 O)," so as amended the introductory sentence shall read as follows: 29 . Food and food products (distinct from food supplements or substitutes , as defined in Rule 120013-13-.10(3)(a)10), including but not limited to specialty food items for use in diets such as: SS-7037 (December 2015)

RDA 1693

2

The introductory sentence to Part 52 of Subparagraph (b) of Paragraph (3) of Rule 1200-13-13-.10 Exclusions is amended by deleting "23 ." at the end of "1200-13-13-. 04(1)(b)23." and replacing it with "22" so as amended the introductory paragraph shall read as follows: 52. Organ and tissue donor services provided in connection with organ or tissue transplants covered pursuant to Rule 1200-13-13-.04(1)(b)22, including, but not limited to:

Statutory Authority: T .C.A. §§ 4-5-202, 4-5-203 , 71-5-105 , and 71 -5-109.

SS-7037 (December 201 5)

3

RDA 1693

I certify that the information included in this filing is an accurate and complete representation of the intent and scope of rulemaking proposed by the agency.

Date: Signature:

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Name of Officer:

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M.P.H. Wendy Long, Director, Bureau of TennCare Tennessee Department of Finance and Administration

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Title of Officer: '-

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~~ i\ ut1t1&SSfl. : i tl()1AR'1 : S~ scribed and sworn to before me on : __-r(o-+-----+~/_1~-- - - - - -;

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Notary Public Signature:

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My commission expires on: ___.,__= ........,oc=--0"'-"'~~0..__ _ __ __ _ __ __

Department of State Use Only

Filed with the Department of State on:

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SS-703 7 (December 2015)

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RDA 1693

Finance and Administration

Email: publications.information@tn.gov. Notice ID(s): ... ADA Contact: HCFA Office of Civil Riqhts Compliance ... (Place substance of rules and other info here.

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