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Aged, Blind and Disabled Manual Policy Manual Number: 125.005 Section: Institutional Medicaid Chapter: Institutional Status
November 3, 2025 Division of TennCare 2
b. Individuals without a PAE
An individual without a PAE is considered continuously confined when he:
i. Has been admitted to a medical institution and is continuously confined in a medical institution (i.e. hospital, NF or ICF/IID) for at least 30 days; ii. Is dually-eligible for Medicare and Medicaid, and is receiving Level 2 Skilled Nursing Facility (SNF) care paid by Medicare. Medicare pays for the first 100 days of Level 2 SNF care; or iii. Has been admitted to a NF to receive hospice services for any length of time.
Note: A dual-eligible individual receiving SNF care paid for by Medicare does not need to be in an Institutional Medicaid category for TennCare to pay the Medicare co-pay. She must receive QMB, but may be eligible as a Supplemental Security Income (SSI) recipient or in another TennCare Medicaid category.
Note: If the dual-eligible individual continues to need Long-Term Services and Supports (LTSS) after his Medicare-covered stay in the SNF, then he must apply for CHOICES. If the individual is applying for HCBS services, he will need a PAE. If the individual applies for nursing facility care, he will need a PAE or may be approved based on continuous confinement.
3. Institution Types
An institution is an establishment that provides food, shelter, treatment and services to four or more individuals. Types of institutions include:
a. Medical Institution
An institution authorized by state law and organized to provide medical care, including nursing and convalescent care. Examples of medical institutions include: hospitals, convalescent or progressive care centers, and Long-Term Care Facilities (LTCFs), providing skilled and intermediate care and hospice services.
b. Institution for the Intellectually and Developmentally Disabled
An institution organized primarily for the diagnosis, treatment or rehabilitation of the intellectually and developmentally disabled. It provides a protected residential setting for the evaluation, rehabilitation and 24-hour supervision of the patient.