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Aged, Blind and Disabled Manual Section: Institutional Medicaid Policy Manual Number: 125.020 Chapter: Post-Eligibility Treatment of Income

July 1, 2026 Division of TennCare 13 b. Ear mold; c. Hearing aid; d. Batteries; and e. Hearing aid orientation. 3. Dental services Effective January 1, 2023, dental services are a covered benefit for all adults enrolled in TennCare Medicaid. Dental services covered by the adult dental benefit are not allowed as an IME for TennCare enrollees. A list of covered procedures is posted on the TennCare website. Deductions can be made for dental services that are not covered by the adult dental benefit, in accordance with TennCare’s dental fee listing, whether such services are provided at a dental office, on-site at the Long-Term Care Facility (LTCF), or through a mobile dental services provider. Denied dental services may be eligible as an IME and will be reviewed on a case-by-case basis but only after denial of coverage by TennCare dental insurance. 4. Other medical service recognized under state law but not covered by TennCare Medicaid Deductions for any other medical service recognized under state law but not covered by TennCare Medicaid will be made at the least of the provider's usual and customary charges, billed charges or 80% of the Medicare fee schedule. Deductions will be allowed only for services that are determined by the State to be medically necessary for the particular individual on whose behalf the services are being requested. 5. Charges for nursing home days incurred as the result of bed-holds or therapeutic leave days Charges for nursing home days incurred as the result of bed-holds or therapeutic leave days that are in excess of the number of days covered under the State Plan for the type of facility in question are not allowable deductions. 6. Prescription Drugs There are four criteria that a prescription drug must meet to be an allowable IME: a. It must not be subject to a payment by a third party (e.g., Medicare or private insurance); b. It must be recognized under State law; c. It must not be covered by Medicaid; and d. It must be determined by the state to be medically necessary. Here are the IME coverage policies for four frequently requested drugs: