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Aged, Blind and Disabled Manual Section: CHOICES Policy Manual Number: 130.005 Chapter: TennCare CHOICES in Long- Term Services and Supports Legal Authority: Social Security Act § 1915(c); 42 CFR 435.217; TennCare 1115 Medicaid Demonstration; Tenn. Comp. R. & Regs. 1200-13-01; Tenn. Comp. R. & Regs. 1200-13-20-.08 1. Overview The TennCare CHOICES in Long-Term Services and Supports (LTSS) program was established in 2008 with the dual purpose of expanding Home and Community-Based Services (HCBS) in the TennCare program and improving access to HCBS and other long-term care services to those who qualify. The CHOICES program allows the State of Tennessee to integrate all Nursing Facility (NF) care and HCBS into the existing managed care system. Individuals who are eligible for CHOICES are approved under different groups based on the setting in which they receive services, and their own Level of Care (LOC) needs. CHOICES enrollees have their care in the Long-Term Care Facility (LTCF) or HCBS program paid for by TennCare Medicaid. These payments, called LTSS payments, are separate from the regular TennCare Medicaid benefit. An applicant/enrollee must have an approved Pre-Admission Evaluation (PAE) and be enrolled in CHOICES in order to be eligible for LTSS payments. Within TennCare, the LTSS Unit is responsible for administering the CHOICES program. The LTSS Unit is responsible for determining whether a CHOICES applicant meets the LOC requirements (also known as medical eligibility) and manages enrollment into long-term care programs and the LTSS database. The Member Services Unit is responsible for determining Medicaid eligibility for a CHOICES applicant. In order to receive CHOICES HCBS, an individual must be eligible in an Institutional Medicaid category or be a Supplemental Security Income (SSI) cash recipient. An individual may not receive CHOICES HCBS without being eligible for Institutional Medicaid or SSI. 2. Definitions a. Group 1 Individuals who are receiving Medicaid-reimbursed LTSS in a NF. Individuals must be eligible for Medicaid and meet NF Level of Care (LOC) criteria. b. Group 2 Individuals age 65 and older, and adults age 21 and older with physical disabilities as defined in TennCare Rule 1200-13-01-.02, who meet the NF LOC criteria, who are eligible for Medicaid either as SSI cash recipients or in an Institutional category and who need and are receiving HCBS instead of NF care.