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Aged, Blind and Disabled Manual Policy Manual Number: 130.005 Section: CHOICES Chapter: TennCare CHOICES in Long-Term Services and Supports August 01, 2024 Division of TennCare 2 c. Group 3 Individuals age 65 and older, and adults age 21 and older with physical disabilities as defined in TennCare Rule 1200-13-01-.02, as SSI recipients or members of the CHOICES At-Risk Demonstration Group, who do not meet the NF LOC criteria but who, in the absence of HCBS, are “At Risk” for institutionalization. Group 3 enrollees are eligible for payment of HCBS. For individuals who are not SSI cash recipients, there must be an available slot for the individual to be enrolled.
New enrollment in Group 3 was limited to SSI cash recipients from July 1, 2015, to September 30, 2022 d. Inactive SSI Enrollee Individuals whose SSI cash benefits have been terminated by the Social Security Administration (SSA) and who remain eligible for TennCare until they have been reviewed for coverage in other eligibility categories. Inactive SSI enrollees are not eligible for CHOICES e. LTSS Payments For purposes of this policy, benefits paid to cover the cost of long-term care in a NF or payments for HCBS for CHOICES-eligible institutionalized individuals f. Personal Needs Allowance Deduction from the institutionalized individual's total income (as calculated for patient liability) to cover personal needs and incidentals. Currently amounts are: i. $50 per month for individuals in a NF or an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID); ii. 300% of the Supplemental Security Income – Federal Benefit Rate (SSI-FBR) for HCBS enrollees, PACE, and Self-Determination Waiver; and iii. 300% of the SSI-FBR for the Comprehensive Aggregate Cap (CAC) and Statewide Waivers g. Pre-Admission Evaluation (PAE)
Evaluation of an individual’s LOC, or medical need, for LTSS. The PAE is completed by the Area Agency on Aging and Disability (AAAD), discharging hospital, Managed Care Organization (MCO), or NF, and is reviewed by the TennCare LTSS Unit. For Medicaid eligible individuals, the PAE is submitted by the MCO, discharging hospital, or NF. h. Pre-Admission Screening/Resident Review (PASRR)
The process by which the State determines whether an individual who resides in or seeks admission to a Medicaid-certified Nursing Facility has, or is suspected of having, a mental illness or an intellectual disability. If so, the PASRR then allows the State to determine whether the