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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 7 Institutional Medicaid eligibility for individuals who have met 30 days continuous confinement in a medical institution only lasts as long as the individual is institutionalized. If the enrollee is discharged from the medical institution, his Institutional Medicaid eligibility will be terminated. Applicants for HCBS cannot be approved for Institutional Medicaid based on 30 days continuous confinement. All HCBS applicants must have an approved, unexpired PAE. 7. Medicare Recipients Requiring Co-Pays or Cross-Over Payments for Skilled Nursing Facility Care (Medicare Cross-Over Payments) Medicare Part A covers the first 100 days in a SNF, when the Medicare enrollee is in the SNF for the purpose of rehabilitation. Medicare typically pays 100% of the cost for the first 20 days, and 80% of the cost for days 21-100. If the Medicare enrollee is also TennCare Medicaid eligible in an Institutional Medicaid category and/or has QMB, TennCare will pay the Medicare co-pays, or cross- over payments, for days 21-100 of the SNF stay. An approved PAE is not required to establish Medicare cross-over payments. However, for Medicare recipients (who are not QMB eligible) who are approved for Institutional Medicaid based on 30 days continuous confinement, patient liability must be established to process the cross-over payment. Note: Medicare may pay for more or less than 100 days of SNF, however, 100 days is the general rule. For the sake of this policy, the Institutional Medicaid eligibility will cover the SNF Medicare co- payment from the date of eligibility through day 100 or the last day of Medicare-approved skilled stay day. 8. Short Term Stay A short-term stay is one of 90 or less days. HCBS-eligible enrollees who enter a NF may remain active in their HCBS case for 90 days. An enrollee cannot be moved out of HCBS if the NF stay is anticipated to be short-term and the enrollee plans to return home to receive HCBS. During a 90-day short-term nursing facility stay for a person in HCBS, the HCBS Personal Needs Allowance (PNA) will continue to apply (300% of the SSI-FBR). This is to allow the enrollee to maintain his community residence in order to facilitate transition back home. If the enrollee remains in the NF beyond 90 days (or such time that it is determined the enrollee needs to remain in the NF beyond 90 days), the MCO will facilitate the member’s transition via the CHOICES Transition process. 9. Other Long-Term Services and Supports Programs PACE and the DDA HCBS waivers are not part of the CHOICES program but provide similar services to the eligible populations. More information about PACE and the DDA HCBS waivers is available at TennCare Long-Term Services and Support site.