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Administrative Manual Policy Manual Number: 200.112 Section: General Administrative Procedures and Compliance Subject: Eligibility of Inmates of Public Institutions

October 3, 2016 TennCare 2

• An intermediate care facility; or • A child-care institution for children receiving foster care payments under IV-E or AFDC foster care under title IV-A. Medical Institution: An institution that: • Is authorized under State law to provide medical care; • Is organized to provide nursing and convalescent care; • Has the necessary professional personnel, equipment, and facilities to manage the medical, nursing, and other health needs of patients continuously and according to accepted standards; and • Is staffed by professional personnel responsible to the institution for professional medical and nursing services. Services must include: o Adequate and ongoing medical care and supervision by a physician; o Registered nurse or licensed practical nurse supervision and services and nurses’ aid services; and o A physician’s guidance on the professional aspects of operating the institution. Examples of medical institutions include: hospitals, convalescent or progressive care centers, Long-Term Care Facilities (LTCFs), providing both skilled and intermediate care, and juvenile psychiatric facilities. Medical institutions eligible for FFP are those that are generally available to the public, organized primarily for the provision of medical care, and do not operate primarily or exclusively to serve inmates. 3. Inmates of Public Institution Status Verification HCFA receives incarceration information through electronic interfaces with the Tennessee Department of Corrections (TDOC) for prisons and from a contractor who works with county jails. Individuals reported as incarcerated are placed in suspended enrollment status and notice of such status is sent to the individual’s mailing address and the correctional facility. HCFA removes an individual’s suspended status for individuals no longer considered inmates of public institutions based on TDOC reports and the contractor’s reports once the inmate status on the report is verified. HCFA will also manually remove an enrollee’s suspended status upon notification by the enrollee and once that notification has been verified. The move from suspended status will be prospective from the point of notification to the state. 4. Eligibility Requirements An individual’s inmate status does not prevent Medicaid eligibility or enrollment, but an individual’s inmate status does impact payment of Medicaid services and MCO assignment. Inmates of public institutions must meet non-financial requirements to receive eligibility in a Medicaid category. For