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TennCare Long-Term Services & Supports (LTSS)

Medicaid

CHOICES

TennCare CHOICES in Long-Term Services and Supports (or CHOICES for short) is for adults (age 21 and older) with a physical disability and seniors (age 65 and older). CHOICES offers services to help a person live in their own home or in the community. These services are called Home and Community Based Services or HCBS. These services can be provided in the home, on the job, or in the community to assist with daily living activities and allow people to work and be actively involved in their local community. CHOICES also provides care in a nursing home if it is needed.

 CHOICES Groups

  • Group 1 is for people of all ages who receive nursing home care. 
  • Group 2 is for certain people who qualify for nursing home care, but choose to receive home care instead or Assistant Living/Community Living Support (service). 
  • Group 3 is for certain people who don’t qualify for nursing home care, but need home care to help them stay at home safely or Assistant Living/Community Living Support (service).

To see if you qualify to enroll in CHOICES, call us at 1-800-690-1606. 

ECF CHOICES

Employment and Community First CHOICES is for people of all ages who have an intellectual or developmental disability (I/DD). This includes people who have significant disabilities.

Services help people with I/DD gain as much independence as possible. People are supported to live with their family or in the community, not in an institution. Residential services are available for adults with I/DD who do not live with family but need supports where they live.

Employment and Community First CHOICES can help the person with I/DD explore the possibility of working. Services can also help people learn skills for work, find a job, and keep a job. This could be a part-time job, a full-time job or self-employment. Working helps people earn money, learn new skills, meet new people, and play an important role in their communities. Work can also help people stay healthy and build self-confidence.

Other services help people learn and do things at home and in the community that help people achieve their goals. If a person lives at home with their family, the services help the family support the person to become as independent as possible. Services also help people get actively involved in their communities and include peer supports for the person and for their family.

 ECF CHOICES Groups

  • Group 4 (Essential Family Supports) Family Support Services are for families caring for a  child under the age of 21 who has an intellectual or developmental disability (I/DD). The child must live at home with their family (not a foster family). 
  • Group 5 (Essential Supports for Employment and Independent Living) Essential Support services are for adults age 21 and older who have an I/DD but don’t qualify for the level of care in a nursing home.
  • Group 6 (Comprehensive Supports for Employment and Community Living) These services are only for adults age 21 and older who would qualify to get care in a nursing home. (This doesn’t mean the person has to receive care in a nursing home. This program provides services at home and in the community. They just need to qualify for nursing home care.)
  • Group 7 (Intensive Behavioral Family Supports) This group is for a small number of children under age 21 who live with their family and have I/DD and severe behavior support needs that place the child or others at risk of serious harm. The behaviors are so challenging that the child is at risk of being placed outside the home. This group provides mental health treatment and other services in the home with the family. (The family must be willing to be part of the child’s treatment.) The services will train and support the family to support the child so they can keep living safely together.
  • Group 8 (Comprehensive Behavioral Supports for Employment and Community Living) This group is for a small number of adults who have I/DD and server behavior support needs and are moving into the community from a place with lots of structure and supervision. This could be coming from a mental health hospital, the foster care system, jail, or a nursing home. These services are mostly for adults age 21 or older, sometimes, a person age 18-20 can receive the services too. They combine 24/7 residential services with mental health treatment and support. People are usually in this group short-term. Once the person is stable in the community, they will move to a different benefit group that can safely meet their needs.

You may review a complete list of services for each benefit group, some of the services have limits.

This plan is available in all counties.

Connections to CARE. Do you have needs in your life that are not being met? These needs can keep you from feeling well and living longer. 

What do you need to reach your best life and health? Tell us! Starting October 8, 2021, take the CARE survey at 
https://stateoftennessee-cvlyz.formstack.com/forms/hipaa_compliant_member_care_survey

Your answers will not have your name on them and will be combined with information from other community members. 

By taking the survey, you’ll give us the information we need to understand what you need to get and stay healthy. Our goal is to help you and others: 

C= Connect with community resources (like food pantries, housing help) 

A= Act for better health by learning about your care needs 

R= Reduce the stigma (shame or blame) often felt by those who need help 

E= Encouragement to take the steps needed for your best life 

Thank you for caring about your health and your community. 

We obey federal and state civil rights laws.  We do not treat people in a different way because of their race, color, birth place, language, age, disability, religion, or sex.  Do you think we did not help you or you were treated differently because of your race, color, birth place, language, age, disability, religion, or sex?  You can file a complaint by mail, by email, or by phone. Download and print the information (PDF 30.64 KB) or see below:

UnitedHealthcare Community Plan
Attn: Appeals and Grievances
P.O. Box 5220
Kingston, NY 12402-5220
Phone: 800-690-1606 TTY: 711

Health Care Finance and Administration
Office of Civil Rights Compliance
310 Great Circle Road, Floor 3W
Nashville, Tennessee 37243
Email: HCFA.Fairtreatment@tn.gov
Phone: 855-857-1673 (TRS 711)

You can get a complaint form online at:
http://www.tn.gov/hcfa/article/civil-rights-compliance

You can get a complaint form online at:
http://www.hhs.gov/ocr/office/file/index.html

Or you can file a complaint online at:
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf

U.S. Department of Health & Human Services
Office for Civil Rights

200 Independence Ave SW, Rm 509F, HHH Bldg.
Washington, D.C. 20201
Phone: 800-868-1019 (TDD): 800-537-7697

CHOICES Home and Community-Based Services (HCBS) – Services that are available only to eligible persons enrolled in CHOICES Group 2 or Group 3 as an alternative to long-term care institutional services in a nursing facility or to delay or prevent placement in a nursing facility. 

CHOICES HCBS – Attendant care, personal care, in-home respite, companion care services.

  • Nursing Home care (Group 2 & Group 3 Short term up to 90 days) 
  • Personal care visits (up to 2 visits per day at intervals of no less than 4 hours between visits) 
  • Attendant care (up to 1080 hours per calendar year; up to 1400 hours per full calendar year only for persons who require covered assistance with household chores or errands in addition to hands-on assistance with self-care tasks) 
  • Home-delivered meals (up to 1 meal per day) 
  • Personal Emergency Response Systems (PERS) 
  • Adult day care (up to 2080 hours per calendar year) 
  • In-home respite care (up to 216 hours per calendar year) 
  • In-patient respite care (up to 9 days per calendar year) 
  • Assistive technology (up to $900 per calendar year) 
  • Minor home modifications (up to $6,000 per project; $10,000 per calendar year; and $20,000 per lifetime) 
  • Pest control (up to 9 units per calendar year)

ECF CHOICES HCBS – Personal assistance, supportive home care, hourly respite, community transportation, and/or any other

Consumer Direction of Eligible CHOICES or ECF CHOICES HCBS - The opportunity for a CHOICES or ECF CHOICES member assessed to need specified types of CHOICES or ECF CHOICES HCBS including for purposes of CHOICES, attendant care, personal care, in-home respite, companion care; and for purposes of ECF CHOICES, personal assistance, supportive home care, hourly respite, and community transportation; and/or any other service specified in TennCare rules as available for consumer direction to elect to direct and manage (or to have a representative direct and manage) certain aspects of the provision of such services—primarily, the hiring, firing, and day-to-day supervision of consumer-directed workers delivering the needed service(s) and for ECF CHOICES, the delivery of each eligible ECF CHOICES HCBS within the authorized budget for that service

ECF CHOICES Consumer Directed Home and Community-Based Services (HCBS) – Services that are available only to eligible persons enrolled in ECF CHOICES Groups 4, 5, 6, 7 or 8 as an alternative to long term care institutional services in a nursing facility or to delay or prevent placement in a nursing facility.

(Only certain ECF CHOICES HCBS are eligible for Consumer Direction. ECF CHOICES HCBS do not include home health or private duty nursing services.)

Benefits & Features

Well and Sick Care

Get the care you need to stay healthy — or to get better if you are injured or sick. And pregnant moms get support to keep you and your baby healthy. Member benefits include:

  • Well Visits. Preventive checkups, shots and lab tests.
  • Healthy First Steps®. A program to help you and your baby stay healthy.
  • NurseLine℠. Speak with a registered nurse 24/7.
  • Shots and Vaccines. Routine shots help protect against illness.
  • Lab and X-rays. Lab tests and x-rays are covered.

Care Coordinator will

  • Provide information about CHOICES and answer your questions
  • Help you get the right kind of long-term services and supports in the right setting for you to address your needs
  • Coordinate all of your physical health, behavioral health (mental health, alcohol or drug abuse) and long-term services and supports needs
  • Help to fix problems and answer questions that you have about your care
  • Check at least once a year to make sure that you continue to need the level of care provided in a nursing home or, for Group 3, continue to be “at risk” of going into a nursing home
  • Communicate with your providers to make sure they know what’s happening with your health care and to coordinate your service delivery

Make sure sight, teeth and hearing are at their best. Benefits include:

Vision.  Covered with limits Not covered for pregnant women age 19 and older. 

  • For children under age 19, vision services are limited to one vision exam (including refractive exam and glaucoma testing) per calendar year, one set of lenses (including bi-focal, tri-focal, etc.) per calendar year; and one set of eyeglass frames every 2 calendar years.
  • For pregnant women age 19 and older, vision services are limited to medical evaluation and management of abnormal conditions and disorders of the eye. The first pair of cataract glasses or contact lens/lenses after cataract surgery are covered.

Dental.  Not covered for pregnant women age 19 and older.

  • Dental care is only for children under age 19. CoverKids does not pay for any routine dental care for pregnant women 19 and older.

Hearing.  Annual hearing screeningHearing aids are limited to 1 per ear per Calendar Year up to the age 5; then 1 per ear every 2 years thereafter.

Members who qualify can get the medically necessary equipment and help needed to live safety at home. Benefits include:

  • Equipment and Supplies. In-home medical safety materials are covered.
  • Nurse Visits. Short-term medical care while recovering at home.
  • Care Coordinator. Someone to get you the services to live safely at home.

Sometimes you might need a little extra help using your health plan. For those times, you can rely on:

  • NurseLine℠. Speak with a registered nurse 24/7.
  • Language Help. Connect to a translator through Member Services.
  • Member Services. Someone to help you understand how to use your benefits.
  • Quitting Tobacco.  Coaches, supplies and medications to help you quit using tobacco.  
  • Weight Control. Support and treatment to reach a healthy weight.
  • Health Education. Free classes to help improve your health.

Cleanings, checkups and  dental care is only for children under age 19. CoverKids does not pay for any routine dental care for pregnant women 19 and older.

Exams and cleanings every six months help keep teeth and gums strong and healthy. If there is a dental problem that needs to be fixed, we’ll fix it as well.

Equipment and Supplies

The health and safety of our members at home are important.

Your health and safety at home are important.

Our plan covers medical equipment ordered by your doctor or case manager. This can include supplies like:

  • Hospital beds.
  • Oxygen tanks.
  • Walkers or wheelchairs.

Health Education

Free classes to help improve your health or address a condition.

Our plan includes classes on diabetes, nutrition and more. You can even get a ride, if needed, to and from the class at no cost to you.

Hearing Care

Trouble hearing can affect your everyday life in many ways. Our plan includes services and support to help protect the hearing of members to age 21.

We cover:

  • Exams, and tests.
  • Hearing aids are limited to 1 hearing aid per ear each calendar year up to the age 5, then 1 hearing aid per ear every 2 years thereafter.

Healthy First Steps®

Build a healthy future for you and your baby and earn great rewards with Healthy First Steps. Our program will help you take the right steps to keep you and your baby healthy. Plus you can earn $20 just for signing up. 

We will help you:

  • Choose a pregnancy provider and a pediatrician (child’s doctor).
  • Schedule visits and exams and arrange rides to your visits.
  • Earn rewards for going to visits throughout your pregnancy and baby’s first 15 months of life.
  • Get supplies, including breast pumps for nursing moms.
  • Connect with community resources such as Women, Infants and Children (WIC) services.

Hospitalization

This plan pays for expenses related to a hospital stay, so you can rest and heal.

This includes:

  • Nursing care.
  • Room and board.
  • Supplies and equipment.
  • Treatment and therapies.
  • Diagnostic tests and exams.

And after you leave the hospital, you are not alone. We make sure you get follow-up care to continue healing at home.

Interpreters

Your doctor and you need to understand each other. Not speaking English well makes this difficult. We can arrange for a medical interpreter to be at your appointments.

We also have people in member services who speak more than one language. Chances are, we have someone who speaks your language.

Lab and X-rays

Knowing what's wrong and finding it early can make all the difference. Our plan covers:

  • Labs and testing.
  • X-rays, scans and other imaging.

We’ll help you get the information needed to improve your health or be at your best.

Language Help

You can receive information in your preferred language. Just ask. We also have people at our member service centers who speak more than one language. Chances are, we have someone who speaks your language.

Member Services

Understanding your health care options can be confusing. We can answer your questions simply and completely.

We help you find:

  • Doctors.
  • Pharmacies.
  • Hospitals or other health facilities.
  • Local resources.

Mental Health

Mental health is as important as physical health. That’s why we have the same coverage for both.

Required care is 100% covered with no copay. This includes:

  • Mental health therapy.
  • Substance abuse treatment.
  • Medications.

No Copays

Members have no copayments for:

  • Preventive care.
  • Annual checkups.

Nurse Visits

Sometimes continued care is needed after leaving the hospital or urgent care. For example, after a serious illness, surgery or injury. In these cases, a nurse will make home visits to:

  • Provide medical care for you.
  • Answer your questions and concerns.
  • Home health. Home nursing care limited to 125 visits per calendar year.

NurseLine℠

Medical questions and situations can sometimes come at inconvenient times. When you have questions about your health or your child’s health, you can call a trained nurse 24/7.

Our NurseLine nurses will: 

  • Listen to the symptoms.
  • Guide you on self-care.
  • Advise you about getting care at a doctor visit or an urgent care center.
  • Help you know when to go to the emergency room.

Prenatal Visits

A pregnancy is a journey you'll want to make with the help of friends, family and a pregnancy doctor, or OB-GYN.

All of your recommended prenatal clinical visits and tests are covered.

At these visits, the clinic will:

  • Make sure you and your baby are healthy.
  • Explain what to expect at each stage of your pregnancy.
  • Answer your questions.

Primary Care Provider

You can have one main person for your health care. He or she can be a doctor, a nurse practitioner, or a physician’s assistant. This person is called your Primary Care Provider (PCP). 

Your PCP is your main doctor for:

  • Preventive care.
  • Treatment if you are sick or injured.
  • Referrals to specialists for certain conditions.

Quitting Tobacco

You know the bad health effects of smoking.

You know you need to quit. We support you while you quit with the help of coaches and supplies. The only thing you won't get from us is a lecture.

Shots and Vaccines

Routine shots help keep you healthy. So, our plan covers:

  • Recommended shots and vaccines.
  • Influenza shots.

Support Coorinator

Support Coordinator will help you to:

  • Identify the services and supports you need,
  • Explore employment options and ways to be part of your community and build relationships
  • Decide what services and supports you will need to meet your needs and reach your goals
  • Develop and access other services and unpaid supports to help too
  • Understand all of the services, providers and settings you can choose from
  • Choose the services you will receive, your provider for each service, and settings (places) where you will receive those services
  • Write your support plan based on your choices, preferences, and support needs
  • Make sure you get the services in your support plan

Not sure who your Support Coordinator is or how to contact them? You can call us at 1-800-690-1606

Transportation

In case of emergency call 911

Important tips for setting up a ride- Please review Tennessee Carriers website- Rider Information Riders | Tennessee Carriers (tenncarriers.com)

  • Call 1-866-405-0238, TTY 711 to set up your ride 
  • Call at least seventy-two (72) hours in advance of your appointment whenever possible
  • If the time for your return trip home was not already scheduled, you are responsible for calling to tell the transporter that you are ready to be picked up for your trip home
  • If you cancel your appointment/visit, call 1-866-405-0238 to cancel your ride 
  • Have your Medicaid ID card available 
  • If you have more than one appointment on the same day, you can get a ride to all covered services. Please give Tennessee Carriers information for each appointment
  • Know the address of your health care provider and the date and time of your appointment 
  • Be specific about where you need a ride to 
  • If your doctor gives you a prescription, you can stop at the pharmacy to get it 
  • Let us know if you have special needs like a wheelchair 
  • Any minor requesting transportation without an accompanying adult will be handled on a case-by-case basis 
  • If you wish to bring someone with you to your appointment, you can have someone ride with you. This is sometimes called an escort. An escort is someone over the age of 12. Please let Tennessee Carriers know you’ll have an escort riding with you
  • If you’re going to an appointment and need to take your child with you, he or she won’t count as your escort

Vision Care

Covered with limits.  Not covered for pregnant women age 19 and older.

For children under age 19, vision services are limited to one vision exam (including refractive exam and glaucoma testing) per calendar year, one set of lenses (including bi-focal, tri-focal, etc.) per calendar year; and one set of eyeglass frames every 2 calendar years. 

For pregnant women age 19 and older, vision services are limited to medical evaluation and management of abnormal conditions and disorders of the eye. The first pair of cataract glasses or contact lens/lenses after cataract surgery are covered.

Weight Control

Our plan encourages a healthy approach to eating and living. To help our members be their best, we cover:

  • Screening for obesity.
  • Support for healthy diet and exercise choices.
  • Health coaching.

Well Visits

Well visits with your doctor can help keep you healthy. These visits can help catch health problems early so they can be treated. Preventive services include:

  • Checkups for adults and children.
  • Well-baby care.
  • Care for women expecting a baby.
  • Routine shots and tests.
  • Mammograms.

You will not have a copayment for preventive care.

Member Resources

Healthier Tennessee is a priority of the Governor’s Foundation for Health & Wellness, involving action promoting healthier behaviors in schools, workplaces and in places of worship. More information is available at www.healthiertn.com

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Medicaid Managed Care