Rolling with Disenrollments
The effective last day of service for an involuntary disenrollment for a Group 1 member who has enrolled in hospice services in the NF.
What is the day before hospice enrollment?
The name of the system we use to review redetermination needs and/or assist member to upload redetermination information.
What is TennCare Access Portal?
The timeline required for a CC to complete all documentation related to a contact made with a member, provider, member representative.
What is 2 days or 48 hours?
The TCare assessment is required for these people.
What is ALL HCBS members?
The timeline for completing the Post Inpatient Stay Assessment (PISA).
What is 2 days after notification of a person's discharge from hospital or SNF?
First assignment we send for an existing HCBS member who has a denied PAE.
What is the HCBS Authorizations Hold Service assignment?
Individuals who receive this are not subject to redetermination by TennCare.
The maximum number of days an assessment can remain open in ICUE.
What is 10 days?
The CC does this if unable to complete a TCare assessment with a person who is listed on the PCSP as a member's natural support.
The frequency of contacts for an HCBS member who is in a SNF for rehab or STS services.
What is once weekly?
Ten reasons for a CHOICES member to be disenrolled.
See PPT
Two ways a member can complete their redetermination if a packet was not received.
What is use the TennCare portal to complete the packet or call TennCare directly to request a new one to complete and return by mail or fax?
The date used to monitor compliance for all assessments in ICUE.
What is the date "completed" date under completed assessments in ICUE?
A TCare assessment is required at these visits.
What are new referral visit, new eligible visit, annually, and with any change in caregiver status?
The 2 types of assessments that must be completed/updated for the 30 day post discharge contact.
What are the TN HCBS Visit Assessment and PCSP?
The only reason a CC would send an assignment to the CMA team to cancel the authorization for a Group 1 member.
What is if the member is receiving Enhanced Respiratory Care (ERC) services?
This is the CC's responsibility if an assigned member is on the monthly redetermination report sent by MCM (3 parts).
What is 1) call the member/family/NF to ensure they are aware of redetermination need and ask if packet has been received, 2) assist with completing packet if needed, 3) document call contact and any assistance that is provided.
This is the appropriate format for documenting activities not associated with a completed assessment in ICUE.
What is a template?
This is required when a CC completes the disenrollment process for a member.
What is closing member's case in TCare?
The visit type that must be marked on the TN HCBS Visit Template for the 30 day post discharge contact.
What is "Post Inpatient Assessment"? (If completing another type of visit in conjunction, that visit type can be marked too but the Post Inpatient Assessment must be marked for compliance with reporting).
Ten steps to complete a voluntary disenrollment for a HCBS member.
What are
1) Gets member signature on Disenrollment Request Form
2)Documents visit/contact to obtain signature
3) Creates assignment to CMA team for voluntary disenrollment
4) Sends assignment to CMA team to place services on hold (or can go ahead to cancel services for date member requests disenrollment
5) Closes case in TCare
6) Waits for remove member assignment and confirms eligibility end date is correct before closing assignment
7) Ensures all HCBS services have been cancelled
8) Closes out all assignments and open assessments
9) End dates self as Case Manager
10) Reassigns program ownership to MCM for program closure
The number of days that the member's packet will be due back to TennCare after the packet was mailed to the member from TennCare.
What is 40?
The day Nurse Tanya's documentation should be completed by if she completed a home visit on Tuesday and plans to take a PTO day on Thursday.
What is Wednesday?
This format is used for documenting unsuccessful attempts to complete a TCare assessment with a member's natural support.
What is notes in brackets?
This must be marked on the PCSP as the reason for updating the PCSP for compliance with reporting for the 30 day post hospital contact.
What is "D-Other" with explanation in the text box below?