REQUIREMENTS PRIOR TO OPERATIONS. 29 A.2.1.1 Licensure 29 A.2.1.2 Readiness Review 29 A.2.2 GENERAL REQUIREMENTS 30 A.2.3 ELIGIBILITY FOR TENNCARE 31 A.2.3.1 Overview 31
REQUIREMENTS PRIOR TO OPERATIONS. 16 2.1.1 Licensure 16 2.1.2 Readiness Review 16 2.2 GENERAL REQUIREMENTS 17 2.3 ELIGIBILITY 17 2.3.1 Overview 17 2.3.2 Eligibility Categories 17 2.3.3 TennCare Applications 18 2.3.4 Eligibility Determination and Determination of Cost Sharing 18 2.3.5 Eligibility for Enrollment in an MCO 18 2.4 ENROLLMENT 18 2.4.1 General 18 2.4.2 Authorized Service Axxx 00 2.4.3 Maximum Enrollment 18 2.4.4 MCO Selection and Assignment 19 2.4.5 Effective Date of Enrollment 21 2.4.6 Eligibility and Enrollment Data 22 2.4.7 Enrollment Period 23 2.4.8 Transfers from Other MCOs 24 2.4.9 Enrollment of Newborns 24 2.4.10 Information Requirements Upon Enrollment 26 2.5 DISENROLLMENT FROM AN MCO 26 2.5.1 General 26 2.5.2 Acceptable Reasons for Disenrollment from an MCO 26 2.5.3 Unacceptable Reasons for Disenrollment from an MCO 26 2.5.4 Informing TENNCARE of Potential Ineligibility 27 2.5.5 Effective Date of Disenrollment 27 2.6 BENEFITS/SERVICE REQUIREMENTS AND LIMITS 27 2.6.1 CONTRACTOR Covered Benefits 27 2.6.2 TennCare Benefits Provided by TENNCARE 34 2.6.3 Medical Necessity Determination 34 2.6.4 Second Opinions 35 2.6.5 Use of Cost Effective Alternative Services 35 2.6.6 Additional Services and Use of Incentives 35 2.6.7 Cost Sharing for Services 35 2.7 SPECIALIZED SERVICES 37 2.7.1 Emergency Services 37 2.7.2 Behavioral Health Services 38 2.7.3 Health Education and Outreach 43 2.7.4 Preventive Services 44 2.7.5 TENNderCare 45 2.7.6 Advance Directives 57 2.7.7 Sterilizations, Hysterectomies and Abortions 57 2.8 DISEASE MANAGEMENT 59 2.8.1 General 59 2.8.2 Member Identification Strategies 60 2.8.3 Stratification 61 2.8.4 Program Content 61 2.8.5 Informing and Educating Members 61 2.8.6 Informing and Educating Providers 61 2.8.7 Program Evaluation 62 ii
REQUIREMENTS PRIOR TO OPERATIONS. 19 2.1.1 Licensure 19 2.1.2 Readiness Review 19 2.2 GENERAL REQUIREMENTS 20 2.3 ELIGIBILITY FOR TENNCARE 21 2.3.1 Overview 21 2.3.2 Eligibility Categories 21 2.3.3 TennCare CHOICES Groups 21 2.3.4 TennCare Applications 21
REQUIREMENTS PRIOR TO OPERATIONS. 35 A.2.1.1 Licensure 35 A.2.1.2 Readiness Review 35 A.2.2 GENERAL REQUIREMENTS 36 A.2.3 ELIGIBILITY FOR TENNCARE AND COVERKIDS 37 A.2.3.1 Overview 37 A.2.3.2 Eligibility Categories 37 A.2.3.3 TennCare CHOICES and I/DD MLTSS Programs 38 A.2.3.4 TennCare/CoverKids Applications 38 A.2.3.5 Eligibility Determination and Determination of Cost Sharing 39 A.2.3.6 Eligibility for Enrollment in an MCO 39 A.2.4 ENROLLMENT IN AN MCO 39 A.2.4.1 General 39 A.2.4.2 Authorized Service Area 39 A.2.4.3 Maximum Enrollment 40
REQUIREMENTS PRIOR TO OPERATIONS. 16 2.1.1 Licensure 16 2.1.2 Readiness Review 16 2.2 GENERAL REQUIREMENTS 17 2.3 ELIGIBILITY 17 2.3.1 Overview 17 2.3.2 Eligibility Categories 17 2.3.3 TennCare Applications 18 2.3.4 Eligibility Determination and Determination of Cost Sharing 18 2.3.5 Eligibility for Enrollment in an MCO 18 2.4 ENROLLMENT 18 2.4.1 General 18 2.4.2 Authorized Service Xxxx 00 2.4.3 Maximum Enrollment 19
REQUIREMENTS PRIOR TO OPERATIONS
