Current Updates (as of 8/3/2021)

Managed Long-Term Services and Supports

On November 13, Tennessee requested an amendment to the TennCare III Demonstration. The proposed amendments would expand coverage of parents and caretaker relatives of dependent children, covering a supply of diapers for infants and young children under age two enrolled in TennCare, and enhancing HCBS available to people with disabilities. Specifically with regard to HCBS, the amendment would add employment services and supports for some individuals enrolled in CHOICES; revise service definitions to combine attendant care and personal care in CHOICEs; revise the definitions of individualized integrated employment, benefits counseling, and self-employment; add community transportation as a covered CHOICES benefit; provide exceptions to individual cost neutrality tests and expenditure caps; and add electronic signatures/verbal authorizations as an option for the person-centered support plan.

(Source: Division of TennCare; 11-13-2023)

Past Updates

On June 11, 2021, the Division of TennCare, Tennessee’s Medicaid agency, released a managed care request for proposals (RFP). Managed care organizations (MCOs) that submit proposals must present approaches and strategies to provide services for beneficiaries in TennCare’s LTSS-CHOICES, which provides home and community-based services to adults 21 years and older with physical disabilities and older adults age 65 years and older; Employment and Community First CHOICES, other integrated MLTSS programs for individuals with I/DD, and D-SNPs.

The RFP also includes language stating that respondents must include plans to incorporate person-centered planning and practices, improving access to LTSS in rural areas using telehealth, and implementing consumer direction in LTSS. MCOs will also be expected to administer Medicare services for dual eligible beneficiaries who enroll in the MCO’s aligned D-SNP. D-SNPs will operate statewide for TennCare members who are eligible for both Medicare and Medicaid.

Proposals from MCOs are due August 13, 2021, with awards expected to be announced on October 8, 2021 and implementation expected to begin on January 1, 2023.

(Source: Managed Care RFP; 6-11-2021, RFP Amendment 1; 6-15-2021)

Medicaid Expansion

Tennessee Flag

On December 15, 2014, Governor Bill Haslam announced the Insure Tennessee plan, a two-year pilot program to expand Medicaid to Tennesseans with no or limited access to health insurance options.  Insure Tennessee would offer uninsured adults with access to employer-sponsored insurance a voucher to make that coverage affordable.  For those without access to employer-based insurance, individuals would be enrolled in TennCare, Tennessee’s Medicaid managed care program.  Enrollees in TennCare would have a Healthy Incentives for Tennesseans (HIT) account, which are modeled after Health Reimbursement Accounts (HRAs).  Enrollees would also be subject to copays and monthly premiums, depending on income level.  The governor plans to call a special legislative session in January to focus on the proposal; approval from CMS is also required.  (Source: HMA Weekly Roundup, 12/17/2014)  

On February 4, 2015, the Hill reported that Governor Bill Haslam’s Insure Tennessee plan - a pilot program to expand Medicaid - died in the state Senate after it was voted down by the Health and Welfare Committee.  (Source: Thehill.com)

Managed LTSS Program

Under TennCare II §1115 Demonstration Waiver, TennCare CHOICES provides primary, acute, behavioral, nursing facility, and HCBS waiver-type services to eligible persons of all ages residing in nursing homes, adults under age 65 with physical disabilities, and adults age 65 and higher. At inception in 2010, LTSS was added to the existing TennCare managed care demonstration. The program is operating statewide, and enrollment is mandatory. (Source: CMS and Truven Health Analytics, The Growth of Managed Long-Term Services and Supports (MLTSS) Programs: A 2012 Update, July 2012) State Website on TennCare CHOICES

On June 30, 2016, CMS gave Tennessee a brief two month extension of its Section 1115 waiver, which authorizes managed care—including MLTSS—in the state. This will allow Tennessee and CMS additional time to negotiate on the details of the waiver renewal, including the status of the state’s access to additional uncompensated care funds through the Unreimbursed Hospital Cost pool, which has been a sticking point in other states 1115 renewal negotiations. (Source: Modern Healthcare 6/30/2016)

Following an extended period of negotiations between Tennessee and CMS, the state finally received approval of the state’s TennCare II 1115(a) demonstration waiver, which includes approval of the state’s uncompensated care (UC) payments through 2018, and is the operating authority for the state’s MLTSS program. The extension is effective December 1, 2016, through June 30, 2021.  (Source: Waiver 12/16/2016)

Amendment to TennCare II Section 1115 Demonstration Waiver

(Approved 6/15/2012; Extension request submitted 6/29/2012)

Under this demonstration, all Medicaid State Plan-eligibles (except those eligible only for Medicare premiums) are enrolled in TennCare Medicaid and receive most of the State Plan services through the demonstration's managed care delivery system. The recently submitted amendment pertains to the CHOICES program, which is Tennessee’s Medicaid managed long-term care program. CHOICES serve three groups: CHOICES 1 serves nursing facility residents; CHOICES 2 serves elderly adults or adults with physical disabilities who meet nursing facility level of care, but who have elected to receive home and community based services; CHOICES 3 serves elderly adults or adults with physical disabilities who do not meet nursing facility level of care, but are “at risk” for institutionalization. The amendment seeks to increase the enrollment target for CHOICES 2, effective July 1, 2012. (Source: Medicaid.gov & application to CMS)
Application for Amendment

Amendments #14 and #16 for the demonstration were approved by CMS (6/15/2012). Amendment #14, effective as of July 1, 2012, authorizes an increase to the enrollment targets for the CHOICES 2 program and approves the rebalancing of the CHOICES managed long-term care program and the creation of Interim CHOICES 3. Amendment #16 pertains to Disproportionate Share Hospital allotment. The Department of Finance and Administration submitted a three-year extension request to CMS on 6/29/2012. (Source: Centers for Medicare & Medicaid Services)
Current Approval Document
Three-year Extension Request Document

The Department of I/DD and TennCare have released a concept paper about the future of the state's HCBS Waivers for individuals with I/DD; the concept paper includes ideas for renewing and redesigning LTSS services for individuals with I/DD. (Source: State I/DD website)
Concept Paper Summary (link no longer available) 
Concept Paper (link no longer available) 

On March 31, 2021 Tennessee submitted a request to amend the 1115 demonstration waiver TennCare III. The amended waiver, to be named TennCare III, would integrate services for beneficiaries with intellectual or development disabilities (I/DD) into the state’s current managed care system. The Department of Intellectual and Developmental Disabilities (DIDD) would provide oversight and management of all Medicaid LTSS for members with I/DD enrolled in the 1915(c) waivers, the Employment and Community First CHOICES Program, and ICF services. These services would become benefits administered by managed care organizations (MCOs) through the state’s managed care service delivery system.

(Source: TennCare III Waiver Amendment Request; 3-31-2021)


State Demonstration to Integrate Care for Dual Eligible Individuals (Withdrawn)

Tennessee submitted (12/21/2012) a letter to Medicare-Medicaid Coordination Office requesting to withdraw its financial alignment demonstration proposal. In the letter, the state expressed its concerns pertaining to the reimbursement methodology. (Source: Letter to Medicare-Medicaid Coordination Office) (Prior to Tennessee’s decision to withdraw from the duals demonstration, the State had proposed, via TennCare PLUS, to enroll full benefit dual eligibles, except PACE participants, starting January 1, 2014, statewide. The demonstration would not have included LTSS for persons with intellectual disabilities (including ICF/MR and §1915(c) waiver services), but dually-eligible members receiving these services would have been included in the demonstration for all other Medicare and Medicaid services. The now-withdrawn demonstration would have operated under a capitated payment model. For more information, click here.) (Source: Demonstration Proposal)

Katie Beckett Waiver

Tennessee lawmakers agreed to fund the Katie Beckett waiver program at $27 million and pass the state’s $38.5 billion budget after negotiations between the House and the Senate. The Senate initially proposed a $15.6 million allocation for the program to cover services for only 300 most-at-need children.

(Source: Lawmakers Fund Katie Beckett Waiver Program, 4-29-2019)