Tenn. Comp. R. & Regs. 1200-13-01-.33

Current through December 10, 2024

Section 1200-13-01-.33 - TEMPORARY BENEFITS UNDER THE AMERICAN RESCUE PLAN ACT ENHANCED HCBS FMAP SPENDING PLAN

(1) Definitions. See Rule 1200-13-01-.02, unless otherwise noted.

(2) Notwithst anding any other rule related to a benefit limit, Expenditure Cap, Individual Cost Neutrality Cap, or Individual Cost Limit, from November 2, 2021, through March 31, 2025, TennCare Enrollees receiving HCBS in CHOICES Groups 2 or 3; ECF CHOICES Groups 4, 5, 6, or 7; or a Section 1915(c) waiver who meet the criteria outlined in this rule may receive an additional one-time increase of up to $3,000 in eligible Family Caregiver Supports ("FCS"), as defined in 1200-13-01-.02.

(3) Eligibility criteria. Services in (4) below will only be approved if they further enable the individual's independence or support and sustain unpaid family caregivers. To be eligible for FCS, an individual must:

(a) Receive HCBS in CHOICES Group 2 or 3; ECF CHOICES Group 4, 5, 6, or 7; or a Section 1915(c) waiver as of July 12, 2021;

(b) Live with a family member or family members who routinely provide(s) unpaid support and assistance or have an unpaid family caregiver(s) who routinely provide(s) unpaid support and assistance; and

(c) Individuals receiving residential services are not eligible for FCS.

(4) Eligible FCS.

(a) Enrollees in CHOICES Groups 2 and 3 who meet the eligibility criteria in (3) above may utilize FCS for the following services:

1. Respite;

2. Adult Day Care;

3. Assistive Technology;

4. Enabling Technology; and

5. Minor Home Modifications.

(b) Enrollees in ECF CHOICES Groups 4, 5, 6, and 7 who meet the eligibility criteria in (3) above may utilize FCS for the following services:

1. Respite;

2. Assistive Technology;

3. Enabling Technology; and

4. Minor Home Modifications.

(c) Enrollees in one of the 1915(c) Waiver programs who meet the eligibility criteria in (3) above may utilize FCS for the following services as defined in 1200-13-01-.25, unless otherwise indicated:

1. Respite;

2. Specialized Medical Equipment and Supplies and Assistive Technology;

3. Enabling Technology as defined in 1200-13-01-.02; and

4. Environmental Accessibility Modifications.

(5) Use of FCS.

(a) For each program, the $3,000 for FCS is a one-time increase that may be utilized anytime between November 2, 2021, and March 31, 2025.

(b) An individual may elect to receive additional units of one service or multiple services; however, the overall limitation on FCS is $3,000 per person.

(c) This assistance is provided in addition to existing service limitations and without regard for an Expenditure Cap, Individual Cost Neutrality Cap, or Individual Cost Limit specified in the approved waiver. However, Enrollees must use all currently available benefits within the benefit limit or Expenditure Cap, Individual Cost Neutrality Cap, or Individual Cost Limit before accessing FCS through this rule.

(d) If an individual has already reached an Expenditure Cap, Individual Cost Neutrality Cap, or Individual Cost Limit, as applicable, these services may be utilized without respect to whether the maximum benefit has already been utilized.

(e) An individual's PCSP shall be modified to reflect any FCS requested and approved pursuant to this rule.

(6) Appeals. Appeals related to the denial, reduction, suspension, or termination of FCS are processed by the Division in accordance with Rules 1200-13-13-.11 and 1200-13-14-.11. Continuation of the FCS approved pursuant to this rule shall not be provided after the exhaustion of the $3,000 limit or after March 31, 2025, whichever comes first.

Tenn. Comp. R. & Regs. 1200-13-01-.33

New rule filed November 1, 2022; effective 1/30/2023.

Authority: T.C.A. §§ 4-5-202, 71-5-105, and 71-5-109.