Common use of Long-Term Services and Supports Benefits for ECF CHOICES Members Clause in Contracts

Long-Term Services and Supports Benefits for ECF CHOICES Members. 2.6.1.6.1 In addition to physical health benefits (see Section A.2.6.1.3) and behavioral health benefits (see Section A.2.6.1.4), the CONTRACTOR shall provide long-term services and supports as described in this Section A.2.6.1.6 to members who have been enrolled into ECF CHOICES by TENNCARE, as shown in the outbound 834 enrollment file furnished by TENNCARE to the CONTRACTOR. 2.6.1.6.2 TennCare enrollees will be enrolled by TENNCARE into ECF CHOICES in accordance with criteria set forth in the approved 1115 waiver and TennCare rule. 2.6.1.6.3 The following long-term services and supports are available to ECF CHOICES members, per Group and subject to all applicable service definitions, benefit limits, and Expenditure Caps, when the services have been determined medically necessary by the CONTRACTOR. Respite (up to 30 days per calendar year or up to 216 hours per calendar year only for persons living with unpaid family caregivers) X X X Supportive home care (SHC) X Family caregiver stipend in lieu of SHC (up to $500 per month for children under age 18; up to $1,000 per month for adults age 18 and older) X Community integration support services (subject to limitations specified in the approved 1115 waiver and TennCare Rule) X X X X Community transportation X X X X Independent living skills training (subject to limitations specified in the approved 1115 waiver and TennCare Rule) X X X X Assistive technology, adaptive equipment and supplies (up to $5,000 per calendar year) X X X X X Minor home modifications (up to $6,000 per project; $10,000 per calendar year; and $20,000 per lifetime) X X X X X Community support development, organization and navigation X X Family caregiver education and training (up to $500 per calendar year) X X Family-to-family support X X Decision-making supports (up to $500 per lifetime) X X X X X Health insurance counseling/forms assistance (up to 15 hours per calendar year) X X Personal assistance (up to 215 hours per month) X X Community living supports (CLS) X X Community living supports— family model (CLS-FM) X X Individual education and training (up to $500 per calendar year) X X X Peer-to-Peer Support and Navigation for Person-Centered Planning, Self-Direction, Integrated Employment/Self- Employment and Independent Community Living (up to $1,500 per lifetime) X X X Specialized consultation and training (up to $5,000 per calendar year1 ) X X X Adult dental services (up to $5,000 per calendar year; up to $7,500 across three consecutive calendar years) X2 X X X Employment services/supports as specified below (subject to limitations specified in the approved 1115 waiver and in TennCare Rule) X X X X X − Supported employment— individual employment support − Exploration− Benefits counseling− Discovery − Situational observation and assessment − Job development plan or self- employment plan − Job development or self- employment start up − Job coaching for individualized, integrated employment or self- employment− Co-worker supports− Career advancement X X X X X Intensive Behavioral Family- Centered Treatment, Stabilization X 1 For adults in the Group 6 benefit group determined to have exceptional medical and/or behavioral support needs, and for adults in Group 8, specialized consultation services are limited to $10,000 per person per calendar year.

Long-Term Services and Supports Benefits for ECF CHOICES Members. 2.6.1.6.1 In addition to physical health benefits (see Section A.2.6.1.3) and behavioral health benefits (see Section A.2.6.1.4), the CONTRACTOR shall provide long-term services and supports as described in this Section A.2.6.1.6 to members who have been enrolled into ECF CHOICES by TENNCARE, as shown in the outbound 834 enrollment file furnished by TENNCARE to the CONTRACTOR. 2.6.1.6.2 TennCare enrollees will be enrolled by TENNCARE into ECF CHOICES in accordance with criteria set forth in the approved 1115 waiver and TennCare rule. 2.6.1.6.3 The following long-term services and supports are available to ECF CHOICES members, per Group and subject to all applicable service definitions, benefit limits, and Expenditure Caps, when the services have been determined medically necessary by the CONTRACTOR. Respite (up to 30 days per calendar year or up to 216 hours per calendar year only for persons living with unpaid family caregivers) X X X Supportive home care (SHC) X Family caregiver stipend in lieu of SHC (up to $500 per month for children under age 18; up to $1,000 per month for adults age 18 and older) X Community integration support services (subject to limitations specified in the approved 1115 waiver and TennCare Rule) X X X X Community transportation X X X X Independent living skills training (subject to limitations specified in the approved 1115 waiver and TennCare Rule) X X X X Assistive technology, adaptive equipment and supplies (up to $5,000 per calendar year) X X X X X Minor home modifications (up to $6,000 per project; $10,000 per calendar year; and $20,000 per lifetime) X X X X X Community support development, organization and navigation X X Family caregiver education and training (up to $500 per calendar year) X X Family-to-family support X X Decision-making supports Conservatorship and alternatives to conservatorship counseling and assistance (up to $500 per lifetime) X X X X X Health insurance counseling/forms assistance (up to 15 hours per calendar year) X X Personal assistance (up to 215 hours per month) X X Community living supports (CLS) X X Community living supports— —family model (CLS-FM) X X Individual education and training (up to $500 per calendar year) X X X Peer-to-Peer Support and Navigation for Person-Centered Planning, Self-Direction, Integrated Employment/Self- Self-Employment and Independent Community Living (up to $1,500 per lifetime) X X X Specialized consultation and training (up to $5,000 per calendar year1 year1) X X X Adult dental services (up to $5,000 per calendar year; up to $7,500 across three consecutive calendar years) X2 X X X Employment services/supports as specified below (subject to limitations specified in the approved 1115 waiver and in TennCare Rule) X X X X X − Supported employment— —individual employment support − support− Exploration− Benefits counseling− Discovery − Discovery− Situational observation and assessment − Job development plan or self- self-employment plan − Job development or self- self-employment start up − Job coaching for individualized, integrated employment or self- self-employment− Co-worker supports− Career advancement X X X X X Intensive Behavioral Family- Centered Treatment, Stabilization X 1 For adults in the Group 6 benefit group determined to have exceptional medical and/or behavioral support needs, and for adults in Group 8, specialized consultation services are limited to $10,000 per person per calendar year.X

Long-Term Services and Supports Benefits for ECF CHOICES Members. 2.6.1.6.1 In addition to physical health benefits (see Section A.2.6.1.3) and behavioral health benefits (see Section A.2.6.1.4), the CONTRACTOR shall provide long-term services and supports as described in this Section A.2.6.1.6 to members who have been enrolled into ECF CHOICES by TENNCARE, as shown in the outbound 834 enrollment file furnished by TENNCARE to the CONTRACTOR. 2.6.1.6.2 TennCare enrollees will be enrolled by TENNCARE into ECF CHOICES in accordance with criteria set forth in the approved 1115 waiver and TennCare rule. 2.6.1.6.3 The following long-term services and supports are available to ECF CHOICES members, per Group and subject to all applicable service definitions, benefit limits, and Expenditure Caps, when the services have been determined medically necessary by the CONTRACTOR. Benefit Group 4 Group 5 Group 6 Group 7 Group 8 Respite (up to 30 days per calendar year or up to 216 hours per calendar year only for persons living with unpaid family caregivers) X X X Supportive home care (SHC) X Family caregiver stipend in lieu of SHC (up to $500 per month for children under age 18; up to $1,000 per month for adults age 18 and older) X Community integration support services (subject to limitations X X X X Benefit Group 4 Group 5 Group 6 Group 7 Group 8 specified in the approved 1115 waiver and TennCare Rule) X X X X Community transportation X X X X Independent living skills training (subject to limitations specified in the approved 1115 waiver and TennCare Rule) X X X X Assistive technology, adaptive equipment and supplies (up to $5,000 per calendar yearyear of Assistive technology and Enabling technology combined) X X X X X Enabling technology (up to $5,000 per calendar year of Assistive technology and Enabling technology combined) X X X X X Minor home modifications (up to $6,000 per project; $10,000 per calendar year; and $20,000 per lifetime) X X X X X Community support development, organization and navigation X X Family caregiver education and training (up to $500 per calendar year) X X Family-to-family support X X Decision-making supports (up to $500 per lifetime) X X X X X Health insurance counseling/forms assistance (up to 15 hours per calendar year) X X Personal assistance (up to 215 hours per month) X X Community living supports (CLS) X X Community living supports— family model (CLS-FM) X X Individual education and training (up to $500 per calendar year) X X X Peer-to-Peer Support and Navigation for Person-Centered Planning, Self-Direction, Integrated Employment/Self- Self-Employment and Independent Community Living (up to $1,500 per lifetime) X X X Specialized consultation and training (up to $5,000 per calendar year1 ) X X X 1 For adults in the Group 6 benefit group determined to have exceptional medical and/or behavioral support needs, and for adults in Group 8, specialized consultation services are limited to $10,000 per person per calendar year. Benefit Group 4 Group 5 Group 6 Group 7 Group 8 Adult dental services (up to $5,000 per calendar year; up to $7,500 across three consecutive calendar years) X2 X1 X X X Employment services/supports as specified below (subject to limitations specified in the approved 1115 waiver and in TennCare Rule) X X X X X − Supported employment— individual employment support − Exploration− Benefits counseling− Discovery − Situational observation and assessment − Job development plan or self- employment plan − Job development or self- employment start up − Job coaching for individualized, integrated employment or self- employment− employment − Co-worker supports− Career advancement X X X X X Intensive Behavioral Family- Centered Treatment, Stabilization and Supports (IBFCTSS) X 1 For adults Intensive Behavioral Community Transition and Stabilization Services (IBCTSS) X 2.6.1.6.4 In addition to the benefits specified above which shall be delivered in accordance with the definitions, including limitations set forth in the Group 6 benefit group determined to have exceptional medical and/or behavioral support needsapproved 1115 waiver and in TennCare rule, a person enrolled in ECF CHOICES Groups 4, 5, and 6 may, subject to requirements described in 2.9.7.3.27.11, receive short-term care (i.e., no more than ninety (90) days) in a NF or ICF/IID, without being required to disenroll from their ECF CHOICES group until such time that it is determined that transition back to HCBS in ECF CHOICES will not occur within ninety (90) days from admission. A person enrolled in ECF CHOICES Groups 7 and 8 shall not be eligible to receive short-term care in a NF or ICF/IID. 2.6.1.6.4.1 The CONTRACTOR shall monitor all inpatient or temporarily in out-of-home placements (e.g., jail, juvenile detention center, residential treatment facility) for Group 7 and 8 members and shall provide updates on these individuals via the member tracking grid and weekly MCO calls. The disenrollment process shall be 1 Limited to adults age 21 and older. initiated by the CONTRACTOR when it is determined that the stay will not be short-term (will exceed ninety (90) days), or it is determined that the member will not transition back to the community utilizing Group 7 and 8 benefits. 2.6.1.6.5 The CONTRACTOR shall review all requests for short-term NF or ICF/IID stays and shall authorize and/or reimburse short-term NF or ICF/IID stays for Groups, 4, 5 and 6 members only when (1) the member is enrolled in ECF CHOICES Group 84, specialized consultation services are limited 5, or 6 and receiving HCBS upon admission; (2) the member meets the applicable institutional level of care in place at the time of admission (NF level of care for a short-term NF stay and ICF/IID level of care for a short-term ICF/IID stay); (3) the member’s stay in the facility is expected to $10,000 per person per calendar year.be less than ninety (90) days; and (4) the member is expected to return to receiving ECF CHOICES HCBS in the community upon its conclusion;