Patient Liability. 2.6.7.2.1 TENNCARE will notify the CONTRACTOR of any applicable patient liability amounts for CHOICES members in Group 1 via the eligibility/enrollment file. The CONTRACTOR shall delegate collection of patient liability to the nursing facility and shall pay the facility net of the applicable patient liability amount.
2.6.7.2.2 In accordance with the involuntary discharge process, including notice and appeal (see Section 2.12.11.3), a nursing facility may refuse to continue providing services to a member who fails to pay his or her patient liability and for whom the nursing facility can demonstrate to the CONTRACTOR that it has made a good faith effort to collect payment.
2.6.7.2.3 If the CONTRACTOR is notified that a nursing facility is considering discharging a member (see Section 2.12.11.3), the CONTRACTOR shall work to find an alternate nursing facility willing to serve the member and document its efforts in the member’s files.
2.6.7.2.4 If the CONTRACTOR is unable to find an alternate nursing facility willing to serve the member, the CONTRACTOR shall determine if it can safely and effectively serve the member in the community and within the cost neutrality cap. If it can, the member shall be offered a choice of HCBS. If the member chooses HCBS, the CONTRACTOR shall forward all relevant information to TENNCARE for a decision regarding enrollment in Group 2 (Section 2.9.6.3).
2.6.7.2.5 If the CONTRACTOR is unable to find an alternate nursing facility willing to serve the member and the CONTRACTOR determines that it cannot safely and effectively serve the member in the community and within the cost neutrality cap, the member declines to enroll in Group 2, or TENNCARE denies enrollment in Group 2, the CONTRACTOR may, pursuant to Section 2.6.1.5.8, request to no longer provide long-term care services to the member.
Patient Liability. The amount of a Covered Person’s income, as determined by the Tennessee Department of Human Services (DHS), to be collected each month to help pay for the Covered Person’s Long-Term Services and Supports.
Patient Liability. TENNCARE will notify the CONTRACTOR of any applicable patient liability amounts for CHOICES and ECF CHOICES members via the outbound 834 enrollment file.
Patient Liability. The amount of a member’s income, as determined by the State, to be collected each month to help pay for the member’s LTSS.
Patient Liability. 2.6.7.2.1 TENNCARE will notify the CONTRACTOR of any applicable patient liability amounts for CHOICES members via the outbound 834 enrollment file.
2.6.7.2.1.1 When TENNCARE notifies the CONTRACTOR of patient liability amounts for CHOICES members via the outbound 834 enrollment file with an effective date any time other than the first day of the month, the CONTRACTOR shall determine and apply the pro-rated portion of patient liability for that month.
2.6.7.2.2 The CONTRACTOR shall delegate collection of patient liability for CHOICES Group 1 members to the nursing facility and shall pay the facility net of the applicable patient liability amount.
2.6.7.2.2.1 In accordance with the involuntary discharge process, including notice and appeal (see Section A.2.12.10.3), a nursing facility may refuse to continue providing services to a member who fails to pay his or her patient liability and for whom the nursing facility can demonstrate to the CONTRACTOR that it has made a good faith effort to collect payment.
2.6.7.2.2.2 If the CONTRACTOR is notified that a nursing facility is considering discharging a member (see Section A.2.12.10.3), the CONTRACTOR shall work to find an alternate nursing facility willing to serve the member and document its efforts in the member’s files.
2.6.7.2.2.3 If the CONTRACTOR is unable to find an alternate nursing facility willing to serve the member and the member otherwise qualifies to enroll in CHOICES Group 2, the CONTRACTOR shall determine if it can safely and effectively serve the member in the community and within the cost neutrality cap. If it can, and the CONTRACTOR is willing to continue serving a member who has failed to pay his or her patient liability or if TENNCARE determines that the member would not have patient liability in the community setting, the member shall be offered a choice of CHOICES HCBS. If the member chooses CHOICES HCBS, the CONTRACTOR shall forward all relevant information to TENNCARE for a decision regarding transition to Group 2 (Section A.2.9.6.8).
2.6.7.2.2.4 If the CONTRACTOR is unable to find an alternate nursing facility willing to serve the member and the CONTRACTOR determines that it cannot safely and effectively serve the member in the community and within the cost neutrality cap, the member declines to enroll in Group 2, or TENNCARE determines that the member would continue to have patient liability in the community setting and the CONTRACTOR is unwilling to continue serving the member who has...
Patient Liability. The amount of an enrollee’s income, as determined by DHS, to be collected each month to help pay for the enrollee’s long-term care services.
Patient Liability. Members receiving LTSS may be required to contribute income towards their long-term care costs. This can be applied to both nursing facility and HCBS services. In general, the providers are collecting the patient liability directly and therefore these payments are removed from the calculation of the capitation rates. The exception to this is for legacy PASSPORT and Choices waiver individuals where the ODM collects the patient liability amounts. For these 2 cases, the capitation rates were not reduced by patient liability amounts.
Patient Liability. 2.21.5.1 TENNCARE will notify the CONTRACTOR of any applicable patient liability amounts for members via the eligibility/enrollment file.
2.21.5.2 The CONTRACTOR shall delegate collection of patient liability to the nursing facility and shall pay the facility net of the applicable patient liability amount.
Patient Liability. 2.6.7.2.1 TENNCARE will notify the CONTRACTOR of any applicable patient liability amounts for CHOICES and I/DD MLTSS Programs members via the outbound 834 enrollment file.
2.6.7.2.2 When TENNCARE notifies the CONTRACTOR of patient liability amounts for CHOICES or I/DD MLTSS Programs members via the outbound 834 enrollment file with an effective date any time other than the first day of the month, the CONTRACTOR shall determine and apply the pro-rated portion of patient liability for that month.
2.6.7.2.3 The CONTRACTOR shall delegate collection of patient liability for CHOICES Group 1 members to the nursing facility and collection of patient liability for members receiving ICF/IID services to the ICF/IID and shall pay the facility net of the applicable patient liability amount.
Patient Liability. Members receiving LTSS may be required to contribute income towards their long-term care costs. This can be applied to both nursing facility and HCBS services. In general, the providers are collecting the patient liability directly and therefore these payments are not included in the base data. The exception to this is for legacy PASSPORT and Choices waiver individuals where ODM collects the patient liability amounts. For these two waiver types, the base data represents payments gross of patient liability amounts. We expect the proportion of legacy individuals to decrease over time; however, the expected impact to patient liability is not material to the CY 2017 rate development process. Potentially Preventable Readmissions (PPR). Effective January 1, 2017, hospitals with excessive preventable readmissions will be penalized in the form of hospital-specific base rate reductions. For hospitals with actual-to- expected readmission ratios greater than 1.0, a base rate reduction of 1% will be effective on January 1, 2017. ODM provided a list of hospitals impacted by this program change and estimated the impact to inpatient expenditures under the MyCare program. Estimated cost reductions were not material.
