REQUIREMENTS PRIOR TO OPERATIONS.
A.2.1.1 Licensure
2.1.1.1 Prior to the start date of operations (as defined in Section A.1 of this Contract) and prior to accepting TennCare enrollees, the CONTRACTOR shall obtain a standard certificate of authority (COA) from TDCI to operate as an HMO in Tennessee in the service area covered by this Contract (see Section A.2.4.2).
2.1.1.2 Prior to the start date of operations and prior to accepting TennCare enrollees, the CONTRACTOR shall ensure that any subcontractor(s) accepting risk under this Contract shall be licensed, as necessary, by TDCI. In particular, if the CONTRACTOR subcontracts for the provision of behavioral health services, and that subcontractor accepts risk, TDCI may require that the subcontractor be licensed as a Prepaid Limited Health Service Organization (PLHSO).
2.1.1.3 Prior to the start date of operations, the CONTRACTOR shall ensure that its staff, all subcontractors and providers, and their staff are appropriately licensed.
2.1.1.4 The CONTRACTOR shall ensure that the CONTRACTOR and its staff, all subcontractors and staff, and all providers and staff retain at all times during the period of this Contract a valid license, as appropriate, and comply with all applicable licensure requirements.
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. 24 A.2.1.1 Licensure 24 A.2.1.2 Readiness Review 24 A.2.2 GENERAL REQUIREMENTS 25 A.2.3 ELIGIBILITY FOR TENNCARE 26 A.2.3.1 Overview 26 A.2.3.2 Eligibility Categories 26 A.2.3.3 TennCare CHOICES Groups 26 A.2.3.4 TennCare Applications 27
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. 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
