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Notice of Change in TennCare II Demonstration Amendment 31

The Commissioner of the Tennessee Department of Finance and Administration is providing official notification, pursuant to 42 CFR § 447.205 and 59 Fed. Reg. 49249, of intent to file an amendment to the TennCare II Demonstration.  The amendment will be filed with the Centers for Medicare and Medicaid Services (CMS), a federal agency located in Baltimore, Maryland, with a Regional Office in Atlanta, Georgia. 

The State is required to meet certain advance notice obligations whenever an amendment to the TennCare Demonstration is filed.  This demonstration amendment, which will be known as “Amendment 31,” is being filed with a proposed effective date of July 1, 2017.  The benefits listed in this notice are currently supported with non-recurring funds that have been made available through a hospital assessment fee scheduled to expire on June 30, 2017.   Should the fee be renewed, the changes contained in Amendment 31 will not occur.

Amendment 31 will eliminate certain currently covered services and establish benefit limits on others.   Children under 21 will not be affected by these changes.  Eligibility for TennCare will not be affected by these changes.  Pregnant women and institutionalized persons will not be affected by proposed benefit limits; however, they will be affected by the elimination of coverage for occupational therapy, speech therapy, and physical therapy.

The specific changes to be made are as follows:

  • Implementation of a combined annual limit of 8 days per person for inpatient hospital and inpatient psychiatric hospital services
  • Implementation of an annual limit on non-emergency outpatient hospital occasions of 8 per person (an “occasion” is a day)
  • Implementation of a combined annual limit on health care practitioners’ office visits of 8 occasions per person (an “occasion” is a day)
  • Implementation of an annual limit on lab and X-ray services of 8 occasions per person (an “occasion” is a day)
  • Elimination of coverage for occupational therapy, speech therapy, and physical therapy

It is the State’s intention to submit this amendment to CMS with the request that it be approved in time for implementation to occur on July 1, 2017.   Corresponding State Plan Amendments will be filed, where appropriate.  We estimate that implementation of the amendment and corresponding State Plan changes will result in a decrease in aggregate annual expenditures of $335,676,745 in State Fiscal Year 2018. 

Copies of this notice will be available in each county office of the Tennessee Department of Health.  Written comments may be submitted by email to public.notice.tenncare@tn.gov or may be mailed to Dr. Wendy Long, Director, Bureau of TennCare, 310 Great Circle Road, Nashville, Tennessee 37243.  Persons wishing to review copies of written comments received may submit their requests to the same email and/or physical address.  The last day on which comments will be accepted is Friday, March 24, 2017.

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