Long Term Care Legislation:
A New Day for Tennessee's Elderly and Disabled

Long term care for the elderly and disabled under Tennessee's TennCare program will dramatically change due to the Long Term Care Community Choices Act of 2008 (the "Act").  This Act reallocates substantial sums of TennCare's $1.2 billion long term care budget to home based services.  Where a substantial portion of that budget was formerly spent on nursing facilities, the Act provides the elderly more alternatives for community-based residential care as well as self-directed care with the ability for members to hire nontraditional providers such as family and friends to provide in-home care.
The Commissioner of Finance and Administration will be developing and implementing specific policies in furtherance of the Act's purposes during the next year.  We anticipate several more years will pass for the full benefits of alternative care to emerge.  Specific changes include:

Establishing a single entry point responsible for coordinating all of the Medicaid benefits that a TennCare-eligible individual may need, including medical, behavioral, nursing care, and home and community-based services.  Tennessee's nine existing Area Agencies on Aging and Disability will serve as that entry point into Tennessee's long term care system, thus, speeding up the approval process for home and community-based care.

Allocating $12 million of new long term care money to enable 2,300 additional people across the state to sign up for the agency's home and community-based services program.

Providing $5.0 million in assistance to current nursing care facilities willing to diversify their lines of business to include home-delivered meals, adult day care, respite and other home care services.

• Increased access to cost-effective home and community-based alternatives to institutional care for Medicaid-eligible individuals. This new system will now include, subject to the availability of funding in each year’s appropriations bill, expansion of PACE (Programs of All Inclusive Care for the Elderly) sites to additional major metropolitan areas of the state and residential alternatives for people who can be served outside nursing facilities (assisted living facilities, adult family care homes, adult foster care homes, companion call models, and home care in public housing).
• Implementation of policies and processes that expedite the determination of Medicaid eligibility and medical eligibility for home and community-based programs and services. These will include presumptive or immediate Medicaid eligibility determination, fast-track eligibility determination, development of specialized units or teams for determination of Medicaid eligibility for HCBS, implementation of facilitated enrollment processes, and the implementation of an on-line medical eligibility application process.
• Restructuring of level of care criteria for new nursing home admissions to ensure that the most intensive care is available to those in highest need.  Eligible nursing facility residents will continue to receive nursing facility services or cost-effective home and community-based waiver services without a requirement of meeting new nursing facility level of care criteria.  Eligible current enrollees in statewide home and community-based services will also continue to receive cost-effective home and community-based waiver services and will not be required to meet new nursing facility level of care criteria except for admission to a nursing facility.  People who need a lesser level of care but are “at risk” of institutional care can qualify for a more moderate package of Medicaid-reimbursed home and community-based waiver services up to a specified enrollment cap.
• Development of initiatives (1) encouraging the use of cost-effective home- and community-based care, (2) aiding those making the transition to nursing to community-based care, (3) assisting nursing facilities in diversifying their lines of business, and (4) expanding cost-effective community-based residential alternatives to institutional care, which may include the development of multiple levels of assisted care living facility services, adult family care homes, adult foster care homes, companion care models, and other cost-effective residential alternatives to nursing facility care.
• Creating an acuity-based reimbursement methodology for nursing facility services, based on an individualized assessment of need, as an alternative to the current cost-based nursing facility reimbursement system, to be implemented over a period of two years.

In summary, the Act attempts to simplify TennCare's long term care system.  While easing an eligible member's access to TennCare's system of care, the Act promotes a continuous quality improvement strategy across the acute/long term continuum.  It focuses on strong quality oversight to ensure that services are delivered as intended and that problems are immediately identified and resolved.  The Act's mandates for development of consumer-direction options for people receiving home and community-based long term care services will provide those persons the ability to employ caregivers delivering unskilled hands-on or support services.  The Act utilizes a fiscal intermediary with eligible members being able to use a budget allowance to direct payment for those home and community-based services necessary to meet that member's long term care needs.

Every nontraditional nursing care facility can expect to provide care to residents of higher acuity needs with accompanying higher responsibility to care for those residents.

If you have questions regarding the application and potential effect of this legislation, please contact a member of our Elder Care Client Services & Planning Team or our Elder Care Litigation Team.
 
Elder Care Client Services & Planning Team
Dana B. Perry, Certified Elder Law Attorney
Gregory D. Willett
Kurt J. Faires
Traci D. Fant

Elder Care Litigation Team
F. Laurens Brock
W. Lee Maddux
Alix C. Michel
David J. Ward
Nathaniel S. Goggans
T. Ryan Malone
Jacob C. Parker