Document:

International Off-Take and Distribution Agreement

 Exhibit 10.2 
 INTERNATIONAL OFF-TAKE AND DISTRIBUTION AGREEMENT 
 BETWEEN 

GEVO, INC 

and 
 SASOL
CHEMICAL INDUSTRIES LIMITED, 
 ACTING THROUGH ITS SASOL SOLVENTS DIVISION 

  
  

 
 Page 1 

 INTERNATIONAL OFF-TAKE AND DISTRIBUTION AGREEMENT 

This International Off-take and Distribution Agreement (this “Agreement”) is made and entered into as of this 29th day of July 2011 (the
“Effective Date”), by and between Gevo, Inc., a Delaware corporation having its principal address at 345 Inverness Drive South, Building C, Suite 310, Englewood, Colorado 80112 (“Manufacturer” or
“Gevo”), and Sasol Chemical Industries Limited, acting through its Sasol Solvents Division, a South African company having its principal address at 1 Sturdee Avenue, Rosebank, 2196 Republic of South Africa
(“Distributor” or “Sasol”) (each individually referred to as a “Party” and collectively, the “Parties”). 
 R E C O R D A L 
  

	(a)	Gevo is a public company founded in 2005 and whose business is the developing, manufacturing and selling of bio-based isobutanol. Gevo intends to market bio-based
isobutanol into global markets, including the Territory and in this regard it currently has no existing customer base, no supply chain or related sales infrastructure to service customers in the Territory; 

 

	(b)	Gevo has successfully piloted its technology and is in the process of retrofitting its first commercial plant for bio-based isobutanol in Luverne, Minnesota. This plant
is expected to start up during 2012; 

  

	(c)	Sasol is a manufacturer of chemicals and as such possesses technical experience, a marketing organisation with market access through a comprehensive supply chain
infrastructure as well as a global customer base in various markets. Sasol is thus well positioned to distribute and sell bio–based isobutanol in the global isobutanol, n-butanol and other related Solvents and Chemical Intermediate markets;

  
  

 
 Page 2 

	(d)	The Parties concluded a non-binding Letter of Intent dated 3 November 2010, pursuant to which the Parties had negotiations with the intention to conclude this
Agreement; 

  

	(e)	The Parties met again during January 2011 for purposes of exploring various options regarding potential marketing relationships as between the Parties with the outcome
of these discussions being that both Parties favoured a distributor based relationship with a corn based pricing mechanism; 

  

	(f)	Taking all of the above into account, and subject to the terms and conditions set out herein below, Gevo desires to appoint Sasol as a distributor for the Product as a
Solvent or as a Chemical Intermediate and Sasol desires to be appointed as such and, for this purpose, Gevo will sell Product to Sasol and Sasol will purchase Product from Gevo in order for Sasol to establish, promote, sell and distribute the
Product as a Solvent or as a Chemical Intermediate as is more fully set out herein below; and 

  

	(g)	This Agreement replaces all other previous agreements, statements, term- sheets, letters of intent, e-mails and other correspondences and communications, or any other
document whether written or oral and whether signed or unsigned between the Parties. 

 NOW, THEREFORE, the Parties do hereby
agree as follows: 
  

	1.	DEFINITIONS  

  

	1.1	For the purposes of this Agreement, the following words/expressions shall have the meaning(s) respectively set out opposite them: 

“Agreement” means this agreement together with annexures hereto; 

  
  

 
 Page 3 

 “Chemical Intermediate” means the Product used for purposes of producing
another chemical substance specifically excluding the uses described in Annexure “E”; 
 “Commencement
Date” means the date of signature hereof; 
 “Control” means the ability to direct the affairs of
another whether by virtue of the ownership of shares, contract or otherwise; 
 “Incoterms 2010” means the
International Chamber of Commerce official rules for the interpretation of Trade Terms which came into force January 1, 2010 and which terms govern this Agreement concluded between the Parties; 

“MSDS” means Material Safety Data Sheet relating to the Product and annexed hereto as Annexure “A”;

 “Product” means chemical grade bio-based isobutanol, which is in accordance with the specification as set out
in Annexure “C”; 
 “Solvent” means the Product used alone or in combination with other
chemical substances for dissolving another substance to form a chemical solution. Typical examples of such applications would be the use of Product in the formulation of inks, paints, coatings and cleaners; and 

“Territory” means the entire world excluding North America, South America and all possessions, protectorates and
territories of the nations located within North America and South America. 
  

	1.2	References to sections and schedules are to the sections in and schedules to this Agreement. 

 

	1.3	Headings are for convenience only and shall be ignored in interpreting this Agreement. 

  
  

 
 Page 4 

	2.	RECORDAL AN INTEGRAL PART OF THE AGREEMENT 

 The Recordal and all the provisions contained thereunder form an integral part of this Agreement and due regard shall be had to the said provisions in the interpretation and understanding of this
Agreement and in the interpretation and understanding of the intention of the Parties. 
  

	3.	SUSPENSIVE CONDITIONS 

  

	3.1	The operation and effectiveness of this entire Agreement is subject to the fulfillment of the following conditions, namely: 

 

	 	(a)	that each Party has obtained the relevant approvals from their respective internal authorities; 

 

	 	(b)	that all external approvals as may be required by the relevant authorities, e.g. relevant anti-trust law authorities, have been obtained; 

 

	 	(c)	that, if deemed necessary by either Party, confirmation by relevant external expert legal counsel is obtained that the agreement complies with the law. The Party
deeming such confirmation necessary shall be responsible for all costs incurred by such external legal counsel. 

  

	3.2	Each Party shall endeavor to fulfill the abovementioned conditions as soon as reasonably practicable, but in no event later than August 31, 2011 or on such other
date as agreed to in writing by the Parties. 

  

	3.3	The Parties may agree in writing to waive any of the conditions set out in Section 3.1 above. 

  
  

 
 Page 5 

	3.4	By signing this Agreement each Party confirms, amongst others, that all conditions in terms of 3.1 have been met and consequently, this Agreement becomes of full force
and effect upon signature thereof by both Parties. 

  

	4.	APPOINTMENT AND ACCEPTANCE AS DISTRIBUTOR 

  

	4.1	Exclusive Distributor within the Territory for Products Used and Sold as Solvents or Chemical Intermediates: Geographic-market restriction

  

	 	(a)	The Manufacturer hereby appoints the Distributor as its exclusive distributor of the Product for use and sale solely as a Solvent or Chemical Intermediate within the
Territory and the Distributor hereby accepts and agrees to such appointment to establish, promote, sell and distribute the Product for use and sale as a Solvent or Chemical Intermediate in the Territory, subject to the terms and conditions set forth
herein. 

  

	 	(b)	The Manufacturer shall refrain from utilizing any other distributor or other sales representative of the Product within the Territory when such Product is to be used or
sold as a Solvent or Chemical Intermediate, and the Manufacturer shall refrain from actively selling Product to customers within the Territory when such Product is to be used or sold as a Solvent or Chemical Intermediate, subject to the terms and
conditions set forth herein. 

  

	 	(c)	The Manufacturer will refer exclusively to the Distributor all orders of Product received by the Manufacturer from any customers within the Territory, provided that
such customers are to use the Product solely as a Solvent or Chemical Intermediate. 

  

	 	(d)	 The exclusivity provisions of this Section 4.1 apply only to the use and

  
  

 
 Page 6 

	 	
sale of the Product as a Solvent or Chemical Intermediate, and do not apply to the use or sale of the Product for any other use. 

 

	4.2	Non-exclusive Distributor outside the Territory: Geographic-market restriction 

 

	 	(a)	The Manufacturer hereby appoints the Distributor as a non-exclusive Distributor of the Product for use and sale solely as a Solvent or Chemical Intermediate outside the
Territory, and the Distributor hereby accepts and agrees to such appointment to establish, promote, sell and distribute the Product for use and sale solely as a Solvent or Chemical Intermediate outside the Territory, subject to the terms and
conditions set forth herein. 

  

	 	(b)	The Manufacturer shall be free to appoint any other distributor or other sales representative of the Product outside the Territory. 

 

	 	(c)	The Manufacturer reserves the right to directly or indirectly sell Product to customers outside the Territory for any use or purpose. 

 

	 	(d)	The Distributor shall not be entitled to any commission, discount or any other compensation with respect to or on account of any sales in terms of 4.2 (b) and (c).

  

	4.3	Product-market restriction: Product to be sold only into the Solvents and/or Chemical Intermediate product market inside and outside the Territory

  

	 	(a)	 The Parties record that the Product has various applications in various relevant product markets but that Sasol is appointed as a distributor of the
Product, inside and outside the Territory, solely for promotion, sale and 

  
  

 
 Page 7 

	 	
distribution of the Product into product markets where the Product is used as a Solvent or Chemical Intermediate. 

 

	 	(b)	Subject to compliance with relevant anti-trust laws, the Distributor shall not promote, sell or distribute the Product for any other use other than set out above and
specifically, the Distributor shall not sell the Product, directly or indirectly, to any customers or end-users for use in any of the excluded fields or uses set forth in Annexure “E”, which Schedule may be amended from time to time by the
Manufacturer in the event the Manufacturer grants distribution or sales rights to third parties. The Distributor shall notify its distributors and customers, in writing, that the Product may only be used as a Solvent or Chemical Intermediate, and
shall cease any future sales to any customer, end-user, or distributor immediately upon becoming aware that the Product is being used or sold by such customer, end-user, or distributor other than for the use for Solvents or Chemical Intermediate or
in the excluded field or uses set forth in Annexure “E”. 

  

	 	(c)	For the avoidance of doubt, Manufacturer shall be free to sell the Product, directly or indirectly, within and outside the Territory when the Product is not for use or
sale as a Solvent or Chemical Intermediate, and Manufacturer shall be free to appoint other distributors to sell the Product, directly or indirectly, within and outside the Territory when the Product is not for use or sale as a Solvent or Chemical
Intermediate. The Distributor shall not be entitled to any commission, discount or any other compensation with respect to or on account of any such sales. 

  

	 	(d)	The Distributor agrees that during the term of this Agreement, it shall not directly or indirectly distribute or sell any bio-based isobutanol other than the Product.

  
  

 
 Page 8 

	4.4	Termination of exclusivity 

  

	 	(a)	In the event the Distributor: 

  

	 	(i)	fails to cease any sale to any customer, end-user, or distributor immediately upon becoming aware that such customer, end-user, or distributor sells or uses the Product
other than for use as a Solvent or Chemical Intermediate or as an excluded application under Annexure “E” or; 

  

	 	(ii)	subject to Product being available and further subject to commercial viability of the relevant transaction, fails or refuses to sell Product to customers who wish to
purchase Product in accordance with this Agreement; or 

  

	 	(iii)	fails to pay any amounts owed to Manufacturer, hereunder, or breaches Sections 4.3(b), 6.1, 7(c), or 9; 

 

	 	(iv)	distributes or sells any bio-based n-butanol, 

 then, in addition to any other rights or remedies provided for hereunder, at law or in equity, the Manufacturer may declare the Distributor’s appointment under Section 4.1 hereof to be
non-exclusive in all or any portion of the Territory. In the event Manufacturer elects to terminate Distributor’s exclusivity, Manufacturer may, at any time during the remaining term of this Agreement, utilize other persons to be non-exclusive
distributors of the Product for use and sale as a Solvent or Chemical Intermediate within the Territory, or the non-exclusive portions thereof, and shall also have the right itself to distribute and sell the Product for use and sale as a Solvent or
Chemical Intermediate therein, regardless of the quantity of Product purchased by Distributor. In the 

  
  

 
 Page 9 

 
event Manufacturer terminates Distributor’s exclusivity, the minimum Product quantity obligations of Distributor as provided for in Section 6.3 shall terminate. 

 

	4.5	Distributor’s take-or-pay obligation 

 Notwithstanding the foregoing and subject thereto that Manufacturer has provided Distributor with two months prior written notice of the date on which Manufacturer shall sell and deliver the first
commercial quantities of Product to the Distributor, as intended in terms of this Agreement and further subject to Manufacturer being compliant with all its obligations in terms of this Agreement: 

 

	4.5.1	in the event Distributor fails to purchase the Minimum Supply Quantity of Product in the 2012 calendar year, Distributor will maintain its exclusivity rights under
Section 4.1 and Distributor will pay Manufacturer a shortfall fee of $100/MT, multiplied by the difference between the Minimum Supply Quantity and the quantity actually purchased in the 2012 calendar year; 

 

	4.5.2	In the event Distributor fails to purchase the Minimum Supply Quantity of Product in the 2013 or 2014 calendar years, Distributor will pay Manufacturer a shortfall fee
of $150/MT, multiplied by the difference between the Minimum Supply Quantity and the quantity actually purchased in the 2013 or 2014 calendar year, as applicable; 

 

	4.5.3	 In the event Distributor fails to purchase the Minimum Supply Quantity of Product for use or sale as a Solvent or Chemical Intermediate in the 2015 or
any later calendar year, and wishes to maintain its exclusivity right for the following calendar year, then Distributor will pay Manufacturer a shortfall fee of $150/MT, multiplied by the difference between the Minimum Supply Quantity and the
quantity actually purchased in the respective calendar year. If Distributor does not elect to maintain its exclusivity right for the following calendar year, then, for 

  
  

 
 Page 10 

	 	
the remainder of the term of this Agreement, Distributor shall lose its exclusivity rights under this Agreement and Manufacturer may utilize other persons to be non-exclusive distributors of the
Product within the Territory, and shall also have the right itself to distribute and sell the Product therein, regardless of the quantity of Product purchased by Distributor. 

 

	4.5.4	For the 2015 and later calendar years, if Distributor fails to purchase the applicable Minimum Supply Quantity for that year, Distributor must provide written notice by
January 31st of the following calendar year of its election whether or not to maintain its exclusivity rights for the following calendar year and pay the shortfall fee, if any, due hereunder. In the event Distributor fails to purchase the
applicable Minimum Supply Quantity for use or sale as a Solvent or Chemical Intermediate within the Territory in any given calendar year and fails to provide Manufacturer written notice of its election on or prior to January 31st of the
following calendar year, then Distributor shall be deemed to have forfeited its exclusivity rights hereunder. 

  

	5.	OBLIGATIONS OF MANUFACTURER 

  

	5.1	Manufacture of Product 

Manufacturer shall use commercially reasonable efforts to maintain the necessary manufacturing capability to fill all orders for the
Product received from Distributor, in a minimum amount (the “Minimum Supply Quantity”) as provided for in Annexure “B” attached hereto. Manufacturer acknowledges that it intends to supply the target volume quantities of
Product set forth in Annexure “F”, but that it shall have no supply-or-pay obligation for quantities of Product in excess of the Minimum Supply Quantity. 
 In the event of a Product shortage for any reason, Manufacturer shall have the right to allocate or apportion available Product among its customers as Manufacturer, in the exercise of its sole discretion,
deems appropriate, without 

  
  

 
 Page 11 

 
incurring any liability to Distributor. However, in the event, the Distributor has submitted a valid purchase order and Manufacturer is unable to supply such order in a timely manner, the
Distributor’s Minimum Supply Quantity shall be reduced by the amount of such purchase order for such year. 
  

	5.2	Supply-or-pay obligation 

Provided that Manufacturer has given written notice to the Distributor as contemplated in 4.5 above, Distributor is not in material breach
of this Agreement (excluding any breach of Section 4.4) and complies with all of its lead time and other obligations under this Agreement, then, (a) in the event the Distributor places orders, consistent with the requirements of
Section 8, to purchase Product from Manufacturer and Manufacturer fails to supply Distributor with the applicable Minimum Supply Quantity of Product in the 2012 calendar year, Manufacturer shall not be deemed to be in breach of this Agreement,
but shall pay Distributor a shortfall fee of $100/MT, multiplied by the difference between the Minimum Supply Quantity and the quantity actually supplied to Distributor in the 2012 calendar year, and (b) in the event Manufacturer fails to
supply Distributor with the applicable Minimum Supply Quantity of Product in the 2013 calendar year or 2014 calendar year, Manufacturer shall not be deemed to be in breach of this Agreement, but shall pay Distributor a shortfall fee of $150/MT,
multiplied by the difference between the Minimum Supply Quantity and the quantity actually supplied to Distributor in the given calendar year. 
  

	5.3	Documentation 

  

	 	(a)	Manufacturer shall furnish Distributor with such reasonable quantities of English language specifications, technical information, promotional material and other
information and literature as Manufacturer in its sole discretion shall deem appropriate to assist Distributor in the effective distribution, marketing and sale of the Product within the Territory. 

  
  

 
 Page 12 

	 	(b)	Manufacturer shall provide the Distributor with an appropriate MSDS and any other relevant documentation as required by law, including applicable safety, health, and
environmental laws. 

  

	 	(c)	Manufacturer shall provide the Distributor with a certificate of analysis (“COA”) generated by Manufacturer simultaneously with the delivery of every batch of
Product to the Distributor showing that the Product is in accordance with the Specifications. 

  

	5.4	Product Warranty and compliance with relevant laws 

 Manufacturer warrants that the Product purchased by Distributor hereunder shall, upon receipt by Purchaser, meet or exceed the minimum specifications set forth in Annexure “C” (the
“Specifications”). Manufacturer also warrants that it shall comply, in all material respects, with all applicable laws in the manufacture of the Product. 

 

	 	(a)	 Warranty Remedies - Distributor’s exclusive remedy under the warranty provided by this Section 5.4 shall be to obtain the replacement
of any Product which, in terms of the COA is determined to not conform to the Specifications. Distributor shall provide prompt written notice to Manufacturer stating the nature and date of any defect and other identifying information concerning the
specific shipment of the Product which Distributor claims fails to comply with the foregoing warranty, and shall comply with such additional procedural requirements as Manufacturer shall prescribe from time to time. In response to any such notice,
Manufacturer may utilize a qualified independent third party surveyor, reasonably acceptable to both Parties, to conduct its own assessment of the Product, in connection with which Distributor shall make the claimed defective Product reasonably
available to Manufacturer. 

  
  

 
 Page 13 

	 	
If upon conclusion of any such assessment by such third party, the Product is found to conform to the warranty in this Section 5.4, Distributor shall reimburse Manufacturer for its costs and
expenses incurred in utilizing such third party to conduct such assessment. For all Product determined by such third party not to conform to such warranty, Manufacturer shall bear all shipping, customs and clearance charges incurred in shipping to
Distributor replacement quantities of the Product and shall furthermore bear all costs for the return of non-conforming Product to Manufacturer. 

  

	 	(b)	Limitations - Except as expressly stated in Section 5.4(a) and to the extent permitted by relevant consumer laws, there are no warranties, express or
implied, by operation of law or otherwise, pertaining to the Product sold under this Agreement. Manufacturer does not make and hereby disclaims any other warranty whatsoever, whether express or implied, including without limitation any guarantee,
representation, warranty or other assurance whatsoever as to the merchantability, fitness, quality, grade or suitability of the Product for any particular purpose or otherwise or correspondence with any description or sample.

  

	6.	OBLIGATIONS OF DISTRIBUTOR 

  

	6.1	The Distributor shall at all times at its own cost and expense use its best efforts to develop the Territory and to promote the sale of the Product therein. In
connection therewith, Distributor shall maintain facilities suitable for performance of all its obligations hereunder; shall provide, continuous representation within the Territory by means of actual sales personnel contact with existing and
prospective customers of the Product in the Territory; and shall hire and maintain a sales staff sufficient in number, qualifications and training to promote and market the Product in the Territory. 

  
  

 
 Page 14 

	6.2	Conduct of Business and Expenses - the Distributor shall conduct its business consistent with the provisions of this Agreement and all applicable laws which may
in any way relate to the importation, sale or distribution of the Product in the Territory. Distributor shall maintain in effect at all times the necessary registrations with any and all governmental agencies, commercial registries, chambers of
commerce and other offices which may be required under local law in order to conduct commercial business in the Territory with respect to the Product. Distributor shall be responsible for all expenses incurred in connection with the operation of its
business and its activities hereunder, including without limitation all expenses for appropriate and customary advertising, promotional items and trade shows, and all communication, travel and accommodations. 

 

	6.3	Product Purchase Requirements - the Distributor shall order and purchase from Manufacturer no less than the Minimum Supply Quantity of Product in each given
calendar year, and such additional quantities of the Product as the Parties may agree upon in writing from time to time. Distributor acknowledges that it intends to purchase the target volume quantities of Product set forth in Annexure
“F”, but that it shall have no take-or-pay obligation for quantities of Product in excess of the Minimum Supply Quantity. 

  

	6.4	Minimum Stocking Requirement - the Distributor agrees, during the continuance of this Agreement, to maintain a sufficient stocking level of the Product to
fulfill adequately and timely the Product requirements of all customers and prospective customers in the Territory. 

  

	6.5	 Distributor Warranty - Subject to the provisions of Section 5.4 hereof and further subject to applicable consumer laws of a relevant
jurisdiction, Distributor shall be solely responsible for any warranty with respect to the Product made to Distributor’s customers. With respect to any warranty claims covered by Manufacturer’s warranty, Distributor shall fully comply with
the requirements of Section 5.4 hereof and the additional procedural requirements from time to time 

  
  

 
 Page 15 

	 	
prescribed by Manufacturer, and Manufacturer shall have no obligation to recognize any such claims unless the prescribed procedures are fully complied with by Distributor.

  

	6.6	Reports - Upon request of Manufacturer and subject to anti-trust laws, Distributor shall furnish to Manufacturer accurate and complete periodic written reports
regarding its Product inventory levels and promotional activities with respect to the Product. Distributor shall promptly report to Manufacturer all suspected Product warranty issues and all customer claims or complaints. 

 

	6.7	Insurance - Distributor shall obtain and maintain a policy of comprehensive business liability insurance, including without limitation public liability and
property damage insurance, issued by an insurer and with limits of liability reasonably acceptable to Manufacturer. Such policy shall name Manufacturer as an additional insured and shall be cancelable only after thirty (30) days’ written
notice to Manufacturer. Distributor shall from time to time furnish Manufacturer with a certificate of insurance evidencing such insurance. 

  

	6.8	Sale & Use Restrictions - Subject to compliance with relevant anti-trust laws, the Distributor shall notify its distributors and customers, in writing,
that the Product may only be used as a Solvent or Chemical Intermediate, and shall cease any future sales to any customer, end-user, or distributor immediately upon becoming aware that the Product is being used or sold by such customer, end-user, or
distributor other than for the use for Solvents or Chemical Intermediate or in the excluded field or uses set forth in Annexure “E”. 

  

	7.	INDEMNITIES AND LIABILITIES 

  

	 	(a)	 Except as provided in Sections 7(c) and 7(d) or due to breach of Section 9, neither Party shall be liable to the other, its agents,
representatives, employees, customers or any other third party, for any incidental, indirect, 

  
  

 
 Page 16 

	 	
special or consequential damages, including without limitation loss of use, loss of revenue or loss of profit, in connection with or arising out of this Agreement or the existence, furnishing or
functioning of the Product or any item or services provided for in this Agreement or from any other cause, including without limitation claims by third parties, even if a Party has been advised of the possibility of such damages.

  

	 	(b)	Subject to the applicable consumer laws of a relevant jurisdiction, and other than as provided in Section 7(d), Manufacturer’s sole liability, whether on
warranty, contract, or negligence grounds under this Agreement shall be limited to the replacement of any quantities of the Product determined by the COA not to comply with the warranty herein; provided, however, that (a) Manufacturer’s
warranty shall not extend to any quantities of the Product following any processing or other alteration thereof by Distributor or any third party and (b) Manufacturer shall be under no obligation to provide replacement Product necessitated in
whole or in part by catastrophe, fault or negligence of the user or any third party, improper or unauthorized use or storage of the Product, or by causes external to the Product, including without limitation loss, damage or destruction in shipment
or as a result of power failure. 

  

	 	(c)	 Distributor shall indemnify, defend and hold harmless Manufacturer and Manufacturer’s officers, directors, shareholders, affiliates, agents,
representatives, employees, successors and assigns (collectively, “Related Persons”) from and against any and all third party liabilities, losses, damages, injuries, costs, expenses, causes of action, claims, suits, demands, legal
proceedings, assessments and similar matters, including without limitation reasonable attorneys’ fees (collectively, “Claims”), resulting from or arising out of (a) the material breach of this Agreement by Distributor,
(b) any use of the Product in combination with any other product not furnished by Manufacturer, (c) any gross negligence 

  
  

 
 Page 17 

	 	
or willful misconduct of Distributor or any of Distributor’s Related Persons, (d) any contamination, damage or adverse effect on the environment or natural resources (including without
limitation the cost of any investigation or remediation related thereto) in any way arising out of or caused or alleged to have been caused by Distributor or any of Distributor’s Related Persons, or (e) any warranty, other than a warranty
identical to that provided in Section 5.4 hereof, made by Distributor to its customers. 

  

	 	(d)	Manufacturer shall indemnify, defend and hold harmless Distributor and Distributor’s Related Persons from and against any and all third party Claims, resulting
from or arising out of (a) the material breach of this Agreement by Manufacturer, (b) any gross negligence or willful misconduct of Manufacturer or any of Manufacturer’s Related Persons or (d) any contamination, damage or adverse
effect on the environment or natural resources (including without limitation the cost of any investigation or remediation related thereto) in any way arising out of or caused or alleged to have been caused by Manufacturer or any of
Manufacturer’s Related Persons, other than to the extent Distributor is required to indemnify Manufacturer pursuant to Section 7(c). 

  

	8.	ORDERING AND SHIPMENT OF PRODUCT 

  

	8.1	Forecasts 

 Distributor
shall furnish Manufacturer, no later than the tenth (10th) day of each month, with a written forecast of Product requirements for the ensuing three (3) months, the first month of which Distributor commits to purchase (“First
Month”). Whenever possible, all such forecasts shall be in sufficient detail to show expected order dates and probability of receiving orders. In no event shall a written forecast for any quarter of a calendar year exceed one-third
(1/3) of the Minimum Supply Quantity for such calendar year. 

  
  

 
 Page 18 

	8.2	Purchase Orders 

 Each
order by Distributor for the shipment of Product shall be by firm purchase order in writing specifying (a) the quantity of Product to be purchased, (b) whether such quantity is within or, when added to prior purchases, would be in excess
of the Minimum Supply Quantity for the then current calendar year within the Territory, (c) the price of the Product determined in accordance with Section 8.3, (d) requested delivery dates and (e) shipping instructions.
Manufacturer may, at its option, accept or reject any such purchase order as provided in Annexure “D” or for quantities in excess of the Minimum Supply Quantity in any given calendar year, in whole or in part by written acknowledgment of
the purchase order to Distributor or by actual delivery in accordance with the purchase order. Further, and notwithstanding anything in this Agreement to the contrary, Manufacturer shall have no obligation to accept any purchase order that would
require Manufacturer to supply Distributor: 
  

	 	(a)	in any individual quarter of a calendar year, with a quantity of Product that would exceed one-third (1/3) of the Minimum Supply Quantity for such calendar year,
or, 

  

	 	(b)	in any individual month of a calendar year, with a quantity of Product that would exceed one-sixth (1/6) of the Minimum Supply Quantity for such calendar year.

  

	8.3	Price 

  

	8.3.1	The price to be paid by Distributor to Manufacturer for the Product in each shipment shall be calculated according to formula’s provided for in Annexure
“D” according to the relevant region of destination. Such Price excludes Value Added Tax (“VAT”). 

  
  

 
 Page 19 

	8.3.2	The Product price calculations are to be performed by Distributor using the formulas in Annexure “D” making use of the specified published market price
indicators together with average actual prices achieved in the past by Distributor. Given these circumstances, Manufacturer has the right, at its sole discretion, to request a third party audit of such pricing calculations. Such third party audit
shall in all respects be subject to and in accordance with anti-trust laws and in respect of the sharing of sensitive information, no raw pricing data shall be shared between the Parties. 

 

	8.4	Terms and Conditions - All Product purchased by Distributor from the Manufacturer shall be on an EXW, (INCOTERMS 2010), purification plant basis.

  

	8.5	Delivery; Risk of Loss - Delivery of any order hereunder shall be deemed to occur upon Manufacturer making the Product available to the carrier or freight
forwarder selected by Distributor. Title to and risk of loss of all Product sold hereunder shall pass to Distributor upon such delivery, and the risks of loss, damage or delay in transit shall be solely the responsibility and risk of Distributor.
All claims for loss, damage or destruction will be made by Distributor to the carrier, but Manufacturer will render all reasonable assistance, at the request and expense of Distributor, in securing satisfactory adjustment of such claims.

  

	8.6	 Payment Requirements - Payment of the net invoice price for all Product purchased by Distributor shall be received by Manufacturer within
forty-five (45) days after Manufacturer transfers the Product to Distributor’s designated carrier or freight forwarder. Each such payment shall be made in United States currency by bank transfer to such bank account as Manufacturer may
from time to time designate in writing, and shall be accompanied by a remittance advice identifying the specific items paid. In the event that Distributor fails to pay Manufacturer in a timely manner as required by this Section 8.6, any unpaid
balance shall be subject to a late charge at the rate of one and one-half percent (1.5%) per month for each month or portion thereof during which such payment is 

  
  

 
 Page 20 

	 	
overdue or, if lower, the highest rate then permitted by applicable law. In addition, Manufacturer may, at its option, suspend all shipments to Distributor (including stoppage in transit), may
require that future shipments be paid for in advance or may make any other credit arrangements satisfactory to Manufacturer in its sole discretion. Manufacturer’s rights pursuant to this Section 8.6 shall be cumulative and without
prejudice to Manufacturer’s right to declare Distributor in default under this Agreement by reason of such delinquency, and Manufacturer shall have the right to avail itself of any and all other remedies to which it may be entitled hereunder,
at law or in equity. 

  

	8.7	Non-conforming Shipments - Manufacturer shall have no liability for any shortage or other discrepancy in any shipment of Product hereunder unless Distributor
sends Manufacturer notice, within ten (10) days after actual receipt of the shipment at Distributor’s facility, that the shortage or discrepancy existed when the shipment was received. In the event a shipment is nonconforming by reason of
any defect in the Product contained in such shipment, Distributor shall so inform Manufacturer within such ten (10) day period, and Manufacturer shall undertake such action as may be required pursuant to its warranty herein, unless the defect
resulted from transit damage, loss or damage following delivery of the Product or Distributor’s fault. 

  

	9.	CONFIDENTIALITY 

  

	9.1	Definition 

 As used
herein, the term “Confidential Information” shall mean all information and material disclosed or otherwise provided by either Party to the other in the course of performing this Agreement. “Confidential Information” does
not include that which (a) is generally known and available in the public domain through no fault of the other Party; (b) was known to the other Party at the time of disclosure without a duty of confidentiality, as evidenced by the
receiving Party’s documentation in existence at the time of disclosure by the disclosing Party; (c) is disclosed with the prior written approval of the disclosing Party; or (d) is

  
  

 
 Page 21 

 
independently developed by the other Party without any use of Confidential Information of the disclosing Party, as evidenced by the other Party’s documentation in existence at the time of
disclosure by the disclosing Party. 
  

	9.2	Restrictions on Use 

 Each
Party agrees not to use the other Party’s Confidential Information for any purpose other than the performance of this Agreement. Neither Party shall disclose Confidential Information of the other Party to any third parties except as otherwise
permitted hereunder. Each Party may disclose Confidential Information of the other Party only to its employees, agents, contractors or representatives who have a need to know such Confidential Information and who are bound to retain the
confidentiality thereof under provisions (including, without limitation, provisions relating to nonuse and nondisclosure) no less strict than those required by this Agreement. Each Party shall maintain Confidential Information of the other Party
with at least the same degree of care it uses to protect its own proprietary information of a similar nature or sensitivity, but no less than reasonable care under the circumstances. 

 

	9.3	Terms of Agreement 

 Each
Party agrees that the terms and conditions of this Agreement shall be treated as Confidential Information of the other Party; provided that each Party may disclose the terms and conditions of this Agreement (a) as required by judicial order or
other legal obligation, provided that, in such event, the Party subject to such obligation shall promptly notify the other Party to allow intervention (and shall cooperate with the other Party) to contest or minimize the scope of the disclosure
(including application for a protective order); (b) as required by applicable securities laws, including without limitation requirements to file a copy of this Agreement (redacted to the extent reasonably permitted by applicable law) or to
disclose information regarding the provisions hereof or performance hereunder, in which case the disclosing Party will notify the other Party in advance of, and give due consideration to the other Party’s comments

  
  

 
 Page 22 

 
regarding, the scope of the proposed disclosure and minimization of same; (c) in confidence, to legal counsel; (d) in confidence, to accountants, banks and financing sources and their
advisors; and (e) in confidence, in connection with the enforcement of this Agreement or any rights hereunder. 
  

	9.4	Relief 

 Each Party
acknowledges that (a) the restrictions contained in Section 9.1 through 9.3 hereof shall apply in all areas where such application is permitted by law, (b) the provisions of this Section 9 are reasonable and necessary to protect
the legitimate interests of the other Party, (c) the restrictions contained in this Section 9 will not prevent such Party from earning or seeking a livelihood and (d) any violation of this Section 9 by such Party would result in
irreparable harm to the other Party. Accordingly, each Party hereby consents and agrees that, if it continues to violate any of the provisions of this Section 9 for a period of five (5) or more business days after notice thereof from the
other Party, such other Party shall be entitled, in addition to other remedies available to it, to an injunction, without the necessity of bond or other undertaking, to be issued by any court of competent jurisdiction restraining the commission or
continuation of any violation of this Agreement. 
  

	9.5	Enforceability 

 In the
event that the whole or any part of the provisions of this Section 9 shall be determined to be invalid by reason of the extent, duration, scope or other provision set forth therein, those provisions shall be reduced so as to cure such
invalidity and in its reduced form the provisions of this Section 9 shall be enforceable in the manner contemplated hereby. The provisions of this Section 9 shall survive the termination or expiration of this Agreement, irrespective of the
reason therefor. 

  
  

 
 Page 23 

	10.	TERM AND TERMINATION 

Subject to the remaining provisions of this Section10, the term of this Agreement is 3 years from the Effective Date, thereafter renewable
on an annual basis subject to the consent of both parties. 
  

	10.1	Termination for Non-payment 

 Either Party may terminate this Agreement in whole or in part upon failure by the other Party, within five (5) business days following notification by the terminating Party, to pay any amount due and
unpaid hereunder. 
  

	10.2	Termination for Cause 

Subject to the provisions of Section 10.1 and 10.3, if either Party defaults in the performance of any provision of this Agreement,
then the non-defaulting Party may give written notice to the defaulting Party that if the default is not cured within thirty (30) days the Agreement will be terminated. If the non-defaulting Party gives such notice and the default is not cured
during the thirty-day period, then this Agreement shall automatically terminate at the end of that period. Either Party may also terminate this Agreement effective immediately upon notice to the defaulting Party in the event of (a) conviction
in any court of competent jurisdiction of the defaulting Party or any principal officer or manager of the defaulting Party, of any crime tending to affect adversely the ownership, operation, management, business or interest of the defaulting Party,
or (b) failure of the defaulting Party to obtain or maintain any license or approval required by law. 
  

	10.3	Termination for Insolvency 

This Agreement shall terminate, without notice, (a) upon the institution by or against either Party of insolvency, receivership or
bankruptcy proceedings or any other proceedings for the settlement of such Party’s debts, (b) upon either Party’s 

  
  

 
 Page 24 

 
making an assignment for the benefit of creditors, or (c) upon general dissolution or ceasing to do business by such Party. 

 

	10.4	Consequences of Termination 

 Upon the expiration or termination of this Agreement for any reason, (a) all sums which either Party then owes to the other hereunder shall become immediately due and payable, (b) all remaining
obligations of Manufacturer to make deliveries and sales hereunder shall immediately cease, (c) Distributor shall immediately cease to hold itself out as an authorized distributor of Manufacturer, (d) Distributor shall immediately return
to Manufacturer all specifications, technical information, promotional material and other information and literature concerning the Product as have previously been furnished to Distributor by Manufacturer and (e) the provisions of
Section 9 hereof shall survive and each Party shall continue to perform and observe such provisions as if such termination had not occurred. 
  

	10.5	No Liability 

 Provided
that the termination, expiration or nonrenewal of this Agreement has occurred lawfully and in terms of this Agreement, neither Party shall be liable by reason of the termination, expiration or nonrenewal of this Agreement to the other Party for
compensation, reimbursement or damages on account of any loss of prospective profits on anticipated sales or on account of expenditures, investment, leases or other commitments relating to the business or goodwill of the other Party. 

 

	11.	MISCELLANEOUS 

  

	11.1	Relationship of Parties 

 Manufacturer and Distributor each hereby acknowledges that it is an independent entity and is not subject to the control of the other Party hereto in any manner except as specifically provided in this
Agreement. Nothing herein shall be construed to make the Parties hereto partners or joint venturers, or to render either Party liable for any of the debts or obligations of the other Party hereto. 

  
  

 
 Page 25 

	11.2	Foreign Corrupt Practices 

The Parties represent that each has read and is familiar with the United States Foreign Corrupt Practices Act of 1977 and will comply with
said act and is aware of the sensitive nature of international military contracting and the types of improprieties which have received widespread publicity concerning some such contracts. The Parties will at all times conduct the work under this
Agreement so as to strictly abide by the laws of the United States and the customer’s country, and will at all times avoid any situation which would cause any representative or agent of the government in any portion of the Territory to appear
to have a conflict of interest. Distributor will not share any commission or fee paid hereunder with any third party or parties other than Distributor’s designated in-country representative(s). 

 

	11.3	Notices 

 Any and all
notices and communications hereunder shall be in writing and shall be deemed to have been duly given when delivered personally, at the time of receipt if by facsimile, telegram or similar means of communication, or fourteen (14) days after
mailing when deposited in the United States or Territory mail, first class postage prepaid, addressed to the Parties at the addresses set forth immediately following the signatures of the Parties or to such other addresses as either of the Parties
may from time to time in writing designate to the other Party hereto. 
  

	11.4	Time 

 Time is of the
essence of this Agreement with respect to each and every provision of this Agreement in which time is a factor. 
  

	11.5	Force Majeure 

 If either
Manufacturer or Distributor shall be unable, by reason of any event referred to herein as “force majeure,” to carry out its obligations under this 

  
  

 
 Page 26 

 
Agreement, either wholly or in part, the Party so failing shall give notice and full particulars of such event or events in writing to the other Party as soon as possible after the occurrence of
any such event, and thereupon such obligation shall be suspended during the continuance of such cause which, however, shall be remedied or removed with all possible dispatch; and the obligations, terms and conditions of this Agreement shall be
extended for such period as may be reasonably necessary for the purpose of making good any suspension so caused, provided that no claim for suspension shall be made by either Party when the period of suspension so caused shall be less than ten
(10) consecutive business days. The events referred to herein as “force majeure” shall include fire, casualty, unavoidable accident, failure of the usual sources of supply, strikes, labor conditions, lockouts, war, acts of God, the
enactment of any federal, state or municipal law or ordinance or the issuance of any executive or judicial order, whether federal, state or municipal, or of any other legally constituted authority, accidents to machinery or any other cause not
within the control of the Party claiming relief from any of the requirements of this Agreement and that, by the exercise of due diligence, the Party is unable to prevent or overcome. Mere inability to make any payment of money required hereunder
shall not constitute an event of “force majeure.” 
  

	11.6	Waiver 

 No delay or
failure by either Party to exercise any right, power or remedy with regard to any breach or default by the other Party under this Agreement shall impair any such right, power or remedy and shall not be construed to be a waiver of any breach or
default of the same or any other provision of this Agreement. Any waiver, permit, consent or approval of any kind or character on the part of either Party of or to any breach or default by the other Party shall be effective only if in writing and
shall not be construed to be a waiver, permit, consent or approval of or to any succeeding breach or default or a waiver of any provision of this Agreement. 

  
  

 
 Page 27 

	11.7	Assignment 

 This
Agreement may not be assigned in whole or in part by either Party without the prior written consent of the other Party (the “Remaining Party”). Notwithstanding the foregoing, a Party (the “Assigning Party”) may, without the
Remaining Party’s consent, delegate and/or subcontract its rights and obligations hereunder to any of its affiliates, provided that (a) no such delegation and/or subcontracting shall relieve the Assigning Party from any of its obligations
hereunder, (b) each such affiliate agrees in writing to be bound by the terms of this Agreement, and (c) the Assigning Party promptly notifies the Remaining Party of such delegation and/or subcontracting and provides the Remaining Party
with a copy of the agreement executed by such affiliate. Further, Manufacturer may assign this agreement in connection with a merger, change in control, or other transfer of all or substantially all of the Manufacturer’s assets which pertain to
this Agreement, provided that (a) such third party agrees in writing to be bound by the terms of this Agreement and (b) Distributor is notified within thirty (30) days after such assignment of such assignment. The Remaining Party may,
at its sole discretion, refuse consent to any other assignments. For the purposes of this Section, an “affiliate” is any entity controlling, controlled by or under common control with the Assigning Party. 

 

	11.8	Successors 

 Subject to
the provisions of Section 11.7 hereof, the covenants, agreements, terms and conditions contained in this Agreement shall be binding upon and shall inure to the benefit of the Parties and their respective successors and assigns. 

 

	11.9	Applicable Law 

 The
existence, validity, construction and operational effect of this Agreement, and the rights and obligations hereunder of each of the Parties, shall be determined in accordance with the laws of England, provided that any provision of this Agreement
which may be prohibited by or otherwise held invalid under such law shall be ineffective only to the extent of such prohibition or invalidity and 

  
  

 
 Page 28 

 
shall not invalidate or otherwise render ineffective any or all of the remaining provisions of this Agreement. Both Manufacturer and Distributor shall comply with the export control laws and
regulations of the United States, and neither Manufacturer nor Distributor shall export or reexport any Product in any manner contrary to the applicable export control laws or laws and regulations of the United States or any other country. Both
Parties hereby confirm their intention to exclude application of the U.N. Convention on the International Sale of Goods if such Convention would otherwise be applicable to any transaction contemplated by this Agreement. 

 

	11.10	Controversy 

 Subject to
the terms of this Section 11.10, all controversies, claims and disputes arising in connection with this Agreement shall be settled by mutual consultation between the Parties in good faith as promptly as possible, but failing an amicable
settlement shall be settled finally by arbitration conducted in London, England, in accordance with the Rules of the London Court of International Arbitration. 
  

	 	(a)	Exclusivity - The Parties hereto hereby agree that, with the exception of claims arising out of a breach of Section 9, the arbitration procedure provided
for herein shall be the sole and exclusive method of resolving any and all of the aforesaid controversies, claims or disputes. Should either Party bring any legal action against the other with respect to any claim required to be arbitrated under
this Agreement by any method other than arbitration, the other party shall be entitled to recover from such party all damages, costs, expenses and attorneys’ fees incurred as a result of such action. 

 

	 	(b)	 Decision by Arbitrators - Manufacturer and Distributor shall each select an arbitrator to resolve any dispute hereunder, and the two arbitrators
so selected shall select a third arbitrator. The three arbitrators so selected shall make a final decision and award according to the terms and 

  
  

 
 Page 29 

	 	
provisions of this Agreement and applicable law. Said decision shall set forth findings of fact and conclusions of law upon which the award is based. The arbitrators may select counsel to provide
advice in preparation of such findings and conclusions, and on any point of law arising in the course of arbitration. The decision of any two (2) arbitrators shall constitute a final decision and award hereunder. The arbitrators shall have no
power to award any damages excluded by, or in excess of, any damage limitations expressed in this Agreement or any subsequent agreement between the Parties. The award shall be in U.S. Dollars and shall earn interest from the date of the award until
satisfied in full at the United States prime interest rate as reported in the WALL STREET JOURNAL on the business day immediately preceding the date of the award. Judgment upon the award may be entered in
any court which has jurisdiction over such matter in accordance with the provisions of Section 11.10(e) hereof. 

  

	 	(c)	Confidentiality - All arbitration proceedings, including all evidence and statements, shall be confidential and shall not be used or disclosed for any other
purpose. 

  

	 	(d)	Costs and Expenses - The costs and expenses of the arbitration, including without limitation attorneys’ fees, shall be borne by the Parties in the manner
determined by the arbitrators. 

  

	 	(e)	 Judicial Action - Legal action for (i) entry of judgment upon any arbitration award or (ii) adjudication of any controversy, claim or
dispute arising from a breach or alleged breach of this Section 11.10 or of Section 9 may be heard or tried only in the courts of London, England. Each of the Parties hereby waives any defense of lack of in personam jurisdiction of
said courts and agrees that service of process of such court may be made upon each of them by personal delivery or by mailing certified or 

  
  

 
 Page 30 

	 	
registered mail, return receipt requested, or the equivalent in the Territory, to the other Party at the address provided for in this Agreement. Both Parties hereby submit to the jurisdiction of
the court so selected, to the exclusion of any other courts which may have had jurisdiction apart from this Section 11.10, and agree that the prevailing Party shall be entitled to recover from the non-prevailing Party reasonable expenses,
including without limitation reasonable attorneys’ fees. 

  

	12.	ENTIRE AGREEMENT 

This Agreement sets forth the entire agreement between the Parties, fully supersedes any and all prior agreements or understandings
between the Parties pertaining to the subject matter hereof and no change in, modification of or addition, amendment or supplement to this Agreement shall be valid unless set forth in writing and signed and dated by both of the Parties subsequent to
the execution of this Agreement. This Agreement may be executed in several counterparts and any and all such executed counterparts shall constitute one (1) Agreement binding on both Manufacturer and Distributor notwithstanding that both are not
signatories to the original or to the same counterpart. 

  
  

 
 Page 31 

 IN WITNESS WHEREOF, the Parties have executed this Agreement as of the day and year first above written.

  

							
	“Manufacturer”	 		 	“Distributor”
			
	GEVO, INC.	 		 	SASOL CHEMICAL INDUSTRIES LIMITED, ACTING THROUGH ITS SASOL SOLVENTS DIVISION
		 		 	
	By:	 		 	
	 /s/    Christopher
Ryan        
	 		 	By:
		 		 	 /s/    TJ
Makhoere        

	Name:	 		 	
	 Christopher Ryan
	 		 	Name:
		 		 	 TJ Makhoere

	Title:	 		 	
	
President             
	 		 	Title:	 	     MD Sasol
Solvents        

		 		 		 	
		 		 		 	
		 		 		 	
		 		 		 	

  
  

 
 Page 32Exhibit 10.2

 Exhibit 10.2 
 AMENDMENT NUMBER 9 
 MIDDLE GRAND REGION 

CONTRACTOR RISK AGREEMENT 
 BETWEEN 
 THE STATE OF TENNESSEE, 

d.b.a. TENNCARE 
 AND 
 AMERIGROUP TENNESSEE, INC. 

CONTRACT NUMBER: FA- 07-16936-00 
 For and in consideration of the mutual promises herein contained and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree to clarify and/or
amend the Contractor Risk Agreement (CRA) by and between the State of Tennessee TennCare Bureau, hereinafter referred to as TENNCARE, and AMERIGROUP TENNESSEE, INC., hereinafter referred to as the CONTRACTOR as specified below. 

Titles and numbering of paragraphs used herein are for the purpose of facilitating use of reference only and shall not be construed to infer a
contractual construction of language. 
  

	1.	Section 1 shall be amended by adding the following definitions: 

 Eligible Individual — With respect to Tennessee’s Money Follows the Person Rebalancing Demonstration (MFP) and pursuant to Section 6071(b)(2) of the Deficit Reduction Act as amended
by Section 2403 of the Affordable Care Act (ACA), the State’s approved MFP Operational Protocol and TENNCARE Rules, a member who qualifies to participate in MFP. Such person, immediately before beginning participation in the MFP
demonstration project, shall; 
  

	 	1.	Reside in a Nursing Facility (NF) or an Intermediate Care Facility for persons with Mental Retardation (ICF/MR) and have resided for a period of not less than ninety
(90) consecutive days in a Qualified Institution. 

  

	 	a.	Inpatient days in an institution for mental diseases (IMDs) which includes Psychiatric Hospitals and Psychiatric Residential Treatment Facilities (PRTF) may be counted
only to the extent that Medicaid reimbursement is available under the State Medicaid plan for services provided by such institution. Medicaid payments may only be applied to persons in IMDs who are over 65 or under 21 years of age.

  

	 	b.	Any days that an individual resides in a Medicare certified Skilled Nursing Facility (SNF) on the basis of having been admitted solely for purposes of receiving
post-hospital short-term rehabilitative services covered by Medicare shall not be counted for purposes of meeting the ninety (90)-day minimum stay in a Qualified Institution established under ACA. 

 

	 	c.	 Short-term continuous care in a nursing facility, to include Level 2 nursing facility reimbursement, for episodic conditions to stabilize a condition
rather than admit to hospital or to facilitate hospital discharge, and inpatient rehabilitation facility services reimbursed by the CONTRACTOR (i.e., not covered by 

	 	
Medicare) as a cost-effective alternative (see Section 2.6.5) and provided in a Qualified Institution shall be counted for purposes of meeting the ninety (90)-day minimum stay in a Qualified
Institution established under ACA. 

  

	 	2.	Be eligible for and receive Medicaid benefits for inpatient services furnished by the nursing facility or ICF/MR for at least one (1) day. For purposes of this
Agreement, an Eligible Individual must reside in a nursing facility and be enrolled in CHOICES Group for a minimum of one (1) day and must be eligible to enroll and transition seamlessly into CHOICES Group 2 (without delay or interruption).

  

	 	3.	Meet nursing facility or ICF/MR level of care, as applicable, and, but for the provision of ongoing CHOICES HCBS, continue to require such level of care provided in an
inpatient facility. 

 Family Member — For purposes of a Qualified Residence under the State’s MFP Rebalancing
Demonstration, a family member includes a person with any of the following relationships to the member, whether related by blood, marriage, or adoption, and including such relationships (as applicable) that may have been established through
longstanding (a year or more) foster care when the member was a minor 
  

	 	1.	Spouse, and parents and siblings thereof; 

  

	 	2.	Sons and daughters, and spouses thereof; 

  

	 	3.	Parents, and spouses and siblings thereof; 

  

	 	4.	Brothers and sisters, and spouses thereof; 

  

	 	5.	Grandparents and grandchildren, and spouses thereof; and 

  

	 	6.	Domestic partner and parents thereof, including domestic partners of any individual in 2 through 5 of this definition. A domestic partner means an adult in a committed
relationship with another adult. Committed relationship means one in which the member, and the domestic partner of the member, are each other’s sole domestic partner (and are not married to or domestic partners with anyone else); and share
responsibility for a significant measure of each other’s common welfare and financial obligations. 

 Step and in-law
relationships are included in this definition, even if the marriage has been dissolved, or a marriage partner is deceased. 
 Family member may
also include the member’s legal guardian or conservator or someone who was the legal guardian or conservator of the member when the member was a minor or required a legal guardian or conservator; 

Money Follows the Person Rebalancing Demonstration (MFP) — A federal grant established under the Deficit Reduction Act and extended under the
Affordable Care Act that will assist Tennessee in transitioning Eligible Individuals from a nursing facility or ICF/MR into a Qualified Residence in the community and in rebalancing long-term care expenditures. The grant provides enhanced match for
HCBS provided during the first 365 days of community living following transition. 
 Qualified Institution — With respect to
Tennessee’s MFP Rebalancing Demonstration, and pursuant to Section 6071(b)(3) of the DRA, a hospital, nursing facility, or ICF/MR. 

  
 2 

	 	1.	An institution for mental diseases (IMDs) which includes Psychiatric Hospitals and Psychiatric Residential Treatment Facilities (PRTF) shall be a Qualified Institution
only to the extent that Medicaid reimbursement is available under the State Medicaid plan for services provided by such institution. Medicaid payments may only be applied to persons in IMDs who are over 65 or under 21 years of age.

  

	 	2.	Any days that an individual resides in a Medicare certified Skilled Nursing Facility (SNF) on the basis of having been admitted solely for purposes of receiving
post-hospital short-term rehabilitative services covered by Medicare shall not be counted for purposes of meeting the ninety (90)-day minimum stay in a Qualified Institution established under ACA. 

Qualified Residence — With respect to Tennessee’s MFP Rebalancing Demonstration, and pursuant to Section 6071(b)(6) of the DRA, the
residence in the community in which an Eligible Individual will reside upon transition to the community which shall be one of the following: 
  

	 	1.	A home owned or leased by an Eligible Individual or the individual’s family member; 

 

	 	2.	An apartment with an individual lease, with lockable access and egress, and which includes living, sleeping, bathing, and cooking areas over which the Eligible
Individual or the individual’s family has domain and control; or 

  

	 	3.	A residence in a community-based residential setting in which no more than four (4) unrelated individuals reside. 

Additional requirements pertaining to a Qualified Residence set forth in MFP Policy Guidance issued by the Centers for Medicare and Medicaid Services
(CMS) shall apply for all persons participating in MFP. 
 TENNCARE PreAdmission Evaluation System (TPAES). —
A_component of the State’s Medicaid Management Information System and part of the system of record for all PreAdmission Evaluation (i.e., level of care) submissions and level of care determinations, as well as enrollments into and transitions
between LTC programs, including CHOICES and the State’s MFP Rebalancing Demonstration (MFP), and which shall also be used to gather data required to comply with tracking and reporting requirements pertaining to MFP. 

Transition Team — Teams the CONTRACTOR may elect to establish in order to fulfill its obligations pursuant to Nursing Facility to Community
Transitions (see Section 2.9.6.8) and the MFP Rebalancing Demonstration (see Section 2.9.8). If an MCO elects to use one or more Transition Teams, the Transition Team shall consist of at least one person who meets the qualifications of a
care coordinator and specific other persons with relevant expertise and experience who are assigned to support the care coordinator(s) in the performance of transition activities for a CHOICES Group 1 member. All transition activities identified as
responsibilities of the care coordinator shall be completed by an individual who meets all of the requirements to be a care coordinator. 
  

	2.	Section 2.9.5.4 shall be amended by adding a new Section 2.9.5.4.1 as follows: 

 

					
		  	2.9.5.4.1	  	In addition to requirements pertaining to nursing facility to community transitions (see Section 2.9.6.8), members in CHOICES Group 1 who are under the age of 21 and who are
residents of a nursing facility and have requested to transition home will be provided coordination of care by CHOICES and MCO Case Management staff:
			
		  	2.9.5.4.1.1	  	Member will be informed by CHOICES care coordinator of disenrollment from CHOICES upon discharge from Nursing Facility;

  
 3 

					
		  	2.9.5.4.1.2	  	Member will be referred by CHOICES Care Coordinator to MCO Case Management within three (3) business days of the transition request, for service identification and implementation in
the home setting;
			
		  	2.9.5.4.1.3	  	MCO Case Manager will be responsible for developing service plan for the home setting;
			
		  	2.9.5.4.1.4.1	  	CHOICES Care Coordinator will communicate weekly via phone or face-to-face visits with the MCO Case Management staff, the member and/or his parent or guardian (as applicable and
appropriate), and the nursing facility staff to ensure timely progression of the transition plan until the transition plan is complete; and
			
		  	2.9.5.4.1.5	  	Any EPSDT benefits needed by the child in the community as an alternative to nursing facility care, including medically necessary home health or private duty nursing, as applicable,
shall be initiated immediately upon transition from a nursing facility (i.e., CHOICES Group 1) to the community and as of the effective date of transition with no gaps between the member’s receipt of nursing facility services and EPSDT
benefits.

  

	3.	Section 2.9.6.3.20.1 shall be deleted and replaced by new Sections 2.9.6.3.20.1 and 2.9.6.3.20.2 and the remaining Sections of 2.9.6.3.20 shall be renumbered
accordingly, including any references thereto. 

  

					
		  	2.9.6.3.20.1	  	For purposes of the CHOICES program, service authorizations for CHOICES HCBS shall include the amount, frequency, and duration of each service to be provided, and the schedule at
which such care is needed, as applicable; and other relevant information as prescribed by TENNCARE. The CONTRACTOR may determine the duration of time for which CHOICES HCBS will be authorized. However, the CONTRACTOR shall be responsible for
monitoring its authorizations and for ensuring that there are no gaps in authorizations for CHOICES HCBS in accordance with the plan of care. Retroactive entry or adjustments in service authorizations for CHOICES HCBS should be made only when
required to accommodate payment of services that had been authorized but an adjustment in the schedule of services was required based on the member’s needs.
			
		  	2.9.6.3.20.2	  	The CONTRACTOR may decide whether it will issue service authorizations for nursing facility services, or whether it will instead process claims for such services in accordance with
the level of care and/or reimbursement (including the duration of such level of care and/or reimbursement) approved by TENNCARE (see Section 2.14.1.12), except that the CONTRACTOR may reimburse a lesser level of service when such lesser level of
service is billed by the facility. If the CONTRACTOR elects to authorize nursing facility services, the CONTRACTOR may determine the duration of time for which nursing facility services will be authorized. However, the CONTRACTOR shall be
responsible for monitoring its authorizations and for ensuring that there are no gaps in

  
 4 

					
		  		  	authorizations for CHOICES nursing facility services in accordance with the level of care and/or reimbursement approved by TENNCARE. Retroactive entry or adjustments in service
authorizations for nursing facility services should be made only upon notification of retroactive enrollment into or disenrollment from CHOICES Group la or lb via the outbound 834 file from TENNCARE.

  

	4.	Section 2.9.6.5.1.1 shall be deleted and replaced as follows: 

 

					
		  	2.9.6.5.1.1	  	As part of the face-to-face intake visit for current members or face-to-face visit with new members in CHOICES Group 1, as applicable, a care coordinator shall conduct any needs
assessment deemed necessary by the CONTRACTOR, using a tool prior approved by TENNCARE and in accordance with protocols specified by TENNCARE. This assessment may include identification of targeted strategies related to improving health, functional,
or quality of life outcomes (e.g., related to disease management or pharmacy management) or to increasing and/or maintaining functional abilities, including services covered by the CONTRACTOR that are beyond the scope of the nursing facility
services benefit. The care coordinator shall ensure coordination of the member’s physical health, behavioral health, and long-term care needs and shall assess at least annually the member’s potential for an interest in transition to the
community. For children under the age of 21 in nursing facilities, this shall include explanation to the member or his parent or authorized representative, as applicable, of benefits available pursuant to EPSDT, including medically necessary
benefits such as home health or private duty nursing that may be provided in the community as an alternative to nursing facility care.

  

	5.	Section 2.9.6.8 shall be amended by adding a new Section 2.9.6.8.2 and the remaining Section 2.9.6.8 shall be renumbered, including any references
thereto. 

  

					
		  	2.9.6.8.2	  	Members in CHOICES Group 1 (who are residents of a nursing facility) and who are under the age of twenty-one (21) and have requested to transition home will be provided coordination
of care by CHOICES and MCO Case Management staff (see Section 2.9.5.4.1).

  

	6.	Section 2.9.6.8 shall be amended by adding a new Section 2.9.6.8.16 and renumbering the remaining Sections accordingly including any references thereto.

  

					
		  	2.9.6.8.16	  	Ongoing CHOICES HCBS and any medically necessary covered home health or private duty nursing services needed by the member shall be initiated immediately upon transition from a
nursing facility (i.e., CHOICES Group 1) to the community (i.e., CHOICES Group 2) and as of the effective date of transition with no gaps between the member’s receipt of nursing facility services and ongoing CHOICES HCBS.

  
 5 

	7.	Section 2.9.6.9.1.1.1 shall be deleted and replaced as follows: 

 

					
		  	2.9.6.9.1.1.1	  	Develop protocols and processes to work with nursing facilities to coordinate the provision of care. At minimum, a care coordinator assigned to a resident of the nursing facility
shall participate in quarterly Grand Rounds (as defined in Section 1). At least two of the Grand Rounds per year shall be conducted on-site in the facility, and the Grand Rounds shall identify and address any member who 1) has experienced a
potential significant change in needs or circumstances (see Section 2.9.6.9.1.1.5); 2) the nursing facility or MCO has expressed concerns; or 3) is under the age of twenty-one (21).

  

	8.	Section 2.9.6.9.4.3.6 shall be amended by adding new text as follows: 

 

					
		  	2.9.6.9.4.3.6	  	Members in CHOICES Group 1 (who are residents of a nursing facility) and who are twenty-one years of age and older shall receive a face-to-face visit from their care coordinator at
least twice a year with an interval of at least one-hundred and twenty (120) days between visits. Members in CHOICES Group 1 (who are residents of a nursing facility) who are under the age of twenty-one (21) shall receive a face-to-face visit from
their care coordinator at least quarterly with an interval of at least sixty (60) days between visits.

  

	9.	Section 2.9.6.9.4.3 shall be amended by adding a new Section 2.9.6.9.4.3.8 and renumbering the remaining Sections accordingly including any references
thereto. 

  

					
		  	2.9.6.9.4.3.8	  	Members in CHOICES Group 2 participating in MFP shall, for at least the first ninety (90) days following transition to the community, be visited in their residence face-to-face by
their care coordinator at least monthly with an interval of at least fourteen (14) days between contacts to ensure that the plan of care is being followed, that the plan of care continues to meet the member’s needs, and the member has
successfully transitioned back to the community. Thereafter, for the remainder of the member’s MFP participation period, minimum contacts shall be as described in 2.9.6.9.4.3.7 unless more frequent contacts are required based on the
member’s needs and circumstances and as reflected in the member’s plan of care, or based on a significant change in circumstances (see Sections 2.9.6.9.2.1.16. and 2.9.8.4.5) or a short-term nursing facility stay (see Sections 2.9.8.8.5
and 2.9.8.8.7).

  

	10.	The punctuation at the end of Sections 2.9.6.9.6.3.4 and 2.9.6.9.6.3.5 shall be amended as follows: 

 

					
		  	2.9.6.9.6.3.4	  	For members in CHOICES Group 2, a completed risk assessment and a risk agreement signed and dated by the member or his/her representative; and
			
		  	2.9.6.9.6.3.5	  	For members in CHOICES Group 2, the cost neutrality cap provided by TENNCARE, and a determination by the CONTRACTOR that the projected cost of CHOICES HCBS, home health, and private
duty nursing services will not exceed the member’s cost neutrality cap.

  
 6 

	11.	Section 2.9.6.12.4 shall be deleted and replaced as follows: 

  

					
		  	2.9.6.12.4	  	The CONTRACTOR shall require and shall conduct readiness review activities as necessary to confirm that the EVV system vendor has a plan in place and will be compliant with all
Version 5010 and ICD-10 coding requirements in a timely manner;

  

	12.	Section 2.9.6 shall be amended by adding a new Section 2.9.6.13 as follows: 

 

					
		  	2.9.6.13	  	TPAES
			
		  	2.9.6.13.1	  	The CONTRACTOR shall use the TENNCARE PreAdmission Evaluation System (TPAES) to facilitate submission of all PreAdmission Evaluation (i.e., level of care) applications, including
required documentation pertaining thereto, and to facilitate enrollments into and transitions between LTC programs, including CHOICES. The CONTRACTOR shall comply with all data entry and tracking processes and timelines established by TENNCARE in
policy or protocol in order to ensure efficient and effective administration and oversight of the CHOICES program.

  

	13.	Section 2.9.7.4.3 shall be amended by adding new Sections 2.9.7.4.3.2 through 2.9.7.4.3.4 as follows: 

 

					
		  	2.9.7.4.3.2	  	If a member electing to participate in consumer direction refuses to receive eligible CHOICES HCBS from contract providers while services are initiated through consumer direction,
the decision must be documented on a signed and dated Consumer Direction Participation Form. The CONTRACTOR shall not encourage a member to forego receipt of eligible CHOICES HCBS from contract providers while these HCBS are being initiated through
consumer direction.
			
		  	2.9.7.4.3.3	  	For any CHOICES Group 2 member electing to participate in consumer direction that refuses to receive eligible CHOICES HCBS from contract providers while services are initiated
through consumer direction, the member’s care coordinator shall visit the member face to face at least monthly to ensure that the member’s needs are safely met, and shall continue to offer eligible CHOICES HCBS through contract
providers.
			
		  	2.9.7.4.3.4	  	If eligible CHOICES HCBS are not initiated within sixty (60) days following referral to the FEA, the CONTRACTOR shall notify the member that eligible CHOICES HCBS must be initiated
by contract providers unless these HCBS are not needed on an ongoing basis in order to safely meet the member’s needs in the community, in which case, the CONTRACTOR shall submit documentation to TENNCARE to begin the process of disenrollrnent
from CHOICES Group 2.

  

	14.	Section 2.9.7.4.4 shall be amended as follows: 

  

					
		  	2.9.7.4.4	  	Except as specified in 2.9.7.4.3.2. and in accordance with requirements pertaining thereto, the CONTRACTOR shall be responsible for providing all needed eligible CHOICES HCBS using
contract providers, including a back-up plan for such services, until all necessary requirements have been fulfilled in order to implement consumer direction of eligible CHOICES HCBS, including but not limited to: the

  
 7 

					
		  		  	FEA verifies that workers for these services meet all necessary requirements (see Section 2.9.7.6.1 of this Agreement); service agreements are completed and signed; and
authorizations for consumer directed services are in place. The CONTRACTOR, in conjunction with the FEA, shall facilitate a seamless transition between contract providers and workers and ensure that there are no interruptions or gaps in
services.

  

	15.	Section 2.9 shall be amended by adding a new Section 2.9.8 and renumbering the remaining sections of 2.9 accordingly, including any references thereto.

 2.9.8 Money Follows the Person (MFP) Rebalancing Demonstration 

2.9.8.1 General 
  

					
		  	2.9.8.1.1	  	The CONTRACTOR shall, in accordance with this Agreement and federal and State laws, regulations, policies and protocols, assist Eligible Individuals living in a Qualified
Institution in transitioning to a Qualified Residence in the community under the State’s MFP Rebalancing Demonstration (MFP).
			
		  	2.9.8.1.2	  	Eligible Individuals transitioning to a Qualified Residence in the community and consenting to participate in MFP shall be transitioned from CHOICES Group I into CHOICES Group 2
pursuant to TENNCARE policies and protocols for Nursing Facility-to-community transitions and shall also be enrolled into MFP. For persons enrolled in CHOICES who are also participating in MFP, the CONTRACTOR shall comply with all applicable
provisions of this Agreement pertaining to the CHOICES program. This section sets forth additional requirements pertaining to the CONTRACTOR’s responsibilities specifically as it relates to MFP.
			
		  	2.9.8.1.3	  	For CHOICES Group 1 members not eligible to participate in MFP or who elect not to participate in MFP, the CONTRACTOR shall nonetheless facilitate transition to the community as
appropriate and in accordance with 2.9.6.8.
			
		  	2.9.8.1.4	  	The CONTRACTOR shall not delay a CHOICES Group 1 member’s transition to the community in order to meet the ninety (90)-day minimum stay in a Qualified Institution established
under ACA and enroll the person into MFP.
			
		  	2.9.8.2	  	Identification of MFP Participants
			
		  	2.9.8.2.1	  	 The CONTRACTOR shall identify members who may have the ability and/or desire
 to transition from a nursing facility to the community in accordance with Section 2.9.6.8.

			
		  	2.9.8.2.2	  	The CONTRACTOR shall assess all nursing facility residents transitioning from the NF to CHOICES Group 2 for participation in MFP. This includes CHOICES Group I members referred for
transition, as well as nursing facility residents referred for CHOICES who are not yet enrolled in CHOICES Group 1 but may be determined eligible for Group I, and who have expressed a desire to move back into the community. However, the resident
must actually be enrolled into Group 1 in order to qualify for MFP.

  
 8 

					
		  	2.9.8.2.3	  	Members may only elect to participate in MFP and the CONTRACTOR may only enroll a member into MFP prior to the member’s transition from the nursing facility to the community.
Members will not be eligible to enroll in MFP if they have already transitioned out of the nursing facility.
			
		  	2.9.8.3	  	Eligibility/Enrollment into MFP
			
		  	2.9.8.3.1	  	Member participation in MFP is voluntary. Members may deny consent to participate in MFP or may withdraw consent to participate in MFP at any time without affecting their enrollment
in CHOICES.
			
		  	2.9.8.3.2	  	If a member withdraws from MFP, he cannot participate in MFP again without meeting the eligibility requirements for enrollment into MFP (e.g., following a ninety (90)-day stay in a
Qualified Institution).
			
		  	2.9.8.3.3	  	Only CHOICES Group 1 members who qualify to enroll in CHOICES Group 2 shall be eligible to transition to Group 2 and enroll into MFP.
			
		  	2.9.8.3.4	  	In addition to facilitating transition from CHOICES Group 1 to CHOICES Group 2 pursuant to Section 2.9.6.8 of this Agreement and TENNCARE’s policies and protocols, the
CONTRACTOR shall facilitate the enrollment of Eligible Individuals who consent into MFP.
			
		  	2.9.8.3.5	  	The member’s care coordinator or, if the CONTRACTOR elects to use transition teams, a person who meets the qualifications of a care coordinator shall, using information
provided by TENNCARE, provide each potential MFP participant with an overview of MFP and answer any questions the participant has. The CONTRACTOR shall have each potential MFP participant or his authorized representative, as applicable, sign an MFP
Informed Consent Form affirming that such overview has been provided by the CONTRACTOR and documenting the member’s decision regarding MFP participation.
			
		  	2.9.8.3.6	  	Once a potential MFP participant has consented to participate in MFP, the CONTRACTOR shall notify TENNCARE within two (2) business days via the Tennessee PreAdmission Evaluation
System (TPAES) unless otherwise directed by TENNCARE, and shall maintain supporting documentation as specified by TENNCARE that shall be made available to TENNCARE upon request.
			
		  	2.9.8.3.7	  	The CONTRACTOR shall verify that each potential MFP participant is an Eligible Individual and shall provide attestation thereof to TENNCARE. The CONTRACTOR shall enter all required
data elements into TPAES unless otherwise directed by TENNCARE, and shall maintain supporting documentation as specified by TENNCARE that shall be made available to TENNCARE upon request.
			
		  	2.9.8.3.8	  	The CONTRACTOR shall verify that each potential MFP participant will transition into a Qualified Residence in the community and shall provide attestation thereof to TENNCARE. The
CONTRACTOR shall enter all required data elements into TPAES unless otherwise directed by TENNCARE and shall maintain supporting documentation as specified by TENNCARE that shall be made available to TENNCARE upon request.

  
 9 

					
		  	2.9.8.3.9	  	Final determinations regarding whether a member can enroll into MFP shall be made by TENNCARE based on information provided by the CONTRACTOR.
			
		  	2.9.8.3.10	  	TENNCARE may request and the CONTRACTOR shall submit in a timely manner additional documentation as needed to make such determination. Documentation submitted by the CONTRACTOR may
be verified, to the extent practicable, by other information, either prior or subsequent to enrollment in MFP, including eligibility, claims and encounter data.
			
		  	2.9.8.4	  	Participation in MFP
			
		  	2.9.8.4.1	  	The participation period for MFP is 365 days. This includes all days during which the member resides in the community, regardless of whether CHOICES LICBS are received each day.
Days are counted consecutively except for days during which the member is admitted to an inpatient facility.
			
		  	2.9.8.4.2	  	The participation period for MFP does not include any days during which the member is admitted to an inpatient facility.
			
		  	2.9.8.4.3	  	MFP participation will be “suspended” in the event a member is re-admitted for a short-term inpatient facility stay. Member will not have to re-qualify for MFP regardless
of the number of days the member is in the inpatient facility, and shall be re-instated in MFP upon return to a Qualified Residence in the community.
			
		  	2.9.8.4.4	  	It may take longer than 365 calendar days to complete the 365-day MFP participation period days since a member’s participation period may be interrupted by one or more
inpatient facility stays.
			
		  	2.9.8.4.5	  	For MFP participants, a significant change in circumstances (see 2.9.6.9.2.1.16.) shall include any admission to an inpatient facility, including a hospital, psychiatric hospital,
PRTF, nursing facility or Medicare-certified Skilled Nursing Facility. The member’s Care Coordinator shall (pursuant to 2.9.6.2.4) visit the member face-to- face within five (5) business days of any inpatient facility admission and shall assess
the member’s needs, conduct a comprehensive needs assessment and update the member’s plan of care, including the member’s Risk Agreement, as deemed necessary based on the member’s needs and circumstances. If the visit is
conducted in the inpatient facility, the CONTRACTOR may elect to have someone who meets the qualifications of a Care Coordinator complete the required face-to-face visit and conduct a comprehensive needs assessment, in which case, the qualified
individual conducting the face-to-face visit shall coordinate with the member’s Care Coordinator to update the member’s plan of care, including the member’s Risk Agreement, as deemed necessary based on the member’s needs and
circumstances.
			
		  	2.9.8.4.6	  	The CONTRACTOR shall review the circumstances which resulted in the inpatient facility admission and shall evaluate whether the services and supports provided to the member are
sufficient to safely meet his needs in the community such that continued participation in CHOICES Group 2 and in MFP is appropriate.

  
 10 

					
		  	2,9.8,4.7	  	The CONTRACTOR shall notify TENNCARE within five (5) business days of admission any time a member is admitted to an inpatient facility. Such notification shall be made via TPAES
unless otherwise directed by TENNCARE. The CONTRACTOR shall maintain supporting documentation as specified by TENNCARE that shall be made available to TENNCARE upon request.
			
		  	2.9.8.4.7.1.	  	For purposes of MFP, admission for observation (which is not considered inpatient care) shall not be considered admission to an inpatient facility. Nor shall participation in MFP be
suspended during observation days.
			
		  	2.9.8.4.8	  	The CONTRACTOR shall be involved in discharge planning on behalf of any MFP participant admitted to an inpatient facility.
			
		  	2.9.8.4.9	  	The CONTRACTOR shall notify TENNCARE within two (2) business days when an MFP participant is discharged from a short-term stay in an inpatient facility. Such notification shall
include whether the member is returning to the same Qualified Residence in which he lived prior to the inpatient stay, or a different residence which shall also be a Qualified Residence. Such notification shall be made via TPAES unless otherwise
directed by TENNCARE. The CONTRACTOR shall maintain supporting documentation as specified by TENNCARE that shall be made available to TENNCARE upon request.
			
		  	2.9.8.4.10	  	If at any time during the member’s participation in MFP, the member changes residences, including instances in which the change in residences occurs upon discharge from an
inpatient facility stay, the CONTRACTOR shall: 1) notify TENNCARE within two (2) business days of the change in residence; 2) verify that the new residence is a Qualified Residence; and 3) provide attestation thereof to TENNCARE. The CONTRACTOR
shall enter all required data elements into TPAES unless otherwise directed by TENNCARE, and shall maintain supporting documentation as specified by TENNCARE that shall be made available to TENNCARE upon request.
			
		  	2.9.8.4.11	  	The CONTRACTOR shall track the member’s residency throughout the 365-day MFP participation period. In addition, the CONTRACTOR shall, for purposes of facilitating completion of
Quality of Life surveys, continue to track MFP participants’ residency for two (2) years following transition to the community which may be up to one (1) year following completion of the MFP participation period, or until the member is no
longer enrolled in the CONTRACTOR’s health plan.
			
		  	2.9.8.4.12	  	The CONTRACTOR shall, using a template provided by TENNCARE, issue a written notice of MFP participation to each member enrolled in MFP which shall not occur prior to transition
from CHOICES Group 1 to CHOICES Group 2. Such notice shall be issued within ten (10) business days of notification from TENNCARE via the outbound 834 enrollment file furnished by TENNCARE to the CONTRACTOR that the member is enrolled in
MFP.
			
		  	2.9.8.4.13	  	The CONTRACTOR shall, using a template provided by TENNCARE, issue a written notice to each member upon conclusion of the 365-day participation period. Such notice shall be issued
within ten (10) business days of notification from TENNCARE via the outbound 834 enrollment file furnished by TENNCARE to the CONTRACTOR that the member is no longer enrolled in MFP.

  
 11 

					
		  	2.9.8.4.14	  	A member who successfully completes 365-day participation period for MFP and is subsequently re-institutionalized may qualify to participate in MFP again but must first meet the
“Eligible Individual” criteria. There shall be a minimum of ninety (90) days between MFP participation occurrences. Prior to enrollment in a second MFP occurrence, the care coordinator shall assess the reason for the
re-institutionalization to determine if the member is an appropriate candidate for re-enrollment in MFP and if so, shall develop a plan of care (including a Risk Agreement) that will help to ensure that appropriate supports and services are in place
to support successful transition and permanency in the community.
			
		  	2.9.8.5	  	Plan of Care
			
		  	2.9.8,5.1	  	For members participating in the MFP, the Plan of Care shall reflect that the member is an MFP participant, including the date of enrollment into MFP (i.e., date of transition from
CHOICES Group 1 to CHOICES Group 2).
			
		  	2.9.8.5.2	  	Upon conclusion of the member’s 365-day participation period in MFP, the Plan of Care shall be updated to reflect that he is longer participating in MFP.
			
		  	2.9.8.6	  	Services
			
		  	2.9.8.6.1	  	A member enrolled in MFP shall be simultaneously enrolled in CHOICES Group 2 and shall be eligible to receive covered benefits as described in 2.6.1.
			
		  	2.9.8.7	  	Continuity of Care
			
		  	2.9.8.7.1	  	Upon completion of a person’s 365-day participation in MFP, services (including CHOICES HCBS) shall continue to be provided in accordance with the covered benefits described in
2.6.1 and the member’s plan of care. Transition from participation in MFP and CHOICES Group 2 to participation only in CHOICES Group 2 shall be seamless to the member, except that the CONTRACTOR shall be required to issue notice of the
member’s conclusion of his 365-day MFP participation period.
			
		  	 2.9.8.8
  
 2.9.8.8.1
	  	 Short-Term Nursing Facility Stay
  

A CHOICES Group 2 member may be admitted for an inpatient short-term nursing facility stay for up to ninety (90) days and remain enrolled in CHOICES Group
2 (see Section 2.6.1.5.4). The CONTRACTOR shall ensure that the member is transitioned from Group 2 to Group 1 at any time: a) it is determined that the stay will not be short-term and the member will not transition back to the community; and b)
prior to exhausting the ninety (90) day short-term nursing facility benefit covered for CHOICES Group 2 members (see Section 2.9.6.8.23.4).

  
 12 

					
		  	2.9.8.8.2	  	A CHOICES Group 2 member participating in MFP may be admitted for an inpatient short-term nursing facility stay during his 365-day participation period and remain enrolled in MFP
regardless of the number of days the member is admitted for inpatient facility care.
			
		  	2.9.8.8.3	  	MFP participants admitted for short-term nursing facility stays shall be re-instated in MFP upon discharge and return to a Qualified Residence in the community. The member is not
required to meet the ninety (90) day residency requirement criteria for re-instatement into MFP.
			
		  	2.9.8.8.4	  	 If the short-term stay will exceed ninety (90) days, the CONTRACTOR shall
 facilitate transition from CHOICES Group 2 to CHOICES Group 1.

			
		  	2.9.8.8.5	  	The member’s care coordinator shall monitor the member’s inpatient stay and shall visit the member face-to-face at least monthly during the inpatient stay or more
frequently as necessary to facilitate timely and appropriate discharge planning.
			
		  	2.9.8.8.6	  	The CONTRACTOR shall conduct a Transition Assessment and develop a Transition Plan (see Section 2.9.6.8) as necessary to facilitate the member’s return to the community. Such
assessment shall include a review of the circumstances which resulted in the nursing facility admission and shall evaluate whether the services and supports provided to the member are sufficient to safely meet his needs in the community such that
transition back to CHOICES Group 2 and continued participation in MFP is appropriate. The CONTRACTOR shall update the member’s plan of care, including the member’s Risk Agreement, as deemed necessary based on the member’s needs and
circumstances.
			
		  	2.9.8.8.7	  	Upon discharge from the short-term stay, within one (1) business day, the care coordinator shall visit the member in his/her Qualified Residence. During the ninety (90) days
following transition and re-instatement into MFP, the care coordinator shall conduct monthly face-to-face in-home visits to ensure that the plan of care is being followed, that the plan of care continues to meet the member’s needs, and the
member has successfully transitioned back to the community.
			
		  	2.9.8.8.8	  	MFP participants admitted for short-term nursing facility stays shall be re-instated in MFP upon discharge and return to a Qualified Residence in the community. The member is not
required to meet the ninety (90) day residency requirement criteria for re-instatement into MFP.
			
		  	2.9.8.8.9	  	Days that are spent in an inpatient facility, including short-term nursing facility stays, do not count as part of the member’s 365-day MFP participation
period.
			
		  	2.9.8.9	  	TPAES
			
		  	2.9.8.9.1	  	The CONTRACTOR shall use the TENNCARE PreAdmission Evaluation System (TPAES) to facilitate enrollments into and transitions between LTC programs, including CHOICES and the
State’s MFP Rebalancing Demonstration (MFP), and shall comply with all data collection processes and timelines established by TENNCARE in policy or protocol in order to gather data required to comply with tracking and reporting requirements
pertaining to MFP. This shall include (but is not

  
 13 

					
		  		  	limited to) attestations pertaining to Eligible Individual and Qualified Residence, changes of residence, inpatient facility admissions and discharges, reasons for re-
institutionalization, and reasons for disenrollment from MFP.
			
		  	2.9.8.10	  	IT requirements
			
		  	2.9.8.10.1	  	Pursuant to Section 2.23 of this Agreement, the CONTRACTOR shall modify its information systems to accommodate, accept, load, utilize and facilitate accurate and timely reporting on
information submitted to by TENNCARE via the outbound 834 file that will identify MFP participants, as well as those MFP participants in suspended status during an inpatient admission.
			
		  	2.9.8.1 I	  	Case Management System
			
		  	2.9.8.11.1	  	The CONTRACTOR’s case management system (see Section 2.9.6.12.6) shall identify persons enrolled in MFP and shall generate reports and management tools as needed to facilitate
and monitor compliance with contract requirements and timelines.
			
		  	2.9.8.12	  	MFP Readiness Review
			
		  	2.9.8.12.1	  	Prior to implementation of MFP, as determined by TENNCARE, the CONTRACTOR shall demonstrate to TENNCARE’s satisfaction that the CONTRACTOR is able to meet all of the
requirements pertaining to MFP set forth in this Agreement.
			
		  	2.9.8.12.2	  	The CONTRACTOR shall cooperate in a “readiness review” conducted by TENNCARE to review the CONTRACTOR’s readiness to fulfill its obligations regarding MFP in
accordance with the Agreement. This review may include, but is not limited to, desk and on-site review of documents provided by the CONTRACTOR, a walk-through of the CONTRACTOR’s operations, system demonstrations (including systems connectivity
testing), and interviews with CONTRACTOR’s staff. The scope of the review may include any and all MFP requirements of the Agreement as determined by TENNCARE.
			
		  	2.9.8.12.3	  	Based on the results of the review activities, TENNCARE, will issue a letter of findings and, if needed, will request a corrective action plan from the CONTRACTOR.
			
		  	2.9.8.13	  	MFP Benchmarks
			
		  	2.9.8.13.1	  	The CONTRACTOR shall assist TENNCARE in meeting the five (5) annual benchmarks established for the MFP Rebalancing Demonstration which are described below in Sections 2.9.8.13.1.1
through 2.9.8.13.1.5.

  
 14 

					
		  	2.9.8.13.1.1	  	Benchmark #1: Number of Persons Transitioned
			
		  	2.9.8.13.1.1.1	  	Assist the projected number of eligible individuals in each target group in successfully transitioning from an inpatient facility to a qualified residence during each year of the
demonstration. Projected numbers:

  

									
	 Calendar Year
	  	# of Elderly
Transitioned	 	  	# of Disabled Adults
Transitioned	 
			
	 2011
	  	 	27	  	  	 	23	  
			
	 2012
	  	 	206	  	  	 	169	  
			
	 2013
	  	 	261	  	  	 	214	  
			
	 2014
	  	 	261	  	  	 	214	  
			
	 2015
	  	 	234	  	  	 	191	  
			
	 2016
	  	 	206	  	  	 	169	  

  

					
		  	19.8.131E2	  	Immediately prior to implementation of MFP and at the beginning of each calendar year thereafter, statewide calendar year numbers for benchmark #1 will be allocated on a regional
basis to each MCO operating in the region, based on the number of persons in CHOICES Group I. For purposes of incentive payments (see Section 3.11), achievement of this benchmark shall be determined on a regional basis by MCO.
			
		  	2.9.8.13.1.2	  	Benchmark #2: Qualified Expenditures for HCBS
			
		  	2.9.8.13.1.2.1	  	Increase the amount and percentage of Medicaid spending for qualified home and community based long-term care services during each year of the demonstration.
			
		  	2.9.8.13.1.2.2	  	For purposes of incentive payments (see Section 3.11), achievement of this benchmark shall be determined on a statewide basis.
			
		  	2.9.8.13.1.3	  	Benchmark #3: Increased Amount and Percentage of HCBS Participants
			
		  	2.9.8.13.1.3.1	  	Increase the number and percentage of individuals who are elderly and adults with physical disabilities receiving Medicaid-reimbursed long-term care services in home and community
based (versus institutional) settings during each year of the demonstration.
			
		  	2.9.8.13.1.3.2	  	For purposes of incentive payments (see Section 3.11), achievement of this benchmark shall be determined on a regional basis by MCO.

  
 15 

					
		  	2.9.8.13.1.4	  	Benchmark #4: Increase Unduplicated Contracted Community Based Residential Alternative
			
		  	2.9.8.13.1.4.1	  	Increase the number of unduplicated licensed CBRAs contracted with MCOs Statewide to provide HCBS in the CHOICES program during each year of the demonstration. Providers enrolled
with more than one (MCO) or in more than one region shall only be counted once. Proposed numbers:

  

					
	 Calendar Year
	  	# of MCO Contracted
CBRAs Statewide	 
		
	 2011
	  	 	70	  
		
	 2012
	  	 	74	  
		
	 2013
	  	 	78	  
		
	 2014
	  	 	82	  
		
	 2015
	  	 	86	  
		
	 2016
	  	 	90	  

  

					
		  	2.9.8.13.1.4. 2	  	For purposes of incentive payments (See Section 3.11), achievement of this benchmark shall be determined on a statewide basis.
			
		  	2.9.8.13.1.5	  	Benchmark #5: Increase Participation in Consumer Direction
			
		  	2.9.8.13.1.5.1	  	Increase the number of persons receiving Medicaid-reimbursed HCBS participating in consumer direction for some or all services during each year of the demonstration. Projected
numbers:

  

					
	 Calendar Year
	  	# in Consumer
Direction	 
		
	 2011
	  	 	450	  
		
	 2012
	  	 	750	  
		
	 2013
	  	 	1,000	  
		
	 2014
	  	 	1,250	  
		
	 2015
	  	 	1,400	  
		
	 2016
	  	 	1,500	  

  

					
		  	2.9.8.13.1.5.2	  	Immediately prior to implementation of MFP and at the beginning of each calendar year thereafter, statewide calendar year numbers for benchmark #5 will be allocated on a regional
basis to each MCO operating in the region, based on the number of persons in CHOICES Group 2. For purposes of incentive payments (see Section 3.11), achievement of this benchmark shall be determined on a regional basis by MCO.

  

	16.	Section 2.18.6.5 shall be deleted and replaced as follows: 

  

					
		  	2.18.6.5	  	The CONTRACTOR shall develop and implement a training plan to educate long- term care providers regarding compliance with all Version 5010 and ICD-10 coding
requirements;

  
 16 

	17.	Section 2.21.4.1.4 shall be amended by deleting obsolete references and shall read as follows: 

 

					
		  	2.21.4.1.4	  	The claims specified in Section 2.21.4.1.3 shall be paid at the time presented for payment by the provider and the CONTRACTOR shall bill the responsible third
party.

  

	18.	The introductory paragraph of Section 2.30.6.4 shall be deleted and replaced as follows: 

 

					
		  	2.30,6.4	  	The CONTRACTOR shall submit a quarterly CHOICES Nursing Facility to Community Transition Report. MFP participants (see 2.9.6.8) shall be identified separately for each data
element described herein. The report shall include information, by month, on specified measures, which shall include but not be limited to the following:

  

	19.	The introductory paragraph of Section 2.30.6.6 shall be deleted and replaced as follows: 

 

					
		  	2.30.6.6	  	The CONTRACTOR shall submit a quarterly CHOICES Consumer Direction of HCBS Report. MFP participants (see 2.9.6.8) shall be identified separately for each data element
described herein. The report shall include current information, by month, on specified measures, which shall include but not be limited to the following:

  

	20.	Section 2.30.6.6 shall be amended by adding a new Item (9) as follows: 

 

					
		  		  	 (9)    The total number and the name, SSN, and phone number, and the authorized representative name and phone
number, if applicable, of each member referred to the FEA (for enrollment into consumer direction) that has indicated on his Consumer Direction Participation Form that he does not wish to receive HCBS from contract providers pending enrollment into
consumer direction, including the member’s date of enrollment in CHOICES Group 2, the date of referral to the PEA for consumer direction, and the total number of days that HCBS have not been received by each member.

  

	21.	Section 2.30.6 shall be amended by adding a new Section 2.30.6.8 and renumbering the remaining Sections accordingly, including any references thereto.

  

					
		  	2.30.6.8	  	The CONTRACTOR shall submit a quarterly MFP Participants Report. The report shall include information on specified measures, which shall include but not be limited to the
following:
			
		  		  	 (1)    The total number and the name and SSN of each CHOICES Group 2 member enrolled into
MFP;

			
		  		  	 (2)    The date of each member’s transition to the community (or for persons enrolled in MFP upon
enrollment to the CONTRACTOR’s health plan, the date of enrollment into the CONTRACTOR’s health plan);

  
 17 

					
		  		  	 (3)    Each member’s current place of residence including physical
address and type of Qualified Residence;
  
 (4)    The date of the last care coordination visit to each member;
  

(5)    Any inpatient facility stays during the quarter, including the member’s name and
SSN type of Qualified Institution, dates of admission and discharge, and the reason for admission; and
  

(6)    The total number and name and SSN of each member disenrolled from MFP during the
quarter, including the reason for disenrollment.
  
 The CONTRACTOR shall
submit its first report following the end of calendar year 2011.

  

	22.	Section 2.30.10.5 shall be deleted and replaced as follows: 

  

					
		  	2.30.10.5	  	The CONTRACTOR shall submit a monthly CHOICES Utilization Report. MFP participants (see 2.9.6.8) shall be identified separately for each data element described herein. The
report shall be submitted on a monthly basis with a one (1) month lag period (e.g., March information sent in the May report) and shall include a summary overview that includes the number of CHOICES member who have not received any long-term care
services within thirty (30) to fifty-nine (59) days, within sixty (60) to eighty-nine (89) days, or in ninety (90) days or more, The report shall also include detailed member data for members who have not received services in the last thirty (30)
days, including the member’s name, social security number, CHOICES group, and CHOICES enrollment date; date of last long-term care service; length of time without long-term care services; whether and when long-term care services will resume;
and the reason/explanation why the member has not received long-term care services.

  

	23.	Section 2.30.10.6 shall be deleted in its entirety and the remaining Sections shall be renumbered accordingly, including any references thereto.

  

	24.	The introductory paragraph of Section 2.30.11.6 shall be deleted and replaced as follows: 

 

					
		  	2.30.11.6	  	The CONTRACTOR shall submit a quarterly CHOICES HCBS Critical Incidents Report (see Section 2.15.7). MFP participants (see 2.9.6.8) shall be identified separately for each
data element described herein, The report shall provide information, by month regarding specified measures, which shall include but not be limited to the following:

  

	25.	The introductory paragraph of Section 2.30.16.4 shall be deleted and replaced as follows: 

 

					
		  	2.30.16.4	  	The CONTRACTOR shall submit a quarterly CHOICES Cost Effective Alternatives Report that provides information on cost effective alternative services provided
to

  
 18 

					
		  		  	CHOICES members (see Section 2.6.5.2). MFP participants (see 2.9.6.8) shall be identified separately for each data element described herein. The report shall provide information
regarding specified measures, including but not limited to the following:

  

	26.	Section 3.3.1 shall be amended by adding a new Section 3.3.1.1 as follows: 

 

					
		  	3.3.1.1	  	The capitation payment for MFP participants who must also he enrolled in CHOICES will be the applicable CHOICES capitation payment. There will be no add-on for MFP
participants.

  

	27.	Section 3 shall be amended by adding a new Section 3.11 and renumbering the remaining Section 3 accordingly, including any references thereto.

 3.11 MFP INCENTIVE PAYMENTS 
  

					
		  	3.11.1	  	Financial incentives will be paid to the CONTRACTOR based on activities performed as part of the MFP Rebalancing Demonstration and in accordance with the following:
			
		  	3.11.1.1	  	Upon successful transition to the community of each MFP demonstration participant up to and including the MCO’s established benchmark for the calendar year — a onetime
payment of $1,000.
			
		  	3.11.1.1.1	  	If a member has been enrolled in more than one MCO during the ninety (90)-day minimum stay in a Qualified Institution established under ADA, the incentive payment shall be awarded
to the MCO in which the person is enrolled at transition to the community and enrollment into MFP.
			
		  	3.11.1.2	  	Upon successful transition to the community of each MFP demonstration participant that exceeds the MCO’s established benchmark for the calendar year — a one-time payment
of $2,000.
			
		  	3.11.1.2.1	  	If a member has been enrolled in more than one MCO during the ninety (90)-day minimum stay in a Qualified Institution established under ADA, the incentive payment shall be awarded
to the MCO in which the person is enrolled at transition to the community and enrollment into MFP.
			
		  	3.11.1.3	  	Upon each MFP demonstration participant’s completion of community living for the full 365-day demonstration participation period without readmission to a nursing facility
(excluding short-term SNF stays solely for purposes of receiving post- hospital short-term rehabilitative services covered by Medicare), a one-time payment of $5,000.
			
		  	3.11.1.3.1	  	If a member has been enrolled in more than one MCO during the 365-day participation period in MFP, a pro-rated portion of the incentive payment shall be awarded to each MCO based on
the number of days the member was enrolled in each plan. Only days included in the 365-day participation period shall be counted and not any days during which MFP participation was suspended during an inpatient facility
stay.

  
 19 

					
		  	3.11.1.4	  	Upon achievement of only one (1) of the remaining MFP program benchmarks 2-5 for each calendar year of the demonstration (including partial year 2011), a one-time payment of $10,000
per MCO.
			
		  	3.11.1.5	  	Upon achievement of only two (2) remaining MFP program benchmarks 2-5 for each calendar year of the demonstration (including partial year 2011), a one-time payment of $25,000 per
MCO.
			
		  	3.11.1.6	  	Upon achievement of only three (3) remaining MFP program benchmarks 2-5 for each calendar year of the demonstration (including partial year 2011), a one-time payment of $50,000 per
MCO.
			
		  	3.11.1.7	  	Upon achievement of all four (4) of the remaining MFP program benchmarks 2-5 for each calendar year of the demonstration (including partial year 2011), a one-time payment of
$100,000 per MCO.
			
		  	3.11.2	  	The CONTRACTOR shall be eligible to receive only one incentive payment pertaining to benchmarks #s 2-5 which shall depend on the total number of benchmarks which the CONTRACTOR
meets or exceeds. These incentive payments are not cumulative.
			
		  	3.11.3	  	MFP incentive payments pertaining to benchmark #1 shall be payable within thirty (30) days following the end of each calendar quarter for activities performed during the
quarter.
			
		  	3.11.4	  	The MFP incentive payments pertaining to benchmark #s 3-5 (which shall depend on the total number of these benchmarks which the CONTRACTOR meets or exceeds) shall be payable within
thirty (30) days following the end of each calendar year for activities performed during the year.
			
		  	3.11.5	  	Any additional MFP incentive payment pertaining to achievement of benchmark #2, which shall reflect the difference between the total incentive payment due the CONTRACTOR for
benchmarks #s 2-5 and the incentive payment already made in Section 3.11.4 above (see Section 3.11.2), shall be due by June 30 following the close of the calendar year to permit adequate time for any lag in claims and encounter
submission.

  
 20 

	28.	The liquidated damage chart in Section 4.20.2.2.7 shall be amended by adding new damages A.27 through A.30 as follows: 

 

					
	A.27	  	 Failure to process a transition referral, including completion of a face-to-face transition screening and assessment and

development of a transition plan timely and in

accordance with 2.9.6.8 and TENNCARE policy and protocols
	    	$500 per occurrence
			
	A.28	  	Failure to initiate CHOICES HCBS or for children under age 21, EPSDT benefits provided as an alternative to nursing facility care in accordance with the member’s plan of care
and to ensure that such HCBS or EPSDT benefits are in place immediately upon transition from a nursing facility to the community for any person transitioning from a nursing facility (i.e., CHOICES Group 1) to the community (i.e., CHOICES Group 2),
including persons enrolled in MFP (see Sections 2.9.5.4.1.5 and 2.9.6.8.16)	    	$500 per day for each day that HCBS are not in place following transition from a nursing facility (i.e., CHOICES Group 1) to the community (i.e., CHOICES Group 2) in addition to the
cost of services not provided
			
	A.29	  	Failure to complete in a timely manner minimum care coordination contacts required for persons transitioned from a nursing facility to CHOICES Group 2, including post-discharge and
following a significant change in circumstances (see Sections 2.9.6 and 2.9.8)	    	$500 per occurrence

  
 21 

					
	A.30	  	Failure to submit complete and accurate data into TPAES pertaining to MFP, or to comply with all data collection processes and timelines established by TENNCARE in policy or
protocol in order to gather data required to comply with tracking and reporting requirements pertaining to MFP. This shall include (but is not limited to) attestations pertaining to Eligible Individual and Qualified Residence, changes of residence,
inpatient facility admissions and discharges, reasons for re-institutionalization, and reasons for disenrollment from MFP.	    	$500 per occurrence

  

	29.	Attachment I shall be deleted and replaced in its entirety as follows: 

 ATTACHMENT I 
 BEHAVIORAL HEALTH SPECIALIZED SERVICE DESCRIPTIONS

 The CONTRACTOR shall provide medically necessary mental health case management and psychiatric rehabilitation services according to the
requirements herein. 
 All behavioral health services shall be rendered in a manner that supports the recovery of persons experiencing mental
illness and enhance the development of resiliency of children and families who are impacted by mental illness, serious emotional disturbance, and/or substance abuse issues. Recovery is a consumer driven process in which consumers are able to work,
learn and participate fully in their communities. Recovery is the ability to live a fulfilling and productive life [with] a disability. 
  

					
	SERVICE	  	Mental Health Case Management	  	

 DEFINITION 
 Mental health case management is a supportive service provided to enhance treatment effectiveness and outcomes with the goal of maximizing resilience and recovery options and natural supports for the
individual. Mental health case management is consumer-centered, consumer focused and strength-based, 

  
 22 

 
with services provided in a timely, appropriate, effective, efficient and coordinated fashion. It consists of activities performed by a team or a single mental health case manager to support
clinical services. Mental health case managers assist in ensuring the individual/family access to services. 
 Mental health case management
requires that the mental health case manager and the individual and/or family have a strong productive relationship which includes viewing the individual/family as a responsible partner in identifying and obtaining the necessary services and
resources. Services rendered to children and youth shall be consumer-centered and family-focused with case managers working with multiple systems (e.g. education, child welfare, juvenile justice). Mental health case management is provided in
community settings, which are accessible and comfortable to the individual/family. The service should be rendered in a culturally competent manner and be outcome driven. Mental health case management shall be available 24 hours a day, 7 days a week.
The service is not time limited and provides the individual/family the opportunity to improve their quality of life. 
 The CONTRACTOR shall
ensure mental health case management is rendered in accordance with all of the service components and guidelines herein, 
 SERVICE
DELIVERY 
 The CONTRACTOR shall: 
  

	 	•	 	 Detenuine caseload size based on an average number of individuals per case manager, with the expectation being that case managers will have mixed
caseloads of clients and flexibility between Levels 1 and 2 (Levels 1 and 2 are defined below); and 

  

	 	•	 	 Ensure that caseload sizes and minimum contacts are met as follows: 

 

					
	 Case Management Type
	  	 Maximum Caseload Size
	  	 Minimum Face-to-Face

Contacts

			
	 Level 1 (Non-

Team Approach)*
	  	25 individuals:1 case manager	  	One (1) contact per week
			
	 Level 1 (Team

Approaches):
	  		  	
			
	Adult CTT	  	 20 individuals:1 team
 20
individuals:1 case manager
	  	One (1) contact per week
			
	 Children & Youth

(C&Y) CTT
	  	 15 individuals:1 team
 15
individuals:1 case manager
	  	One (1) contact per week
			
	CCFT	  	 15 individuals:1 team
 15
individuals:1 case manager
	  	One (1) contact per week
			
	ACT	  	 100 individuals:1 team
 15
individuals: I case manager
	  	One (1) contact per week
			
	PACT	  	 100 individuals:1 team
 15
individuals:1 case manager
	  	One (1) contact per week
			
	Level 2*	  	35 individuals:1 case manager	  	Two (2) contacts per month

  

	*	For case managers having a combination of Level 1 & Level 2 (non-team) individuals, the maximum caseload size shall be no more than 30 individuals: 1 case manager.

 The CONTRACTOR shall ensure that the following requirements are met: 

  
 23 

	 	1)	All mental health case managers shall have, at a minimum, a bachelor’s degree or be licensed as a Registered Nurse; 

 

	 	2)	Supervisors shall maintain no greater than a 1:30 supervisory ratio with mental health case managers; 

 

	 	3)	Mental health case managers who are assigned to both a parent(s) and child in the same family, should have skills and experience needed for both ages; mental health
case managers who are assigned to individuals with co-occurring disorders (mental illness and substance abuse disorders) should have the skills and experience to meet the needs of these individuals; 

 

	 	4)	Fifty-one percent (51%) of all mental health case management services should take place outside the case manager’s office; 

 

	 	5)	The children and youth (C&Y) (under age eighteen (18)) mental health case management model shall provide a transition from C&Y services into adult
services, including adult mental health case management services. The decision to serve an 18-year old youth via the C&Y case management system versus the adult system shall be a clinical one made by a provider. Transition from children’s
services, including mental health case management, shall be incorporated into the child’s treatment plan; and 

  

	 	6)	All mental health case management services shall be documented in a treatment plan. Mental health case management activities are correlated to expected outcomes and
outcome achievement and shall be monitored, with progress being noted periodically in a written record. 

 Level 1

 Level I mental health case management is the most intense level of service. It provides frequent and comprehensive support to
individuals with a focus on recovery and resilience. The CONTRACTOR shall ensure the provision of level 1 mental health case management to the most severely disabled adults and emotionally disturbed children and youth, including individuals who are
at high risk of future hospitalization or placement out of the home and require both community support and treatment interventions. Level 1 mental health case management can be rendered through a team approach or by individual mental health case
managers. Team approaches may include such models as ACT, CTT, CCFT and PACT, as described below: 
 Assertive Community Treatment (ACT)

 ACT is a way of delivering comprehensive and effective services to adults diagnosed with severe mental illness and who have needs that
have not been well met by traditional approaches to delivering services. The principles of ACT include: 
  

	 	1)	Services targeted to a specific group of individuals with severe mental illness; 

 

	 	2)	Treatment, support and rehabilitation services provided directly by the ACT team; 

 

	 	3)	Sharing of responsibility between team members and individuals served by the team; 

 

	 	4)	Small staff (all team staff including ease managers) to individual ratios (approx. 1 to 10); 

 

	 	5)	Comprehensive and flexible range of treatment and services; 

  

	 	6)	Interventions occurring in community settings rather than in hospitals or clinic settings; 

 

	 	7)	No arbitrary time limit on receiving services; 

  

	 	8)	Individualized treatment, support and rehabilitation services; 

  

	 	9)	Twenty-four (24) hour a day availability of services; and 

  

	 	10)	Engagement of individuals in treatment and monitoring. 

  
 24 

  
 Continuous Treatment Team
(CTT) 
 CTT is a coordinated team of staff (to include physicians, nurses, case managers, and other therapists as needed) who provide a
range of intensive, integrated mental health case management, treatment, and rehabilitation services to adults and children and youth. The intent is to provide intensive treatment to families of children and youth with acute psychiatric problems in
an effort to prevent removal from the home to a more restrictive level of care, An array of services are delivered in the home or in natural settings in the community, and are provided through a strong partnership with the family and other community
support systems. The program provides services including crisis intervention and stabilization, counseling, skills building, therapeutic intervention, advocacy, educational services, medication management as indicated, school based counseling and
consultation with teachers, and other specialized services deemed necessary and appropriate. 
 Comprehensive Child and Family Treatment
(CCFT) 
 CCFT services are high intensity, time-limited services designed for children and youth to provide stabilization and deter the
“imminent” risk of State custody for the individual. There is usually family instability and high-risk behaviors exhibited by the child/adolescent. CCFT services are concentrated on child, family, and parental/guardian behaviors and
interaction, CCFT services are more treatment oriented and situation specific with a focus on short-term stabilization goals. The primary goal of CCFT is to reach an appropriate point of stabilization so the individual can be transitioned to a less
intense outpatient service, 
 Program of Assertive and Community Treatment (PACT) 

PACT is a service delivery model for providing comprehensive community-based treatment to adults with severe and persistent mental illness. It involves
the use of a multi-disciplinary team of mental health staff organized as an accountable, mobile mental health agency or group of providers who function as a team interchangeably to provide the treatment, rehabilitation and support services persons
with severe and/or persistent mental illnesses need to live successfully in the community. 
 Level 2 

Level 2 mental health case management is a less intensive level of service than Level 1 and is focused on resilience and recovery. The
CONTRACTOR shall ensure that level 2 mental health case management is provided to individuals whose symptoms are at least partially stabilized or reduced in order to allow treatment and rehabilitation efforts. 

SERVICE COMPONENTS 
 The
CONTRACTOR shall ensure that mental health case management incorporates the following service components: 
 Crisis Facilitation

 Crisis facilitation is provided in situations requiring immediate attention/resolution for a specific individual or other person(s) in
relation to a specific individual. It is the process of accessing and coordinating services for an individual in a crisis situation to ensure the necessary services are rendered during and following the crisis episode. Most crisis facilitation
activities would involve face-to-face contact with the individual. 

  
 25 

 Assessment of Daily Functioning 
 Assessment of daily functioning involves the on-going monitoring of how an individual is coping with life on a day to day basis for the purposes of determining necessary services to maintain community
placement and improve level of functioning. Most assessments of daily functioning are achieved by face- to-face contact with the individual in his or her natural environment. 
 Assessment/Referral/Coordination 
 Assessment/referral/coordination involves
assessing the needs of the individual for the purposes of referral and coordination of services that will improve functioning and/or maintain stability in the individual’s natural environment. 

Mental Health Liaison 
 Mental
health liaison services are offered to persons who are not yet assigned to mental health case management. It is a short-term service for the purposes of service referral and continuing care until other mental health services are initiated.

  

					
	SERVICE	  	Psychiatric Rehabilitation	  	

 DEFINITION 
 Psychiatric rehabilitation is an array of consumer-centered recovery services designed to support the individual in the attainment or maintenance of his or her optimal level of functioning. These services
are designed to capitalize on personal strengths, develop coping skills and strategies to deal with deficits and develop a supportive environment in which to function as independent as possible on the individual’s recovery journey.

 Services included under psychiatric rehabilitation are as follows. 
 SERVICE COMPONENTS 
 Psychosocial Rehabilitation 

Psychosocial rehabilitation services utilize a comprehensive approach (mind, body, and spirit) to work with the whole person for the purposes of improving
an individuals’ functioning, promoting management of illness(s), and facilitating recovery. The goal of psychosocial rehabilitation is to support individuals as active and productive members of their communities. Individuals, in partnership
with staff, fonn goals for skills development in the areas of vocational, educational, and interpersonal growth (e.g. household management, development of social support networks) that serve to maximize opportunities for successful community
integration, Individuals proceed toward goal attainment at their own pace and may continue in the program at varying levels intensity for an indefinite period of time. 
 Supported Employment 
 Supported employment consists of a range of services to assist
individuals to choose, prepare for, obtain, and maintain gainful employment that is based on individuals’ preferences, strengths, and experiences. This service also includes a variety of support services to the individual, including
side-by-side support on the job. These services may be integrated into a psychosocial rehabilitation center. 

  
 26 

 Peer Support 
 Peer support services allow individuals to direct their own recovery and advocacy process and are provided by persons who are or have been consumers of the behavioral health system and their family
members and are Certified Peer Support Specialists. A Certified Peer Support Specialist is a person who has identified himself or herself as having received or is receiving mental health or co-occurring disorder services in his or her personal
recovery process and has undergone training recognized by the Tennessee Department of Mental Health, Office of Consumer Affairs on how to assist peers with the recovery process. 
 These services include providing assistance with more effectively utilizing the service delivery system (e.g. assistance in developing plans of care, accessing services and supports, partnering with
professionals) or understanding and coping with the stressors of the person’s illness through support groups, coaching, role modeling, and mentoring. Activities which promote socialization, recovery, self- advocacy, development of natural
supports, and maintenance of community living skills are rendered so individuals can educate and support each other in the acquisition of skills needed to manage their illnesses and access resources within their communities. Services are often
provided during the evening and weekend hours. 
 Illness Management & Recovery 

Illness management and recovery services refers to a series of weekly sessions with trained mental health practitioners for the purpose of assisting
individuals in developing personal strategies for coping with mental illness and promoting recovery. Illness management and recovery is not limited to one curriculum, but is open to all evidenced-based and/or best practice classes and programs such
as WRAP (Wellness Recovery Action Plan). 
 Supported Housing 
 Supported housing services refers to services rendered at facilities that are staffed twenty-four (24) hours per day, seven (7) days a week with associated mental health staff supports for
individuals who require treatment services and supports in a highly structured setting. These mental health services are for persons with serious and/or persistent mental illnesses (SPMI) and are intended to prepare individuals for more independent
living in the community while providing an environment that allows individuals to live in community settings. Given this goal, every effort should be made to place individuals in facilities near their families and other support systems and original
areas of residence. Supported housing services are mental health services and do not include the payment of room and board. 
  

					
	SERVICE	  	Crisis Services	  	

 Definition 

Behavioral health crisis services shall be rendered to individuals with a mental health or substance use/abuse issue when there is a perception of a
crisis by an individual, family member, law enforcement, hospital staff or others who have closely observed the individual experiencing the crisis. Crisis services are available twenty-four (24) hours a day, seven (7) days a week. Crisis
services include twenty-four (24) hour toll free telephone lines answered in real time by trained crisis specialists and face-to-face crisis services including, but not limited to: prevention, triage, intervention, evaluation/referral for
additional services/treatment, and follow-up services. Peer support specialists shall be utilized in conjunction with 

  
 27 

 
crisis specialists to assist adults in alleviating and stabilizing crises and promote the recovery process as appropriate. Behavioral health crisis service providers are not responsible for
pre-authorizing emergency involuntary hospitalizations. 
 The Mental Health Crisis Response Services — Community Face-to-Face Response
Protocols provide guidance for calls that are the responsibility of a crisis response service to determine if a Face-to-Face evaluation is warranted and those that are not the responsibility of the crisis response service. These Protocols were
developed to ensure that consumers who are experiencing a behavioral health crisis and have no other resources receive prompt attention. All responses are first determined by clinical judgment. 

Guidance for All Calls: 
  

	 	•	 	 For calls originating from an Emergency Dept., telehealth is the preferred service delivery method for the crisis response service

  

	 	•	 	 After determining that there is no immediate harm, ask the person if he or she can come to the closest walk-in center 

 

	 	•	 	 If a Mandatory Pre-screening Agent (MPA) not employed by a crisis response service is available, there may be no need for a crisis evaluation by mobile
crisis 

  

	 	•	 	 For all other calls, unless specified in the Protocols, if a person with mental illness is experiencing the likelihood of immediate harm then a
response is indicated. 

 All of the provisions of the original Agreement not specifically deleted or modified herein shall
remain in full force and effect. Unless a provision contained in this Amendment specifically indicates a different effective date, for purposes of the provisions contained herein, this Amendment shall become effective October 1, 2011.

 The CONTRACTOR, by signature of this Amendment, hereby affirms that this Amendment has not been altered and therefore represents the
identical document that was sent to the CONTRACTOR by TENNCARE. 

  
 28 

 IN WITNESS WHEREOF, the parties have by their duly authorized representatives set their signatures.

 

 
  

  
 29

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00195-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00195-of-00352.parquet"}]]