reglab/housing_qa huggingface dataset:
TN Code § 71-5-1409 (2021)
2021 Tennessee Code|Title 71 - Welfare|Chapter 5 - Programs and Services for Poor Persons|Part 14 - Long-Term Care Community Choices Act of 2008|§ 71-5-1409. Nursing Facility Transition Initiative

  The commissioner shall develop and implement a nursing facility transition initiative.   The commissioner shall specify in contractor risk agreements with contractors responsible for coordination of medicaid primary, acute and long-term care services requirements related to nursing facility-to-community transitions.   Contractor requirements shall include identification of nursing facility residents who may be appropriate for transition to home and community-based settings, as well as assessment and care plan development by a qualified entity. The contractor shall plan and facilitate those transitions in a timely manner. Contractors shall be permitted to coordinate or subcontract with local community-based organizations to assist in the identification, planning and facilitation processes, and may offer, as a cost-effective alternative to continued institutional care, a per-person transition cost allowance not to exceed two thousand dollars ($2,000) for items such as, but not limited to, first month's rent, rent deposits, utility deposits, kitchen appliances, furniture and basic household items.   It is the legislative intent of this section to provide more opportunities for home and community-based services for the at-risk population, subject to the availability of funding in each year's appropriations bill.
TN Code § 71-5-1410 (2021)
2021 Tennessee Code|Title 71 - Welfare|Chapter 5 - Programs and Services for Poor Persons|Part 14 - Long-Term Care Community Choices Act of 2008|§ 71-5-1410. Strategies to Assist Nursing Facilities in Diversifying Their Lines of Business

  The commissioner shall develop and implement strategies to assist nursing facilities in diversifying their lines of business, including provision of home and community-based services and specialized nursing facility care to meet the targeted needs of chronic care populations.   The strategies may include, but are not limited to, provision of training and technical assistance, streamlined provider enrollment processes for home and community-based services and development of special acuity-based rates to meet the more intensive caregiving demands of certain chronic care populations, subject to the availability of funding in each year's appropriations bill.
TN Code § 71-5-1411 (2021)
2021 Tennessee Code|Title 71 - Welfare|Chapter 5 - Programs and Services for Poor Persons|Part 14 - Long-Term Care Community Choices Act of 2008|§ 71-5-1411. Plan to Expand Cost-Effective Community-Based Residential Alternatives to Institutional Care

  The commissioner shall develop and implement a plan to expand cost-effective community-based residential alternatives to institutional care for persons who are elderly or adults with physical disabilities, or both, which may include, but not limited to, the development of multiple levels of assisted-care living facility services, adult family care homes, adult foster care homes, companion care models and other cost-effective residential alternatives to nursing facility care.   The commissioner and the board for licensing health care facilities shall work to develop or modify, or both, licensure requirements for such facilities to support a nursing facility substitute framework for members who want to age in place in residences that offer increasing levels of cost-effective home and community-based care as an alternative to institutionalization as members' needs change.
TN Code § 71-5-1412 (2021)
2021 Tennessee Code|Title 71 - Welfare|Chapter 5 - Programs and Services for Poor Persons|Part 14 - Long-Term Care Community Choices Act of 2008|§ 71-5-1412. Transition Period Following Implementation of Managed Long-Term Care Service Delivery System

  A managed care organization (MCO) shall contract with any nursing facility licensed under title 68, chapter 11, part 2, and certified by the centers for medicare and medicaid services, that provides medicaid nursing facility services pursuant to an approved preadmission evaluation (PAE) and is willing to contract with the MCO to provide that service under the same terms and conditions as are offered to any other participating facility contracted with that MCO to provide that service under any policy, contract, or plan that is part of the TennCare managed long-term care service delivery system. Terms and conditions shall not include the rate of reimbursement.   Nothing in this section shall be interpreted as preventing the bureau of TennCare or an MCO from enforcing a contract between an MCO and a nursing facility or as preventing the bureau of TennCare from adopting reasonable and necessary requirements for the participation of a nursing facility in the TennCare program. All requirements for participation adopted after July 1, 2016, shall be promulgated by the bureau of TennCare as a rule under title 4, chapter 5, part 2, and shall include a hearing under § 4-5-203, prior to the enforcement of such requirement as part of any provider contract, unless otherwise required by federal law.
TN Code § 71-5-1415 (2021)
2021 Tennessee Code|Title 71 - Welfare|Chapter 5 - Programs and Services for Poor Persons|Part 14 - Long-Term Care Community Choices Act of 2008|§ 71-5-1415. Quality Assurance and Quality Improvement Strategies

 The commissioner shall develop and implement quality assurance and quality improvement strategies to ensure the quality of long-term care services provided pursuant to this part and shall specify in contractor risk agreements with contractors responsible for coordination of medicaid primary, acute and long-term care services requirements related to the quality of long-term care services provided. The strategies may include the use of electronic visit verification for data collection and reporting, HEDIS measures pertaining to long-term care services, and shall include mechanisms to ensure direct feedback from members and family or other caregivers regarding the quality of services received. The commissioner shall ensure that recipients of long-term care services are notified how to contact the bureau of TennCare if they have concerns about the long-term care services they are or are not receiving and the process for resolving such issues.
TN Code § 71-5-1416 (2021)
2021 Tennessee Code|Title 71 - Welfare|Chapter 5 - Programs and Services for Poor Persons|Part 14 - Long-Term Care Community Choices Act of 2008|§ 71-5-1416. Funding to Increase Access to Home and Community-Based Services in the State-Funded Options Program

 Subject to the availability of funding, the commissioner shall designate in each year's appropriations bill an amount of money that can be used to increase access to home and community-based services in the state-funded options program for persons who do not qualify for medicaid long-term care services. This funding may be used to provide services such as home-delivered meals, homemaker services and personal care, and to reduce the waiting list for these services under the options program, or to offer transportation services or assistance to non-medicaid-eligible individuals.
TN Code § 71-5-1417 (2021)
2021 Tennessee Code|Title 71 - Welfare|Chapter 5 - Programs and Services for Poor Persons|Part 14 - Long-Term Care Community Choices Act of 2008|§ 71-5-1417. Funding for Medicaid Long-Term Care Services

 The commissioner shall provide medicaid long-term care services subject to the availability of funding in each year's appropriations bill.
TN Code § 71-5-1420 (2021)
2021 Tennessee Code|Title 71 - Welfare|Chapter 5 - Programs and Services for Poor Persons|Part 14 - Long-Term Care Community Choices Act of 2008|§ 71-5-1420. Veterans Education Benefits

 Notwithstanding any other provision of this chapter, to the extent permitted by federal law, the value of federal veterans education benefits received by an applicant shall not be included as any form of income when making eligibility determinations for assistance under this part.
TN Code § 71-5-1421 (2021)
2021 Tennessee Code|Title 71 - Welfare|Chapter 5 - Programs and Services for Poor Persons|Part 14 - Long-Term Care Community Choices Act of 2008|§ 71-5-1421. Prompt Payment of Claims and Liability for Bad Faith Failure to Pay Claims Promptly

 Any managed care organization shall comply with § 56-32-126 and any prompt pay provisions within the MCO contractor risk agreements with TennCare. In addition, the MCO shall ensure that ninety percent (90%) of clean claims for nursing facility services shall be processed and paid within fourteen (14) calendar days and ninety-nine and one half percent (99.5%) paid within twenty-one (21) days.
TN Code § 71-5-1422 (2021)
2021 Tennessee Code|Title 71 - Welfare|Chapter 5 - Programs and Services for Poor Persons|Part 14 - Long-Term Care Community Choices Act of 2008|§ 71-5-1422. Pilot Project for Disabled Individuals and Family Members to Self-Direct Supports and Services

  The commission on aging and disability shall develop a pilot project proposal in accordance with this section. The long-term care services planning council shall be responsible for evaluating the implementation of the project. If funded in the general appropriations act, the pilot project shall be implemented and shall continue for three (3) years. The commission shall annually report on the pilot project to the council,  the health and welfare committee of the senate and the health committee of the house of representatives. At the end of the project the commission shall report on the project to the council and to the standing committees of the senate and the house of representatives. The council shall also make reports of any evaluations that it might undertake of the project to the standing committees of the senate and the house of representatives.   The commission on aging and disability shall develop a pilot project in a county or counties of one (1) of the area agencies on aging and disability (AAAD) and shall enter into a contract with the selected AAAD in order to implement the project. The project shall utilize the services of an aging and disability resource center located in the AAAD. Subject to any approvals required from the commission by the contract, a working group from the selected AAAD shall design the project and determine whether to use a program manager in the project. In selecting the AAAD, the commission shall consider any administrative and oversight efficiencies that locating the project in any particular AAAD might afford the project.   The project shall offer families with a member with a disability who requires long-term supports and services and individuals with a disability who require long-term supports and services opportunities to direct their own services. The families and individuals shall exercise choice, control and responsibility for their services within a cost neutral framework.   The project may involve the following:  Personal control and choice;   Encouragement of cost-effective decision-making in the purchase of supports and services;   Allowing eligible families and individuals to receive a cash allowance or an individual budget to obtain personal assistant services and related supports; and   Providing fiscal agent and supportive broker services to sustain individuals and families in directing their own services.
TN Code § 71-5-1423 (2021)
2021 Tennessee Code|Title 71 - Welfare|Chapter 5 - Programs and Services for Poor Persons|Part 14 - Long-Term Care Community Choices Act of 2008|§ 71-5-1423. Hearing on Resident’s Appeal of Involuntary Discharge From Facility — Timeframe for Hearing and Final Order

 If a resident appeals the facility's notice of involuntary discharge to that resident and a hearing is requested pursuant to 42 C.F.R. § 431.220(a)(3) before the bureau of TennCare:   The hearing shall be conducted and a final order rendered within ninety (90) days from the date of the resident's appeal of the facility's involuntary discharge notice;   The timeframe specified in subdivision (1) may be extended or continued with the consent of both the facility and the resident; and   The timeframe specified in subdivision (1) may be extended by the presiding administrative law judge without the consent of the facility, but only after a showing by the resident, or the resident's representative, that the resident faces a substantial threat of irreparable damage or injury if a continuance is not granted.
TN Code § 71-5-1424 (2021)
2021 Tennessee Code|Title 71 - Welfare|Chapter 5 - Programs and Services for Poor Persons|Part 14 - Long-Term Care Community Choices Act of 2008|§ 71-5-1424. Hearing on Appeal of Tenncare’s Initial Determination of Ineligibility for Nursing Facility Services — Motion to Intervene by Facility

 If an individual appeals TennCare's initial determination that they are not eligible for TennCare nursing facility services:   The hearing on any appeal of an initial determination that the individual is not financially eligible shall be conducted and a final order rendered within ninety (90) days from the date of the individual's appeal; provided, however, that if the individual files a petition for reconsideration of an initial order or appeals an order, other than a final order, pertaining to an initial determination made by TennCare under this section prior to the expiration of the ninety-day period, the running of the ninety-day period shall be tolled pending the outcome of such petition for reconsideration or appeal; and   The facility may be entitled to participate in any proceeding and hearing that appeals an initial determination that the individual is not financially or medically eligible through the filing of a motion to intervene in that proceeding under § 4-5-310. The administrative judge or hearing officer shall grant a facility's motion to intervene in the appeal of a resident or former resident's eligibility, absent a showing by one (1) or more parties to the appeal that the facility's participation would cause that party to incur an undue burden or unnecessary expense.
TN Code § 71-5-1425 (2021)
2021 Tennessee Code|Title 71 - Welfare|Chapter 5 - Programs and Services for Poor Persons|Part 14 - Long-Term Care Community Choices Act of 2008|§ 71-5-1425. Guidance Regarding Whether Temporary Family Healthcare Structures Are Covered — Federal Approval of Waiver Amendment to Offer Benefit — Applicability of Waiver

  As part of the plan to expand cost-effective community-based residential alternatives to institutional care as required pursuant to § 71-5-1411(a), the bureau of TennCare shall seek written guidance from the centers for medicare and medicaid services regarding whether a temporary family healthcare structure, as defined in § 13-7-501, may be covered in whole or in part under the program established pursuant to this part, and, if so, shall, upon appropriation by the general assembly specifically to cover temporary family healthcare structures, seek federal approval of a waiver amendment to offer such benefit to eligible older adults and persons with disabilities who choose temporary family healthcare structures in lieu of care in other settings.   Any waiver approved pursuant to subsection (a) shall apply only to a person who:  Meets the CHOICES 2 activities of daily living criteria;   Meets financial eligibility requirements for medical assistance under this chapter; and   Is either:  A person with a developmental or intellectual disability, as defined in § 33-1-101, who is related to the owner or occupier of the property; or   An older adult who is related to the owner or occupier of the property.
TN Code § 71-5-1501 (2021)
2021 Tennessee Code|Title 71 - Welfare|Chapter 5 - Programs and Services for Poor Persons|Part 15 - Ground Ambulance Service Provider Assessment Act|§ 71-5-1501. Short Title

  This part shall be known and may be cited as the “Ground Ambulance Service Provider Assessment Act.”   The intent of this part is to enhance EMS services and improve access to emergency medical pre-hospital care in this state.
TN Code § 71-5-1502 (2021)
2021 Tennessee Code|Title 71 - Welfare|Chapter 5 - Programs and Services for Poor Persons|Part 15 - Ground Ambulance Service Provider Assessment Act|§ 71-5-1502. Part Definitions

 As used in this part:   “Ambulance provider” means a public or private ground-based ambulatory service, other than an ambulance service based on federal property, that bills for transports and has a base of operations within the state;   “Assessment” means the medicaid ambulance provider assessment established by this part;   “Bureau” means the bureau of TennCare;   “Medicaid transport” means ground ambulance services specified in the Healthcare Common Procedure Coding System (HCPCS) under codes A0225, A0426, A0427, A0428, A0429, A0433, and A0434, and paid by medicaid, as recorded by the managed care organization under contract to the bureau;   “Net operating revenue” means all revenues, regardless of payer source, collected by ambulance providers for patient services excluding charity care or any other uncompensated patient services, in accordance with 42 CFR 433.68;   “Office of emergency medical services” means the office of emergency medical services within the department of health; and   “Total transports” means all transports reported during the base period by a provider to the office of emergency medical services.
TN Code § 71-5-1503 (2021)
2021 Tennessee Code|Title 71 - Welfare|Chapter 5 - Programs and Services for Poor Persons|Part 15 - Ground Ambulance Service Provider Assessment Act|§ 71-5-1503. Annual Coverage Assessment on Covered Hospitals

  An ambulance provider shall pay an assessment to the bureau:  In accordance with this part;   In the amount designated in § 71-5-1504;   Quarterly, on a day determined by the bureau; and   No more than thirty (30) business days after the day on which the bureau issues the ambulance provider notice of the assessment.     The bureau shall:  Determine the standards and procedures used to implement and enforce this part;   Collect the assessment described in subsection (a); and   Transfer assessment proceeds to the state treasurer for deposit into the ambulance service assessment revenue fund created in § 71-5-1508.     An ambulance provider shall not increase charges or add a surcharge to ground transports based on, or as a result of, the assessment described in subsection (a).
TN Code § 71-5-1504 (2021)
2021 Tennessee Code|Title 71 - Welfare|Chapter 5 - Programs and Services for Poor Persons|Part 15 - Ground Ambulance Service Provider Assessment Act|§ 71-5-1504. Calculation of Uniform Assessment per Ground Transport — Quarterly Transport Data

  The bureau shall calculate a uniform assessment per ground transport for each ambulance provider pursuant to subsection (b).   Except as otherwise provided in subsection (c), each quarter of the state fiscal year, the assessment due from each ambulance provider will equal the rate set in subsection (e) multiplied by each provider's total transports reported from the most recent available completed quarter of transport data recorded by the office of emergency medical services. Ambulance providers will be required to submit a quarterly reporting of all transports to the office of emergency medical services in a manner determined by the office of emergency medical services and the bureau.   If the quarterly transport data is not adequate or available for the calculation of assessments, then the bureau shall use total transports submitted to the office of emergency medical services for calendar year 2019. If neither the quarterly transport data nor total transports submitted to the office of emergency medical services are adequate or available, then the bureau shall use the annual cost and utilization report submitted pursuant to § 71-5-1507. The adequacy and availability of the data must be determined solely by the bureau.   The bureau shall apply any annual changes to the assessment rate, calculated as described in subsection (b), uniformly to all assessed ambulance providers.   The assessment shall generate the lesser of:  Nine dollars and nine cents ($9.09) per transport that is part of a provider's total transports as that term is defined in § 71-5-1502; or   In the event that nine dollars and nine cents ($9.09) per transport causes the statewide assessment to exceed six percent (6%) of statewide net operating revenues, the per transport assessment will equal an amount that shall generate six percent (6%) of statewide net operating revenues.     [Deleted by 2020 amendment.]   [Deleted by 2020 amendment.]
TN Code § 71-5-1505 (2021)
2021 Tennessee Code|Title 71 - Welfare|Chapter 5 - Programs and Services for Poor Persons|Part 15 - Ground Ambulance Service Provider Assessment Act|§ 71-5-1505. Maintenance of Coverage Trust Fund

  Upon approval by the centers for medicare and medicaid services of the assessment imposed by this part, the bureau shall reimburse each ambulance provider with qualifying ground ambulance service medicaid transports in an amount calculated by the bureau. This calculation will be determined by the bureau's estimate of assessment collections and the resulting available program funding, less an annual amount of seventy-five thousand dollars ($75,000) to offset medicaid administration expenses and an annual amount of eighty thousand dollars ($80,000) to offset administrative expenses for the Tennessee Ambulance Services Association. If less than these amounts is needed to offset the administrative expenses, the bureau shall only deduct the amount needed. The bureau's estimate of assessment collections and the resulting program funding, netting out any amounts for offset administrative expenses, must be divided by the bureau's projected number of medicaid transports. The resulting amounts will be the additional payment amount made for each medicaid transport reported by the MCO's on a quarterly basis. This amount may change from quarter to quarter.   The bureau shall disburse supplemental payments to ambulance providers based on medicaid transports from the base period as determined by the bureau and as authorized by the centers for medicare and medicaid services.
TN Code § 71-5-1506 (2021)
2021 Tennessee Code|Title 71 - Welfare|Chapter 5 - Programs and Services for Poor Persons|Part 15 - Ground Ambulance Service Provider Assessment Act|§ 71-5-1506. Policy Measures to Ensure Enforcement and Compliance — Penalties — Quarterly Transport Count Data

  The bureau has the authority to create policy measures that ensure the enforcement and compliance of this part. The bureau shall require an ambulance provider that fails to pay an assessment due under this part to pay the bureau, in addition to the assessment, a penalty of fifty dollars ($50.00) per calendar day for each day the assessment remains unpaid in full after the date due. The bureau may waive penalties for a delinquent provider if the provider has entered into a payment plan approved by the bureau. If the provider fails to comply with the terms of the payment plan, then the bureau may reinstate the waived penalties. Other enforcement measures determined by the bureau include, but are not limited to, recoupments, withholding of future payments, and loss of medicaid ID.   The bureau shall require ambulance providers to submit quarterly transport count data for all transports to the office of emergency services within thirty (30) days of the end of the quarter.