On March 6, 2008, Tennessee Governor Phil Bredesen released details of the proposed "Long-Term Care Community Choices Act of 2008" (the Act) which aims to simplify access to home and community-based services (HCBS) and increase the number of people receiving care for their long-term needs in their homes and communities. In recent months, Bredesen has criticized the State's long-term care system for its limited access and options, fragmented and overly-complicated services and limited resources. The changes recommended by the Act show that Bredesen was serious when he indicated that 2008 would be the year to deliver on his promise to expand alternatives to nursing homes for elderly and physically disabled individuals through the TennCare program. In his January 2008 State of the State address Bredesen noted that Tennessee typically ranks last among states that offer alternatives to traditional nursing homes.
The Act is the result of more than two dozen working sessions and information meetings held by TennCare officials during February 2008 as well as the work of a bipartisan Long-Term Care legislative study committee. The following is a summary of several key components of the Act:
Consumer Choice and Options
- Consumer-Directed Options: The Act provides for consumer-directed options for persons receiving HCBS, such as the ability to select, direct or employ unskilled support staff (including non-traditional family members, friends or neighbors) and the ability to manage a needs-based budget where money is directed through a fiscal intermediary rather than provided to a TennCare member.
- Expansion of Community-Based Residential Alternatives: The Act expands residential care choices in the community beyond nursing home care to include multiple levels of assisted care living facility services, adult family care homes, adult foster care homes, companion care models and other residential alternatives to nursing homes and modifies licensure requirements for such facilities to ensure that there is a framework offering increasing levels of community-based care as an alternative to nursing homes.
Simplified Process for Accessing Services
- Single Point of Entry: The Act provides for a single point of entry to the long-term care system for people who are not currently on TennCare by creating one place to go for information about all long-term care options through TennCare and other available programs, including counseling, assistance in evaluating long-term care options, screening and intake for long-term care programs and facilitated Medicaid enrollment.
- HCBS Initiative: The Act provides for strategies that encourage the use of HCBS, where appropriate, rather than nursing homes. Such strategies include advising individuals and families, prior to nursing home admission, that alternatives exist and creating plans to transition nursing home patients to HCBS settings.
- Streamlined Eligibility: The Act provides for the implementation of a streamlined process for determining eligibility for HCBS, including expedited Medicaid eligibility determination and enrollment for new members.
"Whole Person" Care Coordination Approach
- Expansion of HCBS through Fully Integrated Long-Term Care System: The Act provides for one entity to coordinate all the care a TennCare member needs, including medical, behavioral and long-term care.
- Transitions from Nursing Facility to Community: The Act will require Medicaid contractors to identify nursing home residents who are appropriate for transition to HCBS and to plan and facilitate their transition.
- Quality Assurance: The Act will develop and implement long-term care quality assurance and quality improvement strategies, including electronic visit verification and mechanisms for feedback from members, members' family or other caregivers.
A complete copy of the bill can be found at this link. The Act must be voted on by the General Assembly and signed into law before becoming effective. If the General Assembly approves the Act, it is anticipated to go into effect on July 1, 2008.
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