or - BlueCross BlueShield of Tennessee · A",,,,>

AMENDM.ENT NUM BER 33

AN AGREEMENT ~'OR TilE AO:lIIN ISTR,\l'ION OF n :NNCAR£ SELECT Ut:TWEEN

I'll E ST.\ TE 0.' TENNt:.'.. .. t:E, d.h.a. TENNCAHE

ANf> VOUJI\'TEI!:R STATE 11 f,,\LTIl PLAN.Il"C.

COI'TRACT t-.'UMIlER: .·A-9!-146J2_CIO

1'" ... ond in «<m ......... """ of tho: ..... ual pnlOfti_ ~ o:om.o'r\Cd ..... od>c.T ~ otl.:I , ........ 10: comodcroIi ..... !he =<:1pI .nII wfl"_y "f "Iud! II botmoy ~r~ 11,," put;'" olgl« III .Iatll'y ~nd.'or omefId lho AJ'<'ItfnftIC fnr thot ,\dminismotion 0( T~n"C"c Sc!",,~ by .nd bc!w""" .he ~UI" ()[ r"""",..:. T~.tnL ... ", FI""",,- ho:rll1!1afkT ref..,."d 1<).' T£NNCARE!. ond VoI"",~ ... Slale Health 1'1 .... 1I~ .• h=malkr ,.f<""rl",,, ,he CONTRACTOR • •• 'P<'<'i!l<d bolo ....

1111<:. """ fJIoIIIIbcti"J 01" "", .. ",phs ....:d bcrrin '"'" lOt tho J'I"P'!'<" <>f r""iluhllit 110<' \If ",ran><c ""Iy 6IId .!u.U 001 Ix: rooq.ItuN II> inc.., "",,1Ja:t ... ' ~()ft!. ........ ioo .. rlan, ....

I. M<:lklll I ,ball 1M" am£nded by madifying Hlld addinl lI.t faliolOlnll denA;I; ..... and ddt 'll,,; th t drilnilioD for [lSI mtdlal e Iml(ibilily r ... r C IIOICES Group ~:

.I.!a!ii:!I~ A .. nUt" pl." til •• i, • requm,d 'ompor'II:lII or ~ pi .. , of"", r<)r all CHOICES mo:mbo..,. ~i.ing tompanJoo can: nr _.",idem;.1 n/OlCES HellS in m. ... 0"-" """'" and .. ·hid. >p«,I1 .. """,id p<:r"J<ln!o .... ·11 • poid <~ ... ",10=0 """"or • .",ID<. ptU~ockn (» apploublc) wOO .c .,·"IIbk, 100,,, .:ov=d \0 _ • I>ac:~ ....... _ ... oo .... 11 be "",,.,.,r.ooI ... ddi\-a noNed ~ In .iIu&I_ ...&ao. ~y Idocdukd QIOICES IICBS ,..,..idcn Of .. <J<k<:r$.", ...... '..;bb~ (If da not ..... ~ at schodookd. 10. CItOlCl'S mcmlx:r or hio/ho:r represco.wi, e .... y not elect ... pan '" the bao:k-"" pi .... g;I W'I without 1I<:rVKeI, '"'" Ndc-up pfaD 0I0I011 !rw;lude lhe D.,no. ~nd lelq>honi:: nW<lbc:,.. ~f PC""'" ;and ~ll.:ndeo to contor;:t am ,be KrVkes I<l be p«:Ivukd by each of the: h.u:d 0;0II'""'"' n .. member and hL .. l!<r rcpresoen,otivc (1111 .l'I'lkohl~) .han .... "" ptimuy ,esfJ<m,ib,lily r~, lhc o.vft<.lpmonl ond imph;"'''''"1ioll .. rthe boo:!l."P pl.n for c_ d,rackd Kn";"'L Tbc FhA ,"'iIl...w.o ~ ,.i,b lhc ........ 1olpmmI and ~flOl''''' <>I1h< inil .. 1 ba(:k."" ...... r.. COIUlIU>tI"" Iii""' ...... Tho: '*" c<>Ot.ii ....... ... 11 be "'"f'UR'ib1e Tot ... w~ as ~ .. iI" ,mplcmcn",'i Ihc '-k."" pi ... and """ upbri", 6IId ""';fy,nl tho Net-lip pIalI on ... """"'" basil.

SgtlNflf fiNk!'! - An jl>divt<lu:o! ... igned by .he I'~A I<) """h CHOICES " .. mbt:, ~"oci~lIl\' in _<>ft'um ... din:ct:ioo who u,isn ,he me'nbo:rl'""","nI,,;ve., neWcd ;n perf"'min~ ""n.in "mploy .. of "",ord ( ..... ,i""" .. fo11"w., de, .. lopin~ job deseri",i""" recruiting. inll!tVlc:,"in&. ond hinnS .....,..kns; ....-mber and w",k ...... fIIllment on com.wner dim:tiorl ~ <:<lNUITl.r dim:llool tr.i~in&; ond "",'.~ (OS plI1 of tho: onlooanIina I'f'XU' (OJ new wOJtas) I ..,bOldtole for Iltc mtmbcr·, wt>tI<ns lhao """'polIU with IIx: scb<duk: ;u whi<h "",,1«1 .'" ~ by II ...... mbc:r ill fClk<a:d ,n 1M plan <>I co",- .·Ibc ,~ bnJI;a- WU abo uti. tloe ,_"b.:r as iI«dN Wi .... <fe-,"1o!>inII .0Id • .,.,r}'inK Iltc .... 1i.oI bock.up plan for <:ooI",mer dllCl:liun, The ~ broIr.rr wlbb<><2leS with Ibc mem ..... ·• """" __ • as II'l""prill., TlIc: ""I'P"fI' bltlk ... dan nUl: hav~ .~tb ... lly Of ""I"'n.ib,h,y (or C<lII,umc:r dirl:CtlOll. "Tho manbocr .,. member', """, .. "",a';". ~ retain a~ihon.y .nd n."coP'l""ibility f.".. OOIlOumer dtr..:rian.

I

Amend",."t 33 (conq

l'!~ - A n .pprOileb to he.lth cot" th~t cmpllas,z,," not. mo,-t:iy It><: .bsc""'C " r disc",", or infirmity bul the pul'1l1it of (lplimum hul!h. II il lUI ootiw proc . .. of hclpmll ",cml>er> bc.:,m,., .... ,'" "r . nd make olloicO$ ll1al will hdp them to ""hi~e . heallhy and mere r"lfilling li fe_ Woll "",.. mdu<k. p"",,<" ' ing iiln" .. , prolonging HI:, and impruY:ng qUIOlity or life .• , oppo...:d to ""'.,.ing ,oldy <>Il ,,,,, ting di, c.«.es. Wdln""" ;" a c<milition of good ph)"" i •• 1 ""d m""'AI he.llh. osp«i:dly when .~comp!i<hod .nd m"jm.,,;octi by per •• ma l ~hoice . nd ""uon. including proper diet. =!$<:, ~nd Io:oht. h.bit,

2. Secliou 2.6.1.3 . lIaU be amended by deletiog and rr pladng Ille " S t:RVICE~I"R£,"'U'1T

LOUT" for D~ntal Servi",," • • follow.:

o.ntJl ~ni< •• , hall bt pro';dfd by IItt D.ftt.1 --1 ikftefil. Managor 6r in ... m. ~&"' ... lhrBugh an !less

, ,,'.IH r pr"llr~m r6r per,un. ,..-ilb inl~lkClUQI

i dis. biliri •• (i.e., mental r. tRrdarioll).

flqwever. the racility, medico) """ .nc't~ia ...-vice. related to lhe donlal service lhal are nol p"",ido.,d by 0 donti., 'l< ill • do",i. f , " Ifice 'hall be co~cred . e,,",ce. provided by the CO;>lTRACTOR wben the dento! lWn'k:e i. c'tl~",cd by the OHM ,..- though au HeSS .... ';v"," 1 program (," porson. with in10llectual di,abililies ('-.... I mo" .. 1 (otoro-t;on

3. Se~t'6u 2.6.1.5 . ball be am~ndcd by deltl'ng Ibe uistinjl: s.,.~t;on 2.6.1.5.:\ and ren6nlbering Ibt r~maiuing Sect;"n a~(ofdingly, Including any rcferencH tbe-reio.

4. Tb~ r ennmb .... ed S...,tiou 2.6.1.5.3.1 shall be amended by adding the phn.e "re'i~w all requn n for short-Ierm NF stays and shall" a. folloM:

2.6. 1.5.3.1 Tbe CONTRACrOR .""11 review ~II req"",,~ for .hort-t<:nn NF O!.~ ond shall amhoriZll; and/or "'''nburst short_\<!nto NI' otays [<If Group 2 and Group 3 memb<1'i only who" (I) tho mem"-, i, enrollod in CUOICfiS Group Z '" 3 • .u opp!iCllble, ."d =ci~;n8 BellS UJ>OIl admis.ion; (2) the m,,,,,ber ,nee," ,he n\lOinJ! f*<;ltily be! of C>fE in pi..:" .t the ti"", or adm;,;. ion; 0) the member', <t4y in the [,""ilily I. <xpec[e(i tn be k .. th.n ni""ty (90) d.y.; """ (4) the member is expected If> return tn lhc community up<J" it. ""nelusion- The CONTRACTOR , ball mon;,o.- III . h"rHclIO NF .tays fo.- Group 1 . nd GrOll!' ] meml>er> and sholl .. n. ure lhaL tho: member i. tr .... iLi<>ne<,l from G'oup 2 nt Group ]. u applicable, to Grotlp I .t ..,y Lime 0) it i. determined thaI the stay wi!! oot be shorL·term or tho membc, will ooL tran.i Lion bac~ to Ii,., community; .n<! b) prior to e"h.". ting the nineLY (9Q)-d.y sh<lrt--l<.'rm NF boo"IICf1t """.",d for CHOICES Group 2 ond Group J memb ....

,

A",,,,><!men! 3} (cont.)

S. Thr r. "" ",bcHd Sect iuR 1.6.1.5.3.1.2 .hall b~ dd~lcd alld r~pl.a l~d 11$ follow,:

2.1>.1.5.3.1.2 The CONTRACTOR ,hallroonitot. on on o>ngoing b •• i, . members utili~in~ tll< .bertt.".,-" NT' benefit. "nJ ' hall .~bmit H' TENNCARE on ~ """'tilly ba.is .. "'C1"M.--by_ ,ne","", "."l> ro.- .""h Group 2 "nd Group 3 ",ember u"li7..in~ the ,bert-ten" NI' .'ay bctltfit. includmg but nul limited '0 the ",,'nc of eaoh Group 2 and Group 3 memheT rec:civing .oort-t.'1I!l NF ",<'Vic". 'he NF in ",-h",h s/hc cum:ntly ":.ide,, ,he do!e of >dmis.ion for ,bert_!em. ' laY,!he rmmoo of days (Or ,hurt· te,,", NF ildy uliliux! Iii< ,hi. admmion, and tbe an!kip",ed dal<.' of <li""h.,.I,'<' back \0 the community. For any memho:.c~c",di"g th~ ninety l'lO)-<by limit "n ,"""-term NF .. ~y. tbe CONTRACrOR ,h.\11 i"clude cxph'l1~ti"" rcga,dinJ!; why the h<mefi, limi' h;u; been =k...J, and ."",ifie actions .ho CO:-lT!t,\CTOR i. t.kong '0 lilcjlita'c di..,hatge III the .",,"'!Unity m t",.,.ititlll to Group l ,.' aWlicablc. including tbe .nticip,Uod ';meline.

6. StctJotl2,7.2.7 .• hall be deleted ~nd rt placrd as rollows,

TIte CONTRACTOR ,h.oll rmvidc Il'ychia tric rch.b ,litan~n =~ice, in ",,"otd:!hC~ with tbe requ;,..,ments;o Att.achment I. Ai <i<""i!,ed in AtlSt:hmOfl,I. the co'·e.-cilitot;on are p'Y"h.ooo<i.1 rd .. bilitatitm, ,uPP"rte<! empio)mcnt, peer ",co\'cry ...... ice., fam,ly ,upport "",,"icc .. ,II""" ","nagemen' lUId ,ccmwy. ODd . upported boustn~. An ;ndividual mly =eiye """ or more of !lies.. "' .... ;.,c. and ma.y r<;>;ei,'c dilT.",m oerv;"<. from different providen.

7. Sectioll 2.7.4.2. I . kall be ddet ~d a"d replaced as rollow,:

2.7.4.2.1 The Annual Community Ou,reach 1'1111 ,h.oll bi: " 'ritlCD in • .,<:OTd!tnce with ~uidahCe prepared by TENNCARE. It ,hall include, !rut i. not limitro to: .11 proposed connnwtitylbctlth education e".,1Ik 'dated to fENNdcrCarn; an rmp'"",d communityihe.lth <!Iil>Cl.tiofl even .. unrelated 10 TENNdc:,c.rc; ond a .)~em :lP(>l'\}vOO by TENNCARE for MI only dooUlllOotinB ond evaluating their n""," !Vi!lliD !hiuy (3(l) day" of occurrence, bu. al'" repottinS on thoi, .wIUdt;"". in ,ho TENNdL..-c,udEPSDT Quarterly Report •. An Annual Evaluation of the Pion 'holl be due no lalcr than ninct)' (90) days foI1owinil tho:: end of a c.londa, yeo< in a form .. approved h:r TENNCARE. TWo evaluation m"", ihCIlIde an appraisal of tho objec'!>'es in the Plan ond iIII u= .. ocnt of ,he .venll condllC!<''"Il in the previou, year in. fonnat apP""'e<! by TENNCARE.

8. Section 2,7.6.2. t(U ~haU be d~leted atld replaced a1 follolO"I:

2.7.6.2.1Il.2 Th<: CONTRACTOR wll p"rt,eip.te in a milUlnum of the (S) interagency oct,,·ili." with "'pr .. cnlat1."" from """e .",,,,,ieo '" oommunity-b.sod organiz.,ioo. 1"'" qu.rn..,.. to d'l>et """",te tOOn no """,,ce. ovailable through rcs or to tlevelop OIIIrt:ach and cdtrco",,,,,,l imlialiv ... All of 1110: agencies engage<! wll be tl>ose ... 1111 serve Tennel'" enroll.", Woo or<: .t rio\; of OCS CIl-'tndy or h~v< 'peda l he.l!bca", "",,<10.

,

"",,,pdment 13 {runt)

9. Seotion l.8.2.1 shall b~ amended by II.ddinll II. new Section V~.2.1.I ,.. folio. ... and reoumbcrillg the u htwg Sectioll!l accordlllgly.

2Xl. l I TlIe COSTRACI OR ,h.n moo"" ,."",,,,,,bk< attorn .. " 10 ... .,.. nlcml:>or". health ri.k u'ili~inll the apptapriat<> cO<nl1l(ln HRA ;fppnwcd by the Bure.u .",1 Po .... l.ti"" H •• hh . toff. The ioli,.,,,,,[ioo <x>lIc"Clc-J ITnm the5e mini ... esson.llI, will be us"" to align iodividual ""'lObe ... with 'J>Propri"[e inlcr>'rntlQll >pp...,,,d,,, •• nd muimiu the ;mpo" ()f the "'-"";cc. provided.

10. Tile ~number.d SCi.'tioR 2.8.2.1.3.1 . ball "" deleted and replacrd lOS rollo, ... :

2.11.1. 1.3.1 All mcmbets identified. .. Le"d 1. tI1roujlh predio:.o.b'.., uK.>dcling. ... d ll<Jt pregnant are cligiblc f<>r ,he liealth Ri.k MaN.~""",m r"'llram. A, a minimum, Ih< CONrRACTOR >han crtroll m.",be .. l1.'j,h cluonic di:\ea.~ thai • .., ptevalem io ~ . iWlir.""nt oumber of memhcl3, nO' memhcr, with other chn:m~ di ... ,"" "'il"jog . i!"",t'cant ""alth "'''>Il'''''' in th~it "'gional flO!",I",,,,,,,.

II, The reoumbered & ollon 2.1U.1.3 shall bft amcnckd by addillJt ~ new So.Hon 1.8.2.1.3.3 ali follows:

1.8.2 , \.3,3 Tile CONTRACTOR shall pi""" ~II Icvd 2 mcmben who "",mot he. """tocted by the procell ",fereDClld in Scctioo 2,&.4 .1.2 ofthi. COOIl'llCl. 0< choo& 00l to enroll in • 1e,..,1 2 pWlI"'m, in u,d I pI'<>!!f'Im.,

12. T h.~ r eonmbered S~ctiOOl 2.8,2.1.4 .h.~ll be dcll'foo ud rephlced,,~ rnuo,":

2_8,2_1.4 l.e~.II M"",bers eligible to panicipal" at lbi. Lcvd .hall be d.:t~ntlined by predi"ti~e modelinll identifying the I<>p throe percent (J%) of members, e"cluding level 2 maternity meml:><m.. to be mosI 01 risk for """ ..... he.lth OUI"""",". Ind/or by ",f~rrnJ. or h •• l,h risk

"""'$II""'''. 13. Sectioll 2,8.4.6.1 .baU be amended by deleting ond rcplad"ll the rofcronce to ~S""tion

1.8.4.5.1 ~ wilh "Seoti(>n 2.8.4.S,2~.

14. I;""tioo 2.8.11.5 .ball be deleted and rcpl..ced as foUUln:

2.8.1 1.5 The CONTRACTOR ,hall submit. tIu-ougb the cu=ni .""un: >y,tem, a liit in Comma Sq>;tmed Value (CSV) forma, consi. ting of the nome. !D, DOfI .• [.-a"fie>liM or.11 ri_<Ii: i".ell and the """"'p<lI'KiinS d.t .. of cli~ib,lity for .be level and p!'OR'lm a"igllmonl, tOr 011 MCO members.

IS, Section 2.11.12 shall IIf dclctro ~",J npla~ed ,n Fun",,'",

H.l2_1 A. appmpri.lo>. the CONTRAcrOR', P"fl\llujoo !-loallh. staff "".11 portk'pate in a coll.bo.-.li", MCorr~nnCue ",orlevroup 10 evol .... te tho common w.nda,d new enro)Jc~ ",....."mcnll.nd odd", .. i"""v .. iv~ w.ys to improve mc~nbe, compleli<ln ",t.o.

,

Ame..dm<;n.3.l (cont.)

2,KI2.2 The CONTRACTOR shan C~ndUCI ~I ~ .. <I t\O,." rnpld cyd~ ,rnpro,'orncnl 1""10C" .nnually. One rapid oyclo irnpro\ctnCnt proj",,\ .~n ~ddr= i"""" ... ing member cng~gcmeftt ro,c, in lhe High Iti.k opt in b'd "r Popul.t;on He.lth program.. rbe .ec<md Dpid cycle CIlgai1C"",n. project <hall ..ddt<..." c"1lj!.O.g,ng fficml>c ... to make heha"","""l cilanl!O" "",,11 .. weit:!U k",. or ,moling " ..... 'i"". The project pl""" .f< to be (cpo""d in tbe quortorly repo" bero~ impk~nenl.tion. The proj<oct, .ho\l ld tb<n be ooud\lo'cd with tho ",suit:! to be rep<><tod ;n tbe ",''' Pop<Ilaticm He.llh Qwnerl)' R~""POI1.

16. Sections 2.9.5 tbrough 2.9.5.& sbull be ,",let"" Kud roplHrd with "l.dl Blank [nlcnlionally~

17. Sc~Ii<HI 2.9.6.2..1-.1 'hall .... deleted and repta«'d.u r"I1" .. ·~:

2.<).6.2.4.1 for members ""roll.d in CHOICES Gtotq> 1. WM Me. up<ltl CHOICES enroilmont, receiving n ..... in~ fll\Oilily >Cnme., tho:> CONTRACTOR ,hall rei'ni:>urK.uch =vic .. in acc<lfliance "'ith m." ",,'cl of rcim~m"m t,,, nu",ing faeiln), ""rvic ... (Le.ell 0' L:~<:I II) "!'P«,.,.t:d by TENNCARE (""" ~t;"" 2.14. 1.15). o~cepl lro. the CONTRACTOR ""'y reimburse, f""iuly .t Ihe Levct I pcr diem no!e when 'UGh rate i, b,11ed by the facility and there is an approved LOC digib;lity .egment for 'LOCh 1"".1 nf rc;mt>u""''''''tll. Ite,m!>w.....",.,nt fur slIeh ",,,,icc, >h..U be from t"" CUm:lIl p<lwider as of tbe df""ri~e dOle of CHOICES enrollment. The CONTRACTOR , hall not move m.mbc:r~ .nrolled in C! IOICES Group 1 WM ore. "P"" CHOICES "","oIIt""n\. rce.i~jni n"nin, f~lit~ :servke •• to a.Mbcr r"",lay "nle .. , (I) tb¢ lnemoor or h;s!Mr 'opr=m.ri"" "l"'eiflc.lly requesto 10 n"'....,. which ,h.lI be oo.:u""'1!Icd in Ihe member', fi!~; (2) the nl<."11l00, or hi",hc, rept='tl!OI;ve pro'-ides ",riu"" C(l!W:O">' to mo'lt Msed on qualify or O!h<:r COII<=< , ... cd by the CONTRACTOR, "hiob ,holl not include the nursina: fac~lity', ,"I~ "f ",imburKmem; ".. (3) th~ facili!y wtlm: the member if ""iding ,. not • <:tint"",,! provider. If the noning r""ilily i. a "",,-contract provider. the CONTRACTOR .mall (a) provide "OIlllnUlOlion of!oo ... " . .,.," pcndinW .mlJ~m"'" or the r""ility ... contract provider (except a facility excluded for. 2-ye .. period wben tlx: facility h •• witl'Mlrawn from M<X&aid p.1rtiei""tioo); (b) provide coolinua!;on of the ,orl"ices p<ndini facilitation of tlld membet. transit"", to. c",,1fact r""i!ily. subject 10 lhe member', agn:emenl with ,uch Ir.n,il;""; or (e) ,nay !,untin"" 10 uimOOric ..".le", lrom the """ .... "00(,""( ,mrsinS facility in ""coni.,.,,, w;,h T""ne.,.. ",Ie. and regulau""".

18. Se~tion 2.9,6.2.4.4 and 2.9.6.1.4.5 ,lIall ~ deleted and replated IS follows:

2,9.6.2.4.4

2.9.6.2.4.5

1'", J>I.tIllO= of \l!e CHOICES I""gram. m." CONTRACTOR moy deei<le ",hetbtr it will ;,,"" ,erv;"" auloorilatioos for "ursini ro,,;!ity =vic .. , or ... ""ther il will in~ process clai"'" fur s""h .crvic<:. In acc<>r<L>nce with the k:\'e! of CI,.. (i.e., reim~nent, in<:1uding the d",,,ioo of such 1"",,1 of reimbursement) .pproved by TENNCARE (.~ Section 2.14.1.1.1). "~ecpt tha! tho: CONTRACTOR m.y reimburse, fllcilily .! the Level r per diem ra'e ""hen such ,ale is hmed by the facility .nd tt..: .. i. an 'ppro"ed LOC eligibility segment ,"<tr o""h level af",ilnbunemenl.

For CHOICES m"",ben approved by TENNCAItE lOr Level l! ,oiml>uroemmt of nursing facility sqvice., tile: CONTRACTOR .h~11 I:>e responsible for monitoring lhc m"",I:>er·. <<mtinued neOO for Medicaid ,oimburs.d .kiUod ""d.-or rehabijitation scrvi<"l, promptly noIifyinl\ TENNCARE when ,a:h 'kined at>dior ,eh.obijjtati~e "",,",cs.re no

,

Amendment 33 (COni.)

IGn8"' mOO..::aily """"''''''Y. :u1<l lb. tho: .u""ni .. ,,,,, uf mfGnn.uo" """ded by TENNCARE to reoval\lllic (be tnem""" Icvd of care (i.e" ,.oimbw:scmenl) to, n",..in!! r""tltly ,e",h .. (."" .1 ... S""ti"" 2.1 ~.1.15).

II). SC<llo,~'i 2.9.6.2 .5.1. 2.9. 6.2.5.2, 2.9.6.2.5.3, a nd ! .9.6.2oS. 1 0 shall be dcl .1~d ~nd r~placed lIS foll,,"·.,

2,9 ,6.2.5.1

2.9,62.U

2.9,6,2.5.J

2.96.2.HO

For mcmbc ... enrolled ttl CHOICIlS Group 2 who ore. up.-.n CHOICES ."rollmenl. ~ivin.ll "",nmunily·b...,d "",identi.l ~1t<:t"'live ",tv;"", thai ~rc "overed in CHOICES. lho: CONTRACTOR ,h.ll, immedi .. tly upon OOli"" of tile membe,', on,<>lltn£nt ,n CIIOI,ES, ~~!horize . u.:h '''''"~''' lmtn 'hc eurr.m pmvid<::r ... of (he etfu:livr dal~ of ClIOI,ES .nrollm<:nI. The CONTRACrOR dian nol Ir"""lion metnoors cnrolle<.! in CIlOICES Groop 1 ... '110 are. IlfK'!1 CHOICeS OIlfol1",ell1. n,.",ivmg :=vi"", in a commun'ry-ha.e<! residential ,jlem>li,.., «Ibng to "rIOtl><:, f""ility \lllI<u; (I) the men,be, (II" h,"""c, "'p"' • .,m .. tivc 'p"dtieally '"<",,,I, to ""WlI., which ,hall be do:><:"'''''nlw in lhe "",onll<',', file; (1) the memher '" hi>.<'!u...- n'p''''''''lOtiv~ pro"ideI; .. rinen eousent 10 ,nove t>a .. d 00 'Iuality or OIl,.". "' ..... "m. rai...-d hy tl><: CONHtACHlR; 0< (3) Ill(: facility where too ",em!>o, i, ""i~i!t\O i. nOl.. contn&ct pro"jder; iftb<: facility "' .. """·COOlT·.u:l

pro,'Kkr. the CONTRACTOR lhall .utll<lti~e rtt<:di<:. !ly "CC"'''''ry """ico. frum tbe ""nennlr""l proVlokr tUr ~l 1 .. ,1 thirty (JO) day. which ""'II be ""Iended os ncce,,<ary to ~"'ute c'll:ntlnuily of c.", pendini the facility', c"tlrollmcnl with !he CONTRACTOR or the mc-tnber'. lranlilloo to a coni,,,,,! provider.

For m<:mb.. .... in CHUICES Group 2 who up.-.n Cli01CES enrallment ore recei"ing .ervi<:e. in " ",-""mullily."""d residential ~ltcmalive .ellinll. wilhin len nO) businc .. doy. of "",;.,., of !he member', enrollment i~ C1101CES the ca", ooonliualor 'hall oond""t. fioc.·IO·f""o vi.il wilh lbe m"","'-"', rorr"nn a comjXohenliive needI ...... ment ( .... S""lioo 1.9.6.5), de\'e!np & J>I.n of ,,= ($OI! Section 2.9.6.6). and . U!horize and initiare addilional CH01CES HeaS specified in the plan of ""'" (i.e ..... io!i"e t""htl<lkliY) ..

Tile con: coordinator ,h.lI. for al! OIher CHOICES m"",ben in Omupo 2 . nd 3 not ' peeified in 1.9.6,1-5, 1 _ 1,Q,6.2.5.2 aho".o, within Ito (10) b.,.inc" day> or notice of the: mcmb....,-'. <,,-ml1ment in CHOICES, coodUCI 3 fo.ce.-to·fa<e "lOil ... ah the member. perform a comp,coonsive needs "","""molll (." Section 2.9.6.5), de~elop a plan of ea", (<ee S.",i"" 2.9.6.6), ond authori,e ilItd initiate CHOICES lIeBS.

A. pM! of the ~e-tD-f",,~ vi. il for member. iu CHOICES Group 2 ()I" Group 3. Ihe ca", "O"rdirulrn- ,hall "",iew, and ",vise .. noce .... 'y. lhe member', ti.~ ."".smcnt. ond dovel"" a ri.k .greo,ncn~ which . hall document idemified rioks 10 the member, Iho C<>IIS<:<juetlCeS of 'L>Ch ri,,,,", «",tciOn to mitig.OIe the idemilie<.! ri.to, and the member', decision "'garding his/ne' >CO"pta"". of risk. 'The risl agro.ment 'hall be signed . ,><1 daled by tM member ""d ;hill . 1ro be siW"'d by the oore coordinator. anestin<ctMt sueh riili and . (, .. reg;e. h.ve been disc""ed w;th the member or hi.,'he, ,epresootali"" prior to tileir dec;'i"" I<> """<pi . och n.l.

26. SecfiUD 2.9.6.3.9 \ hall be ~meDdcd by ddetiDg a Dd replacln~ Ihe r . rerCnCfI5l0 ~ DIlS~ ",ifh "TENNCAREM

•

Amertdmem H (coni)

2 1. Secl i\lRS 2.9.6.3.10.1 , 2.9.6.3 .2(1.2 , a nd 2.9 .6_'.20.3 ~haU "" deleled a nd re placed ~. foIJo.,..J:

2.9.6.3.20.1 For J"lll'<""1 \If (lie CIOfCES (lfO~ .. m. ocTVic-c authorinlio:>n1 for CHOICF.S HCSS .h .. 11 include tile .unoon~ frequency. _tid dunh"'" "f """h sc .... i<:e tu be p«J~ided. and the ",r.:dule .t which .""h co", i. nc't,ded. os ~i'Plicab"': and "It..,r rd",..,n, int<xm.ttitm a0 duf .. tion ~flim" for which CIlOlCES IlCIlS will "" aulbooved. How""". ,ho CONTRACTOR .hilll be ":<I""'.ihlc for monitoring its '"lhori7"'t;'"", and [(It' .n,urinil th~t !here ore no gop< in .uthoo'iz.tio'" for CHOICES HeRS in ""e<>nl"""e with the plan uf can:. Tho; CONTRACTOR .h.1l further be ..... poruible for ." ... ",ing that .. ",icc aulhori.at;mlll a1l.' cO"'"'tent with the plan of ""re, i""ludin~ thc «hedule.t wllieh "" .... ic .. = ""o:dcd and ' 1lJ updot<:> to tbe plan "I' cot<: md,IOT schedule. and ""'''cpt in the followinK eil"U1"'l • ...,~, [or notifying pruyi ... ", in a<iv"""e wi .. " a """'ice authori?",,,,,,, (including a ""bedu"') will be ChOIlgcl. Rctroaot;"e entry or adjustment, in .., .... lCO authori>Ol!i" .. (<)f CHOICES HeBS .h<luld be m.de only when «quire<! III """ommodlltc payment of """,;';os th.t had b«n .ut""dtt<! Dtit an adju",,,,.nt .... the schedule of .,,, .. icos WI. required but:d 011 the ",.,mhe,·, ",:cd>.

2.9.6.3.20.2 NOIwithstanding tbe addteo, ""til", pbon~ number in !be 1134 file, for purrmcs of Ihe EVV 'y,t"'" (..,e Section 2.9.6.12.5.), the CONTRACTOR dt.ll use the member', addn: .. or pbone number '" appropri'k: .Itcmlllive plum<! number .. c,,"finnod Juting the intake vi.it (~ Sec\ioo 2.9.6.3.9.1 . tId updated (a. applicable) during 'Ubo"'lUCl1l can:: coordinatioo emu""l. (""" Socii"" ~.9.(,,9.2.U), tbtooi\! lOVV alert munitoring ()C

00.:, member Ct>ll:\ltC!:$ for aU !lCSS Ihal will be louo:<! into the EVV .yotom.

2,9.6.3.20..3 Tbe CONTR,\CTOR may uecid. "heti><.'1' it will iss"" """,ioe autboriz .. non, for nuning fa6lity ....... iC« .... I'Ibdher it will insread process ei;umo fo-r . uch .erv~. in ""co-rda1\C~ with the I""d of "arc "OO.'or reimbursement (jll..-luding the dural;on of ouch l,...,ei of cot<: oad.'or reimbone,,""'t) .pproved by TFNNCARE (= S..,tioll 2.14.1. (5). ~.¢cpt that ,he CONTRAcroR m.y reimbut5<e a facility al tb<: Levell pe:r di"", rate when . och n* i, billed by tho facility and there i. an .pprovt,d tOC oligibility "gmeJlt for .uch 1e",,1 or reimbursement. !f lhe CONTRACTOR dect. to authori,e nuning facility",,,,",,,,,, the CONTRACTOR may <klt:'rm;"" the: duratioo of lime roc whi(;h nursing fa",lity """"ie" will he 'Ylhorized. However. (I", CONl'RA(."TOR .hall be tt.'SpOI1sible for m()l)ilonng it. authorizatiool .nd for ""'Ufinll lhal: lhen:: ate no j!>!", in .uthoriutio,", fnr- CHOICES nuning facility 50 .... """ in 'cC<)fda"". with !be level of clOrC . nd!nr- ttimb"""""""t approvtld by TENNCARF. R"ln>a~1ive entry or JOtijlJStmats in ...... icc "uthoril2uOOS for nutiinll fucililY oervic..,. should be mode <JIlly upon not,r",ation of .-.fro.OCti.-e cnrollment imo (It' disenroll"",nl from CHOICES Group la or II> via the ""thound 834 file (rom

TENNCARE.

zz. Secti",n 2.9.6.5. 1.1 . ban be am~Ddcd by I dding t be word, " overall Wellll~'5~ aJ folloln:

H.6.5.U A. "",t of the r..,e-IO-facc intoke vi,;t ('If current mmIlEcrJ or r..,e·!<>-f..,. visit wi,h "",W members in CHOICES Group I. ~I applicable, a ca .. c roordinatOl' .hall cooo"'t any""" ... ""..,..""",1 deemed ""C""II)' by lhe CONTRACTOR. ",inH a tool prj'" appro;ed by TFNNCARE ond iII accordance .... 'ill> prolocots s.p<ICifoed by TENNCARE. Tbi, ....... menl m:oy include idenliflCatioo of wi"Ied ,tr.IeIl;';' ttlated to improvlnll ov=lI .... elln" ... he:llth. rtEIlctionai, or quality of life ouleomes (q: .. related to Population Health or pb.rrn""y tnan.lgern.m) '" to ;""re",ing and/or m.imaininll functional .b,jili"".

,

,ncbl,/lnlJ ocrvtces """en:<! by (he COSTRACTOR Ihlt a", br:).1)nd tIw: !\COP" of !he IIU"I'"1 focilily lel"\"ices """"fit. "The ca", OOOfd inaror shaU CII'"'" CO(l«lin:uiUl! of the "",m!).:" pohy.ical hcob!\. bchn."..1 hca!lh. >nd Io"M·lmn c~ """d. _rid .h~ I1 .,.., .. O!

Ico.,( """,,1Jy the ""'mb.. .... P"!",u,.1 for.ln in~ in Ifo""l"'" to !he eornmllll!ty. For children under (('" oge of 21 'II Run'lIII r""Hit;.,... thi< sholl incl"'" c~p!;l",;1I1oo to Ih~ ,,,,,,,,bet ." Itj. pan;nI. '" ' "Ibonlcd tq>tnCN'("·c. as "",(;"able, of benefi .. "",iloble 1"'"_ Ml EPSm-. ;".~"",ntI ~Iy necn.a.y b ..... d ... ouch '"' t._ t.:.llh Of

".-"-s", d.uy n .... n' ~ ""'r he ...... -ided ito !he cum""",,'y ... III ~h<mali' .. '" mn .... f.a<;dny CMC.".

H . Sectio .. 2.9.6.5. : .2 \haJt ~ deleted and replact<! as fo-llo ... ', :

2.9.6.5.2.1 At a mmu""," . for mcmbo.. .... in CHOICES Group 1 and 1. t'w ct>tr"lp"'hcn. i,'c n.edo ............ 111 lila!! ....... , (I) !he "ttmbc,·, nvefoU .... 11 ....... incl .... :"lI phy.i<.I. \>c!I;I~,o .. l. funcIlOna!, >nd psyc"""",,ial fIfI<'tlto, .n<! 11\ ..... Iualion of lhe IMmb<:1"·. li".,... .. 11>uJ1h a. 01 re~tc. 10 the member' •• boltl)" III ml1n1.in •• arc .nd hc.>hhy I;.;nl .n~""J"jJ"'M; (2) ,he .........t.ct •• _01 """"",,",0, ,n.;llIdillll un: bo.os ptU\'idcd II)' ",,,,.1)" 1"" ... bIn -.1,'.,.. <Hher Y"'F"cn.. and """.""", an: >en'1oa the """nbet .. curn:nIly .n;elv"'l1 I~ ofpa) .... ). and ........ her lhere i. 811)" ,nlicipe1ed ~;., 11M.' manbt:r., .....t rur ""'h <3n." '" ..... i«t .... lilt .'''~~Ity of _II go", Otf "",led fmen dE .....-, uq;vcr.,.. PO)"'r. and (l l ,t.: ph~ .ia l "".Im. !><I.v",",1 hQ.hh. """ Ioog.tam e ..... ocrvkn oM OIhor .n,,,.t IUppnr! OUV..,a ll1d ... iOlmce (c .... ho,,,lue .,... 'rt«:>me ' .... ,_C) Ih •• • '" needed. u al'l'l;e..b le. til """m, tW member', ""'llh .... fety and w.ture Ln tho oomm<mity an.! '0 dcl.oy Of pn:V~OI tbe .,.,.,><1 r .... l""lilulioo;;o( plac""","!.

14, Sectio .. 2.9.6.5.2,", i ll.1I be .... ~.drd by addilllt I IItW Section 1.9.6.5.!.-I.1 :Ill r ... lk>>l1:

2.9.6S.2." . I . "01" CHOICES GroupJ ~ w'-cc'-&c inneedo muI' in' ...... ition ... 0..,...1, I"" CQNTRACTOII. oMll mjllCSO !he nnsilion by subrnin'ftJ. PAE ... n:NNCA~ ..... """" rcceivine .PI'fflY&l f« IbIo IIWJI ..... •• cnroIlmcM ,nlo <.itt"", 1, eutn dIU ... y nn; K"n';.,q.) opeciflCd in II><: plaa nr can: ..., ;~i! ..... ed '"";thin c.". (S) b ... , ...... d.1ys. ""C<'f" ... hal .uch tcfV"'«,.) may be initiated only tipI>O «lfZIIIklIon or I n M~'rw ... n .... pena;nina to at>Oth .. servi<:c luch m.t ><!valle<' n<>Iiao j. n:quin:d. In .uch C"". t!\l: new Klilioe(s) .boll be inilialed upO<t e,I'''. ';'''' of the 04v."~e noliec period (It upon fd<>luli.on ohny li",...l)" lik:d ~pp<.l ",quirin~ "",,110,",1101\ of lh~ "",;'I;nll bcn< r. I:>_

25. ~trion L9.6.6. I.1 $ball lM: .... caded by addlalC Ibe .. ord, ~0 ...... 11 ,"'c ilae .. , ~ a¥ rollo"-I:

2.9.&.6.1. 1 fnr members in CIiOlCES 0.""" I, dE u"'" .... ·s..- ~iRlIOf m:>y: III my ",,!he pI.vI of c,m, de<dopcd by ''''' " ... ;.., £acilil.)" 1M ... ",ICC dcl;~ ~ or .s...'CIopiI,. • pWl of <;UI.": f ... !be a><mbcI': aQd (2) "'fII'kmcoI. !he "",""in, r"dlity plan of ....... l)C!;<'>ury w,th dE <k'~ ~nd ~npIcrn<nlation of tI'1ICled ..... o.i .. to improV<." <)\..,.. 11 lO'ell".,... he.lth. fuoctoonol, .,.. quality of !ire <>ufco","" (0 B , related lO Populalion 1!~lth.,.. ph.rm""y tnI;""~mo:m) <)I" to ;""reb<: . ndl...- m.in""n functional . biliti ••. A eopy of ;ul)" ' UW""","n", lO Ihe "'nina fl"ilily pi.., of CI ... ond u[ldaee. lO ,uch .uppk:lnem., lh.U be m"'''l.!Iill/ld II)' the CONTRACTOR In tho: member'. CHOlCES

'"

•

"meOldmen! 33 (ronl.)

26. S~ction 2.9.6.6.2.4 , haJi he deleted aDd r t plated a~ fo lio ... , :

Th" plan ur core d<vol.,.,.,.:l foc CHOICES members m Group' 2 .nd J prIor It> inili.lion "rCIiOiCES !lcas ,laU at . minim~m include, ( I) pertinen, <k'lYl<)~flphi" infonn.{''''' regarding ,he member Inchxling (he fn<.'II1btor', current add",,,,, .nd plKl"" nurnbc:r(.), tho: name and «>nlao{ infQrma{ion of =y tc""""n{.{iv~ md. Ii.t or C>Ihct I""on.o authorih:<! by tltc ""'ml>::r {o NVC ac"CIt, to hettltll tare (including IIIf1g.-1cnn "are) re"'-!cd informati(1n and m ""j,t w\{h a"""""",,,,{. planoing. and", trnpI<1IlcnLO{;',n "i"h.:-. ltIl "",.., (including long-term c~'c) I"I:I.t~":: pctfll<tttod by f.m'ly ,,",mbers .00 other c.n:givet1l; (J) home heo.Illl, prj",,", duty nLl"ing, and J,>rlg.t<rm cor<: "en,Ce< ,be m",nbc, WIU =ivo Imm mbef p.o.y", """"-'C:. iru:luding tile poyor of '''''h """"'ceo; (4) home ke.llll >rid privole duty nUr.ling [hal will be .uthori:1.<:tl hy {he COl'ITRACTOR; (~) CIIOICES HCBS ,b.t "m!,., .uthorized hy 'he CO,,'TRACTOR. including the .mounl, froqu.:""y, duration. .1Id ""ope (I.,let ~nd r"""rio,," ro be perfo rmed) of oach """,icc 10 he pro~idod, the schedule at which .uch ""lirc ,. needed. and rloe addr ... or pi"",,, nurnocr{.) {hat will be used to log vi,i,. into the EVV '~."'m . ... applicablo; (6). detailed b..ck.up ploD for situati"", when I"I:galll'ly ..,hedulod IICBS p",..iders "'" una,·.ilah\e or do nat .rrive a • .clIcxIuk:d; the ba.c~-up plan may include poi<! aM unpo.id ,uppor!i and .hallmdudo: rbe .Iaffiet ",,11 {"lepoo"" numbers of PC""'" and agende. {a oont:let md tbe: ....... ia:. provukd by li,ted "",,!;oCto; the CONTRACTOR ",.n ., .... {he adequacy of the bac~'''p plan; .nd (7) for CHOICES Group 2 "'om"""'. me projected '[enne...., """'tilly and annual c<181 of Ilom" beaith .nd priv"~ dUly nuni"" ;o.:"tif>eJ iu (4) abo.·., 000 {he projected tllon!hly and .nm",1 CO$! of CHOICES HCnS .pecifocd in (~) &boYO, ilIld Ii," CHOICES Group 3 """"ben. the I'wjCCted r(l!al co.! of CHOICES liens specified in (~) .b.",,,. excluding Ihe cool of I,Unor h<>me modific.t;.m •.

27. Seo.:lioll 2.9.6.6.2.5.1 s hall be amended by addlnlZ tbe words "over.ul wellneR," ... foil", .. :

2.9.6.6.2.5. 1 D.:s.:riplion of \be membc,'. ovorall well""" •• olJlTClll [>hy.;,.1 and b<:h.aoioral he.ltlt condition. and fun.tiooal slatus (i e,. ""' .. of functional deficit). and the member', phy.ioal. beh.v; ...... 1 and !Unct",,,.1 """d.;

211. Section 2.9.6.6.2.5.6 ~ball bl! amended by adding tbe " 'ord "",cline'''', W IU (01101'0'5:

2.9.6.6.2.5.6 A I""", ... ccnl=d .Utem.,.t!! of ~04!o, objective. 1M desired wcllne ... health, r"""lio",,1 ..,d 'l');Ility or lif~ OUoc"""" Itt tlH: member and bow CflOlCES ~ ... ~ imended to f>olp th. ""m"" ... .. hiC\'£ Irn. ... e go.a!J;;

29. SeClion 2.9.6.6.2.6.4 sball be deleted and replaced as folio"'.:

2.9.6.6.2.6.4 l""tall<"" in .... hi<h • ~mber· • • i~""lu", i. no! =4uin:d Ire limited to: n "ImIber;niti.ted .ct.edule ch.n~ .. 10 ,he POe that do not ~lt", {M level of 5erVtcOS (i.e. llle otllOllllt, durnlion 0< type or 'CIVic",) <lcuilod in the curnm POe for Ihe member; 2) chanil" in the prcwcder "IIwe)' thol will deliver 5erVlces \bat do 001 alter !he levd of ....... i< .. (i,e. tlt<:: amoun!, dmation or type of~) deuilcd in the current POC fer the mom""r; ~ve,-, .n l<;hcdulc chlulgl:$" must be mem!>er·initi.le<I; J) chanll"' ilt. the member'. =1 addn: .. oud p!K>nt> numba(.) or th~ ~ numbell,o) th.t will be ""ed to log "i,;ts into the EVV .ysteJJl;") Ill .. end of a member', pmicir>riO!l in MFP i! the

•

Amoodmoot H (00)>1.)

conolu,"''' o( hi~ 3M·day parti<;ipohO<! period; or 5) inst,,, .. ,," .. permi tted pursuant to Tome...., polic;.;. .n<! pr"'ocQT., Documentation or . uch change. !hall be maintaiocd in the member", rc'Cofd,.

30. Se<:!IOn8 2.9.6.6.2 .8 aDd l.9.6.6.2.3.1 . baJl b-e deleted and replated a! foUo"'! :

1.~,6,6.2,~ Within Ii,. (5) bu,;"",. dJ.ys of coml'leting a .... " .. ,me,1I ur. member', need,. the mcml>er' . c~'" <oor<iinalor .holl uj><la\e the member' , plan of ""'" .. appropri.tc. ond the CONTRACTOR shall aUlhuril<: ,tid iuili'li: CHOICES HCBS in tho upd>t-:d 1'10" of ca .... cx<<pt ",b<m u>eh • ..-v;":-o(.) may be initiated only upoll ,x>mplctwn or lIII od",~ octiu" '''''h lbot ad',ance !lOll"" i. required, In .".,h ~ .... , IlCBS io the upd"",J plan of core sh;Ui be inili. too "poll expirslion "r llIe ad.'"""" n<)Iicc porioU ll< upon rew1ution of my limely fi led .ppeal requiri08 O<Huinualion u( the c"i'lin~ bend,,, The CONTRACTOR 'hall c""'ply with ""!"'femenl. foo- ,e" .. Occ awiloriT.3tion in Sc<:liO<! 2 . 9.6.2.~.12. cflonge of provide, io Sc<:,;on 2.9.6,2513, ond ""Ike of """ice delay Ln Sedi,,,, 2-'JA2.5.14,

2.9.6.6.2 X 1 Within three (3) tomi""., day. of upd'''inj! the member', plan of c .... tho membe. ', care coordinator/c"", <:<><mlin.~"" toam ""II provide a ""I'Y of.1I rele,'ant ,hang"" t" th~ fEA .• s applicable, and !<> other prov,tlcrs .udlOrired 10 dollv., care 10 the mem"" •. Relevant infont,",i"n ,hali i""lud<: ""y ;or""".tion needed to en,ure the pro,,;<ion of quality care for the member;rnd 10 help <:<>sure ,he member. health ... rely. ond ",elfa",. ;""Iudtn~ btl! 001 limited In ony <:honge. '" the ",.k< and function. to he l"-'1'rormcd.

3 1. Seelkln 2.9.6.6.2.9 'hllll he d eleted and replaced as folio"'.,

2,9.6.6.2.9 The 111<-.... 1>0,'. car. <>:)<')I'd,,,,,t,,, shall iIIlorm each member of nis/her eligibility .tIt! dill<! .ad cdu.,:l\. """"beTS regarding the importance or maimlirung TennC'.re CHOICES eliaibility, tho, ctigib,lily musl be wdct..,,-,jj1cd at least oooe a year. and {hat members reod~i"t CUOICES HCIlS may be cU"laCted by TENNCARE or ill tlc,i!9'<'" to off~r ."'.;"."". wilh tt>o re(\etOOl1inauon pwc:c .. (0 ~" collecting appropriate documentalion and complelirli tbe "",:eO$llI)llo.m.). ",hen .<>eh proc .... ha.,.,. been completed timely and the tnemw i. at ri.k of k,.inll eligibility.

32. Secl;"n 2.9.6.8.26 UraD be ,uuellded by deletillg Ibe phTne ~(e.g., OtiS)".

33. Section 2.9.6.8.26.2 .ball 1>1' deleted a lld replacw as ra llo .. '",

2.9.6,8.26,2 1'1", (."ONTRACTOR . ball. in a monner p"eacribed by TENNCARE notifY: a) TENNCARE of .n NF disohargos ""d eloct;oll! or ho'pie<; .ervicO$ in. NF .nd of all NF dhdurg<o> :rnd l,.".[e", Mlween NF.; ~Jld b) "'ceiving NF. "fall applicable kvcl or c.", iofonnation when I "",mbe, i. tr.truferr,nf; between Nil.,

34, Section 2.9.6.9. 1.1.5 ~haU be am endt d by deleliog Ind r~ plad"ll Ih~ Mrd "J)HS~ "ilh ~TF.NNCARE".

1I"",oomcm n (cont)

35. Section 2.9.6.9. 1.1 , ha ll be amended by addinll a new Section 2.9.6.9.1.1 .7 31 fol1o .... ~ :

2.9.6.9.1.1.7 JJevd"l' f'tot<.>e<>h .00 proces ... for "",e coordin'ID'" to ""o')'l~ .Ild "'ron Q' opproptiale concern< r.ganling NF fJ""jily.

36. Section 2.9.6.9.2.1.5 ~hall be deleted and ~placed a§ (01t0"':

2.',.6.9.2.1.5 [)ocu"",nt and contllm the 'Whc.nf. curren! addrc ... nd "h"n. numher(.) or 'I'I'ropri.t. alternative phone number(.) th.t the mem"","' , """'jcc rrm';dcr will .... 10

k>jj vi,it' into th. EVV 'Yotom.:rnd ... i.llh. "",mb<:< in UpdotinK hi. or her odd"". ,.. ith TENNCIIRE or the Social Security Admini.jntion, if appJicohle.

37. Sedion 2.9.6.'.2. 1.17.2 . haH be dcMed and replat ed as follol'l'5:

2.9.0.9.2.1.11.2 Sig>,itic.nt chong< in health .ndlor functional "OIU'. ;,,,,luding any c!>anlle Ih>ll ",.nlts in the member'~ kvel of ""'" W\d trm.ition het""«m ClIOICES Groups, ".g., tran1ilions (rom Group 2 10 Group 3 o. Gtoup 3 to Group 2;

311. S~tion 2.9.6.9.2.1 sball tfe amended by nddillll a new Se~lilln 2.'.6.11.2.1.18 A. folillwo and rcnumrn.riult Ibe ~lj~ljllg S<.'dillu o«.cordin gly 'nduding any r eferent'" t ber\'to.

2.9.6.9.2.1.18 '11.''''=0. due 10 a chang~ in "i.c~ln.tlnCc',. membe. is approved rot tramit;"" from Group 2 10 Grcmp 3 nt front Group 3 to Grotip 2. wilhin fi", (S) " ... in"". daY' nf ""hO<Juled initiatioo of"" .. or n><XIificd CHOICES HCaS in !I", updated 1'("" of care, the """"be,', care coordinator/care coordination team ,hall <om"'" membc .. in C!lOICES GrotIp< 2 and 3 10 ",,,,firm that new '" modified "'f>'icc:i are b<:i~ provided in ""cordon"" with tt..: plan or earn. and thaI (he member', n"",,11 ll:e being met (.""h initjal conlact may be conducted by phooc:).

39. Setlinn 2.'1.6.11.3.1 shall be amended hy addillg n~'" Sections 2.9.6.'1.3.1.2 and 2.9.6.9.3. 1.7 at folio"" sud renumbering the r emaining Section! .~oordillgly illduding any rd.rence$ (heroio.

2.9.0.9.3. 1.2 Track and monitor all mombers who •• LOC eUWbility bo. on expiration dale md <n.'Ute that a t.oe ",.",,,,, .. ,,Oll\ (i.e., P Ali) i. <;orTlpleted and sutnnmed to TENNCARE . 1 Je .. t eight (S) business days prior 10 expirati"" of the member's "u",,,,1 LOC cliWbiHty .. gmen~ tncludin& .11 tequirtd ,upporting documomalioo ""oded to appmprilwly determine the member's LOC eligibility going f<><Ward.

2.9.6.9.3.1.7 A •• ist men""' .. in e't.hli' l"n~ ".u .chiO'·i "~ pc."" .. 1 weill,.... gools.

A",endmom 33 (oont.)

40. Th~ .... nnmbol .... d Section 2.9.6.9.3.1.\ I shlill be dele!rd and replaced H~ rouow"

2.96.9.3. L II When lbe COl<lTRACTOR .. ~llit.l1ing a memba"', admi .. ion to • nursing facility, e= !hoi aIll'ASRR requireme"" have I>t:en mel prior 10 lhe member', .<.hnl .. io:.m II> a "ur,ing fa~ililY. i!)Cludinj! a PASRR le\'ells",ooninl! ."da. ,pplinble. ~ 10",1 j[ I'''SRR "".tluation, wbctJ>er Ih. IK:J"tClling i. complelO<! by th. n .... in~ f""ili!y. lho C'ONTRACroR. or .""'her entity.

2.9.6.9J.I.I1.1 The CONTRAeroR. .h.1I """rdm;!!. with lhe nllfiins facility to help ¢r1.>ur~ thai ourun< mformation regordini:!lIt member', menUI health or in.,]leclual di,abili!,os noedli (0$ a"~itable) i, refle"ted in the I',\SRR screening in 0Nlcr to ""ppori "" al'P"'Pfi.te P ASRR determiruuiOll.

41. Sectron 2.9.6.9.-'.3.5 .hall ~ ~..,~aded by adding a lIew Sectioo 2.9.6.9.".3.5. I n. foil", .. ;

2,9.6.9.4.3.5.1 When ~ membtr i. ~pprovod for 1"'Milion from GrollI' 2 ,n Gr""l' 3 or frotn Om"p 1 to GrollI' 2. wilhin fh'e (~) !>wine .. .JaY' of ",,~ul"d ini!i.,i"" ,,[ U'" {If modified CHOICES /ICBS in the upd:ucd plan of 01"', the ltI<.'tI\bc:t', care <:oordinatOflcl'" C<lOl"dinalion ",am ,haIl contacl members in CHOICES "mllj>l 2 ",d j (0 ""nilml thO! n<."W or mrxii!,,,cl oen.-i<;"" I", being provided;n ~e with ,he pi"" of CA ... , "lid that III< mOlIlber'.nc:.d. ore being met (.uch ;nili"", "ootltC' may be conduc(.,d by phone).

42. Sc~!lon 2.9.6.9.4.3.9 .ball be amended by ddel~d tbe phnnc "Dr Group 3" so that tbe amended Sectl<>O ['('ads as fo(lows:

2.9,6.9.4.3.9 Member. in CHOICES Group 1: parridp>ling in MFP . h.lI. Ii.". 31 lcaslIhe firsl11;""!), (90) day> !"I"'willi Ir.",itioo.lo tho community, be vis.ited ln lhoir residcnco reclO-lo-lice by their c~'" coordinuo>r a t lou, monthly wi'h "" ;n,,,,,,,,1 of al le.SI f<>W1een (14) do.ys bet ... ocn C(Jlltocto 10 en,u", th .. ,he pIon Qf c~n: i . hein~ followoo. thai the ploo or can: oonlin"" to moot the member', <lCcd., lOll the "",,,,ber "" •• u",,,,,.fully transiti",,~d back to ,!"Ie c<)numm.!)'. Thereaft .... I"" !he remaind<r of the member', MFP participation period, minimum cootll<'" sha ll be •• d.""rib«i in 2.9.6.9.4.3.7 ""Ie., IOOre !l1:qut"nt comac'" are required bose<! on the member', nocdli ond ci"''IlllO(.lnee. and .. ,etJecled in the member', plan of Ca",. Of" ba$cd on .. $ignif'lcant choni:"' in ci",umston<es (..,. Sec!i()fll 2.9.6.9.2. U 7, and 2.9.8.4.5) <It ~ .hor!-Ienn n,.,.i1Ig fueili!)' <lay (. "" S.cuom 2.9.8.8.5 md B.ll..S.7).

43. Section 2.9.6.ID.3.3 shall be amended by adding (he phra,e "or Group 3, lIS IIPI'(kHblc~ HI th"elld of the nlrtioJ:,tnt.

2.9.6.10.3.3 If elig,ble CHOICES !ICES .'" <K>I ini,ialed wilbin 'i~ly (60) day. ("Uowing rd"eml to lhe Fr,"" I"" CONTRACTOR sbaU II<llify ,he m",nber Ih.I o!igible CHOICES HCRS mu&1 be inltiated by ~ona-act providen unles.!~ HeBS ~Te n<>t needed on.n OIIll"itlf; basio in ""le, '0 oakly meel the member', n~.d. in the community, in which c...,. the CONTRAerOR oha.lI ",!>mil OOeoml!lltation 10 TENNCAKE to bei!n the proce .. of disenmnmenl from CHOICES Graup 2 or Group 3, I. applicable.

"

~~. Sectiou 2.lI.b.ID.S shall h~ ~mended by addrngll new SeelioD 2.9.6.IO.S.1 ~~ foHows:

1.9.6.lOS1 The member Dr memoc'" ,el""'-"nlative mu;! ,~ajn aUlhurily and re'p<msih;li!y r<>, CO""''''''' diro<tioo.

45. Suli<lu. 2. 1I.1i.1f). 7 !hrOllllh 2.9.10.6. Jj <It:tll he deleted and replaced ft. follows:

2.9.6.10.7

H.6.IOS

29.6.10.9

2.9.6.10.10

2.96.1O.11

I'Urlnemoc", electing '0 participate in oo~swne; dlrection. tnc ",.mber. care roonlinali>r .hal! intcgra(~ II><: member', b..,k·up !'Ian [,,' ooos.umcr-di=tcd ,,,Hi<oro (i<>eluding any ~pda"" ,homo) into lhe memoor', hoek-up piau for so"';c"" I"""ldod by rom,.c! ptovi(le ... o. app1ic~ble •• 00 the member', pl~n of care. T"" .a'e COIlfdimtl<lr 'hall ,eview tho hack-up "lOll ,Jewlop.:d by I"" member (l!' hi$,h.". fOj)l'eSemaTive (n 'Wlic4bl~) for eon~umer directiun 10 delonn;"e lI, !ldeq""oy (0 o.<!dres. I"" member'. ,,<ods. Tho: 0"," """",dmalOf .batl ~.s;.\ the "",nther in impk:",cming .he ~k-l.lp »10" o. ""eded. and ~Il """,itor for 1;lIe.1Id ",;,sed .i,irs ond to c,mITo that the b""k .... 1' plan wo. implemented timely ond that the """UOOt', ncod, iIJ'e tldn!! mel.

For m<:ml>cr> d.:<:ting to p.I'1i<:il"'l" in ""nswne, direction, the member', co", cooroimtlor olWl ,c.o., .... the odcq"'''y of lbe moml""'. b!ICk.up plan for o""""mer di:ectioo on at l.,st on ."".oJ ba,;i. or 0. ll-cque"lly .. ""oded, whk-h ,lI.o.lI ;l\Cloo. any tim" thcf. ore dlan!l<" in 11-.. typo, .moun,. duati"", ""<J!l<' of eligible (IlOICES HCIIS or tnc ",I><:dul" " which 'llCh """"ice; on: """ded. ch.nge. in <on,"mtt· di.-.:ctcd wOlke" (when such worke ... II"" ..,tve ..... haGk_up to o1h<r wort .... ) or changos in the ~' ·.il.biljTy ofp.id or unpaid "'ok-up workers to dc~~er ""od~d c"' •.

1'0< """"""'" <loc!;n!! to p;onkipa!e in cOllSum."r din:ction, the memb • .'J'. "'-'" c<-.iil'tl!or .holl develop and/or updale Ti.~ agreement which 10k", into l>CCQunl the member' . deci$j"" to parti<ipa'e in co" .... mer di=tioo. on<! which i<i<.'ntif"", any addiLion.l risks """""ia. ... 'tl ",ilb Ibe m~m"""'. <1«, .. "" to d;re<:t hiolher ""tv«c •. lhe potenlial conscque""". of . t>I.'h ri,k. 0:\ ... ell .. ""'""u"'" to mitliate the.., ri.k •. 1M ",ember', repre"",,,ative (if applicob!c) oholl p;u1icipa!e in (he <i.k J><eo>"""lt 1""'=. The new or upd. led ri,k agreement. ~II be ,igocd by 'ho membe, (or the member. 'cprooenlative. lIS applicable) and the O&I'e coordi""lor. The CONTRACTOR shall provide. ropy of the 'hk agt .. mont 10 !be mcmberlrcprc:"''''''livc ond!he FEA.

On at! ongoing b .. is, the CONTRACTOR .h.1I .f1Su,e thai ""od. """,enm"",. ."d updales 10 the pion or care occur J'I'I' rcquh'ln<:nt •• pccifi<>d in Stc!io!li 2.9.6.9 of thi. Comnct. n..: care ooonlinllo< .ball en'ure tMI, rv.- membe<s "",tidp",ing;o consume: directIOn, the FEA i. invited to participate: in these meetiJlg3 ao al'l""'Pri'!c:.

Withln We<: (3) bu,i"" •• day. of updl,,;ng tl'" membe,'. ,,!;tn of "",e (se" s..-.;ti"" 2.9.6.6.2.~.I), the member', em: coonii""torIc.", co""din&lioo ICIm .hall provide a ""l'J' of.1I relevont chlllie& 10 the FEA (""" Section 1 9.6.6.2,S, I. of !his ConInlCL),

Amendm.nt 33 (cont)

2.96.11).12

2.96.1lI.0

W ilhin tWO (2) \>,..,,,,,,,. day. ~f =-"dpl of tile n<>lification frOOl lhe FEA indkolini 'hal .11 requ'~nt3 ha"e 1><"" fulfill"d and I&.. uale t~3t lbe """"un.,, di",c1ion c." bogftt 10 • • "":I"her, .be L'ONTRALTOR . hall ibrwfrn! to the FEA an .utt\ori:aLion 1'0' """."m~r Jin:<:l<:d service' for that memb<r. F.a.h atnh(]tiutMn for """,,,,,,.r di=led .. ",ic"::' ,hall i""lude: ""th<>rimd ~""';co, 'ulhorizcd ""il< of """,i.e, indUtling amount, freq.."..,y and dlffilli<J01 ond m. «h<:<1ule al which ",,,,ices ar" n,,.<Ic:d, ,tart and "nd dotes, and "-"";.;. oo<\e(')'

The member. co ... cl>Ol'<!;nlt<>rlcore «l<lrdmalin" learn ""'II wuri< ",iln OIld coon]inale w;!b tbe FEA ;~ ,mplememing """"",ncr d;,-cctton d digiblc CHOICES IICBS {,~. S""t;on 2.9,7.:1.4),

46. Section 2.'},6,11} ""aU be amen.d~d by adding 8 new SodioR 2,9.6.10.14 as fOllows Hnd renumbering Ihe remaining Secllon accordingly, induding ally referonc~, thereto.

2.9,6.111.14 Tho "",m!>er', care ,,,,,,,din.tM , hall ')1(""'''' c:on,um.."t' Ji"'"t;on of c1ig;ble CIiOlCES lienS,

47. Tbe renumbered Srction 2.9.6.1\1.17 ~b~11 be ddeted .. nd replaced ,n follo.n:

2.9.6.10.17 Jf OJ any thne.bw<: or nosl""t i, '""",cttd, In. "",,,,!>cr', care ,,,,,rdino..,, or too FEA ,Iulll report U'>e .Il_go';on. to ttw CONTRACrOR within 24 IIoon in ""conlanc. with tbe CONTRACTOR' , abu"" and ocgleet plan p.-o«><:olo. The notifioa'Km >h.ll i""lude at • minimum, Ihe ""'mher name; date of aUegation roported .w<>r i<kolified: """'ri;>tion of is .... ; mea.""", I.ken to mitikaiC ri'k; ltatus of reponin& I<> CPS <>r APS. os appropri.te. If tile .Ikpt;"n i. in ret .... """ to • wor~"r or rep"'",ntali¥e, the Fl'.A .hall con1 ... , the "",ml>erhepreoent;Uive to imm<.'{jialdy ,-"Ie.",!be work .. or representative from hi,1ber duuC1! Wltil the m¥estigation i, complete. Tile FEA 'holl "",itY the CONTRActOR rejl.rdioa !bit .ommunic,uioo with tho mernbcrlreprniln .. tiv" .nd tho- member or fOI>""OntaUv.·. de<i<ioo. 'fbe COl'. cl>OI'<!imt<>r .hltll ""It w;th ,he member 10 find . new repr<:o<:ntative.nd the FUA ' holl work ",;th the "",mb<>r to fond a .uil.blc r~,tt_ worl;"", if .pplicoble. If the aUegati"". ore .oo.t.mti.tod ... ,e,ult of tM in""'tigation, ,ho: 'l-l".,,,,,wtive or worker 'hltll "" 10"g~ ... 1>c .n"wro to I"'rt",ipate in the CHOICES pro!!T0m .. a "'I"'=ntol"o or w~Iter. If Ill<: invtlltigotion is i"""""lu.sive, the me:mb.:r may elcot tn ",1lI;n ,he w<>rl;or '" reJl",,,,nto.ti¥e. rbe member'. cue coordi ... lor. with a .. ,i.lane" frum tho FEA .. appropriate • .t.all make any update! W tbe member's plan of "ore and/or ri.k as""s.mentlri. k agn:ernenr d.crned nece ... ry to help .... ,,'" the InCmbee's health and •• fety, ~nd $11n1l provide:, at I .... llltllually, education of the member and hiSiher "'I"'C$o"'ative of the risk aI', and .i"" and symptoms of, abuse and ""a:\ect. Tbe CONTRA<",OR m.ty init;"t" ""tion 10 in,olantary di""roll the member from con,umer direclion.1 ""y time tl><: CONTRACTOR re.ls that tho member', deci,;ons or actio". ""n,titulo """,.""""blo ti.k "",II that the member'. I>¢CdII c.n no long ... bo • ..rety on.:! eIT"cti"dy mot in the communily while p:trticip!lting in con<wner directioo.

A"",t>,l"",,,, 33 (COni.)

48. S~<tion 2.9.6.11.18.1 shall be dcl~!~d and replarcd a~ folio"!:

2.9.6.! 1.18, I Tho CHOICES pn'~ra", i""ludi"~ . <Ie ... __ npt;"" of the Cl!OlCES grouP'!; eligibility tOr CHOICES enroll"",,,,; """,lh""n' m CHOICES; """,limen! lori<IO for Groups 2.11<1 3 (exdudinw Interim (,roup 3). including "'<erYC o.p""ny ""d a<imi";'tra,ion of w;unng 1i,1S; and CIIO ICES !>omefi! •• i",fuJing bo:ner;t limill. tM inJi~ido>l emL """Lrality cap for Group 2. and the cx""ndil~'" cap for {i,,,,,p J;

4 9, SeetiuD 2.9.6.12.1 ~hall ~ deJC\~d a nd I"<')llae«l a s follows:

2.9,6.12.1 Notw;lh,!:Indins ,I'e odJress ;n><l/<lr phone nwnbo:r in tn.. 834 tHe. Ihe CONTRACfOR ,'"'II "se the "",,,,\>er's od<Ir<oss Or phD"" number or .ppropriate .ltomotive pho"" numberf .IlIJCBS WI! wilt bo: logacd into!1Ie EYV 'Y'!<[Jl.

50, Seetlnn 2,9.1,1.1 ~ bQn be amended by adding rbe [>Itr~se " iu Group r ((l the ICcond oellfftl« '" follows:

2.9.71 I The CONlRACroR ,11:111 orrer C<>Il.,uno< di=rion of digible CHO!CES HeRS k:> .11 CHOICES Group 2 and 3 members who .N d<:(etmme<J by .. care coordi",,,,,", thr",,~h!he ncod. lISseosmenli""",'cosmenl pn>C""" W nocd .ttend.nt ,",re, penonal <a",. in"born~

""pil<:, rompanion carc """'icc. ~ndiof:my ot",r "",""icc 'i"'\'ificd in 'r"""C..-e rul"" and "'guiotioo •• s aVililable for <omum.,.- di"""i"". (Compon;on c"'" i. only av.il.ble for P""""'" in Gro\lP 2 deering 0011$""""" direction or eliiible CIlOlCES HCBS.) A """ice !hat i. not 'pecified in T'!tnt:.", rule! and regul~tions .. available [or ."",,wner d;rec!ion or !hat .. 001 a CUOfCES HCRS Ohallnol be "0 ... "'''",," directed. C(}IISl)tne, direc!ion;n CHOICES .fTor<h """"bets thd opportunity 10 ,",vo choke 1nd "onlroi o'-or how eligible CHOICES HCBS .ore p!"ovided, wOO provide!; Ibe '0"'00 and how much w ..... ~ers are paid fot provlding '''fe, up to • 'peciftod ,"a.imum amoont cst(!bli.h«I by TENNCARE (s .. SeeliGn 2,9.7.6-11), Mombor p-.lftic;pouoo ;n <"".ume, di,ecitO!! or eligible CIlOICES HeBS il! voluotary. Memben may 01<'01 (u pafljcipalt in Of wllhdro'" from coo.uroe, direction of e1igibj,,: CHOICES HCRS ar any t;m<:, servico by ""fYi«, wilhout ~ff<:<rin~ thcir enrollment in CHOICES. To the ext",,1 p",,,;ble. lhe: member .hal! provide hislhcr <a:r~ coordinator len (10) <lay. odvance ooti"" roKOfding h;"ber imenllO "" 10080< dir<:ct ooe ~r more eIiK ib!. CUOICES tlCBS ..... 10 ",'ithdnw from p0l1iclpouon m C"",Il,mCf" di"",tion of oliiibll: CHOICES tlCBS ent;rely. The CONTRA(.TOR r.h.U rtspnnd to tb..> member', ""lOIn! in kttpin~ wilb the t imefunnct ond !""O"0lli"" oct fonb in thi. &ci.1illn, in 0""" to fxilillte • • """,Iess tran.ition k:> I.wropoi.to ,\\IVied ddivo'Y. T£NNCARE may c. labli.h , ••• on.ble litni!.!;""O on II", I'n.><j"m",y With ""h",b m~mb",,, may opt inro JJId om uf Co,,"um'" dirt"!i",, of oligible CHOICF,S HeliS.

51. The title of Section 2.9.7.1 shall be amended f(I lay "Repr~eDlative ror Con.umer D;fe<tloa ~.

"

Amendmont J3 (~<J£\I)

52. Secliun 2.9.7.2.6 . hall be deleted ~lId replaced .1.I follows:

2.9,7.2.6 A member m.y chll"ll" h; .. hcr rq""'enta,i"" al .oy lim<! The momber .haI! immediot"ly D<)!ify ~l",r '"'''' COOniiMiOJ.tId the fEA when Iio/ohe intonds to <h""S~ "'I"Ou.'T\!aI;~e,. fho care coo .. ,"",,(>( ,tali "efi/), thol the t><w rel"=nt:u;,~ meet. the qll;l.Hficaulln. os "" .. on'hed .bo,,,, A new rep"0""ntativc .gree!Tl<.'T\t .hal! he completod and ,i¥I"'d. in Ihe """"""" of ~ ""'" ooordinator. prior to th. now rcpreoentJlivo "",um;n~ the;r f~pecti,e T""pomibiiilies. The c~rc coonlin.tor ' hon immedi.tdy ""nCy the F[A in wrjlin~ "'hen a !l1¢mber ch.n~"'. h;',her reprc.e!l!.tivc .. 1<1 p"O\o'ide a c'<>P)' of !be rc'pn"",moti'e a~fo.mcnt. The CONTRACTOR shill f.cililllle I ... mk .. tran,inon to 'he new "'ll"""enl~tive. and c,,"ure '''''I th.re ar" no ;nlerrupli"". OJ gapo in ""rvic"". Pc; ""rt ~f lht need ... "".,ncn\ and pion <>f c.", proc •• ,. the care coordinator .hall cduc.te {he mem"", .. about !he importo.nce or ootit)tin~ the c .. ~ coordinator ptior to .:hanginll" repre"""''';''''.

53. Stctions 2.9.7.3.2.1 "lid 2.9.7.3.2.2 shall be deleted an!! r~pl"c~d a.' fon"",,:

2.9.7.3.2 . 1

2.9.7.3.2.2

A .. ign a.upportS I:>mkor to !<lich CHOICES member erecling (Q portic;po.t~ in con...", ... din:ctio" of eli~ ib!e CHOICES llellS. The .uppon. brok.r 'hoa "" fe'l""',;b!e ror .,,,;,,;ng {he n",mbcr "ith en",Ument inlll coo..,,,,,,r dir"",;"o.n<! with the <moUm""t of new wort"",;

Notify til<: member'. care eoo<dill.Otor upon bo.."C<lmini aw". of my .dditional T; , k .. """i.{ed with Ill<: membe" participo!mg io ",m.u""," di ... ::..-tM!ll thaI may """d ill be add"",e<\ in {he n,k .. ..,."""''tIt l nd jJlan of co", pwc='(;.<.

54. S«tilln~ 2.9.7.3.2.9 shall tJ.e deleted and repla~ed as roIJow~:

2.9.7,3.2.9 tkv.:lop and imple""",! • ~S$ {o OUppOr! membe'" Of {ho,.", fCp<'<SeO,",i_ 1n cn.urin~ that comu""" difected workers m.imain in {he member' , home (OJ .ltem,ri"e I"".tion Of

["""'O{ appnlvnd by TENNCARE) <i<J<umonl>!i<)n of service delivery (o <upport pa)1tlcn($ fur oervic •• providod thl'O<l!!h Con$umc'" diroctioo. ~nd peril>dic.Ily m<>nilor .uch do<:u""'!J(~{ioo;

55. Sectinn 2.'J.7.3.1.12 ;hall IJ.e a m ended by addiDll the wo rd ~and~ In Ihe end 01 the

paraguph. Ihe exilltiDg S~tjon 2.9,7.3..2.13 'hall he deleted in it. ootirely and the rcoumlK!rod S(ocliun 2.9.7,3.2.13 sball be deleted and replaced as folkll's. All nference, 'hall be updated IItt6nUngly.

2.9.7.3.1.13 Notify lht COr-<TRACTOR wi!hjn 00 ",oro 1hou twcnl}~fO\ ... (24 ) 1><><11' or ;dcnbn""l000 of critical incidents (~C<: s<ction 2.15.1).

56.. S~clion 2,9.7.3 .. '-1 (hrough 1.9.7.3.3.6 .hall be deleted and r eplaced as fullo ... ;

1.9.7.3.3.1

2.9,7.3,3.1 As needed, as.ist the member andtor rep"'!lentali\'e in locating and rocrniting workers;

Amend",ent H (ront.)

2,<).7.3.3.3

2.9.7.3,3.4

2.9.7.3.3.5

2.9,7.3.3.6

A. needed, assist tile mernl.>cr and/or representative", mte""cw;ng work,," (developing l]uestions. cva lualing respo""",,);

Assi:!t tile m<-'I11i:>cl" and'or representat;\"c in d""'eloping (as part of the onooanl.i"8 p"lCC<~ for neW workers) a schedule fur tbe member" s worl<CI1< that comports with the schedule al which :;.:rvicc. are needed by the memocr n. reflected in the "Ian of care;

As,~isl the mC"Tllbc, aOOlor ro:prescntati\"c U\ managing and monitonng payments to worken; and

A-'<!liSI !he m~lnhcr/"'Pre<comti\"e in ;dC"Tllllicalion an.! training of n~w worko"" as needed.

57. Motion 2.9.7.3.~ sball bt deleted and r!'placed 1lI foUo .. ,:

2.9.7.3.4 The CONTRA{.·TOR·, "~'" CO<'roiruotion functinru; ohall "'" duplico.l<': lhe . _ftl bmkecagc lilncuoll!l ",,'fonned by !he FEA (II" ito .ubcOlltnc'or. A member', C.Ie coo,dinalOl" 011.11 he '.'IX""ible )'" ""mitrninglhe m"",boor'. ",,[Vic.~ throug!J "o,,"'umer diTedi"".

511. Sti:tlon 2.9.7.4.5 and 2.9.7.4.7 ,hall be delekd and rfplactd as follmu:

2.9.7.4.5 lbc: care ,"""""nato< ' han dootcnnin. if the "'ember ""II 'W"'mt • rep",,,,,,,lot;,,,, to .~umo: the cOt\$llIIltt direction fu""ti""" OIl hislher t>dtalf. If d", member 00.. oot intc-nd te appoint I TCprc$Cnt~!i\·e. the c.re coordinator :!!tall determine the exten! 10 which a member requires u<i.taHce II> ponkipalO ;0 <x>ruWlleJ" d'=1i"" of .ligible CHOICES HCaS. bued upoo th. ","ulrs of the member' , resJlOflW' 10 the .. 11: ... """",..,01 instrument developed by TENNCARE. 11>c .. If· .... ~n.nt illO!rlJm<:nt ,h. 1l he completed by the member with ~.i.taru;e from the moml>er·. cue coonJinator ... aj>P<O!Jrill •. 1be car< coordinator ,hall m. the comp!etod ,,,,If .• ,",,,,,,,,,,,,1 in tho member'. iile and prov;de. <:Ojly to lb. FEA.

2,9.7.4,7 Within twe (2) bu,ina.s <Loy:< of 'i8nmg lhc teprc,entative agreement or c<>mp!el><>n of lhe self-...... m<;nt inlllrull":1I1 ,f the II'I<:mber h.a. oot ,>.:. iSnlt.d • "'t'"'",l'Ilat .. v" .nd the can: coocdinuor determines th"t ,hi: m<tllbcr """" not '<!quire a tepr .. ""tativ<: to ,.., .. 1 the memb<:r ill din:<{ing hi5Jber car., thl: CONTRACTOR ohall forw:ard to the FEA • refillI1l1 inilia ting rile: member', parli<:iparion in COMumel' direction of eligible CHOICES HCSS. 'The refum>! sholl include .1. minimum: rhe dale of tho: re[<!mII: the mentller', lWoe, oddres" tdept\Oilt num"""', lind """i.J II<:C'I.Lrity own""'" (SSN); the O>Ut'le of the rep<l':I<:nwhfC and !dep/>orte nmnber (if .wlhble); member', MeO lD number, """"bet·, CHOICES onrolhncnl date; eligible ..,Iooted HCSS. inclOOini amount, frequc:ncy and <Juration or.,....,b by typ<:; and cue coordin"o,', n.me and contact information. TIle CONTRACTOR >ltall .J"" forward to tM ITA • copy of the wr;,ten <:oofll'lll:uloo of tho mcml><". <k<:i,ion 10 partici!"le in consumer direction or eligible CHOICES IleUS, tlu: . igned I'(K', and the rqn.enta!ive agreement, if applicabl •. Referrals shall boo ,ubmilted ekcltonica11y on a daily bui, u>ing the agreed upon <!ala imerface (either •• tandard electronic file tmufer or the fEA', web pornl technoloi)' or both) and procc ... Ref.",,) •• hlll he • .wminod on • tn<:mber-by.memhe, b .. i •.

Amooomon, JJ (0001.)

59. S .. .ti\lll~ 2.9.7.4.10.1, 2.9.7.4.10.4. 2.9.7.4.10.6, 2.9.7.4.10.7, V1.7.4.10.1O. 2.9.7.4.10.11, and 2.9.7.4.10. iJ ~Ilall be deleted " lid replaced as folio,,':

29.7.4.10.1

Z.Q H.lO.4

Tile m<'mooin'P"' ... en'"'i,'e ( .. 'pplicabl<j ,!WI ha"" prim"')' re;punlibili,y r", ,he <!evelopm.n( and implo,,,.nt,lion ~f lhe b.ck-up plan fur ""TIS""",' din:<lcU ",,,,i<,,,,. The PEA sIlall .. ,iSl \he mcmb<."tfrepI't<entalive '" needed in dcvo],,ping and '-eri(yi,l,ll lhe iO;I;.1 ba<:k-up pl." for oon.urmr dirtc!;oo that >dr:qu~,~]y iden,ifie' how Ihe m<'mb<:r{"'p"',ema'i,c will oddrc", .itUllu,Kl. when l ""heduled w",kor;, not a¥ailab!e (}t" fAil. to 'how up~. ""heduk:,L -n.., to.", """,-dinat"" wI! aMi" t/I<: member al needed with ;,nplementmg Ihe b1.ck·up plan :md Jh~1 update .nd verilY !he b3c.·up plan annually and ... <lCed<:d.

All pe",on. andlor """.ni""i"", noted ill the b.c •• up f'l,n for Wn. umcr di",ctioo 'hall 1>0 oonttu:lod by lite memberltcpr<:<en,.'iv~ to deto;rrnine their willi:ngn'",.".;1 ava,labi lhy {o serve .. "'ok.up ,,,,,,,..,U. Fur !he in;,ia! b""k·u!, pl.n. the FEA .h~1l confirm wilh tI",se pen<m •• rJdIor C>rs"ni:ta{iml> their ,.-illingnc .. ond availability 10 provide co",..-Itm nee<kd. 00.:"",,,,,, coolirmroon in the n><:nth<..,.' , tile and ~"",...-d a copy "I' the oc.:umentation 10 Ihe CONTRACTOR. The car" t,,,,rdin:d<>r Ih.oil t-.. "'''pon>ible rur "p,btin~.1Id verifying (he back-up plan "".n OOlgoi"ll blSi •.

1.'U .4. t 0.6 rhe c"", ooonHnat<>r 'hall ."iol (he memb.". ur bislher rcpresenta{;,e t ... applic.ble) in impk:mentiog the bock-up pl." 1M ,on""mer din:ctio~ aI """,dod. monitOl" 10 en""", thol {tie back.up pl." i. implemenled on<! effectively woding 10 meot lhe mom!>cr', needs. :md immcm..,dy add"", a"y .OOC","'" ",i,11 II><: ba"~-"P pl:m or the member', c .. e.

2.9.7.4. I (I, 7 The care coordin.to.- .t..1I ... i,t til<: """"her"" ltiolbcr repI'eKJlI'li,-e (as applicable) i:n rc,iew;0ti:.1Id updating the bock_up plan for con.."".,,- di""";",, al]~'" .nnually.1td os frequently IS """"'sarr . ..-hich .hall inc!<U!c any ti"'" 'ocr<: ...., ch.rng,,-, in the type. ,moonl, duration, oc""" of eligible CIlOICES HCBS or the ICbc:dulc ~I which .""h .. ",icc, are needed. "banges in wooers (when .""h won"" al$o """" ... a batie.up (Q

other won.,,) and changes in lhe ••• ilahility of poid ur unpoid hack.up w"rltt" ta &olivor MCded care. A, part of Ihe annual feyi"w of the back_up plan, the mc-mbe,- or h;"-,her re~.m>live and !lit care coordinalot .b.olJ "onf...." (luI.! each perso" .peci l;ed ill '00 back-up plAn C<lntin"". to be willing and avaHable !O ""ve •• back-up workers 10 ddiv"," needed care.OO ro perf""" (tie ra.~1 .l1li fun"t;"'" loeedt:d by the m"mber. A,,'y updat<:< 1.0 lbe b",,~·up plan for COO5umrr difeOtion wll be pro"idcd to lbe FEA.

2-9.7 A. 10, 10 lM care coordinalor .natl de""lop ","",or updale 'hx ai"'em<:nl which takes into 'COOIInt th¢ "'ember". dec"i,", {o partidp,u.e in con.none. direction, .nd which identifi .. any addition.l risk. as_i.ted with {he onemkr', ",,"i.ion to d;=, hi.,ber ",,"'i< .. , lhe po;.enligl """.<q~ nf .""h "ol •••• wdl os nw.uur<"l to mitigale thcso ,i.n. Tile m.mt>cr/n.'P"'''''''lOlivc ""all panidpotc in the proc .... lhe m<mber". ,epre"''''ative (if .pplicoble) ,bal! !=1icipare in the risk ._ .. "".11 I'f<""'''' The oow Of updated risk 'grecmc:n{ shall be .ipcd by!M memb-a 01" hi,'l'leI" representalive ( •• applicable) and by the care coordinator. Thc COI\"JRACfOR. memb<:rlrepre ... "I0{"·e ond FEA ,11>.11 receive • copy of\he fisk agreement. The CONTRACTOR.rd tbe ~EA .ha.11 eocb t'le. copy of the ri,k .gra:ment in the _",ber'. flI~.

Amc'nd",cntB (COlli.)

2.9.7.4. I O. II The FEA oh.>l1 noufy the membe,·. c~'" c" .. ,dina!..,.. immcdialel~ if t!ley ~ne aw","" of change. In tho> mem!:er', neods .nWo< circum't",,, •• which WlUt";lt\l • t'C3 .... 'm.'" of nee<k and.'"," ri.<k. "'" changel to tbe plot' "r ""r<) Or ,i,k 19tcen><>llt

2.".7.4.10.13 On.n (Klgoing baoi., ~,e CONTRACTOR sbaU ¢M1!re Ihat lI"ods ten"""!!>",,,. ilnd upod;t,,,,, III Ih. plan of care occu, 1'<" ""Iui",men/I ,"""cificd in Sc<tiono 2.9.6.9 of lhi, Contract The care CO<.l!"dinalor 'hali eo,,,,,, ,ilat lho FEA i. invited to partkipate in Ih."" """,ting. o. opproprit.le.

6(1. Serlin", 2 .9.7.~.~ and '! .9.7.~.8 shall b~ dd t led and rcplao:ed a~ follows:

2.9.7.5.5 On. w .... kly bas .. 'he FEA ,11.'1 (( upod;ttt lhe membe,·. con: coordina1or of ,'''' ".'us of .omplcling '~~ui",d funClioo5 neoc.s;uy to initiat" ~"""wnet direcuoo, iooludinll obtaining completed p3perwork from the In<:ml>t"T/f"1,n:""l\ati," and obtaining workers for • • ch i<i<:nuficd """'tim", dir""led se",ke and ony .nt"'ip.'cd timof,""""", by which qualifitld ... o<ken :<hall be "",urcd .Itd Coosumer dire<:t<d ..-rvic,," "...y bcj[i,~

2.9.7-5.8 Upon the: scheduled 0Iaf1 <!ate of """'",,1« direct.d .. rvices, the member', care coordinator.'e"", coord''''li"" team .hall begin rnonitooll,l! I<> ""OW\" !h~t """'K:<'I have been initiated .nd cooli"lI<' to be provided U outhori=:!. Thi. shalJ include ongoing """"loring "ia e]cctronic v"i! ,·.rific.uoo to enSure \h;tt scnioes ate provided in ""oo<daooe Wilh the memb",', pia" of !.-ue. i",,!~di~1! ,he ;unoonl. frequency. duration ond ""ope of ""oh .,""ic<:. in acconJ.ooe wilh ,he member . $<:"'icc s.che<luk Upon tb. i<ltntilkal!Oll of ony 2"l'" in core. 100 member' , care C(XltdiMtoricare coordinalion !eam w ll .s.,,1 the 'l!<)mber or hislher ,eprcscnt;ll;"~ '" rIteded in implemonting Lho member', back·up pi"" for CO"""",,," d,,""t;oll.

6 1. Seffi<>n Z. 9. 7.6. 1. 1 ~bllll be deleted and rl'pla~ed a. follllW5'

2.9.7.6.1.1 A "wrober C;lI>Jl,,1 ",~iv" a background cbeck for. potential worke •. A ~k;:rmmd cbe.:;k moy reveal a poW"ti.] woolcr'. [>lot orhnino.l cooducl lhal may [>01 •• n unacccpuhlc ri.~ to the """"beT. The ["Iklwing li~ may place the member.1 ri.l ond moy result Ln ~ potenl,al wo<l<cr failing"'" b""kifOUnd check. pos.i!>ly dioqualifym2 a PO""'" from ",,,,in~ •• a Wt",kcr:

Atnendm",u]3 (COlli.)

62. Sct:lioll 2.9.1.6.1.2 Ibrougb 2.9.1.6.l.1.!'i ~b"U be dd.l~d alid replaced and Sectloll 2.9.7.6.' ' ha ll 1:>0 .mended hy adding a new Sections 2.9.1.6.1.3, aud 2.9.7.6.1.4 aDd 2.9.7.6.1..J.! ,.. fo llows;

2.').7.6.1.2 fr. potenh,,1 wodo' taib lhe b.e~ruWl<l cba:k. 1M poIemi.! wodcr ""y .-cq""" on individu,di,ed ..... "Olen' 'h>l will be cOlldll"tro by tbe ,,,,,,,,1><,,- wi,h Ihe help Qf lbe FEA. Tbe individualized "' .. "">eni proec .. wi!! hdp determine ",helber lhe potential ... ·ocl.er may be e""luded becouoo of pao.1 crimi",,1 cO<\dUCI. Th. ind lvidualiz.d asoo .. ",,,ot "ill provide the pot~ntial wc:tder wilh "",ice th.t! tlci,h. In, 00.11 >CreC""d 001 bee ..... or crimi",,1 ~"nd""l and provide .n opportllnity for the poIen,il l woner tn explain why Ihe oxclu:rion . t>ould 001 be awlie.l1O hi,il"" ~~rt:unul""",," floe member, with !he .«ist.1ncc ~flh<: FEA wi!! coruidor tbe following f"",,,,,,;

2 .9.7.~ . 1 .2, ! WhO\h¢, or not the evid<n<e iathc:red during the plMcnu.1 wo.-I...-r· , inclividualUcd .,.r.e .. mcnt , Ito)"" that tl!(: crimin.] "onduci i, reblt:d 10 lhe job in . uch. w:ty that """td rtac~ tl>< m.",be< 'Hi, k;

2,9.7.6. 1.1.2 The nature and gravity of the olfense of conduct. sucll as ",hcthcr the offense is rela!ed to physical or !\CXlIal or emotional abuse of aoother person. if lhe offense involvOl; violence again.! anotiu:r pefSlOn or lhe manufacture, ~!e or di.lnbulion

of drugs; and

2,9.7.6,1 .2 .3 The time 1M! ha. pas:.oo since the offense or ooniluct and/or com pletion of the

sentence.

2.9.7.6,1 .3 After considcrinB ,he iooi~idua~>ed aoliCS,mcnl and any otber evide!l<e oubmiltcd by the pott;nli.1 worw. !ho< m"",ber C:m decide not 10 hire the potential wOfIcer or nay rcqu<.t frum TENNCARE on <l<c<plion 10 tlto: Ix,re,ni. 1 worker', po .. ;ble di"lualiftcation.

2.9.7.6.1.4 If. m"",be.- doci<ks to "'quest I n e>'ceplion to the pos. ib!~ di.quahficlttion of th~ potont;;,l wot"k~r. the FEA , hall ... j., tl>< member in comp!etinw !ho exception ~" F""" and submitting; !he pt>I=li~1 .. odOf"' individU.l1i7~d a""",""",ol W TENNCARE. TENN(;AR!:l oIWl TIO¥H:"" !h<: exceplion rcqUC11 """ detenniJ!c wbeillu {It n(>{ the poIen!;oi wot\;",-'. possible .,.,dIHion from Otnploymenl would b<: Jt>b ",I . te<! :md oOllS;olenl wilh busin .... """eo.ily (i. • . lite exclusion dfectively linb """"i f", criminal e<)<tdu<;t.nd its <lange .. with the riskJ inherem in the dulies of a ""rtioulor P""ilion), tho nature and gravity of the erimhul oonduet. on<! the lime tbat h •• p"",,al . irn:e the criminal conduci .nd or tl>< oomple!ion of lhe ""nten<e. and Ih . 1 .pplio~bl" fodent .nd .lilte laws do OO! prohibit the hirilll: of pe<WIl' com'i<1l:IId""t io qu"'tion.

2.9,7.6. 1.4. 1 TENNCARE approved eJ<cep!ionJ 10. pet.mi.1 worker', di. qn;>lir,.,.,lion .hall ,>llly he effo<tive for ~ mv:imuPl of {}n(l (I) )'t"tr from the .pproval d'l~ ",d truly l>e ,evoked if 1M member i. ot-ri.k. The m<mbcr is ,,:.pemible f<>r req..,.!;t>a: I ... newal of the W<J'("kd , excg>lioo t" d,oqualificauoo and the FEA . ball assist the member with IIlat n:Q""" . RCI'I,'w~l $ $b~1I fonow the '~"p!ioo w di"luali[]c.tion pro::..s outlined in Section 2 9.7.~. 1.4.

Ame,Klmen! B (COOl.)

63. SeclioR 2.9.7.7.2 .baU be am~R!lcd by adding A nt", Section 2.9.1.7.2.9 al fuIlG"'~:

2.9.7.7.2.9 ETJ<urin~ worken m.int.io daily w"ununic.rioo OOIe. for lUtMrill..:t "",Ylce, provided.

64. Section 2.9.7.7.4.4 shall be deleted and r eplaced as f"U"",~:

2.9.7.7.4,4 Y,."ud ~nd abu$C id~",irLCa!ioo and reponing;

65. Section 2.9.7.7.4.7 .hall be amended by dele/illg tbe >lord ~and~ from the eod of the paragraph, Section 2.9.7.7.4.8 shall be deleted and r.placed, aod SerlinA 2.9.7.7A .hall be amended b)· adding a new S ... tion 2.9.7.7.4.9 .. folto"",,

2.9.7.7.4.8

2.IU.7 .4.9

As .ppropri.le, odmini'trlJioo of ",If·du<:<tcd health eve mk(.). The member or hi<lhcr rcprc. cnt'U¥e wit be ",sp" ... ibl~ for training Lho "'<>rkey(.) ,""",ding irxlividualiLed "",vicc nco:,l, .00 p.-cfcr= ••• nd fi>t 'l"'df", lraioJng reganling 1I<. lth cat<: ,..k. the member or hi,,/""r r"prcscn!oti'~ .~ !<> .. If·direol (00 applicableL <tiKI

Uni¥" ..... 1 precaution •• nd blood borne pathogen. traininll.

Mi. 5.,.,'ion 2.9.7.7.7 ,hall be deleled and reploced al foliO ... ·.:

2.9.7.7.7 ff>e FEA . ball be re'p"""iblc ["" ,'erifYinK aad va[,<l,uillll !hI: .... orke'· . ~'\)t1,pletion "r r"'l~i"'d CPR .ad FiNl Aid training from on approved pro~ider prior 10 initi.,"'n of oe,vic •• anc! payment for .. ",ice" O"goilllt.!he FEA .ball .... ute th.t work." m.intain CPR and fin! .id certification ond reo.:;ve required ",IT .. "", t,.inilli IS • ooo<iilion "r C<1ntmued employn:><m. The rEA may assiSi .. 'ortom; ;n 1oc'lIing oppropriat. courses for i,rilial cenific~uion and recertificalioo &. appropriate. Additional {raining components may be p<ov;dcd to a worker 10 add, .. , , .. """ identified by the rn .... ca.., coord'""t"". m.mher andlor III< ~m.!ivc or It (h. ''''Ioeo' of the ",mer.

47. 5ec,iuo 2.9.7.IIA and 2.9.7.H.5 ohaJl be delcted and nptoced .. follow",

2.9,7,8,4 Th~ CONTRACTOR .hall monitor imp~nl-lltion of lhe I»ck·up plan by tho ",<,,,he, or hiSiher repr"""l-lIlive.

2.9.7,S.5 The CONTRACTOR ,hall mooUor • "",mber', pal1idpatioo in con,umer direction of eligible CHOICES flCES 10 det.""i .... a\ a minimum, the ,ue .... and the vi.t>Hity ofth.e ,erv'<;. delivery m"dell", tbe member. The COmRACTOR ,hall note any pattern,. such •• frequem turnover of repre.."tal i<' •• 0' worker •• habit""ll.!e .nd/or mi,oed ""ito by .. orker., unaulhorized "'hoduJ. cbange •• failure to oooperale with lbe FEA '00 cbangi"i bew.'ct:II """,um« direct"", of eligible CHOICES HCSS .nd contracl provid.", thaI m~y worr"" t inl""'''''tioo by the COl-ITRACTOR. The CONTRACTOR may submit • ,equeot to TENNCARE. pum .. m to Tonne • .., poli<:y, 10 in,,,hll1tarily withdraw the member from coo".m." direction of .I'~;ble CHOICES HCES ifthc CONTRACTOR has coo""",, about its ~bility to pralC<:l the be~l ili. ,.[cty arid welfa.., of \he member ( ... Section 2.9.7.9.4), Tho FEA may submit . ""lueS! 10 tile COmRACTOR 10 mvoluntorily .... itlldraw tlte member from co""ume, direction of eliiible CHOICES flCES due to conccrm reg<lnling the momber', bealth. .afely and wei f • .., if the member ""m,m.", in C(~'''UllCr direcLion. The

Amendment B ("ont.)

CONTRACTOR muo( . ubm,t ""PI"" "r all . oc;' r"que," tu TEi'<NCARE wrth documontJ!ion of its ooci,ion.

611. S..,tion 2.9.8.4.5 shall be amended by ddeting the referen.e M(,,~ 2.9.6.9.2.1.16)" and replacing it "ilh (See SC~IiOR 2.'1.6.9.2.1.(7)".

69. Sttllon 2.9.!l.8.4 , hall be dde!ed .nd r~placcd as foIlOl'il:

1.9.A.H.4 If tn. .hort-term .toy will exoeed niooty (9Q) day •• tile CON11tACroR ,h.11 r"",lilate transition from ClIOICES GrollP 2 (0 CHOlCF.S Groop L A t .. ",il;"n from Group 2 to

0I'0Il1' I will t10I nocessitate a memb<:r'. dioenrolir",mt frnm MH', rogard!e .. ~f lbe knglh of ' ''Y ;n ti>e r""ility, e~"ept in c .... lhat core coordioalO! ha • • • """'" ti>e ,. .. \On r"" ttu, re-in.titutiooaUution and de!.nnined Ihil tile member i. 001 on oppropoio'" c.r,didal~ for c""linue<! enro!lm.m in CHOICES Group 2 and MFP.

711. Sl!<:lion 2.9.11.5,2 shall he amended by adding the word "no" u (0]1(1""

2,9.S.5.2 Up"" """"l""ion nfthe ",embet', .l65.day pltlicipalion ~"ri<ld in MFI'. the Plan of Care , hall be upd.tod lu ron",! thai i>e i, "" loogttt [>'Irticipatin~ in ~1FP

71. Tbe opeQing parllwapb of Section 2,9.12.2 ,hall be delclcd aDd replaced II. foHo .. '~:

TIMI CONTRACTOR ohll! coordin~w with the OHM ~ndi<>r tI-.: 10 HCnS ... oive. "onl"",lor for denl.1 "''fV;""~. C<><>«Ii""tiun of ocnbl oervic",. al • ,nininlum. inclll<les e"abli,hing

f'I'O<'''''''' to.,

72. SectioR 2.'~.12.3 ~hllU be del~ted aurl replaced a~ follow"

(2) Qwratin~ rril)Siplq

CO<><t!il\ating the dc!ivery of do"",) service. 10 TCI\nC"", mcmbt.-r . .. ,be primary .e. punsii:>ility of Ihe DBM And/or Iflo ID HCBS w:Ove. c<>n!Ioc'l<lr. How"""" the CONl'RACfOR , hill I'fOvid~ c<>mdi",,"on ."si.tanc~ and , h.t! bo: rt,poruiblc for communic.ring ,h. DUM/ llcnS p«WK!cr "'<vi",,". p"'vidt:r rtlations, andor claim coordinator """loct inform.lion 10 ot! of itt contt';lct providers. With respect to . pecific member i"",,", Ehc CONTRACTOR , hall work with li>e DBM/HCIlS """,dinotor (o", .. do; a n:sol~tion. Should .y .. cmi<: i",_ ari.~, lhe CONTRACTOR . h.ll =et and ",.,,)v. the i." ••• with the OBMflICtlS waiVe, contrac!or. In lhe evenl WI . ""h i .. "", Olll!lOt he ,esolved, tbe MCO ..,d the OBM'lICBS w. i= cOI1lracror , ball meet with TENNCARE 10 ,...,h HIli.l ",..,lution ofmalter>. involved. fil1lll re,ohIl;on ohy>tem is.""" . hon ""oW' wilhffi ninety (\00) ""ronda. d. ys from ",h,rr. ! W TENNCARE.

Am.OOmcn' J3 (cont.)

73. Se~lion 2.9.15.3 .hall be amended by adding a new S""';(lO 1.9.15.3.1 \\'hich .hall rcad a. fnlin, ... :

2.9, I ~.3.1 If ~ "",mOO! receiving home hc~lth ()( prin,. duty nuning "",ic •• will bo> , ubject to a rCOOolioo in cO"cred .., .... ic .. l>mvH.\od by the CONTRACJOR up"n turrung t"cnl~--on~ (ll) years of "1\<' >tid ,he member .1", rcc'Civ .. !lCOS W.iv"," ..,,,,i~<-.,, from DIDO. ,he CONTRACTOR, DIDD. and !he IndepenUcnt $uppo<! Coonjin.tor (lSC) .. 'Wlicllhlc ' ha\). put,",nt to policies . 00 proc ..... ""tabh.hed hy TFNNCARE. c,)(>rtiina'e "" ... fil . to implement any chang .. in lIellS W.ivor ~"';c"" ot the <arne tj"", that MeO $¢rVic~1 arc redu.:.d 10 ensure"" •• amI.,., •• (",,,,iri,,,, •• po .. ;bl~,

74. Serlion 2.11.8 shnll be .mended by ~dding a ncw S....,li(l1) 2.11.8.1.3 at f"IIo ... and renum""ring fh~ exilti lll: S""tion ...,cordingly, includin!: ~ny r.fcrencH thuet(l.

2.1 ! ,8. !.3 Tn the .~tCllI the CONTRACTOR ru., dek~O\"" credemi.hJlK ' ilr=nents In ploc~ witb 'BY "pprtI"M <klegatcd ~rcden(ilIIin8 'go""y, ,II<: CONTR,\CTOR , hall ensure all provi<kn .ubmit~d 10 the CONTRACrOR from th. ""leVted ~redentialini aamt i. lIl.tled to ill ~""'''''r fikl ond inlo it; d.i"", proce"'ng sy"em within thiny (lC) ... ie,ldar days of "'"";pt.

75. S~lion 2.1 1.8A. 1.2,4 ~hall be amroded b)' ~dding 1I ne .. Sedion 2.11.K.-I.1.2,4.1 D. folioWI:

2.11.8.-1.1.2.4.1 If .. a policy ;nd 1"'"'''''' in pi"". to oddre.u ""L'q>t''''' rcque$u for w<)ri", .. woo fail a cr;m;nalllllck~round check (..:e MCtion 2.9.16);

7/). Seo:til)n 2.12,-1 sball "" deldcd in il .• entirety Mnd the uhtinj!: Section 2,12,10 !ball be deleted ~nd replaced by a new ~dion 1.12.8 a. foHo .... , I"~ remaining Sedio .... shall "" rCllumllcred !Kcordiogly Il\cludlug lI.Ily rduencllS tbe rd(l.

2.12. 3 No other ret"", Il< c<)ndiliolu; agre.d to by the CONTRACJOR lI1lvitler , Iuoll ""p,,, 0' ,upot:"ede ,he requi,emenli Ii, oed in &ction 2.12.9 1><10'"

n. Section 2.12.'.1.66,1 ~hall be dclcled lIl}d r~placed )Ill foUows:

2,IV'.66 I lo"il'-"-!':c th. t no """"" on the grounds of handicap, md.'or d ... bi!,ty. age. roce. color, rdil':in~. $eX ..... 'ional origin, or any ",he, c1,..,ific",korr. prol.C!ed Ullder federal or ,UIe laws . hall be uclOO.d from part,dpatioo in, exc"'pl as .pot:dtled in Section 2.J.S, or be denied """"fi,, of, or be olh..-wi.e .ubjcct.d 10 discrimination in t,," perfonn:mce of I'wvide!" , obligation under its "Sn:omctU with the: CONTRACTOR ()( in the employment pnclic .. of th~ provider.

Amendm<m B (coot.)

7l1. TIH! ~CHllm""rcd Sc~tlon 2. 12.IO.HI $hall be delered and r eplaced as foHow,:

1.12.lO.lO R~qui,e III< nu"ing [""ility to comply with fcclcr~1 P",.dmi •• ion S<:"',,"in~ and Rc>idenl Review (PASIUI.) requirro"'t115 appliCilh l. 10 oU m ... ;n;: facility ,e,,,\ents, regorJI ... of payor source. h>eludmi .""urinl,: dIM. lowl I .cn:ct1ing has been compl<ted j>I"l()f to .dmi"ion. a level II evaluation has be"" c"Omplcted prior to admi .. i"" wOO!! ill,H",.ed by the level! oore<'llina, ;and a revie ... i5 oo"'pi<ted hosed upon a . igni[tcanl ph)'>i""l ".. m<rual cban~c in the ,e,i<\cnt', condition that might impa<:! the """llbcr', o""d fur".. benetil From .ped.Ii,cd .. ,.,,""' •. The [""ility ,ho ll collat><)fUlC wilh th. CONTRACTOR ."d with "'h~r provki<,. as I",eded to help ensu,. IMl cult",,1 iofonnation n:gilIding the member", me" ... 1 health '" inldl""lu,1 di"bilirics """",~.,. ..... ilabl") i. rdl""'.d In the r ASRR .."eooinll in r>rder to ,upport an appropri ... P ASRk determinalion.

79. S""lion l.13.1.2 sball be amended by deleriog Ihe ells/jng Sec lion 2.1,\.1.2.9 and rcptadng it "lIb ne .. SectioDs 2.B. I.2.9 and 2.13.1.1.10 a, folio ... and the rcm:oininll SCClirms .~all be r~numbered ac(ordingly. indudlng any rcferen(et Ihereto.

2.13.1.2.9 Tbe CONTRACTOR .gre .. 10 implemenl relrospective cpi.ooc ~d ",im"'-'=menl """ PCMH .1t11"8ie< """"iSI~""l with T~""",uec·. multi_pooyer ,,"yltl<:rtt reform inillatiYc 10 • manne, ond on a IUndi"", approved by TENNCARE. Thi' indude.:

2.1).1.1.9.1 V,ing I the retroopec'i~~ admiui.tralive pro<."= that i •• ligned wllh the model &.. ... ieo<-"<l byTENNCARE:

2.IJ.I.B2 1~leme,uing key dc';i,:Ilohoi<>e. IS direclCd by TENNCARE. including the dcfinltion of e.:tCh episode ~lld dcllnitioo. of quality mc",,,·e.;

2.13.1.2.9,3 DQli~ering periormanc" rC!l<>n, wilh.ame: ~nee and ~Omelll u !hose designod by the .!ltlC I poyer coalition:

2.13.1.2.9,4 lmpkl"""'llItilHl it! a .,..,e di<.'ta(ed by th<: State. likely 1·5 n<:", ~l';wdc. po..'T quam:r with 'ppmpriale k:. d tin'd 10 .J1,tw ply.:r" .nd pru~ide, eontracling;

2.13.1.2.9.5 I'arucipote in • Stale-ltd proc; ... to Ik.ign Ol1d "'uno;, new episodes. inc .. ><ling the seeling of dink.] input rmm payer medic .. 1 team. and dinieol lcad.:n; th'''''ghou,

T """"'''''''.

2.13.1.2.10 The CONTRACTOR oIlall implement State Budi"\ Roo»C!lOn. and hymen! Reform Initi.ti""" mcludlDIl re1ro'pc<liye episode hased rdmbUlSCmc"'. a. described by TENNCARE. The CONTRACTOR's failu .. til implement State Bl/dict Reduct;"" •• nd/or hymom Reform lni!iatiw. .. describe;! by TENNCARE may. at the dlscretioo uf TENNCARE, result in the CONTRACTOR forfoitillg ""io~, mat would lave been "",II=! ba,o:d "" the timely iml'h.m<ntarioo. including tile forfeilUrc of recoupment from pru~ide".

80. Scttion 2. UA.3 . hall be d~leted and r~pl:o.ed ;" follow!:

2.13.4.3 If. prior t<> the end dO!<: .pedtied by Tl'.NNCARIi in il$ ~ppro,"al of l.evel LI rdmhUNeml:llt for ounin2 facility oervi""". rIM! CONTRAt'TOR dctcrmm .. that the ml':ffiber 110 longer oeedJ ond/or the OU"ini: facility il no lon2ot providing the <killed ond/or rc!labil;t:ltive >eMCO' for which L,.'vd U "'imb ..... =Q( of """io!! facility """ic .. w .. approved by

,,~ 33 (CON.)

T!':~RE.. tho; OONlltACTOR $hili OOI;fy (ENNCAIt!': ..... as Uf'I"OI"WioolC. .... 11 $Ubm;t a ~, h> I1IO<hfy 11>0 """"""" •• bel "r""mblnOmcm fi>r ...... ,n, ($.1I1y ~·ocn n.. CONTRACfQR >hall lubmll oo.:..m.:.u.,;.", as i{><lcifk4 by ~RIlI<> MIf'P'Jfl tho ""1"""'. 111<: CON"I"RAn·OR may ~!/If: ...... "'1 Illcilil), II tho; u:-'·~I I (""""'" tlwI l.evel Ull'<'" di"," ... ~ (>!~y "''''''' ouch "'IC t' bIlled by !he nunonll (.dlily """ tkre i, an apf>«»'ro LOC olill'bllity seW""'"' !ht ,uclo level ,,( ",irnb\lncmcllt .... """" 'PP"",,1 from rj,NNCARE .. I". ",111<,',," in ,~ I11Cmb...,.·. ~·eI of c • .., (i.e .• r.im~~/l\Cnl) .. rdlocted an ,he <)U!bo,,,,d ~J4 ""roJIm~"llilt

2.] 4.1.15.1 rile CONTRACTOR wi! (ftI.IU"C ,"", "'""Il! rrimbu~ ,,( n""lzIt f"';"il)' UTe .. _·;deIl fur CllOlcr.s ,fII,."fllbM who:. h:".., bom lkI ..... i1lC\l by II,NNC,o,RE "' be dig>bk rOf lC\"d n mlnb~n .. r """"Dl: fa<iHIJ ""'" f .... thI: paiod ..,.,../In! by TENNCAIIK ~'<q>I .-hen Ic\·el I rrinlbur.nnmt ;. hilkd by IM....un. bcib'y _ dI<n is In OPfI'9,·ed I..OC dia;ihility qnICIII rOf $IJdI leocl <>f ",im""""""",,. TII<c COl'lTRACTOR WU """,i.".. .... _Q ...... <:OIl<blioa. .... ,r IIY "'""Q)I,'TRACTOII. "'*"""- I"" .. pn<.>r 10 !he ~ d.oll: opa:;fl\:d by T ENSCAR!':. 1M ,!It,,*,,, .... .....,. ..

MqUtrQ..,.Ji".. tho fIo.:IIII} ill "" 1ot!P"" providi"1l tho >killed and,'or rd'IabiliQti.·c oervm fOr ... 1IidI Level II mrnbw1cmca1 of ....... irIg f"'-ilily""'" wn ~ by l\;N"CARF~ the COI'.TRAt.,TOR mly ... blnil '" TENNCARE. ""1""'1 to Ino.Iify IlIr: mtrnber. level of rcimbunc:mcnl fo. n ... It'~ f,",,'lity ....... iceo. 11><: CO~RAt"OR ..... ll Jubnti!

docllml.'IIla'''''' "" ,~i{jed by TENNCARE I<> 1tljlp<H"t u.." ~.l. Tho tONTRACTOR may cei"'b ...... t"" n",.,inH tic,1I1y at (he Le\"~l l (~'her tho .. l.",,~l II) pcr d["~ '"''' ooly wkn wch ral<: i. hilled by ,he "UlJin~ facility 0lId then: ..... 11'I""",·eJ LOC ~liJlibilily ..,gment f ........... h ...... ·ct ,,( """,bun'''''''''t '" llpon ~pprm·.1 from IF.N"NCARE of. red""t"'" in !he me",be,· a lewl ~f ~orc (l~, ..,im~l) .. rdlcclcd on "'" .... 11>our>o.l ~J4 enrollmenl file.

tn. S«tion 2. 14.5.Z IUId Sui .... 2.140505 ~ltall be dddf"d and repla«d ... rtl ll" .. t:

2. loI.J .2 Tile OONTR..\ CTOR .... , decide whe\hI:t il .. ill ;""'" ",,",o.e -..tlww:_ roo- ft""""11 facilil)' ~ ..... · ... 111 .... ~ ... ·tli iNk..t ~ cWmo fOr _II ..... ice/; in ~ willi the lc¥el of ~ (IA .• "";mburs<-. incl...!inc ttu: ....... ion of "",It b"CI of n:imbur:ocmall) .ppru.....t by TENNCARE (t« S«:riou. 2.141.11), fIl<CtpI """ the o)NTRAClOR onay rcunburo.e I flC,lity II !be l",·d I P'" di.on nile .. ·heft "",h I ...... ""~;. billed by lbe r .... ilily I!ld Ibm: ;, on oppnwod LOC digibohly ",""'111 r", .... It Io~d of mmburllCTlleflt.

2.14.1.1 Tho CONTRACJ"OR may ... "mnl .... Ihe <!urali<>no(timo ro.- whi<;h CIlQICES Ficas .... ,11 be: ~ulhorizod !I",,~_. 1"" CONTRACTOR sholl be , .. ponaiblc for rtOCnioonn. iu iutllo<izo""m _ ( ................. Ii lkillhcrc = no gaps;" ~~.!ionl (01' CI1010lS !less In 1tIX<lr"dIu"","";!h lho .... <II" <.'8I"c. TlMt OONTRACTOlI. _""tI r,,"her bc NtpCnOlbIo: for cnNn"ll tltat ....... "'. a",~, ....... IR "",,"il.It:nI .... ,," ,he: p/.on or ew1". inl:ludinJI the ..,hedu.Ic: at .... hJch .,.... ..... are ..-.dod ....t aD)' ~ ... , ... pI;ta of ewe ado'or ~e. .-.nd Q.ocpI In IlIr: Wimoinc e,rrwmlllnce. r .. lKII;ryidg proYo;Icn '" .0._ ... htn • ~ auIhonmion (ind",lin; • ..,hcdulc) WIll be clwn&a1 ~>C cnttY or tdJ- ill """ioe NIIorintions b" ... ·UOtCES I/cBS should be Imdc .. nt~ .... hen n:quiKd to

"

AmcnJm<mI JJ (.om.)

,""c'Omm<l<ialc P'Y<ll<'n( of oervic"" that n;od be .. .., .u,horized but in alljustmcnt in tn.: 'lCbC<lule of <ctviccs y,-.. required bued <>II the ,,,,,,,,be,, nee"'.

83. S~liun~ l.IS.3.1 Ibruagb 2.15.3.2.6 .hall he dtletcd and replaced as rnUo ... s:

2,15.3.1 The CONTRActOR , 1'I;t1l perform M le •• ttwo (2) clinical ,00 tb~ (3) T>lllH:lin;cal PIP •. C1;n;';~1 Plh irocIU<!e project< tbcu.iog nn prev~nti~n .M cate of ,""ule aod chronic clll!diu""". hl¥k-¥olwnc """ic'eS, high--ti'k .ervlC ••. and continuity . nd coordination of .ar,,; oon-clinie<ll PIP, ;ncludt: rm.i<"u f<)Cll>illi on .,aibbllity. """e,,.ib,lity, alld "ullur,,1 competency of '<m'le"". int<;lJ'<.",on.1 .'j}l;Cl' of care. and .ppe.I •. grlCViltlCeS, aod ",he.complltinl5.

2.15 .3. 1.1 The two (2) clin;~al PIP, ,hall includ<: "lit (I) in the orea ofbeha'Wra; 1l .. lIh th.t i. rel .... nt to one of the Populalion fkallh progt.",. for bipoolor di.OHler. ma,;o" <l<prcSSiOl1, or ocl:uzophrenla . nd <me (t) in th~ """ of either child heallh ~r "",,'nat.al (pretllltaL'poolpanUnl) health.

2. !5.1.1.2 000 (I) of the Ill"'" (.1) oon·dlnic.l PIP • • holl be in lhc =. or kltll!"tenn eIre. '!'he CHOICES special . Iu.dy may not be 110<.-.1 ••• PIP. Tho: CONTRACTOR mall usc ""isting proc«'''', rntlbt>dol<lg;e., .nd proIOOOIs. inclUlling lhe OtS prot;>Col •.

2.15.3 .2 '!Oe CONTRACTOR ,hall etliure tllll CMS protocol> f", PIP> arc roUo...-ed 011<1 lhat .n ""p' Oll~in-cd in the CMS pmtocol, for po:rfonrumce improvement P"'je<;r. are dtX'\lm"nled.

84. S~liuD 2.15.&.2 sball In d~leled and n-p!aocd '" follow.:

2.IH.2 Annually, the CONTRACI'OR ,ball conducl: a CAHPS ,urvey, 1'he CONTRACTOR .haU enter into"" agreement will! a vendor !hat,. e<:rtiflcd by NCQA to perfonn CA!lPS "''''''Y'I. The CONTRACroR', ;'endor . rutH pcrfoon the CAIIPS adult "",r.'OY. CAUl'S child ."",.y ond lite CAHl'S obildren with ohronic conditi,",' ,ur;'ey "''''' ~>e trIOSl c1.l!rent CAI-IPS version spedfled by NCQA Sun'oy =ull:l ,haU be reportod 10 TENNCARE "\Uf. toly for eadl required CAlif'S . urvey li.l00 abo,' •. S""'''Y result. <It.U be submmed to "E~CARE. NCQA .00 TENNCARE'. EQRO O1Ullllllly by June 1 S of ellCb calendar year.

85. Sectilln 2.15.1.1.4.3, 2.15.1.1"'.6, and 2.15, 1. 1.4.1 ~bllli be deleled and replaced a~ [ollow,:

l.t57.143

215.7.1.V;

~u;rinll that it •• tafT .nd "",tnot CHOICES IlCUS p.-ovidor1 immodillttly (which ,lull "", ""ceed tw<:nty.four 1Ioun) lake .re .. to prevent further harm t() any ioo.1I membet~ and .... pond to :my =ergency needs of m"",ben. If ,be allegalion il ;n ",fore"". to • CHOICES HCBS worker. Ihe w<>rl;", shall bt imrnedillOly td .. ",d from pmvi<!i1!& .ervicc. L<> .ny TennCare member l.U1tillbe invesligation i. complete,

Ddln;ng !bt: ",Ie and respon.ibilit;c" of the !toeal l;1llploy« ",""t (sec defin;tioo ;n Sc<t;on I) Lq rcp"'tin~. Iny eriTi<al itlCidenu. which 011.11 ioci"&' reporting incident. to \be CONTRACTOR using the proc'" developed m a acc<Irda"e<: with Steli,", 2.15,7.1.4.1, . nd reponing to lh. CONTR.-\CTOR within 24 booro in accordance with the abuse and lleilecl plait protocol. lIIy\ime there i, a '''''pieion of abuse "" neg"el (,« Section 2.9.7,8,6); traininl/ employ....-. contracton of !be FEA (inelud",!! ' "1'1""" broken), and "",,""mer-directed work .... regarding reporting, and oooperatinl/ wilh I ....

l.IU 1.47

... ,-c>bpI_ "f any en,,,,,,' "",od<nIs; and ...... "" coowm\<:nI and a"'I11~"" n'pldHIg <:nbCal ,ncidcnl """,","S """ n ..... o;c'ne .... Sudo. rok: ""'" n::ar-ril>" . JeI; .... 11 be &r.n<d in. ,Un_ thM ;'«IIlSiotml " llh req ... ....- in Ito;" s..:.:._ LI51.1 ":os ,,'<"Ii •• nlNNc.-I..Rh·. ""nil...:' ","iI!o the lio.:al=pl<>yu .!."""' ...... k!\>ClllCi.;<II\InC. ".", ... """ ,II.: CONTRACTOR :u-.J too FEA.

Re\ iewi"lI any H!/\ "'pUn' (~,..,di,,!: criticoJ """<Ie,,t> and in> uIIJl.:ltc. I •• l'P'"opri.l~ lO <klenni"" a"y ""ce~,,"f)' "'M1"<" ~"" ..""',,. """ded by tk memM aMi ..... h .... h~ .. '''f''''5<'t'I~'ivc HI help ""'ur<: the l"II<mkr". healtll o.nd .. fuly_

HE>. S.~rla ll 2.lS-l .hall be '"I\fnd~d by adding a lie .. S«linn :.13.7 • .1 ~Ad ruum""dll l: Ibe r"",aiol" l: SKl ina acrordinKly.lndudl.~ • • y r2f~rfllcn tltudo.

1. I~, 1.3 II""", Ibllb Ascn<Y erilial,,.;,,,,,,,, lI<"JIDlImg

l.I~ D .I T"" CONTRM.'TOR WII ,dcnoi(y and un .11 sipufoca ........... 11c:aJ'~ A,,--.q- (HHAl crittaI inc ....... " .............. , .......ct1(lfl·F.s aoroll<a. A IUIA m...--al ; .......... t./IOl1 inc!OOc .Io:ooc oillft,rocant "",idealt ilia, an: "'port<>I l<>"'" COmltACfOIl from the III1A u",ltrdinl WleXI",.:te;! <bIll. ~'K~ injury .... (tty ;"o.ues, ... ..... 1'""1001 pil)1inJ.1I'COIW ~ lIuWlI .I!uoe "" ""KIe<:t_ F..or;h '''''Kkn< mUJI be •• ported. ~ ,he TENN<'ARE Jll'CKnb"d III1A Crili~.l Inc"""', rq>OII Irmrb!e "ith;n ' ... ..,nty·f<)Uf (24) bOIIn of .be ( ;QNfkAClOR ,,,,,";vmil infOfMlarim. ,dauv. L<> , ucft 1ft incidetlt. An ...,.:Iot~d ~PI'n. Includillj ...... Its ,,( ;n"""" G.\100 .nd """-t ".". mu., II..- ""bmin"" !o TEN:--.ICARP. ,..u)"n th1rt:Y ()O) c.!end.or day. af n<)tifio ... "" o( 'M inc:'dcnt.

117. S~ffio n 1.17.4.7.17 ' hall M .m~lItkd h~ d~lellnll. .h" phfU" ", and OilS" a_d dele!;n: and ,.,pl,daR tilt: phrase ~railur" 10 ftod fy OIlS~ .. ilh "failure to IIotify T£,'I<INCAIU'_

! .11SJ.5 1\ ~ 0( Ibr: nalU lO file • .lilCT1fl"linatd <:Oft'.pIaiIn, • pru.-.dt;d r<lf II)' .pplioblc (ederal

and N!C ci,';1 .. ~ "'*'. ""'I..tiote, bill IlOI IimibOd hi Till<" VI <lr lW Civ,1 RiaNs Act of 1964. "'" 1\"" OiK-ri>a'nltinot 1\1:1 or 1975. T ... ", IX of tt..: Educot;"" ...... -.Jm.."hll oJ 1912. So.:riaI!. '>1M of the Ro:/>ab,liUlKIR ACI of 1971 . _ rides II lAd III of lhe AIrIc-nc.aos .. iIh n;..billriu Act <If 1990 Mill ;"dudes • p/I<>ne """""'r f .... l uUt.no;C .nd ..... cbIue hnk IG the """'plaint r,..",. Thc n ... i<"<l .hall t>c ronsidcn:d a Vita! Document ond . hall t>c .... ,'Ible "" minim .... in lht: En_liol! .nd Sl"'mslr I""~ .. ,,,,":

MOJ. Sr<11an 2. 18.11).1 ~haU be dddtd . nd rt pl.c<!d so rollmu:

2, 18.10 2 n", CONTRACTOR , hall pro.,do: an ed..,alion plan for 0.11 In<mbc;t, wIth bdu..", .. l """lilt ... ~ cduc"iou ,IIOU ~ .... on a n:~ul .. bosis. All minimum. C\!""atlo<ral ",ateril. shall "",lox!. in(""",",,,,,, on medical""", .nd lbrir , irk dTU:1li; bc'hlo vlor1ol """1th d~ and U"CIlmcnt upIio:>ftl: Klf.""'p poupo.. """ .. rcccm:ry senicu, tamoly ouppoo1 ....... "'n, ond OIlier ,""""""';1)1 ""Pf'DI1 ...... i.:cs a".,labJ_ r ... ......",. .. and r". .... lia.,

"

,\meoo",,,"'.H (c..,nl.)

90. S~c!illn 2.19.3.111 ,hall tJ.. dele!ed and replaced as follows:

1.19 . .). 18 \1=l><r TonnC .. e cli~;b'lity ond eli~ibility-re\atcd ~rievmce. and appeall (i""luding l>ut " <It

limil«d to I""i-tenn COl. elillibilily and enrollment), ;,",Iudi"g t~.,.."ination of oligibility, elkcl;". d.,,,, of cowng.:, and 1110 clcl~nninali"o of p<emium, copoymont, "00 pali""t liability ""pon,ib,l;tico .haJJ be directed 10 TENNCARE.

91. s.-ctittn 2.2(1.1.8 sltall be ameuded by del~tin g th~ word Nrepayment" a nd r~pladng it with Ult phnltill "r~o"pm"nt IIr witbb<lld~ u fonow",

2.2111.8 This prohibiti<>n "'=ribed .00v. in Secti"" 2.20.1.7 .hall "" limited to •• pt<>ific rrovider($j. [or ' 1'«i('" d"",,, and for . pod!ic ;0$""'. ocrvi.ocs ,,,. clai ..... Too CONTRACTOR <hall chccl< with the Bun;.u ofT"nnC",~. Pmgrxm !"t~grity Unit before inilialinglny recouplUem ..,.. withhold of any J'IT'grom in,egrity rdat«d fUlllls (S<!o S.~'1i()Q 2 20.1.7) \0 "n.u", tb.>. the recoupment or ... ithhold io I"'rmiuible. ln the event \hal the: CONTRALTOR obI.,,,-, fund. in CL..es wll<rc ""'''''pmenl or withhold;' prohibi.oo undor!hi. "",liN>. 11>0 CONTRACTOR will ,eturn Ih. funds to ,ho pI'(»'ilkr.

n_ Se~tio" 2.20.2. 11 sball be amended by adding a ne ... e"tc nce H~ rollo,,~:

2.20.2.11 'fltc CONTRACroR, . oo..:onttoo:l"" ond pr,widcr .. wh"U>cc "o"lra,,1 Of """-"""",,,,1, shall. upon n..'q"'''( arod "" roquircd by thi. Contra ct ,,.. .t.(e and/or fcdc",] law, rna"" anilahle '" the ill] MI'CU/OIG ony ~oo all adrnini<tntivo, tirtanci.l and medical 1'<:"",do n:1.tmg to tbe delivery <If item. or service. for which T """C .. ~ moni •• ore ex""nded. Such r""",d. win be m.de available it DO co"'o til< ""'Iucsring agency. In oddtlion. 'he TBt MFCUIOIG ""If,'" required by this Con ... act or <tate and.'nr redeml law, be .now"cd ""co .. 10 !he place of b""iooss .tld 10 all TennC.re rewrdt of ooy com'''''"r •• ubcon ,rao"" '" provider. wh<lher c",maC! or """-COOl'''''!. durinK """".II>u,j",, .. hours. ""cop! under 'pecial drcum'tlJlCC$ wb.m after Mur odmi,.ioll 'haU be .llowed. Spec,al ci",um'W1GOJ . 11011 he determined by the TBl MFCU/OlG

93. SectIon 2.22.5 s llllll be IIm""d«l by adding. IWW Section 2.22.5,4 K. folio .. ",

2.22.5.4 The CONTRAC'TOR . hall monilor. "". '" al I ..... monthly h.,i •. the nunlbo:r of .. d, long_ term c.,.., prtlvKler'. dt:nied <loim. ('" lOOH-!ertl1 cot<! .000Ux:o (NF and CHOICES HeBS), and .hall initiate tr.i~ins ""d t<:ohnicol ... i~to""" "' ",,«led to any Iong_ t""" c...., provid...... hose ",onthly volume of denied dai",. for loog-term ~"'. oe",,"'" c:tceeill. twenty pen:cnt (20%). The CONTRACTOR , halJ submit to TENNCARE ona Guartcrly bali •. I r"port of all long-term care "ontraclors for woorn the number or denied cbi"" for Ions-term care .. ",,;c.,o exceeded twenty pen:ent (2rr'!.) of the tOlaI number of dailM (Of long-term care """'''<OJ . ubmiued dunnll any ",ontll. the 10111 nllltlber ..,d percent of de!1ied ell ;mo for Ions-term c.,.., "-",,icc. fnr thlt month, !he tOlal doU .. val,.., of donic<! claims rOf loo i -!enn care """.,<s, the type "r intervention (e.g., tra;n;nK Of tochnkal ''';'I~nce) <lctorm;""d to txt ,",cofud and provided by the CONTRACTOR . • nd Ihe currenl ,1I1l1. uf such denied claims (e.g .. resubmitted. pending action by the provider, delermillOd to De duplioOle cJ;oi .... , Ole.).

Amendment B (.""q

94. Sectioll 2.l4.4.3 shlill b<' delcc~d and replacm as (ol1ow~:

2.14.4.3 'n,., U)"NTRA<'-""T(}R·. abu •• >nd ""gleec plo" .hon aho define the role.nd re,pou.ibilicies of the FEA ond oupporn. br<:>kor (_ defln;I;"" in Scclion I) .n ., .. ""iog .nd ,cdacinB ~ member', ri." of ~bu.., and ""lIlecl. identifyin~ and reporting .btI"" and negh'''', protecting ~ "",mb..,. if .by .... "ndJOf negJect is .u."""ted; t,aining <mpt<>ye<-.. , ""nlnc!"", of!he FHA (i""ludio;: ,uwom hrokcrs}. .nd consume,·dire<led worken rts,,,j,ng the protocol, i<len.tilied in Sectin,," 2.24.4.2.1 lhrou~h Z.24.~ .2.6 abo\e; oDd training rn<:mhen and CIife.!l.iv ...... rcgording identification .,ld n:por!lII" Gf , u<p<."cte..t .\Iu.( ondl.". neglcct S""h mle and re'l'<l",ibiliti .. _hal! be defl""J in a In"","" that i. """"i'tent with rcqui=t. in thi • .'>.:"!;"n 2.2404 •• well as TENN(;AI{£·. c~){I!ract .... ith the r,.cal omri<':Ycr .~""! and 1h< model contract betw .. n!he CONTRACl"OR .oolhe FEA.

9S. StcttoD~ 2.27.S.14, 2.27.5.2a and 2.27.S.24 .hall b<' deloted Iud replaero as fOlio,,',:

2.27.$ 14 Cr •• k.nd implemen' poliei .. and I""""durc$ 1.0 lddreu flf"sen' and rulW"e HIP A,vlHTECH rc~lIl.o<y ,cqu,,,,,,,,,,,!>,, oc:<:d.d. ineludi11& but not linlitw to: u.e ,00 dioc!oo",e "r data; do·identifi"ati"" or d .... , minimum _c'OU)" oo:;e ... ; acwuntini "r di. d""urc:s; onrollee', ,;gIl, to amend, ac:ecs. , rc:que.1 ,e,tried",,,,; OOIlee or priv"'-'Y prao;tic"" .n<! rliht 10 file I complainl, and bre.ch l>Otific. lioo;

2.27.5.20 COIlli",,", to prol""t .nd secure PIH AND per,,,,,ally idemif",bk: ",f","rna';"" rc:1a,i ng 10 enrollees who ore do...,,,,,sed fo< fifty (50) years Mia ... ;,,\( Ihe da!~ of otI cnro/le." de.lth. "rr ... -ti,·c So:p!Cmber 23. 2011;

2.27.5.24 Obtain ~ lhi,d (31d) ~ny .mille.lion of lhci, II!P AA .r.nd.o.ld tnln...,uOll compliaJ>c:<, nine!.y (90) ".kndaT day. bet"", Ihe oI. n date oj" <>pera!iont. if applicable •• nd upon "'G""! by TENNCARE.

96. S('d;ol1 2.27.''''.7 shall bf deleted and repla«d as folio",,,:

2.27.9.4 7 [f I court i .. ue< • subpoena for ~ c ..... record ,It fur any CONTRACTOR repre.e:nllu;ve to {"'Iif} cooc.m;n~ "It 'Wlic.n! or bcncliciary, [he COt<m.ACTOR must OO1iry the Slate at !'"" ten (10) dayo prior 10 tbe requirtd prod""lion da!e so tho S ... te nay W"'~ with the CONTRACTOK ",,,,rdinor CONTRACTOR', ;o[onn;ng tho C<>\lIt "fIM applioabk: statutory pro~;,i<>Iu, polici.,. and "'llIIlaliom "'lI1rie,;O& dioclosure of inf()I"rttJ.Wn. dfocuY<: until bn. 1,2014; on<!

97. Sed/ODS 2.27.10.1 1.2, 2.27.la.1 1..1, and 2.27.1a.II." ,.hal1l>c del~l~d ~nd replaced ~8 rouo.n:

2.27.1O! 1.2 "'P,<)!ecte<\ Health !nforrnal;"oI~.Uy l<lemifable Infonn.rion~ (PHI/I'll) (45 C-F.R. ~ 160.103; OMB Cin:"lar M-06-19) - "PYot""te<l hOMtth inf"""a'ion~ '" " PfW m .. n. ind;vidu,"IIly identjflable health i"["""";,,,, thai ;" (i) T,..nsm.iuod by electmni<: "', •. Ill; (ii) Maintained in "1""lronic media; or (iii) Tr.",mitt.d or maintained in lilY OIlter fonn or medIum

2.17.10.113 "P~rsonally [dcmifiable infomlllion~ or "PIl" ",f .... 10 any inform.ll"" .bou! an individual ",.;n!<linod by an agency. including, but nol limited to. ed""atjoo, tinal)Cial

f\mc"dm<nt33 (cont.)

1,""'''''liM>, medical ~iSI()ry, and erim",.r <>r employment hisl<>ly and mlonn'lioo whio~ <an be ";cd '" di'lin~"i.h or ":ICe on individ" • ..r. ideI,hly, sl>Ch 0' lI><i' min''', """ill) <courily "umber, bi<lmctrie records, elC .. atone. or wit ... ccmbi""<i with oLh.,,- p.,r..,.,al "'" iden,if)tin, inronn.llion which i. lined or Im.ble to & .""oilk: in<livld""l , ,,,,,h .. dale ."d pI"'" ofbinh. moln.,·, maiden name •• Ie,

2.27.10. I I .j. "lniliyid"",lly ldenlifi.blc H •• llb Inf""nation" infornu.liOfl that i. a .uboct of hoalth infonntin." including dcm<>graphi< int<lmIaliou cullc"t.d rmm .n individual, .nd: (I) I. <""'t~ '" r«;oi,'oo by • beolth c"''' provider, he.hlt plan. employer, or htallh "Me dearinghot\\l.: and (2) ",1'1"" 10 tlte jMlil, presenl, ,>£ ful.,,-c phy,;';'1 ,,' !]"",ul fIt.lth Of

C<mdili"" of an in<ilvidu.al; Ih. I"'"yi.ion of fIt;tlth Coro tn ~n individual; m lbe p.t.1, p""""t, <>r fulu", poym<ot It>r the j>lWi.iO<l of It.ohh co .. to .n individ""l; .00 (il i<lenlif",. lbe individual; or (H) wilh n:.p"ct 1<1 which th= i, • rea.onable ba,i. to belic,'c tl><> mf<>rmotion can be used 10 identify the iBdivi<.lual.

OJII. S""lion~ 2.27.ludl b~ am~nd~d hy . dding new S""lion~ 2.27.11 Ihrough 2,21.13 all follo .. s:

1.27.11 Semi,iYe Dau Rcl .. ttd 10 Ak:OOoI and Drug Abuse Enrolle. Rcconls rOO' SUMta!ICe Abwoe Treatment.

2n12

2.21.13

2.11.11.1 Thi. fnrormotion "". been <lioclooed 10 you rrom reoordIIl>roIeClCd by Federal canlldemiality ruko (42 erR part 2). The FI!denI nil .. prohibit you from makin,:my further di.w)ow", of this infonnltioo l1li1 ... further di",l[lOure i. '''l''",.ly permitted by tbc written cooselll of lhe f'C"'oo 10 whom it p"".i", "'"' OIhe .... i .. rermined by 42 CFR pan 2.

2.27.! 1.2 A ~e"e"'l authorjlO!i"" ror the .. lea .. of mod)c.] Of oHX.T !nlbnnatjOJl is NOT .ufficicnt ror thi, P"'I""<'. The Fede,..l ",leII ramct .ny """ of the inr""""tion to criminally ;n,,,,tigale '" proscctIDo Iny .""'hoI or dfllg at>use patient. 42 C.F R. ~ 2.11 (SAMHSA)

Federal T"" Informati"" (FTI).

2.21,12.1 Any 1'1'1 "",de available ,hall be used only r",. tbe PU'l""''' of c.rrying out the pro"';<i"", of thi. CootuCI.

2.27.l2.2 lnformaricm contained in ouch matcri.l "'.ll be treated as confidenlial and ,hili not be div1.d~oo or made k"",.." in any motWef to any per>on e><eq>! •• may be n« ... ory ;n the performanoe of this Cootract. ltapection by", <Ii.do,uN to anyo,", other lban an officer of employer of lho Gr.tntee ill OIri<tly prohibited

~'~il"", to comply willi fed •• a! "'!l:Lit.tion. fOgarding H1PANfIlT8Cfl, SSf\, Medi<aid. ClIIP, SAMHSA, Ind ITI dot.> ""'y ..... ult in crim;nol on<! civil fin",.,.,d penolti<:._

99, Se~ion. 2,28.3, 1.28.6.2, and 2.28.7 shall he deldcd .nd replactd u foll",,-,:

2.1~.J The CONTRACTOR', oon-di""riminalion compli.nce plan !.hoU i""lude w.inen polioies .,.d procedure! that demonSU3te non·discrimilllUion in lhe provision ohe .... ",,,, '" members. Tho polioy .haI! .lso demonstrate oon-discriminalion in the pro"ision of t.nsuagc ... islonce ..,,,,ic,,, for members with Limite<! English l'rnficiency ontl Ib .... requiring communicaiion ",i".nce in al!cn'\J.tive formall (oeo Senion 2.\~.!). Th"'" polloi ... and ~u .. , ,h.lI be prior approved in ""itivg hyTENNCARE.

,\,ll<-oomcnI33 (COOl.)

2.28.6..1 Discrimin.ation Camp",-u,t •• gam.\ lhe CONTRM,.,OR·. Provide .. , !'ro",dor', Employees audIo< p"""do,.,.' . Sul>cunlraclun, Should "o mpl.int. coo<cming .Ikged ""IS of d;ocrimina,ion committed by 100 CONTRACTOR' , pmv..m... 1'I'0"i<lo<', employees And/or ,ubwrnr!>C1on .. bled to {he P<I"is"," or aoo/<>f ace", .. 10 Tofl/lCare coverro .. TV;';"" be "'t"'>'1"d to (he CONTRACTOR. lhe CONTRACTOR' l nDrtdiwtiminaliOll """'pilon<:<: officer .111111 inform TENNCARE of .uch "empI.int. within two (2) hils;"" .. day. from tile d.1e CONTRACfOR learn, of """II compl.ints. If TFNNCARE roquest. that the CONTRACTOR'S nOllill,crimi".t;"" compli"""" "ffieer assi'l TENNCARF. with cooductine the In;{;al i"=li~'lion, lbe CONTRACTOR'S "",><Ii",rimin.tion rompli.nee oAke!- within the (5) busin~ .. day. fi'om !he date of the TeqUdt .hall <!an the initial UlV"",UgaM n. Ooco an ;ni ,i,! inve,!j~I>OO h .. ""en compkted. the CONTRACTOR' , nondi>Crim;not,,\Il C<Jmplia""" off,,,cr . 11.,11 "'I"'rt hiOlh<r d.:termina{i"", {o fENNCARE. A{ a minimum. lhe CONTRACI'OR', ooruii..,riminalion "ompliance off"'"", Hll"'rt ;hall indud~ the "-"'nlily oft"" porty ming lhe oomplaint; tile omnplain:mC, rd l l",,,,,hip l(> 'M CONTRACTOR; the ci,eutmtan<'" of lhe complain l: Wale ro mplain' mod; .. 1<1 the CONTRACTO R', .uggcste<i 'esoluti(l<l. TENNCARE ' holl rev,ew tile CONTRA('''TOR', ,niH.1 inYe01lglltiun' _ad tktcnn;,,,, {he appropriate resolulion. for th. complaints ... set forth in Se<tion 2,28,6.3 below, TENNC.\RE reserves the d~h' 1<> in> oslipte ,,1<1 ",,,,!v. all c""'plainls coo",,,m;,,& alleged acts of di""ri>niruttion rornmi,ted by 1"'-' CONTRACTOR', pro, ; ...... ;llld 'UbOOllirllCl."..,

2 2~, 7 The CONTRACTOR .shall _ ond h.,·. ~",jl.ble to T enneare enroll"" •. f<:1ll1Core' , Discrimw!iun campllin! f<JOT\ located un TennC~",'. web';!. U/ldcr \he r.oodi",riminallon link .t hUp:ilwww.tn·Bovi!L.fl .. cardmclllhe ..... hlmL Th. di",riminali'\Il L'Olllp"'-inl fOml shall be provided te fennCor" enron"". upon requ<;s1 ond in the "lC>nbc. hlndbook, Thi' complaint form sh;aU be con.roered a Vital !:lo.:umeo' ond . han be avail.ble al a minimum ;n llie En;lish and Spanish langWlge5. When reqUt'" for as.e'!.:mc" {(> Jile a di""rimi"a!inn c""'plain, are made by e"wllee., the CONTRACTOR sholl a,sis, !he en",ll"",. with .uilrn rttiug ccmp!a" ,t, to TEN~CARE, tn addition, !he CONTRACTOR shall inform it' employ"",, providen .• nd !ubooorracl"" how to . .. i.1 TENNCARF. ooroll ... with obl'l,ning di ... -rim;tI;IliOll complaint ferm. and u.isl.oce from the: CONTRACTOR wi/h .ui>mming the tbnns 10 TENNCARE and tb"CONfRACTOR.

100, Sed ion2.29.\.J .haU he amended hy addiug a new Secl!OD 2.29,1.3.19 •• foll<lW1- and Ib" remaining S~elion sh.1I be r enumbered ~cCllrdingly, including any rcfcrcncClIlberdo.

2.19,13.\9 A .lOff pc"",n to ",tv" •• the Lilig.ti"" Hold COOtacL lb;, iruJividu.ol oII.U be ""pomib!c forr.,pooding to oUlil;gatioo bold ""I"".ts from TENNCARE;

101, Seedon 2,.10.1 ~haJ[ be amended by adding 3 now Section 2.30,1.8 "'lIkh .• hall read .... (oIIoM:

2,30,1.8 In .ccortl"""" ...-ith Ille "'<lui",m",,\< ""I forth in 42 U.S.C ~ JOOkk. tho CONTRACTOR must develop .nd maintain the abilitJ to col""'! . nd Tc:port &". on roo ••• thnicity-. "", primary I.nguago. and d" .. bility ,wu. for app!iclnts ond member. or><! from .pplic..uo· and ,nembers· porcol. or l~il1 guardi'", if oppli.;.nll Of membeTo on: minor.r 0< l"AI'IlIy inc.poeitated individual., In collecling !ti. dal.!he CONTRACTOR .blr.1l """ tho om"" of M""ao:cment and Budge! {OMB) <!on<iard>, ot. minimum, for race ond e1h<ricity ""'0$=. Roc" . 00 Ethnic St.ul<iaro. ",mbli,hcd for F.dfm,/ S,rt/i$l;"' .• and Ad"'ini.rmliw R<poT/inl( ;""Iud<: tllC fuUowinJ,:: c'lo>~o<i", •• defined by the OMS ,

2,30.1.8.I!tace Amenc"" Indian or i\1""k. N,,;"e, A,io". hla!:k or Africon American. native IIa .. aiian or otll<.'I" Pacific r,l,nde,. white;

2.JO.I.~,l Etbnfdty Hi'pamc (yt L"t\no. NOl !-lispanic (yt L:tt;"".

102. Seotfun l~~O.5lhr"ugh 1 •• 10.5.3 ~baU be delct<>d llIId repla<ed as follow~:

2.3005.1 The CON'IRACTOR .hall .ubmit a q""rtcrly Pop"I~lio" IlmirA Uptimo ReJkffI ad.dr=ing All , • .",,, (7) Populati,," !lc.hh Progranu {oco S""tioo 2.8.4 or this C""traCl~ Tf><, report ,hall ,,>elude proceu and <>P<""'linnal dal> on<! any portill<ltl( norr.tiw 10 i""l""" OIly ,,,.mn~ .hang ... ".",wg "" new i"iliati",,,, occurrillll In the ruponing I"'riod.

2-3(H.2 TIl< CONTRACTOR .h.lI .ui;>mitl quon..-ly ['()Pl'i;lfiun f[~~ll~ S/r(1l![I£alioq /J4w Rrpo('/, through lhe eurreIU .""ure oystem. which ,h.lf i""lude • li,l in Comma S.p ..... ted Value (CSVI r""mol consi'linK of the no""" /I), [)On, .tr~lific:.at'(>Il or all ri,k level •• "d Ille cOffo,por.ding dalt. of eliiibilily for the lc¥d and progr.m ... ignm<mt. f<rr . 11 or the ('OmMCTOR '. m,.'mben (.'ICc S<c!ion 2.8.1 1.5).

2.30.S.3 The CONTRACTOR ,!WI .ubrni! an"Wllly, on Dc<:cmbc ... 1 dIet ,~~ c/o$(> or ~ lIate li~~l y=. a f'vpulllti.on H",,[1Ir AM""[ /tepvrl in I,", fon"," described in tJu, annual tep<lrt

!emplak: p",wid....! by TEh'NCARE. The report >hall inclmlc ",,!,ve p.ll1icipa!Km .-.1"', "" do.igna!od by NC'QA. for l"""¥''''''' with acti". iute"",n!i"",. Still,.! !"lln aruI in{Crmcdu.l~ (lUJcome dot!> ,opor!~;' requirod. Member salis faction mall be reponed Nscd upon NCQA re<juireme"tl .lon~ with f'-""lioMl ,t;I(u. for members in tite C1tronic Can: M3nal!ement I nd Complex Case Management P""Ilraros.

2.30.1.4 The CON'fRACfOR ",.n .ubm!1 .n~ ... lly 00 M.rclt 30. ~ ['1)p"iQti"" /Io:a/lh Frog",,,, ik""rip(i&r follo"'ing the gui<bt""c pro¥idcd by TENNCARH oddrt:'$ing Section 2,8 of this Contract 'The J'fO!l",m <ks'riptioo ,bon incllide a written deoeriptiou of how the plan ... om {hot mcrnben. k ... lrucn 21 y"''' of age ",ill have 'heir hcallll ri.k. ido.'ntiflCd =d their hollth ""0& "",I at (he "PI'<opriate ri,k Len'- 1he pt"<lgnom delt<ription .ha l! a l50 inctude a CHOICES n.u-nti¥e .. o-utlined in :iecri"" 2.8.11 of thi. Contract ond adc1re$l\ lhe: ClinicAl Practice Guideline. rcfen:ncc in S~"t>on 2.~.6 or Illi' C""noeL

103. Seclions 2.30.6 •. 1 throngh 2.30.6.1.3 shall be dcleloo 10 their tnllrcty and the r emaining Se~'I{)n. shall he rcnum~r~d accorllil1g1y, inclllding any refcrencu thenln,

Amondmo<nl n (C<IOII.)

..... S<"<:rio. !.:MU ...... 11 be .m-.Ied b}' addiol: • ot" Scc:OOD l.JC1.'.-6 ~ folo"A~ aad I"tnURlMrinc ,k .. rfM~ini.ItS«'lofU KfOrdiogly.

2_JO b.-6 U""" enrollmcnl "fCHOICES OM>P2..,..) ~(ir.nd ........ "'~ ~ TENNCARIi 10.."...." .. ~ I>.h:l<.up ho:.hh plan ar.dtlll' enroll """""" .. itt CIiOlCts Un.""? 2 ;tnol,.", J), tfl<, CUNTRACTOR ..... II ""Inn". monthly .'1"111'<1"8 Fact/d)l Skurt-Tcrm Stav Ikl"wl ,n ~ fOfmOt spt<:,fiC<i by TIiNNCi\RE that o)CIlIIks bUI il nOi limit ... '''' ror ~.ch Oroop 1 nnd Group 3 m.mh<t "hliril1Jl ,~ $ho)lNenn NF "oy bmelil, ,1\0; """~ or.,.,h 0""'1' 2 and Group 3 member I\. .... ."ivjn~ .1"t<n1--1Cfm NP ""V",,,", ~l~ NF in .. hiob ",bo: ."",,",Iy .... ~, \lie dole qf >dmiuion for sh<m.,.:rm &I~y, ,'''' nu",be, or day. of shoot·I."" NP suy unl",ed ror th .. . ldmiu;"" . .>nd tb<: .m";"I"II<d <1>.", f.tf Ji""ttorg< b.d, '" .ho 9Dlnmuomy. f(ll ony ono:m ....... 01e<:¢<M11loo: ,,;"'1)1 \'IQ}4ay ~"'" "" .11 .... H.rm NF '""Y. the: CON"TIIACTOR .... 11 mcludc .. pW>3Iion T~T""" ... 1Iy IhI: bwelil Jim .. """ """" ..... "ttdo:d. ..... .<pK.roc OKlO.".. "'" CONTRl,t.1"OJl. Is 10k."!! '" fio;i~''''' di .... lwge 10 tho corn .. ",ni' y <If InNitI<OJl Lo (l""", ' ... • ppI .... bk, ,11<1"","1: tho: .."""",1Cd " .... , ......

l OS. Sullo. lJO.1! slllaIl be . .. ,eaded by .. hi'''l II...,,, S«tloll 2.3"'2.,., 10 110"-) .. hielo ".,. lM"e\'iou.J}· dd .. r:d i n lIfTor.

:.30 (!.9 Tlte CONlRACfOR _holl .ubm~ a quarte<"ly RdIa""""IIIC1It11 ... d'_lk<-urrr:nra KOport in accordance willt So..~iM 2.15.1.2 11001 """'ideo mformal'''''. by '1"M>f1lb It"gudina ."""ifk.! )TI<uura, "hkh Jhall ,n<lud!: 1><1, "'" bt I,mll"" to I~ folwwin¥,

2.30 12.9.l.l [);ole of 'JC=OOC

2.J012.9.1..1 ~m:

1(16. S«r10D 1..10.17 .b~U be amclldtd by add[n2 _ n~w SeI"!wn 1.30.17.'., followl:

2.10.17.6 The (,UNTR.,\CTOR ohlll 0 .. 1",,,, '" TENNCA RE 011. q ... rtcrly ""'i •.• I"'n"'" Cloims Report un .11 I""II'~ ~uo: ~IrKIOfl (NF and !leBS) r.....- ,,·lIom lhe llumbe. of """ied cwm. for 1on~.","" ~.I<.' SI:"Ic~$ "",cC<:<kd lwen!y P':fl'\lnl (2OY.) of tho wr.1 number of claim. fur ""'1I:-mm COI"C services fUhmined dunng any moolh, 11,. fqlOll , hall !nelod< \be no"", and prQYld,,, numbet of ,r.. lana·term oa", <""IrK!or. \be K>IIIIIMllW IIId percent of den;e.j daim. (.,.- 1""II-I.tI1I can! ..,...00 for 1M' _It, !he '''' .. dollo, "al"" Dr denied 01""". for ..... I-len'll ."'" "",>C", 1M ')'PO Dr iAt ..... ntion \~ I .... ,niDII or ICC""",al _~) ""'Cf1ained Il> too: ~ and pomldeclby <be CONTRACTOR, ud ,be CIII'ImI

..... of ....... dem<:d ru.'TOf\e.a~ resabmmm, pendiQ& CJ:iolq by 'ho PlO'!"'" dttern>iKd 10 be do.pIialc: da", ... ""'-j.

• • ~ -.. ..,'"

Amo!ld,,,,,,,' OJ (e",u.)

101. Section 3.4.8 _hll be ddeted ~nd rcp.a~ed as r"UO""~ :

3.4.S In lflo event lbe ll:MI1nl or the fi"" and <In<': 11;)11' pert~nt (5.W.1 pmniwn la. ;. incn'aSt:d or deere.oed during lhe lenn of ,Ws Contt""t, the poymcnl$ .hotll be i",",' .... d or decreased by ~o amount equ,d 10 ,"" ;norease.'deorU>e in ~i<nn poy,blo I!y ,1>0 COl-.'TRAL'·OR.

illS. ~tinn 4.'1.1 shllll ~ deleted aod repbced as foll",05:

4 9.1 In 00 .vell! .lIon 'M m.~imum liah,hty oftbe SUIte under this Aweemen, d<lt"ing ,Ik: origin.l ""m of'!!e Contract e,ec<d th",e b,lIioo. ,brce hWldred eighty rour mjlli<>n. .L. hu!ldrcd .i.ty ,hcc"" ,hO"Ulld, ,iA hundtod five dolb ... and ";""'Y cento ($.3.3B4.1>63.605.90)

1{I9. S~ti"l\ 5.4.1.2. 12 sball be del~'ed a od T"Platoo as follows:

5.4 7.2. 11 File.1I reJ>I.>nillll ""all ;""Jude. but nO! !Ie limited 10 any nee""",,,), dat. a"d:"r rqx>rting required to comply wilh Ihe Medicaid rayr".,.!! for PmllM)" Care ~, "'4"'''''' in S<CIIDn 2.ll. 9 of thi. Ccn""c~

I HI. Section !I.20.2.2.7 sball he amended by .. rlrlitrg new PROGRAM ISSUES , U:WEL~ A.:n anrl A.J4 105 rollol" s:

,LB Failure 10 en,ure IlIot. ,,,,,mI>cr ,';'5()() per day, p.:r ".:cum""," ['" ":tell. ",.I"ada,- day utili~i"i lbe ,1\o<H''''' ""Y Ihal a member e"".,'" the nincly (90) d~y """"fit bend.! i. tr.o.-i!ioJled [rom limit in accC>l"danc~ with th;' ~gre<:mcnt. Those Group 2 or GrollI' .1 ... amounts ,hall be multiplie<l by lwo (2) when the applicabk:. 10 Group I .'aoy CONTRACTOR b •• 1101 complied with Ihe Ca •• 1oad time a) it a <kIc""ined 'Oal the and Slaffillll ="",mel1d.,;on •• , .pedfied ;" Section , olay will not !Ie ohon-tenn Or ,he 2.9.6.1 1.11 oHhi. Conttact , , mcm!ler "ill not trtlll,itinn back W the """,n,unity: and b) pri<>r to oxhausting tho: ",,,,,,y (Q(l}-d.y .horHonn NF hrncfil <m-<n."ti fC>l" CflO!CES Group 2 and G,,,,,p 3 ~mbe" (oe. Secl;nn

feu. 2.6.U.3.1 Failure to complete .rod submil to $500 per <lay. per ""CW"I'Cncc for each cah:ndu day TENNCARE at least d~1 (8) !ley<><\d ei~h! (8) bu.ines. day. prio< 10 nphli"" of bu:>;JIelS days prior 10 expiroliou Ihe ",ember', """""I LOC eli~bility legmen'- Thr:u: ora member', current LOC amount •• hall "" multiplied by Iwo (1) whrn the elillibility ..,~cnt. a new LOC CONTRAC"TROR has not complied with lhe C .. <;c!r>ad I .""".menl. inolud;nilall ~uircd and Staffing recommCt1danon< •• 'p<.'Ci!1cd in ~cch"" support>njl documentation needed 2,9.6, \ ! 9 orthi, COOU.CI , to appropri",dy dctenni"" Ihe member', LOC eit&ib,lity goinil (<><word (s"" Seclio" 2 9.~.9.3. 1.11 v

111. Section 5.32.1 Ihall be deleted and r eplaced a. follow",

5.12.1 No pcfS<l11 on til." ground.,. of hondio.p. and/or disability, a~e. t><:e, <olor, relil:ion, ,"x, mhOn.l origin, O'!"

.ny OIn..T <t ... ification. protoc'cd under r.detal or ,! .. ~ law, .hall be cxdllllod f,om plU!icipill;"" in, •. <e"PI a. specified in Secl;"" 1.3.6 of!hi. Contract. '" be deIliod heft.fits of, 0' be otherwioc 'ubjetted tn dlK,;,mna'ion in tho pc,rorm.ncc of thi. Cont""'l or in (he employmefll l""""li<;c. "fthe <':ONTRACTOR

Ill. MonM lIoalik C .... M"dag~""'"1 Sen!""" \n lutachmcnt I ~ba11 be ~me,,,l~d hy delt11llg and replating !l.e paragrapbs lah~kd " 1."",,1 2a and I.."el 211." •• r<>lJO""

L~~eJ 2 m..,tal health c..., ""'""gcm<:nl i. a b, inten,i,'e l.vd or ",,"icc thon Lev,,! 1 and i. r""""t:d <>" ",.W"""e ."d "",..,vel)'_ n", <':ONTRA(.-'lOR ,hall ""sure thO! level 2 memal be.lth Ca$<: 'n~n:tgemo n' i, providod to individual> woo$C $ymplOllli ore II Ie .. t pa"ially 5lal>ilizod or red....,od ill order to .ll~w !re.ttnent and r<iliabitilali(1Il effort •.

Whe", a~-..jJ.bl., pea- ,eoovery .<",icc.< onJ f.mily .apport .... ic •• may be ....cd a, "" odjuncl I" !he ~"'" monaj,'« in moni!<>ring tile member prior!O di""har2e from Level 2 case management, lI",.,.""er, al no ""'" ""(Xlld PI'<" ('e<:(Iv~ry """"ic ... nd family ,uppon",rYic .. in \he foom of Certified I'eer Roc""el)' ~",,"iali>l ""dlo, Certified !'.mily Support Speciali.IS, or arty other form, become • '"M,itule for "".., m01l41!<'D in II,., delivcl)' or ene mOll"gcmen! .. ",ico •.

113, P~)cllflltrlc Rehabilitatiou S~ni.c~ in Attacbmellt I sball be ~mended b y deldin:;: and r"Placing the paragnophs labeled ~Peer SIlPlXlrt" and adding lIew paragraphs labdcd Family SnPP'lrf Suv;" •• a~ follll,"'

r oer R.<o~. ry Son-Ire!

P.er "",,,v.1)' ..,'v;cco . llow indivKl""I . t" direct ,tleir o .. n rcco~'Y aoo odvocacy proces.. and are providod try perliOlII wOO In: or ~vc be"" COIl,umm of the bchavitIfJ.l bealth syorem 3IId are Cc-nifled Poer Recovery Speci.1i,IS. A Certi rl«l Peor fU:,;ovC<)' SpedaliM it • P"""" who !IllS id.mitiod him. elf or "" .. elf as h",,;ng ,,,,,.,,,,,,d or i. ",, __ <,iving ,nenral health, ,ut..rancc iibuoe or co--occurring di _ do:, "'",;<:4 in 00. or her p<roonoJ """",err ro-OCCSl, h • • Il1l<krg"'''' tt!lining """'gnized by !be '1'.""",_ Department of Memal Ueolth ond S"~ .. ncc A bu,"" S"'-"';';"" on bow to ... ist peers with In.: ","O\'err IX"""" .!ld r""eivo<! ",,-nitlcation.

Th",e ",,,,icc. include providin~ ... i'tallCe with more efleoti",ly Ulilizing me "",IOe <lcli.-cry 'Y'l"'" (o.~ .. ,jslOnce in developi ng pi,,,,, of """', ""ces.inll: .."",iceo and support.<, pw1nering with prof ... i()flals] or Wld",,uanding and coping wi!b !be Slre.son. of the po""n'. in"" .. thmu!>h . upport 8fOU!", ",I" modeling, .nd men!<>ring. AClivi!i.1 whicb promote rociali7.a1ioo, recovery, .. !f·~vO<:;lCY, dCHlopment or natural supports, and m.in!eno",," or communl!y livinli 'kill' ~re rmd,-red ' 0 indhiduat. can "J""o!e .nd ,ul"P'X! ""ch OIher in the ""'Iui.iuOll of •• ill. needed to mana~ ~heir ill,,.,..,,,, . nd aCe"" ,cwurcc. within their communi lie •. Ser, .. io". an: often pro"i""d duriJ1i the C\leninll: .nd w«lend ooun_

Amernlmonl 33 (COni.)

family Supporl S<nkn

Fomily oupporI <erVi,,"" ore u..cd to ."isl <>Ih<lr ""'''Sive" of children (>!" youth dl'gn<.lsed with "tII(}I.iooal. bej,ui"",l, or """",,,,"mng <fuord" .... ltd are provided by jtet$O!l . who or<: a Ce,tif><:d F;.nily Support Spee,.li,1 A Certified Family Support Specwli'l i •• p<ts01l " '00 h •• previ()u,ly ""If_'dc'ntificd ~. U'" can:ai~er or .. child ()1 youth with :m ettIOIiooal. bcN.vioral .". "'>-ooourring dioortlo:r .nu who h." ."",,...,rully "avigJ.IW lhe chilu,s<rvin, ,y.lelm 10 """"".l,cotm""lo,,u ",,,,,m;,,,, """""ory to build ''''ili''11<1 ..,d 10.1"" .""co .. i" the 00""'_ school •• n<! COlY1munily_ -ni. i,-,divid,"d h ... ",,« .. sholly c-ornplolM trAin in\( rccognir.cd by TDMHSAS <In how 10 .""lot olher ""TC~iv<:" in [<>Slering "'llili.mcy in lOOr ,-hild bo""d on I.hc principk .. of I'\.,>ili"""y and ",cowry_

fl>e$e .cr.-ic"" include wi. ti"!! ",,,,,given in IIllInasinll Ih<:ir child', ill""'" oM l,lSICr;1li\ "",;Iirncy and il<:>po in lhe n-.::overy """,<:$,. Tho«: <liTocl c'TCI!iv"""O-<""'l:iver ,uPJ>!Ht 'o...-ic,," i""I\>do, but .", IlOl limited In, dcvdnping Il)nu.l .nd inlo.m.l <uppo,l>, .... i .. ing in lh. developn.mt or ,Irongln.,ba •• d romily.md individU11 &001 .. "->rving o •• n . d,'oc;(o, mc"tor. ".- facilitator fo, ",,,,,\utioo of ISO""" Iht .. ca'<1>iv"t b u"ln\~ tn rew!v¢ on his or her own. <>r proviJing cdLlCation 00 .y01~m naviglliion o.nd *ill. neC<uory 10 III-lin{ain • ~hi1d wi,h ""lOIl"",,-l, ochlt,·ioral ,>< ",,"occurring di'<.>«i<n ill 'heir ho<ne .... ..-ir<ll1ll>Ctl1_

114. Th~ nefi"i~i"1L ""de'- (',i,i, Sel-..-k~. ill ,\ttachment \ ~h~1I Il<" deleted ~nd u plaud ~. (o tlm ... :

iklinltion

Bchavi ..... r !Jeollh c,i.i. "'...-;.;'" . han be ",n<l<1'«110 individual. with. men"'! h,,.1(1) or wb.",,,,, .. """.huse ;,;", .. when th<n:;,. Jl"TC"Jltioo of. eri , i, by an individual, f;urnly member, law cnl(",'"mem. bo$pi(.O.l '\.lff Of otll<'" wOO bove cl<)Scl~ oo.cn-oo 11>:) individ...u ¢'I'e'icncing the cri,i •. Cri,i. ~, are avail.ble twonty.four (24) !Iou ... " day. ~vcn (7) day, a week.. ('<iois $<'rVi<:el inc\oo. 1w=IJ-wur (24) hour toll Ire(: lelephone jire, "Oli,,"or<xi in ""'-I lime: by trained ~rnil .peei.list> and r..,o·lo-l;";" ori". ,ervi<:cs i""luding, bUI not limi1ed to: prevention, tri.~e. inte...-ention. ",'.In"lien/,ere .... l fu, additional ,,,,,,iees/tn:3lment, and follow. up "$t...-icc •. C<r1ified Peer Recovery Specialist. and/<>r Certified P"",ily Support Speci.li.a ,hI! h< utili«d in conjunction with cri,is spodoli'ts to .... i.1 adllito. and chilJren in rul",'iatinll and lubiliziog c,ise, ond prumore tl>< recovery proceu .. '-PP"'I'ri~1e, Ikhavi<lral h .. lth eri,i, """,icc providers Ire 001 resp<.>n!lible lOr pre·outhorizi,,¥ eme'1lcrn:y in'lOl"mB", hoopillliztlliOOl,

Tile Mental Hellth Cri,;. R •• pon ... Sen-ico. - Communny faoo-\O·F"". Reopon<e Protocol. pr"",idr: guidance for CiU, tlult lire the ",. poo,,, bilily of" eri. ;. ""'P""'" ,,,,,ice to determine if. Face·ro.Foc. ~'VJ.I""ti<KI i. "",monted and tI>ooe lhat . re not 1m. ""'po!l.ibility of tm. crniJ ""pt.",... ,e...-ic., These Protocol. "'ere developed '0 ""'u"" thot COItOumen who "'~ e><pr:rk:ncillj! 0 behavioral health cri.i. Ind !\ave no ,>thor reKnm;<:. uccivo promp1lt1ention. AU re.potI",," ne fi,.,t ,\c(ermiood by clinic.l judgment.

(iuiJalfCo/or All Call,: • For c..U. origimling from an Eme'1l"lICY ~pt .. t.Ieho.lth i. the prcf..-red """ice delivery melhod Yo<

the c,i.i. ""po_ se...-ice • Ar .... , tktmmlniug thlt the,e ;, 00 immedi.te honn, .,k II>< pe'''''' if Ito or ,he can corne to the eIO..,,1

w. lk_in """"" • If. Mandatory Pr •• .c,.""ing Agent (MPA) no! "mployed by. <;ri.;. '",pon.., oervi<:o i. ,,'.iloble.

If>ore may be 00 !\<!cd I" ... cri. i •• ",I""lion by moo'''' en.i, • For.1I OIhorc.lIs, Wile"" .peeified in tho; Pm1ocols, if. pe<Wfl ,,·;,h 10= .. 1 ill .... • .. u "'pc';cn"',,g 11><

likolihood of i",,,,,,diale hann then • ~ i. indi<:alt>:.l_

'u!>mdtneat H (ront.)

11 ~ \ tla,bml1l t III sluo U IlII dd«rd . Dd rtpI:attd u r"llG.n:

.\ · I·rACII~n;S"r III CESKiUL .\ CCJ,;SS ST ANO .\RI.IS

In 1""",,,1. contraclOn .MIl prnvido: .,'.noble. 1lCal,,,I>I ... and tdoqUdte .,umber. or ,,,,,t,'ul,"""] r"",li,,,,, • ..,rvi..:e 1,.1"'"'''' ."vi"" .il"', prof"",;."..I, a11ie4. "'HI p;uaoncdkll petsonntl fOf ~ 1"""";",, (If c~",11:d ...... ice •. ,..:lud'~K .11 """,,"&cncy """";';;"'. "" ,,24.hour-a.<!:ay. 7-d.iy.a ..... """ bu;'. AI. minimlWl. ,lui Ih:.tll,ncludc,

(a) ~e Ibn!; 30 milo

(bl ~ Urbut. 10 mtla

(d) AppoinwenlIWoiI .... [·imco. u..w 0Pd cUII<lINry pnaio:e (..,. W""'11111 l>olo7wl. I0OI !O "",,,,,,,,,-1 III'CICb (rono date of I "",,,,,II', roq ........ [", "'iu1ac appo;nlman. and 4. houn {or "'i= cue. W.;ti"K times .... U IK>I .. " ."<>Cd ~5 m'~"ta

... J)ocumo..'Illiltiol,· rl~1lI mUl, h""~ "')">Iten ",. pi ... " 10 """,,ulnent oppainlmall .. ho.:duhns 1;""",-

• T"",kinl . PI;wo mllll hI.'c • lyat~m ill pi.., 10 aoc""""'l 1M c~chance of ..... "obc' informooJDt ,f. pn;w>d<:1, <II"'" than tb< primary ~-an: pnn-idtT (1.10.. IdlOOI.bosI:d din;" or Iteolth ~ clime), """ __ hoalll> care.

• S"",,,olly Cue IIId ~ ~ Ref .... ' oppotlltmCIIIS 10 ~'01$ (e_ •• spoc .... ly phYSICian l-CfYJCeS. boo.pict- call<. home hahh C" .... lubmnce ........ """tment.. ",haboli~ Mtri<;a, "".) ""'II ..... «cccd :lO days (or """"'" <:ale .. 4~ ho .... r .... "'JCftI can:. AU cmaF'lCY <1*'t iJ immaliac, aI !he fOe""'" facility .... ,Wlle. regar..u",," or~. Woit"" tim".N1l "'" =~ 4S m..-.

• l~pil.l.

(I) Transpon d .. t;mc ..... HI be 1M "" ... 1 ond cll''''rna'Y. "0\ to exccc.l)O on,t ... CJ.,-.:pt In rwal ore ... where lce ... disllllCc may ~ ¥l"elllot. rf 11"'"1 .... the ,Wl<IUd n.edt lQ be (hi: I;Ommuni(y 'tondon! k.< """,,,,,,ug <In. and cx~.ption. mUSt be just,fled Qnd do.·wucnted l<.> th<o S,.IO <XI the b .. i. of c<>mmunily lIa"d.mls.

T..-p>n d;.u.1IU 10 ltcmscd MMI DIy Ot", .,..,.od.rs w~1 l>o !he u .... 1 ....r 0 .. 0 .. '., .. 1)' IlOIlO nccal 20 .n,k. far T..mC11I: cnmll= in tubon _at. 1\1){ 10.,.""'" 10 mil.,. rc. TcnnCm enroll""" 1ft........-m "'f;oj; ......... w n=d 60 ""r...IbrTCMC~ CIlIol~ In """' :arns a..-epI"'''''''' _""1)" oQnd.uds ..... .toa.mmw;"'" >hall """,y.

"

(.) "j""''''f'lI'I ~i......:e WIll bo the ........ nJ ."''''na£)', nul \<> ... ooed JO mile., """ct'I in rutlIl . "". • ... lIon ""' .... ,_ily .!lIlditrdo ""'. doc"""nl>!>QII .lIall apply.

(hI AI'P'I'IfIIJ'l<fW"';nlf uti<$: U .... H<l ... ..., .... 'Y nut III aca. ... j w.:d.f fbo: 1q\II..-.. ~ IUId 4lI boln lOr "'l. ...... o.n, W~jlin& nm.:. .... 11 "'" ucftd 45 mNJU!o..

• ,\II "<11,,,.nvic<lt IlOl $pe<;(~ hen: <1>011 ""''1'1 1/10 ....,.J and rustDmOt)' .... ~ fill the C<IRInI .... ~y '1*

do.oocrmlllCd "" llSNCARE,

TENNCARE ",\II c,·.lu.lc the "'-'Cd for !\llthu "'II(In ",hen \he "bu,' •• lanIl .. <Is .... no! mel AI iii $Ok! di",,,,,ion TfNNCARF. may decl one: (If lItre<! nlll""'" ( 11 TEl·'NCA ItI'. m.y m!",-.t • Co""clive A~i'io" PIIJl (CAP). (2). 1t"'lU"'i fot Inf"..,...hOl'l (Rfl), (lj or on 0.. R.:quo:~ R"pOn (ORR) <kp<.'1IIi,oC <'In Ibe "", .... \y of 'M <kfldmcy.

TIlt .cquntc<i CAP, IlFl or ORR I"""'''' .... U do:wl the CO!{rltA('TOIl" ....... or\: a.kqoIacy ................ uy ,I",mote ----. ...... ""UftWI)Wio/I of ...nq... marleI condil""" :ond.m II< p/IJt few _lion. It TENSCAllli ~ tho! COI'ITRACTOR'. ~ .... -"U:01n aioono:" rtf .. l! ....... lC " •• ","',.,. Qf"";""" martel .<>nd",.,..., TF.NNCAIi.E may dOCl to rcq~ po:riodk ¢ .... &om It.: (.'OSTRA(vroR tClI"tdlnjl; "from 10 14lmo, .",,11 .:a>dili""'-

116. ,\II.cllme"l Y sb.n be deleted IlDd replaced .. rOu(".,~;

An' AC IlMt:1'IT V ACC. :.. .. S .. AVAlL\Blun' f Ok S I>IIA VIORAI. IU:'U .' ·\! SF.RVI Ci:S

'.lIe CONTRA(.'1"OA JlIaU IIdhere to the: folllowio\i k~"';onI """'!tlo ... r.o. ....... ""'IUII'l: .. ..., .. 10 .... "'" .. " ,.-.... IUId ","*ilob!hly .., bcIoIvoor.ll '-Ilb ocnm f'" .11 _onI>.:Q (aduiu IIftd ~14rm), fOO' !he poupOS<: of ......... mg bd\a..,oral hc~ltll pro.iJc:r ""' ....... >doqoIa.y. TH.NCNtE WIll <:\"'II ...... he CO~"RACTOit'. p"""idc. _utk ",la.i .. " 10 the r<qujr<mnv, & ... ,1'1_ below. I'rtwidon onv"'11 aduflo ",ll be cval"o'ed "' ...... Ie!y from thew MrvinK cl>ildn:n_

Ik CONTRACTOR >I>.n o:RIUI"C access '" bello""",,) n..llh """"""'" fill the prOYilion of rovn<:d ...... """. AI • mllllmOOl. dti. _ .hac

The COmltACTi)R .... n ha." prcMdcr agoulftCfll. w ..... """ ...... oftbo: tuYOI>:S laiN in !he !ahIc below ..... "'"'" d .. ,...,....pl"" IlI!I time lOr adma~_m ~

Amondmenl Jl (con',)

'Ole CONI'Jl.ACTOlt .... U cooncl .. "h ., I¢ .. t """ (I) J'<ovicleI or "fVkc In ,'''' Gral>ll Iklj: ..... fur ,\.111. 1.'1' nl<nlh<n -----T .... "'I .... _ oo..s ..... ,,~ 6Q ",Ib f".. at InM 1~ nf CIIIIJ) ,lItml,..", or><! '''''' .. Il0l ... oeed 9Q m,lot

mil .. for at

_._-.-. __ ._._--------_._.-----...

Tho: CO:-''TIL\Cl'Olt ~ """Ira<t wi"' .. l=it one (q~ .... of-"," .n the G.ud It<'lPOn for CJUI,I/

ifutp1. " 'U/Iift

• it

~,.

Amendmen,]) ("""q

rENNCARE will .val""t~ tho :>t."ed for funher •• li(l!l whon tile above '!alldorct. .re not mo' A, ils .ow di,creuon TENN(' ARE IIllIY ded "'"'" of tlm,e <>pIi{lIl.1!' (1) TfNNCARE m.y "''1''''1>1 • Conce!;" •. ~cl~m Pl~n (CAP), (2) • Rcq"""1 ['" Infunnatioo (RFl), (3) or an Oil Req ..... , R.pon (ORR) oo!"""linl\ ()rI the "'v<:rity or!ll< oofie i"""JI '

The "*,,,.,td CAP, RFl or ORR ""p<>n5< , ball do!>il lho CONTRACTOR' . ""I"""r~ a<kquacy c"".idcring any . It.male nleUu"", documcnul!ton of uniqllC m.rI:", c(lndilmrl> ondot it. plan roc c=lion, IC TENNCARE del~nnj!ICS lito: CONTRACTOR '$ ro!Ip<.>,.,e &m""",,,,Ic< ,he c~"'lcnce of .l!~m~e mea,ure1 or unique muk.eT condilio1w, TENNCARE ma.y dect 10 <"«I""'" perH>dic upti;ll.' from the COt-ITRACTOR re&~rd;n8 eff"", k> <><kIreo. JUCh """,jilin .... _

At • mjnimum, pmv;<!er, for ,be f"llowing .clVice types 'hall be reported on (he Provider Enrollment fil.:

S.rvk.1)~

Child

.,

"

Amendmctn ,3 (C<lnl_)

111. "~h'b'f B of Atta~hmeDI IX shall be amended by deleting fhe word MPeer SupportM a nd replacing it wilh "Peer Reco~ery Ser-ioes and Family Supp<lrt ServkuM

•

118. Attachment XII .hall be ddded ~nd replaced as fO]JOl ... :

L P">grml Requirements

A TTACUMENT XII COMMUNITY IIEALTlI RECORI)

1_ Til .. CONTRACTOR 'han """i,e dn,,- fil", Ii-om TEt..'NC ARE for ~1l T<->nnC.", enrolloos lb~t 1""lud. tj", foUowinK:

a. M~rship and eligibility file. F __ eh daily I'out,mi .. ion will meet the 2701271 .tondan:llrMI • ..:!iWl f=o1.

11_ Medical claim <"""un!", .Jala from ,II MallO"'" Ca", o..g.runtiom (MCO)_ I!ocio weekly ,,"n.mi .. ;on will illClude all ell;"" proa:,'ied by each MCa for tl>< prior peri"".

c. Phonna,:y cllim eo .. ,,,,,,,te, data du. 1I b<: provided <>I, a weekly !>aoio. Each tnln>ttIi .. i<Jn wiU ;ncl""" aU pt,armacy olaim. proce",cd Ibr the prior period.

d. Provider file >hall I>< prnvi<\od on" roondtly b •• is .tid.M1I includ.: the Noti.,.,.l PrtJvide, ldentlJier for each providet-; ho~r, TENNCARE .ball 001 be respon,iblc for l;n1:in~ .,..,h pro"i<\er to • common prtJvidtr number fur uid tile.

2_ rhe CONTRACTOR , t>o.U provide dat. imelj:mion ,,-,,"v",eo; for .n -r"""cue e!lro!l~ ...... hKh ,,,,,I<""" m:Jimlining an Enlerpri.e Mailer PeI300 Index (EMPI). The EMPI prOVl&' • cem",l ",,,,,,ilOljl for pc'"",,-"entric datil from a VUl<oly of c"{)(\tributmlj: ,y.terns, and bcilitl"" lite intcogrity ofa ,in~1<: person record. The mi .. ion of lbe EMPI if< 11> prOv,de functionality to find Ihe right per""n with tbe right infonrullioo It 1M ri~hl lime~. wen •• pr""ide a solutioo to identify and eliminate " "'OllY duplicate records a. """ibl",

Amrndmmt lJ (roaL)

J, 1110: COSTRACroR ,b.dl provide ~ d~ """III> ~ for drildn:n """'"'" :>f~ "",Indy ' 0 .he "'''JI'fd Be!.I ~ ... "< N<i."rk pro.'"," llW io.;l...s.:..1bI: iUllmo"'8 com ..... ""' ...

~. M,d.k.t;"" ;n[""""{;o" f,om el."". do:,ail.

4. n.. L'ONTIlACfO(I; w.u ~ I J)'SImI .... ,toobte to ~,tn<. """ c:omp,,~. d,oto~l bQltto m;.;on:I \10.1 • .. ;n be ....... ro ... IohIc .. .:kmaDtI «> the Do-putmn.I "rChildrm Sc:rvioa (OCS, throuJll> I ... do t-cd "PJ'I_ once I ~hiId'" cnICn:d inI .. S!.a1~ cusLotly.

s. Upon ""',r-""' ...... idtnIiflCM;"ft oIlbi: p" .... 'Yn." pmnok, .... ,gnallO I ;hM .. OO m:cntly mIm:d SII" c...c.xly. en. CONTII ACl·UII. . MII m • ..., .. ·., .. bIe.o {he....,ped P'.wid<r ,he dm;~:ol beahh_"1lni ""","""d in Seclion I, h"", "' obQ\e ~II .... 1Ob twucd oppI;..c;.,.,.

6 The dinkll health ,ocor<l will ""Iy be tnaJe I~.ilabk to I ;nwidct ... 110 is aUlllcnti ... co,t I nd 1'<H"{Crcd 10 ulilia: lhe wd> b1ost>d appl",.""". fbc: CON"TRACTOR :thai! provide lwo (2) lUll lime Qm~kIy~"o to ","i,. lhe providor in the ""thentOeltl"" In.! "'11"""'i,,., proc.... Upon """'p""''''' ",r tl'" authentic.!ion and I'Ojl..tralion (1<\"","", the "..,,,'!4::. ,..ill be lObI<: '" lOCCnO !he dinic.1 he.lIh nn>«I.

7. n.. COt-"TRACTOR of .. !! m.l.inl2.in. "" 01-" di<ricl.l he.Jtb "",on! dw ill ..... miottd to OCS and/or ,"" .... ljnnl providcn l M ""II be made mlil.1blol .. port ""'Lues(.

S Rcsp ..... ibiliua ofTFoNNCARE "'" listed ... 1 ......

~. I'roYlSliIn o f Dam and Prov-m !nf<lnnll11OD: TENNCARE shall IITllIIg<: rot lhe: rollo ... ing dalll to tIC' provided. AU daw. prov;.kd (NI I .. 'l"ek1y basis wI! bo: pIO~1de4 ..... kole\" dlIO

W~~y ofthc "cek follow'l\I \be da .. roU""tion.

b. Elij;'ibihty files daily IMI It>t'CI {II.: m.j\lirc.rn:.:nl~ of the HIPAA S .. ndard Trattlacllon fur EI'Sihil ity (270071).

e, Medical claim cru:ountcr data ["rom .ll plU'til'lpaling Mea. ,hall [x, provided on a wo:ckly buis. Each weekly lninsmiUK)n will ,"elude aU claims processed hy CACh Mea for lbe prior jl<.-riod.

oJ. P~y ct.im cncowl!et da .. sha ll be pruvtded 00 I ,,·eckly haois. Each .nnsmiJJiWn wi:! include all pluumacy claim. pru«$JOId rOt' Ihc p""r pmod.

II. P"",!der fi1c shall be prO,tdctl on I monthly bosll and include Ihe N •• oone! I'm ... ider Idmufanlliw =:h provider, howr'l:f. TEh'NCARE shall DO. tIC' .espoll$i\)l~ kif hnlll" each p .... ·Jdcr 10 a I:OCIIIDnn pro~ockr I>WIIbcr f'ur.aid file.

-'"uend"""" 33 ("""\.)

All of the pnwi.,,,,,, of the on~i". 1 Coom.ct 001 .pedfica.lly dele.ed or modi lied herein .tlaIl"1!nom In full tbrO" and dfc"C'_ Unle .. a pro.i,ion COIltoilk-"II in Ihi~ Amendment specifically iodica,,,,, • cliff.",,, •• rrecti~e Wire. fQ' ptll'\'<'Se< ofthe pnwi.ioos comame<! ben:in, ,hi. Amend,,,,,ot _,hal! ba-ome effective Jan~ 1. 2014_

Til<: 5101(: i! ,x" bound by thi. ,\""",dmcm until it i • • i!,:ll<d by IlIe Cmttnct !'lrt;", .00 awovc-d by appropriOle oflid.!s in aO<:<l<'dance with 'ppiioable-T~ !aws .,0.1 "'!lu!.tio". (dependous upon the """if",. of Ihilt Coo"O<;', .. id ~1T>ci.l, may i",,!ude, but ore 001 limilol,o. ,!>c Cummi .... o" •• of f'''''''''" .nd Admini.\uti<X\ the Commi .. ,io.>ncr "f H=u Resoo", .... 1Id th" Comp'mIkr "f Iho T "''''ury).

T1>o CONTRACJ'OR. by .ignalure oflh" AmcndmenI, h<reby .mrms lMlthi' Amcndmertt ha, 00' been aUor<:d and ,hcrcf"", rep<=nt> ,II<; !denllo.l do<umcut I ... W'.' ",nl 10 the CONTRACTOR by TENNCARE

IN WITNESS WHEREOF, Ih.! p."i •• llavo by It-.:i r duly aulh<,.;",d r.preoetltative • .." their "glUm,"",_

STAn: OF nSi'iE.<jsu: m:p,\RT.\IK"TO~· f' IXANCE A",D AD)IINI~iTR.\TIOS

/lATE: -'.1 Z,,;':c5"'/!'-':,Ic!j,--~_

VOLUSTEER STATE U&,\Lni I'I.A. ... , INC.

~~~c .... 91'~ P",:a"~ftt '" CEO VSIIP

D,\'fE: ~-,,!.:I ~-,I-,qc.'J.:g,---~~

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