Amends TCA Section 71-5-164.
Present law requires the commissioner of finance and administration to establish a distinct Katie Beckett program ("program") that is composed of two parts, Part A and Part B. Part B of the program must be administered by the department of intellectual and developmental disabilities and be designed as a medicaid diversion plan that offers a capped package of essential wraparound services and supports as well as premium assistance, using a sliding fee scale based on parent income, for a child who is under 18 and meets the following criteria:<br /> <br /> (1) Has medical needs that (i) meet the level of care criteria established specifically for children; (ii) would qualify the child for institutionalization in an acute care hospital, nursing facility, or intermediate care facility for individuals with intellectual disabilities or place the child at risk of institutionalization; and (iii) are likely to last at least 12 months or result in death; and<br /> <br /> (2) Is not medicaid eligible and is not receiving long-term services from any alternative waiver program established under this title.<br /> <br /> Present law requires Part B of the program to provide services in the most integrated setting appropriate and cost-effective way possible in order to utilize available funding to assist as many children and families as possible; support and sustain child health; utilize, support, and sustain family caregiving; plan and prepare the child for transition to employment and community living with as much independence as possible; and delay the need for medicaid eligibility and services. Further, Part B of the program must determine eligibility for services based solely upon medical necessity and provide children applying for or enrolled in Part B of the program with the same appeal rights accorded all other TennCare and department of intellectual and developmental disabilities applicants and enrollees.<br /> <br /> This bill adds to the present law by providing that, subject to appropriations, Part B of the program must serve a minimum of 5,000 program participants, subject to approval by the federal centers for medicare and medicaid services. Further, it is the legislative intent that the general assembly appropriate $13,000,000 in fiscal year 2024-2025 to fund an expansion of Part B of the program to meet such service requirements.<br />
Present law requires the commissioner of finance and administration to establish a distinct Katie Beckett program ("program") that is composed of two parts, Part A and Part B. Part B of the program must be administered by the department of intellectual and developmental disabilities and be designed as a medicaid diversion plan that offers a capped package of essential wraparound services and supports as well as premium assistance, using a sliding fee scale based on parent income, for a child who is under 18 and meets the following criteria:<br /> <br /> (1) Has medical needs that (i) meet the level of care criteria established specifically for children; (ii) would qualify the child for institutionalization in an acute care hospital, nursing facility, or intermediate care facility for individuals with intellectual disabilities or place the child at risk of institutionalization; and (iii) are likely to last at least 12 months or result in death; and<br /> <br /> (2) Is not medicaid eligible and is not receiving long-term services from any alternative waiver program established under this title.<br /> <br /> Present law requires Part B of the program to provide services in the most integrated setting appropriate and cost-effective way possible in order to utilize available funding to assist as many children and families as possible; support and sustain child health; utilize, support, and sustain family caregiving; plan and prepare the child for transition to employment and community living with as much independence as possible; and delay the need for medicaid eligibility and services. Further, Part B of the program must determine eligibility for services based solely upon medical necessity and provide children applying for or enrolled in Part B of the program with the same appeal rights accorded all other TennCare and department of intellectual and developmental disabilities applicants and enrollees.<br /> <br /> This bill adds to the present law by providing that, subject to appropriations, Part B of the program must serve a minimum of 5,000 program participants, subject to approval by the federal centers for medicare and medicaid services. Further, it is the legislative intent that the general assembly appropriate $13,000,000 in fiscal year 2024-2025 to fund an expansion of Part B of the program to meet such service requirements.<br />
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