SAMPLE POLICY WORK

– Official transfer documentation must verify the cost cap limitation as the primary factor necessitating the switch to the CAC Waiver. – Clinical assessments should accompany financial records to demonstrate that the individual’s need for services remains unchanged despite the transfer.

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Financial and Administrative Records:

– Submit detailed financial statements, cost reports, or correspondence from the Statewide Waiver program indicating the cost cap achievement. – A transfer summary should outline the rationale for the transfer to the CAC Waiver, including any changes in service delivery or care planning anticipated as a result.

Procedural Guidance:

1. Verification of Transfer Reason: Intake teams are required to collect and review all financial and administrative documents that confirm the individual’s transfer due to cost cap limitations. 2. Cross-Functional Review: Eligibility and finance teams collaborate to validate that the necessary documentation satisfies both financial thresholds and clinical service needs. 3. Documentation and Record Update: Once confirmed, the individual’s digital profile should be updated to reflect their transfer status. This update must include all supporting financial and administrative documentation for audit purposes.

Roles and Responsibilities:

• Intake and Finance Coordinators: Collect and verify all financial documents related to cost cap limitations, ensuring that transfer criteria are fully met. • Eligibility Teams: Assess clinical and financial documentation side by side to confirm the individual qualifies for continued services under the CAC Waiver. • Compliance and Regulatory Affairs: Oversee the integration process to ensure that all transfers follow internal policies and align with TN.0357.R05.00 requirements, as well as relevant TennCare guidelines.

c. Cross-Group Procedural Guidance and Documentation

To ensure uniformity in the identification and verification of all target population groups, a common set of procedures applies across the four priority categories. These processes help maintain consistency in documentation, evaluation, and record keeping.

Step-by-Step Approval Process for Eligibility Determination 1. Initial Screening: