SAMPLE POLICY WORK

• Feedback is compiled monthly by the Compliance and Regulatory Affairs Team and reviewed by department heads during coordination meetings to identify process improvements.

By adhering to these structured eligibility criteria, procedural checks, and comprehensive documentation processes, Simpl Care Services LLC ensures that all four priority target groups — Former Arlington Developmental Center members, Former Clover Bottom Developmental Center members, Individuals discharged from the Harold Jordan Center with a 90+ day stay, and Individuals transferred from the Statewide Waiver due to cost cap limitations — are accurately identified and receive the high- quality, person-centered care to which they are entitled. This robust policy framework not only safeguards compliance with TN.0357.R05.00 and related regulations but also reinforces our agency’s commitment to ethical practice, transparency, and quality outcomes in the delivery of services to individuals with intellectual and developmental disabilities. VII. ELIGIBILITY DETERMINATION The purpose of the Eligibility Determination section is to outline the step-by-step process for verifying an individual’s eligibility for the CAC Waiver at Simpl Care Services LLC. This section establishes robust procedures, detailed documentation requirements, and clearly defined roles for ensuring that only those who meet the regulatory criteria receive services. The following policies and procedures are designed to promote transparency, accountability, and compliance with the Tennessee CAC Waiver (TN.0357.R05.00) as well as all applicable state and federal guidelines.

a. Purpose and Overview

Purpose Statement: The primary purpose of this eligibility determination process is to ensure that all applicants are accurately screened and verified in accordance with the CAC Waiver requirements. Establishing a clear, standardized process is essential to safeguard service integrity, direct resources to individuals with intellectual and developmental disabilities whose needs are greatest, and maintain full regulatory compliance. Regulatory Alignment: Align eligibility criteria with TN.0357.R05.00, TennCare guidelines, and other relevant legal documents. • Quality Assurance: Ensure that only eligible individuals receive personalized and high-quality services. • Operational Consistency: Provide staff at all levels with a definitive procedure to follow from the initial inquiry to the final confirmation of eligibility. •