SAMPLE POLICY WORK

– Feedback is collected, analyzed, and used to update the eligibility determination procedure to ensure continuous process improvement. • Record Retention: – All documentation related to eligibility — initial forms, evaluation reports, verification notes, and final decisions — must be stored securely in the agency’s centralized digital repository in compliance with HIPAA, TennCare, and other state and federal guidelines.

e. Roles and Responsibilities in Eligibility Determination

A successful eligibility determination process relies on the coordinated efforts of multiple teams and clearly defined responsibilities:

Intake Staff •

Responsibilities: –

Conduct initial inquiries and complete the pre-screening checklist. – Collect all required documentation from the applicant or their legal representative. – Ensure that all documents are formatted properly and forwarded to eligibility specialists for the next phase. • Key Actions: – Use standardized intake forms. – Maintain organized records for easy verification. Review the comprehensive set of documents for each applicant. – Validate the authenticity and completeness of psychological evaluations and other supporting records. – Initiate requests for additional information when discrepancies or gaps are identified. • Key Actions: – Mark files as “Initial Approval” only after thorough examination. – Document findings in the electronic record with detailed notes. Eligibility Specialists • Responsibilities: –

Supervisory and Management Staff • Responsibilities: –

Perform a final review of eligibility determinations. – Confirm that all regulatory and internal guidelines are met before granting final eligibility.