SAMPLE POLICY WORK

– Oversee the timely completion of the process and address any escalation issues. • Key Actions: – Update records with “Final Confirmation.” – Organize interdepartmental reviews if necessary for complex cases.

Compliance and Regulatory Affairs Team • Responsibilities: –

Monitor the entire eligibility process through periodic internal audits. – Ensure that all eligibility determinations align with TN.0357.R05.00, TennCare guidelines, and other federal regulations. – Collect, analyze, and implement feedback from audit reviews to enhance the process. • Key Actions: – Maintain a regulatory watch calendar for updates. – Compile audit reports and recommend corrective actions when needed.

IT and Record Management Personnel • Responsibilities: –

Maintain the secure digital repository where all eligibility documentation is stored. – Ensure that the electronic record system is updated in real time with the latest statuses and entries. – Implement security protocols to protect sensitive applicant data in compliance with HIPAA and state data protection regulations. Key Actions: – Ensure accessibility for authorized personnel while maintaining data integrity. – Regularly back up records and update version control logs for any changes made to eligibility files.

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f. Regulatory References and Integration

To ensure that the eligibility determination process meets every regulatory standard, the following references must be integrated into daily operational practices:

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Tennessee CAC Waiver (TN.0357.R05.00): All eligibility criteria and required documentation must strictly adhere to the mandates outlined in this waiver. TennCare Guidelines: Eligibility practices must be compliant with current TennCare rules, ensuring that service delivery aligns with state-mandated care protocols and reimbursement processes.

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