eligibility determination process detailed in the previous section. Enrollment begins only once eligibility is confirmed by authorized personnel.
2. Documentation Collection and Verification: All required forms and supporting documentation must be gathered from the applicant or their legal representative and verified for accuracy and completeness.
3.
Internal Enrollment Meeting: A formal internal review, conducted by enrollment specialists along with care coordinators and eligibility specialists, ensures that all criteria have been met and documents are in order.
4. External Coordination and Communication:
A designated liaison coordinates directly with TennCare and other regulatory agencies, transmitting the approved enrollment documentation and ensuring that any additional queries are resolved promptly. Official Enrollment and Record Entry: Once final approval is received from both internal leadership and external agencies, the individual’s enrollment is finalized and all digital records are updated in the secure electronic repository. Post-Enrollment Follow-Up: After enrollment, ongoing quality assurance checks and communication protocols ensure that the enrolled individual’s service plan is initiated and maintained as per the approved care plan.
5.
6.
The following sections provide a detailed description of each step, along with the required documentation, roles, and responsibilities, alongside key procedural guidelines.
Step 1: Eligibility Confirmation
Procedural Guidance: Before initiating the enrollment process, staff must confirm that all eligibility criteria have been met:
•
Review of Eligibility Documentation:
– The Eligibility Specialist performs a final verification of the applicant’s records, including psychological evaluations, medical records, historical service documentation, and any additional evidence required by Tennessee CAC Waiver guidelines. – A standardized eligibility checklist is used to ensure that each element has been verified and is up to date (e.g., confirmation of intellectual disability
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