choices_group_3Since the CHOICES program underwent some major revisions in July of 2012, consumers and service providers have been questioning the logic of denying coverage to Group 3 beneficiaries for care received in assisted living. I am excited this month to share what looks like a ray of hope that the omission will be rectified.

In this February 6 memo, the Tennessee Bureau of TennCare informed Tennessee assisted living facilities about a proposed change to CHOICES Group 3. Under the proposed amendment, CHOICES Group 3 beneficiaries would become eligible for coverage of care received in assisted living facilities. The proposed amendment has been posted for comments from the public on the TennCare website. We strongly encourage you to follow the link and read to find out how you can submit your comments.

Why is this so important? CHOICES Group 3 beneficiaries are considered “at risk” of needing nursing home care if action is not taken to provide preventive care services. This group was introduced in last year’s restructuring of the CHOICES program. According to the current rules, Group 3 beneficiaries can receive up to $15,000 a year in coverage of home and community-based services, but these services cannot be received in an assisted living facility. As I discussed in a blog last September, prior to last year’s changes, many of the people who are now in Group 3 would have qualified for up to $1,100 per month in an assisted living facility. A major concern when the new law was introduced was that individuals who were already in an assisted living facility might be retroactively disqualified for benefits. It also seemed illogical to deny Group 3 members the opportunity to receive care in an assisted living facility as long as their cost of care did not exceed the $15,000 annual limit.

It is encouraging to see that TennCare has heard the voices of professionals and individuals who recognized problems in the CHOICES program. Even more encouraging is that TennCare has responded with appropriate action to solve those problems. If the amendment is successful, the Bureau of TennCare plans to request an effective date of July 1, 2013 – one year after the creation of Group 3. Let’s hope that the amendment goes into effect promptly so that Group 3 members can get the care that they need in the most appropriate setting to fit their situation.

If you or your clients or loved ones may be affected by this change, don’t forget to lend your voice to the cause: visit the TennCare website and send in your comments right away!