Cuts in TennCare Nursing Services

Please respond to all mailings from your managed care company or you will lose all nursing service.

The general guideline is this:

Between now and Sept. 6, if someone gets a call or a letter from their managed care company, they need to appeal and ask for a continuation of benefits. It is highly likely that by appealing and having your doctor's support, you will be able to keep your nursing services until Sept. 6.

Starting Sept. 7, there is a new ball game with new rules on nursing services. The new rules will limit nursing services for 100% of the adults receiving more than the new limits. Most likely no one will be able to get 24/7 after Sept. 7. But you will be able to keep services up to the new limits being offered if you get your doctor's support and respond to the letter from your managed care company.

So, if you know what the rules are and you have your doctor's support, you may be able to keep nursing services within the new limits. However, you will have to be proactive.

It is likely that you will not immediatel lose your services on Sept. 7 because of the new rules. But it is likely that sometime after Sept. 7, you will get a letter from your Managed Care Company saying that you nursing care will change in 10 days and you will have new limits in nursing services.

When you get this letter from your managed care company, you need to read the letter carefully and understand what you are being asked to do. If you get a phone call, and not a letter, and are told that your nursing services will be reduced or cut, you need to file an appeal immediately and say on the appeal that you did not get a letter from your managed cae organization notifying you of the cuts as required by the Grier Concent Decree.

If the offer of nursing and home health aids by your managed care company is less than what the new limits are or if the limits are not the combination that you need, then you need to appeal this offer. Check the date on the envelope. Do not throw the envelope away. You have 10 days from the date on the envelope to appeal. If you are not given 10 days, them If ones does not appeal, then you may lose most or all of your nursing services.

The new limits on home health aide care and home health nurse care are attached. I hope that this helps.