case study:Financial Administration and Support Brokerage Services within Managed Care in Tennessee

PCG Public Partnerships, LLC | 148 State Street, Tenth Floor, Boston, Massachusetts 02109 | tel: (855) 243-8775 fax: (617) 717-0085

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THE OPPORTUNITY In 2008, the state of Tennessee passed the Long-Term Care Community Choices Act (CHOICES), fundamentally restructuring the long-term care system in Tennessee. Among other things, CHOICES integrated nursing facility and home and community-based care into a managed care delivery system. It also provided participant direction as an option to those who were eligible for home and community-based care.

Unlike traditional participant direction programs, TennCare structured this program within managed care. Medicaid recipients would select a managed care organization and, should participant direction be appropriate, the managed care organization (MCO) and financial administrator would work together to authorize the individual for services. TennCare also determined that it wanted consumer directed workers to utilize a telephonic timesheet system (EVV) rather than standard physical or electronic timesheets. Finally, the program also required supports brokerage services.

The expectation was that the CHOICES program would be popular because until the CHOICES program, Tennessee offered few home and community-based options for long-term care recipients. Consumer direction numbers could not be predicted but were expected to grow significantly over time.

THE RESULTPCG Public Partnerships, LLC (PPL) worked side-by-side with TennCare, structuring the participant direction program for a year prior to go-live and helping TennCare with participant direction policies, procedures, rules, and regulations. Among other tasks, PPL

• Developed data transfers between PPL, the three MCOs, TennCare, and the EVV system;

• Subcontracted with three supports brokerage agencies to provide statewide services;

• Launched PPL services regionally, following the roll-out of the CHOICES program;

• Enforced state and federal program requirements;

• Configured PPL information technology platforms to fit the state’s unique program requirements;

• Developed materials and processes to support program participants;

• Customized reports to the state’s program requirements; and

• Instituted monthly meetings with the state to improve program efficiency.

THE RESULT• Since April 2010, over 1,000 individuals have been referred for

participant direction and about 360 are actively receiving services.

• On average, another 28 individuals per month start receiving services.

• On average, PPL customer service staff members field 1,300 calls per month.

• Vital employment of over 300 FTEs providing consumer-directed services.

• PPL won a re-bid for the contract.

THE CLIENT Tennessee Department of Finance and Administration, Bureau of TennCare (TennCare)

THE PROJECTProvision of financial administration and supports brokerage services for consumer direction in the TennCare CHOICES Long-Term Care Program.