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Attention TennCare and CoverKids members:
Renewals are starting soon. Don't risk a gap in your health insurance! Verify your contact information with TennCare. You can do this online or by phone 1-855-259-0701.
TennCare Long-Term Services & Supports (LTSS)
Medicaid
CHOICES
TennCare CHOICES in Long-Term Services and Supports (or CHOICES for short) is for adults (age 21 and older) with a physical disability and seniors (age 65 and older). CHOICES 提供服務，協助個人住在自己的家中或社區。These services are called Home and Community Based Services or HCBS. These services can be provided in the home, on the job, or in the community to assist with daily living activities and allow people to work and be actively involved in their local community. CHOICES also provides care in a nursing home if it is needed.
CHOICES Groups
- Group 1 is for people of all ages who receive nursing home care.
- Group 2 is for certain people who qualify for nursing home care, but choose to receive home care instead or Assistant Living/Community Living Support (service).
- Group 3 is for certain people who don’t qualify for nursing home care, but need home care to help them stay at home safely or Assistant Living/Community Living Support (service).
To see if you qualify to enroll in CHOICES, call us at 1-800-690-1606.
ECF CHOICES
Employment and Community First CHOICES is for people of all ages who have an intellectual or developmental disability (I/DD). This includes people who have significant disabilities.
Services help people with I/DD gain as much independence as possible. People are supported to live with their family or in the community, not in an institution. Residential services are available for adults with I/DD who do not live with family but need supports where they live.
Employment and Community First CHOICES can help the person with I/DD explore the possibility of working. Services can also help people learn skills for work, find a job, and keep a job. This could be a part-time job, a full-time job or self-employment. Working helps people earn money, learn new skills, meet new people, and play an important role in their communities. Work can also help people stay healthy and build self-confidence.
Other services help people learn and do things at home and in the community that help people achieve their goals. If a person lives at home with their family, the services help the family support the person to become as independent as possible. Services also help people get actively involved in their communities and include peer supports for the person and for their family.
ECF CHOICES Groups
- Group 4 (Essential Family Supports) Family Support Services are for families caring for a child under the age of 21 who has an intellectual or developmental disability (I/DD). The child must live at home with their family (not a foster family).
- Group 5 (Essential Supports for Employment and Independent Living) Essential Support services are for adults age 21 and older who have an I/DD but don’t qualify for the level of care in a nursing home.
- Group 6 (Comprehensive Supports for Employment and Community Living) These services are only for adults age 21 and older who would qualify to get care in a nursing home. (This doesn’t mean the person has to receive care in a nursing home. This program provides services at home and in the community. They just need to qualify for nursing home care.)
- Group 7 (Intensive Behavioral Family Supports) This group is for a small number of children under age 21 who live with their family and have I/DD and severe behavior support needs that place the child or others at risk of serious harm. The behaviors are so challenging that the child is at risk of being placed outside the home. This group provides mental health treatment and other services in the home with the family. (The family must be willing to be part of the child’s treatment.) The services will train and support the family to support the child so they can keep living safely together.
- Group 8 (Comprehensive Behavioral Supports for Employment and Community Living) This group is for a small number of adults who have I/DD and server behavior support needs and are moving into the community from a place with lots of structure and supervision. This could be coming from a mental health hospital, the foster care system, jail, or a nursing home. These services are mostly for adults age 21 or older, sometimes, a person age 18-20 can receive the services too. They combine 24/7 residential services with mental health treatment and support. People are usually in this group short-term. Once the person is stable in the community, they will move to a different benefit group that can safely meet their needs.
You may review a complete list of services for each benefit group, some of the services have limits.
本計劃在以下的郡提供：
Anderson, Bedford, Benton, Bledsoe, Blount, Bradley, Campbell, Cannon, Carroll, Carter, Cheatham, Chester, Claiborne, Clay, Cocke, Coffee, Crockett, Cumberland, Davidson, DeKalb, Decatur, Dickson, Dyer, Fayette, Fentress, Franklin, Gibson, Giles, Grainger, Greene, Grundy, Hamblen, Hamilton, Hancock, Hardeman, Hardin, Hawkins, Haywood, Henderson, Henry, Hickman, Houston, Humphreys, Jackson, Jefferson, Johnson, Knox, Lake, Lauderdale, Lawrence, Lewis, Lincoln, Loudon, Macon, Madison, Marion, Marshall, Maury, McMinn, McNairy, Meigs, Monroe, Montgomery, Moore, Morgan, Obion, Overton, Perry, Pickett, Polk, Putnam, Rhea, Roane, Robertson, Rutherford, Scott, Sequatchie, Sevier, Shelby, Smith, Stewart, Sullivan, Sumner, Tipton, Trousdale, Unicoi, Union, Van Buren, Warren, Washington, Wayne, Weakley, White, Williamson, and Wilson.
- TennCare Long-Term Services & Supports (LTSS)
搜尋本計劃的服務提供者和承保資料。
查找醫師、醫院和專科醫師。
查找此計畫承保的藥物。
Need Help and Civil Rights
We obey federal and state civil rights laws. We do not treat people in a different way because of their race, color, birth place, language, age, disability, religion, or sex. Do you think we did not help you or you were treated differently because of your race, color, birth place, language, age, disability, religion, or sex? You can file a complaint by mail, by email, or by phone. Download and print the information (PDF 30.64 KB) or see below:
UnitedHealthcare Community Plan
Attn: 申訴及投訴
P.O. Box 5220
Kingston, NY 12402-5220
Phone: 800-690-1606 TTY: 711
Health Care Finance and Administration
Office of Civil Rights Compliance
310 Great Circle Road, Floor 3W
Nashville, 田納西 37243
Email: HCFA.Fairtreatment@tn.gov
電話： 855-857-1673 (TRS 711)
You can get a complaint form online at:
http://www.tn.gov/hcfa/article/civil-rights-compliance
You can get a complaint form online at:
http://www.hhs.gov/ocr/office/file/index.html
Or you can file a complaint online at:
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
U.S. Department of Health & Human Services
Office for Civil Rights
200 Independence Ave SW, Rm 509F, HHH Bldg.
Washington, D.C. 20201
Phone: 800-868-1019 (TDD): 800-537-7697
CHOICES Home and Community-Based Services (HCBS)
CHOICES Home and Community-Based Services (HCBS) – Services that are available only to eligible persons enrolled in CHOICES Group 2 or Group 3 as an alternative to long-term care institutional services in a nursing facility or to delay or prevent placement in a nursing facility.
CHOICES HCBS – Attendant care, personal care, in-home respite, companion care services.
- Nursing Home care (Group 2 & Group 3 Short term up to 90 days)
- Personal care visits (up to 2 visits per day at intervals of no less than 4 hours between visits)
- Attendant care (up to 1080 hours per calendar year; up to 1400 hours per full calendar year only for persons who require covered assistance with household chores or errands in addition to hands-on assistance with self-care tasks)
- Home-delivered meals (up to 1 meal per day)
- Personal Emergency Response Systems (PERS)
- Adult day care (up to 2080 hours per calendar year)
- In-home respite care (up to 216 hours per calendar year)
- In-patient respite care (up to 9 days per calendar year)
- Assistive technology (up to $900 per calendar year)
- Minor home modifications (up to $6,000 per project; $10,000 per calendar year; and $20,000 per lifetime)
- Pest control (up to 9 units per calendar year)
ECF CHOICES HCBS
ECF CHOICES HCBS – Personal assistance, supportive home care, hourly respite, community transportation, and/or any other
Consumer Direction of Eligible CHOICES or ECF CHOICES HCBS - The opportunity for a CHOICES or ECF CHOICES member assessed to need specified types of CHOICES or ECF CHOICES HCBS including for purposes of CHOICES, attendant care, personal care, in-home respite, companion care; and for purposes of ECF CHOICES, personal assistance, supportive home care, hourly respite, and community transportation; and/or any other service specified in TennCare rules as available for consumer direction to elect to direct and manage (or to have a representative direct and manage) certain aspects of the provision of such services—primarily, the hiring, firing, and day-to-day supervision of consumer-directed workers delivering the needed service(s) and for ECF CHOICES, the delivery of each eligible ECF CHOICES HCBS within the authorized budget for that service
ECF CHOICES Consumer Directed Home and Community-Based Services (HCBS) – Services that are available only to eligible persons enrolled in ECF CHOICES Groups 4, 5, 6, 7 or 8 as an alternative to long term care institutional services in a nursing facility or to delay or prevent placement in a nursing facility.
(Only certain ECF CHOICES HCBS are eligible for Consumer Direction. ECF CHOICES HCBS do not include home health or private duty nursing services.)
Katie Beckett Program
田納西’s Katie Beckett program is for children under the age of 18 with significant disabilities or complex medical needs. This program is for children who are not Medicaid eligible because of their parent’s income or assets.
This program has two parts, A and B, and will provide services and/or help paying for medical care that private insurance does not cover.
To learn more please visit https://www.tn.gov/tenncare/long-term-services-supports/katie-beckett-waiver.html
承保福利和特點
設備和用品
The health and safety of our members at home are important.
您在家中的健康和安全很重要。
我們的計劃承保您的醫師或照護經理開立的醫療器材。這些可能包括下列用品：
- 醫療用床
- 氧氣罐。
- 助行器或輪椅。
健康教育
Free classes to help improve your health or address a condition.
Our plan includes classes on diabetes, nutrition and more. You can even get a ride, if needed, to and from the class at no cost to you.
聽力照護
聽力障礙會在很多方面對您的日常生活產生影響。Our plan includes services and support to help protect the hearing of members to age 21.
我們承保：
- Exams, and tests.
- Hearing aids are limited to 1 hearing aid per ear each calendar year up to the age 5, then 1 hearing aid per ear every 2 years thereafter.
健康首要步驟 (Healthy First Steps®)
加入「Healthy First Steps」計劃，爲您和您的寶寶創造健康的未來，並賺取豐厚獎勵。我們的計劃將幫助您採取正確的步驟來保持您和寶寶的健康。此外，註冊還可以賺取$20獎勵。
我們將幫助您：
- 選擇懷孕服務提供者和兒科醫師（孩子的醫師）。
- 預約就診和檢查，並安排就診接送服務。
- 您在整個懷孕期間和寶寶 15 個月大之前參與就診可獲得獎勵。
- 獲取用品，包括哺乳媽媽的擠奶器。
- 與社區資源聯繫，例如女性、嬰兒和兒童 (Women, Infants and Children, WIC) 服務。
住院
This plan pays for expenses related to a hospital stay, so you can rest and heal.
這些包括：
- 照護。
- 病房與餐宿。
- 用品與設備。
- 治療。
- 診斷檢驗和檢查。
在您離開醫院後仍可獲得關懷。我們保證您可獲得後續照護幫助您在家治癒。
翻譯人員
醫師和您需要相互瞭解，無法說流暢的英文會造成困難。在您就診時，我們可安排醫療翻譯人員在場。
我們也有保戶服務人員會說不只一種語言。我們可請到能夠說您的語言的人員，
檢驗室檢驗和 X 光檢查
知道健康出了什麼問題，並及早找出問題所在，可能是成功治療的關鍵。我們的計劃承保：
- 檢驗室檢驗。
- X 光、掃描和其他影像技術。
我們會協助您取得所需資訊，幫助改善您的健康或達到最佳狀態。
語言幫助
You can receive information in your preferred language. 你只需提出來。We also have people at our member service centers who speak more than one language. 我們可請到能夠說您的語言的人員，
保戶服務
Understanding your health care options can be confusing. 我們會簡潔而完整地回答您的問題。
We help you find:
- 醫師。
- 藥房。
- 醫院或其他保健設施。
- 當地資源。
精神健康
心理健康與身體健康一樣重要。That’s why we have the same coverage for both.
所需照護為 100% 承保，無共付額。這些包括：
- Mental health therapy.
- 物質濫用治療。
- 藥物。
No Copays
Members have no copayments for:
- 預防照護。
- 年度檢查。
護士看診
在離開醫院或緊急照護機構後，有時候會需要持續照護。例如，在重病、手術或受傷後。在這些情況下，護士將會進行居家訪視，以便：
- Provide medical care for you.
- Answer your questions and concerns.
- Home health. Home nursing care limited to 125 visits per calendar year.
護士諮詢專線
Medical questions and situations can sometimes come at inconvenient times. When you have questions about your health or your child’s health, you can call a trained nurse 24/7.
Our NurseLine nurses will:
- 聽取您的症狀。
- 引導您進行自助照護。
- 建議您看醫生或到緊急護理中心看診。
- 幫助您了解什麽時間應該掛急診。
產前看診
A pregnancy is a journey you'll want to make with the help of friends, family and a pregnancy doctor, or OB-GYN.
承保推薦的所有產前看診和檢驗。
在看診時，診所將：
- 確保您和您的孩子都健康。
- 說明您在懷孕期各個階段可能會有的症狀。
- 回答您的問題。
主要照護提供者
You can have one main person for your health care. He or she can be a doctor, a nurse practitioner, or a physician’s assistant. This person is called your Primary Care Provider (PCP).
您的主要照護醫師 (PCP) 就是為您提供下列服務的主治醫師：
- 預防照護。
- 在您生病或受傷時為您治療。
- 針對您的特殊健康問題，將您轉診給專科醫生。
戒煙
You know the bad health effects of smoking.
You know you need to quit. We support you while you quit with the help of coaches and supplies. The only thing you won't get from us is a lecture.
預防針和疫苗
Routine shots help keep you healthy. 因此，我們的計劃承保：
- 建議施打的預防針和疫苗。
- 流感預防針。
Support Coorinator
Support Coordinator will help you to:
- Identify the services and supports you need,
- Explore employment options and ways to be part of your community and build relationships
- Decide what services and supports you will need to meet your needs and reach your goals
- Develop and access other services and unpaid supports to help too
- Understand all of the services, providers and settings you can choose from
- Choose the services you will receive, your provider for each service, and settings (places) where you will receive those services
- Write your support plan based on your choices, preferences, and support needs
- Make sure you get the services in your support plan
Not sure who your Support Coordinator is or how to contact them? You can call us at 1-800-690-1606
載送
In case of emergency call 911
Important tips for setting up a ride- Please review 田納西 Carriers website- Rider Information Riders | 田納西 Carriers (tenncarriers.com)
- 請致電 1-866-405-0238，聽障專線 (TTY) 711 來安排您的接送服務
- Call at least seventy-two (72) hours in advance of your appointment whenever possible
- If the time for your return trip home was not already scheduled, you are responsible for calling to tell the transporter that you are ready to be picked up for your trip home
- If you cancel your appointment/visit, call 1-866-405-0238 to cancel your ride
- 準備好您的 Medicaid ID 卡
- If you have more than one appointment on the same day, you can get a ride to all covered services. Please give 田納西 Carriers information for each appointment
- 瞭解您的健康照護服務提供者的地址以及約診的日期和時間
- 具體說明您需要搭乘前往的目的地
- 如果您的醫師給您處方，您可以到藥房領取處方
- 如果您有輪椅等特殊需求，請告知我們
- Any minor requesting transportation without an accompanying adult will be handled on a case-by-case basis
- If you wish to bring someone with you to your appointment, you can have someone ride with you. This is sometimes called an escort. An escort is someone over the age of 12. Please let 田納西 Carriers know you’ll have an escort riding with you
- If you’re going to an appointment and need to take your child with you, he or she won’t count as your escort
視力照護
Covered with limits. Not covered for pregnant women age 19 and older.
For children under age 19, vision services are limited to one vision exam (including refractive exam and glaucoma testing) per calendar year, one set of lenses (including bi-focal, tri-focal, etc.) per calendar year; and one set of eyeglass frames every 2 calendar years.
For pregnant women age 19 and older, vision services are limited to medical evaluation and management of abnormal conditions and disorders of the eye. The first pair of cataract glasses or contact lens/lenses after cataract surgery are covered.
Weight Control
Our plan encourages a healthy approach to eating and living. To help our members be their best, we cover:
- Screening for obesity.
- Support for healthy diet and exercise choices.
- Health coaching.
康復看診
康復看診可以幫助您保持健康。These visits can help catch health problems early so they can be treated. 預防保健服務包括：
- 成人和兒童的健康檢查。
- 健康寶寶照護。
- 孕婦照護。
- 施打例行預防針和檢測。
- 乳房攝影檢查。
You will not have a copayment for preventive care.
Healthier 田納西 is a priority of the Governor’s Foundation for Health & Wellness, involving action promoting healthier behaviors in schools, workplaces and in places of worship. More information is available at www.healthiertn.com.
深入了解
Medicaid Managed Care