Commissioner: means the commissioner of finance and administration or the commissioner's designee. See Tennessee Code 71-5-1403
Cost-effective: means that the total cost of services provided to an eligible elderly or physically disabled adult in the home or other community-based setting does not exceed the cost of reimbursement for institutional care in a nursing facility. See Tennessee Code 71-5-1403
Entitlement: A Federal program or provision of law that requires payments to any person or unit of government that meets the eligibility criteria established by law. Entitlements constitute a binding obligation on the part of the Federal Government, and eligible recipients have legal recourse if the obligation is not fulfilled. Social Security and veterans' compensation and pensions are examples of entitlement programs.
Representative: when applied to those who represent a decedent, includes executors and administrators, unless the context implies heirs and distributees. See Tennessee Code 1-3-105
State: when applied to the different parts of the United States, includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
(1) By January 1, 2000, the long-term care services planning council, in consultation with the long-term care advisory council, shall develop an operational plan and budget projections for a program for home-based and community-based services (HBCS) to elderly and disabled individuals in need of assistance. The program should provide services to elderly and disabled individuals in need of assistance who do not qualify for long-term care services under medical assistance pursuant to part 1 of this chapter. The council shall report on the program to the general assembly.(2) Nothing in the plan developed pursuant to this section shall be construed to create an entitlement for individuals.(3) The plan should identify eligible services, the extent and manner in which such services are allocated and made available to elderly and disabled individuals in need of assistance who do not qualify for long-term care services under medical assistance pursuant to part 1 of this chapter, and the manner in which such services are coordinated with each other and long-term care services available outside the program, including, but not limited to, medical assistance and medicare.(4) The plan shall develop and include mechanisms to include the choice of an individual and the individual’s representative regarding which covered services to receive, how services are provided and who provides services.(5) The plan should propose a mechanism to impose cost-sharing to be set by rule with respect to covered services.(6) The plan shall provide for quality assurance and safeguards for the eligible individuals.(7) The plan shall designate a state agency to administer the program or to supervise administration of the program.(b)(1) HBCS, as defined in § 71-5-103, shall be available to eligible elderly and disabled individuals in need of assistance under the program established by this section. The program shall set limits to services based on available fiscal resources. The services shall be specified in a manner that permits flexibility for providers to meet the needs of eligible individuals in a cost-effective manner with services to be delivered in an individual’s home, a range of community residential arrangements, or outside the home.(2) HBCS would be provided under the plan required in this section to program participants if an:
(A) Assessment pursuant to § 71-5-1407 has been made; and(B) Individualized plan of care is developed with involvement from the individual or the individual’s representative.(3) The state shall make reasonable efforts to identify and arrange services described in the plan, but nothing in this section shall be construed as requiring the state to provide all the services such plan may specify.(c) The commissioner of health is authorized to promulgate rules and regulations to effectuate the purposes of this section. All such rules and regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.(d) The department of disability and aging shall equitably allocate funding resources between urban and rural areas to program components that provide services to elderly and disabled individuals in need of assistance who do not qualify for long-term care services under medical assistance pursuant to part 1 of this chapter.(e) By August 1, 2001, the department of disability and aging shall establish an average maximum statewide unit cost for service provided to elderly and disabled individuals in need of assistance who do not qualify for long-term care services pursuant to part 1 of this chapter. In developing the rate, the department of disability and aging shall take into account the unit of service rate permitted for such service under any federal waiver for providing assistance under this chapter if such service is also provided under the federal waiver and in no case can it be more than twenty percent (20%) above the average statewide unit cost for that specific service.
