A Nurse Care Management program for IDD Waiver Members

1. A Nurse Care Management program for IDD Waiver Members FAQ’s (Frequently Asked Questions ) SelectCommunity

2. What is SelectCommunity? • SelectCommunity is a Nurse Care Management service that is offered through TennCare Select. • The SelectCommunity Program was developed for persons with Intellectual Disabilities to allow for Care Management coordination and continuity of care of physical and behavioral health covered services. • The Nurse Care Manager will work with the ISC, the Provider agency, DIDD Case Manager, and any Medical Providers that support the individual. • There is no charge to the individual, family or provider’s for this service. • This is an added layer of service that is provided to the individual and the Circle of Support. • The Nurse Care Managers provide support and coordination of services to the individual and the entire team/Circle of Support that provide support to the individual. • This service was only offered to Arlington Class members until 06/1/2010. Now it is open to all Waiver Members. • The individual and/or family/conservators are included in all decision making. • The Nurse Care Manager strives to maximize the member’s fullest potential by addressing all of his/her developmental, physical and behavioral health needs. • The individual’s quality of life is of primary concern. • The Nurse Care Manager is an active member of the Circle of Support.

3. What Company manages SelectCommunity? • VSHP, a subsidiary of BlueCross BlueShield of TN (BCBST), manages SelectCommunity. • VSHP is a TennCare Managed Care Company • The Bureau of TennCare has contracted with VSHP to offer the SelectCommunity Program • BCBST/VSHP has offices in the West, Middle & East Grand Regions of the state.

4. Who Qualifies for SelectCommunity? • The target population for SelectCommunity includes the TennCare Members with Intellectual and Developmental Disabilities who are actively enrolled in one the State of Tennessee’s 3 Section 1915 (c) Home and Community Based Services (HCBS) waiver programs for persons with intellectual disabilities. • The three (3) waiver programs are: • Arlington Waiver • Statewide or “Main” Waiver • Self-Determination Waiver

5. What qualifications does the Nurse Care Manager have? • All of SelectCommunity's Nurse Care Managers are Registered Nurses. • They are required to have • At least 3 years of professional nursing experience • At least 2 years of providing Care Management services • Prefer Nurses that are Certified Case Managers (CCM) and Certified Developmental Disabilities Nurse (CDDN) • If not CCM or CDDN certified the Nurse Care Managers are required to take the above certification exams when eligible. • The Nurse Care Managers are provided initial and ongoing training related to Intellectual & Developmental Disabilities

6. What does the Nurse Care Manager do? • The Nurse Care Manager (NCM): • Is the leader of the Care Management team for SelectCommunity • Will be the primary point of contact, for instance if a conservator, medical provider or a member of the Circle of Support (CoS) contacts the NCM with a need for the individual, the NCM will follow up on that request and/or need and inform the CoS of the outcome. • The NCM will keep the CoS updated on all of his/her activities for the individual. • The NCM will make face to face visits with the individual and provide a written report to the provider agency and to the CoS as requested. • The frequency of the Face to Face visits are based on the individuals’ needs • The NCM is an active part of the Circle of Support and will attend all CoS/ISP meetings. • The NCM will assist in locating specialists and in scheduling appointments for the individual. • The NCM will attend medical appointments as needed with the individual and his/her family and/or support staff.

7. What does the Nurse Care Manager do? • The NCM will provide coordination of the full array of services that the individual is receiving. • The NCM will assist in obtaining authorizations for services that are covered by TennCare Select. • The NCM will verify that the services that have been authorized by TennCare Select are provided. • The NCM will work with the Circle of Support (CoS) including the ISC, DIDD Case Worker, DIDD Provider Agencies, ICF/IDD and Nursing Facility providers implementing the Individuals Plan of Care.

8. When can I enroll? • Individuals can enroll at any time, it is open enrollment for SelectCommunity statewide.

9. How do I enroll? • You should have received a letter in the mail from the Bureau of TennCare, the legal conservator will need to sign the form and return: • Via mail to the Bureau of TennCare or • Fax to : MCC Change Unit at 1-866-581-5735 • What if I didn’t get a letter? What if I lost my letter? • Complete the “Opt-In Form” that is on the last slide of this presentation and submit to the TennCare Solutions Unit via Fax or mail. (Faxing the form is the fastest way to opt in) • Or you may Call TennCare Solutions unit at 1-800-878-3192 and ask to sign up for the SelectCommunity Program

10. Will my TennCare Company Change? • Individuals who sign up for SelectCommunity will have TennCare Selectas their Medicaid Managed Care Company. • If the individual is already a TennCare Selectmember, their insurance will not change, they will receive the additional service of a Nurse Care Manager. • SelectCommunity is only offered through TennCare Select • If the individual is currently enrolled with another Managed Care Company, their insurance will change to TennCare Select.

11. Will I have to change Doctors? • Individuals who have Medicare will NOT have to change providers, Medicare is the primary payor with TennCareSelect being the secondary payor. (Medicare will pay first then TennCare pays second) • If you do not have Medicare and TennCare Select is the primary payor the doctors will need to be in the TennCare Select network. • If you have a MD that is not in the network, SelectCommunity can send a representative from their Provider Relations office to that MD’s office to discuss signing up to become a TennCare Select Provider. • If the individual’s physician does not enroll into the TennCare Select network SelectCommunity will work with that member/conservator to find them a new physician/provider that is in network.

12. How can I find out if my Doctor is a TennCare Select Provider? • You or your representative can call your Providers office and ask if they are a provider for TennCare Selector • You or your representative can check VSHP web site at • http://www.bcbst.com/FindADoctor/#

13. When will my TennCare Selectbecome effective? • The effective date is set by the Bureau of TennCare. • Your current insurance will remain effective until the effective date of your TennCare Select.

14. Will TennCare SelectCover Dental services? • Dental services are not covered for adults by TennCare, however if the individual is unable to cooperate with the dentist and requires anesthesia for his/her dental work, TennCare Select will pay for the hospital and anesthesia charges. • The actual Dental work is a Waiver service.

15. What if we change our mind after we sign up for SelectCommunity? • The individual or conservator will be allowed to quit the program if they change their mind.

16. How long does the NCM services last? • Your Nurse Care Manager will contact the individual and/or conservator as soon as SelectCommunity is notified by the Bureau of TennCare that you have enrolled. • Care Management services will begin immediately when SelectCommunity receives notification that you have enrolled, regardless of the effective date for your TennCare Select. • Nurse Care Management services are provided as long as the individual is enrolled in TennCare Select. • The individual will not be discharged from NCM services unless they or their conservator request for the NCM services to stop.

17. Who can I call if I still have questions?

18. SelectCommunity Opt-In Form • Yes, I want to sign up for TennCare Select/SelectCommunity. • Please tell us: • Date: _____________________________ • TennCare member name: _______________________________________________________ • TennCare Social Security Number: _______________________________________________ • Is your address different than what TennCare has on file? If so, please tell us: • Your New Address: ____________________________________________________________ • City, State, Zip: ________________________________________________________________ • TennCare member (or guardian/conservator) signs here: _____________________________ • * For the fastest service: • Please FAX to: 1-866-581-5735 • Attention: TennCare Solutions Unit • Or you may mail to the address below: • If you mail the form in the process could take up to 6 weeks • TennCare Bureau • P.O. Box 820 • Nashville, TN 37202-9968 • The Bureau of TennCare will send you a letter that tells you when this change is made. Your new Nurse Care Manager will be in touch as soon as SelectCommunity receives your information from TennCare. • Return this page only if you want to sign up for SelectCommunity.