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

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Presentation on theme: "A Nurse Care Management program for IDD Waiver Members FAQ’s (Frequently Asked Questions ) SelectCommunity 1."— Presentation transcript:

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

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. 2

3 What Company manages SelectCommunity? 3  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? 4  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? 5  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? 6  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? 7  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? 8  Individuals can enroll at any time, it is open enrollment for SelectCommunity statewide.

9 How do I enroll? 9  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  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 and ask to sign up for the SelectCommunity Program

10 Will my TennCare Company Change? 10  Individuals who sign up for SelectCommunity will have TennCare Select as their Medicaid Managed Care Company.  If the individual is already a TennCare Select member, 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? 11  Individuals who have Medicare will NOT have to change providers, Medicare is the primary payor with TennCare Select 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? 12  You or your representative can call your Providers office and ask if they are a provider for TennCare Select or  You or your representative can check VSHP web site at 

13 When will my TennCare Select become effective? 13  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 Select Cover Dental services? 14  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? 15  The individual or conservator will be allowed to quit the program if they change their mind.

16 How long does the NCM services last? 16  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? 17

18 SelectCommunity Opt-In Form 18  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:  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  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.


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