applying for TennCare Medicaid or TennCare Standard coverage shall disclose the
availability of any third party health care coverage to the agency responsible
for determining the individual's eligibility for TennCare.
(2) An individual enrolled in TennCare
Medicaid or TennCare Standard shall disclose access to third party resources to
his/her specified Managed Care Contractors as soon as s/he becomes aware of the
existence of any third party resources.
(3) Managed Care Contractors under contract
with the Tennessee Departments of Finance and Administration or Mental Health
and Developmental Disabilities shall provide all third party resource
information obtained from the plan's enrollees to the Bureau of TennCare on a
regular basis as required by their contracts.
(4) Managed Care Contractors shall enforce
TennCare subrogation rights pursuant to T.C.A. §
(5) Managed Care Contractors may pay health
insurance premiums for their enrollees if such payments are determined by the
Bureau to be cost effective.
TennCare shall be the payor of last resort, except where contrary to federal or
Asset Disregards for
Qualifying Long Term Care Insurance Policies:
(a) Individuals who purchase a qualified long
term care insurance policy may have certain assets disregarded in the
determination of eligibility for TennCare Medicaid. The Department of Human
Services (DHS) shall disregard an individual's assets up to the amount of
payments made by the individual's qualifying long-term care insurance policy
for services covered under the policy at the time of TennCare
(b) The amount of the
individual's assets properly disregarded under these provisions shall continue
to be disregarded through the lifetime of the individual.
(c) Assets which were disregarded for
purposes of Medicaid eligibility determination during the person's lifetime are
also protected from estate recovery. When the amount of assets disregarded
during the person's lifetime was less than total benefits paid by the qualified
long term care insurance policy, additional assets may be protected in the
estate recovery process up to the amount of payments made by the individual's
qualifying long term care policy for services covered under the policy. If no
assets were disregarded during the person's lifetime, the personal
representative may designate assets to protect from estate recovery up to the
lesser of the two options specified above, even if a qualified long term care
policy's benefits were not completely exhausted.
(8) Upon enrollment in TennCare Medicaid or
TennCare Standard an individual assigns to the Bureau any rights to third party
insurance benefits to which the individual may be entitled.
(9) Upon accepting medical assistance, an
enrollee in TennCare Medicaid or TennCare Standard shall be deemed to have made
an assignment to the Bureau of the right to third party insurance benefits to
which the enrollee may be entitled.
(10) The Bureau shall utilize direct billing
when it is determined that a previously paid service may have been covered by a