TennCare Long-Term Services & Supports (LTSS)

Care Coordinator will

• Provide information about CHOICES and answer your questions
• Help you get the right kind of long-term services and supports in the right setting for you to address your needs
• Coordinate all of your physical health, behavioral health (mental health, alcohol or drug abuse) and long-term services and supports needs
• Help to fix problems and answer questions that you have about your care
• Check at least once a year to make sure that you continue to need the level of care provided in a nursing home or, for Group 3, continue to be “at risk” of going into a nursing home
• Communicate with your providers to make sure they know what’s happening with your health care and to coordinate your service delivery

Make sure sight, teeth and hearing are at their best. Benefits include:

Vision.  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.

Dental.  Not covered for pregnant women age 19 and older.

• Dental care is only for children under age 19. CoverKids does not pay for any routine dental care for pregnant women 19 and older.

Hearing.  Annual hearing screeningHearing aids are limited to 1 per ear per Calendar Year up to the age 5; then 1 per ear every 2 years thereafter.

Members who qualify can get the medically necessary equipment and help needed to live safety at home. Benefits include:

• Equipment and Supplies. In-home medical safety materials are covered.
• Nurse Visits. Short-term medical care while recovering at home.
• Care Coordinator. Someone to get you the services to live safely at home.

Sometimes you might need a little extra help using your health plan. For those times, you can rely on:

• NurseLine℠. Speak with a registered nurse 24/7.
  
• Language Help. Connect to a translator through Member Services.
• Member Services. Someone to help you understand how to use your benefits.
• Quitting Tobacco.  Coaches, supplies and medications to help you quit using tobacco.  
• Weight Control. Support and treatment to reach a healthy weight.
• Health Education. Free classes to help improve your health.

Cleanings, checkups and  dental care is only for children under age 19. CoverKids does not pay for any routine dental care for pregnant women 19 and older.

Exams and cleanings every six months help keep teeth and gums strong and healthy. If there is a dental problem that needs to be fixed, we’ll fix it as well.

Your health and safety at home are important.

Our plan covers medical equipment ordered by your doctor or case manager. This can include supplies like:

• Hospital beds.
• Oxygen tanks.
• Walkers or wheelchairs.

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.

We cover:

• 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.

Build a healthy future for you and your baby and earn great rewards with Healthy First Steps. Our program will help you take the right steps to keep you and your baby healthy. Plus you can earn $20 just for signing up. 

We will help you:

• Choose a pregnancy provider and a pediatrician (child’s doctor).
• Schedule visits and exams and arrange rides to your visits.
• Earn rewards for going to visits throughout your pregnancy and baby’s first 15 months of life.
• Get supplies, including breast pumps for nursing moms.
• Connect with community resources such as Women, Infants and Children (WIC) services.

This includes:

• Nursing care.
• Room and board.
• Supplies and equipment.
• Treatment and therapies.
• Diagnostic tests and exams.

And after you leave the hospital, you are not alone. We make sure you get follow-up care to continue healing at home.

Your doctor and you need to understand each other. Not speaking English well makes this difficult. We can arrange for a medical interpreter to be at your appointments.

We also have people in member services who speak more than one language. Chances are, we have someone who speaks your language.

Knowing what's wrong and finding it early can make all the difference. Our plan covers:

• Labs and testing.
• X-rays, scans and other imaging.

We’ll help you get the information needed to improve your health or be at your best.

You can receive information in your preferred language. Just ask. We also have people at our member service centers who speak more than one language. Chances are, we have someone who speaks your language.

Understanding your health care options can be confusing. We can answer your questions simply and completely.

We help you find:

• Doctors.
• Pharmacies.
• Hospitals or other health facilities.
• Local resources.

Mental health is as important as physical health. That’s why we have the same coverage for both.

Required care is 100% covered with no copay. This includes:

• Mental health therapy.
• Substance abuse treatment.
• Medications.

Members have no copayments for:

• Preventive care.
• Annual checkups.

Sometimes continued care is needed after leaving the hospital or urgent care. For example, after a serious illness, surgery or injury. In these cases, a nurse will make home visits to:

• Provide medical care for you.
• Answer your questions and concerns.
• Home health. Home nursing care limited to 125 visits per calendar year.

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: 

• Listen to the symptoms.
• Guide you on self-care.
• Advise you about getting care at a doctor visit or an urgent care center.
• Help you know when to go to the emergency room.

All of your recommended prenatal clinical visits and tests are covered.

At these visits, the clinic will:

• Make sure you and your baby are healthy.
• Explain what to expect at each stage of your pregnancy.
• Answer your questions.

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). 

Your PCP is your main doctor for:

• Preventive care.
• Treatment if you are sick or injured.
• Referrals to specialists for certain conditions.

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.

Routine shots help keep you healthy. So, our plan covers:

• Recommended shots and vaccines.
• Influenza shots.

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

In case of emergency call 911

Important tips for setting up a ride- Please review Tennessee Carriers website- Rider Information Riders | Tennessee Carriers (tenncarriers.com)

• Call 1-866-405-0238, TTY 711 to set up your ride 
• 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 
• Have your Medicaid ID card available 
• If you have more than one appointment on the same day, you can get a ride to all covered services. Please give Tennessee Carriers information for each appointment
• Know the address of your health care provider and the date and time of your appointment 
• Be specific about where you need a ride to 
• If your doctor gives you a prescription, you can stop at the pharmacy to get it 
• Let us know if you have special needs like a wheelchair 
• 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 Tennessee 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

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.

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.

Well visits with your doctor can help keep you healthy. These visits can help catch health problems early so they can be treated. Preventive services include:

• Checkups for adults and children.
• Well-baby care.
• Care for women expecting a baby.
• Routine shots and tests.
• Mammograms.

You will not have a copayment for preventive care.