ADA Inspections Nationwide, LLC
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ADAIN Blog

by Richard Acree of ADA Inspections Nationwide, LLC

Explaination of Amendment #1 to TN HB 498, Part A, of the Katie Beckett Bill

Amendment #1 to TN HB 498 provides that Part A of the Katie Beckett program:

(1) Must be designed to provide a pathway to eligibility for medicaid services and essential wraparound home- and community-based services by waiving the deeming of the parents' income and resources as applicable to a child who is under 18 years of age and:


(A) Has medical needs that: result in severe functional limitations that meet criteria established specifically for children; would qualify the child for institutionalization in an acute care hospital, nursing facility, or intermediate care facility for individuals with intellectual disabilities; and are likely to last at least 12 months or result in death;


(B) Is not receiving long-term services from any alternative waiver program established under this title;


(C) Would otherwise qualify for supplemental security income due to the child's disability but for the income or resources of their parent;


(D) For whom a licensed physician has certified that in-home care is an appropriate way to meet the child's needs; and


(E) For whom the cost of care outside of the institution does not exceed the estimated medicaid cost of appropriate institutional care;

(2) Must offer an integrated program that: 

(A) As funding permits, provides children meeting the above criteria with treatment and support;


(B) Accepts applications for the program during periods of open enrollment;


(C) Prioritizes for enrollment into the program children with the most significant disabilities or complex medical needs;


(D) Delivers medically necessary care and essential wraparound services and supports in the most integrated setting appropriate and cost-effective way possible in order to utilize available funding to serve as many children as possible; and


(E) If approved by the federal centers for medicare and medicaid services: requires periodic reevaluations of an enrolled child's eligibility based upon eligibility criteria for all open categories of TennCare coverage; and at the time of reevaluation, allows the bureau of TennCare to disenroll a child who no longer meets the eligibility criteria for any open category of TennCare coverage;


(3) Must provide children applying for or enrolled in Part A of the program with the same appeal rights accorded all other TennCare applicants and enrollees; and


(4) May require parents of children enrolled in Part A of the program to purchase and maintain available private or employer-sponsored insurance that offers coverage for the child, and establish buy-in or premium requirements, using a sliding fee scale based on parent income, to help offset state costs and ensure program sustainability. Any premiums must take into account any amounts paid by a family for private insurance also provided for the child.