Additional Rights to Appeals for Thousands of Families Who Will Get Letters Reducing Their TennCare Home Health-Nursing Services.

This is your life. Take Action!

You have the right to appeal, even if the nursing hours being offered you are the same as the new limits!

If you’ve gotten word that your home health or private duty nursing will be reduced or cut because of the new policy, you can appeal! You can appeal even if the hours offered by your managed care company are the same as the new limits, but less than what you are getting now. In your appeal, say that you believe you have a “valid legal dispute.” This is because your care is medically necessary and the TennCare rules do not allow these cuts. If you get a call or letter from TennCare asking for more information about your appeal, call THCC at 1-877-431-7083 for more advice.

On the TennCare appeal form that you can print off by clicking here, answer all the questions, but not not fill out Part A and Part C on page 2. However, answer the following for each number on the Appeal Form to file an appeal for a valid legal dispute:

Page 1, #3 - Check __X__ Need care or medicine

Page 2, #5 - Write in: "This is a valid legal dispute. My care is medically necessary and the TennCare rules do not allow these cuts."

Page 2, Part B. Need care or medicine. What kind - be specific Put in the number of hours of nursing care that you were getting before September 7

What is the problem? Check __X__ Can't get as much of the care or medicine as I need>

Did your doctor prescribe the care or medicine? Check __X__ Yes. Put the name of your doctor who prescribed this care. Your doctor must agree with you. You will not be able to win your appeal without your doctor's support.

Answer all the questions in Part B to the best of your ability. Remember that you only have 10 days to appeal if you want to keep your benefits during the appeal period.

Do not answer anything in Part A or Part C of the Appeal Form.

Fax your appeal to 1-888-345-5575. Keep a copy of your appeal and the confirmation for the fax.

More more information, see the attached Question and Answers for answers to 12 important questions. Also go to our web site, www.thcc2.org, and click on Action Alerts for more information on these cuts in nursing services.

Take care,

Tony Garr, Executive Director, tgarr@thcc2.org