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Partners- Program Updates
  • LTSS Forms
  • LTSS Information
  • LTSS Protocols
  • LTSS Provider Registration
  • LTSS Resources
  • LTSS Training

LTSS Forms

The following forms are utilized by MCOs, Nursing Facilities, AAADs, Hospitals, etc. only. If you are interested in the CHOICES program, click the How to Apply page:

If you are interested in completing the Employment and Community First CHOICES Self-Referral Form, click the Self-Referral Form page:

  • MDS Section Q, Nursing Facility Referral Form
  • NF Discharge Transfer Notice
  • NF Voluntary discharge form
  • PAE Certification Form
  • PAE Form
  • PASRR Level I Screening Form
  • Request for NF (ICF) Admission Form
  • CHOICES Safety Determination Form
  • TPAES Acceptable Use Policy
  • TPAES TCMIS Access Request Instructions
  • Transfer/Discharge/Hospice form
  • ECF Referral List Removal Form
  • CHOICES Re-Enrollment Hospice Form
  • Katie Beckett MD Cert Form
  • Katie Beckett Cost of Care Form (prior to enrollment)
  • ECF Safety Determination Form
  • KB Part A Peer to Peer Request Form

Stay Informed

  • Notice of Change in Medicaid State Plan: Graduate Medical Education
  • Notice of Change in Medicaid State Plan: COVID-Related Services
  • Notice of Annual Monitoring Report to CMS
  • Katie Beckett Program
  • Redetermination
  • Need Language help?
  • TennCare's Opioid Strategy
  • Moratorium on Rural Health Centers and Final Rate Setting
  • Upcoming Procurements
  • 1095-B Health Coverage Tax Document

Legal

  • Estate Recovery
  • TennCare Forms and Agreements
  • Privacy Policies
  • HIPAA Privacy Information
  • TennCare Public Records
  • Subrogation
  • Civil Rights Notice

Fraud and Abuse

  • Program Integrity
  • Report TennCare Fraud

Quick Links

  • Deputy Commissioner
  • Eligibility Reference Guide
  • Enrollment Data
  • kidcentral tn
  • TennCare Enrollment and Eligibility Facts
  • TennCare 2021 Agency Priorities
  • FY23 Recommended Budget
TennCare
Stephen Smith

310 Great Circle Rd.
Nashville, TN 37243
1-800-342-3145
Tenn.Care@tn.gov
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