PCG Public Partnerships Case Study, TennCare CHOICES Program
Financial Administration and Support Brokerage
Services within Managed Care in Tennessee
PCG Public Partnerships, LLC (PPL) worked side-by-side with TennCare,
structuring the participant direction program for a year prior to go-live
and helping TennCare with participant direction policies, procedures,
rules, and regulations. Among other tasks, PPL
• Developed data transfers between PPL, the three MCOs, TennCare,
and the EVV system;
Tennessee Department of Finance and Administration,
Bureau of TennCare (TennCare)
• Subcontracted with three supports brokerage agencies to provide
• Launched PPL services regionally, following the roll-out of the
• Enforced state and federal program requirements;
Provision of financial administration and supports brokerage
services for consumer direction in the TennCare CHOICES
Long-Term Care Program.
• Configured PPL information technology platforms to fit the state’s
unique program requirements;
• Developed materials and processes to support program participants;
• Customized reports to the state’s program requirements; and
• Instituted monthly meetings with the state to improve program
In 2008, the state of Tennessee passed the Long-Term Care Community
Choices Act (CHOICES), fundamentally restructuring the long-term care
system in Tennessee. Among other things, CHOICES integrated nursing
facility and home and community-based care into a managed care delivery
system. It also provided participant direction as an option to those who
were eligible for home and community-based care.
Unlike traditional participant direction programs, TennCare structured
this program within managed care. Medicaid recipients would select
a managed care organization and, should participant direction be
appropriate, the managed care organization (MCO) and financial
administrator would work together to authorize the individual for services.
TennCare also determined that it wanted consumer directed workers to
utilize a telephonic timesheet system (EVV) rather than standard physical
or electronic timesheets. Finally, the program also required supports
• Since April 2010, over 1,000 individuals have been referred for
participant direction and about 360 are actively receiving services.
• On average, another 28 individuals per month start receiving services.
• On average, PPL customer service staff members field 1,300 calls per
• Vital employment of over 300 FTEs providing consumer-directed
• PPL won a re-bid for the contract.
The expectation was that the CHOICES program would be popular
because until the CHOICES program, Tennessee offered few home and
community-based options for long-term care recipients. Consumer
direction numbers could not be predicted but were expected to grow
significantly over time.
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