Hospital Presumptive Eligibility
TennCare is implementing a Hospital Presumptive (PE) program effective July 1, 2016. Using the Hospital PE process, participating hospitals can screen and provide immediate coverage to qualified individuals -- and help these patients complete the regular TennCare application process. See the following for additional information:
- General overview of Hospital PE program.
- Information about becoming a qualified hospital for Hospital PE.
- More information about Hospital PE operations and training.
- A list of hospitals participating in the Hospital PE program.
Becoming a Qualified Hospital for Hospital PE
The Hospital PE program is entirely voluntary for hospitals. To participate, a hospital must:
- Participate in the TennCare Medicaid program and maintain a network provider agreement with at least one TennCare Managed Care Organization (MCO);
- Be signed up for TennCare Online Services;
- Be located in Tennessee;
- Make determinations consistent with policies and procedures of the state;
- Comply with all training requirements; and
- Comply with all performance standards.
To sign up for the Hospital PE program, a hospital must:
- Complete the Application to Become a Qualified Entity;
- Sign up for TennCare Online Services if you have not already done so;
- Register all employee users with TennCare Online Services;
- Complete the Hospital PE Information Contact Survey;
- Complete, sign, and date the Memorandum of Understanding (MOU) ;
- Email both the completed Application to Become a Qualified Entity and the signed MOU to HospitalPE.TennCare@tn.gov or fax these materials to 615-734-5325.
After becoming a Qualified Entity, you will receive instructions to sign up for the TennCare Access portal to submit Hospital Presumptive Eligibility Applications.
Information regarding newborns: Applications for newborns can also be submitted through TennCare Access and will be evaluated for child eligibility categories. However, if the mother is enrolled at the time of the child’s birth and mother’s information is included on the HPE application for the child, the system will automatically approve the child in a deemed newborn category, if applicable.
If you have additional questions, email HospitalPE.TennCare@tn.gov.
The following hospitals in Tennessee are enrolled as qualified entities to make Hospital PE determinations for TennCare:
Ascension St. Thomas- Midtown
Ascension St. Thomas- Rutherford
Ascension Saint Thomas- Sumner
Ascension St. Thomas- West
Baptist Memorial Hospital
Baptist Memorial Hospital - Collierville
Baptist Memorial Hospital - Carroll County
Baptist Memorial Hospital - Tipton
Baptist Memorial Hospital - Union City
Baptist Memorial Hospital for Women
Blount Memorial Hospital
Bradley Medical Center
Bristol Regional Medical Center
Claiborne Medical Center
Cookeville Regional Medical Center
Creekside Behavior Health
Crestwyn Behavioral Health
Cumberland Medical Center
East Tennessee Children's Hospital
Erlanger Bledsoe
Erlanger East Hospital
Erlanger Medical Center
Erlanger North Hospital
Fort Loudoun Medical Center
Fort Sanders Regional Medical Center
Franklin Woods Community Hospital
Greeneville Community Hospital
Hancock County Hospital
Hardin Medical Center
Hawkins County Memorial
Holston Valley Medical Center
Indian Path Community Hospital
Jackson-Madison County General Hospital District
Johnson City Medical Center
Johnson County Community Hospital
LeConte Medical Center
Livingston Regional Hospital
Maury Regional Hospital
Methodist Healthcare Hospital
Methodist Medical Center of Oak Ridge
Morristown- Hamblen Hospital
Parkridge East Medical Center
Parkridge Medical Center
Parkwest Medical Center
Regional One Health
Riverview Regional Medical Center
Roane Medical Center
Saint Francis Hospital- Bartlett
Saint Francis Hospital
Southern Tennessee Regional Health System- Lawrenceburg
Southern Tennessee Regional Health System- Pulaski
Southern Tennessee Regional Health System- Winchester
Starr Regional Medical Center
Sycamore Shoals Hospital
Tennova Healthcare - Clarksville Gateway
Tennova Healthcare - Newport Medical Center
Tennova Healthcare - North Knoxville
Tennova Healthcare - Turkey Creek Medical Center
TriStar Centennial Medical Center
TriStar Hendersonville Medical Center
TriStar Horizon Medical Center
TriStar Northcrest Medical Center
TriStar Skyline Medical Center
TriStar Southern Hills Medical Center
TriStar Stonecrest Medical Center
TriStar Summit Medical Center
Unicoi County Memorial Hospital
University of Tennessee Medical Center
Vanderbilt Tullahoma - Harton Hospital
Vanderbilt University Medical Center
Vanderbilt Wilson County Hospital
West Tennessee Healthcare Dyersburg Hospital
Woodridge Psychiatric Hospital
Please find below the most up-to-date versions of the Hospital PE Operations and Training materials:
- Hospital PE Worksheet
- Hospital PE Eligibility Notice (English) - Hospital PE Eligibility Notice (Spanish)
- Hospital PE Errata Sheet
- Hospital PE Reference Guide
- Hospital PE FAQs
- Deemed Newborns
- TennCare Access Portal Training Documents
Questions? Email HospitalPE.TennCare@tn.gov.