Þ-K1ô. Proposed Rule(s) Filing Form --" ' l::"#! f:,i!":;:" å,,'æi. X Amendment New Repeal. i 120":0:-13:.13 j. ii' "3::y,

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1 Department of State Divisíon of Publications 312 Rosa L. Parks Avenue, Bth Floor Snodgrass/TN Tower Nashville, TN Phone: Fax: '1-5'133 For Department of State Use Only Sequence Number: Rule ld(s): File Date: Þ-K1ô Effective Date: Proposed Rule(s) Filing Form of a rulemaking hearing, lt is the intent of the Agency to promulgate h hearing is filed within sixty (60) days of the first day of the month be effective, the petition must be filed with the Agency and be ';,:; ;i:t:';i,l{" : "i ii' "3::y, "i l::"#! f:,i!":;:" å,,'æi ÄgencylBòardiöömmission:. Tennessee oepaitment of Finanóe and Àdm n ðiräiion Division: Bureau of Tenn0are Gontáct Þerson: öeorgö wooos --" ' 'i Äâ iess:, 310 ð,reat óircrö nôä : Zapt Revision Type (check ail that appty): X Amendment New Repeal _ Phone; (615) George.woods@!n.gov j i nyle(s) Revised (ALL chapters and rules contained in filing must be listed here. lf needed, copy and paste additional tables to accommodate multiple chapters. Please enter only ONE Rule Number/Rule Îitte pär row i öë"ptär"ñrrbe;- j i 120":0:-13:.13 j i.ru-!e- N"1 mber. i i :1?09:1_3-::!_3:110 i Chap-ter Ti!!-e TennGare Medicaid Rule Title Exclusions

2 (Place substance of rules and other info here. Statutory authority must be given for each rule change. For information on formatting rules go to Rules of Tennessee Department of fínance and Administration Bureau of TennOare Chapter TennCare Medicaid Amendment Part 19. of Subparagraph (a) of Paragraph (3) of Rule Exclusions is amended by deleting the number 6 where it appears and replacing it with the number 5 so as amended Part 19. shall read as follows: 19. Orthodontic services, except as defined in Rule '13-.04(1)(b)5. or (1Xb)5. Statutory Authority: T.C.A. $S and

3 I certify that this is an accurate and complete copy of proposed rules, lawfully promulgated and adopted by the (board/commission/other authority) on (dafe as mm/dd/yyyy), and is in compliance with the provisions of TCA The Secr eby instructed that, in the absence of a petition for proposed rules being filed under the conditions set out herein and in the locations described, he is to treat the proposed rules as being placed on file in his office as rules at the expiration of sixty (60) days of the first day of the month subsequent to the filing of the proposed rule with the Secretary of State.,, /"- f -'" STATE OF TENNESSEE \i Darin J. Gordon Director, Bureau of TennCare of Officer: Tennessee Department of Finance and Admimnistation to before me on: Public Signature: My commission expires on: All proposed rules provided for herein have been examined by the Attorney General and Reporter of the State of Tennessee and are approved as to legality pursuant to the provisions of the Administrative Procedures Act, Tennessee Code Annotated, Title 4, Chapter 5. /2 General and Reporter Date Department of State Use Only Filed with the Department of State on: Effective on: Tre Hargett Secretary of State SS-7038 (July 2010) RDA 1693

4 Regulatory Flexibility Addendum Pursuant to $ T.C.A through , prior to initiating the rule making process as described in T.C,A. $ (a)(3) and T.C.A. $ (a), all agencies shall conduct a review of whether a proposed rule or rule affects small businesses. (lf applicable, insert Regulatory Flexibility Addendum here) The rule has no affect on small businesses. SS-7038 (July 2010) 4 RDA 1693

5 lmpact on Local Governments Pursuant to T.C.A and "any rule proposed to be promulgated shall state in a simple declarative sentence, without additional comments on the merits of the policy of the rules or regulation, whether the rule or regulation may have a projected impact on local governments." (See Public Chapter Number 1070 (htto://state.tn.us/sos/acts/106/pub/oc1070.pdf) of the 2010 Session of the General Assembly) ( lnsert statement here) The rule is not projected to have an impact on local governments. SS-7038 (July 20'10) RDA 1693

6 Additional Information Required by Joint Government Operations Committee All agencies, upon filing a rule, must also submit the following pursuant to TCA (i)(1). (A) A brief summary of the rule and a description of all relevant changes in previous regulations effectuated by such rule; (B) A citation to and brief description of any federal law or regulation or any state law or regulation mandating promulgation of such rule or establishing guidelines relevant thereto; The rule is lawfully promulgated and adopted by the Department of Finance and Administration in accordance with Tennessee Code Annotated AA and (C) ldentification of persons, organizations, corporations or governmental entities most directly affected by this rule, and whether those persons, organizations, corporations or governmental entities urge adoption or rejection of this rule; person, organization, corporation or governmental Tennessee Deoartment of Finance and Administration. entities most directly affected by this rule is the (D) ldentification of any opinions of the attorney general and reporter or any judicial ruling that directly relates to the rule; The rule was reviewed and approved by the Tennessee Attorney General. No additional opinion was given or (E) An estimate of the probable increase or decrease in state and local government revenues and expenditures, if any, resulting from the promulgation of this rule, and assumptions and reasoning upon which the estimate is based. An agency shall not state that the fiscal impact is minimal if the fiscal impact is more than two percent (2%) of the agency's annual budget or five hundred thousand dollars ($500,000), whichever is less; he promulgation of this rule is not anticipated to have an effect on state and local government revenues and (F) ldentification of the appropriate agency representative or representatives, possessing substantial knowledge and understanding of the rule; Director, Bureau of TennCare (G) ldentification of the appropriate agency representative or representatives who will explain the rule at a scheduled meeting of the committees; Darin J. Gordon Director, Bureau of TennCare (H) Office address, telephone number, and address of the agency representative or representatives who will explain the rule at a scheduled meeting of the committees; and 310 Great Circle Road Nashville, TN (615) Darin.J.Gordon

7 GW

8 Department of State Division of Publications 312 Rosa L Parks Avenue, Bth Floor Snodgrass/TN Tower Nashville, TN Phone: Fax: reqister.information@tn.qov For Department of State Use Only Sequence Number: Rule ld(s): File Date: Effective Date: Proposed Rule(s) Filing Form Proposed rules are subm tted pursuant to T.C.A. S , in lieu of a rulentaking hearing. lt is the íntent of the Agency to promulgate fhese r rles without a rulentaking hearing rnless a petilion requesting such hearing ís fíled wilhín síxty (60) days of the first day of the month subseqttettf to the filing of the proposed rule with tlrc Secretary of State. To be effective, the pelition must be filed with the Agency and be signed by twenty-five (25) persons who will be affected by the amendments, or submitted by a municipality which will be affecled by the antendmenls, or an assoc alion of twenly-five (25) or more mernbers, or any standing committee of the General Assembly. The agency shall forward suclt petit ot1 to tlte Secretary of Stafe Agency/Board/Gommiss-ion:, Te-nqessee Department of Frnance and Administration Division: Bureau of TennCare Co_ntact Person: ' George Woods AddréCC: 310 Great Öirôie RoaO Zip: Phone; (615) George.woods@tn.gov Revision Type (check all that apply): X Amendment New Repeal Rule(s) Revised (ALL chapters and rules contained in filing must be listed here. lf needed, copy and paste additional tables to accommodate multiple chapters. Please enter only ONE Rule Number/Rule Title per row) Chapter Number Rule Number

9 (Place substance of rules and other info here. Statutory authority must be given for each rule change. For information on formatting rules go to Rules of Tennessee Department of finance and Administration Bureau of TennCare Chapter TennCare Medicaid Amendment Part 19. of Subparagraph (a) of Paragraph (3) of Rule Exclusions is amended by deleting the number 6 where it appears and replacing it with the number 5 so as amended Part 19. shall read as follows: 19. Orthodontic services, except as defined in Rule (1Xb)6.8. or (1Xb)6-.0. Statutory Authority: T.C.A. SS and

10 I certify that this is an accurate and complete copy of proposed rules, lawfully promulgated and adopted by the (board/commission/other authority) on (dafe as mm/dd/yyyy), and is in compliance with the provisions of TCA The Secretary of State is hereby instructed that, in the absence of a petition for proposed rules being filed under the conditions set out herein and in the locations described, he is to treat the proposed rules as being placed on file in his office as rules at the expiration of sixty (60) days of the first day of the month subsequent to the filing of the proposed rule with the Secretary of State. Date: Signature: Name of Officer: Darin J. Gordon Director, Bureau of TennCare Title of Officer: Tennessee Department of Finance and Admimnistation Subscribed and sworn to before me on; Notary Public Signature: My commission expires on: All proposed rules provided for herein have been examined by the Attorney General and Reporter of the State of Tennessee and are approved as to legality pursuant to the provisions of the Administrative Procedures Act, Tennessee Code Annotated, Title 4, Chapter 5. Department of State Use Only Robert E. Cooper, Jr. Attorney General and Reporter Date Filed with the Department of State on: Effective on: Tre Hargett Secretary of State SS-7038 (July 2010) RDA 1693

11 Regulatory Flexibility Addendum Pursuant to S T.C.A through , prior to initiating the rule making process as described in T.C.A, $ (a)(3) and T.C.A. $ (a), all agencies shall conduct a review of whether a proposed rule or rule atfects small businesses. (lf applicable, insert Regulatory Flexibility Addendum here) The rule has no affect on small businesses.

12 lmpact on Local Governments Pursuant to T.C.A and "any rule proposed to be promulgated shall state in a simple declarative sentence, without additional comments on the merits of the policy of the rules or regulation, whether the rule or regulation may have a projected impact on local governments." (See Public Chapter Number 1070 ( 06/pub/pc1070.pdf) of the 2010 Session of the General Assembly) (lnsert statement here) The rule is not projected to have an impact on local governments.

13 Additional lnformation Required by Joint Government Operations Committee All agencies, upon filing a rule, must also submit the following pursuant to TCA (i)(1). (A) A brief summary of the rule and a description of all relevant changes in previous regulations effectuated by such rule; (B) A citation to and brief description of any federal law or regulation or any state law or regulation mandating promulgation of such rule or establishing guidelines relevant thereto; The rule is lawfully promulgated and adopted by the Department of Finance and Administration with Tennessee Code Annotated SS and (C) ldentification of persons, organizations, corporations or governmental entities most directly affected by this rule, and whether those persons, organizations, corporations or governmental entities urge adoption or rejection of this rule; person, organization, corporation or governmental ent of Finance and Administration. entities most directly this rule is the (D) ldentification of any opinions of the attorney general and reporter or any judicial ruling that directly relates to the rule; The rule was reviewed and approved by the Tennessee Attorney General. No additional opinion was given or (E) An estimate of the probable increase or decrease in state and local government revenues and expenditures, if any, resulting from the promulgation of this rule, and assumptions and reasoning upon which the estimate is based. An agency shall not state that the fiscal impact is minimal if the fiscal impact is more than two percent (2o/o) of the agency's annual budget or five hundred thousand dollars ($500,000), whichever is less; The promulgation of this rule is not anticipated to have an effect on state and local government revenues and (F) ldentification of the appropriate agency representative or representatives, possessing substantial knowledge and understanding of the rule; Director, Bureau of TennCare (G) ldentification of the appropriate agency representative or representatives who will explain the rule at a scheduled meeting of the committees; Director. Bureau of T (H) Office address, telephone number, and address of the agency representative or representatives who will explain the rule at a scheduled meeting of the committees; and 310 Great Circle Road Nashville, TN (615) s

14 GW

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