Forms, Policies, and Formularies

Part A/MAI Forms
Letter of Medical Necessity, Updated July 2015
Request for Additional Funding Form, Updated July 2022
Comprehensive Monitoring Tool, Updated July 2022                                                                                                  Part A-Additional Funding Form, Updated July 2022


Part A/MAI Policies
Grievance Policy and Reporting Form
Memphis TGA Eligibility Policy, Updated February 2023
Memphis TGA Transportation Policy, Updated February 2023
Memphis TGA Food Vouchers Policy, Updated March 2022
Memphis TGA Imposition & Assessment of Client Charges,  Updated September 2017
Memphis TGA Time and Effort Reporting, Updated September 2017
Memphis TGA Program Income, Updated September 2017

Part A/MAI Formularies
Local Pharmaceutical Assistance, Update June 2022

Local Pharmaceutical Assistance Resource, Update March 2022
Laboratory Procedures, Updated March 2014

Oral Health Care – Beginning June 1, 2017, Part A will use the TN Part B formulary for oral health services. See below. If you have any questions, please contact your fiscal specialist

Tennessee Part B Forms
2024 Poverty Guidelines, Updated January 2024
Modified Adjusted Gross Income (MAGI) Worksheet, Updated February 2017

Tennessee Part B Policies
Case Management Manual, Updated June 2022
Part B Eligibility Certification
Part B Housing Policy, Updated June 2022                                                                                                            Part B Program Release of Information and Client Rights and Responsibilities, Update June 2022                          Part B Oral Health Program Rights and Responsibilities, Update June 2022

Tennessee Part B Formularies
AIDS Drug Assistance Program (ADAP), Updated July 2016                                                                                     TN ADAP Formulary , Updated July 2022                                                                                                                   MS ADAP Formulary, Updated  July 2022 
Medical Services Fee Schedule, Updated April 2022

Other Resources
Ryan White Part A-MAI Fiscal Update & Review, September 2017                                                                          Memphis TGA Ryan White Subrecipient Services Inventory, Updated July 2023                                                                        Ryan White Program Policies and Procedures, Updated January 2024

Memphis TGA Performance Measure Codes and Guidance, Updated October 2022

Memphis TGA RSR Monthly QA Process, , Updated October 2022


Training Materials
CAREWare Referrals, September 2018                                                                                                                    Quick Start Guide 1 Navigating CAREWare Version 6                                                                                          Quick Start Guide 2 Setting up Contracts and Services                                                                                        Quick Start Guide 3 Adding Clients, Demographics, Services, and Annual Review Data                                      Quick Start Guide 4 Customizing Tabs and Fields                                                                                                  Quick Start Guide 5 Clinical Setup and Medical Data Entry                                                                                Quick Start Guide 6 Working with Prebuilt Reports, including the RSR and ADR                                                  Quick Start Guide 7 Creating Basic Custom Reports                                                                                                  Quick Start Guide 8 Advance Custom Reports