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
2022 Poverty Guidelines, Updated April 2022
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 Services Inventory, Updated August 2022 Ryan White Program Policies and Procedures, Updated July 2022
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
