Commission Offers Recommendations for Future of Tennessee’s Medicaid Managed Care Program
The 18-member Commission on the Future of TennCare, tasked with making recommendations about the future of Tennessee's Medicaid managed care program, released its final 62-page report on Nov. 17. Tennessee Gov. Don Sundquist (R) appointed the commission on Jan. 27 to make recommendations for the program (Bureau of TennCare release, 11/17). The program, which began in January 1994, covers 1.3 million Tennesseans, 800,000 of whom are eligible for Medicaid under federal rules, plus a 500,000-member "expansion population." The state received a section 1115 waiver under Title XIX of the Social Security Act to operate the program. After determining that the program's' "needs are extensive and the issues complex," the commission noted that "there were no quick and easy solutions to the problems identified," such as the make-up of administrative bureaucracy and failures in care delivery. However, the group has submitted more than 50 "detailed policy recommendations" on TennCare's future, including the following:
- TennCare should continue to operate as a managed care program;
- Despite constraints on the spending of federal money, both the state and the federal government should continue to fund the program, but "strenuous efforts should be directed toward negotiating terms more compatible with managed care, rather than oppositional to it";
- "Substantial improvements" in resources for staff, information systems and technology and "continued actuarial funding" are necessary;
- The program should adopt uniform billing procedures, create a "centralized credentializing process and standardized drug formulary" and develop policies to "better align the financial risks and incentives among" Tennessee, managed care companies and providers;
- The program should remain available for individuals who are Medicaid-eligible and those who are Medicaid-ineligible;
- The program should create two new "products": TennCare Assist to help low-income Tennesseans purchase employer-sponsored insurance and TennCare Standard for individuals without access to employer-sponsored insurance and/or individuals "uninsurable from an underwriting standpoint" due to the high cost of care for chronic illness;
- All Tennessee children should have access to health coverage;
- A board of 12-15 members should replace the Steering Committee and the legislative Oversight Committee in governing TennCare;
- TennCare Partners, the behavioral health program under TennCare, should continue to operate, and the state should ensure that "there is a meaningful choice of managed care plans";
- TennCare should continue to compensate disproportionate share providers through "an annual special payment methodology."