Access MedPlus Files $160M Claim Against TennCare
Access MedPlus, the second-largest managed care plan participating in TennCare, Tennessee's 1.3 million-member Medicaid managed care program, has filed a $160 million suit against the state, the Nashville Tennessean reports. The suit alleges that the state has failed to pay Access MedPlus "in an actuarially sound manner" since TennCare's inception in 1994. Access MedPlus claims that the state's capitation rate is too low, resulting in underpayment to the company of approximately $160 million over the past six years. Company representatives stated that the reasons behind the claim are twofold. First, the MCO is concerned by the "dramatic" increase in the number of TennCare beneficiaries with "costly medical conditions" that have joined the plan over the past 11 months. Second, the state has implemented the Grier consent decree, the settlement of a federal lawsuit that expands the rights of enrollees to "appeal" coverage decisions. According to Access MedPlus officials, the Grier settlement alone "may cost [the company] an additional $80 million a year." During a Dec. 12 news conference, Glen Watson, CEO of Access MedPlus' parent company Medical Care Management Co., said that if Access MedPlus wins its claim, "85% of any money recovered will go directly" to providers in its network. The company has been under "involuntary state supervision" since May, following complaints by providers that Access MedPlus failed to pay them on time or in full. Saying they had yet to see the claim, state officials had no comment on the suit, which will be heard by the Tennessee Claims Commission (Snyder, Nashville Tennessean, 12/13).This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.