Tennessee Moves to Take Full Control of Access MedPlus
Tennessee officials Jan. 4 filed a petition to give the state "full possession of the assets of Access MedPlus," stating that the financial troubles of MCO, which insures 365,000 TennCare enrollees, have been "hazardous" to both subscribers and providers, the Chattanooga Times & Free Press reports. The move comes one day after Gov. Don Sundquist (R) announced that the state would "honor the outstanding health care claims [of] hospitals and doctors in the Access MedPlus health care network," and that the MCO's TennCare enrollees would retain their coverage in the event the MCO was placed in receivership. In a petition filed in state court, Anne Pope, commissioner of the Department of Commerce and Insurance, wrote that she "has reasonably determined that (Access) is in financially and operationally hazardous condition. Continued operation of the health maintenance organization under the present circumstances, without rehabilitation, would be hazardous to the enrollees and the people of this state as well as to creditors and health care providers." Last spring, the department placed Access MedPlus, TennCare's second-largest MCO, under state supervision due to late payments to providers, capitalization problems and an "inadequate health care provider network," the Times & Free Press reports (Commins, Chattanooga Times & Free Press, 1/5). State officials yesterday said they hoped their action "would help restore the trust of providers" in TennCare, even as the program's provider network is "eroding" across the state (Snyder/Russell, Nashville Tennessean, 1/5). Access MedPlus spokesperson Phil West called the state's action "unwarranted," and said the MCO "remain[s] committed to the TennCare program" and will challenge the state's action (Chattanooga Times & Free Press, 1/5). The state's petition follows an Access MedPlus advertising campaign that charged unnamed "powerful forces" were trying to shut the MCO down (Kaiser Daily Health Policy Report, 1/4).
Pay or Play?
In other TennCare news, Sundquist and some state legislators have begun discussing whether to operate the financially struggling Medicaid managed care program under a "pay or play" system. Under such a system, businesses, insurers and providers who either participated in TennCare or subsidized it would be rewarded in some way, while those who did not would suffer some financial disadvantage. Under the current TennCare system, many groups "are gaining financially" by not participating, according to Deputy Finance Commissioner John Tighe. For instance, some commercial insurers "benefit from TennCare because they don't have to provide" coverage for the more "expensive" TennCare population in their private business lines, while some businesses view TennCare as a substitute for providing employer-sponsored coverage. Both Sundquist and state Sen. Bob Rochelle (D) believe that any pay or play system should use a reward model that encourages companies to participate in TennCare rather than punishing them for not participating. However, both Rochelle and Dave Goetz, executive vice president of the Tennessee Association of Business, cautioned that a pay or play system could have a negative effect on small businesses, which often cannot afford to offer health insurance to their employees (Commins, Chattanooga Times & Free Press, 1/4).