Hey, TN Duers! Please fill me in on what Marcia Blackburn was talking about at the hcr summit!

TennCare Overview

The TennCare program operates under a Section 1115 waiver from the Centers for Medicare and Medicaid Services (CMS) in the United States Department of Health and Human Services. It is a demonstration program. The principle being demonstrated by TennCare is that a state can organize its Medicaid program under a managed care model and generate sufficient savings to extend coverage to additional populations who would not otherwise be Medicaid eligible, without compromising quality of care.

TennCare is one of the oldest Medicaid managed care programs in the country, having begun on January 1, 1994. It is the only program in the nation to enroll the entire state Medicaid population in managed care.

Medicaid waiver programs are time-limited. The first TennCare waiver ended on June 30, 2002. The waiver under which TennCare is now operating is called “TennCare II.” It began on July 1, 2002, and has been extended through June 30, 2010. In the summer of 2009, the state will begin preparing the next extension request.

TennCare services are offered through managed care entities. Medical and behavioral services are covered by “at risk” Managed Care Organizations in each region of the state. Enrollees have their choice of MCOs serving the areas in which they live, except that some enrollees are assigned to TennCare Select. TennCare Select is a managed care plan for certain populations such as children in state custody and enrollees who may be living temporarily out-of-state. In addition to the MCOs, there is a Pharmacy Benefits Manager for coverage of prescription drugs and a Dental Benefits Manager for provision of dental services to children under age 21. Coordination of care is the responsibility of the enrollee’s primary care provider in his or her MCO.

Long-term care services are provided in Nursing Facilities (NFs) and Intermediate Care Facilities for persons with Mental Retardation (ICFs/MR), as well as under Home and Community Based Services waivers for persons who would otherwise require care in a NF or ICF/MR. These services have historically been “carved out” of TennCare and paid for by the state through a fee-for-service arrangement. However, the state is making plans to bring long-term care services for persons who are elderly and disabled into the managed care program, beginning in the spring of 2010.

The Bureau of TennCare within the Tennessee Department of Finance and Administration is the state agency charged with responsibility for administering the TennCare program. In addition to overseeing the contracts with the managed care entities and overseeing the long-term care program, the Bureau of TennCare is responsible for payment of Medicare premiums, deductibles, and/or coinsurance for certain low-income Medicare beneficiaries.

http://www.tennessee.gov/tenncare/news-about.html

TennCare Managed Care Organizations Receive High Marks in Behavioral Health
Released on Sun, Oct 25, 2009 - 11:00 pm under

* Health Care
* TennCare

NASHVILLE — The Bureau of TennCare today announced the results of the 2009 HEDIS/CAHPS Report: A Comparative Analysis of Audited Results from TennCare Managed Care Organizations (MCOs). The report shows that TennCare’s Middle Tennessee MCOs performed above – and in many cases significantly exceeded – the 2008 national Medicaid average for measures related to behavioral health as well as drug and alcohol dependence treatment.

This is the first HEDIS/CAHPS report that looks at behavioral health measures, given that 2008 was the first full calendar year for TennCare to have fully-integrated health plans that provided both physical and behavioral health coverage for enrollees in Middle Tennessee. The report demonstrates that the MCOs performed well in behavioral health measures including, antidepressant medication management, follow-up care for children prescribed to attention-deficit hyperactivity disorder medication and follow up after hospitalization for mental illness.

“I’m pleased that as a result of integration, we now have the ability to track performance related to behavioral health using objective measures that have been validated by a nationally recognized external quality assurance authority,” said Darin Gordon, Director of TennCare. “This report provides encouraging news about the current status of care in middle Tennessee and will provide a baseline for measuring future improvements. We look forward to next year when, as a result of recently integrating behavioral and physical health in East and West Tennessee, we will have access to statewide data.”

Performance related to initiation and ongoing treatment of alcohol and drug dependence treatment were also significantly higher than the 2008 national Medicaid average. For example, the weighted state rate for initiation of alcohol and drug treatment in 13-17-year olds was 56.4 percent – well above the national Medicaid average of 39.9 percent.

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https://news.tennesseeanytime.org/node/3265">MORE

http://www.tn.gov/tenncare/forms/hedis09.pdf

Satisfaction with TennCare Remains High
Released on Mon, Aug 24, 2009 - 7:28 am under

* Health Care
* TennCare

KNOXVILLE – The Center for Business and Economic Research at the University of Tennessee, Knoxville today released the findings from its study, “The Impact of TennCare: A Survey of Recipients 2009.” The results show TennCare continues to earn high marks from those who receive its services – with enrollees reporting quality ratings that are the highest since the program’s inception in 1994.
http://www.utk.edu/news/article.php?id=5111">Click here to view the complete release from the Center for Business and Economic Research at UT Knoxville.

http://news.tennesseeanytime.org/node/2425