TennCare Puts Public on Notice of Possible Cutbacks

State of Tennessee Notice of Change in TennCare II Demonstration; Jan. 28, 2011:

The Commissioner of the Tennessee Department of Finance and Administration is providing official notification, pursuant to 42 CFR § 447.205 and 59 Fed. Reg. 49249, concerning intent to file an amendment to the TennCare II Demonstration and its State plan. The amendment will be filed with the Centers for Medicare and Medicaid Services (CMS), a federal agency located in Baltimore, Maryland, with a Regional Office in Atlanta, Georgia.

The State is required by CMS and State law to meet certain advance notice obligations whenever an amendment to the TennCare demonstration is filed. This amendment is being filed with an effective date of July 1, 2011. The benefits listed in this notice are benefits that are currently supported with non-recurring funds that will expire on June 30, 2011. Should there be no new funds to replace the non-recurring funds, the benefit changes will be required as of July 1, 2011.

The amendment to be filed will eliminate certain currently covered services and establish benefit limits on others. Children under 21 will not be affected by these changes. Eligibility for TennCare will not be affected by these changes. Pregnant women and institutionalized persons are not affected by proposed benefit limits.

The specific changes to be made are as follows:

• Implementation of a $2 copay on non-emergency transportation

• Implementation of a combined annual limit of 8 days per person for inpatient hospital and inpatient psychiatric hospital services

• Implementation of an annual limit on non-emergency outpatient hospital services of 8 occasions per person (an “occasion” is a day)

• Implementation of a combined annual limit on physicians’ and nurse practitioners’ office visits of 8 per person

• Implementation of an annual limit on lab and X-ray services of 8 occasions per person (an “occasion” is a day)

• Elimination of coverage for occupational therapy, speech therapy, and physical therapy

• Elimination of podiatrists’ services and physician’s assistant services

It is our intention to submit this amendment to CMS with the request that it be approved in time for implementation to occur on July 1, 2011. Corresponding State Plan Amendments will be filed, where appropriate. We estimate that implementation of the amendment and corresponding State plan changes will result in a decrease in aggregate annual expenditures of $103,456,753 in state funds in State Fiscal Year 2012.

Copies of this notice will be available in each county office of the Tennessee Department of Human Services. Written comments should be addressed to Mr. Darin Gordon, Director, Bureau of TennCare, 310 Great Circle Road, Nashville, Tennessee 37243.

  • C. Susanne Manager

    As a practice manager based at a large local hospital, I, for one, agree with this step to save Tennessee tax payers millions. All too often tenncare recipients are using our local emergency rooms on a weekly basis, for every ailment ranging from a cough, cold, to toothaches. They use the ER as opposed to having to schedule an appointment with their primary care doctor. They have no ‘skin in the game’, as they are not required to pay any type of co-payment as they are supposedly indigent. Most have their cell phones and name brand clothing. I am surprised by how many come for a prescription for many over the counter drugs because they don’t want anything not covered by their ‘card’. It seems to me, at least this would be a great first step as we all are being asked to tighten our belts and sacrifice. Next we need to take on ‘food stamp cards’…