Senate Commerce and Labor Committee is updated on the state’s TennCare Program

TennCare Director Dave Roberts testified before the Senate Commerce and Labor Committee on Tuesday to provide an overview of TennCare’s coverage and services. As of October 2018, approximately 1.34 million Tennesseans were covered by TennCare, which accounted for 20.5 percent of the state’s budget.

Roberts said they focus on providing high quality, cost effective care for all TennCare members and utilize public-private partnerships with the three managed care organizations (MCO) in the state – Amerigroup, BlueCross BlueShield, and United Healthcare – to help provide quality care to members.  The MCOs play a large role in patient care and are responsible for providing traditional physical healthcare needs as well as behavioral health and long term services support (LTSS), if needed.  MCOs also create savings to taxpayers through negotiated rates per member which increase budget predictability. Tennessee’s Medicaid program has successfully controlled costs compared with the rest of the country, with its medical trend (increase in spending) for fiscal year 2019 at 2.1 percent compared with 4.9 percent across the country.

Roberts also outlinedfour key priorities for the agency. First addressed was TennCare Connect – a new 21st Century eligibility system anticipated to go live this spring.  It will include a mobile app and provide a better user experience for members and state employees.

The second matter addressed was the status of the work and community engagement requirement waiver submitted to the Center for Medicaid Services (CMS), per the direction of legislation passed by the General Assembly last year. TennCare submitted the proposal to CMS on December 28, 2018, but has yet to engage in conversations with CMS on further details. As of January, 16 states have submitted work and community engagement requirement waiver requests to CMS, and so far, 8 have been granted.

The third priority outlined is the delivery system reform for physical and mental healthcare, which will improve quality of care, as well as cut costs. The goal is to increase resources to primary care physicians to improve preventative care, education, and chronic disease care for patients. Improving existing episodes of care is also an important part of this initiative.

Finally, TennCare provided updates on its opioid prevention strategy and improvements to opioid prescriptions.  Before the TN Together legislative package was passed last year, more than 40 percent of prescriptions for first time and acute opioid users were 7-day supplies or more. Since the legislation was implemented, over 90 percent of those prescriptions have been for 6 days or less.  Additionally, the state has seen the biggest decrease in opioid prescriptions paid for by TennCare, as well as the first decline in babies born with neonatal abstinence syndrome (NAS) since 2011.

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