TennCare may terminate health care contract

From Staff Reports

   The Bureau of TennCare has recently notified Universal Care of Tennessee, Inc. of the state's intention to terminate its contract with the health plan effective April 30, 2002. The state has developed a back-up plan for current members.
   "We must act firmly to hold managed care organizations accountable for their contractual obligations, specifically to pay providers promptly and accurately," said Mark Reynolds, TennCare Director. "The Department of Commerce and Insurance (TDCI) and TennCare are working together to review the health plan's difficulties, explore all options and work for the best outcome for TennCare members, providers and the state."
   The decision to terminate the state's TennCare contract with Universal Care was based on problems identified in the state's oversight of the managed care organization (MCO). The problems highlighted include the MCO's failure to demonstrate sufficient financial capital, failure to demonstrate minimum net worth and to pay claims in a timely manner.
   The contract termination would be suspended if Universal can resolve these problems by April 19, 2002. If these problems are not resolved, Universal's 134,636 members in Middle Tennessee will be transferred to the state's back-up health plan, TennCare Select, on May 1, 2002.
   Doctors, hospitals and other providers who contracted with Universal Care, but not TennCare Select, will be encouraged to join the TennCare Select network. Providers with questions about joining the TennCare Select network can call TennCare Select at 1-800-276-1978 or after hours at 1-800-999-1658.
   TennCare is the state's managed health care insurance program for 1.4 million Tennesseans who are Medicaid-eligible, uninsured or uninsurable.