Bredesen redefines TennCare

By Jennifer Lassiter
star staff
jlassiter@starhq.com

  In a teleconference held for reporters on Friday, Gov. Phil Bredesen answered questions concerning the "bronze" plan, a final attempt to save the embattled TennCare program.
  The administration is now in phase two of restructuring the state's $7.6 billion health care system for the poor and disabled, which was initiated after legislation approved a reform in late spring.
  The end of coverage for most types of cosmetic surgery, along with tattoo removal and body piercing, will be some of the new changes in the health care program. "This was evidence we lost our way with TennCare," said Bredesen. The governor said it was hard to explain why some single mothers were being turned away, while items such as cosmetics were being covered.
  Bredesen said prescription drug costs were the "driving factor" in cost saving and the reconstruction of TennCare. "We had to look at what it is we buy," he said. A central theme of Bredesen's message centered around offering a cheaper generic drug that has the same effect as a premium brand.
  The new plan revises the prescription pharmacy benefit by implementing a six-prescription-per-month limit for all enrollees, and asking enrollees to use the lowest costing effective drug. This plan exempts children, pregnant women, and the disabled.
  Taking cost into account was another major element of Bredesen's plan. The new medical necessity definition ensures items and services provided must meet four major requirements. "It's OK to take cost into account," said Bredesen.
  The more comprehensive plan requires that the services provided by a physician receive a diagnosis, or treat an enrollee's medical condition. The treatment must be safe and effective along with being the least costly treatment adequate, and cannot be experimental.
  Specific precautions have been taken so the new definition of medical necessity is not used in excess. For example, cost considerations will not override a patient's medical needs. TennCare would remove limits on cancer patients, and cover preventative care initiatives.
  The ultimate goal for the governor and the administration is to save TennCare without inhibiting other programs in the state with savings centered around reducing growth of costs, not by taking funds out of the program.
  Bredesen highly recommended the public respond to the draft TennCare waiver presented on Thursday by calling the hot-line number, 1-800-669-1851, or visiting the state's Web site at www.tennessee.gov.