Comments on TennCare revisions welcomed

By Jennifer Lassiter
star staff

  The restructuring of TennCare has been a priority for Gov. Bredesen to preserve the state's health care program. The cost of the currently unsustainable program will continue to increase dramatically, from $7.6 billion in 2004 to $12.2 billion in 2008.
  A draft waiver outlining the state's strategy for saving TennCare was formally submitted to the TennCare Oversight Committee of the General Assembly yesterday.
  Focusing on critical structural elements of the current program, the state has redesigned the foundation of the plan.
  The new plan calls for coverage and benefits for the 1.3 million enrollees in the state's health care program for the poor, disabled and uninsured.
  The new plan:
  * Maintains TennCare's current enrollment, preserving health care coverage for over 400,000 Tennesseans who would not otherwise have health benefits under traditional Medicaid.
  * Exempts children form all benefit limits, copays and premiums payments.
  * Provides the strongest protections to the most vulnerable TennCare enrollees (children, pregnant women and the disabled) and then extends benefits to other eligible enrollees with a tiered benefit package and cost-sharing obligations.
  * Revises the pharmacy benefit by implementing a six prescription per month limit for all enrollees other than children, pregnant women and the disabled. All enrollees will be required to use the cheapest, yet safe and effective drug.
  * Establishes an advisory commission to review TennCare's performance and make recommendations to keep the program sustainable.
  * Improves program administration and works to eliminate fraud and abuse.
  "This draft waiver application represents the work of hundreds of state officials, health providers and other Tennesseans who are committed to TennCare's survival," said Bredesen. "W have worked hard to reconstruct a thoughtful plan that provides coverage for as many people as possible. I'm convinced this is the best approach for saving TennCare, and over the next 30 days we hope to get more input from enrollees and the public regarding this approach."
  The state will gather public comment on the draft waiver application over the next 30 days through a series of public meetings, a dedicated phone line, and a Web site that was specifically created to capture public comment.
  The draft waiver can be found online at Tennesseans who want to submit a comment on the waiver application can visit and follow the instructions or call 1-800-669-1851.