TennCare program to be overhauled

By Bob Robinson
STAR STAFF

   Gov. Don Sundquist has announced major changes in TennCare, the state's managed health care program for 1.4 Tennesseans. The changes were recommended by the Commission on The Future of TennCare, appointed in 1999, after public comments were received.
   Scott Williams, chief executive officer of Sycamore Shoals Hospital in Elizabethton, a part of Mountain States Health Alliance (MSHA), said the recommended changes are a good beginning.
   "However, it is critical that hospitals receive direct payments for services rendered to TennCare patients," Williams said.
   At Sycamore Shoals, TennCare comprises 20 percent of all patients, the highest percentage among MSHA hospitals except for Johnson County, according to Williams.
   Under the current plan, TennCare contracts with managed care organizations, like Health Maintenance Organizations. In turn, HMOs pay hospitals for services provided to TennCare patients, according to Lola Potter of TennCare.
   Gov. Sundquist said the new TennCare program will now include three basic divisions:
   * TennCare Medicaid will offer the same benefits comparable to those in other states.
   * TennCare Standard will offer a package of benefits comparable to those offered by commercial HMO plans.
   This program will be open to uninsured adults living in poverty and to uninsured children whose family incomes are below two times the poverty level and who lack access to employer-sponsored group health insurance.
   Premiums and copayments will be required for those with incomes above the poverty level.
   Individuals who have access to commercial insurance through their employers will not qualify.
   TennCare Standard will also be open to uninsured found to be "medically eligible." This eligibility requirement will only apply to those who meet strict, new guidelines administered by a private sector insurance underwriter.
   * TennCare Assist will assist low-income families who have access to private insurance. TennCare Assist will help those families pay their share of family coverage in their employer-sponsored health insurance plan.
   TennCare Standard and TennCare Assist will be available during an open enrollment period each year.
   The Tennessee General Assembly will determine how many additional people will be enrolled in TennCare annually based on their appropriations for the program, according to the governor.
   The new program will be submitted to the federal government before the end of the year. It is estimated to save taxpayers approximately $5 billion over the next 10 years, which would mean nearly $1.5 billion in state money and more than twice that in federal funds, according to Gov. Sundquist.
   "I believe the new TennCare will set a new standard for state health care programs in our country. I ask for your support and welcome your input to help us make that goal a reality," Gov. Sundquist added.
   Those with questions or comments regarding TennCare are encouraged to write to Future of TennCare, P.O. Box 159, Nashville, TN 37202-0159 or visit their Web site, www.TennesseeAnytime.org.