Contractor problems created backlog in TennCare nursing home applications

Nursing home applications got so backed up when TennCare changed its processing system that administrators reported more than half of their patients did not get timely eligibility determinations, reports The Tennessean.

Jesse Samples, executive director of Tennessee Health Care Association, which represents nursing homes, told TennCare Director Darin Gordon in an email that the problem was causing serious cash flow issues for its members and stressful circumstances for patients.

Gordon responded that the agency’s internal statistics showed better performance but admitted its “more limited approach” in communicating applications was causing frustrations.

The emails obtained by The Tennessean through an open records request reveal that TennCare cannot place all the blame for its backlogged Medicaid applications on the federal government. After a class action lawsuit was filed on behalf of people seeking coverage, the state agency argued in court papers that healthcare.gov, the federal insurance exchange, had caused the issues. But nursing home applications were not filed through that website.

Nursing home applications got backlogged because TennCare stopped having state employees with the Department of Human Services process them and outsourced that work to a private contractor. The applications got sent to a new service center operated by Cognosante LLC, which was awarded a four-year, $31 million contract.

…The state wound up taking punitive actions, levying a fine of almost $1 million, said Sarah Tanksley, a TennCare spokesperson.

“TennCare’s new service center, Tennessee Health Connection, experienced an unexpectedly high volume of applications in the first quarter of 2014 while also experiencing some technical difficulties associated with the startup of this new call center,” Tanksley said. “As a result, the state took significant actions to address the problems and levied significant fines against the vendor.”

Cognasante and TennCare then worked for several weeks to improve the service, she said, and resolved the application problems early last year.