Category Archives: TennCare

3-Star Healthy draft to be submitted soon

Rep. Cameron Sexton, chairman of the 3-Star Healthy task force, says the group expects to submit a draft TennCare expansion pilot proposal to the U.S. Centers for Medicare and Medicaid Services in a week and he’s optimistic about approval, reports The Tennessean.

In a meeting Monday at Tennessee Tower, presenters with expertise in telehealth and a specific workforce training program called “individual placement and support” told task force members and interested health care officials about how the initiatives could bolster the TennCare expansion proposal as well as existing programs. Continue reading →

Counseling service bilked TennCare for $300K

MEMPHIS, Tenn. (AP) — The owner of a Memphis counseling service has pleaded guilty to defrauding TennCare of more than $300,000 by billing for services that were never performed.

According to a news release from the U.S. Attorney’s Office in Memphis, Vicky Fox began contracting with Tennessee’s Medicaid program in 2008 for grief counselling and psychotherapy services at her Rainbow Center for Children and Adolescents.

After one of Rainbow Center’s licensed clinical social workers left in January 2012, Fox continued to use that worker’s provider number to bill for phantom services.

The Tennessee Bureau of Investigation began looking into the billing in August 2014 at the request of the Bureau of TennCare.

Fox pleaded guilty on Friday to one count of health care fraud. She is scheduled to be sentenced in November.

Haslam advisor Will Cromer moves to TennCare

News release from the governor’s office
NASHVILLE—Tennessee Gov. Bill Haslam today announced that Will Cromer, his special assistant for strategy and policy director, will be joining the Bureau of TennCare as deputy director and chief of staff.

“Will has been one of my closest and most trusted advisors for more than six years, and while I think this is a great opportunity for him and the new leadership team Dr. Long is assembling at TennCare, I would be lying if I said I won’t miss having him one floor away,” Haslam said. “Will is incredibly smart and thoughtful, and he has been at the heart of every major policy decision and initiative we’ve launched in our office. I’m excited to see him apply his knowledge and experience in helping manage this $11 billion agency.”

As special assistant for strategy and policy director, Cromer has led the development and implementation of Haslam’s policy agenda and served as a key advisor and member of the governor’s senior team. He has developed legislation, overseen strategic initiatives, assisted with budget development and served as a liaison to various state agencies and stakeholders.

“It has been an incredible honor to be a part of Governor Haslam’s team and to work every day on a wide range of issues facing our state, from education reform to health care policy to economic development,” Cromer said. “TennCare is one of our most critical areas in state government, and I look forward to continuing to serve this administration and the people of Tennessee in this new capacity.”

Cromer, 31, has served as Haslam’s policy director since his 2010 campaign for governor, during which he was responsible for platform development, debate preparation, issue research and positioning, and assisting with strategic messaging and speechwriting.

Prior to his time with Haslam, Cromer worked for the State Collaborative on Reforming Education (SCORE), a bipartisan education initiative founded by former U.S. Senate Majority Leader Bill Frist, where he was involved in a number of areas in the early stages of the organization. Before that he worked in the nonprofit sector in Washington, D.C., promoting free market policies.

A Nashville native, Cromer is an honors program graduate of Belmont University, where he served as student body president.

He currently serves on the board of directors of the Tennessee Student Assistance Corporation and is a member of the Governor’s Rural Development Task Force, Three Branches Institute, and Public Safety Subcabinet.

Cromer and his wife, Catherine, live in Nashville.

Cromer begins at TennCare on Tuesday, September 6. His successor will be named at a later date.

Harwell task force: Medicaid for veterans, those with behavioral disorder

By Eric Schelzig, Associated Press
NASHVILLE, Tenn. — GOP lawmakers on Thursday for the first time presented details of a more limited approach to Medicaid expansion than was envisioned by Republican Gov. Bill Haslam’s failed Insure Tennessee proposal.

Members of a task force appointed by Republican House Speaker Beth Harwell said the 3-Star Health proposal would first focus on extending coverage to uninsured people with behavioral health problems and to veterans. The program would include health savings accounts, incentives for healthy living and penalties for improper use of emergencies.

Republican Rep. Cameron Sexton of Crossville said the task force has presented its plan to Centers for Medicare and Medicaid Services but acknowledged that no other state has been approved for a similar approach.

“We’re looking for a measured approach, where we can have a phased-in approach to work toward closing the gap,” he said. Continue reading →

Harwell task force presents Medicaid plan to feds (press release)

News release from House Republican Caucus
(NASHVILLE) — Earlier today, members of the ‘3-Star Healthy Taskforce’ and TennCare met with representatives from the Centers for Medicare and Medicaid Services (CMS) to discuss the Taskforce’s proposal to close the insurance coverage gap in Tennessee.

“We feel that today’s meeting was a significant step forward in achieving the Taskforce’s stated goal of presenting a plan to the legislature that improves access to healthcare and closes the insurance coverage gap,” said Representative Matthew Hill.

“This conservative and measured approach of focusing on behavioral health, mental illness and substance abuse, and uninsured veterans is one of the most significant steps forward for healthcare in Tennessee,” continued Chairman Cameron Sexton. “This patient population has been underserved in the State of Tennessee for generations.”

The grey paper presented to CMS pursues a different direction than Insure Tennessee and details a two-phase approach the Taskforce is seeking for approval. Continue reading →

Some reporting from HarwellCare task force, meeting 6

Excerpts from some reporting on the sixth meeting of House Speaker Beth Harwell’s “3-Star Healthy Project” task force, held Tuesday in Nashville and to be followed by at least one more session with federal health care officials:

WPLN says the group “seems to favor giving more support to clinics over offering poor Tennesseans government insurance through Medicaid.”

That’s somewhat encouraging to Mary Bufwack, the president and chief executive of United Neighborhood Health Services, a network of nonprofit clinics around Nashville that provide primary and OB/GYN care. Bufwack agrees getting low-income people in to see doctors would be a good thing, but who pays for what happens after that, when those doctors discover medical problems that need more treatment?

“Expanding primary health care actually sometimes uncovers and identifies problems that need more specialists,” Bufwack says. “My concern is we make sure the people have the access needed to specialty, hospital and other kinds of services that are absolutely vital.”

Plus, Bufwack says, Tennessee’s clinics are nowhere close to being big enough to handle the number of people who need coverage.
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From The Tennessean:

The five lawmakers who attended Tuesday’s meeting — Sexton, Reps. Matthew Hill, R-Jonesborough; Roger Kane, R-Knoxville; Steve McManus, R-Cordova; and Karen Camper, D-Memphis — reached no conclusions, but a variety of government officials offered ideas to consider as the group moves forward.

During his presentation, Douglas Varney, commissioner of the Department of Mental Health and Substance Abuse Services, made a variety of recommendations to the group, including suggesting that providing primary care providers with more education on substance abuse can help address the needs of those struggling with the problem.

Beyond Varney, the task force also heard testimony from Raquel Hatter, commissioner of the Department of Human Services, and Valerie Nagoshiner, chief of staff for the Department of Health. Hatter fielded several questions about the various programs that provide temporary financial assistance to Tennesseans, while Nagoshiner focused her comments on a variety of health care safety nets the state has.

With significant talks about mental health and substance abuse throughout the day, Sexton ultimately concluded the issue probably would be included in the task force’s final recommendations.

“If we’re looking at starting at some point, I’d say there’s a good chance that we would be starting at the behavioral health side,” he said after the meeting.
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From Nashville Post Politics:

In comments after the almost three-hour meeting, committee member Rep. Roger Kane (said) that whatever the task force comes up with won’t be a whitewashed version of Gov. Bill Haslam’s plan to expand insurance coverage.

“We’re not going to be able to get Insure Tennessee 2.0 through the House,” Kane said bluntly. When asked if legislators, once safely re-elected in November, might change their minds, Kane shook his head. “I’m going to say the answer is still no. It wasn’t an election year last year, and we couldn’t get it passed then.”

It remains unclear whether the task force created by House Speaker Beth Harwell to come up with a conservative alternative to Insure Tennessee actually has the wherewithal or the political capital to get anything done.

… Beyond an expansion of low-cost community health clinics, which task force chair Rep. Cameron Sexton has endorsed, nothing in today’s presentations indicated what other ideas might make it into an official proposal — although a few moments were revealing of the panel’s general lack of knowledge surrounding some of the issues.

Appeals court backs TennCare applicants in lawsuit

By Travis Loller, Associated Press
NASHVILLE, Tenn. — Tennessee’s Medicaid program has to provide applicants with a fair hearing if it cannot process their requests on time, under an order that’s been upheld by a federal appeals court.

Applications for most forms of Medicaid should be processed within 45 days, by law. Applications based on disability are allowed 90 days.

Applicants for TennCare — Tennessee’s version of Medicaid — sued in July 2014, complaining that their applications had been pending for months, and the state had refused to provide hearings.

A federal judge in Nashville issued a preliminary injunction in September 2014 requiring hearings for those whose applications were not timely processed. The injunction is a temporary ruling in effect while the case works its way through the courts. The judge also granted the lawsuit class-action status, meaning anyone in a similar situation to the original plaintiffs could be considered a plaintiff.

The state appealed, asking the 6th U.S. Circuit Court of Appeals to dismiss the lawsuit on technical grounds.

On Monday, a 6th Circuit panel ruled 2-1 in favor of the TennCare applicants.
Continue reading →

Sunday column: Harwellcare task force providing political insurance?

House Speaker Beth Harwell left Democrats howling and some fellow Republicans scratching their heads with the announcement last week that she has set up a task force to contemplate how to deal with health care coverage for poor Tennesseans.

Of course, Republican Gov. Bill Haslam proposed in late 2014 his idea on how to deal with those folks after more than a year of contemplation and compromising. It was called Insure Tennessee and was summarily shot down last year by the Republican supermajority, with Harwell waffling, refusing to either support or oppose a plan denounced as part of GOP-despised Obamacare by critics and defended by Haslam as an innovative way to expand Medicaid.

The governor, who has created dozens of task forces to study stuff while avoiding a decision on various matters, was on hand at the announcement of Harwell’s “3-Star Healthy Project” to praise participants for taking a “political risk” in being willing to even talk about such things.

Actually, there doesn’t seem to be much political risk here. Harwell waited until after the qualifying deadline for legislative candidates had passed before setting up the task force. She and all four Republican representatives appointed to the panel now have no opposition in GOP primaries. It may be worth noting, though, that all four — and Harwell — do have Democratic opponents waiting in November. Ergo, any political risk they face is from underdog Democrats.
Continue reading →

Harwell to study health care via task force; Democrats howl

By Erik Schelzig, Associated Press
NASHVILLE, Tenn. — Republican House Speaker Beth Harwell on Tuesday touted a new initiative to improve health care access in the state, but Democrats quickly derided it as an election-year “charade” to deflect criticism of lawmakers who rejected the governor’s Insure Tennessee proposal.

Harwell said she began talking with health policy experts at Vanderbilt University’s medical school to come up with alternatives last year after lawmakers rejected Republican Gov. Bill Haslam’s proposal to extend health coverage to 280,000 low-income Tennesseans.

Harwell, R-Nashville, has dubbed her initiative the “3-Star Healthy Project,” and said it will tap conservative ideas like encouraging greater responsibility for enrollees; create health savings accounts funded by co-payments; and provide more support for people trying to rejoin the workforce.

She is a creating task force to propose ways to improve access to health care in Tennessee. Harwell said the four Republican House members she has appointed to the task force will work to come up with a specific proposal to make to the federal government as early as June, though the plan could require lawmaker approval next year.

Democrats called the announcement an attempt to give Republicans political cover for rejecting Insure Tennessee.

“This is simply designed to give the false impression that the House Republican leadership is willing to do anything about health care,” said House Democratic Caucus Chairman Mike Stewart of Nashville. “It’s clearly not. This is a charade, it’s an effort to delay, and to not simply pass Gov. Haslam’s Insure Tennessee plan.

“It’s pathetic,” Stewart said.
Continue reading →

Wendy Long named new TennCare director

News release from the governor’s office

NASHVILLE – Tennessee Gov. Bill Haslam today announced Dr. Wendy Long will become the director of TennCare and deputy commissioner of Health Care Finance and Administration (HCFA).

Long will replace Darin Gordon, who is leaving at the end of June after 10 years as TennCare director. She has served as deputy director and chief of staff of the Health Care Finance and Administration division of the Tennessee Department of Finance and Administration since 2013.  Long served as chief medical officer for TennCare from 2004-2012.

“We are fortunate to have someone with such a depth of experience working in TennCare to take on this assignment,” Haslam said. “TennCare is among the best managed Medicaid programs in the nation, and this move will help us maintain that performance. Tennesseans can have great confidence in Dr. Long in this important position.”

Started in 1994, TennCare is the state’s Medicaid program, a $10.5 billion health care enterprise that provides services to nearly 1.5 million Tennesseans. In her role as deputy director of HCFA, Long has provided leadership to all areas of its operation including oversight of contracts with TennCare’s network of managed care companies.

“I am honored that Gov. Haslam asked me to serve in this role,” Long said. “My tenure as TennCare’s deputy director has provided invaluable experience and I am grateful for this leadership opportunity. The dedicated staff at Health Care Finance and Administration are an exceptional group of public servants and I look forward to our continued efforts to promote the delivery of high-quality, cost-effective care for the citizens of Tennessee.”

Prior to becoming TennCare’s chief medical officer in 2004, Long held a variety of positions of increasing responsibility at the Tennessee Department of Health including assistant commissioner and medical director for the Bureau of Health Services.  Long also has previous TennCare experience having served as medical director from 1997-1999 and as interim director from March 1998-January 1999.

Long received her undergraduate and medical degrees from Ohio State University and completed a preventive medicine residency and master of public health program at the University of South Carolina.

Long and her husband, Rick, have two grown children, Brian and Lindsey.