Category Archives: TennCare

Darin Gordon stepping down as TennCare director

News release from the governor’s office
NASHVILLE – Tennessee Gov. Bill Haslam today announced TennCare Director and Deputy Commissioner of Health Care Finance and Administration Darin Gordon will enter the private sector at the end of June, leaving a nationally respected legacy of stability and innovation for a program serving some of Tennessee’s most vulnerable populations.

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 and has earned customer satisfaction ratings above 90 percent for the past seven years.

Having taken on his role in 2006, Gordon is not only the longest serving TennCare director in state history but also is currently the longest serving director in the country. During the 12 years prior to his appointment, the position changed hands 10 times. Continue reading

TennCare pushing birth control for drug-abusing women

TennCare officials are pushing health care providers to prescribe birth control implants to mothers of children with drug dependency, reports WPLN.

The state’s prescription painkiller epidemic is the underlying problem. Babies born to mothers hooked on opiates often suffer withdrawals, known as neonatal abstinence syndrome. According to the latest figures, 93 percent of all NAS births in the state are to mothers on TennCare. The agency now spends $50 million a year on the related hospital bills as infants go through detox in a neonatal intensive care unit.

To make sure mothers don’t end up having a second child with the same condition, TennCare is prodding obstetricians to recommend long-acting birth control implants.

“We want to put in place the right incentives for that conversation to occur,” chief medical officer Vaughn Frigon says.“That’s really a conversation that’s best between the treating physician and the mother. But what we want to do is make sure that those contraceptives are available.”

TennCare has made it so doctors can get paid more for the procedure if its done while a new mother is still in the hospital. The agency has also made it easier for hospitals to keep the implants or intrauterine devices (IUD) on hand.

The latest TennCare data shows fewer women on prescribed painkillers taking birth control pills too. Among 30 to 34-year-olds, just 15 percent of those on prescribed opiates also were on contraceptives.

Women’s health groups are somewhat wary. Health officials have also been pushing birth control as women leave jail in some counties with particularly high instances of neonatal abstinence syndrome.

Hospitals plan post-election push for Insure Tennessee

By Eric Schelzig, Associated Press
NASHVILLE, Tenn. — The Tennessee Hospital Association, a key supporter of Republican Gov. Bill Haslam’s unsuccessful effort to expand Medicaid in the state, is planning a new push to pass the measure once this year’s presidential election is over.

The members of the hospital group had pledged to cover the entire $74 million state share of Haslam’s Insure Tennessee proposal, which would have drawn down $2.8 billion in federal Medicaid funds over two years.

But Republican lawmakers rejected Haslam’s plan last year amid fears that it was too closely linked to President Barack Obama’s signature health care law.

THA President Craig Becker said the group is spending about $400,000 to found a nonprofit called Tennesseans for a Responsible Future that is aimed at gathering support for passing the measure once Obama leaves office next year.

“It really is to kind of offset some of the misconceptions and certainly to educate our legislators to what Insure Tennessee is and what it isn’t,” Becker said. “And what it isn’t is Obamacare.”
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Pharmacy charged meds for dead to TennCare

NASHVILLE, Tenn. (AP) — A Nashville company will pay as much as $7.8 million in a settlement related to accusations that it charged Medicare and TennCare for medications for dead patients.

The Tennessean ( ) reports U.S. Attorney for the Middle District of Tennessee David Rivera on Tuesday announced the settlement of the False Claims Act case involving Nashville Pharmacy Services, which specializes in dispensing HIV and AIDS medications.

According to a news release, the company billed Medicare and TennCare for medications for 15 patients after they had died and billed for medications for 22 people who didn’t have prescriptions.

The company didn’t admit liability, but will have to make contingency payments based on its revenue to the federal and state governments for the next five years. Rivera says those payments could reach $7.8 million.

Haslam eyes program to help intellectually disabled get jobs

By Lucas Johnson, Associated Press
NASHVILLE, Tenn. — Gov. Bill Haslam said Tuesday that a program to help people with intellectual disabilities find jobs makes sense, but he wants to learn more about it before investing $19 million.

The Republican governor heard from state health officials during a week of budget hearings at the state Capitol. He’s scheduled to hear from 26 state agencies as he crafts his annual spending proposal that will likely top $34 billion.

State health officials on Tuesday told Haslam that the job service would target people receiving home- and community-based services through TennCare, the state’s version of Medicaid, and that it’s part of a unique program where “employment and independent living is the first and preferred option” in assisting Tennesseans with intellectual and developmental disabilities.

Haslam told reporters following the hearing that he favors the program but wants to dig down further and understand how it will work.

“Obviously, $19 million is a big chunk of new money,” he said. “The program does make sense to me.”
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Haslam: Insure TN is still dead

Gov. Bill Haslam says gestures of support for Insure Tennessee since the last legislative session – including resolutions approved by city councils in Chattanooga and Knoxville recently – haven’t changed the hearts and minds of Republican state legislators. So he has no intention of trying for passage of the modified Medicaid expansion plan in 2016.

Gubernatorial quote from the Times-Free Press:

“There’s been a statewide effort to rally the cause, but I haven’t noticed a changing public opinion and definitely haven’t seen a change in our legislature.”

“My sense is there will be a lot of people waiting to see what happens in the ’16 presidential election — just, again, to be as honest as I can — before they’ll do that,” Haslam said. “We would still love it to happen. We still think it’s the right thing to do. Nothing I’ve seen since then (the 2015 session) has changed my mind.”

Ramsey sees ‘zero chance’ for Insure TN revival

The Tennessee Justice Center brought its campaign to revive Gov. Bill Haslam’s Insure Tennessee proposal to Kingsport this week, reports the Times-News under the headline, “Insure Tennessee is dead, but don’t tell that to advocates.”

Within the article, Lt. Gov. Ron Ramsey is quoted as saying Insure Tennessee has “zero chance” of getting through the Legislature next year.

“There’s nothing to prevent a legislator from bringing it forward,” Ramsey said of Insure Tennessee. “There’s a possibility that one of the Democrats will bring it forward, but I think most people are in the same boat I’m in, that we’re a year away from a presidential election, and things are going to change in Washington one way or the other and I think most of the Republican candidates are saying they want to give states their Medicaid money in block grants and let them design their own program with no strings attached. I think we’re one year away from that.”

Statewide TennCare fraud bust: 24 arrested

News release from Department of Finance and Administration
NASHVILLE, Tenn. – A statewide round-up of suspects has netted two dozen arrests of suspects charged with TennCare fraud. The suspects are charged in various counties on numerous TennCare fraud charges, including under-reporting income, living out of state, failing to disclose resource information and transferring property in order to qualify for TennCare, doctor shopping, presenting forged prescriptions or selling prescriptions. all received using TennCare benefits.

The Office of Inspector General (OIG) conducted a statewide roundup concluded today, with special agents fanning out across the state to crack down on those who had an outstanding warrant for TennCare fraud. The roundup is part of a new approach to take people into custody soon after an indictment by a grand jury and to locate and arrest fugitives.

“We want everyone to know that if someone is involved in committing TennCare fraud, the chance of getting caught has increased substantially,” Inspector General Manny Tyndall said. “Our office will investigate, prosecute, and arrest those who abuse the TennCare program. It should also be noted that investigations and arrests have been expedited because of the efforts of local law enforcement agencies to assist the OIG in combatting combat TennCare fraud.”

OIG Special Agent teams were positioned in all three grand divisions of the state—East, Middle, West—with a list of individuals wanted along with identifying information and warrants. The toughest task was finding the people they were trying to serve, because so many had multiple addresses.

Those arrested are:
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Ohio governor urges Medicaid expansion in TN

Probable Republican presidential candidate John Kasich, who as Ohio governor successfully pushed Medicaid expansion in his state, said in Nashville Thursday that he hopes Gov. Bill Haslam can do the same in Tennessee.

From The Tennessean:

“I’m very big on Haslam, I think he’s really smart. But you have to all work those people in the legislature, and you’ve got to tell them this is what it’s all about,” Kasich said in speaking with several doctors and administrators at Vanderbilt University Medical Center.

“The problem that a lot of you have is you get upset with them, and then when they don’t do what you want them to do, then you go and you support them. You’re all the same: You’re all worried about whether they’re going to like us the next day. Either you mean it or you don’t.”

…”Part of the problem is people develop an ideological opposition and then don’t want to be confused by the facts,” Kasich said.

“I think we are a healthier state, a more inclusive state, a better state and a more unified state as a result of this. I think you’ll get it done here. I don’t know who holds it up. But it’s always a struggle.”

At the same time, Kasich said states should have some flexibility in how they spend their money: For Ohio, people are eligible for Medicaid if they earn up to 138 percent of the federal poverty line. Kasich said there are discussions about dropping that to 100 percent, then combining the leftover funds with a “modest state subsidy” to help people earning between 100 percent and 138 percent of the federal poverty level purchase coverage on the private health care exchange.

Opponents to any form of Medicaid expansion in Tennessee disagreed with Kasich’s analysis. Justin Owen of The Beacon Center of Tennessee, a conservative think tank that successfully helped defeat Insure Tennessee this year, blasted Kasich for expanding Medicaid in Ohio.

“Gov. Kasich’s Medicaid expansion under Obamacare has been an abysmal failure. Rather than come to our state and shill for Tennessee to duplicate Ohio’s disasters, Gov. Kasich should go back home and try to fix the mess he’s created,” Owen said in a statement.
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TennCare transition: Another contractor replaced after poor performance

TennCare has replaced the vendor that ran a problem-plagued call center for state residents checking on their Medicaid eligibility, according to The Tennessean.

The state awarded a $56.5 million contract this year to Automated Health Systems Inc. to run the Tennessee Health Connection through 2018. Previously, Cognosante LLC held a three-year contract valued at $31 million to operate the call center.

State residents had complained that the call center could not answer their questions, and the association that represents Tennessee nursing homes had notified TennCare it was not processing resident applications in a timely manner.

“This transition to a new call center vendor is another example of the state continuously improving processes and customer experience and holding our contracted vendors accountable,” said Kelly Gunderson, a spokesperson for TennCare. “This transition was seamless to our applicants and members and will result in improved customer service for our callers.”

The call center contract is separate from the $35.7 million computer system that Northrop Grumman was supposed to build for TennCare to determine Medicaid eligibility according to new income guidelines.

TennCare canceled that contract and is in the process of finding another vendor. Tennessee’s government has a history of dealing with failed computer systems across state agencies.