Tag Archives: cms

CMS Says 30 TN Medicare Contractors Not Licensed in TN

Joint news release from Tennessee congressional delegation:
WASHINGTON – Members of the Tennessee United States congressional delegation today announced that their inquiry into whether the administration awarded Medicare contracts to businesses not licensed in Tennessee has resulted in the finding that 30 of 98 suppliers were not licensed and will have their contracts voided.
On May 21, Senators Lamar Alexander and Bob Corker (R-Tenn.), along with Representatives Marsha Blackburn (R-Brentwood), Phil Roe (R-Johnson City), John J. Duncan, Jr. (R-Knoxville), Chuck Fleischmann (R- Ooltewah), Scott DesJarlais, (R-Jasper), Jim Cooper (D-Nashville), Diane Black (R-Gallatin), and Steve Cohen (D-Memphis) sent a letter to the administration requesting details on its policy of awarding Medicare contracts for durable medical equipment to businesses not licensed in Tennessee, a violation of the administration’s bid policy and a violation of Tennessee state law. Durable medical equipment includes products that are intended for at-home care of sick or injured individuals. The category includes wheelchairs, crutches, blood pressure monitors, and hospital beds.
In a letter responding to the May 21 inquiry from the members, the administrator of the Centers for Medicare and Medicaid Services, Marilyn Tavenner, said: “We have determined that certain out-of-state suppliers that were licensed in their home state, but that did not meet aspects of existing Tennessee licensing requirements at the time of bid submission, were awarded contracts. As a result, CMS will take steps to void contracts for these suppliers in the Tennessee competitive bidding areas, consistent with the policies and guidelines established for the competitive bidding program. This applies to approximately 30 out of the 98 contract suppliers in the Tennessee Competitive Bidding Areas.”
Note: The full text of the CMS response is below:

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Haslam’s Medicaid Expansion Plan Not in Line With New Fed Guidelines

Republican Gov. Bill Haslam has gotten some of the “clarity” he wants from the Obama administration on his plan to use federal Medicaid dollars to provide insurance for an estimated 181,000 low-income Tennesseans, reports Andy Sher.
He probably won’t like some of what they’re telling him.
That’s because the guidance, issued Friday, says no to several provisions Haslam included in the “Tennessee Plan” he unveiled Wednesday to state lawmakers.
…Reached by phone, TennCare spokeswoman Kelly Gunderson said no one could comment on the guidance issued by the federal Centers for Medicare and Medicaid Services.
Under those guidelines, Tennessee could indeed do just what Haslam wants: Use new Medicaid dollars to enroll people earning up to 138 percent of the federal poverty level in insurance exchanges.
But that’s only if states make the program optional for the Medicaid-eligible population. Beneficiaries “must be able to choose an alternative to private insurance to receive Medicaid benefits,” CMS says.
To get the flexibility wants and put new beneficiaries into the exchange, Haslam would have to obtain a federal waiver of Medicaid requirements. That can take considerable time.
Haslam also wants new beneficiaries to have the same benefits and co-payments as other enrollees in the exchange’s private insurance plans.
But CMS says states would have to make “arrangements” with the exchange’s insurers for “wrap around benefits,” that is, extra benefits required under traditional Medicaid rules.
That includes things like providing transport to and from a doctor’s office, experts said.
Traditional Medicaid co-payments also appear to be required. TennCare Director Darin Gordon said for Medicaid enrollees in the exchange to pay the same co-payments as others, the cost would be 6 percent of the premium.
Gordon Bonnyman, an attorney and Medicaid expert with the Tennessee Justice Center, said it’s “always been pretty clear that some of things on their list would not be legally permissible.”
But, he added, “The good news is that the core of the plan can go forward which is using Medicaid matching money” to pay for premiums in the exchange.
Nothing in the guidelines prevents Haslam from moving ahead with a major component of his plan, reforming payments to health providers.