Archives     Advertise     Editorial Calendar     Subscribe     Contact Us    


Governor Rolls Out TennCare Modified Block Grant Proposal


 
Governor Bill Lee

In mid-September, Governor Bill Lee and Deputy Commissioner and Director of TennCare Gabe Roberts unveiled the state's plan to gain more flexibility in managing Tennessee's Medicaid program. Billed as an innovative modified block grant, Tennessee is the first state to propose this type of alternate financing to the Centers for Medicare & Medicaid Services. If accepted, it would not only allow the state to have great operational control of its Medicaid program but would also reward good financial stewardship with a percentage of shared savings being returned to the program.

"We're encouraged about the opportunity we have as a state to do something we think is going to significantly, positively impact both the TennCare population that we currently serve and really be positive for the state as a whole," said Gov. Lee.

Whereas a traditional block grant awards a set amount to a state, the hybrid approach proposed by Tennessee would allow for per capita increases as enrollment increases and account for inflationary projections each year for core medical services. The modified block grant excludes administrative costs, the uncompensated care payments to hospitals that is supported by an annual hospital assessment, prescription drugs that will continue to be covered as they are now with a state match to federal dollars, costs for dual eligibles and services currently carved out of the TennCare waiver.

The difference between what TennCare spends and what CMS projects would have been spent if TennCare was a traditional state Medicaid program ... known as the budget neutrality cap ... is the amount of shared savings. That pool of saved dollars would be split at an agreed upon percentage (Tennessee has requested a 50/50 split) between the federal government and the state.

While the governor was hesitant to put a dollar amount on the shared savings that might be returned to Tennessee before CMS has responded to the plan or agreed upon a percentage split, it could be as much as $1 billion that the state could then reinvest in enhanced services and programming to address not only healthcare but also proactively address prevention and health.

With the modified block grant proposed, Gov. Lee noted, "We think we have crafted a waiver that is going to really mitigate the risks that Tennesseans have but actually give us an opportunity to benefit from the efficiencies."

He added the federal government recognizes the effectiveness of the TennCare program and is interested in incentivizing programs that save taxpayer dollars while providing quality care as a model for other states. "We think it's really good for Tennessee, but it's also a win for the federal government," Gov. Lee continued.

Although it's possible TennCare rolls might eventually expand to a larger population (think years down the road), the administration was quick to say that isn't what this proposal addresses. Its focus is specifically on better serving those who qualify for TennCare under current rules.

However, by potentially using shared savings to reinvest in community programming that promotes health and prevention, a larger sector of the population could see some residual benefit. Rural health transformation is a priority. Additionally, having more flexibility with demonstration projects might allow the state to more quickly identify best practice interventions that could then be replicated by other payers and providers outside of TennCare, as well.

A 30-day public comment period is underway and will end on Oct. 18, 2019. Those who wish to submit points of consideration may do so by emailing comments to: public.notice.tenncare@tn.gov or mailing written comments to Gabe Roberts, Director, Division of TennCare, 310 Great Circle Rd., Nashville 37243.

By statute, the state's modified block grant proposal must be submitted to CMS by Nov. 20, 2019. If an agreement on the submitted waiver is reached between CMS and Tennessee, then it must go back to the General Assembly for approval prior to implementation.

Links to additional information on the state's proposal to CMS are available for review at NashvilleMedicalNews.com.

WEB:

Notice of Change in TennCare II Demonstration: Amendment 42 (Proposed Block Grant)

Executive Summary of Amendment 42

Quick Overview of Amendment 42

FAQs

TennCare

 
Share:

Related Articles:


Recent Articles

Hot spots identified for colorectal cancer mortality rates among young women

Read More

ONcology Rounds

Read More

Minority Report

All cancers are not created equally. Recent Vanderbilt research show stomach, lung and appendiceal cancers are on the rise and detected later among certain ethnic groups.

Read More

Rounding on Addiction

Read More

Women and Addiction

Prenatal addiction services needed to bridge the gap in addiction, obstetrics

Read More

State of Recovery

Efforts are underway by TDMHSAS leadership to reach more Tennesseans suffering with addiction through education and recovery initiatives.

Read More

AMA Backs Policy Proposals to Cover More of the Uninsured

CHICAGO -- The American Medical Association (AMA) House of Delegates adopted principles today supporting public policy approaches that have the potential to expand insurance coverage to millions of the uninsured, including those who have lost their coverage during the COVID-19 pandemic.

Read More

Statins to be Studied for Prevention of Dementia, Disability, and Heart Disease

Vanderbilt University Medical Center (VUMC) researchers are enrolling adults age 75 and over to study whether taking atorvastatin, a drug commonly used to lower cholesterol, also called Lipitor®, can help maintain health by preventing dementia, disability, and heart disease.

Read More

Addressing Opioid Usage in the Hospital Setting

Opioid misuse often traces its roots to medically valid pain management intervention. Increased awareness of addiction has led providers to look for effective alternatives. In the hospital setting, recent studies find Caldolor® might be one such option.

Read More

Nashville Health Care Council: 25 Years Old & Growing

This year marks the 25th anniversary of the Nashville Health Care Council, an organization that was founded by the local health care community with the purpose of establishing Nashville as the nation's health care capital.

Read More

Email Print
 
 

 

 


Tags:
Block Grant, Gabe Roberts, Governor Bill Lee, Medicaid, Medicaid Waiver, Shared Savings, TennCare
Powered by Bondware
News Publishing Software

The browser you are using is outdated!

You may not be getting all you can out of your browsing experience
and may be open to security risks!

Consider upgrading to the latest version of your browser or choose on below: