Archives     Advertise     Editorial Calendar     Subscribe     Contact Us    


TMA Issues Statement on Medicaid Block Grant Proposal


 

Editor's Note: Since the October paper hit desks with initial reactions to the governor's proposed TenCare Modified Block Grant, TMA has had the opportunity to take a deeper dive into the full proposal and has released an updated statement.

The largest professional organization for doctors in Tennessee has submitted its public comments regarding the proposal to convert federal funding for TennCare to a block grant. Like many other organizations, the Tennessee Medical Association is cautious about the lack of detail in the preliminary proposal, while raising specific questions and concerns that physicians would like to see addressed in the negotiations.

TMA Statement:

Tennessee's physicians are unable to determine at this time whether the state's proposal to convert federal Medicaid funding to a block grant can realistically improve healthcare access and quality while reducing cost. There are some positives in the preliminary waiver request, but the draft raises more questions than answers about how it could affect doctors and their patients.

We cannot reduce overall funding without changing eligibility requirements or cutting benefits for our state's most vulnerable patient population. State officials should work toward a solution that provides enough funding to at least maintain current TennCare levels, or preferably cover more Tennesseans in need, and boosts physician participation by reducing administrative and clinical barriers to healthcare delivery. Hospitals won't help access for patients in rural areas of the state if there are no physicians to treat them.

TMA submitted detailed comments and questions during the public comment period. We expect the TennCare Bureau and Lee administration to be judicious in negotiations with CMS, and to engage the physicians who actually deliver care as the process moves forward.

Biggest Issues and Questions

  • Shared savings - How will the state realize actual savings, and why are projections based on traditional Medicaid instead of the 25 years of actual TennCare data using the 1115 demonstration waiver?
  • Episodes of care - The state proposes to continue using episodes of care payment reform efforts, but the program has serious design flaws. How can the state ask the federal government for performance-based rewards without risk for penalties when, under the current episodes program, TennCare financially penalizes doctors for costs beyond their control? The program has proven to cut costs on the backs of physicians but is not proven to increase quality or efficiency of care.
  • TennCare oversight - The state wants exemption from federal mandates, but TMA is concerned that there would be no oversight if the waiver becomes permanent. TennCare should be subject to a periodic renewal process (e.g. every five years) to keep it accountable for how it utilizes resources and treats physicians.
  • Drug formulary - Having a closed formulary with only one drug per therapeutic class is dangerous. There needs to be a way for patients to have access to appropriate treatment that physicians deem medically necessary, including off-label medications for children, without burdensome prior authorization. There also should be an appeals process for patients. The current EPSDT program should be preserved.
  • Optimizing effectiveness and efficiency - The waiver may give the state flexibility to reduce its administrative burden, but will TennCare pass that on to physicians or use freedom from federal mandates to create new, unlimited and unchecked requirements at the state level?
  • Physician fees - The draft makes no mention of physicians directly benefiting from savings, or improving administrative requirements for the providers who deliver care. We believe the state should pay its fair share for dual Medicare-Medicaid eligible enrollees. TMA agrees with penalizing enrollees for TennCare fraud, but the physicians who treat them in good faith should not have payment recouped.
  • Technology to support rural health transformation - In addition to telehealth, "adopting technologies" should include funds to resolve TennCare's technological problems that create administrative and financial headaches for physicians, such as moving from paper requirements to allowing the choice to submit paper or electronic claims.
 
Share:

Related Articles:


Recent Articles

Self-Care on the Front Lines of Coronavirus

Physicians, nurses, respiratory therapists and the full complement of support staff at hospitals and clinics are battling coronavirus on the front lines. When caring for others, it's all too easy to forget to take care of yourself.

Read More

The Onsite Foundation Announces New Virtual Support Group for Frontline Healthcare Workers and Medical Staff as part of 'Support in Service' Program

The Onsite Foundation, a 501(c)(3) non-profit public charity, today announced a new support group offering under the Foundation's 'Support in Service' program for frontline healthcare workers and medical staff across the country affected by the COVID-19 pandemic.

Read More

New Study Looks at Cost Impact of OTC Birth Control

A new study explores the impact on unintended pregnancies, consistent use of progestin-only OTC birth control pills at various price points.

Read More

Behavioral Health in a Time of Social Isolation

Last month, the Nashville Health Care Council brought together experts for a virtual panel discussion on behavioral health in the midst of social distancing orders.

Read More

COVID-19 & Mental Health

As the virus takes its toll, providers are finding new ways to reach patients and preparing for the mental health fallout ahead.

Read More

Sharing Best Practices in Behavioral Health

Nashville-based online video service provides evidence-based training to public and providers.

Read More

May is Mental Health Month

May is Mental Health Month with excellent resources from national organizations for both patients and providers.

Read More

Business Insights

Read More

Celebrating 15 Years of Incredible Leaders

Following are the 15 classes of Women to Watch. Some of these trailblazers have happily retired after a career of service. Others have moved to other positions and taken up new challenges since they were first recognized.

Read More

New Study Looks at Cost Impact of OTC Birth Control

A new study explores the impact on unintended pregnancies, consistent use of progestin-only OTC birth control pills at various price points.

Read More

Email Print
 
 

 

 


Tags:
Block Grant, Medicaid, Medicaid Waiver, Shared Savings, TennCare, TMA
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: