Federal judge may rule on decree clarifications today

U.S. District Court Judge John Nixon issued an order last Friday that gives the state and the Bureau of TennCare the power to define what treatments are medically necessary in the so-called Grier consent decree.

Nixon had already issued a partial order the day before that authorized the state to require prior authorization for prescription drugs and the power to limit prescriptions to five per month. His latest ruling went even further.

Some pharmacy benefits of the medically needy enrollees were scheduled to end on Monday. But state officials said they needed clarification on some sections of Nixon’s ruling, and gave those enrollees a 10-day extension of pharmacy benefits.

The extension did not affect another 200,000 people who did lose their benefits on Monday and will eventually be removed from the program all together.

Legal advocates for enrollees and state attorneys argued over the 10 clarifications in court on Tuesday. One issue that seemed to cause the most debate deals with the state’s ability to deny a claim if the treating physician can’t “justify deviation from the standard course of treatment.”

“We are making great progress,” said TennCare spokesman Michael Drescher. “We would like to get to a point of resolution.”

Gov. Phil Bredesen said Monday he hopes to make a decision about retaining the 97,000 medically needy enrollees sometime this week.