Bredesen unveils TennCare bill
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Bredesen said Monday that he hopes enacting statutes instead of administrative changes will make it clear “this isn’t just Phil’s program.”
Bredesen characterizes the reform plan, which decreases benefits for some of TennCare’s 1.3 million enrollees by limiting prescription drugs, doctor visits and days in hospital care, as the state’s last best hope to save TennCare.
TennCare is the state’s expanded Medicaid program providing health care for poor, disabled and uninsured Tennesseans. It costs $7.3 billion a year; the federal government pays two-thirds of the cost and state government the rest.
Bredesen laid out the proposed reforms to the General Assembly in February. On Monday the administration presented the changes in state law that will be necessary to make it happen.
As it turns out, many of the proposed changes to law are not strictly necessary.
“We’re trying to get clear legislative authority so it’s clear this is the policy of the state of Tennessee and not something being done administratively within the TennCare program,” Bredesen said. “I would think any judge would give more deference to the law than to an administrative decision.”
“Even though this is an administrative function, we have to be hand in hand on this,” said House Speaker Jimmy Naifeh. He added the bill might delay the end of the legislative session, but said that if “dragging it out another week will stabilize TennCare, I’ll have no regrets.”
House Majority Leader Kim McMillan, D-Clarksville, said putting the governor’s proposals into law won’t prevent court action, but “will make the argument stronger that this is what the General Assembly and the governor wanted.”
The changes in law come in two parts. One would strengthen TennCare’s ability to prevent and to prosecute fraud and abuse.
“People are concerned about the program because they’re concerned about fraud and abuse,” Bredesen said. “We’re trying to assure people we’re not turning a blind eye to it.”
The proposal would create the Office of Inspector General for the TennCare program, consolidating existing fraud units in TennCare and the Tennessee Bureau of Investigation and expanding their scope.
It will enable the state to sue over TennCare fraud not only in the county where it occurs but in Nashville as well and add at least one assistant district attorney in the capital to aid prosecution.
The fraud legislation also increases some existing penalties and adds new ones.
Included in the new penalties are ones for people who know but don’t turn in someone fraudulently getting TennCare services.
“I don’t know how many conversations I’ve had with people over the last year who have said they know of someone improperly getting services,” Bredesen said. “We’re saying, ‘Help us out a little bit.'”
The penalty for a health care provider who submits claims for a person they suspect fraudulently obtained TennCare coverage is increased from $10,000 to $25,000.
The second bill involves changes in the law allowing TennCare to enact measures to cut costs.
The law would authorize TennCare to define who is exempted from the benefit limits or cost-sharing requirements. It would give TennCare the authority to exclude drugs that have nonprescription alternatives and to require the use of generic drugs or therapeutic equivalents.
The proposal would provide for certain hospitals, clinics or health departments to take TennCare patients who cannot afford the co-payments required elsewhere.
Finance Commissioner Dave Goetz said this is an effort to limit the increasing use of emergency room care. The network of places that will accept patients who don’t pay co-payments will be designed to make it more inconvenient to get care that way.
The proposal also would set up a TennCare Foundation, funded through the budget process, to mete out money to people who need to exceed the benefit limits for legitimate medical reasons.
The bill gives TennCare the authority to set up a disease management program. People with chronic diseases, such as diabetes or heart problems, account for a high percentage of TennCare’s costs.
The bill also sets up an 11-member TennCare Advisory Commission, appointed by the governor, to review benefits, costs, enrollment and so forth and present a report annually to the governor and General Assembly.
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On the Net:
TennCare Bureau: http://www.state.tn.us/tenncare