TennCare’s Access MedPLUS Fights One Lawsuit, Settles Another
TennCare patients on May 9 alleged in a U.S. District Court that Access MedPLUS, the second-largest MCO in the state's TennCare Medicaid managed care program, is not honoring "its duties to patients" because few medical specialists in the plan's network are willing to treat beneficiaries, the Nashville Tennessean reports. Lawyers for the plaintiffs said that patients should be permitted to switch plans "quickly" if Access MedPLUS is precluding access to "need[ed]" care (Carlson, Nashville Tennessean, 5/9). The plan covers about 360,000 TennCare beneficiaries (Synder, Nashville Tennessean, 5/3). Witnesses for the health plan said the company is "complying with the rules" of handling appeals and works "on time" to find specialists for patients. U.S. District Judge John Nixon has yet to reach a decision in the case, but has ordered both sides to "submit proposed findings" (Nashville Tennessean, 5/9).
Making Payments
Meanwhile, Access MedPLUS last month settled a lawsuit with West Tennessee Healthcare, which owns six hospitals, over alleged nonpayment of claims. Under the agreement, the hospital system will to continue providing services to the 40,000 Access MedPLUS patients in the area. In order to correct the "long-standing" payment problems, Access MedPLUS, which is currently operating under state supervision, has installed a new computer system. The system went online May 1 and began processing dental claims. Bills from other providers will be "phased into the system" over the next few months. The company expects state supervision to be lifted "because of improvements in the company's overall operation" (Nashville Tennessean, 5/3). A Tennessee judge on Jan. 17 ruled that Access MedPLUS should remain under "state supervision" at least through May because of the MCO's repeated failure to pay providers and "negative net worth," which placed it in violation of state law (Kaiser Daily Health Policy Report, 1/18).
TennCare Mental Health Dispute Settled
In other TennCare-related news, Centerstone Community Mental Health Centers Inc., middle Tennessee's largest community behavioral health care provider, has reached an agreement in a "long-standing" contract dispute with Premier Behavioral Systems of Tennessee, one of two groups contracted by the state to pay TennCare claims. Centerstone had alleged that Premier was underlaying for services Centerstone provided to beneficiaries of TennCare Partners, the mental health component of the TennCare program. Two arbitration panels determined that Premier owed Centerstone $6.45 million in reimbursements to cover the underpayments at two facilities; additional payment disputes for three other Centerstone facilities were pending at the time of the settlement. According to the Nashville Tennessean, terms of the settlement were not disclosed (Russell, Nashville Tennessean, 5/10).
