Citing Financial Instability, TennCare Officials ‘Threaten’ to Terminate Contract With Access MedPlus

Officials from TennCare, Tennessee's Medicaid managed care program, on Sept. 19 notified the insurer Access MedPlus it would be dropped from the program on Oct. 31 unless it shows by Oct. 9 that its finances are in order, the Chattanooga Times & Free Press reports. Access MedPlus, the largest managed care organization in TennCare, did not submit audited financial statements to the state that were due in May (Commins, Chattanooga Times & Free Press, 9/20). In addition, Access failed to file an account of administrative expenses due Aug. 1 and a statement on its financial solvency due Sept. 1 (Wade, Memphis Commercial Appeal, 9/20). State officials also said that in June and July, Access was still not meeting a state requirement that it pay 90% of its claims within 30 days (Snyder, Nashville Tennessean, 9/20). The move to "pull the plug" on Access is the first time in TennCare's history that the state has taken steps to drop an MCO from the program. However, the action comes after "years of dispute" between the state and Access MedPlus, which has been "under supervision" by the state Departments of Commerce and Insurance since 2000, when its computer claims processing system failed, leaving providers unpaid and the state unable to gauge its solvency (Memphis Commercial Appeal, 9/20). In January, the state attempted to place Access MedPlus in receivership, but a court ruled the state had not shown the MCO was in such "hazardous financial" shape that a state takeover was warranted (Chattanooga Times & Free Press, 9/20). The state was scheduled to appeal the ruling Oct. 9, but opted to issue the Sept. 19 warning due to the insurer's "apparently deepening financial problems" (Memphis Commercial Appeal, 9/20).

Access Responds
While Access MedPlus has not responded to the state's "specific complaints" -- issued in a letter to Access officials -- spokesperson Phil West said the MCO was underpaid last year by $20 million. He added that the state had also assigned an "disproportionate number" of "costly" and "severely ill" patients to Access "without adequate compensation" (Nashville Tennessean, 9/20). West said the company has been in negotiations with the state for weeks on the MCO's financial situation and that Access officials presented the state with an "independent analysis" indicating the MCO had been underpaid. He added, "We are very disappointed with the state's action but continue to believe these issues can be worked out." However, the Commercial Appeal reports he did not say why the company has not released the required financial information (Memphis Commercial Appeal, 9/20). Access MedPlus has 279,000 TennCare enrollees who would likely be moved to TennCare Select, a "backup plan" managed by BlueCross BlueShield of Tennessee, if the contract is terminated. TennCare Director Mark Reynolds said that "displaced" members would be shifted into other TennCare MCOs. "In this transition, we are going to try very hard to ensure that enrollees don't get lost in the shuffle," he said (Chattanooga Times & Free Press, 9/20).