Tennessee State Officials to Decide This Week Whether to Retain TennCare Contract with Access MedPLUS

Tennessee state officials reviewing the financial situation at Access MedPLUS, the state's largest TennCare plan, may decide as early as Oct. 16 whether to end the health plan's contract with the state's Medicaid managed care program, the Nashville Tennessean reports. Health plans participating in TennCare are required to maintain a net worth of $12.5 million, but according to Access MedPLUS documents, the firm was running a $44 million deficit as of June 30, 2002 (Snyder, Nashville Tennessean, 10/16). In addition, the Chattanooga Times & Free Press reports that as of June 30, Access MedPLUS maintained a $36 million negative net worth, while an independent review reported the losses at $51 million. However, the audits also say that the state owed Access MedPLUS $20 million for "disproportionate[ly]" assigning "severely ill" TennCare patients to the health plan (Chattanooga Times & Free Press, 10/16). State officials have said they will terminate the Access MedPLUS TennCare contract on Oct. 31, 2001, if the MCO is unable to prove its financial solvency. Access MedPlus has been under state supervision since May 2000 because of its failure to pay providers "accurately or on time" (Kaiser Daily Health Policy Report, 10/10). TennCare spokesperson Lola Potter said it is "not clear at this time" if state officials have received all of the documents they requested from Access MedPLUS. If the Access MedPLUS contract is terminated, the plan's TennCare beneficiaries will move to TennCare Select, a "back-up plan" managed by BlueCross BlueShield of Tennessee.

Physician Lawsuit
In a related issue, Access MedPLUS officials are scheduled to appear in court on Oct. 16 regarding a lawsuit over "erroneous billing" filed Oct. 9 by the Tennessee Medical Association and several doctors (Chattanooga Times & Free Press, 10/16). TMA is seeking a temporary restraining order against the MCO to prevent the company from "recouping" alleged overpayments and to require the company to "pay the amounts that have been withheld" (Kaiser Daily Health Policy Report, 10/10). According to Potter, Access MedPLUS claims that "computer problems" caused the company to overpay more than 100 providers by a total of $21 million. However, TMA spokesperson Russ Miller said Access MedPLUS is claiming the overpayments in order to show additional assets during its state audit.

Protests for Access
Although Access MedPLUS officials are not commenting on the health plan's legal problems, about 25 black community leaders on Oct. 15 marched on the state Capitol in Nashville to protest alleged discrimination against the health plan, which is the only minority-owned TennCare plan (Chattanooga Times & Free Press, 10/16). Carrying signs and singing "We Shall Overcome," the protesters said the state should support the health plan with the "same fervor" that it lured "white" businesses, such as the hospital chain HCA, to the state. Ludye Wallace, president of the Nashville branch of the NAACP, said, "Why not try and help Access MedPLUS ... rather than try and take it over or destroy it or run them out of business?" (AP/Memphis Commercial Appeal, 10/16). For further information on state health policy in Tennessee, visit State Health Facts Online.