Access MedPLUS Loses TennCare Contract; Granted Three Weeks to Resolve TMA Lawsuit

Citing financial concerns, Tennessee officials announced on Oct. 16 that TennCare, the state's Medicaid managed care program, will terminate on Oct. 31 its contract with Access MedPLUS, the program's largest health plan, the Nashville Tennessean reports. A state audit of the health plan found that as of June 30, Access MedPLUS, which provides care for about 279,000 TennCare beneficiaries, had a $54 million negative net worth -- "well below" the $12.5 million the state requires for participating TennCare plans (Snyder, Nashville Tennessean, 10/17). 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). Once the contract expires, the state will shift Access MedPLUS beneficiaries to TennCare Select, a "backup" plan operated by BlueCross BlueShield of Tennessee. Although members in West and East Tennessee will have three months to select a new TennCare plan, "Midstate" members will have to remain in TennCare Select, as it is the only area TennCare plan with "room" to absorb new beneficiaries, according to TennCare spokesperson Lola Potter. To ease the transition, the state will allow Access MedPLUS members to visit their current doctors for four months after the contract expires, regardless of whether the doctors participate in the TennCare Select network. Hospital officials also "immediately questioned" whether TennCare, which has a shortage of doctors, can care for Access MedPLUS members. In response, Potter said the state is considering raising payment rates to encourage doctors to participate in TennCare Select. According to Potter, the loss of Access MedPLUS will likely cost less than the state's April 1999 takeover of Xantus Healthplan of Tennessee, the third-largest TennCare plan, which had a $24 million debt and more than $50 million in unpaid claims (Snyder, Nashville Tennessean, 10/17).

Provider Lawsuit
In related news, Davidson County Circuit Judge Barbara Haynes on Oct. 16 decided to grant Access MedPLUS three weeks to resolve a dispute with doctors (Loggins, Nashville Tennessean, 10/17). On Oct. 8, the Tennessee Medical Association filed a lawsuit alleging that Access MedPLUS had "attempted to excuse itself from paying just debts by unilaterally crediting their records ... for amounts that they assert were overpaid to providers" (Kaiser Daily Health Policy Report, 10/10). TMA attorney David Steed told Haynes yesterday that Access MedPLUS hopes to force doctors to "write off" a number of claims for services provided to TennCare patients enrolled in the health plan. However, Access MedPLUS attorney Harlan Dodson called the charge a "false, libelous statement" and said that the TMA should provide Access MedPLUS with a list of disputed claims to allow the company to resolve them without a court order. Haynes issued an injunction on additional "takebacks" of payments to doctors, but she said that she would not "put it into effect" until the lawyers in the case report to her regarding efforts to settle the dispute on Nov. 9 (Loggins, Nashville Tennessean, 10/17). As part of the contract termination, the state has agreed to reimburse doctors owed payments by Access MedPLUS for services provided between May 2000 and February 2001 (Snyder, Nashville Tennessean, 10/17). For further information on state health policy in TennCare, visit State Health Facts Online.