TennCare Oversight Committee Holds Hearing To Examine Court Order

The joint TennCare Oversight Committee met last week to learn what steps Tennessee is taking to improve services for children enrolled in TennCare, the state's Medicaid managed care program, the Chattanooga Times & Free Press reports. During the hearing, TennCare officials presented a number of initiatives to the lawmakers -- not detailed by the Times & Free Press -- but they did not address how the state would respond to a court decision ordering children to be moved into a separate program (Park, Chattanooga Times & Free Press, 1/17). Last month, U.S. District Judge John Nixon ordered state officials to move 550,000 children under age 21, who make up 40% of total TennCare enrollment, into another program because the state has "failed to provide adequate" early and periodic screening, diagnosis and treatment (Kaiser Daily Health Policy Report, 1/10). Nixon's ruling said that although Tennessee had agreed to have screening rates of 80% by September 2001, the state had reached only 31.5% in 2000 (Chattanooga Times & Free Press, 1/17). Michelle Johnson, an attorney with the Tennessee Justice Center, which filed the suit that led to Nixon's ruling, told committee members than even though managed care organizations are being paid to provide periodic screenings, children are not receiving the services. She added that the court order only means the state must work with patient advocates to "carve out" a program that ensures the "federally mandated" screenings are delivered to children (Wade, Memphis Commercial Appeal, 1/17). This component of Medicaid requires children to receive periodic screening, such as vaccinations and age-appropriate laboratory tests, as well as vision, dental and hearing services, even if such benefits are not required for the rest of a state's Medicaid population (Kaiser Daily Health Policy Report, 8/14/01). But state Rep. Gene Caldwell (D), chair of the oversight committee, said that screening rates are "better ... than the record indicates" because physician coding systems are "inaccurate" (Chattanooga Times & Free Press, 1/17). TennCare officials have said Nixon's order could eliminate the managed care aspect of TennCare, effectively ending the state's federal waiver to operate the program and forcing the state to return to a traditional Medicaid program (Kaiser Daily Health Policy Report, 1/10). However, TennCare director Mark Reynolds said the "implications" of the decision will not be known until a special master is appointed to oversee the creation of a new program (Chattanooga Times & Free Press, 1/17). Johnson added, "The judge's ruling does not call for the dismantling of TennCare .. It calls for treating this population differently" (Memphis Commercial Appeal, 1/17).

More TennCare News
The following briefly summarizes other news coverage on TennCare from last week:

• Vanderbilt University Medical Center has been named the first of the five "Centers of Excellence" that will help the state expand its TennCare services to children. In addition to improving services, Vanderbilt will also train doctors. Lawmakers on the TennCare Oversight Committee, who announced the selection, said it is a "step toward addressing" the court order (Lewis, Nashville Tennessean, 1/17).
• Although Gov. Don Sundquist (R) "lashed out" at the Tennessee Justice Center for "push[ing TennCare] past its capabilities," his "irritation" with the advocacy group is "misplaced," a Nashville Tennessean editorial states. The Justice Center provides TennCare beneficiaries, who have "no political clout," with a "voice" in state government, the editorial adds. Noting that TennCare has "plenty of natural enemies" and that Sundquist and the Justice Center share "common goals," the Tennessean concludes: "With all the challenges TennCare faces, it needs its advocates like Sundquist and the Tennessee Justice Center to be on the same team" (Nashville Tennessean, 1/17).