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Public Notice

Notice of Change in TennCare II Demonstration

 

The Commissioner of the Tennessee Department of Finance and Administration is providing official notification, pursuant to 42 CFR 447.205 and 59 Fed. Reg. 49,249, concerning intent to file an amendment to the TennCare II Demonstration and its State plan. The amendment will be filed with the Centers for Medicare and Medicaid Services (CMS), a federal agency located in Baltimore, Maryland.

 

The amendment will eliminate certain currently covered services and establish benefit limits on others. Eligibility for TennCare will not be affected by these changes. The changes are necessary because of increased program enrollment and reduced state revenues.

 

The following benefit limits are being proposed. Children under age 21 will be exempt from these benefit limits. Pregnant women will be able to receive pregnancy-related services in excess of these benefit limits.

  • Implementation of an annual limit of $10,000 per person for inpatient hospital services, including inpatient psychiatric hospital services
  • Implementation of an annual limit of 8 non-emergency visits to outpatient hospitals, per person
  • Implementation of an annual limit on health care professional office visits of 8 per person
  • Implementation of an annual limit of lab and X-ray services of 8 occasions per person (an “occasion” is a day)

 

We are proposing to eliminate the following benefits for adults. Children under age 21 will continue to have access to these benefits.

  • Occupational therapy, speech therapy, and physical therapy
  • Hospice care

 

We are also proposing to implement a $2 copay on non-emergency transportation. Children under age 21, pregnant women, and institutionalized persons (including recipients of Home and Community Based Services) will be exempt from this copay.

 

It is our intention to submit this amendment to CMS with the request that it be approved in time for implementation to occur on July 1, 2010. Corresponding State Plan Amendments will be filed, where appropriate. We estimate that implementation of the amendment and corresponding State plan changes will result in a decrease in aggregate annual expenditures of $117,311,240 in state funds in State Fiscal Year 11.

 

Following discussions with CMS, an additional change is being requested in the implementation date of a revised cost-sharing plan for TennCare. The state is asking to move the date of implementation from January 1, 2010, to October 1, 2010.

 

Copies of this notice will be available in each county office of the Tennessee Department of Human Services. Written comments should be addressed to Mr. Darin Gordon, Director, Bureau of TennCare, 310 Great Circle Road, Nashville, Tennessee 37243. Or you may contact Susie Baird at the Bureau of TennCare, 310 Great Circle Road, Nashville, Tennessee 37243 , or at 615-507-6480.