|January 1, 1994||TennCare was implemented, replacing the state's Medicaid program. TennCare covered three groups:
|December 31, 1994||Because TennCare enrollment was approaching capacity, the "Uninsured" category (Group 2, above) was closed. No more new Uninsured people were allowed to enroll, although persons whose Medicaid was ending and who met the "Uninsured" criteria were allowed to stay in the program. The "Uninsurable" category (Group 3, above) remained open, as did Medicaid.|
|April 1995||Rusty Siebert was named new TennCare Director.|
|May 1996||Theresa Lindsey was named new TennCare Director.|
|July 1, 1996||TennCare Partners, a carveout for mental health and substance abuse services, began.|
|August 26, 1996||An Agreed Order related to the appeals of service denials, known briefly as Grier, was entered. Grier modified an already existing Consent Decree from 1979 known as Daniels, regarding the Medicaid eligibility of individuals who previously received SSI cash payments, but no longer do.|
|April 1, 1997||Enrollment was re-opened to uninsured children under the age of 18. There was no income limit for eligibility in this category. Cost-sharing was required of those in this category who had incomes over the poverty level.|
|May 21, 1997||Enrollment was opened to "dislocated workers," who were defined as persons losing employment through a bona fide plant closing. There was no income limit for eligibility in this category, and the fact that these persons may have had access to COBRA did not disqualify them. Cost-sharing was required of those in this category who had incomes over the poverty level.|
|January 1, 1998||The age limit for uninsured children was extended to the 19th birthday. In addition, uninsured children living in families with incomes below 200% of the poverty level could enroll in TennCare, even if their parents had access to insurance.|
The John B. Consent Decree, which required the state to maintain the health of children enrolled in TennCare by meeting the federal Early Periodic Screening Diagnostic and Treatment (EPSDT) standards, was signed.
Dr. Wendy Long was named the Interim Director of TennCare.
The Rosen lawsuit, which dealt with due process rights for people being terminated from TennCare, was filed in federal court.
Pharmacy benefits were carved out of the BHO program and provided directly by TennCare.
|December 7, 1998||Newberry, a lawsuit dealing with delivery of home health services, was filed in federal court.|
|January 14, 1999||Glen Jennings was named Acting TennCare Director.
|February 1, 1999||Brian Lapps was named new TennCare Director.|
|March 31, 1999||Xantus, the third largest MCO, was placed in receivership.|
|June 1999||Prudential, the second smallest MCO in TennCare, gave notice that it would be leaving TennCare effective December 31, 1999 . Prudential served only residents of Shelby County .|
|September 27, 1999||John Tighe was named Acting TennCare Director.|
|October 16, 1999||A Revised Consent Decree Governing TennCare Appeals, which was a follow up to Grier, was filed in federal court. This consent decree outlined improvements in the appeals process.|
|December 15, 1999||Blue Cross, TennCare's largest MCO, gave notice that it would be leaving TennCare effective July 1, 2000 . Blue Cross subsequently withdrew its notice of termination.|
|January 2000||Governor Sundquist appointed a 17-member Commission on the Future of TennCare to make recommendations about what should be done when the TennCare waiver expired in December 2001.|
|January 5, 2000||An Agreed Order Governing TennCare Appeals for Children in State Custody, which was a follow up to Grier, was filed in federal court.|
|March 2000||Governor Sundquist hosted a Summit on the Future of TennCare to gather ideas from doctors, hospital executives, managed care executives, and Tennessee lawmakers about future directions for the program.|
John Tighe presented a proposal for “TennCare II” to the state legislature. The proposal outlined a new business model for TennCare that called for greater program accountability. As part of TennCare II, active recruitment was initiated to bring new MCOs into the program.
Access MedPlus, an MCO providing TennCare services, was placed under the administrative supervision of the Tennessee Department of Commerce and Insurance (TDCI), primarily for failure to meet prompt payment requirements.
A Remedial Plan regarding provision of TennCare services to children in state custody, a follow-up to Grier, was filed with the federal court.
|June 1, 2000||Mark Reynolds was named new TennCare Director.|
Pharmacy benefits for dual eligibles (persons who are eligible for both Medicare and Medicaid) were carved out of the MCO program.
Blue Cross ended its participation as a risk-bearing MCO and began operating under the exigency provisions of its contract, which the state could invoke to require continuation of services for up to one more year.
John Deere, the second smallest MCO following the departure of Prudential, gave notice that it would be leaving TennCare effective January 1, 2001. John Deere subsequently withdrew its notice of termination.
|July 31, 2000||The Revised Consent Decree Governing TennCare Appeals of October 16, 1999 , also known as Grier, was modified to clarify its terms and allow more time for full implementation.|
|September 2000||A three-judge panel of the Sixth Circuit Court of Appeals denied a request for a stay of implementation of Grier pending appeal. The stay had been requested by a number of organizations who had requested intervention in the lawsuit. These organizations included six TennCare MCOs, the Tennessee Association of Health Maintenance Organizations, the Tennessee Hospital Association, and the Tennessee Pharmacists' Association.|
|November 2000||The Commission on the Future of TennCare presented its recommendations to Governor Sundquist.|
|January 2001||The Tennessee Justice Center filed a complaint in federal court regarding allegations of contempt in John B.
|July 2001||Two new MCOs, Better Health Plans and Universal Care, began operating.|
|October 2001||Contract with Access MedPlus was terminated.|
|December 20, 2001||An Order was issued in the John B. case appointing a special master to help the State develop and implement and plan for compliance with EPSDT standards.|
|June 24, 2002||Manny Martins was named new TennCare Director.|
|July 1, 2002||
TennCare was revamped with the intention of dividing it into three programs with separate benefit structures: one for Medicaid eligibles (TennCare Medicaid); one for Demonstration eligibles (TennCare Standard); and one for low income persons who need help purchasing available insurance (TennCare Assist).
TennCare Assist has not yet been funded, and the TennCare Standard benefit package has not been implemented due to a settlement agreement reached in federal court. All persons enrolled in TennCare currently have the same package of benefits.
Eligibility changes in the new program included the following:
|October 2002||A dental carveout program was initiated.|
|January 1, 2003||
Benefit reductions were scheduled to be implemented for Medicaid eligible adults and persons who were enrolled in TennCare Standard.
A “pharmacy-only” program was scheduled to go into effect for TennCare/Medicare dual eligibles who had been grandfathered into the new program.
New copays were scheduled to be implemented.
Due to litigation against the State, none of these changes were implemented.
|March 28, 2003||Governor Phil Bredesen announced that benefit changes which had been scheduled to go into effect on January 1 would take place on April 1, 2003. The benefit reductions did not occur due to progress on a Settlement Agreement between the State and the plaintiffs in four lawsuits against the State.|
|June 1, 2003||Contract with Universal was terminated and Universal's enrollees moved to TennCare Select.|
|July 1, 2003||All pharmacy services were carved out to a single Pharmacy Benefits Manager (PBM).|
|August 1, 2003||The State’s contract with Xantus was terminated. Xantus’ enrollees were moved to TennCare Select.|
|August 26, 2003||The State reached a Settlement Agreement with the plaintiffs in Grier, Rosen, Newberry, and John B. which included:
|December 11, 2003||McKinsey and Company released the first of two reports analyzing the status of TennCare and identifying options for consideration.|
|February 11, 2004||McKinsey and Company released the second of its two reports analyzing the status of TennCare and identifying options for consideration.|
|February 17, 2004||Governor Bredesen announced his proposals for “TennCare Transformation.” Work groups were developed for key areas and tasked with developing specific recommendations to implement the Governor’s proposals.|
|July 12, 2004||J.D. Hickey was named the new Director of TennCare.|
|August 19, 2004||The State released a draft waiver amendment request for public comment. The waiver amendment would effectuate the Governor’s recommendations for reforming and restructuring TennCare.|
|September 24, 2004||The State submitted the waiver amendment request to reform and restructure TennCare.|
|November 10, 2004||Governor Bredesen acknowledged that the proposed TennCare restructuring could not proceed without significant modification of the Consent Decrees and announced that the State would begin the process of phasing out TennCare and returning to the traditional Medicaid program.|
|January 10, 2005||Governor Bredesen proposed an alternative plan for modifying TennCare in an attempt to keep children on the program. The new proposal included eliminating the Uninsured and Uninsurable adult categories and implementing some benefit reductions for adult enrollees.|
|March 24, 2005||CMS announced that it had approved the state's request to disenroll Uninsured and Uninsurable adults and to close the non-pregnant adult Medically Needy categories.|
|April 29, 2005||The state closed new enrollment into the non-pregnant adult Medically Needy categories.|
|June 8, 2005||CMS approved a waiver amendment allowing the State to place a limit on prescription drug coverage for non-institutionalized adults and to eliminate dental and methadone clinic services for adults.|
|August 1, 2005||The waiver amendment allowing the State to place a limit on prescription drug coverage for non-institutionalized adults and to eliminate dental and methadone clinic services for adults was implemented.|
|December 6, 2005||Governor Bredesen announced that the State would re-open the non-pregnant adult Medically Needy category as a Demonstration group rather than a Medicaid group.|
|January 11, 2006||The state submitted a waiver amendment to CMS to be able to enroll 100,000 non-pregnant adult Medically Needy individuals as a new demonstration population.|
|April 7, 2006||A Request for Proposal (RFP) was issued for the first time to recruit MCOs to the TennCare program. The RFP sought MCOs to serve enrollees in Middle Tennessee using an integrated medical and behavioral services model.|
|May 21, 2006||The State submitted a waiver amendment request to add a Standard Spend Down (SSD) Demonstration category for non-pregnant adults aged 21 or older who are aged, blind, or disabled, or are the caretaker relatives of Medicaid eligible children. The SSD category would be capped at 105,000 enrollees.|
|June 15, 2006||The State submitted to CMS a request for an extension of the TennCare waiver, which was scheduled to expire on June 30, 2007.|
|July 17, 2006||Darin Gordon was named the new Director of TennCare.|
|November 14, 2006||CMS approved the "Standard Spend Down" program, which was the name given to the new program to cover non-pregnant adult Medically Needy persons as a demonstration population under the waiver.|
|December 31, 2006||TennCare became the first Medicaid program in the country in which all MCOs were accredited by the National Committee for Quality Assurance (NCQA). Active MCOs that did not obtain NCQA accreditation by this date were terminated from the TennCare program.|
|April 1, 2007||Two new MCOs, AmeriChoice and Amerigroup Community Care, began providing full risk managed care and integrated physical and behavioral health services to TennCare enrollees in Middle Tennessee.|
|June 30, 2007||Expiration date of the TennCare waiver. As CMS introduced a new dollar limit on pool payments, the State was granted a short-term extension.|
|October 5, 2007||After six short-term extensions, CMS granted the waiver extension requested by the State for the approval period that began on July 1, 2007.|
|November 2007||The State conducted an ex parte review of eligibility for persons in the non-pregnant Medically Needy category who had been held on TennCare since the category closed on April 29, 2005. Requests for Information (RFIs) were mailed to persons not found eligible through the ex parte review process.|
|December 1, 2007||The state ended collection of new premiums for TennCare Standard members with incomes at or above 100% of poverty.|
|February 1, 2008||The State entered a motion in federal court requesting permission to review the eligibility of Daniels class members and terminating the eligibility of those persons who were determined not eligible for TennCare.|
|February 29, 2008||The state submitted a waiver amendment to CMS ("Amendment #6") that would allow limits to be placed on home health and private duty nursing services for adults.|
|March 6, 2008||Governor Bredesen announced details of his proposed “Long-Term Care Community Choices Act of 2008,” which would consolidate long-term care services for elderly and disabled TennCare eligible individuals with managed care services.|
|April 25, 2008||Following a competitive bid process, TennCare awarded SXC Health Solutions (later known as Catamaran) with a three year PBM contract, effective October 1, 2008.|
|July 11, 2008||The State submitted a concept paper to CMS outlining the Long-Term Care Community Choices program, which would be submitted as a wavier amendment request at a later date.|
|July 22, 2008||CMS approved Amendment 6, allowing limits to be placed on home health and private duty nursing services for adults.|
|September 2008||After receiving approval from CMS, TennCare implements adult home health and private duty nursing benefit limits.|
|October 2, 2008||The State submitted a waiver amendment request (“Amendment 7”)_to CMS to implement the Long-Term Care Community Choices program. CMS approved the waiver amendment request on July 22, 2009.|
|November 2008||Two new MCOs, AmeriChoice and Blue Cross Blue Shield, which were selected through a competitive bid process, began providing full risk managed care and integrated physical and behavioral health to TennCare enrollees in West Tennessee.|
|January 2009||Two new MCOs, AmeriChoice and Blue Cross Blue Shield, which were selected through a competitive bid process, began providing full risk managed care and integrated physical and behavioral health to TennCare enrollees in East Tennessee. This marked the return of full financial risk for TennCare MCOs statewide.|
|January 8, 2009||The U.S. Court of Appeals for the Sixth Circuit released the State from the Daniels court order which prevented TennCare from re-verifying the eligibility of approximately 147,000 enrollees, collectively referred to as the “Daniels class.” The Daniels class consisted of individuals who at one time received SSI cash payments but no longer did and who had not been subject to reverification.|
|May 2009||TennCare begins the Daniels re-verification process. Enrollees in the Daniels class are asked to fill out the re-verification form all other enrollees must complete annually to determine whether they are still eligible for the program.|
|June 2009||The State submitted a request for a three year extension of the TennCare waiver, scheduled to expire on June 30, 2010.|
|July 22, 2009||CMS approved Amendment 7 to implement the Long-Term Care Community Choices program, now known as the TennCare CHOICES in Long-Term Care Program (CHOICES). Implementation of CHOICES began in March 2010.|
|September 1, 2009||TennCare Select assumed responsibility for the behavioral health services of its enrollees, resulting in program-wide integration of medical and behavioral health services. TennCare Select is operated by Blue Cross Blue Shield and serves approximately 72,000 children, including foster children, children receiving SSI, and children under age 21 in a nursing facility (NF) or Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID). TennCare Select also serves as the State’s back-up MCO.|
|September 28, 2009||TennCare Select assumed responsibility for the behavioral health services of its enrollees, resulting in program-wide integration of medical and behavioral health services. TennCare Select is operated by Blue Cross Blue Shield and serves approximately 72,000 children, including foster children, children receiving SSI, and children under age 21 in a nursing facility (NF) or Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID). TennCare Select also serves as the State’s back-up MCO.|
|December 15, 2009||CMS approved the State’s request for a three-year extension of the TennCare waiver for the approval period beginning on July 1, 2010. With the extension approval, CMS also approved Amendment 8 to remove limits on inpatient and outpatient substance abuse treatment benefits for adults.|
|January 2010||TennCare completed the Daniels re-verification process. Approximately 100,000 individuals were on the program whose eligibility could not be verified. Of those no longer eligible for TennCare, more than 65 percent continued to have health coverage through Medicare.|
|March 2010||TennCare began shifting to an annual MCO change period based on Grand Region: West Tennessee – March; Middle Tennessee – May; East Tennessee – July.|
|March 1, 2010||The CHOICES program began implementation in Middle Tennessee.|
|March 23, 2010||The Patient Protection and Affordable Care Act (ACA) was signed into law by President Barack Obama. Implementation of the ACA resulted in multiple changes in Medicaid programs, such as TennCare, including application processes, eligibility criteria, and benefit requirements.|
|May 14, 2010||TennCare submitted a waiver amendment request (“Amendment 10”) to CMS. Amendment 10 recognizes the additional revenues available to TennCare from the hospital assessment fee.|
|June 2010||TennCare began to transition certain individuals enrolled in IID waiver programs to Select Community, a nurse care manager program operated by TennCare Select.|
|July 21, 2010||TennCare submitted a waiver amendment request (“Amendment 11”) to CMS. This amendment expands the PSHP pool and adds Nashville General Hospital as a participant.|
|November 2010||The Center for Health Care Strategies (CHCS), a non-profit health policy resource center, identified CHOICES as one of five Medicaid long-term care programs demonstrating expertise in addressing long-term care needs using a managed care approach.|
|December 16, 2010||CMS approved Amendment 11 to expand the PSHP pool and adding Nashville General Hospital as a participant.|
|January 1, 2011||AmeriChoice changed its name to UnitedHealthcare Community Plan.|
|January 3, 2011||TennCare opened registration for the Electronic Health Record (EHR) Incentive Program. Tennessee was one of only 11 states that began to operate the EHR Incentive Program on the day it was launched by CMS. The program awarded cash grants to Medicare and Medicaid providers to demonstrate “meaningful use” of electronic health record technology.|
|January 7, 2011||TennCare submitted a grant proposal to CMS to participate in the Money Follows the Person (MFP) demonstration program, in which long-term care funding supports, or “follows”, the patient to appropriate community placements.|
|February 22, 2011||TennCare is awarded an MFP grant through 2016. Grant funds are required to be used for HCBS supports and for transition of NF patients back into the community.|
|February 28, 2011||TennCare submitted a waiver amendment request (“Amendment 12”) to CMS. This amendment proposes several changes to the TennCare benefit package for adults to bring TennCare’s budget in line with state revenues.|
|April 5, 2011||TennCare is awarded a grant from the Center for Medicare and Medicaid Innovation (CMMI) to devise a system of integrated care for Medicare/Medicaid dual eligibles. Tennessee is one of only 15 states to be awarded a grant. TennCare’s proposed plan, TennCare Plus, would add Medicare Part A and Part B benefits to the TennCare program, allowing dual eligibles to receive coordination of care through their TennCare MCO.|
|July 1, 2011||The Bureau of TennCare began covering medically necessary smoking cessation products for all enrollees. Previously, the benefit was only available to pregnant women and enrollees under the age of 21.|
|September 12, 2011||The TennCare Standard Spend Down Program opened enrollment for the third time accepting new enrollees.|
|February 7, 2012||The TennCare Standard Spend Down Program opened enrollment for the fourth time accepting 2,500 new applicants.|
|February 14, 2012||The District Court for Middle Tennessee issued a decision for John B. following a month long trial, ruling that the State was in substantial compliance with earlier orders and the case can be closed. The case went to the Sixth Circuit Court of Appeals for further review.|
|March 1, 2012||The State submitted a waiver amendment request to open the “Interim CHOICES 3” eligibility category to preserve eligibility for individuals who would do not meet the NF level of care, but are at risk of institutionalization.|
|June 29, 2012||The State submitted an extension request for the TennCare Demonstration waiver, which is set to expire on June 30, 2013.|
|August 3, 2012||The State issued an RFP for a new PBM. The contract between TennCare and Catamaran (formerly SXC Health Solutions) was set to expire on May 31, 2013.|
|November 6, 2012||TennCare awarded the new PBM contract to Magellan Health Services, effective June 1, 2013.|
|December 19, 2012||TennCare announced its decision to join Catalyst for Payment Reform (CPR). CPR is a national independent organization led by large purchasers of health insurance with active involvement of providers, health plans, consumers, and labor groups working to improve health care quality and reduce costs by identifying and coordinating workable solutions to improve how health care is paid for in the United States.|
|December 21, 2012||The State withdrew its proposal for TennCare Plus.|
|December 31, 2012||CMS approved the State’s application to renew the TennCare Demonstration waiver for a three-year period beginning July 1, 2013 through June 30, 2016.|
|February 21, 2013||Tennessee was one of 16 states receiving a Round One Model Design Award under CMS’ State Innovation Model (SIM) Initiative to develop a health care payment and delivery reform system.|
|March 14, 2013||The Sixth Circuit Court of Appeals issued a unanimous opinion upholding the District Court’s decision to dismiss the John B. case, bringing the lawsuit to a close after 17 years.|
|October 1, 2013||Open enrollment for the ACA-implemented Federally-Facilitated Marketplace (FFM), also known as HealthCare.gov, began. Tennesseans enrolling in health care insurance plans, including the TennCare program, can submit applications through the FFM.|
|October 2, 2013||The State issued an RFP for three MCOs to provide managed care services statewide, rather than in selected Grand Regions, with service delivery set to begin on January 1, 2015.|
|December 16, 2013||The State announced that Amerigroup, Blue Cross Blue Shield, and UnitedHealthcare had been awarded the statewide service delivery contracts. New contracts with these MCOs will be effective from January 1, 2014 through December 31, 2016, with an option for five one-year extensions.|
|December 17, 2013||The State submitted a waiver amendment request to CMS in order to continue new enrollment in the Interim CHOICES 3 group through June 30, 2015 and increase funding in the Essential Access Hospital (EAH) and the Public Hospital Supplemental Payment (PHSP) Pools.|
|December 30, 2013||CMS approved the State’s waiver amendment request to continue new enrollment in the Interim CHOICES 3 group through June 30, 2015. The request for increased funding in the EAH and PHSP Pools remains under consideration by CMS.|
|January 1, 2014||Many provisions of the ACA were fully implemented. Medicaid programs, including TennCare, enact changes to multiple program areas, such as application processes, eligibility criteria, and benefit requirements, as mandated by the ACA.|
|May 2014||The Tennessee Health Care Innovation Initiative released the preview reports for Wave 1 episodes of care: acute asthma exacerbation, perinatal and total joint replacement.|
|June 2, 2014||TennCare submitted to CMS a concept paper, developed in collaboration with the Department of Developmental Disabilities, outlining a Employment and Community First (ECF) CHOICES, an MLTSS program providing HCBS for individuals with intellectual and developmental disabilities. The goal of ECF CHOICES is to promote and support integrated, competitive employment and independent living for eligible persons.|
|July 27, 2014||The Wilson lawsuit, regarding TennCare’s application and eligibility determination process since the implementation of the ACA, was filed in federal court.|
|September 2014||A U.S. District Court Judge, presiding over the Wilson case, ordered TennCare to take responsibility for delayed applications, calling for the agency to hold hearings upon request for coverage determinations.|
|December 15, 2014||Governor Haslam announced plans for Insure Tennessee, a two-year pilot program to provide health care coverage to certain low-income individuals who lack access, or have limited options, to health insurance. Insure Tennessee is an alternative approach to the optional Medicaid expansion that would provide benefits to adults with incomes up to 138% of the poverty level who are not otherwise eligible for Medicaid, and included a choice of two plans:
|December 2014||Tennessee was awarded a Round Two SIM Model Test Award to implement and test its health care payment and delivery system reform focusing on primary care transformation, episodes of care, and long-term services and supports.|
|February 2, 2015||The Tennessee General Assembly convened a special session, called by Governor Haslam, to consider a joint resolution on Insure Tennessee. Following two days of hearings, the Tennessee Senate Health and Wellness Committee voted 7-4 against the implementation Insure Tennessee, ending the special session.|
|April 18, 2015||The State submitted a waiver amendment request to CMS to extend funding of the supplemental payment pools, primarily used to offset the costs of uncompensated care, which expires on December 31, 2015. The State requested extension of funding through the end of the current waiver approval period on June 30, 2016.|
|June 23, 2015||The State submitted a waiver amendment request to CMS to implement the ECF CHOICES program to provide managed long-term services and supports to individuals with intellectual and developmental disabilities.|
|July 23, 2015||The State submitted a waiver amendment request to CMS to close enrollment for the Standard Spend Down eligibility category.|