FOR IMMEDIATE RELEASE
MARCH 30, 2007
TWO NEW HEALTH PLANS TAKE OVER TENNCARE COVERAGE IN MIDDLE TENNESSEE
TENNCARE TAKING STEPS TO HELP EASE TRANSITION FOR ENROLLEES
NASHVILLE - Two managed care organizations, AmeriChoice and Amerigroup Community Care, will each begin serving approximately 170,000 Middle Tennessee TennCare enrollees on April 1, 2007. The change means TennCare enrollees in the entire region now have a choice between MCOs to manage their care rather than only one plan for almost all of Middle Tennessee.
The transition also marks an important step in the State's overall management of the TennCare program. The two MCOs have assumed full financial risk, marking the return to a true managed-care model in TennCare. The new contracts also integrate behavioral health and physical health coverage to provide better coordination of care for enrollees.
"This is a significant milestone not only for the TennCare program and enrollee choice, but for our entire state," said Darin Gordon, TennCare's director. "This much anticipated return to managed care with the MCO plans accepting financial responsibility will help improve enrollee care and help ensure that this government-funded program remains on solid footing."
Middle Tennessee enrollees received notification of their random assignment to either Amerigroup or AmeriChoice in March. Both plans have contracts with doctors and hospitals in the region that exceed the U.S. government's standards for operation.
"The new MCOs will continue to deliver the same services, products and treatment options that TennCare enrollees have received through their former MCOs and BHOs. We expect both networks to continue to expand even further beyond this startup date," said Winnie Toler, Chief of Networks for TennCare. "While we expect normal market adjustments as thousands of providers, enrollees and new case managers establish relationships, at the end of the day, our first priority will be to ensure that enrollees have uninterrupted access to their healthcare."
Many enrollees' providers have joined either, or both, of the new plans. However, if that is not the case, the enrollees still have options.
Starting April 1, enrollees opting to move from their pre-assigned plan to the other will have until May 16 to switch. These enrollees will have up to 90 days to access care from providers in their new plan's network, as well as the providers they normally saw under their old plan. If providers are not in the network, they will be reimbursed at in-network rates during these 90 days. During that 90-day period, enrollees are expected to continue to work with their new plan to secure a new in-network doctor.
"TennCare has helped ease the transition for enrollees with a 90-day continuity of care plan," said Gordon. "Enrollees, not just those in active medical treatment, have extra time to either find a provider in the new MCO network or talk to their current provider about joining the plans if they haven't already."
During and after the transition, TennCare Select - which is operated by BlueCross BlueShield of Tennessee - and Premier Behavioral Health will continue to serve several comparatively small populations in Middle Tennessee such as foster children, children receiving SSI, and nursing facility or ICF-MR residents under age 21. Those populations constitute about 5 percent of TennCare's enrollee population; all other enrollees will receive care through either of the new plans. Windsor Healthplan, an MCO serving only Davidson County today, did not win the competitive bid process and will no longer serve TennCare enrollees in Middle Tennessee.
"It is important for providers to know that if they choose to contract with one or both of the new plans, the sooner the better," said Toler. "It does take time to credential a new provider and establish payment procedures."
AmeriChoice and Amerigroup Community Care were awarded contracts through competitive bidding last year. The two companies have similar contracts throughout the country and serve more than 2.5 million people altogether.
Enrollees and providers with questions may call:
TennCare is Tennessee's managed-care Medicaid program serving approximately 1.2 million low-income children, pregnant women and disabled Tennesseans, with an annual budget of $7 billion.
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