TennCare Eliminates Plan To Enact 'Hard Limits' On Doctor, Hospital Visits

Main Category: Health Insurance / Medical Insurance
Article Date: 08 Mar 2006 - 17:00 PDT

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Tennessee is rescinding a plan to place "hard limits" on the number of doctor and hospital visits TennCare beneficiaries can make each year after the HHS Departmental Appeals Board on Tuesday ruled in favor of Tennessee in its dispute with CMS over $550 million in health care funds, the AP/Knoxville News-Sentinel reports. Tennessee from 1991 to 2002 levied a bed tax on nursing homes and used the revenue to receive federal Medicaid matching funds. CMS sought reimbursement for the matching funds, and the state had set aside $50 million in reserve in case HHS ruled against Tennessee in the appeals process. To offset the reserve fund, Gov. Phil Bredesen (D) in his budget proposal last month announced plans to save $55 million by limiting TennCare beneficiaries to 12 doctors' visits per year and 20 days of hospitalization. The limits were scheduled to begin July 1. However, Bredesen on Wednesday announced that the appeals board had ruled in the state's favor and that Tennessee will use the $50 million reserve to eliminate the planned hard limits on care. He said the state instead will enact non-pharmaceutical "soft limits" on some beneficiaries that will require them to receive approval before exceeding the designated number of visits to health care providers. Bredesen said, "That's a major win, and I can't tell you how pleased I am about it. I think it really softens and mitigates a lot of the legitimate criticism that was out there about the package that we had" (Schelzig, AP/Knoxville News-Sentinel, 3/2).

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