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TENNCARE

Bishops Criteria for Reform, from A Framework for Comprehensive Health Care Reform, 1993

A fundamental measure of our society is how we care for and stand with the poor and vulnerable.

• Respect for Life:  Whether it preserves and enhances sanctity and dignity of human life from conception to natural death.
• Priority Concern for the Poor: Whether it gives special priority to meeting the most pressing healthcare needs of the poor and under served, ensuring that they receive quality health services.
• Comprehensive Benefits:  Whether it provides comprehensive benefits sufficient to maintain and promote good health; to provide preventative care; to treat disease, injury, and disability appropriately; and to care for persons who are chronically ill or dying.
• Pluralism:  Whether it allows and encourages the involvement of the public and private sectors, including the voluntary, religious, and nonprofit sectors, in the delivery of care and services; and whether it ensures respect for religious and ethical values in the delivery of healthcare for consumers and for individual and institutional providers.
• Quality:  Whether it promotes the development of processes and standards that will help to achieve quality and equity in health services, in the training of providers, and in the informed participation of consumers in decision making on healthcare.
• Cost Containment and Controls:  Whether it creates effective cost-containment measures that reduce waste, inefficiency, and unnecessary care; measures that control rising costs of competition, commercialism, and administration; and measures that provide incentives to individuals and providers for effective and economical use of limited resources.
• Equitable Financing:  Whether it assures society's obligation to finance universal access to comprehensive health care in an equitable fashion, based on ability to pay; and whether proposed cost-sharing arrangements are designed to avoid creating barriers to effective care for the poor and vulnerable.

Following the Bishops Criteria for Reform the Tennessee Catholic Public Policy Commission adopts the following recommendations and suggestions:

• In strengthening TennCare, all available management tools must be used to contain costs while maintaining appropriate quality care. These include using evidence based medicine guidelines wherever possible, a strong utilization review program for prescription drugs and use of home and community based programs whenever possible.
• We urge that cost savings in the TennCare program be used to ensure access to appropriate services to those who need it most, especially those who, because of ongoing illness or disability, find themselves uninsurable.
• The use of most cost effective yard stick should replace lowest cost alternative especially where prevention or early intervention through the use of prescription medicine would avoid higher costs later by avoiding unnecessary hospitalization or more invasive operations and/or treatment.
• We support the state's move toward more risk-based contracts arrangement with MCO's and urge a faster transition to those contracts.
• We support the states increased use of generic substitution and urge its expansion as well as examining the use of therapeutic substitution while using appropriate protocols and which maintain the central role of the prescribing provider.
• We support the Governor's approach for a cooperative employment-based program for the working poor.
• We do not believe that there should be two standards of health care in Tennessee.  The definition of medical necessity to be effective in January could be misunderstood by MCO's.  We urge the adoption of a cost effective standard to ensure that the standard of care provided to the poor not be second class.
• Specifically we urge the immediate implementation of broad-based disease management programs, controlling drug misuse, overuse, and abuse with Prospective and Retrospective Drug Use Review.
• We ask that enrollment is reopened to the medically eligible or uninsurable whose inability to obtain commercial insurance is verified by independent medical underwriters.  These are among the sickest group of patients who lost coverage.  Those who could have paid significant premiums for TennCare coverage would again under this provision.
• We believe that Tennessee should find a way to allow small business to pool their resources and use the state's purchasing power to provide insurance for their employees.
• We support restoring the medically needy or spend-down program as operated by Tennessee and 34 other states for more than 25 years.
• We ask that uninsured children up to age 19 with incomes below 200% of poverty have coverage.  The state should also begin exploring the new Medicaid buy-in program for disabled children in families up to 300% of poverty. ·         We also ask for the state completely review the recently passed federal budget reconciliation act, and take full advantage of opportunities to expand long-term care provided in the home and community, including new resources for Money Follows the Person grants and provisions which allow state to adult less stringent eligibility requirements for HCBS compared to nursing home care.

Finally, these changes should be viewed collectively rather than individually. While no one change by itself will solve the problems facing TennCare, collectively we believe these suggestions can provide us with much better outcomes and at significantly reduced costs. This should be the goal of any reform package.

Legislation regarding TennCare and Healthcare in Tennessee: