TennCare Changes 2011

TennCare Update – Feb. 15, 2011

PAs are encouraged to continue to make comments to CMS via the link on the TennCare website at http://www.tn.gov/tenncare/.

Click here to view a sample letter that was drafted by a TAPA member.

Also, be sure to refer to TAPA’s talking points when drafting your comments. The talking points can be accessed by clicking here.

TennCare Update – Feb. 2, 2011

On Tuesday, John Williams and Katherine Moffat spoke with TennCare Director Darin Gordon regarding the proposed elimination of PA services for adult TennCare patients. The situation is a bit complicated, but the bottom line is that TennCare does not desire the elimination of PA services.

As previously discussed, TennCare must propose $1 billion in cuts due to a budget gap resulting in the loss of non-recurring revenues for the upcoming fiscal year beginning July 1. The non-recurring revenue that will be eliminated June 30, 2011, is the hospital fee that was passed by the General Assembly last year. Because the fee expires June 30, TennCare cannot include those revenues in its upcoming budget proposal.

With regard to no longer covering services provided by PAs, TennCare proposed to the Centers for Medicare and Medicaid Services (CMS) a limit of eight (8) office visits for each TennCare patient per year. The intention was to limit services, not providers. Under TennCare’s initial proposal to CMS, the patient could see the provider of his/her choice (MD, NP, PA, etc.) for those 8 visits.

Under federal law, CMS recognizes physicians and nurse practitioners (NP) as mandatory providers. PAs are considered optional providers. CMS notified TennCare that they oppose combining mandatory providers with optional providers under one benefit limit. In order to meet TennCare’s budget target, including optional providers such as PAs and podiatrists would have required a more severe limit on physicians or a situation where only mandatory providers were covered. TennCare pushed back on this approach by CMS and has argued that services should be what is considered, not what type of provider delivers the service. However, the current TennCare proposal has accepted the CMS position, subject to further negotiations.

Negotiations continue between TennCare and CMS. TAPA has been in communication with the American Academy of Physician Assistants (AAPA), and they are working with us and TennCare to intervene with CMS on our behalf. Based upon this new information, TAPA is recommending that PAs take the following actions:

1. Submit comments to TennCare on this proposal. The 30-day comment period is currently in effect. Go to TennCare’s website at http://www.state.tn.us/tenncare/. Scroll to the “Public Notice” box. At the bottom of the box, it states that comments should be directed to Susie Baird. You can click on the link to get the email address, or send comments to her attention at Tenn.Care@tn.gov. TAPA has developed some talking points to use when drafting comments to CMS on this proposal.
   
   Click here to access these talking points
   
   It is imperative that CMS hear from practicing PAs on this issue.
2. Continue to contact the governor. It is critical to continue to educate the new governor about the important role that PAs play in this state’s healthcare delivery system. The governor’s phone number is (615) 741-2001, and his email address is bill.haslam@tn.gov.
3. Continue to contact state legislators. Besides educating legislators about the vital healthcare services that PAs provide in their communities, the most important point to make with legislators right now is to ask them to support the renewal of the hospital fee. If the hospital fee is renewed by the General Assembly this year, it will generate enough revenues to close the TennCare budget gap and make these proposed cuts unnecessary. Remind legislators of how many of their TennCare constituents will lose their PA healthcare provider if they do not support the hospital fee.
4. Renew or join TAPA. Being a member of TAPA ensures that you receive critical news and information. This situation illustrates how imperative it is to have a vibrant organization working on your behalf. Your dues payments ensure that TAPA has the financial resources necessary to hire staff and a lobbyist to protect your interests.
5. Share this email with other PAs you interact with in your practice or are friends with. We need to make sure that all PAs in Tennessee are engaged in this issue. TAPA does not have up-to-date contact information on non-members, so we need your assistance to reach out to those PAs who are not on our mailing list.

TAPA representatives will be attending the TennCare budget hearing on Thursday morning at 10 a.m. Central time. The public can view these hearings at www.tn.gov. Look for the “Gov. Haslam’s Budget Hearings” link in the last box on the right side of the screen.

TAPA will continue to update PAs as more developments occur. Those with questions can call the main office at (615) 463-0026 or email kmoffat@tnpa.com.

TennCare Update – Feb. 1, 2011 Comments and Information

Dear Tennessee PAs,

Many of you read the news articles over the weekend regarding TennCare’s proposal to eliminate coverage of adult services provided by physician assistants (PA). Rest assured that TAPA is on top of this issue and is working hard to fight these proposed budget cuts.

It is important to remember that at this point, these cuts are only a proposal. TennCare is required by law to give the public a 30-day notice of their proposed program changes before they submit this request to the Centers for Medicare and Medicaid Services (CMS). This 30-day notice period allows the public to weigh in on the proposed changes, which is exactly what is happening right now.

As we all know, the state is looking at a dire financial situation. TennCare has been instructed to cut $1 billion from its budget. A similar proposal to make deep cuts in the TennCare budget was presented last year. As a result, the Tennessee Hospital Association (THA) drafted legislation imposing a fee on the net revenue of hospitals.

That bill was passed by the General Assembly, and the hospital fee has generated nearly $1 billion, including federal matching funds, to make the proposed TennCare cuts unnecessary in the current fiscal year. The fee was imposed for only one year, and the General Assembly will have to renew it for future years. We believe that the fee will be extended again this year, but that does not guarantee that PAs will be included as covered providers. This is where our hard work begins.

The next step is the governor will hold budget hearings this week. Each department’s commissioner will present their department’s budget to the governor. TennCare is scheduled to present their budget on Thursday, Feb. 3 at 10 a.m. CST. The public can watch the hearings at www.tennessee.gov. Look for the “Gov. Haslam’s Budget Hearings” link in the last box on the right side of the screen.

Here is what PAs can do right now to help in the fight:

1. Contact Gov. Haslam’s office before Thursday morning, and ask that PAs continue to be covered providers for adult TennCare services. Use TAPA’s talking points to make your argument. Be sure to share how many adult TennCare patients you see each week, each month, each year. The governor’s phone number is (615) 741-2001, and his email address is bill.haslam@tn.gov.
2. Call and email your state legislators this week. To find out your state legislator, visit http://www.legislature.state.tn.us. On the main screen, you will see a box that says “Find My Legislator”. Enter your address and you’ll get the names, phone numbers and email addresses of your legislators. Call them and/or email them, and use TAPA’s talking points to make your argument. Tell these legislators how many of their constituents receiving TennCare benefits receive healthcare services in your practices.
3. Renew or join TAPA. Being a member of TAPA ensures that you receive critical news and information. This situation illustrates how imperative it is to have a vibrant organization working on your behalf. Your dues payments ensure that TAPA has the financial resources necessary to hire staff and a lobbyist to protect your interests.
4. Share this email with other PAs you interact with in your practice or are friends with. We need to make sure that all PAs in Tennessee are engaged in this issue. TAPA does not have up-to-date contact information on non-members, so we need your assistance to reach out to those PAs who are not on our mailing list.

As more developments occur, TAPA will continue to keep PAs informed about what is going on and what they can do to help protect the interests of the PA profession and the patients they serve. If you have any questions, please contact the TAPA office at (615) 463-0026.