Join for Free

X

ONECare Population Health Academy – Join For Free

"*" indicates required fields

Already a member of the OPEN MINDS network? Click here to login.
Name*
Address*
Consent*
This field is hidden when viewing the form
This field is hidden when viewing the form
MM slash DD slash YYYY
This field is hidden when viewing the form
This field is hidden when viewing the form

X

Oops! You need to be logged in to use this form.

Tennessee Announces Intent To Award Next Medicaid MCO Contracts To Incumbents; Contracts Include Changes In Coverage Options For Consumers With I/DD

|

By OPEN MINDS Circle

On November 8, 2021, the Tennessee Division of TennCare announced intent to award Medicaid managed care organization (MCO) contracts to incumbents Anthem/Amerigroup Tennessee, Blue Cross Blue Shield of Tennessee/BlueCare Tennessee, and UnitedHealthcare Community Plan. The current contracts are valued at $12 billion annually. The MCOs serve 1.5 million people, and deliver physical health and behavioral health benefits, and long-term services and supports (LTSS) for most populations, including families and children, Medicare/Medicaid dual eligibles, and aged and disabled adults. The new contracts are scheduled to begin in January 2022, with implementation for beneficiaries on January 1, 2023. The initial contract term runs for three years through December 2025, followed by seven one-year renewal options, for a maximum of 10 years.

TennCare released the request for proposals (RFP 31865-00603) on June 11, 2021, with proposals due by August 31, 2021. The state has not disclosed how many bids were received or the names of the unsuccessful bidders. The incumbents hold contracts that were awarded in April 2014. Each of the three serves the East, Middle, and West regions of the state. As of March 2021, BlueCare served 629,082 members, representing 40.4% of all TennCare members. UnitedHealthcare serves 465,572 members, representing 29.9% of all TennCare members. Amerigroup/Anthem serves 463,792 members, representing 29.8% of all TennCare members.

The RFP asked bidders to describe approaches for administering currently carved out LTSS for people intellectual/developmental disability (I/DD) that are provided under 1915(c) waivers. The state submitted a waiver amendment on March 15, 2021, to integrate these services into TennCare, and approval is anticipated by the end of 2021. The waiver makes the following changes relative to services for people with I/DD:

  • Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) services and 1915(c) waiver services will be administered through TennCare (maintaining concurrent 1915(c) authority for waiver services and Medicaid State Plan authority for ICF/IID services). This integration began on September 1, 2021. All ICF/IIDs were asked to join the TennCare MCO networks. Medicaid fee-for-service (FFS) ICF/IID reimbursement process no longer exists. In-network ICF/IIDs and those that have not entered a network agreement are receiving their previous FFS rates during a six-month continuity of care period. Beginning, March 1, 2022, the MCOs will prepare to transfer residents from out-of-network facilities to in-network facilities.
  • ICF/IID services will include a Community Informed Choice process to ensure that individuals understand the full array of community-based options available to meet their needs, and having been fully informed, affirmatively choose institutional placement.
  • Enabling Technology (ET) will be added as a benefit in the Employment and Community First CHOICES program. Limitations currently applicable to the Assistive Technology, Adaptive Equipment and Supplies (AT/AES) benefit will be applied across the ET and AT/AES benefits combined; however, an MCO may authorize services in excess of the combined benefit limit as a cost-effective alternative to institutional placement or other medically necessary covered benefits.
  • The special term and condition governing the TennCare Select health plan will be modified so that members with I/DD assigned to TennCare Select as of July 1, 2021, may remain enrolled in TennCare Select, while members enrolled after that date will be assigned to a traditional MCO.

Each MCO must also operate a statewide Medicare Special Needs Plan-Dual Eligibles (D-SNP) for members eligible for both Medicare and full Medicaid benefits. The state can continue to contract with other plans to operate a D-SNP for beneficiaries that have partial Medicaid benefits, such as Medicaid coverage of Medicare premiums and/or cost-sharing. The new MCOs must also be willing to accept half of the eligible population in each region of the state, and up to 70% if the state determines another MCO in the region is not adequately serving members and chooses to transfer members. The MCOs will be required to lead delivery system transformation efforts for the following initiatives:

  • Patient-Centered Medical Homes (PCMH): to improve the quality of primary care services for TennCare members.
  • Episodes of Care (Episodes): to improve the health care delivered in association with acute health care events.
  • Tennessee Health Link (THL): to coordinate health care services for TennCare members with the highest behavioral health needs.
  • Quality Improvement in Long-Term Services and Supports (QuILTSS) initiatives: to improve quality and shifting payment to outcomes-based measures for the QuILTSS program and for enhanced respiratory care.

The responses were evaluated and awarded a maximum of 1,000 points. However, the state has not yet released the evaluation scoring sheets. According to the RFP, the first evaluation focused on the bidder’s general qualifications and experience, with the maximum score of 150 points. The second evaluation focused on the technical qualifications, experience, and approach, with the maximum score of 850 points. The technical evaluation categories are as follows:

  • 100 points for the approach for controlling cost trends and utilization.
  • 150 points for the approach for providing LTSS-CHOICES, Employment and Community First CHOICES, and other integrated managed LTSS programs for people with intellectual/developmental disability (I/DD) and people enrolled in D-SNPs.
  • 150 points for the approach to providing behavioral health and addiction disorder services.
  • 100 points for delivery system transformation strategies to support PCMH, Episodes, THL, and QuILTSS.
  • 150 points for strategies to ensure access to quality and care.
  • 100 points for provider organization relations and support strategies.
  • 100 points for plans for monitoring population health and addressing non-medical risk factors to improve member health status.

For more information about the RFP, contact: Matt Brimm, Director of Contracts, Division of TennCare, Tennessee Division of Health Care Finance and Administration, 310 Great Circle Road, Nashville, Tennessee 37243; 615-507-6450; Email: Matt.Brimm@tn.gov; Website: https://www.tn.gov/content/tn/generalservices/procurement/central-procurement-office–cpo-/supplier-information/request-for-proposals–rfp–opportunities1/tncare_2021_mco.html#collapseca9c4a855f0c46058b1a3938b6f65968-1

For more information about the current TennCare contracts, contact: Connor Tapp, Jr., External Outreach Coordinator, Division of TennCare, Tennessee Division of Health Care Finance and Administration, 310 Great Circle Road, Nashville, Tennessee 37243; Email: connor.tapp@tn.gov; Website: https://www.tn.gov/tenncare.html