Four days of budget testimony from more than a dozen departments can make anyone’s head spin. If you missed the hearings they are still available here online. Most hearings last 30 minutes to an hour. Below are highlights from two of those hearings.

Division of Mental Retardation Services (DMRS)

Questions were raised about several lawsuits.

Arlington Lawsuit (West TN) - There are presently 148 people at Arlington at a cost of $850 per person per day. This comes to more than $310,000 a year for a single resident. Officials plan to close the facility within three years, in part because it would cost more than $10 million for necessary renovations. The next settlement hearing will be held in January 2007.

Clover Bottom Lawsuit (Nashville) - Green Valley has been removed from the suit and officials are turning their focus to the Harold Jordan this spring. The facility presently houses about 143 people at a cost of $900 per day. In regard to Green Valley there are about 290 residents and half of them are medically fragile.

Waiting List Lawsuit - There was a settlement agreement two years ago and since 2005 an additional 2,000 people have received services, but at least 4,800 remain on the waiting list and half of those are children. The Division indicated its intent to focus on children who are on the list and suggested that it would take only $9 1/2 million to clear the waiting list. Conceivably this money could come from procedural reforms in processing payments to providers, such reforms could save $10 million. The division suggested it might take 1 1/2 years to implement the reforms and the Governor questioned why it couldn’t take place sooner, perhaps by using Managed Care Organizations to process payments.

Commissioner Norris suggested that another goal for the coming year would be restructuring case management to make it an administrative function that would save money. Case management is presently provided through at least 23 local agencies and providers. He also suggested there was a need to restructure existing waivers for children.

There were positive signs that the Governor wanted to see stronger action taken to resolve issues faced by DMRS and that he did not care to see any undue delays. He appeared interested in clearing the waiting lists once and for all as well as speeding up the closings of developmental centers and perhaps state ICF/MRs which are costing a fortune.

However, there were concerns to come out of the hearing as well. There were suggestions that one need only raise or eliminate the cap on private ICF/MR beds in order to speed the closing of the developmental centers; however, this only transfers individuals with MR from one institution to another institution. Furthermore, Commissioner Norris suggested that most residents did not need the level of care provided in an ICF/MR.

Lifting the cap does not promote a greater utilization of home and community based services that improve independence for residents and provide greater cost savings to the state. A lifting of the cap might be a quick fix, but it doesn’t resolve the underlying need to move away from a reliance upon institutional models.

TennCare Bureau

Reported that:

  • $120 million in savings from 2006 will be moved to the TennCare Reserve Fund.
    Middle Tennessee MCO’s have been competitively bid and are at full risk while there is movement to integrate physical and mental health care.
  • Previous recipients of care from the Senior Services Waiver are suing to stay with Senior Services rather than move to the new expanded statewide wavier.
    There will be a hearing in March in the John B case.
  • Many administrators are spending upwards of 60% of their time with matters related to lawsuits. The Governor suggested it might be time to beef up staffing so that administrators could focus more on their primary functions.
  • New investment growth will outpace inflationary growth in TennCare for the first time in eight years.
  • Only 25% of TennCare teens received all recommended immunizations in 2005.
  • Requests an enhanced rate for providers of care to patients on ventilators.

Anticipated Expansion of Programming

  1. Expanded PACE Program ($13 million) - PACE is a capitated managed care benefit for nursing-home eligible people over 55 that transports them to comprehensive medical and social services. Presently the program only operates in Hamilton County, but Knox, Davidson and Shelby counties are targeted for expansion of the program. For more on the Hamilton County program visit Alexian Brothers.
  2. Electronic Visit Verification (Nearly $1million) - Technology that would enable TennCare to track provider visits to HCBS enrollee’s homes. A provider would make a call to TennCare upon arrival at a home, perform services and then make make a second call to TennCare prior to leaving.
  3. Pre-Pregnancy Coverage (Nearly $3 million) - Provide Primary care and OB/GYN care to adult females between 101% and 185% of the Federal Poverty Line.
  4. Smoking Cessation Products (Nearly $2 million) - Add coverages of products such as nicotine replacement gums, patches and lozenges to the pharmacy benefit.
  5. Weight Watchers Expansion ($275,000) - Expand target population from obese to overweight enrollees.

Proposed 2008 TennCare Budget - By the Numbers

  • Medical and Behavioral Health Services - 41%
  • Pharmacy - 18%
  • Long-Term Care - 13% (presumably nursing home care)
  • Mental Retardation Services - 11%
  • Medical Cost Sharing - 6%
  • Miscellaneous - 5%
  • Administrative - 3%
  • Dental - 2%
  • Long Term Care Alternatives (HCBS & PACE) - 1%

This means that about $939 million will go into traditional long-term care, presumably nursing homes and institutions, while only $55 million goes into Home and Community Based Alternatives.

TennCare 2008 Budget Presentation in PDF format - Note: it is not available in text or html format for users of screen readers.