TennCare officials urged to end payment moratorium

Friday, December 28, 2018, Vol. 42, No. 52

NASHVILLE (AP) — National and state health care organizations are calling on TennCare officials to immediately end a moratorium on special payments to rural clinics that is putting some in imminent danger of closing,

The Tennessean reports , the moratorium began more than a year ago, put in place by TennCare officials while they create new billing rules for the state's approximately 150 rural clinics. It was supposed to last six months but has since been extended twice.

Sarah Tanksley is a spokewoman for TennCare, the state's version of Medicaid. She said the moratorium is necessary to give Tennessee time to develop the rules. She added that the state Comptroller's office, which audits the clinics, sees significant potential for fraud or waste.

But Bill Finerfrock, executive director of the National Association of Rural Health Clinics, said it should not take this long.

"Forty-nine other states have figured out how to do this and do not have the same kinds of issues," he said.

Representatives from organizations including the Tennessee Hospital Association have told TennCare officials both in letters and in person that clinic closures would worsen an already acute health care crisis in rural Tennessee, where many hospitals have closed.

A Servolution Health Services clinic in Speedwell is one of about 20 rural health clinics opened in the past 15 months that have been hit by the moratorium.

"It's been a big shock to us," said co-CEO Alicia Metcalf. "It's harder and harder to keep open the doors with no money coming in."

TennCare's Tanskey said new rural health clinic providers are paid for seeing TennCare enrollees "just like any provider in the TennCare network."

But Rebecca Jolley, executive director of the Rural Health Association of Tennessee, estimated those payments only cover about 20-30 percent of rural clinics' actual cost of treating TennCare patients.

The supplemental payments cover the actual cost to the clinic and are important in rural areas where small clinics have little negotiating power on rates, Jolley said.

In urban areas, hospitals and large physician practices typically can negotiate higher payments with the private insurance companies that manage TennCare.

Jamie Ellerbook is a pediatric nurse practitioner who opened Pediatric Associates of West Tennessee in July. She said the regular TennCare payments without the promised supplements are not enough to keep the lights on and pay her staff.

"It's not all just ear infections and strep throat that has to be taken care of. If I have to close my doors, people may die," she said during a public meeting on November 27. "That's extreme, but it is a very real truth."

Currently, the moratorium is scheduled to end in April, but there are no guarantees the state won't seek another extension.


Information from: The Tennessean, http://www.tennessean.com