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    CMS Letter To TennCare On June 30

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    USA TODAY Network
    The Centers for Medicare & Medicaid Services (CMS) sent a letter to the Director of TennCare notifying him of proposed changes to Tennessee's section 1115 Medicaid demonstration waiver in response to public comments. CMS has concerns about Tennessee's closed formulary and financing model and is asking the state to remove pharmacy flexibilities from the waiver and submit a new financing model based on a per member per month cap instead of an aggregate cap. CMS also wants Tennessee to clarify that it cannot cut benefits or coverage without approval. CMS will work with Tennessee on expenditure authorities to invest budget neutrality savings into initiatives like adult dental coverage and home and community-based services. CMS requests Tennessee submit an amendment with these changes by August 30, 2022.

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    CMS Letter To TennCare On June 30

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    USA TODAY Network
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    The Centers for Medicare & Medicaid Services (CMS) sent a letter to the Director of TennCare notifying him of proposed changes to Tennessee's section 1115 Medicaid demonstration waiver in response to public comments. CMS has concerns about Tennessee's closed formulary and financing model and is asking the state to remove pharmacy flexibilities from the waiver and submit a new financing model based on a per member per month cap instead of an aggregate cap. CMS also wants Tennessee to clarify that it cannot cut benefits or coverage without approval. CMS will work with Tennessee on expenditure authorities to invest budget neutrality savings into initiatives like adult dental coverage and home and community-based services. CMS requests Tennessee submit an amendment with these changes by August 30, 2022.

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    CMS letter to TennCare on June 30

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    CMS letter to TennCare on June 30

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    The Centers for Medicare & Medicaid Services (CMS) sent a letter to the Director of TennCare notifying him of proposed changes to Tennessee's section 1115 Medicaid demonstration waiver in response to public comments. CMS has concerns about Tennessee's closed formulary and financing model and is asking the state to remove pharmacy flexibilities from the waiver and submit a new financing model based on a per member per month cap instead of an aggregate cap. CMS also wants Tennessee to clarify that it cannot cut benefits or coverage without approval. CMS will work with Tennessee on expenditure authorities to invest budget neutrality savings into initiatives like adult dental coverage and home and community-based services. CMS requests Tennessee submit an amendment with these changes by August 30, 2022.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    3K views2 pages

    CMS Letter To TennCare On June 30

    Uploaded by

    USA TODAY Network
    The Centers for Medicare & Medicaid Services (CMS) sent a letter to the Director of TennCare notifying him of proposed changes to Tennessee's section 1115 Medicaid demonstration waiver in response to public comments. CMS has concerns about Tennessee's closed formulary and financing model and is asking the state to remove pharmacy flexibilities from the waiver and submit a new financing model based on a per member per month cap instead of an aggregate cap. CMS also wants Tennessee to clarify that it cannot cut benefits or coverage without approval. CMS will work with Tennessee on expenditure authorities to invest budget neutrality savings into initiatives like adult dental coverage and home and community-based services. CMS requests Tennessee submit an amendment with these changes by August 30, 2022.

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    of 2

    DEPARTMENT OF HEALTH & HUMAN SERVICES

    Centers for Medicare & Medicaid Services


    7500 Security Boulevard, Mail Stop: S2-26-12
    Baltimore, Maryland 21244-1850

    June 30, 2022

    Mr. Stephen Smith


    Director of TennCare
    Tennessee Department of Finance and Administration
    310 Great Circle Road
    Nashville, TN 37243

    Dear Mr. Smith,

    This letter is to advise Tennessee of a decision by The Centers for Medicare & Medicaid
    Services (CMS) to propose changes to the waiver and expenditure authorities and the Special
    Terms and Conditions (STCs) for the TennCare III section 1115 demonstration (11-W-00369/4),
    in response to the federal public comment period which closed on September 9, 2021.
    After reviewing the public comments, CMS has significant concerns on the following items and
    whether they promote the objectives of Medicaid and should be supported under section 1115
    authority. CMS is evaluating a range of actions, but is asking the state to make the following
    changes to address these concerns. Making these adjustments would significantly mitigate CMS
    concerns. The following list summarizes CMS’ proposed changes to TennCare III.

    Closed Formulary
    Remove the expenditure authority for pharmacy and associated pharmacy flexibilities from the
    demonstration.

    Financing of the Demonstration and Limitations on Reductions in Benefits or Coverage


    Submit a new financing and budget neutrality model, based on a traditional per member per
    month cap instead of an aggregate cap. Additionally, modify the STCs to more explicitly state
    that Tennessee cannot cut benefits or coverage in effect December 31, 2021 without an
    amendment to the demonstration, subject to additional public comment period and CMS
    approval.

    Demonstration Expenditure Authorities


    We support the state’s policy goals to expand coverage and benefits and propose that instead of
    the current framework for savings and investment, CMS will work with the state on necessary
    expenditure authorities to meet common goals. In place of the structure in the current
    demonstration, the state should include in the demonstration amendment a request for
    expenditure authority for state reinvestments for initiatives that the state would like to support
    Page 2 - Mr. Stephen Smith

    with budget neutrality savings (e.g., adult dental services, expanded 12-month postpartum
    coverage and enhanced home and community-based services; etc.).

    We appreciate your state’s commitment to improving the health of the people in Tennessee, and
    being responsive to the concerns raised during the public comment period. At this time, CMS
    requests that Tennessee submit an amendment to the demonstration including the changes listed
    above, subject to the requirements for an amendment as described in the STCs, by August 30,
    2022.

    We look forward to receipt of the amendment, and working in partnership with your team. If you
    have any questions, please contact your CMS project officer, Ms. April Wiley. Ms. Wiley can be
    reached at [email protected] to answer any questions regarding you section 1115
    demonstration. If you have any specific questions about this letter, please contact Ms. Judith
    Cash, Director, State Demonstrations Group, Center for Medicaid and CHIP Services, at (410)
    786-9686.

    Sincerely,

    Daniel Tsai
    Deputy Administrator and Director

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