Tennessee Bureau of TennCare in Partnership with Altarum Medicare-Medicaid Services for States

TennCare, Tennessee’s long-standing Medicaid managed care program, provides comprehensive coverage of physical and behavioral health services and long-term services and supports. Of the more than 1.6 million people enrolled in TennCare, approximately 150,000 are full benefit dual-eligible (FBDE) individuals. This group has several options for how they receive their Medicare benefits, which in Tennessee include both coordination-only dual eligible special needs plans (CO D-SNPs) and fully integrated dual eligible special needs plans (FIDE SNPs) that are aligned with TennCare plans. The state’s project under the Advancing Medicare & Medicaid Integration initiative will build off these well-established managed care elements to advance and expand full integration for dual-eligible individuals.

Project Goals

With support from Arnold Ventures, Tennessee is working with Altarum Medicare-Medicaid Services for States (AMMS) to achieve two key goals: 1) advance quality and experience of care, health equity, and cost efficiency of services for full-benefit dual-eligible D-SNP enrollees; and 2) increase enrollment in FIDE SNPs that are aligned with TennCare plans to improve access to coordinated and integrated care.

Project Approach

To achieve the project goals, Tennessee and AMMS are undertaking a 24-month effort that includes:

• Reviewing and refining quality measure and data reporting requirements. AMMS and Tennessee will review and refine current aligned CO D-SNP and FIDE SNP quality measure and data reporting requirements to reflect state goals to address equitable access to integrated care for diverse FBDE individual subpopulations. AMMS and Tennessee will incorporate the updated quality measure and data requirements into the state’s contracts with CO D-SNPs and FIDE SNPs and the reporting templates used by these plans. In addition, AMMS will help the state to build out its processes for overseeing and monitoring both CO D-SNPs and FIDE SNPs. Finally, AMMS will work with Tennessee to review and revise CO D-SNP and FIDE SNP program policies to support state Medicaid cost efficiencies and possible savings, with a focus on state Medicaid agency contracts.
• Identifying and addressing barriers to FIDE SNP enrollment. AMMS will work with Tennessee to explore barriers to enrollment in the FIDE SNP program. This process will include reviewing and comparing the state’s contracts with the CO D-SNPs and FIDE SNPs aligned with TennCare plans and conducting stakeholder engagement activities with consumer advocacy organizations, provider organizations, and other key stakeholders. AMMS will develop policy options for increasing enrollment in FIDE SNPs and supporting transitions from less to more integrated models, including updates to the contracts to align and enhance model of care design for FIDE SNPs, as well as change program eligibility criteria, provider rate structures, marketing practices, and plan payment and incentive structures.

Support for Other States

Many states are in the same position as Tennessee — they know they want to improve care for their dual-eligible populations by providing fully-integrated programs, but face resource gaps that prevent them from moving forward. Arnold Ventures launched the Advancing Medicare & Medicaid Integration initiative to support states and help fill those resource gaps. Learn more about funding opportunities.