The TennCare Bureau's presentation of new methodology that will be used for hospital supplemental payment calculations beginning in state fiscal year 2019.
The Joint Annual Report (JAR) is a key source of data used by the Bureau of TennCare to calculate supplemental pool payments for hospitals. Over time, THA has received many questions from facilities regarding the TennCare supplemental payment methodology and this data source. On September 5, 2018, THA staff presented a webinar that walks through the JAR form and discusses the data elements used in the calculations and how they are used. A recording of the webinar is available as well as a slide deck that was used in the presentation.
Background information related to the audit of the Disproportionate Share Hospital (DSH) Payments for SFY2012.
The materials for SFY2012 DSH audit also are applicable to the current year. Click More to see the background information and the schedule for the SFY2015 Audit.
Audit Schedule Updated 1-29-2018
Provides information regarding reimbursement for Emergency Medical Services for certain non-citizens.
Provides information regarding the enrollment of presumptively eligible applicants into temporary TennCare Medicaid as a bridge to ongoing coverage.
The Bureau of TennCare has implemented a newborn presumptive eligibility (NPE) program on August 18, 2014.
Information regarding the change of scope of medical/core services, dental services, pharmacy services, or optometry services by a health center.
As the Health Care Finance and Administration (HCFA/TennCare) begins to phase in the Patient Centered Medical Home (PCMH) and Tennessee Health Link (HL) components of the Health Care Innovation Initiative, they have begun working to establish a system to provide real time information to the providers who will be designated by HCFA to provide intensive care management for TennCare enrollees. Central to this effort is access to hospital ADT information to ensure the responsible provider is immediately aware of his patients’ encounters with the hospital, especially visits to the ED. To help hospitals understand HCFA’s goals and the benefits of hospital ADT feeds to the providers responsible for managing the care of enrollees, a webinar facilitated by Brooks Daverman, Director of Strategic Planning and Innovation Group within HCFA, Mary Moewe, Director of eHealth, and other key staff was held on June 1, 2016. To view the webinar, click More.
Background information related to implementation of the second and final year of the Tennessee Medicaid Hospital Rate Variation project. The goal of the project is to mitigate excessive variation in reimbursement for essentially the same routine inpatient and outpatient services provided by Tennessee hospitals participating in Tennessee Medicaid managed care networks.
NEW! In May 2016, AON reviewed the new DRGs that CMS added since the initial classification of DRGs into the service categories used for the rate variation implementation. The updated Service Class Map is available under Resources in this section, and all changes are highlighted.
Provides an overview of the new assessment fee process including how the fee is calculated and paid. Also includes information on how the acuity- and quality-based transitional payments will be calculated and paid to facilities in State Fiscal Year 2015.