Insurers in Tennessee will refund $10 million to a pool of more than 300,000 consumers through an Affordable Care Act requirement this month.
The Medical Loss Ratio rule requires insurers to spend at least 80 percent of premiums on patient care and quality. "If insurers spend an excessive amount on profits and red tape, they owe a refund back to consumers," Sylvia Burwell, Health and Human Services secretary, said in a release.
According to data from the Centers for Medicare and Medicaid Services, Tennesseans in the refund pool will receive an average of $53 per family. Tennessee had the 14th-highest total refund figure, but the seventh-lowest refund per family. Rebates are required to be provided by Aug. 1.
For the refund data per state, click here.
The Times Free Press has a story on the bureaucratic breakdown between the state and federal health insurance application processes, reporting that in-person Medicaid assistance has been dropped in favor of pushing all applicants to the federal exchange.
Behind the confusion is a series of major TennCare changes that have gone largely unheralded amid the hubbub of health reform. The state is still trying to finish a $35.7 million computer system, called the 'Tennessee Eligibility Determination Systems,' or 'TEDS,' which will make TennCare enrollment decisions according to a new federal calculation. Originally expected to be completed last year within what state officials called an 'impossible' federal timeframe, TEDS still has no projected completion date. Until that's finished, the state is directing all TennCare applicants to the federal marketplace —chiefly via Healthcare.gov.
But problems with the federal site continue to plague Tennessee applicants, "because of problems with how the federal system is communicating with the TennCare system. In many cases, those applicants don't know they're in limbo, state officials acknowledged."
Meanwhile, the state removed all in-person TennCare services from its [Department of Human Services] offices, saying that offices were no longer connected to TennCare under the new system.
The Times Free Press reports officials defend the current process, saying its the most efficient and convenient way to handle signups while they finish TEDS.
Post-acute care company naviHealth announced today a collaboration with Security Health Plan of Wisconsin to manage post-acute services for the health plan's Medicare Advantage and commercial members.
Through the deal, terms of which were not disclosed in a release, naviHealth will assess Security Health members in the hospital to manage their post-acute care and rehabilitation. The company announced a similar partnership last month with a Michigan-based insurer to use decision-support technology in post-acute care management.
"We are thrilled to work with Security Health Plan to provide personalized care plans for the members, delivered through our high-tech high-touch approach," Clay Richards (pictured), naviHealth president and CEO, said in the release.
POSTDATA: WARRANTY DEEDS