Baggett P, Harkey J B, Alexander J R
Managed Care Consulting Associates, Franklin, TN, USA.
Manag Care Q. 1999 Spring;7(2):6-14.
TennCare was implemented in Tennessee on January 1, 1994, as the state's replacement program for Medicaid. Created through a demonstration waiver under Section 1115(a) of the Social Security Act, TennCare is unlike any other state Medicaid program in the nation because it includes coverage of uninsured and uninsurable Tennesseans. By contracting with managed care organizations (MCOs) to administer the Medicaid benefit package to TennCare enrollees, the state virtually privatized the program and dramatically shifted the state's responsibility from one of total administration to an oversight function only. Amid provider lawsuits, MCO contract controversy, and general chaos surrounding the new program, the implementation of TennCare created one of the most significant health care events in the state's history. This article provides an overview of the TennCare program and its impact on enrollees, providers, and the state budget.
田纳西医疗保健计划于1994年1月1日在田纳西州实施，作为该州医疗补助计划的替代方案。田纳西医疗保健计划是根据《社会保障法》第1115(a)条通过示范豁免创建的，它与美国其他任何州的医疗补助计划都不同，因为它涵盖了没有保险和无法参保的田纳西州居民。通过与管理式医疗组织（MCO）签约，为田纳西医疗保健计划的参保人管理医疗补助福利套餐，该州实际上将该计划私有化，并将该州的责任从全面管理大幅转变为仅进行监督。在提供者诉讼、MCO合同争议以及围绕新计划的普遍混乱中，田纳西医疗保健计划的实施成为该州历史上最重要的医疗保健事件之一。本文概述了田纳西医疗保健计划及其对参保人、提供者和州预算的影响。
