TennCare Announces One-Time Penalty Adjustments for Episodes of Care

September 26, 2017 

The TennCare Bureau recently announced it will make a one-time adjustment to reduce penalties for the CY 2016 performance period. Final performance reports for CY 2016 performance period were released on August 30, 2017. TennCare will require penalized providers pay just one-third of the shared risk penalty that is owed to a respective MCO. Providers who received a final performance report that showed a penalty will receive a separate letter that shows the reduced penalty amount. Providers who have an overall episodes reward or providers who had no change in payment as a result of their episodes will not see a change. Providers will not see a change to episodes from their commercial payers—episodes in the commercial market are rewards-only.

The adjustment is being coordinated across the TennCare United Healthcare, Amerigroup, and Blue Care plans at the direction of the state. It is a one-time adjustment and should not be expected in future years.

Contact payment.reform@tn.gov with any questions.