------------------------------------------------------------------------------ NewsBank, inc. - The Commercial Appeal - 1998 - Article with Citation ------------------------------------------------------------------------------ Headline: Tenn. shunts disabled into nursing homes, federal suit says Date: December 8, 1998 Section: Metro Page: B1 Edition: Final Dateline: NASHVILLE Length: 768 words Author: Paula Wade The Commercial Appeal\ Nashville Bureau Text: NASHVILLE - Lawyers for six disabled Tennesseans filed a federal lawsuit Monday charging that Tennessee illegally forces disabled people into nursing homes by systematically denying them in-home long-term care options through TennCare. The 41-page lawsuit, filed by the nonprofit Tennessee Justice Center in U.S. District Court here, alleges that the state's policies violate federal Medicaid requirements to provide medically necessary home health services. The suit also alleges the state violates the Americans With Disabilities Act, which requires that publicly funded services for the disabled be given in the least restrictive setting possible. The suit asks the court to force the state to provide home- and community-based care to eligible TennCare patients rather than providing a nursing home as the only available source for long-term care services. If successful, the suit could accelerate and broaden the state's fledgling efforts to create and fund a viable long-term care network for the elderly and disabled, a limited plan that is being drafted by a state advisory panel. "TennCare routinely refuses to provide medically necessary care in the home, even though such care is mandated by law and ostensibly covered by the program," the lawsuit alleges. Gordon Bonnyman, executive director of TJC, said the suit was necessary for two reasons: because TennCare managed care organizations (MCOs) are continuing to withdraw home health care from patients who are receiving it now and because state policymakers are trapped between two politically powerful interest groups, nursing homes and MCOs, when it comes to long-term care. "This wouldn't be the first time that the state will be able to point to the big bad federal court that made them do the right thing," Bonnyman said, adding he will seek an injunction preventing the TennCare MCOs from cutting off home care services to their patients while the suit is pending. The Justice Center is a public interest law firm that has successfully sued the state several times to force changes in TennCare, the state's managed care health program for the poor, uninsured and uninsurable. Recently, the state entered into a settlement agreement with Bonnyman guaranteeing it will obey federal requirements for the early and periodic screening, diagnosis and treatment of children, mandates the state evaded in TennCare's first years. The suit delineates in detail the bureaucratic catch-22 created by Tennessee's policies regarding TennCare and long- term care. Because TennCare's private health contractors, the managed care organizations, do not cover nursing home services, the suit states, the MCOs save money when disabled TennCare patients go into nursing homes instead of getting home health services through TennCare. Until last year, such home health services were typically paid for through Medicare, but when federal rules withdrew Medicare payments for most home health care, those patients who also were eligible for TennCare got the services through that program. Tennessee Health Commisioner Nancy Menke has told lawmakers TennCare was never intended to provide the many long-term care services needed by the disabled and the state intends to change its rules to reflect that policy. Meanwhile, the state has backed TennCare MCOs' attempts to withdraw services. "It's taken a few years for the MCOs to target the folks who are really costly, and they're saying, `We don't want to pay for that, let 'em go to the nursing home,' "Bonnyman said. The suit lists six disabled people, detailing their battles with the state for their care. The first, Stephen Newberry, 37, of Murfreesboro, has spinal muscular atrophy and is severely disabled. After years of having medically necessary home health care paid by Medicaid and then TennCare, Blue Cross is seeking to cut off his at-home care. He has appealed. "In any event . . . the commissioner (Menke) is moving to revise TennCare rules in a manner which will make him ineligible for further care in the future, and force his placement in a nursing home," the suit states. Newberry's home health care costs Blue Cross $6,000 per year. The state pays Blue Cross $1,080 for Newberry. Nursing home care is $33,000, which would be paid for by TennCare. "The big question here is how you pay for long-term care services if the MCOs have to deliver them. The state's going to have to tell the nursing home industry they're going to have to share'' the $700 million in TennCare funds that go to nursing homes, Bonnyman said. To reach reporter Paula Wade, call 615-242-2018, or E-mail wade@gomemphis.com Copyright 1998 The Commercial Appeal, Memphis, TN Accession Number: 9811200113 ------------------------------------------------------------------------------