BREAKING NEWS: 3-Star Health Task Force Includes Pharmacist-Provided MTM In CMS Proposal
The Tennessee Pharmacists Association (TPA) applauds members of the 3-Star Health Task Force for their inclusion of pharmacist-provided Medication Therapy Management (MTM) services in their proposal to expand coverage for uninsured patients in Tennessee. This 3-Star Health Task Force, which consists of Representative Cameron Sexton (R-Crossville), Representative Matthew Hill (R-Jonesborough), Representative Steve McManus (R-Cordova), Representative Roger Kane (R-Knoxville), Representative Karen Camper (D-Memphis), and SenatorRichard Briggs (R-Knoxville), was commissioned by House Speaker Beth Harwell to work toward improving access to health care coverage for uninsured Tennesseans. Representative Sexton stated earlier this week that the Task Force was looking at ways to improve access to health care, have it be measurable based on outcomes, and provide another alternative to Insure Tennessee.
Yesterday, the 3-Star Health Task Force released a Grey Paper outlining its proposal for the two-phase implementation of this plan. Per the Grey Paper, the Task Force’s charge is to increase access to care for the groups in what is called the “coverage gap” through a phased approach. This group includes childless adults who have incomes up to 138% of the federal poverty level (FPL). The Task Force also wants to create links to programs to promote job placement, training, and education, and a “bridge” to the exchange or employer coverage for those whose incomes rise. The Task Force envisions a two-phase approach that would begin as soon as a waiver or state plan amendment could be approved by the U.S. Centers for Medicare and Medicaid Services (CMS) and voted on by the legislature – hopefully in early 2017. Phase 2 would begin in early 2018, if triggers (to be specified) are met.
Under Phase 1 of this proposal, the plan would create a 3-Star Health Insurance Pilot for Behavioral Health and Uninsured Veterans, with enhanced accountability provisions. This pilot would test the most innovative approaches used in other states to improve health and to encourage enrollees to access care wisely. One specific approach listed in this pilot is the implementation of Medication Therapy Management (MTM) fees for community pharmacists for select high-risk patient groups and/or medications.
The Task Force met with officials from CMS on Tuesday of this week, along with Darin Gordon, the outgoing chief of TennCare, and his successor, Dr. Wendy Long. Representative Sexton plans to follow up with CMS in a few weeks to see what the next step is.
TPA greatly appreciates the work of this Task Force and thanks them for their recognition of the value and role of pharmacists in improving patient health outcomes, increasing patient access to care, and reducing overall health care costs, through their inclusion of pharmacist-provided MTM as part of this proposal.