The Medicaid/TennCare section of the Division of State Audit, under an agreement with the Division of TennCare in the Department of Finance & Administration, provides examination services for the state's TennCare program.
In 1994, Tennessee moved most of its Medicaid program under a managed care waiver approved by the Health Care Financing Administration. The waiver program is called TennCare (see TennCare Rules here).
The Contractor Risk Agreements between the state and each managed care organization (MCO) require that an audit of each MCO’s business transactions be performed by a licensed certified public accountant. The agreement for such audits shall be subject to prior approval of the Comptroller of the Treasury and must be submitted on a standard "Contract to Audit Accounts" form available here. From time to time, the Division of TennCare requests that the Comptroller’s Division of State Audit provide special review or other attestation work for various aspects of the TennCare program. Examinations and reports of the MCOs are performed and released by the Tennessee Department of Commerce and Insurance, with assistance from Comptroller of the Treasury auditors.
The Medicaid/TennCare section of the Division of State Audit performs desk reviews and examinations of Medicaid long-term care facilities. This section also performs examinations of rural health clinics and federally-qualified health centers and calculates “wrap-around” payments on quarterly reports submitted to the Comptroller of the Treasury by these providers.
Information about Tennessee Medicaid Owners' Compensation Ranges may be downloaded here. (Note: There are two sheets in this file; the first sheet is for nursing facilities and the second is for parent companies. Please select "Save As" after clicking the link to download this resource. To access this resource, you must have Microsoft Excel 97 or a more recent version. Microsoft Excel is a registered trademark of the Microsoft Corporation.)
The Medicaid Level II NF Pro-forma Rate Worksheet may be downloaded here. (Note: The file was last updated on February 29, 2002. Please select "Save As" after clicking on the link. To access this resource, you must have Microsoft Excel 97 or a more recent version. Microsoft Excel is a registered trademark of the Microsoft Corporation.)
The Medicaid/TennCare section is led by an assistant director and three legislative audit managers.