Performance Audit of Selected Programs and Activities of the Division of TennCare

We have audited the Division of TennCare (the division) for the period July 1, 2021, through May 31, 2024. Our audit scope included assessments of program effectiveness, efficiency, internal control, compliance, prospective analyses, and compliance with provisions of laws, regulations, policies, procedures, contracts, and grant agreements in the following areas: the division’s process for shared savings from the TennCare III waiver; the division’s assessment of the behavioral health provider network; the division’s transition process to a new Fiscal Employer Agent for home- and community-based services; the division’s compliance with federal requirements for the unwinding renewal process; the division’s process for cybersecurity over information systems; and the division’s plan to replace the Medicaid Management Information System. Additionally, our audit scope included follow-up on a prior audit finding in the division’s episodes of care strategy for payment reform. For our sample design, we used nonstatistical audit sampling; we conducted the audit in accordance with GAO [GAGAS]. The Division of TennCare’s management is responsible for internal controls and compliance with laws and contracts.