Tenn. Code Ann. § 71-6-118 — TN Code / Title 71 / Chapter 6 / Section 71-6-118
Confidentiality of information, reports and proceedings - Penalties
Status: in_force

(a) (1) The identity of a person who reports abuse, neglect, or exploitation, as those terms are defined in § 71-6-102 , as required under this part, is confidential and may not be revealed except as otherwise provided in this section or upon an order by a court with jurisdiction under this part for good cause shown. (2) The identity of a person who makes a report pursuant to § 39-15-509(a) , is confidential and may not be revealed except as otherwise provided in this section or upon an order by a court with jurisdiction under this part for good cause shown. (b) Except as otherwise provided in this part, it is unlawful for any person, except for purposes directly connected with the administration of this part or title 39, to disclose, receive, make use of, authorize, or knowingly permit, participate in, or acquiesce in the use of any list or the name of, or any information concerning, persons receiving services pursuant to this part, or any information concerning a report or investigation of a report made confidential pursuant to subsection (a), directly or indirectly derived from the records, papers, files, or communications of the department of human services or divisions thereof acquired in the course of the performance of official duties. (c) (1) When necessary to protect elderly or vulnerable adults in a healthcare facility licensed by any state agency, the information, reports, and investigations described in subsection (b) may be disclosed to any agency providing licensing or regulation for that facility; however, the information, reports, and investigations shall retain the protection of subsection (b) when disclosed to such agency and may not be disclosed to, or used by, any other person. (2) Notwithstanding subsections (a) and (b), adult protective services: (A) May report to law enforcement or public health authorities any information from its investigations or records regarding illness, disease, injuries, or any offense for which reports are made confidential under subsection (a) obtained in the course of an investigation; and (B) Shall provide to the district attorney general a complete and unredacted copy of adult protective services' entire investigative file, including the identity of the person who reported the alleged conduct, upon the commencement of a criminal prosecution for alleged conduct involving an elderly or vulnerable adult victim obtained in the course of an investigation; provided, however, that the identity of the person who reported the alleged conduct must remain confidential, must be exempt from other provisions of law, shall not be a public record, and shall not be disclosed for any other purpose other than criminal investigation or criminal prosecution. (3) Upon the return of a criminal indictment or presentment arising from a report of alleged conduct involving an elderly or vulnerable adult victim where the identity of the person reporting the conduct has been provided to the district attorney general pursuant to this subsection (c), the district attorney general shall request and the court shall enter a protective order preventing further release of the identity of the person reporting for any purpose other than criminal prosecution. (4) As used in this subsection (c), "elderly or vulnerable adult" includes an adult, as defined in § 71-6-102 , an elderly adult, as defined in § 39-15-501 , and a vulnerable adult, as defined in § 39-15-501 . (d) Nothing in this section shall preclude the district attorney general from complying with the continuing duty to disclose evidence under the rules of discovery in a criminal prosecution. (e) A knowing violation of subsection (a) or (b) or subdivision (c)(1) is a Class B misdemeanor. Amended by 2024 Tenn. Acts, ch. 655,s 2, eff. 7/1/2024. Amended by 2024 Tenn. Acts, ch. 655,s 1, eff. 7/1/2024. Amended by 2021 Tenn. Acts, ch. 500, s 18, eff. 10/1/2021. Amended by 2018 Tenn. Acts, ch. 1050, s 15, eff. 1/1/2019. Acts 1986, ch. 630, § 17; T.C.A., § 14-25-118; Acts 1989, ch. 591, § 112; 2008 , ch. 1005, §§ 4, 5.
(a) (1) The identity of a person who reports abuse, neglect, or exploitation, as those terms are defined in § 71-6-102 , as required under this part, is confidential and may not be revealed except as otherwise provided in this section or upon an order by a court with jurisdiction under this part for good cause shown. (2) The identity of a person who makes a report pursuant to § 39-15-509(a) , is confidential and may not be revealed except as otherwise provided in this section or upon an order by a court with jurisdiction under this part for good cause shown.
(1) The identity of a person who reports abuse, neglect, or exploitation, as those terms are defined in § 71-6-102 , as required under this part, is confidential and may not be revealed except as otherwise provided in this section or upon an order by a court with jurisdiction under this part for good cause shown.
(2) The identity of a person who makes a report pursuant to § 39-15-509(a) , is confidential and may not be revealed except as otherwise provided in this section or upon an order by a court with jurisdiction under this part for good cause shown.
(b) Except as otherwise provided in this part, it is unlawful for any person, except for purposes directly connected with the administration of this part or title 39, to disclose, receive, make use of, authorize, or knowingly permit, participate in, or acquiesce in the use of any list or the name of, or any information concerning, persons receiving services pursuant to this part, or any information concerning a report or investigation of a report made confidential pursuant to subsection (a), directly or indirectly derived from the records, papers, files, or communications of the department of human services or divisions thereof acquired in the course of the performance of official duties.
(c) (1) When necessary to protect elderly or vulnerable adults in a healthcare facility licensed by any state agency, the information, reports, and investigations described in subsection (b) may be disclosed to any agency providing licensing or regulation for that facility; however, the information, reports, and investigations shall retain the protection of subsection (b) when disclosed to such agency and may not be disclosed to, or used by, any other person. (2) Notwithstanding subsections (a) and (b), adult protective services: (A) May report to law enforcement or public health authorities any information from its investigations or records regarding illness, disease, injuries, or any offense for which reports are made confidential under subsection (a) obtained in the course of an investigation; and (B) Shall provide to the district attorney general a complete and unredacted copy of adult protective services' entire investigative file, including the identity of the person who reported the alleged conduct, upon the commencement of a criminal prosecution for alleged conduct involving an elderly or vulnerable adult victim obtained in the course of an investigation; provided, however, that the identity of the person who reported the alleged conduct must remain confidential, must be exempt from other provisions of law, shall not be a public record, and shall not be disclosed for any other purpose other than criminal investigation or criminal prosecution. (3) Upon the return of a criminal indictment or presentment arising from a report of alleged conduct involving an elderly or vulnerable adult victim where the identity of the person reporting the conduct has been provided to the district attorney general pursuant to this subsection (c), the district attorney general shall request and the court shall enter a protective order preventing further release of the identity of the person reporting for any purpose other than criminal prosecution. (4) As used in this subsection (c), "elderly or vulnerable adult" includes an adult, as defined in § 71-6-102 , an elderly adult, as defined in § 39-15-501 , and a vulnerable adult, as defined in § 39-15-501 .
(1) When necessary to protect elderly or vulnerable adults in a healthcare facility licensed by any state agency, the information, reports, and investigations described in subsection (b) may be disclosed to any agency providing licensing or regulation for that facility; however, the information, reports, and investigations shall retain the protection of subsection (b) when disclosed to such agency and may not be disclosed to, or used by, any other person.
(2) Notwithstanding subsections (a) and (b), adult protective services: (A) May report to law enforcement or public health authorities any information from its investigations or records regarding illness, disease, injuries, or any offense for which reports are made confidential under subsection (a) obtained in the course of an investigation; and (B) Shall provide to the district attorney general a complete and unredacted copy of adult protective services' entire investigative file, including the identity of the person who reported the alleged conduct, upon the commencement of a criminal prosecution for alleged conduct involving an elderly or vulnerable adult victim obtained in the course of an investigation; provided, however, that the identity of the person who reported the alleged conduct must remain confidential, must be exempt from other provisions of law, shall not be a public record, and shall not be disclosed for any other purpose other than criminal investigation or criminal prosecution.
(A) May report to law enforcement or public health authorities any information from its investigations or records regarding illness, disease, injuries, or any offense for which reports are made confidential under subsection (a) obtained in the course of an investigation; and
(B) Shall provide to the district attorney general a complete and unredacted copy of adult protective services' entire investigative file, including the identity of the person who reported the alleged conduct, upon the commencement of a criminal prosecution for alleged conduct involving an elderly or vulnerable adult victim obtained in the course of an investigation; provided, however, that the identity of the person who reported the alleged conduct must remain confidential, must be exempt from other provisions of law, shall not be a public record, and shall not be disclosed for any other purpose other than criminal investigation or criminal prosecution.
(3) Upon the return of a criminal indictment or presentment arising from a report of alleged conduct involving an elderly or vulnerable adult victim where the identity of the person reporting the conduct has been provided to the district attorney general pursuant to this subsection (c), the district attorney general shall request and the court shall enter a protective order preventing further release of the identity of the person reporting for any purpose other than criminal prosecution.
(4) As used in this subsection (c), "elderly or vulnerable adult" includes an adult, as defined in § 71-6-102 , an elderly adult, as defined in § 39-15-501 , and a vulnerable adult, as defined in § 39-15-501 .
(d) Nothing in this section shall preclude the district attorney general from complying with the continuing duty to disclose evidence under the rules of discovery in a criminal prosecution.
(e) A knowing violation of subsection (a) or (b) or subdivision (c)(1) is a Class B misdemeanor.
Amended by 2024 Tenn. Acts, ch. 655,s 2, eff. 7/1/2024.
Amended by 2024 Tenn. Acts, ch. 655,s 1, eff. 7/1/2024.
Amended by 2021 Tenn. Acts, ch. 500, s 18, eff. 10/1/2021.
Amended by 2018 Tenn. Acts, ch. 1050, s 15, eff. 1/1/2019.
Acts 1986, ch. 630, § 17; T.C.A., § 14-25-118; Acts 1989, ch. 591, § 112; 2008 , ch. 1005, §§ 4, 5.
Tenn. Code Ann. § 71-2-403 — TN Code / Title 71 / Chapter 2 / Section 71-2-403
Review of records and registries - Verification - Exclusion from access to adults
Status: in_force

(a) A review of the records and registries set forth in subdivisions (a)(1)-(6) shall be conducted for all new employees or for volunteers who are counted in the staff/adult participant ratio and those volunteers who have unsupervised access to the adult participants in adult day care centers, and for all new department licensing staff who regulate the adult day care licensing program and all new counselors and supervisors providing services in the adult protective services program: (1) Criminal background history; (2) Juvenile records history available to the Tennessee bureau of investigation (TBI); (3) Any available juvenile court records, if determined necessary by the department; (4) Vulnerable persons registry pursuant to title 68, chapter 11, part 10; (5) State's sex offender registry; and (6) Records of indicated perpetrators of abuse or neglect of children or adults maintained by the department of children's services and the department of human services. (b) (1) Except as otherwise provided in this subdivision (b)(1) and in subsections (c) and (e), and except where the context or intent would otherwise render the language inapplicable to the persons having access to adults in an adult day care center, the procedures, requirements and any other statutory provisions involving the requirements for disclosure forms, the methodology for obtaining and reporting the fingerprint-based criminal and available juvenile histories of a person, the exclusions of persons with a prohibited records history, the appeals processes, the department's authority to allow by rule of the department for exemptions from a verified prohibited history, permissive review procedures and any other consistent procedures, shall be the same for persons subject to this section as those provided in § 71-3-507 for persons having access to children in childcare agencies licensed by the department of human services pursuant to chapter 3, part 5 of this title; provided, that the adult day care center, and not the department, shall be responsible for all of the costs of the fingerprint background checks conducted by the TBI and the federal bureau of investigation for its employees or volunteers subject to this section. (2) With respect to volunteers, this section applies only to those volunteers who serve as volunteers for more than thirty-six (36) hours in any one (1) calendar year. (c) The adult day care center may require that the costs of the background check be a part of the application process by a prospective employee or volunteer, or it may pay the costs and recover the costs of the fingerprint-based background checks from the prospective employee following employment. The department shall pay all costs required for its employees subject to the required background reviews. (d) The TBI shall make any reports of positive matches pursuant to this section in the same manner as provided for any of the processes authorized by § 71-3-507 . (e) Conviction by a criminal court or adjudication by the juvenile court for an offense or a lesser included offense involving the physical, sexual or emotional abuse, neglect, financial exploitation or misuse of funds or theft from any person, or that constitutes conviction or adjudication for an offense involving violence against any person, or conviction of an offense involving the manufacture, sale, possession or distribution of any drug, or a no-contest plea to such offenses, and any pending warrants, indictments, presentments or petitions for such offenses, or the identification of any person on the department of health's vulnerable persons registry pursuant to title 68, chapter 11, part 10, on the state's sex offender registry or identification as a perpetrator of abuse or neglect of children or adults in the records of the department of children's services or department of human services as provided in § 71-3-515 shall disqualify such person from employment with, or from having any access whatsoever to adults in, an adult day care center as defined by this part, and from employment with the department as regulatory staff in the department's adult day care licensing program and service staff in the adult protective services program. Amended by 2013 Tenn. Acts, ch. 101,s 1, eff. 4/8/2013. Acts 1996, ch. 1058, § 4; 1997, ch. 449, § 2; 2000, ch. 981, § 69; 2009, ch. 410, § 1.
(a) A review of the records and registries set forth in subdivisions (a)(1)-(6) shall be conducted for all new employees or for volunteers who are counted in the staff/adult participant ratio and those volunteers who have unsupervised access to the adult participants in adult day care centers, and for all new department licensing staff who regulate the adult day care licensing program and all new counselors and supervisors providing services in the adult protective services program: (1) Criminal background history; (2) Juvenile records history available to the Tennessee bureau of investigation (TBI); (3) Any available juvenile court records, if determined necessary by the department; (4) Vulnerable persons registry pursuant to title 68, chapter 11, part 10; (5) State's sex offender registry; and (6) Records of indicated perpetrators of abuse or neglect of children or adults maintained by the department of children's services and the department of human services.
(1) Criminal background history;
(2) Juvenile records history available to the Tennessee bureau of investigation (TBI);
(3) Any available juvenile court records, if determined necessary by the department;
(4) Vulnerable persons registry pursuant to title 68, chapter 11, part 10;
(5) State's sex offender registry; and
(6) Records of indicated perpetrators of abuse or neglect of children or adults maintained by the department of children's services and the department of human services.
(b) (1) Except as otherwise provided in this subdivision (b)(1) and in subsections (c) and (e), and except where the context or intent would otherwise render the language inapplicable to the persons having access to adults in an adult day care center, the procedures, requirements and any other statutory provisions involving the requirements for disclosure forms, the methodology for obtaining and reporting the fingerprint-based criminal and available juvenile histories of a person, the exclusions of persons with a prohibited records history, the appeals processes, the department's authority to allow by rule of the department for exemptions from a verified prohibited history, permissive review procedures and any other consistent procedures, shall be the same for persons subject to this section as those provided in § 71-3-507 for persons having access to children in childcare agencies licensed by the department of human services pursuant to chapter 3, part 5 of this title; provided, that the adult day care center, and not the department, shall be responsible for all of the costs of the fingerprint background checks conducted by the TBI and the federal bureau of investigation for its employees or volunteers subject to this section. (2) With respect to volunteers, this section applies only to those volunteers who serve as volunteers for more than thirty-six (36) hours in any one (1) calendar year.
(1) Except as otherwise provided in this subdivision (b)(1) and in subsections (c) and (e), and except where the context or intent would otherwise render the language inapplicable to the persons having access to adults in an adult day care center, the procedures, requirements and any other statutory provisions involving the requirements for disclosure forms, the methodology for obtaining and reporting the fingerprint-based criminal and available juvenile histories of a person, the exclusions of persons with a prohibited records history, the appeals processes, the department's authority to allow by rule of the department for exemptions from a verified prohibited history, permissive review procedures and any other consistent procedures, shall be the same for persons subject to this section as those provided in § 71-3-507 for persons having access to children in childcare agencies licensed by the department of human services pursuant to chapter 3, part 5 of this title; provided, that the adult day care center, and not the department, shall be responsible for all of the costs of the fingerprint background checks conducted by the TBI and the federal bureau of investigation for its employees or volunteers subject to this section.
(2) With respect to volunteers, this section applies only to those volunteers who serve as volunteers for more than thirty-six (36) hours in any one (1) calendar year.
(c) The adult day care center may require that the costs of the background check be a part of the application process by a prospective employee or volunteer, or it may pay the costs and recover the costs of the fingerprint-based background checks from the prospective employee following employment. The department shall pay all costs required for its employees subject to the required background reviews.
(d) The TBI shall make any reports of positive matches pursuant to this section in the same manner as provided for any of the processes authorized by § 71-3-507 .
(e) Conviction by a criminal court or adjudication by the juvenile court for an offense or a lesser included offense involving the physical, sexual or emotional abuse, neglect, financial exploitation or misuse of funds or theft from any person, or that constitutes conviction or adjudication for an offense involving violence against any person, or conviction of an offense involving the manufacture, sale, possession or distribution of any drug, or a no-contest plea to such offenses, and any pending warrants, indictments, presentments or petitions for such offenses, or the identification of any person on the department of health's vulnerable persons registry pursuant to title 68, chapter 11, part 10, on the state's sex offender registry or identification as a perpetrator of abuse or neglect of children or adults in the records of the department of children's services or department of human services as provided in § 71-3-515 shall disqualify such person from employment with, or from having any access whatsoever to adults in, an adult day care center as defined by this part, and from employment with the department as regulatory staff in the department's adult day care licensing program and service staff in the adult protective services program.
Amended by 2013 Tenn. Acts, ch. 101,s 1, eff. 4/8/2013.
Acts 1996, ch. 1058, § 4; 1997, ch. 449, § 2; 2000, ch. 981, § 69; 2009, ch. 410, § 1.
Tenn. Code Ann. § 71-3-126 — TN Code / Title 71 / Chapter 3 / Section 71-3-126
Restrictions on use of electronic benefits transfer cards by TANF recipients - Reimbursement - Violations and penalties - System for review - Right to hearing - Rules and regulations - Revenues and fines deposited in general fund
Status: in_force

(a) For the purposes of this section, the term "public assistance benefits" means money or property provided directly or indirectly to eligible persons through the temporary assistance to needy families program. (b) (1) A recipient of public assistance benefits shall not knowingly use an electronic benefits transfer card in: (A) A liquor store as defined in 42 U.S.C. § 608(a)(12)(B)(i) ; (B) A casino, gambling casino, or gaming establishment as defined in 42 U.S.C. § 608(a)(12)(B)(ii) ; (C) An adult cabaret as defined in § 7-51-1102 ; or (D) A retail store licensed to do business in this state that derives its largest category of sales from the sale of loose tobacco, cigars, cigarettes, pipes, and other smoking accessories. (2) To the extent permitted by federal law, any person who violates this subsection (b) shall reimburse the department for the purchase. (3) The department shall notify all recipients of electronic benefit cards of the prohibitions set forth in subdivision (b)(1) and the penalties under current law for knowingly using an EBT card in any prohibited business location. (c) (1) A person or business entity, or any agent or employee of the person or business entity shall not knowingly accept public assistance benefits from an electronic benefits transfer card for the purchase of any goods or services in: (A) A liquor store as defined in 42 U.S.C. § 608(a)(12)(B)(i) ; (B) A casino, gambling casino, or gaming establishment as defined in 42 U.S.C. § 608(a)(12)(B)(ii) ; (C) An adult cabaret as defined in § 7-51-1102 ; or (D) A retail store licensed to do business in this state that derives its largest category of sales from the sale of loose tobacco, cigars, cigarettes, pipes, and other smoking accessories. (2) Any person or business entity who knowingly violates this subsection (c) shall be subject to the following civil penalties: (A) One thousand dollars ($1,000) for the first violation; (B) Two thousand five hundred dollars ($2,500) for the second violation within five (5) years; (C) Five thousand dollars ($5,000) for a third or a subsequent violation within five (5) years. The district attorney general may bring an action to suspend the business licenses and permits of the person or business entity for one (1) year for any violation under this subsection (c). The department is authorized to bring an action to enforce any civil penalty under this subsection (c) in a complaint filed in the chancery court of the county where the merchant is located. (d) (1) A recipient of public assistance benefits shall not knowingly use an electronic benefit transfer card in an automated teller machine or point-of-sale device located in: (A) A liquor store as defined in 42 U.S.C. § 608(a)(12)(B)(i) ; (B) A casino, gambling casino, or gaming establishment as defined in 42 U.S.C. § 608(a)(12)(B)(ii) ; or (C) An adult cabaret as defined in § 7-51-1102 . (2) Any person who knowingly violates this subsection (d) shall reimburse the department for the amount withdrawn and used subject to any prohibition in federal law. Upon a third or subsequent violation, if permitted by federal law, the person shall be permanently disqualified from receiving public assistance benefits by means of direct cash payment or an electronic benefits transfer access card. (e) The department of human services shall establish a system for reviewing electronic benefit transactions of recipients pursuant to this section on such basis as the commissioner may determine, but not less than on a quarterly basis. (f) A person or entity subject to a penalty or sanction under this section shall have the right to a hearing pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. (g) (1) The commissioner of human services is authorized to promulgate rules and regulations, including emergency rules, to effectuate the purposes of this section. All such rules and regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act. (2) The department shall add by rule to the prohibited use of an electronic benefits transfer card other purchases to the fullest extent later permitted by federal law. (h) Any revenues deposited or civil fines collected pursuant to subsection (c) shall be deposited into the general fund. Amended by 2015 Tenn. Acts, ch. 392,Secs.s2, s3 eff. 7/1/2016. Amended by 2015 Tenn. Acts, ch. 392,s 1, eff. 7/1/2016. Added by 2013 Tenn. Acts, ch. 312,s 1, eff. 7/1/2014.
(a) For the purposes of this section, the term "public assistance benefits" means money or property provided directly or indirectly to eligible persons through the temporary assistance to needy families program.
(b) (1) A recipient of public assistance benefits shall not knowingly use an electronic benefits transfer card in: (A) A liquor store as defined in 42 U.S.C. § 608(a)(12)(B)(i) ; (B) A casino, gambling casino, or gaming establishment as defined in 42 U.S.C. § 608(a)(12)(B)(ii) ; (C) An adult cabaret as defined in § 7-51-1102 ; or (D) A retail store licensed to do business in this state that derives its largest category of sales from the sale of loose tobacco, cigars, cigarettes, pipes, and other smoking accessories. (2) To the extent permitted by federal law, any person who violates this subsection (b) shall reimburse the department for the purchase. (3) The department shall notify all recipients of electronic benefit cards of the prohibitions set forth in subdivision (b)(1) and the penalties under current law for knowingly using an EBT card in any prohibited business location.
(1) A recipient of public assistance benefits shall not knowingly use an electronic benefits transfer card in: (A) A liquor store as defined in 42 U.S.C. § 608(a)(12)(B)(i) ; (B) A casino, gambling casino, or gaming establishment as defined in 42 U.S.C. § 608(a)(12)(B)(ii) ; (C) An adult cabaret as defined in § 7-51-1102 ; or (D) A retail store licensed to do business in this state that derives its largest category of sales from the sale of loose tobacco, cigars, cigarettes, pipes, and other smoking accessories.
(A) A liquor store as defined in 42 U.S.C. § 608(a)(12)(B)(i) ;
(B) A casino, gambling casino, or gaming establishment as defined in 42 U.S.C. § 608(a)(12)(B)(ii) ;
(C) An adult cabaret as defined in § 7-51-1102 ; or
(D) A retail store licensed to do business in this state that derives its largest category of sales from the sale of loose tobacco, cigars, cigarettes, pipes, and other smoking accessories.
(2) To the extent permitted by federal law, any person who violates this subsection (b) shall reimburse the department for the purchase.
(3) The department shall notify all recipients of electronic benefit cards of the prohibitions set forth in subdivision (b)(1) and the penalties under current law for knowingly using an EBT card in any prohibited business location.
(c) (1) A person or business entity, or any agent or employee of the person or business entity shall not knowingly accept public assistance benefits from an electronic benefits transfer card for the purchase of any goods or services in: (A) A liquor store as defined in 42 U.S.C. § 608(a)(12)(B)(i) ; (B) A casino, gambling casino, or gaming establishment as defined in 42 U.S.C. § 608(a)(12)(B)(ii) ; (C) An adult cabaret as defined in § 7-51-1102 ; or (D) A retail store licensed to do business in this state that derives its largest category of sales from the sale of loose tobacco, cigars, cigarettes, pipes, and other smoking accessories. (2) Any person or business entity who knowingly violates this subsection (c) shall be subject to the following civil penalties: (A) One thousand dollars ($1,000) for the first violation; (B) Two thousand five hundred dollars ($2,500) for the second violation within five (5) years; (C) Five thousand dollars ($5,000) for a third or a subsequent violation within five (5) years. The district attorney general may bring an action to suspend the business licenses and permits of the person or business entity for one (1) year for any violation under this subsection (c). The department is authorized to bring an action to enforce any civil penalty under this subsection (c) in a complaint filed in the chancery court of the county where the merchant is located.
(1) A person or business entity, or any agent or employee of the person or business entity shall not knowingly accept public assistance benefits from an electronic benefits transfer card for the purchase of any goods or services in: (A) A liquor store as defined in 42 U.S.C. § 608(a)(12)(B)(i) ; (B) A casino, gambling casino, or gaming establishment as defined in 42 U.S.C. § 608(a)(12)(B)(ii) ; (C) An adult cabaret as defined in § 7-51-1102 ; or (D) A retail store licensed to do business in this state that derives its largest category of sales from the sale of loose tobacco, cigars, cigarettes, pipes, and other smoking accessories.
(A) A liquor store as defined in 42 U.S.C. § 608(a)(12)(B)(i) ;
(B) A casino, gambling casino, or gaming establishment as defined in 42 U.S.C. § 608(a)(12)(B)(ii) ;
(C) An adult cabaret as defined in § 7-51-1102 ; or
(D) A retail store licensed to do business in this state that derives its largest category of sales from the sale of loose tobacco, cigars, cigarettes, pipes, and other smoking accessories.
(2) Any person or business entity who knowingly violates this subsection (c) shall be subject to the following civil penalties: (A) One thousand dollars ($1,000) for the first violation; (B) Two thousand five hundred dollars ($2,500) for the second violation within five (5) years; (C) Five thousand dollars ($5,000) for a third or a subsequent violation within five (5) years. The district attorney general may bring an action to suspend the business licenses and permits of the person or business entity for one (1) year for any violation under this subsection (c). The department is authorized to bring an action to enforce any civil penalty under this subsection (c) in a complaint filed in the chancery court of the county where the merchant is located.
(A) One thousand dollars ($1,000) for the first violation;
(B) Two thousand five hundred dollars ($2,500) for the second violation within five (5) years;
(C) Five thousand dollars ($5,000) for a third or a subsequent violation within five (5) years. The district attorney general may bring an action to suspend the business licenses and permits of the person or business entity for one (1) year for any violation under this subsection (c). The department is authorized to bring an action to enforce any civil penalty under this subsection (c) in a complaint filed in the chancery court of the county where the merchant is located.
(d) (1) A recipient of public assistance benefits shall not knowingly use an electronic benefit transfer card in an automated teller machine or point-of-sale device located in: (A) A liquor store as defined in 42 U.S.C. § 608(a)(12)(B)(i) ; (B) A casino, gambling casino, or gaming establishment as defined in 42 U.S.C. § 608(a)(12)(B)(ii) ; or (C) An adult cabaret as defined in § 7-51-1102 . (2) Any person who knowingly violates this subsection (d) shall reimburse the department for the amount withdrawn and used subject to any prohibition in federal law. Upon a third or subsequent violation, if permitted by federal law, the person shall be permanently disqualified from receiving public assistance benefits by means of direct cash payment or an electronic benefits transfer access card.
(1) A recipient of public assistance benefits shall not knowingly use an electronic benefit transfer card in an automated teller machine or point-of-sale device located in: (A) A liquor store as defined in 42 U.S.C. § 608(a)(12)(B)(i) ; (B) A casino, gambling casino, or gaming establishment as defined in 42 U.S.C. § 608(a)(12)(B)(ii) ; or (C) An adult cabaret as defined in § 7-51-1102 .
(A) A liquor store as defined in 42 U.S.C. § 608(a)(12)(B)(i) ;
(B) A casino, gambling casino, or gaming establishment as defined in 42 U.S.C. § 608(a)(12)(B)(ii) ; or
(C) An adult cabaret as defined in § 7-51-1102 .
(2) Any person who knowingly violates this subsection (d) shall reimburse the department for the amount withdrawn and used subject to any prohibition in federal law. Upon a third or subsequent violation, if permitted by federal law, the person shall be permanently disqualified from receiving public assistance benefits by means of direct cash payment or an electronic benefits transfer access card.
(e) The department of human services shall establish a system for reviewing electronic benefit transactions of recipients pursuant to this section on such basis as the commissioner may determine, but not less than on a quarterly basis.
(f) A person or entity subject to a penalty or sanction under this section shall have the right to a hearing pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
(g) (1) The commissioner of human services is authorized to promulgate rules and regulations, including emergency rules, to effectuate the purposes of this section. All such rules and regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act. (2) The department shall add by rule to the prohibited use of an electronic benefits transfer card other purchases to the fullest extent later permitted by federal law.
(1) The commissioner of human services is authorized to promulgate rules and regulations, including emergency rules, to effectuate the purposes of this section. All such rules and regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act.
(2) The department shall add by rule to the prohibited use of an electronic benefits transfer card other purchases to the fullest extent later permitted by federal law.
(h) Any revenues deposited or civil fines collected pursuant to subsection (c) shall be deposited into the general fund.
Amended by 2015 Tenn. Acts, ch. 392,Secs.s2, s3 eff. 7/1/2016.
Amended by 2015 Tenn. Acts, ch. 392,s 1, eff. 7/1/2016.
Added by 2013 Tenn. Acts, ch. 312,s 1, eff. 7/1/2014.
Tenn. Code Ann. § 71-5-1419 — TN Code / Title 71 / Chapter 5 / Section 71-5-1419
Operational plan and budget for home-based and community-based services to elderly and disabled individuals
Status: in_force

(a) (1) By January 1, 2000, the long-term care services planning council, in consultation with the long-term care advisory council, shall develop an operational plan and budget projections for a program for home-based and community-based services (HBCS) to elderly and disabled individuals in need of assistance. The program should provide services to elderly and disabled individuals in need of assistance who do not qualify for long-term care services under medical assistance pursuant to part 1 of this chapter. The council shall report on the program to the general assembly. (2) Nothing in the plan developed pursuant to this section shall be construed to create an entitlement for individuals. (3) The plan should identify eligible services, the extent and manner in which such services are allocated and made available to elderly and disabled individuals in need of assistance who do not qualify for long-term care services under medical assistance pursuant to part 1 of this chapter, and the manner in which such services are coordinated with each other and long-term care services available outside the program, including, but not limited to, medical assistance and medicare. (4) The plan shall develop and include mechanisms to include the choice of an individual and the individual's representative regarding which covered services to receive, how services are provided and who provides services. (5) The plan should propose a mechanism to impose cost-sharing to be set by rule with respect to covered services. (6) The plan shall provide for quality assurance and safeguards for the eligible individuals. (7) The plan shall designate a state agency to administer the program or to supervise administration of the program. (b) (1) HBCS, as defined in § 71-5-103 , shall be available to eligible elderly and disabled individuals in need of assistance under the program established by this section. The program shall set limits to services based on available fiscal resources. The services shall be specified in a manner that permits flexibility for providers to meet the needs of eligible individuals in a cost-effective manner with services to be delivered in an individual's home, a range of community residential arrangements, or outside the home. (2) HBCS would be provided under the plan required in this section to program participants if an: (A) Assessment pursuant to § 71-5-1407 has been made; and (B) Individualized plan of care is developed with involvement from the individual or the individual's representative. (3) The state shall make reasonable efforts to identify and arrange services described in the plan, but nothing in this section shall be construed as requiring the state to provide all the services such plan may specify. (c) The commissioner of health is authorized to promulgate rules and regulations to effectuate the purposes of this section. All such rules and regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. (d) The department of disability and aging shall equitably allocate funding resources between urban and rural areas to program components that provide services to elderly and disabled individuals in need of assistance who do not qualify for long-term care services under medical assistance pursuant to part 1 of this chapter. (e) By August 1, 2001, the department of disability and aging shall establish an average maximum statewide unit cost for service provided to elderly and disabled individuals in need of assistance who do not qualify for long-term care services pursuant to part 1 of this chapter. In developing the rate, the department of disability and aging shall take into account the unit of service rate permitted for such service under any federal waiver for providing assistance under this chapter if such service is also provided under the federal waiver and in no case can it be more than twenty percent (20%) above the average statewide unit cost for that specific service. Amended by 2024 Tenn. Acts, ch. 688,s 186, eff. 7/1/2024. Acts 1999, ch. 477, § 3; 2001, ch. 461, § 1; T.C.A. § 71-5-1408 ; Acts 2008 , ch. 1190, §§ 1, 9.
(a) (1) By January 1, 2000, the long-term care services planning council, in consultation with the long-term care advisory council, shall develop an operational plan and budget projections for a program for home-based and community-based services (HBCS) to elderly and disabled individuals in need of assistance. The program should provide services to elderly and disabled individuals in need of assistance who do not qualify for long-term care services under medical assistance pursuant to part 1 of this chapter. The council shall report on the program to the general assembly. (2) Nothing in the plan developed pursuant to this section shall be construed to create an entitlement for individuals. (3) The plan should identify eligible services, the extent and manner in which such services are allocated and made available to elderly and disabled individuals in need of assistance who do not qualify for long-term care services under medical assistance pursuant to part 1 of this chapter, and the manner in which such services are coordinated with each other and long-term care services available outside the program, including, but not limited to, medical assistance and medicare. (4) The plan shall develop and include mechanisms to include the choice of an individual and the individual's representative regarding which covered services to receive, how services are provided and who provides services. (5) The plan should propose a mechanism to impose cost-sharing to be set by rule with respect to covered services. (6) The plan shall provide for quality assurance and safeguards for the eligible individuals. (7) The plan shall designate a state agency to administer the program or to supervise administration of the program.
(1) By January 1, 2000, the long-term care services planning council, in consultation with the long-term care advisory council, shall develop an operational plan and budget projections for a program for home-based and community-based services (HBCS) to elderly and disabled individuals in need of assistance. The program should provide services to elderly and disabled individuals in need of assistance who do not qualify for long-term care services under medical assistance pursuant to part 1 of this chapter. The council shall report on the program to the general assembly.
(2) Nothing in the plan developed pursuant to this section shall be construed to create an entitlement for individuals.
(3) The plan should identify eligible services, the extent and manner in which such services are allocated and made available to elderly and disabled individuals in need of assistance who do not qualify for long-term care services under medical assistance pursuant to part 1 of this chapter, and the manner in which such services are coordinated with each other and long-term care services available outside the program, including, but not limited to, medical assistance and medicare.
(4) The plan shall develop and include mechanisms to include the choice of an individual and the individual's representative regarding which covered services to receive, how services are provided and who provides services.
(5) The plan should propose a mechanism to impose cost-sharing to be set by rule with respect to covered services.
(6) The plan shall provide for quality assurance and safeguards for the eligible individuals.
(7) The plan shall designate a state agency to administer the program or to supervise administration of the program.
(b) (1) HBCS, as defined in § 71-5-103 , shall be available to eligible elderly and disabled individuals in need of assistance under the program established by this section. The program shall set limits to services based on available fiscal resources. The services shall be specified in a manner that permits flexibility for providers to meet the needs of eligible individuals in a cost-effective manner with services to be delivered in an individual's home, a range of community residential arrangements, or outside the home. (2) HBCS would be provided under the plan required in this section to program participants if an: (A) Assessment pursuant to § 71-5-1407 has been made; and (B) Individualized plan of care is developed with involvement from the individual or the individual's representative. (3) The state shall make reasonable efforts to identify and arrange services described in the plan, but nothing in this section shall be construed as requiring the state to provide all the services such plan may specify.
(1) HBCS, as defined in § 71-5-103 , shall be available to eligible elderly and disabled individuals in need of assistance under the program established by this section. The program shall set limits to services based on available fiscal resources. The services shall be specified in a manner that permits flexibility for providers to meet the needs of eligible individuals in a cost-effective manner with services to be delivered in an individual's home, a range of community residential arrangements, or outside the home.
(2) HBCS would be provided under the plan required in this section to program participants if an: (A) Assessment pursuant to § 71-5-1407 has been made; and (B) Individualized plan of care is developed with involvement from the individual or the individual's representative.
(A) Assessment pursuant to § 71-5-1407 has been made; and
(B) Individualized plan of care is developed with involvement from the individual or the individual's representative.
(3) The state shall make reasonable efforts to identify and arrange services described in the plan, but nothing in this section shall be construed as requiring the state to provide all the services such plan may specify.
(c) The commissioner of health is authorized to promulgate rules and regulations to effectuate the purposes of this section. All such rules and regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
(d) The department of disability and aging shall equitably allocate funding resources between urban and rural areas to program components that provide services to elderly and disabled individuals in need of assistance who do not qualify for long-term care services under medical assistance pursuant to part 1 of this chapter.
(e) By August 1, 2001, the department of disability and aging shall establish an average maximum statewide unit cost for service provided to elderly and disabled individuals in need of assistance who do not qualify for long-term care services pursuant to part 1 of this chapter. In developing the rate, the department of disability and aging shall take into account the unit of service rate permitted for such service under any federal waiver for providing assistance under this chapter if such service is also provided under the federal waiver and in no case can it be more than twenty percent (20%) above the average statewide unit cost for that specific service.
Amended by 2024 Tenn. Acts, ch. 688,s 186, eff. 7/1/2024.
Acts 1999, ch. 477, § 3; 2001, ch. 461, § 1; T.C.A. § 71-5-1408 ; Acts 2008 , ch. 1190, §§ 1, 9.
Tenn. Code Ann. § 71-4-812 — TN Code / Title 71 / Chapter 4 / Section 71-4-812
Disclosure of personal information prohibited - Exceptions
Status: in_force

(a) Notwithstanding any other law to the contrary, the state shall not disclose personal information about any person obtained in connection with an account established under this part, except under the following circumstances: (1) To any individual or entity authorized by the eligible individual or the eligible individual's legal representative; (2) In compliance with a subpoena or a court order; (3) To the comptroller of the treasury or the comptroller's designees for the purpose of an audit; (4) To the internal revenue service, the United States department of the treasury, or the social security administration for the purpose of filing notices, reports, statements, or any other required documentation; or (5) In any administrative proceeding or court action involving the state, the department of the treasury, the state treasurer, or the remaining trustees relative to an account established under this part. (b) For the purposes of this section, "personal information" shall include, but not be limited to, social security number; bank account numbers; transit routing numbers; credit card numbers; debit card numbers; business or residential addresses; telephone or cell phone numbers; e-mail addresses; disability certifications or determinations; and medical records. Acts 2015, ch. 470, § 12.
(a) Notwithstanding any other law to the contrary, the state shall not disclose personal information about any person obtained in connection with an account established under this part, except under the following circumstances: (1) To any individual or entity authorized by the eligible individual or the eligible individual's legal representative; (2) In compliance with a subpoena or a court order; (3) To the comptroller of the treasury or the comptroller's designees for the purpose of an audit; (4) To the internal revenue service, the United States department of the treasury, or the social security administration for the purpose of filing notices, reports, statements, or any other required documentation; or (5) In any administrative proceeding or court action involving the state, the department of the treasury, the state treasurer, or the remaining trustees relative to an account established under this part.
(1) To any individual or entity authorized by the eligible individual or the eligible individual's legal representative;
(2) In compliance with a subpoena or a court order;
(3) To the comptroller of the treasury or the comptroller's designees for the purpose of an audit;
(4) To the internal revenue service, the United States department of the treasury, or the social security administration for the purpose of filing notices, reports, statements, or any other required documentation; or
(5) In any administrative proceeding or court action involving the state, the department of the treasury, the state treasurer, or the remaining trustees relative to an account established under this part.
(b) For the purposes of this section, "personal information" shall include, but not be limited to, social security number; bank account numbers; transit routing numbers; credit card numbers; debit card numbers; business or residential addresses; telephone or cell phone numbers; e-mail addresses; disability certifications or determinations; and medical records.
Acts 2015, ch. 470, § 12.
Tenn. Code Ann. § 71-5-2314 — TN Code / Title 71 / Chapter 5 / Section 71-5-2314
Payment of claims under TennCare partners program
Status: in_force

This section is intended to ensure the prompt and accurate payment of all claims incurred by providers delivering services to enrollees of the TennCare partners program, and to formalize the resolution of all claims disputes arising under the partners program. Accordingly, the standards and requirements set forth at § 56-32-126(b) , shall be applicable to the TennCare partners program. Specifically, all entities contracting with the state in the partners program shall have the same rights and obligations as defined for TennCare health maintenance organizations at § 56-32-126(b) . The commissioner of commerce and insurance has the authority to conduct periodic examinations of these entities to verify compliance with this section. Any entity found to be in noncompliance with this section shall be subject to the imposition by the commissioner of the same penalties and other remedies set forth at § 56-32-120 . Acts 1999, ch. 276, § 2.
This section is intended to ensure the prompt and accurate payment of all claims incurred by providers delivering services to enrollees of the TennCare partners program, and to formalize the resolution of all claims disputes arising under the partners program. Accordingly, the standards and requirements set forth at § 56-32-126(b) , shall be applicable to the TennCare partners program. Specifically, all entities contracting with the state in the partners program shall have the same rights and obligations as defined for TennCare health maintenance organizations at § 56-32-126(b) . The commissioner of commerce and insurance has the authority to conduct periodic examinations of these entities to verify compliance with this section. Any entity found to be in noncompliance with this section shall be subject to the imposition by the commissioner of the same penalties and other remedies set forth at § 56-32-120 .
Acts 1999, ch. 276, § 2.
Tenn. Code Ann. § 71-3-905 — TN Code / Title 71 / Chapter 3 / Section 71-3-905
Eligibility for exemption
Status: in_force

Under this section, self-employment will be considered the same as a job component, if the individual's income, divided by the minimum wage, equals at a minimum twenty (20) hours per week. To receive the self-employment exemption outlined in this part, low-income entrepreneurs must be enrolled in the job component of the temporary assistance for needy families (TANF) or successor program, and must be enrolled in a micro-lending program providing entrepreneurship training, technical assistance and peer support. Acts 1996, ch. 886, § 5.
Under this section, self-employment will be considered the same as a job component, if the individual's income, divided by the minimum wage, equals at a minimum twenty (20) hours per week. To receive the self-employment exemption outlined in this part, low-income entrepreneurs must be enrolled in the job component of the temporary assistance for needy families (TANF) or successor program, and must be enrolled in a micro-lending program providing entrepreneurship training, technical assistance and peer support.
Acts 1996, ch. 886, § 5.
Tenn. Code Ann. § 71-5-2311 — TN Code / Title 71 / Chapter 5 / Section 71-5-2311
Payment for hospitalization
Status: in_force

(a) Whenever any hospital has entered into either or both of such contracts with any county, the hospital shall render monthly statements to the county mayor of the county showing the name and address of each patient so received and treated at the expense of the county, and the length of time treated, and an account for the keep of the patient, and whether the patient was treated under the annual contract plan or by special contract with the county mayor as provided in this part. (b) Upon the presentation of the account, the county mayor shall inspect the account, and if found correct, shall issue a county warrant for same, which shall be paid as other county expenses. Acts 1911, ch. 54, § 5; Shan., § 2706a5; Code 1932, § 4827; impl. am. Acts 1978, ch. 934, §§ 16, 36; T.C.A. (orig. ed.), §§ 14-1011, 14-20-311; Acts 2003, ch. 90, § 2.
(a) Whenever any hospital has entered into either or both of such contracts with any county, the hospital shall render monthly statements to the county mayor of the county showing the name and address of each patient so received and treated at the expense of the county, and the length of time treated, and an account for the keep of the patient, and whether the patient was treated under the annual contract plan or by special contract with the county mayor as provided in this part.
(b) Upon the presentation of the account, the county mayor shall inspect the account, and if found correct, shall issue a county warrant for same, which shall be paid as other county expenses.
Acts 1911, ch. 54, § 5; Shan., § 2706a5; Code 1932, § 4827; impl. am. Acts 1978, ch. 934, §§ 16, 36; T.C.A. (orig. ed.), §§ 14-1011, 14-20-311; Acts 2003, ch. 90, § 2.
Tenn. Code Ann. § 71-5-2111 — TN Code / Title 71 / Chapter 5 / Section 71-5-2111
Joint institutions
Status: in_force

(a) County legislative bodies may unite in the establishment of joint homes, hospitals, almshouses or poor farms for the care of the indigent or the chronic sick of the respective counties. (b) The legislative body of a county, by majority vote at any regular session, may sell or otherwise dispose of the property owned by the county and used for such purposes, and may contract with one (1) or more other counties for the joint ownership, construction, control and operation of a common institution, or may contract with one (1) or more other counties for the care of its indigent or chronic sick persons in institutions owned, controlled and operated by the other county or counties. Acts 1929, ch. 135, § 1; Code 1932, § 4795; impl. am. Acts 1978, ch. 934, §§ 7, 36; T.C.A. (orig. ed.), §§ 14-811, 14-20-111.
(a) County legislative bodies may unite in the establishment of joint homes, hospitals, almshouses or poor farms for the care of the indigent or the chronic sick of the respective counties.
(b) The legislative body of a county, by majority vote at any regular session, may sell or otherwise dispose of the property owned by the county and used for such purposes, and may contract with one (1) or more other counties for the joint ownership, construction, control and operation of a common institution, or may contract with one (1) or more other counties for the care of its indigent or chronic sick persons in institutions owned, controlled and operated by the other county or counties.
Acts 1929, ch. 135, § 1; Code 1932, § 4795; impl. am. Acts 1978, ch. 934, §§ 7, 36; T.C.A. (orig. ed.), §§ 14-811, 14-20-111.
Tenn. Code Ann. § 71-5-1304 — TN Code / Title 71 / Chapter 5 / Section 71-5-1304
Processing of applications - Funding - Determination of grant
Status: in_force

Applications shall be processed by the department on a first come, first served basis and are subject to the amount annually appropriated for this program in the general appropriations act. Based on the application, the department shall calculate a projected annual nursing home expense for the individual, which shall be the average per diem nursing home expense for the days claimed times three hundred sixty-five (365) days. The projected annual nursing home expense shall be deducted from the prior year's annual income certified by the patient. The remainder shall be the adjusted annual income for purposes of this grant. The amount of the daily grant shall be determined as follows: (1) The amount of the payments made pursuant to this part shall be based upon adjusted annual income; (2) Adjusted annual income for the purposes of determining eligibility must not exceed three hundred fifty percent (350%) of the federal poverty guidelines for an individual as published annually by the United States department of health and human services for determining medicaid eligibility; (3) Individual payments under this part for adjusted annual incomes ranging from zero dollars ($0.00) to an amount calculated to be one hundred eighty-five percent (185%) of the individual poverty guidelines is six dollars and fifty cents ($6.50) per day; (4) Maximum individual payments under this part for adjusted annual incomes ranging from one hundred eighty-six percent (186%) to three hundred fifty percent (350%) of the individual poverty guidelines are not to exceed six dollars ($6.00) per day, as determined by rules and regulations promulgated by the commissioner of health in order to meet the sums annually appropriated for this program. Acts 1992, ch. 954, § 1.
Applications shall be processed by the department on a first come, first served basis and are subject to the amount annually appropriated for this program in the general appropriations act. Based on the application, the department shall calculate a projected annual nursing home expense for the individual, which shall be the average per diem nursing home expense for the days claimed times three hundred sixty-five (365) days. The projected annual nursing home expense shall be deducted from the prior year's annual income certified by the patient. The remainder shall be the adjusted annual income for purposes of this grant. The amount of the daily grant shall be determined as follows:
(1) The amount of the payments made pursuant to this part shall be based upon adjusted annual income;
(2) Adjusted annual income for the purposes of determining eligibility must not exceed three hundred fifty percent (350%) of the federal poverty guidelines for an individual as published annually by the United States department of health and human services for determining medicaid eligibility;
(3) Individual payments under this part for adjusted annual incomes ranging from zero dollars ($0.00) to an amount calculated to be one hundred eighty-five percent (185%) of the individual poverty guidelines is six dollars and fifty cents ($6.50) per day;
(4) Maximum individual payments under this part for adjusted annual incomes ranging from one hundred eighty-six percent (186%) to three hundred fifty percent (350%) of the individual poverty guidelines are not to exceed six dollars ($6.00) per day, as determined by rules and regulations promulgated by the commissioner of health in order to meet the sums annually appropriated for this program.
Acts 1992, ch. 954, § 1.
Tenn. Code Ann. § 71-5-149 — TN Code / Title 71 / Chapter 5 / Section 71-5-149
Disease management program
Status: in_force

The bureau of TennCare shall adopt a state disease management program, which may include contracting with a vendor that specializes in the provision of disease management services. The disease management program shall be designed to improve care to and reduce overall expenditures for TennCare beneficiaries with chronic illnesses. The disease management program may include the development of evidence-based medical practice guidelines, support services to assist physicians in monitoring their patients, more closely managed patient care, including management of the proper use of prescription drugs by patients, and the development of individual patient treatment plans that may include recommendations for improved medication compliance and improved lifestyle and behavioral compliance. The adoption of a disease management program is not an agency action and does not require rulemaking. Acts 2006, ch. 931, § 1.
The bureau of TennCare shall adopt a state disease management program, which may include contracting with a vendor that specializes in the provision of disease management services. The disease management program shall be designed to improve care to and reduce overall expenditures for TennCare beneficiaries with chronic illnesses. The disease management program may include the development of evidence-based medical practice guidelines, support services to assist physicians in monitoring their patients, more closely managed patient care, including management of the proper use of prescription drugs by patients, and the development of individual patient treatment plans that may include recommendations for improved medication compliance and improved lifestyle and behavioral compliance. The adoption of a disease management program is not an agency action and does not require rulemaking.
Acts 2006, ch. 931, § 1.
Tenn. Code Ann. § 71-5-2401 — TN Code / Title 71 / Chapter 5 / Section 71-5-2401
Establishment - Members - Recommendations concerning drugs on auto-exemptions list
Status: in_force

(a) There is established in the department of finance and administration a state TennCare pharmacy advisory committee. The committee shall make recommendations regarding a preferred drug list (PDL) to govern all state expenditures for prescription drugs for the TennCare program. (b) (1) The state TennCare pharmacy advisory committee shall be composed of fifteen (15) members. Except for initial appointments, members shall be appointed to three-year terms. (2) Appointments by the governor shall be made as follows: (A) One (1) practicing psychiatrist who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested psychiatric groups, including, but not limited to, the Tennessee Psychiatric Association. The initial appointee shall serve a three-year term; (B) One (1) practicing nurse practitioner or physician assistant who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested nursing or physician assistant groups, including, but not limited to, the Tennessee Nurses Association or the Tennessee Academy of Physician Assistants. The initial appointee shall serve a one-year term; (C) One (1) practicing physician who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested geriatric groups, including, but not limited to, the Tennessee Geriatric Society and the Tennessee Chapter of the American Association of Retired Persons, and who is a gerontologist or whose practice otherwise is primarily among the aged. The initial appointee shall serve a two-year term; (D) One (1) practicing pediatrician who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested pediatric groups, including, but not limited to, the Tennessee Chapter of the American Academy of Pediatrics. The initial appointee shall serve a one-year term; (E) One (1) family practitioner who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested family physician groups, including, but not limited to, the Tennessee Academy of Family Physicians. The initial appointee shall serve a two-year term; (F) One (1) practicing cardiologist who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested cardiology groups, including, but not limited to, the Tennessee Chapter of the American College of Cardiology. The initial appointee shall serve a three-year term; (G) One (1) practicing pharmacist who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested chain drug groups, including, but not limited to, the Tennessee Chain Drug Council. The initial appointee shall serve a one-year term; (H) One (1) pharmacy director from a managed care organization participating in the TennCare program. The initial appointee shall serve a two-year term; and (I) One (1) member of an organization engaged in advocacy on behalf of members of the TennCare program. The initial appointee shall serve a three-year term. (3) Appointments by the speaker of the senate shall be made as follows: (A) One (1) general internist who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested medical groups, including, but not limited to, the Tennessee Medical Association. The initial appointee shall serve a three-year term; and (B) One (1) practicing pharmacist who is engaged in the retail distribution of prescription drugs and who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested pharmacist groups, including, but not limited to, the Tennessee Pharmacists Association. The initial appointee shall serve a two-year term. (4) Appointments by the speaker of the house of representatives shall be made as follows: (A) One (1) general internist who participates in the TennCare program from a list of all general internists provided by interested medical groups, including, but not limited to, the Tennessee Chapter of the American College of Physicians. The initial appointee shall serve a one-year term; and (B) One (1) practicing pharmacist who is engaged in the distribution of prescription drugs in the nursing home industry and who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested pharmacist groups, including, but not limited to, the Tennessee Pharmacists Association. The initial appointee shall serve a three-year term. (5) The pharmacy director and medical director of TennCare; the chair of the health committee of the house of representatives, or the chair's designee; and the chair of the health and welfare committee of the senate, or the chair's designee shall serve as ex officio members of the state TennCare pharmacy advisory committee. (c) The appointing authorities shall consult with the interested groups listed in subsection (b) to determine qualified persons to fill the positions. (d) In making appointments to the committee, the appointing authorities shall strive to ensure the committee's membership is representative of the state's geographic and demographic composition with appropriate attention to the representation of women and minorities. (e) The governor shall appoint a chair and vice chair of the committee, whose terms shall expire on December 31 of the year in which they are appointed or upon the appointment of their successors by the governor, whichever is later. (f) (1) The chair of the committee shall call meetings of the committee and shall preside at all regular and special meetings of the committee, appoint members to any subcommittees established by the committee, prepare agendas with the assistance of the pharmacy director and the medical director of TennCare, and notify members of their removal from the committee. (2) The vice chair shall exercise all powers of the chair in the event of the absence or inability of the chair to serve and shall perform other duties as the chair may assign to the vice chair. (g) Committee meetings shall follow Robert's Revised Rules of Order. (h) Committee meetings shall be subject to title 8, chapter 44; provided, however, that notice of meetings and the agenda for the meetings shall be made available to the public not less than ten (10) days prior to any meeting of the committee. (i) Committee decisions shall be made based on affirmative votes of the majority of members present at official meetings. (j) The committee shall keep minutes of all meetings including votes on all recommendations regarding drugs to be included on the state preferred drug list. (k) A quorum shall be established by the presence of eight (8) committee members present at an official meeting. (l) The chair may request that other physicians, pharmacists, faculty members of institutions of higher learning, or medical experts who participate in various subspecialties act as consultants to the committee as needed. (m) Vacancies shall be filled by the appropriate appointing authority in the same manner as full terms for the remainder of the unexpired term. (n) (1) The TennCare pharmacy advisory committee shall have recommendation authority over any new proposed deletions or additions to drugs currently on the TennCare bureau's auto-exemption list. It is the legislative intent that, insofar as practical, the TennCare bureau shall have the benefit of the committee's recommendations prior to deleting or adding a drug from the auto-exemption list. (2) The pharmacy advisory committee shall establish a special review subcommittee comprised of practicing medical specialists and medical faculty members of institutions of higher learning with expertise in the usage and prescribing of the medications under review to provide expert advice on the new proposed changes. The subcommittee shall be appointed by the chairman in consultation with members of the pharmacy advisory committee. (3) Meetings of the special review subcommittee established pursuant to this subsection (n) shall meet the requirements of the state's open meetings law, compiled in title 8, chapter 44, and documents relating to any recommendations made by the subcommittee to limit access to a medication or biological under review shall be available under the open records law. Members of the public attending the meeting shall be granted the opportunity to comment on information presented prior to the subcommittee making its final recommendation. Amended by 2016 Tenn. Acts, ch. 1079, s 7, eff. 7/1/2016. Acts 2003 , ch. 350, § 1; 2005, ch. 153, §§ 1, 2; 2009 , ch. 509, § 1; 2012 , ch. 699, §§ 3, 4; 2012 , ch. 825, § 1.
(a) There is established in the department of finance and administration a state TennCare pharmacy advisory committee. The committee shall make recommendations regarding a preferred drug list (PDL) to govern all state expenditures for prescription drugs for the TennCare program.
(b) (1) The state TennCare pharmacy advisory committee shall be composed of fifteen (15) members. Except for initial appointments, members shall be appointed to three-year terms. (2) Appointments by the governor shall be made as follows: (A) One (1) practicing psychiatrist who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested psychiatric groups, including, but not limited to, the Tennessee Psychiatric Association. The initial appointee shall serve a three-year term; (B) One (1) practicing nurse practitioner or physician assistant who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested nursing or physician assistant groups, including, but not limited to, the Tennessee Nurses Association or the Tennessee Academy of Physician Assistants. The initial appointee shall serve a one-year term; (C) One (1) practicing physician who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested geriatric groups, including, but not limited to, the Tennessee Geriatric Society and the Tennessee Chapter of the American Association of Retired Persons, and who is a gerontologist or whose practice otherwise is primarily among the aged. The initial appointee shall serve a two-year term; (D) One (1) practicing pediatrician who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested pediatric groups, including, but not limited to, the Tennessee Chapter of the American Academy of Pediatrics. The initial appointee shall serve a one-year term; (E) One (1) family practitioner who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested family physician groups, including, but not limited to, the Tennessee Academy of Family Physicians. The initial appointee shall serve a two-year term; (F) One (1) practicing cardiologist who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested cardiology groups, including, but not limited to, the Tennessee Chapter of the American College of Cardiology. The initial appointee shall serve a three-year term; (G) One (1) practicing pharmacist who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested chain drug groups, including, but not limited to, the Tennessee Chain Drug Council. The initial appointee shall serve a one-year term; (H) One (1) pharmacy director from a managed care organization participating in the TennCare program. The initial appointee shall serve a two-year term; and (I) One (1) member of an organization engaged in advocacy on behalf of members of the TennCare program. The initial appointee shall serve a three-year term. (3) Appointments by the speaker of the senate shall be made as follows: (A) One (1) general internist who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested medical groups, including, but not limited to, the Tennessee Medical Association. The initial appointee shall serve a three-year term; and (B) One (1) practicing pharmacist who is engaged in the retail distribution of prescription drugs and who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested pharmacist groups, including, but not limited to, the Tennessee Pharmacists Association. The initial appointee shall serve a two-year term. (4) Appointments by the speaker of the house of representatives shall be made as follows: (A) One (1) general internist who participates in the TennCare program from a list of all general internists provided by interested medical groups, including, but not limited to, the Tennessee Chapter of the American College of Physicians. The initial appointee shall serve a one-year term; and (B) One (1) practicing pharmacist who is engaged in the distribution of prescription drugs in the nursing home industry and who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested pharmacist groups, including, but not limited to, the Tennessee Pharmacists Association. The initial appointee shall serve a three-year term. (5) The pharmacy director and medical director of TennCare; the chair of the health committee of the house of representatives, or the chair's designee; and the chair of the health and welfare committee of the senate, or the chair's designee shall serve as ex officio members of the state TennCare pharmacy advisory committee.
(1) The state TennCare pharmacy advisory committee shall be composed of fifteen (15) members. Except for initial appointments, members shall be appointed to three-year terms.
(2) Appointments by the governor shall be made as follows: (A) One (1) practicing psychiatrist who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested psychiatric groups, including, but not limited to, the Tennessee Psychiatric Association. The initial appointee shall serve a three-year term; (B) One (1) practicing nurse practitioner or physician assistant who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested nursing or physician assistant groups, including, but not limited to, the Tennessee Nurses Association or the Tennessee Academy of Physician Assistants. The initial appointee shall serve a one-year term; (C) One (1) practicing physician who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested geriatric groups, including, but not limited to, the Tennessee Geriatric Society and the Tennessee Chapter of the American Association of Retired Persons, and who is a gerontologist or whose practice otherwise is primarily among the aged. The initial appointee shall serve a two-year term; (D) One (1) practicing pediatrician who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested pediatric groups, including, but not limited to, the Tennessee Chapter of the American Academy of Pediatrics. The initial appointee shall serve a one-year term; (E) One (1) family practitioner who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested family physician groups, including, but not limited to, the Tennessee Academy of Family Physicians. The initial appointee shall serve a two-year term; (F) One (1) practicing cardiologist who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested cardiology groups, including, but not limited to, the Tennessee Chapter of the American College of Cardiology. The initial appointee shall serve a three-year term; (G) One (1) practicing pharmacist who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested chain drug groups, including, but not limited to, the Tennessee Chain Drug Council. The initial appointee shall serve a one-year term; (H) One (1) pharmacy director from a managed care organization participating in the TennCare program. The initial appointee shall serve a two-year term; and (I) One (1) member of an organization engaged in advocacy on behalf of members of the TennCare program. The initial appointee shall serve a three-year term.
(A) One (1) practicing psychiatrist who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested psychiatric groups, including, but not limited to, the Tennessee Psychiatric Association. The initial appointee shall serve a three-year term;
(B) One (1) practicing nurse practitioner or physician assistant who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested nursing or physician assistant groups, including, but not limited to, the Tennessee Nurses Association or the Tennessee Academy of Physician Assistants. The initial appointee shall serve a one-year term;
(C) One (1) practicing physician who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested geriatric groups, including, but not limited to, the Tennessee Geriatric Society and the Tennessee Chapter of the American Association of Retired Persons, and who is a gerontologist or whose practice otherwise is primarily among the aged. The initial appointee shall serve a two-year term;
(D) One (1) practicing pediatrician who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested pediatric groups, including, but not limited to, the Tennessee Chapter of the American Academy of Pediatrics. The initial appointee shall serve a one-year term;
(E) One (1) family practitioner who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested family physician groups, including, but not limited to, the Tennessee Academy of Family Physicians. The initial appointee shall serve a two-year term;
(F) One (1) practicing cardiologist who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested cardiology groups, including, but not limited to, the Tennessee Chapter of the American College of Cardiology. The initial appointee shall serve a three-year term;
(G) One (1) practicing pharmacist who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested chain drug groups, including, but not limited to, the Tennessee Chain Drug Council. The initial appointee shall serve a one-year term;
(H) One (1) pharmacy director from a managed care organization participating in the TennCare program. The initial appointee shall serve a two-year term; and
(I) One (1) member of an organization engaged in advocacy on behalf of members of the TennCare program. The initial appointee shall serve a three-year term.
(3) Appointments by the speaker of the senate shall be made as follows: (A) One (1) general internist who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested medical groups, including, but not limited to, the Tennessee Medical Association. The initial appointee shall serve a three-year term; and (B) One (1) practicing pharmacist who is engaged in the retail distribution of prescription drugs and who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested pharmacist groups, including, but not limited to, the Tennessee Pharmacists Association. The initial appointee shall serve a two-year term.
(A) One (1) general internist who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested medical groups, including, but not limited to, the Tennessee Medical Association. The initial appointee shall serve a three-year term; and
(B) One (1) practicing pharmacist who is engaged in the retail distribution of prescription drugs and who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested pharmacist groups, including, but not limited to, the Tennessee Pharmacists Association. The initial appointee shall serve a two-year term.
(4) Appointments by the speaker of the house of representatives shall be made as follows: (A) One (1) general internist who participates in the TennCare program from a list of all general internists provided by interested medical groups, including, but not limited to, the Tennessee Chapter of the American College of Physicians. The initial appointee shall serve a one-year term; and (B) One (1) practicing pharmacist who is engaged in the distribution of prescription drugs in the nursing home industry and who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested pharmacist groups, including, but not limited to, the Tennessee Pharmacists Association. The initial appointee shall serve a three-year term.
(A) One (1) general internist who participates in the TennCare program from a list of all general internists provided by interested medical groups, including, but not limited to, the Tennessee Chapter of the American College of Physicians. The initial appointee shall serve a one-year term; and
(B) One (1) practicing pharmacist who is engaged in the distribution of prescription drugs in the nursing home industry and who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested pharmacist groups, including, but not limited to, the Tennessee Pharmacists Association. The initial appointee shall serve a three-year term.
(5) The pharmacy director and medical director of TennCare; the chair of the health committee of the house of representatives, or the chair's designee; and the chair of the health and welfare committee of the senate, or the chair's designee shall serve as ex officio members of the state TennCare pharmacy advisory committee.
(c) The appointing authorities shall consult with the interested groups listed in subsection (b) to determine qualified persons to fill the positions.
(d) In making appointments to the committee, the appointing authorities shall strive to ensure the committee's membership is representative of the state's geographic and demographic composition with appropriate attention to the representation of women and minorities.
(e) The governor shall appoint a chair and vice chair of the committee, whose terms shall expire on December 31 of the year in which they are appointed or upon the appointment of their successors by the governor, whichever is later.
(f) (1) The chair of the committee shall call meetings of the committee and shall preside at all regular and special meetings of the committee, appoint members to any subcommittees established by the committee, prepare agendas with the assistance of the pharmacy director and the medical director of TennCare, and notify members of their removal from the committee. (2) The vice chair shall exercise all powers of the chair in the event of the absence or inability of the chair to serve and shall perform other duties as the chair may assign to the vice chair.
(1) The chair of the committee shall call meetings of the committee and shall preside at all regular and special meetings of the committee, appoint members to any subcommittees established by the committee, prepare agendas with the assistance of the pharmacy director and the medical director of TennCare, and notify members of their removal from the committee.
(2) The vice chair shall exercise all powers of the chair in the event of the absence or inability of the chair to serve and shall perform other duties as the chair may assign to the vice chair.
(g) Committee meetings shall follow Robert's Revised Rules of Order.
(h) Committee meetings shall be subject to title 8, chapter 44; provided, however, that notice of meetings and the agenda for the meetings shall be made available to the public not less than ten (10) days prior to any meeting of the committee.
(i) Committee decisions shall be made based on affirmative votes of the majority of members present at official meetings.
(j) The committee shall keep minutes of all meetings including votes on all recommendations regarding drugs to be included on the state preferred drug list.
(k) A quorum shall be established by the presence of eight (8) committee members present at an official meeting.
(l) The chair may request that other physicians, pharmacists, faculty members of institutions of higher learning, or medical experts who participate in various subspecialties act as consultants to the committee as needed.
(m) Vacancies shall be filled by the appropriate appointing authority in the same manner as full terms for the remainder of the unexpired term.
(n) (1) The TennCare pharmacy advisory committee shall have recommendation authority over any new proposed deletions or additions to drugs currently on the TennCare bureau's auto-exemption list. It is the legislative intent that, insofar as practical, the TennCare bureau shall have the benefit of the committee's recommendations prior to deleting or adding a drug from the auto-exemption list. (2) The pharmacy advisory committee shall establish a special review subcommittee comprised of practicing medical specialists and medical faculty members of institutions of higher learning with expertise in the usage and prescribing of the medications under review to provide expert advice on the new proposed changes. The subcommittee shall be appointed by the chairman in consultation with members of the pharmacy advisory committee. (3) Meetings of the special review subcommittee established pursuant to this subsection (n) shall meet the requirements of the state's open meetings law, compiled in title 8, chapter 44, and documents relating to any recommendations made by the subcommittee to limit access to a medication or biological under review shall be available under the open records law. Members of the public attending the meeting shall be granted the opportunity to comment on information presented prior to the subcommittee making its final recommendation.
(1) The TennCare pharmacy advisory committee shall have recommendation authority over any new proposed deletions or additions to drugs currently on the TennCare bureau's auto-exemption list. It is the legislative intent that, insofar as practical, the TennCare bureau shall have the benefit of the committee's recommendations prior to deleting or adding a drug from the auto-exemption list.
(2) The pharmacy advisory committee shall establish a special review subcommittee comprised of practicing medical specialists and medical faculty members of institutions of higher learning with expertise in the usage and prescribing of the medications under review to provide expert advice on the new proposed changes. The subcommittee shall be appointed by the chairman in consultation with members of the pharmacy advisory committee.
(3) Meetings of the special review subcommittee established pursuant to this subsection (n) shall meet the requirements of the state's open meetings law, compiled in title 8, chapter 44, and documents relating to any recommendations made by the subcommittee to limit access to a medication or biological under review shall be available under the open records law. Members of the public attending the meeting shall be granted the opportunity to comment on information presented prior to the subcommittee making its final recommendation.
Amended by 2016 Tenn. Acts, ch. 1079, s 7, eff. 7/1/2016.
Acts 2003 , ch. 350, § 1; 2005, ch. 153, §§ 1, 2; 2009 , ch. 509, § 1; 2012 , ch. 699, §§ 3, 4; 2012 , ch. 825, § 1.
Tenn. Code Ann. § 71-1-205 — TN Code / Title 71 / Chapter 1 / Section 71-1-205
Procedures for advance payments - Limitation - Appropriation
Status: in_force

(a) The commissioner of finance and administration is directed to establish procedures to provide for the advance payments authorized in § 71-1-201 . At the termination of the contract or upon termination of provision of contracted social service by the agency, the department of human services shall withhold any outstanding advance from funds otherwise payable to the agency under the contract with the department. (b) The advance payments shall not exceed an amount appropriated for the advance payments in the general appropriations act for each fiscal year. Acts 1976, ch. 454, § 5; 1978, ch. 887, § 1; T.C.A., § 14-2405; Acts 1984, ch. 789, § 2; T.C.A., § 14-32-105.
(a) The commissioner of finance and administration is directed to establish procedures to provide for the advance payments authorized in § 71-1-201 . At the termination of the contract or upon termination of provision of contracted social service by the agency, the department of human services shall withhold any outstanding advance from funds otherwise payable to the agency under the contract with the department.
(b) The advance payments shall not exceed an amount appropriated for the advance payments in the general appropriations act for each fiscal year.
Acts 1976, ch. 454, § 5; 1978, ch. 887, § 1; T.C.A., § 14-2405; Acts 1984, ch. 789, § 2; T.C.A., § 14-32-105.
Tenn. Code Ann. § 71-4-808 — TN Code / Title 71 / Chapter 4 / Section 71-4-808
Authority to offer investment options to participants
Status: in_force

Notwithstanding any other law to the contrary, the trustees shall be authorized to offer investment options to eligible individuals participating in the qualified ABLE program. Acts 2015, ch. 470, § 8.
Notwithstanding any other law to the contrary, the trustees shall be authorized to offer investment options to eligible individuals participating in the qualified ABLE program.
Acts 2015, ch. 470, § 8.
Tenn. Code Ann. § 71-5-182 — TN Code / Title 71 / Chapter 5 / Section 71-5-182
Violations - Damages - Definitions
Status: in_force

(a) Subject to subdivision (a)(2), any person who: (1) (A) Knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval under the medicaid program; (B) Knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim under the medicaid program; (C) Conspires to commit a violation of subdivision (a)(1)(A), (a)(1)((B), or (a)(1)((D); or (D) Knowingly makes, uses, or causes to be made or used, a false record or statement material to an obligation to pay or transmit money, or property to the state, or knowingly conceals, or knowingly and improperly, avoids, or decreases an obligation to pay or transmit money or property to the state, relative to the medicaid program; is liable to the state for a civil penalty of not less than five thousand dollars ($5,000) and not more than twenty-five thousand dollars ($25,000), adjusted by the Federal Civil Penalties Inflation Adjustment Act of 1990 ( 28 U.S.C. § 2461 note); Public Law 101-410, plus three (3) times the amount of damages which the state sustains because of the act of that person. (2) However, if the court finds that: (A) The person committing the violation of this subsection (a) furnished officials of the state responsible for investigating false claims violations with all information known to such person about the violation within thirty (30) days after the date on which the defendant first obtained the information; (B) The person fully cooperated with any state investigation of such violation; and (C) At the time such person furnished the state with the information about the violation, no criminal prosecution, civil action, or administrative action had commenced under §§ 71-5-181 - 71-5-186 with respect to the violation, and the person did not have actual knowledge of the existence of an investigation into the violation; the court may assess not less than two (2) times the amount of damages which the state sustains because of the act of the person. (3) A person violating this subsection (a) shall also be liable for the costs of a civil action brought to recover any such penalty or damages. (b) For purposes of this section, "knowing" and "knowingly" mean that a person, with respect to information: (1) Has actual knowledge of the information; (2) Acts in deliberate ignorance of the truth or falsity of the information; or (3) Acts in reckless disregard of the truth or falsity of the information, and no proof of specific intent to defraud is required. (c) "Claim" means any request or demand, whether under a contract or otherwise, for money or property and whether or not the state has title to the money or property, that is presented to any employee, officer, or agent of the state, or is made to any contractor, grantee, or other recipient, if the money or property is to be spent or used on the state's behalf or to advance a state program or interest, and if the state provides or has provided any portion of the money or property requested or demanded; or if the state will reimburse such contractor, grantee, or other recipient for any portion of the money or property which is requested or demanded; and does not include requests or demands for money or property that the state has paid to an individual as compensation for state employment or as an income subsidy with no restrictions on that individual's use of the money or property. (d) "Obligation" means an established duty, whether or not fixed, arising from an express or implied contractual, grantor-grantee, or licensor-licensee relationship, from a fee-based or similar relationship, from statute or regulation, or from the retention of any overpayment. (e) "Material" means having a natural tendency to influence, or be capable of influencing, the payment or receipt of money or property. (f) Any person who engages, has engaged or proposes to engage in any act described by subsection (a) may be enjoined in any court of competent jurisdiction in an action brought by the attorney general and reporter. The action shall be brought in the name of the state and shall be granted if it is clearly shown that the state's rights are being violated by such person or entity and the state will suffer immediate and irreparable injury, loss or damage pending a final judgment in the action, or that the acts or omissions of such person or entity will tend to render such final judgment ineffectual. The court may make such orders or judgments, including the appointment of a receiver, as may be necessary to prevent any act described by subsection (a) by any person or entity, or as may be necessary to restore to the medicaid program any money or property, real or personal, which may have been acquired by means of such act. Amended by 2013 Tenn. Acts, ch. 99, s 1, eff. 4/11/2013. Acts 1993, ch. 364, § 2; 2004, ch. 784, § 2; 2012 , ch. 806, §§ 1 - 5.
(a) Subject to subdivision (a)(2), any person who: (1) (A) Knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval under the medicaid program; (B) Knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim under the medicaid program; (C) Conspires to commit a violation of subdivision (a)(1)(A), (a)(1)((B), or (a)(1)((D); or (D) Knowingly makes, uses, or causes to be made or used, a false record or statement material to an obligation to pay or transmit money, or property to the state, or knowingly conceals, or knowingly and improperly, avoids, or decreases an obligation to pay or transmit money or property to the state, relative to the medicaid program; is liable to the state for a civil penalty of not less than five thousand dollars ($5,000) and not more than twenty-five thousand dollars ($25,000), adjusted by the Federal Civil Penalties Inflation Adjustment Act of 1990 ( 28 U.S.C. § 2461 note); Public Law 101-410, plus three (3) times the amount of damages which the state sustains because of the act of that person. (2) However, if the court finds that: (A) The person committing the violation of this subsection (a) furnished officials of the state responsible for investigating false claims violations with all information known to such person about the violation within thirty (30) days after the date on which the defendant first obtained the information; (B) The person fully cooperated with any state investigation of such violation; and (C) At the time such person furnished the state with the information about the violation, no criminal prosecution, civil action, or administrative action had commenced under §§ 71-5-181 - 71-5-186 with respect to the violation, and the person did not have actual knowledge of the existence of an investigation into the violation; the court may assess not less than two (2) times the amount of damages which the state sustains because of the act of the person. (3) A person violating this subsection (a) shall also be liable for the costs of a civil action brought to recover any such penalty or damages.
(1) (A) Knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval under the medicaid program; (B) Knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim under the medicaid program; (C) Conspires to commit a violation of subdivision (a)(1)(A), (a)(1)((B), or (a)(1)((D); or (D) Knowingly makes, uses, or causes to be made or used, a false record or statement material to an obligation to pay or transmit money, or property to the state, or knowingly conceals, or knowingly and improperly, avoids, or decreases an obligation to pay or transmit money or property to the state, relative to the medicaid program; is liable to the state for a civil penalty of not less than five thousand dollars ($5,000) and not more than twenty-five thousand dollars ($25,000), adjusted by the Federal Civil Penalties Inflation Adjustment Act of 1990 ( 28 U.S.C. § 2461 note); Public Law 101-410, plus three (3) times the amount of damages which the state sustains because of the act of that person.
(A) Knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval under the medicaid program;
(B) Knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim under the medicaid program;
(C) Conspires to commit a violation of subdivision (a)(1)(A), (a)(1)((B), or (a)(1)((D); or
(D) Knowingly makes, uses, or causes to be made or used, a false record or statement material to an obligation to pay or transmit money, or property to the state, or knowingly conceals, or knowingly and improperly, avoids, or decreases an obligation to pay or transmit money or property to the state, relative to the medicaid program; is liable to the state for a civil penalty of not less than five thousand dollars ($5,000) and not more than twenty-five thousand dollars ($25,000), adjusted by the Federal Civil Penalties Inflation Adjustment Act of 1990 ( 28 U.S.C. § 2461 note); Public Law 101-410, plus three (3) times the amount of damages which the state sustains because of the act of that person.
is liable to the state for a civil penalty of not less than five thousand dollars ($5,000) and not more than twenty-five thousand dollars ($25,000), adjusted by the Federal Civil Penalties Inflation Adjustment Act of 1990 ( 28 U.S.C. § 2461 note); Public Law 101-410, plus three (3) times the amount of damages which the state sustains because of the act of that person.
(2) However, if the court finds that: (A) The person committing the violation of this subsection (a) furnished officials of the state responsible for investigating false claims violations with all information known to such person about the violation within thirty (30) days after the date on which the defendant first obtained the information; (B) The person fully cooperated with any state investigation of such violation; and (C) At the time such person furnished the state with the information about the violation, no criminal prosecution, civil action, or administrative action had commenced under §§ 71-5-181 - 71-5-186 with respect to the violation, and the person did not have actual knowledge of the existence of an investigation into the violation; the court may assess not less than two (2) times the amount of damages which the state sustains because of the act of the person.
(A) The person committing the violation of this subsection (a) furnished officials of the state responsible for investigating false claims violations with all information known to such person about the violation within thirty (30) days after the date on which the defendant first obtained the information;
(B) The person fully cooperated with any state investigation of such violation; and
(C) At the time such person furnished the state with the information about the violation, no criminal prosecution, civil action, or administrative action had commenced under §§ 71-5-181 - 71-5-186 with respect to the violation, and the person did not have actual knowledge of the existence of an investigation into the violation; the court may assess not less than two (2) times the amount of damages which the state sustains because of the act of the person.
the court may assess not less than two (2) times the amount of damages which the state sustains because of the act of the person.
(3) A person violating this subsection (a) shall also be liable for the costs of a civil action brought to recover any such penalty or damages.
(b) For purposes of this section, "knowing" and "knowingly" mean that a person, with respect to information: (1) Has actual knowledge of the information; (2) Acts in deliberate ignorance of the truth or falsity of the information; or (3) Acts in reckless disregard of the truth or falsity of the information, and no proof of specific intent to defraud is required.
(1) Has actual knowledge of the information;
(2) Acts in deliberate ignorance of the truth or falsity of the information; or
(3) Acts in reckless disregard of the truth or falsity of the information, and no proof of specific intent to defraud is required.
(c) "Claim" means any request or demand, whether under a contract or otherwise, for money or property and whether or not the state has title to the money or property, that is presented to any employee, officer, or agent of the state, or is made to any contractor, grantee, or other recipient, if the money or property is to be spent or used on the state's behalf or to advance a state program or interest, and if the state provides or has provided any portion of the money or property requested or demanded; or if the state will reimburse such contractor, grantee, or other recipient for any portion of the money or property which is requested or demanded; and does not include requests or demands for money or property that the state has paid to an individual as compensation for state employment or as an income subsidy with no restrictions on that individual's use of the money or property.
(d) "Obligation" means an established duty, whether or not fixed, arising from an express or implied contractual, grantor-grantee, or licensor-licensee relationship, from a fee-based or similar relationship, from statute or regulation, or from the retention of any overpayment.
(e) "Material" means having a natural tendency to influence, or be capable of influencing, the payment or receipt of money or property.
(f) Any person who engages, has engaged or proposes to engage in any act described by subsection (a) may be enjoined in any court of competent jurisdiction in an action brought by the attorney general and reporter. The action shall be brought in the name of the state and shall be granted if it is clearly shown that the state's rights are being violated by such person or entity and the state will suffer immediate and irreparable injury, loss or damage pending a final judgment in the action, or that the acts or omissions of such person or entity will tend to render such final judgment ineffectual. The court may make such orders or judgments, including the appointment of a receiver, as may be necessary to prevent any act described by subsection (a) by any person or entity, or as may be necessary to restore to the medicaid program any money or property, real or personal, which may have been acquired by means of such act.
Amended by 2013 Tenn. Acts, ch. 99, s 1, eff. 4/11/2013.
Acts 1993, ch. 364, § 2; 2004, ch. 784, § 2; 2012 , ch. 806, §§ 1 - 5.
Tenn. Code Ann. § 71-3-1108 — TN Code / Title 71 / Chapter 3 / Section 71-3-1108
[Effective until 6/30/2025. See T.C.A. 71-3-1113] Program administration - Reporting and audit requirements
Status: in_force

(a) The department may administer the program directly or contract with insurance companies, managed care plans or other entities to provide services to enrollees. Payments for services to contracted entities may require the contractor to assume full or partial risk for the cost of services provided under the contract. (b) The department may contract directly with health care providers to provide services to enrollees and establish appropriate rates of payments for services. (c) The department may enter into contracts or interagency agreements with an outside entity or other state agency to assist in the administration of the program, including performing eligibility determinations and appeals. (d) The department shall establish periodic reporting requirements and audit requirements for contractors. Contractors and subcontractors shall maintain complete and detailed records as specified by the department regarding the operation of the plan, and shall provide the department and the comptroller of the treasury's office with access to records under the terms defined by the department. Acts 2006, ch. 867, § 7.
(a) The department may administer the program directly or contract with insurance companies, managed care plans or other entities to provide services to enrollees. Payments for services to contracted entities may require the contractor to assume full or partial risk for the cost of services provided under the contract.
(b) The department may contract directly with health care providers to provide services to enrollees and establish appropriate rates of payments for services.
(c) The department may enter into contracts or interagency agreements with an outside entity or other state agency to assist in the administration of the program, including performing eligibility determinations and appeals.
(d) The department shall establish periodic reporting requirements and audit requirements for contractors. Contractors and subcontractors shall maintain complete and detailed records as specified by the department regarding the operation of the plan, and shall provide the department and the comptroller of the treasury's office with access to records under the terms defined by the department.
Acts 2006, ch. 867, § 7.
Tenn. Code Ann. § 71-6-103 — TN Code / Title 71 / Chapter 6 / Section 71-6-103
Rules and regulations - Reports of abuse or neglect - Investigation - Providing protective services - Consent of adult - Duties of other agencies
Status: in_force

(a) The commissioner has the discretion to adopt such rules, regulations, procedures, guidelines, or any other expressions of policy necessary to effect the purpose of this part insofar as such action is reasonably calculated to serve the public interest. (b) (1) Any person, including, but not limited to, a physician, nurse, social worker, department personnel, coroner, medical examiner, alternate care facility employee, or caretaker, having reasonable cause to suspect that an adult has suffered abuse, neglect, or exploitation, shall report or cause reports to be made in accordance with this part. Death of the adult does not relieve one of the responsibility for reporting the circumstances surrounding the death. However, unless the report indicates that there are other adults in the same or similar situation and that an investigation and provision of protective services are necessary to prevent their possible abuse, neglect or exploitation, it shall not be necessary for the department to make an investigation of the circumstances surrounding the death; provided, that the appropriate law-enforcement agency is notified. (2) If a hospital, clinic, school, or any other organization or agency responsible for the care of adults has a specific procedure, approved by the director of adult protective services for the department, or the director's designee, for the protection of adults who are victims of abuse, neglect, or exploitation, any member of its staff whose duty to report under this part arises from the performance of the staff member's services as a member of the staff of the organization may, at the staff member's option, fulfill that duty by reporting instead to the person in charge of the organization or the organization head's designee who shall make the report in accordance with this chapter. (c) An oral or written report shall be made immediately to the department upon knowledge of the occurrence of suspected abuse, neglect, or exploitation of an adult. Any person making such a report shall provide the following information, if known: the name and address of the adult, or of any other person responsible for the adult's care; the age of the adult; the nature and extent of the abuse, neglect, or exploitation, including any evidence of previous abuse, neglect, or exploitation; the identity of the perpetrator, if known; the identity of the complainant, if possible; and any other information that the person believes might be helpful in establishing the cause of abuse, neglect, or exploitation. Each report of known or suspected abuse of an adult involving a sexual offense that is a violation of §§ 39-13-501 - 39-13-506 that occurs in a facility licensed by the department of mental health and substance abuse services as defined in § 33-2-402 , or any hospital shall also be made to the local law enforcement agency in the jurisdiction where such offense occurred. (d) Upon receipt of the report, the department shall take the following action as soon as practical: (1) Notify the appropriate law enforcement agency in all cases in which the report involves abuse, neglect, or exploitation of the adult by another person or persons; (2) Notify the appropriate licensing authority if the report concerns an adult who is a resident of, or at the time of any alleged harm is receiving services from, a facility that is required by law to be licensed or the person alleged to have caused or permitted the harm is licensed under title 63. The commissioner of health, upon becoming aware through personal knowledge, receipt of a report or otherwise, of confirmed exploitation, abuse, or neglect of a nursing home resident, shall report such instances to the Tennessee bureau of investigation for a determination by the bureau as to whether the circumstances reported constitute abuse of the medicaid program or other criminal violation; (3) Initiate an investigation of the complaint; (4) Make a written report of the initial findings together with a recommendation for further action, if indicated; and (5) After completing the evaluation, the department shall notify the person making the report of its determination. (e) Any representative of the department may enter any health facility or health service licensed by the state at any reasonable time to carry out its responsibilities under this part. (f) Any representative of the department may, with consent of the adult or caretaker, enter any private premises where any adult alleged to be abused, neglected, or exploited is found in order to investigate the need for protective services for the purpose of carrying out this part. If the adult or caretaker does not consent to the investigation, a search warrant may issue upon a showing of probable cause that an adult is being abused, neglected, or exploited, to enable a representative of the department to proceed with the investigation. (g) If a determination has been made that protective services are necessary when indicated by the investigation, the department shall provide such services within budgetary limitations, except in such cases where an adult chooses to refuse such services. (h) In the event the adult elects to accept the protective services to be provided by the department, the caretaker shall not interfere with the department when rendering such services. (i) If the adult does not consent to the receipt of protective services, or if the adult withdraws consent, the services shall be terminated, unless the department determines that the adult lacks capacity to consent, in which case it may seek court authorization to provide protective services. (j) (1) Any representative of the department actively involved in the conduct of an abuse, neglect, or exploitation investigation under this part shall be allowed access to the mental and physical health records of the adult that are in the possession of any individual, hospital, or other facility if necessary to complete the investigation mandated by this chapter. (2) To complete the investigation required by this part, any authorized representative of the department actively involved in the conduct of an investigation pursuant to this part shall be allowed access to any law enforcement records or personnel records, not otherwise specifically protected by statute, of any person who is: (A) A caretaker of the adult; or (B) The alleged perpetrator of abuse, neglect or exploitation of the adult, who is the subject of the investigation. (3) (A) If refused any information pursuant to subdivisions (j)(1) and (2), any information from any records necessary for conducting investigations pursuant to this part may be obtained upon motion by the department to the circuit, chancery or general sessions court of the county where such records are located, or in the court in which any proceeding concerning the adult may have been initiated or in the court in the county in which the investigation is being conducted. (B) The order on the department's motion may be entered ex parte upon a showing by the department of an immediate need for such information. (C) The court may enter such orders as may be necessary to ensure that the information sought is maintained pending any hearing on the motion, and to protect the information obtained from further disclosure if the information is made available to the department pursuant to the court's order. (4) (A) The department may be allowed access to financial records that are contained in any financial institution, as defined by § 45-10-102(3) : (i) Regarding: (a) The person who is the subject of the investigation; (b) Any caretaker of such person; and (c) Any alleged perpetrator of abuse, neglect or exploitation of such person; (ii) By the issuance of an administrative subpoena in the name of the commissioner or an authorized representative of the commissioner that is: (a) Directed to the financial institution; and (b) Complies with §§ 45-10-106 and 45-10-107 ; or (iii) By application, as otherwise required pursuant to § 45-10-117 , to the circuit or chancery court in the county in which the financial institution is located, or in the court in which any proceeding concerning the adult may have been initiated or in which the investigation is being conducted, for the issuance of a judicial subpoena that complies with the requirements of § 45-10-107 ; provided, that the department shall not be required to post a bond pursuant to § 45-10-107(a)(4) . (B) Nothing in this subdivision (j)(4) shall be construed to supersede the provision of financial records pursuant to the permissible acts allowed pursuant to § 45-10-103 . (5) Any records received by the department, the confidentiality of which is protected by any other statute or regulation, shall be maintained as confidential pursuant to such statutes or regulations, except for such use as may be necessary in the conduct of any proceedings pursuant to its authority pursuant to this part or title 33 or 34. (k) (1) If, as a result of its investigation, the department determines that an adult who is a resident or patient of a facility owned or operated by an administrative department of the state is in need of protective services, and the facility is unable or unwilling to take action to protect the resident or patient, the department shall make a report of its investigation, along with any recommendations for needed services to the commissioner of the department having responsibility for the facility. It shall then be the responsibility of the commissioner for that department and not the department of human services to take such steps as may be necessary to protect the adult from abuse, neglect, or exploitation and, in such cases, the affected administrative department of the state shall have standing to petition the court. (2) (A) Notwithstanding subdivision (k)(1) or any other provision of this part to the contrary, the department of human services shall not be required to investigate and the department of mental health and substance abuse services or the department of disability and aging, or their successor agencies, shall not be required to report to the department of human services any allegations of abuse, neglect or exploitation involving any person that arise from conduct occurring in any institutions operated directly by either the department of mental health and substance abuse services or the department of disability and aging. (B) Allegations of abuse, neglect or exploitation of individuals occurring in the circumstances described in subdivision (k)(2)(A) shall be investigated, respectively, by investigators of the department of mental health and substance abuse services and the department of disability and aging, or their successor agencies, who have been assigned to investigate the allegations. (l) In the event the department, or a law enforcement agency, in the course of its investigation, is unable to determine to its satisfaction that sufficient information is available to determine whether an adult is in imminent danger or lacks the capacity to consent to protective services, an order may be issued, upon a showing of probable cause that an adult lacks capacity to consent to protective services and is being abused, neglected, or exploited, to require the adult to be examined by a physician, a psychologist in consultation with a physician or a psychiatrist in order that such determination can be made. An order for examination may be issued ex parte upon affidavit or sworn testimony if the court finds that there is cause to believe that the adult may be in imminent danger and that delay for a hearing would be likely to substantially increase the adult's likelihood of irreparable physical or mental harm, or both, and/or the cessation of life. Amended by 2024 Tenn. Acts, ch. 688,s 188, eff. 7/1/2024. Amended by 2015 Tenn. Acts, ch. 387, s 1, eff. 7/1/2015. Acts 1978, ch. 899, § 1; T.C.A., § 14-2603; Acts 1980, ch. 513, §§ 3-5, 8; 1986, ch. 630, §§ 5-8; T.C.A., § 14-25-103; Acts 1993, ch. 439, § 3; 1995, ch. 486, §§ 2, 14; 1999, ch. 247, § 2; 2000, ch. 947, §§ 6, 8M; 2001, ch. 204, §§ 1, 2; 2003 , ch. 169, § 7; 2009 , ch. 212, §§ 1, 2; 2010 , ch. 1100, §§ 141, 142; 2012 , ch. 575, § 1.
(a) The commissioner has the discretion to adopt such rules, regulations, procedures, guidelines, or any other expressions of policy necessary to effect the purpose of this part insofar as such action is reasonably calculated to serve the public interest.
(b) (1) Any person, including, but not limited to, a physician, nurse, social worker, department personnel, coroner, medical examiner, alternate care facility employee, or caretaker, having reasonable cause to suspect that an adult has suffered abuse, neglect, or exploitation, shall report or cause reports to be made in accordance with this part. Death of the adult does not relieve one of the responsibility for reporting the circumstances surrounding the death. However, unless the report indicates that there are other adults in the same or similar situation and that an investigation and provision of protective services are necessary to prevent their possible abuse, neglect or exploitation, it shall not be necessary for the department to make an investigation of the circumstances surrounding the death; provided, that the appropriate law-enforcement agency is notified. (2) If a hospital, clinic, school, or any other organization or agency responsible for the care of adults has a specific procedure, approved by the director of adult protective services for the department, or the director's designee, for the protection of adults who are victims of abuse, neglect, or exploitation, any member of its staff whose duty to report under this part arises from the performance of the staff member's services as a member of the staff of the organization may, at the staff member's option, fulfill that duty by reporting instead to the person in charge of the organization or the organization head's designee who shall make the report in accordance with this chapter.
(1) Any person, including, but not limited to, a physician, nurse, social worker, department personnel, coroner, medical examiner, alternate care facility employee, or caretaker, having reasonable cause to suspect that an adult has suffered abuse, neglect, or exploitation, shall report or cause reports to be made in accordance with this part. Death of the adult does not relieve one of the responsibility for reporting the circumstances surrounding the death. However, unless the report indicates that there are other adults in the same or similar situation and that an investigation and provision of protective services are necessary to prevent their possible abuse, neglect or exploitation, it shall not be necessary for the department to make an investigation of the circumstances surrounding the death; provided, that the appropriate law-enforcement agency is notified.
(2) If a hospital, clinic, school, or any other organization or agency responsible for the care of adults has a specific procedure, approved by the director of adult protective services for the department, or the director's designee, for the protection of adults who are victims of abuse, neglect, or exploitation, any member of its staff whose duty to report under this part arises from the performance of the staff member's services as a member of the staff of the organization may, at the staff member's option, fulfill that duty by reporting instead to the person in charge of the organization or the organization head's designee who shall make the report in accordance with this chapter.
(c) An oral or written report shall be made immediately to the department upon knowledge of the occurrence of suspected abuse, neglect, or exploitation of an adult. Any person making such a report shall provide the following information, if known: the name and address of the adult, or of any other person responsible for the adult's care; the age of the adult; the nature and extent of the abuse, neglect, or exploitation, including any evidence of previous abuse, neglect, or exploitation; the identity of the perpetrator, if known; the identity of the complainant, if possible; and any other information that the person believes might be helpful in establishing the cause of abuse, neglect, or exploitation. Each report of known or suspected abuse of an adult involving a sexual offense that is a violation of §§ 39-13-501 - 39-13-506 that occurs in a facility licensed by the department of mental health and substance abuse services as defined in § 33-2-402 , or any hospital shall also be made to the local law enforcement agency in the jurisdiction where such offense occurred.
(d) Upon receipt of the report, the department shall take the following action as soon as practical: (1) Notify the appropriate law enforcement agency in all cases in which the report involves abuse, neglect, or exploitation of the adult by another person or persons; (2) Notify the appropriate licensing authority if the report concerns an adult who is a resident of, or at the time of any alleged harm is receiving services from, a facility that is required by law to be licensed or the person alleged to have caused or permitted the harm is licensed under title 63. The commissioner of health, upon becoming aware through personal knowledge, receipt of a report or otherwise, of confirmed exploitation, abuse, or neglect of a nursing home resident, shall report such instances to the Tennessee bureau of investigation for a determination by the bureau as to whether the circumstances reported constitute abuse of the medicaid program or other criminal violation; (3) Initiate an investigation of the complaint; (4) Make a written report of the initial findings together with a recommendation for further action, if indicated; and (5) After completing the evaluation, the department shall notify the person making the report of its determination.
(1) Notify the appropriate law enforcement agency in all cases in which the report involves abuse, neglect, or exploitation of the adult by another person or persons;
(2) Notify the appropriate licensing authority if the report concerns an adult who is a resident of, or at the time of any alleged harm is receiving services from, a facility that is required by law to be licensed or the person alleged to have caused or permitted the harm is licensed under title 63. The commissioner of health, upon becoming aware through personal knowledge, receipt of a report or otherwise, of confirmed exploitation, abuse, or neglect of a nursing home resident, shall report such instances to the Tennessee bureau of investigation for a determination by the bureau as to whether the circumstances reported constitute abuse of the medicaid program or other criminal violation;
(3) Initiate an investigation of the complaint;
(4) Make a written report of the initial findings together with a recommendation for further action, if indicated; and
(5) After completing the evaluation, the department shall notify the person making the report of its determination.
(e) Any representative of the department may enter any health facility or health service licensed by the state at any reasonable time to carry out its responsibilities under this part.
(f) Any representative of the department may, with consent of the adult or caretaker, enter any private premises where any adult alleged to be abused, neglected, or exploited is found in order to investigate the need for protective services for the purpose of carrying out this part. If the adult or caretaker does not consent to the investigation, a search warrant may issue upon a showing of probable cause that an adult is being abused, neglected, or exploited, to enable a representative of the department to proceed with the investigation.
(g) If a determination has been made that protective services are necessary when indicated by the investigation, the department shall provide such services within budgetary limitations, except in such cases where an adult chooses to refuse such services.
(h) In the event the adult elects to accept the protective services to be provided by the department, the caretaker shall not interfere with the department when rendering such services.
(i) If the adult does not consent to the receipt of protective services, or if the adult withdraws consent, the services shall be terminated, unless the department determines that the adult lacks capacity to consent, in which case it may seek court authorization to provide protective services.
(j) (1) Any representative of the department actively involved in the conduct of an abuse, neglect, or exploitation investigation under this part shall be allowed access to the mental and physical health records of the adult that are in the possession of any individual, hospital, or other facility if necessary to complete the investigation mandated by this chapter. (2) To complete the investigation required by this part, any authorized representative of the department actively involved in the conduct of an investigation pursuant to this part shall be allowed access to any law enforcement records or personnel records, not otherwise specifically protected by statute, of any person who is: (A) A caretaker of the adult; or (B) The alleged perpetrator of abuse, neglect or exploitation of the adult, who is the subject of the investigation. (3) (A) If refused any information pursuant to subdivisions (j)(1) and (2), any information from any records necessary for conducting investigations pursuant to this part may be obtained upon motion by the department to the circuit, chancery or general sessions court of the county where such records are located, or in the court in which any proceeding concerning the adult may have been initiated or in the court in the county in which the investigation is being conducted. (B) The order on the department's motion may be entered ex parte upon a showing by the department of an immediate need for such information. (C) The court may enter such orders as may be necessary to ensure that the information sought is maintained pending any hearing on the motion, and to protect the information obtained from further disclosure if the information is made available to the department pursuant to the court's order. (4) (A) The department may be allowed access to financial records that are contained in any financial institution, as defined by § 45-10-102(3) : (i) Regarding: (a) The person who is the subject of the investigation; (b) Any caretaker of such person; and (c) Any alleged perpetrator of abuse, neglect or exploitation of such person; (ii) By the issuance of an administrative subpoena in the name of the commissioner or an authorized representative of the commissioner that is: (a) Directed to the financial institution; and (b) Complies with §§ 45-10-106 and 45-10-107 ; or (iii) By application, as otherwise required pursuant to § 45-10-117 , to the circuit or chancery court in the county in which the financial institution is located, or in the court in which any proceeding concerning the adult may have been initiated or in which the investigation is being conducted, for the issuance of a judicial subpoena that complies with the requirements of § 45-10-107 ; provided, that the department shall not be required to post a bond pursuant to § 45-10-107(a)(4) . (B) Nothing in this subdivision (j)(4) shall be construed to supersede the provision of financial records pursuant to the permissible acts allowed pursuant to § 45-10-103 . (5) Any records received by the department, the confidentiality of which is protected by any other statute or regulation, shall be maintained as confidential pursuant to such statutes or regulations, except for such use as may be necessary in the conduct of any proceedings pursuant to its authority pursuant to this part or title 33 or 34.
(1) Any representative of the department actively involved in the conduct of an abuse, neglect, or exploitation investigation under this part shall be allowed access to the mental and physical health records of the adult that are in the possession of any individual, hospital, or other facility if necessary to complete the investigation mandated by this chapter.
(2) To complete the investigation required by this part, any authorized representative of the department actively involved in the conduct of an investigation pursuant to this part shall be allowed access to any law enforcement records or personnel records, not otherwise specifically protected by statute, of any person who is: (A) A caretaker of the adult; or (B) The alleged perpetrator of abuse, neglect or exploitation of the adult, who is the subject of the investigation.
(A) A caretaker of the adult; or
(B) The alleged perpetrator of abuse, neglect or exploitation of the adult, who is the subject of the investigation.
(3) (A) If refused any information pursuant to subdivisions (j)(1) and (2), any information from any records necessary for conducting investigations pursuant to this part may be obtained upon motion by the department to the circuit, chancery or general sessions court of the county where such records are located, or in the court in which any proceeding concerning the adult may have been initiated or in the court in the county in which the investigation is being conducted. (B) The order on the department's motion may be entered ex parte upon a showing by the department of an immediate need for such information. (C) The court may enter such orders as may be necessary to ensure that the information sought is maintained pending any hearing on the motion, and to protect the information obtained from further disclosure if the information is made available to the department pursuant to the court's order.
(A) If refused any information pursuant to subdivisions (j)(1) and (2), any information from any records necessary for conducting investigations pursuant to this part may be obtained upon motion by the department to the circuit, chancery or general sessions court of the county where such records are located, or in the court in which any proceeding concerning the adult may have been initiated or in the court in the county in which the investigation is being conducted.
(B) The order on the department's motion may be entered ex parte upon a showing by the department of an immediate need for such information.
(C) The court may enter such orders as may be necessary to ensure that the information sought is maintained pending any hearing on the motion, and to protect the information obtained from further disclosure if the information is made available to the department pursuant to the court's order.
(4) (A) The department may be allowed access to financial records that are contained in any financial institution, as defined by § 45-10-102(3) : (i) Regarding: (a) The person who is the subject of the investigation; (b) Any caretaker of such person; and (c) Any alleged perpetrator of abuse, neglect or exploitation of such person; (ii) By the issuance of an administrative subpoena in the name of the commissioner or an authorized representative of the commissioner that is: (a) Directed to the financial institution; and (b) Complies with §§ 45-10-106 and 45-10-107 ; or (iii) By application, as otherwise required pursuant to § 45-10-117 , to the circuit or chancery court in the county in which the financial institution is located, or in the court in which any proceeding concerning the adult may have been initiated or in which the investigation is being conducted, for the issuance of a judicial subpoena that complies with the requirements of § 45-10-107 ; provided, that the department shall not be required to post a bond pursuant to § 45-10-107(a)(4) . (B) Nothing in this subdivision (j)(4) shall be construed to supersede the provision of financial records pursuant to the permissible acts allowed pursuant to § 45-10-103 .
(A) The department may be allowed access to financial records that are contained in any financial institution, as defined by § 45-10-102(3) : (i) Regarding: (a) The person who is the subject of the investigation; (b) Any caretaker of such person; and (c) Any alleged perpetrator of abuse, neglect or exploitation of such person; (ii) By the issuance of an administrative subpoena in the name of the commissioner or an authorized representative of the commissioner that is: (a) Directed to the financial institution; and (b) Complies with §§ 45-10-106 and 45-10-107 ; or (iii) By application, as otherwise required pursuant to § 45-10-117 , to the circuit or chancery court in the county in which the financial institution is located, or in the court in which any proceeding concerning the adult may have been initiated or in which the investigation is being conducted, for the issuance of a judicial subpoena that complies with the requirements of § 45-10-107 ; provided, that the department shall not be required to post a bond pursuant to § 45-10-107(a)(4) .
(i) Regarding: (a) The person who is the subject of the investigation; (b) Any caretaker of such person; and (c) Any alleged perpetrator of abuse, neglect or exploitation of such person;
(a) The person who is the subject of the investigation;
(b) Any caretaker of such person; and
(c) Any alleged perpetrator of abuse, neglect or exploitation of such person;
(ii) By the issuance of an administrative subpoena in the name of the commissioner or an authorized representative of the commissioner that is: (a) Directed to the financial institution; and (b) Complies with §§ 45-10-106 and 45-10-107 ; or
(a) Directed to the financial institution; and
(b) Complies with §§ 45-10-106 and 45-10-107 ; or
(iii) By application, as otherwise required pursuant to § 45-10-117 , to the circuit or chancery court in the county in which the financial institution is located, or in the court in which any proceeding concerning the adult may have been initiated or in which the investigation is being conducted, for the issuance of a judicial subpoena that complies with the requirements of § 45-10-107 ; provided, that the department shall not be required to post a bond pursuant to § 45-10-107(a)(4) .
(B) Nothing in this subdivision (j)(4) shall be construed to supersede the provision of financial records pursuant to the permissible acts allowed pursuant to § 45-10-103 .
(5) Any records received by the department, the confidentiality of which is protected by any other statute or regulation, shall be maintained as confidential pursuant to such statutes or regulations, except for such use as may be necessary in the conduct of any proceedings pursuant to its authority pursuant to this part or title 33 or 34.
(k) (1) If, as a result of its investigation, the department determines that an adult who is a resident or patient of a facility owned or operated by an administrative department of the state is in need of protective services, and the facility is unable or unwilling to take action to protect the resident or patient, the department shall make a report of its investigation, along with any recommendations for needed services to the commissioner of the department having responsibility for the facility. It shall then be the responsibility of the commissioner for that department and not the department of human services to take such steps as may be necessary to protect the adult from abuse, neglect, or exploitation and, in such cases, the affected administrative department of the state shall have standing to petition the court. (2) (A) Notwithstanding subdivision (k)(1) or any other provision of this part to the contrary, the department of human services shall not be required to investigate and the department of mental health and substance abuse services or the department of disability and aging, or their successor agencies, shall not be required to report to the department of human services any allegations of abuse, neglect or exploitation involving any person that arise from conduct occurring in any institutions operated directly by either the department of mental health and substance abuse services or the department of disability and aging. (B) Allegations of abuse, neglect or exploitation of individuals occurring in the circumstances described in subdivision (k)(2)(A) shall be investigated, respectively, by investigators of the department of mental health and substance abuse services and the department of disability and aging, or their successor agencies, who have been assigned to investigate the allegations.
(1) If, as a result of its investigation, the department determines that an adult who is a resident or patient of a facility owned or operated by an administrative department of the state is in need of protective services, and the facility is unable or unwilling to take action to protect the resident or patient, the department shall make a report of its investigation, along with any recommendations for needed services to the commissioner of the department having responsibility for the facility. It shall then be the responsibility of the commissioner for that department and not the department of human services to take such steps as may be necessary to protect the adult from abuse, neglect, or exploitation and, in such cases, the affected administrative department of the state shall have standing to petition the court.
(2) (A) Notwithstanding subdivision (k)(1) or any other provision of this part to the contrary, the department of human services shall not be required to investigate and the department of mental health and substance abuse services or the department of disability and aging, or their successor agencies, shall not be required to report to the department of human services any allegations of abuse, neglect or exploitation involving any person that arise from conduct occurring in any institutions operated directly by either the department of mental health and substance abuse services or the department of disability and aging. (B) Allegations of abuse, neglect or exploitation of individuals occurring in the circumstances described in subdivision (k)(2)(A) shall be investigated, respectively, by investigators of the department of mental health and substance abuse services and the department of disability and aging, or their successor agencies, who have been assigned to investigate the allegations.
(A) Notwithstanding subdivision (k)(1) or any other provision of this part to the contrary, the department of human services shall not be required to investigate and the department of mental health and substance abuse services or the department of disability and aging, or their successor agencies, shall not be required to report to the department of human services any allegations of abuse, neglect or exploitation involving any person that arise from conduct occurring in any institutions operated directly by either the department of mental health and substance abuse services or the department of disability and aging.
(B) Allegations of abuse, neglect or exploitation of individuals occurring in the circumstances described in subdivision (k)(2)(A) shall be investigated, respectively, by investigators of the department of mental health and substance abuse services and the department of disability and aging, or their successor agencies, who have been assigned to investigate the allegations.
(l) In the event the department, or a law enforcement agency, in the course of its investigation, is unable to determine to its satisfaction that sufficient information is available to determine whether an adult is in imminent danger or lacks the capacity to consent to protective services, an order may be issued, upon a showing of probable cause that an adult lacks capacity to consent to protective services and is being abused, neglected, or exploited, to require the adult to be examined by a physician, a psychologist in consultation with a physician or a psychiatrist in order that such determination can be made. An order for examination may be issued ex parte upon affidavit or sworn testimony if the court finds that there is cause to believe that the adult may be in imminent danger and that delay for a hearing would be likely to substantially increase the adult's likelihood of irreparable physical or mental harm, or both, and/or the cessation of life.
Amended by 2024 Tenn. Acts, ch. 688,s 188, eff. 7/1/2024.
Amended by 2015 Tenn. Acts, ch. 387, s 1, eff. 7/1/2015.
Acts 1978, ch. 899, § 1; T.C.A., § 14-2603; Acts 1980, ch. 513, §§ 3-5, 8; 1986, ch. 630, §§ 5-8; T.C.A., § 14-25-103; Acts 1993, ch. 439, § 3; 1995, ch. 486, §§ 2, 14; 1999, ch. 247, § 2; 2000, ch. 947, §§ 6, 8M; 2001, ch. 204, §§ 1, 2; 2003 , ch. 169, § 7; 2009 , ch. 212, §§ 1, 2; 2010 , ch. 1100, §§ 141, 142; 2012 , ch. 575, § 1.
Tenn. Code Ann. § 71-5-1413 — TN Code / Title 71 / Chapter 5 / Section 71-5-1413
Acuity-based reimbursement methodology for nursing facility services
Status: in_force

(a) The commissioner shall develop and implement an acuity-based reimbursement methodology for nursing facility services, based on an individualized assessment of need, as an alternative to the current cost-based nursing facility reimbursement system. (b) The methodology may include, but is not limited to, the development of enhanced rates for specified chronic care services that may encourage the establishment of chronic care units that specialize in the care of persons with specified chronic care conditions, such as persons who are ventilator-dependent. (c) The comptroller of the treasury shall set the medicaid rates for nursing facility services under the existing cost-based nursing facility reimbursement system and any acuity-based reimbursement system developed pursuant to this section and adopted by the bureau of TennCare in a rulemaking hearing in which interested persons may provide testimony under the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. To the extent possible, any acuity-based reimbursement system shall be implemented in conjunction with the implementation of § 71-5-1407 . Nothing in this section shall prevent TennCare from implementing rate adjustments as required pursuant to an act (including an annual appropriation act) of the general assembly that requires such adjustment. Nor shall TennCare be required to promulgate a rule to implement rate adjustments that are required pursuant to an act of the general assembly, unless such implementation requires a change in the underlying rate methodology. (d) When both acuity and quality supplemental transition payments as described in § 71-5-1004 are transitioned into the medicaid per diem rates of the nursing home reimbursement system, the bureau of TennCare is authorized to adopt rules necessary to implement a new nursing home reimbursement system, subject to the following limitations: (1) Any rules promulgated by the bureau of TennCare under this subsection (d) shall be developed in consultation with the comptroller of the treasury and with the Tennessee Health Care Association; and (2) Any rules or regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act; provided, however, that the bureau of TennCare shall not promulgate emergency rules under this subsection (d) as authorized in § 4-5-208 . (e) Under any TennCare dual-eligible demonstration project, skilled nursing facilities shall be reimbursed for medicare skilled nursing facility services in an amount that is consistent with the net payment they would have received for the service absent such demonstration in a medicare fee-for-service system, taking together the primary payment by medicare and the secondary payment of cost sharing by medicaid, in accordance with the institutional crossover payment methodology set forth in the medicaid state plan. Nursing facilities participating in any TennCare dual-eligible demonstration project shall be reimbursed for medicaid nursing facility services in a manner that is consistent with the methodology for medicaid nursing facility services delivered outside the demonstration. Nothing in this section shall prevent a skilled nursing facility or nursing facility from agreeing, at its own discretion, to contract with an MCO under any alternative payment methodology including, but not limited to, shared risk or savings arrangements or quality incentive payments that may be offered under such dual demonstration in order to promote evidence-based best practices and to engage the facility in key quality improvements, such as reduced avoidable hospital admissions and reduced hospital readmissions. Amended by 2018 Tenn. Acts, ch. 836, s 10, eff. 7/1/2018. Amended by 2017 Tenn. Acts, ch. 377, s 6, eff. 7/1/2017. Amended by 2016 Tenn. Acts, ch. 883, s 16, eff. 7/1/2016. Acts 2008 , ch. 1190, § 14; 2012 , ch. 971, § 4.
(a) The commissioner shall develop and implement an acuity-based reimbursement methodology for nursing facility services, based on an individualized assessment of need, as an alternative to the current cost-based nursing facility reimbursement system.
(b) The methodology may include, but is not limited to, the development of enhanced rates for specified chronic care services that may encourage the establishment of chronic care units that specialize in the care of persons with specified chronic care conditions, such as persons who are ventilator-dependent.
(c) The comptroller of the treasury shall set the medicaid rates for nursing facility services under the existing cost-based nursing facility reimbursement system and any acuity-based reimbursement system developed pursuant to this section and adopted by the bureau of TennCare in a rulemaking hearing in which interested persons may provide testimony under the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. To the extent possible, any acuity-based reimbursement system shall be implemented in conjunction with the implementation of § 71-5-1407 . Nothing in this section shall prevent TennCare from implementing rate adjustments as required pursuant to an act (including an annual appropriation act) of the general assembly that requires such adjustment. Nor shall TennCare be required to promulgate a rule to implement rate adjustments that are required pursuant to an act of the general assembly, unless such implementation requires a change in the underlying rate methodology.
(d) When both acuity and quality supplemental transition payments as described in § 71-5-1004 are transitioned into the medicaid per diem rates of the nursing home reimbursement system, the bureau of TennCare is authorized to adopt rules necessary to implement a new nursing home reimbursement system, subject to the following limitations: (1) Any rules promulgated by the bureau of TennCare under this subsection (d) shall be developed in consultation with the comptroller of the treasury and with the Tennessee Health Care Association; and (2) Any rules or regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act; provided, however, that the bureau of TennCare shall not promulgate emergency rules under this subsection (d) as authorized in § 4-5-208 .
(1) Any rules promulgated by the bureau of TennCare under this subsection (d) shall be developed in consultation with the comptroller of the treasury and with the Tennessee Health Care Association; and
(2) Any rules or regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act; provided, however, that the bureau of TennCare shall not promulgate emergency rules under this subsection (d) as authorized in § 4-5-208 .
(e) Under any TennCare dual-eligible demonstration project, skilled nursing facilities shall be reimbursed for medicare skilled nursing facility services in an amount that is consistent with the net payment they would have received for the service absent such demonstration in a medicare fee-for-service system, taking together the primary payment by medicare and the secondary payment of cost sharing by medicaid, in accordance with the institutional crossover payment methodology set forth in the medicaid state plan. Nursing facilities participating in any TennCare dual-eligible demonstration project shall be reimbursed for medicaid nursing facility services in a manner that is consistent with the methodology for medicaid nursing facility services delivered outside the demonstration. Nothing in this section shall prevent a skilled nursing facility or nursing facility from agreeing, at its own discretion, to contract with an MCO under any alternative payment methodology including, but not limited to, shared risk or savings arrangements or quality incentive payments that may be offered under such dual demonstration in order to promote evidence-based best practices and to engage the facility in key quality improvements, such as reduced avoidable hospital admissions and reduced hospital readmissions.
Amended by 2018 Tenn. Acts, ch. 836, s 10, eff. 7/1/2018.
Amended by 2017 Tenn. Acts, ch. 377, s 6, eff. 7/1/2017.
Amended by 2016 Tenn. Acts, ch. 883, s 16, eff. 7/1/2016.
Acts 2008 , ch. 1190, § 14; 2012 , ch. 971, § 4.
Tenn. Code Ann. § 71-6-121 — TN Code / Title 71 / Chapter 6 / Section 71-6-121
Posting of contact information on adult protective service
Status: in_force

(a) All offices of physicians licensed pursuant to title 63, chapter 6 or 9, all health care facilities licensed pursuant to title 68, chapter 11, all senior centers, all community centers and all pharmacies shall post the following in the main public entrance: (1) Contact information including the statewide toll-free number of the division of adult protective services, and the number for the local district attorney general's office; and (2) A statement that a person of advanced age who may be the victim of abuse, neglect, or exploitation may seek assistance or file a complaint with the division concerning abuse, neglect, and exploitation. (b) The information listed in subsection (a) shall be posted on a sign no smaller than eleven inches (11") in width and seventeen inches (17") in height. (c) All nursing homes, assisted living facilities and any other residential facility licensed by the board of licensing health care facilities shall upon admission provide to each resident the division of adult protective services' statewide toll-free number. (d) Any licensed nursing home that complies with the requirements of § 68-11-254 shall be exempt from the requirements of subsections (a) and (b). (e) (1) All offices of physicians licensed pursuant to title 63, chapter 6 or 9, all health care facilities licensed pursuant to title 68, chapter 11, all community centers, and all pharmacies shall post in the main public entrance, on a sign no smaller than eight and one-half inches (8 1/2") in width and eleven inches (11") in height, a statement that any person, regardless of age, who may be the victim of domestic violence may call the nationwide domestic violence hotline, or any other hotline that may be determined by the departments of health and commerce and insurance and communicated to health care providers subject to this section pursuant to subdivision (e)(2), with that number printed in boldface type, for immediate assistance. (2) The departments of health and commerce and insurance, through the various regulatory and licensure boards with oversight of health care providers, shall include a statement notifying providers of the requirements of subdivision (e)(1) in the newsletters or other routine correspondences of such boards and shall post a copy of such statement on the departments' websites. The statement shall include a contact telephone number for providers to request that a copy of the statement be mailed to them. Upon initial licensure, the various boards shall also provide initial licensees with the statement along with instructions for compliance with subdivision (e)(1). (f) All offices of physicians licensed pursuant to title 63, chapter 6 or 9, all health care facilities licensed pursuant to title 68, chapter 11, all community centers, and all pharmacies shall post on a sign no smaller than eight and one-half inches (8 1/2") in width and eleven inches (11") in height in the main public entrance a statement that a teen involved in a relationship that includes dating violence may call a national toll-free hotline, with that number printed in boldface type, for immediate assistance. (g) Notwithstanding the provisions of subsections (a)-(f) regarding the size of the posters, physicians' offices, health care facilities, community centers and pharmacies are authorized to incorporate all of the information required in subsections (a)-(f) in a single poster at least eight and one-half inches (8 1/2") in width and fourteen inches (14") in height that shall be posted in the main public entrance. (h) The departments of health and commerce and insurance, through the various regulatory and licensure boards with oversight of health care providers, shall include a statement notifying providers of the requirements of subsections (a)-(g) in the newsletters or other routine correspondences of those boards and shall post a copy of the statement on the departments' websites. The statement shall include a contact telephone number for providers to request that a copy of the statement be mailed to them. Upon initial licensure, the various boards shall also provide initial licensees with the statement along with instructions for compliance with subsections (a)-(g). Acts 2004, ch. 780, § 6; 2006, ch. 804, §§ 1, 2; 2007 , ch. 446, §§ 1, 2.
(a) All offices of physicians licensed pursuant to title 63, chapter 6 or 9, all health care facilities licensed pursuant to title 68, chapter 11, all senior centers, all community centers and all pharmacies shall post the following in the main public entrance: (1) Contact information including the statewide toll-free number of the division of adult protective services, and the number for the local district attorney general's office; and (2) A statement that a person of advanced age who may be the victim of abuse, neglect, or exploitation may seek assistance or file a complaint with the division concerning abuse, neglect, and exploitation.
(1) Contact information including the statewide toll-free number of the division of adult protective services, and the number for the local district attorney general's office; and
(2) A statement that a person of advanced age who may be the victim of abuse, neglect, or exploitation may seek assistance or file a complaint with the division concerning abuse, neglect, and exploitation.
(b) The information listed in subsection (a) shall be posted on a sign no smaller than eleven inches (11") in width and seventeen inches (17") in height.
(c) All nursing homes, assisted living facilities and any other residential facility licensed by the board of licensing health care facilities shall upon admission provide to each resident the division of adult protective services' statewide toll-free number.
(d) Any licensed nursing home that complies with the requirements of § 68-11-254 shall be exempt from the requirements of subsections (a) and (b).
(e) (1) All offices of physicians licensed pursuant to title 63, chapter 6 or 9, all health care facilities licensed pursuant to title 68, chapter 11, all community centers, and all pharmacies shall post in the main public entrance, on a sign no smaller than eight and one-half inches (8 1/2") in width and eleven inches (11") in height, a statement that any person, regardless of age, who may be the victim of domestic violence may call the nationwide domestic violence hotline, or any other hotline that may be determined by the departments of health and commerce and insurance and communicated to health care providers subject to this section pursuant to subdivision (e)(2), with that number printed in boldface type, for immediate assistance. (2) The departments of health and commerce and insurance, through the various regulatory and licensure boards with oversight of health care providers, shall include a statement notifying providers of the requirements of subdivision (e)(1) in the newsletters or other routine correspondences of such boards and shall post a copy of such statement on the departments' websites. The statement shall include a contact telephone number for providers to request that a copy of the statement be mailed to them. Upon initial licensure, the various boards shall also provide initial licensees with the statement along with instructions for compliance with subdivision (e)(1).
(1) All offices of physicians licensed pursuant to title 63, chapter 6 or 9, all health care facilities licensed pursuant to title 68, chapter 11, all community centers, and all pharmacies shall post in the main public entrance, on a sign no smaller than eight and one-half inches (8 1/2") in width and eleven inches (11") in height, a statement that any person, regardless of age, who may be the victim of domestic violence may call the nationwide domestic violence hotline, or any other hotline that may be determined by the departments of health and commerce and insurance and communicated to health care providers subject to this section pursuant to subdivision (e)(2), with that number printed in boldface type, for immediate assistance.
(2) The departments of health and commerce and insurance, through the various regulatory and licensure boards with oversight of health care providers, shall include a statement notifying providers of the requirements of subdivision (e)(1) in the newsletters or other routine correspondences of such boards and shall post a copy of such statement on the departments' websites. The statement shall include a contact telephone number for providers to request that a copy of the statement be mailed to them. Upon initial licensure, the various boards shall also provide initial licensees with the statement along with instructions for compliance with subdivision (e)(1).
(f) All offices of physicians licensed pursuant to title 63, chapter 6 or 9, all health care facilities licensed pursuant to title 68, chapter 11, all community centers, and all pharmacies shall post on a sign no smaller than eight and one-half inches (8 1/2") in width and eleven inches (11") in height in the main public entrance a statement that a teen involved in a relationship that includes dating violence may call a national toll-free hotline, with that number printed in boldface type, for immediate assistance.
(g) Notwithstanding the provisions of subsections (a)-(f) regarding the size of the posters, physicians' offices, health care facilities, community centers and pharmacies are authorized to incorporate all of the information required in subsections (a)-(f) in a single poster at least eight and one-half inches (8 1/2") in width and fourteen inches (14") in height that shall be posted in the main public entrance.
(h) The departments of health and commerce and insurance, through the various regulatory and licensure boards with oversight of health care providers, shall include a statement notifying providers of the requirements of subsections (a)-(g) in the newsletters or other routine correspondences of those boards and shall post a copy of the statement on the departments' websites. The statement shall include a contact telephone number for providers to request that a copy of the statement be mailed to them. Upon initial licensure, the various boards shall also provide initial licensees with the statement along with instructions for compliance with subsections (a)-(g).
Acts 2004, ch. 780, § 6; 2006, ch. 804, §§ 1, 2; 2007 , ch. 446, §§ 1, 2.
Tenn. Code Ann. § 71-5-1418 — TN Code / Title 71 / Chapter 5 / Section 71-5-1418
Long-term care client information, referral and assistance agency
Status: in_force

(a) To address the need of this state to develop for the future the framework and infrastructure for a comprehensive long-term care system that makes an appropriate place for both institutional care and a broad array of home-based and community-based services (HBCS), this section establishes a program that is intended to provide information, referral and assistance on a wide variety of quality, cost-effective and affordable long-term care choices and that should be designed to provide data collection and individual assessment and referral to community-based services and appropriate placement in long-term care facilities. (b) As used in this section, unless the context otherwise requires: (1) "Area agency on aging" means the agency defined in § 52-8-101 ; (2) "Assessment services" means prescreening and evaluation of an individual's health and functional status to estimate the need for long-term care services and to identify appropriate service options that meet these needs; (3) "Department" means the department of disability and aging; (4) "Hospital" has the meaning ascribed to such term under § 68-11-201 ; and (5) "Nursing home" has the meaning ascribed to such term under § 68-11-201 . (c) (1) There is established a long-term care client information, referral and assistance program, which shall be administered by the department and shall be implemented by area agencies on aging in accordance with this section. (2) Individuals in the community seeking long-term care services for the elderly and disabled may obtain information about the available services and receive assistance in accessing needed services from the appropriate area agency on aging. Individuals who are initially prescreened by the area agency on aging will be referred to the local health department if determination of eligibility for medicaid-funded programs is needed. Area agency on aging staff may assist the individual to ensure that appropriate documentation is collected and available when the individual is referred to the local health or human services department for medical and financial eligibility determination. (3) [See the Compiler's Notes.] With the consent of the consumer or the consumer's representative, a copy of the data gathered by the information, referral and assistance provider during the screening process will be provided to the health department to facilitate the preadmission evaluation assessment process and to the department of human services for use in beginning the financial eligibility determination process. Staff from the health department and the department of human services will contact the applicant to collect information for assessment. (4) For those individuals already residing in nursing facilities or awaiting nursing facility placement following hospital discharge or directly seeking nursing home services, the preadmission evaluation (PAE) application will continue to be completed by the nursing facility, hospital staff or the individual's physician and submitted to the division of long-term care of the bureau of TennCare for medical criteria determination. (5) [See the Compiler's Notes.] For those determined to be medically or financially ineligible for medicaid/TennCare funded services, the area agency on aging information, referral and assistance agency will: (A) Conduct a more in-depth assessment of the person's needs; (B) Identify appropriate community services to meet those needs, including eligibility requirements; (C) Identify providers, including government agencies, private non-profit agencies, and for-profit agencies based upon rules and regulations adopted by the commission on aging and disability; (D) Provide information on "How to Select a Provider"; and (E) Offer tracking and follow-up to assure the client has received services. (6) Any entity that provides client screening and assessment services pursuant to this section shall not also directly provide long-term care services. (d) [See the Compiler's Notes.] Prior to January 1, 2000, the commissioner of health in consultation with the department and the commissioner of human services, shall adopt by rule, promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, a long-term care client assessment and referral data entry form. The purpose of this form is for data collection and referral services only, not to determine eligibility for services. Such form shall be concise and questions shall be limited to those necessary to carry out the stated purposes. The long-term care client assessment and referral data entry form shall be used by all information, referral and assistance providers. (e) [See the Compiler's Notes.] The department and the area agencies on aging shall cooperate in compiling results of all assessment services conducted under this section. Area agencies on aging may provide assessment services under this section to assist persons seeking or needing long-term care. In providing such services, the staff of the area agencies on aging shall provide assessment and referral services. (f) The department, after consultation with the commissioner of health, shall assure that each area agency on aging shall compile comprehensive resource information for use by individuals and agencies related to long-term care resources, including offices of the department of health, the department of human services and county health departments. This information shall include, but not be limited to, resources available to assist persons in selecting among all available long-term care options, including both institutional and non-institutional care, and such information shall be accurate and balanced. (g) [See the Compiler's Notes.] Area agencies on aging shall provide to all individuals, or caregivers of individuals in need of long-term care services, comprehensive information on the range of long-term care services that are appropriate for that individual and that are available in that individual's community. (h) On and after July 1, 2000, the area agencies on aging will operate or contract for a home care ombudsman program supervised by the commission on aging and disability, office of the state long-term care ombudsman. The home care ombudsman will investigate consumer/family member complaints regarding the quality of care, and assist in the resolution of problems between the consumer/family and a case manager or service provider. (i) The department shall adopt rules to govern such matters, as the department deems necessary for the administration of this program. Such rules shall be promulgated in accordance with the Uniform Administrative Procedures Act. Amended by 2024 Tenn. Acts, ch. 688,s 185, eff. 7/1/2024. Acts 1999, ch. 477, § 2; T.C.A. § 71-5-1407 ; Acts 2008 , ch. 1190, §§ 1, 8.
(a) To address the need of this state to develop for the future the framework and infrastructure for a comprehensive long-term care system that makes an appropriate place for both institutional care and a broad array of home-based and community-based services (HBCS), this section establishes a program that is intended to provide information, referral and assistance on a wide variety of quality, cost-effective and affordable long-term care choices and that should be designed to provide data collection and individual assessment and referral to community-based services and appropriate placement in long-term care facilities.
(b) As used in this section, unless the context otherwise requires: (1) "Area agency on aging" means the agency defined in § 52-8-101 ; (2) "Assessment services" means prescreening and evaluation of an individual's health and functional status to estimate the need for long-term care services and to identify appropriate service options that meet these needs; (3) "Department" means the department of disability and aging; (4) "Hospital" has the meaning ascribed to such term under § 68-11-201 ; and (5) "Nursing home" has the meaning ascribed to such term under § 68-11-201 .
(1) "Area agency on aging" means the agency defined in § 52-8-101 ;
(2) "Assessment services" means prescreening and evaluation of an individual's health and functional status to estimate the need for long-term care services and to identify appropriate service options that meet these needs;
(3) "Department" means the department of disability and aging;
(4) "Hospital" has the meaning ascribed to such term under § 68-11-201 ; and
(5) "Nursing home" has the meaning ascribed to such term under § 68-11-201 .
(c) (1) There is established a long-term care client information, referral and assistance program, which shall be administered by the department and shall be implemented by area agencies on aging in accordance with this section. (2) Individuals in the community seeking long-term care services for the elderly and disabled may obtain information about the available services and receive assistance in accessing needed services from the appropriate area agency on aging. Individuals who are initially prescreened by the area agency on aging will be referred to the local health department if determination of eligibility for medicaid-funded programs is needed. Area agency on aging staff may assist the individual to ensure that appropriate documentation is collected and available when the individual is referred to the local health or human services department for medical and financial eligibility determination. (3) [See the Compiler's Notes.] With the consent of the consumer or the consumer's representative, a copy of the data gathered by the information, referral and assistance provider during the screening process will be provided to the health department to facilitate the preadmission evaluation assessment process and to the department of human services for use in beginning the financial eligibility determination process. Staff from the health department and the department of human services will contact the applicant to collect information for assessment. (4) For those individuals already residing in nursing facilities or awaiting nursing facility placement following hospital discharge or directly seeking nursing home services, the preadmission evaluation (PAE) application will continue to be completed by the nursing facility, hospital staff or the individual's physician and submitted to the division of long-term care of the bureau of TennCare for medical criteria determination. (5) [See the Compiler's Notes.] For those determined to be medically or financially ineligible for medicaid/TennCare funded services, the area agency on aging information, referral and assistance agency will: (A) Conduct a more in-depth assessment of the person's needs; (B) Identify appropriate community services to meet those needs, including eligibility requirements; (C) Identify providers, including government agencies, private non-profit agencies, and for-profit agencies based upon rules and regulations adopted by the commission on aging and disability; (D) Provide information on "How to Select a Provider"; and (E) Offer tracking and follow-up to assure the client has received services. (6) Any entity that provides client screening and assessment services pursuant to this section shall not also directly provide long-term care services.
(1) There is established a long-term care client information, referral and assistance program, which shall be administered by the department and shall be implemented by area agencies on aging in accordance with this section.
(2) Individuals in the community seeking long-term care services for the elderly and disabled may obtain information about the available services and receive assistance in accessing needed services from the appropriate area agency on aging. Individuals who are initially prescreened by the area agency on aging will be referred to the local health department if determination of eligibility for medicaid-funded programs is needed. Area agency on aging staff may assist the individual to ensure that appropriate documentation is collected and available when the individual is referred to the local health or human services department for medical and financial eligibility determination.
(3) [See the Compiler's Notes.] With the consent of the consumer or the consumer's representative, a copy of the data gathered by the information, referral and assistance provider during the screening process will be provided to the health department to facilitate the preadmission evaluation assessment process and to the department of human services for use in beginning the financial eligibility determination process. Staff from the health department and the department of human services will contact the applicant to collect information for assessment.
(4) For those individuals already residing in nursing facilities or awaiting nursing facility placement following hospital discharge or directly seeking nursing home services, the preadmission evaluation (PAE) application will continue to be completed by the nursing facility, hospital staff or the individual's physician and submitted to the division of long-term care of the bureau of TennCare for medical criteria determination.
(5) [See the Compiler's Notes.] For those determined to be medically or financially ineligible for medicaid/TennCare funded services, the area agency on aging information, referral and assistance agency will: (A) Conduct a more in-depth assessment of the person's needs; (B) Identify appropriate community services to meet those needs, including eligibility requirements; (C) Identify providers, including government agencies, private non-profit agencies, and for-profit agencies based upon rules and regulations adopted by the commission on aging and disability; (D) Provide information on "How to Select a Provider"; and (E) Offer tracking and follow-up to assure the client has received services.
(A) Conduct a more in-depth assessment of the person's needs;
(B) Identify appropriate community services to meet those needs, including eligibility requirements;
(C) Identify providers, including government agencies, private non-profit agencies, and for-profit agencies based upon rules and regulations adopted by the commission on aging and disability;
(D) Provide information on "How to Select a Provider"; and
(E) Offer tracking and follow-up to assure the client has received services.
(6) Any entity that provides client screening and assessment services pursuant to this section shall not also directly provide long-term care services.
(d) [See the Compiler's Notes.] Prior to January 1, 2000, the commissioner of health in consultation with the department and the commissioner of human services, shall adopt by rule, promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, a long-term care client assessment and referral data entry form. The purpose of this form is for data collection and referral services only, not to determine eligibility for services. Such form shall be concise and questions shall be limited to those necessary to carry out the stated purposes. The long-term care client assessment and referral data entry form shall be used by all information, referral and assistance providers.
(e) [See the Compiler's Notes.] The department and the area agencies on aging shall cooperate in compiling results of all assessment services conducted under this section. Area agencies on aging may provide assessment services under this section to assist persons seeking or needing long-term care. In providing such services, the staff of the area agencies on aging shall provide assessment and referral services.
(f) The department, after consultation with the commissioner of health, shall assure that each area agency on aging shall compile comprehensive resource information for use by individuals and agencies related to long-term care resources, including offices of the department of health, the department of human services and county health departments. This information shall include, but not be limited to, resources available to assist persons in selecting among all available long-term care options, including both institutional and non-institutional care, and such information shall be accurate and balanced.
(g) [See the Compiler's Notes.] Area agencies on aging shall provide to all individuals, or caregivers of individuals in need of long-term care services, comprehensive information on the range of long-term care services that are appropriate for that individual and that are available in that individual's community.
(h) On and after July 1, 2000, the area agencies on aging will operate or contract for a home care ombudsman program supervised by the commission on aging and disability, office of the state long-term care ombudsman. The home care ombudsman will investigate consumer/family member complaints regarding the quality of care, and assist in the resolution of problems between the consumer/family and a case manager or service provider.
(i) The department shall adopt rules to govern such matters, as the department deems necessary for the administration of this program. Such rules shall be promulgated in accordance with the Uniform Administrative Procedures Act.
Amended by 2024 Tenn. Acts, ch. 688,s 185, eff. 7/1/2024.
Acts 1999, ch. 477, § 2; T.C.A. § 71-5-1407 ; Acts 2008 , ch. 1190, §§ 1, 8.
Tenn. Code Ann. § 71-2-401 — TN Code / Title 71 / Chapter 2 / Section 71-2-401
Part definitions
Status: in_force

As used in this part, unless the context otherwise requires: (1) "Adult day care" means services provided to five (5) or more adult recipients, for more than three (3) hours per day, by a provider of such services who is not related to such adult, pursuant to an individualized plan of care designed to maintain or restore each adult's optimal capacity for self care through medical or social services; (2) "Adult day care center" means a facility that provides adult day care services; (3) "Commissioner" means the commissioner of human services; (4) "Department" means the department of human services; and (5) "Related" means, for purposes of this part, a person who is related to the adult day care services recipient as a legal or biological parent, spouse, child, sibling, aunt, uncle, nephew or niece of any degree, grandparent or grandchild of any degree, or cousin to the third degree, or a step parent, or a step grandparent of any degree. Amended by 2017 Tenn. Acts, ch. 276,s 1, eff. 7/1/2017. Acts 1996, ch. 1058, § 2; 1997, ch. 449, § 1.
As used in this part, unless the context otherwise requires:
(1) "Adult day care" means services provided to five (5) or more adult recipients, for more than three (3) hours per day, by a provider of such services who is not related to such adult, pursuant to an individualized plan of care designed to maintain or restore each adult's optimal capacity for self care through medical or social services;
(2) "Adult day care center" means a facility that provides adult day care services;
(3) "Commissioner" means the commissioner of human services;
(4) "Department" means the department of human services; and
(5) "Related" means, for purposes of this part, a person who is related to the adult day care services recipient as a legal or biological parent, spouse, child, sibling, aunt, uncle, nephew or niece of any degree, grandparent or grandchild of any degree, or cousin to the third degree, or a step parent, or a step grandparent of any degree.
Amended by 2017 Tenn. Acts, ch. 276,s 1, eff. 7/1/2017.
Acts 1996, ch. 1058, § 2; 1997, ch. 449, § 1.
Tenn. Code Ann. § 71-5-1002 — TN Code / Title 71 / Chapter 5 / Section 71-5-1002
Legislative intent - Creation of nursing home assessment trust fund
Status: in_force

(a) It is declared to be the legislative intent that every person is exercising a taxable privilege who engages in the business of providing nursing home care. The assessment fee imposed by this part shall be in addition to all other privilege taxes. (b) The nursing home assessment trust fund is created. The general assembly intends that the proceeds of the annual assessment not be used as a justification to reduce or eliminate the state funding to the TennCare program. The fund shall not be used to replace any moneys otherwise appropriated to the TennCare program by the general assembly. (c) The trust fund shall consist of: (1) Amounts collected or received by the bureau from nursing home assessments under this part; (2) Investment earnings credited to the assets of the nursing home assessment trust fund. The state treasurer shall invest amounts deposited within the account in accordance with law, and all investment earnings shall be credited back to the fund; and (3) Any penalties levied in conjunction with the administration of this part. (d) The trust fund is created for the purpose of receiving funds as specified in this section. Collected assessment funds shall be used to secure federal matching funds available through the state medicaid plan. (e) All revenue collected pursuant to this part shall be deposited in the nursing home assessment trust fund. (f) All nursing home annual assessment fee payments made by nursing homes under this section and received by this state; all investment earnings credited to the nursing home annual assessment fee payments; any interest and penalties paid under this section by any nursing home; and all funds generated by federal matching payments made relative to the nursing home annual assessment fee shall be available to and used by the bureau of TennCare for the sole purpose of providing payment to nursing homes. (g) No part of the nursing home annual assessment fee payments made by nursing homes under this section and received by this state; the investment earnings credited to the nursing home annual assessment fee payments; the interest and penalties paid under this section by any nursing home; or the funds generated by federal matching payments made relative to the nursing home annual assessment fee shall be used for any purpose other than providing payment to nursing homes. (h) The fund shall be used exclusively for the following purposes: (1) To make expenditures for nursing facility services under the TennCare program for FY 2024-2025 at the full rates for the specified fiscal year as provided for under bureau of TennCare rules relative to the acuity- and quality-based reimbursement system and in accordance with § 71-5-105(a)(3)(B) ; (2) To provide funding for the implementation of an acuity-based reimbursement system that shall include at a minimum a quality performance component for nursing facility services and a nursing rate component. The nursing rate component shall be adjusted by the average medicaid case-mix of the facility utilizing the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Resource Utilization Group-Version 4 (RUG-IV), 48-Grouper model; and (3) To pay nursing home covered services covered for medicaid beneficiaries within medicare upper payment limits, as negotiated with the bureau of TennCare. The upper payment limit of all nursing homes shall be calculated by the bureau of TennCare using the higher of the cost-based or prospective payment system approach in accordance with 42 C.F.R. 447.272 . (4) [Deleted by 2019 amendment.] (i) Any funds remaining in the nursing home assessment trust fund after payments are made as provided for in subsection (h) shall remain in the trust fund as a reserve for future uses consistent with subsection (h). If the funds in the nursing home assessment trust fund are insufficient to meet all the purposes established in § 71-5-1004(b) , the bureau of TennCare shall not be required to procure additional funding from other sources to make the payments noted in § 71-5-1004(b) , but instead shall be permitted to reduce all payments on a pro rata basis so as not to exceed the amounts held at any time in the nursing home assessment trust fund. Amended by 2024 Tenn. Acts, ch. 1037,s 1, eff. 7/1/2024. Amended by 2023 Tenn. Acts, ch. 384, s 1, eff. 7/1/2023. Amended by 2022 Tenn. Acts, ch. 1059, s 1, eff. 7/1/2022. Amended by 2021 Tenn. Acts, ch. 530, s 1, eff. 7/1/2021. Amended by 2020 Tenn. Acts, ch. 644, s 1, eff. 7/1/2020. Amended by 2019 Tenn. Acts, ch. 423, s 1, eff. 7/1/2019. Amended by 2018 Tenn. Acts, ch. 836, s 2, eff. 7/1/2018. Amended by 2017 Tenn. Acts, ch. 377, s 1, eff. 7/1/2017. Amended by 2016 Tenn. Acts, ch. 883, s 1, eff. 7/1/2016. Amended by 2015 Tenn. Acts, ch. 360, s 2, eff. 7/1/2015. Acts 2014 , ch. 859, § 1.
(a) It is declared to be the legislative intent that every person is exercising a taxable privilege who engages in the business of providing nursing home care. The assessment fee imposed by this part shall be in addition to all other privilege taxes.
(b) The nursing home assessment trust fund is created. The general assembly intends that the proceeds of the annual assessment not be used as a justification to reduce or eliminate the state funding to the TennCare program. The fund shall not be used to replace any moneys otherwise appropriated to the TennCare program by the general assembly.
(c) The trust fund shall consist of: (1) Amounts collected or received by the bureau from nursing home assessments under this part; (2) Investment earnings credited to the assets of the nursing home assessment trust fund. The state treasurer shall invest amounts deposited within the account in accordance with law, and all investment earnings shall be credited back to the fund; and (3) Any penalties levied in conjunction with the administration of this part.
(1) Amounts collected or received by the bureau from nursing home assessments under this part;
(2) Investment earnings credited to the assets of the nursing home assessment trust fund. The state treasurer shall invest amounts deposited within the account in accordance with law, and all investment earnings shall be credited back to the fund; and
(3) Any penalties levied in conjunction with the administration of this part.
(d) The trust fund is created for the purpose of receiving funds as specified in this section. Collected assessment funds shall be used to secure federal matching funds available through the state medicaid plan.
(e) All revenue collected pursuant to this part shall be deposited in the nursing home assessment trust fund.
(f) All nursing home annual assessment fee payments made by nursing homes under this section and received by this state; all investment earnings credited to the nursing home annual assessment fee payments; any interest and penalties paid under this section by any nursing home; and all funds generated by federal matching payments made relative to the nursing home annual assessment fee shall be available to and used by the bureau of TennCare for the sole purpose of providing payment to nursing homes.
(g) No part of the nursing home annual assessment fee payments made by nursing homes under this section and received by this state; the investment earnings credited to the nursing home annual assessment fee payments; the interest and penalties paid under this section by any nursing home; or the funds generated by federal matching payments made relative to the nursing home annual assessment fee shall be used for any purpose other than providing payment to nursing homes.
(h) The fund shall be used exclusively for the following purposes: (1) To make expenditures for nursing facility services under the TennCare program for FY 2024-2025 at the full rates for the specified fiscal year as provided for under bureau of TennCare rules relative to the acuity- and quality-based reimbursement system and in accordance with § 71-5-105(a)(3)(B) ; (2) To provide funding for the implementation of an acuity-based reimbursement system that shall include at a minimum a quality performance component for nursing facility services and a nursing rate component. The nursing rate component shall be adjusted by the average medicaid case-mix of the facility utilizing the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Resource Utilization Group-Version 4 (RUG-IV), 48-Grouper model; and (3) To pay nursing home covered services covered for medicaid beneficiaries within medicare upper payment limits, as negotiated with the bureau of TennCare. The upper payment limit of all nursing homes shall be calculated by the bureau of TennCare using the higher of the cost-based or prospective payment system approach in accordance with 42 C.F.R. 447.272 . (4) [Deleted by 2019 amendment.]
(1) To make expenditures for nursing facility services under the TennCare program for FY 2024-2025 at the full rates for the specified fiscal year as provided for under bureau of TennCare rules relative to the acuity- and quality-based reimbursement system and in accordance with § 71-5-105(a)(3)(B) ;
(2) To provide funding for the implementation of an acuity-based reimbursement system that shall include at a minimum a quality performance component for nursing facility services and a nursing rate component. The nursing rate component shall be adjusted by the average medicaid case-mix of the facility utilizing the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Resource Utilization Group-Version 4 (RUG-IV), 48-Grouper model; and
(3) To pay nursing home covered services covered for medicaid beneficiaries within medicare upper payment limits, as negotiated with the bureau of TennCare. The upper payment limit of all nursing homes shall be calculated by the bureau of TennCare using the higher of the cost-based or prospective payment system approach in accordance with 42 C.F.R. 447.272 .
(4) [Deleted by 2019 amendment.]
(i) Any funds remaining in the nursing home assessment trust fund after payments are made as provided for in subsection (h) shall remain in the trust fund as a reserve for future uses consistent with subsection (h). If the funds in the nursing home assessment trust fund are insufficient to meet all the purposes established in § 71-5-1004(b) , the bureau of TennCare shall not be required to procure additional funding from other sources to make the payments noted in § 71-5-1004(b) , but instead shall be permitted to reduce all payments on a pro rata basis so as not to exceed the amounts held at any time in the nursing home assessment trust fund.
Amended by 2024 Tenn. Acts, ch. 1037,s 1, eff. 7/1/2024.
Amended by 2023 Tenn. Acts, ch. 384, s 1, eff. 7/1/2023.
Amended by 2022 Tenn. Acts, ch. 1059, s 1, eff. 7/1/2022.
Amended by 2021 Tenn. Acts, ch. 530, s 1, eff. 7/1/2021.
Amended by 2020 Tenn. Acts, ch. 644, s 1, eff. 7/1/2020.
Amended by 2019 Tenn. Acts, ch. 423, s 1, eff. 7/1/2019.
Amended by 2018 Tenn. Acts, ch. 836, s 2, eff. 7/1/2018.
Amended by 2017 Tenn. Acts, ch. 377, s 1, eff. 7/1/2017.
Amended by 2016 Tenn. Acts, ch. 883, s 1, eff. 7/1/2016.
Amended by 2015 Tenn. Acts, ch. 360, s 2, eff. 7/1/2015.
Acts 2014 , ch. 859, § 1.