reglab/statecodes huggingface dataset:
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-127 - Conflict with federal law - Single state agency

If it is found that any of the provisions of this part are in conflict with the single state agency requirements of the federal Medicaid Law, Title XIX, then, and in that event, the department of finance and administration shall become the single state agency.
Acts 1969, ch. 326, § 9; T.C.A., §§ 14-1928, 14-23-127.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-128 - Contracts with health maintenance organizations - Requirements

Notwithstanding any other law to the contrary, the department of health shall follow, as nearly as is practicable, the requirements of
42 U.S.C. § 1395mm
, as amended, together with any federal rules and regulations promulgated pursuant to such law, with respect to a health maintenance organization with which the state has entered into a contract for the provision of services under this part.
Acts 1981, ch. 286, § 2; T.C.A., § 14-23-128.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-129 - Charges for services of physician assistants

Charges to be reimbursed for physician assistants from medicaid funds shall not exceed sixty percent (60%) of the charges provided for licensed physicians under the medicaid program or fees charged by licensed physicians that are reasonable in the locality where the services are provided.
Acts 1983, ch. 168, § 12; T.C.A., § 14-23-129.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-131 - Contributed funds

(a)
For the purposes of this part, political subdivisions may appropriate funds directly to the department, other public agencies and private sources may transfer funds to the department, and the department may accept unconditional and unrestricted donations of such funds.
(b)
Contributed funds shall be subject to the department's administrative control and allocated as provided in the general appropriations act, except such contributions shall not reduce state general revenue funding.
(c)
At the end of any fiscal year, the unobligated balance of any such funds shall not revert to the general fund, but shall be reappropriated for these purposes in the next fiscal year.
Acts 1987, ch. 71, § 1.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-132 - Medicaid providers - Responsibilities - Changes in ownership or controlling interest

(a)
No change of ownership or controlling interest of an existing medicaid provider, including, but not limited to, hospitals, nursing home facilities, home health agencies, and pharmacies, can occur until provision is made for moneys owed to medicaid. The purchaser shall notify medicaid of the purchase at the time of ownership change and is financially liable for the outstanding liabilities to medicaid for one (1) year from the date of purchase or for one (1) year following medicaid's receipt of the provider's medicare final notice of program reimbursement, whichever is later. The purchaser shall be entitled to utilize any means available to it by law to secure and recoup these funds from the selling entity. In addition, purchasers of nursing facilities are responsible for obtaining an accurate accounting and transfer of funds held in trust for medicaid residents at the time of the change of ownership or controlling interest.
(b)
If the division of medicaid has not reimbursed a business for medicaid services provided under the medicaid program at the time the business is sold, when such an amount is determined the division of medicaid shall be required to reimburse the person owning the business; provided, that such sale included the sale of such assets.
Acts 1992, ch. 933, §§ 2, 3.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-133 - Provision of information concerning Norplant and other contraceptives

(a)
The department of human services shall provide written information concerning the availability through the medicaid program of the Norplant contraceptive implant, and other functionally equivalent contraceptives that provide similar long-lasting pregnancy prevention, to all temporary assistance for needy families (TANF) recipients or to recipients of any successor program when such persons apply for benefits or are recertified. The department shall provide information concerning the availability of birth control and contraceptive implants to all males whose incomes are below the federal poverty level and who are receiving any other state or federal government subsidies, including, but not limited to, food assistance pursuant to part 3 of this chapter, if such males also qualify for medicaid and are able to impregnate females. Such information shall also be supplied to other women of child-bearing age whose income is below the federal poverty level and are receiving any other state or federal government subsidies, including, but not limited to, food assistance pursuant to chapter 5, part 3 of this title, if such persons also qualify for medicaid. The information provided shall clearly state that qualified health care providers are available to discuss the contraceptive in more detail upon request.
(b)
Together with the information concerning availability required to be provided pursuant to subsection (a), the department shall also provide to each eligible recipient information regarding any risks involved in having such contraceptive implanted, as well as information on the use of all types of contraceptives, including abstinence, and the moral benefits of abstinence until marriage, and the health and other benefits of abstinence, which shall be disseminated in a manner that is reasonably calculated to make the information easily accessible to all recipients under the TANF program or to recipients of any successor program, as well as to other women of child-bearing age whose incomes are below the federal poverty level and who are receiving any other state or federal government subsidies, including, but not limited to, food assistance pursuant to chapter 5, part 3 of this title, if such persons also qualify for medicaid. The department's case workers will assist in making the appointment with the appropriate county health department.
Acts 1993, ch. 255, § 1; 1996, ch. 950, § 17.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-134 - Rules and regulations - Funding medical assistance

The commissioner of finance and administration is authorized to promulgate rules and regulations to effectuate the purposes of the amendments to §§
71-5-102
- 71-5-106 by Acts 1993, ch. 358. All such rules and regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
Acts 1993, ch. 358, § 7; 2007, ch. 505, §§ 1, 2.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-135 - State unemployment health care benefits - Scope - Conditions

If a person who previously had health insurance through their employer becomes uninsured due to bona fide closure of the employer's business or plant, such person, and the person's dependents shall automatically be eligible to enroll in the TennCare program at the expiration of the eighteen-month period authorized for continuing insurance coverage under COBRA. The department shall accept the application of such person prior to the expiration of the eighteen-month period so that health insurance through TennCare will begin immediately upon expiration of COBRA coverage and such person and the person's dependents will at no time be without health care coverage. However, nothing in this section shall be construed or interpreted to provide TennCare coverage in situations where a business or plant declares bankruptcy or otherwise declares it is going out of business when the purpose, primary or otherwise, of such declaration is to establish TennCare coverage for its employees and the business or plant intends to reopen under the same or another identity with essentially the same ownership or management, or both. Reopening of a business with the same or another identity and essentially the same ownership or management, or both, shall be considered refutable evidence that the earlier closure was for the purpose of establishing TennCare eligibility for the business's employees. It is the legislative intent that this section be implemented only to the extent that it is determined to be consistent with the terms, conditions and eligibility criteria of the TennCare waiver as approved by the United States department of health and human services.
Acts 1994, ch. 857, § 1.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-136 - Hold harmless requirements prohibited

No health insurer, prepaid group health plan, health maintenance organization, preferred provider organization or similar entity licensed under this part that provides or administers health insurance under the TennCare Program, shall require, by contract or otherwise, any title 63 or 68 licensee to indemnify or hold harmless such TennCare managed care organization or title 56 licensee for tort or patent or copyright infringement liability that such TennCare managed care organization or title 56 licensee incurs, experiences, or causes by act or omission, or by act or omission of the title 63 or 68 provider to the extent the act or omission was pursuant to a directive of the title 56 licensee.
Acts 1997, ch. 376, § 2.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-137 - Disclosures required of persons associated with managed care organizations

(a)
The following persons associated with a managed care organization that participates in the TennCare program shall make disclosures required in §
8-50-502
:
(1)
Officers and directors of the managed care organization;
(2)
Any person who is the legal or beneficial owner of five percent (5%) or more of the stock or other ownership interest in the managed care organization; and
(3)
Any person who controls, is controlled by or is under common control with, the managed care organization and who has entered into a management agreement, service contract, cost-sharing agreement or reinsurance contract with a managed care organization. For purposes of this subdivision (a)(3), "control" has the same meaning as set forth in §
56-11-101(b)
.
(b)
An official in the legislative branch, or an official in the executive branch and their immediate families, as such terms are defined in §
3-6-301
, shall disclose any ownership interest or other connection as an officer, employee or director that such person may have in any managed care organization that participates in the TennCare program.
(c)
The compensation from the managed care organization of all persons required to make disclosure under subsection (a) shall be disclosed in addition to the disclosure required under subsection (a).
(d)
Disclosures required by this section shall be made to the bureau of TennCare and shall be made by March 1 of each year for the previous calendar year.
Amended by 2013 Tenn. Acts, ch. 89,s 4, eff. 7/1/2013.
Acts 1999, ch. 379, § 1.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-138 - Compliance with provisions regarding authorizations for pharmacy services

Any managed care organization participating in the TennCare program shall comply with the provisions of §
56-32-138
concerning authorizations given to a pharmacy services provider for care to be delivered to an enrollee receiving TennCare benefits.
Acts 2001, ch. 340, § 3.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-141 - Eligibility of aliens for medical assistance

(a)
Aliens shall be eligible for medical assistance, including participation in the TennCare program, only to the same extent as permitted under federal law and regulations for receipt of federal financial participation under Title XIX of the federal Social Security Act, except as otherwise provided in this section.
(b)
In accordance with Section 1903(v)(1) of the federal Social Security Act, an alien shall only be eligible for the full scope of medical assistance benefits, if the alien has been lawfully admitted for permanent residence, or is otherwise permanently residing in the United States under color of law.
(c)
For purposes of this section, aliens "permanently residing in the United States under color of law" shall be interpreted to include all aliens residing in the United States with the knowledge and permission of the United States immigration and naturalization service and whose departure the United States immigration and naturalization service does not contemplate enforcing and with respect to whom federal financial participation is available under Title XIX of the federal Social Security Act.
Acts 2002, ch. 880, § 17.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-142 - Confidentiality and disclosure of proprietary information

(a)
All proprietary information, including but not limited to, provider reimbursement information provided either to the Tennessee department of commerce and insurance or to the TennCare bureau, or any successor entity operated by the state of Tennessee for the purpose of administering the TennCare program, or any successor program shall be deemed confidential and not subject to disclosure under the Tennessee Public Records Act, compiled in title 10, chapter 7. Nothing contained in this section shall be construed to conflict with or obviate §§
56-9-202(b)
and
56-9-504(f)
.
(b)
This section shall not apply to disclosures to the medicaid fraud unit of the Tennessee bureau of investigation for law enforcement activities authorized by federal or state law.
(c)
Nothing in this section shall be construed to limit access to, or use of, these records by governmental agencies performing official functions.
Acts 2002, ch. 880, § 18.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-145 - Cost effectiveness of providers

(a)
Notwithstanding any law to the contrary, any initiative, program or measure operated by the bureau of TennCare, including, but not limited to, disease management programs, may require enrollees to obtain prescription drugs, durable medical equipment, or medical supplies in such manner as the bureau of TennCare determines to be the most cost-effective.
(b)
The bureau of TennCare shall consult with Tennessee pharmacists who are providers actively participating in the TennCare pharmacy program in making a determination of cost effectiveness of any proposed pharmacy program.
Acts 2004, ch. 673, § 23.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-146 - Pharmacy lock-in program

On and after July 1, 2004, the bureau of TennCare, through its authority to promulgate rules and regulations, may implement and maintain a pharmacy lock-in program designed to address member abuse, over utilization and quality of care concerns for TennCare enrollees.
Acts 2004, ch. 673, § 28.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-147 - Personal needs allowance - Protecting nursing home residents from diversion of allowance

(a)
In determining the amount of an eligible individual's income available for the cost of long-term nursing home care authorized under this part on or after January 1, 2025, a deduction shall be made from the person's total income in the amount of seventy dollars ($70.00) per month to be treated as a personal needs allowance within the meaning of applicable federal regulations.
(b)
(1)
The health facilities commission is directed to review, and revise as necessary, recommendations previously developed to protect nursing home residents from vendors and others who would seek to provide inappropriate or unneeded goods and services, or otherwise divert personal needs allowance funds for uses other than those meeting residents' personal needs.
(2)
The recommendations shall be provided to the chair of the health and welfare committee of the senate and the chair of the health committee of the house of representatives not later than January 15, 2025.
Amended by 2024 Tenn. Acts, ch. 986,s 1, eff. 5/21/2024.
Acts 2004, ch. 851, §§ 1, 2; 2009 , ch. 592, § 1.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-149 - Disease management program

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.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-150 - Reimbursement for TennCare crossover payments

The bureau of TennCare shall reimburse pharmacies for covered products and services provided for full benefit dual eligibles as TennCare crossover claims at one hundred percent (100%) of the federal medicare program's allowable charge for participating providers.
Acts 2009, ch. 607, § 1.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-152 - Procedure to obtain data sets derived from all payer claims database - Use of data - Annual report

(a)
Pursuant to §
56-2-125(d)(2)(B)
, and no later than October 1, 2016, the deputy commissioner of finance and administration responsible for the TennCare program shall establish a procedure permitting the following to obtain data sets derived from the all payer claims database through the department authorized to access the database for the purposes authorized in §
56-2-125(b)(1)
within available resources of the bureau of TennCare:
(1)
The department of finance and administration;
(2)
The department of health;
(3)
The department of mental health and substance abuse services;
(4)
The department of disability and aging; and
(5)
Other departments of this state.
(b)
Any data retrieved from the database or the managing vendor may only be used for internal purposes of the department. The data shall be confidential and shall not be a public record for the purposes of title 10, chapter 7. If any department seeks to produce reports based upon the data as public documents, then the department shall submit a request for approval of that use of the data to the Tennessee health information committee.
(c)
The bureau of TennCare shall submit an annual report to the chairs of the health and welfare committee of the senate and the health committee of the house of representatives that shall describe the nature and purpose of any requests to utilize data from the all payer claims database submitted to the bureau or the health information committee. Any request for data from departments that cannot be provided within existing resources of the bureau shall be identified in this report. The report shall also describe the disposition made by the Tennessee health information committee of each request to utilize the data and shall detail how each member of the committee voted on each request. The bureau shall submit the report by January 15 each year.
Amended by 2024 Tenn. Acts, ch. 688,s 182, eff. 7/1/2024.
Amended by 2021 Tenn. Acts, ch. 64, s 124, eff. 3/29/2021.
Amended by 2019 Tenn. Acts, ch. 345, s 138, eff. 5/10/2019.
Added by 2016 Tenn. Acts, ch. 1079, s 4, eff. 7/1/2016.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-153 - Verification of information

(a)
Prior to awarding assistance, and on a quarterly basis thereafter, the bureau of TennCare shall verify identity information for each respective applicant and enrollee against the following:
(1)
Wage and income information maintained by state and federal sources;
(2)
Immigration status information maintained by federal citizenship and immigration services; and
(3)
Information maintained by the department of health, office of vital records.
(b)
Subsection (a) shall not take effect until the last day of the first full quarter following implementation of an automated, electronic eligibility system by the bureau of TennCare. The bureau of TennCare shall notify the executive secretary of the code commission upon implementation of an automated, electronic eligibility system.
Added by 2017 Tenn. Acts, ch. 191,s 4, eff. 12/1/2017.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-155 - Prior authorization for CRT or manual wheelchairs prohibited - Exceptions - Section definitions

(a)
A managed care organization shall not require a participant in a TennCare program to obtain and submit a prior authorization for repairing complex rehabilitation technology (CRT) or manual wheelchairs unless:
(1)
The repairs are covered under a manufacturer's warranty;
(2)
The cost of the repairs exceeds the cost to replace the CRT or manual wheelchair; or
(3)
The CRT or manual wheelchair in need of repair is subject to replacement because the age of the CRT or manual wheelchair exceeds, or is within one (1) year of the expiration of, the recommended lifespan of the CRT or manual wheelchair.
(b)
As used in this section:
(1)
"Complex rehabilitation technology" has the same meaning as defined in §
71-5-159
; and
(2)
"Managed care organization" has the same meaning as defined in §
71-5-156
.
Added by 2023 Tenn. Acts, ch. 447, s 2, eff. 7/1/2023.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-157 - Establishment of state policy to avoid use of state funds for elective abortions

(a)
It is the policy of the state to favor childbirth as integral to the health and welfare of the citizens of the state and therefore to favor family planning services that do not include elective abortions or the promotion of elective abortions within the continuum of care or services offered by the provider and to avoid the direct or indirect use of state funds to promote or support elective abortions.
(b)
In furtherance of this state policy, a waiver amendment to the existing TennCare II waiver that requires elective abortion providers be excluded from participation as providers in the TennCare program shall be submitted to the federal centers for medicare and medicaid services for approval. The waiver amendment shall be implemented within ten (10) business days of approval.
(c)
For purposes of this section, an "elective abortion provider" means any entity that performed, or operated or maintained a facility that performed, more than fifty (50) abortions in the previous year, or any affiliate of such an entity.
(d)
This section does not affect compliance with §
9-4-5116
.
Acts 2018, ch. 682, § 1.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-158 - Amendment to TennCare ll waiver relating to work and community engagement requirements for certain adult enrollees

An amendment to the existing TennCare II waiver shall be submitted to the federal centers for medicare and medicaid services (CMS) authorizing the bureau of TennCare to create reasonable work and community engagement requirements for able-bodied working age adult enrollees without dependent children under the age of six (6). The waiver shall be consistent with the most recent guidance to state medicaid directors provided by CMS concerning opportunities to promote work and community engagement in demonstration projects authorized under § 1115 of the federal social security act (
42 U.S.C. § 1315
). The state shall seek the necessary approval from the United States department of health and human services to utilize funds from the temporary assistance to needy families (TANF) program under the Families First Act of 1996, compiled in chapter 3, part 1 of this title, for eligible expenditures related to the waiver. Implementation of the waiver shall be contingent upon the available use of TANF funds or other federal appropriations to meet the requirements of the waiver.
Acts 2018, ch. 869, § 1.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-159 - Complex rehabilitation technology

(a)
As used in this section, "complex rehabilitation technology":
(1)
Means items classified within medicare as group 3, group 4, or group 5 power wheelchairs and manual wheelchairs with the HCPCS billing codes K0005 and E1161; and
(2)
Includes options and accessories related to any of such items.
(b)
The commissioner of finance and administration, or the commissioner's designee, shall recognize complex rehabilitation technology as a separate covered service from other items considered to be durable medical equipment within medicare, and must list complex rehabilitation technology benefits separately on any proposed budget document or other financial publication made available to the public if the budget document or other financial publication establishes a change in reimbursement for complex rehabilitation technology.
Added by 2019 Tenn. Acts, ch. 96,s 1, eff. 3/28/2019.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-160 - Maintenance of coverage trust fund

(a)
There is continued and revived, if necessary, a segregated account within the state treasury that shall be known as the maintenance of coverage trust fund created by Chapter 909 of the Public Acts of 2010. The fund shall not be used to replace any moneys otherwise appropriated to the TennCare program by the general assembly or to replace any moneys appropriated outside of the TennCare program.
(b)
The maintenance of coverage trust fund shall consist of:
(1)
All annual coverage assessments received by the bureau; and
(2)
Investment earnings credited to the assets of the maintenance of coverage trust fund.
(c)
Monies credited or deposited to the maintenance of coverage trust fund together with all federal matching funds shall be available to and used by the bureau only for expenditures in the TennCare program and shall include the purposes authorized in the annual coverage assessment act enacted by the general assembly and codified in this title.
Amended by 2014 Tenn. Acts, ch. 877,s 2, eff. 7/1/2014.
Amended by 2013 Tenn. Acts, ch. 250,s 2, eff. 7/1/2013.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-162 - Identification of child enrollees eligible for federal supplemental security income upon reaching 18 years of age - Counseling - Enrollment assistance

The bureau of TennCare shall establish a program that:
(1)
Identifies child enrollees in TennCare who, by reason of a disability, are likely to be eligible for federal supplemental security income upon reaching eighteen (18) years of age;
(2)
In the year prior to each eligible child enrollee's eighteenth birthday, counsels the child and the child's parent or guardian on the benefits available from and enrollment requirements for the federal supplemental security income program; and
(3)
Provides enrollment assistance to the child prior to the child's eighteenth birthday in a manner that the bureau determines is most likely to ensure that there will be no gap in TennCare eligibility or coverage due to the child reaching eighteen (18) years of age.
Added by 2019 Tenn. Acts, ch. 310,s 1, eff. 5/8/2019.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-163 - Submission of waiver in order to provide medical assistance to TennCare ll waiver population by means of block grant

(a)
The governor, acting through the commissioner of finance and administration, is directed to submit to the federal centers for medicare and medicaid services a waiver amendment to the existing TennCare II waiver, or to submit a new waiver, in order to provide medical assistance to the TennCare II waiver population by means of a block grant in accordance with this section no later than one hundred eighty (180) days after May 24, 2019. The block grant authorized by this section may convert the federal share of all medical assistance funding for this state into an allotment that is tailored to meet the needs of this state and that:
(1)
When determining the base amount for the block grant, factors the current inaccurate reflection of the state's labor costs in the state's Medicare Wage Index and the index's negative impact on healthcare delivery in this state;
(2)
Is indexed for population growth;
(3)
Is indexed for inflation and other costs;
(4)
Excludes from the block grant financing amount any expenses that are not included in the state's existing 1115 demonstration waiver;
(5)
Excludes administrative costs from the block grant financing amount and permits the state to continue to draw federal matching funds for administrative costs;
(6)
Provides the state with maximum flexibility with regard to existing federal mandates and regulations and with implementing cost controls as determined appropriate by the state, and either exempts the state from the requirements of any new mandates, regulations, or federal court orders during the period of block grant financing or increases the amount of block grant financing to offset any cost increases to the state from such mandates, regulations, or federal court orders;
(7)
Provides the state with maximum flexibility regarding pharmacy benefits including fluctuation of prescription drug costs, diabetic testing supplies, and over-the-counter medications;
(8)
Provides the state with maximum flexibility to serve other needy populations with distinct financial or healthcare needs; and
(9)
Remains at the level set according to the block grant without any decrease in the federal share of all medical assistance funding for this state based on deflation or a reduction in population.
(b)
A waiver amendment to the existing TennCare II waiver requested pursuant to subsection (a), if approved by the federal government and the commissioner of finance and administration, does not take effect unless subsequently authorized by joint resolution of the general assembly.
Added by 2019 Tenn. Acts, ch. 481,s 1, eff. 5/24/2019.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-165 - Reimbursement of ambulance service provider that provides covered service to TennCare recipient

(a)
The bureau of TennCare shall reimburse an ambulance service provider that provides a covered service to a TennCare recipient at a rate not less than sixty-seven and one-half percent (67.5%) of the federal medicare program's allowable charge for participating providers. For purposes of this section, "ambulance service provider" means a public or private ground-based ambulance service that bills for transports and has a base of operations in this state.
(b)
This section does not affect the Ground Ambulance Service Provider Assessment Act, compiled under part 15 of this chapter. Funds described under this section and part 15 of this chapter may not be used to fund the other.
(c)
The bureau of TennCare shall seek an intergovernmental transfer of funds, in consultation with, and subject to approval of, the commissioner of finance and administration for the sole purpose of increasing the rate of reimbursement to ambulance service providers that provide covered services to TennCare recipients at a rate greater than the rate described under subsection (a).
(d)
The bureau of TennCare, in consultation with and subject to approval of the commissioner of finance and administration, shall develop and implement a program substantially similar to the federal centers for medicare and medicaid services' Emergency Triage, Treat, and Transport (ET3) model, established pursuant to Section 1115A of the federal Social Security Act (
42 U.S.C. § 1315a
), in a manner that complies with this section.
Amended by 2022 Tenn. Acts, ch. 919, s 1, eff. 4/27/2022.
Acts 2020, ch. 658, §§ 1, 2.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-166 - Annual review of medications and forms of treatment for sickle cell disease, and services for enrollees with diagnosis of sickle cell disease, that are eligible for coverage under medical assistance program

(a)
This section is known and may be cited as "Terrence's Law."
(b)
The bureau of TennCare shall conduct an annual review of all medications and forms of treatment for sickle cell disease, and services for enrollees with a diagnosis of sickle cell disease, that are eligible for coverage under the medical assistance program. The purpose of the annual review is to determine if the available covered medications, treatments, and services are adequate to meet the needs of enrollees with a diagnosis of sickle cell disease, and whether the bureau should seek to add additional medications, treatments, or services.
(c)
When conducting the annual review required by this section, the bureau of TennCare shall solicit and consider input from the general public, with specific emphasis on attempting to receive input from persons or groups with knowledge and experience in the area of sickle cell disease treatment.
(d)
On or before January 15, 2022, and on or before January 15 each year thereafter, the bureau of TennCare shall submit a report to the chief clerks of the senate and the house of representatives for distribution to the appropriate subject matter committees, and to the legislative librarian, that details the bureau's findings from the annual review required by this section, as well as any recommendations to the general assembly based upon those findings. The bureau shall publish the annual report required by this subsection (d) to its website in a manner accessible by the general public.
Added by 2021 Tenn. Acts, ch. 186, s 1, eff. 4/20/2021.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-167 - Physical address requirement for telehealth providers

(a)
As used in this section:
(1)
"Healthcare provider" means a person who is licensed, certified, or authorized or permitted by the laws of this state to administer health care in the ordinary course of business or practice of a profession; and
(2)
"Telehealth provider group" means two (2) or more healthcare providers that share a common employer and provide healthcare services exclusively via telehealth.
(b)
This chapter does not require:
(1)
A vendor or healthcare provider who provides healthcare services exclusively via telehealth to maintain a physical address or site in this state in order to be eligible to enroll as a vendor or provider for the medical assistance program; or
(2)
A telehealth provider group to have a service address in this state in order to be eligible to enroll as a vendor or provider group for the medical assistance program, as long as the healthcare providers that comprise the telehealth provider group are licensed with the appropriate healthcare licensing authority in this state or are otherwise authorized by law to provide healthcare services in this state.
Added by 2023 Tenn. Acts, ch. 55, s 1, eff. 3/21/2023.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-181 - Tennessee Medicaid False Claims Act - Short title

(a)
The title of this section and §§
71-5-182
- 71-5-185 is and may be cited as the "Tennessee Medicaid False Claims Act."
(b)
"Medicaid program" as used in §§
71-5-182
- 71-5-185 includes the TennCare program and any successor program to the medicaid program.
Acts 1993, ch. 364, § 1.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-184 - Service - Limitations

(a)
A subpoena requiring the attendance of a witness at a trial or hearing conducted under §
71-5-183
may be served at any place in the United States.
(b)
A civil action under §
71-5-183
may not be brought:
(1)
More than six (6) years after the date on which the violation of §
71-5-182
is committed; or
(2)
More than three (3) years after the date when facts material to the right of action are known or reasonably should have been known by the official of the state charged with responsibility to act in the circumstances, but in no event more than ten (10) years after the date on which the violation is committed, whichever occurs last.
(c)
If the state elects to intervene and proceed with an action brought under §
71-5-183(b)
, the state may file its own complaint or amend the complaint of a person who has brought an action under §
71-5-183(b)
to clarify or add detail to the claims in which the state is intervening and to add any additional claims with respect to which the state contends it is entitled to relief. For statute of limitations purposes, any such state pleading shall relate back to the filing date of the complaint of the person who originally brought the action, to the extent that the claim of the state arises out of the conduct, transactions, or occurrences set forth, or attempted to be set forth, in the prior complaint of that person.
(d)
In any action brought under §
71-5-183
, the state shall be required to prove all essential elements of the cause of action, including damages, by a preponderance of the evidence.
(e)
Notwithstanding any other law, the Tennessee Rules of Criminal Procedure, or the Tennessee Rules of Evidence, a final judgment rendered in favor of the state in any criminal proceeding charging fraud or false statements, whether upon a verdict after trial or upon a plea of guilty or nolo contendere, shall stop the defendant from denying the essential elements of the offense in any action that involves the same transaction as in the criminal proceeding and that is brought under subsection (a) or (b) or §
71-5-183
.
Acts 1993, ch. 364, § 4; 2012, ch. 806, § 8.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-185 - Venue

Any action under §
71-5-183
may be brought in any judicial district in which the defendant or, in the case of multiple defendants, any one (1) defendant can be found, resides, transacts business, or in which any act proscribed by §
71-5-182
occurred. A summons as required by the Rules of Civil Procedure shall be issued by the appropriate district court and served at any place within or outside the United States.
Acts 1993, ch. 364, § 5.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-188 - Actuarial study of TennCare

(a)
The comptroller of the treasury may conduct an annual actuarial study of the medical assistance program and any participating managed care organizations. The final study, and the oral and written comments, shall be reported to the finance, ways and means committees of the senate and the house of representatives, the office of legislative budget analysis and the fiscal review committee of the general assembly on or before April 15 of each year.
(b)
The study will include the state's assessment of the rates paid to its contracted managed care organizations and behavioral health organizations each year. Included in the analysis will be a review of payments for hospital providers for similar services for comparable populations in other state medicaid programs. The review will be considered in determining reasonable payment rates for hospital providers, including safety net hospitals providing essential and unduplicated services and sole community provider hospitals.
(c)
In addition, the study shall include an analysis of actual provider costs. This analysis will be used to determine reasonable costs for comparison with the provider assumptions used in the study. Information used to compile this study shall be public information.
(d)
Before reporting the final study to the committees of the general assembly, the comptroller of the treasury shall release a copy of the draft study to interested parties and hold a public hearing within thirty (30) days of release, in order to afford all interested persons or their representatives an opportunity to present facts, views or arguments relative to the draft study under consideration. The agency shall afford each interested person an opportunity to present facts, views or arguments in writing, whether or not the person had an opportunity to present them orally.
Amended by 2021 Tenn. Acts, ch. 64, s 125, eff. 3/29/2021.
Amended by 2019 Tenn. Acts, ch. 345, s 139, eff. 5/10/2019.
Acts 1999, ch. 370, § 1; 2000, ch. 913, § 1; 2003 , ch. 389, § 1; 2006, ch. 820, §§ 1 - 3; 2010 , ch. 1030, § 20; 2011 , ch. 410, § 6 (c).
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-189 - Accounting of TennCare funds

The bureau of TennCare shall provide to the comptroller of the treasury on a quarterly basis an accounting of funds involved in the pharmacy rebate program, including a summary of bills and receipts.
Acts 1999, ch. 531, § 1.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 1 - MEDICAL ASSISTANCE ACT (§§ 71-5-NEW — 71-5-199) › Section 71-5-190 - TennCare prescription drug utilization review committee

(a)
In order to provide oversight of prescription drug utilization under the TennCare program, there is hereby created a TennCare prescription drug utilization review committee. The committee shall consist of: one (1) member of the house of representatives appointed by the speaker of the house; one (1) member of the senate appointed by the speaker of the senate; and two (2) pharmacists, two (2) physicians, two (2) representatives of managed care organizations, two (2) representatives of pharmaceutical companies and two (2) consumers, all of whom shall be appointed by the comptroller of the treasury. The TennCare bureau shall provide to the committee such information as the committee deems appropriate concerning the prescriptions made to TennCare enrollees who receive more than seven (7) prescriptions. The committee shall review such information and make recommendations to the health and welfare committee of the senate, the health committee of the house of representatives, and the TennCare bureau concerning potential drug interactions, abuse of prescription drugs or other appropriate matters.
(b)
(1)
Non-legislative members of the committee shall serve without compensation, but they shall be entitled to reimbursement for all necessary expenses incurred in the performance of their duties, in accordance with the comprehensive state travel regulations promulgated by the commissioner of finance and administration and approved by the attorney general and reporter.
(2)
Legislative members of the committee shall not receive from the state an expense allowance or mileage allowance paid solely in consideration for serving on or attending meetings of the committee; provided, that this subdivision (b)(2) shall at no time preclude a legislative member from receiving an expense allowance or mileage allowance otherwise payable to such member in connection with attending the general assembly.
Amended by 2021 Tenn. Acts, ch. 64, s 126, eff. 3/29/2021.
Amended by 2019 Tenn. Acts, ch. 345, s 140, eff. 5/10/2019.
Amended by 2013 Tenn. Acts, ch. 236, s 53, eff. 4/19/2013.
Acts 1999, ch. 536, § 1; 2000, ch. 796, § 1; 2011 , ch. 410, § 6 (d).