Part 1 - MEDICAL ASSISTANCE ACT

Section 71-5-NEW - [Newly enacted section not yet numbered]
Section 71-5-NEW - [Newly enacted section not yet numbered] [Effective 7/1/2024] (§ 71-5-NEW)
Section 71-5-101 - Short title
Section 71-5-102 - Purpose
Section 71-5-103 - Part definitions
Section 71-5-104 - Administration by department
Section 71-5-105 - [Effective Until 7/1/2024] Powers and duties of department - Total number of ICF/MR beds - Certificate of need exemption for DIDD public ICF/MR non-facility beds established pursuant to federal litigation
Section 71-5-105 - [Effective 7/1/2024] Powers and duties of department - Total number of ICF/MR beds - Certificate of need exemption for DIDD public ICF/MR non-facility beds established pursuant to federal litigation
Section 71-5-106 - Determination of eligibility for medical assistance
Section 71-5-107 - Kinds of medical services
Section 71-5-108 - Payment methodology for medicaid enrollees not enrolled in medicare
Section 71-5-109 - Expenditures not to exceed appropriation
Section 71-5-110 - Application for medical assistance - Application for TennCare enrollment - Notice of change in application information
Section 71-5-111 - Investigation - Determination of eligibility
Section 71-5-112 - Hearing concerning eligibility
Section 71-5-113 - Hearing concerning matters other than eligibility
Section 71-5-114 - Subpoena and examination of witnesses
Section 71-5-115 - Financial responsibility of relative - When may be considered - Reimbursement from responsible parties
Section 71-5-116 - Lien on real estate - Claim against estate - Restrictions
Section 71-5-117 - Recovery of benefits - State's right of subrogation - Assignment of insurance benefit rights - Commissioner authorized to require certain information identifying persons covered by third parties - State's right of action - Determination of subrogation interest - Attorney's fees - Remittance of net subrogation interest - Subrogation interest hearing - Legislative intent
Section 71-5-118 - Contracts with vendors - Sanctions against vendors - Grounds for actions against providers - Administrative remedy to recover benefits from applicant - Collection activity report - Applicant warning - Prompt process of hospital presumptive eligibility applications
Section 71-5-119 - Discrimination prohibited
Section 71-5-120 - Residency requirement - Determination - Appeal
Section 71-5-121 - Transfer of income or resources
Section 71-5-122 - Statement of interest of vendors or suppliers holding equity interest in hospitals, apothecaries or nursing homes
Section 71-5-123 - Statement of public officials as to interest in vendors or providers
Section 71-5-124 - Duties of department of finance and administration
Section 71-5-125 - Duties of fiscal review committee
Section 71-5-126 - Medicaid expansion under federal Patient Protection and Affordable Care Act prohibited without joint resolution of General Assembly
Section 71-5-127 - Conflict with federal law - Single state agency
Section 71-5-128 - Contracts with health maintenance organizations - Requirements
Section 71-5-129 - Charges for services of physician assistants
Section 71-5-130 - Determination of payments to vendors - Audits
Section 71-5-131 - Contributed funds
Section 71-5-132 - Medicaid providers - Responsibilities - Changes in ownership or controlling interest
Section 71-5-133 - Provision of information concerning Norplant and other contraceptives
Section 71-5-134 - Rules and regulations - Funding medical assistance
Section 71-5-135 - State unemployment health care benefits - Scope - Conditions
Section 71-5-136 - Hold harmless requirements prohibited
Section 71-5-137 - Disclosures required of persons associated with managed care organizations
Section 71-5-138 - Compliance with provisions regarding authorizations for pharmacy services
Section 71-5-139 - Protection of TennCare patients' federal and court ordered rights by health care providers receiving TennCare funds
Section 71-5-140 - Deductions for dental services paid by eligible individuals in long-term care facilities
Section 71-5-141 - Eligibility of aliens for medical assistance
Section 71-5-142 - Confidentiality and disclosure of proprietary information
Section 71-5-143 - TennCare advisory commission - Composition - Purpose - Expert assistance - Confidentiality - Conflict - Compensation
Section 71-5-144 - Medically necessary items and services
Section 71-5-145 - Cost effectiveness of providers
Section 71-5-146 - Pharmacy lock-in program
Section 71-5-147 - Personal needs allowance - Protecting nursing home residents from diversion of allowance
Section 71-5-148 - Health care safety net for uninsured
Section 71-5-149 - Disease management program
Section 71-5-150 - Reimbursement for TennCare crossover payments
Section 71-5-151 - Report on use of technical assistance groups of healthcare providers in developing episode of care
Section 71-5-152 - [Effective Until 7/1/2024] Procedure to obtain data sets derived from all payer claims database - Use of data - Annual report
Section 71-5-152 - [Effective 7/1/2024] Procedure to obtain data sets derived from all payer claims database - Use of data - Annual report
Section 71-5-153 - Verification of information
Section 71-5-154 - Annual report relating to coverage of mental health treatment
Section 71-5-155 - Prior authorization for CRT or manual wheelchairs prohibited - Exceptions - Section definitions
Section 71-5-156 - Development of policy regarding births involving neonatal abstinence syndrome and opiod use by women of childbearing age
Section 71-5-157 - Establishment of state policy to avoid use of state funds for elective abortions
Section 71-5-158 - Amendment to TennCare ll waiver relating to work and community engagement requirements for certain adult enrollees
Section 71-5-159 - Complex rehabilitation technology
Section 71-5-160 - Maintenance of coverage trust fund
Section 71-5-161 - Hospital payment rate corridors
Section 71-5-162 - Identification of child enrollees eligible for federal supplemental security income upon reaching 18 years of age - Counseling - Enrollment assistance
Section 71-5-163 - Submission of waiver in order to provide medical assistance to TennCare ll waiver population by means of block grant
Section 71-5-164 - [Effective Until 7/1/2024] Waiver for purpose of establishing Katie Beckett program
Section 71-5-164 - [Effective 7/1/2024] Waiver for purpose of establishing Katie Beckett program
Section 71-5-165 - Reimbursement of ambulance service provider that provides covered service to TennCare recipient
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
Section 71-5-167 - Physical address requirement for telehealth providers
Section 71-5-168 - 71-5-180 - Reserved
Section 71-5-181 - Tennessee Medicaid False Claims Act - Short title
Section 71-5-182 - Violations - Damages - Definitions
Section 71-5-183 - Civil actions - Employee remedies
Section 71-5-184 - Service - Limitations
Section 71-5-185 - Venue
Section 71-5-186, 71-5-187 - Reserved
Section 71-5-188 - Actuarial study of TennCare
Section 71-5-189 - Accounting of TennCare funds
Section 71-5-190 - TennCare prescription drug utilization review committee
Section 71-5-191 - Uniform TennCare claims process
Section 71-5-192 - Information management system
Section 71-5-193 - Children's mental health care - Development of interagency projects and programs
Section 71-5-194 - Spend down eligibility for medical assistance
Section 71-5-195 - Study on use of prescription drugs in nursing homes
Section 71-5-196 - Veterans education benefits
Section 71-5-197 - Authority over TennCare pharmacy purchases - Confidential information - Exemption from open meeting laws
Section 71-5-198 - Prescription drug program waiver
Section 71-5-199 - [Effective Until 7/1/2024] State preferred drug list
Section 71-5-199 - [Effective 7/1/2024] State preferred drug list