Bill > SB0334

This bill introduces the "Tennessee Medicaid Modernization and Access Act of 2025," which aims to improve TennCare (Tennessee's Medicaid program) reimbursement rates for key healthcare services, specifically obstetrics/gynecology (OB/GYN), primary care, outpatient mental health, and substance use disorder (SUD) treatment. The legislation requires TennCare to align its reimbursement rates with either the Medicare fee schedule or average commercial rates, whichever is higher, starting in calendar year 2025. The bill mandates annual reviews by the Department of Health and Bureau of TennCare to ensure ongoing alignment with current Medicare and commercial rates, and allows healthcare providers to request administrative hearings if they believe they have received incorrect reimbursement. Additionally, providers may receive extra incentive payments based on quality of care and improved patient access, particularly in rural and underserved areas. The bill requires annual reporting to legislative committees about the fiscal impacts, provider participation rates, and outcome metrics, and directs state agencies to seek federal and private funding to support these reimbursement adjustments. Importantly, the bill emphasizes improving healthcare access and provider compensation while maintaining flexibility in implementation through potential phased approaches for specific services.

Budget and Finance, Health and Social Services

https://wapp.capitol.tn.gov/apps/Billinfo/default.aspx?BillNumber=SB0334&ga=114