Bill > HB0372

This bill establishes the "Tennessee Medicaid Modernization and Access Act of 2025," which aims to update TennCare (Tennessee's Medicaid program) reimbursement rates for key healthcare services, specifically obstetrics/gynecology, primary care, outpatient mental health, and substance use disorder treatments. The bill 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 legislation mandates that the Department of Health and Bureau of TennCare conduct annual reviews to ensure rates remain competitive, and allows healthcare providers to request administrative hearings if they believe they have received incorrect payments. Providers may also receive additional incentive payments based on quality of care and improved patient access, particularly in rural and underserved areas. The bill requires an annual joint report to legislative committees detailing the fiscal impacts, provider participation rates, and outcome metrics. Importantly, the bill does not automatically appropriate funds but calls for potential funding through federal, private, or state sources, with the intent that administrative costs will be covered in the general appropriations act. The legislation is designed to improve healthcare access, support equitable provider compensation, and enhance overall healthcare outcomes for Medicaid beneficiaries in Tennessee.

Budget and Finance, Business and Industry, Government Affairs, Health and Social Services

https://wapp.capitol.tn.gov/apps/Billinfo/default.aspx?BillNumber=HB0372&ga=114