Bill > SB1797

This bill aims to protect qualified nursing facilities from arbitrary contract terminations by managed care organizations (MCOs), which are entities like health maintenance organizations that contract with the state's TennCare program to provide healthcare services. The bill clarifies that MCOs cannot suspend, deny, refuse to review, terminate, or otherwise end a contract with a qualified nursing facility unless specific conditions are met, such as the facility being terminated from the TennCare program by the Bureau of TennCare, the Bureau authorizing the termination, the facility being excluded from Medicare or Medicaid, or the Bureau suspending payments due to a fraud investigation. Importantly, the bill establishes that only the Bureau of TennCare has the exclusive authority to decide if a nursing facility should be terminated from participating in the TennCare program, and MCOs are prohibited from independently determining a facility's eligibility or terminating contracts without cause, for convenience, or without specifying grounds. If an MCO has concerns about a nursing facility's performance, it must report these to the Bureau and continue the contract while the Bureau investigates, ensuring that beneficiaries can continue receiving care.

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https://wapp.capitol.tn.gov/apps/Billinfo/default.aspx?BillNumber=SB1797&ga=114