HB 372

This bill enacts the "Tennessee Medicaid Modernization and Access Act of 2025, "" which requires TennCare reimbursements for key services in calendar year 2025 and subsequent years to be updated to match the medicare fee schedule or the average commercial rate, whichever is higher. Such updates may be implemented through phasing in for specific key services, if necessary. As used in this bill, ""key services"" means obstetrics-gynecology (OB/GYN), primary care, outpatient mental health, and substance use disorder (SUD) services . This bill requires t he department of health, in consultation with the bureau of TennCare, to conduct an annual review to ensure TennCare reimbursement rates align with changes in the medicare fee schedule and average commercial rates and with the CMS 2024 final rule. A healthcare provider of key services that is entitled to receive TennCare reimbursement wh o alleges a delay in payment or receives an erroneous level of reimbursement pursuant to this bill, may, in accordance with rules promulgated by the commissioner of health, submit a written request for an administrative hearing, and the decision made after the hearing is final. This bill authorizes healthcare providers receiving increases under this bill to receive additional incentive payments based on metrics for quality of care and improved patient access, particularly in rural and underserved areas. The department of health must consult with the bureau of TennCare to establish and enforce these quality and access metrics. The bureau of TennCare must submit a request to CMS to modify the state medicaid plan, as necessary, to implement this bill . Thi s bill requires the department of health and bureau of TennCare to actively seek and apply for federal, private, or other available funds, and actively direct available state funds, to support reimbursement adjustments under this bill, with particular atte ntion to key services. It is the legislative intent that funds be annually appropriated in the general appropriations act to cover administrative costs to implement this bill. ANNUAL REPORT Beginning February 1, 2026, and no later than February 1 of ea ch subsequent year, this bill requires the department of health and the bureau of TennCare to submit an annual joint report to legislative committees having jurisdiction over insurance, that details fiscal impacts, provider participation rates, access impr ovements, and outcome metrics for key services impacted by this bill . RULEMAKING This bill authorizes t he bureau of TennCare and the department of health, as necessary, to promulgate rules to effectuate this bill. APPLICABILITY This bill applies to a ll TennCare reimbursements for key services occurring on or after January 1, 2025."