HB 867

ESTABLISHMENT AND ADMINISTRATION OF THE PILOT PROGRAM This bill establishes the maternal health monitoring pilot program , to be administered by the bureau of TennCare ("bureau""), to offer eligible participants improv ed maternal health care through remote patient monitoring for maternal hypertension and maternal diabetes. An "" e ligible participant"" is a patient who i s a recipient of TennCare, is a member of a participating managed care organization, and i s pregnant . This bill requires t he bureau to select a managed care organization and technology vendor to administer the pilot program in a manner determined by the bureau. For the purpose of administering the pilot program, the participating managed care organization must contract directly with a technology vendor to offer remote patient monitoring for maternal hypertension and maternal diabetes. REMOTE PATIENT MONITORING FOR MATERNAL HYPERTENSION AND DIABETES When offering remote patient monitoring for maternal hy pertension and maternal diabetes to an eligible participant under the pilot program, this bill requires the technology vendor to ensure that (i) r emote patient monitoring for maternal hypertension and maternal diabetes is possible during the second and thi rd trimesters and for up to three months postpartum; ( ii ) r emote patient monitoring devices are delivered to the eligible participant; and (iii ) t he eligible participant has a process to be trained in how to use the remote patient monitoring devices. Thi s bill requires the technology vendor to e mploy an obstetrician or maternal fetal medicine physician who is licensed in this state and is caring for an eligible participant during pregnancy ("" healthcare provider "") or a nursing team and a ssign a program man ager to support implementation and administration of this pilot program and to coordinate efforts with participating managed care organizations and the bureau. As used in this bill, a ""nursing team"" means a team of two or more nurses licensed in this stat e, and at least one dietitian or diabetes care and education specialist who is licensed, certified, or authorized or permitted by the laws of this state to administer health care in the ordinary course of practice of such professions . This bill requires t he technology vendor's healthcare provider or nursing team to be capable of supporting the eligible participant by (i) m onitoring and reviewing health data of the eligible participant; ( ii ) c reating an agreed-upon escalation pathway with the managed care organization if the eligible participant's remote patient monitoring readings, in conjunction with the eligible participant's symptoms, require immediate attention from the eligible participant's healthcare provider; and ( iii ) p roviding health coaching to the eligible participant in matters including nutrition, condition management, and healthy behavior modification. PILOT PARTICIPATION GOALS This bill requires t he bureau to implement the pilot program in as many counties as necessary to ensure participa tion of no less than 300 eligible participants. The participating managed care organization must ensure that eligible participants in the counties selected by the bureau have access to the pilot program. The pilot program must be operational no later tha n 180 calendar days after the date on which the contract is entered between the participating managed care organization and the technology vendor. The bureau must implement the pilot program as necessary to ensure participation of a statistically relevant number of eligible participants. FEE PAYMENT FOR ADMINISTRATION OF THE PILOT PROGRAM Subject to appropriations or the availability of funds, this bill requires the bureau to pay a fee to the participating managed care organization to administer the pilot program. The participating managed care organization must contract with the technology vendor. Payment for contracting with the technology vendor must be bundled to include costs of providing remote patient monitoring for maternal hypertension and maternal diabetes. It is the legislative intent that an initial appropriation of $600, 000 be appropriated in fiscal year 2025-2026 and each subsequent fiscal year to offset the c o sts of the pilot program. ANNUAL REPORT On or before January 1 of each year, this bill requires the bureau to submit a report, in consultation with the participating managed care organization and technology vendor, on the evaluation of the pilot program, including recommendations regarding whether the pilot program should be expanded throughout this state, to the speaker of the house of representatives, speaker of the senate, chair of the health and welfare committee of the senate, and the chair of the c ommittee of the house of representatives having jurisdiction over health-related matters. RULEMAKING This bill authorizes t he director of TennCare to promulgate rules to effectuate this bill ."