TN HB2093

Managed care organizations (MCOs) in the TennCare program must contract with any qualified nursing facility certified by CMS that is willing to accept the same terms and conditions offered to other participating facilities, excluding reimbursement rates.

MCOs are prohibited from establishing their own participation requirements, network admission criteria, or termination standards for qualified nursing facilities beyond those set by the Bureau of TennCare.

The Bureau of TennCare holds exclusive authority to terminate a qualified nursing facility from the TennCare program; MCOs cannot independently terminate facility contracts except when the Bureau has taken final action, authorized termination in writing, suspended payments for fraud investigations, or the facility has been excluded from Medicare/Medicaid.

Contract provisions allowing MCOs to terminate nursing facility agreements without cause, for convenience, or without specifying grounds are void and unenforceable as contrary to public policy.

Effective July 1, 2026, applying to policies, plans, and contracts entered into, renewed, amended, or delivered on or after that date.