SB 907 would exempt certain high-cost prescription drugs from Tennessee's business tax on sales receipts. The bill specifically targets prescription medicines where the 30-day supply cost exceeds the Medicare Part D specialty tier threshold for 2025, as determined by the federal Centers for Medicare and Medicaid Services. It also extends the tax exemption to services related to preparing, storing, handling, administering, educating patients about, and monitoring these exempted drugs. This change would apply to pharmacies and other entities selling these medications starting July 1, 2025.
SB 2394 requires the Tennessee Department of Mental Health and Substance Abuse Services to submit its report on strategies to increase mental health and substance abuse resources in electronic format. The report must detail plans for services funded by Medicaid, TennCare, or other public and private sources. This bill amends specific sections of Tennessee law to mandate the electronic submission format, without changing the report's content or requirements.
SB 2287 requires Tennessee's Medicaid program (TennCare) to create a method for setting birthing center reimbursement rates that match hospital rates for similar services, with annual increases tied to hospital rate changes. It also directs the state health department to prioritize allocating federal rural health grant funds to birthing centers in rural counties, and to second priority to urban centers serving rural residents without local birthing options. This bill directly affects birthing centers (especially in rural areas) and Medicaid beneficiaries who use these services. The key changes are concrete: standardized reimbursement rates and targeted grant funding to improve access to maternity care in underserved regions.
HB 2597 requires Tennessee's Medicaid program (TennCare) to set payment rates for birthing centers to match hospital rates for similar services, with annual increases aligned to hospital rate changes. It also directs the Tennessee Department of Health to prioritize federal grant funds for birthing centers in rural counties and for urban centers serving rural residents without nearby birthing options. This bill directly affects birthing centers, particularly in rural areas, by altering their Medicaid payment structure and federal grant eligibility. The key mechanisms are the rate comparability requirement and the funding priority system for rural maternal care access.
HB 2331 bars Tennessee state departments, agencies, or entities from contracting with pharmacy benefits managers (PBMs) that have been disciplined by the Department of Finance and Administration or Department of Commerce and Insurance. The bill directly affects PBMs facing disciplinary actions and state agencies seeking to hire them. Key provisions amend multiple Tennessee codes to require this prohibition for all state contracts, renewals, or amendments entered after July 1, 2026. This policy change aims to prevent state entities from working with PBMs that have violated regulations. The law applies broadly to all state agencies, not just Medicaid programs.
SB 2425 requires TennCare to separately evaluate an individual's physical and mental conditions when determining eligibility for residential facility benefits, such as nursing homes or skilled nursing facilities. This change applies to all individuals seeking these benefits under Tennessee's Medicaid program. The bill mandates that eligibility scoring must assess physical health and mental health as distinct factors, rather than combining them. It directly affects TennCare beneficiaries applying for or receiving residential care services. The policy change aims to ensure more precise eligibility assessments by addressing physical and mental health needs independently.
HB 2093 prevents managed care organizations (MCOs) from unilaterally ending contracts with qualified nursing facilities in Tennessee's TennCare program, except under specific circumstances. The bill gives the TennCare bureau exclusive authority to decide if a nursing facility can be terminated from the program, not the MCOs. MCOs must report concerns about facilities to the bureau instead of acting alone, and must continue services during the bureau's review. This changes how MCOs manage nursing facility contracts, ensuring only the bureau can approve terminations.
SB 1797 prohibits managed care organizations (MCOs) in Tennessee from unilaterally suspending, denying, terminating, or otherwise ending contracts with qualified nursing facilities participating in the TennCare program. The bill directly affects nursing homes certified to provide Medicaid nursing care and MCOs that contract with them. Key provisions require MCOs to report concerns about facility performance to the Bureau of TennCare (not to act independently), and grant the bureau exclusive authority to determine termination - only allowing MCOs to act if the bureau has authorized termination, suspended payments for fraud, or if the facility was excluded from Medicare/Medicaid. The bill ensures nursing facilities cannot be removed from TennCare networks without bureau approval, maintaining service continuity for Medicaid beneficiaries during reviews.
SB 2118 would restrict Tennessee's Medicaid program (TennCare) from covering or reimbursing medical procedures intended to help an individual live as a gender inconsistent with their sex assigned at birth or to treat gender dysphoria. The bill defines "medical procedure" to include surgeries and the prescription of puberty blockers or hormones. Exceptions are allowed for procedures treating congenital defects, precocious puberty, or physical injuries (but not gender dysphoria), and for existing treatments started before the law's effective date (with coverage ending March 31, 2027). The law would take effect July 1, 2026.
SB 1936 creates a new licensing system for facilities providing nonresidential care to medically dependent children under 20 who require technology-based nursing care (e.g., ventilators or feeding tubes). These "prescribed pediatric extended care centers" must serve four or more unrelated minors and provide care for no more than 12 hours per day. The bill requires TennCare (Tennessee’s Medicaid program) to seek federal approval to cover services from these licensed centers. It defines key terms like "medically dependent minor" and sets requirements for facility licensing, including background checks and facility zoning compliance.
