(a) As used in this section:(1) “Bureau” means the bureau of TennCare;(2) “Managed care organization” or “MCO” means a health maintenance organization, behavioral health organization, or managed health insurance issuer that has a contract with the bureau and participates in the TennCare program;(3) “Qualified nursing facility” means a nursing home that is licensed under title 68, chapter 11, part 2, and is certified by the bureau to provide medicaid nursing facility services; and(4) “Termination”:(A) Means the involuntary removal, exclusion, or non-renewal of a qualified medicaid provider from an MCO's provider network or the medicaid program; and(B) Does not include the voluntary withdrawal by the qualified medicaid provider.
(1) “Bureau” means the bureau of TennCare;
(2) “Managed care organization” or “MCO” means a health maintenance organization, behavioral health organization, or managed health insurance issuer that has a contract with the bureau and participates in the TennCare program;
(3) “Qualified nursing facility” means a nursing home that is licensed under title 68, chapter 11, part 2, and is certified by the bureau to provide medicaid nursing facility services; and
(4) “Termination”:(A) Means the involuntary removal, exclusion, or non-renewal of a qualified medicaid provider from an MCO's provider network or the medicaid program; and(B) Does not include the voluntary withdrawal by the qualified medicaid provider.
(A) Means the involuntary removal, exclusion, or non-renewal of a qualified medicaid provider from an MCO's provider network or the medicaid program; and
(B) Does not include the voluntary withdrawal by the qualified medicaid provider.
(b) A managed care organization shall not include a provision in the MCO's contract with a qualified nursing facility to provide medicaid nursing facility services that permit actual or constructive termination by the MCO without cause, for convenience, or termination without specifying the grounds for termination. In conjunction with the department of commerce and insurance, the bureau shall review and approve all standard contract templates used by MCOs for facility contracting to ensure compliance with this subsection (b).
(c) A managed care organization (MCO) shall contract with any nursing facility licensed under title 68, chapter 11, part 2, and certified by the centers for medicare and medicaid services, that provides medicaid nursing facility services pursuant to an approved preadmission evaluation (PAE) and is willing to contract with the MCO to provide that service under the same terms and conditions as are offered to any other participating facility contracted with that MCO to provide that service under any policy, contract, or plan that is part of the TennCare managed long-term care service delivery system. Terms and conditions shall not include the rate of reimbursement.
(d) Nothing in this section shall be interpreted as preventing the bureau of TennCare or an MCO from enforcing a contract between an MCO and a nursing facility or as preventing the bureau of TennCare from adopting reasonable and necessary requirements for the participation of a nursing facility in the TennCare program. All requirements for participation adopted after July 1, 2016, shall be promulgated by the bureau of TennCare as a rule under title 4, chapter 5, part 2, and shall include a hearing under § 4-5-203, prior to the enforcement of such requirement as part of any provider contract, unless otherwise required by federal law.