Present law requires hospitals that provide services to TennCare enrollees to be reimbursed from state funds based on corridor rates set by this state's actuary and approved by the bureau of TennCare ("bureau").
This bill adds to the present law by providing the following:
(1) The minimum and maximum level for aggregate rates to a hospital with no more than 49 licensed beds, operating in a rural area (rural hospital) for services to TennCare enrollees must be based on the percentages of the rural hospital's current medicare reimbursement determined by (2) below;
(2) For routine, nonspecialized inpatient services for Tenncare enrollees at rural hospitals, the minimum level of reimbursement to the hospital is 100 percent and the maximum level is 120 percent; and
(3) The department of health may seek a federal waiver or other authorization deemed necessary to implement (2) above, without requiring the expansion of medicaid.
Present law requires the bureau to publish the list of MS-DRGs included in each service category on its website, and the bureau must update the list annually to reflect all changes as necessary. Generally, MS-DRG is a classification system used by medicare to determine hospital payments based on inpatient hospital stay categories such as diagnosis, severity, and resource utilization. This bill requires the bureau to also annually furnish an updated list of MS-DRGs directly to participating rural hospitals.
As used in this bill, a "rural area" means an area that is not delineated as an urbanized area by the federal bureau of the census.

Statutes affected:
Introduced: 71-5-161(d), 71-5-161