House Bill 364, also known as "Emma's Bill," amends Tennessee Code Annotated regarding TennCare by modifying the criteria for determining medical necessity. Specifically, it replaces the phrase "It must be the least costly alternative" with "Except as provided in subsection (g), it must be the least costly alternative." This change allows for exceptions to the least costly requirement when assessing a patient's medical needs.

The bill introduces a new subsection (g) that mandates the bureau to consider a patient's overall condition when determining medical necessity. This comprehensive review includes factors such as the patient's mobility, cognitive awareness, need for constant nursing supervision, and requirement for life-sustaining equipment. The intent is to ensure that funding and medical services provided to patients are based on their individual health needs rather than solely on cost considerations. The act is set to take effect on July 1, 2025.

Statutes affected:
Introduced: 71-5-144(b)(3), 71-5-144