House Bill 372, also known as the "Tennessee Medicaid Modernization and Access Act of 2025," aims to amend Tennessee's Medicaid reimbursement structure under TennCare. The bill mandates that starting in 2025, TennCare reimbursements for key services—including obstetrics-gynecology, primary care, outpatient mental health, and substance use disorder services—must be updated to align with either the Medicare fee schedule or the average commercial rate, whichever is higher. The Department of Health, in consultation with the Bureau of TennCare, is tasked with conducting annual reviews to ensure compliance with these updated reimbursement standards, as outlined in the CMS 2024 final rule.

Additionally, the bill allows healthcare providers to request administrative hearings in cases of delayed or erroneous reimbursements and establishes a framework for incentive payments based on quality of care and patient access metrics. The Bureau of TennCare is also required to seek modifications to the state Medicaid plan as necessary and to pursue funding to support these reimbursement adjustments. An annual report detailing the fiscal impacts and improvements in access and outcomes for key services will be submitted to the relevant legislative committees starting in 2026. The act will take effect upon becoming law and applies to all TennCare reimbursements for key services occurring on or after January 1, 2025.