House Bill 364, also known as "Emma's Bill," amends Tennessee Code Annotated regarding the determination of medical necessity within the TennCare program. The bill modifies Section 71-5-144(b)(3) by replacing 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 sets the stage for a new subsection that allows for a broader consideration of a patient's overall condition when determining medical necessity.

The newly added subsection (g) stipulates that the bureau must consider various aspects of a patient's overall condition, which may influence the level of funding and the medical services provided, even if this does not align with the least costly treatment option. Factors to be considered include the patient's mobility, cognitive awareness, need for constant nursing supervision, and requirement for life-sustaining equipment. This bill is set to take effect on July 1, 2025, emphasizing a more comprehensive approach to patient care within the TennCare system.

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