Senate Bill 1797 amends Tennessee Code Annotated to establish clearer regulations regarding managed care organizations (MCOs) and their relationships with qualified nursing facilities participating in the TennCare program. The bill defines key terms such as "managed care organization," "qualified nursing facility," and "termination," while also outlining the conditions under which MCOs can contract with nursing facilities. Notably, the bill prohibits MCOs from adopting participation requirements or termination standards that exceed those set by the bureau of TennCare, ensuring that qualified nursing facilities can participate under the same terms as other providers. Additionally, the bureau is granted exclusive authority to determine the eligibility and termination of nursing facilities from the TennCare program.

The bill also includes provisions that protect nursing facilities from arbitrary termination by MCOs, requiring that any such actions must be based on specific causes as defined in the legislation. MCOs are mandated to report any performance concerns regarding nursing facilities to the bureau and must continue to honor contracts during the bureau's review process. Furthermore, the bill stipulates that any contractual provisions allowing MCOs to terminate contracts without cause are void and unenforceable. The act is set to take effect on July 1, 2026, and applies to all relevant policies and contracts entered into or renewed after that date.

Statutes affected:
Introduced: 71-5-1412