Amends TCA Title 8; Title 39; Title 49; Title 50; Title 53; Title 56; Title 63; Title 68 and Title 71.

This bill establishes a standard definition of "medical necessity" (and, in some instances "medically necessary") for various provisions of present law. Under this bill, the term means: (A) Reasonably calculated to prevent, diagnose, correct, cure, alleviate, or prevent worsening of conditions in the patient that endanger life, cause suffering or pain, result in an illness or infirmity, threaten to cause or aggravate a handicap, or cause physical deformity or malfunction; and (B) No other equally effective, more conservative, or substantially less costly course of treatment is available and suitable for the patient's best interest. Under this bill, medical necessity will be presumed if a healthcare provider, practitioner, prescriber, or physician, as applicable, who has conducted a physical examination or assessment of a patient, has documented rationale and supportive language in such patient's medical record to support the diagnosis, treatment, and management of an ailment, disease, or illness and has prescribed, recommended, or approved a drug, treatment, prescription, or order, as applicable, unless sufficient evidence is produced to substantiate that the applicable drug, treatment, prescription, or order is not in the patient's best interest. The bill applies the definition and presumption discussed above to the present law provisions governing the following: (1) Prescribing or supplying anabolic steroids when there is no medical necessity for them; (2) Funding under the BEP for educational services to children in residential mental health facilities based on medical necessity; (3) Medical necessity under the workers' compensation utilization review system and treatment guideline provisions; (4) Medically necessary medical treatment, attendance, and hospitalization under the workers' compensation claims and payment provisions; (5) Provisions governing whether a medical necessity requires prescribing a brand name drug instead of a generic; (6) Health care coverage generally, and, specifically, utilization review to determine the medical necessity of a service; telehealth coverage; and external review of adverse coverage determinations; (7) The medical necessity of prescribing opioids; (8) Medical necessity generally in regard to the practice of medicine and the practice of pharmacy; (9) The medical necessity of prescribing a controlled substance in regard to the statute regulating high volume prescribers of controlled substances; (16) The medical necessity of a physician's order in regard to care at a nursing home and reports of violations; (17) Coverage of care for medically necessary services provided in an assisted living facility; (18) Exemption to the age restriction on blood donation when a medical necessity exists in the person's immediate family; (19) Coverage under TennCare; and (20) Coverage under the pharmaceutical connection program.