Amends TCA Title 71.
This bill requires the bureau of TennCare to create and implement a three-year pilot program, ending June 30, 2026, that provides the following: (1) Remote maternal health services to a TennCare recipient who meets the eligibility criteria described below; (2) Medically necessary remote maternal health services to a TennCare recipient eligible for up to 12 months postpartum; and (3) Payment to healthcare providers who provide remote maternal health services that includes the cost of the remote patient monitoring devices being used. ELIGIBILITY CRITERIA Under this bill, a TennCare recipient is eligible to receive remote maternal health services pursuant to the program if the following criteria are met: (1) The recipient is pregnant; (2) The recipient's healthcare provider determines that remote maternal health services are in the best interest of the patient; (3) The recipient's healthcare provider determines (A) the recipient has an increased likelihood of experiencing a higher-risk pregnancy, due to the presence of certain existing health conditions, age factors, lifestyle factors, or conditions of pregnancy; (B) the recipient lives in a county without a licensed obstetrician/gynecologist who participates in TennCare; or (C) the recipient's healthcare provider determines the recipient is unable to access consistent obstetrical care due to factors that include transportation, child care, employment requirements and socioeconomics; and (4) The remote maternal health services meet the criteria established by current law to be deemed medically necessary medical services by the TennCare program. This bill authorizes the director of TennCare to seek a federal waiver that the director determines is necessary to implement the pilot program described in this bill.
This bill requires the bureau of TennCare to create and implement a three-year pilot program, ending June 30, 2026, that provides the following: (1) Remote maternal health services to a TennCare recipient who meets the eligibility criteria described below; (2) Medically necessary remote maternal health services to a TennCare recipient eligible for up to 12 months postpartum; and (3) Payment to healthcare providers who provide remote maternal health services that includes the cost of the remote patient monitoring devices being used. ELIGIBILITY CRITERIA Under this bill, a TennCare recipient is eligible to receive remote maternal health services pursuant to the program if the following criteria are met: (1) The recipient is pregnant; (2) The recipient's healthcare provider determines that remote maternal health services are in the best interest of the patient; (3) The recipient's healthcare provider determines (A) the recipient has an increased likelihood of experiencing a higher-risk pregnancy, due to the presence of certain existing health conditions, age factors, lifestyle factors, or conditions of pregnancy; (B) the recipient lives in a county without a licensed obstetrician/gynecologist who participates in TennCare; or (C) the recipient's healthcare provider determines the recipient is unable to access consistent obstetrical care due to factors that include transportation, child care, employment requirements and socioeconomics; and (4) The remote maternal health services meet the criteria established by current law to be deemed medically necessary medical services by the TennCare program. This bill authorizes the director of TennCare to seek a federal waiver that the director determines is necessary to implement the pilot program described in this bill.
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