Amends TCA Title 4; Title 56; Title 68 and Title 71.

This bill adds to present law concerning TennCare. This bill specifically adds provisions concerning selection of a managed care organization (MCO) by an enrollee, medical loss ratio, and selection of MCOs by the bureau of TennCare. ENROLLEE SELECTION This bill authorizes each TennCare recipient to choose a managed care organization (MCO) upon enrollment in TennCare. If a recipient does not choose an MCO, this bill requires the TennCare program to automatically assign the recipient to the MCO with the lowest number of active recipients until the membership among each MCO is no more than 20 percent greater or less than another. Once the membership among the MCOs is within 20 percent, then the TennCare program will be required to assign recipients to the various MCOs on a rotating basis. This bill requires the bureau of TennCare to promulgate rules for enrollee selection by July 1, 2023. MEDICAL LOSS RATIO This bill requires an MCO to comply with federal centers for medicare and medicaid services (CMS) guidelines for medical loss ratio (MLR). For contract rating periods beginning on or after January 1, 2024, this bill requires each MCO to provide a remittance for an MLR reporting year. If the ratio for an MLR reporting year does not meet the minimum MLR standard required by CMS, then the bureau of TennCare shall determine the remittance amount on an MCO-specific basis and calculate the federal and nonfederal share amounts associated with each remittance. For the remittance funds collected in a fiscal year, the bureau shall: (1) Return the federal share amounts from the remittance funds collected to the CMS; and (2) Deposit the remaining remittance funds into the general fund. This bill requires the bureau to post certain information related to MLR on the bureau's website. SELECTION OF MCOS Beginning with the calendar year that begins January 1, 2024, this bill establishes a selection process that the bureau of TennCare must utilize to select MCOs. This bill prohibits the bureau from using a competitive bidding or RFP process to select MCOs beginning January 1, 2024. By January 1, 2024, this bill requires the bureau to contract with at least one MCO that is partnered with a provider participation entity (PPE), if the MCO and partnered PPE: (1) Demonstrate the ability to fulfill TennCare MCO contract requirements; and (2) Meet eligibility requirements that are listed in the full text of this bill. This bill requires the bureau to submit to the commerce and labor committee of the senate and the committee of the house of representatives with oversight responsibility for TennCare all eligibility qualifications and standards developed for managed care organizations for approval by those committees.