Amends TCA Title 56; Title 63; Title 68 and Title 71.

This bill prohibits an individual eligible for and enrolled in the TennCare program or in a successor medicaid program in this state ("an enrollee") from remaining in an emergency department or emergency room facility for more than 72 hours unless a healthcare professional determines there is a medically necessary reason that the enrollee must remain in the emergency department or emergency room facility beyond such time period. This bill provides that if an enrollee is required to remain in an emergency department or emergency room facility in violation of this bill for more than 72 hours, but less than 14 days, due to an error, delay, or lack of authorization by TennCare or a managed care organization, then TennCare or the managed care organization, as applicable, is subject to the imposition of the same penalties and other remedies set forth in state law against HMOs by the commissioner of commerce and insurance, including, but not limited to, monetary penalties and cease and desist orders. Further, this bill provides that if an enrollee is required to remain in an emergency department or emergency room facility in violation of this bill for a period of more than 14 days due to an error, delay, or lack of authorization by TennCare or a managed care organization, then TennCare must pay for all emergency medical services provided to the enrollee from the time the enrollee entered the emergency department or emergency room facility until the enrollee is discharged. Payment due pursuant to this provision must be at a rate that a private insurer or entity would pay or reimburse a provider for such emergency medical services. This bill prohibits an enrollee from being penalized for being required to remain in an emergency department or emergency room facility in violation of this bill.