Tennessee Medicaid Modernization and Access Act of 2025
Amends TCA Title 63; Title 68 and Title 71.
Tennessee HB0372, titled the "Tennessee Medicaid Modernization and Access Act of 2025," mandates that TennCare reimbursements for key services—specifically obstetrics-gynecology, primary care, outpatient mental health, and substance use disorder services—be updated to align with the higher of the Medicare fee schedule or average commercial rates starting in 2025. The bill requires annual reviews of reimbursement rates, allows healthcare providers to request administrative hearings for payment disputes, and establishes incentive payments based on quality care metrics. Additionally, it mandates annual reporting on fiscal impacts and access improvements related to these changes.
Tennessee HB0372, titled the "Tennessee Medicaid Modernization and Access Act of 2025," mandates that TennCare reimbursements for key services—specifically obstetrics-gynecology, primary care, outpatient mental health, and substance use disorder services—be updated to align with the higher of the Medicare fee schedule or average commercial rates starting in 2025. The bill requires annual reviews of reimbursement rates, allows healthcare providers to request administrative hearings for payment disputes, and establishes incentive payments based on quality care metrics. Additionally, it mandates annual reporting on fiscal impacts and access improvements related to these changes.
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Hulsey, Bud
114th General Assembly
January 27, 2025
April 15, 2026
Taken off notice for cal in s/c Finance, Ways and Means Subcommittee of Finance, Ways and Means Committee