Tennessee House Bill HB0332

Tennessee 2023-2024 Regular Session

• Introduced: 1/20/23
• Refer: 1/30/23
• Refer: 3/14/23

Caption

AN ACT to amend Tennessee Code Annotated, Title 4; Title 56; Title 68 and Title 71, relative to managed care organizations.

Impact

The proposed amendments include ensuring that MCOs adhere to federal guidelines regarding the medical loss ratio (MLR), introducing accountability measures for underperformance. If an MCO fails to meet the MLR standard, it must make remittances that would contribute to state revenues. The legislation intends to boost oversight over MCO operations and improve the financial management of healthcare resources within the TennCare system, which could enhance care quality for beneficiaries.

Summary

House Bill 0332 seeks to amend various sections of the Tennessee Code Annotated related to managed care organizations (MCOs) and the TennCare program. The bill introduces provisions whereby recipients of TennCare may select their managed care organization during enrollment. If they do not make a selection, the program will automatically assign them to an organization with the least number of active members, striving for balanced membership across organizations. This aims to streamline the enrollment process for recipients and maintain equity among MCOs in the state.

Sentiment

The general sentiment surrounding HB0332 is supportive, particularly among those advocating for improved healthcare accountability and transparency. Stakeholders believe that the bill will lead to more efficient healthcare management and potentially better outcomes for TennCare recipients. However, there are concerns among some parties about whether the automatic assignment of MCOs could limit choice and flexibility for some recipients, which could lead to debates about patient autonomy.

Contention

Notable points of contention include the methods by which MCO contracts will be awarded, avoiding competitive bidding processes. Some stakeholders may argue that this approach may hinder opportunities for diverse providers and limit competition. Moreover, the provision requiring MCOs to demonstrate stringent qualifications and partnerships with provider participation entities is crucial, as it raises questions about access and equity in terms of healthcare service delivery across different regions in Tennessee.