HB 1836 increases the reimbursement rate for ambulance services under TennCare from 67.5% to 110% of the federal Medicare program's allowable charges for participating providers. It also deletes the Ground Ambulance Service Provider Assessment Act, removing a requirement for ambulance providers to pay an annual assessment. The bill takes effect on July 1, 2026, and specifies that any remaining funds in the ambulance service assessment revenue fund after June 30, 2026, must stay in the fund until expended. This change directly affects ambulance service providers participating in TennCare.
SB 1722 requires Tennessee health insurance companies to pay non-network medical laboratories (that are eligible to join an insurance network) at least the federal Centers for Medicare & Medicaid Services (CMS) clinical laboratory fee schedule rate for covered lab tests. It also allows insurers to set the same performance standards for these non-network labs as they do for in-network providers. The law will take effect on July 1, 2026, and applies to health insurance and managed health insurance issuers in Tennessee.
SB 748 changes how Tennessee's TennCare program reimburses ambulance services. It requires TennCare to pay public or private ambulance providers in Tennessee at least 67.5% of Medicare's rate for emergency transports and 100% of Medicare's rate for non-emergency transports. This applies specifically to ambulance services with a base of operations in Tennessee that bill for covered services provided to TennCare recipients. The bill amends Tennessee law to establish these specific reimbursement rates relative to Medicare's allowable charges.
SB 138 requires the TennCare program to reimburse air ambulance services operating within Tennessee at a rate of at least 67.5% of the federal Medicare program's standard rate for participating providers. This directly affects public and private air ambulance companies with a Tennessee base that provide covered emergency or nonemergency transports to TennCare recipients. The bill mandates this reimbursement rate for all covered services, applying to transports occurring on or after the law's effective date. It amends Tennessee Code Sections 71-5-165 (Title 71) and related provisions in Title 68.
SB 185 establishes minimum (100%) and maximum (120%) reimbursement rates for rural hospitals providing routine inpatient services to TennCare enrollees. It directly affects rural hospitals defined as those with 49 or fewer beds located in non-urban census areas. The bill requires these rates to be based on each hospital's current Medicare reimbursement rates for the federal fiscal year, rather than a fixed formula. The legislation is pending review by the Senate Finance Committee and has not yet become law.
HB 372, the "Tennessee Medicaid Modernization and Access Act of 2025," aligns TennCare’s reimbursement rates for key healthcare services - obstetrics/gynecology, primary care, outpatient mental health, and substance use disorder treatment - with either the Medicare fee schedule or average commercial rates in Tennessee, whichever is higher. This change directly affects healthcare providers who serve Medicaid patients and Medicaid beneficiaries, particularly in rural and underserved areas, by ensuring providers receive fairer compensation. The bill requires annual reviews to update rates based on Medicare or commercial benchmarks and mandates new annual reports on fiscal impacts and access improvements. It does not automatically appropriate funds but requires future budget allocations to cover implementation costs.
HB 150 requires Tennessee's TennCare program to reimburse air ambulance services operating in the state at 67.5% of the federal Medicare rate for covered emergency or nonemergency transports to TennCare recipients. This applies to both public and private air ambulance providers with a Tennessee base of operations that bill for these services. The bill amends Tennessee Code Sections 71-5-165 and related provisions to establish this specific reimbursement rate. It directly affects air ambulance providers serving TennCare patients within Tennessee. The policy change takes effect upon becoming law for transports occurring on or after that date.
HB 15 would allow Tennessee's governor to expand Medicaid eligibility exclusively for sickle cell disease treatment, in alignment with federal law. The bill requires the governor to negotiate with federal health officials (Centers for Medicare and Medicaid Services) on the specific terms of this expansion. This change would directly affect Tennessee residents diagnosed with sickle cell disease by potentially providing Medicaid coverage for their treatment. The expansion is strictly limited to sickle cell disease and must comply with the federal Patient Protection and Affordable Care Act.
HB 173 sets new minimum (100%) and maximum (120%) reimbursement rates for rural hospitals providing services to TennCare patients, directly affecting rural hospitals with 49 or fewer beds located outside urbanized areas. The bill requires these rates to be calculated based on each hospital's current federal Medicare reimbursement rates. It amends Tennessee Code to define "rural hospital" and mandates that TennCare's reimbursement levels align with Medicare rates for routine inpatient care. The director may seek federal waivers to implement this without expanding Medicaid eligibility.
HB 201 requires Tennessee's TennCare program to reimburse ambulance services at specific rates: 67.5% of Medicare's rate for emergency transports and 100% for nonemergency transports. It directly affects public and private ambulance providers operating in Tennessee that bill for services to TennCare recipients. The bill amends Tennessee law to set these reimbursement levels based on existing Medicare payment standards for participating providers. This policy change ensures ambulance services receive minimum payment rates aligned with federal Medicare benchmarks. The bill is currently under review by the Finance, Ways, and Means Subcommittee.
