Tennessee Senate Bill SB1797

Tennessee 2025-2026 Regular Session

• Introduced: 1/20/26

Caption

AN ACT to amend Tennessee Code Annotated, Title 56; Title 68, Chapter 11 and Title 71, Chapter 5, relative to managed care organizations.

Impact

The enactment of SB1797 effectively centralizes authority under the bureau of TennCare regarding the eligibility and participation of nursing facilities in the Medicaid program. It prohibits MCOs from independently imposing participation requirements, termination standards, or network admission criteria beyond those approved by the bureau. This shift is expected to protect nursing facilities from potential exploitative practices by MCOs, fostering a more equitable environment for healthcare providers and ultimately benefiting Medicaid beneficiaries by maintaining their access to necessary services.

Summary

Senate Bill 1797 amends various sections of the Tennessee Code Annotated related to managed care organizations (MCOs), specifically in the context of Medicaid and nursing facilities. The bill mandates that MCOs contract with any qualified nursing facility that provides Medicaid nursing facility services and adheres to the established terms and conditions. This ensures that facilities cannot be arbitrarily denied participation based on restrictive standards set by MCOs but must adhere to criteria approved by the bureau of TennCare. The intent of this legislation is to enhance access to care and restrain potential abuse in the contractual relationships between MCOs and nursing facilities.

Sentiment

The overall sentiment surrounding SB1797 appears to be supportive among advocacy groups and stakeholders who prioritize access to quality care. Proponents argue that the bill strengthens protections for nursing facilities and enhances the collaborative process between MCOs and healthcare providers. Conversely, some concerns have been voiced regarding the potential impacts on MCOs' operational flexibility, with detractors suggesting that overly stringent regulations could limit the MCOs' ability to manage networks effectively and could lead to unintended consequences in care quality and efficiency.

Contention

While SB1797 is largely viewed as a protective measure for nursing facilities, there are debates over the balance between regulation and operational flexibility for MCOs. Notably, there are concerns that the bill does not sufficiently address the financial implications for MCOs in terms of reimbursement rates. Key points of contention also include questions about how compliance with the bill will be monitored and the potential bureaucratic implications for nursing facilities, particularly when dealing with any corrective action plans initiated by the bureau.