3-15-507 - - Tennessee Statutes

3-15-507. “Managed care organization” defined Scope of committee's oversight. [Effective until June 30, 2014. See the Compiler's Notes.]

(a)  For the purposes of this part, “managed care organization” and “MCO” mean any health maintenance organization, behavioral health organization, any entity regulated pursuant to title 56, chapter 32, and contractors of such entities.

(b)  The committee shall review regularly the following programs, functions and activities of the department of health and the TennCare program:

     (1)  Eligibility and enrollment standards, including determinations of how TennCare enrollees are assigned to MCOs, or other matters related to eligibility and assignment of TennCare enrollees;

     (2)  Provisions of services, facilities or programs by TennCare providers, including TennCare's standard benefit package or other related matters;

     (3)  Education programs for TennCare enrollees, MCOs and providers, including eligibility, access to TennCare providers and MCOs, benefit package offered, deductibles and co-payments required or other related matters;

     (4)  Review and evaluation of performance of TennCare MCOs, including their compliance with contracts entered into with the state, review of MCO contracts entered into with any TennCare provider or other related matters;

     (5)  Compliance by the department with provisions of the TennCare federal waiver, including review of proposed amendments to the waiver for system changes, and evaluations or reports prepared for or by the federal government, or other related matters;

     (6)  Staffing within the department, including recruitment, selection, training, compensation, discipline or other matters;

     (7)  Management, including planning, budgeting, information systems, organizational structure, rules and regulations, department policies and procedures or other related matters; and

     (8)  Any other matters considered material.

[Acts 1994, ch. 830, § 8; 1999, ch. 226, §§ 1, 2.]