TennCare

Plain English Breakdown

Checked against official source text during the last sync.

TennCare Network Reporting Reform Act

This bill requires TennCare to publish specific data and metrics related to its waiver programs on their website each year.

What This Bill Does

• Requires the director of TennCare or a designee to gather and make public certain data about TennCare's waiver programs starting January 15, 2026.
• Includes data relevant to network adequacy, federally required metrics, and information on service utilization percentage, appointment wait time, and time between approval and receipt of services.
• Requires the published data to be organized by service or benefit type, enrollment group, county, and demographics.
• Specifies that the data must come from the previous calendar year and be available for download in a comma-separated values file format.

Who It Names or Affects

• TennCare
• People receiving services through TennCare's waiver programs

Terms To Know

1115(c) and 1915(c) waiver programs

Programs administered by TennCare under federal waivers for home- and community-based services.

network adequacy

The sufficiency of the healthcare provider network to meet the needs of beneficiaries.

Limits and Unknowns

• Does not specify what happens if TennCare fails to comply with these requirements.
• Details on how the data will be used or interpreted are not provided in this bill.

Official Summary Text

Beginning no later than January 15, 2026, and no later than each January 15 of each subsequent year,
this bill requires
the director of TennCare, or the director's designee,
to
gather, collate, and make available to the public on the TennCare website:

(
1
) Data relevant to the network adequacy of TennCare's 1115(c) and 1915(c) waiver programs
. For purposes of this bill
"
1115(c) and 1915(c) waiver programs"
means
a program administered by the bureau of TennCare pursuant to a federal 1115(c) demonstration waiver or a 1915(c) home- and community-based services (HCBS) waiver
. The
1115(c) and 1915(c) waiver programs
i
nclude t
he CHOICES and Employment and Community First CHOICES programs; the Katie Beckett program; the self-determination waiver program; the HCBS program; and the comprehensive aggregate cap home and community based services program;

(
2
) Federally required netw
ork adequacy reporting metrics; and

(
3
) Data on service utilization percentage, appointment wait time, and time between approval and receipt of service
(all of which terms are defined in the full text of this bill)
.

This bill requires that the d
ata and
metrics
described in (1)
–
(3) are
published
, the data and metrics
must:

(
1
) Be delineated by service or benefit, waiver group enrollment type, county, and demographics;

(
2
) Use data from the previous calendar year;

(
3
) Be located on a publicly acc
essible page of the TennCare website; and

(
4
) Be published and available for download on such web page in a comma-separated values file format.

Current Bill Text

SENATE BILL 706
By Massey

HOUSE BILL 711
By Hale

HB0711
002524
- 1 -

AN ACT to amend Tennessee Code Annotated, Title 71,
relative to TennCare.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
SECTION 1. This act is known and may be cited as the "TennCare Network Reporting
Reform Act."
SECTION 2. Tennessee Code Annotated, Title 71, Chapter 5, Part 1, is amended by
adding the following as a new section:
(a) As used in this section:
(1) "1115(c) and 1915(c) waiver programs":
(A) Means a program administered by the bureau of TennCare
pursuant to a federal 1115(c) demonstration waiver or a 1915(c) home-
and community-based services (HCBS) waiver; and
(B) Includes the CHOICES and Employment and Community First
CHOICES programs; the Katie Beckett program; the self-determination
waiver program; the HCBS program; and the comprehensive aggregate
cap home and community based services program;
(2) "Appointment wait time" means the number of days between the
setting of a provider appointment and the date of the appointment;
(3) "Data" means aggregated and disaggregated data;
(4) "Service utilization percentage" means the number of benefit units
provided to an individual with a disability divided by the number of benefit units

- 2 - 002524

allocated to such individual as identified in the individual's person-centered plan
or waiver cap; and
(5) "Time between approval and receipt of service" means the number of
days between the approval of new services in a person-centered plan and the
date the delivery of such service begins.
(b)
(1) Beginning no later than January 15, 2026, and no later than each
January 15 of each subsequent year, the director of TennCare, or the director's
designee, shall gather, collate, and make available to the public on the TennCare
website:
(A) Data relevant to the network adequacy of TennCare's 1115(c)
and 1915(c) waiver programs;
(B) Federally required network adequacy reporting metrics; and
(C) Data on service utilization percentage, appointment wait time,
and time between approval and receipt of service.
(2) Data and metrics required to be published pursuant to subdivision
(b)(1) must:
(A) Be delineated by service or benefit, waiver group enrollment
type, county, and demographics;
(B) Use data from the previous calendar year;
(C) Be located on a publicly accessible page of the TennCare
website; and
(D) Be published and available for download on such web page in
a comma-separated values file format.
SECTION 3. This act takes effect upon becoming a law, the public welfare requiring it.