TennCare establishes new network adequacy standards for managed care organizations

On February 20, 2025, the Tennessee State Legislature introduced Senate Bill 1372, a significant piece of legislation aimed at enhancing the network adequacy standards for Managed Care Organizations (MCOs) under the TennCare program. The bill seeks to address critical gaps in healthcare access for various provider types, including adult and pediatric primary care, obstetrics and gynecology, mental health services, and pediatric specialists.

Key provisions of Senate Bill 1372 mandate the development of quantitative standards for network adequacy, which will be published on the bureau's website for public accessibility. This transparency is intended to empower consumers and ensure that MCOs maintain sufficient provider networks to meet the healthcare needs of TennCare beneficiaries. Should deficiencies in network adequacy be identified, the bill requires the bureau to create a remediation plan, outlining specific corrective actions and timelines for MCOs to follow.

The legislation also stipulates that the Department of Finance and Administration must establish rules to enforce these standards by July 1, 2026, including civil penalties for non-compliance. This regulatory framework aims to hold MCOs accountable and ensure that they provide adequate access to healthcare services.

Debate surrounding Senate Bill 1372 has highlighted concerns regarding the potential impact on healthcare providers and the financial implications for MCOs. Supporters argue that the bill is essential for improving healthcare access and quality for vulnerable populations, while opponents caution that increased regulations could lead to higher costs for MCOs, which may ultimately be passed on to consumers.

The bill's introduction comes at a time when healthcare access remains a pressing issue in Tennessee, particularly for low-income families relying on TennCare. Experts suggest that if enacted, Senate Bill 1372 could lead to improved health outcomes by ensuring that beneficiaries have timely access to necessary medical services.

Senate Bill 1372 is set to take effect on July 1, 2025, pending further legislative approval and the establishment of accompanying regulations. As discussions continue, the bill's implications for Tennessee's healthcare landscape will be closely monitored by stakeholders across the state.