Tenn. Comp. R. & Regs. 1200-13-05-.02 - IMPLEMENTATION OF CONTRACT AMENDMENTS FOR EXISTING CONTRACTS BETWEEN HOSPITALS AND MCOS

These contracts set rates for a period of two years effective July 1, 2013, and provided for rate amendments to be negotiated and implemented on July 1, 2015.

(1) For hospitals that had existing contracts with MCOs in place on July 1, 2013, and the MCO and hospital had negotiated contract amendments to bring rates for total TennCare into the Rate Corridors and the rates in the contracts have not been adjusted since July 1, 2013, the MCOs will reissue those amendments with a new effective date of July 1, 2015.
(2) In the case of a hospital that had contracts with MCOs in place on July 1, 2013, which contracts included amendments implementing rates within the Rate Corridors, and where the rates in the contracts have been adjusted since July 1, 2013, the Bureau shall evaluate the rates in the current contracts to determine if the total TennCare rates for the hospital are within the Rate Corridors. If the rate adjustments cause the total TennCare reimbursement for the hospital to be outside of the Rate Corridors, the affected MCOs shall implement contract amendments approved by the Bureau in consultation with the TennCare Actuary to bring the hospital rates into the Rate Corridors effective July 1, 2015.
(3) In the case of a hospital with contracts in existence on July 1, 2013, which contracts include rates outside of the Rate Corridors, the affected MCOs shall implement contract amendments to bring total TennCare rates into the Rate Corridors with an effective date of July 1, 2015. The Bureau shall verify that the new contract rates in conjunction with contracts between the hospital and all other MCOs bring the hospital's total TennCare rates within the Rate Corridors.

Notes

Tenn. Comp. R. & Regs. 1200-13-05-.02
Original rule filed June 26, 1985; effective July 26, 1985. Emergency rule filed July 1, 2015; effective through December 28, 2015. Amendment filed September 21, 2015; effective 12/20/2015.

Authority: T.C.A. ยงยง 4-5-208, 71-5-105, 71-5-109, and 71-5-2801.

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