Title 71 Welfare

Chapter 1 Administration

Part 1 Department of Human Services

§ 71-1-101. Short title.

This part may be cited as the “Welfare Organization Law of 1937.”

History (3)

Acts 1937, ch. 48, § 15
C. Supp. 1950, § 4765.1 (Williams, § 4765.15)
T.C.A. (orig. ed.), §§ 14-101, 14-1-101.

§ 71-1-102. Part definitions.

As used in this part, unless the context otherwise requires:
1. (1) “Commissioner” means the commissioner of human services;
2. (2) “Department” means the department of human services;
3. (3) “Director” means the director of a division within the department;
4. (4) “Division” means one (1) of the divisions created within the department of human services for the purposes of administration;
5. (5) “Region” means one (1) or more counties grouped for the purpose of local administration; and
6. (6) “Regional director” means the director of a region.

History (5)

Acts 1937, ch. 48, § 14
1939, ch. 95, § 8
C. Supp. 1950, § 4765.3 (Williams, § 4765.1)
impl. am. Acts 1975, ch. 219, §§ 1 (a, b), 2 (a, b)
T.C.A. (orig. ed.), §§ 14-102, 14-1-102.

§ 71-1-103. Department created.

There is created a department of state government, which shall be known and designated as the department of human services.

History (5)

Acts 1937, ch. 48, § 1
1939, ch. 95, § 2
C. Supp. 1950, § 4765.3 (Williams, § 4765.1)
impl. am. Acts 1975, ch. 219, § 1 (a, b)
T.C.A. (orig. ed.), §§ 14-103, 14-1-103.

§ 71-1-104. Succession to previous agencies — Workshop for blind.

(a) The department shall in all respects be the legal successor to the corporate powers, duties, and responsibilities of the commission for the blind, and any other state welfare commissions other than those that may be excepted by § 71-1-105(a)(1). The department shall succeed to all the rights and obligations of these agencies; provided, that the workshops for the blind located at Nashville and Memphis shall, through this department or by contract with a nonprofit organization or organizations, continue to be operated for the employment of blind persons.
(b) Notwithstanding § 12-2-112 or § 12-2-403, the department has the authority, subject to the approval of the state building commission, to convey ownership of the workshops to any such contractor without financial consideration, including real and personal property, inventory of materials, and stores for resale. The instrument of conveyance to such nonprofit contractor shall provide that the real property and production equipment conveyed, or sufficient remuneration for the real property and production equipment, shall revert to the state at any time the contractor or its successor shall cease operating a workshop for the benefit of the blind, unless the state finds in its sole discretion that it is in the state's best interest to allow such real property and production equipment to be sold to such contractor or contractor's successor at such time as the contractor or contractor's successor shall cease operating a workshop for the benefit of the blind. If the state deems it appropriate to convey such real property and production equipment to the contractor, then the amount of remuneration to be paid by the contractor or its successor to the state shall be determined at the time the real property and production equipment is originally conveyed to the contractor, to be based upon the appraised value of the real property and production equipment at the time of the original conveyance to the contractor.

History (10)

Acts 1937, ch. 48, § 2
1939, ch. 95, § 3
1943, ch. 154, § 1
mod. C. Supp. 1950, § 4765.4 (Williams, §§ 4765.2, 4765.3a)
modified
T.C.A. (orig. ed.), § 14-140
Acts 1982, ch. 863, § 1
1986, ch. 829, § 1
T.C.A., § 14-1-104
Acts 2003, ch. 355, § 56.

§ 71-1-105. Powers and duties.

(a) The department is charged with the administration or supervision of all of the public welfare activities of the state as provided in this section. The department shall:
1. (1) Administer or supervise all functions of the federal Social Security Act (42 U.S.C.), established or to be established in Tennessee that may be assigned to it by law, regulation or executive order;
  Backlinks (1)
  
  71-1-104(a)
2. (2) Cooperate with the federal government or its agencies or instrumentalities, in establishing, extending, strengthening or reforming services to assist persons and families in need of such services from this state;
3. (3) Promote the unified development of the institutional and noninstitutional agencies subject to its jurisdiction, including the determination of all matters of general policy and the control of the administration of each of the institutional or noninstitutional agencies in the department, so that each institutional or noninstitutional agency shall perform its function as an integral part of the general system;
4. (4) Establish and enforce reasonable rules and regulations governing the custody, use and preservation of the records, papers, files and communications of the department. The use of such records, papers, files and communications by any other agency or department of the government to which they may be furnished shall be limited to the purpose for which they are furnished and by the law by which they may be furnished;
5. (5)
  1. (A) License or approve, and supervise, adult day care centers and child care agencies as defined in chapter 2, part 4, and chapter 3, part 5 of this title, and to promulgate any regulations it deems necessary to carry out the licensing laws;
  2. (B) Establish criteria for the approval of persons or entities who receive any state or federal funds for the provision of care for adults or children whether those persons or entities are licensed or approved as provided in chapter 2, part 4 or chapter 3, part 5, of this title, or whether they are otherwise unlicensed, and, if determined by the department to be necessary, provide for such criteria in regulations promulgated pursuant to the Uniform Administrative Procedures Act, compiled at title 4, chapter 5, part 2; and
  3. (C) Utilize any state, federal, local or private funding to provide for any child care or adult day care services or training that it deems necessary to promote the welfare of children and adults or that is required or permitted by state or federal law or regulations, and to provide such services or training directly or by contract with any public or private entities;
6. (6) Promote and employ the use of such measures as are designed to restore persons receiving assistance or services from the department to a condition of self-support in the community and pursue the preventive aspects of its work, including providing, to the extent possible, foster care for adults who are unable to maintain an independent living arrangement, and such other services to those liable to become destitute or handicapped as will prevent their becoming or remaining public charges;
7. (7) Study the causes of economic dependency or rehabilitative service requirements for persons in need of economic support or rehabilitative services in Tennessee and promote efficient methods for assisting persons in need of such support or services;
8. (8) Cooperate with the commissioner of social security, and with any other agency or instrumentality of the federal government in any reasonable manner that may be necessary to qualify for federal aid for assistance to persons who are entitled to assistance under the Social Security Act, except as otherwise provided by subdivision (a)(1), and in conformity with this part, including the making of such reports, in such form and containing such information as the commissioner of social security or any other agency or instrumentality of the federal government may, from time to time, require and comply with such requirements as such commissioner, agency, or instrumentality may, from time to time, find necessary to assure the correctness and verification of such reports;
9. (9) Receive and expend as provided by law any public and private donations, not provided for by § 71-1-113, and the department may expend a reasonable proportion of any such donation for administrative purposes;
10. (10) Assist and cooperate with other departments, agencies, instrumentalities, and institutions of the state and federal governments, when so requested, in performing services in conformity with the purposes of this part;
11. (11) Act in cooperation with the federal government in welfare matters of mutual concern in conformity with this part and in the administration of any federal funds granted to this state or any state appropriations to aid in the furtherance of any such functions of the state government, including relief and assistance of needy citizens;
12. (12) Make such rules and regulations and take such action as may be deemed necessary or desirable to carry out this part and that are not inconsistent with this part;
13. (13) Administer such additional public welfare functions as are hereby or may be vested in it by law pursuant to this part;
14. (14) Be authorized to license blind persons to operate vending stands in state and county buildings; provided, that, in the opinion of the director of vocational rehabilitation and the custodian of such building or buildings, a suitable place may be found for the location of such stand or stands to be operated in accordance with the Randolph-Sheppard Vending Stand Act of June 20, 1936, chapter 638, 49 Stat. 1559 (20 U.S.C. § 107 et seq.), or amendments to that act;
15. (15) Enforce the provisions of Title IV-D of the Social Security Act (42 U.S.C. § 651 et seq.), relative to child and spousal support and establishment of paternity and to contract with public or private entities to provide any services necessary to carry out such provisions;
16. (16)
  1. (A) Conduct investigations, including, but not limited to, investigation into the existence of:
    1. (i) Trafficking in, or fraud involving, the food assistance program administered by the department pursuant to chapter 5, part 3 of this title;
    2. (ii) Fraud, abuse, theft, misappropriation, or misuse of property, funds, or services by a person or entity in a program administered by the department; and
    3. (iii) Misconduct by an employee, contractor, or agent of the department concerning or related to the operation of a department program or laws, regulations, or policies governing the department's operations; and
  2. (B)
    1. (i) Except as provided in subdivisions (a)(16)(B)(ii) and (iii), records and information obtained pursuant to an investigation conducted pursuant to this subdivision (a)(16), including the identities of witnesses or individuals with information relevant to the investigations, are confidential and not open for inspection by members of the public under title 10, chapter 7; however, operational records of a state agency, including the department, which are not investigative records or not otherwise protected under state or federal law or other legal authority, must remain open for inspection by members of the public;
    2. (ii) The records and information to which this subdivision (a)(16)(B) applies cease to be confidential under subdivision (a)(16)(B)(i) upon closure of the investigation by the department and final adjudication of any administrative appeal of an action taken based upon the results of the investigation or the conclusion of all court proceedings in a criminal prosecution related to the investigation as evidenced by an order of the court, including the opportunity for direct appeal having been exhausted, whichever occurs later;
    3. (iii) This subdivision (a)(16)(B) does not prevent the department from sharing information or records with the district attorney general or law enforcement personnel for the purpose of cooperating with a law enforcement investigation or with the comptroller of the treasury or the comptroller's designee for the purpose of audit. Information or records that the department shares with the district attorney general or law enforcement remain confidential under subdivision (a)(16)(B)(i), except to the extent that a court orders otherwise, the information or records are used as evidence in a criminal prosecution, or the Tennessee rules of criminal procedure require disclosure. Information or records that the department shares with the comptroller or comptroller's designee for the purpose of audit remain confidential under subdivision (a)(16)(B)(i) and under § 10-7-504(a)(22)(A) as an audit working paper; and
    4. (iv) A knowing violation of this subdivision (a)(16)(B) is a Class B misdemeanor;
17. (17) When conducting any investigation pursuant to subdivision (a)(16)(A) or (a)(16)(B):
  1. (A) Have the power to issue subpoenas to compel the attendance of witnesses, the examination of witnesses under oath, and the production of books, accounts, papers, records, and documents relating to an investigation; provided, that:
    1. (i) The materials to be produced are relevant to the investigation;
    2. (ii) The materials to be produced are specified with reasonable particularity; and
    3. (iii) The subpoenas command production of the materials covering only a reasonable period of time;
    Backlinks (1)
    
    71-1-116(a)(1)
  2. (B) Have the power to compel the production of employment records during an investigation. For purposes of this subdivision (a)(17)(B), “employment records” includes records of future, past, or present employees who are applying for or have received a form of public assistance or are members of the household of a person who is applying for or has received a form of public assistance from this state or another state;
    Backlinks (1)
    
    71-1-116(b)
  3. (C) Have the authority to refer any matter to the appropriate enforcement authority for criminal prosecution;
  4. (D) Have the authority to refer any matter to the appropriate enforcement authorities for civil proceedings, including, but not limited to, referral to the attorney general and reporter for civil recovery;
  5. (E) Have the authority to cooperate with other state agencies to investigate fraud and abuse in programs administered by the department;
  6. (F) Have the authority to furnish information to educate the public about the fraud and abuse laws pertaining to programs administered by the department; and
  7. (G) Have the authority to contract with entities as necessary to carry out the required duties of subdivisions (a)(17)(C)-(F).
(b) Notwithstanding any state law or regulation to the contrary, the department may provide low-income energy assistance at any percentage of the federal income poverty level that is permitted by federal law.
(c) The department is authorized to take actions necessary to support the development of shared services alliances and family child care networks to improve the quality of child care in this state, give child care providers access to innovative child care business resource platforms, and provide a means of cost savings to child care providers through negotiated discounts. The department may contract with one (1) or more entities as necessary to implement this subsection (c).

Backlinks (1)

71-1-113

History (24)

Acts 1937, ch. 48, § 3
1937, ch. 299, § 1
1939, ch. 95, §§ 4-6
impl. am. Acts 1943, ch. 154, § 1
C. Supp. 1950, § 4765.5 (Williams, §§ 371.3, 4765.3)
impl. am. Acts 1955, ch. 102, § 1
modified
Acts 1972, ch. 624, § 2
1973, ch. 337, § 1
impl. am. Acts 1975, ch. 219, § 1 (a), (b)
1975, ch. 279, § 1
modified
T.C.A. (orig. ed.), § 14-105
Acts 1984, ch. 789, § 3
T.C.A., § 14-1-105
Acts 1993, ch. 284, § 1
1996, ch. 1079, § 153
1998, ch. 1098, § 64
2000, ch. 981, §§ 14, 51
2010, ch. 626, § 1
2013, ch. 402, § 1
2018, ch. 789, § 1
2021, ch. 498, § 4
2021, ch. 515, § 1.

§ 71-1-106. Appointment of chief officer and personnel.

The chief administrative and executive officer of the department shall be appointed by the governor solely on a basis of merit as measured by education, ability, and experience in the administration of public welfare activities and without regard to residence or political affiliation. Such officer shall serve at the pleasure of the governor. Such officer shall have general charge and supervision of the department and shall appoint the heads of such divisions as may be created. The choice of personnel shall be made on the basis of merit as measured by experience and training in each particular field. Vacancies in superior positions shall be filled so far as practicable by promotion based on meritorious service.

History (3)

Acts 1937, ch. 48, § 8
C. Supp. 1950, § 4765.11 (Williams, § 4765.8)
T.C.A. (orig. ed.), §§ 14-106, 14-1-106.

§ 71-1-107. Duties of commissioner.

As chief executive officer of the department, the commissioner shall be charged with the supervision and administration of all welfare activities subject to its jurisdiction. The commissioner at all times has the power, which the commissioner may also delegate to officers and employees of the department, of visitation, inspection and administration of local governmental welfare agencies subject to the commissioner's supervision and the books, records and accounts of each institution or agency shall be open to the commissioner's inspection. In the supervision and administration of local welfare activities, the commissioner shall advise with local authorities, and may provide such specialized services as may be necessary to the end that the laws shall be faithfully executed and that the various welfare agencies of the local government shall function effectively in relationship to one another and to the department.

History (3)

Acts 1937, ch. 48, § 9
C. Supp. 1950, § 4765.12 (Williams, § 4765.9)
T.C.A. (orig. ed.), §§ 14-107, 14-1-107.

§ 71-1-108. Authority over personnel.

The commissioner has the power, having regard to the efficient performance of the department's functions, to create positions in the department and in any division, region, agency, institution or service of the department for the accomplishment of the purposes of this part and to abolish these positions and the existing positions of officers and employees who by this part are transferred to the department. The positions in the department shall be classified by the commissioner according to the nature of the duties to be performed and the minimum qualifications for appointment, and such appointments shall be made on a merit basis. The commissioner, having regard to the nature of the services to be performed and the salaries paid for similar work elsewhere, shall establish a salary range for each class of position and within such salary range shall provide by rule for recognition of efficiency of service and length of service. All matters relating to personnel of the department shall be handled in accordance with, and under rules and regulations promulgated pursuant to authority of, title 8, chapter 30, parts 2 and 3.

History (3)

Acts 1937, ch. 48, § 10
C. Supp. 1950, § 4765.13 (Williams, § 4765.10)
T.C.A. (orig. ed.), §§ 14-108, 14-1-108.

§ 71-1-109. Legal assistance — Property — Rules.

The attorney general and reporter shall, when requested, advise the department on matters of law. The department may acquire, hold, and alienate property necessary or desirable for the performance of the functions vested in it by law. It shall have all powers necessary and proper for the carrying out of its functions, including the power to adopt and promulgate rules binding upon itself, and all persons subject to its control.

History (5)

Acts 1937, ch. 48, § 6
1949, ch. 114, § 1
C. Supp. 1950, § 4765.9 (Williams, § 4765.6)
Acts 1979, ch. 422, § 27
T.C.A. (orig. ed.), §§ 14-109, 14-1-109.

§ 71-1-110. Advisory committees — Multi-disciplinary protective services advisory teams.

(a) The commissioner has the authority to appoint, with the consent and approval of the governor, a committee or committees of citizens to act in an advisory capacity on any matter within the jurisdiction of the department, and to reimburse such members for their actual expenses in attending meetings of such committee or committees called at the commissioner's discretion from time to time. All reimbursement for travel expenses shall be in accordance with the comprehensive travel regulations as promulgated by the department of finance and administration and approved by the attorney general and reporter.
(b) The commissioner shall establish in each service region at least one (1) multi-disciplinary adult protective services evaluation team for review of protective services cases. All reimbursement for travel expenses shall be in accordance with the comprehensive travel regulations as promulgated by the department of finance and administration and approved by the attorney general and reporter.

Backlinks (1)

71-6-125(a)(2)

History (7)

Acts 1937, ch. 48, § 13
1949, ch. 113, § 1
C. Supp. 1950, § 4765.16 (Williams, § 4765.13)
Acts 1976, ch. 806, § 1 (142)
1977, ch. 482, § 12
T.C.A. (orig. ed.), §§ 14-110, 14-1-110
Acts 1996, ch. 1079, § 154.

§ 71-1-111. Hearings — Evidence.

The commissioner has the power to conduct or cause to be conducted hearings relating to the fact determination that the department is authorized or required to make; provided, that the commissioner, and any officer or employee of the department upon written authorization from the commissioner, has the power to administer oaths and affirmations, take depositions, issue subpoenas, and require the production of any books and records that may be necessary.

History (3)

Acts 1937, ch. 48, § 12
C. Supp. 1950, § 4765.15 (Williams, § 4765.12)
T.C.A. (orig. ed.), §§ 14-111, 14-1-111.

§ 71-1-112. Divisions and regions — Division of housing and emergency shelter.

(a) For the efficient and economical performance of the powers and functions vested in the department:
1. (1) The commissioner may establish within the department such divisions as may be necessary for the effective administration of the department. These divisions shall be charged with such duties and responsibilities as may be delegated to them by the commissioner, and the commissioner shall have the power to allocate and reallocate functions among such divisions. Each division shall be administered by a director who shall be appointed by the commissioner solely on a basis of merit as measured by training, ability and experience;
2. (2) There shall be established, for the purposes of local administration throughout the state, regions comprised of one (1) or more counties. Each such region shall be administered or supervised by a regional director, who shall be appointed by the commissioner solely on a basis of merit as measured by training, ability, and experience. The regional director, or such employees as the regional director may delegate, shall have the power of visitation and report of all charitable and relief institutions within the region that rightly come under the department as set out in this part, and such other powers as may be delegated by the commissioner. The regional director shall foster cooperation and intelligent coordination of work between all public and private charitable and social agencies in the region to the end that public resources and charitable donations may be efficiently managed and the needs of the region adequately cared for; and
3. (3) The commissioner has the power to create such subordinate divisions and such departmental agencies within the department as may be necessary to carry out the purposes of this part.
(b)
1. (1) There is created within the department a division of housing and emergency shelter. The commissioner shall appoint a director of housing and emergency shelter as provided in this subsection (b). The commissioner shall employ all consultants or staff assigned or performing duties for the division.
2. (2) The director has the power, duty and responsibility to:
  1. (A) Coordinate consultant or staff assignments and administrative functions and activities of the division;
  2. (B) Assign personnel to staff the various offices designated to carry out the purposes of this subsection (b) that assures the most efficient use of personnel; and
  3. (C) Coordinate the efforts of the division of housing and emergency shelter with all other individuals, agencies and organizations providing similar or equivalent services.
3. (3) The division shall cooperate and integrate its services with local agencies, local homeless coalitions, local and state housing authorities, and other local and state agencies, and shall engage in such activities as well as promote a high level of communication among the many individuals, entities and organizations concerned with homelessness issues. The division shall actively participate, subject to funds specifically appropriated in the general appropriations act, in the weatherization, rehabilitation and renovation of housing that qualifies for appropriate programs as determined by the division. The division shall work directly with the departments of mental health and substance abuse services and disability and aging to ensure that adequate and appropriate institutional and community-based services and shelter are provided to persons in need of them.
4. (4) The division shall develop and implement a plan for providing rental units on a sliding fee scale. In so doing, emphasis shall be given to locating rental units at a cost to the individual of less than one hundred fifty dollars ($150) per month. The division shall also develop and implement a plan for providing emergency shelter for individuals who are unable to pay rent. In carrying out its duties and responsibilities, the division shall maximize all federal and private funds and grants and block funding, as well as create a mechanism for providing rental and other deposits and subsidy payments for eligible individuals. The division shall actively be involved in new programs designed to relieve the housing shortage for eligible individuals as determined by the division and shall initiate and implement any such programs as they become available and feasible.
5. (5) The offices of the division shall be located in areas that are easily accessible to those who require the services of the division. Office space for such offices may be located in conjunction with any present agency of state government or an appropriate agency of local government that serves the population sought to be served by this subsection (b). Personnel from such agencies may be utilized by the division where appropriate. Such offices shall also serve as a coordinating center to provide information and referral services for crisis intervention, counseling, case management, job placement services, day shelter, transportation services and access to other agencies that serve the population in which such individuals are included.
6. (6) The division is authorized to promulgate necessary and appropriate rules and regulations to implement the effect and intent of this subsection (b). Such rules shall be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
7. (7) The funding for the division, created by this subsection (b), shall be subject to funds specifically appropriated for such purpose in the general appropriations act.

History (10)

Acts 1937, ch. 48, § 11
1939, ch. 95, § 7
C. Supp. 1950, § 4765.14 (Williams, § 4765.11)
Acts 1955, ch. 25, § 1
T.C.A. (orig. ed.), §§ 14-112, 14-1-112
Acts 1990, ch. 1070, §§ 1-7
2000, ch. 947, § 6
2010, ch. 1100, § 131
2012, ch. 575, § 1
2024, ch. 688, § 176.

§ 71-1-113. Expenditure of funds.

The department shall administer and expend funds appropriated to it by the general assembly or available from allotments by the federal government to the state or from contributions from the counties, cities, or other local units of government, or from other sources, in carrying out the duties imposed upon it by § 71-1-105, including the special training of personnel required to carry out such duties, and including grants to public or other nonprofit institutions of higher learning for training personnel employed or preparing for employment in a public welfare program, and for such other purposes as may be specified by law or delegated to it by the governor, including the publication of reports and the dissemination of information as to the cause and treatment of social ill-being and the prevention of maladjustment and delinquency.

Backlinks (1)

71-1-105(a)(9)

History (5)

Acts 1937, ch. 48, § 4
C. Supp. 1950, § 4765.6 (Williams, § 4765.4)
Acts 1953, ch. 10, § 1
1957, ch. 99, § 1
T.C.A. (orig. ed.), §§ 14-113, 14-1-113.

§ 71-1-114. Compliance with federal requirements authorized.

In the event that the federal government increases the percentages of funds to be furnished by it that may be matched by the state and used in connection with chapters 2-4 of this title, providing assistance to aged persons, aid to dependent children, or any successor program, and aid to the needy blind, the department is authorized to conform to the provisions of federal acts relating to the matching of administrative expense in a higher ratio than provided in such acts and to conform to the provisions for a higher ratio of matching of funds for assistance purposes. The department is further authorized to use any funds granted by the federal government in connection with such programs for the purpose for which they are granted and subject to the limitations or conditions contained in such grants.

History (5)

Acts 1937, ch. 48, § 4(b), as added by Acts 1941, ch. 40, § 1
C. Supp. 1950, § 4765.7 (Williams, § 4765.4)
impl. am. Acts 1975, ch. 219, § 1 (a, b)
T.C.A. (orig. ed.), §§ 14-114, 14-1-114
Acts 1996, ch. 950, § 22.

§ 71-1-115. Conditions imposed on local governments.

Whenever the department has discretion to expend funds appropriated for the purposes either through the officers and employees of the department or in the form of grants-in-aid to local governmental authorities, it shall decide with reference to the use of grants-in-aid according to the availability and adequacy of the facilities under the control of the local governmental authorities, as compared with the facilities of the department for furnishing the services required to be rendered; such funds shall be made available according to uniform rules to all local authorities performing similar functions. In formulating such rules, the department has the power to:
1. (1) Fix minimum standards of service and efficiency to be required of the local governmental authorities in carrying out the functions reposed in them by law;
2. (2) Provide for the termination of any grant-in-aid to any such authority whenever the department shall find that such minimum standards are not being complied with; and
3. (3) Require that as a condition of receiving grants-in-aid the local units of government shall bear specific proportions of the total expense of performing the designated functions.

History (3)

Acts 1937, ch. 48, § 7
C. Supp. 1950, § 4765.10 (Williams, § 4765.7)
T.C.A. (orig. ed.), §§ 14-115, 14-1-115.

§ 71-1-116. Judicial enforcement of subpoena — Notice — Inspection of employment records and credit bureau reports.

(a)
1. (1) If a person, firm, or corporation subpoenaed pursuant to authority granted pursuant to § 71-1-105(a)(17)(A) fails to comply with the subpoena, after reasonable notice to the person, firm, or corporation, the department may seek judicial enforcement of the subpoena by filing, through the attorney general and reporter, a petition with the circuit or chancery court of Davidson County or of the judicial district in which such person, firm, or corporation resides.
2. (2) A petition filed pursuant to subdivision (a)(1) must incorporate or be accompanied by a certification regarding the notice given and the failure of such person, firm, or corporation to attend or produce the items requested.
3. (3) Upon the filing of a petition pursuant to subdivision (a)(1) in the proper form, the court shall order the person, firm, or corporation named in the petition to appear and show cause why the person, firm, or corporation should not be required to comply with the subpoena or be held in contempt for failure to comply. The court may employ all judicial power provided by law to compel compliance with a subpoena requested pursuant to subdivision (a)(1), including the powers granted in §§ 29-9-103 — 29-9-106. The court is authorized to impose costs and sanctions against any person, firm, or corporation against whom a petition is filed pursuant to subdivision (a)(1) in the same manner and on the same bases as may be imposed for failure to comply with judicially issued subpoenas under the Tennessee Rules of Civil Procedure. The court may order the person, firm, or corporation to comply with the subpoena and may punish each day of noncompliance with the order as a separate contempt of court.
4. (4) The subpoena enforcement remedies set forth in subdivision (a)(3) are cumulative and not exclusive of any other remedies provided by law.
(b) Employment records, as defined in § 71-1-105(a)(17)(B), shall be open to inspection and copying by a department representative at any reasonable time and as often as may be necessary.
(c) The department shall also have the right to compare information reported to the department by applicants or recipients with data maintained by the credit bureaus.

History (1)

Acts 2018, ch. 789, § 2.

§ 71-1-117. Public inspection of welfare lists.

The commissioner is authorized and instructed to make public to any citizen of Tennessee through the office of the commissioner or county human services offices the names of all recipients of public welfare grants and the amount of each grant per month, each list to be broken down by counties. Only the list containing the recipients resident in a particular county is to be available for inspection in that county. The lists of all counties are to be available for inspection in the office of the commissioner.

Backlinks (5)

History (3)

Acts 1953, ch. 29, § 1 (Williams, § 4765.13a)
impl. am. Acts 1975, ch. 219, §§ 1 (a, b), 2 (a, b)
T.C.A. (orig. ed.), §§ 14-117, 14-1-117.

§ 71-1-118. Restrictions on use of welfare list.

(a) The welfare lists referred to in § 71-1-117 cannot be used for political or commercial purposes and no one will be permitted to copy such a list.
(b) A violation of this section is a Class C misdemeanor.

Backlinks (4)

History (3)

Acts 1953, ch. 29, § 2 (Williams, § 4765.13a)
T.C.A. (orig. ed.), §§ 14-118, 14-1-118
Acts 1989, ch. 591, § 113.

§ 71-1-119. Utilization of senior citizens' services.

The department may establish a program utilizing senior citizens as volunteers and, to the extent funds are available, as employees in programs that provide services for children, persons with disabilities and other senior citizens. The department may utilize such federal funds as are available for these purposes.

History (4)

Acts 1974, ch. 706, § 1
impl. am. Acts 1975, ch. 219, § 1
T.C.A., §§ 14-119, 14-1-119
Acts 2011, ch. 47, § 96.

§ 71-1-120. Federal funds — Administrative economy.

This section shall be construed, insofar as is practicable, so as to be consistent with Title XX of the Social Security Act (42 U.S.C. §§ 1397 et seq.), and regulations issued under the authority of that act. The commissioner shall take reasonable steps to assure that the cost of administering, monitoring, and overseeing services performed by public providers and private providers shall be accomplished as economically as practicable. In the event that such expenditures are estimated to exceed six percent (6%) of the total estimated expenditures for services provided by public providers and private providers, the commissioner shall include in the annual service plan a statement to that effect, accompanied with an explanation of the reasons why such expenditures cannot be held to or below six percent (6%) of the estimated cost of services provided by public and private providers.

History (2)

Acts 1976, ch. 687, §§ 1, 2
T.C.A., §§ 14-120, 14-1-120.

§ 71-1-121. Access to public assistance records by authorized counsel.

Notwithstanding any other law to the contrary, the department shall grant access to all public assistance records, reports, documents, case files or other similar documents about a person who has applied for or is receiving or has received public assistance, including, but not limited to, temporary assistance for needy families (TANF), or any successor program, food assistance pursuant to chapter 5, part 3 of this title, medicaid and Title XX services (42 U.S.C. §§ 1397 et seq.), to authorized counsel for the person.

History (3)

Acts 1981, ch. 355, § 1
T.C.A., § 14-1-121
Acts 1996, ch. 950, § 23.

§ 71-1-122. Review of human services advisory committees.

The human services advisory committees appointed by the commissioner shall periodically be subject to review pursuant to the governmental entity review law, compiled in title 4, chapter 29, simultaneously with, and as an adjunct to, the department.

History (2)

Acts 1985, ch. 127, § 3
T.C.A., § 14-1-122.

§ 71-1-123. Recovery by state of certain benefits incorrectly paid or for which recipient is reimbursed.

(a)
1. (1) Any benefits paid to, or on behalf of, any recipient cannot be recovered from such a beneficiary unless such assistance has been incorrectly paid, or unless the recipient or beneficiary recovers or is entitled to recover from a third-party reimbursement for all or part of the costs of care or treatment for an injury or illness for which the assistance is paid.
2. (2) To the extent of payments of assistance, the state shall be subrogated to all rights of recovery, for the cost of care or treatment for an injury or illness for which assistance is provided, contractual or otherwise, of the recipients against any person.
3. (3) Payments to a provider of services shall not be withdrawn or reduced to recover funds obtained by the recipient from third parties for services rendered by such provider if these funds were obtained without the knowledge or direct assistance of the provider of assistance.
4. (4) When the state asserts its right to subrogation, the state shall notify the recipient, in language understandable to all recipients, of such recipient's rights of recovery against third parties and that such recipient should seek the advice of an attorney regarding those rights of recovery to which such recipient may be entitled.
5. (5) If, while receiving assistance, the recipient becomes possessed of any resource or income in excess of the amount stated in the application for the assistance provided, it is the duty of the recipient immediately to notify the agency designated to determine eligibility for the assistance of the receipt or possession of such resource or income.
6. (6) When it is found that any person has failed to so notify the agency that such person is or was possessed of any resource or income in excess of the amount allowed, or when it is found that within three (3) years prior to the date of that person's application, or as otherwise provided by policy or state plan, a recipient made an assignment or transfer of property for the purpose of rendering the recipient eligible for assistance as provided in this part, any amount of assistance paid in excess of the amount to which the recipient was entitled shall constitute benefits incorrectly paid. Any benefits incorrectly paid shall be recoverable from the recipient, while living, as a debt due to the state and, upon the recipient's death, as a claim classified with taxes having preference under the laws of this state.
(b)
1. (1) Upon accepting assistance from the programs designated in this part, the recipient shall be deemed to have made an assignment to the state of the right to third-party insurance benefits to which the recipient may be entitled.
2. (2) Failure of the recipient to reimburse the state for the assistance received from any third-party insurance benefits received as a result of an illness or injury for which the assistance was paid may be grounds for removing the recipient from future participation in the benefits available under these programs as provided by policy or state plan; provided, that:
  1. (A) Any removal from participation shall be after appropriate advance notice to the recipient;
  2. (B) The provider of service shall not be prevented from receiving payment from the state for assistance services previously furnished the recipient; and
  3. (C) Nothing in this subsection (b) shall require an insurer to pay benefits to the state that have already been paid to the recipient.
(c)
1. (1) The right of subrogation by the state to the recipient's right to recovery shall be subject to ordinary and reasonable attorney fees.
2. (2) Where a recipient has retained an attorney, the attorney shall not be considered liable unless the attorney has notice from the state of the state's claim of subrogation prior to disbursement of the funds to the recipient.
(d) This section shall apply to all programs provided by the department pursuant to the Social Security Act (42 U.S.C.), as amended, and the federal Rehabilitation Act (29 U.S.C § 701 et seq.), as amended, and as provided in the Vocational Rehabilitation Law of Tennessee, compiled in title 49, chapter 11, part 6.

History (1)

Acts 1990, ch. 609, § 1.

§ 71-1-124. Quarterly report detailing department's access to and use of federal funds.

(a) Notwithstanding any law to the contrary, the commissioner shall submit a report quarterly to the persons identified in subsection (c) detailing the department's access to and use of federal funds. The report may be submitted electronically.
(b) The report must include information, in the aggregate and per program, regarding:
1. (1) The amount and source of federal funds available to be spent by the department in the current fiscal year;
2. (2) The amount of federal funds budgeted to be spent and expected to be actually spent in the current fiscal year;
3. (3) The amount and percentage of federal funds set aside as reserve, both cumulatively and in the current fiscal year;
4. (4) Whether there are restrictions or requirements under federal law on how federal funds can be spent, and what those restrictions or requirements are;
5. (5) Whether there are restrictions or requirements under state law on how federal funds can be spent, and what those restrictions or requirements are;
6. (6) Whether and how the restrictions or requirements described in subdivisions (b)(4)-(5) prevented the department's expenditure of federal funds; and
7. (7) Whether unspent federal funds available to the department carry over to the next fiscal year or are lost.
(c) Persons to whom the commissioner must submit the report include:
1. (1) The speakers of the house of representatives and the senate;
2. (2) The chief clerks of the house of representatives and the senate;
3. (3) The chairs of the finance, ways and means committees of the house of representatives and the senate;
4. (4) The chairs of the health committee of the house of representatives and the health and welfare committee of the senate;
5. (5) The executive director of the general assembly's fiscal review committee, for distribution to the members of the committee;
6. (6) The directors of the office of legislative budget analysis; and
7. (7) The legislative librarian.
(d) For purposes of this section, “program” includes programs administered by the department for adult and family services, child support, and rehabilitation services, including:
1. (1) The child care benefits program;
2. (2) The temporary cash assistance program, through the state's temporary assistance to needy families (TANF) program;
3. (3) The supplemental nutrition assistance program (SNAP);
4. (4) The child support enforcement program;
5. (5) Rehabilitation services; and
6. (6) The disability determination program.

History (1)

Acts 2021, ch. 308, § 1.

§ 71-1-125. Inclusion of information detailing access to use of federal TANF funds in annual block grant report.

(a) Notwithstanding a law to the contrary, the commissioner shall include in the annual block grant report submitted pursuant to § 9-4-5404, information detailing the department's access to the use of federal TANF funds as described in subsection (b).
(b) The report described in subsection (a) must include information detailing the department's access to and use of federal TANF funds during the previous federal fiscal year, subtotaled by the four (4) purposes of the TANF program, as described by 45 C.F.R. § 260.20, for which the funds were expended, including:
1. (1) Overall spending and the number of contracts through which services or assistance were provided in furtherance of each respective purpose;
2. (2) Examples of expenditures in furtherance of each respective purpose, including:
  1. (A) Expenditures for programs to encourage two-parent family formation and two-parent family preservation; and
  2. (B) Expenditures for parenting education, mediation, marriage education, marital counseling, visitation facilitators, and initiatives to facilitate fatherhood support and inclusion; and
3. (3) A review of all program expenditures to ensure inclusion of both parents.
(c) For purposes of this section, “federal TANF funds” means the state's temporary assistance for needy families (TANF) program administered by the department.

History (2)

Acts 2022, ch. 693, § 1
2024, ch. 855, § 1.

§ 71-1-126. Review of state medicaid program.

The commissioner of finance and administration is hereby directed to begin the process of reviewing, for the purposes of reforming, the state's medicaid program. Such review shall include reviewing managed care programs and applying for needed federal waivers as well as the development of plans for consideration by the governor and the general assembly outlining options the state has under federal law concerning, but not limited to, eligibility, scope and duration of services, optional services, and rate structures. The governor is hereby authorized to appoint committees, as the governor deems appropriate, to assist in the overall review of the medicaid program, it being the legislative intent that the state of Tennessee develop a medicaid program that can continue to provide the necessary health care services to those appropriately in need at a cost that can be supported within existing sources of revenue.

History (4)

Acts 1992, ch. 913, § 19
2010, ch. 1030, § 18
2013, ch. 236, § 62
2016, ch. 797, §§ 6, 7.

§ 71-1-127. Annual training about human trafficking.

The department shall work with a nonprofit charitable organization that focuses on human trafficking advocacy and education to provide mandatory annual training to appropriate department personnel in the identification, intervention, prevention, and treatment of human trafficking victims, and in the proper action that should be taken when dealing with a known or suspected victim of human trafficking. The training must also inform department personnel of the resources and agencies available to provide help and services for victims of human trafficking. The training selected by the department must be submitted to, and approved by, the Tennessee bureau of investigation's human trafficking advisory council.

History (1)

Acts 2022, ch. 842, § 3.

§ 71-1-128. [Reserved.]

§ 71-1-129. “Parents as first teachers” pilot projects.

Acting in consultation with the departments of education, health, mental health and substance abuse services, and disability and aging, through a system of competitive grants and technical assistance, the department of human services shall establish and implement “parents as first teachers” pilot projects in one (1) or more counties of the state. On or before January 1, 1998, the department shall report to the governor and to the general assembly concerning pilot project findings and recommendations.

History (4)

Acts 1995, ch. 483, § 1
2010, ch. 1100, § 132
2012, ch. 575, § 1
2024, ch. 688, § 177.

§ 71-1-130. Day care services — Rate of reimbursement — Market rate study — Enrollment-based child care subsidy payments program.

(a) The department shall perform a market rate study of day care rates annually.
(b) In compliance with federal law and regulations and from the market rate study or utilizing an alternative methodology, the department shall annually determine an amount to be paid as reimbursement on behalf of low-income families, for the provision of child or infant care by a day care center, family day care home, or group day care home.
(c) The commissioner shall report to the governor and the general assembly, no later than October 1 of each year, the results of the market rate study; the results of an alternative methodology utilized, if applicable; and the annual rate that has been requested by the department in its budget.
(d) The average rate to be paid by the department for day care services in fiscal year 1990-1991 shall be forty-six dollars ($46.00) per week. An additional two dollars ($2.00) per day may be paid for transportation in “as-needed” day care, if it is furnished by the day care provider.
(e) The amounts to be paid by the department for day care services and transportation under this section shall be subject to the availability of funding each year in the general appropriations act.
(f) In any case where the department terminates a certificate for an eligible child for child care services with a child care provider, the department shall promptly, but in any event within forty-eight (48) hours, inform the provider that the child's certificate is or will no longer be in effect.
(g)
1. (1) A parent or other caretaker of an eligible child who receives a subsidy certificate from the department shall be solely responsible for payment to the provider of child care services any required copayments or other payments required pursuant to any contractual agreement with the provider of child care services.
2. (2) Unless extenuating circumstances or other good cause applies as determined by the department, upon removal of a child from a provider of child care services, no subsidy certificate shall be issued or any payments made by the department on behalf of the child to any subsequent provider of child care services, unless the parent or other caretaker of the eligible child has made all required copayments to, or has reached an agreement regarding outstanding copayments with, the previous provider of child care services.
3. (3) For purposes of this subsection (g), “copayment” means the department-imposed fee required to be paid by the parent or caretaker on behalf of the eligible child to the provider of child care services as a condition for the receipt of a subsidy certificate.
4. (4) Nothing in this subsection (g) shall be construed to require the department to resolve or mediate any dispute between the parent or caretaker of any eligible child and the provider of child care services relative to outstanding copayments.
(h) For purposes of this section, “alternative methodology”:
1. (1) Means a method of determining the costs of day care other than by a market rate study; and
2. (2) Includes cost-of-quality studies and cost estimation models.
(i)
1. (1) The department may utilize an enrollment-based child care subsidy payments program that complies with all applicable federal funding requirements and legal authority and that seeks to provide adequate, stable payments to providers of child care services under this section by establishing effective payment practices based upon accurate time and attendance systems.
2. (2) The department shall consider program standards, such as, but not limited to, the following:
  1. (A) The child's developmental and educational goals when authorizing care periods eligible for reimbursement;
  2. (B) Accommodation of variable parent schedules;
  3. (C) Authorizing pay based upon enrollment rather than attendance;
  4. (D) Using a range of hours to determine authorized care amounts; and
  5. (E) Simplifying and streamlining payment processes with providers.
3. (3) The department shall publish on the department's publicly accessible website an overview of child care services and the methodology used to issue payments to providers of child care services, including any changes to the methodology during the previous year, if applicable.

History (6)

Acts 1990, ch. 1072, § 1
T.C.A. (orig. ed.), § 71-3-129
Acts 1996, ch. 950, § 21
2006, ch. 747, § 1
2021, ch. 484, § 1
2021, ch. 498, §§ 1-3.

§ 71-1-131. Confidentiality of records.

(a)
1. (1)
  1. (A) The records of the department, its contractors or agents concerning the provision of Title IV-D child or spousal support services shall be confidential and information in such records shall not be subject to public inspection by any person or entity and the records shall not be used in judicial, administrative or legislative proceedings or for law enforcement activities, except as otherwise provided in this section.
  2. (B) Any information provided to the department, its contractors or agents by any other state or federal agencies or other entities, that is required by federal or state law or regulations to be provided to the department as part of the department's Title IV-D responsibilities to establish, enforce or modify child or spousal support, but which information is otherwise protected as confidential by the laws or regulations of the United States or by any state's, territory's or other government's law or regulations, shall also be confidential, and shall be held by the department in a confidential manner. Such information shall also not be subject to public inspection by any person or entity and shall not be used in judicial, administrative or legislative proceedings or for law enforcement activities, except as otherwise provided in this section.
  3. (C) Except as limited by subdivision (a)(2), the department, its contractors or agents may disclose any information in the records of the Title IV-D child or spousal support records for purposes directly connected with the establishment of paternity or the establishment, modification, or enforcement of child or spousal support in any judicial or administrative proceeding or for the administration of any part of the child support program.
2. (2) Except where information in the child or spousal support record provided to the department pursuant to any federal or state law or regulation for purposes related to the establishment, enforcement or modification of child or spousal support under the Title IV-D child support program is otherwise specifically protected from further disclosure or further use by any other federal, state, territorial or other government law or regulation, the department is specifically authorized to further utilize or further disclose any information from the Title IV-D child or spousal support records for any purposes that it determines in its sole discretion are directly connected with:
  1. (A) The administration of the plan or program approved under Parts A, B, D, or E of Title IV of the Social Security Act or under Titles I, XIV, XIX, or XX of the Social Security Act, or the supplemental security income program (SSI) established under Title XVI of the Social Security Act;
  2. (B) Any investigations, prosecutions, or civil, criminal or administrative proceeding conducted in connection with the administration of any such plan or program under subdivision (a)(2)(A);
  3. (C) The administration of any other federal or federally assisted program that provides assistance, in cash or in kind, or services, directly to individuals on the basis of need;
  4. (D) Reporting to an appropriate agency or official, information on known or suspected instances of physical or mental injury, sexual abuse or exploitation, or negligent treatment or maltreatment of a child who is the subject of a child enforcement activity under circumstances that indicate that the child's health or welfare is threatened by such treatment;
  5. (E) A response to a request for child support payment records of a child support obligor; and
  6. (F) Inquiries from legislative representatives of an obligor or obligee concerning child support payment records or child support legal and administrative procedures utilized to attempt recovery of support payments involved in individual cases under a support order upon a release for that person authorized in any suitable manner as determined by the department or its contractors by the affected person. An inquiry and release by one party under this subdivision (a)(2)(F) does not authorize release of information involving the other party other than the child support payment record and child support legal or administrative procedures utilized to attempt recovery of support payments from the other party. Nothing in this subdivision (a)(2)(F) shall be construed to authorize release of any information that is otherwise protected as confidential pursuant to this section.
3. (3)
  1. (A) Notwithstanding the foregoing provisions of this section and any other law to the contrary, no information shall be disclosed by the department pursuant to this section from Title IV-D records maintained by the department, its contractors or agents when:
    1. (i) A protective order has been entered against one party and the release of information from such record would disclose the whereabouts of the party or the child for whose benefit the protective order was entered; or
    2. (ii) The department, its contractors or agents have reason to believe that the release of information concerning the whereabouts of one party or the child to another person may result in physical or emotional harm to the party or the child.
  2. (B) In situations in which the prohibitions of subdivisions (a)(3)(A)(i) and (ii) arise, the department shall notify the secretary of health and human services if it determines that there exists reasonable evidence of domestic violence or child abuse against a party or the child and that the disclosure of such information could be harmful to the party or the child.
  3. (C) When a disclosure of information is made from the United States department of health and human services' federal parent locator service (FPLS) to a court of this state or an agent of the court of this state, and the court is notified that FPLS has reasonable evidence to show that domestic violence or child abuse has occurred, the court shall determine whether disclosure to any other person of information received from FPLS could be harmful to the parent or child and, if the court determines that disclosure to any other person could be harmful, the court and its agents shall not make such disclosure.
4. (4) Notwithstanding any law to the contrary, when any information regarding a consumer report, as defined in 15 U.S.C. § 1681a, from a consumer reporting agency is obtained by the department, its contractors or agents, such information will be kept confidential and will be used solely for the purposes of establishing an individual's capacity to make child or spousal support payments or in determining the appropriate level of such payments, and such report shall be confidential and will not be available by subpoena or court order for any civil, criminal, or administrative proceeding, law enforcement activity or for any other purpose, except for the purpose of the establishment, enforcement and modification of child or spousal support obligations by the department, or by any federal, state, territorial, or foreign child or spousal support enforcement agency, or by their contractors or agents.
5. (5) Notwithstanding any law to the contrary, any financial information obtained from a financial institution by the department, its contractors or agents regarding an individual shall be confidential and will not be available by subpoena or court order for any civil, criminal or administrative proceeding, law enforcement activity or for any other purpose, and shall be disclosed only for the purpose of and to the extent necessary for the establishment, enforcement and modification of child or spousal support obligations by the department, its contractors or agents or by any federal, state, territorial, or foreign child support enforcement agency or their contractors or agents.
6. (6) Notwithstanding any law to the contrary, any information that is required to be given to the department of human services, its contractors or agents by any requirement of federal or state law or regulations as part of the department's responsibilities to enforce child or spousal support, but that is otherwise not subject to subdivisions (a)(4) and (a)(5), and that is otherwise ordinarily protected by federal or state law or regulations from disclosure or use because it is protected as confidential information, shall be confidential and shall not be available by subpoena or court order for any civil, criminal, administrative proceeding, law enforcement activity, or for any other purpose. Such information shall be disclosed only to the extent permitted by such federal or state laws or regulations, or only for the purpose of and to the extent necessary for the establishment, enforcement and modification of child support obligations by the department, its contractors or agents or by any federal, state, territorial, or foreign child support enforcement agency or their contractors or agents.
7. (7)
  1. (A)
    1. (i) Except as released pursuant to subdivision (a)(2) by the department, its contractors or agents, and except as prohibited by subdivisions (a)(3) — (a)(6), the records or portions of records or testimony of current or former employees, agents or contractors of the department concerning the Title IV-D child support program may be released only pursuant to a written order for their disclosure issued by a judicial or administrative tribunal and served personally upon the commissioner of human services or the commissioner's designee at least five (5) business days prior to the date designated for disclosure. A subpoena shall not be sufficient to obtain the disclosure of Title IV-D child support records. Unless waived by the department, any order for disclosure not properly served shall be void and of no effect whatsoever.
    2. (ii) Except as necessary for use in a judicial proceeding or an administrative proceeding concerning a Title IV-D child or spousal support matter in which such records must be disclosed, and for any appeal from the proceeding, any records of the Title IV-D child support program that may be ordered disclosed pursuant to this subdivision (a)(7)(A) for use in any other civil or criminal judicial or other administrative proceeding must also have a written protective order issued by the court or administrative law judge or hearing officer and served upon the commissioner of human services prior to the release of the records pursuant to this subdivision (a)(7)(A). The protective order shall state that there will be no further disclosure beyond the necessary use by the tribunal and the parties for the conduct of those proceedings. The department shall not be required to disclose any records until the receipt of the protective order by the department or its designee.
  2. (B) The department may comply with a properly served order issued by a state or local judicial or administrative tribunal pursuant to this subdivision (a)(7) by sending copies of pertinent portions of the record requested, or by sending an abstract of the pertinent information from its computer records or other records, in a sealed envelope addressed to the court or administrative body or the person taking a deposition, together with an affidavit of an authorized agent of the department attesting to the authenticity of the record, unless the court or administrative body, for good cause shown, enters an order in the record requiring the attendance of a department, contractor or agent employee at the proceeding.
  3. (C) The department, its contractors or agents may file a motion to quash or modify any subpoena or order for disclosure issued by any judicial or administrative tribunal or by any legislative entity, and no records shall be disclosed pursuant to any subpoena or order until the conclusion, including appeal, of the proceedings seeking to quash or modify the subpoena or order.
8. (8) A knowing violation of the provisions restricting the disclosure of information pursuant to this section shall be a Class B misdemeanor.
(b) Notwithstanding any other provisions of this section, information that is required to be provided to the department of human services, its contractors or agents by the department of labor and workforce development shall not be further disclosed or utilized except to the extent permitted and for the purposes allowable pursuant to § 50-7-701 or under applicable federal or state law or regulations.

Backlinks (2)

History (3)

Acts 1997, ch. 551, § 10
1998, ch. 1098, §§ 65-67
1999, ch. 520, § 47.

§ 71-1-132. Rule making authority — Compliance with federal law — Notice of rulemaking.

(a)
1. (1) The department shall have rulemaking authority to establish any rules necessary for the administration of the child support program operated pursuant to Title IV-D of the Social Security Act (42 U.S.C. § 651 et seq.), and shall have rulemaking authority to establish any rules to carry out the requirements of any title or part of any title that the department administers and that are necessary to implement the Title IV-D child support program and to effectuate any federal legislative or regulatory changes.
2. (2) Notwithstanding any law to the contrary, the department shall have authority after July 1, 1997, to promulgate any emergency rules, following approval by the attorney general and reporter pursuant to § 4-5-208, to implement chapter 551 of the Acts of 1997 or of any title or part of any title that the department administers and that may be necessary to implement chapter 551 of the Acts of 1997, which emergency rules shall become effective upon the effective date of any provisions of Acts 1997, ch. 551, if the implementation period of any provisions of chapter 551 of the Acts of 1997, occurs before July 1, 1998; provided, however, that the department shall promulgate permanent rules to implement chapter 551 of the Acts of 1997, pursuant to a rulemaking hearing as required by the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. Nothing in this subsection (a) shall be construed to abrogate the ability of the department at any time to utilize the provisions for implementing emergency rules as otherwise permitted by the Uniform Administrative Procedures Act.
(b) Notwithstanding any other state law to the contrary, the department shall have the authority to immediately implement any federal legislative or regulatory changes by emergency rules following approval by the attorney general and reporter pursuant to § 4-5-208 if such federal legislative or regulatory changes occur before July 1, 1998; provided, however, that permanent rules shall be promulgated pursuant to the Uniform Administrative Procedures Act. Nothing in this subsection (b) shall be construed to abrogate the ability of the department at any time to utilize the provisions for implementing emergency rules as otherwise permitted by the Uniform Administrative Procedures Act.
(c) Notwithstanding any other law to the contrary, any forms mandated by the secretary of health and human services that are required to be utilized by the department of human services in any aspect of the Title IV-D child support program administered by the department shall be implemented immediately by emergency rule of the department following approval by the attorney general and reporter pursuant to § 4-5-208, and shall, in all respects, immediately supersede any forms in use at the time the department implements the use of such federal forms by emergency rule. Any requirements of the laws or regulations of this state that are inconsistent with the language or procedures established by such federal forms shall be subordinate to the requirements imposed by such federal forms.
(d) Prior to the filing of a notice of rulemaking for permanent rules pursuant to this section, the department shall send the rules for review by an advisory group composed of two (2) representatives of the state court clerks' conference appointed by the president of the state court clerks' association; two (2) representatives of the judges of courts who have child support responsibilities, one (1) of whom will be appointed by the chief justice of the supreme court and one (1) of whom will be appointed by the president of the council of juvenile and family court judges; one (1) representative of the administrative office of the courts; two (2) citizen representatives who are attorneys appointed by the commissioner of human services, one (1) of whom will be an advocate for child support obligors and one (1) of whom will be an advocate for child support obligees; and two (2) representatives of the department of human services designated by the commissioner. The department shall implement procedures to ensure that the work of the advisory group is accountable and transparent to the public. This section does not prevent the department from filing any notice of rulemaking prior to or at the time the proposed permanent rules are sent to the advisory group where the department determines that immediate filing of the notice without prior review by the advisory group is necessary to meet any requirements relative to the potential expiration of emergency rules or to comply with any federal statutory or regulatory requirements or any federal policy directives, nor does the requirement of this subsection (d) supersede any requirements of subsection (c).

History (3)

Acts 1997, ch. 551, § 68
2009, ch. 566, § 12
2021, ch. 526, § 1.

§ 71-1-133. Child care services fraud — Restitution — Civil recovery of overpayments.

(a)
1. (1) Whoever knowingly obtains, or attempts to obtain, or aids or abets any person or entity to obtain or attempt to obtain, by means of a willfully false statement or representation or by impersonation, or by any fraudulent scheme, any child care services, or payments for child care services, that are provided under any program by the department of human services or by or through any of the department's grantees or contractors, to which such person or entity is not entitled, or of a value greater than that to which such person or entity is entitled, the value of which is, or would be, one hundred ($100) or more, commits a Class E felony. Upon conviction, such person shall be sentenced for such offense as provided by law, or shall be fined not less than one thousand dollars ($1,000) nor more than five thousand dollars ($5,000), or both.
2. (2) If the value of child care services or the payment for such services obtained in the manner described in subdivision (a)(1) is, or would be, less than one hundred dollars ($100), such person commits a Class A misdemeanor and shall be sentenced for such offense, or shall be fined, or both, as provided by law.
(b) In addition to any of the penalties pursuant to subsection (a), any person convicted of any offense specified in subsection (a) shall be ordered to make restitution in the total amount found to be the value of the child care services that form the basis for the conviction. In the event any person ordered to make restitution pursuant to this section is found to be indigent and, therefore, unable to make restitution in full at the time of conviction, the court shall order a periodic payment plan consistent with the person's financial ability.
(c) Notwithstanding any other law to the contrary, prosecutions for any of the offenses specified in subsection (a) shall be commenced within four (4) years next after the commission of the offense. For purposes of this subsection (c), any such offense that is based upon a willful failure to report information as required by law or by any program requirements relating to eligibility for child care services is considered a continuing offense until such information is reported.
(d) The department may recover by civil action in any appropriate court the value of child care services that have been incorrectly paid to or received by any person or any entity and the costs of the proceeding and reasonable attorneys fees necessary for collection.
(e)
1. (1) For purposes of this section, “child care” means the supervision, protection, and provision for the basic physical, developmental or emotional needs of a child, or evidence of any effort to provide for, or any apparent or stated intent to provide for, the supervision, protection, and basic physical, developmental or emotional needs of a child by any person or entity outside the child's own home or by a person who comes to the child's home, whether or not the person or entity is licensed to provide such care or is unregulated.
2. (2) For purposes of this section “services” means the payment for, or provision by, the department, its grantees or its contractors of:
  1. (A) Any costs of, or any fees for, child care provided by any person or entity;
  2. (B) Any transportation costs or any transportation fees for the child to obtain child care or any related child care services; or
  3. (C) Any food supplement or meal assistance programs, excluding the food stamp or food assistance program under chapter 5, part 3 of this title, for a child who is receiving child care.

History (1)

Acts 2000, ch. 923, § 1.

§ 71-1-134. License, certification or registration — Notifications — Prerequisites — Website — Electronic notifications.

(a) The department and each board, commission, agency or other governmental entity created pursuant to this title shall notify each applicant for a professional or occupational license, certification or registration from the department, board, commission, agency or other governmental entity where to obtain a copy of any statutes, rules, guidelines, and policies setting forth the prerequisites for the license, certification or registration and shall, upon request, make available to the applicant a copy of the statutes, rules, guidelines, and policies.
(b) The department and each board, commission, agency or other governmental entity created pursuant to this title shall notify each holder of a professional or occupational license, certification or registration from the board, commission, agency or other governmental entity of changes in state law that impact the holder and are implemented or enforced by the entity, including newly promulgated or amended statutes, rules, policies, and guidelines, upon the issuance and upon each renewal of a holder's license, certification or registration.
(c) The department and each board, commission, agency or other governmental entity created pursuant to this title shall establish and maintain a link or links on the entity's website to the statutes, rules, policies, and guidelines that are implemented or enforced by the entity and that impact an applicant for, or a holder of, a professional or occupational license, certification, or registration from the entity.
(d)
1. (1) The department and each board, commission, agency, or other governmental entity created pursuant to this title shall allow each holder of a professional or occupational license, certification or registration from the department, board, commission, agency or other governmental entity to have the option of being notified by electronic mail of:
  1. (A) Renewals of the holder's license, certification or registration;
  2. (B) Any fee increases;
  3. (C) Any changes in state law that impact the holder and are implemented or enforced by the entity, including newly promulgated or amended statutes, rules, policies and guidelines; and
  4. (D) Any meeting where changes in rules or fees are on the agenda. For purposes of this subdivision (d)(1)(D), the electronic notice shall be at least forty-five (45) days in advance of the meeting, unless it is an emergency meeting then the notice shall be sent as soon as is practicable.
2. (2) The department and each board, commission, agency or other governmental entity created pursuant to this title shall notify each holder of a license, certification or registration of the availability of receiving electronic notices pursuant to subdivision (d)(1) upon issuance or renewal of the holder's license, certification or registration.

History (2)

Acts 2008, ch. 1070, § 12
2012, ch. 952, § 9.

§ 71-1-135. Victims of human trafficking.

(a) The commissioner of human services shall establish a plan for the delivery of services to victims of human trafficking after consultation with the following departments:
1. (1) Department of children's services;
2. (2) Department of health;
3. (3) Department of disability and aging;
4. (4) Department of mental health and substance abuse services; and
5. (5) Tennessee bureau of investigation.
(b) The plan developed under subsection (a) shall include, but not be limited to, provisions to:
1. (1) Identify victims of human trafficking in this state;
2. (2) Identify community-based services for victims of human trafficking;
3. (3) Assist victims of human trafficking through the provision of information regarding access to benefits and services to which those victims may be entitled;
4. (4) Coordinate delivery of services and information concerning health care, mental health care, legal services, housing, job training, education and victim's compensation funds;
5. (5) Prepare and disseminate educational materials and provide training programs to increase awareness of human trafficking and the services available to victims; and
6. (6) Assist victims of human trafficking with family reunification.
(c) In addition to the requirements of subsection (b), the plan shall include a timeline for which the department anticipates the state would be capable of implementing the plan, along with anticipated rates of assistance to victims of human trafficking, cost of implementation, an itemized rationale for both, and any other factor that the department opines will significantly contribute to or detract from the success of implementing the plan.
(d) By July 1, 2013, the department of human services shall transmit a copy of the plan and issue a report to the chair of the judiciary committee of the senate and the chair of the judiciary committee of the house of representatives.

History (5)

Acts 2012, ch. 575, § 1
2012, ch. 963, § 1
2013, ch. 236, § 33
2019, ch. 345, § 132
2024, ch. 688, § 178.

Part 2 Advances to Social Services Contractors

§ 71-1-201. Advance payment.

Organizations, businesses, or institutions engaged in contracts with the state to provide social services to third parties, including Title XX (42 U.S.C. §§ 1397 et seq.), weatherization, low income energy assistance and other community services administered or funded by the department of human services, that are partially funded by federal grants provided on a cost reimbursement basis, may request advance payment from the state.

Backlinks (1)

71-1-205(a)

History (4)

Acts 1976, ch. 454, § 1
T.C.A., § 14-2401
Acts 1984, ch. 789, § 1
T.C.A., § 14-32-101.

§ 71-1-202. Application to state agency or department.

Organizations or businesses having state contracts to provide services may make application to the state agency or department having jurisdiction over the contractor for advance payment. No funds shall be released to the contractor until the third party contractor has demonstrated that state matching fund requirements have been met.

History (2)

Acts 1976, ch. 454, § 2
T.C.A., §§ 14-2402, 14-32-102.

§ 71-1-203. Approval — Procedure.

Upon approving an application for funds, the state agency or department with jurisdiction over the contractor shall forward the application to the director of accounts for payment.

History (2)

Acts 1976, ch. 454, § 3
T.C.A., §§ 14-2403, 14-32-103.

§ 71-1-204. Limitation on use of funds.

Funds provided under this part shall only be used to cover costs incurred by third party social service contractors to cover necessary capital expenditures, to provide cash flow, or for other proper purposes where payment is required in cash and cost reimbursement is unacceptable.

History (2)

Acts 1976, ch. 454, § 4
T.C.A., §§ 14-2404, 14-32-104.

§ 71-1-205. Procedures for advance payments — Limitation — Appropriation.

(a) The commissioner of finance and administration is directed to establish procedures to provide for the advance payments authorized in § 71-1-201. At the termination of the contract or upon termination of provision of contracted social service by the agency, the department of human services shall withhold any outstanding advance from funds otherwise payable to the agency under the contract with the department.
(b) The advance payments shall not exceed an amount appropriated for the advance payments in the general appropriations act for each fiscal year.

History (5)

Acts 1976, ch. 454, § 5
1978, ch. 887, § 1
T.C.A., § 14-2405
Acts 1984, ch. 789, § 2
T.C.A., § 14-32-105.

Chapter 2 Programs and Services for Elderly Persons

Part 1 [Repealed]

§ 71-2-101. [Repealed]

History (5)

Acts 1981, ch. 428, § 2
1982, ch. 834, § 2
T.C.A., § 14-6-101
Acts 2001, ch. 397, § 2
repealed by Acts 2024, ch. 688, § 98, effective July 1, 2024.

§ 71-2-102. [Repealed]

History (5)

Acts 1981, ch. 428, § 3
1982, ch. 834, § 3
T.C.A., § 14-6-102
Acts 2001, ch. 397, § 3
repealed by Acts 2024, ch. 688, § 98, effective July 1, 2024.

§ 71-2-103. [Repealed]

History (5)

Acts 1981, ch. 428, § 4
1982, ch. 834, § 4
T.C.A., § 14-6-103
Acts 2001, ch. 397, § 4
repealed by Acts 2024, ch. 688, § 98, effective July 1, 2024.

§ 71-2-104. [Repealed]

Backlinks (2)

History (11)

Acts 1981, ch. 428, § 5
1982, ch. 834, § 5
1984, ch. 943, § 2
T.C.A., § 14-6-104
Acts 2001, ch. 397, § 5
2003, ch. 311, § 1
2010, ch. 1100, §§ 133, 134
2012, ch. 575, § 2
2012, ch. 986, §§ 12-14
2015, ch. 24, § 7
repealed by Acts 2024, ch. 688, § 179, effective July 1, 2024.

§ 71-2-105. [Repealed]

History (14)

Acts 1981, ch. 428, § 6
1982, ch. 834, § 6
1984, ch. 943, § 3
T.C.A., § 14-6-105
Acts 2001, ch. 397, § 6
2002, ch. 703, § 1
2012, ch. 986, § 15
2013, ch. 236, § 58
2014, ch. 556, § 5
2015, ch. 461, § 1
2016, ch. 690, §§ 1-4
2022, ch. 1049, § 2
2023, ch. 221, §§ 1, 2
repealed by Acts 2024, ch. 688, § 98, effective July 1, 2024.

§ 71-2-106. [Repealed]

History (6)

Acts 1981, ch. 428, § 7
1982, ch. 834, § 7
1984, ch. 943, § 4
T.C.A., § 14-6-106
Acts 2001, ch. 397, § 7
repealed by Acts 2024, ch. 688,§ 98, effective July 1, 2024.

§ 71-2-107. [Repealed]

History (8)

Acts 1981, ch. 428, § 8
1982 ch. 834, § 8
1984, ch. 943, § 5
T.C.A., § 14-6-107
Acts 2001, ch. 397, § 8
2012, ch. 800, § 49
2012, ch. 986, § 16
repealed by Acts 2024, ch. 688, § 98, effective July 1, 2024.

§ 71-2-108. [Repealed]

History (6)

Acts 1981, ch. 428, § 10
1982, ch. 834, § 11
1984, ch. 943, § 6
T.C.A., §§ 14-6-109, 71-2-109
Acts 2001, ch. 397, § 9
repealed by Acts 2024, ch. 688, § 98, effective July 1, 2024.

§ 71-2-109. [Repealed]

History (4)

Acts 1989, ch. 353, § 1
T.C.A., § 71-2-111
Acts 2001, ch. 397, § 10
repealed by Acts 2024, ch. 688, § 98, effective July 1, 2024.

§ 71-2-110. [Repealed]

History (5)

Acts 1997, ch. 436, § 1
T.C.A., § 71-2-112
Acts 2001, ch. 397, § 11
2015, ch. 461, § 2
repealed by Acts 2024, ch. 688, § 98, effective July 1, 2024.

§ 71-2-111. [Repealed]

History (3)

Acts 2001, ch. 397, § 12
2009, ch. 566, § 12
repealed by Acts 2024, ch. 688, § 98, effective July 1, 2024.

§ 71-2-112. [Repealed]

History (2)

Acts 2016, ch. 1044, § 5
repealed by Acts 2024, ch. 688, § 98, effective July 1, 2024.

§ 71-2-113. [Repealed]

History (2)

Acts 2016, ch. 1044, § 6
repealed by Acts 2024, ch. 688, § 98, effective July 1, 2024.

§ 71-2-114. [Repealed]

History (2)

Acts 2016, ch. 1044, § 7
repealed by Acts 2024, ch. 688, § 98, effective July 1, 2024.

§ 71-2-115. [Repealed]

History (2)

Acts 2018, ch. 548, § 1
repealed by Acts 2024, ch. 688, § 98, effective July 1, 2024.

§ 71-2-116. [Repealed]

Backlinks (1)

4-29-248(a)(41)

History (4)

Acts 2018, ch. 955, § 2
2020, ch. 561, § 3
2023, ch. 466, § 15
repealed by Acts 2024, ch. 688, § 98, effective July 1, 2024.

§ 71-2-117. [Repealed]

Backlinks (1)

4-29-247(a)(44)

History (4)

Acts 2019, ch. 364, § 2
2020, ch. 526, §§ 1-4
2023, ch. 466, § 16
repealed by Acts 2024, ch. 688, § 98, effective July 1, 2024.

§ 71-2-118. [Repealed]

History (2)

Acts 2022, ch. 1081, § 2
repealed by Acts 2024, ch. 688, § 98, effective July 1, 2024.

Part 2 Old Age Assistance

§ 71-2-201. Short title.

This part may be cited as the “Old-Age Assistance Law.”

History (3)

Acts 1937, ch. 49, § 20
C. Supp. 1950, § 4765.17 (Williams, § 4765.34)
T.C.A. (orig. ed.), §§ 14-201, 14-2-101.

§ 71-2-202. Part definitions.

As used in this part, unless the context otherwise requires:
1. (1) “Assistance” means either money payments made to or in behalf of aged persons in need, or medical care and treatment, nursing home care, drugs including hospitalization, and outpatient care or any other type of remedial care recognized under state law in behalf of aged persons in need, or any of these, but does not include subdivisions (1)(A)-(1)(D) unless the federal Social Security Act (42 U.S.C.), is amended to include one (1) or more of the following:
  1. (A) Any such payments to or care in behalf of any individual who is an inmate of a public institution, except as a patient in a medical institution, or any individual who is a patient in an institution for tuberculosis or mental diseases;
  2. (B) Any such payments to any individual who has been diagnosed as having tuberculosis or psychosis and is a patient in a medical institution as a result of tuberculosis or psychosis;
  3. (C) Any such care in behalf of any individual, who is a patient in a medical institution as a result of a diagnosis that such individual has tuberculosis or psychosis, with respect to any period after the individual has been a patient in such an institution as a result of such diagnosis, for forty-two (42) days; or
  4. (D) Is not an inmate of any private institution except such private institution as has been approved by the department at the time of receiving assistance;
2. (2) “Department” means the department of human services;
3. (3) “Recipient” means a person who was receiving old age assistance benefits during the month of December 1973, and is now qualified under the provisions of Public Law 93-66 to continue to receive a state money payment as a supplement to the federally-provided supplemental security income benefits; and
4. (4) “Regional director” means the director of a region under chapter 1, part 1 of this title.

History (9)

Acts 1937, ch. 49, § 1
1939, ch. 134, § 1
C. Supp. 1950, § 4765.18 (Williams, § 4765.17)
Acts 1957, ch. 117, § 1
1965, ch. 14, § 1
1973, ch. 337, § 2
1974, ch. 628, § 1
impl. am. Acts 1975, ch. 219, § 1
T.C.A. (orig. ed.), §§ 14-202, 14-2-102.

§ 71-2-203. Eligibility for assistance.

Assistance shall be granted under this part to any person who:
1. (1)
  1. (A) Is sixty-five (65) years of age or older;
  2. (B) Is living within this state voluntarily and not for a temporary purpose, that is, with no intention of presently removing from the state; provided, that temporary absence from the state, with subsequent returns to the state or intent to return when the purposes of the absence have been accomplished, shall not, for the purpose of this part, interrupt continuity of residence;
  3. (C) Has not sufficient income or other resources to provide a reasonable subsistence compatible with decency and health; and whose spouse is not able to meet such person's needs as determined by the department's standards; and
  4. (D) Within five (5) years immediately preceding application or during receipt of assistance, has not, in order to evade any provision of this part, made an assignment or transfer of property, the proceeds from which at the fair market value, irrespective of the actual consideration received, would under the state standards of need still be available to meet the needs of the individual. Any transfer of property to a husband, wife, son, daughter, son-in-law, daughter-in-law, nephew or niece, within the period above mentioned, shall be prima facie evidence that the transfer was made with the intent to evade this part; or
2. (2) Was receiving old age assistance benefits during the month of December 1973, and is now qualified under Public Law 93-66 to continue to receive a state money payment as a supplement to the federally-provided supplemental security income benefits.

History (15)

Acts 1937, ch. 49, § 2
1949, ch. 85, § 1
1949, ch. 135, § 1
C. Supp. 1950, § 4765.19 (Williams, § 4765.18)
Acts 1951, ch. 104, § 1
1951, ch. 223, § 1
1955, ch. 24, § 1
1955, ch. 169, § 1
1957, ch. 81, § 1
1957, ch. 116, § 1
1965, ch. 14, § 2
1967, ch. 64, §§ 1, 2
1970, ch. 369, § 1
1974, ch. 628, § 2
T.C.A. (orig. ed.), §§ 14-203, 14-2-103.

§ 71-2-204. Determination of amount of assistance.

The amount of assistance that any person shall receive in the form of supplementary money payments shall be determined by an application of § 212(a) of Public Law 93-66 and rules and regulations made by the department establishing standards of need and allowable resources to the recipient's present personal and economic circumstances.

History (13)

Acts 1937, ch. 49, § 3
1945, ch. 187, § 1
C. Supp. 1950, § 4765.20 (Williams, § 4765.19)
Acts 1953, ch. 8, § 1
modified
1957, ch. 22, § 3
1957, ch. 117, § 2
1961, ch. 24, § 1
1965, ch. 14, § 3
1967, ch. 64, § 3
1973, ch. 303, § 12
1974, ch. 628, § 3
T.C.A. (orig. ed.), §§ 14-204, 14-2-104.

§ 71-2-205. Duties of department.

The department shall:
1. (1) Supervise the administration of assistance to the needy aged under this part by the regional directors;
2. (2) Make such rules and regulations and take such action as may be necessary or desirable for carrying out this part. All rules and regulations made by the department shall be binding on the counties and shall be complied with by the respective regional directors;
3. (3) Establish standards for personnel employed by the department in the administration of this part and make necessary rules and regulations to maintain such standards;
4. (4) Prepare and supply to the regional directors such forms as it may deem necessary and advisable;
5. (5) Cooperate with the commissioner of social security, or any federal officer or agency made successor to the commissioner of social security, in any reasonable manner as may be necessary to qualify for federal aid for assistance to the needy aged and in conformity with this part, including the making of such reports in such forms and containing such information as the commissioner of social security may from time to time require, and comply with such provisions as such commissioner may from time to time find necessary to assure the correctness and verification of such reports; and
6. (6) Publish an annual report and such interim reports as may be necessary.

History (5)

Acts 1937, ch. 49, § 4
C. Supp. 1950, § 4765.21 (Williams, § 4765.20)
modified
Acts 1973, ch. 303, § 13
T.C.A. (orig. ed.), §§ 14-206, 14-2-105.

§ 71-2-206. Duty of regional directors.

The regional directors shall administer this part in the counties of their regions, subject to the rules and regulations prescribed by the department, and shall report to the department at such time and in such manner as it may direct.

History (3)

Acts 1937, ch. 49, § 5
C. Supp. 1950, § 4765.22 (Williams, § 4765.21)
T.C.A. (orig. ed.), §§ 14-207, 14-2-106.

§ 71-2-207. Appeal to department.

If any award of assistance is modified or cancelled under any provision of this part, the recipient may appeal to the department in the manner and form prescribed by it. The department shall, upon receipt of such an appeal, give the recipient reasonable notice and opportunity for a hearing.

History (6)

Acts 1937, ch. 49, § 9
1945, ch. 187, § 1
C. Supp. 1950, § 4765.26 (Williams, § 4765.25)
Acts 1973, ch. 303, § 15
1974, ch. 628, § 5
T.C.A. (orig. ed.), §§ 14-212, 14-2-107.

§ 71-2-208. Finality of departmental decision.

All decisions of the department shall be final and shall be binding upon the county involved and shall be complied with by the regional director or a designated agent.

History (4)

Acts 1937, ch. 49, § 9
1945, ch. 187, § 1
C. Supp. 1950, § 4765.26 (Williams, § 4765.25)
T.C.A. (orig. ed.), §§ 14-214, 14-2-108.

§ 71-2-209. Periodical reinvestigation of grants.

All assistance grants in the form of money payments made under this part shall be reconsidered by the regional director or a designated agent as frequently as may be required by the rules of the department. After such further investigation as the regional director or a designated agent may deem necessary or the department may require, the amount of assistance may be changed or assistance may be entirely withdrawn if the recipient's circumstances have altered to warrant such action.

History (6)

Acts 1937, ch. 49, § 10
1945, ch. 187, § 1
C. Supp. 1950, § 4765.27 (Williams, § 4765.26)
Acts 1957, ch. 117, § 5
1973, ch. 303, § 17
T.C.A. (orig. ed.), §§ 14-215, 14-2-109.

§ 71-2-210. Change in circumstances of recipient.

If at any time during the continuance of assistance the recipient becomes possessed of any property or income in excess of the amount stated in the application, it shall be the duty of the recipient immediately to notify the regional director or a designated agent of the receipt or possession of such property or income. The regional director or a designated agent may, after investigation, either cancel the assistance or alter the amount of the money payment in accordance with the circumstances. Any assistance paid after the recipient has come into possession of such property or income and in excess of the recipient's need as determined by the department's standards shall be recoverable in a suit by the state as a debt due to the state.

History (7)

Acts 1937, ch. 49, § 11
1945, ch. 187, § 1
C. Supp. 1950, § 4765.28 (Williams, § 4765.27)
Acts 1957, ch. 117, § 6
1961, ch. 13, § 1
1974, ch. 628, § 6
T.C.A. (orig. ed.), §§ 14-216, 14-2-110.

§ 71-2-211. Removal of recipient from county.

Any recipient who moves to another county in this state shall be entitled, with the approval of the department, to receive assistance in the county to which the recipient has moved, and the regional director or a designated agent of the county from which the recipient has moved shall transfer all necessary records relating to the recipient to the regional director or a designated agent of the county to which the recipient has moved.

History (5)

Acts 1937, ch. 49, § 13
1945, ch. 187, § 1
C. Supp. 1950, § 4765.30 (Williams, § 4765.29)
Acts 1951, ch. 161, § 1
T.C.A. (orig. ed.), §§ 14-217, 14-2-111.

§ 71-2-212. Amendment of part.

All assistance granted under this part shall be deemed to be granted and to be held subject to any amending or repealing statute that may hereafter be passed, and no recipient shall have any claim for compensation, or otherwise, by reason of such recipient's assistance being affected in any way by any amendment or repealing statute.

History (3)

Acts 1937, ch. 49, § 19
C. Supp. 1950, § 4765.36 (Williams, § 4765.33)
T.C.A. (orig. ed.), §§ 14-218, 14-2-112.

§ 71-2-213. Charging for assistance to applicants unlawful.

(a) It is unlawful for any person, firm, or corporation to directly or indirectly either charge or receive anything of value for assisting any person in making application to the proper authorities of this state, or any of them, for relief or assistance under any statutes of this state providing for financial assistance to persons over sixty-five (65) years of age.
(b) A violation of this section is a Class C misdemeanor.

History (4)

Acts 1937, ch. 118, § 1
C. Supp. 1950, § 4765.37
T.C.A. (orig. ed.), §§ 14-219, 14-2-113
Acts 1989, ch. 591, § 113.

§ 71-2-214. Unlawful use of lists of recipients.

(a) Except as permitted by §§ 71-1-117 and 71-1-118, it is unlawful for any person, except for purposes directly connected with the administration of this part, to solicit, disclose, receive, make use of, authorize or knowingly permit, participate in, or acquiesce in the use of, any list or names of, or any information concerning, persons applying for or receiving old-age assistance, directly or indirectly derived from the records, papers, files, or communications of the department or divisions of the department, or acquired in the course of the performance of official duties.
(b) A violation of this section is a Class C misdemeanor.

History (6)

Acts 1941, ch. 148, § 1
C. Supp. 1950, § 4765.37 (Williams, § 11412.7)
impl. am. Acts 1953, ch. 29, §§ 1, 2
impl. am. Acts 1975, ch. 219, § 1 (a, b)
T.C.A. (orig. ed.), §§ 14-220, 14-2-114
Acts 1989, ch. 591, § 113.

§ 71-2-215. Penalty for fraudulent acts.

Whoever:
1. (1) Knowingly obtains, or attempts to obtain, or aids, or abets any persons to obtain by means of a willfully false statement or representation or by impersonation, or other fraudulent device, assistance to which such person is not entitled or assistance greater than that to which such person is justly entitled; or
2. (2) With intent to defraud, aids or abets in buying or in any way disposing of the property, either personal or real, of a recipient of assistance, without the consent of the department;
3. commits a Class E felony.

History (6)

Acts 1937, ch. 49, § 18
1943, ch. 42, § 2
C. Supp. 1950, § 4765.35 (Williams, § 4765.32)
Acts 1955, ch. 26, §§ 1, 2
T.C.A. (orig. ed.), §§ 14-221, 14-2-115
Acts 1989, ch. 591, § 102.

§ 71-2-216. Assistance not assignable — Exemption from execution.

Assistance granted under this part is not transferable or assignable, at law or in equity, and none of the money paid or payable under this part shall be subject to execution, levy, attachment, garnishment or other legal process, or to the operation of any bankruptcy or insolvency law.

History (3)

Acts 1937, ch. 49, § 8
C. Supp. 1950, § 4765.25 (Williams, § 4765.24)
T.C.A. (orig. ed.), §§ 14-222, 14-2-116.

Part 3 Medical Care for the Aged

§ 71-2-301. Part definitions.

As used in this part, unless the context otherwise requires:
1. (1) “Applicant” means a person requesting medical assistance under this part;
2. (2) “Department” means the department of human services;
3. (3) “Medical assistance” means vendor payments or other payments for drugs in behalf of any person in need of this form of medical assistance as determined by department standards; and
4. (4) “Recipient” means a person receiving medical assistance under the terms of this part.

History (4)

Acts 1961, ch. 96, § 1
1971, ch. 43, § 1
impl. am. Acts 1975, ch. 219, § 1(a, b)
T.C.A., §§ 14-1601, 14-3-101.

§ 71-2-302. Determination of amount of medical assistance.

The amount of medical assistance that any person shall receive in the form of drugs under this part shall be determined by measuring the income and resources of such person against the statewide standards provided in § 71-2-303(3) and shall be approved by the regional director or a designated agent and the county mayor of the county in which such person resides.

History (5)

Acts 1961, ch. 96, § 3
1971, ch. 43, § 3
impl. am. Acts 1978, ch. 934, §§ 16, 36
T.C.A., §§ 14-1603, 14-3-102
Acts 2003, ch. 90, § 2.

§ 71-2-303. Duties of department.

The department shall:
1. (1) Supervise the administration of medical assistance;
2. (2) Make such rules and regulations and take such action as may be necessary or desirable for carrying out of this part, to the end that equitable treatment shall be afforded to individuals in similar circumstances. All rules and regulations made by the department shall be binding on the counties and shall be complied with by the respective regional directors;
3. (3) Establish statewide standards for determining the amount of medical assistance that any person shall receive;
  Backlinks (1)
  
  71-2-302
4. (4) Employ personnel for the administration of this part in conformity with title 8, chapter 30, and the rules and regulations of the department of human resources; and
5. (5) Publish an annual report and such interim reports as may be necessary.

History (4)

Acts 1961, ch. 96, § 4
1971, ch. 43, § 4
T.C.A., §§ 14-1604, 14-3-103
Acts 2012, ch. 800, § 49.

§ 71-2-304. Appeal to department by applicant or recipient.

If an application is not acted upon by the regional director, or a designated agent, and the county mayor within a reasonable time after the filing of the application, or is denied in whole or in part, or if any award of medical assistance is modified or cancelled under any provision of this part, the applicant or recipient may appeal to the department in the manner and form prescribed by the department, and shall be afforded a reasonable notice and opportunity for a fair hearing by the department. Written notice of a right to a fair hearing shall be given by the county office to each applicant and recipient at such time as the county office takes any action concerning the amount awarded to the individual or the action on the application of the individual.

History (4)

Acts 1961, ch. 96, § 5
impl. am. Acts 1978, ch. 934, §§ 16, 36
T.C.A., §§ 14-1605, 14-3-104
Acts 2003, ch. 90, § 2.

§ 71-2-305. Review on motion of department — Notice to applicants or recipients — Hearing — Decision final.

The department may also, upon its own motion, review any decision of a regional director, or a designated agent, and county mayor, and may consider any application upon which a decision has not been made by the regional director, or a designated agent, within a reasonable time. The department may make such additional investigation as it may deem necessary, and shall make such decision on such application as in its opinion is justified and in conformity with this part. Applicants or recipients affected by such decisions of the department shall be notified of such decision in writing, and shall, upon request, be given reasonable notice and opportunity for a fair hearing by the department. All decisions of the department shall be final and shall be binding upon the county involved and shall be complied with by the regional director or a designated agent.

History (4)

Acts 1961, ch. 96, § 6
impl. am. Acts 1978, ch. 934, §§ 16, 36
T.C.A., §§ 14-1606, 14-3-105
Acts 2003, ch. 90, § 2.

§ 71-2-306. Recipient receiving property or income — Notice required — Recovery — Fraudulently obtaining aid or disposing of property — Penalty.

(a) If, at any time during the certification for medical assistance, the recipient becomes possessed of any property, real or personal, or income in excess of the amount stated in such recipient's application for medical assistance or transfers any of such recipient's property, real or personal, it shall be the duty of the recipient to immediately notify the local county office of the department. Any medical assistance paid after the recipient has come into possession of property, real or personal, or income, or has transferred any of such recipient's property, real or personal, that renders the recipient ineligible to receive medical assistance under the rules and regulations of the department, shall be recoverable in a suit by the state as a debt due the state.
(b) Whoever:
1. (1) Knowingly obtains, or attempts to obtain, or aids, or abets any person to obtain by means of a willfully false statement or representation or by impersonation, or other fraudulent device, medical assistance to which such person is not entitled or medical assistance greater than that to which such person is justly entitled; or
2. (2) With intent to defraud, aids or abets in buying or in any way disposing of the property, either personal or real, of a recipient of medical assistance, without the consent of the department;
3. commits a Class E felony and is punishable accordingly, except such acts shall be punished as Class A misdemeanors where the amount involved is less than five hundred dollars ($500).

History (5)

Acts 1961, ch. 96, § 12
1965, ch. 13, § 1
impl. am. Acts 1975, ch. 219, § 1 (a, b)
T.C.A., §§ 14-1612, 14-3-106
Acts 1989, ch. 591, §§ 1, 6, 103.

§ 71-2-307. Charge for assistance in obtaining aid — Misdemeanor.

(a) It is unlawful for any person, firm or corporation to directly or indirectly either charge or receive anything of value for assisting any person in making application to the proper authorities of this state for medical assistance under this part.
(b) A violation of this section is a Class C misdemeanor.

History (3)

Acts 1961, ch. 96, § 13
T.C.A., §§ 14-1613, 14-3-107
Acts 1989, ch. 591, § 113.

§ 71-2-308. Improper use of names of recipients — Penalty.

(a) It is unlawful for any person, except for purposes directly connected with the administration of this chapter, to solicit, disclose, receive, make use of, authorize or knowingly permit, participate in, or acquiesce in the use of, any list or names of, or any information concerning, persons applying for or receiving medical assistance, directly or indirectly derived from the records, papers, files or communications of the department or divisions of the department, or acquired in the course of the performance of official duties.
(b) A violation of this section is a Class C misdemeanor.

History (4)

Acts 1961, ch. 96, § 14
impl. am. Acts 1975, ch. 219, § 1 (a, b)
T.C.A., §§ 14-1614, 14-3-108
Acts 1989, ch. 591, § 113.

Part 4 Adult Day Care

§ 71-2-401. Part definitions.

As used in this part, unless the context otherwise requires:
1. (1) “Adult day care” means services provided to five (5) or more adult recipients, for more than three (3) hours per day, by a provider of such services who is not related to such adult, pursuant to an individualized plan of care designed to maintain or restore each adult's optimal capacity for self care through medical or social services;
2. (2) “Adult day care center” means a facility that provides adult day care services;
3. (3) “Commissioner” means the commissioner of human services;
4. (4) “Department” means the department of human services; and
5. (5) “Related” means, for purposes of this part, a person who is related to the adult day care services recipient as a legal or biological parent, spouse, child, sibling, aunt, uncle, nephew or niece of any degree, grandparent or grandchild of any degree, or cousin to the third degree, or a step parent, or a step grandparent of any degree.

History (3)

Acts 1996, ch. 1058, § 2
1997, ch. 449, § 1
2017, ch. 276, § 1.

§ 71-2-402. Licensing requirements — Exemption for limited respite care services program.

(a) No person or any entity of any kind, public or private, shall provide adult day care in this state without first obtaining a license as provided in this part.
(b) If any person or entity appears to be subject to the licensing requirements of this part and is currently licensed by any other agency of state government, the commissioner shall consult with the head of such other state agency, and, if after such consultation, the commissioner determines that the services to adults that are provided by the person or entity are adequately regulated by the licensing requirements of that other state agency, then the commissioner may determine that no licensing of such person or entity by the department pursuant to this part shall be necessary.
(c)
1. (1) A limited respite care services program is exempt from licensure under this part.
2. (2) For purposes of this subsection (c), “limited respite care services program” means a program that has as its sole purpose to provide primary caregivers of appropriate adults with relief from normal caregiving duties and responsibilities and:
  1. (A) Is operated by a religious institution or religious organization that provides custodial care for aging adults and adults with limitations on activities of daily living:
    1. (i) Who can function in a group setting;
    2. (ii) Who can feed and perform toilet functions without the assistance of a personal aide accompanying them; and
    3. (iii) Who attend no more than three (3) days each calendar week, no more than twelve (12) hours in any one (1) week, and no more than six (6) hours in any one (1) day;
  2. (B) Is registered with the department pursuant to rule promulgated by the commissioner under § 71-2-412;
  3. (C) Maintains records that include, at a minimum, dates and times of each adult's attendance;
  4. (D) Provides care services for less than fifteen (15) adults at the same time; and
  5. (E) Does not administer medications to adults while under the program's care.
3. (3) For purposes of this subsection (c), “religious institution” or “religious organization” means an entity exempt from registration as a bona fide religious institution under § 48-101-502.
4. (4) The department is authorized to make site visits to a program in order to ensure compliance with the terms of the exemption permitted under this subsection (c).

History (2)

Acts 1996, ch. 1058, § 3
2018, ch. 607, § 1.

§ 71-2-403. Review of records and registries — Verification — Exclusion from access to adults.

(a) A review of the records and registries set forth in subdivisions (a)(1)-(6) shall be conducted for all new employees or for volunteers who are counted in the staff/adult participant ratio and those volunteers who have unsupervised access to the adult participants in adult day care centers, and for all new department licensing staff who regulate the adult day care licensing program and all new counselors and supervisors providing services in the adult protective services program:
1. (1) Criminal background history;
2. (2) Juvenile records history available to the Tennessee bureau of investigation (TBI);
3. (3) Any available juvenile court records, if determined necessary by the department;
4. (4) Vulnerable persons registry pursuant to title 68, chapter 11, part 10;
5. (5) State's sex offender registry; and
6. (6) Records of indicated perpetrators of abuse or neglect of children or adults maintained by the department of children's services and the department of human services.
(b)
1. (1) Except as otherwise provided in this subdivision (b)(1) and in subsections (c) and (e), and except where the context or intent would otherwise render the language inapplicable to the persons having access to adults in an adult day care center, the procedures, requirements and any other statutory provisions involving the requirements for disclosure forms, the methodology for obtaining and reporting the fingerprint-based criminal and available juvenile histories of a person, the exclusions of persons with a prohibited records history, the appeals processes, the department's authority to allow by rule of the department for exemptions from a verified prohibited history, permissive review procedures and any other consistent procedures, shall be the same for persons subject to this section as those provided in § 71-3-507 for persons having access to children in childcare agencies licensed by the department of human services pursuant to chapter 3, part 5 of this title; provided, that the adult day care center, and not the department, shall be responsible for all of the costs of the fingerprint background checks conducted by the TBI and the federal bureau of investigation for its employees or volunteers subject to this section.
2. (2) With respect to volunteers, this section applies only to those volunteers who serve as volunteers for more than thirty-six (36) hours in any one (1) calendar year.
(c) The adult day care center may require that the costs of the background check be a part of the application process by a prospective employee or volunteer, or it may pay the costs and recover the costs of the fingerprint-based background checks from the prospective employee following employment. The department shall pay all costs required for its employees subject to the required background reviews.
(d) The TBI shall make any reports of positive matches pursuant to this section in the same manner as provided for any of the processes authorized by § 71-3-507.
(e) Conviction by a criminal court or adjudication by the juvenile court for an offense or a lesser included offense involving the physical, sexual or emotional abuse, neglect, financial exploitation or misuse of funds or theft from any person, or that constitutes conviction or adjudication for an offense involving violence against any person, or conviction of an offense involving the manufacture, sale, possession or distribution of any drug, or a no-contest plea to such offenses, and any pending warrants, indictments, presentments or petitions for such offenses, or the identification of any person on the department of health's vulnerable persons registry pursuant to title 68, chapter 11, part 10, on the state's sex offender registry or identification as a perpetrator of abuse or neglect of children or adults in the records of the department of children's services or department of human services as provided in § 71-3-515 shall disqualify such person from employment with, or from having any access whatsoever to adults in, an adult day care center as defined by this part, and from employment with the department as regulatory staff in the department's adult day care licensing program and service staff in the adult protective services program.

Backlinks (1)

71-3-515(a)

History (5)

Acts 1996, ch. 1058, § 4
1997, ch. 449, § 2
2000, ch. 981, § 69
2009, ch. 410, § 1
2013, ch. 101, § 1.

§ 71-2-404. Profits — Application requirements.

If an adult day care center is operated only by a municipality or county or by a nonprofit corporation, no part of the net earnings may lawfully inure to the benefit of any private shareholder or individual. An applicant for initial licensure as an adult day care center shall file with the department, pursuant to its regulations, an application on forms furnished by the department, which shall include, but not be limited to, the following:
1. (1) Evidence satisfactory to the department that the applicant, its directors and officers, if the applicant is a nonprofit corporation, and the person designated to manage the day to day affairs of the proposed adult day care center are of reputable and responsible character;
2. (2) Evidence satisfactory to the department of the ability of the applicant to comply with this part and of rules and regulations adopted pursuant to this part by the department;
3. (3) Such other information as may be required by the department for the proper administration and enforcement of this part.

History (1)

Acts 1996, ch. 1058, § 5.

§ 71-2-405. Licensing procedures — Fees — Biennial licenses — Transfers of licenses.

(a)
1. (1) An application for a license shall be submitted to the department in such manner as the department may require.
2. (2) An application for a license shall be accompanied by the appropriate fee for the license and shall be received by the department not less than thirty (30) days prior to the expiration date of the existing license. Failure to timely submit a renewal application for a license shall result in expiration of the existing license.
3. (3) Each application submitted to the department for a new license or for the renewal of a license shall be accompanied by the fee required for the license.
4. (4) The commissioner may approve applications for renewal of a license as a biennial or triennial licensee if the commissioner determines that the applicant's methods of care and history of compliance clearly demonstrate that a biennial or triennial license is warranted.
5. (5) The fees for adult day care centers shall be:
  1. (A)
    1. (i) Centers caring for less than twenty (20) participants:
      1. Annual Fee$ 125
    2. (ii) Centers caring for twenty (20) to one hundred (100) participants:
      1. Annual Fee$ 200
    3. (iii) Centers caring for more than one hundred (100) participants:
      1. Annual Fee$ 400
  2. (B) The fees shall be earmarked and dedicated to the department for the improvement of the quality of adult services in this state.
  3. (C) If the department issues a temporary license after the application fee is paid, no further fee shall be required until the adult day care center applies again for an annual license or for renewal of the regular annual, biennial or triennial license.
  4. (D) Any adult day care center that is operated by a public, nonprofit agency or local municipality operating under a grant from the department and that pays an administrative fee as part of the monitoring requirements of such grant shall be exempt from the licensing fee.
(b)
1. (1) If the department determines that the applicant for annual license does not meet all of the requirements for such license, but has presented satisfactory evidence that the facility that is proposed for the care of adults has received fire safety, environmental safety and any necessary food establishment approval, that the applicant and the personnel who will care for the adults are capable in substantially all respects to care for the adults and that the applicant has the ability and intent to comply with the licensing law and regulations, the department may issue a temporary license to the applicant.
2. (2) The purpose of the temporary license is to permit the license applicant to demonstrate to the department that the applicant has complied with all licensing laws and regulations applicable prior to the issuance of an initial annual license.
3. (3) Within six (6) months of the issuance of the temporary license, the department shall determine if the applicant has complied with all regulations governing the adult day care centers. The department may extend the period of the temporary license for an additional six (6) months if the department determines that the applicant has made substantial progress in meeting the requirements of the law and regulations for an initial annual license.
4. (4)
  1. (A) If the department determines that the applicant for any license complies with all licensing laws and regulations for adult day care centers, the department shall issue an annual, biennial or triennial license. The department may issue a restricted license as provided in § 71-2-407 if circumstances warrant. If the applicant has not complied with such laws or regulations or if circumstances do not warrant the issuance of a restricted license, the application shall be denied.
  2. (B) A biennial or triennial license may not be granted as the first license immediately following any temporary license. If a biennial or triennial license is granted, the commissioner may limit the biennial or triennial license to an annual or biennial or triennial license at the next renewal period, or may at any time reduce the biennial or triennial licensure period to a shorter period. Such reduction in the licensing period may be appealed pursuant to the procedures for appeal of license denials or revocations.
  3. (C) The annual, biennial or triennial license shall expire, respectively, twelve (12), twenty-four (24) or thirty-six (36) months from the date of its issuance unless the licensee has made timely reapplication for renewal and the department has not determined the status of the application, in which case the existing license shall continue in effect, unless suspended, until such determination is made and until a timely filed appeal is resolved by entry of a final order regarding the license application pursuant to § 4-5-314.
(c)
1. (1) Each license issued or renewed pursuant to this part shall not be transferable to any other person or entity, and the sale, or transfer of the adult day care facility by any means, from the person or entity that is named as the licensee to any other person or entity shall void the existing license or any pending appeal of the denial or revocation of the existing license, and shall require an application by the transferee for an annual license and the payment of the required licensing fee. The adult day care center, the ownership or control of which has been transferred by the existing licensee, may not continue operation until a temporary or annual license is granted to the transferee. The new licensee in such circumstances may not be the transferor or any person or entity acting on behalf of the transferor.
2. (2) If, however, the department determines that any person or entity has transferred nominal control of a center to any persons or entities who are determined by the department to be acting on behalf of the purported transferor in order to circumvent a history of violations of the licensing law or regulations or to otherwise attempt to circumvent the licensing law or regulations or any prior licensing actions instituted by the department, the department may deny the issuance of any license to the applicant. The denial of the license may be appealed as provided in § 71-2-408.
3. (3)
  1. (A) The license of any center shall not be voided nor shall any pending appeal be voided pursuant to this subsection (c) solely for the reason that the center is subject to judicial orders directing the transfer of control or management of an adult day care center or its license to any receiver, trustee, administrator or executor of an estate, or any similarly situated person or entity.
  2. (B) If the current licensee dies, and provided that no licensing violations require the suspension, denial or revocation of the agency's license, the department may grant family members of the licensee, or administrators or executors of the licensee, a temporary license to continue operation for a period of six (6) months. At the end of such period, the department shall determine whether an annual or extended license should be granted to a new licensee as otherwise provided in this section.
  3. (C) Nothing in this subsection (c) shall be construed to prevent the department from taking any regulatory or judicial action as may be required pursuant to the licensing laws and regulations that may be necessary to protect the adults in the care of such center.

History (3)

Acts 1996, ch. 1058, § 6
1997, ch. 449, §§ 4, 5
2000, ch. 981, § 70.

§ 71-2-406. Revocation of license.

(a) If, during the period of any license issued by the department, it determines that the license issued to the adult day care center should be revoked because of a failure to comply with the standards of this part or the regulations adopted pursuant to this part for the operation of such a center, the department may, after notice and an opportunity to show compliance with all lawful requirements for retention of the license, revoke such license upon sixty (60) days' notice to the licensee or other person responsible for the day to day operation of the adult day care center.
(b)
1. (1) A license may be summarily suspended by the department if, pursuant to § 4-5-320, the department finds in its summary suspension order that the public health, safety, or welfare imperatively requires emergency action, and incorporates a finding to that effect in its order, and that the order states what action must be taken by the licensee to immediately effect compliance with the licensing standards.
2. (2) The summary suspension order shall be reviewed by a hearing officer appointed by the commissioner within five (5) working days of the suspension order, excluding Saturdays, Sundays and legal holidays, who shall make a written determination of whether probable cause exists for continuance of the suspension order after opportunity for response and an informal hearing before such officer by the licensee.
3. (3) The department shall adopt such other rules as may be necessary to provide due process procedures involving the licensing of adult day care centers that are consistent with law, and to accomplish the revocation, denial and suspension of license procedures as may be required by this part.

History (1)

Acts 1996, ch. 1058, § 7.

§ 71-2-407. Restricted licenses.

(a) In determining whether to deny, revoke or suspend a license, or in granting any license, the department may choose to deny, revoke or suspend or grant only certain authority of the licensee to operate and may permit the licensee to continue operation, but may restrict or modify the licensee's authority to provide certain services or perform certain functions, including, but not limited to: transportation or food service, enrollment of adult participants at the center, the center's hours of operation, the center's use of certain parts of the center's physical facilities or any other function of the adult day care center that the department determines should be restricted or modified to protect the health, safety or welfare of the adult participants. The actions authorized by this subdivision (a) may be appealed as otherwise provided in this part for any denial or revocation.
(b) At any hearing on a denial, revocation or suspension, the administrative law judge or hearing officer may, as part of the decision regarding the status of the applicant's or licensee's license, direct that the adult day care center be allowed to operate on a probationary or conditional status, or may allow the license to remain in effect with any restrictions or conditions on the center's authority to provide care.

Backlinks (1)

71-2-405(b)(4)(A)

History (2)

Acts 1996, ch. 1058, § 8
2000, ch. 981, § 71.

§ 71-2-408. Notification of denial — Hearings.

Immediately upon the denial of any application for issuance or renewal of a license or upon the revocation of any license, the department shall notify the applicant in writing. Not later than ten (10) days after the department mails the notice, the applicant may submit a written petition for a hearing to the department. Upon receipt by the department of the petition in proper form, such petition shall be set for hearing. The hearing shall be held within sixty (60) days of receipt of the petition. The proceedings shall be conducted in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, with the department having all the powers granted in the Uniform Administrative Procedures Act to ensure:
1. (1) Compliance with regulations adopted pursuant to this chapter;
2. (2) Continued demonstrated community need;
3. (3) Conformity of the program to individual participants' assessed and reassessed needs and interests with particular attention to visual, auditory and equipment needs;
4. (4) Suitability of program changes to the community and participants served; and
5. (5) Compliance with any requirements of law or regulations pertaining to fire and safety.

Backlinks (1)

71-2-405(c)(2)

History (3)

Acts 1996, ch. 1058, § 11
T.C.A., § 71-2-410
Acts 2000, ch. 981, § 72.

§ 71-2-409. Inspections — Refusal — Probation.

(a) The department may conduct inspections of every licensed facility or suspected adult day care center. The evaluation method adopted by the department shall be published and distributed to each licensed adult day care center and any other interested person.
(b) Any duly authorized officer, employee or agent of the department may, upon presentation of proper identification, enter and inspect any place providing adult day care at any time, with or without advance notice, to secure compliance with, or to prevent a violation of, any provision of this part or any regulation adopted under this part. If refused entrance for inspection of a licensed or suspected adult day care center, the chancery or circuit court of the county where the licensed or suspected adult day care center is located may issue an immediate ex parte order permitting the department's inspection upon a showing of probable cause and the court may direct any law enforcement officer to aid the department in executing such order and inspection. Refusal to obey such order may be punished as contempt.
(c)
1. (1) If, during the licensing period, the department determines that an adult day care center is not in compliance with the laws or regulations governing its operation, the department may place the adult day care center on probation for a definite period of not less than thirty (30) days nor more than sixty (60) days as determined by the department, and the department shall require the posting by the center of the notice of probation. The department shall provide the center a written basis describing the violation of the licensing rules that support the basis for the probationary status.
2. (2)
  1. (A) If placed on probation, the center shall immediately post a copy of the probation notice, together with a list provided by the department of the violations that were the basis for the probation, in a conspicuous place as directed by the department and with the center's license, and the center shall immediately notify in writing the responsible adult day care participant and the responsible relative or caretaker of each of the adults in its care of the center's status, the basis for the probation and of the center's right to an informal review of the probationary status.
  2. (B) If the center requests an informal review within two (2) business days of the imposition of probation, either verbally or in writing to the department's licensing staff that imposed the probation, the department shall informally review the probationary status by a departmental staff person who was not involved in the decision to impose the probation. The center may submit any written or oral statements as argument to the departmental staff person within five (5) business days of the imposition of the probation. Written and oral statements may be received by any available electronic means. The departmental staff person shall render a decision in writing upholding, modifying or lifting the probationary status within ten (10) business days of the imposition of the probation.
3. (3) If the departmental staff person does not lift the probation under subdivision (c)(2)(B), the center may also appeal such action in writing to the commissioner within five (5) business days of the receipt of the notice of the departmental staff person's decision regarding the center's probationary status as determined in subdivision (c)(2)(B). If timely appealed, the department shall conduct an administrative hearing pursuant to the contested case provisions of the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, part 3, concerning the department's action within fifteen (15) business days of receipt of the appeal and shall render a decision in writing within seven (7) business days following conclusion of the hearing. The hearing officer may uphold, modify or lift the probation.
4. (4) This subsection (c) shall be discretionary with the department, and shall not be a prerequisite to any licensing action, to suspend, deny or revoke a license of an adult day care center.
(d) The department shall make available to all interested persons a list of all licensed adult day care centers and the services that each facility provides. Reports on the results of each inspection, evaluation or consultation performed pursuant to this section shall be kept on file in the department, and all inspection reports, consultation reports, lists of deficiencies and plans of correction shall be open to public inspection during regular business hours.

History (4)

Acts 1996, ch. 1058, § 12
T.C.A., § 71-2-411
Acts 2000, ch. 981, § 72
2001, ch. 453, § 23.

§ 71-2-410. Governing boards.

The department shall require each adult day care center operated by a municipality or county or by a nonprofit corporation and caring for ten (10) or more persons to have a governing board. The governing board of an adult day care center, having final authority and responsibility for conduct of the center, shall be comprised of four (4) or more persons. The governing board may include members who may be recipients of the services of the adult day care center, relatives of such recipients, or representatives of community organizations with particular interest in programs for the elderly. No member of the governing board, nor any member of the immediate family of a member of the governing board, shall have any direct or indirect interest in any contract for supplying services to the adult day care center.

History (4)

Acts 1996, ch. 1058, § 13
1997, ch. 449, § 3
T.C.A. § 71-2-412
Acts 2000, ch. 981, § 72.

§ 71-2-411. Compliance.

Each adult day care center that files an affidavit with the department as of January 1, 1997, certifying that such facility is in existence and in operation shall have two (2) years to fully comply with this part.

History (3)

Acts 1996, ch. 1058, § 14
T.C.A., § 71-2-413
Acts 2000, ch. 981, § 72.

§ 71-2-412. Rules and regulations.

(a) The commissioner is authorized to promulgate rules and regulations to effectuate the purposes of this part. All such rules and regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
(b) All rules and regulations promulgated to effectuate the purposes of this part shall also be reviewed by the health and welfare committee of the senate and the health committee of the house of representatives.
(c) Notwithstanding any law to the contrary, the commissioner shall have the authority to amend the rules for licensure of adult day care by entities contracted to provide medicaid-reimbursed home- and community-based services pursuant to chapter 5, part 14 of this title, as needed to be consistent with the home- and community-based settings final rule, published in the Federal Register at 79 FR 2947 (January 16, 2014), including the authority to differentiate licensure requirements for any entity contracted to provide medicaid-reimbursed home- and community-based services pursuant to chapter 5, part 14 of this title, in order to allow the facility or entity to comply with the federal rule and continue to receive medicaid reimbursement for home- and community-based services. Rules adopted by the department under this subsection (c) shall be developed with input from stakeholders and promulgated in accordance with the Uniform Administrative Procedures Act; provided, however, that the department shall not promulgate emergency rules under this subsection (c) as defined in § 4-5-208. Licensure survey and enforcement shall be conducted in a manner consistent with any rule issued under this subsection (c).

Backlinks (1)

71-2-402(c)(2)(B)

History (5)

Acts 1996, ch. 1058, § 15
T.C.A., § 71-2-414
Acts 2000, ch. 981, § 72
2013, ch. 236, § 59
2015, ch. 153, § 3.

§ 71-2-413. Advisory committee.

There is hereby established an advisory committee consisting of not less than seven (7) members appointed by the commissioner. The advisory committee shall assist the commissioner in implementing this part. The advisory committee shall reflect the diversity of this state with respect to urban and rural areas, the three (3) grand divisions and the various ethnic groups of this state.

History (3)

Acts 1996, ch. 1058, § 16
T.C.A., § 71-2-415
Acts 2000, ch. 981, § 72.

§ 71-2-414. Implementation.

It is the intent of the general assembly that this part, with the exception of the employment of one (1) employee to assist in the implementation of this part, be implemented within the existing resources of the department.

History (3)

Acts 1996, ch. 1058, § 20
T.C.A., § 71-2-416
Acts 2000, ch. 981, § 72.

§ 71-2-415. Construction.

This part is declared to be remedial in nature and this part shall be liberally construed to effectuate its purposes.

History (3)

Acts 1996, ch. 1058, § 19
T.C.A. § 71-2-417
Acts 2000, ch. 981, § 72.

§ 71-2-416. Adult day care and senior centers as model programs.

(a) The department of finance and administration shall designate up to five (5) publicly or privately supported adult day care centers or senior centers within the state as model programs worthy of emulation with respect to one (1) or more of the following activities:
1. (1) Comprehensive health education programs;
2. (2) Nutrition assessment and screening;
3. (3) Nutrition counseling; or
4. (4) Health or nutrition referral services.
(b) The selected model programs shall be programs that are designed to enhance the dignity and wellness of senior citizens and to encourage the independence and involvement of senior citizens in the community. The selected model programs must also be designed to achieve a tangible impact in areas that are traditionally socially and economically underserved.
(c) Prior to designating the model programs, nominations shall be solicited from across the state. In selecting model programs, due consideration shall be given to the level of community acceptance and support for the programs and to the techniques by which the acceptance and support have been achieved.
(d) Subject to the availability of funding for such purposes as contained within the fiscal year 2007-08 budget of the department of finance and administration, state grants shall be awarded to the model programs selected pursuant to this section. The dollar amount of each grant awarded shall be determined by the commissioner of finance and administration. Payment of any grant to any model program shall be conditional upon the willingness of the chief administrative officer of the program to provide informational and consultative assistance to those agencies of state or local government that may desire to emulate, in whole or in part, the model program. Any grant so received by a publicly supported agency shall be in addition to all other public funds that may be otherwise appropriated to the agency and it is not intended to supplant any other funding resource. Any funds not paid to a model program by June 30, 2008, shall revert to the general fund.
(e) The commissioner of finance and administration shall undertake appropriate activities to publicize the department of finance and administration's activities in implementing this section and to publicize the activities and achievements of the model programs.

History (1)

Acts 2007, ch. 573, § 1.

Part 5 Prescription Drug Programs

§ 71-2-501. Legislative intent — Enrollment in prescription drug discount card program and transitional assistance program benefits — Automatic enrollment.

(a) It is the intent of the legislature that the state of Tennessee, through the bureau of TennCare, be designated as the authorized representative for elderly and disabled enrollees, who are eligible medicare beneficiaries, but have lost or may lose eligibility for TennCare benefits due to changes in the TennCare program, for the purpose of facilitating and effectuating enrollment in a medicare-approved prescription drug discount card program or programs, and for applying for transitional assistance program medicare drug benefits, pursuant to 42 U.S.C. § 1395 et seq. As the eligible enrollee's legally authorized representative for this purpose, TennCare may designate or select one (1) or more programs as preferred plans, for purposes of automatically enrolling such medicare beneficiaries, to expedite access to prescription drug discounts and secure related transitional assistance payments for those medicare enrollees eligible for such assistance.
(b) To expedite and assure enrollment of individuals into a program, TennCare may enroll a medicare-eligible beneficiary in a program or programs, and apply for available transitional assistance on the enrollees' behalf, in the absence of any action or application of the individual beneficiary seeking such enrollment or assistance; provided, that each individual so enrolled shall be informed of the following:
1. (1) In advance of enrollment in a program, the state's intent to enroll the individual in a program, unless the individual informs TennCare, within ten (10) days of receipt of such notice, that the individual does not want to be so enrolled;
2. (2) The procedures by which the individual may disenroll from the preferred sponsor's program;
3. (3) The existence of alternative medicare-approved prescription drug discount card sponsors in the region in which the individual resides; and
4. (4) The means through which the individual may change the individual's enrollment to an alternative sponsor or may obtain assistance in doing so.
(c) TennCare shall determine the procedures for automatic enrollment in a preferred sponsor's program and application for transitional assistance, where applicable.

History (1)

Acts 2005, ch. 474, § 4.

§ 71-2-502. Facilitation of automatic enrollment.

In facilitating automatic enrollment, TennCare may do one (1) or all of the following:
1. (1) Enter into a contract that has been competitively procured, pursuant to title 12, with one (1) or more program sponsors, to facilitate automatic enrollment, which contracts shall be subject to comment by the fiscal review committee, pursuant to the procedures found under title 3, chapter 7;
2. (2) Identify those medicare eligible enrollees who meet the federal income criteria for transitional assistance;
3. (3) Preliminarily enroll the beneficiary into a preferred sponsor's program;
4. (4) Apply for medicare transitional assistance program benefits through the medicare transitional assistance program on behalf of an eligible enrollee; and
5. (5) Preliminarily enroll beneficiaries into a preferred program, with an opt-out provision for the individual.

History (1)

Acts 2005, ch. 474, § 4.

§ 71-2-503. Entitlement not created by program.

The program established in this part is not, nor does it in any way create, an entitlement.

History (1)

Acts 2005, ch. 474, § 4.

Chapter 3 Programs and Services for Children

Part 1 Temporary Assistance

§ 71-3-101. Short title.

This may be cited as the “Families First Act of 1996.”

History (2)

Acts 1996, ch. 950, § 2
T.C.A., § 71-3-151.

§ 71-3-102. Program subject to availability of federal funds.

Continuation of the families first program is subject to, and limited by, the availability of federal funds that may be made available to the state of Tennessee by congress and the United States department of health and human services, or its successor agency.

History (2)

Acts 1996, ch. 950, § 3
T.C.A., § 71-3-152.

§ 71-3-103. Part definitions.

(a) As used in this part, unless the context otherwise requires:
1. (1) “Assistance” means, unless otherwise required by the context, temporary assistance;
2. (2) “Caretaker relative” means the father, mother, grandfather or grandmother of any degree, brother or sister of the whole or half-blood, stepfather, stepmother, stepbrother, stepsister, aunt or uncle of any degree, first cousin, nephew or niece, the relatives by adoption within the previously named classes of persons, and the biological relatives within the previous degrees of relationship, and the legal spouses of persons within the previously named classes of persons, even if the marriage has been terminated by death or divorce, with whom a child is living;
3. (3) “Child” or “children” means:
  1. (A) A person or persons under eighteen (18) years of age; or
  2. (B) A person who has not attained nineteen (19) years of age and who is a full-time student in a secondary school or the equivalent and who is expected to graduate by the nineteenth birthday;
4. (4) “Department” means the department of human services;
5. (5) “Dependent child” means, except as otherwise stated in this part, a child living with a caretaker relative if the child is deprived of parental support due to death of a parent, continued absence of a parent from the home, physical or mental incapacity of a parent, or unemployment or underemployment of either or both parents and if the child's legally responsible relatives are not able to provide adequate care and support of such child without temporary assistance;
6. (6) “Family” means the eligible unit of children and parent or parents or caretaker relative or relatives residing in a common residence; and
7. (7) “Temporary assistance” means the program to provide economic support and other support services to families that is provided by the state utilizing funds made available by congress and the secretary of health and human services to the state pursuant to the Social Security Act (42 U.S.C. § 301 et seq.), and any state funds that may be appropriated by the general assembly designated to support the temporary assistance program. If at any time, federal funds are not available to provide the continuation of the temporary assistance program, the state shall not be obligated to continue the program by using only state funds.
(b) It is the intent of the general assembly that any welfare program administered by the state shall be in compliance with Title VI of the Civil Rights Act of 1964 (42 U.S.C. § 2000d et seq.), and regulations promulgated pursuant to that act, and all other applicable federal civil rights legislation.

History (2)

Acts 1996, ch. 950, § 4
T.C.A., § 71-3-153.

§ 71-3-104. Eligibility for temporary assistance.

(a)
1. (1) A family shall be eligible for temporary assistance pursuant to this part if:
  1. (A) A dependent child resides in this state with a caretaker relative in that family, or an individual who applies for temporary assistance is pregnant, or as otherwise defined by the department;
  2. (B) The family meets income standards based upon the standard of need for a family based upon its size and income and based upon resource limits as determined by the department in its rules;
  3. (C) The family members are engaged in work activities as set forth in subsection (g), except as exempted by this part or by rule of the department;
  4. (D) The caretaker relative has agreed to and complies with a personal responsibility plan as developed by the department in accordance with subsection (h); and
  5. (E) The family or individual of the family is otherwise eligible pursuant to federal or state laws or regulations.
2. (2)
  1. (A) To the extent permitted by federal law and guidance, the department shall create a two-year pilot program establishing an optional alternative temporary assistance pathway offering enhanced educational support services or enhanced cash assistance for families with individuals who are actively pursuing a degree, professional certification, or other educational advancement.
  2. (B) In addition to requirements established by the department by rule pursuant to this subdivision (a)(2), the eligibility requirements of subdivision (a)(1) and this part apply to families or individuals seeking assistance under this subdivision (a)(2).
  3. (C) A family may elect that all enhanced temporary assistance for which the family qualifies under this subdivision (a)(2) be provided as enhanced support services, rather than enhanced cash assistance.
  4. (D) Notwithstanding § 71-3-105(f)(2), the department shall establish by rule the maximum enhanced grant amounts for families participating in the alternative temporary assistance pathway under this subdivision (a)(2), which must not exceed an amount one hundred percent (100%) greater than the maximum grant amounts authorized under § 71-3-105(f)(2).
  5. (E) The annual cost of the pilot program authorized under this subdivision (a)(2) must not exceed the amount of the state's annual federal temporary assistance for needy families block grant award.
  6. (F) The pilot program established under this subdivision (a)(2) terminates two (2) years from the effective date of the first rule promulgated pursuant to this subdivision (a)(2) regarding the program.
(b)
1. (1) A caretaker relative who becomes ineligible for any reason other than a failure to comply with work requirements or to cooperate with child support obligations shall be eligible for transitional childcare assistance for a period specified by the department while the caretaker relative is employed, in school, or in employment training. Childcare assistance terminated due to failure to comply with work requirements shall be reinstated upon verification by the department that the work requirements were, in fact, being met immediately preceding such ineligibility. Childcare assistance shall be paid, on a sliding fee scale based upon the family's income for so long as federal funding or any related waiver is in effect.
2. (2) Food stamp assistance shall continue to be available to these families as prescribed by federal or state law or regulations.
3. (3)
  1. (A) A family that becomes financially ineligible for temporary assistance due to an increase in a caretaker relative's earned income, but continues to meet all other eligibility criteria, including compliance with the program's work requirements, shall be eligible for transitional temporary assistance for no more than six (6) months.
  2. (B) The amount of the transitional temporary assistance shall be based upon the family's income and household size.
  3. (C) Receipt of transitional temporary assistance shall count toward the recipient's maximum time limit under subsection (d).
  4. (D) The department is authorized to promulgate rules to effectuate this subdivision (b)(3) in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
(c) Persons who are recipients of temporary assistance and who marry while receiving such assistance may disregard the new spouse in determining eligibility for three (3) months after the date of marriage.
(d)
1. (1) Except as provided in this part or as otherwise required by federal law, no family shall receive assistance if that family includes an adult who has received temporary assistance from this program or the program of any other state or territory for a total of sixty (60) months, whether or not consecutive, unless an exemption is granted pursuant to this part.
2. (2) As to a child who was not the head of a household or who was not married to the head of a household, the sixty (60) month time limit stated in subdivision (d)(1) shall not begin to run during the time that the child was a member of a family receiving assistance under this part.
3. (3) A family shall be eligible for temporary assistance beyond the sixty-month time limit stated in subdivision (d)(1) if:
  1. (A) The family does not contain an adult;
  2. (B) The caretaker relative is sixty-five (65) years of age or older;
  3. (C) The caretaker relative is caring for a disabled or incapacitated child relative or disabled adult relative, based upon criteria set forth in the department's rules;
  4. (D) The caretaker relative is disabled, based upon criteria set forth in the department's rules; or
  5. (E) As otherwise required by federal and state laws or regulations.
4. (4) The exemptions in subdivision (d)(3) are subject to the limitations for the percentages of individuals allowed to receive temporary assistance beyond sixty (60) months.
Backlinks (1)
- 71-3-107(f)
(e)
1. (1) No payment of assistance shall be made for an individual who is not the head of a household, who has not reached eighteen (18) years of age, who has a child who is at least sixteen (16) weeks of age in the person's care, and who has not successfully completed a high school education or its equivalent, unless the individual participates in educational activities directed toward the attainment of a high school diploma or its equivalent.
2. (2) No payment of assistance shall be made to an individual who is head of a household, who has not reached twenty (20) years of age, who has a child who is at least sixteen (16) weeks of age in the person's care, and who has not successfully completed a high school education or its equivalent unless the individual participates in:
  1. (A) Educational activities directed toward the attainment of a high school diploma or its equivalent; or
  2. (B) Thirty (30) hours of countable work activities as delineated in subsection (g).
(f)
1. (1) Except as provided in subdivision (f)(2), if a person applying for assistance under this chapter is under eighteen (18) years of age, has never married, and is either pregnant or has the applicant's child in the applicant's care, the applicant is not eligible for assistance if:
  1. (A) The applicant and the applicant's child or children do not live in a place maintained by the applicant's parent, legal guardian, or other adult relative as such person's own home or other suitable living arrangement as otherwise defined by rule of the department; and
  2. (B) The department determines after investigation that the physical or emotional health or safety of the person applying for assistance or the dependent child or children would not be jeopardized if the applicant and the dependent child or children were required to live in one of the situations described in subdivision (f)(1)(A).
2. (2) Subdivision (f)(1) does not apply if:
  1. (A) The person applying for assistance has no parent, legal guardian or other adult relative whose whereabouts are known;
  2. (B) No parent, legal guardian or other adult relative of the person applying for assistance allows the person to live in the home of that parent, legal guardian or other adult relative as determined by the department's verification; or
  3. (C) The department otherwise determines that there is good cause not to apply subdivision (f)(1).
(g) All family members who are not otherwise exempt pursuant to rules of the department and who receive temporary assistance pursuant to this part shall engage in work, training or educational activities. The department shall define the types of activities by rule. These activities may include, but shall not be limited to, the following:
1. (1) Employment;
2. (2) Work experience activities;
3. (3) On-the-job training;
4. (4) Job search and job readiness assistance;
5. (5) Community service programs;
6. (6) Vocational educational training;
7. (7) Job skills and educational training related directly to employment;
8. (8) Education directly related to employment, in the case of a recipient who has not received a high school diploma or a certificate of high school equivalency; and
9. (9) Satisfactory attendance at a secondary school, in the case of a recipient who:
  1. (A) Has not completed secondary school; and
  2. (B) Is a dependent child or a head of a household who is nineteen (19) years of age or younger.
(h)
1. (1) As a condition of eligibility, an applicant for or a recipient of temporary assistance must agree to a personal responsibility plan developed by the department in direct consultation with the applicant or recipient. For all applicants or recipients who are not exempt from the work requirements established by this part, an individualized career plan shall be developed establishing goal-oriented work activities designed to provide the applicant or recipient with an opportunity to move toward self-sufficiency. Supportive services determined essential to successful engagement in the work activities shall be provided. At least once each twelve (12) months throughout the period of continuous temporary assistance provided pursuant to this part, the department shall monitor and evaluate the personal responsibility plan to promote the recipient's success in gaining self-sufficiency.
2. (2)
  1. (A) The personal responsibility plan shall require participation in personal responsibility activities as set forth in subsection (g). The department may provide either a parent education training class for parents or caretakers of children in pre-kindergarten through third grade (pre-K-3) or a program of volunteer service in school in which a parent or caretaker relative who is a recipient of temporary assistance under this part may agree to participate.
  2. (B) The personal responsibility plan shall also require the parent or other caretaker relative, regardless of age or disabling status, to enter a plan that requires, but is not limited to, the following:
    1. (i) The children in the family attend school;
    2. (ii) The children in the family receive immunizations and health checks; and
    3. (iii) The parent or caretaker relative cooperate in the establishment and enforcement of child support, including, but not limited to, the naming of the father of a child for purposes of paternity establishment, unless good cause not to cooperate exists, as defined by the department.
  3. (C) The personal responsibility plan shall include requirements, if the need is identified relative to the child, that:
    1. (i) The parent or a suitable adult or guardian shall attend two (2) or more conferences within a year with the child's teacher to review the child's status in school;
    2. (ii) Attend at least eight (8) hours of parenting classes; or
    3. (iii) The parent shall participate in such support services that the child may need as determined by the department to overcome any school, family, or other barriers that may interfere with the child's and the family's ability to be successful.
  4. (D)
    1. (i) Unless exempt, refusal or failure to engage in full-time employment, part-time employment or other training or other work preparation activities as set forth in subsection (g), without good cause, or the failure to cooperate in the establishment or enforcement of child support without good cause, shall result in denial of eligibility for, or termination of, temporary assistance for the entire family unit.
    2. (ii) Failure to comply with the personal responsibility plan as required under subdivisions (h)(2)(B)(i) and (ii), without good cause, shall result in a percentage reduction with regard to the temporary assistance payment in the amount of twenty percent (20%) until such time as compliance occurs.
  5. (E) The personal responsibility plan may provide transportation assistance, if needed to participate in required activities; provided, that the department shall first utilize available community transportation resources before providing such assistance from department funds. The department shall provide childcare services for those individuals who are receiving benefits, participating in work activities delineated in subsection (g), and not exempt from work activities pursuant to this part.
3. (3) The work requirements shall be excused for:
  1. (A) [Deleted by 2024 amendment.]
  2. (B) A parent or caretaker relative who proves to the satisfaction of the department that the person must provide personal care for a disabled relative child or adult relative living in the home;
  3. (C) A single parent with a child under sixteen (16) weeks of age;
  4. (D) A person who is sixty-five (65) years of age or older;
  5. (E) A nonparental caretaker relative who chooses not to be included in the assistance group; and
  6. (F) Other exemptions that may be required by federal law or regulation, as well as other exemptions that may be established by rule of the department in order to promote the purposes of this part.
4. (4) If, without good cause, a recipient of temporary assistance fails to comply with a child support or work plan requirement imposed by this part or prescribed within the personal responsibility plan, then the family shall be subject to appropriate sanction by the department, which may include termination of assistance for a period to be determined by the department.
(i) [Deleted by 2024 amendment.]
(j) No payment of temporary assistance shall be made to an individual for ten (10) years from the date of conviction, guilty plea or plea of nolo contendere of that individual in a federal or state court for having made a fraudulent statement or representation with respect to the place of residence of the individual in order to receive assistance simultaneously from two (2) or more states under the temporary assistance program under this part, TennCare or any program of medical services under Title XIX of the Social Security Act (42 U.S.C. § 1396 et seq.), the Food Stamp Act of 1977 (7 U.S.C. § 2011 et seq.), or under the supplemental security income program under Title XVI of the Social Security Act (42 U.S.C. § 1381 et seq.).
(k)
1. (1) No payment of assistance shall be made to an individual who is fleeing to avoid prosecution or custody or confinement after conviction under the laws of the place from which the individual flees, for a crime, or an attempt to commit a crime, that is a felony under the laws of the place from which an individual flees, or that, in the case of the state of New Jersey, is a high misdemeanor under the laws of such state, or who is violating a condition of probation or parole imposed by federal or state law.
2. (2)
  1. (A) Pursuant to the option granted the state by 21 U.S.C. § 862a(d), an individual convicted on or before June 30, 2011, under federal or state law of a felony involving possession, use or distribution of a controlled substance shall be exempt from the prohibition contained in 21 U.S.C. § 862a(a) against eligibility for families first program benefits for such convictions, if such person, as determined by the department:
    1. (i)
      1. (a) Is currently participating in a substance abuse treatment program approved by the department of human services;
      2. (b) Is currently enrolled in a substance abuse treatment program approved by the department of human services, but is subject to a waiting list to receive available treatment, and the individual remains enrolled in the treatment program and enters the treatment program at the first available opportunity;
      3. (c) Has satisfactorily completed a substance abuse treatment program approved by the department of human services; or
      4. (d) Is determined by a treatment provider licensed by the department of mental health and substance abuse services not to need substance abuse treatment according to TennCare guidelines; and
    2. (ii) Is complying with, or has already complied with, all obligations imposed by the criminal court, including any substance abuse treatment obligations.
  2. (B) Eligibility based upon the factors in subdivision (k)(2)(A) must be based upon documentary or other evidence satisfactory to the department, and the applicant must meet all other factors of program eligibility, including, specifically, being accountable for the requirements of the personal responsibility plan required by this part.
  3. (C) Notwithstanding subdivision (k)(2)(A) or (k)(2)(B) to the contrary, a person convicted of a Class A felony for violating title 39, chapter 17, part 4, or convicted of an offense in another jurisdiction that would be classified as a Class A felony under title 39, chapter 17, part 4, if committed in this state, is not eligible for the exemptions provided by subdivision (k)(2)(A) or (k)(2)(B).
  4. (D) Pursuant to the option granted the state by 21 U.S.C. § 862a(d), an individual convicted on or after July 1, 2011, under federal or state law of a felony involving possession, use or distribution of a controlled substance shall be exempt from the prohibition contained in 21 U.S.C. § 862a(a) against eligibility for families first program benefits for such convictions, if such person meets the following requirements:
    1. (i) Requirements contained in subdivision (k)(2)(A) or (k)(2)(B) and (C);
    2. (ii) If treatment was prescribed according to the requirements in subdivision (k)(2)(A) or (k)(2)(B), successful completion of a substance abuse program must occur within three (3) attempts. If such person does not complete the originally prescribed treatment program within three (3) attempts, the individual shall be ineligible for a period of three (3) years.
  5. (E) Pursuant to the option granted the state by 21 U.S.C. § 862a(d), an individual convicted of a second drug felony under federal or state law of a felony involving possession, use or distribution of a controlled substance on or after July 1, 2011, shall not be eligible for families first program benefits for a period of three (3) years from the date of conviction.
(l) No payment of assistance pursuant to this part shall be made for an illegal alien in a family.

Backlinks (5)

History (16)

Acts 1996, ch. 950, § 5
1999, ch. 520, § 47
2000, ch. 981, § 76
2002, ch. 715, § 1
2007, ch. 31, §§ 1-8
2009, ch. 186, § 38
2010, ch. 1056, § 1
2010, ch. 1100, § 135
2011, ch. 221, § 1
T.C.A., § 71-3-154
Acts 2012, ch. 575, § 1
2012, ch. 912, §§ 1-3
2014, ch. 960, § 1
2018, ch. 789, § 3
2021, ch. 515, § 5
2024, ch. 570, §§ 1-3.

§ 71-3-105. Rules and regulations — Deductions — Reports to governor and general assembly — Miscellaneous provisions.

(a) In determining eligibility under § 71-3-104 for, and amounts of, grants under the temporary assistance program, the department of human services shall adopt rules and regulations establishing a standard of need that reflects the true cost of the following, less any discounts for other sources of assistance provided for in subsection (b):
1. (1) Safe, healthful housing;
2. (2) Minimum clothing for health and decency;
3. (3) A low cost adequate food budget as recommended by the United States department of agriculture's thrifty food plan (7 U.S.C. § 2012(u));
4. (4) An allowance for essential medical care; and
5. (5) Other necessary items including, but not limited to, transportation, personal care and educational expenses.
(b) The department shall deduct from the costs determined in subsection (a) the value of the following:
1. (1) Housing assistance programs;
2. (2) Food coupons or food stamps or food assistance under chapter 5, part 3 of this title; and
3. (3) TennCare or medicaid.
(c) The commissioner shall report to the governor and the general assembly no later than October 1 of each year regarding projected annual adjustments to the standard of need necessitated by changes in the costs and benefits described in subsections (a) and (b). The report of the commissioner shall also contain:
1. (1) An estimate of the percentage of the adjusted standard of need that could be paid if the appropriation for the next fiscal year were to remain constant;
2. (2) An estimate of the cost of paying the same percentage of the standard of need considering necessary adjustments in such standard of need;
3. (3) The recommendation of the commissioner as to the percentage of the adjusted standard of need that should be paid in the next fiscal year and the cost of that adjusted standard of need; and
4. (4) Any other relevant information that would be helpful to the governor and the general assembly in making decisions concerning the temporary assistance program.
(d) Any amount of earned income in an aid-to-the-blind case, as provided in § 71-4-105, and any other income required by federal statutes to be exempt in determining need, shall be exempt and shall not be considered as a resource in determining the amount of assistance to be paid to any person under this part.
(e) The standard of need for each fiscal year shall be established by rule on July 1 of each year in accordance with subsections (a) and (b).
(f)
1. (1) The department of human services shall conduct a temporary assistance client characteristics study at least once every three (3) years. The study shall be conducted either by contract or within the department and shall be completed prior to any review, required by federal regulation, of the temporary assistance standard of need and temporary assistance grant payments.
2. (2)
  1. (A) Notwithstanding subdivision (f)(2)(B), the maximum grants for the temporary assistance program, expressed as a percentage of the standard of need, may be raised if approved as a line item in the annual appropriations act or by rule.
  2. (B) The maximum standard grant for the temporary assistance program for all assistance group sizes is no less than twenty-five percent (25%) of the standard of need for the applicable assistance group size.
  3. (C) The department is authorized to promulgate rules to effectuate this subsection (f) in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
  Backlinks (1)
  
  71-3-104(a)(2)(D)
3. (3) The department of human services shall conduct a study or engage with a research partner to study the impact and effectiveness of the increase in the maximum standard grant and lifetime maximum benefit timeframe authorized under this act.
(g) In determining eligibility under § 71-3-104, the department shall adopt rules that use the standard of need less any exemption provided by subsection (d) to determine eligibility for amounts of grants. Such rules shall be adopted in a manner in which the maximum amount of child support and other income may be provided to the family and children without loss of grant and medicaid benefits.

History (5)

Acts 1996, ch. 950, § 6
2010, ch. 1030, § 19
T.C.A., § 71-3-155
Acts 2018, ch. 789, § 4
2021, ch. 515, §§ 6, 7.

§ 71-3-106. [Reserved.]

§ 71-3-107. Administration and organization — Rulemaking — Notice — Cooperation and review of rules by state entities.

(a) The department shall administer the families first program established by this part.
(b) The commissioner has the authority to organize the department in any manner necessary as permitted by law, to establish any necessary county or district or regional offices and to appoint area and district managers and directors in those offices or in the department's state office, and to establish any necessary internal policies and procedures for the proper administration of the families first program and for the provision of temporary assistance, child support, jobs programs and other related support services.
(c) From time to time, the commissioner may appoint committees composed of representatives from the public or private sectors, or both, for such purpose and duration as may be deemed appropriate or required. Members of such committees shall be reimbursed for their actual expenses for attending meetings of their respective committees. All reimbursement for travel expenses shall be in accordance with the comprehensive travel regulations as promulgated by the department of finance and administration and approved by the attorney general and reporter.
(d) The department shall administer the program of economic assistance to families under Titles IV-A (42 U.S.C. § 601 et seq.), IV-D (42 U.S.C. § 651 et seq.), and IV-F (repealed) of the Social Security Act or related federal laws or regulations as they may continue to exist pursuant to federal statutes and regulations on or after September 1, 1996, and as such program statutes and regulations may be amended, or pursuant to any waivers that are granted by the federal government from those regulations as a result of the enactment of this legislation.
(e) Acting in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, the department shall have rulemaking authority to establish any necessary rules for the administration of this part and shall have rulemaking authority to establish any rules to carry out the requirements of any title or part of any title that the department administers and that are necessary to immediately implement this part to effect any federal legislative changes.
(f) The department shall establish by rule the procedures for provision of notice of the eligibility determination to the applicant or recipient as well as the grievance and appeal procedures that are applicable to meet due process. It is the intent of this section that grievance and appeals procedures available pursuant to this part, and of chapter 5, part 12 of this title shall not be more narrow than such procedures available to recipients of assistance upon August 31, 1996. The department shall also establish by rule, administrative procedures through which a recipient shall be granted an extension of temporary assistance, beyond the maximum eighteen-month period and the maximum sixty-month period set forth in § 71-3-104(d), for “good cause” or based upon the failure of the state to timely provide essential child care, transportation, education or job training services prescribed within the recipient's personal responsibility plan.
(g) All other agencies of the state shall cooperate with the department in any manner necessary for the administration of this part.
(h) Each governmental entity of the state, directly affected by any permanent rule promulgated by the department of human services to implement this part and of chapter 5, part 12 of this title, shall review such permanent rule not later than fourteen (14) calendar days after the rule is filed with the secretary of state. Prior to such deadline, the affected governmental entity shall submit written comments to the secretary of state for filing with the applicable rule and for distribution to the chair of the government operations committee of the senate and to the chair of the government operations committee of the house of representatives. Such written comments shall include, but not be limited to, a description of the impact of such permanent rule upon the existing rules, policies or procedures of the affected governmental entity.
(i) The commissioner of human services shall develop a written plan or statement providing for interagency coordination of services provided under this part and chapter 5, part 12 of this title, which shall include services provided by the departments of human services, education, labor and workforce development, and transportation.

History (5)

Acts 1996, ch. 950, § 8
1999, ch. 520, § 47
2000, ch. 981, § 68
2009, ch. 103, § 2
T.C.A., § 71-3-157.

§ 71-3-108. Modifications to program — Federal waivers.

(a) The commissioner of human services is authorized, pursuant to the requirements of subsections (b) and (c), to immediately implement changes necessary as a result of federal legislation designed to reform welfare programs that are, or may be in the future, administered by the department of human services or other appropriate state agencies.
(b) It is the intent of the general assembly that any modifications to the state's welfare programs be implemented that are required by federal law or that are necessary to ensure or enhance federal funding of the state's welfare programs or that are necessary for the implementation of such changes. Acting in accordance with § 4-5-108, the department shall have authority to immediately implement any federal legislative changes by emergency rules; provided, that permanent rules shall be promulgated pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
(c) For purposes of this section, “welfare program” is defined as any federal or state means-tested program administered by the department of human services, or any child support enforcement program administered by the department of human services pursuant to Title IV-D of the Social Security Act (42 U.S.C. § 651 et seq.), the Carl D. Perkins Vocational and Applied Technology Act authorized by P.L. 101-392 [repealed], and the Adult Education Act, authorized by P.L. 100-297 [repealed], as amended by the National Literacy Act of 1991, P.L. 102-73 [repealed].
(d)
1. (1) The commissioner of human services is authorized to seek and to implement waivers to carry out this part and chapter 5, part 12 of this title to the extent permitted by federal authorities.
2. (2)
  1. (A) If waivers that are necessary to implement any or all of the provisions of this part, chapter 3, parts 9 and 10 and chapter 5, part 12 of this title cannot be obtained, or in those counties for which the continued operation of the existing welfare program may be required by the federal authorities for the evaluation of any waivers granted by the federal government, the department shall continue to administer, pursuant to the requirements of federal statutes and regulations, the federally funded programs of economic or welfare assistance to families and children under Titles IV-A and IV-D of the Social Security Act (42 U.S.C. § 601 et seq. and 42 U.S.C. § 651 et seq.), respectively, as they may continue to exist on or after September 1, 1996, until such time as such programs may be terminated or modified by the congress of the United States, the United States department of health and human services or its successor, or the general assembly.
  2. (B)
    1. (i) If at any time:
      1. (a) The congress of the United States terminates or modifies the Title IV-A block grant program for federally funded economic or welfare assistance to families and children to the states under the temporary assistance to needy families program (TANF) as provided in Public Law 104-193 (1996) (42 U.S.C. § 601 et seq.), as amended;
      2. (b) The congress of the United States, or the United States department of health and human services or its successor terminates, or modifies, Tennessee's Section 1115 waiver obtained pursuant to subdivision (d)(1) on July 26, 1996, that resulted in the creation of the families first program; or
      3. (c) In the future, action by congress, or by the United States department of health and human services or its successor, terminates or modifies any subsequent federally funded economic or welfare assistance program or any waiver that may be obtained for the operation of such a program for families and children, or a waiver that may be obtained for a welfare program demonstration project;
    2. (ii) Then, in that circumstance, the department shall continue to administer, pursuant to the requirements of federal statutes and regulations existing at that time or subsequently enacted, the programs of economic or welfare assistance to families and children under Titles IV-A and IV-D of the Social Security Act (42 U.S.C. § 601 et seq. and 42 U.S.C. § 651 et seq.), respectively, as they may continue to exist on or after the date of such termination or modification or until the granting of a new waiver, and this part, chapter 3, parts 9 and 10 and chapter 5, part 12 of this title shall be superseded to the extent:
      1. (a) Those provisions are inconsistent with any federal requirements for which no waiver exists; or
      2. (b) No further federal funding is available, unless the general assembly specifically authorizes and funds the continuation of such provisions that do not otherwise conflict with federal law, regulation or waiver requirements.
  3. (C) The termination or modification of any federally funded programs for the economic assistance to families and children shall not result in any entitlement to funding by the state of Tennessee for such programs pursuant to this part, chapter 3, parts, 9 and 10 and chapter 5, part 12 of this title, or otherwise, unless appropriations are made in the appropriations act specifically for such purpose.
  4. (D) Notwithstanding any law to the contrary, the department shall have authority to implement any rules, by emergency rule, that are necessary to:
    1. (i) Maintain compliance with such terminations or modifications;
    2. (ii) Maintain federal funding;
    3. (iii) Comply with any federal regulation that has not been waived; or
    4. (iv) Comply with any waiver requirements;
    5. provided, however, that the department shall promulgate permanent rules pursuant to a rulemaking hearing as required by the Uniform Administrative Procedures Act.
(e) Child support received by the department with respect to recipients of temporary assistance shall be passed on to the recipient in the same manner as was the practice of the department prior to July 1, 1996, with respect to recipients of aid to families with dependent children (AFDC). However, the department shall not be required to pass through any portion of child support that by federal law must be paid to the federal government. The department shall seek any available waiver from a requirement that any portion of child support must be paid to the federal government, and, if a waiver is granted, pass the support through to the recipient of temporary assistance as required in this subsection (e).

Backlinks (1)

71-3-110

History (4)

Acts 1996, ch. 950, § 9
2003, ch. 119, § 1
2009, ch. 566, § 12
T.C.A., § 71-3-158.

§ 71-3-109. Diversion grants.

(a) Except for a child-only grant for temporary assistance, the department shall evaluate appropriate cases to determine if a diversion grant would be effective in meeting a family's immediate and compelling need and prevent the family from going on temporary assistance or to assist the family in leaving temporary assistance. The diversion grant shall be awarded pursuant to the requirements in subsections (b) and (c) and the rules of the department.
(b) The diversion grant:
1. (1) Shall meet immediate needs so that an applicant or recipient can avoid temporary cash assistance;
2. (2) May be granted as the department considers appropriate;
3. (3) May not cover the same type of immediate need met by a previous diversion grant unless the department determines that the current immediate need is a new and verified emergency;
4. (4) May range from one (1) to twelve (12) months of temporary cash assistance, dependent upon the department's determination that there is a compelling need for a diversion grant;
5. (5) Shall be calculated based upon the amount of temporary cash assistance an applicant is eligible to receive under the Temporary Assistance for Needy Families/Families First program; and
6. (6) May not duplicate periods of temporary cash assistance.
(c) The applicant's temporary assistance eligibility period will be reduced by the number of months the applicant receives a diversion grant.

History (1)

Acts 2014, ch. 787, § 1.

§ 71-3-110. Distribution system.

The commissioner of human services has the authority to establish a system for distribution of any benefits provided by this part, or under the continued provisions of federal law and regulations as provided under § 71-3-108, by means of electronic benefits transfer system and to contract with public or private entities to provide any services necessary to carry out such provision as the commissioner shall determine is appropriate.

History (3)

Acts 1996, ch. 950, § 11
T.C.A., § 71-3-160
Acts 2013, ch. 402, § 3.

§ 71-3-111. Training and supervision.

(a) The department shall appropriately train and supervise all employees and other persons who are responsible for developing, evaluating and managing personal responsibility plans for recipients of temporary assistance. Such training and supervision shall include, but not be limited to, a competency based case management program to measure the effectiveness of each plan and to provide appropriate oversight and implementation.
(b) Any necessary part-time or temporary job counseling and job placement personnel shall be employed as provided by law.
(c) Any additional full-time positions required by the various departments involved in the implementation of this part and of chapter 5, part 12 of this title shall be employed as provided by law.

History (2)

Acts 1996, ch. 950, § 29
T.C.A., § 71-3-161.

§ 71-3-112 — 71-3-114. [Reserved.]

§ 71-3-115. Investment of funds in individual development or other accounts.

Any individual development accounts or other such accounts established for the benefit of recipients under this part or related programs shall be administered as approved by the state treasurer, who shall prescribe investment procedures for the corpus of such funds in a manner that the state treasurer determines in consultation with the commissioners of human services and finance and administration; provided, that the interest accruing from such accounts shall remain in those accounts and shall be distributed to the recipients, on an equitable basis, in the manner determined by the state treasurer in consultation with the commissioners.

History (2)

Acts 1996, ch. 950, § 34
T.C.A., § 71-3-165.

§ 71-3-116. Veterans education benefits.

Notwithstanding any other provision of this chapter, to the extent permitted by federal law, the value of federal veterans education benefits received by an applicant shall not be included as any form of income when making eligibility determinations for assistance under this part.

History (2)

Acts 2003, ch. 239, § 1
T.C.A., § 71-3-166.

§ 71-3-117. Amendment of provisions.

All assistance granted under this part shall be deemed to be granted and to be held subject to any amending or repealing statute that may hereafter be passed, and no recipient shall have any claim for compensation, or otherwise, by reason of such recipient's assistance being affected in any way by any amending or repealing statute.

History (3)

Acts 1937, ch. 50, § 16
C. Supp. 1950, § 4765.54 (Williams, § 4765.53)
T.C.A. (orig. ed.), §§ 14-317, 14-8-117.

§ 71-3-118. Charging for assistance to applicants unlawful.

(a) It is unlawful for any person, firm, or corporation either to charge or to receive, directly or indirectly, anything of value for assisting any person in making application to the proper authorities of this state, or any of them, for relief or assistance under any statutes of this state providing for financial assistance to dependent children.
(b) A violation of this section is a Class C misdemeanor.

History (5)

Acts 1937, ch. 118, § 1
1941, ch. 41, § 1
mod. C. Supp. 1950, § 4765.56 (Williams, § 4765.37)
T.C.A. (orig. ed.), §§ 14-318, 14-8-118
Acts 1989, ch. 591, § 113.

§ 71-3-119. Use of lists of recipients.

(a) Except as permitted by §§ 71-1-117 and 71-1-118, it is unlawful for any person, except for purposes directly connected with the administration of this part, to solicit, disclose, receive, make use of, authorize or knowingly permit, participate in, or acquiesce in the use of any list or names of, or any information concerning, persons applying for or receiving aid and services to needy families with children, directly or indirectly derived from the records, papers, files, or communications of the department or divisions of the department, or acquired in the course of the performance of official duties.
(b) A violation of this section is a Class C misdemeanor.

History (7)

Acts 1941, ch. 148, § 1
C. Supp. 1950, § 4765.56 (Williams, § 11412.7)
impl. am. Acts 1953, ch. 29, §§ 1, 2
Acts 1963, ch. 129, § 1
impl. am. Acts 1975, ch. 219, § 1 (a, b)
T.C.A. (orig. ed.), §§ 14-319, 14-8-119
Acts 1989, ch. 591, § 113.

§ 71-3-120. Fraudulent receipt of temporary assistance — Penalties — Statute of limitations.

(a) A person commits an offense who, knowingly, obtains, or attempts to obtain, or aids, or abets any person to obtain, by means of a willfully false statement, representation, or impersonation, or by any other fraudulent means or in any manner not authorized by this part, or by the regulations or procedures issued or implemented by the department of human services pursuant to this part, temporary assistance for a dependent child as provided pursuant to this part, either by check or by an electronic benefits transfer process, or any assistance provided pursuant to this part by any other means as determined by the department, to which such child is not entitled or in an amount greater than that to which such child is entitled.
(b) A person commits an offense who, knowingly, in any manner not authorized by this part or the regulations or procedures implemented by the department of human services pursuant to this part, presents for payment, or causes to be presented for payment, transfers, exchanges, sells, or otherwise uses, or aids or abets any person to present for payment, transfer, exchange, sell, or otherwise use any temporary assistance check, or any electronic benefits card, authorization or personal identification number, device or other thing or means issued or utilized for the purpose of providing temporary assistance benefits pursuant to this part electronically or otherwise.
(c) A person who receives a temporary assistance check or any electronic benefits card, authorization or personal identification number, device or other thing or means issued or utilized for the purpose of providing temporary assistance benefits electronically or otherwise, knowing them to have been presented for payment, transferred, exchanged, sold or otherwise used in any manner not authorized by this part or the regulations or procedures implemented by the department of human services pursuant to this part, commits an offense.
(d) An offense under this section is a Class E felony if the value of such temporary assistance sought to be obtained, or that is obtained, is one hundred dollars ($100) or more, and upon conviction of the offense, such person shall be sentenced for such offense as provided by law, or shall be fined not less than one thousand dollars ($1,000) nor more than five thousand dollars ($5,000), or both, unless the offense is committed by means of a willfully false impersonation, assumption of a false identity, or presentation of a false identification, in which case the fine is not less than two thousand five hundred dollars ($2,500) nor more than ten thousand dollars ($10,000); and, if such temporary assistance sought to be obtained, or that is obtained, is of a value less than one hundred dollars ($100), such person commits a Class A misdemeanor and shall be sentenced or fined, or both, as provided by law.
(e)
1. (1) In addition to or in lieu of the penalties in subsection (d), the court may order that such person be disqualified from participation in the temporary assistance program:
  1. (A) For twelve (12) months for the first offense;
  2. (B) For twenty-four (24) months for the second offense; and
  3. (C) Permanently for the third offense.
2. (2) Individuals found by a court to have used or received benefits in a transaction involving the sale of a controlled substance, as defined in § 102 of the Controlled Substances Act (21 U.S.C. § 802), must be disqualified from participation in the temporary assistance program:
  1. (A) For twenty-four (24) months for the first such violation; and
  2. (B) Permanently for the second such violation.
3. (3) Individuals found by a court to have used or received benefits in a transaction involving the sale of firearms, ammunition, or explosives must be permanently disqualified from participation in the temporary assistance program upon the first such violation.
4. (4) Individuals convicted by a court for having trafficked benefits in an aggregate amount of five hundred dollars ($500) or more must be permanently disqualified from participation in the temporary assistance program upon the first such violation.
5. (5) Disqualification of an adult pursuant to this section from eligibility for assistance under this part must not disqualify or suspend the eligibility of an innocent adult or child of the disqualified adult's family.
(f) The department shall enclose a copy of the penalties provided in this section one (1) time, in notice form, to each recipient of assistance pursuant to this part and post a notice to such effect in noticeable places in each of its assistance offices.
(g) In addition to any of the penalties in subsection (d), any person convicted of any offense specified in subsection (a), (b) or (c) shall be ordered to make restitution in the total amount found to be the value of the temporary assistance that forms the basis for the conviction. In the event any person ordered to make restitution pursuant to this section is found to be indigent and, therefore, unable to make restitution in full at the time of conviction, the court shall order a periodic payment plan consistent with the person's financial ability.
(h) Notwithstanding any other law to the contrary, prosecutions for any of the offenses specified in subsection (a), (b) or (c) shall be commenced within four (4) years next after the commission of the offense. For purposes of this subsection (h), any such offense that is based upon a willful failure to report information as required by law is considered a continuing offense until such information is reported.

History (8)

Acts 1937, ch. 50, § 15
C. Supp. 1950, § 4765.53 (Williams, § 4765.52)
Acts 1955, ch. 28, § 1
T.C.A. (orig. ed.), §§ 14-320, 14-8-120
Acts 1989, ch. 591, § 104
1999, ch. 248, § 1
2021, ch. 515, § 2
2024, ch. 570, § 4.

§ 71-3-121. Transfer of benefits — Exemption.

Assistance granted under this part shall not be transferable or assignable at law or in equity, and none of the money paid or payable under this part shall be subject to execution, levy, attachment, garnishment or other legal process, or to the operation of any bankruptcy or insolvency law.

History (3)

Acts 1937, ch. 50, § 16-a, as added by Acts 1941, ch. 37, § 1
C. Supp. 1950, § 4765.55 (Williams, § 4765.53a)
T.C.A. (orig. ed.), §§ 14-321, 14-8-121.

§ 71-3-122. Prosecution of deserting spouse or parent.

Whenever any dependent spouse or dependent child shall make an application to the county office of the department for an aid and services to needy families with children grant, and an investigation of the circumstances of the applicant reveals that the applicant was put in such needy circumstances by reason of the fact that the dependent spouse was deserted or abandoned by that spouse's or the child's parent, then it shall be the duty of the county office to notify the chief counsel of the department, whose duty it shall be to certify such fact to the prosecuting attorney of the county, who shall institute the necessary criminal proceedings against the spouse or parent who has deserted the dependent spouse or family.

History (4)

Acts 1951, ch. 257, § 1 (Williams, § 4765.53b)
1963, ch. 129, § 1
1976, ch. 754, § 1
T.C.A. (orig. ed.), §§ 14-322, 14-8-122.

§ 71-3-123. Civil action against deserting spouse or parent.

(a) All payments made by the department to such spouse or dependent child shall be recoverable against the deserting spouse or parents by the state as a debt due to the state, and such recovered payments shall be deposited by the state treasurer to the credit of the aid and services to needy families with children fund.
(b) In the event the deserting spouse or parent has left the state, then the secretary of state shall be the lawful attorney or agent for such spouse or parent and service of process shall be made by serving a copy of the process on the secretary of state, and such service shall be sufficient service upon the spouse or parent; provided, that notice of such service and a copy of the process are forthwith sent by registered mail by the prosecuting attorney to the last known out-of-state address of the spouse or parent.
(c) The property of the spouse or parent within the state shall be subject to execution for payment of any judgment taken against such spouse or parent.

History (4)

Acts 1951, ch. 257, § 2 (Williams, § 4765.53c)
1963, ch. 129, § 1
1976, ch. 754, § 2
T.C.A. (orig. ed.), §§ 14-323, 14-8-123.

§ 71-3-124. Assignment of support rights to state — Enforcement and collection of rights — Collection service fee — Attorneys — Caretaker relative eligibility — Standing to petition.

(a)
1. (1) Each applicant or recipient who receives or authorizes payment of public or temporary assistance pursuant to Title IV-A or IV-E of the Social Security Act (42 U.S.C. § 601 et seq. and 42 U.S.C. § 670 et seq.), respectively, or any successor program providing temporary assistance or foster care or adoption assistance shall be deemed to have assigned to the state any rights to support from any other person such applicant or recipient may have:
  1. (A) In the applicant's own behalf or in behalf of any other family member for whom the applicant is applying for or receiving aid; and
  2. (B) That have accrued at the time such assignment is executed.
2. (2) Each payment shall constitute “receipt” for purposes of determining when the assignment is executed.
3. (3) During the terms of such assignment, the department shall be subrogated to the rights of the child or children or the person having custody to collect and receive all child support payments.
4. (4) The department has the right to initiate any support action in its own name or in the name of the recipient under existing laws of this state and to recover any payments ordered by the courts of this or any other state.
5. (5) In the exercise of its subrogation rights, the department shall give the person having custody prior notice of any action taken to enforce or modify support and shall inform the custodian of the right to intervene to protect any future interest; provided, that failure to provide such notice shall not be a defense to the obligor in any proceeding.
6. (6)
  1. (A) Notwithstanding any law to the contrary, neither the department of human services, nor any Title IV-D child support contractor of the department, nor any recipient of public assistance in this or any other state or territory, shall be required to demonstrate to a court or administrative tribunal in this state that the caretaker of the child for whom child support is sought is vested with any more than physical custody of the child or children in order to have standing to petition for child support from the legal parent of the child or children for whom support is sought, or to seek enforcement or modification of any existing orders involving such child or children.
  2. (B) Legal custody of a child to whom a child support obligation is owed shall not be a prerequisite to the initiation of any support action or to the enforcement or modification of any support obligation, whether or not the obligation has been assigned to this state or any other state or territory by operation of law.
(b) The department shall certify to the clerks of the appropriate state courts that an assignment of any and all rights, title and interest in support rights has been made to this state by a public assistance or temporary assistance recipient of this state. The department may also, in its discretion, certify to the clerk of the appropriate court in this state that a recipient of public assistance or temporary assistance in another state has assigned support rights to that state pursuant to federal law. Upon receipt of this certification, the clerks of the appropriate state courts shall transmit support payments that they receive on behalf of such public assistance or temporary assistance recipient. The clerk shall transmit the amount directly to the agency specified by the department in accordance with § 36-5-101. The clerks are to identify these payments by the names of the parties involved in the cause of action and by the docket number of the cause of action. These support payments shall be transmitted to the department or the specified agency continuously until the department notifies the clerks of the appropriate state courts that it is no longer necessary to do so. The department shall send to each recipient notice of payments received in such recipient's behalf quarterly.
(c)
1. (1) Upon the filing of an application by an individual not otherwise eligible for support services under this section, the department may initiate support actions for an individual, in accordance with Title IV-D of the Social Security Act (42 U.S.C. § 651 et seq.), as amended.
2. (2) The department or any entity, public or private, that contracts with the department to establish paternity or to establish, modify or enforce child or spousal support pursuant to Title IV-D of the Social Security Act shall have authority and standing to file any legal actions to establish paternity or to establish, modify or enforce child or spousal support in any judicial or administrative proceeding on behalf of the department and the state for persons who have assigned rights of support to the department pursuant to this section, or who have otherwise applied for child or spousal support services pursuant to subdivision (c)(1) or Title IV-D of the Social Security Act. The department or its contractors may file such legal actions without the necessity of intervening in an existing action or naming the state as a party to the action. The department or its contractors shall not be required to provide proof that the obligor, the obligee or the child has applied for or is receiving Title IV-D child support services in order to meet the requirements for conducting Title IV-D child support judicial or administrative actions.
(d) The provision of services under a child support enforcement program that includes services by an attorney or an attorney's representative employed by, under contract to, or representing the department shall not create an attorney-client relationship with any party other than the state. Attorneys employed by or under contract to the department shall have an affirmative duty to notify individuals applying for child support services or temporary assistance for needy families (TANF) recipients or recipients of any successor program providing temporary assistance whose rights to support have been assigned, who contact or are contacted by the attorney or other child support enforcement program staff that any legal services provided by the child support enforcement program are solely on behalf of the state, and that no incidents of the lawyer-client relationship, including the confidentiality of lawyer-client communications, exist between the attorney and the applicant or recipient. No such duty shall exist when the applicant for services is another governmental agency acting on behalf of an individual and there is no direct contact between the child support enforcement program and the individual seeking support.
(e)
1. (1) As a condition of eligibility for consideration of the caretaker relative in the request for assistance under the TANF program or any successor program providing temporary assistance, each applicant for or recipient of benefits under this program shall cooperate, unless good cause not to cooperate is shown to exist in accordance with 45 Code of Federal Regulations, Sections 232.40 through 232.49 as they may be amended, with the department and its Title IV-D contractors in:
  1. (A) Identifying and locating the parent of a child for whom aid is claimed;
  2. (B) Establishing the paternity of a child born out of wedlock for whom aid is claimed;
  3. (C) Obtaining support payments for the applicant or recipient and for a child for whom aid is claimed; and
  4. (D) Obtaining any other payments or property due the applicant or recipient of the child.
2. (2) Cooperation with the department and its Title IV-D contractors shall be defined by the department in rules that are consistent with federal regulations.
3. (3) If a caretaker relative fails to cooperate with the department or its Title IV-D contractors under subdivision (e)(1), the department shall, consistent with federal regulations, deny assistance to that caretaker relative of a child or children who are otherwise eligible for TANF or any successor program providing temporary assistance and it shall, consistent with federal regulations, provide assistance to the eligible child in the form of a protective payment, but such assistance will be determined without regard to the needs of the caretaker relative.
4. (4) The commissioner shall promulgate rules to carry out this section.

Backlinks (4)

History (11)

Acts 1977, ch. 110, § 1
T.C.A., § 14-324
Acts 1982, ch. 764, § 1
1985, ch. 477, §§ 9, 10
1986, ch. 890, § 15
T.C.A., § 14-8-124
Acts 1988, ch. 938, § 3
1994, ch. 987, § 16
1996, ch. 950, § 28
1998, ch. 1098, § 68
2000, ch. 922, § 38.

§ 71-3-125. Child support enforcement by district attorneys general.

(a) The district attorneys general have the authority, within budgetary limitations, to establish child support enforcement programs within their judicial districts.
(b) Such authority includes:
1. (1) The hiring of clerical and professional staffs;
2. (2) The entering into contracts with other agencies; and
3. (3) Such other authority as may be necessary to carry out the requirements of the child support enforcement programs under Title IV-D of the Social Security Act (42 U.S.C. § 651 et seq.).
(c) Any legal services furnished under the authority of this section shall be solely on behalf of the state, and shall not create an attorney-client relationship with any party other than the state.

History (3)

Acts 1977, ch. 235, § 1
T.C.A., §§ 14-325, 14-8-125
Acts 1988, ch. 938, § 4.

§ 71-3-126. Restrictions on use of electronic benefits transfer cards by TANF recipients — Reimbursement — Violations and penalties — System for review — Right to hearing — Rules and regulations — Revenues and fines deposited in general fund.

(a) For the purposes of this section, the term “public assistance benefits” means money or property provided directly or indirectly to eligible persons through the temporary assistance to needy families program.
(b)
1. (1) A recipient of public assistance benefits shall not knowingly use an electronic benefits transfer card in:
  1. (A) A liquor store as defined in 42 U.S.C. § 608(a)(12)(B)(i);
  2. (B) A casino, gambling casino, or gaming establishment as defined in 42 U.S.C. § 608(a)(12)(B)(ii);
  3. (C) An adult cabaret as defined in § 7-51-1102; or
  4. (D) A retail store licensed to do business in this state that derives its largest category of sales from the sale of loose tobacco, cigars, cigarettes, pipes, and other smoking accessories.
2. (2) To the extent permitted by federal law, any person who violates this subsection (b) shall reimburse the department for the purchase.
3. (3) The department shall notify all recipients of electronic benefit cards of the prohibitions set forth in subdivision (b)(1) and the penalties under current law for knowingly using an EBT card in any prohibited business location.
(c)
1. (1) A person or business entity, or any agent or employee of the person or business entity shall not knowingly accept public assistance benefits from an electronic benefits transfer card for the purchase of any goods or services in:
  1. (A) A liquor store as defined in 42 U.S.C. § 608(a)(12)(B)(i);
  2. (B) A casino, gambling casino, or gaming establishment as defined in 42 U.S.C. § 608(a)(12)(B)(ii);
  3. (C) An adult cabaret as defined in § 7-51-1102; or
  4. (D) A retail store licensed to do business in this state that derives its largest category of sales from the sale of loose tobacco, cigars, cigarettes, pipes, and other smoking accessories.
2. (2) Any person or business entity who knowingly violates this subsection (c) shall be subject to the following civil penalties:
  1. (A) One thousand dollars ($1,000) for the first violation;
  2. (B) Two thousand five hundred dollars ($2,500) for the second violation within five (5) years;
  3. (C) Five thousand dollars ($5,000) for a third or a subsequent violation within five (5) years. The district attorney general may bring an action to suspend the business licenses and permits of the person or business entity for one (1) year for any violation under this subsection (c). The department is authorized to bring an action to enforce any civil penalty under this subsection (c) in a complaint filed in the chancery court of the county where the merchant is located.
(d)
1. (1) A recipient of public assistance benefits shall not knowingly use an electronic benefit transfer card in an automated teller machine or point-of-sale device located in:
  1. (A) A liquor store as defined in 42 U.S.C. § 608(a)(12)(B)(i);
  2. (B) A casino, gambling casino, or gaming establishment as defined in 42 U.S.C. § 608(a)(12)(B)(ii); or
  3. (C) An adult cabaret as defined in § 7-51-1102.
2. (2) Any person who knowingly violates this subsection (d) shall reimburse the department for the amount withdrawn and used subject to any prohibition in federal law. Upon a third or subsequent violation, if permitted by federal law, the person shall be permanently disqualified from receiving public assistance benefits by means of direct cash payment or an electronic benefits transfer access card.
(e) The department of human services shall establish a system for reviewing electronic benefit transactions of recipients pursuant to this section on such basis as the commissioner may determine, but not less than on a quarterly basis.
(f) A person or entity subject to a penalty or sanction under this section shall have the right to a hearing pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
(g)
1. (1) The commissioner of human services is authorized to promulgate rules and regulations, including emergency rules, to effectuate the purposes of this section. All such rules and regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act.
2. (2) The department shall add by rule to the prohibited use of an electronic benefits transfer card other purchases to the fullest extent later permitted by federal law.
(h) Any revenues deposited or civil fines collected pursuant to subsection (c) shall be deposited into the general fund.

History (2)

Acts 2013, ch. 312, § 1
2015, ch. 392, §§ 1-3.

Part 3 Custody and Care of Dependent Children

§ 71-3-301. County legislative body binding out as apprentices.

The county legislative body may bind out as apprentices suitable orphan children, or the children of any person unable to provide for their support, until the age of eighteen (18) years.

History (7)

Code 1858, § 1622 (deriv. Acts 1762, ch. 5, § 19
1825, ch. 46, § 1)
Shan., § 2706
mod. Code 1932, § 4822
impl. am. Acts 1971, ch. 162, § 3
impl. am. Acts 1978, ch. 934, §§ 7, 36
T.C.A. (orig. ed.), §§ 14-1501, 14-9-101.

§ 71-3-302. Illegitimate children as apprentices.

The county legislative body may bind out illegitimate children in the same way as orphans, upon its satisfactorily appearing that the mother of such illegitimate children disregards their moral and mental culture, and either keeps or lives in a house of ill fame, and upon its further appearing that the condition of such children would be thereby bettered, although the mother may provide ordinary food and clothing for the mother's children.

History (5)

Code 1858, § 1625
Shan., § 2708
Code 1932, § 4918
impl. am. Acts 1978, ch. 934, §§ 7, 36
T.C.A. (orig. ed.), §§ 14-1502, 14-9-102.

§ 71-3-303. Reimbursement for county support of illegitimates.

For the purpose of indemnifying the county against charges for the maintenance of illegitimate children, the father, if the father can be ascertained, is liable to proceedings as provided in title 36, chapter 2.

History (4)

Code 1858, § 1623
Shan., § 2707
Code 1932, § 4917
T.C.A. (orig. ed.), §§ 14-1503, 14-9-103.

§ 71-3-304. Procedure for taking child from institution.

(a) When any child has been placed in any institution organized for the purpose of maintaining, supporting, and educating orphans or destitute children, with the consent of its parents, guardian, or custodian, no parent, guardian, or other person shall have the right to take the child from the institution against the consent of the institution or those in charge of the institution, except by habeas corpus proceedings, in which it shall appear that it is in the best interest of the child to take it from the institution.
(b) This section shall apply to all institutions, whether corporations or mere voluntary societies or associations.
(c) Any person taking or attempting to take any child from any institution, in violation of this section, commits a Class A misdemeanor, and shall be fined or imprisoned or both, in the discretion of the court.

History (6)

Acts 1911, ch. 2, §§ 1-3
Shan., §§ 4433a81-4433a83
Code 1932, §§ 4709-4711
T.C.A. (orig. ed.), §§ 14-1504
Acts 1989, ch. 591, §§ 1, 6
T.C.A., § 14-9-104.

Part 5 Child Care Agencies

§ 71-3-501. Part definitions.

As used in this part, unless otherwise exempted pursuant to § 71-3-503, and unless the context otherwise requires:
1. (1) “Care giver,” “care givers,” “care provider” or “care providers,” means the person or persons or entity or entities directly responsible for providing for the supervision, protection, and basic needs of the child;
2. (2) “Child” or “children” means a person or persons under eighteen (18) years of age;
3. (3) “Child care” means the provision of supervision and protection, and, at a minimum, meeting the basic needs, of a child or children for less than twenty-four (24) hours a day;
4. (4) “Child care agency” or “agency” means and only where the context requires in any other provision of law, a place or facility, regardless of whether it is currently licensed, that is operated as a family child care home, a group child care home, a child care center, or a drop-in center, as those terms are defined in this part, or that provides child care for five (5) or more children who are not related to the primary caregiver for three (3) or more hours per day;
5. (5) “Child care center” means any place or facility operated by any person or entity that provides child care for three (3) or more hours per day for at least thirteen (13) children who are not related to the primary caregiver; provided, that a child care agency shall not be classified as a “child care center” that operates as a “group child care home” and keeps three (3) additional school-age children as permitted in subdivision (10); provided, further, that all children, related or unrelated shall be counted in the adult-to-child supervision ratios and group sizes applicable to child care centers; with the exception, that if the child care center is operated in the occupied residence of the primary caregiver, children nine (9) years of age or older who are related to the primary caregiver will not be counted in determining the adult-to-child supervision ratios or group sizes applicable to child care centers if such children are provided a separate space from that occupied by the child care center. The department may permit children in the separate space to interact with the children in the licensed child care center in such manner as it may determine is appropriate;
6. (6) “Commissioner” means the chief administrative officer in charge of the department of human services;
7. (7) “Department” means the department of human services;
8. (8) “Drop-in center” means a place or facility operated by any person or entity providing child care, at the same time, for fifteen (15) or more children, who are not related to the primary caregiver, for short periods of time, not to exceed eighteen (18) hours per week and for not more than nine (9) hours per day for any individual child during regular working hours, Monday through Friday six o'clock a.m. (6:00 a.m.) to six o'clock p.m. (6:00 p.m.); provided, however, that a drop-in center may provide such child care during evenings after six o'clock p.m. (6:00 p.m.) and weekends, Friday, six o'clock p.m (6:00 p.m.) through Sunday, ten o'clock p.m. (10:00 p.m.), so long as the drop-in center provides no more than a total of twenty (20) hours per week, exclusive of snow days, defined as days when the school of the affected child is closed; provided, further, that drop-in centers may provide such care during snow days; provided, however, that, notwithstanding any other requirements of this part, training requirements for the staff of this class of child care agency shall be limited to basic health and safety precautions and the detection and reporting of child abuse and neglect for children in care; provided, further, that, notwithstanding any other provision of this chapter to the contrary, drop-in centers that provide child care for no more than two (2) hours per day with a maximum of ten (10) hours per week without compensation, while the parent or other custodian is engaged in short-term activities on the premises of the organization, shall register as providing casual care, as defined in § 71-3-503(a)(9), and shall not be deemed to be a drop-in center or regulated as a drop-in center;
9. (9) “Family child care home” means any place or facility that is operated by any person or entity that provides child care for three (3) or more hours per day for at least five (5) children but not more than seven (7) children who are not related to the primary caregiver; provided, that the maximum number of children present in the family child care home, including related children of the primary caregiver shall not exceed twelve (12), with the exception that, if the family child care home is operated in the occupied residence of the primary caregiver, children related to the primary caregiver nine (9) years of age or older will not be counted in determining the maximum number of children permitted to be present in a “family child care home” if those children are provided a separate space from that occupied by the family child care home. The department may permit children in the separate space to interact with the children in the licensed family child care home in such manner as it may determine is appropriate;
10. (10) “Group child care home” means any place or facility operated by any person or entity that provides child care for three (3) or more hours per day for at least eight (8) children who are not related to the primary caregiver; provided, however, that the maximum number of children present in a group child care home, including those related to the primary caregiver, shall not exceed twelve (12) children, with the exception that, if the group child care home is operated in the occupied residence of the primary caregiver, children related to the primary caregiver nine (9) years of age or older will not be counted in determining the maximum number of children permitted to be present in a group child care home, if those children are provided a separate space from that occupied by the group child care home; and, provided, further, that up to three (3) additional school age children, related or unrelated to the primary caregiver, may be received for child care before and after school, on school holidays, on school snow days and during summer vacation. The department may permit children in the separate space to interact with the children in the licensed group child care home in such manner as it may determine is appropriate;
11. (11) “License”:
  1. (A) Means a license issued by the department of human services that authorizes a child care agency to operate as a family child care home, a group child care home, a child care center, or a drop-in center that provides child care for five (5) or more children who are not related to the primary caregiver for three (3) or more hours per day; and
  2. (B) Includes both continuous licenses, issued after a provisional licensure period, and provisional licenses, an initial license valid for one hundred twenty (120) days for the purpose of allowing the agency to demonstrate their ability to attain and maintain compliance with all licensing laws and rules; and
12. (12) “Related” means the children, step-children, grandchildren, step-grandchildren, siblings of the whole or half-blood, step-siblings, nieces, nephews or foster children of the primary caregiver.

Backlinks (13)

History (7)

Acts 2000, ch. 981, § 2
2001, ch. 453, §§ 1, 2
2005, ch. 93, § 1
2005, ch. 151, § 1
2015, ch. 271, § 1
2022, ch. 892, § 1
2023, ch. 433, § 4.

§ 71-3-502. Licensing of child care agencies — Regulations of child care agencies — Assistance in meeting child care standards — Application for license — Provisional license — Transfer of license prohibited — Denial of license — Quality assessment and rating system — Curriculum guideline addressing personal safety.

(a)
1. (1) All persons or entities operating a child care agency as defined in this part, unless exempt as provided in § 71-3-503, must be licensed by the department as a child care agency.
2. (2)
  1. (A) The department has the authority to issue regulations pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, part 2, for the licensing of any persons or entities subject to any provisions of this part and for enforcement of appropriate standards for the health, safety and welfare of children in their care.
  2. (B) To the extent they are not inconsistent with the statutory provisions of this part, the regulations of the department that are in effect July 1, 2021, shall remain in force and effect until modified by regulatory action of the department.
3. (3) The department's regulations of child care agencies shall be developed based upon consideration of the criteria in subdivisions (a)(3)(A)-(F). In determining whether to initially grant a license or whether to take any licensing action involving a licensed child care agency, the statutory criteria in subdivisions (a)(3)(A)-(F) may be cited and considered by the department and by the child care agency board of review as the basis for such action in addition to the regulations:
  1. (A) The safety, welfare and best interests of the children in the care of the agency;
  2. (B) The capability, training and character of the persons providing or supervising the care of the children;
  3. (C) Evidence that the expected performance of the caregivers, supervisors or management of the child care agency seeking initial licensure or renewal of licensure will be such as to protect children in care from injury, harm or the threat of injury or harm; or, during licensure, that the actual performance of any of the duties of caregivers, supervisors or management of a licensed child care agency demonstrates or has demonstrated a level of judgment that a reasonable person would exercise or would have exercised, under existing or under reasonably foreseeable circumstances, that would prevent or would have prevented injury, harm, or the threat of injury or harm, to any child in care;
  4. (D) The quality of the methods of care and instruction provided for the children;
  5. (E) The suitability of the facilities provided for the care of the children; and
  6. (F) The adequacy of the methods of administration and the management of the child care agency, the agency's personnel policies, and the financing of the agency.
  Backlinks (1)
  
  49-1-302(i)(2)(B)
4. (4) The department shall promulgate regulations that address the following areas:
  1. (A) Training for directors and care givers as follows:
    1. (i) Preemployment training for directors, including, but not limited to, training in interviewing and evaluating care givers for service in an agency;
    2. (ii) Training for caregivers that includes, but is not limited to, preservice orientation as well as additional training within the first six (6) months of employment as provided by rule; and
    3. (iii) The department of human services shall promulgate rules that consider the prior education and experience of a registered nurse who is seeking approval under the department's rules as a director of a child care agency that operates as part of a facility licensed under title 68 as a nursing home;
  2. (B) Liability and accident insurance coverage, including minimum amounts of coverage based upon insurance industry standards, for both facilities and vehicles owned, leased or contracted for by the child care agency; provided, that this requirement shall not apply to a child care agency that is under the direct management of a self-insured administrative department of the state, a county, a municipality or any combination of those three (3); and
  3. (C)
    1. (i) Education of the parents of children in day care regarding the benefits of immunizing their children against influenza.
    2. (ii) The department of human services shall work to increase immunization awareness and participation among parents of children in child care agencies by working with the department of health in publishing on the department's website information about the benefits of annual immunization against influenza for children six (6) months of age to five (5) years of age;
    3. (iii) The department shall work with child care agencies and providers to ensure that the information is annually distributed to parents in August or September.
5. (5) The department shall enact these regulations by emergency rule to be effective July 1, 2000; provided, however, permanent rules shall be promulgated pursuant to the Uniform Administrative Procedures Act.
6. (6)
  1. (A) The department of human services licensure rules for child care centers serving preschool children contained in Tenn. Comp. R. & Regs. 1240-4-3-.07(4)(e), and licensure rules for child care centers serving school-age children contained in Tenn. Comp. R. & Regs. 1240-4-6-.07(4)(f), and in any other portions of those rules, that were part of the amendments filed as permanent rules for each rule on September 29, 2000, enacted on December 13, 2000, and effective on July 1, 2001, and that define or reference the age groups for “infants” as being comprised of children who are six (6) weeks to twelve (12) months of age, and the age groups for “toddlers” as being comprised of children who are thirteen (13) months to twenty-three (23) months of age, shall expire on July 19, 2001.
  2. (B) “Infant” and “toddler” categories of children in the care of a child care agency licensed pursuant to this part shall be defined as follows, until otherwise modified by rule of the department:
    1. (i) “Infants” shall be comprised of children six (6) weeks to fifteen (15) months of age; and
    2. (ii) “Toddlers” shall be comprised of children twelve (12) months to thirty (30) months of age.
  3. (C) All other department rules not specifically designated to expire by subdivision (a)(6)(A), or affected by the definitions in subdivision (a)(6)(B), including, but not limited to, the definitions or references to the age range for the “2 year old” category in the care of a child care agency, descriptions or definitions of any other age groups of children, adult to child ratios, and, except as modified by chapter 436 of the Public Acts of 2001, and the effective dates of the rules, shall remain in full force and effect or shall become effective in accordance with the department's regulations.
  4. (D) The department of human services shall have authority to immediately implement emergency rules effective on July 19, 2001, or as soon thereafter as possible, to define the age groups for “infants” and “toddlers” as defined by subdivision (a)(6)(B) and to make any conforming rule changes in the text or in the adult to child supervision charts contained in Tenn. Comp. R. & Regs. 1240-4-3 or 1240-4-6 or in any other rule of the department that may be necessary to implement the changes made by this section relative to the age range definition for the “infant” and “toddler” groups. Permanent rules shall be implemented as otherwise provided by the Uniform Administrative Procedures Act.
(b)
1. (1) The department shall assist applicants or licensees in meeting the child care standards of the department unless the circumstances demonstrate that further assistance is not compatible with the continued safety, health or welfare of the children in the agency's care and that regulatory action affecting the agency's license is warranted. All costs and expenses arising from or related to meeting the child care standards of the department shall be borne entirely by the applicant or licensee; provided, the department may, in its discretion, provide from available funds for technical assistance to child care agencies, and the training of child care givers.
2. (2) If a license is revoked or an application for licensure is denied, then the department shall offer reasonable assistance to the parent, guardian, or custodian of children in care in planning for the placement of the children in licensed child care agencies or other suitable care.
(c) Application for a license to operate a child care agency shall be made in writing to the department in such manner as the department determines and shall be accompanied by the appropriate fee established by rule as provided in subsection (f).
(d)
1. (1) A person or entity that does not have an existing license may apply for a provisional license. The purpose of the provisional license is to permit the license applicant to begin the operation of a child care agency after meeting certain minimum requirements and to demonstrate during the provisional licensing period that it has the ability to attain and maintain compliance with all licensing laws and regulations.
2. (2) An applicant shall receive a provisional license upon the presentation of satisfactory evidence that:
  1. (A) The facility that is proposed for the care of children has received fire safety and environmental safety approval, and that, after appropriate inspection, the department has determined that the site does not endanger the safety or welfare of children;
  2. (B) The applicant and the personnel who will care for the children are capable in all substantial respects of caring for the children;
  3. (C) The applicant has the ability to attain and maintain compliance with the licensing laws and regulations, both during and after the provisional licensing period;
  4. (D) The applicant, owner, director or an employee of the agency has not previously been associated in an ownership or management capacity with any child care agency that has been cited by the department for violations of this part or the department's regulations, including the agency for which the application is pending, unless the department determines that a reasonable basis exists to conclude that such individual is otherwise qualified to provide child care; and
  5. (E) The criteria in subdivision (a)(3) support the issuance of a provisional license.
3. (3) If the department determines that any of the criteria in subdivision (d)(2) has not been, or cannot be met, then it may deny the application for a provisional license.
4. (4)
  1. (A) If the department determines that the applicant has fully complied with subdivision (d)(2) and with all other laws and regulations governing the specific classification of child care agency for which the application was made, that the child care agency has demonstrated the ability to maintain compliance with all licensing regulations following the provisional licensure period, and that it has a reasonable likelihood of maintaining licensure, then the department shall issue a license.
  2. (B) If the applicant has not satisfactorily demonstrated compliance with the requirements for licensing as determined by the department, a license may be denied by the department.
5. (5) The licensee shall post the license in a clearly visible location as determined by the department so that parents or other persons visiting the agency can readily view the license and all the information on the license.
6. (6)
  1. (A)
    1. (i) The license shall describe the ownership of the child care agency, the person who is charged with the day-to-day management of the child care agency, and, if the agency is owned by a person other than the director, or if the agency is under the ownership or direction or control of any person or entity who is not also the on-site director or manager of the agency, the license shall also state the corporate or other name of the controlling person or entity, its address and telephone number where the parents, guardians or custodians may have contact regarding the agency's operations.
    2. (ii) If the child care agency is operated by a public or private nonprofit entity and is subject to the control or direction of a board of directors or other oversight authority, the license shall list the name, address and telephone number of the chair of the board or other executive head of such controlling body.
  2. (B) In order for a child care agency to offer before or after-school services under this part, the department must issue a license bearing a notation that the agency is authorized to provide before or after-school care services. An agency may not offer such services unless its license bears such notation.
7. (7)
  1. (A) In granting any license, the department may limit the total number of children who may be enrolled in the agency regardless of the agency's physical capacity or the size of its staff.
  2. (B) Adult/child ratios and group sizes in group child care homes and child care centers may exceed requirements set by rule of the department of human services by up to ten percent (10%), rounded to the nearest whole number, for no more frequently than three (3) days per week; provided, however, infant and toddler groups may never exceed the required ratios and group sizes.
  3. (C)
    1. (i) The department may promulgate rules, under the Uniform Administrative Procedure Act, to provide for the amounts of liability coverage for any personal vehicles that are not owned, operated by, or contracted by the child care agency for the transportation of children enrolled in the agency, but which are utilized by parents, staff or volunteers only for occasional field trips for children enrolled at the agency.
    2. (ii) Such rules must provide that any vehicles not owned, operated by, or contracted for by the agency for any transportation of children enrolled at the agency, and which are utilized only as described in subdivision (d)(7)(C)(i) for field trips must provide evidence of currently effective liability coverage for such nonagency vehicles in amounts sufficient to provide adequate coverage for children being transported by such vehicles.
    3. (iii) Subject to department rule, all vehicles used by or on behalf of a child care center to provide transportation of children, that are designed to transport six (6) or more passengers, shall be equipped with a child safety monitoring device that shall prompt staff to inspect the vehicle for children before an alarm sounds. In order to facilitate the affordability of such devices for centers, the department is authorized to establish a grant program to subsidize a portion or all of the cost of such devices for centers; provided, however, that the department may only use private donations that it receives for such purpose to fund the grants. Only devices approved by the department are authorized for use on such a vehicle. This subdivision (d)(7)(C)(iii) shall not apply:
      1. (a) When all children in a vehicle are five (5) years of age and in kindergarten, or older than five (5) years of age, except that if any one (1) of such children is developmentally or physically disabled or nonambulatory then this subdivision (d)(7)(C)(iii) shall apply; or
      2. (b) To vehicles used exclusively for the provision of occasional field trips.
    4. (iv) Vehicles used by a licensed child care agency for the transportation of children shall be subject only to color and marking requirements promulgated by the department and shall be exempt from any other such requirements that may be set forth in state law or local ordinance. Color and marking requirements shall be issued by the department, in consultation with the department of safety, as deemed appropriate for the safe operation, proper identification, or registration of the vehicle.
    5. (v) Such rules shall prohibit a newly hired employee or existing employee who is full-time or part-time, or, as defined by the department, a substitute employee of a child care agency, or a contractor or other persons or entities providing any form of transportation services for compensation to a child care agency, from engaging in any form of driving services involving children in a child care agency until the employee or substitute employee has undergone a drug test and the results are negative for illegal drug use. The rules shall provide exceptions for emergency transportation requirements in limited circumstances, as deemed appropriate by the department.
      Backlinks (1)
      
      71-3-514(a)(4)
8. (8) If the department fails to issue a license within one hundred twenty (120) days of the granting of the provisional license, then the provisional license continues in effect, unless suspended, as provided in § 71-3-509, until such determination is made. If a license is denied following the issuance of a provisional license, and if a timely appeal is made of the denial of a license, then the provisional license remains in effect, unless suspended, until the board of review renders a decision regarding the denial of a license.
9. (9) If a provisional license is denied or a license is denied following the issuance of a provisional license, the applicant may appeal the denial or restriction as provided in § 71-3-509.
(e)
1. (1) Except as provided in this subsection (e), no license for a child care agency shall be transferable, and the transfer by sale or lease, or in any other manner, of the operation of the agency to any other person or entity shall void the existing license immediately and any pending appeal involving the status of the license, and the agency shall be required to close immediately. If the transferee has made application for, and is granted, a provisional license, the agency may continue operation under the direction of the new licensee. The new licensee in such circumstances may not be the transferor or any person or entity acting on behalf of the transferor.
2. (2) If the department determines that any person or entity has transferred nominal control of an agency to any persons or entities who are determined by the department to be acting on behalf of the purported transferor in order to circumvent a history of violations of the licensing law or regulations or to otherwise attempt to circumvent the licensing law or regulations or any prior licensing actions instituted by the department, the department may deny the issuance of any license to the applicant. The denial of the license may be appealed as provided in § 71-3-509.
3. (3)
  1. (A) The license of any agency shall not be voided nor shall any pending appeal be voided pursuant to this subsection (e) solely for the reason that the agency is subject to judicial orders directing the transfer of control or management of a child care agency or its license to any receiver, trustee, administrator or executor of an estate, or any similarly situated person or entity.
  2. (B) If the current licensee dies, and provided that no licensing violations require the suspension, denial or revocation of the agency's license, the department may grant family members of the licensee, or administrators or executors of the licensee, a new provisional license to continue operation for a period of one hundred twenty (120) days. At the end of such period, the department shall determine whether a license should be granted to a new licensee as otherwise provided in this section.
  3. (C) Nothing in this subsection (e) shall be construed to prevent the department from taking any regulatory or judicial action as may be required pursuant to the licensing laws and regulations that may be necessary to protect the children in the care of such agency.
(f)
1. (1) Prior to January 1, 2022, the licensure application fees as they existed for child care agencies on June 30, 2021, apply. On or after January 1, 2022, licensure fees apply only to applications for provisional licenses for child care agencies licensed pursuant to this part in amounts established by rules promulgated by the department pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
2. (2) In order to address the need for and encourage the development of extended child care for parents working during nights or on weekends, or for any other nontraditional child care needs for which the department determines that available child care is inadequate or unavailable in all or any part of the state, the department may promulgate rules pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, providing for alternative fee schedules in order to recognize and encourage the development of child care to meet such needs.
(g) [Deleted by 2021 amendment.]
(h) All licensure application fees collected by the department from family child care homes, group child care homes, child care centers and drop-in centers shall be paid into the general fund, but shall be earmarked for, and dedicated to, the department. Such earmarked fees shall be used by the department exclusively to improve child care quality in this state by funding activities that include child care provider training activities, but excluding any costs associated with conducting criminal background checks. Increased fees shall be used solely for a variety of training options, which can be accessed by agencies, organizations and individuals for grants for workshops, conferences and scholarships that improve the quality of child care in this state.
(i) Notwithstanding any provisions of title 13, chapter 7, to the contrary, upon adoption of a resolution by a two-thirds (⅔) vote of the county legislative body, any zoning authority, in determining the suitability of a request for any use of property for the establishment or alteration of any child care agency, may consider the criminal background of the person or persons making a request to such board, or may consider the criminal background of any person or persons who will manage or operate such child care agency. The board may require the person to submit a fingerprint sample and a criminal history disclosure form and may submit the fingerprint sample for comparison by the Tennessee bureau of investigation pursuant to § 38-6-109, or it may conduct the background check by other means as it deems appropriate. The zoning authority shall be responsible for all costs associated with obtaining such criminal background information.
(j)
1. (1)
  1. (A) The department shall establish and implement a quality assessment and rating system for the purpose of evaluating, individually and collectively, child care agencies licensed or approved by the department pursuant to this part so that parents or other caretakers of children enrolled, or being considered for enrollment, at a child care agency, may make more informed decisions regarding the care of their children by comparing the quality of services offered by child care agencies, to encourage the improvement of out-of-home child care for children in this state, and to support child care providers in continuously improving the quality of services and support they provide families. The quality assessment and rating system established pursuant to this subsection (j) must be developed in a manner easily usable by parents or other caretakers of children to make informed choices related to child care.
  2. (B) For purposes of this subsection (j), “child care agencies” includes child care centers, group child care homes, and family child care homes.
2. (2)
  1. (A) The department shall promulgate rules establishing the quality assessment and rating system under this subsection (j). Each child care agency must receive a quality assessment and rating evaluation after the rules establishing the quality assessment and rating system under this subsection (j) become effective, and annually thereafter. This quality assessment and rating system must include an annual evaluation of each child care agency by the department and must reflect key indicators of performance comparison among all child care agencies in this state, which may include information related to the following:
    1. (i) Health and safety practices; and
    2. (ii) Teacher-child interactions.
  2. (B) The department shall not discriminate or fail to recognize the credentials of any accrediting agency based upon religious affiliation, race, age, color, sex, or national origin.
  3. (C) Upon completion, the quality assessment and rating results of each child care agency must be available on the department's website and posted in a clear and visible location at each child care agency for review by the parents or other caretakers of children enrolled, or being considered for enrollment, at the child care agency.
3. (3) Any child care agency that accepts the department's child care assistance subsidy payments may receive higher subsidy payments or other financial performance incentives, as determined by the department, based upon the child care agency's quality assessment and rating results, subject to available funding in the department's budget.
4. (4) The commissioner and the comptroller of the treasury may, in their discretion, conduct audits of the records of any child care providers as necessary to verify that the expenditures by a child care provider of state or federal child care subsidy funds are being made according to state or federal requirements.
5. (5) A child care agency is subject to denial or revocation of the agency's license by the department and may also be subject to a civil penalty of five hundred dollars ($500) imposed by the department if the child care agency knowingly:
  1. (A) Provides false information or fails to provide any information to the department, the comptroller, or their agents or designees that is required or necessary to perform any of the requirements of this title or to enforce state or federal law or regulations, or child care subsidy or licensing requirements;
  2. (B) Fails to allow entrance by any person designated by the department to perform the evaluation required by this subsection (j); or
  3. (C) Continues to display expired or revoked quality assessment and rating results after written notice by the department.
(k) The department is authorized to review possible dangers to children and workers in child care facilities from carbon monoxide gas and to issue such rules and regulations as it may deem necessary.
(l)
1. (1) The department of human services shall make available to child care providers licensed by the department a curriculum guideline in any suitable format addressing personal safety containing a component related to the prevention of child sexual abuse and shall allow child care providers licensed by the department to choose terminology and instructional methods that accomplish the goal of providing clear, effective and appropriate instruction in personal safety. The department is encouraged to distribute a sample curriculum that is developmentally-appropriate and age-appropriate, child-friendly and family-friendly, and designed to be acceptable to a broad range of providers, parents and legal guardians.
2. (2) The personal safety curriculum that will be implemented by the child care provider must be made available so parents and legal guardians have the opportunity to review it and so parents and legal guardians will be aware of this component of the child care provider's curriculum. The department shall develop a standard notification form to be provided to the parents or legal guardians by the child care agency. The notification form shall contain the following information:
  1. (A) The method of instruction and sample terminology used in the personal safety/child sexual abuse curriculum;
  2. (B) The availability of the instructional materials for review by the parents or legal guardians; and
  3. (C) A place for the parents or legal guardians to sign acknowledging they have been provided an opportunity to review the personal safety curriculum, have been notified of the child sexual abuse/personal safety curriculum for their child and the individual record for each child shall include a copy of the signed notification form.
3. (3) If a parent has questions regarding the personal safety component of the quality early childhood education curriculum, then the provider or a representative of the provider shall meet with the parent and discuss the personal safety component of the curriculum.
4. (4) The department of human services is expressly authorized and directed to implement by emergency rules, effective October 1, 2008, a rule regarding implementation of this requirement for the personal safety curriculum; provided, that any permanent rules shall be promulgated pursuant to the Uniform Administrative Procedures Act.

History (15)

Acts 2000, ch. 981, § 3
2001, ch. 453, §§ 3-6, 24, 25
2003, ch. 170, § 2
2004, ch. 696, § 1
2005, ch. 151, §§ 2-7
2005, ch. 453, §§ 1, 2
2006, ch. 906, § 1
2008, ch. 687, § 1
2008, ch. 1032, § 1
2009, ch. 566, § 12
2010, ch. 789, §§ 1-3
2010, ch. 1132, § 1
2011, ch. 410, § 3(ii)
2016, ch. 839, § 13
2021, ch. 280, §§ 1-21.

§ 71-3-503. Program and facilities exempt from licensing.

(a) A program or activity that falls within the definition of a child care agency shall be exempt from the licensing requirements of this part upon demonstration of clear and convincing evidence that it meets one (1) of the following exemptions in subdivisions (a)(1)-(11), or, if no specific exemption exists in subdivisions (a)(1)-(11), there is clear and convincing evidence demonstrating that the program or activity meets the criteria of subsection (c):
1. (1) Entities or persons licensed or otherwise regulated by other agencies of the state or federal government providing health, psychiatric or psychological care or treatment or mental health care or counseling for children while the entity or person is engaged in such licensed or regulated activity;
2. (2) Preschool or school age child care programs, a Title I program, a school-administered head start or an even start program, and all state-approved Montessori school programs, that are subject to regulation by the department of education or other departments of state government;
3. (3) Private or parochial kindergartens for five-year-old children if such kindergartens operate on the public school kindergarten schedule;
4. (4) Child care centers operated by church-related schools, as defined by § 49-50-801, which shall be subject to regulation by the department of education pursuant to title 49, chapter 1, part 11;
5. (5) Educational programs. To qualify for an educational program exemption, a child care agency must meet the following criteria:
  1. (A) That the sole or primary purpose of the program is:
    1. (i) To prepare children for advancement to the next educational level through a prescribed course of study or curriculum that is not typically available in a department-regulated child care setting;
    2. (ii) To provide specialized tutoring services to assist children with the passage of mandatory educational proficiency examinations; or
    3. (iii) To provide education-only services to special needs children; and
  2. (B) That the program time scheduled to be dedicated to the educational activity is reasonably age appropriate for the type of activity and the ages served;
6. (6)
  1. (A) “Parents' Day Out” or similar programs operated by a religious institution or religious organization that provide custodial care and services for children of less than school age, with no child attending more than twelve (12) hours in each calendar week;
  2. (B) Existing and all future programs shall register with the department their intent to operate a Parents' Day Out program prior to offering the service, and, as evidence of their exempt status, these programs shall maintain records that include, at a minimum, dates and times of each child's attendance;
  3. (C) The records and forms shall be made available during regular business hours to the commissioner or commissioner's designee;
  4. (D) Each separate location or campus of a religious institution or religious organization shall be considered a separate religious institution or religious organization for the purpose of Parents' Day Out or any similar program;
7. (7) Recreational programs. To qualify for a recreational program exemption, a child care agency must meet the following criteria:
  1. (A) That the sole or primary purpose of the program or activity is to provide recreational services, e.g., organized sports or crafts activities;
  2. (B) That the sole or primary purpose of the program or activity is dedicated to recreational activities for a substantial portion of the hours of operation;
  3. (C) That the majority of program staff responsible for the direct delivery of services possesses specialized qualifications that are directly related to the recreational services being offered;
  4. (D) That at least seventy-five percent (75%) of any individual child's program time is spent engaging in the recreational activities that are reasonably age appropriate for the type of activity and the ages served;
  5. (E) That the supervision or care of children, or other types of child care-related services, is incidental to its overall purpose; and
  6. (F) That no individual child could participate in the program or activity:
    1. (i) For more than seven (7) hours per day; or
    2. (ii) If a child participates for more than seven (7) hours per day, that such child could not continue to participate for more than seven (7) consecutive weeks and for no more than one hundred twenty (120) days per calendar year;
8. (8) Camp programs. To qualify for a camp program exemption, a child care agency must meet the following criteria:
  1. (A) That the primary purpose of the program or activity is to provide intensive recreational, religious, outdoor or other activities that are not routinely available in full-time child care;
  2. (B) That the program or activity operates exclusively during the summer months and less than ninety (90) days in any calendar year; and
  3. (C) That the enrollment periods for participation in the program or activity clearly define the duration of the program or activity and exclude drop-in child care;
9. (9)
  1. (A) “Casual care” operations consisting of places or facilities operated by any person or entity that provides child care, at the same time, for a minimum of five (5) children, but less than fifteen (15) children, who are not related to the primary caregiver, during short periods of time that do not exceed ten (10) hours per week or six (6) hours per day for any individual child while the parents or other custodians of the children are engaged in short-term activities, not including employment of the parent or other custodian of the child;
  2. (B) These operations shall register with the department their intent to conduct casual care of children, and, as evidence of their exempt status, these operations shall maintain records that include, at a minimum, the children's names, ages, addresses, dates and times of attendance, the parents' or custodians' names, addresses, and intended whereabouts while the children are in care, and the telephone numbers of persons to contact in the event of an emergency. All records shall be made available at any time to any authorized representative of the department;
  3. (C) Failure to comply with the requirements of this subdivision (a)(9) shall subject the violator to a civil penalty by the department not to exceed five hundred dollars ($500) for the first violation and not to exceed one thousand dollars ($1,000) for subsequent violations, and the department may seek injunctive relief in the chancery or circuit court of the county where the place or facility is located to prevent further operation of the place or facility or to obtain entry to conduct any inspection of the operation;
  Backlinks (1)
  
  71-3-501(8)
10. (10)
  1. (A) Any program or facility operated by, or in affiliation with, any Boys and Girls Club that provides care for school-aged children and that holds membership in good standing with Boys and Girls Clubs of America and that is certified as being in compliance with the purposes, procedures, voluntary standards and mandatory requirements of Boys and Girls Clubs of America;
  2. (B) Any such Boys and Girls Club that applies to participate in state or federally funded programs that require child care licensing by the state as a term of eligibility may elect to apply to the department for child care licensing and regulation. Upon meeting departmental standards, the Boys and Girls Club may be licensed as a child care center/provider;
  3. (C) The department is hereby authorized to grant a waiver from any rule concerning grouping of children and adult/child ratios for child care centers to any Boys and Girls Club that falls within both subdivisions (a)(11)(A) and (a)(10)(A) and (B), and that is providing after-school child care to mixed groups of school-aged children; and
11. (11) Nurseries, babysitting services and other children's activities that are not ordinarily operated on a daily basis, but are associated with religious services or related activities of churches or other houses of worship. Such services or activities may include limited special events that shall not exceed fourteen (14) days in any calendar year.
(b)
1. (1) Exempt programs under subdivisions (a)(3), (6) and (9) shall post a sign stating, “This facility is not required to be licensed by the state as a child care agency.”
2. (2) When a parent, custodian or guardian initially registers a child with an exempt program under subdivisions (a)(3), (6) and (9), which is required to post a sign pursuant to this subsection (b), the parent, custodian or guardian shall sign a form indicating that the parent, custodian or guardian has been advised and understands that the program is not licensed and is not required to be licensed by the state as a child care agency. The same language that is required to be placed on the sign shall be printed on such form at least in 16-point type with a signature line for the parent, custodian or guardian immediately following such language. The signed form shall be maintained with the records of the exempt entity.
(c) In analyzing whether the program or activity is exempt pursuant to this section, unless the department determines upon clear and convincing evidence that the program or activity qualifies for an exemption based upon the criteria set forth in subdivisions (a)(1)-(11), the department shall consider the following nonexclusive criteria to determine if the program or activity is clearly distinguishable from child care services typically regulated by the department and otherwise qualifies for exemption from licensing:
1. (1) The sole or primary purpose of the program or activity is to provide specialized opportunities for the child's educational, social, cultural, religious or athletic development, or to provide the child with mental or physical health services;
2. (2) The time period in which the program or activity provides these opportunities is consistent with a reasonable time period for the completion of the program or activity, considering the age of each child served and the nature of the program;
3. (3) The primary purpose of the program or activity is not routinely available or could not be made routinely available in the typical child care settings regulated by the department;
4. (4) Parents could reasonably be expected to choose the program or activity because of the unique nature of what it offers, rather than as a substitute for full-time, before or after school, holiday or weather-related child care; and
5. (5) If the program or activity is regulated by any other federal, state or local agency, it is required by such other agency to comply with standards that substantially meet or exceed department licensing regulations.
(d)
1. (1) The department shall not be required to grant exemptions to programs or activities that offer otherwise exempt opportunities or services as a mere component of a program or activity that the department determines primarily constitutes substitute child care.
2. (2) No program or activity shall be exempt from licensing solely for the reason that the care and supervision of children that constitutes child care is offered only on a part-time or periodic basis.
3. (3) Exemption from licensure does not exempt the program or activity from compliance with any other local, state or federal requirements.
(e) A child care agency claiming an exemption pursuant to this section may submit to the department's licensing director, or designee, a sworn, written request for exemption in such manner and form as the department may require. The request shall provide a detailed description of the operation of the program or activity, the program's or activity's purpose and the applicant's basis for claiming an exemption. The department shall provide a written response to the exemption request stating the reasons the exemption was granted or denied.

Backlinks (6)

History (5)

Acts 2000, ch. 981, § 4
2001, ch. 453, § 7
2005, ch. 151, §§ 8-12
2013, ch. 72, §§ 1, 2
2021, ch. 162, § 1.

§ 71-3-504. Injunctions against unlicensed operations.

(a) The department may, in accordance with the laws of this state governing injunctions, maintain an action in the name of the state of Tennessee to enjoin any person, partnership, association, corporation or other entity from establishing, conducting, managing or operating any place or facility providing services to children without having a license as required by law, or from continuing to operate any such place or facility following suspension of a license or following the effective date of the denial or revocation of a license.
(b) In charging any defendant in a complaint for such injunction, it shall be sufficient to charge that such defendant did, upon a certain day and in a certain county, establish, conduct, manage or operate a place, home or facility of any kind that is a child care agency, as defined in this part or to charge that the defendant is about to do so without having in effect a license as required by law, or that the defendant continues to operate any such place or facility following suspension of a license, or following the effective date of the denial or revocation of a license, without averring any further or more particular facts concerning the case.

History (2)

Acts 2000, ch. 981, § 5
2001, ch. 453, § 8.

§ 71-3-505. Criminal violations.

(a)
1. (1) A person or entity operating a child care agency, as defined in § 71-3-501, without being licensed by the department commits a Class A misdemeanor.
2. (2) It is a Class E felony for a person or entity to operate a child care agency:
  1. (A) While a suspension of a license issued by the department is in effect;
  2. (B) Following the effective date of a denial or revocation of a license by the department; or
  3. (C) Without being licensed by the department and within ten (10) years of a previous finding by the department that the person or entity operated a child care agency without being licensed by the department.
(b) Each day of operation without an effective license constitutes a separate offense.
(c)
1. (1) It is unlawful for any person who is an operator, licensee or employee of a child care agency to make any statement, whether written or verbal, knowing such statement is false, including, but not limited to, statements regarding:
  1. (A) The number of children in the child care agency;
  2. (B) The area of the child care agency used for child care; or
  3. (C) The credentials, licensure or qualification of any care giver, employee, substitute or volunteer of the child care agency, when such statement is made to a parent or guardian of a child in the care of such agency, to any state or local official having jurisdiction over such agencies, or to any law enforcement officer.
2. (2) In order for subdivision (c)(1) to apply, the falsity of the statement must place at risk the health or safety of a child in the care of the child care agency.
3. (3) A violation of subdivision (c)(1) is a Class A misdemeanor.
4. (4) This subsection (c) includes statements made in any child care agency license application that misrepresents or conceals a material fact that would have resulted in the license being denied.
5. (5) In addition to any punishment authorized under this subsection (c), the department may also take any licensure action authorized under this part.

History (2)

Acts 2000, ch. 981, § 6
2022, ch. 985, § 2.

§ 71-3-506. Public agencies — Inspection and report.

Any child care agency, as defined in this part, that is under the direct management or control of an administrative department of the state, a county, municipality, or development district, or any combination of these, shall be subject to licensure pursuant to this part; provided, however, that the requirements for audits set forth in former § 71-3-502(j)(6)(C) and (D) [repealed] shall be satisfied by audits that are conducted by the comptroller of the treasury or other public agency auditors.

History (2)

Acts 2000, ch. 981, § 7
2005, ch. 151, § 13.

§ 71-3-507. Criminal history violation information required of persons having access to children — Review of records and registries — Verification — Exclusion from access to adults.

(a)
1. (1) The following shall complete a disclosure form in a manner approved by the department disclosing criminal records, juvenile records histories and the status of such person on the department of health's vulnerable persons registry pursuant to title 68, chapter 11, part 10, the state's sex offender registry and status as an indicated perpetrator of abuse or neglect in the records of the department of children's services and the department of human services, or in any jurisdiction, and shall agree to release all such records to the childcare agency and to the department to verify the accuracy of the information contained on the disclosure form:
  1. (A) A person:
    1. (i) Applying to work with children as a paid employee, director, or manager with a child care agency licensed by the department;
    2. (ii) Applying to work with the department in a position in which significant contact with children is likely in the course of the person's employment;
    3. (iii) Applying for a child care agency license issued by the department that is not the renewal of an existing license; and
    4. (iv) Seeking to be an operator, as defined by the rules of the department, of a licensed child care agency who would have significant contact with children in the course of such role and is not otherwise exempted from the application of this section by rules of the department;
  2. (B) A person who is a new substitute staff person, paid or unpaid, and who is to be used by the childcare agency to meet childcare standards and who serves as a substitute for more than thirty-six (36) hours in any one (1) calendar year; or
  3. (C) A person fifteen (15) years of age or older who resides in a childcare agency that is being licensed initially or who moves into a childcare agency following initial licensure.
2. (2)
  1. (A) Persons subject to the requirements of subdivision (a)(1) shall also supply a fingerprint sample in a manner prescribed by the department and by the Tennessee bureau of investigation (TBI), and shall submit to a fingerprint-based background review of criminal history records, and juvenile records that are available to the TBI, to be conducted by the TBI, and shall submit to a review of the person's status on the department of health's vulnerable persons registry under title 68, chapter 11, part 10, and on the state sex offender registry, and, pursuant to § 71-3-515, a review of the person's status in the department of children's services and the department of human services records of indicated perpetrators of abuse or neglect of children or adults, as well as equivalent administrative registries in any jurisdiction in which the person has resided in the past five (5) years and a review of any available juvenile records in juvenile court.
  2. (B) All persons subject to the requirements of subdivision (a)(1), and all persons applying to work with the department in any position in which any significant contact with children is likely in the course of the person's employment with the department, shall have the fingerprint-based background review, including juvenile records available to the TBI, and the registry and perpetrator records and juvenile records reviews required by subdivision (a)(2)(A) completed as required by this section prior to assuming any role described in subdivision (a)(1) or prior to employment with the department; and if the person is fifteen (15) years of age or older and:
    1. (i) The person is a resident of a childcare agency, the person must have the fingerprint-based background review, including juvenile records available to the Tennessee bureau of investigation (TBI), and the registry and perpetrator records reviews, and, if determined necessary by the department, juvenile court records reviews, required by subdivision (a)(2)(A) completed prior to the granting of a license to the childcare agency in which the person resides at the time of initial application; or
    2. (ii) If the person is to become a resident of the childcare agency, the person must have the reviews required by subdivision (a)(2)(B)(i) completed prior to the person's becoming a resident of the childcare agency.
  3. (C) The person or entity with which a person subject to subdivision (a)(1) will be or is associated shall be responsible for obtaining and submitting the fingerprint sample, as directed by the department, and any information necessary to process the fingerprint-based background reviews and reviews required by this section prior to the person's assumption of any role described in subdivision (a)(1). If the person is not employed directly by a licensed child care agency but is employed by a substitute pool or staffing agency and assigned to work as a substitute employee at a licensed child care agency, then the substitute pool or staffing agency is responsible for obtaining and submitting the fingerprint sample, as directed by the department, and any information necessary to process the fingerprint-based background reviews and reviews required by this section prior to the person's assumption of any role described in subdivision (a)(1) at a licensed child care agency.
3. (3) The disclosure forms shall include at a minimum the following information:
  1. (A) The social security number of the applicant, substitute or resident;
  2. (B) The complete name of the applicant, substitute or resident;
  3. (C) Disclosure of information relative to any violations of the law, including pending criminal or juvenile charges of any kind, and any conviction or juvenile adjudication involving a sentence or suspended or reduced sentence, and a release by the person of all records involving the person's criminal and juvenile background history and records relative to the person's status on the department of health's vulnerable persons registry maintained pursuant to title 68, chapter 11, part 10, on the state's sex offender registry and the status of the person as an indicated perpetrator of abuse or neglect of a child or adult as determined by any agency of this state or any other jurisdiction;
  4. (D) A space for the person to state any circumstances that should be considered in determining whether to allow the person who has a criminal, juvenile, registry or abuse or neglect records history to be employed or to provide substitute services or to remain as a resident in the agency; and
  5. (E) A listing of the residences of the applicant, substitute, or resident for the past five (5) years.
4. (4) The form shall notify the person that falsification of required information may subject the person to criminal prosecution, and that the person's employment, licensing, or other status or circumstances in the child care agency or the department is dependent upon the person's criminal and available juvenile records history status, the person's status on the department of health's vulnerable persons registry pursuant to title 68, chapter 11, part 10, and on the state's sex offender registry, and, pursuant to § 71-3-515, the person's status as an indicated perpetrator of abuse or neglect of children or adults as contained in the records of the department of children's services and the department of human services, or in the equivalent administrative registries in any jurisdiction in which the person has resided in the past five (5) years.
5. (5) A copy of the disclosure form shall be maintained in the childcare agency's records for review by the department, and the department shall maintain a copy of the disclosure form in the records of the applicant for a license or as operator or for employment with the department.
6. (6) The child care agency, substitute pool, or staffing agency shall notify the department within thirty (30) days of an employee leaving employment.
(b)
1. (1) The disclosure form and information contained on the form obtained pursuant to this section, together with the fingerprints of the person, shall be submitted by the child care agency for its applicants, licensees, operators, substitutes, or residents, and by the department for its applicants, to the appropriate department staff or state contractors providing fingerprinting services, in the format required by the department and the TBI. The child care agency shall attest on the disclosure form that the person is required to undergo a criminal background check or state registry review, and is either a resident or has been selected by the child care agency to fill a position as an employee or substitute who will work directly with children. A substitute pool or staffing agency assigning persons to work as substitute employees at a licensed child care agency shall submit the disclosure form for such persons and shall also attest on the disclosure form that the person is required to undergo the criminal background check or state registry review, and has been selected by the substitute pool or staffing agency to fill a position as an employee or substitute who will work directly with children. The department or contractor shall transmit the necessary information to the TBI for completion of the fingerprint-based background review of criminal records and juvenile records that are available to the TBI.
2. (2) The TBI shall compare the information and the fingerprint sample received with the computer criminal history files maintained by the bureau and, to the extent permitted by federal law, with federal criminal databases and shall conduct the fingerprint and criminal history background check for the person pursuant to § 38-6-109. It shall report the existence of any criminal or juvenile history involving the person to the department, which shall inform the childcare agency and the person regarding the person's ability to assume a position for which a background review is required by this section.
3. (3) The childcare agency shall document in its records the clearance or exclusion letter regarding the person's ability to assume a position for which a background review is required, and the department shall maintain a record of the results of all persons for whom a criminal background history is received.
4. (4) The department shall notify in writing the appropriate district attorney general of any falsification of the information on the disclosure form.
5. (5)
  1. (A) The department shall pay to the TBI or state contractors providing fingerprinting services the cost of obtaining, handling, and processing the criminal history background fingerprint check requested by the agency or by the department as set forth in § 38-6-109. Payment of the costs is to be made in accordance with §§ 38-6-103 and 38-6-109.
  2. (B) The department shall only be responsible for payment of one (1) processing fee that is required by the TBI. If the fingerprint sample is rejected and if any further costs are required to process the fingerprint, the child care agency is responsible for any further costs, regardless of the number of efforts required to obtain a valid fingerprint sample. The child care agency, substitute pool, or staffing agency will be responsible for repayment to the department for any processing fees if it submits a person's disclosure form more than one (1) time for the criminal history background check within a thirty (30) day period, or if it submits a person for a criminal history background check who is not a resident or a person who has been selected by the child care agency, substitute pool, or staffing agency to fill a position as an employee, or substitute who will work directly with children.
(c)
1. (1) All persons subject to subsection (a), and employees of the department's licensing division, shall also be subject to a review by the department of their status on the department of health's vulnerable persons registry pursuant to title 68, chapter 11, part 10, and on the state's sex offender registry and a review conducted pursuant to § 71-3-515, of their status in the department of children's services and the department of human services records of indicated perpetrators of abuse or neglect of children or adults or in the equivalent administrative registries in any jurisdiction in which the person has resided in the past five (5) years and a review of any available juvenile records in juvenile court.
2. (2) The department shall conduct the review for license applicants and operators.
3. (3) The results of the inquiry to the registries and the departments' records shall be maintained with the department.
(d)
1. (1) The child care agency or the department shall not permit a person to assume any role described in subdivision (a)(1) prior to the completion of a review of the criminal history and juvenile records available to the TBI and the juvenile court, including the fingerprint-based background review, review of the department of health's vulnerable persons registry and the state's sex offender registry, and, pursuant to § 71-3-515, a review of the department of children's services and the department of human services records of indicated perpetrators of abuse or neglect of children or adults, or in the equivalent administrative registries in any jurisdiction in which the person has resided in the past five (5) years, and juvenile court records reviews. The reviews must demonstrate that the person is not subject to a criminal history, a juvenile history, or a history on the registries or in the records of the department of children's services or the department of human services or the equivalent administrative registries in any jurisdiction in which the person has resided in the past five (5) years that would, as described in this part, disqualify or otherwise exclude the person from any role described in subdivision (a)(1).
2. (2) The criminal history, juvenile records, and administrative registry review provided for in subdivision (d)(1) shall additionally be completed at least once every five (5) years.
(e)
1. (1)
  1. (A)
    1. (i) Whether obtained by use of the procedures established in this section or whether information is obtained by any other means, no person shall be employed with, be a licensee or operator of, provide substitute services to, or have any access whatsoever to children in a childcare agency as defined by this part, nor shall the person be employed with the department in a position having significant contact with children, whose criminal or available juvenile background records, registry or perpetrator records demonstrate that the person has been convicted of, pled guilty or no contest to an offense or lesser included offense, is the subject of a juvenile petition or finding that would constitute an offense or lesser included offense, or whose criminal or juvenile background history report or other information demonstrates the existence of a pending warrant, indictment, presentment or petition, involving:
      1. (a) The physical, sexual or emotional abuse or neglect of a child;
      2. (b) A crime of violence against a child or any person;
      3. (c) Any offense determined by the department, pursuant to properly promulgated rules, to present a threat to the health, safety or welfare of children;
      4. (d) The identification of the person on the department of health's vulnerable persons registry pursuant to title 68, chapter 11, part 10, or on the state's sex offender registry, or, whose status, pursuant to a review under § 71-3-515, of the department of children's services and the department of human services records of indicated perpetrators of abuse or neglect of children or adults, reviews of equivalent administrative registries in any jurisdiction in which the person has resided in the past five (5) years, or reviews of available juvenile court records, demonstrate a history that would require the person's exclusion under this part.
    2. (ii) No person who is currently charged with or who has been convicted of or pled guilty to a violation of § 39-13-213, § 55-10-101, § 55-10-102 or § 55-10-401, or any felony involving use of a motor vehicle while under the influence of any intoxicant, may, for a period of five (5) years after the date of the conviction or felony plea, be employed as or serve as a driver transporting children for a childcare agency.
  2. (B)
    1. (i) Upon receipt from the department of the criminal and juvenile fingerprint-based background report or other information regarding the criminal, juvenile, vulnerable persons, sex offender or perpetrator records histories of a person about whom this information was obtained, the department shall notify the childcare agency and the person of the person's clearance to assume a position with the childcare agency or that the person must be excluded from positions or circumstances with the agency described in subdivision (a)(1) or from any access to children.
    2. (ii) The childcare agency, and the department for its employees, shall immediately exclude any person from employment, from substitute services or from any access whatsoever to children in the childcare agency or, if a resident of a childcare agency, the agency shall exclude the resident from access to children in the childcare agency, if the criminal, juvenile, registry, perpetrator records history or other information regarding the person place the person within the prohibited categories established in subdivision (e)(1)(A). The department shall deny the license or operator status of any such person. If an exemption from the exclusion is provided for by rule of the department pursuant to subsection (f), the person shall remain excluded or that person's license or operator status shall be denied until it is determined by the department that there is a basis for an exception from the exclusion.
    3. (iii) The failure of a childcare agency to exclude a person with a prohibited criminal, juvenile, vulnerable persons or sex offender registry or perpetrator records history at a childcare agency from employment with the agency, or from the provision of substitute services to children in the agency, or the failure, as determined by the department, to adequately restrict the access of a resident or any other person in a childcare agency to children being cared for by the agency, shall subject the childcare agency to immediate suspension of the agency's license by the department.
  3. (C) The child care agency, substitute pool, or staffing agency shall immediately notify the department on the same business day of an arrest, pending indictment, or other information regarding a person who is an employee, substitute, volunteer, or resident which places the person within the prohibited categories established in subdivision (e)(1)(A) if the child care agency, substitute pool, or staffing agency knows or reasonably should know of such arrest, pending indictment, or other information. The child care agency, substitute pool, or staffing agency shall immediately exclude the person if the person must be excluded from positions or circumstances described in subdivision (a)(1) or from any access to children.
2. (2) Any person who is excluded pursuant to this section or whose license or operator status is denied or revoked based upon the results of a disclosure form statement, fingerprint-based background, criminal or juvenile records history, registry or perpetrator history review pursuant to this part, or other records review, may appeal the exclusion to the department within ten (10) days of the mailing date of the notice of such exclusion to the subject person.
3. (3) If timely appealed, the department shall provide an administrative hearing pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, part 3, in which the appellant may challenge the accuracy of the determination.
4. (4) The appellant may not collaterally attack the factual basis of an underlying exclusionary record except to show that the appellant is not the person identified on the record. Further, except to show that the appellant is not the person identified on the record, the appellant may not collaterally attack or litigate the facts that are the basis of a reported pending criminal or juvenile charge except to show that the charge was, or since the report was generated, has been dismissed, nolled, has resulted in an acquittal or has been expunged.
(f)
1. (1) The department may by rule provide for a review process that utilizes an advisory group of law enforcement personnel, persons experienced in child protective services, persons experienced in child development issues and childcare providers, or other persons it determines are appropriate, to consider and, if appropriate, recommend to the department exemptions from the exclusions established by this section, or for any other exclusions of persons established pursuant to the department's rules, that are based on the person's criminal background or juvenile background history or from the records of the person maintained in the vulnerable persons or sex offender registries or contained in the indicated perpetrator records of the departments of children's services or human services.
2. (2) Any exemption granted must be based upon extenuating circumstances that would clearly warrant the exemption, and this determination shall be made in writing in the record of the department and of the childcare agency and shall be open to public inspection.
3. (3) If an exemption rule is promulgated by the department under this part or by any state agencies utilizing the methods authorized by subsection (g) or (h), the person who is not granted an exemption from the exclusion upon review of the person's criminal, juvenile, registry or other records history pursuant to this part may have this issue considered in an administrative appeal as provided by subsection (e).
(g)
1. (1)
  1. (A) A child care agency as defined in § 37-5-501 or § 71-3-501, a child care program as defined in § 49-1-1102, the department of children's services, the department of education, the department of human services, the department of mental health and substance abuse services, the department of disability and aging and any other state agency or any person or entity that contracts with the state may require the persons set forth in subdivisions (g)(1)(A)(i)-(iii) to undergo a background or records review of any kind, to complete a disclosure form stating the person's criminal and juvenile records history and agree to release all records involving the person relating to the criminal, juvenile and perpetrator records history of the person to the entities described in this subdivision (g)(1)(A), and, if further required by the requesting entity, to supply a fingerprint sample and submit to a fingerprint-based review of criminal and juvenile records available to the TBI to be conducted by the TBI. The person may also be required to submit to a review of the person's status on the department of health's vulnerable persons registry under title 68, chapter 11, part 10, and on the state's sex offender registry, and pursuant to § 71-3-515, a review of the department of children's services and the department of human services records of indicated perpetrators of abuse or neglect of children or adults, and, if determined necessary by the agency, department or contractor, a review of any available juvenile records in juvenile court. The department shall maintain the results of these inquiries. Failure or refusal of a person to submit to or complete the disclosures, background and records reviews required by the entities in this subdivision (g)(1)(A) shall result in the immediate exclusion of the person from any position or status for which these reviews are required by this section:
    1. (i) A person applying to work or substitute, or currently working, in any capacity as a paid employee, licensee or operator, substitute or volunteering, with children with the entities in subdivision (g)(1)(A) or who otherwise has access to children in those entities;
    2. (ii) An applicant for a foster parent position or an applicant to be an adoptive parent, or a current foster parent or a current prospective adoptive parent with the department of children's services; or
    3. (iii) A person fifteen (15) years of age or older who resides in a childcare agency licensed pursuant to this part or title 37, chapter 5, part 5, and who is not otherwise required by subdivision (a)(1), or who is not otherwise required by any other law.
  2. (B) Nothing in this subsection (g) shall be construed to mean that any other law that mandates that fingerprint-based background, registry or any records review be conducted on applicants for employment, licensee, operator, substitute, volunteer or agency resident status is made voluntary, repealed or superseded in any manner by this subsection (g), and this section is supplementary to, and is not in lieu of, any mandatory provisions for such other statutorily required background, registry or records checks.
2. (2) The disclosure form shall contain the information described in subdivisions (a)(3) and (4).
3. (3) A copy of the disclosure form shall be maintained in the requesting entity's records of the persons for whom the background check is sought.
4. (4)
  1. (A) The fingerprints of the person shall be submitted to the TBI in the format required by the bureau.
  2. (B) The TBI shall compare the information received and the fingerprints of the person with the computer criminal history files, and juvenile history files available to and maintained by the bureau and, to the extent permitted by federal law, with federal criminal databases to verify the accuracy of the criminal or juvenile violation information pursuant to § 38-6-109, and shall report the existence of any criminal or juvenile history involving the person to the department or relevant state agency.
  3. (C)
    1. (i) For a person who was not subject to a fingerprint-based or other records screening prior to assuming a role described in subdivision (g)(1)(A), that person's existing status in the role shall be conditional upon the satisfactory outcome of any requested fingerprint-based background review, criminal, and available juvenile records review, and upon vulnerable persons and sex offender registries and department of children's services and department of human services perpetrator records, reviews, and, if determined necessary by the entity, a review of any available juvenile records in juvenile court, that may be conducted pursuant to this section; provided, however, that if a person is initially applying to assume any type of role described in subdivision (g)(1)(A), and an entity described in subdivision (g)(1)(A) utilizes this subsection (g) as a preemployment screening procedure, the person shall not assume the role until satisfactory completion of the reviews.
    2. (ii) In either circumstance in subdivision (g)(4)(C)(i), the criminal and available juvenile history and fingerprint-based background review, the vulnerable persons and sex offender registry review and any review of the perpetrator records of the departments of children's services and human services must demonstrate that the person is not subject to a criminal or juvenile history or a history on these registries or in such records that would, as described in this part, disqualify or otherwise exclude that person from any role described in subdivision (g)(1)(A). If the fingerprint-based background or records review, or any other information from any other source confirms that subsection (e) is applicable, that person shall not be permitted to have further contact with children in such role, except as otherwise permitted by this section.
    3. (iii) A person's employment or contract status shall not remain in a conditional status for a position with any state agency for which federal law or regulations do not permit the state agency to license or approve the position until all necessary licensing requirements are met, unless specifically authorized by state or federal law or regulation to the contrary.
    4. (iv) The employment status of persons for whom a post-employment fingerprint-based background, registry or record review was conducted, or the status of existing licensees or operators, substitutes, volunteers or residents of a childcare agency for whom these reviews were conducted after license approval, and who were not otherwise subject to prestatus applicant or access reviews and to the exclusionary provisions provided in this section, shall be governed by any regulations that may govern their status in a regulated entity or by applicable employment law.
  4. (D) The results of the inquiry to the TBI or other registry or records review shall be documented in the records of the department.
  5. (E) If the information submitted on the disclosure form appears to have been falsified, the entity requesting the background check, or if the entity is regulated by or has a contract with this state, the regulatory or contracting agency shall notify the district attorney general of the falsification in writing.
  6. (F) Any costs incurred by the TBI in conducting the investigations of the applicants shall be paid by the entity that requests the investigation and information. Payment of the costs is to be made in accordance with §§ 38-6-103 and 38-6-109.
(h)
1. (1)
  1. (A) The department or appropriate state agency as listed in subdivision (g)(1) may require the following persons to submit a disclosure form as set forth in subdivisions (a)(3) and (4), a copy of which the department shall maintain in the department's records as a supplemental method of criminal and juvenile background history review, and agree to release all records involving the following persons relating to the criminal and available juvenile history of the persons:
    1. (i) For an applicant for employment, for license or operator status, or for substitute or volunteer status with childcare agencies or childcare programs, or with the state agencies or their contractors, as listed in subdivision (g)(1) or with the entities that the state agencies may regulate;
    2. (ii) For residents of new childcare agencies;
    3. (iii) For current employees, licensees, operators, substitutes, or volunteers of childcare agencies; or
    4. (iv) For current residents of childcare agencies.
  2. (B) The department or appropriate state agency, as listed in subdivision (h)(1)(A) may then access directly the TBI's Tennessee crime information computer (TCIC) system and conduct a name search of Tennessee criminal and available juvenile history records by using only the information contained on the disclosure form completed pursuant to subdivision (h)(1)(A), or by using other information available to the searching entity.
2. (2) The results of the search must be maintained in the records of the department and are subject to review by the entities regulating the department.
3. (3) This subsection (h) does not make voluntary, repeal, or supersede other law that mandates that criminal and juvenile background reviews be conducted on applicants for employment, for license or operator status, for substitute or volunteer service positions, or for resident status. This subsection (h) is supplementary to, and is not in lieu of, mandatory provisions for other statutorily required criminal and juvenile background reviews.
(i) Subsections (e) and (f), including, but not limited to, the exclusion of persons from providing care or being licensed for the care of children or having access to children upon determination of the criminal, available juvenile, registry or perpetrator records background of such persons, the suspension of operations of or the denial or regulation of any license, certification or approval of any entities that fail to exclude persons with an exclusionary history, and the exemptions from the exclusionary provisions shall be applicable to those persons having exclusionary backgrounds or histories determined by the processes established by subsections (g) and (h) or by any other means.
(j) Any person disqualified by a state agency from care for or access to children based upon the results of any fingerprint-based, criminal, juvenile, registry, perpetrator records or other records review conducted under subsections (g) and (h), or by any other means may, as provided in subdivisions (e)(2)-(4), appeal that determination to a state agency that has made the request.
(k) Nothing in this section shall be construed to prevent the exclusion of any person from providing care for, from being licensed or certified or approved for the care of children pursuant to this part or from having access to a child in a child caring situation if a criminal or juvenile proceeding background history or other record that would require the person's exclusion under this part is discovered and verified in any other manner other than through a procedure established pursuant to this section. All procedures, rules and appeal processes established pursuant to this section for the protection of children and the due process rights of excluded persons shall also be applicable to those persons.
(l) It is unlawful for any person to falsify any information required on the disclosure form required by this section. A person who knowingly fails to disclose on the disclosure form required information or who knowingly discloses false information or who knowingly assists another to do so commits a Class A misdemeanor.

Backlinks (3)

History (13)

Acts 2000, ch. 981, § 8
2001, ch. 453, §§ 9-14
2006, ch. 808, § 1
2008, ch. 922, §§ 1-3
2009, ch. 410, § 2
2010, ch. 1100, § 136
2012, ch. 575, § 1
2013, ch. 101, § 2
2015, ch. 22, §§ 1, 2
2016, ch. 839, §§ 1-12
2022, ch. 977, §§ 4-12
2023, ch. 433, § 5
2024, ch. 688, § 179.

§ 71-3-508. Inspection of entities providing child care.

(a) It is the duty of the department, through its duly authorized agents, to inspect at regular intervals, without previous notice, all child care agencies or suspected child care agencies, as defined in § 71-3-501.
(b)
1. (1) The department is given the right of entrance, privilege of inspection, access to accounts, records, and information regarding the whereabouts of children under care for the purpose of determining the kind and quality of the care provided to the children and to obtain a proper basis for its decisions and recommendations.
2. (2) If refused entrance for inspection of a licensed, approved or suspected child care agency, the chancery or circuit court of the county where the licensed, approved or suspected child care agency may be located may issue an immediate ex parte order permitting the department's inspection upon a showing of probable cause, and the court may direct any law enforcement officer to aid the department in executing such order and inspection. Refusal to obey the inspection order may be punished as contempt.
3. (3) Except where court orders prohibit or otherwise limit access, parents or other care takers of children in the care of a child care agency licensed pursuant to this part shall be permitted to visit and inspect the facilities and observe the methods for the care of their children at any time during which the children are in the care of the agency and, except those records of other children in the care of the agency and their parents or caretakers, shall further be permitted to inspect any records of the agency that are not privileged, or are not otherwise confidential, as provided by law or regulation, and the parents' or caretakers' access for these purposes shall not be purposely denied by the agency.
(c)
1. (1) In the conduct of any investigations of any child care agency, the department, if it determines such to be necessary, may require the child care agency to enter into a plan for the safety of children in the agency's care pending the outcome of any investigation by the departments of human services or children's services, or by any law enforcement or regulatory agency.
2. (2)
  1. (A) Such plan may require, but is not limited to:
    1. (i) The exclusion or restriction of any individuals from access to the children in care;
    2. (ii) The closure or restricted use of any part or parts of the agency's facilities;
    3. (iii) The reinspection of any of the agency's facilities by any other health, fire or safety agency;
    4. (iv) The modification or elimination of any service provided, or of any procedures utilized or any program conducted by the agency; or
    5. (v) The receipt of further training by the agency's management, staff or volunteers.
  2. (B) The plan may be based upon any preliminary or upon any final findings by the department. The plan may be established in coordination with:
    1. (i) The conduct of any child abuse or neglect investigation by the department of children's services;
    2. (ii) Any criminal investigation by a law enforcement agency;
    3. (iii) Any investigation of the child care agency by any other regulatory agency; or
    4. (iv) In any combination of these investigations,
  3. and may be based upon any preliminary or final findings of such departments or agencies. The plan may also incorporate any recommendations of such departments or agencies based upon their preliminary or final findings.
3. (3) The department may enforce the provisions of the safety plan by civil penalty not to exceed five hundred dollars ($500), by suspension of the agency's license if appropriate, by issuance of a restricted license to the child care agency, by denial or revocation of the child care agency's license, or by any combination of these penalties.
4. (4) Any plan that exceeds ninety (90) days when proposed or that continues for more than ninety (90) days may be appealed to the child care agency board of review.
(d) Any violation of the inspection rights established in this section is a Class A misdemeanor.

History (2)

Acts 2000, ch. 981, § 9
2001, ch. 453, § 15.

§ 71-3-509. Violations of licensing regulations — Probation — Civil penalties — Suspension, denial and revocation of licenses — Appeal procedures.

(a) If any complaint is made to the department concerning any alleged violation of the laws or regulations governing a child care agency, the department shall investigate such complaint and shall take such action as it deems necessary to protect the children in the care of such agency.
(b)
1. (1) If the department determines that a child care agency is not in compliance with the laws and regulations governing its operation, the department may place the agency on probation for a definite period of not less than thirty (30) days nor more than sixty (60) days, as determined by the department. Upon a determination by the department to place an agency on probation, the department shall serve written notice to the agency by personal delivery describing the violations of the licensing laws or rules that support the basis for the probationary status and the procedures for appeal of the probationary status. Ten (10) business days after the service of the probation notice on the agency, the department shall require the agency to post the notice of probation as directed by the department.
2. (2)
  1. (A) If placed on probation, the agency shall immediately post a copy of the probation notice, together with a list provided by the department of the violations that were the basis for the probation, in a conspicuous place as directed by the department and with the agency's license, and the agency shall immediately notify in writing the custodians of each of the children in its care of the agency's status, the basis for the probation and of the agency's right to an informal review of the probationary status.
  2. (B) If the agency requests an informal review within two (2) business days of the imposition of probation, either verbally or in writing to the department's licensing staff that imposed the probation, the department shall informally review the probationary status by a licensing supervisor or other designee who was not involved in the decision to impose the probation. The agency may submit any written or oral statements as argument to the licensing supervisor or designee within five (5) business days of the imposition of the probation. Written and oral statements may be received by any available electronic means. The licensing supervisor or designee shall render a decision in writing upholding, modifying or lifting the probationary status within seven (7) business days of the imposition of the probation.
3. (3) If the licensing supervisor or designee does not lift the probation under subdivision (b)(2)(B), the agency may also appeal such action in writing to the commissioner within five (5) business days of the receipt of the notice of the licensing supervisor or designee's decision regarding the agency's probationary status as determined in subdivision (b)(2)(B). If timely appealed, the department shall conduct an administrative hearing pursuant to the contested case, provisions of the Uniform Administrative Procedures Act, compiled at title 4, chapter 5, part 3, concerning the department's action within fifteen (15) business days of receipt of the appeal, and shall render a decision in writing within seven (7) business days following conclusion of the hearing. The hearing officer may uphold, modify or lift the probation.
4. (4) This subsection (b) shall be discretionary with the department, and shall not be a prerequisite to any licensing action, to impose a civil penalty or to suspend, deny or revoke a license of a child care agency.
(c)
1. (1) If the department determines that there exists any violation with respect to any person or entity required to be licensed pursuant to this part, the department may assess a civil penalty against such person or entity for each separate violation of a statute, rule or order pertaining to such person or entity in an amount ranging from fifty dollars ($50.00) for minor violations up to a maximum of one thousand dollars ($1,000) for major violations or violations resulting in death or injury to a child as defined in the rules of the department. Each day of continued violation constitutes a separate violation.
2. (2) The department shall by rule establish a graduated schedule of civil penalties designating the minimum and maximum civil penalties that may be assessed pursuant to this subsection (c). In developing the graduated civil penalty procedure, the following factors may be considered:
  1. (A) Whether the amount imposed will be a substantial economic deterrent to the violator;
  2. (B) The circumstances leading to the violation and the agency's history of violations;
  3. (C)
    1. (i) The extent of deviation from the statutes, rules or orders governing the operation of the child care agency;
    2. (ii) The severity of the violation, including specifically the level of risk of harm to the children in care of the person or entity caused by the violation; and
    3. (iii) The penalty may be further classified based upon whether the violation resulted in the issuance of an order of summary suspension, denial or revocation of the license of the agency and whether death or injury of a child occurred as a result of violation;
  4. (D) The economic benefits gained by the violator as a result of noncompliance;
  5. (E) The agency's efforts to comply with the licensing requirements; and
  6. (F) The interest of the public.
3. (3) The department shall assess the civil penalty in an order that states the reasons for the assessment of the civil penalty, the factors used to determine its assessment and the amount of the penalty.
4. (4) The order may be served on the licensee personally by an authorized agent of the department who shall complete an affidavit of service, or the order may be served by certified mail, return receipt requested.
5. (5) The licensee may appeal the penalty to the board of review by filing a request for an appeal in writing with the commissioner within ten (10) days of the service of the order.
6. (6)
  1. (A) Civil penalties assessed pursuant to this subsection (c) shall become final ten (10) days after the date an order of assessment is served if not timely appealed, or, if timely appealed, within seven (7) days following entry of the board's order unless the board's order is stayed.
  2. (B) If the violator fails to pay an assessment when it becomes final, the department may apply to the chancery court for a judgment and seek execution of such judgment.
  3. (C) Jurisdiction for recovery of such penalties shall be in the chancery court of Davidson County.
7. (7) All sums recovered pursuant to this subsection (c) shall be paid into the state treasury, but shall be earmarked to be used by the department exclusively to improve child care quality in this state by funding activities that include, but are not limited to, child care provider training activities, but excluding any costs associated with conducting criminal background checks.
8. (8) This subsection (c) relative to civil penalties shall be discretionary with the department, and shall not be a prerequisite to any licensing action to suspend, deny or revoke a license of a child care agency. Civil penalties may also be imposed in conjunction with the probation, suspension, denial or revocation of a license.
(d)
1. (1) If the department determines that any applicant for a provisional license has failed to attain, or an existing licensee has failed to maintain, compliance with licensing laws or regulations after reasonable notice of such failure and a reasonable opportunity to demonstrate compliance with licensing laws or regulations, the department may deny the license following the issuance of a provisional license or may revoke the existing license; provided, that the department at any time may deny a provisional license if the applicant fails to meet the initial requirements for its issuance; and, provided, further, that if the department determines that repeated or serious violations of licensing laws or regulations warrant the denial or revocation of the license, then, notwithstanding any provisions of § 4-5-320 or this subsection (d) to the contrary, the department may seek denial or revocation of the license regardless of the licensee's demonstration of compliance either before or after the notice of denial of the application or before or after notice of the revocation.
2. (2) Notwithstanding § 4-5-320, the notice of denial or revocation may be served personally by an authorized representative of the department who shall verify service of the notice by affidavit, or the notice may be served by certified mail, return receipt requested.
3. (3) If application for a provisional license is denied, a license is denied following the issuance of a provisional license, or if an existing license is revoked, the applicant may appeal the denial or revocation by requesting in writing to the department a hearing before the child care agency board of review within ten (10) days of the personal delivery or mailing date of the notice of denial or revocation. Failure to timely appeal shall result in the expiration of any existing license immediately upon the expiration of the time for appeal.
4. (4) The hearing upon the denial or revocation shall be heard by the board of review within thirty (30) days of the date of service of the notice of denial or revocation; provided, that, for good cause as stated in an order entered on the record, the board or the administrative law judge may continue the hearing. In order to protect the children in the care of the agency from any risk to their health, safety and welfare, the board or administrative law judge shall reset the hearing at the earliest date that circumstances permit.
5. (5)
  1. (A) If timely appeal is made, pending the hearing upon the denial or revocation, the child care agency may continue to operate pending the decision of the board of review unless the license is summarily suspended as provided in subsection (e).
  2. (B) The board, as part of its decision regarding the status of the applicant's application for a license or the licensee's license, may direct that the child care agency be allowed to operate on a probationary or conditional status, or may grant or continue the license with any restrictions or conditions on the agency's authority to provide care.
(e)
1. (1) Subject to this subsection (e), if the department determines at any time that the health, safety or welfare of the children in care of the child care agency imperatively requires emergency action, and incorporates a finding to that effect in its order, summary suspension of the license may be ordered by the department pending any further proceedings for revocation, denial or other action. If the department determines that revocation or denial of the license is warranted following suspension, those proceedings shall be promptly instituted and determined as authorized by this part.
2. (2) The department shall set forth with specificity in its order the legal and factual basis for its decision, stating in the order the specific laws or regulations that were violated by the agency, and shall state with specificity in the order the reasons that the issuance of the order of summary suspension is necessary to adequately protect the health, safety or welfare of children in the care of the child care agency. Summary suspension may be ordered in circumstances that have resulted in death, injury or harm to a child or that have posed or threatened to pose a serious and immediate threat of harm or injury to a child based upon the intentional or negligent failure to comply with licensing laws or regulations.
3. (3) In issuing an order of summary suspension of a license, the department shall use, at a minimum, the following procedures:
  1. (A) The department shall proceed with the summary suspension of the agency's license and shall notify the licensee of the opportunity for an informal hearing within three (3) business days of the issuance of the order of summary suspension;
  2. (B) The notice provided to the licensee may be provided by any reasonable means and, consistent with subdivision (e)(2), shall inform the licensee of the reasons for the action or intended action by the department and of the opportunity for an informal hearing as permitted by subdivision (e)(3)(C);
  3. (C)
    1. (i) The informal hearing described by this subdivision (e)(3) shall not be required to be held under the contested case provisions of the Uniform Administrative Procedures Act;
    2. (ii) The hearing is intended to provide an informal, reasonable opportunity for the licensee to present to the hearing official the licensee's version of the circumstances leading to the suspension order;
    3. (iii) The sole issues to be considered are:
      1. (a) Whether the public health, safety or welfare imperatively require emergency action by the department;
      2. (b) What, if any, corrective measures have been taken by the child care agency following the violation of licensing laws or regulations and prior to the issuance of the summary suspension order that eliminate the threat to the public health, safety or welfare of the children in the care of the agency; and
      3. (c) Whether the agency demonstrates a reasonable ability to maintain or continue compliance with all relevant licensing laws and regulations; and
    4. (iv) The hearing official may lift, modify or continue the order of summary suspension;
  4. (D) Subsequent to the hearing on the summary suspension, the department may proceed with revocation or denial of the license or other action as authorized by this part, regardless of the decision concerning summary suspension of the license.
4. (4) The department shall by rule establish any further necessary criteria that it determines are required for the determination of circumstances that warrant imposition of the summary suspension order and any other necessary procedures for implementation of the summary suspension process.
5. (5) If the conditions existing in the child care agency present an immediate threat to the health, safety or welfare of the children in care, the department may also seek a temporary restraining order from the chancery or circuit court of the county in which the child care agency is located, seeking immediate closure of the agency to prevent further harm or threat of harm to the children in care, or immediate restraint against any violations of the licensing laws or regulations that are harming or that threaten harm to the children in care. The department may seek any further injunctive relief as permitted by law in order to protect children from the violations, or threatened violations of the licensing laws or regulations. The use of injunctive relief as provided by this subdivision (e)(5) may be used as an alternative, or supplementary measure, to the issuance of an order of summary suspension or any other administrative proceedings.
(f)
1. (1) In determining whether to deny, revoke or summarily suspend a license, the department may choose to deny, revoke or suspend only certain authority of the licensee to operate and may permit the licensee to continue operation, but may restrict or modify the licensee's authority to provide certain services or perform certain functions, including, but not limited to, transportation or food service, enrollment of children at the agency, the agency's hours of operation, the agency's use of certain parts of the agency's physical facilities or any other function of the child care agency that the department determines should be restricted or modified to protect the health, safety or welfare of the children. The board of review, in considering the actions to be taken regarding the license, may likewise restrict a license or place whatever conditions on the license and the licensee it deems appropriate for the protection of children in the care of the agency.
2. (2) The actions by the department or the board authorized by this subsection (f) may be appealed as otherwise provided in this part for any denial, revocation or suspension.
(g)
1. (1) When an application for a license has been denied, or a license has been revoked, on one (1) occasion, the child care agency may not reapply for a license for a period of one (1) year from the effective date of the denial or revocation order if not appealed, or, if appealed, from the effective date of the board's or reviewing court's order.
2. (2) If application for a license has been denied, or a license has been revoked, on two (2) occasions, the child care agency may not reapply for a license for a period of two (2) years from the effective date of the denial or revocation if not appealed, or, if appealed, from the effective date of the board's or reviewing court's order.
3. (3) If an application for a license has been denied, or a license has been revoked, on three (3) occasions, the agency shall not receive another license for the care of children.
4. (4) No person who served as full or part owner or as director or as a member of the management of a child care agency shall receive a license to operate a child care agency if that person participated in such capacity in a child care agency that has been denied a license, or that had a license revoked, on three (3) occasions.
5. (5)
  1. (A) The time restrictions of subdivisions (g)(1) and (2) may be waived by the board of review in the hearing in which the denial or revocation is sustained, or, if requested by the former licensee in writing to the commissioner, in a separate subsequent hearing before the board of review or, in the discretion of the commissioner, upon review by the commissioner.
  2. (B) The agency must show to the board's or the commissioner's satisfaction that the agency has corrected the deficiencies that led to the denial or revocation, and that the child care agency can demonstrate that it has the present and future ability, and is willing, to maintain compliance with licensing laws or regulations. The decision of the board or the commissioner shall be reduced to an order, which shall be a final order pursuant to the Uniform Administrative Procedures Act, and may be appealed pursuant to § 4-5-322.
  3. (C) No waiver may be granted for any permanent restriction that has been imposed pursuant to subdivision (g)(3).
(h)
1. (1) In conducting hearings of the appeal of a denial or revocation of a license before the board of review or for review of summary suspension orders, it is the legislative intent that such hearings be promptly determined consistent with the safety of the children in the care of the child care agency appealing the department's licensing action and with the due process rights of the license applicants or licensees.
2. (2) If, however, the administrative procedures division of the office of the secretary of state certifies by letter to the recording secretary of the board of review that the division's contested case docket prevents the scheduling of a hearing on the appeal of the denial or revocation of a license before the board of review within the initial time frames set forth in this part, then the department shall have the authority to obtain an attorney who shall act as the administrative law judge to conduct the proceedings before the board. The substitute administrative law judge may be obtained by contract with a private attorney or by contract or agreement with another state agency. The substitute administrative law judge shall have all authority as an administrative law judge of the department of state. The hearing may be continued by order of the board for the purpose of obtaining a substitute judge.
3. (3) Hearings on summary suspension orders shall be heard by an administrative law judge from the administrative procedures division of the secretary of state's office, if the administrative law judge is available within the time frames for a summary suspension hearing. If the administrative procedures division of the secretary of state's office informs the department that an administrative law judge is unavailable, the department may obtain an administrative law judge or hearing officer who is not an employee of the department who may be obtained by the department by contract with a private attorney or by contract or agreement with another state agency. The administrative law judge or hearing officer shall have authority, as otherwise permitted in this section, to enter orders binding on the department resulting from show cause hearings involving summary suspension orders. If the administrative procedures division of the office of the secretary of state informs the department that the division's contested case docket prevents the scheduling of a hearing on the issuance of a summary suspension order within the initial time frames set forth in this part, and if the department is unable to obtain a private or state agency administrative law judge or hearing officer to hear the show cause hearing on the summary suspension order within the time frames set forth in this part, the department may utilize a hearing officer from the department's administrative review section.
(i) By July 1, 2000, any initial rules to implement this section shall be by emergency rules of the department; provided, however, that any permanent rules shall be promulgated pursuant to the Uniform Administrative Procedures Act.

Backlinks (3)

History (4)

Acts 2000, ch. 981, § 10
2001, ch. 453, §§ 16-19
2009, ch. 566, § 12
2021, ch. 280, §§ 22-24.

§ 71-3-510. Board of review — Composition.

(a)
1. (1) A child care agency licensing board of review shall review:
  1. (A) Actions initiated by the departments of human services and children's services to deny or revoke or to otherwise limit any license except for summary suspension of, or probation involving, a license;
  2. (B) Actions to review any civil penalties imposed by the department of human services; or
  3. (C) Any safety plan implemented by the department of human services that will be, or has been in effect ninety (90) days or more.
2. (2)
  1. (A) In reviewing any licensing action pursuant to this part or pursuant to title 37, chapter 5, part 5, the board of review shall consist of nine (9) persons. Five (5) members of the board shall include the commissioners of health and education or their designees, the executive director of the commission on children and youth or designee, and a member from one (1) current or previous standards committee from the departments of human services and children's services. Four (4) persons shall be selected from a pool of up to twelve (12) representatives at-large to be selected by the five (5) stated board members, as follows:
    1. (i) Four (4) shall be selected to serve for one (1) year;
    2. (ii) Four (4) shall be selected to serve for two (2) years; and
    3. (iii) Four (4) shall be selected to serve for three (3) years.
  2. (B) Thereafter, each at-large representative shall be selected to serve for terms of three (3) years or until such representative's successor is selected.
(b) A quorum of the board shall consist of five (5) persons.
(c) In establishing a quorum for the board to conduct its review of the licensing actions of the departments, the chair shall randomly select the names of the at-large members of the board for the board's current licensing review action from the pool of twelve (12) persons selected pursuant to subsection (a) until the nine-member composition is reached or, if that is not possible, until a quorum is reached.
(d) The commissioner of education or the commissioner's designee shall serve as the chair of the board until a chair is selected by the board. The board shall elect a vice chair who shall serve in the absence of the chair. If the chair resigns, is unable to perform the duties of the chair or is removed, or the chair's term on the board expires, the commissioner of education shall appoint a new chair until the board can elect a chair. The vice chair shall have authority to sign all orders of the board in the absence of the chair and for actions of the panels under subsection (f).
(e) The recording secretary for the board shall be a member of the professional staff of the department of human services based upon an inter-agency agreement for the services of the recording secretary as the commissioners of children's services and human services may deem appropriate, and any person selected by the agreement of the departments shall serve as recording secretary for the board. The recording secretary shall be responsible for scheduling the board's meetings and arranging for the facilities to conduct the hearings of the board for both departments and such other duties as may be necessary to accommodate the business of the board. The recording secretary shall serve without additional compensation from the department.
(f) In order to complete the work of the board, the chair may appoint one (1) or more panels of the board with a quorum of five (5) members, at least two (2) of whom shall be randomly selected at-large members selected by the chair. The chair of the board shall appoint the chair of the panel. The panel shall have complete authority to hear any case under the board's jurisdiction and shall have complete authority to enter any necessary orders concerning licensing actions conducted before the board of review. Any orders of the panel shall be signed by the chair of the panel, or by the board chair or vice chair.
(g) Any necessary regulations governing the board's procedure shall be promulgated by the department of human services, in consultation with the department of children's services, in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, part 2.
(h) Any applicant or licensee may petition the chancery court of Davidson County pursuant to § 4-5-322 for judicial review of the board's decision.
(i)
1. (1) All members of the review board shall serve without pay.
2. (2) The four (4) members at-large who are selected to serve on the board and the members from the standards committees of the departments shall receive reimbursement in conformity with law and regulations for their expenses incurred in the performance of their official duties pursuant to this part. Such expenses for the representatives from the standards committees from the respective department shall be paid from the funds appropriated to the departments.
3. (3) The expenses for the at-large members shall be shared equally by the departments of children's services and human services.
4. (4) All reimbursement for travel expenses shall be in accordance with the comprehensive state travel regulations applicable to state employees.

Backlinks (1)

4-29-251(a)(3)

History (2)

Acts 2000, ch. 981, § 11
2001, ch. 453, §§ 20-22.

§ 71-3-511. Licensing standards committees.

(a) The commissioner of human services shall appoint a standards committee composed of twelve (12) citizens, three (3) from each grand division of the state, and three (3) at-large for the purpose of developing or reviewing standards and regulations for each class of child care agency defined in this part. The classes of child care regulated by the department shall be represented by members of the standards committee.
(b) For any new class of child care agency as defined in this part, the standards committee shall develop and recommend to the commissioner the standards and regulations for that new class of child care agency. The standards and regulations of each existing class of child care agency shall be reviewed by a standards committee beginning every four (4) years following the date of submission of its last recommendations or more frequently as the commissioner may direct.
(c) The standards committee shall act in an advisory capacity to the commissioner in recommending any initial standards or regulations for any new class of child care agency or any changes to the existing standards or regulations of any class of child care agency.
(d) The committee shall cease to exist upon submitting its recommendations to the commissioner, but may be reestablished by the commissioner at any time to further review its recommendations or to consider additional standards or regulations or to consider revisions to the standards or regulations.
(e)
1. (1) In making appointments to the committee, the commissioner shall strive to ensure that at least one (1) person serving on the committee is sixty (60) years of age or older and that at least one (1) person serving on the committee is a member of a racial minority.
2. (2) Except as otherwise provided in this section, in making appointments to the standards committees, the departments shall strive to ensure that the membership of the standards committees includes a balance of representatives of the regulated industry and persons whose expertise would be of assistance to the departments. The departments shall appoint child advocates, social workers, attorneys, and other such persons with knowledge and expertise in the specified area, as well as citizen members to the committees.
(f) The members of the committee shall not receive any compensation for their services but shall be reimbursed for their travel to and from the committee meetings and for their meals and lodging in accordance with the state travel procedures and regulations.

Backlinks (2)

History (3)

Acts 2000, ch. 843, § 2
2000, ch. 981, § 12
2011, ch. 282, § 3.

§ 71-3-512. Five-year-olds attending day care institutions lacking kindergarten status.

(a) A family child care home, group child care home or child care center that lacks approved kindergarten status for purposes of § 49-6-201 shall not enroll or continue to enroll any child five (5) years of age during the period of the local education agency's regular school year, without first obtaining from the child's parents or legal guardians a signed acknowledgment of the fact that the child's attendance at the family child care home, group child care home or child care center does not satisfy the mandatory kindergarten prerequisite for the child's enrollment in the first grade.
(b) Any such signed acknowledgment shall be retained by the family child care home, group child care home or child care center for a period of two (2) years. Failure to comply with the requirements of this section may subject the family child care home, group child care home, or child care center to probation, denial or revocation of the child care agency license, or to civil penalty, by the department.

History (1)

Acts 2000, ch. 981, § 13.

§ 71-3-513. Public records — Exceptions.

The records of any entity entering into a contract or grant with the state for child care broker services relating to such grant or contract shall be public records open for public inspection in accordance with § 10-7-503. Nothing in this section shall be construed to allow a social security number or residential address of any person to be considered a public record.

History (1)

Acts 2000, ch. 981, § 79.

§ 71-3-514. Establishment of drug testing policy.

(a)
1. (1) All persons or entities operating a child care agency as defined in this part, unless exempt as provided in § 71-3-503, shall establish a drug testing policy for employees, directors, licensees and operators of child care agencies and for other persons providing services under contract or for remuneration for the agency, who have direct contact, as defined by the department, with a child in the care of the agency.
2. (2) The policy shall specify how testing should be completed by the child care agency and provide for immediate and effective enforcement action involving such persons by the child care agency in the event of a positive drug test.
3. (3) The policy shall be provided by the child care agency to persons employed or engaged for contract or remunerative services prior to July 1, 2009, and to all such persons upon initial employment or initial engagement in contract or remunerative services for the agency.
4. (4) The policy established pursuant to this section shall not supersede the requirements of § 71-3-502(d)(7)(C)(v) that all persons described in § 71-3-502(d)(7)(C)(v) satisfactorily complete a drug test prior to engaging in transportation services for children in a child care agency.
(b)
1. (1) The policy shall require drug testing based upon reasonable suspicion that employees, directors, licensees, or operators of a child care agency, or other persons providing services under contract or for remuneration for the agency are engaged in the use of illegal drugs.
2. (2) The policy shall require persons employed or engaged for contract or remunerative services prior to July 1, 2009, to have a drug test based upon reasonable suspicion that the persons are engaged in the use of illegal drugs.
3. (3) Events that may give rise to reasonable suspicion for purposes of requiring a drug test include, but are not limited to:
  1. (A) Deterioration in job performance or changes in personal traits or characteristics;
  2. (B) Appearance in a specific incident or observation which indicates that an individual is under the present influence of drugs;
  3. (C) Changes in personal behavior not attributable to other factors;
  4. (D) Involvement in or contribution to an accident where the use of drugs is reasonably suspected, regardless of whether the accident involves actual injury; or
  5. (E) Alleged violation of or conviction of criminal drug law statutes involving the use of illegal drugs or prescription drugs.
(c) A child care agency shall, at no expense to the state, maintain for five (5) years and immediately make available to the department upon request a copy of drug testing results for an individual who is employed as a caregiver, director, licensee or operator at the child care agency, or for other persons providing services under contract or for remuneration for the agency, who have direct contact with children in the care of the agency.
(d) It shall be the responsibility of the individual who is to be tested to pay the appropriate fees necessary to obtain a drug test pursuant to the policy established by a child care agency. Drug testing results obtained under this section are confidential and may be disclosed only for purposes of enforcing this part.
(e) Notwithstanding subsection (a), a licensee or operator of a family child care home who has direct contact with children in the care of the family child care home shall submit to a drug test at the expense of the licensee or operator, when the department has reasonable suspicion to believe that the licensee or operator is engaged in the use of illegal drugs.
(f) A child care agency that does not comply with this section is subject to the department:
1. (1) Denying the application for a provisional license;
2. (2) Denying a license following the issuance of a provisional license; or
3. (3) Suspending or revoking a license issued.

History (2)

Acts 2008, ch. 1068, § 1
2021, ch. 280, §§ 25, 26.

§ 71-3-515. Development of procedure for submitting names and other identifying information to determine if persons have perpetrated abuse or neglect of a child or adult — Due process rights.

(a) The department of children's services and the department of human services shall develop a procedure whereby the names and other identifying information for all potential employees of the department of human services in that department's licensing division and adult protective services program and any persons who are subject to § 71-2-403 or § 71-3-507, and who, under those sections, may have contact with children in a childcare agency or with adults in an adult day care agency licensed by the department of human services, shall be submitted to the department of children's services and the department of human services adult protective services program to determine if the potential employees or other persons subject to those provisions were found by the department of children's services or the department of human services adult protective services program to have perpetrated abuse or neglect of a child or adult.
(b) No person shall be reported as an indicated perpetrator of abuse or neglect for purposes of this part or chapter 2, part 4 of this title, by either the department of children's services or the department of human services adult protective services program unless it is determined that the due process rights of the person were either offered, but not accepted, or were fully concluded pursuant to the rules of the department of children's services or the department of human services and applicable state and federal law.

Backlinks (7)

History (2)

Acts 2009, ch. 410, § 3
2013, ch. 101, § 3.

§ 71-3-516. Restrictions on license for drop-in center regarding care of school-age children on snow days.

Any license for a drop-in center issued under this part shall specify whether the center is appropriate for handling school-age children on snow days. A drop-in center may not accept any school-age child for care unless the department determines that center is an appropriate and safe location for such children on snow days. The department shall determine whether the center has adequate space for school-age children and shall set a limit on the number of such children that a center may accept on any one day. No child thirteen (13) years of age or older may be cared for by a drop-in center on a snow day. The center shall also provide to the department a list of trained care givers and other staff who are available for emergency calling and shall annually update such list.

History (2)

Acts 2005, ch. 93, § 2
T.C.A., § 71-3-534.

§ 71-3-517. Development of a written multi-hazard plan to protect children in emergencies.

(a) All persons or entities operating a child care agency as defined in this part, excluding drop-in child care centers and those programs and facilities exempt from licensing as provided in § 71-3-503, shall, in consultation with appropriate local authorities and local emergency management, develop a written multi-hazard plan to protect children in the event of emergencies, including, but not limited to, fires, tornados, earthquakes, chemical spills, and floods. Such persons or entities shall also inform parents and guardians of children attending the child care agency of the plan.
(b) The written plan required pursuant to this section shall include:
1. (1) Procedures for child care agency staff to notify parents in an emergency;
2. (2) The development of designated relocation sites and evacuation routes to those sites;
3. (3) Reunification plans for children and families; and
4. (4) Written individualized plans for accommodating a child's special needs in an emergency situation.
(c) The child care agency shall maintain documentation that the emergency plan is reviewed monthly.
(d) All child care agency staff persons shall be trained on the plan annually.
(e) The child care agency shall implement these emergency procedures through timely practice drills to meet local regulations and local emergency services plans and shall maintain documentation of drills for one (1) year. Such drills shall involve the following:
1. (1) At least one (1) fire drill shall be conducted monthly;
2. (2) Child care agencies shall alternate drills each month to cover each shift while children are present, including extended care hours;
3. (3) At least one (1) drill other than fire shall be conducted every six (6) months; and
4. (4) All drills shall be conducted in such a way as to simulate, as closely as is practical, conditions of a real emergency, with alarms to be utilized and evacuation plans to be practiced.
(f)
1. (1) Emergency telephone numbers for the following entities shall be posted next to all child care agency telephones and shall be readily available to all child care agency staff members:
  1. (A) Fire department;
  2. (B) Police department and sheriff's office;
  3. (C) Nearest hospital emergency room;
  4. (D) Department of children's services child abuse hotline;
  5. (E) Local emergency management agency;
  6. (F) Ambulance or rescue squad;
  7. (G) Poison control center; and
  8. (H) Department of human services child care complaint hotline.
2. (2) If a generic emergency number, including, but not limited to, 911 service, is operable in the community, it shall also be posted in the manner prescribed in this subsection (f).
(g) All contact information for parents, guardians, and emergency personnel shall be readily available to all child care agency staff, including work, home and cell phone numbers.

History (1)

Acts 2013, ch. 216, § 1.

§ 71-3-518. Priority on wait list of children with parent or guardian serving on active duty in armed forces.

(a) Unless otherwise prohibited by federal or state law, no child care agency licensed under this part shall place a dependent child on a wait list behind a child without a parent or legal guardian serving on active duty in the armed services of the United States, if the dependent child:
1. (1) Has a parent or legal guardian that is an active-duty member of the armed services of the United States; or
2. (2) Has a parent who was killed, died as a direct result of injuries received or has been officially reported as being either a prisoner of war or missing in action while serving honorably as a member of the United States armed forces during a qualifying period of armed conflict or was formerly a prisoner of war or missing in action under such circumstances.
(b) To be eligible under subdivision (a)(2), the dependent child or the legal guardian of the dependent child shall:
1. (1) Present official certification from the United States government that the parent veteran was killed or died as a direct result of injuries received while serving honorably as a member of the United States armed forces during a qualifying period of armed conflict; or
2. (2) Present official certification from the United States government that the parent veteran has been officially reported as being a prisoner of war or missing in action while serving honorably as a member of the United States armed forces during a qualifying period of armed conflict or was formerly a prisoner of war or missing in action under such circumstances as appropriate within one hundred and eighty (180) days prior to applying for child care services.
(c) As used in this section, “dependent child”, “qualifying period of armed conflict”, and “serving honorably” have the same meanings as in § 49-7-102.

History (2)

Acts 2013, ch. 291, § 1
2014, ch. 972, § 2.

§ 71-3-519. Designation of staff person to serve as liaison to provide official, uniform message.

The commissioner shall designate a specific departmental staff person to serve, in addition to the staff person's other duties, as a liaison to provide an official, uniform message to child care providers, community stakeholders, department child care staff, and partner agencies, using all appropriate channels of communication.

History (1)

Acts 2021, ch. 406, § 1.

§ 71-3-520. Child care improvement pilot program — Funding — Funding subject to review.

(a) There is created a child care improvement pilot program to provide grants to nonprofit organizations to be used for establishing a new child care agency in this state or making improvements to, or assisting with staffing, recruitment, or salary gaps, at an existing child care agency in this state. The program must be operated from July 1, 2023, to June 30, 2026.
(b) There is created within the state general fund a special account to be known as the child care improvement fund (the fund).
(c) The department of human services shall administer the fund, and moneys in the fund must be expended and obligated only in accordance with this section and in accordance with appropriations made by the general assembly.
(d) Unless otherwise specified in this section, moneys deposited in the fund must be used only to implement and administer the purposes set forth in this section. In addition to appropriations made to the fund, the department may accept other funds, public or private, by way of gift or grant to the fund. A gift or grant must be deposited into the fund to be expended in accordance with this section.
(e) The state treasurer shall invest moneys in the fund for the benefit of the fund in accordance with § 9-4-603. Interest accruing on investments and deposits of the fund must be credited to and remain part of the fund.
(f) Any unencumbered moneys and any unexpended balance of the fund remaining at the end of a fiscal year do not revert to the general fund, but must be carried forward until expended in accordance with this section. No part of the fund shall be diverted to the general fund or any other public fund.
(g) All expenditures from the fund are subject to review in the form of a written report submitted by the department to the commissioner of finance and administration no later than January 15, 2024, and by January 15 each year thereafter until the close of the pilot program period.

History (1)

Acts 2023, ch. 452, § 1.

§ 71-3-521. Notification of permanent closure — Format of notice — Exclusions.

(a) As used in this section:
1. (1) “Enrolled child” means a child who:
  1. (A) Is currently enrolled at the child care center and for whom tuition or attendance fees are being paid;
  2. (B) Has attended the child care center within the last ninety (90) calendar days; or
  3. (C) Is currently on a wait list for enrollment at the child care center; and
2. (2) “Permanent closure” means the child care center ceases to do business as a child care center and discontinues all child care indefinitely.
(b) As early as practicable prior to permanent closure, a child care center shall provide notice of the permanent closure to the parents or guardians of each enrolled child.
(c) Notice required by subsection (b) may be provided by a written or electronic communication, a posting of such notice at the child care center, or a public posting of such notice that the child care center deems an appropriate means for communication with parents or guardians.
(d) This section does not prohibit the department of human services from exercising any duty or power given to the department of human services in this title or by rule regarding the operational status or licensure of a child care center.

History (1)

Acts 2024, ch. 657, § 1.

Part 6 Orphan Asylums

§ 71-3-601. Governing board.

All orphan asylums or houses for destitute children, incorporated under the laws of the state, shall be governed by boards of managers, trustees, or directors, which shall consist of twelve (12) or more persons, five (5) or more of whom shall constitute a quorum.

Backlinks (1)

71-3-602

History (4)

Acts 1885, ch. 92, § 1
Shan., § 4343
Code 1932, § 4573
T.C.A. (orig. ed.), §§ 14-1201, 14-11-101.

§ 71-3-602. Powers over property.

The corporations enumerated in § 71-3-601 may own and hold real and personal property necessary for building, cultivation, and to rent out to raise means to assist in the support of such corporations.

History (4)

Acts 1885, ch. 92, § 8
Shan., § 4351
Code 1932, § 4580
T.C.A. (orig. ed.), §§ 14-1202, 14-11-102.

§ 71-3-603. Admission of children.

All such asylums or houses at the option of its board may receive or take charge of any destitute orphan or indigent child of either sex, or children of indigent parents, under eighteen (18) years of age, from any part of the state.

Backlinks (1)

71-3-604

History (6)

Acts 1885, ch. 92, § 3
Shan., § 4345
mod. Code 1932, § 4574
T.C.A. (orig. ed.), § 14-1203
Acts 1984, ch. 663, § 1
T.C.A. (orig. ed.), § 14-11-103.

§ 71-3-604. Control of indigent children.

The children referred to in § 71-3-603 shall be under the exclusive jurisdiction and control of the board until they become eighteen (18) years of age. The board may, in its discretion, require the parents of such indigent children to surrender all right and claim to the control of them, and to consent for the asylum to provide homes for them, by adoption by proper and suitable parties, for the purpose of caring for and educating them, teaching them trades and household duties generally.

History (4)

Acts 1885, ch. 92, § 3
Shan., § 4346
Code 1932, § 4575
T.C.A. (orig. ed.), §§ 14-1204, 14-11-104.

§ 71-3-605. [Reserved.]

§ 71-3-606. Welfare of child controlling.

No child shall be received into the asylum, or detained in the asylum, except that the welfare of the child may be thereby promoted, nor shall any child be indentured or given in adoption, except that the best interest of the child shall be thereby secured.

History (4)

Acts 1885, ch. 92, § 4
Shan., § 4347
Code 1932, § 4576
T.C.A. (orig. ed.), §§ 14-1206, 14-11-106.

§ 71-3-607. Control of orphans and foundlings.

In all cases in which orphans or foundling children are placed in any of the orphan homes, whether voluntarily by their parent or parents or guardian or by the order of some competent court or other authority, or whether they come into the care and custody of any such institution as foundlings, the managing board shall have the right to retain the custody of such children until the children are eighteen (18) years of age; provided, that § 71-3-609 applies; and provided further, that such institutions may, within such homes or asylums, provide for such children, or may so provide for them in homes of suitable families outside of such institutions.

History (4)

Acts 1891, ch. 117, § 1
Shan., § 4353
Code 1932, § 4582
T.C.A. (orig. ed.), §§ 14-1207, 14-11-107.

§ 71-3-608. Penalty for interference with children.

It is a Class B misdemeanor for any person to interfere in any way with any of such children in the control and custody of such homes while they are there or at the homes provided for them by such institutions.

History (5)

Acts 1891, ch. 117, § 2
Shan., § 4354
Code 1932, § 4583
T.C.A. (orig. ed.), §§ 14-1208, 14-11-108
Acts 1989, ch. 591, § 112.

§ 71-3-609. Petition to take child from home.

At any time after the assumption of control by any of such homes, if the parent or other person, in whom the legal custody of such child would otherwise be, believes such parent or other person entitled to the custody of the child, such person may file a petition in the chancery court of the county in which the home is situated, and set out the facts upon which action is sought, and notice thereof shall be given to such institution, and proof may be taken and the application decided as the chancellor, in the chancellor's sound judgment, may determine, both as to the merits and the adjudication of costs. For this purpose jurisdiction is conferred upon the chancery courts, with the right of appeal.

Backlinks (1)

71-3-607

History (4)

Acts 1891, ch. 117, § 3
Shan., § 4355
Code 1932, § 4584
T.C.A. (orig. ed.), §§ 14-1209, 14-11-109.

§ 71-3-610. Education of children.

The board shall cause all children over six (6) years of age in such asylum to be instructed in such branches of useful knowledge as may be suited to their years and capabilities, and cause the girls to be taught domestic vocations, such as sewing, mending, knitting, and housekeeping in all its departments. The boys shall be taught such useful trades as the board may direct. All children in such asylums, of sufficient age, shall be taught according to the course of the common schools.

History (4)

Acts 1885, ch. 92, § 5
Shan., § 4348
Code 1932, § 4577
T.C.A. (orig. ed.), §§ 14-1210, 14-11-110.

§ 71-3-611. Expenses paid by parent or guardian.

Any of such asylums may, at discretion, receive any child placed in its care and keeping by such child's parents or guardian, or those having the child in charge, and may keep and care for the child until the child is eighteen (18) years of age, unless sooner taken away by the request of such child's parent or parents, or those having guardianship or control of the child. The asylum shall not receive any child under this section until its parent or parents, or guardian, or person having the child in charge, shall agree with the officers of the asylum to supply sufficient funds, or such portion of the funds as the board of managers may agree upon, for the maintenance of the child in the asylum during such child's stay, and shall further agree to abide by all rules, bylaws, and requirements of the asylum. Should a child be admitted having a guardian lawfully appointed and qualified, who has money or property of such child under such guardian's control, such guardian shall be required to pay to the asylum such portion of the child's funds as the guardian may lawfully use, or the guardian may be authorized to use, for the child's support.

History (4)

Acts 1885, ch. 92, § 7
Shan., § 4350
Code 1932, § 4579
T.C.A. (orig. ed.), §§ 14-1211, 14-11-111.

§ 71-3-612. County contributions to expenses.

The expenses of such asylum shall be met as follows, to wit: at the end of each fiscal year, each of the boards of managers shall make a statement of the financial condition of the asylum under its control, which shall especially show how much the necessary expenses of the asylum exceeded its income, and this excess shall be paid by the several counties that had a child or children in the asylum for any part of the fiscal year; each county shall pay so much per capita according to the number of children from that county in the asylum and the length of time that they were there. Of all these particulars, strict, accurate, and systematic accounts shall be kept by the officers of the board, and when the pro rata of any county shall be thus ascertained and a statement of the pro rata has been brought to the notice of the county mayor or financial agent of any such county, it shall be that person's duty forthwith to draw that person's warrant on the county trustee of the county in payment of the same. No county shall be liable to pay at a greater rate than fifty dollars ($50.00) per capita per annum for each child it had in the asylum, and no county shall pay any expenses of any children of that county unless the child or children be apprenticed to or sent to the asylum by the proper authorities, and by proper orders of the county legislative body.

History (6)

Acts 1885, ch. 92, § 6
Shan., § 4349
Code 1932, § 4578
impl. am. Acts 1978, ch. 934, §§ 7, 16, 36
T.C.A. (orig. ed.), §§ 14-1212, 14-11-112
Acts 2003, ch. 90, § 2.

Part 7 Project RAP

§ 71-3-701. Project RAP — Creation — Services.

(a) There is created within the department of children's services the responsible adolescent parenting project (also known as “Project RAP”).
(b) The project shall include information, programs, counseling, and services:
1. (1) For teens who are pregnant with, or who have recently had, their first child; and
2. (2) For foster care teens.
(c) Project RAP may also include information, programs, counseling and services for other teens at high risk of pregnancy. In administering the project, the department shall strive to improve the parenting skills of those Project RAP clients who are pregnant or who are recent first time parents. The department shall also strive to prevent unintended future pregnancies among the total Project RAP client population and to encourage all project participants to pursue and complete educational and vocational opportunities.

History (2)

Acts 1989, ch. 293, § 1
1996, ch. 1079, § 182.

§ 71-3-702. Current operation — Expansion.

During fiscal year 1989-1990, the department shall continue to operate Project RAP in Memphis as a model program, as it has since 1986. Beginning July 1, 1990, if and only if funds are specifically allocated in the general appropriations act for the purpose of expanding Project RAP, then the department shall geographically expand Project RAP into additional areas of the state in which there are significant concentrations of first time teen mothers, foster care teens, and other teens at high risk of pregnancy. In implementing such expansion, priority shall be given to establishing Project RAP in each of the state's three (3) grand divisions within those areas in which the project can exercise maximum impact both upon the state's pregnancy rate, among females seventeen (17) years of age and under, and upon taxpayer expenditures for temporary assistance for needy families (TANF), other types of public assistance, and medicaid.

History (1)

Acts 1989, ch. 293, § 2.

Part 9 TANF — Self-Employment Project Exemption

§ 71-3-901. Purpose of part.

The purpose of this part is to invest in the self-sufficiency of temporary assistance for needy families (TANF) recipients, or successor program.

History (1)

Acts 1996, ch. 886, § 1.

§ 71-3-902. “Low-income entrepreneur” defined.

For the purpose of this part, unless the context otherwise requires, a low-income entrepreneur is one who is starting or expanding a business and who meets the eligibility criteria for receipt of temporary assistance for needy families (TANF), or successor program.

History (1)

Acts 1996, ch. 886, § 2.

§ 71-3-903. Self-employment profits not counted against public assistance benefits.

Low-income entrepreneurs will be allowed to escrow profits from their business enterprise that are not reinvested into their business into an account, which will be placed in a micro-lending intermediary program and not be counted against their public assistance benefits until they accumulate five thousand dollars ($5,000) for the period they are eligible for the temporary assistance for needy families (TANF) or successor program. Under this provision, participating entrepreneurs, who are otherwise eligible for TANF, or successor program, will not have their benefits reduced and will not lose the supplemental benefits extended to them as TANF, or successor program, recipients for the life of the escrow account as defined in this section. Participants must notify the department of human services in advance of their decision to elect this option.

Backlinks (1)

71-3-904

History (1)

Acts 1996, ch. 886, § 3.

§ 71-3-904. Reapplication for exemption.

The exemption in § 71-3-903 can be reapplied for whenever the participant is eligible for temporary assistance for needy families (TANF), or successor program.

History (1)

Acts 1996, ch. 886, § 4.

§ 71-3-905. Eligibility for exemption.

Under this section, self-employment will be considered the same as a job component, if the individual's income, divided by the minimum wage, equals at a minimum twenty (20) hours per week. To receive the self-employment exemption outlined in this part, low-income entrepreneurs must be enrolled in the job component of the temporary assistance for needy families (TANF) or successor program, and must be enrolled in a micro-lending program providing entrepreneurship training, technical assistance and peer support.

History (1)

Acts 1996, ch. 886, § 5.

§ 71-3-906. Micro-lending program.

A micro-lending program is one that provides training, technical assistance and loan funds to low-income entrepreneurs to start or expand a business venture.

History (1)

Acts 1996, ch. 886, § 6.

§ 71-3-907. Program dependent on federal waivers.

The program is dependent on the availability of appropriate waivers from the federal departments of health and human services and agriculture, for which the department of human services is authorized to make application.

History (1)

Acts 1996, ch. 886, § 7.

Part 10 Individual Development Account Demonstration Projects

§ 71-3-1001. Purpose of part.

The purpose of this part is to create an opportunity for temporary assistance for needy families (TANF), or successor program, recipients to build assets as a transition to self-sufficiency, to encourage TANF program, or successor program, recipients to secure and maintain employment and to provide the support necessary for TANF program, or successor program, recipients to make the transition from welfare to work.

History (1)

Acts 1996, ch. 989, § 1.

§ 71-3-1002. Individual development account demonstration projects.

Six (6) urban and six (6) rural communities in Tennessee, two (2) of each in each grand division, will participate in an individual development account (IDA) demonstration project.

History (1)

Acts 1996, ch. 989, § 2.

§ 71-3-1003. Individual development accounts.

In the selected communities, temporary assistance for needy families (TANF) or successor program, recipients may deposit up to five thousand dollars ($5,000) in special savings accounts for career development goals for post-secondary education of themselves or their children, small business development, home ownership purposes or transportation needs. For the period the participant is eligible for the TANF program, or successor program, the individual development account (IDA) shall not be considered when computing the asset limit of the participant when determining the participant's eligibility for the TANF program, or successor program, or food stamps, as permitted by waiver from the federal departments of health and human services and agriculture.

History (1)

Acts 1996, ch. 989, § 3.

§ 71-3-1004. Matching funds.

(a) The temporary assistance for needy families (TANF), or successor program, recipients who are not employed will not be eligible to receive matching fund donations into their individual development accounts (IDAs).
(b) For those TANF program, or successor program, recipients who secure employment while participating in this project, their IDAs may begin to be matched immediately.
(c) Matching funds may be secured from public and private funds.
(d) For the purposes of this part, public funds utilized to provide such matching funds shall not include state funds.

History (2)

Acts 1996, ch. 989, § 4
2000, ch. 894, § 1.

§ 71-3-1005. Eligibility of demonstration project participants.

To be eligible, demonstration project participants must be a member of a group that meets twice a month to make contributions into their individual development accounts (IDAs) and receive support, training and technical assistance to ensure they secure and maintain employment while building their IDA, and must notify the department of human services in advance of establishing such an account.

History (1)

Acts 1996, ch. 989, § 5.

Part 11 CoverKids Act of 2006 [Effective until June 30, 2025.]

§ 71-3-1101. Short title. [Effective until June 30, 2025.]

This part shall be known and may be cited as the “CoverKids Act of 2006.”

History (1)

Acts 2006, ch. 867, § 7.

§ 71-3-1102. Part definitions. [Effective until June 30, 2025.]

As used in this part, unless the context otherwise requires:
1. (1) “Department” means the department of finance and administration;
2. (2) “Enrollee” means an individual who is eligible and enrolled in the program;
3. (3) “Program” means any program established to provide health coverage to children pursuant to this part;
4. (4) “Tennessee medicaid program” means the federal- and state-financed, state-run program of medical assistance established pursuant to Title XIX (42 U.S.C. § 1396 et seq.), including any waivers thereof;
5. (5) “Title XIX” means Title XIX of the Social Security Act, Subchapter XIX, Chapter 7 of Title 42, United States Code (42 U.S.C. § 1396 et seq.), providing grants to states for medical assistance programs; and
6. (6) “Title XXI” means Title XXI of the Social Security Act, Subchapter XXI, Chapter 7 of Title 42, United States Code (42 U.S.C. §§ 1397aa, et seq.), establishing the State Children's Health Insurance Program.

History (1)

Acts 2006, ch. 867, § 7.

§ 71-3-1103. Purpose. [Effective until June 30, 2025.]

The purpose of this part is to create a program to provide health care coverage for uninsured children who are not eligible for health care services under any part of Tennessee's medicaid program, either pursuant to the medicaid state plan or pursuant to any medicaid waivers secured by the bureau of TennCare. It is the intent of the legislature to create and fund a program separate from the Tennessee medicaid program and Title XIX (42 U.S.C. § 1396 et seq.), and not subject to any consent decrees or judicial orders applicable to the Tennessee medicaid program.

History (1)

Acts 2006, ch. 867, § 7.

§ 71-3-1104. Department authority — Not an entitlement program — Benefits subject to appropriations. [Effective until June 30, 2025.]

The department is authorized to establish, administer, and monitor a program to provide health care coverage to uninsured children pursuant to Title XXI (42 U.S.C. § 1397aa et seq.). The department may not use money appropriated for this program to expand eligibility criteria for the Tennessee medicaid program or any other program operated under this title. The program shall not constitute an entitlement to coverage for eligible individuals, and the availability of program benefits is subject to appropriations.

History (1)

Acts 2006, ch. 867, § 7.

§ 71-3-1105. Federal approval. [Effective until June 30, 2025.]

The department is authorized to seek federal approval for the program, pursuant to Title XXI (42 U.S.C. § 1397aa et seq.), through a state plan, state plan amendment or request for federal waivers.

History (1)

Acts 2006, ch. 867, § 7.

§ 71-3-1106. Rules and regulations regarding eligibility — Cap on enrollment — Development of an option for those who are ineligible. [Effective until June 30, 2025.]

(a) The department shall adopt rules and regulations to establish eligibility criteria for the program, which shall limit eligibility to an individual who:
1. (1) Is eighteen (18) years of age or younger;
2. (2) Has a combined family income at a level to be determined by the department;
3. (3) Is not already covered by private insurance that offers creditable coverage, as defined in 42 U.S.C. § 300gg-3(c);
4. (4) Is not eligible for coverage under the Tennessee medicaid program;
5. (5) Is a United States citizen or qualified alien, as defined in 8 U.S.C. § 1641(b); and
6. (6) Is a Tennessee resident.
(b) The department may establish additional eligibility criteria as appropriate.
(c) The department may establish a cap on the number of individuals who may be enrolled in the program.
(d) The department may establish an option for individuals who do not meet eligibility criteria necessary to obtain Title XXI (42 U.S.C. § 1397aa et seq.), funding to purchase coverage through the program.

History (1)

Acts 2006, ch. 867, § 7.

§ 71-3-1107. Coverage for pregnant women regardless of age. [Effective until June 30, 2025.]

The department is authorized to provide health care coverage for pregnant women and may provide the coverage consistent with this part, except that no age-related eligibility restrictions shall apply to pregnant women.

History (1)

Acts 2006, ch. 867, § 7.

§ 71-3-1108. Program administration — Reporting and audit requirements. [Effective until June 30, 2025.]

(a) The department may administer the program directly or contract with insurance companies, managed care plans or other entities to provide services to enrollees. Payments for services to contracted entities may require the contractor to assume full or partial risk for the cost of services provided under the contract.
(b) The department may contract directly with health care providers to provide services to enrollees and establish appropriate rates of payments for services.
(c) The department may enter into contracts or interagency agreements with an outside entity or other state agency to assist in the administration of the program, including performing eligibility determinations and appeals.
(d) The department shall establish periodic reporting requirements and audit requirements for contractors. Contractors and subcontractors shall maintain complete and detailed records as specified by the department regarding the operation of the plan, and shall provide the department and the comptroller of the treasury's office with access to records under the terms defined by the department.

History (1)

Acts 2006, ch. 867, § 7.

§ 71-3-1109. Duty and authority to review and audit expenditures. [Effective until June 30, 2025.]

The commissioner of finance and administration and the comptroller of the treasury have the duty and authority to review and audit such expenditure of funds as may be made under this part. Nothing in this section shall limit the authority of the commissioner of finance and administration to ensure that program expenditures are maintained within legislative appropriations.

History (1)

Acts 2006, ch. 867, § 7.

§ 71-3-1110. Additional rules and regulations. [Effective until June 30, 2025.]

(a) The department may adopt additional rules and regulations governing the program, including, but not limited to, any rules or regulations necessary to comply with or to implement any federal requirement, federal waiver or state plan governing the program. The department is authorized to promulgate emergency rules pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. All rules and regulations governing the program shall be promulgated in accordance with the Uniform Administrative Procedures Act.
(b) The rules may include, as necessary, but need not be limited to:
1. (1) The application, enrollment and disenrollment processes for the program;
2. (2) The benefit package to be provided through the program;
3. (3) Provisions for participant cost sharing, if any, including, at the department's discretion:
  1. (A) The establishment of enrollment fees, premiums, deductibles and copayments; and
  2. (B) The process for setting the amounts of enrollment fees, premiums, deductibles, and copayments, taking into account a participant's family income;
4. (4) The type of professionals or other provider entities who may deliver services or direct the delivery of services and the qualifications required of those professionals or entities; and
5. (5) Provisions regarding the sharing of health information under this part.
(c) In adopting rules, the department shall consider the federal requirements on which the receipt of Title XXI (42 U.S.C. § 1397aa et seq.), funding is contingent and shall not establish any program criteria or requirements that will disqualify the program from that funding. Rules adopted by the department must, when appropriate, take into account the availability of appropriated funds.

History (2)

Acts 2006, ch. 867, § 7
2009, ch. 566, § 12.

§ 71-3-1111. Annual report. [Effective until June 30, 2025.]

This part shall be reviewed annually by the commerce and labor committee of the senate, the insurance committee of the house of representatives, the finance, ways and means committee of the senate and the finance, ways and means committee of the house of representatives, and these committees shall recommend necessary changes to the governor and the general assembly.

History (3)

Acts 2006, ch. 867, § 10
2013, ch. 236, § 17
2019, ch. 345, § 133.

§ 71-3-1112. [Obsolete]

§ 71-3-1113. Repealer. [Effective until June 30, 2025.]

This part shall be repealed on June 30, 2025.

History (4)

Acts 2006, ch. 867, § 14(a)
2010, ch. 872, § 6
2015, ch. 343, § 1
2020, ch. 582, § 1.

§ 71-3-1114. Email notice that enrollee must redetermine eligibility. [Effective until June 30, 2025.]

As a part of the process for redetermining an enrollee's eligibility for the program, the department shall establish a procedure that sends an email notice to the enrollee, or the parent or guardian of the enrollee, that the enrollee must redetermine eligibility for the program. The email notice is required only when the department has an email address for the enrollee or the parent or guardian of the enrollee.

History (1)

Acts 2018, ch. 943, § 1.

Part 12 Drug Testing

§ 71-3-1201. Part definitions.

For the purposes of this part:
1. (1) “Caretaker relative” means the father, mother, grandfather or grandmother of any degree, brother or sister of the whole or half-blood, stepfather, stepmother, stepbrother, stepsister, aunt or uncle of any degree, first cousin, nephew or niece, the relatives by adoption within the previously named classes of persons, and the biological relatives within the previous degrees of relationship, and the legal spouses of persons within the previously named classes of persons, even if the marriage has been terminated by death or divorce, with whom a child is living;
2. (2) “Chain of custody” means the methodology of tracking specified materials or substances for the purpose of maintaining control and accountability from initial collection to final disposition for all such materials or substances, and providing for accountability at each stage in handling, testing and storing specimens and reporting test results;
3. (3) “Confirmation test,” “confirmed test” or “confirmed drug test” means a second analytical procedure used to identify the presence of a specific drug or metabolite in a specimen, which test must be different in scientific principle from that of the initial test procedure and must be capable of providing requisite specificity, sensitivity and quantitative accuracy;
4. (4) “Drug” means marijuana, cocaine, methamphetamine, amphetamine, and opiates such as morphine. The commissioner of human services may add additional drugs by rule;
5. (5) “Drug test” or “test” means any chemical, biological or physical instrumental analysis administered by a drug testing agency authorized to do so pursuant to this part, for the purpose of determining the presence or absence of a drug or its metabolites pursuant to regulations adopted by rule by the commissioner of human services;
6. (6) “Drug testing agency” means an entity that has the required credentials as established by regulatory or certification authorities to administer tests using a person's urine, blood or DNA that will detect and validate the presence of drugs in such person's body;
7. (7) “Drug treatment program” means a service provider that provides confidential, timely and expert identification, assessment and resolution of drug or alcohol abuse problems affecting persons;
8. (8) “Five panel test” means a test for marijuana, cocaine, methamphetamine, amphetamine, and opiates such as morphine;
9. (9) “Initial drug test” means a procedure that qualifies as a “screening test” or “initial test” pursuant to regulations governing drug testing approved by rule by the commissioner of human services;
10. (10) “Legal guardian” means a person or entity that has the legal authority to provide for the care, supervision or control of a minor child as established by law or court order;
11. (11) “Protective payee” means a caretaker relative or a legal guardian of the child; provided, however, that person defined as a caretaker relative or guardian who is the applicant of TANF benefits who tests positive for the use of a drug as defined in this part shall be excepted from this definition; and
12. (12) “Specimen” means tissue, fluid or a product of the human body capable of revealing the presence of drugs or their metabolites.

History (1)

Acts 2012, ch. 1079, § 2.

§ 71-3-1202. Implementation of program of suspicion-based drug testing for applicants to TANF.

(a) The department of human services shall develop a plan to implement a program of suspicion-based drug testing for each applicant who is otherwise eligible for temporary assistance for needy families (TANF), or its successor program.
(b)
1. (1) Dependent children under eighteen (18) years of age are exempt from the drug testing requirement pursuant to this part; provided, however, that any minor parent who is an applicant for TANF benefits who does not live with a parent, legal guardian, or other adult caretaker relative must comply with the drug testing requirements of this part.
2. (2) In a two-parent household, only one (1) parent shall be required to undergo a drug test.
(c) The implementation shall occur in phases over a two-year period. The department shall report on the status of the implementation to the health and welfare committee of the senate and the health committee of the house of representatives. The status reports shall be sent to the chairs of each committee quarterly beginning October 1, 2012, during the implementation period.
(d)
1. (1) The department shall consult with substance abuse treatment experts, as determined by the commissioner of human services, and shall develop appropriate screening techniques and processes that will establish reasonable cause that an applicant for TANF is using a drug as defined by this part and that can be used to establish the necessary criteria to permit the department to require the applicant to undergo a urine-based five (5) panel drug test to be conducted by a drug testing agency.
2. (2) The applicant may inform the drug testing agency administering the test of any prescription or over-the-counter medication the person is taking. No drug for which an applicant has a current valid prescription shall be a basis for denial of TANF benefits pursuant to this part.
3. (3) Following an initial positive drug test, the applicant shall undergo a confirmation test using the same urine sample from the initial positive test prior to determination of TANF eligibility. The results of the confirmation test shall be used to determine final eligibility for TANF benefits.
(e) The department shall identify and select a screening tool such as the substance abuse subtle screening inventory (SASSI) or such other screening techniques as part of the development of the screening technique that will be employed for this program.
(f)
1. (1) The department shall develop a plan for funding of the costs of the screening process, the urine-based drug testing process, any personnel and information systems modification costs, and any other costs associated with the development and implementation of the testing process.
2. (2) The plan shall provide for funding from existing TANF or other funding available to the department, from appropriations requested by the department or from any combination of sources.
(g) The department shall develop a plan for any modification of its information systems necessary to properly track and report on the status of applicants who are screened and who must undergo testing as required by this part, including a detailed analysis of costs for systems analysis, programming and testing of modifications and implementation dates for completion of the modifications.
(h) The drug testing plan shall require, at a minimum, the following:
1. (1) That the department shall establish a referral process for any applicant who tests positive to be referred to an appropriate treatment resource for drug abuse treatment or other resource by the department for an appropriate treatment period as determined by the department. The plan shall require evidence of ongoing compliance during the treatment period. If the applicant is otherwise eligible during the treatment period, the applicant shall receive TANF benefits during the treatment period no longer than six (6) months;
2. (2) That refusal of an applicant who tests positive to enter a treatment plan or failure to complete the treatment plan shall result in ineligibility for TANF benefits for six (6) months;
3. (3) That at the conclusion of the treatment period the applicant shall be tested again using the urine-based five (5) panel drug test, and the plan shall require that upon retesting, if the applicant tests positive for the use of drugs that is validated by a confirmation test, the applicant shall be ineligible for TANF benefits for six (6) months;
4. (4) That if the person tests positive for drugs in a subsequent drug test after the six (6) months disqualification period that person shall be ineligible to receive TANF benefits for one (1) year from the date of the positive confirmation drug test;
5. (5) That if a caretaker relative is deemed ineligible for TANF benefits as a result of failing a drug test, the dependent child's eligibility for TANF benefits is not affected, and an appropriate protective payee shall be designated to receive TANF benefits on behalf of the child who is under sixteen (16) years of age.

History (2)

Acts 2012, ch. 1079, § 3
2013, ch. 236, § 60.

§ 71-3-1203. Submission of final plan and proposed rules.

The department shall submit to the health and welfare committee of the senate and the health committee of the house of representatives its final plan and proposed rules for administration of the drug testing program for TANF applicants by January 15, 2014, and shall implement the drug testing program beginning July 1, 2014, based on the plan submitted, unless otherwise directed by law.

History (2)

Acts 2012, ch. 1079, § 4
2013, ch. 236, § 60.

§ 71-3-1204. Confidentiality.

(a) All information, interviews, reports, statements, memoranda and drug test results, written or otherwise, received by the department as part of the drug testing program established by this part shall be confidential and not subject to disclosure, and may not be used or received in evidence, obtained in discovery or disclosed in any public or private proceedings, except in accordance with the administration of this part or the TANF or successor program, or in proceedings conducted pursuant to title 37 concerning the protection or permanency of children or in adjudicating any claims or actions arising from the administration of this part, unless the person tested provides written consent permitting disclosure.
(b) Information regarding drug test results for tests administered pursuant to this part shall not be released to law enforcement authorities or used in any criminal proceeding against the applicant. Information released contrary to this section is inadmissible as evidence in a criminal proceeding.
(c) This section does not prohibit the department or a drug testing agency conducting a drug test from having access to an adult applicant's drug test information or using the information when consulting with legal counsel in connection with actions brought under or related to this section, or when the information is relevant to its defense in a civil or administrative matter.
(d) This section does not prohibit the reporting of child abuse, child sexual abuse, or neglect of child pursuant to title 37, chapter 1, part 4 or 6.

History (1)

Acts 2012, ch. 1079, § 5.

§ 71-3-1205. Rules.

(a) The commissioner of human services is authorized to adopt rules, pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, necessary for the administration of this part, and shall have rulemaking authority to promulgate any rules to carry out the requirements of any title or part of any title that the department administers and that are necessary to immediately implement this part or related titles or parts.
(b) In promulgating rules, the commissioner shall consider, at a minimum:
1. (1) Testing procedures established by the United States departments of health and human services and transportation;
2. (2) Screening procedures established by substance abuse experts to determine that a person exhibits the criteria to determine that there is reasonable cause to suspect that a person is likely to use drugs as defined in this part;
3. (3) Body specimens and minimum specimen amounts that are appropriate for drug testing;
4. (4) Methods of analysis and procedures to ensure reliable drug testing results, including standards for initial tests and confirmation tests;
5. (5) Minimum cut-off detection levels for each drug or metabolites of the drug for the purposes of determining a positive test result;
6. (6) Chain-of-custody procedures to ensure proper identification, labeling and handling of specimens tested; and
7. (7) Retention, storage and transportation procedures to ensure reliable results of drug tests used in the administration of this part.

History (1)

Acts 2012, ch. 1079, § 6.

§ 71-3-1206. Confirmed positive drug test does not deem applicant handicapped or disabled.

An applicant whose drug test result is confirmed as positive in accordance with this part shall not, because of that result alone, be deemed to have a handicap or disability as defined under federal, state or local handicap and disability discrimination laws.

History (1)

Acts 2012, ch. 1079, § 7.

Chapter 4 Programs and Services for Persons With Disabilities

Part 1 Aid to the Blind

§ 71-4-101. Short title.

This part may be cited as the “Aid to the Blind Law.”

History (3)

Acts 1937, ch. 51, § 21
C. Supp. 1950, § 4765.57 (Williams, § 4765.75)
T.C.A. (orig. ed.), §§ 14-501, 14-13-101.

§ 71-4-102. Part definitions.

As used in this part, unless the context otherwise requires:
1. (1) “Assistance” means money payments made to or in behalf of blind persons in need, or medical care, or both, including hospitalization, outpatient care and treatment, nursing home care, drugs or any other type of remedial care recognized under state law in behalf of blind persons in need, but does not include subdivisions (1)(A)-(1)(D) unless the Social Security Act (42 U.S.C.), is amended to include one (1) or more of the following:
  1. (A) Any such payments to or care in behalf of any individual who is an inmate of a public institution, except as a patient in a medical institution, or any individual who is a patient in an institution for tuberculosis or mental diseases;
  2. (B) Any such payments to any individual who has been diagnosed as having tuberculosis or psychosis and is a patient in a medical institution as a result of having tuberculosis or psychosis;
  3. (C) Any such care in behalf of any individual, who is a patient in a medical institution as a result of a diagnosis that such person has tuberculosis or psychosis, with respect to any period after the individual has been a patient in such an institution as a result of such diagnosis, for forty-two (42) days; or
  4. (D) Is not an inmate of any private institution except such private institution as has been approved by the department at the time of receiving assistance;
2. (2) “Department” means the department of human services;
3. (3) “Ophthalmologist” means a physician licensed to practice medicine in this state and who is actively engaged in the treatment of diseases of the human eye;
4. (4) “Optometrist” means any person licensed to practice optometry in this state and holding a current certificate of registration;
5. (5) “Recipient” means a person who was receiving aid to the blind benefits during the month of December, 1973, and is now qualified under Public Law 93-66 to continue to receive a state money payment as a supplement to the federally provided supplemental security income benefits; and
6. (6) “Regional director” means the director of a region under chapter 1, part 1 of this title.

History (10)

Acts 1937, ch. 51, § 1
1939, ch. 166, § 1
C. Supp. 1950, § 4765.58 (Williams, § 4765.57)
Acts 1951, ch. 194, § 1
1957, ch. 117, § 21
1965, ch. 16, § 1
1973, ch. 337, § 4
1974, ch. 628, § 13
impl. am. Acts 1975, ch. 219, § 1
T.C.A. (orig. ed.), §§ 14-502, 14-13-102.

§ 71-4-103. Blindness defined.

(a) A person shall be considered “blind” for the purposes of this part whose vision, with correcting glasses, is so defective as to prevent the performance of activities for which eyesight is essential.
(b) The department shall promulgate rules and regulations stating, in terms of ophthalmic measurements, the amount of visual acuity that a recipient may have and still be eligible for assistance under this part.

History (4)

Acts 1937, ch. 51, § 2
C. Supp. 1950, § 4765.59 (Williams, § 4765.58)
Acts 1974, ch. 628, § 14
T.C.A. (orig. ed.), §§ 14-503, 14-13-103.

§ 71-4-104. Eligibility for assistance.

Assistance shall be granted under this part to any blind person who:
1. (1) Is living within this state voluntarily and not for a temporary purpose, that is, with no intention of presently removing from the state; provided, that temporary absence from the state, with subsequent returns to the state or intent to return when the purposes of the absence have been accomplished, shall not, for the purpose of this part, interrupt continuity of residence;
2. (2) Has not sufficient income or other resources to provide a reasonable subsistence compatible with decency and health, and whose spouse is not able to meet the person's needs as determined by the department's standards;
3. (3) Is not an inmate of any public institution at the time of receiving assistance, nor of any private institution at the time of receiving assistance, except such private institution as has been approved by the department. An inmate of any institution may, however, make application for such assistance;
4. (4) Within five (5) years immediately preceding application or during receipt of assistance, has not in order to evade any provision of this part made an assignment or transfer of property, the proceeds from which at the fair market value, irrespective of the actual consideration received, would under the state standards of need still be available to meet the needs of the individual. Any transfer of property to a husband, wife, son, daughter, son-in-law, daughter-in-law, brother, sister, brother-in-law, sister-in-law, nephew or niece, within the period above mentioned, shall be prima facie evidence that the transfer was made with the intent to evade the provisions of this part;
5. (5) Is not receiving at the same time old-age assistance;
6. (6) Shall not during the period of assistance refuse treatment if the examining ophthalmologist certifies that such treatment will restore, or partially restore, eyesight; or
7. (7) Was receiving aid to the blind benefits during the month of December, 1973, and is now qualified under Public Law 93-66 to continue to receive a state money payment as a supplement to the federally-provided supplemental security income benefits.

History (16)

Acts 1937, ch. 51, § 3
1939, ch. 166, § 2
1949, ch. 134, § 1
1949, ch. 171, § 1
C. Supp. 1950, § 4765.60 (Williams, § 4765.59)
Acts 1951, ch. 233, § 1
1955, ch. 32, § 1
1955, ch. 168, § 1
1957, ch. 81, § 4
1957, ch. 116, § 3
1965, ch. 16, § 2
1967, ch. 63, §§ 1, 2
1970, ch. 370, § 1
1972, ch. 506, § 3
1974, ch. 628, § 15
T.C.A. (orig. ed.), §§ 14-504, 14-13-104.

§ 71-4-105. Determination of amount of assistance.

The amount of assistance that any person shall receive in the form of supplementary payments shall be determined by an application of 212 (a) of Public Law 93-66, and rules and regulations made by the department establishing standards of need and allowable resources to the recipient's present personal and economic circumstances.

Backlinks (1)

71-3-105(d)

History (12)

Acts 1937, ch. 51, § 4
1945, ch. 186, § 1
C. Supp. 1950, § 4765.61 (Williams, § 4765.60)
Acts 1951, ch. 79, § 1
1953, ch. 9, § 1
1957, ch. 117, § 22
1961, ch. 29, § 1
1965, ch. 16, § 3
1967, ch. 63, § 3
1973, ch. 303, § 24
1974, ch. 628, § 16
T.C.A. (orig. ed.), §§ 14-505, 14-13-105.

§ 71-4-106. Duties of department.

The department shall:
1. (1) Supervise the administration of assistance to the needy blind under this part by the regional directors;
2. (2) Make such rules and regulations and take such action as may be necessary or desirable for carrying out this part. All rules and regulations made by the department shall be binding on the counties and shall be complied with by the respective regional directors;
3. (3) Establish standards for personnel employed by the department in the administration of this part and make necessary rules and regulations to maintain such standards;
4. (4) Compile and supply to the regional director such forms as it may deem necessary and advisable;
5. (5) Cooperate with the commissioner of social security, or any federal officer or agency made successor to the commissioner of social security, in any reasonable manner as may be necessary to qualify for federal aid for assistance to the needy blind and in conformity with this part, including the making of such reports in such forms and containing such information as the commissioner of social security may from time to time require, and comply with such provisions as such commissioner may from time to time find necessary to assure the correctness and verification of such reports;
6. (6) Publish an annual report and such interim reports as may be necessary;
7. (7) Designate a suitable number of ophthalmologists, duly licensed to practice medicine in Tennessee and actively engaged in the treatment of diseases of the human eye, or who are licensed, registered optometrists actively engaged in the practice of optometry in Tennessee, to examine recipients of assistance to the blind;
8. (8) Fix the fees to be paid to ophthalmologists and optometrists for such examinations, such fees to be paid out of funds allocated to the department; and
9. (9) Designate a suitable number of optometrists duly licensed to practice optometry in this state and holding a current certificate of registration to examine recipients of assistance to the blind; provided, that nothing in this part shall at any time be construed by any state or local agency as conferring upon the optometrist any rights or privileges with regard to the practice of optometry not specifically authorized under title 63, chapter 8.

History (8)

Acts 1937, ch. 51, § 5
1943, ch. 152, § 1
C. Supp. 1950, § 4765.62 (Williams, § 4765.61)
Acts 1951, ch. 194, §§ 2-6
modified
Acts 1973, ch. 303, § 25
1974, ch. 628, § 17
T.C.A. (orig. ed.), §§ 14-507, 14-13-106.

§ 71-4-107. Duties of regional directors.

The regional directors shall administer this part in the counties of their regions, subject to the rules and regulations prescribed by the department, and shall report to the department at such times and in such manner as it may direct.

History (3)

Acts 1937, ch. 51, § 6
C. Supp. 1950, § 4765.63 (Williams, § 4765.62)
T.C.A. (orig. ed.), §§ 14-508, 14-13-107.

§ 71-4-108. Appeal to department.

(a) If any award of assistance is modified or cancelled under any provision of this part, the recipient may appeal to the department in the manner and form prescribed by it.
(b) The department shall, upon receipt of such an appeal, give the recipient reasonable notice and opportunity for a hearing.

History (6)

Acts 1937, ch. 51, § 10
1945, ch. 186, § 1
C. Supp. 1950, § 4765.67 (Williams, § 4765.66)
Acts 1973, ch. 303, § 27
1974, ch. 628, § 18
T.C.A. (orig. ed.), §§ 14-514, 14-13-108.

§ 71-4-109. Finality of department decisions.

All decisions of the department shall be final and shall be binding upon the county involved and shall be complied with by the regional director or a designated agent.

History (4)

Acts 1937, ch. 51, § 10
1945, ch. 186, § 1
C. Supp. 1950, § 4765.67 (Williams, § 4765.66)
T.C.A. (orig. ed.), §§ 14-516, 14-13-109.

§ 71-4-110. Reinvestigation of awards.

(a)
1. (1) All assistance grants in the form of money payments made under this part shall be reconsidered by the regional director or a designated agent as frequently as may be required by the rules of the department.
2. (2) After such further investigation as the regional director or a designated agent may deem necessary or the department may require, the amount of assistance in the form of money payments may be changed or assistance may be entirely withdrawn if the recipient's circumstances have altered to warrant such action.
(b) A recipient shall submit to a reexamination as to eyesight when required to do so by the regional director or a designated agent or the department. Such recipient shall also furnish any information required by the regional director or a designated agent or by the department.

History (5)

Acts 1937, ch. 51, § 11
1945, ch. 186, § 1
C. Supp. 1950, § 4765.68 (Williams, § 4765.67)
Acts 1957, ch. 117, § 25
T.C.A. (orig. ed.), §§ 14-517, 14-13-110.

§ 71-4-111. Change in property or income of recipient.

(a) If, at any time during the continuance of assistance, the recipient becomes possessed of any property or income in excess of the amount stated in the application, it shall be the duty of the recipient immediately to notify the regional director or a designated agent of the receipt or possession of such property or income.
(b) The regional director or a designated agent may, after investigation, either cancel the assistance or alter the amount of the money payment in accordance with the circumstances.
(c) Any assistance paid after the recipient has come into possession of such property or income and in excess of the recipient's need as determined by the department's standards shall be recoverable in a suit by the state as a debt due to the state.

History (7)

Acts 1937, ch. 51, § 12
1945, ch. 186, § 1
C. Supp. 1950, § 4765.69 (Williams, § 4765.68)
Acts 1957, ch. 117, § 26
1961, ch. 11, § 1
1974, ch. 628, § 19
T.C.A. (orig. ed.), §§ 14-518, 14-13-111.

§ 71-4-112. Removal of recipient from county.

Any recipient who moves to another county in this state shall be entitled, with the approval of the department, to receive assistance in the county to which the recipient has moved, and the regional director or a designated agent of the county from which the recipient has moved shall transfer all necessary records relating to the recipient to the regional director or a designated agent of the county to which the recipient has moved.

History (5)

Acts 1937, ch. 51, § 14
1945, ch. 186, § 1
C. Supp. 1950, § 4765.71 (Williams, § 4765.70)
Acts 1951, ch. 162, § 1
T.C.A. (orig. ed.), §§ 14-519, 14-13-112.

§ 71-4-113. Amendment of law.

All assistance granted under this part shall be deemed to be granted and to be held subject to any amending or repealing statute that may hereafter be passed, and no recipient shall have any claim for compensation, or otherwise, by reason of the recipient's assistance being affected in any way by any amending or repealing statute.

History (3)

Acts 1937, ch. 51, § 20
C. Supp. 1950, § 4765.77 (Williams, § 4765.74)
T.C.A. (orig. ed.), §§ 14-520, 14-13-113.

§ 71-4-114. Charging for assistance to applicants.

(a) It is unlawful for any person, firm, or corporation to directly or indirectly either charge or receive anything of value for assisting any person in making application to the proper authorities of this state, or any of them, for relief or assistance under any statutes of this state providing for financial assistance to the needy blind.
(b) A violation of this section is a Class C misdemeanor.

History (5)

Acts 1937, ch. 118, § 1
1941, ch. 41, § 1
mod. C. Supp. 1950, § 4765.78 (Williams, § 4765.37)
T.C.A. (orig. ed.), §§ 14-521, 14-13-114
Acts 1989, ch. 591, § 113.

§ 71-4-115. Unlawful use of lists.

(a) Except as permitted by §§ 71-1-117 and 71-1-118, it is unlawful for any person, except for purposes directly connected with the administration of this part, to solicit, disclose, receive, make use of, authorize or knowingly permit, participate in, or acquiesce in the use of, any list or names of, or any information concerning, persons applying for or receiving aid to the blind, directly or indirectly derived from the records, papers, files, or communications of the department or divisions of the department, or indirectly derived from the records, papers, files, or communications of the department or divisions of the department, or acquired in the course of the performance of official duties.
(b) A violation of this section is a Class C misdemeanor.

History (6)

Acts 1941, ch. 148, § 1
C. Supp. 1950, § 4765.78 (Williams, § 11412.7)
impl. am. Acts 1953, ch. 29, §§ 1, 2
impl. am. Acts 1975, ch. 219, § 1 (a, b)
T.C.A. (orig. ed.), §§ 14-522, 14-13-115
Acts 1989, ch. 591, § 113.

§ 71-4-116. Fraudulent devices.

A person who knowingly obtains, or attempts to obtain, or aids, or abets any person to obtain by means of a willfully false statement or representation or by impersonation, or other fraudulent device, assistance to which such person is not entitled or assistance greater than that to which such person is justly entitled, or whoever with intent to defraud aids or abets in buying or in any way disposing of the property, either personal or real, of a recipient of assistance without the consent of the department, commits a Class E felony.

History (5)

Acts 1937, ch. 51, § 19
C. Supp. 1950, § 4765.76 (Williams, § 4765.73)
Acts 1955, ch. 23, §§ 1, 2
T.C.A. (orig. ed.), §§ 14-523, 14-13-116
Acts 1989, ch. 591, § 105.

§ 71-4-117. Assignment of benefits — Exemption.

Assistance granted under this part shall not be transferable or assignable, at law or in equity, and none of the money paid or payable under this part shall be subject to execution, levy, attachment, garnishment or other legal process, or to the operation of any bankruptcy or insolvency law.

History (4)

Acts 1937, ch. 51, § 9
1937, ch. 51, § 20-a, as added by Acts 1941, ch. 38, § 1
C. Supp. 1950, § 4765.66 (Williams, §§ 4765.65, 4765.74a)
T.C.A. (orig. ed.), §§ 14-524, 14-13-117.

§ 71-4-118. Veterans education benefits.

Notwithstanding any other provision of this chapter, to the extent permitted by federal law, the value of federal veterans education benefits received by an applicant shall not be included as any form of income when making eligibility determinations for assistance under this part.

History (1)

Acts 2003, ch. 239, § 5.

Part 2 Vocational Services to the Blind — General Provisions

§ 71-4-201. Policy of state.

It is the policy of the state to encourage and enable persons who are blind or visually impaired to participate fully in the social and economic life of this state and to engage in remunerative employment.

Backlinks (1)

66-7-104(d)

History (3)

Acts 1972, ch. 480, § 1
T.C.A., §§ 14-638, 14-14-101
Acts 2011, ch. 47, § 97.

§ 71-4-202. Employment by public agencies.

It is the further policy of this state that totally blind or partially blind persons and persons otherwise disabled shall be employed in the state service, the service of the political subdivisions of the state, in the public schools and in all other employment supported in whole or part by public funds on the same terms and conditions as the able-bodied, unless it is shown that the particular disability prevents the performance of the work involved in such employment.

Backlinks (1)

66-7-104(d)

History (2)

Acts 1972, ch. 480, § 2
T.C.A., §§ 14-639, 14-14-102.

§ 71-4-203. Division of services for the blind created.

(a) The department of human services shall create a division of services for the blind to develop measures for the prevention of blindness, the restoration of sight, and the vocational adjustment of blind persons, including employment in regular industries, independent business, workshops for the blind, or home industries, rehabilitation training and the instruction of adult blind in their homes; provided, that nothing in this section shall be construed to interfere with vending stands already located in state buildings and operated by blind persons.
(b) All state service regulations now in force and effect in other divisions of the department shall apply in carrying out this section; provided, that this subsection (b) does not apply to employees in the workshops for the blind paid on a piecework or hourly basis.

History (5)

Acts 1953, ch. 13, §§ 1, 2 (Williams, §§ 4765.3b, 4765.3c)
modified
impl. am. Acts 1975, ch. 219, § 1 (a, b)
T.C.A. (orig. ed.), §§ 14-601, 14-14-103
Acts 2012, ch. 800, § 49.

§ 71-4-204. Purchases made by the state, governing subdivisions of the state, or public institutions.

All purchases made by any agency of the state, whether or not through the purchasing division of the department of general services, or by any county, municipality, or other governing subdivision of the state, or by any public institution, shall be made from an agency of the state or a nonprofit workshop for the blind in Tennessee, operating under the approval of the department of human services and the division of services for the blind. This requirement shall not apply if these products are not available within the time period provided in § 71-4-205, or in any case where products or services are available for procurement from any agency of this state and procurement from any agency of this state is required under any provisions of any law in effect on July 1, 1977.

Backlinks (1)

71-4-703(e)

History (4)

Acts 1973, ch. 316, § 1
modified
1977, ch. 283, § 2
T.C.A., §§ 14-646, 14-14-104.

§ 71-4-205. Blind-made products — Conformity to standards — Prices.

Materials purchased from approved or state-operated workshops for the blind in Tennessee must conform to applicable federal standards and specifications for such products and be priced in accordance with prices provided by such standards. Workshops are to be given sixty (60) days from the date of receipt of the order to fill and deliver the order, in order to allow for procurement of materials and manufacture of the goods.

Backlinks (2)

History (4)

Acts 1973, ch. 316, § 1
modified
1977, ch. 283, § 3
T.C.A., §§ 14-647, 14-14-105.

Part 3 Vocational Services to the Blind — Home Industries Program

§ 71-4-301. Use of appropriation for home industries.

(a) The appropriation heretofore made by chapter 119 of the Public Acts of 1945 for the use and benefit of the department of human services shall be expended by the department for the purchase of raw materials and supplies to be used by blind persons in this state in home industries.
(b) The director of services for the blind of the department has jurisdiction, under the supervision of the commissioner of human services, of the expenditure and repayment of such funds.
(c) Despite any law to the contrary, purchases of such material by the director of services for the blind may be made without the necessity of taking bids for the purchases, advertisement for such bids or other restrictions now governing the purchases of materials generally on behalf of the state.

History (4)

Acts 1945, ch. 119, § 1
mod. C. Supp. 1950, § 4765.79 (Williams, § 4765.78)
impl. am. Acts 1975, ch. 219, § 1 (a, b)
T.C.A. (orig. ed.), §§ 14-614, 14-14-201.

§ 71-4-302. Bond of director — Liability.

(a) The director of services for the blind shall be required to execute bond for the faithful accounting for and distribution of the funds coming into the director's hands under this part. The bond shall be in such sum as may be fixed by the commissioner of human services, with the approval of the governor, the payments for the bond to be made from such revolving fund.
(b) Any person having a claim against the director for an alleged mispayment or nonpayment of the proceeds of sale under this part shall have a right of action against such director under the bond required by subsection (a).

History (4)

Acts 1945, ch. 119, § 2
C. Supp. 1950, § 4765.79 (Williams, § 4765.78)
impl. am. Acts 1975, ch. 219, § 2 (a, b)
T.C.A. (orig. ed.), §§ 14-615, 14-14-202.

§ 71-4-303. Application for purchase of materials.

(a) Any blind person desiring that materials and supplies for home industries be purchased for such person's benefit shall make application to the director of services for the blind stating the materials desired, the finished product that it is proposed to make and form, the probable cost of the finished product, and the probable sale price of the finished product to be fabricated from such materials.
(b) Each such application shall likewise contain an express covenant on the part of such person to repay to the fund the amount furnished by it for the purchase of materials and supplies for the person's benefit, and also shall contain an express covenant on the person's part to deliver to the director all the finished products so made from such materials or so much of such materials and supplies furnished and not used.

History (3)

Acts 1945, ch. 119, § 2
C. Supp. 1950, § 4765.79 (Williams, § 4765.78)
T.C.A. (orig. ed.), §§ 14-616, 14-14-203.

§ 71-4-304. Denial of application for materials.

The director of services for the blind may, at the director's discretion, decline to purchase material and supplies for any blind person under this part, whenever and if information available to such director indicates that there is a probability that the amount of such purchase will not be repaid to the state, that the blind person in question possesses sufficient financial ability to purchase such raw materials, that through intermingling of goods the raw materials and supplies purchased with advances from this fund or the finished product may not be satisfactorily identified to such an extent that a contract repayment may be enforced by identifying the finished product.

History (3)

Acts 1945, ch. 119, § 2
C. Supp. 1950, § 4765.79 (Williams, § 4765.78)
T.C.A. (orig. ed.), §§ 14-617, 14-14-204.

§ 71-4-305. Sale of products — Distribution of proceeds.

(a) All finished products made from raw material and supplies purchased with the proceeds of advances under this part shall be detailed to the director of services for the blind at such times and places as the director may designate.
(b) Upon receipt of such finished articles, the director, with the approval of the commissioner, shall proceed to sell them in such manner and in such method, either singly or collectively, as will net the highest price. In case of a collective sale, the proceeds shall be ratably apportioned, when several blind persons contributed finished products, in proportion to the amount of such finished products made by each.
(c) Out of the proceeds of the sale of any finished product made by any blind person, the director of services for the blind shall repay to the revolving fund the amount of the advances made from it to the maker of such finished products and shall pay the remainder of the proceeds of such sale to such blind person.
(d) The director shall not be permitted to make or deduct any charges for the director's services in negotiating such sale.

History (3)

Acts 1945, ch. 119, § 2
C. Supp. 1950, § 4765.79 (Williams, § 4765.78)
T.C.A. (orig. ed.), §§ 14-618, 14-14-205.

Part 4 Vocational Services to the Blind — Business Enterprise Program

§ 71-4-401. Program established — Purpose.

(a) The vocational rehabilitation service of the department of human services is authorized to establish and supervise a business enterprise program for the blind.
(b) The purpose of this program shall be to promote the vocational rehabilitation of blind individuals and to assist them in becoming self-supporting.

History (5)

Acts 1949, ch. 99, § 1
C. Supp. 1950, § 4765.92 (Williams, § 4765.78a)
impl. am. Acts 1975, ch. 219, § 1 (a, b)
T.C.A. (orig. ed.), §§ 14-619, 14-14-301
Acts 1994, ch. 723, § 1.

§ 71-4-402. [Reserved.]

§ 71-4-403. Purchase of materials without formal procedures.

(a) Notwithstanding another law, and except as provided in subsection (b), the commissioner of human services or the commissioner's designee may make purchases of materials, services, equipment, stock, and merchandise for use in a business enterprise program for the blind without the necessity of taking bids for the purchases, advertising bids for such purchases, or complying with other restrictions governing the purchase of goods and services generally on behalf of this state.
(b) Subsection (a) does not apply to the purchase of software for use in inmate commissary facilities.

History (4)

Acts 1949, ch. 99, § 3
C. Supp. 1950, § 4765.92 (Williams, § 4765.78c)
T.C.A. (orig. ed.), §§ 14-621, 14-14-303
Acts 2024, ch. 609, § 1.

§ 71-4-404. Certification of disbursements and repayments.

Disbursements from and repayments to the revolving fund shall be made on the certification of the director of services for the blind.

History (4)

Acts 1949, ch. 99, § 4
C. Supp. 1950, § 4765.92 (Williams, § 4765.78d)
impl. am. Acts 1975, ch. 219, § 1 (a, b)
T.C.A. (orig. ed.), §§ 14-622, 14-14-304.

§ 71-4-405. Rules governing disbursements — Liability for losses.

Disbursements from the revolving fund shall be made in accordance with rules and regulations recommended by the director approved by the commissioner; provided, that the director shall not be accountable for losses incurred in the making and obtaining of repayment of such advance except for losses due to the director's willful misconduct.

History (3)

Acts 1949, ch. 99, § 5
C. Supp. 1950, § 4765.92 (Williams, § 4765.78e)
T.C.A. (orig. ed.), §§ 14-623, 14-14-305.

Part 5 Vocational Services to the Blind — Vending Stands

§ 71-4-501. Legislative intent — Construction.

It is the intent of the general assembly to grant to blind individuals a priority in the establishment and operation of vending facilities on public property in this state. To that end, this part shall be liberally construed to give the blind individuals who are eligible for such priority the greatest possible opportunities to operate such vending facilities so that they may become self-supporting.

Backlinks (1)

68-14-713(e)

History (1)

Acts 1994, ch. 723, § 2.

§ 71-4-502. Part definitions.

As used in this part, unless the context otherwise requires:
1. (1) “Blind individual” means any person who meets the requirements for services through the business enterprise program for the blind under part 4 of this chapter and who has been trained and licensed by the department to operate a vending facility under the program's requirements;
2. (2) “Department” means the department of human services or its successor that has been designated under the Randolph-Sheppard Act (20 U.S.C. §§ 107-107f), as the state licensing agency;
3. (3) “Priority” means the right of the department to establish on any public property a vending facility to be operated by a blind individual. This priority means that when the department has surveyed a public property and determined that such property is suitable for the location of a vending facility, it shall have the right of first refusal and the exclusive right to the operation of any and all vending facilities on any public property that it determines are capable of being operated by a blind individual that it licenses, or by an individual who may be operating the facility as a temporary manager until a licensed blind individual can assume the operation of the vending facility. Except as provided in subdivision (4) and §§ 71-4-504 — 71-4-506, the priority shall apply to all existing, altered, or new buildings, facilities, or grounds. This priority shall be exercised exclusively by the department in its sole discretion on behalf of legally blind individuals who are qualified and licensed as vending facility managers by the department and who are deemed capable of providing the type of service required by the management of the public property;
4. (4) “Public property” means all property owned or leased by the state of Tennessee, any county, municipality, or any other entity that is created by act of the general assembly to perform any public function; provided, that primary and secondary schools, and entities created under title 42, and their operations, are specially excluded from this definition; and provided further, that institutions that are governed by the University of Tennessee system or the state university and community college system and their operations are also specifically excluded from this definition, except that the vending facilities presently in operation at such institutions on April 29, 1996, shall continue to operate at their present locations or, if necessary, at a location comparable in terms of potential patronage, with the priority established by this part. Moreover, the existing priority shall extend to any new structures on any of the campuses governed by the University of Tennessee or the state university and community college system and the priority shall also extend to the establishment of at least one (1) vending facility on any new campus that is developed either by the University of Tennessee system or the state university and community college system. Nothing in this part shall limit the ability of an institution that is governed by the University of Tennessee or the state university and community college system to contract for food services (cafeterias, restaurants, food courts and catering services) in new buildings or on new campuses; provided, that a site suitable to the institution, after consultation with the department, is also made available for a blind vendor to manage and operate automated vending machines and/or a counter service as jointly agreed to by the institution and department in the new building or on the new campus; and
5. (5) “Vending facility” means a location or structure or space that may sell foods, beverages, confections, newspapers, periodicals, tobacco products, and other articles and services that are dispensed automatically by a machine or manually by sales personnel or attendants and that may be prepared on or off the premises in accordance with applicable health laws. A “vending facility” may consist, exclusively or in appropriate combination as determined by the department, of automatic vending machines, cafeterias, snack bars, catering services, food concession vehicles, cart services, shelters, counters, and any appropriate equipment necessary for the sale of articles or services described in this subdivision (5). A “vending facility” may encompass more than one (1) building on a public property.

History (3)

Acts 1994, ch. 723, § 2
1996, ch. 829, § 1
2012, ch. 976, § 1.

§ 71-4-503. Vending facilities on public property — Priority — Establishment.

(a) Whenever any new buildings or other facilities are to be constructed by the state or on any other public property or when any existing contracts expire or are changed in any way, the department shall be notified and it shall promptly make an investigation and survey of the public property to determine if, in its judgment, the location is suitable for one (1) or more vending facilities. If, in the department's judgment, the location is suitable for a vending facility, the department may exercise its priority to establish such a vending facility.
(b) If the department exercises the priority under this part, it shall have the right to establish such a vending facility, and it shall provide the necessary alterations, plumbing and electrical services, the necessary equipment, merchandise, a licensed or temporary manager, and the appropriate supervision of the manager. The public property management shall cooperate with the department in whatever manner necessary in order for it to carry out this part. The space for the vending facilities and utilities shall be provided at no cost; provided, that the cost of telephone service shall not be the responsibility of the public property management. In cafeteria operations, the licensed or temporary manager may be required to pay a percentage of sales to the public property management in accordance with agreements negotiated between the department and the public property management.

Backlinks (5)

History (1)

Acts 1994, ch. 723, § 2.

§ 71-4-504. Vending machines in lieu of on-site manager.

(a) If, after conducting a survey, the department determines that there is not sufficient population to support an on-site manager but the public property management desires vending machine services, the department shall have the right to place vending machines on the property and to make the necessary arrangements to ensure that vending machine services are provided and that the vending machines are properly maintained.
(b) The income generated from the vending machines placed under the provisions of this section shall accrue to the unassigned funds held by the department for its blind vendors.

Backlinks (1)

71-4-502(3)

History (1)

Acts 1994, ch. 723, § 2.

§ 71-4-505. Cafeterias.

(a) The priority established by this part applies to cafeterias, as defined by the department, as limited by this section.
(b) If a new cafeteria is to be constructed on public property or any existing cafeteria contracts on public properties expire, or both, the department shall receive notification pursuant to § 71-4-503 and shall be afforded the opportunity to submit a proposal for the operation of the proposed cafeteria. If the department's proposal, when considered with all other proposals, is found to be competitive in terms of quality of service, pricing of merchandise, and the rate of commission or the rental to be paid, then a priority shall be granted to the department and the cafeteria operation shall be awarded to the department. The department's proposal will not be considered competitive if its proposed payment of annual commissions, rental fees, or a combination of annual commission and rental fees, is not within two percent (2%) of that submitted by an organization that would otherwise be awarded the cafeteria operation. Nothing in this section shall be construed to allow the property management to take any action regarding an existing facility to defeat an already existing priority.
(c) If the department's proposal is rejected and there is disagreement as to whether the department's proposal is competitive, the dispute shall be resolved in accordance with § 71-4-507.

History (1)

Acts 1994, ch. 723, § 2.

§ 71-4-506. Effect of part.

Nothing in this part shall supersede any cooperative agreements that are in effect between the department and public property management on July 1, 1994, regarding the current operation of vending facilities on public properties, nor shall anything in this part preclude the department from entering into future agreements that may be less restrictive than this part, if, in the department's judgment, such agreements are in the best interest of the program.

Backlinks (1)

71-4-502(3)

History (1)

Acts 1994, ch. 723, § 2.

§ 71-4-507. Dispute resolution.

(a) Except as stated in subsection (b), if a dispute arises between the management of public property and the department concerning any matter contained in this part, then either party may file a complaint setting forth the dispute with the secretary of state. Within ten (10) days of the filing of the complaint, the secretary of state shall appoint an administrative law judge from the administrative procedures division of the secretary of state's office who shall set an administrative hearing to be held under the Uniform Administrative Procedure Act, compiled in title 4, chapter 5, part 3, within thirty (30) days of the appointment, unless for good cause shown a later time is deemed necessary. Notwithstanding other provisions of the law to the contrary, the secretary of state or the secretary of state's designee has the authority to render a final order following entry of an initial order by the administrative law judge. Such order shall be appealable as provided by § 4-5-322.
(b) The secretary of state shall be without jurisdiction to hear any complaint concerning the qualifications or status of a licensed or temporary manager who is operating under a license or agreement of the department, and shall be without jurisdiction to hear or establish any damage award for or against any person, any officer or employee of the state, or any public property's governing body or its officers or employees.
(c) The case may be heard and decided entirely upon stipulations and briefs of all parties without the presentation of oral or other written evidence, it being the intent of the general assembly to allow for an early resolution to the disputes arising under this part.

Backlinks (1)

71-4-505(c)

History (1)

Acts 1994, ch. 723, § 2.

§ 71-4-508. Administrative review or evidentiary hearing.

(a) The department has exclusive jurisdiction to provide an opportunity for an administrative review or evidentiary hearing to a blind individual under this part who is dissatisfied with any action arising from the operation or administration of the vending facility program.
(b) The aggrieved blind individual licensed by the department shall submit a written request to the director of services for the blind for an administrative review or a full evidentiary hearing pursuant to the rules and regulations promulgated by the department, which shall be provided by the department to the blind individual. If the blind individual is dissatisfied with any action taken or decision rendered as a result of such hearing, that individual may file a complaint with the United States secretary of education for an arbitration hearing as provided by federal law and regulations.
(c) Nothing in this part shall be construed as a waiver of the state's sovereign immunity under the Eleventh Amendment of the Constitution of the United States or under the Constitution of Tennessee.

History (1)

Acts 1994, ch. 723, § 2.

§ 71-4-509. Proceeds set aside for blind vendors.

(a) After considering the recommendation from the committee of blind vendors, the department shall set aside or cause to be set aside a percentage of the net proceeds of the vending facilities in a reasonable amount not to exceed fifteen percent (15%) of their net income and pursuant to a schedule approved by the United States secretary of education. Such funds shall be expended on behalf of blind vendors only for purposes specified by regulations promulgated in accordance with the Randolph-Sheppard Act (20 U.S.C. §§ 107-107f).
(b) All funds set aside pursuant to subsection (a) and funds in the account for unassigned funds established for the blind vendors program, and all other revenue, except funds appropriated by the state or matching federal funds, shall be invested by the state treasurer pursuant to § 9-4-603, for the benefit of those funds.

History (1)

Acts 1994, ch. 723, § 2.

Part 6 Vocational Rehabilitation of the Blind

§ 71-4-601. Short title.

This part may be cited as the “Vocational Rehabilitation of the Blind Law.”

History (2)

Acts 1955, ch. 243, § 1
T.C.A., §§ 14-625, 14-14-401.

§ 71-4-602. Part definitions.

As used in this part, unless the context otherwise requires:
1. (1) “Blind individual” means any person whose visual acuity with maximum correction does not exceed 20/200 in the better eye, except that in those instances in which the visual acuity exceeds 20/200 but is accompanied by a limitation in the fields of vision such that the widest diameter of the visual field subtends an angle no greater than 20 degrees (20°), visual acuity is not a factor limiting eligibility. Those clients with serious eye disabilities not covered by this subdivision (1) will be accepted for services when referred to the division by the division of vocational rehabilitation, in the department of education; provided, that such referrals are supported by appropriate justification, and that the client is otherwise eligible. Likewise, when it is determined through careful evaluation of all factors that a client who is eligible under this subdivision (1) for services of the division can more adequately be served by the division of vocational rehabilitation, such client will be referred to that agency for services and will be accepted; provided, that the referral is justified by supporting evidence and the client is otherwise eligible for the services of that agency;
2. (2) “Blind individual with an employment barrier” means a person who is blind, and whose blindness constitutes a substantial barrier to employment;
3. (3) “Commissioner” means the commissioner of human services;
4. (4) “Department” means the department of human services;
5. (5) “Director” means the director of the division of services for the blind;
6. (6) “Division” means the division of services for the blind in the department of human services;
7. (7) “Eligible individual with employment barriers” when used with respect to diagnostic and related services, training guidance and placement, means any blind individual with a disability who is a citizen of this state, whose vocational rehabilitation is determined feasible by the division of vocational rehabilitation, and when used with respect to other vocational rehabilitation services, means an individual meeting the requirements of this subdivision (7) who is also found by the division to require financial assistance with respect to vocational rehabilitation services, after full consideration of the person's eligibility for any similar benefit by the way of pension, compensation and insurance;
8. (8) “Establishment of a workshop or rehabilitation facility” means:
  1. (A) In the case of a workshop, the construction of a new building or the expansion, remodeling, or alteration of existing buildings, necessary to adapt such buildings to workshop purposes or to increase the employment opportunities in workshops, and the acquisition of initial equipment necessary for new workshops or to increase the employment opportunities in workshops; and
  2. (B) In the case of a rehabilitation facility, the construction of a new building or the expansion, remodeling, or alteration of existing buildings, and initial equipment of such buildings, necessary to adapt such buildings to rehabilitation facility purposes or to increase their effectiveness for such purposes and initial staffing;
9. (9) “Maintenance” means the provision of money on behalf of a blind individual with employment barriers to cover the necessary living expenses, and health and maintenance essential to achieving the individual's vocational rehabilitation;
10. (10) “Nonprofit,” when used with respect to a rehabilitation facility or a workshop, means a rehabilitation facility and a workshop, respectively, owned and operated by a corporation or association, no part of the net earnings of which inures, or may lawfully inure, to the benefit of any private shareholder or individual and the income of which is exempt from taxation under § 101(6) of the Internal Revenue Code (26 U.S.C. § 101(6));
11. (11) “Physical restoration” includes:
  1. (A) Corrective surgery or therapeutic treatment necessary to correct or substantially modify a physical or mental condition that is stable or slowly progressive and that constitutes a substantial barrier to employment, or that necessitates institutional care or attendant care, but that is of such a nature that such correction or modification may reasonably be expected to eliminate or substantially reduce such barrier within a reasonable length of time, and includes psychiatric treatment, dentistry, physical therapy, occupational therapy, speech or hearing therapy, treatment of medical complications and emergencies that are associated with or arise out of physical restoration services or are inherent in the conditions under treatment, and other medical services related to rehabilitation;
  2. (B) Necessary hospitalization, either inpatient or outpatient, nursing or rest home care, in connection with surgery or treatment specified in subdivision (11)(A);
  3. (C) Prosthetic devices essential to obtaining or retaining employment, or to achieving such ability of independent living as to dispense with the need for expensive institutional care or dispense with or largely dispense with the need of an attendant at home;
12. (12) “Prosthetic appliance” means any appliance designed to support or take the place of a part of the body, or to increase the acuity of a sensory organ;
13. (13) “Rehabilitation facility” means a facility operated for the primary purpose of assisting in the rehabilitation of physically handicapped individuals:
  1. (A) That provides one (1) or more of the following types of services:
    1. (i) Testing, fitting, or training in the use of prosthetic devices;
    2. (ii) Prevocational or conditioning therapy;
    3. (iii) Physical or occupational therapy;
    4. (iv) Adjustment training; or
    5. (v) Evaluation or control of special disabilities; or
  2. (B) Through which is provided an integrated program of medical, psychological, social, and vocational evaluation and services under competent professional supervision;
14. (14) “Remunerative occupation” includes employment as an employee or self-employed, practice of a profession, homemaking or farm and family work for which payment is in kind rather than cash, sheltered employment, and home industry or other homebound work of a remunerative nature;
15. (15) “Vocational rehabilitation” means making an individual able, or increasing an individual's ability to:
  1. (A) Engage in a remunerative occupation; or
  2. (B) Dispense with or largely dispense with the need of an attendant at home or expensive institutional care, through providing the individual needed vocational rehabilitation services;
16. (16) “Vocational rehabilitation services” means:
  1. (A) Diagnostic and related services, including transportation, incidental to the determination of whether an individual is a blind individual with employment barriers, and if so, the individual's eligibility for, and the nature and scope of other vocational rehabilitation services to be provided; and
  2. (B) The following services provided eligible blind individuals with employment barriers needing such services:
    1. (i) Training;
    2. (ii) Guidance;
    3. (iii) Placement;
    4. (iv) Maintenance, not exceeding the estimated costs of subsistence during vocational rehabilitation;
    5. (v) Occupational licenses, tools, equipment, initial stocks, including livestock, and supplies, including equipment and initial stocks and supplies for vending stands, books, and training materials to any or all of which the state may retain title;
    6. (vi) Transportation, other than provided as diagnostic and related services; and
    7. (vii) Physical restoration; and
17. (17) “Workshop” means a place where any manufacture or handiwork is carried on and that is operated for the primary purpose of providing remunerative employment to individuals with severe disabilities who cannot be readily absorbed in the competitive labor market.

History (7)

Acts 1955, ch. 243, § 3
1957, ch. 79, § 1
1959, ch. 174, § 1
impl. am. Acts 1975, ch. 219, §§ 1 (a, b), 2 (a, b)
Acts 1977, ch. 19, § 1
T.C.A., §§ 14-626, 14-14-402
Acts 2011, ch. 47, §§ 98-103.

§ 71-4-603. Declaration of policy — Plan.

(a) It is hereby declared to be the policy of this state to provide rehabilitation services, to the extent needed and feasible, to eligible blind individuals with employment barriers throughout the state to the end that they may engage in useful and remunerative occupations to the extent of their capabilities, thereby increasing their social and economic well-being and that of their families, and the productive capacity of this state and of the nation, and also thereby reducing the burden of dependency on families and taxpayers.
(b) Pursuant to such policy, the vocational rehabilitation services shall be provided under this part to blind citizens throughout the state, and the vocational rehabilitation plan adopted pursuant to this part shall be in effect in all political subdivisions of the state.

History (3)

Acts 1955, ch. 243, § 2
T.C.A., §§ 14-627, 14-14-403
Acts 2011, ch. 47, § 104.

§ 71-4-604. Creation of division of vocational rehabilitation of the blind — Director — Appointment — Regulations and state plan.

(a)
1. (1) The division of vocational rehabilitation of the blind, called “the division” in this part, and the office of director of rehabilitation of the blind, the incumbent of which is called the “director,” in this part are hereby established in the department of human services.
2. (2) The director shall be appointed, in accordance with established personnel standards, on the basis of training, experience and demonstrated ability in the field of vocational rehabilitation, or related fields, with the approval of the commissioner, and shall be the head of the division.
(b) Except as may be otherwise provided with respect to the blind, the division shall be the sole state agency to supervise and administer vocational rehabilitation services authorized by this part, under the state plan formulated and administered pursuant to this part, except such part or parts of the vocational rehabilitation services as may be administered in a political subdivision or subdivision of this state by a sole local agency of the subdivision, and the division shall be the sole agency to supervise such local agency or agencies in the administration of such part or parts of the vocational rehabilitation services.
(c) The director shall prepare, conformable to this part, the proposed regulations and a proposed state plan of vocational rehabilitation, and from time to time prepare such proposed changes as shall appear to be necessary or desirable. Upon approval of the proposed regulations and proposed state plan by the commissioner, such approved proposals shall constitute the state regulations and state plan.

History (4)

Acts 1955, ch. 243, § 4
1972, ch. 506, § 4
impl. am. Acts 1975, ch. 219, § 1 (a, b)
T.C.A., §§ 14-628, 14-14-404.

§ 71-4-605. Types of services — Workshops — Federal funds — Gifts.

(a) All rehabilitation services, as defined in this part, may be provided under this part to eligible blind handicapped individuals, and in any event, such services shall include training, maintenance, placement, guidance and physical restoration services.
(b) Within such limits and under such conditions as may be specified in appropriations for rehabilitation facilities and workshops for the blind, the department may establish rehabilitation facilities and workshops for the blind.
(c)
1. (1) Appropriations, federal grants and donations for vocational rehabilitation services for the blind, unless otherwise restricted, shall be available for all vocational rehabilitation services for the blind provided under the state plan for the blind, and for the acquisition of vending stands or other equipment and initial stocks, including livestock, and supplies for use by blind individuals in any type of small business, the operation of which will be improved through management and supervision by the division.
2. (2) State appropriations and donations for vocational rehabilitation of the blind shall likewise be available for the purpose, whenever federal funds are made available to the state under § 3 of the federal vocational rehabilitation of the blind amendments of 1954, for initiating projects for the extension and improvement of vocational rehabilitation services for the blind, or under § 4 of such act for projects for research, demonstrations, training and traineeships, and for planning for an initiating expansion of vocational rehabilitation services for the blind under the state plan for the blind.
3. (3) The general assembly shall appropriate for vocational rehabilitation of the blind such sums as are necessary, along with available federal and other funds, to carry out the purposes of this part. The acceptance of such federal and other funds, and their use for vocational rehabilitation of the blind, subject to such restrictions as may be imposed by the donor and are not inconsistent with this part, is hereby authorized.
(d) The state treasurer is hereby designated as the custodian of all funds received from the federal government for the purpose of carrying out any federal statutes pertaining to the vocational rehabilitation of the blind.
(e) The director is hereby authorized and empowered with the approval of the commissioner to accept and use gifts made unconditionally by will or otherwise for carrying out the purposes of this part. Gifts made under such conditions, as in the judgment of the commissioner are proper and consistent with this part, may be so accepted and shall be held, invested, reinvested, and used in accordance with the conditions of the gift.

History (3)

Acts 1955, ch. 243, § 5
impl. am. Acts 1975, ch. 219, § 1 (a, b)
T.C.A., §§ 14-629, 14-14-405.

§ 71-4-606. Federal employees included.

Rehabilitation services provided under the state plan for the blind shall be available to any blind civil employee of the United States disabled while in the performance of the blind civil employee's duty, on the same terms and conditions as apply to other persons.

History (2)

Acts 1955, ch. 243, § 6
T.C.A., §§ 14-630, 14-14-406.

§ 71-4-607. Administration — Personnel — Rules and regulations.

(a) The department is hereby authorized to adopt and promulgate rules and regulations with respect to methods of administration, use of medical and other records of individuals who have been provided vocational rehabilitation services for the blind, and the establishment and maintenance of personnel standards, including provisions relating to the tenure, appointment and qualification of personnel, which shall govern with respect to such matters notwithstanding any other law; provided, that such activities must conform with any applicable rules and regulations of the department of human resources.
(b) The department of human services is also authorized and directed to adopt and promulgate rules and regulations respecting:
1. (1) The establishment and maintenance of minimum standards governing the facilities and personnel utilized in the provision of vocational rehabilitation services for the blind; and
2. (2) The order to be followed in selecting those to whom vocational rehabilitation services are to be provided in situations where such services cannot be provided to all eligible blind people.

History (5)

Acts 1955, ch. 243, § 7
impl. am. Acts 1959, ch. 9, § 4
impl. am. Acts 1961, ch. 97, § 4
impl. am. Acts 1975, ch. 219, § 1 (a, b)
T.C.A., §§ 14-631, 14-14-407.

§ 71-4-608. Cooperation and utilization of other agencies.

Pursuant to the general policies of the department, the director and the division are authorized to:
1. (1) Cooperate with and utilize the services of the state agency or agencies administering the state's public assistance program, the federal bureau of old-age and survivors insurance under the United States department of health and human services, and other federal, state and local public agencies providing services relating to vocational rehabilitation, and with the state system of public employment offices in the state, and shall make maximum feasible utilization of the job placement and employment counseling services and other services and facilities of such offices;
2. (2) Cooperate with political subdivisions, other public and nonprofit organizations and agencies, in their establishment of workshops and rehabilitation facilities, and, to the extent feasible in providing vocational rehabilitation services, shall utilize all such facilities meeting the standards established by the department;
3. (3) Enter into contractual arrangements with the federal bureau of old-age and survivors insurance under the United States department of health and human services, with respect to certifications of disability and performance of other services, and with other authorized public agencies for performance of services related to vocational rehabilitation, for such agencies;
4. (4) Contract with schools, hospitals, and other agencies, and with doctors, nurses, technicians and other persons, for training, physical restoration, transportation, and other vocational rehabilitation services; and
5. (5)
  1. (A) Contract with a nonprofit organization or organizations for the management and operation of workshops for the blind located at Nashville and Memphis and, in fulfillment of the terms of such contract or contracts, lease the present workshop facilities to the organization or organizations for the period of time as specified in the contract; provided, that any contract entered into for this purpose shall not be effective until approved by the governor, attorney general and reporter, and comptroller of the treasury. Such contract shall also be governed by former § 12-4-109 [See the Compiler’s Notes] and the regulations promulgated pursuant to former § 12-4-109. A contractor that manages and operates a workshop under this subdivision (5) shall not be bound by enactments of the general assembly that govern:
    1. (i) The administration of personnel, including title 8, chapter 30;
    2. (ii) The purchase of goods and services, including title 12, chapter 3 [see the Compiler’s Notes] and former §§ 12-4-109 and 12-4-110 [see the Compiler's Notes]; and
    3. (iii) The administration, disposition, and inventory of property and surplus property, including title 12, chapter 2 and § 4-3-1105.
  2. (B) However, a contractor may purchase, inventory, and dispose of goods, property, and surplus property under these laws, with the approval of and under conditions set by the procurement commission. The department of general services may, upon request, purchase supplies and equipment for a contractor to manage and operate a facility. The purchases shall be made on the same terms and rules that govern the purchase of supplies and equipment by such department. The contractor shall pay for all such purchases. Any contractor operating a workshop under this subdivision (5) shall pay the minimum wage, unless a certificate of exemption is granted under the federal Fair Labor Standards Act of 1938 (29 U.S.C. § 201 et seq.), as amended, and shall also comply with all other state and federal laws applying to employment in the private sector.

Backlinks (2)

History (6)

Acts 1955, ch. 243, § 8
impl. am. Acts 1975, ch. 219, § 1 (a, b)
T.C.A., § 14-632
Acts 1982, ch. 863, § 2
T.C.A., § 14-14-408
Acts 2011, ch. 295, § 19.

§ 71-4-609. Maintenance not transferable — Exempt from creditors.

The right of a blind individual to maintenance under this part shall not be transferable or assignable at law or in equity, and shall be exempt from the claims of creditors.

History (2)

Acts 1955, ch. 243, § 9
T.C.A., §§ 14-633, 14-14-409.

§ 71-4-610. Hearing on grievances.

Any blind individual applying for or receiving vocational rehabilitation who is aggrieved by any action of the vocational rehabilitation service for the blind shall be entitled in accordance with regulations promulgated by the commissioner to a fair hearing, and the decision so made after such hearing shall be final.

History (2)

Acts 1955, ch. 243, § 10
T.C.A., §§ 14-634, 14-14-410.

§ 71-4-611. Illegal use of lists — Penalty.

(a) It is unlawful, except for purposes directly connected with the administration of the vocational rehabilitation program, and in accordance with regulations, for any person or persons to solicit, disclose, receive, or make use of, or authorize, knowingly permit, participate in, or acquiesce in the use of any list of, or names of, or any information concerning persons applying for or receiving vocational rehabilitation, directly or indirectly derived from the records, papers, files, or communications of the state or subdivisions or agencies of the state, or acquired in the course of the performance of official duties.
(b) A violation of this section is a Class C misdemeanor.

History (3)

Acts 1955, ch. 243, § 11
T.C.A., §§ 14-635, 14-14-411
Acts 1989, ch. 591, § 113.

§ 71-4-612. Veterans education benefits.

Notwithstanding any other provision of this chapter, to the extent permitted by federal law, the value of federal veterans education benefits received by an applicant shall not be included as any form of income when making eligibility determinations for assistance under this part.

History (1)

Acts 2003, ch. 239, § 4.

Part 7 Purchase of Goods and Services from Persons with Disabilities

§ 71-4-701. Purpose — Applicability.

(a) The purpose of this part is to further the policy of the state to encourage and assist individuals with severe disabilities to achieve maximum personal independence through useful, productive, and gainful employment by assuring expanded competitive integrated employment opportunities, thereby enhancing their dignity and capacity for self-support and realizing independence and self-sufficiency.
(b) This part applies to all governmental entities that are supported in whole or in part by the general assembly.

History (3)

Acts 1991, ch. 499, § 1
1996, ch. 827, § 1
2020, ch. 782, § 1.

§ 71-4-702. Part definitions.

As used in this part:
1. (1) “Central nonprofit agency” means the agency designated by the committee to facilitate, by subcontract or other means, the fulfillment of orders from governmental entities for commodities and services and to assist the committee in administering the program described under this part;
2. (2) “Certified commodities or services” means:
  1. (A) Commodities and services that have been recommended by the central nonprofit agency as suitable for procurement by any state governmental entity or as suitable for statewide contracts and that are certified pursuant to procedures approved by the state procurement commission as to quality, availability, and fair market price; and
  2. (B) Commodities and services that have been recommended by the central nonprofit agency as suitable for procurement by political subdivisions and that are certified by the chief financial officer of the political subdivisions as to quality, availability, and fair market price;
3. (3) “Committee” means the advisory committee for providing competitive integrated employment for individuals with severe disabilities, created by § 71-4-703;
4. (4) “Competitive integrated employment” means employment available to individuals with severe disabilities or a customized employment available to individuals with severe disabilities, at a setting typically found in the community, at minimum wage or greater with the same benefits as nondisabled employees receive, in which eligible individuals interact with nondisabled individuals, other than nondisabled individuals who are providing services to those eligible individuals, to the same extent that nondisabled individuals in comparable positions interact with other persons;
5. (5) “Governmental entity” means a state governmental entity or a political subdivision;
6. (6) “Individuals with severe disabilities” means individuals who have a physical or mental impairment that substantially limits major life activities;
7. (7) “Political subdivision” means any local governmental entity, including, but not limited to, any city, town, municipality, metropolitan government, county, utility district, school district, public building authority, housing authority, emergency communications district, and development district created and existing pursuant to the laws of this state, or any instrumentality of government created by any one (1) or more local governmental entities;
8. (8) “Production of commodities” means packaging, assembly, distribution, or other manufacturing processes; and
9. (9) “State governmental entity” means any agency, authority, board, commission, department, or office within the executive, legislative, or judicial branches of state government, or any autonomous state agency, authority, board, commission, council, department, office, or institution of higher education.

History (6)

Acts 1991, ch. 499, § 1
1996, ch. 827, §§ 2-6, 13
2002, ch. 526, § 7
2011, ch. 295, §§ 16, 19
2014, ch. 739, § 1
2020, ch. 782, § 1.

§ 71-4-703. Advisory committee — Responsibilities — Purchasing requirements for governmental entities — Applicability of part.

(a)
1. (1) There is created the committee for providing competitive integrated employment for individuals with severe disabilities, and composed of the following:
  1. (A) The commissioner of general services or the commissioner's designee;
  2. (B) The commissioner of finance and administration or the commissioner's designee;
  3. (C) The commissioner of human services or the commissioner's designee;
  4. (D) The commissioner of mental health and substance abuse services or the commissioner's designee;
  5. (E) The commissioner of disability and aging or the commissioner's designee;
  6. (F) The commissioner of transportation or the commissioner's designee;
  7. (G) One (1) member who is a private citizen and parent of a child with disabilities, or an individual with disabilities;
  8. (H) One (1) member who is a private citizen and represents agencies serving people who are blind;
  9. (I) One (1) member who is a private citizen and represents entities serving people with disabilities; and
  10. (J) One (1) member who is a private citizen and represents the business community.
2. (2) The governor shall appoint the private citizen members described in subdivisions (a)(1)(G)-(J) to three-year terms.
3. (3) The members of the committee shall organize and appoint a chair and determine their operating procedures. A majority of the members of the committee constitutes a quorum, and all official action of the committee requires a quorum.
4. (4) Members serve without compensation and do not receive travel expenses.
(b) The committee shall provide oversight to the central nonprofit agency in developing and implementing a state and political subdivision procurement program of commodities and services and in employing individuals with severe disabilities.
(c) The committee shall:
1. (1) Meet quarterly;
2. (2) Designate a central nonprofit agency for fulfillment of government orders for commodities or services;
3. (3) Require the central nonprofit agency to develop measures for evaluating its effectiveness; and
4. (4) Evaluate the activities of the central nonprofit agency to assure effective and efficient administration of this part.
(d) Every governmental entity that is supported in whole or in part by the general assembly may purchase all services or commodities required by the governmental entity from the central nonprofit agency as long as commodities or services purchased by state governmental entities are certified pursuant to procedures approved by the procurement commission and are available, and commodities or services purchased by political subdivisions are certified by the chief financial officer of the political subdivision.
(e) This part has precedence over any law requiring governmental entity procurement of commodities or services, except laws that require purchases from nonprofit organizations operating under §§ 71-4-204 and 71-4-205; laws establishing preference for blind vendors operating under chapter 4, part 5 of this title; and laws requiring purchases under §§ 41-22-118 — 41-22-124.
(f) This part does not apply in any case:
1. (1) In which commodities or services are available from any state governmental entity;
2. (2) Where the procurement commission determines that the commodities or services do not meet the reasonable requirements of a state governmental entity; or
3. (3) Where the chief financial officer determines that the commodities or services do not meet the reasonable requirements of the political subdivision.

Backlinks (2)

History (9)

Acts 1991, ch. 499, § 1
1996, ch. 827, §§ 7-10
2002, ch. 526, §§ 8, 9
2010, ch. 1100, § 137
2011, ch. 295, §§ 16, 19
2012, ch. 575, § 2
2014, ch. 739, § 2
2020, ch. 782, § 1
2024, ch. 688, § 180.

§ 71-4-704. Central nonprofit agency — Designation — Functions and operations — Fee.

(a) The functions and operations of the designated central nonprofit agency include, but are not limited to, the following:
1. (1) Ensure that the priorities for orders from governmental entities are maintained under this part and that opportunities are provided to individuals with severe disabilities to pursue competitive integrated employment;
2. (2) Evaluate the qualifications and capabilities of entities for production of commodities or performing services. The central nonprofit agency must assure that individuals with severe disabilities are receiving competitive integrated employment in the production of commodities or performance of services. At a minimum, fifty percent (50%) of the hours worked on the production of commodities or performing services in the program are required to be provided by individuals with severe disabilities. Hours worked by supervisors with severe disabilities are to be included in the determination;
3. (3) Recommend with appropriate justification, including recommended prices, suitable commodities or services for procurement and, as market conditions change, recommend price changes or revisions;
4. (4) Fulfill or distribute and allocate, by subcontract or any other means, orders from governmental entities; and
5. (5) Maintain the necessary records and monitor data on the entities to ensure compliance in the production of commodities and performance of services.
(b) The central nonprofit agency shall charge a fee for fulfilling the orders. This fee must not exceed rates approved by the committee. The fee must be factored as an administrative expense into the overall cost.

History (6)

Acts 1991, ch. 499, § 1
1996, ch. 827, §§ 11, 12
2002, ch. 526, § 10
2011, ch. 295, §§ 16, 19
2014, ch. 739, § 3
2020, ch. 782, § 1.

§ 71-4-705. Cooperation between committee and governmental entities — Annual report of committee.

(a) In furtherance of the purposes of this part and in order to contribute to the economy of state government, it is the intent of the general assembly that there be close cooperation between the committee and any state governmental entity from which procurement of commodities or services is required under the law currently in effect. The central nonprofit agency may enter into cooperative agreements, contracts, or other arrangements as may be determined to be necessary for the effective coordination and efficient realization of the objectives of this part.
(b) The committee shall annually report, on or before December 31, to the governor and to each member of the general assembly concerning the number of governmental entities participating in the program, the total dollar amount of purchases, and any other information the committee deems appropriate.

History (3)

Acts 1991, ch. 499, § 1
2014, ch. 739, § 4
2020, ch. 782, § 1.

Part 8 Achieving a Better Life Experience (ABLE) Act

§ 71-4-801. Short title.

This part shall be known and may be cited as “The Achieving a Better Life Experience (ABLE) Act.”

History (1)

Acts 2015, ch. 470, § 1.

§ 71-4-802. Purpose of part.

The purpose of this part is to authorize the establishment of a qualified ABLE program as an agency or instrumentality of the state to assist an eligible individual in saving money to meet the eligible individual's qualified disability expenses. The intent of the program is to encourage and assist individuals and families to save private funds for the purpose of supporting individuals with disabilities to maintain health, independence, and quality of life.

History (1)

Acts 2015, ch. 470, § 2.

§ 71-4-803. Part definitions.

As used in this part, unless the context otherwise requires:
1. (1) “Account” means an account established by; owned by; and for the benefit of an eligible individual, who is also the designated beneficiary on the account, and maintained under a qualified ABLE program for payment of the eligible individual's qualified disability expenses, as provided in this part;
2. (2) “Code” means § 529A of the Internal Revenue Code of 1986 (26 U.S.C. § 529A), as amended, and all rules, regulations, notices, and interpretations released by the United States treasury, including the internal revenue service;
3. (3) “Contracting state” means a state without a qualified ABLE program that has entered into a contract with a state with a qualified ABLE program to provide residents of the contracting state access to a qualified ABLE program;
4. (4) “Designated beneficiary” means the eligible individual who has established and owns an ABLE account, and for whose benefit the account has been established;
5. (5) “Disability certification” means a certification acceptable to the United States department of treasury made by the eligible individual or the eligible individual's parent or guardian certifying that the eligible individual has a medically determinable physical or mental impairment that results in marked and severe functional limitations and that can be expected to result in death or that has lasted or can be expected to last for a continuous period of not less than twelve (12) months, or is blind within the meaning of § 1614(a)(2) of the Social Security Act (42 U.S.C. § 1382c(a)(2)); and such blindness or disability occurred before the individual attained the age of twenty-six (26); and including a copy of the eligible individual's diagnosis relating to the individual's relevant impairment or impairments, signed by a physician meeting the criteria of § 1861(r)(1) of the Social Security Act (42 U.S.C. § 1395x(r)(1));
6. (6) “Eligible individual” means an individual who is entitled to benefits based on blindness or disability under title II or XVI of the Social Security Act (42 U.S.C. §§ 401-425 and 42 U.S.C. § 1381 et seq.), and such blindness or disability occurred before the individual attained age twenty-six (26), or a disability certification for the individual was filed with the United States department of the treasury. The eligible individual is the account owner and the designated beneficiary on the account;
7. (7) “Legal representative” means an individual who or entity that can act on behalf of an eligible individual for the purpose of establishing, maintaining, transacting, and terminating an account, including, but not limited to, a parent, conservator, guardian, custodian, fiduciary, trustee, or individual or entity with a power of attorney;
8. (8) “Person” means an individual, association, corporation, trust, charitable organization, or other such entity;
9. (9) “Qualified ABLE program” or “program” means the ABLE program that is a qualified program pursuant to and in compliance with the code, and that is created pursuant to this part;
10. (10) “Qualified disability expenses” means any expenses related to the eligible individual's blindness or disability that are made for the benefit of an eligible individual who is the designated beneficiary. Qualified disability expenses include the following: education; housing; transportation; employment training and support; assistive technology and personal support services; health; prevention and wellness; financial management and administrative services; legal fees; expenses for oversight and monitoring; funeral and burial expenses; and other expenses approved by federal rules and regulations; and
11. (11) “State” means the state of Tennessee.

History (2)

Acts 2015, ch. 470, § 3
2016, ch. 793, § 4.

§ 71-4-804. Trustees of qualified ABLE program — State treasurer authorized to establish qualified ABLE program — Program revenues.

(a) The commissioner of finance and administration, the chair of the finance, ways and means committee of the senate, the chair of the finance, ways and means committee of the house of representatives, and the state treasurer shall serve as trustees for a qualified ABLE program that may be established pursuant to this part.
(b) The state treasurer is authorized to establish a qualified ABLE program. If the state treasurer establishes a qualified ABLE program, the state treasurer shall develop a plan that shall include provisions for the implementation, administration, operation, marketing, investment options, customer service, and investment management services for the plan, which shall be approved by the remaining trustees. The state treasurer may modify the terms of the plan with the concurrence of the commissioner of finance and administration.
Backlinks (1)
- 71-4-813(a)
(c) All revenues collected by the program shall remain with the program. To the extent that the program has unused revenues during a given fiscal year, the unused revenues shall not revert to the general fund, but shall be carried forward to the next succeeding fiscal year or years, and shall be used to fund the program. For the purposes of this subsection (c), “revenues” include, but are not limited to, state appropriated funds, monetary gifts, grants, or any other monetary aids received by the program from public or private sources; however, “revenues” do not include the contributions and earnings in an ABLE account.

History (2)

Acts 2015, ch. 470, § 4
2016, ch. 793, § 5.

§ 71-4-805. Authority of state treasurer.

The state treasurer has the following powers and authorities necessary and convenient to carry out the purposes and provisions of this part, the purposes and objectives of the program and the trustees' plan, and the powers delegated by any other law of this state and the code, including, but not limited to, the following express powers:
1. (1) Provide investment options or investment products for eligible individuals who have established an ABLE account;
2. (2) Purchase insurance from insurers licensed to do business in this state providing for coverage against any loss in connection with the program's property, assets, or activities;
3. (3) Make, execute, and deliver contracts, conveyances, and other instruments necessary and proper for the implementation of the program;
4. (4) Contract for the provision of all or any part of the services necessary for the administration, implementation, operation, or management of the program;
5. (5) Enter into a contract with another state that has a qualified ABLE program as a contracting state in order to provide similar benefits to Tennessee residents, or allow residents of other states to participate in a Tennessee qualified ABLE program;
6. (6) Contract with financial consultants, actuaries, auditors, investment managers, and other consultants and professionals as necessary to carry out the duties and responsibilities under this part and the plan established by the trustees. These services may be procured in a manner prescribed by the trustees without regard to the requirements of former § 12-4-109, if the trustees determine that the services are necessary or desirable for the efficient administration of this part. All expenses and fees incidental to the procurement of services shall be charged to and paid from participant accounts;
7. (7) Administer or operate the program at the direction of the trustees' plan;
8. (8) Promote, advertise, market, and publicize the program;
9. (9) Solicit and accept monetary gifts made by will, trust, or other disposition, grants, loans, and other monetary aids from any personal source or participate in any other way in any federal, state, or local governmental programs in carrying out the purpose of this part;
10. (10) Establish and impose reasonable residency requirements for designated beneficiaries that must be met by the designated beneficiary prior to establishing an account;
11. (11) Establish and impose reasonable limits on the number of accounts;
12. (12) Establish and impose limits on contributions that may be made by or on behalf of a designated beneficiary;
13. (13) Provide adequate safeguards to prevent aggregate contributions on behalf of a designated beneficiary in excess of the contribution limitations established by the trustees;
14. (14) Establish and impose restrictions for a change in or substitution of designated beneficiaries;
15. (15) Establish and impose limitations on distributions and rollovers from the account used for qualified disability expenses;
16. (16) Establish and impose restrictions or conditions on the transfer of account ownership;
17. (17) Establish and impose restrictions on the investment direction of deposits in an account and the interest earned thereon;
18. (18) Determine the disposition of an account upon the designated beneficiary's death or the abandonment of an account;
19. (19) Enter into memoranda of understanding with appropriate state agencies to develop, implement, and market educational programs and related informational materials to inform individuals with disabilities and their legal representatives about the ABLE program;
20. (20) Impose and collect application fees and other administrative fees and charges in connection with any transaction under this part;
21. (21) Promulgate reasonable rules as are necessary to carry out the purpose and intent of this part, and to ensure that the program is in compliance with the code and other applicable provisions of federal or state laws or rules. All such rules shall be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5;
22. (22) Enter into participation agreements with eligible individuals or an eligible individual's legal representative;
23. (23) Define the terms and conditions under which payments may be withdrawn from the program and impose reasonable charges for withdrawal;
24. (24) Enter into agreements with any public or private employer under which an employee may agree to have a designated amount deducted in each payroll period from the wages or salary due the employee for the purpose of making contributions to an account pursuant to a participation agreement. The agreement shall be subject to the approval of the trustees and in conformity with such terms and conditions as determined by the trustees. In the event the agreement is approved by the trustees, the employer shall be responsible for submitting to the trustees such information and for performing the duties prescribed by the trustees to implement its employee contributions to an account by payroll deduction. All costs and expenses incidental to implementing and administering a payroll deduction program shall be borne by the respective employer;
25. (25) Operate and provide for the operation of the program in a manner that qualifies the program under the code and takes any and all necessary action to maintain such qualification; provided, that the account owner's rights to fund the respective accounts shall not be limited or impaired;
26. (26) Seek rulings from the secretary of the United States department of the treasury and the internal revenue service relating to the program; and
27. (27) Make changes to the program that are required for eligible individuals to obtain federal income tax benefits or treatment provided by the code.

History (1)

Acts 2015, ch. 470, § 5.

§ 71-4-806. Accounts established for eligible individuals — Notice to United States treasury department — Monthly electronic statements to social security administration.

(a) The qualified ABLE program that is established and maintained by the state as an agency or instrumentality thereof shall comply with all requirements of the code and shall:
1. (1) Allow one (1) or more persons to make contributions for a taxable year into an account for the benefit of an eligible individual who is also the designated beneficiary during the taxable year. The designated beneficiary shall be an eligible individual at the time the account is established, at the time of any contribution to the account, and at the time of a distribution from an account for qualified disability expenses; and
2. (2) Limit one (1) eligible individual or designated beneficiary to one (1) account.
(b) The state treasurer shall submit a notice to the secretary of the United States department of the treasury at the time that an account is established. The notice shall contain the name and state of residence of the designated beneficiary and such other and further information as the secretary of the United States department of the treasury may require.
(c) On a monthly basis, the qualified ABLE program shall submit electronic statements to the commissioner of the social security administration containing distributions and account balances from all accounts.
(d) Contributions from a student's individualized education account to an achieving a better life experience account for the benefit of the student along with the earnings in the achieving a better life experience account may only be expended for the student's education expenses in accordance with this part, and the rules promulgated pursuant thereto, and the code.

History (2)

Acts 2015, ch. 470, § 6
2016, ch. 793, §§ 2, 3.

§ 71-4-807. Administration of program by state treasurer.

The state treasurer shall carry out the day-to-day operations and responsibilities of the program. The state treasurer shall exercise such powers, duties, and responsibilities contained in this part to implement the purpose of this part; may assign any duties and responsibilities to the state treasurer's staff or private vendors and contractors, as the state treasurer deems necessary and proper; and may consult with professionals as necessary about the administration of the program. The state treasurer may also establish policies, guidelines, and operating procedures in accordance with this part.

History (1)

Acts 2015, ch. 470, § 7.

§ 71-4-808. Authority to offer investment options to participants.

Notwithstanding any other law to the contrary, the trustees shall be authorized to offer investment options to eligible individuals participating in the qualified ABLE program.

History (1)

Acts 2015, ch. 470, § 8.

§ 71-4-809. Authority of state treasurer to request assistance from and exchange data with other departments and agencies.

In conjunction with the state treasurer's authority contained in this part, the state treasurer has the authority to request assistance from, and exchange data with, other departments and agencies of the state in carrying out the purpose and intent of this part and the requirements contained in the code, including, but not limited to, the office of vital records. Notwithstanding any other law to the contrary, the office of vital records shall provide the state treasurer with vital records information without charge.

History (1)

Acts 2015, ch. 470, § 9.

§ 71-4-810. Assets, income and distributions exempt from taxation, garnishment, attachment or assignment.

Notwithstanding any other law to the contrary, all assets, income, and distributions of qualified ABLE programs as defined by the code, this part, or the laws of another state are exempt from any state, county, or municipal tax and shall not be subject to execution, attachment, or garnishment, nor shall any assignment thereof be enforceable in any court. This exemption shall include a qualified ABLE program defined in § 529A of the Internal Revenue Code (26 U.S.C. § 529A), and shall include any properly authorized payments made to or by such funds.

History (1)

Acts 2015, ch. 470, § 10.

§ 71-4-811. Suspension or termination of program.

If the trustees determine that the program is financially infeasible or is not beneficial to the citizens of this state or the state itself, the trustees may suspend or terminate the program immediately.

History (1)

Acts 2015, ch. 470, § 11.

§ 71-4-812. Disclosure of personal information prohibited — Exceptions.

(a) Notwithstanding any other law to the contrary, the state shall not disclose personal information about any person obtained in connection with an account established under this part, except under the following circumstances:
1. (1) To any individual or entity authorized by the eligible individual or the eligible individual's legal representative;
2. (2) In compliance with a subpoena or a court order;
3. (3) To the comptroller of the treasury or the comptroller's designees for the purpose of an audit;
4. (4) To the internal revenue service, the United States department of the treasury, or the social security administration for the purpose of filing notices, reports, statements, or any other required documentation; or
5. (5) In any administrative proceeding or court action involving the state, the department of the treasury, the state treasurer, or the remaining trustees relative to an account established under this part.
(b) For the purposes of this section, “personal information” shall include, but not be limited to, social security number; bank account numbers; transit routing numbers; credit card numbers; debit card numbers; business or residential addresses; telephone or cell phone numbers; e-mail addresses; disability certifications or determinations; and medical records.

History (1)

Acts 2015, ch. 470, § 12.

§ 71-4-813. Death of beneficiary — Prohibited government actions.

(a) Following the death of an individual who is the designated beneficiary of a qualified ABLE account established under § 71-4-804(b), the state shall not:
1. (1) Seek recovery of an account balance remaining in the designated beneficiary's account for medical assistance paid to or on behalf of the designated beneficiary on or after the date the participation agreement was entered into and the account was established for the designated beneficiary, except as required by federal law; or
2. (2) File a claim for payment under § 529A(f) of the Internal Revenue Code of 1986 (26 U.S.C. § 529A).
(b) Subsection (a) applies to the extent permitted pursuant to federal law, including § 529A of the Internal Revenue Code of 1986 (26 U.S.C. § 529A).

History (1)

Acts 2023, ch. 44, § 1.

Part 11 Aid to Disabled Persons — General Financial Assistance

§ 71-4-1101. Short title.

This part may be cited as the “Aid to the Disabled Act.”

History (2)

Acts 1953, ch. 16, § 18 (Williams, § 4765.170)
T.C.A. (orig. ed.), §§ 14-401, 14-16-101.

§ 71-4-1102. Part definitions.

As used in this part, unless the context otherwise requires:
1. (1) “Assistance” means money payments made to or in behalf of totally disabled persons in need, or medical care, or both, including hospitalization, outpatient care and treatment, nursing home care, drugs or any other type of remedial care recognized under state law in behalf of permanently and totally disabled persons in need, but does not include subdivisions (1)(A)-(1)(D) unless the federal Social Security Act (42 U.S.C.), is amended to include one (1) or more of the following:
  1. (A) Any such payments to or care in behalf of any individual who is an inmate of a public institution, except as a patient in a medical institution, or any individual who is a patient in an institution for tuberculosis or mental diseases;
  2. (B) Any such payments to any individual who has been diagnosed as having tuberculosis or psychosis and is a patient in a medical institution as a result of having tuberculosis or psychosis;
  3. (C) Any such care in behalf of any individual, who is a patient in a medical institution as a result of a diagnosis that such person has tuberculosis or psychosis, with respect to any period after the individual has been a patient in such an institution as a result of such diagnosis, for forty-two (42) days; or
  4. (D) Is not an inmate of any private institution except such private institution as has been approved by the department at the time of receiving assistance;
2. (2) “Department” means the department of human services;
3. (3) “Permanently and totally disabled” means that the individual has been determined to have a permanent physical or mental impairment, disease or loss that substantially precludes the individual from engaging in useful occupations within the individual's competence, such as holding a job or homemaking. Such determinations shall be made in accordance with standards that shall be established by the department in consultation with an advisory committee, which committee shall include physicians nominated by the state medical society, and after review of the medical findings by a reviewing physician or physicians;
4. (4) “Recipient” means a person who was receiving aid to the permanently and totally disabled benefits during the month of December, 1973, and is now qualified under Public Law 93-66 to continue to receive a state money payment as a supplement to the federally provided supplemental security income benefits; and
5. (5) “Regional director” means the director of a region, or a designated agent in a county office, under chapter 1, part 1, of this title.

Backlinks (2)

History (9)

Acts 1953, ch. 16, § 1 (Williams, § 4765.153)
Acts 1957, ch. 117, § 15
1965, ch. 9, § 1
1973, ch. 337, § 3
1974, ch. 628, § 7
impl. am. Acts 1975, ch. 219, § 1 (a, b)
T.C.A. (orig. ed), § 14-402
Acts 1986, ch. 905, § 2
T.C.A., § 14-16-102.

§ 71-4-1103. Eligibility for assistance.

Assistance shall be granted under this part to any permanently and totally disabled person who:
1. (1) Is eighteen (18) years of age or older;
2. (2) Is living within this state voluntarily and not for a temporary purpose, that is, with no intention of presently removing from the state; provided, that temporary absence from the state, with subsequent returns to the state or intent to return when the purposes of the absence have been accomplished, shall not, for the purpose of this part, interrupt continuity of residence;
3. (3) Has not sufficient income or other resources to provide a reasonable subsistence compatible with decency and health, and whose spouse is not able to meet the person's needs as determined by the department's standards;
4. (4)
  1. (A) Is not an inmate of a public institution and:
    1. (i) Is not a patient in an institution for tuberculosis or mental diseases; or
    2. (ii) Is not a patient in a medical institution as a result of a diagnosis of tuberculosis or psychosis;
  2. (B) An inmate of any public institution ineligible under subdivision (4)(A) may, however, make application for such assistance, but the assistance, if granted, shall not begin until after such person ceases to be an inmate;
5. (5) Within five (5) years immediately preceding application or during receipt of assistance, has not in order to evade any provision of this part made an assignment or transfer of property, the proceeds from which at the fair market value, irrespective of the actual consideration received, would under the state standards of need still be available to meet the needs of the individual. Any transfer of property to a husband, wife, son, daughter, son-in-law, daughter-in-law, brother, sister, brother-in-law, sister-in-law, nephew or niece, within the period above mentioned, shall be prima facie evidence that the transfer was made with the intent to evade the provisions of this part;
6. (6) Is not receiving for the same month old-age assistance, aid to the blind, or aid to dependent children;
7. (7) Was receiving aid to the permanently and totally disabled benefits during the month of December 1973, and is now qualified under Public Law 93-66 to continue to receive a state money payment as a supplement to the federally-provided supplemental security income benefits.

History (12)

Acts 1953, ch. 16, § 2 (Williams, § 4765.154)
Acts 1955, ch. 30, § 1
1955, ch. 125, § 1
1957, ch. 81, § 3
1957, ch. 116, § 2
1965, ch. 9, § 2
1967, ch. 51, §§ 1, 2
1970, ch. 487, § 1
1974, ch. 628, § 8
T.C.A. (orig. ed.), § 14-403
Acts 1986, ch. 905, § 2
T.C.A., § 14-16-103.

§ 71-4-1104. Amount of assistance.

The amount of assistance that any person shall receive in the form of supplementary payments shall be determined by an application of § 212(a) of Public Law 93-66, and rules and regulations made by the department establishing standards of need and allowable resources to the recipient's present personal and economic circumstances.

History (10)

Acts 1953, ch. 16, § 3 (Williams, § 4765.155)
modified
Acts 1957, ch. 22, § 5
1957, ch. 117, § 16
1961, ch. 27, § 1
1965, ch. 9, § 3
1967, ch. 51, § 3
1973, ch. 303, § 18
1974, ch. 628, § 9
T.C.A. (orig. ed.), §§ 14-404, 14-16-104.

§ 71-4-1105. Duties of department.

The department shall:
1. (1) Supervise the administration of assistance to the permanently and totally disabled under this part;
2. (2) Make such rules and regulations and take such action as may be necessary or desirable for carrying out this part to the end that equitable treatment shall be afforded to individuals in similar circumstances. All rules and regulations made by the department shall be binding on the counties and shall be complied with by the respective regional directors;
3. (3) Establish criteria for determining who is permanently and totally disabled within the meaning of § 71-4-1102;
4. (4) Establish standards for the determination of need of the individual including:
  1. (A) Statewide requirements essential to maintaining a minimum standard of economic security based on studies of current living costs;
  2. (B) Methods and procedures for measuring income and resources against such statewide requirements;
  3. (C) Property reserves that will not preclude eligibility for assistance under this part;
5. (5) Employ personnel for the administration of this part in conformity with title 8, chapter 30, and the rules and regulations of the department of human resources;
6. (6) Prescribe the form of and supply to the regional directors such forms as it may deem necessary and desirable;
7. (7) Cooperate with the commissioner of social security, or any federal officer or agency made successor to the commissioner of social security, in any reasonable manner as may be necessary to qualify for federal aid for assistance to the permanently and totally disabled and in conformity with this part, including the making of such reports in such form and containing such information as the commissioner of social security may from time to time require, and comply with such provisions as such commissioner may from time to time find necessary to assure the correctness and verification of such reports; and
8. (8) Publish an annual report and such interim reports as may be necessary.

History (8)

Acts 1953, ch. 16, § 4 (Williams, § 4765.156)
modified
Acts 1973, ch. 303, § 19
1974, ch. 628, § 10
T.C.A. (orig. ed.), § 14-405
Acts 1986, ch. 905, § 2
T.C.A., § 14-16-105
Acts 2012, ch. 800, § 49.

§ 71-4-1106. Duties of regional directors.

The regional directors shall administer this part in the counties of their regions, subject to the rules and regulations prescribed by the department pursuant to this part, and shall report to the department at such times and in such manner as the department may direct.

History (4)

Acts 1953, ch. 16, § 5 (Williams, § 4765.157)
T.C.A. (orig. ed.), § 14-406
Acts 1986, ch. 905, § 2
T.C.A., § 14-16-106.

§ 71-4-1107. Appeal to department.

(a) If any award of assistance is modified or cancelled under any provision of this part, the recipient may appeal to the department in the manner and form prescribed by it.
(b) The department shall, upon receipt of such an appeal, give the recipient reasonable notice and opportunity for a hearing.

History (6)

Acts 1953, ch. 16, § 9 (Williams, § 4765.161)
Acts 1973, ch. 303, § 21
1974, ch. 628, § 11
T.C.A. (orig. ed.), § 14-411
Acts 1986, ch. 905, § 2
T.C.A., § 14-16-107.

§ 71-4-1108. Reconsideration of awards.

(a) All assistance grants in the form of money payments made under this part shall be reconsidered by the regional director, or a designated agent, as frequently as may be required by the rules and regulations of the department.
(b) After such further investigation as the regional director, or a designated agent, may deem necessary or the department may require, the amount of assistance in the form of money payments may be changed or assistance may be entirely withdrawn if the recipient's circumstances have altered to warrant such action.
(c)
1. (1) A recipient shall submit to a reexamination as to such recipient's permanent and total disability when required to do so by the regional director, or a designated agent, or the department.
2. (2) A recipient shall also furnish any information bearing on such recipient's eligibility required by the regional director, or a designated agent, or by the department.

History (6)

Acts 1953, ch. 16, § 10 (Williams, § 4765.162)
Acts 1957, ch. 117, § 19
1973, ch. 303, § 23
T.C.A. (orig. ed.), § 14-413
Acts 1986, ch. 905, § 2
T.C.A., § 14-16-108.

§ 71-4-1109. Notice of change of status by recipient.

(a) If at any time during the continuance of assistance the recipient becomes possessed of any property or income in excess of the amount stated in the application, it shall be the duty of the recipient immediately to notify the county office of the receipt or possession of such property or income.
(b) The regional director, or a designated agent, may, after investigation, either cancel the assistance or alter the amount of the money payments in accordance with the circumstances.
(c) Any assistance paid after the recipient has come into possession of such property or income and in excess of such recipient's need as determined by the department's standards shall be recoverable in a suit by the state as a debt due to the state.

History (5)

Acts 1953, ch. 16, § 11 (Williams, § 4765.163)
Acts 1957, ch. 117, § 20
1961, ch. 17, § 1
1974, ch. 628, § 12
T.C.A. (orig. ed.), §§ 14-414, 14-16-109.

§ 71-4-1110. Removal of recipient from county.

Any recipient who moves to another county in this state shall be entitled with the approval of the department to receive assistance in the county to which the recipient has moved, and the regional director, or a designated agent, of the county from which the recipient has moved shall transfer all necessary records relating to the recipient to the regional director, or a designated agent, of the county to which the recipient has moved.

History (2)

Acts 1953, ch. 16, § 12 (Williams, § 4765.164)
T.C.A. (orig. ed.), §§ 14-415, 14-16-110.

§ 71-4-1111. Amendment of law.

All assistance granted under this part shall be deemed to be granted to be held subject to any amending or repealing act that may hereafter be passed, and no recipient shall have any claim for compensation, or otherwise, by reason of such recipient's assistance being affected in any way by any amending or repealing act.

History (4)

Acts 1953, ch. 16, § 17 (Williams, § 4765.169)
T.C.A. (orig. ed.), § 14-416
Acts 1986, ch. 905, § 2
T.C.A., § 14-16-111.

§ 71-4-1112. Assignment of benefits prohibited — Exemption from legal process.

Assistance granted under this part shall not be transferable or assignable, at law or in equity, and none of the money paid or payable under this part shall be subject to execution, levy, attachment, garnishment or other legal process, or to the operation of any bankruptcy or insolvency law.

History (4)

Acts 1953, ch. 16, § 8 (Williams, § 4765.160)
T.C.A. (orig. ed.), § 14-417
Acts 1986, ch. 905, § 2
T.C.A., § 14-16-112.

§ 71-4-1113. Fraudulent devices — Penalty.

A person who:
1. (1) Knowingly obtains, or attempts to obtain, or aids or abets any persons to obtain, by means of a willfully false statement or representation or by impersonation, or other fraudulent device, assistance to which such person is not entitled or assistance greater than that to which such person is justly entitled; or
2. (2) With intent to defraud, aids or abets in buying or in any way disposing of the property, either personal or real, of a recipient of assistance, without the consent of the department;
3. commits a Class E felony.

History (3)

Acts 1955, ch. 30, § 2
T.C.A., §§ 14-431, 14-16-113
Acts 1989, ch. 591, § 106.

§ 71-4-1114. Charging disabled to file application — Illegal use of lists — Penalty.

(a) It is unlawful for any person, firm or corporation to directly or indirectly either charge or receive anything of value for assisting any person in making application to the proper authorities of this state, or any of them, for relief or assistance under this part.
(b) It is unlawful for any person, except for purposes directly connected with the administration of this part, to solicit, disclose, receive, make use of, authorize or knowingly permit, participate in, or acquiesce in the use of, any list of names of, or any information concerning, persons applying for or receiving aid to the permanently and totally disabled, directly or indirectly derived from the records, papers, files or communications of the department or divisions of the department, or acquired in the course of the performance of official duties, except as provided by §§ 71-1-117 and 71-1-118.
(c) A person violating this section commits a Class C misdemeanor.

History (6)

Acts 1955, ch. 30, § 3
impl. am. Acts 1975, ch. 219, § 1 (a, b)
T.C.A., § 14-432
Acts 1986, ch. 905, § 2
T.C.A., § 14-16-114
Acts 1989, ch. 591, § 113.

§ 71-4-1115. Veterans education benefits.

Notwithstanding any other provision of this chapter, to the extent permitted by federal law, the value of federal veterans education benefits received by an applicant shall not be included as any form of income when making eligibility determinations for assistance under this part.

History (1)

Acts 2003, ch. 239, § 3.

Part 12 Aid to Disabled Persons — Personal Care Service Subsidies

§ 71-4-1201. Part definitions.

As used in this part, unless the context otherwise requires:
1. (1) “Division” means the division of vocational rehabilitation of the department of human services;
2. (2) “Employed” means engaged in activity of thirty (30) or more hours per week for which the individual receives remuneration at a rate not less than the federal minimum wage;
3. (3) “Family member” means an individual's parent, grandparent, sibling, child, spouse, spouse's parent, spouse's grandparent, spouse's sibling or spouse's child;
4. (4) “Personal care assistance services” means services rendered at least five (5) days a week at the times of day that are required by an individual with a severe physical disability to become physically independent in connection with actual employment. These services include, but are not limited to, any or all of following:
  1. (A) Routine bodily functions, such as bowel or bladder care;
  2. (B) Dressing;
  3. (C) Preparation and consumption of food;
  4. (D) Moving into, out of, or turning in bed;
  5. (E) Routine bathing;
  6. (F) Ambulation; or
  7. (G) Any other similar activity of daily living as determined appropriate by the division; and
5. (5) “Severe physical disability” means a functional loss of both arms and both legs, when it is anticipated that the loss will be permanent.

History (2)

Acts 1986, ch. 905, § 3
T.C.A., § 14-16-201.

§ 71-4-1202. Authorized.

The division shall subsidize personal care assistance services pursuant to this part for an individual eligible under § 71-4-1205. Such subsidy for any individual shall not exceed forty (40) hours per week.

Backlinks (1)

71-4-1204(a)

History (2)

Acts 1986, ch. 905, § 4
T.C.A., § 14-16-202.

§ 71-4-1203. Eligibility.

An individual is eligible for a personal care assistance services subsidy under this part if such individual:
1. (1) Is eighteen (18) years of age or older;
2. (2) Has a severe physical disability;
3. (3) Is receiving or has received vocational rehabilitation services from the division;
4. (4) Is employed or ready for employment;
5. (5) Has a need documented under § 71-4-1205 for not less than fourteen (14) hours a week of personal care assistance service provided by a person other than a family member, which services are necessary to enable the individual to be employed;
6. (6) Is not otherwise eligible for personal care assistance services under other state or federal programs;
7. (7) Agrees to a periodic reevaluation of such individual's need for personal care assistance services and of the extent of that need;
8. (8) Has no or insufficient personal income or other support from public services, family members or neighbors;
9. (9) Agrees to recruit, hire, fire, and supervise the person who provides personal care assistance services to such individual; and
10. (10) Qualifies under § 71-4-1206.

History (2)

Acts 1986, ch. 905, § 5
T.C.A., § 14-16-203.

§ 71-4-1204. Amount.

(a) The division shall determine the amount of subsidy provided under § 71-4-1202 by the following formula:
1. (1) Individual's annual gross income, including social security disability income (SSDI), supplemental security income (SSI) and disability pensions;
2. (2) Subtract federal and state income taxes paid from the amount in subdivision (a)(1);
3. (3) Subtract standard federal personal and state income tax exemptions from the remainder in subdivision (a)(2);
4. (4) Subtract F.I.C.A. or mandatory pension contributions from the remainder in subdivision (a)(3);
5. (5) Subtract impairment related work expenses that are incurred by the individual in order to function on a job and that are not reimbursed by a third party from the remainder in subdivision (a)(4);
6. (6) Divide the remainder in subdivision (a)(5) by two (2); and
7. (7) Subtract four thousand eight hundred dollars ($4,800) from the quotient in subdivision (a)(6).
(b) If there is no income remaining after application of the formula in subsection (a), the division shall subsidize full cost for personal care assistance services provided to that individual.
(c) If there is income remaining after application of formula in subsection (a), the cost to the division for personal care services provided to that individual shall be reduced by the amount of that income.
(d) This program may supplement any other program for which the individual is eligible.

History (2)

Acts 1986, ch. 905, § 6
T.C.A., § 14-16-204.

§ 71-4-1205. Eligibility evaluation teams.

(a) The director of the division shall designate one (1) or more evaluation teams, which shall consist of at least two (2) persons, one (1) of whom shall be a licensed medical professional and one (1) of whom shall be a licensed occupational therapist or physical therapist.
(b) Each individual who applies to the division for a personal care assistance services subsidy shall be evaluated by an evaluation team, which shall determine the need of that individual for personal care assistance service and the extent of that need.
(c) An individual receiving a personal care assistance services subsidy pursuant to this part shall be periodically reevaluated by an evaluation team to determine such individual's continuing need for personal care assistance services and the extent of that need.

Backlinks (2)

History (2)

Acts 1986, ch. 905, § 7
T.C.A., § 14-16-205.

§ 71-4-1206. Rules and regulations — Establishment of hourly rate.

(a) The commissioner of human services shall promulgate, in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, such rules as shall be necessary to ensure that this part is implemented in an efficient and effective manner.
(b) The commissioner is authorized to establish the hourly rate for the subsidy for personal care assistance services. Funding for the subsidy provided by this part shall be from year to year as such funds are specifically appropriated in the general appropriations act pursuant to title 9, chapter 4, part 51.

Backlinks (1)

71-4-1203(10)

History (2)

Acts 1986, ch. 905, § 8
T.C.A., § 14-16-206.

§ 71-4-1207. Funds.

(a) In addition to any state funds appropriated to provide services under this part, the department of human services may apply for and use any federal or private funds, grants, and other support that is available to carry out the personal care assistance program.
(b) Expenditures under this part shall be subject to the approval of the commissioner of finance and administration.

History (2)

Acts 1986, ch. 905, §§ 11, 13
T.C.A., § 14-16-207.

§ 71-4-1208. Annual reports — Register of individuals.

The department of human services shall annually report to the governor and the general assembly on the progress made in the personal care assistance program and shall maintain a register of individuals served and individuals eligible for the program but unserved.

History (2)

Acts 1986, ch. 905, § 9
T.C.A., § 14-16-208.

§ 71-4-1209. [Reserved.]

§ 71-4-1210. Veterans education benefits.

Notwithstanding any other provision of this chapter, to the extent permitted by federal law, the value of federal veterans education benefits received by an applicant shall not be included as any form of income when making eligibility determinations for assistance under this part.

History (1)

Acts 2003, ch. 239, § 2.

Part 22 Services to Families of Preschool Children with Disabilities

§ 71-4-2201. Development of incentives.

To the extent that federal funds are not jeopardized and in accordance with responsibilities required to be performed by the interagency coordinating council created pursuant to 20 U.S.C. § 1482, the council shall advise and assist the lead agency appointed pursuant to 20 U.S.C. § 1476 [repealed] in developing incentives that will encourage programs serving young children with disabilities to provide or improve services to families of preschool children with disabilities. The development of the incentives may include, but is not limited to:
1. (1) Identifying and publicizing model programs with parent involvement components or model practices for services to parents;
2. (2) Assuring that training opportunities are provided to educate program staff in current best practices for serving families; and
3. (3) Identifying and coordinating all available resources within the state from federal, state, local and private sources for existing programs and for future programs to hire staff to provide training and support services to parents.

History (2)

Acts 1988, ch. 625, § 1
2011, ch. 47, § 105.

Part 23 Authorized Complex Rehabilitation Technology Suppliers

§ 71-4-2301. Part definitions.

As used in this part:
1. (1) “Authorized complex rehabilitation technology supplier” means a seller of complex rehabilitation technology that supplies products and services for complex rehabilitation technology equipment;
2. (2) “Complex rehabilitation technology”:
  1. (A) Has the same meaning as defined in § 71-5-159; and
  2. (B) Includes a manual wheelchair;
3. (3) “Manual wheelchair”:
  1. (A) Has the same meaning as described in § 71-5-159(a)(1); and
  2. (B) Includes a nonpower, specialized, and medically necessary wheelchair;
4. (4) “Preventative maintenance” means an assessment of a complex rehabilitation technology and its use by an authorized technician working on behalf of an authorized complex rehabilitation technology supplier, including an assessment of:
  1. (A) The physical condition of the complex rehabilitation technology; and
  2. (B) Any needed repairs that the authorized technician is able to complete;
5. (5) “Repair” means the repair or replacement of a deficient, broken, or otherwise malfunctioning part, component, hardware, or software, when the deficient, broken, or otherwise malfunctioning state of such part, component, hardware, or software results in the incapacity of or otherwise diminished capacity for use of a complex rehabilitation technology; and
6. (6) “TennCare program”:
  1. (A) Means the medical assistance program provided for in title 71, chapter 5, or a successor program; and
  2. (B) Includes the CoverKids program provided for in title 71, chapter 3, part 11.

History (1)

Acts 2024, ch. 1050, § 2.

§ 71-4-2302. Coverage and reimbursement for medically necessary repairs and annual preventative maintenance.

(a) A policy, certificate, or agreement for health insurance coverage issued under the TennCare program must provide coverage and reimbursement for:
1. (1) Medically necessary repairs provided by authorized complex rehabilitation technology equipment suppliers; and
2. (2) At least one (1) preventative maintenance visit per year provided by authorized complex rehabilitation technology equipment suppliers, including appropriate reimbursement for services rendered during the preventative maintenance, parts, labor, diagnostic and evaluation time, and other related costs.
(b) A TennCare program enrollee must be informed of the coverage required under this part at the time of initial enrollment and when a current enrollee renews a policy, certificate, or agreement for health insurance coverage under the TennCare program.
(c) A policy, certificate, or agreement for health insurance coverage issued in this state under the TennCare program must:
1. (1) Not require medical documentation or proof of continued need for a repair or preventative maintenance of a complex rehabilitation technology; and
2. (2) Consistent with federal law and regulations, provide coverage for telehealth visits for complex rehabilitation technology.
(d) Subdivision (c)(1) does not prohibit a policy issued under the TennCare program from requiring documentation needed for a medical necessity determination to be made in accordance with § 71-5-144.

History (1)

Acts 2024, ch. 1050, § 2.

§ 71-4-2303. Preventative maintenance — Requirements and implementation — Documentation of services.

(a) A preventative maintenance visit may be performed at any location agreed upon by the enrollee and the authorized complex rehabilitation technology supplier and is not required to be performed at the enrollee's location.
(b)
1. (1) Preventative maintenance must be performed by a qualified technician who is an employee of the authorized complex rehabilitation technology supplier, and must be performed according to the manufacturer's guidelines. The preventative maintenance may be performed during a complex rehabilitation technology appointment for an unrelated issue, and is not required to be a standalone appointment or event.
2. (2) The authorized complex rehabilitation technology supplier shall document and maintain all records of preventative maintenance services performed pursuant to this part.

History (1)

Acts 2024, ch. 1050, § 2.

Chapter 5 Programs and Services for Poor Persons

Part 1 Medical Assistance Act

§ 71-5-101. Short title.

This part may be cited as and shall be known as the “Medical Assistance Act of 1968.”

Backlinks (1)

71-5-124(a)

History (2)

Acts 1968, ch. 551, § 1
T.C.A., §§ 14-1901, 14-23-101.

§ 71-5-102. Purpose.

(a) The purpose of this part is to make possible medical assistance to those recipients determined to be eligible under this chapter to receive medical assistance that conforms to the requirements of Title XIX of the Social Security Act (42 U.S.C. § 1396 et seq.), and the regulations promulgated pursuant to Title XIX. Medical assistance pursuant to this part may also be provided pursuant to any federal waiver received by the state that waives any or all of the provisions of Title XIX or pursuant to any other applicable federal law to the extent adopted by means of an amendment to the required Title XIX state plan.
(b)
1. (1) Except as may be required by federal law or regulation, it is hereby declared to be the public policy of the state of Tennessee that participation in the TennCare program, or its successor programs, is not an entitlement and is conditional upon, among other things, specific appropriations for the program.
2. (2) Not less than annually, the governor shall recommend and the general assembly may, through provisions of the general appropriations act, prioritize the funding for the TennCare program in a manner that specifies that funds are available to:
  1. (A) Continue coverage for enrollees currently in the program;
  2. (B) Extend coverage to potential new enrollees, or categories of new enrollees, at current, higher or lower income levels;
  3. (C) Withdraw coverage from all enrollees not eligible for medicaid; or
  4. (D) Reimburse medical care providers for costs unreimbursed by managed care organizations out of state funds appropriated for that purpose or such federal funds as would be permitted to be used for that purpose under the terms of the TennCare waiver.
(c) Continuation, extension and withdrawal of coverage for enrollees in the TennCare program shall be determined in accordance with such priorities, if any, established by the general assembly in the general appropriations act.
(d) The bureau of TennCare shall have the authority to develop and implement initiatives or program modifications to control the costs of the TennCare program to the extent permitted under federal law and the TennCare waiver. Such cost-saving measures may include, but are not limited to, the elimination of covered benefits or limitations on the scope, intensity, or duration of such benefits; implementation of cost sharing requirements for enrollees, including the medicaid population; increases in cost sharing requirements for the expansion population; enforcement of cost sharing requirements through denial of service for failure to meet co-payment requirements with alternative access to medically necessary care through established safety net providers; enforcement of collection of required co-payments by providers; reassignment of enrollees into different eligibility categories; restrictions on eligibility for non-mandatory medicaid or waiver expansion categories; and the elimination from TennCare eligibility of some or all of the non-mandatory medicaid or waiver expansion categories. The bureau of TennCare may implement a premium-assistance initiative for persons disenrolled from TennCare. The bureau of TennCare shall also be authorized, in establishing or modifying benefits or cost sharing requirements, to define, through rules and regulations, categories of eligible enrollees who may be exempted from some or all benefit limits or cost sharing requirements, along with any requirements that must be met by such enrollees to prove or maintain exempted status. The bureau of TennCare shall have all such authority to control costs notwithstanding any other state law to the contrary.

Backlinks (1)

71-5-134

History (8)

Acts 1968, ch. 551, § 2
1973, ch. 276, § 1
T.C.A., § 14-1902
Acts 1982, ch. 730, § 1
T.C.A., § 14-23-102
Acts 1993, ch. 358, § 1
2002, ch. 880, § 3
2004, ch. 673, § 1.

§ 71-5-103. Part definitions.

As used in this part, unless the context otherwise requires:
1. (1) “Adult behavioral health services for the seriously and persistently mentally ill” means behavioral health services for individuals nineteen (19) years of age and older, including, but not limited to, assessment, evaluation, diagnostic, therapeutic intervention, case management, psychiatric medication management, labs related to medication management and pharmacy assistance and coordination;
2. (2) “Adult emergency dental services” means dental services for individuals twenty-one (21) years of age and older to treat a dental condition that manifests itself by symptoms of sufficient severity, including severe pain, infection or trauma, that:
  1. (A) A prudent layperson who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate dental attention to potentially result in:
    1. (i) Placing the person's, or with respect to a pregnant woman, her unborn child's, health in jeopardy;
    2. (ii) Serious impairment of bodily functions;
    3. (iii) Serious dysfunction of any bodily organ or part; or
  2. (B) Includes treatment of dental condition necessary for an individual to receive essential medical treatment, including, but not limited to, extraction of abscessed or periodontally involved teeth prior to an individual receiving a prosthetic heart valve, a donor organ, other replacement prosthetic devices or head and neck radiation therapy;
3. (3) “Applicant” means any person who has applied for benefits under this part;
4. (4) “County office” means the county office of the state department of human services in the county wherein the applicant resides;
5. (5) “Department” means the department of health;
6. (6) “Home-based and community-based services” means any of the following supportive services and systems, as approved by the health care financing administration (HCFA), that are provided to older persons and individuals with disabilities to remain independent and avoid inappropriate institutionalization and that help individuals maintain physical, social, and spiritual independence in the least restrictive environment:
  1. (A) Living environments and supportive services, e.g., assisted care living facilities, homes for the aged and assistive technology;
  2. (B) Personal care, homemaker and chore services;
  3. (C) Adult day services;
  4. (D) Congregate and home delivered meals;
  5. (E) Home care organizations;
  6. (F) Rehabilitative care;
  7. (G) Assisted transportation or mobility services; and
  8. (H) Support services to caregivers, including hospice and respite care;
7. (7) “Medical assistance” means payment of the cost of care, services and supplies necessary to prevent, diagnose, correct or cure conditions in the person that cause acute suffering, endanger life, result in illness or infirmity, interfere with the person's capacity for normal activity, or threaten some significant handicap and that are furnished an eligible person in accordance with this part and the rules and regulations of the department. Such care, services and supplies include services of qualified practitioners licensed under the laws of this state;
8. (8) “Medically needy” means a class or classes of persons whose present income and financial assets are not sufficient to meet their present liabilities for health costs; provided, that the department of health or the department of human services, as may be designated by the governor, may through regulation establish an income limitation as well as other criteria, such as cash, savings, intangible assets and real and personal property for the determination of “medically needy.” To the extent of any federal waiver received by the state that waives any or all of the provisions of Title XIX (42 U.S.C. § 1396 et seq.), or pursuant to any other federal law as adopted by amendment to the required Title XIX state plan, “medically needy” means those persons whose income and assets are insufficient to purchase health insurance and those persons who are uninsurable as a result of an existing or prior medical condition;
9. (9) “Mobile dental services” means an intact comprehensive dental services unit operated on-site at a long-term care facility, interfacing with the facility's common electrical and water sources;
10. (10) “Recipient” means any person who has been determined eligible to receive benefits under this part and who has received such benefits;
11. (11) “Resident” means any individual who is living within the state, with the intent that such person's permanent home be within the state, and not temporarily. Temporary absences from the state shall not cause a person to lose residential status;
12. (12) “Responsible parties” means the following representatives and relatives of recipients of medical assistance pursuant to this part who are not financially eligible to receive benefits under this part: parents, spouses, children, and guardians;
13. (13) “Title XIX” means Title XIX of the Social Security Act as amended (P.L. 89-97) (42 U.S.C. § 1396 et seq.), administered by the United States department of health and human services or its successor in office and including amendments of Title XIX and other federal social security laws replacing that title in whole or in part; and
14. (14) “Vendor” means any person, institution, agency, or business concern providing medical care services or goods authorized under this part, holding, where applicable, a current valid license to provide such services or to dispense such goods; or any health maintenance organization, as defined in title 56, chapter 32, with which the state has entered into a contract based on a per capita rate of payment for services provided under this part.

Backlinks (4)

History (13)

Acts 1968, ch. 551, § 3
1973, ch. 276, § 2
impl. am. Acts 1975, ch. 219, § 1 (a, b)
Acts 1979, ch. 177, § 2
T.C.A., § 14-1903
Acts 1981, ch. 286, § 1
1982, ch. 730, §§ 2, 3
T.C.A., § 14-23-103
Acts 1993, ch. 358, § 2
1998, ch. 1093, § 3
2002, ch. 717, § 1
2008, ch. 1064, § 1
2009, ch. 95, § 1.

§ 71-5-104. Administration by department.

(a) The department of health is hereby designated as the department to administer this part as provided in Title XIX or as provided by any federal waiver received by the state that waives any or all of the provisions of Title XIX or pursuant to any other federal law as adopted by amendment to the required Title XIX state plan.
(b) The bureau of TennCare shall notify each member of the general assembly via electronic mail or other type of electronic communication when it:
1. (1) Proposes a change in services or reimbursement that affects more than two thousand five hundred (2,500) beneficiaries; or
2. (2) Proposes a change that will affect current or future appropriations made by the general assembly in any amount that is greater than ten million dollars ($10,000,000).
(c) The bureau of TennCare shall report at least quarterly to members of the Tennessee general assembly via electronic mail or other type of electronic communication on the following:
1. (1) Status of TennCare reform and improvements;
2. (2) Number of recipients on TennCare and costs to the state;
3. (3) Viability of MCOs and providers in the TennCare program; and
4. (4) Success of fraud detection and prevention.
Backlinks (1)
- 71-5-151(a)
(d) The bureau of TennCare shall concurrently transmit to members of the general assembly via electronic mail or other type of electronic communication TennCare's annual budget proposal when presented in a public forum.

History (8)

Acts 1968, ch. 551, § 4
1973, ch. 276, § 3
impl. am. Acts 1975, ch. 219, § 1 (a), (b)
T.C.A., § 14-1904
Acts 1982, ch. 730, § 4
T.C.A., § 14-23-104
Acts 1993, ch. 358, § 3
2010, ch. 1079, § 3.

§ 71-5-105. Powers and duties of department — Total number of ICF/MR beds — Certificate of need exemption for DIDD public ICF/MR non-facility beds established pursuant to federal litigation.

(a) The department shall:
1. (1) Supervise the administration of medical assistance for eligible recipients;
2. (2) Make uniform rules and regulations, not inconsistent with the law, for implementing, administering and enforcing this part in an efficient, economical and impartial manner;
3. (3)
  1. (A) Establish, in consultation with the comptroller of the treasury, rules and regulations for the determination of payment for hospitals, and other health care providers who contract with the department for the care of persons eligible for assistance pursuant to this part;
  2. (B) Establish, in consultation with the comptroller of the treasury and the Tennessee Health Care Association (THCA), rules for an acuity and quality-based reimbursement methodology for nursing facility services paid for by the bureau of TennCare under the rules of the department and as designated and certified by the department. Payment determination components shall include acuity adjusted direct care, non-acuity adjusted direct care, quality, administration, fair market value capital, a cost-based component, and an inflation index factor. The inflation index factor that shall be the most recent Skilled Nursing Facility without Capital Market Basket Index as published by IHS Global Insight (IHS Economics) or other index as may be agreed to by the bureau of TennCare and the comptroller of the treasury, in consultation with THCA, should this index cease to be produced. The commissioner may establish the maximum amount to be paid to nursing facilities, consistent with the requirements of federal law and § 71-5-124(b);
    Backlinks (1)
    
    71-5-1002(h)(1)
4. (4) Cooperate with the appropriate federal department in any reasonable manner as may be necessary to qualify for federal aid in connection with the medical assistance program;
5. (5) Within sixty (60) days after the close of each fiscal year, prepare and print an annual report, which shall be submitted to the governor and members of the general assembly. This report shall include a full account of the operations and the expenditures of all funds under this part, adequate and complete statistics divided by counties about all medical assistance within the state, rules and regulations of the department promulgated to carry out this part, and such other information as it may deem advisable;
6. (6) Prepare or have prepared and release a summary statement monthly showing by counties the amount paid under this part and the total number of persons assisted;
7. (7) Establish and enforce safeguards to prevent unauthorized disclosures or improper use of the information contained in applications, reports of investigations and medical examinations, and correspondence in the individual case records of recipients of medical assistance;
8. (8) Furnish information to acquaint needy persons and the public generally with the plan for medical assistance of this state;
9. (9) Cooperate with agencies in other states in establishing reciprocal agreements to provide for payment of medical assistance to recipients who have moved to another state, consistent with this part and of Title XIX as amended;
10. (10) Contract, to the extent feasible, with one (1) or more contractors or fiscal intermediaries, or both, to provide or arrange services under this part. All such contracts shall be procured in accordance with the requirements of title 12, chapter 4, part 1; provided, that the department shall be required to solicit competitive proposals for contracts with fiscal intermediaries;
11. (11) Increase the coverage under medicaid for inpatient hospital days from fourteen (14) days to twenty (20) days, as provided for in the public health regulations of the United States department of health and human services, health care financing administration (HCFA). Coverage for inpatient hospital days shall be unlimited for any infant under the age of one (1) year to the extent required by federal law or regulations. The commissioner is further directed to promulgate a rule establishing a system of prospective reimbursement, targeted reimbursement, diagnosis-related groups, other method of reimbursement related to diagnosis, or other method of reimbursement pursuant to any federal waiver that waives any or all of the provisions of Title XIX that the state may receive or pursuant to any other federal law as adopted by amendment to the required Title XIX state plan, at which time such mechanism shall be used to determine the number of inpatient hospital days instead of the twenty-day limitation provided in this subdivision (a)(11); and
12. (12) Notwithstanding any law to the contrary, assist the council on children's mental health care in developing a plan that will establish demonstration sites in certain geographic areas where children's mental health care is child-centered, family-driven, and culturally and linguistically competent and that provides a coordinated system of care for children's mental health needs in this state.
(b)
1. (1) Subject to subdivision (b)(3), the total number of beds in private for-profit and private not-for-profit intermediate care facilities for individuals with intellectual disabilities (ICF/IID) must not be less than six hundred ninety-six (696) absent a reduction in the occupancy rate to eighty percent (80%) or less of the statewide available occupancy as determined annually and must not exceed a total maximum number of eight hundred four (804) upon the voluntary surrender by the certificate of need providers. To determine the statewide available occupancy, the department of disability and aging shall use the data from cost reports submitted by providers to the comptroller of the treasury. The department shall demonstrate a commitment to assisting providers who chose to transition a current site from ICF/IID services to home and community-based services (HCBS) in achieving compliance with the HCBS settings rules. In compliance with the certificate of need process, private for-profit and private not-for-profit ICF/IID beds may be transferred from one (1) location or one (1) provider to another, but the total number of such beds must not exceed eight hundred four (804).
2. (2) An available private ICF/IID bed may be filled only upon completion of a community-informed choice process established and administered by the department of disability and aging that fairly and completely represents available options in order to ensure that the placement is the most integrated and cost-effective setting and subject to the individual's freedom of choice. Providers may refuse persons based on needs compatibility considering the total mix of persons in the facility. The department of disability and aging shall demonstrate a commitment to ensuring the individual's freedom of choice and ensure that each eligible service recipient is fully informed of all services available to the recipient, including community ICF/IID facilities and the specialized services the facilities provide.
3. (3) The total number of private for-profit and not-for-profit ICF/IID beds authorized in subdivision (b)(1) is permanently reduced upon voluntary surrender of a certificate of need for the specified number of ICF/IID beds by the owner. A surrendered bed must not be reestablished by the same or another owner.
(c) Notwithstanding any authority to the contrary, DIDD public ICF/MR non-facility beds established pursuant to federal litigation settlements or orders arising out of the cases United States v. State of Tennessee, 798 F. Supp. 483; 1992 U.S. Dist. LEXIS 14004 (W.D. Tenn. 1992), or People First of Tennessee, et al., v. Clover Bottom Developmental Center, et al., NO. 00-5342 (Docket) (C.A.6 Mar. 22, 2000), shall be exempt from all requirements and processes for the application and granting of certificates of need as set forth in § 68-11-1607. The establishment of all private ICF/MR non-facility beds remains subject to certificate of need requirements and processes.

Backlinks (2)

History (24)

Acts 1968, ch. 551, § 5
T.C.A., § 14-1905
Acts 1982, ch. 730, § 5
1984, ch. 787, § 9
1986, ch. 831, § 1
1986, ch. 884, § 1
T.C.A., § 14-23-105
Acts 1989, ch. 45, § 1
1989, ch. 296, § 1
1992, ch. 903, § 1
1993, ch. 358, § 4
1997, ch. 478, § 3
2006, ch. 761, § 1
2007, ch. 307, § 1
2008, ch. 1062, § 11
2008, ch. 1190, § 19
2009, ch. 458, § 1
2009, ch. 477, § 1
2010, ch. 1100, § 139
2013, ch. 239, § 1
2016, ch. 630, § 1
2018, ch. 836, § 1
2023, ch. 254, § 1
2024, ch. 688, § 181.

§ 71-5-106. Determination of eligibility for medical assistance.

(a)
1. (1) The departments of health and human services, as may be designated by the governor, shall make the determination of eligibility under this part, subject to approval of the finance, ways and means and health and welfare committees of the senate and the finance, ways and means and health committees of the house of representatives. Such determination of eligibility may be accomplished through contractual agreement with agencies of the federal government. Eligibility for assistance shall be determined in a manner that will ensure that medical assistance is provided, within the limits of available resources subject to federal financial participation, to all persons who, although ineligible for supplementary security income (SSI), complied under Title XVI of the Social Security Act (42 U.S.C. § 1381 et seq.), or are medically needy.
2. (2)
  1. (A) A notice that awards medicaid benefits shall include the following statement:
    1. “A person with both medicare and medicaid does not usually need other health insurance. Did you buy a medicare supplement policy after November 4, 1991? If so, you can have the insurance company put your policy and your payments on hold. The insurance company can do this for up to twenty-four (24) months while you are on medicaid. If you lose medicaid during the twenty-four-month period, you can get your policy back.
    2. “To put your policy on hold, contact your insurance company within ninety (90) days of when you get medicaid. To get your policy back, you must tell your insurance company within ninety (90) days after you lose medicaid.”
  2. (B) A notice that terminates medicaid benefits shall include the following statement:
    1. “Did you have medicare supplement insurance that you put on hold while you had medicaid? You may be able to get your policy back if you have put it on hold less than two (2) years ago. Contact your insurance company within ninety (90) days after you lose medicaid. Tell the insurance company that you want your policy reinstated.”
(b) In determining the eligibility of an individual for benefits under this chapter, resources that have been previously owned and transferred by the individual, or such individual's spouse, shall be treated in a manner consistent with Title XIX of the Social Security Act.
(c) Any transaction described in subsection (b) shall be presumed to have been for the purpose of establishing eligibility for benefits or assistance under this part, unless such individual or eligible spouse furnishes convincing evidence to establish that the transaction was exclusively for some other purpose.
(d) For purposes of subsection (b), the value of such a resource or interest shall be the fair market value of such resource or interest at the time it was sold or given away, less the amount of compensation received for such resource or interest, if any.
(e) In the event that any resource, or interest in any resource, is given away or sold for less than fair market value by a person holding a power of attorney by the owner of the resource or interest, such resource or interest shall not be counted as a resource to the owner of the property pursuant to subsections (b)-(d) under the following circumstances:
1. (1) The power of attorney was not executed for the purpose of establishing or continuing medicaid eligibility;
2. (2) The owner of the property has, at the time of the transfer, neither actual nor constructive knowledge of the transfer or is unable because of mental or physical incapacity to take reasonable and necessary steps to prevent such sale or transfer.
(f) If any resource or interest in any resource is given away or sold for less than fair market value by a person holding a power of attorney by the owner of such resource, the sale or gift shall be set aside by a court of competent jurisdiction as being in defraud of the state upon motion of the state of Tennessee or of any party representing the owner of the resource, unless the person holding the power of attorney proves by a preponderance of the evidence that the sale or gift was exclusively for some other purpose than the establishment or continuance of medicaid eligibility.
(g) In addition to the requirements of subsection (f), the person exercising the power of attorney and the person to whom the resource is given or sold for less than fair market value shall be jointly and severally liable to the state of Tennessee for any costs incurred by it in providing medicaid benefits to the owner of the resource, until such time as the conveyance is set aside, for any costs, including attorney fees, court costs, and any other related expenses, incurred by it in having the conveyance set aside, and for any losses incurred as a result of any damage, destruction, expenditure, waste, transfer of the resources or other act of the persons involved that diminishes the value of the resource. Such liability shall be limited to the actual value of the resource.
(h) In the event that a person otherwise eligible for medicaid has filed an action in court to set aside a transfer for less than value because of fraud, duress, trick or otherwise, such person shall be or shall remain eligible, or both, and the state of Tennessee shall have recourse under subsections (f) and (g) to set aside the transfer and recover.
(i) In addition to the other categories of eligibility under this section, there shall be a category of medical assistance eligibility for those children who:
1. (1)
  1. (A) Were born after September 30, 1967;
  2. (B) Are eighteen (18) years of age or younger; and
  3. (C) Are in intact families that meet the TANF income and resource requirements; or
2. (2) As provided in Title IV of the Social Security Act (42 U.S.C. § 601 et seq.), have been determined to be a child with special needs, for whom there is in effect an adoption assistance agreement between the department of children's services and an adoptive parent or parents, and who the department of children's services has determined cannot be placed with an adoptive parent or parents without medical assistance because such child has special needs for medical, mental health, or rehabilitative care.
(j) Subsections (b)-(j) shall not limit the ability of the state to extend medical assistance to persons who are medically needy pursuant to any federal waiver received by the state that waives any or all of the provisions of Title XIX or pursuant to any other federal law as adopted by amendment to the required Title XIX state plan.
(k) Effective January 1, 1998, if the actual enrollment of non-previously enrolled children under eighteen (18) years of age that began on April 1, 1997, has not reached seventy-five percent (75%) of anticipated enrollment level of fifty thousand (50,000) children, the commissioner of health shall offer enrollment in the Title XIX waiver program, TennCare, to children under eighteen (18) years of age whose family income is below two hundred percent (200%) of the federal poverty level schedule in effect for calculation of TennCare premiums. Such offer of enrollment in the TennCare program shall be made in accordance with TennCare promulgated rules and regulations. It is the legislative intent that this section be implemented only to the extent that it is determined to be consistent with the terms, conditions and eligibility criteria of the TennCare waiver as approved by the United States department of health and human services and that state and federal funding is available for such purpose.
(l) Beginning January 1, 2003, the bureau of TennCare or its designee shall determine eligibility for TennCare on an annual basis as follows:
1. (1) All non-medicaid eligible TennCare enrollees will have the responsibility to complete an eligibility process each year; in the absence of reapplication and completion of the process, coverage will expire;
2. (2) Upon notification by the bureau of TennCare, the enrollee must submit application for continuation of eligibility within ninety (90) days; once an application has been timely submitted, the enrollee must provide all required documentation to verify continued eligibility in accordance with TennCare rules and regulations;
3. (3) Notification to the enrollee is presumed when a notice is mailed to the last known address;
4. (4) Lack of receipt of the notification does not excuse the responsibility of the enrollee to submit an application and provide documentation for continuation of eligibility as required by TennCare rules and regulations if the enrollee has changed addresses and failed to notify the bureau of TennCare or its designee; and
5. (5) Failure of the enrollee to contact the bureau of TennCare or its designee concerning a change in address relieves the bureau of responsibility for contacting the enrollee.
(m) To the extent permitted by federal law, the state may impose a reasonable fee for costs of eligibility determinations for applicants applying for medical assistance as part of the medically eligible expansion population under the TennCare waiver.
(n) In the TennCare waiver expansion population, except for persons medically eligible as uninsurable persons, enrollment shall not be permitted for individuals from households with incomes of greater than two hundred fifty percent (250%) of federal poverty levels.
(o) Except as may be required by federal law or the TennCare waiver, no person shall be eligible to receive TennCare benefits, except employee health insurance subsidy payments, as part of the TennCare waiver expansion population if such person is enrolled in a health insurance plan as such coverage is defined in TennCare rules and regulations, or if such person is eligible for participation in medicare or group health insurance offered through an employer or family member's employer, or COBRA coverage.
(p) All determinations of eligibility for persons medically eligible as uninsurable in the TennCare waiver's expansion population shall be made on the basis of health conditions that prevent the person from obtaining health insurance. Such a determination will be based upon a review of medical records and information in accordance with TennCare rules and regulations.
(q) To the extent permitted by the terms of relevant court orders and decrees, any applicable federal waiver under Title XIX of the federal Social Security Act or any other federal law, the bureau of TennCare may not remove persons from eligibility for or participation in medical assistance provided pursuant to this chapter for reasons relating to restricting eligibility or enrollment for fiscal or other reasons that are not required by federal law until the bureau has complied with both of the following:
1. (1) The bureau has verified at the time of application the validity of the social security number of every person enrolled in the medical assistance program provided pursuant to this chapter with appropriate federal databases in order to determine whether persons who are not lawful residents of the United States are present in the program, or are otherwise fraudulent applicants; and
2. (2) Removed from the program all such ineligible persons who are current recipients in the program but are not lawful residents of the United States, or are otherwise fraudulent applicants.
(r)
1. (1) An individual who is an inmate of a public institution shall have eligibility for medical assistance suspended but not terminated during periods of actual incarceration.
2. (2) An individual who is an inmate of a public institution shall be eligible for temporary reinstatement of medical assistance for care received outside of a jail or correctional facility in a hospital or other health care facility for more than twenty-four (24) hours.
3. (3) A public institution may make efforts to establish eligibility for or renew assistance for such individuals prior to their release from the public institution.

Backlinks (2)

History (24)

Acts 1968, ch. 551, § 6
1973, ch. 276, § 4
1974, ch. 440, § 1
T.C.A., § 14-1906
Acts 1981, ch. 315, §§ 1-3
1981, ch. 476, § 1
1982, ch. 714, § 1
1985, ch. 430, § 2
1986, ch. 845, § 1
T.C.A., § 14-23-106
Acts 1987, ch. 332, § 1
1989, ch. 143, § 1
1991, ch. 406, § 1
1992, ch. 799, § 1
1993, ch. 358, §§ 5, 6
1997, ch. 495, § 1
1998, ch. 1097, § 29
2002, ch. 880, § 2
2004, ch. 673, §§ 4-8
2009, ch. 429, § 1
2013, ch. 236, § 86
2014, ch. 926, § 1
2019, ch. 345, § 134
2021, ch. 64, § 120.

§ 71-5-107. Kinds of medical services.

(a) Medical assistance, including demonstration projects and programs designed to enhance the efficient and economic operation of the medicaid program, shall be provided to those classes of individuals determined to be eligible under § 71-5-106. This medical assistance, in the amount, scope, and duration determined by the commissioner of health and to the extent permitted by federal law, may include:
1. (1) Inpatient hospital services, other than services in an institution for tuberculosis or mental diseases;
2. (2) Outpatient hospital services;
3. (3) Other laboratory and X-ray services;
4. (4) Skilled nursing home services, other than services in an institution for tuberculosis or mental diseases;
5. (5) Physicians' services, whether furnished in the office, the patient's home, a hospital, a skilled nursing home, or elsewhere;
6. (6) Drugs;
7. (7) Inpatient hospital services for individuals sixty-five (65) years of age or over in an institution for tuberculosis or mental diseases, and inpatient hospital services for individuals under twenty-one (21) years of age in institutions for mental diseases, or in case of an individual who was receiving such inpatient services for mental disease in the period immediately preceding the date on which such individual becomes twenty-one (21) years of age:
  1. (A) The date on which such individual no longer requires the services; or
  2. (B) If earlier, the date such individual becomes twenty-two (22) years of age;
8. (8) Nonmedical nursing care shall be rendered in accordance with the tenets and practice of a recognized church or religious denomination to any indigent person otherwise qualified for assistance under this part who depends upon healing by prayer or spiritual means alone in accordance with the tenets and practice of such church or religious denomination;
9. (9) Skilled nursing home services for individuals sixty-five (65) years of age or over in institutions for tuberculosis or mental diseases;
10. (10) Medical screening, diagnostic and treatment services for eligible categorically connected individuals under twenty-one (21) years of age;
11. (11) Psychiatric clinic services in approved facilities;
12. (12)
  1. (A) Home health care services provided in the recipient's home. The services may follow the recipient into the community subject to subdivision (a)(12)(B);
  2. (B) Home health nurses or aides may accompany a recipient outside the home during the course of delivery of prior approved home health nurse or home health aide services if all of the following criteria are met:
    1. (i) The home health nurse or home health aide shall not transport the recipient;
    2. (ii) The home health agency shall have discretion as to whether or not to accompany a recipient outside the home. The circumstance under which a home health agency may exercise such discretion shall include, without limitation, when the home health agency has concern regarding any of the following:
      1. (a) The scheduling or safety of the transportation;
      2. (b) The health or safety of their employee or the recipient;
      3. (c) The ability to safely and effectively deliver services in the alternative setting; and
      4. (d) The additional expense that would be required to accompany a patient outside the home;
    3. (iii) Additional visits or hours of care will not be approved for coverage for the purpose of accompanying a recipient outside the home. Services will be limited to services to which the recipient would be entitled if the services were provided exclusively at the recipient's place of residence; and
    4. (iv) No additional reimbursement shall be paid to the home health agency in association with the decision of a home health agency to accompany a patient outside the home;
  3. (C) Nothing in this subdivision (a)(12) is intended to create an entitlement to services outside the home;
  4. (D) A home health agency shall not be subject to any claims or cause of action as result of exercising its discretion under this subdivision (a)(12);
13. (13) Transportation for approved emergency medical examination or treatment, or both;
14. (14) Intellectual disability and rehabilitation services;
15. (15) Intermediate care facilities services;
16. (16) Medical services rendered by community or neighborhood health organizations or clinics, including organizations or clinics where some or all of the medical services are provided by medical students presently enrolled in a medical school accredited by the Association of American Medical Colleges or licensed registered nurses, or both, and where such students or licensed registered nurses are under the direction of a licensed physician or physicians;
17. (17) Family planning services and supplies;
18. (18) Basic dental care services;
19. (19) Medical and surgical services rendered by ambulatory surgical treatment centers;
20. (20) Services rendered by rural health clinics;
21. (21) Medical assistance and home- and community-based services to those eligible being served through a health care financing administration (HCFA) approved waiver designed to provide more efficient and economical alternatives to institutional care;
22. (22) Services by nurse anesthetists who are registered by the Tennessee board of nursing, who have completed an advance course in anesthesia, and who hold a current certification from the American Association of Nurse Anesthetists as a nurse anesthetist;
23. (23) Nurse midwife services performed by a person who is licensed by the Tennessee board of nursing as a registered nurse under the authority of the Nursing Practice Act, compiled in title 63, chapter 7, and certified by the American College of Nurse Midwives as a certified nurse midwife;
24. (24) Services provided by certified pediatric nurse practitioners and certified family nurse practitioners as required by federal law;
25. (25)
  1. (A) Sickle cell disease management services and public education campaign activities specifically related to sickle cell disease, as authorized by 42 U.S.C. § 1396d(a)(27) and (x), with reimbursement in accordance with any applicable state plan amendment;
  2. (B) Any contract between a managed care organization (MCO) and the bureau of TennCare to provide medical assistance pursuant to this part shall be appropriately revised or amended in order to comply with the implementation of subdivision (a)(25)(A);
26. (26) Language interpreter services, which may include:
  1. (A) Sign language interpreter services when such services are necessary to help recipients who are deaf or hard of hearing obtain covered services; and
  2. (B) Spoken language interpreter services to all recipients with limited English proficiency;
27. (27) Services within the practice of chiropractic performed by a person who is authorized by title 63, chapter 4, to engage in the practice of chiropractic; and
28. (28) Rapid whole genome sequencing. As used in this subdivision (a)(28), “rapid whole genome sequencing”:
  1. (A) Means an investigation of the entire human genome, including coding and non-coding regions and mitochondrial deoxyribonucleic acid, to identify disease-causing genetic changes that returns the preliminary positive results within seven (7) days and final results within fifteen (15) days from the date of receipt of the sample by the lab performing the test; and
  2. (B) Includes patient-only whole genome sequencing, duo whole genome sequencing of the patient and one (1) biological parent, and trio whole genome sequencing of the patient and both biological parents.
(b) With respect to recipients determined to be “medically needy,” all or a part of the medical services outlined in subsection (a) may be provided, and may, within applicable federal legislation and regulations, be of lesser amounts, duration and scope than medical services provided other medicaid recipients in order to ensure that an expenditure of state funds shall not exceed the amount provided for the operation of the medicaid program.
(c) When the amount, duration, and scope of medical services is lessened so as to no longer include intermediate care facility services, the commissioner of health, with approval of the commissioner of human services, may continue to provide intermediate care facility services to those recipients who have been determined to be medically indigent and placed in a medicaid certified intermediate care facility bed at the time such change in the amount, duration, and scope of medical services is made.
(d) The department shall assist in the development of a demonstration project, which would provide cost effective alternatives to long-term care under the Omnibus Budget Reconciliation Act of 1981, to the extent permissible under the federal law, for institutional and residential homes that provide domiciliary care for the aged and mentally disabled, which project would include the Foster-Group Care Home Association. The development of such demonstration project shall begin on July 1, 1982.
(e) The bureau of TennCare shall have the authority to implement a comprehensive disease management program for certain enrollees of the TennCare program to the extent permitted under federal law and the TennCare waiver. The bureau, through its authority to promulgate rules and regulations, may identify enrollees eligible to participate and the disease categories to be included in the comprehensive disease management program. The bureau, also through its authority to promulgate rules and regulations, may put in place requirements regarding the continued participation of enrollees in the program.
(f) Subject to the availability of funding earmarked for such programs in the general appropriations act and to the extent permitted under federal law and the TennCare waiver, the bureau of TennCare shall have the authority to create in whole or in part and administer a program to be named “The TennCare safety net” which will provide two different components to assist eligible TennCare enrollees:
1. (1) Certain medical providers in Tennessee shall provide non-emergency health care services without co-payment requirements to certain specified TennCare enrollees. Such services are intended to include only services that are both medically necessary and within the scope of TennCare benefits for the particular enrollee but for which the enrollee cannot meet the co-payment requirements. Through its authority to promulgate rules and regulations, the bureau of TennCare will identify the parameters of this component of the TennCare safety net program, including which enrollees are eligible to participate in this program, allowable benefits under the program, designation of both urban and rural providers who participate in this program, and a funding methodology pursuant to which such providers shall be compensated;
2. (2)
  1. (A) A TennCare foundation will be established that will accept and review applications for medical assistance submitted on behalf of certain specified TennCare enrollees. The members of the foundation shall be appointed by the governor, who shall determine the size and composition of the foundation's membership. The governor should strive to ensure that the membership is representative of the state's geographic and demographic composition with appropriate attention to the representation of women and minorities. Terms for the members will be staggered and the length of terms will be detailed by the governor in making initial or subsequent appointments. The governor shall appoint the chair and vice-chair. For the purposes of administration and availability of records, the TennCare foundation shall be located within the bureau of TennCare; staff assistance shall be provided by the bureau of TennCare or by another entity, should the governor so determine. At the discretion of the governor, the foundation may be placed within another appropriate agency, may create or be reconstituted as a nonprofit entity, or may be terminated at any time; and
  2. (B) Applications for medical assistance from the foundation are not intended, and should not be used, as a means to circumvent or avoid the benefit limits established by the bureau of TennCare. It is expected that these applications will be submitted to address special, unforeseen, or exceptional circumstances. Such applications must be submitted by a licensed medical provider who is treating the enrollee and shall request the provision of medically necessary health care services recommended or prescribed by the enrollee's treating provider that are beyond the scope of benefits provided through the TennCare program benefit package for which the enrollee is eligible. For the purposes of this subsection (f), “beyond the scope of benefits” means a benefit that is covered within limits by TennCare but for which the enrollee has exceeded the covered limits of that benefit. It does not include benefits that are not covered to any extent under TennCare for the applicant. The foundation will not consider matters of eligibility for the TennCare program. Through its authority to promulgate rules and regulations, the bureau of TennCare will identify the parameters of this component of the TennCare safety net program, including the process for making application to this foundation, which enrollees are eligible to apply, and a mechanism for determining which applications will be reviewed by the foundation. The foundation will not have rule-making authority;
  3. (C)
    1. (i) Notwithstanding the availability of assistance from the foundation, no enrollee has an expectation of or an entitlement to assistance from the foundation;
    2. (ii) There exists no right of appeal regarding an application for assistance; and
    3. (iii) Because the level of funding provided to the foundation is limited, the foundation may not be able to fully or partially fund all applications. The decisions of which applications to fund will be solely within the discretion of the foundation;
  4. (D) Nothing in this subsection (f) shall be construed to require a contested case hearing as set forth in the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, nor shall any determinations made by the foundation be considered final orders from which appeals can be taken. The consideration of applications provided for by this subdivision (f)(2)(D) shall not constitute hearings as set forth in the Uniform Administrative Procedures Act;
  5. (E) The foundation shall consider applications and determine in its sole discretion and without requirement for written findings whether the application should be granted in whole or in part. The foundation's determination on an enrollee's application shall have no binding precedential effect on the consideration of any other enrollees' applications;
  6. (F) In the event that a matter being considered by the foundation presents a real or apparent conflict of interest for any staff or member, such staff or member shall disclose the conflict to the chair and be recused from any official action taken on the matter;
  7. (G) Notwithstanding the open meetings law, compiled in title 8, chapter 44 or any other law to the contrary, any and all meetings of the TennCare foundation are to be considered confidential and closed to the public. Members and staff shall maintain strict standards of confidentiality in the handling of all matters before the foundation. In addition, all relevant federal and state laws regarding patient privacy and confidentiality will be adhered to. All material and information, regardless of form, medium, or method of communication, provided to or acquired by a foundation member or staff in the course of the foundation's work, shall be regarded as confidential information, shall not be disclosed, and are not public records. In addition, all material and information, regardless of form, medium, or method of communication, made or generated by a member or foundation staff in the course of the foundation's work, shall be regarded as confidential information and shall not be disclosed and are deemed not to be a public record. All necessary steps shall be taken by members and staff to safeguard the confidentiality of such material or information in conformance with federal and state law;
  8. (H) Every October 1, the foundation shall report in writing to the governor, the health and welfare committee and commerce and labor committee of the senate, and the health committee and insurance committee of the house of representatives regarding how funds allocated to the foundation were spent during the previous fiscal year. Such report shall contain the following information:
    1. (i) How many applications were received;
    2. (ii) How many applications the foundation granted;
    3. (iii) The type of services and items that were funded; and
    4. (iv) Statistical information, by gender, race, and division of the state, on who applied for and who received the funds;
  9. (I) Whether members shall receive reasonable compensation for their service on the TennCare foundation will be determined at the discretion of the governor; members may be reimbursed for those expenses allowed by the comprehensive travel regulations promulgated by the department of finance and administration and approved by the attorney general and reporter;
  10. (J) If any federal or state court or other tribunal with jurisdiction:the challenged provisions may not be severed from the remainder of this subdivision (f)(2). In this event, all provisions of this subdivision (f)(2) will terminate and have no further effect. Such termination shall occur no later than ninety (90) days after the effective date of the order unless such order is stayed by the issuing court or the reviewing court pending disposition of an appeal of the order. The decision whether or not to appeal any such order will be at the sole discretion of the bureau of TennCare. This nonseverability provision shall be self-executing. If this subdivision (f)(2) is terminated while appropriated funds remain, the unused funds shall revert back to the general fund. Any payments for services or items which have been approved but not yet disbursed as of the date of termination shall be paid, but no further applications for payments shall be considered or granted after the date of termination. In the event of termination under this subsection (f), the foundation may be reinstated only by new legislative action and a new appropriation by the general assembly.
    1. (i) Determines that any aspect of subdivision (f)(2)(A), (f)(2)(B), (f)(2)(C), (f)(2)(D), (f)(2)(E), or (f)(2)(G) violates federal law, state law, or any existing court order or consent decree, and
    2. (ii) Makes effective an order enjoining compliance with any aspect of these provisions or requiring non-trivial changes in the terms or applications of these provisions,
(g) The bureau of TennCare shall have the authority, in collaboration with one or more medical schools located in Tennessee, to establish an evidence-based medicine initiative for the purpose of developing medical protocols and integrating standards of best practices within the delivery of TennCare services. To the extent that evidence-based medical protocols are authorized by the bureau of TennCare, such protocols shall satisfy the standard of medical necessity as set forth in § 71-5-144. The bureau of TennCare, through its authority to promulgate rules and regulations, shall establish the parameters for the initiative, including who can participate and how the initiative is to be implemented.

Backlinks (2)

History (31)

Acts 1968, ch. 551, § 7
1969, ch. 326, §§ 1, 2
1972, ch. 596, § 1
1973, ch. 73, §§ 1, 3, 4
1973, ch. 262, § 1
1973, ch. 276, § 5
1974, ch. 802, § 2
1976, ch. 572, § 1
1978, ch. 875, § 1
modified
T.C.A., § 14-1907
Acts 1981, ch. 225, §§ 1-4
1981, ch. 476, § 2
1982, ch. 740, §§ 6-8, 19
T.C.A., § 14-23-107
Acts 1987, ch. 310, §§ 1, 2
1988, ch. 510, §§ 1, 2
1993, ch. 183, § 1
1998, ch. 1093, § 2
2004, ch. 673, § 2
2009, ch. 471, § 1
2011, ch. 197, § 2
2011, ch. 410, § 6(b)
2013, ch. 236, § 77
2015, ch. 122, § 1
2017, ch. 243, § 1
2019, ch. 329, § 6
2019, ch. 345, § 135
2021, ch. 64, § 121
2021, ch. 524, § 1
2024, ch. 1020, § 1.

§ 71-5-108. Payment methodology for medicaid enrollees not enrolled in medicare.

The TennCare bureau is directed to submit a state plan amendment to the centers for medicare and medicaid services that sets out a payment methodology for medicaid enrollees who are not also enrolled in medicare, consistent with provisions in § 6085 of the federal Deficit Reduction Act of 2005, regarding emergency services furnished by noncontract providers for managed care enrollees. The payment amount shall be the average contract rate that would apply under the state plan for general acute care hospitals. A tiered grouping of hospitals by size or services may be utilized to administer these payments. The payment methodology developed pursuant to this section shall be budget neutral for the state fiscal year 2007-2008 when compared to the actual experience for emergency services furnished by non-contract providers for medicaid managed care enrollees prior to January 1, 2007. It is the intent that this section only applies to the emergency services furnished by noncontract providers for medicaid managed care enrollees.

History (1)

Acts 2007, ch. 409, § 1.

§ 71-5-109. Expenditures not to exceed appropriation.

(a) In no event shall the services paid for by the state including assistance from the United States government require expenditure of state funds in excess of the amount appropriated for such purpose.
(b) The commissioner may by rule and regulation fix the maximum level of services as are deemed necessary to ensure that an expenditure of state funds shall not exceed the amount provided for those purposes, as approved by the commissioner of finance and administration.

History (2)

Acts 1968, ch. 551, § 9
T.C.A., §§ 14-1909, 14-23-109.

§ 71-5-110. Application for medical assistance — Application for TennCare enrollment — Notice of change in application information.

(a) An applicant for medical assistance under this part, or a person acting in the applicant's behalf, shall file the application in a place and manner as may be designated by the department of health or the department of human services as may be designated by the governor.
(b) Any application for TennCare enrollment shall include the applicant's legal place of residence in addition to the applicant's address, if the address is different from the applicant's legal place of residence or is or contains a post office box number, and a telephone number. The inability to provide a legal place of residence or telephone number due to homelessness shall not, in itself, preclude eligibility. To the extent permitted by federal law, the application of a self-employed individual for medical assistance as a part of the TennCare program shall include a copy of the individual's most recent federal income tax return or, if the individual's business is newly established, documentation deemed sufficient by the bureau of TennCare or the department of human services to project self-employment earnings pending completion of the upcoming year's income tax return.
(c)
1. (1) Unless expressly exempted by rule of the department from reporting under this section, each enrollee in and applicant for TennCare uninsured or uninsurable coverage, including a person who applies on behalf of a family member, shall notify the bureau of any material change affecting any information given to the bureau or the bureau's designee on or with the person's TennCare application. The enrollee or applicant shall be responsible for mailing documentation of any such change within thirty (30) days of any change. The bureau shall update the person's file to reflect such changes. An enrollee or applicant, including a person who applies on behalf of a family member, commits the offense of theft of services under title 39, chapter 14, who intentionally fails to so notify the bureau of any material change that would, if properly reported, result in ineligibility or an increase in the amount of any premium or cost sharing.
2. (2) The department shall ensure that application forms for TennCare uninsured or uninsurable coverage under this part used after July 1, 2000, apprise applicants of the requirements of this chapter.

History (9)

Acts 1968, ch. 551, § 10
impl. am. Acts 1975, ch. 219, § 1 (a, b)
T.C.A., § 14-1910
Acts 1982, ch. 730, § 10
T.C.A., § 14-23-110
Acts 1999, ch. 139, § 1
2000, ch. 853, § 3
2002, ch. 880, §§ 6, 15
2004, ch. 673, § 9.

§ 71-5-111. Investigation — Determination of eligibility.

When an application for medical assistance under this part is filed with the agency designated to determine eligibility under this part, the agency shall promptly make or cause to be made such investigation as it may deem necessary. The object of such investigation shall be to ascertain the fact supporting the application and such other information as may be required.

History (5)

Acts 1968, ch. 551, § 11
impl. am. Acts 1975, ch. 219, § 1 (a, b)
T.C.A., § 14-1911
Acts 1982, ch. 730, § 11
T.C.A., § 14-23-111.

§ 71-5-112. Hearing concerning eligibility.

Whenever a hearing concerning eligibility determinations is required by state or federal law or constitutional provision, the agency designated to determine eligibility shall hear such hearings before a hearing officer or administrative judge designated by the agency. The hearing shall be held in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.

Backlinks (1)

71-5-113(a)

History (5)

Acts 1968, ch. 551, § 12
impl. am. Acts 1975, ch. 219, § 1 (a, b)
T.C.A., § 14-1912
Acts 1982, ch. 730, § 12
T.C.A., § 14-23-112.

§ 71-5-113. Hearing concerning matters other than eligibility.

(a) Except as required in § 71-5-112, whenever a hearing is required by state or federal law or constitutional provision, the department shall provide such hearings before the commissioner or the commissioner's designee.
(b) Such hearing shall be held in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, except that the commissioner may adopt rules that establish procedures not necessarily in accordance with the Uniform Administrative Procedures Act for the review of appeals from denials of claims for payment for medical assistance under this part where the amount of the claim is less than five hundred dollars ($500).
(c) The procedures shall include the opportunity for an informal hearing before the commissioner or the commissioner's designee, who shall not be a medicaid employee.

History (5)

Acts 1968, ch. 551, § 13
T.C.A., § 14-1913
Acts 1982, ch. 730, § 13
1984, ch. 607, § 1
T.C.A., § 14-23-113.

§ 71-5-114. Subpoena and examination of witnesses.

(a) The appropriate departments have the power to subpoena witnesses, to compel their attendance and the production of papers and writings.
(b) The officers and employees designated by the appropriate department may administer oaths and examine witnesses under oath in connection with any application or proceedings under this part.

History (2)

Acts 1968, ch. 551, § 14
T.C.A., §§ 14-1914, 14-23-114.

§ 71-5-115. Financial responsibility of relative — When may be considered — Reimbursement from responsible parties.

To the extent permitted by federal law, the department may require or permit that responsible parties of a recipient of medical assistance supplement or reimburse for any benefit or benefits rendered to the recipient pursuant to this part.

History (5)

Acts 1968, ch. 551, § 15
1979, ch. 177, § 1
T.C.A., § 14-1915
Acts 1982, ch. 730, § 14
T.C.A., § 14-23-115.

§ 71-5-116. Lien on real estate — Claim against estate — Restrictions.

(a) No applicant shall be required to execute an agreement for a lien on real property occupied as the applicant's residence on account of medical assistance paid or to be paid on the applicant's behalf pursuant to this part.
(b) No lien may be imposed against the real property of any recipient prior to the individual's death, on account of medical assistance paid or to be paid on the recipient's behalf pursuant to this part, except pursuant to a court judgment for recovery of benefits incorrectly paid on behalf of the recipient.
(c)
1. (1) There shall be no adjustment or recovery of any payment for medical assistance correctly paid on behalf of any recipient pursuant to this part from the recipient's estate, except in the case of a recipient who was fifty-five (55) years of age or older at the time the recipient received medical assistance or services pursuant to this part. In that case, adjustment or recovery from the recipient's estate may be pursued only after the death of the individual's surviving spouse, if any, and only at a time when the individual has no surviving child who is under eighteen (18) years of age or no surviving child, as defined in § 1614 of the Social Security Act, who is blind or permanently and totally disabled, or a child who became blind or permanently and totally disabled after reaching majority, if the TennCare bureau and the personal representative agree, or, in the event of a disagreement, the court, after de novo review, finds that repayment would constitute an undue hardship to the blind or disabled child.
2. (2) Before any probate estate may be closed pursuant to title 30, with respect to a decedent who, at the time of death, was enrolled in the TennCare program, the personal representative of the estate shall file with the clerk of the court exercising probate jurisdiction a release from the bureau of TennCare evidencing either:
  1. (A) Payment of all medical assistance benefits, premiums, or other costs due from the estate under law;
  2. (B) Waiver of the bureau's claims; or
  3. (C) A statement from the bureau that no amount is due.
  Backlinks (1)
  
  30-2-310(c)(3)
(d)
1. (1) To facilitate and enhance compliance with subsection (c), the following notices shall be provided:
  1. (A) Within thirty (30) days of receipt of notice of a person's death, the department of health shall notify the bureau of TennCare, in a format to be specified by the bureau, of the death of any individual fifty-five (55) years of age or older. Each notification shall include the decedent's name, date of birth and social security number;
  2. (B) Within sixty (60) days of the date of issuance of either letters of administration or letters testamentary, the personal representatives of decedents shall provide notice of the death of any individual fifty-five (55) years of age or older to the bureau of TennCare, in a format to be specified by the bureau, shall state whether the decedent was a TennCare recipient and shall request a release from the bureau of TennCare pursuant to subdivision (c)(2), and an affidavit confirming notice shall be filed pursuant to § 30-2-301(b)(3);
  3. (C) Personal representatives of decedents shall provide notice to the court concerning whether or not the decedent was a TennCare recipient pursuant to § 30-1-117; and
  4. (D) Personal representatives of decedents shall provide the notice to creditors specified in § 30-2-306 to the bureau of TennCare, if the decedent was a TennCare recipient. If a notice to creditors is provided to the bureau, the bureau shall file a claim for recovery in accordance with the requirements of title 30, chapter 2, part 3.
2. (2) It is the legislative intent of subdivision (d)(1) that, after the date of death, the bureau of TennCare strive vigorously to recoup any TennCare funds expended for a decedent during the decedent's lifetime.
(e) The bureau of TennCare shall publish a form of notice to be used pursuant to subdivisions (d)(1)(A) and (B), with instructions for use of the form written in plain language. The form and instructions shall be available at the office of any clerk of court exercising probate jurisdiction, as well as available on the bureau's website. Notice shall be provided via certified mail or in any other manner designated by the bureau.
(f) Recoveries pursuant to this section shall be prorated among the federal government, the state, and the county involved, if any, in proportion to the amounts that each contributed to the assistance and services.

Backlinks (4)

History (6)

Acts 1968, ch. 551, § 16
impl. am. Acts 1971, ch. 162, § 3
T.C.A., §§ 14-1916, 14-23-116
Acts 1994, ch. 682, § 1
2002, ch. 880, § 9
2006, ch. 639, § 3.

§ 71-5-117. Recovery of benefits — State's right of subrogation — Assignment of insurance benefit rights — Commissioner authorized to require certain information identifying persons covered by third parties — State's right of action — Determination of subrogation interest — Attorney's fees — Remittance of net subrogation interest — Subrogation interest hearing — Legislative intent.

(a) Medical assistance paid to, or on behalf of, any recipient cannot be recovered from a beneficiary unless such assistance has been incorrectly paid, or, unless the recipient or beneficiary recovers or is entitled to recover from a third party reimbursement for all or part of the costs of care or treatment for the injury or illness for which the medical assistance is paid. To the extent of payments of medical assistance, the state shall be subrogated to all rights of recovery, for the cost of care or treatment for the injury or illness for which medical assistance is provided, contractual or otherwise, of the recipients against any person. Medicaid payments to the provider of the medical services shall not be withdrawn or reduced to recover funds obtained by the recipient from third parties for medical services rendered by the provider if these funds were obtained without the knowledge or direct assistance of the provider of medical assistance. When the state asserts its right to subrogation, the state shall notify the recipients in language understandable to all recipients, of recipient's rights of recovery against third parties and that recipient should seek the advice of an attorney regarding those rights of recovery to which recipient may be entitled. If, while receiving assistance, the recipient becomes possessed of any resource or income in excess of the amount stated in the application provided for in this part, it shall be the duty of the recipient immediately to notify the agency designated to determine eligibility under this part of the receipt or possession of such resource or income. When it is found that any person has failed to so notify the agency that such person is or was possessed of any resource or income in excess of the amount allowed or when it is found that, within five (5) years prior to the date of recipient's application, a recipient made an assignment or transfer of property for the purpose of rendering the recipient eligible for assistance under this part, any amount of assistance paid in excess of the amount to which the recipient was entitled shall constitute benefits incorrectly paid. Any benefits incorrectly paid shall be recoverable from the recipient, while living, as a debt due to the state and, upon the recipient's death, as a claim classified with taxes having preference under the laws of this state.
(b) Upon accepting medical assistance, the recipient shall be deemed to have made an assignment to the state of the right of third party insurance benefits to which the recipient may be entitled. Failure of the recipient to reimburse the state for medical assistance received from any third party insurance benefits received as a result of the illness or injury from which the medical assistance was paid may be grounds for removing the recipient from future participation in the benefits available under this part; provided, that any removal from participation shall be after appropriate advance notice to the recipient and that the provider of service shall not be prevented from receiving payment from the state for medical assistance services previously furnished the recipient, and that nothing in this subsection (b) shall require an insurer to pay benefits to the state that have already been paid to the recipient.
(c)
1. (1) For purposes of this subsection (c), “third party for medical services” or “third parties” includes, but is not limited to, a health and liability insurer, an administrator of an ERISA plan, an employee welfare benefit plan, a workers' compensation plan, CHAMPUS, medicare, and other parties that are by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service.
2. (2)
  1. (A) The commissioner of finance and administration, the director of the bureau of TennCare, and individual managed care organizations under contract with the state are authorized to require certain information identifying persons covered by third parties for medical services. As a condition of doing business in the state or providing coverage to residents of this state, and subject to subdivision (c)(3), a third party for medical services shall, upon request from the commissioner, the director, or a managed care organization, but no less frequently than monthly, electronically provide full eligibility files that contain information to determine the period that the recipient, the recipient's spouse, or the recipient's dependents may be or may have been covered by the third party. The eligibility files shall also include the nature of the coverage that is or was provided by the third party, the name, address, date of birth, social security number, group number, identifying number of the plan, and effective and termination dates.
  2. (B) No third party shall be liable to a policyholder for proper release of this information to the commissioner, the director, or managed care organization.
  3. (C) The information shall be provided pursuant to a written request from the commissioner, the director, or managed care organization, with each third party establishing confidentiality requirements.
3. (3)
  1. (A) A third party for medical services shall, consistent with 42 U.S.C. § 1396a(25)(I):
    1. (i) Accept the state's right of recovery and the assignment to the state of the right of an individual or other entity to payment from the party for an item or service for which payment has been made under the state plan or under a waiver of such plan;
    2. (ii) In the case of a responsible third party, other than Medicare plans, that requires prior authorization for an item or service furnished to an individual eligible to receive medical assistance under this chapter, accept authorization provided by the state that the item or service is covered under the state plan or under a waiver of such plan for such individual, as if such authorization were the prior authorization made by the third party for such item or service; and
    3. (iii) Agree not to deny a claim submitted by the state solely on the basis of the date of submission of the claim, the type or format of the claim form, a failure to present proper documentation at the point of sale that is the basis of the claim, or in the case of a responsible third party, other than Medicare plans, a failure to obtain a prior authorization for the item or service for which the claim is being submitted, if:
      1. (a) The claim is submitted by the state within the three-year period beginning on the date the item or service was furnished; and
      2. (b) Any action by the state to enforce its rights with respect to such claim is commenced within six (6) years of the state's submission of such claim.
  2. (B) Third parties shall respond to any inquiry by the state regarding a claim for payment for any health care item or service that is submitted not later than three (3) years after the date of the provision of such health care item or service.
4. (4) Third parties shall agree to respond to the request for payment, by providing payment on the claim, written request for additional information with which to process the claim, or written reason for denial of the claim, within sixty (60) working days after receipt of written proof of loss or claim for payment for health care services provided to a recipient of medical assistance who is covered by the entity. Notwithstanding title 56, a failure to pay or deny a claim within one hundred forty (140) days after receipt of the claim constitutes a waiver of any objection to the claim and an obligation to pay the claim.
5. (5) A payment made by a third party to the bureau or managed care organization under contract with the state shall be considered final thirty (30) months after payment is made. After that date, the amount of the payment is not subject to adjustment.
6. (6) A third party shall treat a managed care organization as the bureau, for the purposes of providing the managed care organization with access to third-party eligibility and claims data authorized under subdivision (c)(2); complying with the assignment to the managed care organization of a TennCare beneficiary's right to payment; and refraining from denying reimbursement to the managed care organization, for a claim in which both of the following apply:
  1. (A) The beneficiary who is the subject of the claim received a medical item or service through a managed care organization that has entered into a contract with the bureau; and
  2. (B) The bureau has delegated third party responsibilities to the managed care organization.
(d)
1. (1) To the extent necessary to reimburse the department for expenditures for its costs for services provided for any child eligible for medical services under Title XIX of the federal Social Security Act, the department shall have a right of action against, and shall be permitted to garnish the wages, salary, or other employment income of, any person who:
  1. (A) Is required by a court or administrative order to provide coverage of the costs of health services to a child who is eligible for medical assistance under Title XIX of the federal Social Security Act;
  2. (B) Has received payment from a third party for the costs of such services provided to such child; and
  3. (C) Has not used such payments from the third party to reimburse, as appropriate, either the other parent or guardian of such child or the provider of such services.
2. (2) The claims by the department for the costs of such services shall be subordinate to any claims for current or past-due child support.
(e) The state's right of action under this section shall be authorized as part of the contractual functions of the individual managed care organization or organizations that incurred the medical expenses on behalf of a TennCare recipient where the TennCare program deems appropriate. The bureau of TennCare shall maintain an easily accessible and clearly identified internet web page, updated at least bi-annually, that identifies the individual managed care organization or organizations having authorization to pursue the state's right of action under this section and such internet web page, at the minimum, shall provide the appropriate manner, method and form for contacting the managed care organization or organizations. The form made accessible through such internet web page shall be consistent with the requirements of subsection (f).
(f) Before the entry of the judgment or settlement in a personal injury case, the plaintiff's attorney shall notify and contact in writing by facsimile or certified mail return receipt requested any entity acting pursuant to and identified in accordance with subsection (e), in order to determine if the state or managed care organization or organizations have a subrogation interest. Notice by the plaintiff's attorney, at the minimum, shall provide the following information: the full name of the plaintiff's client; the client's date of birth; the client's social security number, if known; the client's TennCare or managed care organization identification number; and the date the client's claim arose. Notice by the plaintiff's attorney shall be consistent with the foregoing in order to be considered valid. Within sixty (60) days of receipt of the above-referenced notice, the entities having a subrogation interest shall respond to the plaintiff's attorney in writing via facsimile or certified mail return receipt requested with either the amount of the subrogation interest or advise the plaintiff's attorney that additional time is necessary in order to determine the amount of the subrogation interest, but in no event shall a response containing the amount of the subrogation interest exceed one hundred twenty (120) days. The plaintiff's attorney shall then inform the court regarding the results of such attorney's notice, if any. Should no specific number be claimed within the period specified herein, the subrogation shall be extinguished and disbursements may be made without recourse upon the plaintiff or the plaintiff's attorney. If the plaintiff's attorney received a timely response from the entities acting pursuant to subsection (e), but the amount of the subrogation interest remains in disagreement, then the trial judge may hold a hearing in accordance with subsection (i). After trial and at the time of the entry of the judgment or settlement in a case in which the state or any entity acting pursuant to subsection (e) has a subrogation interest under this section, it is the responsibility of the trial judge to calculate the amount of the subrogation interest and incorporate the court's findings concerning the subrogation interest in the final judgment or settlement. The gross amount of the subrogation interest shall be based upon the findings of the jury concerning medical expenses and evidence introduced after the trial about the total sum of moneys paid by the state or any entity acting pursuant to subsection (e) for medical expenses for injuries arising from the incident that is the basis of the action. The gross amount of the subrogation interest shall be reduced by one (1) or more of the following factors, as applicable:
1. (1) To the extent that the plaintiff is partially at fault in the incident giving rise to the litigation, the subrogation interest is reduced by the percentage of fault assessed against the plaintiff;
2. (2) To the extent that the finder of fact allocated fault to a person who was immune from suit, the subrogation interest is reduced by the percentage of fault assessed against the immune person;
3. (3) To the extent that the finder of fact allocates fault to a governmental entity that has its liability limited under state law and the fault of the entity, when multiplied by the total dollar value of the damages found by the finder of fact, exceeds the amount of judgment that can be awarded against the entity, the subrogation interest is reduced proportionately by a percentage derived by dividing the uncollectable portion of the judgment against the governmental entity by the total damages awarded; or
4. (4) To the extent that the finder of fact allocated fault to a person that the plaintiff did not sue, the subrogation interest is reduced by the percentage of fault assessed against the nonparty.
(g) After these calculations are performed, the judge should further reduce the subrogation interest pro rata by the amount of reasonable attorneys' fees and litigation costs incurred by the plaintiff in obtaining the recovery as required in [former] subsection (c) [repealed].
(h) The amount determined after performance of the calculations in subsections (f) and (g) is the net subrogation interest. If the plaintiff or plaintiff's attorney collects the judgment, each has the obligation to promptly remit the net subrogation interest, and attorneys' fees and costs to any counsel employed by the state or its assignee, as required by the final judgment. In the event that the plaintiff and such plaintiff's attorney collect only a portion of the final judgment, each has the obligation to promptly remit a pro rata share of the net subrogation interest, and attorneys' fees and costs to any counsel employed by the state or its assignee, as required by the final judgment. In the event that plaintiff or plaintiff's attorney later collect additional moneys against the judgment, there is a continuing obligation on both of them to remit a pro rata share of the moneys collected as required by the final judgment.
(i) In the event that the case between the plaintiff and the defendant is settled before trial but after a lawsuit is filed and the parties and the state or its assignee are unable to reach an agreement on the amount of the subrogation interest, the trial judge shall hold a hearing to determine the gross and net subrogation interests, taking into account the criteria listed in subsections (f) and (g) and the likelihood of collecting any judgment against parties determined to be at fault. Any aggrieved party may appeal the court's decision.
(j) It is the intention of the general assembly that subsections (f) through (i) be used in lieu of application of the “made whole” doctrine for any recovery authorized under this section. Subsections (f) through (i), inclusive, shall also apply to cases that have been settled when no lawsuit has been filed.

History (15)

Acts 1968, ch. 551, § 17
impl. am. Acts 1975, ch. 219, § 1 (a, b)
T.C.A., § 14-1917
Acts 1980, ch. 535, §§ 1-3
1982, ch. 730, § 15
T.C.A., § 14-23-117
Acts 1992, ch. 967, § 1
1994, ch. 987, § 17
1997, ch. 102, § 1
2000, ch. 807, § 1
2003, ch. 337, §§ 1-4
2007, ch. 233, §§ 1, 2
2010, ch. 776, §§ 1-3
2017, ch. 26, § 1
2024, ch. 531, §§ 1, 2.

§ 71-5-118. Contracts with vendors — Sanctions against vendors — Grounds for actions against providers — Administrative remedy to recover benefits from applicant — Collection activity report — Applicant warning — Prompt process of hospital presumptive eligibility applications.

(a) The commissioner of finance and administration has the authority to enter into contracts with qualified vendors to provide to eligible recipients medical assistance allowed under § 71-5-107. The commissioner has the authority to terminate or suspend existing contracts with providers, to refuse to enter into contracts with providers, and to recover any payments incorrectly paid if the commissioner finds that such actions will further the purpose of this section. Any action against such provider shall be treated as a contested case in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. If a hearing is requested by the provider, it shall be held prior to the imposition of any of the sanctions of this subsection (a), except that upon a finding by the commissioner that the public health, safety, or welfare imperatively requires emergency action, these sanctions may be imposed pending an opportunity for the provider to request a prompt hearing. Furthermore, the commissioner has the right to set off any money incorrectly paid against any claim for money submitted by the provider pending an opportunity for a hearing. Grounds for action against providers under this subsection (a) include, but are not limited to, the following:
1. (1) Violation of the terms of the contract;
2. (2) Violation of any provision of this part or the rules promulgated pursuant to this part;
3. (3) Billing for medical assistance that was not delivered;
4. (4) Provision of medical assistance that is not medically necessary or justified;
5. (5) Provision of medical assistance of a quality that is below professionally recognized standards;
6. (6) Revocation or suspension of a provider's professional license or other disciplinary action by the agency regulating the profession of the provider; and
7. (7) Failure to produce records, upon request, by authorized representatives of the commissioner as necessary to substantiate the medical assistance for which claims have been submitted.
(b) Without regard to any other civil or criminal liability that might attach, by operation of this section or any other law, to an enrollee or applicant's action in obtaining medical assistance or any assistance under this part, to which such person is not entitled, the bureau of TennCare shall have an administrative remedy for the recovery of the amount of any medical assistance benefits or payments improperly paid as a result of any misrepresentation made by such person, to the extent that such amount has not otherwise been recovered by the bureau. The bureau shall also have a right to recover in such administrative proceedings its reasonable costs and attorneys' fees, as well as interest on the amount owed by the person, calculated from the date that medical assistance was improperly paid. Any action against such person shall be treated as a contested case in accordance with the Uniform Administrative Procedures Act. In an administrative action under this subsection (b), the bureau shall show that the amount sought to be recovered was paid in the form of medical assistance as a result of material misrepresentation by the person against whom recovery is sought, but the bureau need not show that such misrepresentation was intentional or fraudulent.
(c) The bureau of TennCare shall report annually in writing to the judiciary committee of the senate and the criminal justice committee of the house of representatives regarding its collection activities of the estate recovery provisions of this chapter.
(d) All applicants for medical assistance under this part, and all applicants for reverification of eligibility to receive such assistance, shall receive a warning, in easily readable language, regarding the state recovery provisions, as well as the administrative, civil and criminal liability provisions of this chapter.
(e) The participating provider shall strive to process hospital presumptive eligibility applications within the first twenty-four (24) hours of the date of admission, when practicable. To the extent a participating provider fails to adhere to this standard, the bureau of TennCare may take remedial steps as allowed by federal law.

History (18)

Acts 1968, ch. 551, § 18
1973, ch. 73, § 2
1978, ch. 539, § 1
T.C.A., § 14-1918
Acts 1982, ch. 730, § 16
T.C.A., § 14-23-118
Acts 1987, ch. 420, § 1
1989, ch. 591, § 107
1991, ch. 406, § 2
1993, ch. 428, § 1
2000, ch. 853, § 1
2002, ch. 702, § 1
2002, ch. 880, §§ 7, 10-13
2004, ch. 673, § 10
2013, ch. 236, § 43
2019, ch. 345, § 136
2020, ch. 775, § 1
2021, ch. 64, § 122.

§ 71-5-119. Discrimination prohibited.

(a) No discrimination shall be practiced or asserted against any applicant for or recipient of medical assistance under this chapter on the basis of race, color or national origin.
(b) The furnishing of care and services under this part to any applicant or recipient of medical assistance shall not be delayed or denied on the basis of race, color or national origin.

History (4)

Acts 1968, ch. 551, § 19
T.C.A., § 14-1919
Acts 1982, ch. 730, § 17
T.C.A., § 14-23-119.

§ 71-5-120. Residency requirement — Determination — Appeal.

(a) No period of residence in this state shall be required as a condition for eligibility for medical assistance under this chapter, but an individual who does not reside in this state shall not be eligible.
(b) The bureau of TennCare shall adopt rules for determining whether an applicant is a resident of this state subject to the requirements of federal law. The rules shall require that state residency is not established unless the applicant does both of the following:
1. (1) The applicant produces one (1) of the following:
  1. (A) A current Tennessee rent or mortgage receipt or utility bill in the adult applicant's name;
  2. (B) A current Tennessee motor vehicle driver's license or identification card issued by the Tennessee department of safety in the adult applicant's name;
  3. (C) A current Tennessee motor vehicle registration in the adult applicant's name;
  4. (D) A document showing that the adult applicant is employed in this state;
  5. (E) A document showing that the adult applicant has registered with a public or private employment service in this state;
  6. (F) Evidence that the adult applicant has enrolled the applicant's children in a school in this state;
  7. (G) Evidence that the adult applicant is receiving public assistance in this state;
  8. (H) Evidence of registration to vote in this state; or
  9. (I) Other evidence deemed sufficient to the bureau or the department of human services, or both, as proof of residency in this state; and
2. (2) The adult applicant declares, under penalty of perjury, that all of the following apply:
  1. (A) The adult applicant does not own or lease a principal residence outside of this state; and
  2. (B) The adult applicant is not receiving public assistance outside of this state. As used in this subdivision (b)(2)(B), “public assistance” does not include unemployment insurance benefits.
(c) Residency for minors shall be determined as otherwise permitted under state and federal law. A minor for the purposes of this subsection (c) is a person younger than nineteen (19) years of age.
(d) A denial of determination of residency may be appealed in the same manner as any other denial of eligibility. A determination of residency shall not be granted unless a preponderance of the credible evidence supports the adult applicant's intent to remain indefinitely in this state. In making determinations or verifications of residency, subject to the requirements of subsection (b), the department of human services shall apply the same policies and procedures as are applied in the determination of residency for other programs administered by the department to the extent permitted under or by federal law.

Backlinks (1)

71-5-124(a)

History (1)

Acts 2002, ch. 880, § 14.

§ 71-5-121. Transfer of income or resources.

In all actions for the transfer of income or resources from an institutionalized spouse for the support of the community spouse, the court shall apply the standards utilized to determine medicaid eligibility in this state, regardless of any state laws relating to community property or the division of marital property.

History (1)

Acts 2002, ch. 880, § 16.

§ 71-5-122. Statement of interest of vendors or suppliers holding equity interest in hospitals, apothecaries or nursing homes.

(a) Any individual or corporate vendor or provider participating under this part who holds an equity interest in any hospital, apothecary, nursing home, or other vendor or provider participating under this part shall submit annually to the department of finance and administration information disclosing their interest in these vendors or providers.
(b) Any such party who fails to file the information required by this section shall not be entitled to participate in the program.

History (2)

Acts 1969, ch. 326, § 4
T.C.A., §§ 14-1923, 14-23-122.

§ 71-5-123. Statement of public officials as to interest in vendors or providers.

Any department head, deputy, assistant, or director of any state department, including, but not limited to, any person who certificates eligibles or who makes payments to vendors or providers participating under this part, and who holds any equity interest in any hospital, apothecary, nursing home, or other vendors or providers participating under this part, shall submit annually to the department of finance and administration information disclosing their interest in these vendors or providers.

History (2)

Acts 1969, ch. 326, § 5
T.C.A., §§ 14-1924, 14-23-123.

§ 71-5-124. Duties of department of finance and administration.

(a) The department of finance and administration shall supervise and assist the department of health, which shall be the single state agency as defined in the federal Medicaid Law, Title XIX with respect to all financial matters in the planning and establishment of the medical assistance program as set forth in §§ 71-5-101 — 71-5-120, and after the program is established on July 1, 1969, the department of finance and administration shall perform those functions with respect to such medical assistance programs as are set forth in title 9, chapter 4, part 51.
(b) In addition, the commissioner of finance and administration and the comptroller of the treasury have the duty and authority to review and audit such expenditure of funds as may be made under this part either directly or indirectly by any fiscal intermediary, and nothing in this section shall limit the authority of the commissioner of finance and administration to ensure that program expenditures are maintained within legislative appropriations.
Backlinks (1)
- 71-5-105(a)(3)(B)

History (2)

Acts 1969, ch. 326, § 6
T.C.A., §§ 14-1925, 14-23-124.

§ 71-5-125. Duties of fiscal review committee.

The fiscal review committee is directed to obtain the following information from the single state agency in charge of medicaid and the department of human services and report quarterly to the membership of the general assembly, except that if an item on the report has not changed from one (1) quarter to the next, there shall be no necessity to repeat this information in the subsequent report:
1. (1) All expenditures under the medicaid program in the preceding quarter;
2. (2) The quarterly allotment for the next quarter;
3. (3) Any requests for additional funds;
4. (4) The classifications set up for the staffing of the medicaid personnel;
5. (5) The names, salary, position and previous work experience of staff hired;
6. (6) Caseloads, increases and decreases;
7. (7) Dollar expenditures and utilization of the separate programs under medicaid; and
8. (8) Copies of all regulations issued to implement the medicaid program.

History (5)

Acts 1969, ch. 326, § 7
impl. am. Acts 1975, ch. 219, § 1 (a, b)
T.C.A., §§ 14-1926, 14-23-125
Acts 2002, ch. 880, § 19
2012, ch. 673, § 4.

§ 71-5-126. Medicaid expansion under federal Patient Protection and Affordable Care Act prohibited without joint resolution of General Assembly.

The governor shall not make any decision or obligate the state of Tennessee in any way with regard to the expansion of optional enrollment in the medical assistance program, also known as the medicaid program, pursuant to the Patient Protection and Affordable Care Act, Public Law 111-148, as interpreted by the United States Supreme Court in National Federation of Independent Business v. Sebelius to be unconstitutional when applied to states as a mandatory expansion, unless authorized by joint resolution of the general assembly.

History (1)

Acts 2014, ch. 662, § 1.

§ 71-5-127. Conflict with federal law — Single state agency.

If it is found that any of the provisions of this part are in conflict with the single state agency requirements of the federal Medicaid Law, Title XIX, then, and in that event, the department of finance and administration shall become the single state agency.

History (2)

Acts 1969, ch. 326, § 9
T.C.A., §§ 14-1928, 14-23-127.

§ 71-5-128. Contracts with health maintenance organizations — Requirements.

Notwithstanding any other law to the contrary, the department of health shall follow, as nearly as is practicable, the requirements of 42 U.S.C. § 1395mm, as amended, together with any federal rules and regulations promulgated pursuant to such law, with respect to a health maintenance organization with which the state has entered into a contract for the provision of services under this part.

History (2)

Acts 1981, ch. 286, § 2
T.C.A., § 14-23-128.

§ 71-5-129. Charges for services of physician assistants.

Charges to be reimbursed for physician assistants from medicaid funds shall not exceed sixty percent (60%) of the charges provided for licensed physicians under the medicaid program or fees charged by licensed physicians that are reasonable in the locality where the services are provided.

History (2)

Acts 1983, ch. 168, § 12
T.C.A., § 14-23-129.

§ 71-5-130. Determination of payments to vendors — Audits.

(a) With regard to the payments to vendors pursuant to this part:
1. (1) The payment for all vendors providing health care that receive payment pursuant to this part shall be determined by the comptroller of the treasury, in accordance with rules and regulations established by the department, pursuant to § 71-5-105, and shall be paid by the department;
2. (2) In order that payment can be determined for all vendors providing health care that receive payment pursuant to this part, the department shall require such vendors to submit to the comptroller of the treasury, cost data, statistical data, and other information, as may be necessary, on such forms as are approved or formulated by the department, in consultation with the comptroller of the treasury and the Tennessee Hospital Association. The comptroller of the treasury, in consultation with the department, may require that such cost data and other information, in order to be acceptable, be certified by the administrator of the vendor and by a licensed public accountant or certified public accountant; and all such data shall be subject to audit by the comptroller of the treasury, or agency or organization designated by the comptroller of the treasury;
3. (3)
  1. (A) To be eligible to receive payment, contracting hospitals shall use uniform hospital statistics and classification of accounts as published by the American Hospital Association for all accounting records, or any other acceptable accounting methods approved by the department in consultation with the comptroller of the treasury and the Tennessee Hospital Association;
  2. (B) In consultation with the comptroller of the treasury, the department may also require other vendors to use uniform statistics and classification of accounts;
4. (4)
  1. (A) Any contracting hospital that does not adopt the uniform classification of accounts, as it shall be established by the department, or that does not submit certified statements when required by the department, shall be assessed a penalty of ten dollars ($10.00) for each day the hospital is not in compliance with this subsection (a);
  2. (B) Any nursing home that does not adopt a uniform classification of accounts, or does not submit certified statements, or does not submit cost data and other information, as required by the department, shall be assessed the penalty provided by subdivision (a)(4)(A);
  3. (C) Any other vendor providing health care pursuant to this part that does not adopt a uniform classification of accounts, or does not submit certified statements, or does not submit cost data and other information, as required by the department, shall be assessed the penalty provided by subdivision (a)(4)(A);
5. (5)
  1. (A) The comptroller of the treasury in carrying out responsibilities under this part, with regard to the determination of payments for particular vendors, and the auditing of data submitted, is hereby authorized to enter into contracts and agreements, and to make such arrangements as are necessary with other state departments and agencies, and with organizations or firms providing such services. The final authority for the determination and certification of payment to the department shall be the comptroller of the treasury;
  2. (B) The departments of human services and health may enter into agreements with the comptroller of the treasury with regard to services performed in payment determination and auditing, and are hereby authorized to reimburse the comptroller of the treasury for the performance of such services out of funds available to the department; and
6. (6) All legal aids granted to the comptroller of the treasury by any other law are expressly reserved to the comptroller of the treasury in auditing any contracting vendor for the purpose of verifying the cost data and other information submitted by the vendor.
(b) Nothing contained in this part shall be construed as obligating the state during any fiscal year for any payment exceeding the amount appropriated by the general assembly for this purpose, and budgeted by the department or departments administering these programs.

History (3)

Acts 1984, ch. 787, § 10
T.C.A., § 14-23-130
Acts 1988, ch. 779, §§ 3-5.

§ 71-5-131. Contributed funds.

(a) For the purposes of this part, political subdivisions may appropriate funds directly to the department, other public agencies and private sources may transfer funds to the department, and the department may accept unconditional and unrestricted donations of such funds.
(b) Contributed funds shall be subject to the department's administrative control and allocated as provided in the general appropriations act, except such contributions shall not reduce state general revenue funding.
(c) At the end of any fiscal year, the unobligated balance of any such funds shall not revert to the general fund, but shall be reappropriated for these purposes in the next fiscal year.

History (1)

Acts 1987, ch. 71, § 1.

§ 71-5-132. Medicaid providers — Responsibilities — Changes in ownership or controlling interest.

(a) No change of ownership or controlling interest of an existing medicaid provider, including, but not limited to, hospitals, nursing home facilities, home health agencies, and pharmacies, can occur until provision is made for moneys owed to medicaid. The purchaser shall notify medicaid of the purchase at the time of ownership change and is financially liable for the outstanding liabilities to medicaid for one (1) year from the date of purchase or for one (1) year following medicaid's receipt of the provider's medicare final notice of program reimbursement, whichever is later. The purchaser shall be entitled to utilize any means available to it by law to secure and recoup these funds from the selling entity. In addition, purchasers of nursing facilities are responsible for obtaining an accurate accounting and transfer of funds held in trust for medicaid residents at the time of the change of ownership or controlling interest.
(b) If the division of medicaid has not reimbursed a business for medicaid services provided under the medicaid program at the time the business is sold, when such an amount is determined the division of medicaid shall be required to reimburse the person owning the business; provided, that such sale included the sale of such assets.

History (1)

Acts 1992, ch. 933, §§ 2, 3.

§ 71-5-133. Provision of information concerning Norplant and other contraceptives.

(a) The department of human services shall provide written information concerning the availability through the medicaid program of the Norplant contraceptive implant, and other functionally equivalent contraceptives that provide similar long-lasting pregnancy prevention, to all temporary assistance for needy families (TANF) recipients or to recipients of any successor program when such persons apply for benefits or are recertified. The department shall provide information concerning the availability of birth control and contraceptive implants to all males whose incomes are below the federal poverty level and who are receiving any other state or federal government subsidies, including, but not limited to, food assistance pursuant to part 3 of this chapter, if such males also qualify for medicaid and are able to impregnate females. Such information shall also be supplied to other women of child-bearing age whose income is below the federal poverty level and are receiving any other state or federal government subsidies, including, but not limited to, food assistance pursuant to chapter 5, part 3 of this title, if such persons also qualify for medicaid. The information provided shall clearly state that qualified health care providers are available to discuss the contraceptive in more detail upon request.
(b) Together with the information concerning availability required to be provided pursuant to subsection (a), the department shall also provide to each eligible recipient information regarding any risks involved in having such contraceptive implanted, as well as information on the use of all types of contraceptives, including abstinence, and the moral benefits of abstinence until marriage, and the health and other benefits of abstinence, which shall be disseminated in a manner that is reasonably calculated to make the information easily accessible to all recipients under the TANF program or to recipients of any successor program, as well as to other women of child-bearing age whose incomes are below the federal poverty level and who are receiving any other state or federal government subsidies, including, but not limited to, food assistance pursuant to chapter 5, part 3 of this title, if such persons also qualify for medicaid. The department's case workers will assist in making the appointment with the appropriate county health department.

History (2)

Acts 1993, ch. 255, § 1
1996, ch. 950, § 17.

§ 71-5-134. Rules and regulations — Funding medical assistance.

The commissioner of finance and administration is authorized to promulgate rules and regulations to effectuate the purposes of the amendments to §§ 71-5-102 — 71-5-106 by Acts 1993, ch. 358. All such rules and regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.

History (2)

Acts 1993, ch. 358, § 7
2007, ch. 505, §§ 1, 2.

§ 71-5-135. State unemployment health care benefits — Scope — Conditions.

If a person who previously had health insurance through their employer becomes uninsured due to bona fide closure of the employer's business or plant, such person, and the person's dependents shall automatically be eligible to enroll in the TennCare program at the expiration of the eighteen-month period authorized for continuing insurance coverage under COBRA. The department shall accept the application of such person prior to the expiration of the eighteen-month period so that health insurance through TennCare will begin immediately upon expiration of COBRA coverage and such person and the person's dependents will at no time be without health care coverage. However, nothing in this section shall be construed or interpreted to provide TennCare coverage in situations where a business or plant declares bankruptcy or otherwise declares it is going out of business when the purpose, primary or otherwise, of such declaration is to establish TennCare coverage for its employees and the business or plant intends to reopen under the same or another identity with essentially the same ownership or management, or both. Reopening of a business with the same or another identity and essentially the same ownership or management, or both, shall be considered refutable evidence that the earlier closure was for the purpose of establishing TennCare eligibility for the business's employees. It is the legislative intent that this section be implemented only to the extent that it is determined to be consistent with the terms, conditions and eligibility criteria of the TennCare waiver as approved by the United States department of health and human services.

History (1)

Acts 1994, ch. 857, § 1.

§ 71-5-136. Hold harmless requirements prohibited.

No health insurer, prepaid group health plan, health maintenance organization, preferred provider organization or similar entity licensed under this part that provides or administers health insurance under the TennCare Program, shall require, by contract or otherwise, any title 63 or 68 licensee to indemnify or hold harmless such TennCare managed care organization or title 56 licensee for tort or patent or copyright infringement liability that such TennCare managed care organization or title 56 licensee incurs, experiences, or causes by act or omission, or by act or omission of the title 63 or 68 provider to the extent the act or omission was pursuant to a directive of the title 56 licensee.

History (1)

Acts 1997, ch. 376, § 2.

§ 71-5-137. Disclosures required of persons associated with managed care organizations.

(a) The following persons associated with a managed care organization that participates in the TennCare program shall make disclosures required in § 8-50-502:
1. (1) Officers and directors of the managed care organization;
2. (2) Any person who is the legal or beneficial owner of five percent (5%) or more of the stock or other ownership interest in the managed care organization; and
3. (3) Any person who controls, is controlled by or is under common control with, the managed care organization and who has entered into a management agreement, service contract, cost-sharing agreement or reinsurance contract with a managed care organization. For purposes of this subdivision (a)(3), “control” has the same meaning as set forth in § 56-11-101(b).
Backlinks (3)
(b) An official in the legislative branch, or an official in the executive branch and their immediate families, as such terms are defined in § 3-6-301, shall disclose any ownership interest or other connection as an officer, employee or director that such person may have in any managed care organization that participates in the TennCare program.
(c) The compensation from the managed care organization of all persons required to make disclosure under subsection (a) shall be disclosed in addition to the disclosure required under subsection (a).
(d) Disclosures required by this section shall be made to the bureau of TennCare and shall be made by March 1 of each year for the previous calendar year.

History (2)

Acts 1999, ch. 379, § 1
2013, ch. 89, § 4.

§ 71-5-138. Compliance with provisions regarding authorizations for pharmacy services.

Any managed care organization participating in the TennCare program shall comply with the provisions of § 56-32-138 concerning authorizations given to a pharmacy services provider for care to be delivered to an enrollee receiving TennCare benefits.

History (1)

Acts 2001, ch. 340, § 3.

§ 71-5-139. Protection of TennCare patients' federal and court ordered rights by health care providers receiving TennCare funds.

(a) In order to protect TennCare patients and ensure the state's compliance with applicable federal regulations or court order, managed care organizations, behavioral health organizations and certain health care providers that receive TennCare funds shall comply with the following requirements:
1. (1) Whenever a TennCare enrollee is entitled under applicable federal regulations or court order to notice and an opportunity to appeal a provider initiated reduction, termination or suspension of inpatient hospital care, where the service being provided to the enrollee is to treat an enrollee's chronic condition across a continuum of services when the next appropriate level of medical service is not immediately available, it shall be the duty of the hospital where the patient is receiving care to timely notify the patient's managed care organization of that fact. The hospital shall also have a duty to cooperate with the managed care organization in the provision to the patient of timely notice of the patient's rights under such applicable federal regulations or court order. In the event that a TennCare enrollee continues to receive inpatient care, as authorized by such applicable federal regulations or court order, because the next level of care prescribed for the patient is not immediately available, the managed care organization shall reimburse the hospital for such additional care. Nothing in this subdivision (a)(1) relieves the managed care organization of its ultimate responsibility for ensuring compliance with applicable federal regulations or court order, with respect to the provision of notice and services to the patient;
2. (2) Whenever a TennCare enrollee is entitled under applicable federal regulations or court order to notice and an opportunity to appeal a provider initiated reduction, termination or suspension of home health services, it shall be the duty of the home care organization that has been caring for the patient to timely notify the patient's managed care organization of the proposed change. The home care organization shall cooperate with the managed care organization in the provision to the patient of timely notice of the patient's rights under such applicable federal regulations or court order. In the event that a TennCare enrollee continues to receive home health services, as authorized by such applicable federal regulations or court order, the managed care organization shall reimburse the home care organization for such additional services. Nothing in this subdivision (a)(2) relieves the managed care organization of its ultimate responsibility for ensuring compliance with applicable federal regulations or court order, with respect to the provision of notice and services to the patient;
3. (3) Whenever a TennCare enrollee is entitled under applicable federal regulations or court order to notice and an opportunity to appeal a provider initiated reduction, termination or suspension of inpatient psychiatric or residential service, it shall be the duty of the facility where the patient is receiving care to timely notify the patient's behavioral health organization of the proposed change. The facility shall also have a duty to cooperate with the behavioral health organization in the provision to the patient of timely notice of the patient's rights under such applicable federal regulations or court order. In the event that a TennCare enrollee continues to receive inpatient or residential care, as authorized by such applicable federal regulations or court order, the behavioral health organization shall reimburse the facility for such additional care. Nothing in this subdivision (a)(3) relieves the behavioral health organization of its ultimate responsibility for ensuring compliance with applicable federal regulations or court order, with respect to the provision of notice and services to the patient; and
4. (4) Whenever a TennCare enrollee who is classified as severely and persistently mentally ill, or severely emotionally disturbed, is entitled under applicable federal regulations or court order to notice and an opportunity to appeal a provider initiated reduction, termination or suspension of behavioral health service, it shall be the duty of the health care provider who is caring for the patient to timely notify the patient's behavioral health organization of the proposed change. The provider shall also have a duty to cooperate with the behavioral health organization in the provision to the patient of timely notice of the patient's rights under such applicable federal regulations or court order. In the event that a TennCare enrollee continues to receive such behavioral health service, as authorized by such applicable federal regulations or court order, the behavioral health organization shall reimburse the provider for that additional care. Nothing in this subdivision (a)(4) relieves the behavioral health organization of its ultimate responsibility for ensuring compliance with applicable federal regulations or court order, with respect to the provision of notice and services to the patient.
(b) The commissioner of finance and administration is authorized to promulgate emergency rules pursuant to § 4-5-208 as necessary to implement this section.

History (2)

Acts 2001, ch. 346, § 1
2009, ch. 566, § 12.

§ 71-5-140. Deductions for dental services paid by eligible individuals in long-term care facilities.

(a) In addition to the deductions from the total income available for the cost of long-term nursing home care authorized pursuant to the rules and regulations of the department of human services, division of medical services, for an eligible individual confined to a long-term care facility, a deduction shall also be authorized and made from such total income available for the costs for dental services paid by the eligible individual.
(b) Deductions for such dental services shall be made for those services whether such services are provided at a dental office, on-site at the long-term care facility, or through a mobile dental services provider that contracts with the long-term care facility.
(c) A mobile dental services provider providing such dental services shall meet and comply with the following requirements:
1. (1) The requirements of § 63-5-121;
2. (2) The mobile dental services provider shall obtain a consent for dental services either from the resident or from the resident's responsible party, which consent shall remain valid and in force for the entire length of stay of the resident unless otherwise revoked by the resident or the responsible party;
3. (3) The mobile dental services provider shall contract with dentists licensed in this state who have a medicare/medicaid number;
4. (4) The mobile dental services provider may provide routine and emergency dental services as consented to under subdivision (c)(2) or subsection (e). Services related to the provision of dentures shall be deemed medically necessary, in writing, by the facility's medical director or the patient's attending physician prior to the delivery of such services. The facility shall not be directly liable to the provider for dental services; and
5. (5) The mobile dental services provider shall maintain records of services provided on standard American Dental Association (ADA) claim forms using appropriate CDT-3 codes for services delivered. Records shall be maintained by the provider of services for five (5) years following the date of service. Records maintained by the mobile dental services provider shall be subject to audit by TennCare, comptroller of the treasury's office or any government regulatory agency at least annually.
(d) Upon the submission of a request by the dental services provider for a deduction under this section to the respective county office of the department of human services, the department staff shall process the request within thirty (30) days of receipt. Such office shall report the approval or disapproval of such deduction directly to the long-term care facility, and the responsible party, if any.
(e) If the responsible party has not signed or refuses to sign the consent required pursuant to subdivision (c)(2), nor notifies the long-term care facility of an arrangement for alternative dental care, the long-term care facility may choose to authorize the provision of dental services on behalf of the resident for the immediate dental care required. However, under no circumstances shall such an authorization for consent to treatment make the facility liable for payment for services beyond those funds received by the facility from the patient's responsible party, if any.
(f) If the facility is the representative payee for the resident's social security income, the dental services provider shall not be required to bill the responsible party, but may be paid from the resident's financial resources received by the long-term care facility. The long-term care facility shall pay the dental services provider within thirty (30) days of receipt of such funds, to the extent such payment is authorized as a deduction by the department of human services.
(g) If the facility is not the representative payee for the resident's social security income, the dental services provider shall bill the responsible party unless the facility agrees to pay the dental services provider from the resident's financial resources received by the facility. The dental services provider shall have the right to bill the responsible party for the authorized deduction in the event such funds are not forwarded to the facility by the responsible party. However, the facility, under either subsection (f) or this subsection (g), shall not be directly liable to the provider for dental services.

History (1)

Acts 2002, ch. 717, § 2.

§ 71-5-141. Eligibility of aliens for medical assistance.

(a) Aliens shall be eligible for medical assistance, including participation in the TennCare program, only to the same extent as permitted under federal law and regulations for receipt of federal financial participation under Title XIX of the federal Social Security Act, except as otherwise provided in this section.
(b) In accordance with Section 1903(v)(1) of the federal Social Security Act, an alien shall only be eligible for the full scope of medical assistance benefits, if the alien has been lawfully admitted for permanent residence, or is otherwise permanently residing in the United States under color of law.
(c) For purposes of this section, aliens “permanently residing in the United States under color of law” shall be interpreted to include all aliens residing in the United States with the knowledge and permission of the United States immigration and naturalization service and whose departure the United States immigration and naturalization service does not contemplate enforcing and with respect to whom federal financial participation is available under Title XIX of the federal Social Security Act.

History (1)

Acts 2002, ch. 880, § 17.

§ 71-5-142. Confidentiality and disclosure of proprietary information.

(a) All proprietary information, including but not limited to, provider reimbursement information provided either to the Tennessee department of commerce and insurance or to the TennCare bureau, or any successor entity operated by the state of Tennessee for the purpose of administering the TennCare program, or any successor program shall be deemed confidential and not subject to disclosure under the Tennessee Public Records Act, compiled in title 10, chapter 7. Nothing contained in this section shall be construed to conflict with or obviate §§ 56-9-202(b) and 56-9-504(f).
(b) This section shall not apply to disclosures to the medicaid fraud unit of the Tennessee bureau of investigation for law enforcement activities authorized by federal or state law.
(c) Nothing in this section shall be construed to limit access to, or use of, these records by governmental agencies performing official functions.

History (1)

Acts 2002, ch. 880, § 18.

§ 71-5-143. TennCare advisory commission — Composition — Purpose — Expert assistance — Confidentiality — Conflict — Compensation.

(a) There is established in the department of finance and administration a TennCare advisory commission. The advisory commission will be separate and distinct from the bureau of TennCare but will be allowed access to all data concerning the operations, management, and program functions of the TennCare program, including information relevant to the TennCare program held or maintained by other state agencies. In accordance with 45 CFR 160.101 et seq., members of the advisory commission will provide nonpaid consulting services to the bureau of TennCare and may have access to protected health information to the extent necessary to perform their advisory function.
(b) The advisory commission shall be appointed by the governor and will be composed of thirteen (13) members who should reflect the broad impact that the TennCare program has on this state. The membership of the advisory commission shall include one (1) representative of the advocacy community; the chair of the health committee of the house of representatives, or the chair's designee; the chair of the health and welfare committee of the senate, or the chair's designee; two (2) representatives from the Tennessee business community; and three (3) representatives from the provider community. In addition, the membership of the advisory commission shall include one (1) person chosen by the governor from a list of three (3) persons nominated by the speaker of the house of representatives, and one (1) person chosen by the governor from a list of three (3) persons nominated by the speaker of the senate. If the governor does not choose a commissioner member from the initial list of three (3) persons nominated by each speaker, the appropriate speaker shall submit another list of three (3) persons for the governor's consideration. In making the appointments, the governor shall strive to ensure that the advisory commission's membership is representative of the state's geographic and demographic composition with appropriate attention to the representation of women and minorities. In making the initial appointments, the governor will designate three (3) initial appointees to serve until December 31, 2005, four (4) initial appointees to serve until December 31, 2006, and four (4) initial appointees to serve until December 31, 2007. Except for initial appointments, members shall be appointed to three-year terms. At the time of the initial appointments of the advisory commission, the governor shall appoint a chair and vice-chair of the commission from the membership of the commission who shall serve until December 31, 2005. The governor shall thereafter appoint a chair and vice-chair to one-year terms from the membership of the commission.
(c) The purpose of the commission is to review annually the health care operations including, but not limited to, cost-management analysis, benefits, enrollment, eligibility, costs, and performance of the TennCare program and to make recommendations to the governor regarding cost-containment strategies and cost-effective program improvements. Such recommendations by the commission will include an assessment of the effectiveness of the existing TennCare program, specific steps that could be taken to reduce program costs, and an evaluation of whether the program is optimizing its use of resources to best meet the needs of TennCare enrollees. Proposed modifications submitted by the commission that may result in increased program expenditures should be accompanied by recommendations to achieve commensurate savings in other program areas in order to achieve overall management of program costs. The commission shall present its recommendations in writing to the governor no later than November 10 of each year.
(d) Subject to an appropriation set forth in the general appropriations act, the commission will have the power to engage expert assistance in accordance with the state procurement processes. The department of finance and administration will provide the commission with appropriate staff and assistance.
(e) Members of the advisory commission shall maintain strict standards of confidentiality in the handling of all matters before the commission in accordance with federal and state law. All material and information, regardless of form, medium, or method of communication, provided to or acquired by a member or the commission staff in the course of the commission's work, shall be regarded as confidential information and shall not be disclosed and are deemed not to be a public record. In addition, all material and information, regardless of form, medium, or method of communication, made or generated by a member or the commission staff in the course of the commission's work, shall be regarded as confidential information and shall not be disclosed and are not public records. All necessary steps shall be taken by members and staff to safeguard the confidentiality of such material or information in conformance with federal and state law.
(f) Items or matters discussed by the commission may from time to time present real or apparent conflicts for members of the commission. Due to the importance of the commission's work and the advisory nature of its recommendations, in the event that a matter being considered by the commission presents a real or apparent conflict of interest, the affected member of the commission shall disclose the conflict to the chair but shall be allowed to discuss and take official action on the particular matter. The professional backgrounds of each member of the advisory commission as well as any conflicts disclosed by a member to the chair during a given year shall be reported in the commission's recommendations as set forth in subsection (c) of this section.
(g) Members shall receive no compensation for their services on the commission but may be reimbursed for those expenses allowed by the comprehensive travel regulations promulgated by the department of finance and administration and approved by the attorney general and reporter.

History (2)

Acts 2004, ch. 673, § 3
2016, ch. 1079, §§ 5, 6.

§ 71-5-144. Medically necessary items and services.

(a) Enrollees under the TennCare program are eligible to receive, and TennCare shall provide payment for, only those medical items and services that are:
1. (1) Within the scope of defined benefits for which the enrollee is eligible under the TennCare program; and
2. (2) Determined by the TennCare program to be medically necessary.
(b) To be determined to be medically necessary, a medical item or service must be recommended by a physician who is treating the enrollee or other licensed healthcare provider practicing within the scope of the physician's license who is treating the enrollee and must satisfy each of the following criteria:
1. (1) It must be required in order to diagnose or treat an enrollee's medical condition. The convenience of an enrollee, the enrollee's family, or a provider, shall not be a factor or justification in determining that a medical item or service is medically necessary;
2. (2) It must be safe and effective. To qualify as safe and effective, the type and level of medical item or service must be consistent with the symptoms or diagnosis and treatment of the particular medical condition, and the reasonably anticipated medical benefits of the item or service must outweigh the reasonably anticipated medical risks based on the enrollee's condition and scientifically supported evidence;
3. (3) It must be the least costly alternative course of diagnosis or treatment that is adequate for the medical condition of the enrollee. When applied to medical items or services delivered in an inpatient setting, it further means that the medical item or service cannot be safely provided for the same or lesser cost to the person in an outpatient setting. Where there are less costly alternative courses of diagnosis or treatment, including less costly alternative settings, that are adequate for the medical condition of the enrollee, more costly alternative courses of diagnosis or treatment are not medically necessary. An alternative course of diagnosis or treatment may include observation, lifestyle or behavioral changes or, where appropriate, no treatment at all; and
4. (4)
  1. (A) It must not be experimental or investigational. A medical item or service is experimental or investigational if there is inadequate empirically-based objective clinical scientific evidence of its safety and effectiveness for the particular use in question. This standard is not satisfied by a provider's subjective clinical judgment on the safety and effectiveness of a medical item or service or by a reasonable medical or clinical hypothesis based on an extrapolation from use in another setting or from use in diagnosing or treating another condition;
  2. (B) Use of a drug or biological product that has not been approved under a new drug application for marketing by the United States Food and Drug Administration (FDA) is deemed experimental;
  3. (C) Use of a drug or biological product that has been approved for marketing by the FDA but is proposed to be used for other than the FDA-approved purpose will not be deemed medically necessary unless the use can be shown to be widespread, to be generally accepted by the professional medical community as an effective and proven treatment in the setting and for the condition for which it is used, and to satisfy the requirements of subdivisions (b)(1)-(3).
(c) It is the responsibility of the bureau of TennCare ultimately to determine what medical items and services are medically necessary for the TennCare program. The fact that a provider has prescribed, recommended or approved a medical item or service does not, in itself, make such item or service medically necessary.
(d) The medical necessity standard set forth in this section shall govern the delivery of all services and items to all enrollees or classes of beneficiaries in the TennCare program. The bureau of TennCare is authorized to make limited special provisions for particular items or services, such as long-term care, or such as may be required for compliance with federal law.
(e) Medical protocols developed using evidence-based medicine that are authorized by the bureau of TennCare pursuant to § 71-5-107 shall satisfy the standard of medical necessity. Such protocols shall be appropriately published to all TennCare providers and managed care organizations.
(f) The bureau of TennCare is authorized to promulgate such rules and regulations as may be necessary to implement this section.

Backlinks (6)

History (1)

Acts 2004, ch. 673, § 22.

§ 71-5-145. Cost effectiveness of providers.

(a) Notwithstanding any law to the contrary, any initiative, program or measure operated by the bureau of TennCare, including, but not limited to, disease management programs, may require enrollees to obtain prescription drugs, durable medical equipment, or medical supplies in such manner as the bureau of TennCare determines to be the most cost-effective.
(b) The bureau of TennCare shall consult with Tennessee pharmacists who are providers actively participating in the TennCare pharmacy program in making a determination of cost effectiveness of any proposed pharmacy program.

History (1)

Acts 2004, ch. 673, § 23.

§ 71-5-146. Pharmacy lock-in program.

On and after July 1, 2004, the bureau of TennCare, through its authority to promulgate rules and regulations, may implement and maintain a pharmacy lock-in program designed to address member abuse, over utilization and quality of care concerns for TennCare enrollees.

History (1)

Acts 2004, ch. 673, § 28.

§ 71-5-147. Personal needs allowance — Protecting nursing home residents from diversion of allowance.

(a) In determining the amount of an eligible individual's income available for the cost of long-term nursing home care authorized under this part on or after January 1, 2025, a deduction shall be made from the person's total income in the amount of seventy dollars ($70.00) per month to be treated as a personal needs allowance within the meaning of applicable federal regulations.
(b)
1. (1) The health facilities commission is directed to review, and revise as necessary, recommendations previously developed to protect nursing home residents from vendors and others who would seek to provide inappropriate or unneeded goods and services, or otherwise divert personal needs allowance funds for uses other than those meeting residents' personal needs.
2. (2) The recommendations shall be provided to the chair of the health and welfare committee of the senate and the chair of the health committee of the house of representatives not later than January 15, 2025.

History (3)

Acts 2004, ch. 851, §§ 1, 2
2009, ch. 592, § 1
2024, ch. 986, § 1.

§ 71-5-148. Health care safety net for uninsured.

(a) To the extent that funds are specifically appropriated by the general appropriations act, including, but not limited to, any such funds that may be available from the bureau of TennCare's reserve funds, the department of finance and administration, in coordination with the department of health and the department of mental health and substance abuse services, is authorized to facilitate the expansion and augmentation of a health care safety net in this state. The health care safety net provides medical assistance and dental assistance to individuals in need of medical care and dental care to adults in need of adult emergency dental services who are uninsured and who lack financial resources to secure medical and dental care. It is the legislative intent that priority should be given to efforts pursuant to this section that benefit the greatest number of such individuals. Such efforts may include, but not be limited to:
1. (1) Improvement and expansion of the provision of medical assistance, both medical services and pharmacy, in the county health departments, with specific emphasis placed in providing assistance in those counties with the largest number of uninsured individuals; such support could include funding for additional staffing needs and facility expansion;
2. (2) Support for community-based health care facilities and practices, including not-for-profit clinics, faith-based facilities, community mental health agencies, and federally qualified health centers, for the provision of health care services to the uninsured;
3. (3) Incentive-based measures to encourage and promote physician involvement and treatment of the uninsured population, including specific steps taken to assist in providing for continuity of care, including specialty care, for such individuals, as well as targeted efforts at comprehensive disease management;
4. (4) Creation and implementation of a twenty-four-hour, seven-day a week health care safety net hotline designed to assist and direct individuals in need of medical care and services to available resources in their areas;
5. (5) Creation of a donated care referral system that can be easily accessed by individuals in need of medical care;
6. (6) Collaborative work with agencies and entities across the state to encourage citizens to volunteer their time, effort, and resources in creative efforts to assist in the overall care and well-being of uninsured individuals in this state; and
7. (7) Support for community-based providers of behavioral health services to seriously and persistently mentally ill adults who are uninsured and who lack financial resources to secure behavioral health care.
(b) Nothing established or supported pursuant to this section shall in any way be construed or determined to be an entitlement by any individual or entity to any medical assistance, medical services, or any pharmacy services, or, if such assistance or services are provided, to any continuing assistance or services by the state or by any other entity or person.

History (5)

Acts 2005, ch. 474, § 1
2008, ch. 1064, § 2
2009, ch. 95, § 2
2010, ch. 1100, § 140
2012, ch. 575, § 1.

§ 71-5-149. Disease management program.

The bureau of TennCare shall adopt a state disease management program, which may include contracting with a vendor that specializes in the provision of disease management services. The disease management program shall be designed to improve care to and reduce overall expenditures for TennCare beneficiaries with chronic illnesses. The disease management program may include the development of evidence-based medical practice guidelines, support services to assist physicians in monitoring their patients, more closely managed patient care, including management of the proper use of prescription drugs by patients, and the development of individual patient treatment plans that may include recommendations for improved medication compliance and improved lifestyle and behavioral compliance. The adoption of a disease management program is not an agency action and does not require rulemaking.

History (1)

Acts 2006, ch. 931, § 1.

§ 71-5-150. Reimbursement for TennCare crossover payments.

The bureau of TennCare shall reimburse pharmacies for covered products and services provided for full benefit dual eligibles as TennCare crossover claims at one hundred percent (100%) of the federal medicare program's allowable charge for participating providers.

History (1)

Acts 2009, ch. 607, § 1.

§ 71-5-151. Report on use of technical assistance groups of healthcare providers in developing episode of care.

(a) In developing or implementing any payment reform initiative involving the use of episodes of care with respect to medical assistance provided under this chapter by the bureau of TennCare or the health care finance and administration (HCFA) of the department of finance and administration, the bureau and HCFA shall report on the use of technical assistance groups of healthcare providers in developing any episode of care. The reports shall include all recommendations made by technical assistance groups throughout the period of implementation of any episode of care. In addition to any other information required in the quarterly report to the general assembly pursuant to § 71-5-104(c), the bureau of TennCare shall summarize in quarterly reports the recommendations of any technical assistance group concerning the payment reform initiative and identify any action taken by the bureau or HCFA to address those recommendations. The bureau and HCFA shall report to the health and welfare committee of the senate and the health committee of the house of representatives by July 1 each year, beginning in 2016, specifically concerning the use of technical assistance groups, on each recommendation made by those groups, and the response by the bureau or HCFA to each recommendation. This section shall apply to any payment reform initiative utilizing episodes of care, including any initiative receiving a state innovation model initiative grant from the federal centers for medicare and medicaid services.
(b) In developing or implementing any payment reform initiative involving the use of episodes of care with respect to medical assistance provided under this chapter by the bureau of TennCare or the HCFA of the department of finance and administration, the bureau and HCFA shall not impose a fine or penalty on any provider. The bureau and HCFA may impose withholds in order to recover some portion of costs that exceeds a cost threshold for an episode developed by the initiative. A withhold may not be called a fine or a penalty.
(c)
1. (1) The bureau of TennCare and the HCFA shall study the means of fair and just implementation of the episodes of care initiatives, especially with respect to costs associated with:
  1. (A) A healthcare facility located in an area that lacks an alternative healthcare facility within a thirty-minute drive;
  2. (B) Lack of more than a single provider of healthcare services for, including, but not limited to, radiology, anesthesia, pathology, or physical therapy; and
  3. (C) Contractual arrangements between the bureau of TennCare, managed care organizations, and other participating providers or healthcare facilities associated with the particular episode of care if such contracts are the cause of increased costs.
2. (2) No later than January 31, 2019, the bureau of TennCare and HCFA shall report the results of the study conducted pursuant to this subsection (c) to the health and welfare committee of the senate and the health committee of the house of representatives.
(d)
1. (1) In developing or implementing any payment reform initiative involving the use of episodes of care with respect to medical assistance provided under this chapter by the bureau of TennCare, a healthcare provider shall not be required to pay the portion of the risk sharing payment that is attributable to the increased cost of pain relief services if the following conditions are met:
  1. (A) The healthcare provider is required to make an episodes of care risk-sharing payment to a managed care organization;
  2. (B) Some portion of the episode costs were due to pain relief services;
  3. (C) The pain relief services provided to the patient were more expensive than an alternative pain relief service; and
  4. (D) The provider can demonstrate that the pain relief services provided to the patient had the effect of reducing opioid use by the patient relative to an alternative pain relief service routinely used by other providers in the episode.
2. (2) The bureau of TennCare is authorized to promulgate rules, pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, as may be necessary to implement this section.
(e) On and after July 1, 2018, in developing or implementing any payment reform initiative involving the use of episodes of care with respect to medical assistance provided under this chapter by the bureau of TennCare or the HCFA of the department of finance and administration, the bureau and the HCFA shall exclude anxiety episodes and non-emergent depression episodes from the initiative. This subsection (e) shall apply to any initiative receiving a state innovation model initiative grant from the federal centers for medicare and medicaid services.

History (6)

Acts 2016, ch. 1079, § 2
2018, ch. 766, § 1
2018, ch. 843, § 1
2018, ch. 1016, § 1
2019, ch. 345, § 137
2021, ch. 64, § 123.

§ 71-5-152. Procedure to obtain data sets derived from all payer claims database — Use of data — Annual report.

(a) Pursuant to § 56-2-125(d)(2)(B), and no later than October 1, 2016, the deputy commissioner of finance and administration responsible for the TennCare program shall establish a procedure permitting the following to obtain data sets derived from the all payer claims database through the department authorized to access the database for the purposes authorized in § 56-2-125(b)(1) within available resources of the bureau of TennCare:
1. (1) The department of finance and administration;
2. (2) The department of health;
3. (3) The department of mental health and substance abuse services;
4. (4) The department of disability and aging; and
5. (5) Other departments of this state.
(b) Any data retrieved from the database or the managing vendor may only be used for internal purposes of the department. The data shall be confidential and shall not be a public record for the purposes of title 10, chapter 7. If any department seeks to produce reports based upon the data as public documents, then the department shall submit a request for approval of that use of the data to the Tennessee health information committee.
(c) The bureau of TennCare shall submit an annual report to the chairs of the health and welfare committee of the senate and the health committee of the house of representatives that shall describe the nature and purpose of any requests to utilize data from the all payer claims database submitted to the bureau or the health information committee. Any request for data from departments that cannot be provided within existing resources of the bureau shall be identified in this report. The report shall also describe the disposition made by the Tennessee health information committee of each request to utilize the data and shall detail how each member of the committee voted on each request. The bureau shall submit the report by January 15 each year.

History (4)

Acts 2016, ch. 1079, § 4
2019, ch. 345, § 138
2021, ch. 64, § 124
2024, ch. 688, § 182.

§ 71-5-153. Verification of information.

(a) Prior to awarding assistance, and on a quarterly basis thereafter, the bureau of TennCare shall verify identity information for each respective applicant and enrollee against the following:
1. (1) Wage and income information maintained by state and federal sources;
2. (2) Immigration status information maintained by federal citizenship and immigration services; and
3. (3) Information maintained by the department of health, office of vital records.
(b) Subsection (a) shall not take effect until the last day of the first full quarter following implementation of an automated, electronic eligibility system by the bureau of TennCare. The bureau of TennCare shall notify the executive secretary of the code commission upon implementation of an automated, electronic eligibility system.

History (1)

Acts 2017, ch. 191, § 4.

§ 71-5-154. Annual report relating to coverage of mental health treatment.

(a) Every managed care organization that participates in the TennCare program shall submit an annual report to the bureau of TennCare on or before March 1 of each year that contains the following information for enrollees in the TennCare program:
1. (1) The frequency with which the managed care organization required prior authorization for all prescribed procedures, services, or medications for mental health and alcoholism or drug dependence benefits during the previous calendar year and the frequency with which the managed care organization required prior authorization for all prescribed procedures, services, or medications for medical and surgical benefits during the previous calendar year. Managed care organizations must submit this information separately for inpatient benefits, outpatient benefits, emergency care benefits, and prescription drug benefits. Frequency shall be expressed as a percentage, with total prescribed procedures, services, or medications within each classification of benefits as the denominator and the overall number of times prior authorization was required for any prescribed procedures, services, or medications within each corresponding classification of benefits as the numerator;
2. (2) A description of the process used to develop or select the medical necessity criteria for mental health and alcoholism or drug dependence benefits and the process used to develop or select the medical necessity criteria for medical and surgical benefits;
3. (3) Identification of all non-quantitative treatment limitations (NQTLs) that are applied to both mental health and alcoholism or drug dependence benefits and medical and surgical benefits. There may be no separate NQTLs that apply to mental health and alcohol or drug dependence benefits but do not apply to medical and surgical benefits within any classification of benefits;
4. (4) The results of an analysis that demonstrates that for the medical necessity criteria described in subdivision (a)(2) and for each NQTL identified in subdivision (a)(3), as written and in operation, the processes, strategies, evidentiary standards, or other factors used to apply the medical necessity criteria and each NQTL to mental health and alcoholism or drug dependence benefits are comparable to, and are applied no more stringently than the processes, strategies, evidentiary standards, or other factors used to apply the medical necessity criteria and each NQTL, as written and in operation, to medical and surgical benefits. At a minimum, the results of the analysis shall:
  1. (A) Identify the factors used to determine that an NQTL will apply to a benefit, including factors that were considered but rejected;
  2. (B) Identify and define the specific evidentiary standards used to define the factors and any other evidentiary standards relied upon in designing each NQTL;
  3. (C) Identify and describe methods and analyses used, including the results of the analyses, to determine that the processes and strategies used to design each NQTL as written for mental health and alcoholism or drug dependence benefits are comparable to and no more stringent than the processes and strategies used to design each NQTL as written for medical and surgical benefits;
  4. (D) Identify and describe the methods and analyses used, including the results of the analyses, to determine that processes and strategies used to apply each NQTL in operation for mental health and alcoholism or drug dependence benefits are comparable to and no more stringent than the processes or strategies used to apply each NQTL in operation for medical and surgical benefits; and
  5. (E) Disclose the specific findings and conclusions reached by the managed care organization demonstrating that the results of the analyses required by this subdivision (a)(4) indicate that the insurer or entity is in compliance with this section and the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (Pub. L. No. 110-343) and its implementing regulations, which include 42 CFR 438.900, 42 CFR 438.905, 42 CFR 438.910, 42 CFR 438.915, 42 CFR 438.920, and 42 CFR 438.930 and any other relevant current or future rules;
5. (5) The rates of and reasons for denial of claims for inpatient, outpatient, prescription drugs, and emergency mental health and alcoholism or drug dependence services during the previous calendar year compared to the rates of, and reasons for, denial of claims in those same classifications of benefits for medical and surgical services during the previous calendar year; and
6. (6) A certification signed by the managed care organization's chief executive officer and chief medical officer that affirms that the managed care organization has completed a comprehensive review of its administrative practices for the prior calendar year for compliance with this section and the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (Pub. L. No. 110-343).
(b) The bureau of TennCare shall monitor managed care organization claims denials for mental health and alcoholism or drug dependence benefits on the grounds of medical necessity within each classification of benefits among inpatient benefits, outpatient benefits, prescription drugs, and emergency care. The bureau of TennCare shall study and compare denial rates among each managed care organization and shall request additional data if significant discrepancies in denial rates are found.

History (1)

Acts 2017, ch. 221, § 1.

§ 71-5-155. Prior authorization for CRT or manual wheelchairs prohibited — Exceptions — Section definitions.

(a) A managed care organization shall not require a participant in a TennCare program to obtain and submit a prior authorization for repairing complex rehabilitation technology (CRT) or manual wheelchairs unless:
1. (1) The repairs are covered under a manufacturer's warranty;
2. (2) The cost of the repairs exceeds the cost to replace the CRT or manual wheelchair; or
3. (3) The CRT or manual wheelchair in need of repair is subject to replacement because the age of the CRT or manual wheelchair exceeds, or is within one (1) year of the expiration of, the recommended lifespan of the CRT or manual wheelchair.
(b) As used in this section:
1. (1) “Complex rehabilitation technology” has the same meaning as defined in § 71-5-159; and
2. (2) “Managed care organization” has the same meaning as defined in § 71-5-156.

History (1)

Acts 2023, ch. 447, § 2.

§ 71-5-156. Development of policy regarding births involving neonatal abstinence syndrome and opiod use by women of childbearing age.

(a) As used in this section:
1. (1) “Bureau” means the bureau of TennCare; and
2. (2) “Managed care organization” or “MCO” means a health maintenance organization, behavioral health organization, or managed health insurance issuer that participates in the TennCare program.
(b) The general assembly finds that issues raised by births of children with neonatal abstinence syndrome and the use of opioids by women of childbearing age constitute a critical problem for enrollees in the TennCare program, healthcare providers, the TennCare program, public health, and the fiscal well-being of the state.
(c) In order to address issues raised by births of children with neonatal abstinence syndrome and the use of opioids by women of childbearing age in the TennCare program, the bureau is directed to promptly fully review these issues and to develop an appropriate and accountable policy response that includes both primary prevention and secondary prevention.
(d) On or before September 1, 2017, the bureau shall issue appropriate requests for information for program initiatives aimed at primary prevention and secondary prevention of births involving neonatal abstinence syndrome and the use of opioids by women of childbearing age enrolled in the TennCare program.
(e)
1. (1) Each MCO that participates in the TennCare program shall provide the overall medical loss ratio for the MCO with respect to the TennCare program. The MCO shall also calculate a medical loss ratio with respect to expenditures associated with neonatal abstinence syndrome and the use of opioids by women of childbearing age enrolled in the TennCare program.
2. (2) For purposes of this subsection (e), “medical loss ratio” means the ratio of medical claims and quality improvement activities to the total funds received by the MCO from the bureau pursuant to its contractor risk agreement.
(f) Nothing in this section shall affect contracts in effect on June 6, 2017, with the managed care organizations for program services related to opioid use by women of childbearing age enrolled in the TennCare program.
(g) The bureau shall report concerning the progress and implementation of the program authorized by this section to the speaker of the house of representatives, the speaker of the senate, the comptroller of the treasury, the chair of the health committee of the house of representatives, and the chair of the health and welfare committee of the senate beginning on September 1, 2017, and thereafter on a quarterly basis.
(h) The bureau shall recommend to the general assembly any legislation necessary to implement initiatives selected under subsection (g) on or before January 15, 2018.
(i) If the commissioner of finance and administration, in consultation with the bureau, determines that a federal waiver or an amendment to an existing federal waiver is necessary in order to implement initiatives under this section, the commissioner shall promptly apply for an appropriate waiver or waiver amendment to the United States department of health and human services.

Backlinks (1)

71-5-155(b)(2)

History (1)

Acts 2017, ch. 483, § 3.

§ 71-5-157. Establishment of state policy to avoid use of state funds for elective abortions.

(a) It is the policy of the state to favor childbirth as integral to the health and welfare of the citizens of the state and therefore to favor family planning services that do not include elective abortions or the promotion of elective abortions within the continuum of care or services offered by the provider and to avoid the direct or indirect use of state funds to promote or support elective abortions.
(b) In furtherance of this state policy, a waiver amendment to the existing TennCare II waiver that requires elective abortion providers be excluded from participation as providers in the TennCare program shall be submitted to the federal centers for medicare and medicaid services for approval. The waiver amendment shall be implemented within ten (10) business days of approval.
(c) For purposes of this section, an “elective abortion provider” means any entity that performed, or operated or maintained a facility that performed, more than fifty (50) abortions in the previous year, or any affiliate of such an entity.
(d) This section does not affect compliance with § 9-4-5116.

History (1)

Acts 2018, ch. 682, § 1.

§ 71-5-158. Amendment to TennCare ll waiver relating to work and community engagement requirements for certain adult enrollees.

An amendment to the existing TennCare II waiver shall be submitted to the federal centers for medicare and medicaid services (CMS) authorizing the bureau of TennCare to create reasonable work and community engagement requirements for able-bodied working age adult enrollees without dependent children under the age of six (6). The waiver shall be consistent with the most recent guidance to state medicaid directors provided by CMS concerning opportunities to promote work and community engagement in demonstration projects authorized under § 1115 of the federal social security act (42 U.S.C. § 1315). The state shall seek the necessary approval from the United States department of health and human services to utilize funds from the temporary assistance to needy families (TANF) program under the Families First Act of 1996, compiled in chapter 3, part 1 of this title, for eligible expenditures related to the waiver. Implementation of the waiver shall be contingent upon the available use of TANF funds or other federal appropriations to meet the requirements of the waiver.

Backlinks (1)

71-5-1204(c)

History (1)

Acts 2018, ch. 869, § 1.

§ 71-5-159. Complex rehabilitation technology.

(a) As used in this section, “complex rehabilitation technology”:
1. (1) Means items classified within medicare as group 3, group 4, or group 5 power wheelchairs and manual wheelchairs with the HCPCS billing codes K0005 and E1161; and
  Backlinks (3)
  
  47-18-3401(4)(A)
  47-18-3401(5)
  71-4-2301(3)(A)
2. (2) Includes options and accessories related to any of such items.
(b) The commissioner of finance and administration, or the commissioner's designee, shall recognize complex rehabilitation technology as a separate covered service from other items considered to be durable medical equipment within medicare, and must list complex rehabilitation technology benefits separately on any proposed budget document or other financial publication made available to the public if the budget document or other financial publication establishes a change in reimbursement for complex rehabilitation technology.

Backlinks (5)

History (1)

Acts 2019, ch. 96, § 1.

§ 71-5-160. Maintenance of coverage trust fund.

(a) There is continued and revived, if necessary, a segregated account within the state treasury that shall be known as the maintenance of coverage trust fund created by Chapter 909 of the Public Acts of 2010. The fund shall not be used to replace any moneys otherwise appropriated to the TennCare program by the general assembly or to replace any moneys appropriated outside of the TennCare program.
(b) The maintenance of coverage trust fund shall consist of:
1. (1) All annual coverage assessments received by the bureau; and
2. (2) Investment earnings credited to the assets of the maintenance of coverage trust fund.
(c) Monies credited or deposited to the maintenance of coverage trust fund together with all federal matching funds shall be available to and used by the bureau only for expenditures in the TennCare program and shall include the purposes authorized in the annual coverage assessment act enacted by the general assembly and codified in this title.

Backlinks (2)

History (4)

Acts 2010, ch. 909, § 1
2012, ch. 645, § 2
T.C.A. § 71-5-1005
Acts 2014, ch. 877, § 2.

§ 71-5-161. Hospital payment rate corridors.

(a) This section continues the hospital payment rate corridors applicable to payments by managed care organizations to hospitals for services provided to TennCare enrollees established by § 71-5-703(b)(3), as enacted by Chapter 276 of the Public Acts of 2015.
(b) Hospital payment rate variation corridors shall be established by the state's actuary and approved by the bureau of TennCare for payments by managed care organizations to hospitals for services provided to TennCare enrollees as follows:
1. (1) As required by § 71-5-703(b)(3), as enacted by Chapter 276 of the Public Acts of 2015, the bureau shall implement provisions in its contractor risk agreements (CRAs) with all managed care organizations requiring payment rates for each hospital in the aggregate from all managed care organizations with which the hospital has network contracts to be no less than the minimum levels or more than the maximum levels set forth in subsections (c) and (d); and
2. (2) Compliance with these standards shall be determined on the basis of the totality of all rates for the hospital by all managed care organizations in the aggregate with which it has a network contract, rather than on the basis of rates for a hospital under a network contract with an individual managed care organization. Managed care organizations shall not enter into or maintain a single case agreement or contract with any hospital that authorizes or requires rates for the hospital that do not conform to the hospital payment variability standards set forth in this section.
(c) The minimum and maximum levels for aggregate rates to hospitals for services to TennCare enrollees shall be based on the percentages of each hospital's federal fiscal year (FFY) 2011 medicare reimbursement set forth in subsection (d). Compliance with these minimum and maximum payment rates shall be determined on the basis of the totality of payments to a hospital for services to TennCare enrollees from all managed care organizations with which the hospital has a network contract. The variation corridors established by this subsection (c) are for the purpose of limiting the amount of variation in the rates paid by TennCare managed care organizations to hospitals, and this subsection (c) shall not create a right by a hospital to receive any actual amount of reimbursement in the aggregate from all TennCare managed care organizations.
(d)
1. (1) For routine, nonspecialized inpatient services, the minimum level is fifty-three and eight-tenths percent (53.8%), and the maximum level is eighty percent (80%);
2. (2) For outpatient services, the minimum level is ninety-three and two-tenths percent (93.2%), and the maximum level is one hundred and four percent (104%);
3. (3) For cardiac surgery services, the minimum level is thirty-two percent (32%), and the maximum level is eighty-three percent (83%);
4. (4) For specialized neonatal services, the minimum level is four percent (4%), and the maximum level is one hundred seventy-four percent (174%); and
5. (5) For other specialized services, the minimum level is forty-nine percent (49%), and the maximum level is one hundred sixty-four percent (164%).
(e) The bureau shall publish the list of MS-DRGs included in each service category on its website, and the bureau shall update the list annually to reflect any changes as necessary.
(f) The bureau shall maintain rules implementing the requirements of this section. All rules promulgated by the commissioner of finance and administration or the bureau prior to and in effect on July 1, 2016, concerning the annual coverage assessment under this part or Chapter 276 of the Public Acts of 2015, shall remain in force and effect and shall be administered and enforced by the bureau until these rules are modified.
(g) The requirements of this section are not applicable in any state fiscal year or portion thereof that is subject to an adjustment to the state's budget neutrality agreement and in which CMS has approved the hospital coverage assessment base.

Backlinks (4)

History (2)

Acts 2016, ch. 854, § 1
2024, ch. 953, § 2.

§ 71-5-162. Identification of child enrollees eligible for federal supplemental security income upon reaching 18 years of age — Counseling — Enrollment assistance.

The bureau of TennCare shall establish a program that:
1. (1) Identifies child enrollees in TennCare who, by reason of a disability, are likely to be eligible for federal supplemental security income upon reaching eighteen (18) years of age;
2. (2) In the year prior to each eligible child enrollee's eighteenth birthday, counsels the child and the child's parent or guardian on the benefits available from and enrollment requirements for the federal supplemental security income program; and
3. (3) Provides enrollment assistance to the child prior to the child's eighteenth birthday in a manner that the bureau determines is most likely to ensure that there will be no gap in TennCare eligibility or coverage due to the child reaching eighteen (18) years of age.

History (1)

Acts 2019, ch. 310, § 1.

§ 71-5-163. Submission of waiver in order to provide medical assistance to TennCare ll waiver population by means of block grant.

1. (a) The governor, acting through the commissioner of finance and administration, is directed to submit to the federal centers for medicare and medicaid services a waiver amendment to the existing TennCare II waiver, or to submit a new waiver, in order to provide medical assistance to the TennCare II waiver population by means of a block grant in accordance with this section no later than one hundred eighty (180) days after May 24, 2019. The block grant authorized by this section may convert the federal share of all medical assistance funding for this state into an allotment that is tailored to meet the needs of this state and that:
  1. (1) When determining the base amount for the block grant, factors the current inaccurate reflection of the state's labor costs in the state's Medicare Wage Index and the index's negative impact on healthcare delivery in this state;
  2. (2) Is indexed for population growth;
  3. (3) Is indexed for inflation and other costs;
  4. (4) Excludes from the block grant financing amount any expenses that are not included in the state's existing 1115 demonstration waiver;
  5. (5) Excludes administrative costs from the block grant financing amount and permits the state to continue to draw federal matching funds for administrative costs;
  6. (6) Provides the state with maximum flexibility with regard to existing federal mandates and regulations and with implementing cost controls as determined appropriate by the state, and either exempts the state from the requirements of any new mandates, regulations, or federal court orders during the period of block grant financing or increases the amount of block grant financing to offset any cost increases to the state from such mandates, regulations, or federal court orders;
  7. (7) Provides the state with maximum flexibility regarding pharmacy benefits including fluctuation of prescription drug costs, diabetic testing supplies, and over-the-counter medications;
  8. (8) Provides the state with maximum flexibility to serve other needy populations with distinct financial or healthcare needs; and
  9. (9) Remains at the level set according to the block grant without any decrease in the federal share of all medical assistance funding for this state based on deflation or a reduction in population.
2. (b) A waiver amendment to the existing TennCare II waiver requested pursuant to subsection (a), if approved by the federal government and the commissioner of finance and administration, does not take effect unless subsequently authorized by joint resolution of the general assembly.

Backlinks (1)

71-5-704(c)

History (1)

Acts 2019, ch. 481, § 1.

§ 71-5-164. Waiver for purpose of establishing Katie Beckett program.

(a) The commissioner of finance and administration is directed to submit, no later than one hundred twenty (120) days after May 24, 2019, to the federal centers for medicare and medicaid services a waiver or waivers pursuant to Section 1115 of the Social Security Act for the purpose of establishing a distinct Katie Beckett program. The Katie Beckett program must be designed in consultation with the commissioner of disability and aging and must be administered in accordance with this section. It is the intent of the general assembly, that subject to approval by the centers for medicare and medicaid services, the Katie Beckett program be composed of two (2) parts as described in subsections (b) and (c); provided, however, that if the centers for medicare and medicaid services only approves one (1) part of the program, either Part A or Part B as described in subsections (b) and (c) respectively, then the approved part may be administered without the other part.
(b) Part A of the Katie Beckett program:
1. (1) Must be designed to provide a pathway to eligibility for medicaid services and essential wraparound home- and community-based services by waiving the deeming of the parents' income and resources as applicable to a child who is under eighteen (18) years of age and:
  1. (A) Has medical needs that:
    1. (i) Result in severe functional limitations that meet criteria established specifically for children;
    2. (ii) Would qualify the child for institutionalization in an acute care hospital, nursing facility, or intermediate care facility for individuals with intellectual disabilities; and
    3. (iii) Are likely to last at least twelve (12) months or result in death;
  2. (B) Is not receiving long-term services from any alternative waiver program established under this title;
  3. (C) Would otherwise qualify for supplemental security income due to the child's disability but for the income or resources of their parent;
  4. (D) For whom a licensed physician has certified that in-home care is an appropriate way to meet the child's needs; and
  5. (E) For whom the cost of care outside of the institution does not exceed the estimated medicaid cost of appropriate institutional care;
2. (2) Must offer an integrated program that:
  1. (A) As funding permits, provides children meeting the criteria in subdivision (b)(1) with treatment and support, including, but not limited to:
    1. (i) Respite care;
    2. (ii) Care coordination; and
    3. (iii) Medically necessary medical care and supportive services;
  2. (B) Accepts applications for the program during periods of open enrollment;
  3. (C) Prioritizes for enrollment into the program children with the most significant disabilities or complex medical needs;
  4. (D) Delivers medically necessary care and essential wraparound services and supports in the most integrated setting appropriate and cost-effective way possible in order to utilize available funding to serve as many children as possible; and
  5. (E) If approved by the federal centers for medicare and medicaid services:
    1. (i) Requires periodic reevaluations of an enrolled child's eligibility based upon eligibility criteria for all open categories of TennCare coverage; and
    2. (ii) At the time of reevaluation, allows the bureau of TennCare to disenroll a child who no longer meets the eligibility criteria for any open category of TennCare coverage;
3. (3) Must provide children applying for or enrolled in Part A of the program with the same appeal rights accorded all other TennCare applicants and enrollees; and
4. (4) May require parents of children enrolled in Part A of the program to purchase and maintain available private or employer-sponsored insurance that offers coverage for the child, and establish buy-in or premium requirements, using a sliding fee scale based on parent income, to help offset state costs and ensure program sustainability. Any premiums must take into account any amounts paid by a family for private insurance also provided for the child.
(c) Part B of the Katie Beckett program:
1. (1) Must be administered by the department of disability and aging;
2. (2) Must be designed as a medicaid diversion plan and offer a capped package of essential wraparound services and supports as well as premium assistance, using a sliding fee scale based on parent income, for a child who is under eighteen (18) years of age and:
  1. (A) Has medical needs that:
    1. (i) Meet the level of care criteria established specifically for children;
    2. (ii) Would qualify the child for institutionalization in an acute care hospital, nursing facility, or intermediate care facility for individuals with intellectual disabilities or place the child at risk of institutionalization; and
    3. (iii) Are likely to last at least twelve (12) months or result in death; and
  2. (B) Is not medicaid eligible and is not receiving long-term services from any alternative waiver program established under this title;
3. (3) Must provide services in the most integrated setting appropriate and cost-effective way possible in order to utilize available funding to assist as many children and families as possible; support and sustain child health; utilize, support, and sustain family caregiving; plan and prepare the child for transition to employment and community living with as much independence as possible; and delay the need for medicaid eligibility and services;
4. (4) Must determine eligibility for services based solely upon medical necessity; and
5. (5) Must provide children applying for or enrolled in Part B of the program with the same appeal rights accorded all other TennCare and department of disability and aging applicants and enrollees.
(d) If the bureau of TennCare finds it cost-effective and all necessary federal waivers are obtained, then parents or guardians of a child meeting the criteria in subsection (b) or (c) may be authorized to hire and manage care providers for specified wraparound services using a consumer direction model.
(e) Beginning February 1, 2020, and no later than February 1 of each year thereafter, the bureau of TennCare and the department of disability and aging shall issue an annual joint report to the insurance committee of the house of representatives and the health and welfare committee of the senate on the status of the Katie Beckett program that includes, but is not limited to, the following information:
1. (1) Total spent on program funding, including state and federal funds;
2. (2) The amount of administrative costs to operate the program;
3. (3) The costs of Part A and Part B, individually;
4. (4) The number of children served through the program;
5. (5) The services provided by and through the program; and
6. (6) The income range of the parents of children participating in the program.
(f) The bureau of TennCare and the department of disability and aging are authorized, as necessary, to promulgate rules to effectuate the purposes of this section. Rules must be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
(g) This section does not create an entitlement to services through the provisions of a Katie Beckett program, and the services provided and the number of individuals served are subject to appropriations made for that purpose.

History (2)

Acts 2019, ch. 494, § 1
2024, ch. 688, § 183.

§ 71-5-165. Reimbursement of ambulance service provider that provides covered service to TennCare recipient.

(a) The bureau of TennCare shall reimburse an ambulance service provider that provides a covered service to a TennCare recipient at a rate not less than sixty-seven and one-half percent (67.5%) of the federal medicare program's allowable charge for participating providers. For purposes of this section, “ambulance service provider” means a public or private ground-based ambulance service that bills for transports and has a base of operations in this state.
(b) This section does not affect the Ground Ambulance Service Provider Assessment Act, compiled under part 15 of this chapter. Funds described under this section and part 15 of this chapter may not be used to fund the other.
(c) The bureau of TennCare shall seek an intergovernmental transfer of funds, in consultation with, and subject to approval of, the commissioner of finance and administration for the sole purpose of increasing the rate of reimbursement to ambulance service providers that provide covered services to TennCare recipients at a rate greater than the rate described under subsection (a).
(d) The bureau of TennCare, in consultation with and subject to approval of the commissioner of finance and administration, shall develop and implement a program substantially similar to the federal centers for medicare and medicaid services' Emergency Triage, Treat, and Transport (ET3) model, established pursuant to Section 1115A of the federal Social Security Act (42 U.S.C. § 1315a), in a manner that complies with this section.

History (2)

Acts 2020, ch. 658, §§ 1, 2
2022, ch. 919, § 1.

§ 71-5-166. Annual review of medications and forms of treatment for sickle cell disease, and services for enrollees with diagnosis of sickle cell disease, that are eligible for coverage under medical assistance program.

(a) This section is known and may be cited as “Terrence's Law.”
(b) The bureau of TennCare shall conduct an annual review of all medications and forms of treatment for sickle cell disease, and services for enrollees with a diagnosis of sickle cell disease, that are eligible for coverage under the medical assistance program. The purpose of the annual review is to determine if the available covered medications, treatments, and services are adequate to meet the needs of enrollees with a diagnosis of sickle cell disease, and whether the bureau should seek to add additional medications, treatments, or services.
(c) When conducting the annual review required by this section, the bureau of TennCare shall solicit and consider input from the general public, with specific emphasis on attempting to receive input from persons or groups with knowledge and experience in the area of sickle cell disease treatment.
(d) On or before January 15, 2022, and on or before January 15 each year thereafter, the bureau of TennCare shall submit a report to the chief clerks of the senate and the house of representatives for distribution to the appropriate subject matter committees, and to the legislative librarian, that details the bureau's findings from the annual review required by this section, as well as any recommendations to the general assembly based upon those findings. The bureau shall publish the annual report required by this subsection (d) to its website in a manner accessible by the general public.

History (1)

Acts 2021, ch. 186, § 1.

§ 71-5-167. Physical address requirement for telehealth providers.

(a) As used in this section:
1. (1) “Healthcare provider” means a person who is licensed, certified, or authorized or permitted by the laws of this state to administer health care in the ordinary course of business or practice of a profession; and
2. (2) “Telehealth provider group” means two (2) or more healthcare providers that share a common employer and provide healthcare services exclusively via telehealth.
(b) This chapter does not require:
1. (1) A vendor or healthcare provider who provides healthcare services exclusively via telehealth to maintain a physical address or site in this state in order to be eligible to enroll as a vendor or provider for the medical assistance program; or
2. (2) A telehealth provider group to have a service address in this state in order to be eligible to enroll as a vendor or provider group for the medical assistance program, as long as the healthcare providers that comprise the telehealth provider group are licensed with the appropriate healthcare licensing authority in this state or are otherwise authorized by law to provide healthcare services in this state.

History (1)

Acts 2023, ch. 55, § 1.

§ 71-5-168. CPT code updates to include reimbursement of remote ultrasound procedures and remote fetal nonstress tests — Qualifications for reimbursement.

(a) As used in this section, “CPT code” means the unique numerical designations established by the American Medical Association for various medical, surgical, and diagnostic services used in billing healthcare services.
(b) No later than December 31, 2024, the bureau of TennCare shall amend existing rules, or promulgate new rules, on fee-for-service and medicaid managed care plans regarding reimbursement to allow for the reimbursement of remote ultrasound procedures and remote fetal nonstress tests utilizing established CPT codes for such procedures when the patient is in a residence or other off-site location that is separate from the patient's provider and the same standard of care is met.
(c) When amending or promulgating rules pursuant to subsection (b), the bureau shall ensure that:
1. (1) A remote ultrasound procedure or remote fetal nonstress test is only reimbursable when the provider uses digital technology:
  1. (A) To collect medical and other forms of health data from a patient and electronically transmit that information securely to a healthcare provider who is in a separate location for the purpose of interpretation and making recommendations;
  2. (B) That is compliant with the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA)(42 U.S.C. § 1320d et seq.); and
  3. (C) That is approved by the federal food and drug administration; and
2. (2) A fetal nonstress test is only reimbursable with a place of service modifier for at-home monitoring with remote monitoring solutions that are cleared by the federal food and drug administration for on-label use for monitoring fetal heart rate, maternal heart rate, and uterine activity.

History (1)

Acts 2024, ch. 674, § 1.

§ 71-5-169. Section definitions — Reimbursement for non-opioid treatment to healthcare providers and hospitals.

(a) As used in this section:
1. (1) “Division” means the division of TennCare; and
2. (2) “Non-opioid treatment” means a drug or biological product that is indicated to produce analgesia without acting on the body's opioid receptors.
(b) The division shall ensure that reimbursement is provided to a healthcare provider who provides a non-opioid treatment to a recipient under the medical assistance program.
(c) The division shall ensure that, to the extent permitted by law, a hospital that provides either inpatient or outpatient services to a recipient is reimbursed under the medical assistance program for any medically necessary non-opioid treatment provided as a part of those services.

History (1)

Acts 2024, ch. 762, § 2.

§ 71-5-170. Denial of non-opioid prescription in favor of opioid prescription prohibited.

Notwithstanding another law, when a healthcare prescriber prescribes a non-opioid medication for the treatment of acute or chronic pain, a managed care organization or other health insurance issuer shall not deny coverage of the non-opioid prescription drug in favor of an opioid prescription drug. As used in this section, “healthcare prescriber” means a prescriber as defined in § 53-10-203.

History (1)

Acts 2024, ch. 762, § 3.

§ 71-5-171. Mental health services — Mandatory coverage and reimbursement.

(a) As used in this section:
1. (1) “Health benefit plan” means a plan of health insurance coverage under the medical assistance program;
2. (2) “Health insurance carrier”:
  1. (A) Means an entity subject to title 56, or subject to the jurisdiction of the commissioner of commerce and insurance, that contracts with healthcare providers in connection with a plan of health insurance, health benefits, or health services; and
  2. (B) Includes a vendor or an entity that provides a health benefit plan of coverage under TennCare or a successor program provided for pursuant to this chapter; and
3. (3) “TennCare health benefit plan” means a health benefit plan issued by a health insurance carrier pursuant to an agreement with the bureau of TennCare to provide health insurance coverage for an enrollee in the medical assistance program.
(b) Notwithstanding another law to the contrary, a TennCare health benefit plan issued by a health insurance carrier must provide coverage and reimbursement for mental health services and treatment to the same extent that the TennCare health benefit plan provides coverage and reimbursement for the treatment of alcoholism and drug dependence.
Backlinks (1)
- 56-7-2360(e)(4)(E)

Backlinks (1)

56-1-102(7)

History (1)

Acts 2024, ch. 949, § 1.

§ 71-5-172 — 71-5-180. [Reserved]

§ 71-5-181. Tennessee Medicaid False Claims Act — Short title.

(a) The title of this section and §§ 71-5-182 — 71-5-185 is and may be cited as the “Tennessee Medicaid False Claims Act.”
(b) “Medicaid program” as used in §§ 71-5-182 — 71-5-185 includes the TennCare program and any successor program to the medicaid program.

Backlinks (6)

History (1)

Acts 1993, ch. 364, § 1.

§ 71-5-182. Violations — Damages — Definitions.

(a) Subject to subdivision (a)(2), any person who:
1. (1)
  1. (A) Knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval under the medicaid program;
  2. (B) Knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim under the medicaid program;
  3. (C) Conspires to commit a violation of subdivision (a)(1)(A), (a)(1)((B), or (a)(1)((D); or
  4. (D) Knowingly makes, uses, or causes to be made or used, a false record or statement material to an obligation to pay or transmit money, or property to the state, or knowingly conceals, or knowingly and improperly, avoids, or decreases an obligation to pay or transmit money or property to the state, relative to the medicaid program;
  5. is liable to the state for a civil penalty of not less than five thousand dollars ($5,000) and not more than twenty-five thousand dollars ($25,000), adjusted by the Federal Civil Penalties Inflation Adjustment Act of 1990 (28 U.S.C. § 2461 note); Public Law 101-410, plus three (3) times the amount of damages which the state sustains because of the act of that person.
2. (2) However, if the court finds that:
  1. (A) The person committing the violation of this subsection (a) furnished officials of the state responsible for investigating false claims violations with all information known to such person about the violation within thirty (30) days after the date on which the defendant first obtained the information;
  2. (B) The person fully cooperated with any state investigation of such violation; and
  3. (C) At the time such person furnished the state with the information about the violation, no criminal prosecution, civil action, or administrative action had commenced under §§ 71-5-181 — 71-5-186 with respect to the violation, and the person did not have actual knowledge of the existence of an investigation into the violation;
  4. the court may assess not less than two (2) times the amount of damages which the state sustains because of the act of the person.
3. (3) A person violating this subsection (a) shall also be liable for the costs of a civil action brought to recover any such penalty or damages.
(b) For purposes of this section, “knowing” and “knowingly” mean that a person, with respect to information:
1. (1) Has actual knowledge of the information;
2. (2) Acts in deliberate ignorance of the truth or falsity of the information; or
3. (3) Acts in reckless disregard of the truth or falsity of the information, and no proof of specific intent to defraud is required.
(c) “Claim” means any request or demand, whether under a contract or otherwise, for money or property and whether or not the state has title to the money or property, that is presented to any employee, officer, or agent of the state, or is made to any contractor, grantee, or other recipient, if the money or property is to be spent or used on the state's behalf or to advance a state program or interest, and if the state provides or has provided any portion of the money or property requested or demanded; or if the state will reimburse such contractor, grantee, or other recipient for any portion of the money or property which is requested or demanded; and does not include requests or demands for money or property that the state has paid to an individual as compensation for state employment or as an income subsidy with no restrictions on that individual's use of the money or property.
(d) “Obligation” means an established duty, whether or not fixed, arising from an express or implied contractual, grantor-grantee, or licensor-licensee relationship, from a fee-based or similar relationship, from statute or regulation, or from the retention of any overpayment.
(e) “Material” means having a natural tendency to influence, or be capable of influencing, the payment or receipt of money or property.
(f) Any person who engages, has engaged or proposes to engage in any act described by subsection (a) may be enjoined in any court of competent jurisdiction in an action brought by the attorney general and reporter. The action shall be brought in the name of the state and shall be granted if it is clearly shown that the state’s rights are being violated by such person or entity and the state will suffer immediate and irreparable injury, loss or damage pending a final judgment in the action, or that the acts or omissions of such person or entity will tend to render such final judgment ineffectual. The court may make such orders or judgments, including the appointment of a receiver, as may be necessary to prevent any act described by subsection (a) by any person or entity, or as may be necessary to restore to the medicaid program any money or property, real or personal, which may have been acquired by means of such act.

Backlinks (10)

History (4)

Acts 1993, ch. 364, § 2
2004, ch. 784, § 2
2012, ch. 806, §§ 1-5
2013, ch. 99, § 1.

§ 71-5-183. Civil actions — Employee remedies.

(a) If the attorney general and reporter finds that a person has violated or is violating § 71-5-182, the attorney general and reporter may bring a civil action under this section against the person.
(b)
1. (1) A person may bring a civil action for a violation of § 71-5-182 for the person and for the state. The action shall be brought in the name of the state of Tennessee. The action may be dismissed only if the court and the attorney general and reporter or district attorney general give written consent to the dismissal and their reasons for consenting.
2. (2) A copy of the complaint and written disclosure of substantially all material evidence and information the person possesses shall be served on the state. The complaint shall be filed in camera, shall remain under seal for at least sixty (60) days, and shall not be served on the defendant until the court so orders. The state may elect to intervene and proceed with the action within sixty (60) days after it receives both the complaint and the material evidence and information.
3. (3) The state may, for good cause shown, move the court for extensions of the time during which the complaint remains under seal under subdivision (b)(2). Any such motions may be supported by affidavits or other submissions in camera. The defendant shall not be required to respond to any complaint filed under this section until twenty (20) days after the complaint is unsealed and served upon the defendant.
4. (4) Before the expiration of the sixty-day period or any extensions obtained under subdivision (b)(3), the state shall:
  1. (A) Proceed with the action, in which case the action shall be conducted by the state; or
  2. (B) Notify the court that it declines to take over the action, in which case the person bringing the action shall have the right to conduct the action.
5. (5) When a person brings an action under this subsection (b), no person other than the state may intervene or bring a related action based on the facts underlying the pending action.
Backlinks (1)
- 71-5-184(c)
(c)
1. (1) If the state proceeds with the action, it shall have the primary responsibility for prosecuting the action, and shall not be bound by an act of the person bringing the action. Such person shall have the right to continue as a party to the action, subject to the limitations set forth in subdivision (c)(2).
2. (2)
  1. (A) The state may dismiss the action notwithstanding the objections of the person initiating the action, if the person has been notified by the state of the filing of the motion and the court has provided the person with an opportunity for a hearing on the motion.
  2. (B) The state may settle the action with the defendant notwithstanding the objections of the person initiating the action, if the court determines, after a hearing, that the proposed settlement is fair, adequate, and reasonable under all the circumstances. Upon a showing of good cause, such hearing may be held in camera.
  3. (C) Upon a showing by the state that unrestricted participation during the course of the litigation by the person initiating the action would interfere with or unduly delay the state's prosecution of the case, or would be repetitious, irrelevant, or for purposes of harassment, the court may, in its discretion, impose limitations on the person's participation, such as:
    1. (i) Limiting the number of witnesses the person may call;
    2. (ii) Limiting the length of the testimony of such witnesses;
    3. (iii) Limiting the person's cross-examination of witnesses; or
    4. (iv) Otherwise limiting the participation by the person in the litigation.
  4. (D) Upon a showing by the defendant that unrestricted participation during the course of the litigation by the person initiating the action would be for purposes of harassment or would cause the defendant undue burden or unnecessary expense, the court may limit the participation by the person in the litigation.
3. (3) If the state elects not to proceed with the action, the person who initiated the action shall have the right to conduct the action. If the state so requests, it shall be served with copies of all pleadings filed in the action and shall be supplied with copies of all deposition transcripts, at the state's expense. When a person proceeds with the action, the court, without limiting the status and rights of the person initiating the action, may nevertheless permit the state to intervene at a later date upon a showing of good cause.
4. (4) Whether or not the state proceeds with the action, upon a showing by the state that certain actions of discovery by the person initiating the action would interfere with the state's investigation or prosecution of a criminal or civil matter arising out of the same facts, the court may stay such discovery for a period of not more than sixty (60) days. Such a showing shall be conducted in camera. The court may extend the sixty-day period upon a further showing in camera that the state has pursued the criminal or civil investigation or proceedings with reasonable diligence and any proposed discovery in the civil action will interfere with the ongoing criminal or civil investigation or proceedings.
5. (5) Notwithstanding subsection (b), the state may elect to pursue its claim through any alternate remedy available to the state, including any administrative proceeding to determine a civil monetary penalty. If any such alternate remedy is pursued in another proceeding, the person initiating the action shall have the same rights in such proceedings as such person would have had if the action had continued under this section. Any finding of fact or conclusion of law made in such other proceeding that has become final shall be conclusive on all parties to an action under this section. For purposes of this subdivision (c)(5), a finding or conclusion is final if it has been finally determined on appeal to the appropriate court of jurisdiction, if all time for filing such an appeal with respect to the finding or conclusion has expired, or if the finding or conclusion is not subject to judicial review.
(d)
1. (1)
  1. (A) If the state proceeds with an action brought by a person under subsection (a), a person shall, subject to subdivision (d)(1)(B), receive at least fifteen percent (15%) but not more than twenty-five percent (25%) of the proceeds of the action or settlement of the claim, depending upon the extent to which the person substantially contributed to the prosecution of the action.
  2. (B) Where the action is one that the court finds to be based primarily on disclosures of specific information, other than information provided by the person bringing the action, relating to allegations or transactions in a criminal, civil, or administrative hearing, report, audit, investigation, or from the news media, the court may award such sums as it considers appropriate, but in no case more than ten percent (10%) of the proceeds, taking into account the significance of the information and the role of the person bringing the action in advancing the case to litigation.
  3. (C) Any payment to a person under subdivisions (d)(1)(A) and (d)(1)(B) shall be made from the proceeds. Any such person shall also receive an amount for reasonable expenses that the court finds to have been necessarily incurred, plus reasonable attorneys' fees and costs. All such expenses, fees, and costs shall be awarded against the defendant.
2. (2) If the state does not proceed with an action under this section, the person bringing the action or settling the claim shall receive an amount that the court decides is reasonable for collecting the civil penalty and damages. The amount shall be not less than twenty-five percent (25%) and not more than thirty percent (30%) of the proceeds of the action or settlement and shall be paid out of such proceeds. Such person shall also receive an amount for reasonable expenses which the court finds to have been necessarily incurred, plus reasonable attorneys' fees and costs. All such expenses, fees, and costs shall be awarded against the defendant.
3. (3) Whether or not the state proceeds with the action, if the court finds that the action was brought by a person who planned and initiated the violation of § 71-5-182 upon which the action was brought, then the court may, to the extent the court considers appropriate, reduce the share of the proceeds of the action that the person would otherwise receive under subdivision (d)(1) or (d)(2), taking into account the role of that person in advancing the case to litigation and any relevant circumstances pertaining to the violation. If the person bringing the action is convicted of criminal conduct arising from such person's role in the violation of § 71-5-181, that person shall be dismissed from the civil action and shall not receive any share of the proceeds of the action. Such dismissal shall not prejudice the right of the state to continue the action.
4. (4) If the state does not proceed with the action and the person bringing the action conducts the action, the court shall award to the defendant its reasonable attorneys' fees and expenses if the defendant prevails in the action and the court finds that the claim of the person bringing the action was clearly frivolous, clearly vexatious, or brought primarily for purposes of harassment.
(e)
1. (1) In no event may a person bring an action under subsection (b) that is based upon allegations or transactions that are the subject of a civil suit or an administrative civil monetary penalty proceeding in which the state is already a party.
2. (2)
  1. (A) The court shall dismiss an action or claim under this section, unless opposed by the state, if substantially the same allegations or transactions as alleged in the action or claim were publicly disclosed in a criminal, civil, or administrative hearing in which the state or its agent is a party; in a state legislative, state comptroller, or other state report, hearing, audit, or investigation; or from the news media, unless the action is brought by the attorney general and reporter or district attorney general or the person bringing the action is an original source of the information.
  2. (B) For purpose of this subdivision (e)(2), “original source” means an individual who either prior to a public disclosure under subdivision (e)(2)(A) has voluntarily disclosed to the state the information on which allegations or transactions in a claim are based; or who has knowledge that is independent of and materially adds to the publicly disclosed allegations or transactions, and who has voluntarily provided the information to the state before filing an action under this section.
(f) The state is not liable for expenses that a person incurs in bringing an action under this section.
(g) Any employee, contractor, or agent shall be entitled to all relief necessary to make that employee, contractor, or agent whole, if that employee, contractor, or agent is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in the terms and conditions of employment because of lawful acts done by the employee, contractor, agent, or associated others in furtherance of an action under this section or other efforts to stop one (1) or more violations of §§ 71-5-181 — 71-5-185. The relief shall include reinstatement with the same seniority status the employee, contractor, or agent would have had but for the discrimination, two (2) times the amount of back pay, interest on the back pay, and compensation for any special damages sustained as a result of the discrimination, including litigation costs and reasonable attorneys' fees. An action under this subsection (g) may be brought in the appropriate court for the relief provided in this subsection (g), but may not be brought more than three (3) years after the date when the retaliation occurred.
(h)
1. (1) Upon written request of the attorney general and reporter, the bureau of TennCare may bring an action as an administrative proceeding on behalf of the state for recovery under § 71-5-182 against any person specified by the attorney general and reporter other than an enrollee, recipient or applicant, subject to the conditions set forth in this subsection (h).
2. (2) The amount of actual damages that the state may seek in such administrative proceeding shall not exceed twenty-five thousand dollars ($25,000). This limit shall not apply to any civil penalties or costs that the state is eligible to recover under § 71-5-182 or to § 71-5-182 related to double or treble damages.
3. (3) Notwithstanding § 71-5-182, the civil penalty for each violation of § 71-5-182 in such administrative proceeding shall be not less than one thousand dollars ($1,000) and not more than five thousand dollars ($5,000).
4. (4) Any administrative action brought pursuant to this subsection (h) shall be subject to § 71-5-184.
5. (5) Any administrative action brought pursuant to this subsection (h) shall be initiated as a contested case in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
6. (6) The bureau of TennCare shall have authority to promulgate rules and regulations pursuant to the Uniform Administrative Procedures Act, as are necessary to implement this subsection (h). For purposes of rendering a final order pursuant to the Uniform Administrative Procedures Act, the bureau of TennCare is designated as the agency to review initial orders and issue final agency decisions. Orders issued by the bureau of TennCare shall have the effect of a final order pursuant to the Uniform Administrative Procedures Act.
7. (7)
  1. (A) Whenever an order issued by the bureau of TennCare pursuant to this part has become final, a notarized copy of the order may be filed in the office of the clerk of the chancery court of Davidson County.
  2. (B) When filed in accordance with this subsection (h), a final order shall be considered as a judgment by consent of the parties on the same terms and conditions as those recited in the order. The judgment shall be promptly entered by the court. Except as otherwise provided in this subsection (h), the procedure for entry of judgment and the effect of the judgment shall be the same as provided in title 26, chapter 6.
  3. (C) A judgment entered pursuant to this subsection (h) shall become final on the date of entry.
  4. (D) A final judgment under this subsection (h) has the same effect, is subject to the same procedures and may be enforced or satisfied in the same manner as any other judgment of a court of record of this state.
8. (8) Any recovery under this subsection (h) in excess of the amounts paid to reimburse the bureau of TennCare for damages and costs and to other interested parties shall be paid to the attorney general and reporter to be used to investigate and prosecute health care fraud in the TennCare program.
9. (9) This subsection (h) is declared to be remedial in nature and shall be liberally construed to effectuate its purposes.

Backlinks (5)

History (5)

Acts 1993, ch. 364, § 3
2005, ch. 474, § 15
2009, ch. 528, §§ 1, 2
2012, ch. 806, §§ 6, 7, 9
2013, ch. 99, § 2.

§ 71-5-184. Service — Limitations.

(a) A subpoena requiring the attendance of a witness at a trial or hearing conducted under § 71-5-183 may be served at any place in the United States.
(b) A civil action under § 71-5-183 may not be brought:
1. (1) More than six (6) years after the date on which the violation of § 71-5-182 is committed; or
2. (2) More than three (3) years after the date when facts material to the right of action are known or reasonably should have been known by the official of the state charged with responsibility to act in the circumstances, but in no event more than ten (10) years after the date on which the violation is committed, whichever occurs last.
(c) If the state elects to intervene and proceed with an action brought under § 71-5-183(b), the state may file its own complaint or amend the complaint of a person who has brought an action under § 71-5-183(b) to clarify or add detail to the claims in which the state is intervening and to add any additional claims with respect to which the state contends it is entitled to relief. For statute of limitations purposes, any such state pleading shall relate back to the filing date of the complaint of the person who originally brought the action, to the extent that the claim of the state arises out of the conduct, transactions, or occurrences set forth, or attempted to be set forth, in the prior complaint of that person.
(d) In any action brought under § 71-5-183, the state shall be required to prove all essential elements of the cause of action, including damages, by a preponderance of the evidence.
(e) Notwithstanding any other law, the Tennessee Rules of Criminal Procedure, or the Tennessee Rules of Evidence, a final judgment rendered in favor of the state in any criminal proceeding charging fraud or false statements, whether upon a verdict after trial or upon a plea of guilty or nolo contendere, shall stop the defendant from denying the essential elements of the offense in any action that involves the same transaction as in the criminal proceeding and that is brought under subsection (a) or (b) or § 71-5-183.

Backlinks (1)

71-5-183(h)(4)

History (2)

Acts 1993, ch. 364, § 4
2012, ch. 806, § 8.

§ 71-5-185. Venue.

Any action under § 71-5-183 may be brought in any judicial district in which the defendant or, in the case of multiple defendants, any one (1) defendant can be found, resides, transacts business, or in which any act proscribed by § 71-5-182 occurred. A summons as required by the Rules of Civil Procedure shall be issued by the appropriate district court and served at any place within or outside the United States.

Backlinks (6)

History (1)

Acts 1993, ch. 364, § 5.

§ 71-5-186, 71-5-187. [Reserved.]

§ 71-5-188. Actuarial study of TennCare.

(a) The comptroller of the treasury may conduct an annual actuarial study of the medical assistance program and any participating managed care organizations. The final study, and the oral and written comments, shall be reported to the finance, ways and means committees of the senate and the house of representatives, the office of legislative budget analysis and the fiscal review committee of the general assembly on or before April 15 of each year.
(b) The study will include the state's assessment of the rates paid to its contracted managed care organizations and behavioral health organizations each year. Included in the analysis will be a review of payments for hospital providers for similar services for comparable populations in other state medicaid programs. The review will be considered in determining reasonable payment rates for hospital providers, including safety net hospitals providing essential and unduplicated services and sole community provider hospitals.
(c) In addition, the study shall include an analysis of actual provider costs. This analysis will be used to determine reasonable costs for comparison with the provider assumptions used in the study. Information used to compile this study shall be public information.
(d) Before reporting the final study to the committees of the general assembly, the comptroller of the treasury shall release a copy of the draft study to interested parties and hold a public hearing within thirty (30) days of release, in order to afford all interested persons or their representatives an opportunity to present facts, views or arguments relative to the draft study under consideration. The agency shall afford each interested person an opportunity to present facts, views or arguments in writing, whether or not the person had an opportunity to present them orally.

History (8)

Acts 1999, ch. 370, § 1
2000, ch. 913, § 1
2003, ch. 389, § 1
2006, ch. 820, §§ 1-3
2010, ch. 1030, § 20
2011, ch. 410, § 6(c)
2019, ch. 345, § 139
2021, ch. 64, § 125.

§ 71-5-189. Accounting of TennCare funds.

The bureau of TennCare shall provide to the comptroller of the treasury on a quarterly basis an accounting of funds involved in the pharmacy rebate program, including a summary of bills and receipts.

History (1)

Acts 1999, ch. 531, § 1.

§ 71-5-190. TennCare prescription drug utilization review committee.

(a) In order to provide oversight of prescription drug utilization under the TennCare program, there is hereby created a TennCare prescription drug utilization review committee. The committee shall consist of: one (1) member of the house of representatives appointed by the speaker of the house; one (1) member of the senate appointed by the speaker of the senate; and two (2) pharmacists, two (2) physicians, two (2) representatives of managed care organizations, two (2) representatives of pharmaceutical companies and two (2) consumers, all of whom shall be appointed by the comptroller of the treasury. The TennCare bureau shall provide to the committee such information as the committee deems appropriate concerning the prescriptions made to TennCare enrollees who receive more than seven (7) prescriptions. The committee shall review such information and make recommendations to the health and welfare committee of the senate, the health committee of the house of representatives, and the TennCare bureau concerning potential drug interactions, abuse of prescription drugs or other appropriate matters.
(b)
1. (1) Non-legislative members of the committee shall serve without compensation, but they shall be entitled to reimbursement for all necessary expenses incurred in the performance of their duties, in accordance with the comprehensive state travel regulations promulgated by the commissioner of finance and administration and approved by the attorney general and reporter.
2. (2) Legislative members of the committee shall not receive from the state an expense allowance or mileage allowance paid solely in consideration for serving on or attending meetings of the committee; provided, that this subdivision (b)(2) shall at no time preclude a legislative member from receiving an expense allowance or mileage allowance otherwise payable to such member in connection with attending the general assembly.

History (6)

Acts 1999, ch. 536, § 1
2000, ch. 796, § 1
2011, ch. 410, § 6(d)
2013, ch. 236, § 53
2019, ch. 345, § 140
2021, ch. 64, § 126.

§ 71-5-191. Uniform TennCare claims process.

(a)
1. (1) Not later than January 1, 2002, the commissioner of commerce and insurance, in consultation with the commissioner of health, shall develop and promulgate by rule a uniform TennCare claims process that contains standardized instructions for completing the form and creates standardized responses to questions and other information required on the form, for providers and managed care organizations participating in the TennCare program to use in the submission of claims by providers seeking payment. Each managed care organization, or its designee that participates in the TennCare program may participate in the development of such uniform claims process. The commissioner of commerce and insurance shall notify all such managed care organizations no less than ten (10) days prior to any and all meetings concerning the development of such claims process to enable such organizations to provide input on the development of such claims process. The uniform process shall require that managed care organizations participating in the TennCare program shall not deviate from the uniform process established by rule pursuant to this section, unless such deviation is specifically approved in writing by TennCare prior to any change being implemented that might result in a claim being rejected for payment. TennCare shall not approve any changes to standardized instructions that do not relate to using alternative codes to facilitate payment for delivered services. Compliance with this section shall be added as a component of the comptroller's annual audit. In addition, such managed care organizations shall be required to develop and implement procedures to ensure that health care providers are regularly informed and educated by the managed care organization regarding billing and claims processing procedures.
2. (2) Any managed care organization that fails to comply with this section shall be subject to the penalties set forth in § 56-32-116 or, in the alternative, § 56-32-120.
3. (3) Such rules shall be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
(b) If this section conflicts with any applicable federal waiver concerning medical assistance services delivered pursuant to chapter 5, part 1 of this title, then the commissioner of health is directed to seek an appropriate modification or amendment to such waiver to permit the implementation of this section.
(c) This section shall be construed so as to be consistent with the terms of any applicable federal waiver for the provision of medical assistance.

History (1)

Acts 2001, ch. 209, § 1.

§ 71-5-192. Information management system.

On or before January 1, 2004, a comprehensive, integrated information management system will be operational for the bureau of TennCare. Not less frequently than quarterly, the division of strategic technology solutions in the department of finance and administration shall provide progress assessments concerning such system to the information systems council (ISC) and the fiscal review committee.

History (2)

Acts 2002, ch. 880, § 4
2020, ch. 690, § 20.

§ 71-5-193. Children's mental health care — Development of interagency projects and programs.

The department shall involve the council in the development of interagency projects and programs, whether state or federally funded, related to children's mental health care, except where otherwise prohibited by state or federal law.

History (1)

Acts 2008, ch. 1062, § 12.

§ 71-5-194. Spend down eligibility for medical assistance.

On or before July 1, 2003, the department of human services shall make available on the department of human services' web page all rules, operating procedures and any other similar material relative to determining an individual's spend down eligibility for medical assistance under this chapter and the operating procedures and any other similar material necessary for a pharmacy to determine which prescriptions used to qualify the patient for TennCare through the spend down eligibility criteria are eligible to be billed to the TennCare program based on the effective date of eligibility for medical assistance.

History (1)

Acts 2003, ch. 131, § 1.

§ 71-5-195. Study on use of prescription drugs in nursing homes.

The comptroller of the treasury, in conjunction with any appropriate TennCare drug utilization review committees, shall study the use of prescription drugs in nursing homes and the costs of those prescription drugs for residents of nursing homes. The study shall examine prescription use overall, and shall focus on any practices that would improve the quality of resident care while reducing costs to the TennCare program. By January 1, 2005, the comptroller of the treasury shall deliver its report to the speakers of the respective houses of the general assembly.

History (1)

Acts 2003, ch. 169, § 8.

§ 71-5-196. Veterans education benefits.

Notwithstanding any other provision of this chapter, to the extent permitted by federal law, the value of federal veterans education benefits received by an applicant shall not be included as any form of income when making eligibility determinations for assistance under this part.

History (1)

Acts 2003, ch. 239, § 6.

§ 71-5-197. Authority over TennCare pharmacy purchases — Confidential information — Exemption from open meeting laws.

(a) The bureau of TennCare is authorized to remove pharmacy services from managed care organization (MCO) contracts and assume direct responsibility for all TennCare pharmacy purchases.
(b) The bureau of TennCare is authorized to implement, either independently or in combination with a state preferred drug list (PDL), cost saving measures for pharmaceutical services, including, but not limited to, tiered co-payments, reference pricing, prior authorization and step therapy requirements; provided, however, that any prior approval process shall, at a minimum, comply with 42 U.S.C. § 1396r-8(d)(5), which requires a response to a request for prior authorization within twenty-four (24) hours and further requires at least a seventy-two (72) hour supply of a covered outpatient drug in an emergency situation.
(c) The bureau of TennCare, through a state pharmacy benefit manager (PBM) or on its own, is authorized to negotiate supplemental manufacturer rebates for TennCare prescription drug purchases; provided, however, that when conducting such negotiations, the bureau or PBM, or both, shall utilize the average manufacturer's price (AMP) as defined in 42 U.S.C. § 1396r-8(k)(1) or any other recognized acceptable basis for negotiating rebates as the cost basis for the product.
(d) Notwithstanding any other law to the contrary, all information and documents containing trade secrets, proprietary information, rebate amounts for individual drugs or individual manufacturers, percent of rebate for individual drugs or individual manufacturers, and manufacturer's pricing that are contained in records of the TennCare bureau, the state of Tennessee and its agents shall be confidential and shall not be a public record for the purposes of title 10, chapter 7, part 5. Nothing in this subsection (d) shall be construed to prohibit the TennCare bureau and the state of Tennessee from disclosing the information covered by this subsection (d) to members of the state TennCare pharmacy advisory committee, who shall be deemed agents of the state of Tennessee for purposes of this subsection (d).
Backlinks (1)
- 71-5-2402(4)
(e) Notwithstanding any other law to the contrary, those portions of meetings of the state TennCare pharmacy advisory committee at which information described in subsection (d) is disclosed for discussion are exempt from title 8, chapter 44.
(f)
1. (1) The bureau of TennCare shall promulgate rules to promote the safe and responsible coverage of opioids for TennCare members who have the TennCare pharmacy benefit. The rules must, at a minimum, address prior authorization requirements for opioid prescriptions, as determined by the bureau, to reduce the development of opioid dependency and addiction. For women of child-bearing age, when prior authorization is required for an opioid prescription, the rules must require the provider to submit information regarding pregnancy status, contraceptive use, and the provision of counseling regarding the risks of becoming pregnant while receiving opioid medication. The information regarding pregnancy status and contraceptive use may, when appropriate, be based on self-reporting by the patient.
2. (2) The rules required by this subsection (f) shall be promulgated pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. On or before January 1, 2019, the bureau shall report to both the health and welfare committee of the senate and the health committee of the house of representatives regarding the status of the rules required by this subsection (f).

History (3)

Acts 2003, ch. 350, § 3
2004, ch. 673, §§ 12, 13
2018, ch. 864, § 1.

§ 71-5-198. Prescription drug program waiver.

(a) If necessary, the bureau of TennCare is authorized to seek a research and demonstration waiver under Section 1115 of the federal Social Security Act from the United States department of health and human services to create a TennCare prescription program, subject to funding by the general assembly and the terms and conditions imposed by the waiver.
(b) To the extent and only to the extent permitted by federal law or the terms of the waiver, the TennCare prescription program may provide a prescription benefit to individuals lacking prescription drug insurance coverage who meet criteria established by the bureau of TennCare and the general assembly in its annual appropriation bill.
(c) To the extent permitted by federal law and the TennCare waiver, the bureau of TennCare may implement, either independently or in combination with a state preferred drug list (PDL), cost saving measures for pharmaceutical services including, but not limited to, tiered co-payments, reference pricing, prior authorization, step therapy requirements, exclusion from coverage of drugs or classes of drugs, mandating the use of generic drugs, and mandating the use of therapeutic equivalent drugs.
(d) To the extent permitted by federal law or the terms of the waiver, the bureau of TennCare, through a state pharmacy benefit manager (PBM) or on its own, may negotiate manufacturer rebates for TennCare prescription drug purchases. The bureau of TennCare shall retain ultimate authority to negotiate or contract directly with a pharmaceutical manufacturer, in the interest of implementing rebates or other cost saving measures and for other purposes permitted by this section. Notwithstanding anything under Tennessee law to the contrary, the bureau's designation of a negotiating agent shall not infringe upon the state's ability to negotiate and contract directly with pharmaceutical manufacturers.
(e) To the extent permitted by federal law or the terms of the waiver, the bureau of TennCare may establish an open enrollment period based on appropriations from the general assembly.
(f) To the extent permitted by federal law or the terms of the waiver, the bureau of TennCare may contract with another department or a private entity to conduct an eligibility determination. The bureau or a contracted entity may implement an eligibility determination process to ensure participants comply with eligibility standards set by the bureau and the general assembly.
(g) As permitted by the waiver or federal law, program participants may purchase prescription drugs through pharmacies participating in the state network.
(h) To the extent permitted by federal law or the terms of the waiver, the bureau of TennCare may establish an enrollment fee to defray administrative expenses associated with the program.

History (3)

Acts 2003, ch. 350, § 4
2004, ch. 673, § 14
2005, ch. 442, § 1.

§ 71-5-199. State preferred drug list.

(a) Except as otherwise provided in this section, the division of TennCare may, in its sole discretion, adopt or amend a state preferred drug list (PDL). The adoption or amendment of a PDL, and the recommendations of the TennCare pharmacy advisory committee to the division are not agency actions and do not require rulemaking.
(b)
1. (1) In establishing and maintaining the PDL, the division shall ensure that a non-opioid drug approved by the United States food and drug administration for the treatment or management of pain is not disadvantaged or discouraged with respect to coverage relative to any opioid or narcotic drug for the treatment or management of pain on the PDL.
2. (2) Subdivision (b)(1) does not prohibit an opioid medication from being preferred over other opioid medications, or a non-opioid medication from being preferred over other non-opioid medications.
(c) This section applies to a non-opioid drug immediately upon its approval by the United States food and drug administration for the treatment or management of pain, regardless of whether the drug has been reviewed by the division for inclusion on the PDL. This section also applies to drugs being provided under a contract between the division and any managed care organization.

History (2)

Acts 2004, ch. 673, § 15
2024, ch. 762, § 1.

Part 2 Community Clinics

§ 71-5-201. Reimbursement for services — Authorization.

(a) Any community or neighborhood health organization or clinic providing medical services to patients through the utilization of medical students presently enrolled in a medical school accredited by the Association of American Medical Colleges, licensed registered nurses, qualified physician assistants, or any combination of students, registered nurses, and physician assistants where such students, registered nurses, and physician assistants, are under the direction of a licensed physician or physicians, may receive payment for their per patient expenses, or portion of the expenses, which may include, but are not limited to, administrative expenses, overhead expenses, and salaries.
(b) [Deleted by 2021 amendment.]

History (8)

Acts 1973, ch. 262, § 2
1975, ch. 58, § 1
T.C.A., § 14-1929
Acts 1981, ch. 476, § 5
1983, ch. 168, § 11
1984, ch. 787, § 11
T.C.A., § 14-23-20
Acts 2021, ch. 565, § 11.

§ 71-5-202. Restrictions on services.

Medical services that are presently provided in specialized public health facilities as in tuberculosis hospitals, mental institutions, and institutions providing highly specialized inpatient care shall not be undertaken by the organizations and clinics covered by this part, and such services will be rendered under present statutes on a referral basis from such organizations and clinics.

History (3)

Acts 1973, ch. 262, § 2
1975, ch. 58, § 3
T.C.A., §§ 14-1931, 14-23-203, 71-5-203.

Part 3 Food Assistance

§ 71-5-301. Short title.

This part may be cited as and shall be known as the “Food Stamp Act of 1971.”

History (2)

Acts 1971, ch. 136, § 1
T.C.A., §§ 14-2201, 14-27-101.

§ 71-5-302. Purpose.

The purpose of this part is to provide for improved levels of nutrition among economically needy households through a cooperative federal-state program of food assistance to be operated in such counties of this state as may be certified by the department of human services and designated by the secretary of the United States department of agriculture, or its successor agency, to participate in the food stamp program in accordance with the requirements of Public Law 88-525 (7 U.S.C. § 2011 et seq.), and any amendments to that law or any other subsequently enacted federal statutes on the same subject.

History (3)

Acts 1971, ch. 136, § 2
impl. am. Acts 1975, ch. 219, § 1 (a, b)
T.C.A., §§ 14-2202, 14-27-102.

§ 71-5-303. Part definitions.

As used in this part, unless the context requires otherwise:
1. (1) “Applicant” means any person who has applied for benefits under this part;
2. (2) “Area manager” means the director or manager of the county or area office of the department of human services;
3. (3) “Assistance” or “food assistance” means food stamp coupons, free food stamps or food purchase assistance that is issued or transferred by means of food coupons, food stamps, electronic benefits transfer processes or other means as determined by the department to an eligible household or low-income family pursuant to this part;
4. (4) “Commissioner” means the commissioner of human services;
5. (5) “County office” means the county office of the department of human services in the county where the applicant or recipient resides and in which county a food stamp program is currently in operation;
6. (6) “Department” means the department of human services;
7. (7) “Food coupons” or “food stamps” means obligations of the United States government issued or transferred by means of food coupons or food stamps to enable the purchase of food for the eligible household;
8. (8)
  1. (A) “Food stamp program or programs” includes the program that enables persons determined eligible for the provision of assistance by the governments of the United States or the state of Tennessee pursuant to this part, to purchase foodstuffs and includes food coupons, food stamps, electronic benefits transfer processes or other means as may be approved for this purpose by the department;
  2. (B) The commissioner of human services shall have authority to establish a system for distribution of any benefits provided by this part by means of an electronic benefits transfer system or by such other means as the commissioner shall determine is appropriate;
9. (9) “Recipient” means any person who has been determined to be eligible to receive benefits under this part and who has received such benefits; and
10. (10) “Resident,” for the purpose of this part, means any individual who is living within a county in this state in which a food stamp program is in operation, with the intent that such individual's permanent home be within the county, and not temporarily. The department shall adopt rules and regulations under which it shall make this determination; provided, that temporary absences from the state or county shall not cause a person to lose residential status.

History (6)

Acts 1971, ch. 136, § 3
1973, ch. 337, § 5
impl. am. Acts 1975, ch. 219, §§ 1 (a, b), 2 (a, b)
T.C.A., §§ 14-2203
14-27-103
Acts 1996, ch. 950, §§ 12, 14.

§ 71-5-304. Duties of department.

The department shall:
1. (1) Supervise the administration of the food stamp or food assistance program in this state for eligible recipients;
2. (2) Make uniform rules and regulations, not inconsistent with law, for carrying out and enforcing this part in an efficient, economical and impartial manner, to the end that the food stamp or food assistance program may be administered uniformly in all counties of this state that have been designated by the United States secretary of agriculture to participate in the food stamp or food assistance program and in which counties a food stamp or food assistance program is currently in operation;
3. (3) Establish state-wide standards for determining the amount of food stamp assistance or food assistance any person, household or family shall receive under this part;
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  71-5-306
4. (4) Cooperate with the secretary of the United States department of agriculture, or any federal officer or agency made successor to the department of agriculture, in any reasonable manner as may be necessary to qualify for federal aid for food stamp assistance or food assistance in conformity with this part, including the making of such reports in such form and containing such information as the secretary of agriculture, or any federal officer or agency made successor to the department of agriculture, may from time to time require, and comply with such provisions as such secretary may from time to time find necessary to assure the correctness and verification of such reports;
5. (5) Establish and enforce safeguards to prevent unauthorized disclosures or improper use of information contained in applications, reports of investigations, and correspondence in the individual case records of recipients of food coupons, food stamps or food assistance transferred electronically or by other means; and
6. (6) Adopt rules and regulations for the implementation of a sliding scale of benefit reduction for individuals receiving food coupons, food stamps or food assistance transferred electronically or by other means for six (6) months or longer in which benefits do not abruptly terminate when a recipient earns above a certain maximum amount, but instead, such benefits gradually lessen in increments of twenty-five percent (25%) of the individual's total benefit every three (3) months; provided, that no rules and regulations shall conflict with federal legislation or provide benefits exceeding federal maximum income guidelines, and no such rules and regulations shall be promulgated that shall cause a decrease or suspension of federal funding. This subdivision (6) shall take effect only to the extent that such provisions are consistent with federal laws and regulations governing the temporary assistance for needy families (TANF) and food stamp or food assistance programs and only to the extent federal financial participation under such programs is available therefor.

History (8)

Acts 1971, ch. 136, § 4
T.C.A., § 14-2204
Acts 1985, ch. 313, §§ 2, 3
T.C.A., § 14-27-104
Acts 1996, ch. 950, § 15
1999, ch. 248, §§ 2-4
1999, ch. 520, § 47
2017, ch. 461, § 4.

§ 71-5-305. Eligibility requirements for assistance.

Assistance under this part shall be granted to any needy person, household or low-income family that meets the requirements set forth in federal statutes and such standards of need as may be established by the department or required by any subsequently enacted federal statute on the same subject.

History (2)

Acts 1971, ch. 136, § 5
T.C.A., §§ 14-2205, 14-27-105.

§ 71-5-306. Determination of amount of assistance.

The amount of assistance to which any person, household or family shall be entitled to receive in the form of food coupons, food stamps or food purchase benefits transferred electronically or by other means under this part shall be determined by measuring the income and resources of such person, household or family against the state-wide standards provided in § 71-5-304(3) and shall be approved by the area manager or the area manager's designated agent in accordance with the rules and regulations made by the department. Any amount of earned income required by federal statute to be exempt in determining need shall be exempt and shall not be considered as a resource in determining the amount of assistance to be paid to any person under this part.

History (4)

Acts 1971, ch. 136, § 6
1973, ch. 337, § 5
T.C.A., §§ 14-2206, 14-27-106
Acts 1996, ch. 950, §§ 13, 16.

§ 71-5-307. Method of applying for assistance.

An applicant for assistance under this part, or a person acting in an applicant's behalf, shall file the application in the county office in the county wherein the applicant resides and in which county a food stamp program is currently in operation, in such manner and form as shall be prescribed by the department.

History (2)

Acts 1971, ch. 136, § 7
T.C.A., §§ 14-2207, 14-27-107.

§ 71-5-308. Investigation of applications — Determination of eligibility.

(a) When an application for food stamp assistance is filed with the county office, the area manager, or a designated agent, shall promptly make or cause to be made such investigation as it may deem necessary. The object of such investigation shall be to ascertain facts supporting the application and such other information as may be required by the rules and regulations of the department. Upon the completion of such investigation, the area manager or the area manager's designated agent shall, within a reasonable period of time, determine eligibility.
(b)
1. (1) Pursuant to the option granted the state by 21 U.S.C. § 862a(d), an individual convicted under federal or state law of a felony involving possession, use or distribution of a controlled substance shall be exempt from the prohibition contained in 21 U.S.C. § 862a(a) against eligibility for food stamp program benefits for such convictions, if such person, as determined by the department:
  1. (A)
    1. (i) Is currently participating in a substance abuse treatment program approved by the department of human services;
    2. (ii) Is currently enrolled in a substance abuse treatment program approved by the department of human services, but is subject to a waiting list to receive available treatment, and the individual remains enrolled in the treatment program and enters the treatment program at the first available opportunity;
    3. (iii) Has satisfactorily completed a substance abuse treatment program approved by the department of human services; or
    4. (iv) Is determined by a treatment provider licensed by the department of health, division of alcohol and drug abuse services, not to need substance abuse treatment according to TennCare guidelines; and
  2. (B) Is complying with, or has already complied with, all obligations imposed by the criminal court, including any substance abuse treatment obligations.
2. (2) Eligibility based upon the factors in subdivision (b)(1) must be based upon documentary or other evidence satisfactory to the department, and the applicant must meet all other factors for program eligibility.
3. (3) Notwithstanding subdivision (b)(1)(A) or (b)(1)(B) to the contrary, a person convicted of a Class A felony for violating title 39, chapter 17, part 4, or convicted of an offense in another jurisdiction that would be classified as a Class A felony under title 39, chapter 17, part 4, if committed in this state, is not eligible for the exemptions provided by this subsection (b).

History (6)

Acts 1971, ch. 136, § 8
1973, ch. 337, § 5
T.C.A., §§ 14-2208, 14-27-108
Acts 1996, ch. 950, § 13
2002, ch. 715, § 2
2024, ch. 570, § 5.

§ 71-5-309. Appeal of determination of area manager.

If an application is not acted upon by the area manager or the area manager's designated agent within a reasonable time after the filing of the application, or is denied in whole or in part, or if an award of food stamp assistance is modified or cancelled under any provisions of this part, the applicant or recipient may appeal to the department in the manner and form prescribed by the department, and shall be afforded reasonable notice and opportunity for a fair hearing by the department. Written notice of a right to a fair hearing shall be given to each applicant and recipient at such time as any action concerning the amount of benefits awarded to the individual is taken or at the time a decision is made on an applicant's eligibility for such assistance.

History (4)

Acts 1971, ch. 136, § 9
1973, ch. 337, § 5
T.C.A., §§ 14-2209, 14-27-109
Acts 1996, ch. 950, § 13.

§ 71-5-310. Review of determinations of area managers.

The department may also, upon its own motion, review any decision of an area manager or an area manager's designated agent and may consider any application upon which a decision has not been made by the area manager or the area manager's designated agent within a reasonable time. The department may make such additional investigation as it may deem necessary, and shall make such decision on such application as in its opinion is justified and in conformity with this part. Applicants or recipients affected by such decisions of the department shall be notified of such decision in writing, and shall, upon request, be given reasonable notice and opportunity for a fair hearing by the department. All decisions of the department shall be binding upon the county involved and shall be complied with by the area manager or the area manager's designated agent.

History (4)

Acts 1971, ch. 136, § 10
1973, ch. 337, § 5
T.C.A., §§ 14-2210, 14-27-110
Acts 1996, ch. 950, § 13.

§ 71-5-311. Election of county to participate.

(a) Any county may elect to participate in the food stamp program by the adoption of a resolution by the county legislative body of the county, requesting certification by the department to the United States department of agriculture, or a successor agency, as to the county's eligibility to so participate in the program.
(b) Any county electing to participate in the program will be bound by all provisions of this part and the regulations issued pursuant to this part for so long as a food stamp program is in operation in the county.

History (4)

Acts 1971, ch. 136, § 11
1973, ch. 303, § 29
impl. am. Acts 1978, ch. 934, §§ 7, 36
T.C.A., §§ 14-2211, 14-27-111.

§ 71-5-312. Administration costs.

Cost of the administration of the food stamp program shall consist of a contribution from the federal government in an amount as provided by congress, and a contribution from the state amounting to one hundred percent (100%) of the administrative expenditures not provided through federal funds.

History (3)

Acts 1971, ch. 136, § 13
1973, ch. 303, § 1
T.C.A., §§ 14-2213, 14-27-112.

§ 71-5-313. Receipt or transfer of property by recipient — Notice required — Recovery of excess payments.

If at any time during the certification for food stamp assistance, the recipient becomes possessed of any property, real or personal, or income in excess of the amount stated in the recipient's application for such assistance or transfers any of the recipient's property, real or personal, it shall be the duty of the recipient to immediately notify the area manager of the local county office of the department of the transfer, receipt or possession of such property or income. Any food stamp assistance paid after the recipient has come into possession of property, real or personal, or income, or, if it is determined that a recipient possessed property or income in an amount greater than that stated in the recipient's application, or has transferred any of the recipient's property, real or personal, that renders the recipient ineligible to receive such assistance under the rules and regulations of the department, the full amount of such assistance shall be recoverable in a suit by the state as a debt due the state.

History (4)

Acts 1971, ch. 136, § 18
1973, ch. 337, § 5
T.C.A., §§ 14-2218, 14-27-113
Acts 1996, ch. 950, § 13.

§ 71-5-314. Fraudulent receipt of food assistance — Penalties — Statute of limitations.

(a) A person commits an offense who, knowingly, obtains, or attempts to obtain, or aids, or abets any person to obtain, by means of a willfully false statement, representation, or impersonation, or by any other fraudulent means or in any manner not authorized by this part, or by the regulations or procedures issued or implemented by the department pursuant to this part, any food coupons, food stamps, or food assistance benefits provided by any electronic benefits transfer process, or any assistance provided pursuant to this part by any other means as determined by the department, to which such person is not entitled or of a greater value than that to which such person is entitled.
(b) A person commits an offense who, knowingly, in any manner not authorized by this part or the regulations or procedures implemented by the department pursuant to this part, presents for payment, or causes to be presented for payment, transfers, exchanges, sells, or otherwise uses, or aids or abets any person to present for payment, transfer, exchange, sell, or otherwise use any food coupons, food stamps or food assistance benefits, or any electronic benefits card, authorization or personal identification number, device or other thing or means issued or utilized for the purpose of providing temporary assistance benefits pursuant to this part electronically or otherwise.
(c) A person who receives food coupons, food stamps or food assistance benefits or any electronic benefits card, authorization or personal identification number, device or other thing or means issued or utilized for the purpose of providing food assistance benefits electronically or otherwise, knowing them to have been presented for payment, transferred, exchanged, sold or otherwise used in any manner not authorized by this part or the regulations or procedures implemented by the department pursuant to this part, commits an offense.
(d) An offense under this section is a Class E felony if the value of such food stamps, food coupons, or food assistance sought to be obtained, or that is obtained, is one hundred dollars ($100) or more, and upon conviction of the offense, such person shall be sentenced for such offense as provided by law, or shall be fined not less than one thousand dollars ($1,000) nor more than five thousand dollars ($5,000), or both, unless the offense is committed by means of a willfully false impersonation, assumption of a false identity, or presentation of a false identification, in which case the fine is not less than two thousand five hundred dollars ($2,500) nor more than ten thousand dollars ($10,000); and, if the food stamps, food coupons, or food assistance sought to be obtained, or that is obtained, is of a value less than one hundred dollars ($100), such person commits a Class A misdemeanor and shall be sentenced or fined, or both, as provided by law.
(e)
1. (1) In addition to or in lieu of the penalties in this section, the court may order that such person be disqualified from participation in the food coupon, food stamp, or food assistance program:
  1. (A) For twelve (12) months for the first offense;
  2. (B) For twenty-four (24) months for the second offense; and
  3. (C) Permanently for the third offense.
2. (2) Individuals found by a court to have used or received benefits in a transaction involving the sale of a controlled substance, as defined in § 102 of the Controlled Substances Act (21 U.S.C. § 802), must be disqualified from participation in the food coupon, food stamp, or food assistance program:
  1. (A) For twenty-four (24) months for the first such violation; and
  2. (B) Permanently for the second such violation.
3. (3) Individuals found by a court to have used or received benefits in a transaction involving the sale of firearms, ammunition, or explosives must be permanently disqualified from participation in the food coupon, food stamp, or food assistance program upon the first such violation.
4. (4) Individuals convicted by a court for having trafficked benefits for an aggregate amount of five hundred dollars ($500) or more must be permanently disqualified from participation in the food coupon, food stamp, or food assistance program upon the first such violation.
5. (5) Except as provided by subdivision (e)(1)(C), individuals found to have made a fraudulent statement or representation with respect to their identity or place of residence in order to receive multiple food coupons, food stamps, or food assistance program benefits simultaneously must be disqualified from participation in the food coupon, food stamp, or food assistance program for ten (10) years.
6. (6) Disqualification of an adult pursuant to this section from eligibility for assistance under this part must not disqualify or suspend the eligibility of an innocent adult or child of the disqualified adult's family.
(f) The department shall enclose a copy of the penalties provided in this section one (1) time, in notice form, to each recipient of assistance pursuant to this part and post a notice to such effect in noticeable places in each of its assistance offices.
(g) In addition to any of the penalties in this section, any person convicted of any offense specified in subsection (a), (b) or (c) shall be ordered to make restitution in the total amount found to be the value of the food coupons, food stamps or food assistance that form the basis for the conviction. In the event any person ordered to make restitution pursuant to this section is found to be indigent and, therefore, unable to make restitution in full at the time of conviction, the court shall order a periodic payment plan consistent with the person's financial ability.
(h) Notwithstanding any other law to the contrary, prosecutions for any of the offenses specified in subsection (a), (b) or (c) shall be commenced within four (4) years after the commission of the offense. For purposes of this subsection (h), any such offense that is based upon a willful failure to report information as required by law is considered a continuing offense until such information is reported.
(i)
1. (1) In addition to any criminal provisions provided by this section, the department is authorized to address intentional program violations or overpayments in the food assistance program through any administrative means, including, but not limited to, settlement of such violations or overpayments by a written agreement with recipients or by the provision of administrative hearings pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, part 3, and federal regulations.
2. (2) The department is authorized to initiate legal action to collect all overpayments and all payments made due to intentional program violations or fraud in the food assistance program.
(j) The department shall implement the following procedures regarding electronic benefits card replacement requests:
1. (1) The department shall, upon the third request within a twelve-month period, notify the recipient to provide information regarding fraud, abuse, and trafficking and inform the recipient of the consequences that result from a fourth request within a twelve-month period, as provided in subdivision (j)(2);
2. (2) The department shall, upon the fourth replacement request within a twelve-month period, notify the recipient that the recipient's case is being monitored for suspicious activity and has been referred to the department's office of inspector general for investigation; and
3. (3) If a third-party vendor provides replacement cards directly to recipients on behalf of the department, the vendor shall notify the department upon a third request within a twelve-month period by a recipient and upon any subsequent request thereafter.

History (13)

Acts 1971, ch. 136, § 19
T.C.A., § 14-2219
Acts 1980, ch. 572, § 3
1981, ch. 390, §§ 1-3
1982, ch. 647, § 1
1985, ch. 34, § 1
T.C.A., § 14-27-114
Acts 1989, ch. 591, §§ 108-111
1999, ch. 248, § 5
2013, ch. 402, § 2
2018, ch. 789, § 5
2021, ch. 515, § 3
2024, ch. 570, § 6.

§ 71-5-315. Veterans education benefits.

Notwithstanding any other provision of this chapter, to the extent permitted by federal law, the value of federal veterans education benefits received by an applicant shall not be included as any form of income when making eligibility determinations for assistance under this part.

History (1)

Acts 2003, ch. 239, § 7.

§ 71-5-316. Data matches.

(a) On at least a quarterly basis, the department of human services shall conduct data matches against information databases as required by federal law, including the following:
1. (1) Earned and unearned income information maintained by the federal internal revenue service;
2. (2) Employer reports of income and unemployment insurance payment information maintained by the federal department of labor;
3. (3) Earned income information maintained by the federal social security administration;
4. (4) Death register information maintained by the federal social security administration;
5. (5) Prisoner information maintained by the federal social security administration;
6. (6) Beneficiary records and earnings information maintained by the federal social security administration;
7. (7) Employment information maintained by the Tennessee department of labor and workforce development;
8. (8) Employment information regarding new hires maintained by the federal department of health and human services;
9. (9) Supplemental security income information maintained by the federal social security administration; and
10. (10) Veterans' benefits information maintained by the federal department of health and human services, in coordination with the Tennessee department of health and Tennessee department of veterans services.
(b) The department of human services shall, upon approval from the secretary of the United States department of agriculture, take any steps necessary to enter into an intra-agency agreement joining a multi-state cooperative that identifies individuals who are currently receiving benefits in other surrounding states to minimize dual participation.

History (2)

Acts 2017, ch. 191, § 3
2018, ch. 789, § 6.

§ 71-5-317. Report — Limitations on exemptions from work requirements applicable to able-bodied adults without dependents.

(a)
1. (1) The department shall submit a report to the general assembly no later than October 31, 2022, and annually thereafter, to include the following:
  1. (A) Information from the preceding federal fiscal year related to all instances in which the department sought, applied for, accepted, or renewed a waiver of or exemption to work requirements under the supplemental nutrition assistance program (SNAP) during that federal fiscal year, including details about why the waiver or exemption was sought, applied for, accepted, or renewed, the duration of the waiver or exemption, and the location where the waiver or exemption was applicable; and
  2. (B) Information from the preceding federal fiscal year related to the number of recipients receiving SNAP benefits in this state, the amount of benefits received, the number of recipients subject to the work requirements of SNAP, and the number of recipients participating in the SNAP employment and training program.
2. (2) The report may be submitted electronically.
(b) The department shall not provide an exemption under 7 U.S.C. § 2015(o)(6)(E) from the work requirements applicable to able-bodied adults without dependents (ABAWDs) if the individual:
1. (1) Refuses, at the time of application and every twelve (12) months thereafter, to register for employment in a manner prescribed by the United States department of agriculture;
2. (2) Refuses, without good cause, to participate in an employment and training program to the extent required by the department;
3. (3) Refuses, without good cause, to provide the department with sufficient information to allow the department to determine the employment status or the job availability of the individual; or
4. (4) Voluntarily and without good cause quits a job or reduces work effort and, after the reduction, the individual is working less than thirty (30) hours per week.

History (1)

Acts 2022, ch. 972, § 1.

§ 71-5-318. Study and report on food assistance program application process.

(a) The department shall identify any federal regulations or state law or rules that it determines inhibit the department's ability to timely review and approve applications and deliver benefits for the food assistance program.
(b) The department shall identify any federal waivers it deems necessary to alleviate any federal regulatory limitations it identifies pursuant to subsection (a), and shall, no later than October 31, 2024, submit applications to the federal government for such waivers.
(c) On or before December 31, 2024, the department shall submit a report to the chair of the health and welfare committee of the senate, the chair of the health committee of the house of representatives, and the legislative librarian that details its findings pursuant to subsection (a), describes any waiver applications it has submitted pursuant to subsection (b) and the status of such applications, and includes recommendations to the general assembly for any statutory changes the department deems necessary to facilitate efficient processing and approval of applications and delivery of benefits for the food assistance program.

History (1)

Acts 2024, ch. 1047, § 1.

Part 4 Energy Assistance

§ 71-5-401. Administration by department of human services.

(a)
1. (1) The department of human services shall administer any funding received under the federal low-income energy assistance and weatherization programs, any other federal funds for energy assistance or energy conservation for residential units and any state funds appropriated to the department for purposes of providing to eligible persons energy assistance and residential weatherization as defined by federal law or regulation. To meet the goal of the American Recovery and Reinvestment Act of 2009, P.L. 111-5, the department shall ensure that there are qualified contractors and contracting firms, energy auditors and auditing firms and energy inspectors and inspection firms qualified to provide weatherization services and products.
2. (2) Administration in accordance with state plan approved by federal government or state law.
  1. (A) The department shall administer the low-income energy assistance and weatherization programs in accordance with the state plan for each program as approved by the federal government for any federal funding, and in accordance with any state law for any state funding provided for such assistance.
  2. (B) The state plan approved by the federal government governing the expenditure of federal funds for such programs shall supersede any state law or regulations that are inconsistent with the approved state plan.
3. (3) Rulemaking authority.
  1. (A) The department has the power to promulgate any necessary regulations to administer the low-income energy assistance and weatherization programs pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
  2. (B) If necessary to provide for the immediate expenditure of any emergency low-income energy assistance or weatherization funds in the event of any severe energy crisis or disaster as declared by the governor, or to provide timely assistance under any funding criteria that require the expenditure of such funds under any short-term funding program, the department shall have authority to promulgate any necessary regulations to implement the provision of such assistance by emergency rule; provided, that any permanent rules shall be promulgated pursuant to the Uniform Administrative Procedures Act.
(b)
1. (1) The department may allocate to the residential weatherization program any funds received for energy assistance under the federal low-income energy assistance program or from any other federal energy assistance fund up to the maximum amount permitted by federal law.
2. (2) Any separate state funding for energy assistance shall be allocated as authorized in the annual appropriations act.
(c) Notwithstanding any state law or regulation to the contrary, the department may provide residential weatherization assistance at any percentage of the federal income poverty level that is permitted by federal law.
(d) Benefit levels shall be determined based upon those prescribed by federal law.

History (3)

Acts 1984, ch. 852, § 1
T.C.A., § 14-21-101
Acts 2009, ch. 529, § 26.

§ 71-5-402. Veterans education benefits.

Notwithstanding any other provision of this chapter, to the extent permitted by federal law, the value of federal veterans education benefits received by an applicant shall not be included as any form of income when making eligibility determinations for assistance under this part.

History (2)

Acts 2003, ch. 239, § 8
T.C.A., § 71-5-403.

Part 5 Pharmaceutical Connection Program

§ 71-5-501. Part definitions.

As used in this part, unless the context otherwise requires:
1. (1) “Department” means the department of finance and administration; and
2. (2) “Manufacturer-sponsored prescription drug assistance program” means a program offered by a pharmaceutical manufacturer, through which the manufacturer provides a drug or drugs to eligible persons at no charge or at a discounted cost.

History (1)

Acts 2005, ch. 474, § 5.

§ 71-5-502. Establishment of pharmaceutical connection program.

(a) The Tennessee pharmaceutical connection program is established to help the uninsured in accessing all manufacturer-sponsored prescription drug assistance programs and other programs for which they may qualify, including, but not limited to, medicare part D prescription drug coverage.
(b) The department shall administer the program and shall utilize a toll-free number and website as the point of contact for those eligible to participate in the program.

History (1)

Acts 2005, ch. 474, § 5.

§ 71-5-503. Assistance by department of finance and administration — Volunteer assistance — Assistance in development of program.

(a) The department shall provide assistance as authorized by this part. The assistance provided shall include:
1. (1) Assisting persons in identifying and accessing manufacturer-sponsored prescription drug assistance programs for which those persons are or may be eligible;
2. (2) Assisting persons in applying for manufacturer-sponsored prescription drug assistance programs for which those persons are or may be eligible;
3. (3) Disseminating information about available programs that can provide assistance with obtaining prescription drugs at a lower cost; and
4. (4) Assisting persons in comparing medicare part D drug plans, and in applying for the plan best suited to those person's needs.
(b)
1. (1) The department may seek and receive voluntary moneys, including grants and gifts, to assist with the implementation of the Tennessee pharmaceutical connection program.
2. (2) The department shall include, within the development of the program, the assistance of foundations, independent and chain community pharmacists, volunteers, state agencies, community groups, area agencies on aging, corporations, hospitals, physicians, and any other entity that can further the intent of the program.

History (1)

Acts 2005, ch. 474, § 5.

§ 71-5-504. Notification about program to pharmaceutical companies — Opportunity for companies to submit information about assistance programs offered by companies.

The department shall notify pharmaceutical companies doing business in Tennessee of the Tennessee pharmaceutical connection program, and shall offer pharmaceutical companies the opportunity to submit information to the department about any pharmaceutical assistance programs the pharmaceutical companies offer, the drugs covered by such programs, and all information required for application to the programs.

History (1)

Acts 2005, ch. 474, § 5.

§ 71-5-505. Strategies to improve access to prescription drugs.

The department may implement additional strategies, subject to available resources, to improve access to prescription drugs for persons who have no or inadequate health insurance, or other resources for the purchase of medically necessary prescription drugs.

History (1)

Acts 2005, ch. 474, § 5.

§ 71-5-506. Annual report.

The department shall prepare and submit an annual report on the operations of the Tennessee pharmaceutical connection program to the governor, the speaker of the senate and the speaker of the house of representatives.

History (1)

Acts 2005, ch. 474, § 5.

§ 71-5-507. Entitlement not created by program.

The program established in this part is not, nor does it any way create, an entitlement.

History (1)

Acts 2005, ch. 474, § 5.

Part 6 Federal Matching Funds

§ 71-5-601. Legislative intent.

It is the intent of the general assembly that, in order to maximize the medical care available to Tennesseans who are uninsurable but for the availability of Access Tennessee, federal matching funds should be identified and any applicable federal waiver should be negotiated that would enable the state to provide additional benefits or to provide subsidies to assist with payment of premiums or copayments to persons who are eligible for the Access Tennessee program or to any subset of persons who are eligible for the Access Tennessee program, including individuals with incomes below two hundred percent (200%) of the federal poverty level. It is the intent of the general assembly that any funds expended pursuant to this part in the future shall be administered in conformity with the federal determination of budget neutrality that was made in 2002 with respect to coverage of uninsurable adults under the TennCare waiver and in conformity with any federal waiver that shall be obtained in the future.

History (1)

Acts 2006, ch. 961, § 2.

§ 71-5-602. Federal waiver authority for matching funds.

The commissioner is directed to identify, apply for and negotiate for federal waiver authority for matching funds to support the provision of coverage under this part, which may include innovative approaches and solutions, which may include, but are not limited to, support for health insurance subsidies.

History (1)

Acts 2006, ch. 961, § 3.

§ 71-5-603. Rules and regulations.

The commissioner may adopt any rules that are necessary and proper to implement this part, including, but not limited to, any rules or regulations necessary to identify, apply for and negotiate a federal waiver. The rules may be promulgated as emergency rules pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.

History (2)

Acts 2006, ch. 961, § 4
2009, ch. 566, § 12.

Part 7 Annual Coverage Assessment Act of 2015 [Expired]

§ 71-5-701. [Expired]

History (2)

Acts 2015, ch. 276, § 1
repealed by terms of § 71-5-706, effective June 30, 2016.

§ 71-5-702. [Expired]

History (2)

Acts 2015, ch. 276, § 1
repealed by terms of § 71-5-706, effective June 30, 2016.

§ 71-5-703. [Expired]

History (2)

Acts 2015, ch. 276, § 1
repealed by terms of § 71-5-706, effective June 30, 2016.

§ 71-5-704. [Expired]

History (2)

Acts 2015, ch. 276, § 1
repealed by terms of § 71-5-706, effective June 30, 2016.

§ 71-5-705. [Expired]

History (2)

Acts 2015, ch. 276, § 1
repealed by terms of § 71-5-706, effective June 30, 2016.

§ 71-5-706. [Expired]

History (2)

Acts 2015, ch. 276, § 1
repealed by terms of § 71-5-706, effective June 30, 2016.

Part 7 TennCare for Working Individuals with Disabilities Act

§ 71-5-701. Short title.

This part is known and may be cited as the “TennCare for Working Individuals with Disabilities Act.”

History (1)

Acts 2024, ch. 1002, § 1.

§ 71-5-702. Part definitions.

As used in this part:
1. (1) “Bureau” means the bureau of TennCare;
2. (2) “Buy-in program” and “program” mean the Medicaid eligibility group created pursuant to this part that enables a working individual with a disability to obtain or retain Medicaid health insurance coverage through medical assistance via the payment of coverage premiums;
3. (3) “Director” means the director of TennCare; and
4. (4) “Medical assistance” means the medical assistance program described in part 1 of this chapter.

History (1)

Acts 2024, ch. 1002, § 1.

§ 71-5-703. Legislative intent.

It is the intent of the general assembly to remove barriers to employment for individuals who, but for income and resources, meet the federal Social Security definition of having a disability, by providing medical assistance to working individuals with disabilities through a buy-in program in accordance with § 1902(a)(10)(A)(ii)(XIII) of the federal Social Security Act (42 U.S.C. § 1396a(a)(10)(A)(ii)(XIII)) and Medicaid eligibility, including using less-restrictive income and resource requirements through the application of § 1902(r)(2) of the Social Security Act (42 U.S.C. § 1396(r)(2)) and cost-sharing requirements established by the bureau and approved by the federal centers for medicare and medicaid services.

History (1)

Acts 2024, ch. 1002, § 1.

§ 71-5-704. Program establishment.

(a) On or before January 1, 2025, the bureau shall establish a buy-in program for working individuals with disabilities that enables such individuals to access health insurance coverage through the medical assistance program, including as a supplement to employer-sponsored coverage.
(b) In establishing the buy-in program, the bureau:
1. (1) Shall establish cost-sharing requirements for the buy-in program in accordance with federal law and this part;
2. (2) Shall establish and modify eligibility and cost-sharing requirements in order to administer the program within available funds;
3. (3) Shall not establish eligibility restrictions for the buy-in program based upon a person's income, resources, or maximum age;
4. (4) May consider, when applicable, a person's income, excluding spousal income or assets, when establishing cost-sharing requirements;
5. (5) Shall include a grace period that provides continuous coverage for an individual who experiences a temporary interruption of employment; and
6. (6) Shall make every effort to coordinate benefits with employer-sponsored coverage available to the working individuals with disabilities receiving benefits under this chapter or other applicable law.
(c) In establishing the buy-in program for working individuals with disabilities pursuant to this part, and in order to serve a new and needy population with distinct financial or healthcare needs in accordance with § 71-5-163(a)(8), the bureau shall, to the extent permitted by federal law, utilize savings realized from the TennCare block grant funding agreement entered into with the federal government pursuant to § 71-5-163.
(d) The bureau shall seek federal approval to exclude resources accumulated in a separate account that result from earnings during an individual's enrollment in the buy-in program, including IRS-approved retirement accounts, when determining the individual's subsequent eligibility for another medical assistance program.
(e) The director is authorized to seek any federal waiver the director deems necessary to effectuate this part.

History (1)

Acts 2024, ch. 1002, § 1.

§ 71-5-705. Program description.

The director shall ensure that the buy-in program:
1. (1) Provides categorically needy scope of care;
2. (2) Provides home- and community-based long-term services and supports for an enrollee who meets the functional requirements for those programs, is approved for those services, and chooses to enroll in the buy-in program;
3. (3) Approves coverage for six (6) months effective the first of the month in which a person applies and meets program requirements;
4. (4) Allows a person who is eligible for another TennCare program to choose not to participate in the buy-in program; and
5. (5) Deems a person ineligible for buy-in program coverage for a month in which the person received TennCare benefits under the medically needy program.

History (1)

Acts 2024, ch. 1002, § 1.

§ 71-5-706. Individual eligibility requirements.

The director shall ensure that the buy-in program:
1. (1) Requires that, for a person to qualify for the program, the person must:
  1. (A) Meet the following general requirements as established for the medical assistance program:
    1. (i) Residence in this state;
    2. (ii) Citizenship or immigration status in the United States;
    3. (iii) Possession of a valid social security account number; and
    4. (iv) Assignment of medical support rights to this state;
  2. (B) Be at least eighteen (18) years of age;
  3. (C) Meet federal disability requirements; and
  4. (D) Be employed full- or part-time, including self-employment;
2. (2) Does not require a resource test;
3. (3) Requires that an enrollee comply with cost-sharing provisions; and
  Backlinks (1)
  
  71-5-708(b)(3)
4. (4) Allows a person who, once approved for the program, experiences a job loss to choose to continue program coverage through the original six (6) months of eligibility, if:
  1. (A) The job loss results from an involuntary dismissal or health crisis; and
  2. (B) The person continues to pay the monthly premium based on the person's income.

History (1)

Acts 2024, ch. 1002, § 1.

§ 71-5-707. Employment requirements.

The director shall ensure that, for the purpose of the buy-in program, a person is considered to be employed if the person:
1. (1) Gets paid for working;
2. (2) Has earnings that are subject to federal income tax; and
3. (3) Unless the person is self-employed, has payroll taxes deducted from earnings received.

History (1)

Acts 2024, ch. 1002, § 1.

§ 71-5-708. Premium payments — Billing and payment of premiums.

(a) The director shall ensure, when determining the premium amount a person must pay for participation in the buy-in program, that:
1. (1) The bureau counts only the income of the person approved for the program, and does not count the income of another household member;
2. (2) For purposes of determining countable income to be used in the premium calculation, the bureau applies the following rules:
  1. (A) Income is considered available and owned when it is:
    1. (i) Received; and
    2. (ii) Can be used to meet the person's needs for food, clothing, and shelter; and
  2. (B) Certain receipts are not income as described in 20 C.F.R. § 416.1103;
3. (3) The buy-in program premium amount equals, rounded down to the nearest whole dollar, five percent (5%) of countable income described in subdivision (a)(2), including both earned and unearned income;
4. (4) When determining the premium amount, the bureau uses the verified income amount until a change in income is reported and processed, unless good cause for delay in verifying changes exists; and
5. (5) A change in the premium amount is effective the month after the change in income is reported to and processed by the bureau.
(b) The director shall ensure, when billing for and processing payments of buy-in program premiums, that:
1. (1) For current and ongoing coverage, the bureau bills for program premiums during the month following the benefit month;
2. (2) The first monthly premium begins the first full month of coverage;
3. (3) Pursuant to § 71-5-706(3), the bureau may terminate program coverage if premiums are not paid in full for four (4) consecutive months;
4. (4) The person must pay the monthly premium in full to avoid losing program coverage and, if a person makes a partial payment, the payment does not count as a full payment toward the premium;
5. (5) Payments received are applied to premiums owed in the following order:
  1. (A) Past due months, beginning with the most delinquent month; and
  2. (B) The current coverage month that has been invoiced; and
6. (6) A person must pay a premium for any month that program coverage is provided, including months when a redetermination of coverage is made, months when continued coverage is requested, and during the period of an aid-pending eligibility appeal.

History (1)

Acts 2024, ch. 1002, § 1.

Part 8 Annual Coverage Assessment Act of 2014 [Repealed]

§ 71-5-801. [Repealed]

History (2)

Acts 2014, ch. 877, § 1
repealed by terms of former § 71-5-806, effective June 30, 2015.

§ 71-5-802. [Repealed]

History (2)

Acts 2014, ch. 877, § 1
repealed by terms of former § 71–5–806, effective June 30, 2015.

§ 71-5-803. [Repealed]

History (2)

Acts 2014, ch. 877, § 1
repealed by terms of former § 71–5–806, effective June 30, 2015..

§ 71-5-804. [Repealed]

History (2)

Acts 2014, ch. 877, § 1
repealed by terms of former § 71–5–806, effective June 30, 2015..

§ 71-5-805. [Repealed]

History (2)

Acts 2014, ch. 877, § 1
repealed by terms of former § 71–5–806, effective June 30, 2015..

§ 71-5-806. [Repealed]

History (2)

Acts 2014, ch. 877, § 1
repealed by its own terms, effective June 30, 2015.

Part 9 Poverty Reduction Plan

§ 71-5-901. Commissioner of human services to conduct study of poverty.

The commissioner of human services shall complete a study of poverty in Tennessee, including its implications and potential solution strategies with feedback from departments, agencies, and selected non-governmental organizations serving the affected populations. Such departments, agencies and organizations shall include, but not be limited to the following:
1. (1) Department of children's services;
2. (2) Department of health;
3. (3) The bureau of TennCare;
4. (4) Department of economic and community development;
5. (5) The Tennessee commission on children and youth;
6. (6) Department of disability and aging;
7. (7) The Room in the Inn program of Middle Tennessee;
8. (8) The Catholic Charities in Tennessee;
9. (9) The Area Relief Ministries of Jackson, Tennessee;
10. (10) The Second Harvest Food Bank of Tennessee;
11. (11) The Neighborhood Christian Center of Memphis, Tennessee; and
12. (12) The Regional Interfaith Alliance of Jackson, Tennessee.

History (2)

Acts 2014, ch. 934, § 1
2024, ch. 688, § 184.

§ 71-5-902. Poverty reduction plan.

(a) The poverty reduction plan shall:
1. (1) Assess the current and future impact of poverty on the residents of Tennessee;
2. (2) Examine the existing barriers, services and resources addressing the needs of persons living in poverty and their families; and
3. (3) Develop a proposed strategy to mobilize the state response to the poverty crisis;
(b) The poverty reduction plan shall include an examination of the following in its assessment and recommendations:
1. (1) A determination of the economic and human impact of poverty in this state;
2. (2) A review of the remedies to reduce the number of individuals and families living in poverty in this state;
3. (3) Information to be utilized as potential legislative remedies for consideration in the one hundred ninth general assembly; and
4. (4) Needed state policies or responses, including directions for the provision of clear and coordinated services and support to persons living in poverty and strategies to address any identified gaps in services.

History (1)

Acts 2014, ch. 934, § 1.

§ 71-5-903. Deadline for submission of findings and recommendations.

(a) The commissioner and other departments, agencies and selected non-governmental organizations conducting the study shall hold a public meeting and utilize technological means to gather feedback on the recommendations from the general public and from persons and families affected by poverty.
(b) The department shall submit its findings and recommendations to the governor and the general assembly in the form of a state anti-poverty plan by January 15, 2015.

History (1)

Acts 2014, ch. 934, § 1.

Part 10 Nursing Home Assessment Trust Fund

§ 71-5-1001. Part definitions.

As used in this part, unless the context otherwise requires:
1. (1) “Account” means the nursing home assessment trust fund created under this part;
2. (2) “Bureau” means the bureau of TennCare;
3. (3) “Commencement date” means the later of July 1, 2014, or the date when the bureau has received the necessary federal approval to implement the assessment described in this part and implements the provisions of the nursing home assessment trust fund;
4. (4) “Continuing care retirement community” means an entity or organization that offers on a single campus setting a continuum of services and facilities for each resident including single and congregate dwellings, assisted living units, and nursing facility services, pursuant to a contract between a resident and a provider by which the resident pays a fee for the right to occupy a space in a designated facility and to receive continuing care for life. Entities or organizations defined in this part shall have a minimum ratio of independent/assisted living beds to nursing facility beds of one-to-one;
5. (5) “Fiscal year” (FY) means the twelve-month period beginning July 1st and ending June 30th of each calendar year;
6. (6) “Fund” as used in this part shall mean the nursing home assessment trust fund created under this part;
7. (7) “Medicaid” has the same meaning as “medical assistance” as defined in § 71-5-103;
8. (8) “Medicare resident day” means a resident day funded under 42 U.S.C. Chapter 7 (Title XVIII of the Social Security Act) commonly referred to as the Medicare program Parts A-D;
9. (9) “Net patient service revenue” means gross inpatient revenues from services provided to nursing home patients less reductions from gross inpatient revenue resulting from an inability to collect payment of charges. Inpatient care revenue excludes non-patient care revenue such as beauty and barber, vending income, interest and contributions, revenues from the sale of meals and all outpatient revenues. Reductions from gross revenue include bad debts, contractual adjustments, uncompensated care, discounts and adjustments and other revenue deductions;
10. (10) “Nursing facility” means any entity defined as a nursing home under § 68-11-201 and licensed under title 68 by the department of health;
11. (11) “Resident day” means a calendar day of care provided to a nursing home resident, including the day of admission and excluding the day of discharge; provided, that one (1) resident day shall be deemed to exist when admission and discharge occur on the same day; and
12. (12) “Upper payment limit” means the limitation established pursuant to 42 C.F.R. 447.272 that disallows federal matching funds when state medicaid agencies pay certain classes of nursing care facilities an aggregate amount for services furnished by that class of nursing care facilities that would exceed the amount that would be paid under medicare payment principles.

History (2)

Acts 2014, ch. 859, § 1
2015, ch. 360, § 1.

§ 71-5-1002. Legislative intent — Creation of nursing home assessment trust fund.

(a) It is declared to be the legislative intent that every person is exercising a taxable privilege who engages in the business of providing nursing home care. The assessment fee imposed by this part shall be in addition to all other privilege taxes.
(b) The nursing home assessment trust fund is created. The general assembly intends that the proceeds of the annual assessment not be used as a justification to reduce or eliminate the state funding to the TennCare program. The fund shall not be used to replace any moneys otherwise appropriated to the TennCare program by the general assembly.
(c) The trust fund shall consist of:
1. (1) Amounts collected or received by the bureau from nursing home assessments under this part;
2. (2) Investment earnings credited to the assets of the nursing home assessment trust fund. The state treasurer shall invest amounts deposited within the account in accordance with law, and all investment earnings shall be credited back to the fund; and
3. (3) Any penalties levied in conjunction with the administration of this part.
(d) The trust fund is created for the purpose of receiving funds as specified in this section. Collected assessment funds shall be used to secure federal matching funds available through the state medicaid plan.
(e) All revenue collected pursuant to this part shall be deposited in the nursing home assessment trust fund.
(f) All nursing home annual assessment fee payments made by nursing homes under this section and received by this state; all investment earnings credited to the nursing home annual assessment fee payments; any interest and penalties paid under this section by any nursing home; and all funds generated by federal matching payments made relative to the nursing home annual assessment fee shall be available to and used by the bureau of TennCare for the sole purpose of providing payment to nursing homes.
(g) No part of the nursing home annual assessment fee payments made by nursing homes under this section and received by this state; the investment earnings credited to the nursing home annual assessment fee payments; the interest and penalties paid under this section by any nursing home; or the funds generated by federal matching payments made relative to the nursing home annual assessment fee shall be used for any purpose other than providing payment to nursing homes.
(h) The fund shall be used exclusively for the following purposes:
1. (1) To make expenditures for nursing facility services under the TennCare program for FY 2024-2025 at the full rates for the specified fiscal year as provided for under bureau of TennCare rules relative to the acuity- and quality-based reimbursement system and in accordance with § 71-5-105(a)(3)(B);
2. (2) To provide funding for the implementation of an acuity-based reimbursement system that shall include at a minimum a quality performance component for nursing facility services and a nursing rate component. The nursing rate component shall be adjusted by the average medicaid case-mix of the facility utilizing the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Resource Utilization Group-Version 4 (RUG-IV), 48-Grouper model; and
3. (3) To pay nursing home covered services covered for medicaid beneficiaries within medicare upper payment limits, as negotiated with the bureau of TennCare. The upper payment limit of all nursing homes shall be calculated by the bureau of TennCare using the higher of the cost-based or prospective payment system approach in accordance with 42 C.F.R. 447.272.
4. (4) [Deleted by 2019 amendment.]
(i) Any funds remaining in the nursing home assessment trust fund after payments are made as provided for in subsection (h) shall remain in the trust fund as a reserve for future uses consistent with subsection (h). If the funds in the nursing home assessment trust fund are insufficient to meet all the purposes established in § 71-5-1004(b), the bureau of TennCare shall not be required to procure additional funding from other sources to make the payments noted in § 71-5-1004(b), but instead shall be permitted to reduce all payments on a pro rata basis so as not to exceed the amounts held at any time in the nursing home assessment trust fund.

History (11)

Acts 2014, ch. 859, § 1
2015, ch. 360, § 2
2016, ch. 883, § 1
2017, ch. 377, § 1
2018, ch. 836, § 2
2019, ch. 423, § 1
2020, ch. 644, § 1
2021, ch. 530, § 1
2022, ch. 1059, § 1
2023, ch. 384, § 1
2024, ch. 1037, § 1.

§ 71-5-1003. Payment of assessments — Determination of rate — Time for payment.

(a) Each nursing home shall pay the nursing home assessment in quarterly installments to the account in accordance with this part. In the event of a change of ownership or management of a nursing facility, the successor entity shall be liable for all unpaid nursing home assessment fees, penalties, and interest, and full payment of those fees, penalties, and interest shall be a precondition to the successor entity obtaining a TennCare identification number.
(b) The aggregated amount of assessments for all nursing facilities during a fiscal year shall not be less than the amount necessary to fund this part or exceed the maximum amount that may be assessed pursuant to the indirect guarantee threshold as established pursuant to 42 C.F.R. 433.68(f)(3)(i). The bureau shall determine the assessment rate prospectively for the applicable fiscal year on a per-resident-day basis, exclusive of medicare resident days. The per-resident day assessment rate shall be established pursuant to subsection (c). The bureau shall promulgate rules for facility reporting of non-medicare resident days and for payment of the assessment.
(c) The total aggregated amount of assessments for all nursing facilities from July 1, 2024, through June 30, 2025, is equal to six percent (6%) of the net patient service revenue. The total aggregated amount of assessment for all nursing facilities, and the annual assessment determined for each nursing facility, must be established on July 1 of each year. Except as provided in subdivision (c)(8), the bureau may allow for one (1) mid-year adjustment to be established prior to January 1. Once established, neither amount must vary during the fiscal year. Each nursing facility has an annual assessment amount that is determined as follows:
1. (1) A licensed nursing home that is licensed on July 1, 2024, for fifty (50) beds or fewer shall pay an assessment rate equal to two and three-quarters percent (2.75%) of net patient service revenue, divided by all non-medicare days. The facility shall pay the per diem rate for each of its non-medicare days;
2. (2) A licensed nursing home that on July 1, 2024, either operates as part of a continuing care retirement community or is certified only to provide medicare skilled nursing facility services, shall pay an assessment rate equal to two and three-quarters percent (2.75%) of net patient service revenue, divided by all non-medicare days. The facility shall pay the per diem rate for each of its non-medicare days;
3. (3) A licensed nursing home that is licensed on July 1, 2024, and provided thirty-five thousand (35,000) or greater medicaid patient days for the twelve (12) months ending December 31 of the prior year shall pay an assessment rate equal to two and three-quarters percent (2.75%) of net patient service revenue divided by all non-medicare patient days. The facility shall pay the per diem rate for each of its non-medicare days;
4. (4) A new nursing home facility that is initially licensed and commences operations on or after July 1, 2024, shall pay in FY 2024-2025 a prorated assessment equal to two thousand two hundred twenty-five dollars ($2,225) per licensed bed per year, prorated to accrue from the date the nursing facility became licensed. The change in ownership of an existing licensed facility does not meet the requirements of this subdivision (c)(4);
5. (5) A licensed nursing home not meeting the criteria of subdivisions (c)(1)-(4) shall pay an equal per facility annual assessment amount at such amount as is necessary to ensure that the total aggregated amount of assessment for all nursing facilities from July 1, 2024, through June 30, 2025, equals six percent (6%) of the net patient service revenue, when such total aggregated assessment amount is established on July 1 of each year;
6. (6) Any excess collections of per facility annual assessments above the targeted six percent (6%) of the net patient service revenue must be retained in the nursing home assessment trust fund account created under this part. If actual collections of per facility annual assessments do not equal the targeted six percent (6%) of the net patient service revenue, then any shortfall may be made up from funds in the nursing home assessment trust fund account created under this part, or from other appropriations to the TennCare program;
7. (7) A facility that ceases to be licensed by the health facilities commission is not required to pay assessment fees accruing after the date of its licensure termination; and
8. (8) The bureau may modify the amount of the annual assessment for each nursing facility established by this subsection (c) if such modification is necessary to comply with 42 CFR 433.68.
(d) Each nursing home shall pay its nursing home annual assessment fee as set forth in subsection (c) in equal quarterly installments, with the first quarterly installment due on the fifteenth day of the first month of the first quarter of the state fiscal year after the bureau of TennCare has satisfied the requirements of [former] subsection (f) [deleted]. Subsequent installments shall be due on the fifteenth day of the first month of the three (3) successive calendar quarters following the calendar quarter in which the first installment is due.
(e) Nursing homes shall not create a separate line-item charge on the bill reflecting the assessment.

Backlinks (2)

History (12)

Acts 2014, ch. 859, § 1
2015, ch. 360, §§ 3, 4
2016, ch. 883, §§ 2, 3, 12, 13
2017, ch. 377, § 2
2018, ch. 836, §§ 3-5
2019, ch. 423, §§ 2-7
2020, ch. 644, §§ 2-7
2021, ch. 530, §§ 2-7
2022, ch. 1059, §§ 2-7
2022, ch. 1119, § 162
2023, ch. 384, § 2
2024, ch. 1037, §§ 2-7.

§ 71-5-1004. Quality-based component of reimbursement methodology for nursing facility services.

(a)
1. (1) A specified amount of the funding for nursing facility (NF) services shall be set aside during each fiscal year for purposes of calculating a quality-based component of each NF provider's per diem payment as a quality incentive component, which shall be in addition to quality informed aspects of the NF reimbursement methodology.
2. (2) At the outset of the implementation of these acuity and quality-based reimbursement systems, the amount of funding set aside for the quality-based component of the reimbursement methodology for nursing facilities shall be no less than forty million dollars ($40,000,000) or four percent (4%) of the total projected fiscal year expenditures for NF services, whichever is greater.
3. (3) In each subsequent year, the amount of funding set aside for the quality-based component of the reimbursement methodology for nursing facilities shall increase at two (2) times the rate of inflation of the index factor. Index factor inflation shall be calculated from the midpoint of the prior state fiscal year to the midpoint of the new state fiscal year.
4. (4) This annual quality-based component index factor adjustment shall continue until such time that the quality-based component of the reimbursement methodology for nursing facilities constitutes ten percent (10%) of the total projected fiscal year expenditures for NF services. Once the quality-based component of the reimbursement methodology constitutes ten percent (10%) of the total projected fiscal year expenditures for NF services, it shall then increase or decrease at a rate necessary to ensure that the quality-based component of the reimbursement methodology remains at ten percent (10%).
5. (5) All noted minimum quality-based component thresholds and index factor inflationary adjustments are made prior to consideration of the budget adjustment factor (BAF).
(b)
1. (1) The base-year annualized medicaid resident day-weighted median costs and prices shall be rebased at an interval no longer than three (3) years after a new base year period has been established. The new base year median costs and prices will be established using the most recently audited or desk reviewed cost reports that have a cost reporting period greater than six (6) months, with a cost report end date eighteen (18) months or more before the start of the rebase period.
2. (2) Cost reports issued a disclaimer of opinion during the audit process or cost reports containing substantial issues, including incomplete filing, during the desk review process, as solely determined by the comptroller of the treasury, will be excluded from the median and price calculations.
3. (3) Only audited or reviewed cost reports available prior to the July 1 rate setting will be considered in the median and price calculations.
Backlinks (1)
- 71-5-1002(i)
(c)
1. (1) The initial quality outcome measures and point values established for the NF reimbursement system implemented on July 1, 2018, shall be based upon the structure of the QuILTSS criteria established by the bureau of TennCare on August 5, 2014. The bureau of TennCare may establish quality outcome measures and performance benchmarks by rulemaking consistent with this section.
2. (2) Quality outcome measures and performance benchmarks for each measure shall not be modified for the first three (3) fiscal years of reimbursement unless agreed to by TennCare in consultation with the Tennessee Health Care Association (THCA). After the initial three (3) year period, quality outcome measures, performance benchmarks for each measure, and point values shall be established in consultation with THCA. Any modifications to such criteria shall be established through rulemaking and shall not be changed for another three-year period.
(d) Any submissions by any facility relating to documentation of and participation in the quality-based component of the reimbursement methodology for nursing facilities shall be confidential and privileged and shall be protected from direct or indirect means of discovery, subpoena, or admission into evidence in any judicial or administrative proceeding. However, nothing in this rule shall be construed to make immune from discovery or use in any judicial or administrative proceeding information, record, or documents that are otherwise available from original sources kept in the facility, and would otherwise be available to a litigant through discovery requested from the facility. The confidentiality provisions of this subsection (d) shall also not apply to any judicial or administrative proceeding contesting the determination of the bureau of TennCare regarding the facility's quality component reimbursement.

Backlinks (1)

71-5-1413(d)

History (5)

Acts 2014, ch. 859, § 1
2015, ch. 360, § 5
2016, ch. 883, §§ 4-8
2017, ch. 377, § 3
2018, ch. 836, § 6.

§ 71-5-1005. Bureau to seek federal approvals if necessary — Bureau authorized to adopt rules and regulations to implement part.

(a) The bureau shall seek necessary federal approval in the form of state plan amendments in order to implement this part, if it determined such approvals are necessary.
(b) The bureau is authorized to adopt rules and regulations necessary to implement this part or obtain approval of the state plan amendments. However, § 71-5-1413 shall be the exclusive authority for rulemaking by the bureau of TennCare regarding the initial rules regarding the acuity-based nursing home reimbursement system and any subsequent modifications to the nursing home reimbursement system.

History (3)

Acts 2014, ch. 859, § 1
2017, ch. 377, § 4
2018, ch. 836, § 7.

§ 71-5-1006. Penalties for late payment — Payment plan — Proceedings before board — Waiver of penalties — Fees in abeyance.

(a) If a part of a quarterly assessment fee imposed by § 71-5-1003 is not paid on or before the due date, then a penalty of five percent (5%) of the unpaid fee balance accrues immediately and is added to the quarterly assessment fee. Thereafter, on the first day of each month during which a part of a quarterly assessment fee remains unpaid, an additional penalty of five percent (5%) of the original quarterly assessment fee balance is imposed. Payment is deemed to have been made upon date of deposit in the United States mail.
(b) The bureau of TennCare may for good cause approve an alternative payment plan, as long as full payment of the assessment fee plus any penalties are made. So long as the facility is current with payment of the current assessment and any authorized payment plan approved by the bureau of TennCare, no further penalties will be applied. Any payments after a penalty is assessed under this section shall be credited first to unpaid assessment amounts rather than to penalty amounts, beginning with the most delinquent installment. The bureau of TennCare may, as part of an approved payment plan, waive, in whole or in part, any penalty or interest imposed under this section. A waiver shall excuse the payment of that penalty or interest amount but shall not excuse payment of any assessments. Nothing in this section shall require the bureau of TennCare to agree to or approve any waiver under this section, and the waivers shall only be approved after the bureau’s determination that there is good cause for the waiver.
(c)
1. (1) If a nursing facility fails to pay a quarterly installment of the nursing home assessment fee within thirty (30) days of its due date or becomes or is in arrears for payment of its nursing home assessment fee on the first day of the state fiscal year, and does not have an approved payment plan for which payments are current, the bureau of TennCare shall direct its contracted managed care organizations (MCOs) to recover the full amount of the then-outstanding nursing home assessment fee and any applicable penalties and interest, which shall be accomplished through recoupment from payments made by the MCOs to nursing facilities to recover the full amount of the then-outstanding nursing home assessment fee and any related penalties and interest. TennCare MCOs shall remit promptly any of these recouped payments to the bureau of TennCare. The bureau of TennCare may recoup such amounts in as few or as many installment payments as it deems appropriate.
2. (2) If a nursing facility is more than ninety (90) days delinquent in paying any installment of its annual nursing home assessment fee; or becomes delinquent in any approved payment plan by more than ninety (90) days or fails to provide timely payment of any and all subsequent quarterly installments of its annual nursing home assessment fee while past due amounts are being recouped pursuant to subdivision (c)(1), the bureau of TennCare shall:
  1. (A) Initiate a proceeding before the board for licensing health care facilities, in accordance with the Uniform Administrative Procedures Act, for the purpose of having the board indefinitely suspend admissions to the facility until all outstanding nursing home assessment fees and applicable penalties and interest have been repaid. Failure of a nursing facility to pay a quarterly installment of the nursing home assessment fee, or any penalties or interest required to be paid by this part, shall be considered by the board to be a license deficiency; and
  2. (B) Initiate proceedings to terminate the nursing facility’s TennCare identification number.
3. (3) Upon initiation of a proceeding before the board for licensing healthcare facilities by the bureau of TennCare pursuant to subdivision (c)(2), the board shall suspend admissions to the facility after the bureau of TennCare meets the burden of proof required by the Uniform Administrative Procedures Act. The board shall have no discretion to impose any sanction or take any action other than that set out in this subdivision (c)(3) in the proceeding. Immediately following the full payment by the facility, or its successor, of all then-outstanding assessment fees and any applicable penalties and interest, any suspension of admissions to the nursing facility imposed according to this section shall be automatically lifted without requiring further action by the board, so long as the full payment of then-outstanding amounts are made within the sixty (60) days immediately following the date of the suspension of admissions.
4. (4) On or after the sixtieth day following the date of suspension of admissions to the nursing facility if either the nursing facility fails to pay all then-outstanding nursing home assessment fees and any applicable penalties and interest accrued thereon or the nursing facility fails to be current on the terms of its payment plan if a plan is in place, then the bureau of TennCare shall initiate proceedings before the board for licensing healthcare facilities in accordance with the Uniform Administrative Procedures Act for the purpose of revoking the nursing facility’s license. Upon initiation of a proceeding before the board by the bureau of TennCare pursuant to this subdivision (c)(4), the board shall revoke the nursing facility’s license upon the bureau of TennCare meeting the burden of proof required by the Uniform Administrative Procedures Act. The board shall have no discretion to impose any sanction or take any action other than that set out in this subdivision (c)(4) in the proceeding.
5. (5) Revocation of either the nursing facility’s license or the nursing facility’s TennCare identification number shall not remedy, discharge, satisfy, or otherwise extinguish the nursing facility’s liability for the then-outstanding nursing home assessment fees and any related penalties and interest.
6. (6) Upon revocation of the nursing facility’s license or termination of the nursing facility’s TennCare identification number, the nursing facility shall be required to reapply for a license, TennCare identification number, or both the license and the identification number, in order to provide services to the TennCare population. As a condition of reapplication, the nursing facility, or its successor shall pay in full all then-outstanding nursing home assessment fees, penalties, and interest.
7. (7) Notwithstanding this part, the bureau of TennCare is authorized to file a civil action against a covered nursing facility and its controlling person or persons to collect any nursing home assessment fees, penalties, and interest when such fees, penalties, and interest have been delinquent for more than ninety (90) days. The bureau of TennCare shall have the right to pursue a civil action pursuant to this subdivision (c)(7) simultaneously while pursuing actions in subdivisions (c)(2) and (4). The bureau of TennCare shall be entitled to receive, in addition to the nursing home assessment fees, penalties, and interest, all reasonable costs of litigation, including attorneys’ fees and court costs, incurred by it in bringing a civil action under this subdivision (c)(7). Exclusive jurisdiction and venue for a civil action authorized in this subdivision (c)(7) shall be in the chancery court for Davidson County. For the purposes of this subdivision (c)(7), “controlling person or persons” means any and all natural persons or entities that own more than fifty percent (50%) of the nursing facility, or the natural person or persons, entity or entities that is or are the majority owner of the nursing facility if no owner owns more than fifty percent (50%) of the nursing facility.
(d) Unless otherwise agreed to by the bureau of TennCare and the nursing facility, full payment to the bureau of TennCare of any outstanding nursing home assessment fees, and any applicable penalties and interest, shall be required for the continuation of the nursing facility’s ongoing certification as a medicaid provider.
(e)
1. (1) Any facility that is delinquent on the payment of its nursing home annual assessment fee imposed by law for any current or prior fiscal year shall establish a payment plan as provided for in this section.
2. (2) If a facility has established a payment plan concerning the delinquency that has been approved by the bureau of TennCare, then all fees and penalties imposed by this section must not be imposed so long as the facility is current with its payment plan, and no interest must accrue on any balance unpaid as of the due date for that amount.
3. (3) If a facility has not established a payment plan approved by the bureau of TennCare, then the bureau has the authority to recoup the amount of any delinquent payments as provided for in this section, and such amounts must be applied to reduce the unpaid balance of any nursing home assessment fees owed by the facility.
(f) Any licensed facility that changes its licensure status to inactive status pursuant to § 68-11-206(b) shall be entitled to request that its nursing home annual assessment fee be held in abeyance until such time as the facility returns to active status, at which time the facility shall resume payment of the annual assessment fee that was held in abeyance. During the abeyance because of inactive status, the facility shall not be determined to be delinquent pursuant to this section. Nothing in this subsection (f) shall operate to excuse any licensee from the payment of its nursing home annual assessment fee.

History (7)

Acts 2014, ch. 859, § 1
2015, ch. 360, § 6
2016, ch. 883, §§ 14, 15
2017, ch. 377, § 5
2018, ch. 836, § 8
2019, ch. 423, §§ 8, 9
2021, ch. 530, § 8.

§ 71-5-1007. Requirements for nursing homes participating in medicaid program — Penalties for noncompliance — Waiver of penalties.

For the purposes of this part, any nursing home participating in the medicaid program shall file cost reports in accordance with the rules adopted by the bureau. Any nursing home participating in the medicaid program that does not adopt the uniform classification of accounts, or other acceptable accounting methods as shall be established by the rules of the bureau, in consultation with the comptroller of the treasury and the Tennessee Health Care Association, or does not submit cost data as required by the bureau, shall be assessed a penalty of one hundred dollars ($100) for each day such provider is not in compliance with this section. The bureau may waive, in whole or in part, any penalty upon a determination that there is good cause for such a waiver. The penalty imposed by this section shall supersede any penalty imposed under § 12-4-304.

History (1)

Acts 2014, ch. 859, § 1.

§ 71-5-1008. Oversight authority of fiscal review committee.

The fiscal review committee shall review and have oversight of the implementation of this part and the nursing home assessment trust fund.

History (1)

Acts 2014, ch. 859, § 1.

§ 71-5-1009. Enactment of part does not excuse payment of assessment fee.

Enactment of this part and any amendments to this part shall not operate to excuse the monthly installment payment of any nursing home assessment fee due during any current or prior fiscal year.

History (4)

Acts 2014, ch. 859, § 1
2015, ch. 360, § 7
2016, ch. 883, § 9
2019, ch. 423, § 10.

§ 71-5-1010. Termination of fee — Suspension of assessment.

(a) The nursing home annual assessment fee established by this part shall terminate on June 30, 2025.
(b) The assessment imposed by this part shall be suspended if the bureau attempts to utilize the money in the account for any use other than permitted by this part.
(c) Any assessment fee obligation imposed by § 71-5-1003 shall be suspended to the extent that, and for the period that receipt of the assessment fee by the state results in, a corresponding reduction in federal financial participation under Title XIX of the federal Social Security Act (42 U.S.C. § 1396 et seq.).

History (10)

Acts 2014, ch. 859, § 1
2015, ch. 360, § 8
2016, ch. 883, § 10
2018, ch. 836, § 9
2019, ch. 423, § 11
2020, ch. 644, § 8
2021, ch. 530, § 9
2022, ch. 1059, § 8
2023, ch. 384, § 3
2024, ch. 1037, § 8.

§ 71-5-1011. [Repealed]

History (3)

Acts 2014, ch. 859, § 1
2015, ch. 360, §§ 9, 10
repealed by 2019, ch. 423, § 12, effective July 1, 2019.

Part 11 Annual Coverage Assessment Act of 2016 [Expired]

§ 71-5-1101. [Expired]

History (2)

Acts 2016, ch. 854, § 2
repealed by terms of § 71-5-1106, effective June 30, 2017.

§ 71-5-1102. [Expired]

History (2)

Acts 2016, ch. 854, § 2
repealed by terms of § 71-5-1106, effective June 30, 2017.

§ 71-5-1103. [Expired]

History (2)

Acts 2016, ch. 854, § 2
repealed by terms of § 71-5-1106, effective June 30, 2017.

§ 71-5-1104. [Expired]

History (2)

Acts 2016, ch. 854, § 2
repealed by terms of § 71-5-1106, effective June 30, 2017.

§ 71-5-1105. [Expired]

History (2)

Acts 2016, ch. 854, § 2
repealed by terms of § 71-5-1106, effective June 30, 2017.

§ 71-5-1106. [Expired]

History (2)

Acts 2016, ch. 854, § 2
repealed by terms of § 71-5-1106, effective June 30, 2017.

Part 12 Families First Councils

§ 71-5-1201. Families first community advisory board.

(a)
1. (1) There is created a families first community advisory board to:
  1. (A) Approve the department's retention of a research partner or partners to assist in the research and evaluation of the Tennessee opportunity pilot program created by this part;
  2. (B) Review and approve the selection of the Tennessee opportunity pilot program recipients of planning grants and implementation grants;
  3. (C) Submit a final report to the general assembly no later than December 31, 2026. The final report must be approved by a majority vote of the advisory board's total membership and must include, at a minimum:
    1. (i) Findings from the Tennessee opportunity pilots and the services provided through each pilot;
    2. (ii) Recommendations for future TANF program spending in this state; and
    3. (iii) Suggested legislation to support the recommendations described in subdivision (a)(1)(C)(ii);
  4. (D) Provide input regarding the effectiveness of existing families first and two-generation program policies and grant programs; and
  5. (E) Make recommendations regarding the development of new or revised policies to enhance the families first and two-generation programs.
2. (2) An advisory board member appointed in accordance with subdivision (b)(6) or (b)(7) shall not vote on matters regarding the review and approval of Tennessee opportunity pilot program recipients of planning grants and implementation grants under subdivision (a)(1)(B), or any other matter involving the review and approval of recipients of monetary awards or grants.
(b) The advisory board is composed of no more than twenty-one (21) members as follows:
1. (1) The commissioner of human services, who shall serve as chair and convener;
2. (2) The commissioner of labor and workforce development, or the commissioner's designee;
3. (3) The commissioner of economic and community development, or the commissioner's designee;
4. (4) The commissioner of education, or the commissioner's designee;
5. (5) The commissioner of health, or the commissioner's designee;
6. (6) Two (2) members of the senate to be appointed by the speaker of the senate;
7. (7) Two (2) members of the house of representatives to be appointed by the speaker of the house of representatives;
8. (8) Three (3) representatives from businesses or business groups in this state, two (2) of whom are to be appointed by the speaker of the senate and one (1) of whom is to be appointed by the speaker of the house of representatives;
9. (9) Three (3) representatives from nonprofits in this state with expertise about services that support economic advancement for low income Tennesseans, one (1) of whom is to be appointed by the speaker of the senate and two (2) of whom are to be appointed by the speaker of the house of representatives; and
10. (10) No more than six (6) members to be appointed by the commissioner of human services. A member appointed under this subdivision (b)(10) must be a representative of local government, a faith-based organization, a Workforce Innovation and Opportunity Act (29 U.S.C. § 3101 et seq.) partner, or a current or former recipient of families first or two-generation program assistance.
(c) Members of the families first community advisory board serve without compensation for their services but may be reimbursed for travel expenses in accordance with the comprehensive travel regulations promulgated by the commissioner of finance and administration and approved by the attorney general and reporter.
(d) Vacancies among the members of the families first community advisory board must be filled in the same manner as in the original selection of members.
(e) The speaker of the senate and the speaker of the house of representatives shall strive to ensure that members appointed to the families first community advisory board reflect the racial, sex, geographic, urban, rural, and economic diversity of the state.
(f) The commissioner of human services must call the first meeting of the families first community advisory board no later than September 1, 2021, at which time the members shall elect a vice chair from among the members appointed pursuant to subdivisions (b)(6)-(10).
(g) A majority of the members of the advisory board constitutes a quorum for the purpose of meeting and conducting business. The families first community advisory board shall meet at least monthly until all implementation grant awards are made, and at least quarterly thereafter. The chair may call special meetings whenever necessary for the transaction of business. The chair shall notify each member of the families first community advisory board of any special meeting at least five (5) days before the time fixed for the special meeting. A majority of the members of the families first community advisory board may petition the chair to call a special meeting, in which case the chair must call a special meeting.
(h) The families first community advisory board may conduct regular or special meetings by conference call or video conference in accordance with the requirements of § 8-44-108.
(i) The families first community advisory board shall retain a highly capable research and evaluation partner or partners to evaluate each pilot program; regularly gather and present the research and data to pilot program leaders and families first community advisory board members to aid continuous improvement throughout each pilot program; and produce regular reports and the final report described in subdivision (a)(1)(C).
(j) The chair of the families first community advisory board may call on appropriate state agencies for reasonable assistance in the work of the families first community advisory board.

History (3)

Acts 1996, ch. 950, § 27
2021, ch. 515, § 4
2023, ch. 51, §§ 1, 2.

§ 71-5-1202. Families first community grants program.

(a) The department shall begin accepting grant applications from eligible nonprofit organizations and other qualified entities, distributed proportionally across the three (3) grand divisions of the state to the extent possible, for programs to provide services to families and individuals eligible for the TANF program and in furtherance of the four (4) purposes of the TANF program.
(b) The department must award community grants in amounts not to exceed fifty million dollars ($50,000,000), subject to appropriations in the general appropriations act, using funds from the department's existing surplus reserve of TANF funds.
(c) The department is authorized to select community intermediaries and external compliance partners to assist in outreach and marketing, evaluation of grant proposals, administration of the grant program funding, and monitoring to ensure compliance with applicable state and federal requirements; provided, that the costs of these activities do not exceed the amount of federal TANF funds available for those purposes.

History (3)

Acts 1996, ch. 950, § 27
1999, ch. 388, § 1
2021, ch. 515, § 4.

§ 71-5-1203. Tennessee opportunity pilot program grants.

(a) In fiscal year 2022, the department shall dedicate one hundred eighty-two million dollars ($182,000,000), subject to appropriations in the general appropriations act, from the department's existing surplus reserve of TANF funds to support the planning, implementation, and evaluation of four-year Tennessee opportunity pilot programs in six (6) communities and one (1) pilot program to be administered by the department with the goal of demonstrating the efficacy of well-implemented two-generation approaches to improving education, health, and economic outcomes for children and the adults in those children's lives.
(b)
1. (1) By July 1, 2021, the department shall dedicate up to five million dollars ($5,000,000), subject to appropriations in the general appropriations act, from the funds dedicated in subsection (a) for Tennessee opportunity pilot planning grants. The department shall award no more than fifty (50) planning grants. The following entities may apply for a planning grant:
  1. (A) A political subdivision of this state;
  2. (B) A nonprofit corporation, created pursuant to title 48;
  3. (C) A development district, created pursuant to the Development District Act of 1965, compiled in title 13, chapter 14; and
  4. (D) A human resource agency, created pursuant to the Human Resource Agency Act of 1973, compiled in title 13, chapter 26.
2. (2) The department shall award the planning grants no earlier than October 1, 2021, in amounts up to five hundred thousand dollars ($500,000), subject to appropriations in the general appropriations act, to applicants that demonstrate commitment and capacity to create a compelling two-generation plan for increasing economic advancement and family well-being in the community. An application must include a detailed description of how the applicant intends to utilize evidence-based practices and evidence-informed practices, including, but not limited to:
  1. (A) Home visiting services;
  2. (B) High-quality child care programs and child care provider networks;
  3. (C) Wrap-around services;
  4. (D) After school and summer learning programs with curricula approved by the department of education;
  5. (E) Workforce training and apprenticeship programs;
  6. (F) Economic advancement supports, including transportation and housing;
  7. (G) High-quality data systems for accountability and continuous improvement; and
  8. (H) Other evidence-based and evidence-informed solutions identified by the community.
3. (3) The department shall define and determine the grant application guidelines, award levels, and selection criteria.
4. (4) The department shall select the planning grant recipient communities and ensure that the recipient communities represent a mix of urban, rural, and suburban populations in this state.
(c) By May 1, 2022, and subject to subsection (d), the department shall award a four-year implementation grant up to twenty-five million dollars ($25,000,000), subject to appropriations in the general appropriations act, to each of six (6) implementation grantees selected from the planning grant recipients that submitted the most compelling and qualified Tennessee opportunity pilot program plans pursuant to subdivision (b)(1). The department shall distribute an implementation grant to each selected implementation grantee in an amount of twenty-five million dollars ($25,000,000), subject to appropriations in the general appropriations act, over four (4) years with no single recipient receiving more than twenty-five million dollars ($25,000,000) over the course of the pilot.
(d) The department shall select the implementation grantees and ensure that there are two (2) implementation grantees from each grand division and that there is a mix of urban, rural, and suburban populations in this state.
(e) No earlier than October 1, 2021, the department shall select and fund a research partner or partners that will support the research and evaluation of the Tennessee opportunity pilot programs. Selected partners shall utilize scientific approaches to research and evaluation, such as randomized controlled trials.
(f) In the event the federal government deems planning grants to be administrative costs, the department must utilize its remaining fiscal capacity for administrative costs to provide the grants. The remainder of funds dedicated for planning grants must be reallocated across the six (6) pilot program grantees with approval of the advisory board.
(g) The department is authorized to enter into, or amend an existing, grant contract or other contract as necessary to ensure successful implementation and completion of the Tennessee opportunity pilot program created by this section, except that the department shall not enter into or amend a contract in a manner that causes the contract to extend beyond December 31, 2026.

Backlinks (1)

71-5-1204(d)(1)

History (5)

Acts 1996, ch. 950, § 27
1999, ch. 520, § 47
2021, ch. 515, § 4
2023, ch. 51, §§ 3, 4
2024, ch. 769, § 1.

§ 71-5-1204. Unexpended and reserve of funds from the temporary assistance for needy families (TANF) program.

(a) The department shall, at the beginning of federal fiscal year 2022, ensure that a rainy-day fund in an amount not to exceed the TANF annual federal award of the existing reserve of federal TANF funds remain unobligated in order to address unforeseen future economic needs, including those resulting from an emergency that has been declared in the state or an economic downturn having statewide impact.
(b) The department shall seek to replenish funds used from the TANF rainy-day reserve fund in the following fiscal year or as soon as the funds are available.
(c) If the amendment to the existing TennCare II waiver authorizing the bureau of TennCare to create reasonable work and community engagement requirements for able-bodied working-age adult enrollees without dependent children under six (6) years of age as provided under § 71-5-158 is approved by the federal centers for medicare and medicaid services, then the department is authorized to set aside fifty-four million dollars ($54,000,000), subject to appropriations in the general appropriations act, in TANF funds to address this expenditure.
(d)
1. (1) In the eighteen-month period following the end of each federal fiscal year, the department must spend or obligate one hundred percent (100%) of unobligated TANF funds that are not allocated to the department's administrative overhead costs; that are not part of the reserve as described in subsection (a); that are not dedicated to the Tennessee opportunity pilot program pursuant to § 71-5-1203; that are not used for the department's cash assistance program; and that are not used on a program or service deemed necessary by the department.
2. (2) Expenditures described in subdivision (d)(1) must be made to eligible nonprofit organizations, other qualified entities, or other federally approved state program to provide services to families and individuals eligible for the TANF program and in furtherance of the four (4) purposes of the TANF program. These services must be distributed, to the extent possible, across this state's ninety-five (95) counties in proportion to each county's percentage share of Tennessee children living in households with incomes at or below the federal poverty level as confirmed by the comptroller of the treasury.
(e) Beginning in the quarter following the end of federal fiscal year 2021, the department shall notify the public of the amount of funds available to be allocated statewide and request and accept proposals from eligible nonprofit organizations and other qualified entities to provide evidence-based and evidence-informed programs and services to individuals and families who are eligible to receive funds from the TANF program pursuant to subsection (a).

History (4)

Acts 1996, ch. 950, § 27
1999, ch. 520, § 47
2021, ch. 515, § 4
2023, ch. 51, § 5.

Part 13 Grant Assistance Program for Nursing Home Care

§ 71-5-1301. Creation of grant assistance program.

There is hereby created a grant assistance program to provide financial support for eligible individuals residing in nursing homes licensed by the state, which individuals do not have their nursing home care paid for, in whole or in part, by a federal, state or combined federal-state medical care program.

History (1)

Acts 1992, ch. 954, § 1.

§ 71-5-1302. Eligibility.

To be eligible to apply for a grant assistance payment under this part, an individual must meet the following qualifications:
1. (1) The individual must have resided or be residing, after June 30, 1992, in a facility licensed by the state as a nursing home. Residents in facilities certified as intermediate care facilities for the mentally retarded are not eligible; and
2. (2) For each day for which grant assistance is sought, the individual's nursing home care must not have been paid for, in whole or in part, by a federal, state or combined federal-state medical care program.

History (1)

Acts 1992, ch. 954, § 1.

§ 71-5-1303. Application for payment — Nursing home certification to department.

(a) An application for grant assistance program payments must be made by the individual or such individual's legally authorized representative on forms prescribed by regulations of the department of health. Such forms shall include a certification of the individual's annual income for the calendar year immediately preceding the beginning of the state fiscal year during which grant assistance will be requested, and such certification shall be made by the individual or individual's legally authorized representative.
(b) Following the application, the nursing home shall provide, following the provision of service, but not less than monthly, on forms prescribed by the department, a certification to the department indicating the number of days the individual resided in the nursing home during the preceding month, the per day expense for care at the facility during that period and the source or sources of payment to defray the expense. Application information and monthly certification information is subject to verification by the department.

History (2)

Acts 1992, ch. 954, § 1
1993, ch. 425, § 1.

§ 71-5-1304. Processing of applications — Funding — Determination of grant.

Applications shall be processed by the department on a first come, first served basis and are subject to the amount annually appropriated for this program in the general appropriations act. Based on the application, the department shall calculate a projected annual nursing home expense for the individual, which shall be the average per diem nursing home expense for the days claimed times three hundred sixty-five (365) days. The projected annual nursing home expense shall be deducted from the prior year's annual income certified by the patient. The remainder shall be the adjusted annual income for purposes of this grant. The amount of the daily grant shall be determined as follows:
1. (1) The amount of the payments made pursuant to this part shall be based upon adjusted annual income;
2. (2) Adjusted annual income for the purposes of determining eligibility must not exceed three hundred fifty percent (350%) of the federal poverty guidelines for an individual as published annually by the United States department of health and human services for determining medicaid eligibility;
3. (3) Individual payments under this part for adjusted annual incomes ranging from zero dollars ($0.00) to an amount calculated to be one hundred eighty-five percent (185%) of the individual poverty guidelines is six dollars and fifty cents ($6.50) per day;
4. (4) Maximum individual payments under this part for adjusted annual incomes ranging from one hundred eighty-six percent (186%) to three hundred fifty percent (350%) of the individual poverty guidelines are not to exceed six dollars ($6.00) per day, as determined by rules and regulations promulgated by the commissioner of health in order to meet the sums annually appropriated for this program.

History (1)

Acts 1992, ch. 954, § 1.

§ 71-5-1305. Grant payments.

Grant payments under this part shall be made to the individual monthly and forwarded to such person at the place of such individual's residence. Grant payments are non-assignable and payable only to the individual or such individual's legally authorized representative, which shall not be the nursing home.

History (2)

Acts 1992, ch. 954, § 1
1993, ch. 425, § 2.

§ 71-5-1306. Rules and regulations.

The department of health is authorized to promulgate regulations pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, as necessary to implement this part. Notwithstanding any other law, the commissioner of health is authorized to promulgate such initial rules as emergency rules pursuant to § 4-5-208.

History (2)

Acts 1992, ch. 954, § 1
2009, ch. 566, § 12.

§ 71-5-1307. [Reserved.]

§ 71-5-1308. Administration of part.

The department of health is authorized to administer this part, including, but not limited to, the ability to contract with other state agencies or entities to make payments or verify income as required by this part.

History (1)

Acts 1992, ch. 954, § 1.

§ 71-5-1309. Funding.

This part shall have no application unless funding is specifically provided for and included in the general appropriations act. During any fiscal year, payments under this part shall not exceed the level of funding specifically provided for such purposes within the general appropriations act.

History (1)

Acts 1992, ch. 954, § 1.

§ 71-5-1310. Total annual income — Certification of income.

The amount of total annual income certified by an individual in order to qualify for a grant pursuant to this part shall include income from all sources. The certification of income by the resident shall be subject to verification by the department in its discretion.

History (1)

Acts 1992, ch. 954, § 1.

§ 71-5-1311. Veterans education benefits.

Notwithstanding any other provision of this chapter, to the extent permitted by federal law, the value of federal veterans education benefits received by an applicant shall not be included as any form of income when making eligibility determinations for assistance under this part.

History (1)

Acts 2003, ch. 239, § 9.

Part 14 Long-Term Care Community Choices Act of 2008

§ 71-5-1401. Short title.

This part shall be known and may be cited as the “Long-Term Care Community Choices Act of 2008.”

History (1)

Acts 2008, ch. 1190, § 2.

§ 71-5-1402. Objectives of long-term care system.

(a) The long-term care system shall recognize that aging is not a disease, but rather a natural process that often includes increasing needs for assistance with daily living activities. To the maximum extent possible and appropriate, the system shall be based on a model of care delivery that acknowledges that services delivered in home and community-based settings are not primarily medical in nature, but rather support services that will provide needed assistance with activities of daily living and that will allow persons to age in place in their homes and communities.
(b) The long-term care system shall also recognize that persons who are elderly or who have physical disabilities, or both, are more likely to have chronic health care conditions and to need preventive, acute and chronic health care services in order to promote healthy living and improve quality of life. The system shall be designed to focus on the needs of the whole person, with coordination of care across the continuum to ensure that medical, behavioral and non-medical long-term care support needs are met.
(c) The long-term care system shall promote independence, choice, dignity and quality of life for elderly or people with physical disabilities, or both, who need long-term care supports and services and shall include consumer-directed options that offer more choices regarding the kinds of long-term care services people need, where they are provided and who will deliver them, with appropriate mechanisms to ensure accountability for taxpayer funds.
(d) The long-term care system shall be designed to reduce fragmentation and to offer a seamless approach to meeting people's needs, including one-stop shopping for information, counseling and assistance regarding long-term care programs in order to support informed decision making, simplified eligibility processes and one-stop shopping for all of the different kinds of services a person may need.
(e) The long-term care system shall recognize and value the critical role of the family and other caregivers in meeting the needs of the elderly and people with physical disabilities and shall offer services such as caregiver training, adult daycare and respite that wrap around the natural support network in order to keep it in place, thereby delaying or preventing the need for more expensive institutional care.
(f) The long-term care system shall deliver needed supports and services in the most integrated setting appropriate and cost-effective way possible in order to utilize available funding to serve as many people as possible in home and community settings.
(g)
1. (1) The long-term care system shall utilize a global budget for all long-term care services for persons who are elderly or who have physical disabilities that allows funding to follow the person into the most appropriate and cost-effective long-term care setting of their choice, resulting in a more equitable balance between the proportion of medicaid long-term care expenditures for institutional, i.e., nursing facility, services and expenditures for home and community-based services and supports.
2. (2) The bureau of TennCare shall report to the general assembly and shall make available to interested persons a separate accounting of long-term care expenditures for:
  1. (A) Nursing facility services;
  2. (B) Home and community-based services made under the CHOICES long-term healthcare program; and
  3. (C) Employment and Community First CHOICES services, under a waiver amendment to the TennCare II demonstration.
3. (3) The accounting shall, under subdivision (g)(2), include prior fiscal year actual expenditures and projected current fiscal year expenditures no later than February 1 of each year. Projected upcoming fiscal year expenditures and the percentage of nursing facility services and home and community-based services relative to total expenditures for the CHOICES long-term healthcare program shall be provided by June 30 of each year.
(h) The long-term care system shall offer a continuum of long-term care services that includes an expanded array of home and community-based options, including community-based residential alternatives to institutional care for persons who can no longer live alone, and that also includes nursing facility services as an integral part of the long-term care continuum for persons with the highest levels of need.
(i) The long-term care system shall include a comprehensive quality approach across the entire continuum of long-term care services and settings that promotes continuous quality improvement and that focuses on customer perceptions of quality, with mechanisms to ensure ongoing feedback from persons receiving care and their families in order to immediately identify and resolve issues and to improve the overall quality of services and the system.

History (3)

Acts 2008, ch. 1190, § 3
2012, ch. 971, § 1
2016, ch. 1079, § 3.

§ 71-5-1403. Part definitions.

As used in this part, unless the context otherwise requires:
1. (1) “Budget allowance” means the amount of money that can be directed, utilizing the services of a fiscal intermediary, by a medicaid-eligible long-term care member participating in this consumer-directed care option, to pay for home and community-based long-term care services defined under the medicaid state plan or any federal waivers or amendments thereto that are necessary to meet the member's long-term care needs and to delay or prevent institutionalization. The budget allowance shall be based on the results of a functional assessment performed by a qualified entity and the availability of family and other caregivers who can help provide needed support, and when combined with the cost of home health services and private duty nursing in the home or other community-based setting, cannot exceed the cost of institutional care;
2. (2) “Commissioner” means the commissioner of finance and administration or the commissioner's designee;
3. (3) “Cost-effective” means that the total cost of services provided to an eligible elderly or physically disabled adult in the home or other community-based setting does not exceed the cost of reimbursement for institutional care in a nursing facility. The total cost of services shall include the cost of home health services and private duty nursing, as well as home and community-based long-term care services provided pursuant to the medicaid state plan or any federal waiver or amendments thereto;
4. (4) “Fiscal intermediary” means an entity with whom the commissioner or a contractor responsible for the coordination of medicaid primary, acute and long-term care services has contracted to help a member participating in this consumer-directed care option manage the member's budget allowance. The fiscal intermediary will manage all payments to providers and paid caregivers for specified home and community-based services on behalf of the member, process employment and tax information as applicable, review records to ensure accuracy and provide full accountability for all expenditures made on behalf of each participating member;
5. (5) “Qualified entity” means an entity with which the commissioner has contracted to assess the needs of persons determined medically eligible for long-term care services and to develop care plans to address their identified needs. Such entity shall have the expertise and capacity to timely perform these services and shall not provide any direct long-term care service which may create a conflict of interest. A managed-care organization performing care coordination services under this part shall be a qualified entity only to the extent that appropriate regulatory and contractual safeguards are in place to help ensure that such assessment and care plan development processes are fair, objective and consistent with the needs of the individual and the individual's family caregivers, as applicable; and
6. (6) “Rebalance” means reaching a more equitable balance between the proportion of medicaid long-term care expenditures used for institutional, i.e., nursing facility, services and those used for home and community-based services and supports under the medicaid state plan or federal waivers or amendments to the medicaid state plan or federal waivers.

History (1)

Acts 2008, ch. 1190, § 4.

§ 71-5-1404. Development and implementation of a statewide fully integrated risk-based long-term care system.

(a) The commissioner shall develop and implement a statewide fully integrated risk-based long-term care system that integrates medicaid-reimbursed primary, acute and long-term care services, building in strong consumer protections and aligning incentives to ensure that the right care is delivered in the right place at the right time. The long-term care system shall rebalance the overall allocation of funding for medicaid-reimbursed long-term care services by expanding access to and utilization of cost-effective home and community-based alternatives to institutional care for medicaid-eligible individuals. The system may include, subject to the availability of funding in each year's appropriations bill, expansion of Programs of All Inclusive Care for the Elderly (PACE) sites in additional major metropolitan areas of the state.
(b) The commissioner shall ensure that comprehensive, person-centered care coordination across all medicaid primary, acute and long-term care services is a central component of the integrated long-term care system and the contractor risk agreement. A qualified entity shall conduct a comprehensive individualized assessment of needs in accordance with protocols developed by the commissioner, and shall develop a care plan with active participation of the member and family or other caregivers that addresses the identified needs and builds on and does not supplant family and other caregiving supports. The entity responsible for care coordination shall cost-effectively implement the care plan, assure coordination and monitoring of all medicaid primary, acute and long-term care services to assist individuals and family or other caregivers in providing and securing necessary care and assure the availability of a qualified workforce, including backup workers when necessary, to timely provide necessary services.
(c) Nothing in this part may be construed to create an entitlement to home and community-based services; provided, however, that the commissioner shall design and implement the integrated long-term care system in a manner that affords access to the appropriate level of cost-effective home and community-based services for the greatest number of medicaid-eligible elderly or physically disabled individuals, or both, possible, subject to the availability of funding in each year's appropriation bill.
(d) The cost of home and community-based services provided to a medicaid-eligible individual, which includes the cost of home health services or private duty nursing, or both, to the extent covered under the medicaid program, shall not exceed the cost of institutional services for that individual in a nursing facility except as permitted under the current medicaid state plan or any federal waivers.
(e) Notwithstanding another law to the contrary, an individual who enters an employment agreement with a provider agency participating in the TennCare program is not ineligible to receive payment under this part for providing TennCare medicaid-reimbursed home- and community-based long-term care services to an individual eligible to receive such TennCare medicaid-reimbursed home- and community-based long-term care services on the basis that the individual providing care and the individual receiving care reside in the same home.

History (2)

Acts 2008, ch. 1190, § 5
2024, ch. 621, § 1.

§ 71-5-1405. Single entry point into the long-term care system.

The commissioner shall ensure that there is a single entry point into the long-term care system that is responsible for ensuring that persons seeking care and their families have access to readily available, easy-to-understand information about long-term care options. Functions performed by the single entry point may include counseling and assistance in evaluating long-term care options, screening and intake for long-term care programs, facilitated enrollment for medicaid financial eligibility and assistance with evaluation of level of care in order to facilitate determination of medical eligibility for medicaid long-term care services. Activities performed by the single entry point shall be conducted based on clear and consistent policies, processes and timelines in order to expedite access to available long-term care programs and services. To ensure the most seamless and efficient system possible, medicaid-eligible persons shall not be required to go back through the single entry point in order to access long-term care services, but rather shall have a single entity that is responsible for coordinating all of the medicaid benefits the member may need, including medical, behavioral, nursing facility and home and community-based services.

History (1)

Acts 2008, ch. 1190, § 6.

§ 71-5-1406. Implementation of policies and processes by commissioner.

The commissioner shall implement policies and processes that expedite the determination of medicaid categorical and financial eligibility and medical eligibility for home and community-based programs and services, either through contracted functions of the department of human services or within the bureau of TennCare. The policies and processes may include, but are not limited to, presumptive or immediate medicaid eligibility determination, fast-track eligibility determination, development of specialized units or teams for determination of medicaid eligibility for HCBS, implementation of facilitated enrollment processes and the implementation of an online medical eligibility application process.

History (1)

Acts 2008, ch. 1190, § 7.

§ 71-5-1407. Level of care and continued stay criteria — Preadmission evaluation (PAE) assessment tool.

(a) The commissioner shall develop level of care criteria for new nursing facility admissions that ensure that the most intensive level of long-term care services is provided to persons with the highest level of need. The bureau of TennCare shall define the state's medical eligibility criteria for all long-term care services, including nursing facility and home- and community-based waiver services and adopt such standards by rule pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. In circumstances under which such standards are initially adopted as emergency rules, the bureau of TennCare shall make the proposed emergency rules available through public notice or a posting on the TennCare website, and shall provide for a public hearing prior to the emergency rule's adoption and implementation. Any changes made to the emergency rules after the public hearing shall be posted on the TennCare website. The bureau of TennCare shall develop the preadmission evaluation (PAE) assessment tool, and shall make the determination of medical eligibility for long-term care services.
(b) Nursing facility residents who meet continued stay criteria and who remain financially eligible for medicaid shall continue to be eligible to receive nursing facility services or cost-effective home and community-based waiver services, and shall not be required to meet new nursing facility level-of-care criteria.
(c) Current enrollees in the statewide home and community-based services waiver program for persons who are elderly or adults with physical disabilities, or both, who meet continued stay criteria and remain financially eligible for medicaid shall continue to be eligible to receive cost-effective home and community-based waiver services and shall not be required to meet new nursing facility level-of-care criteria except for admission to a nursing facility.
(d) The commissioner shall develop and seek approval of a waiver application or amendment to a waiver application that allows persons who meet a lesser level of care, i.e., who do not meet new nursing facility level-of-care criteria, but are at risk of institutional care, to qualify for a more moderate package of medicaid-reimbursed home and community-based waiver services up to a specified enrollment cap.

Backlinks (2)

History (2)

Acts 2008, ch. 1190, § 8
2012, ch. 971, § 2.

§ 71-5-1408. Strategies to encourage utilization of cost-effective home and community-based services — Requirements related to nursing facility diversion.

(a) The commissioner shall develop and implement strategies to encourage the utilization of cost-effective home and community-based services in lieu of institutional placement.
(b) The commissioner shall specify in contractor risk agreements with integrated long-term care contractors requirements related to nursing facility diversion. The requirements may include, but are not limited to, the following:
1. (1) Documentation prior to approval of nursing facility admission that an individual and the individual's family or other caregivers have been advised of home and community-based alternatives and that the alternatives are not appropriate, cost-effective or desired; and
2. (2) A requirement for care coordinators to work with hospital discharge planners and to provide face-to-face visits in nursing facilities within a minimum number of days following admission to develop a plan, as appropriate, for transition back to a home or community-based setting.

History (1)

Acts 2008, ch. 1190, § 9.

§ 71-5-1409. Nursing facility transition initiative.

(a) The commissioner shall develop and implement a nursing facility transition initiative.
(b) The commissioner shall specify in contractor risk agreements with contractors responsible for coordination of medicaid primary, acute and long-term care services requirements related to nursing facility-to-community transitions.
(c) Contractor requirements shall include identification of nursing facility residents who may be appropriate for transition to home and community-based settings, as well as assessment and care plan development by a qualified entity. The contractor shall plan and facilitate those transitions in a timely manner. Contractors shall be permitted to coordinate or subcontract with local community-based organizations to assist in the identification, planning and facilitation processes, and may offer, as a cost-effective alternative to continued institutional care, a per-person transition cost allowance not to exceed two thousand dollars ($2,000) for items such as, but not limited to, first month's rent, rent deposits, utility deposits, kitchen appliances, furniture and basic household items.
(d) It is the legislative intent of this section to provide more opportunities for home and community-based services for the at-risk population, subject to the availability of funding in each year's appropriations bill.

History (1)

Acts 2008, ch. 1190, § 10.

§ 71-5-1410. Strategies to assist nursing facilities in diversifying their lines of business.

(a) The commissioner shall develop and implement strategies to assist nursing facilities in diversifying their lines of business, including provision of home and community-based services and specialized nursing facility care to meet the targeted needs of chronic care populations.
(b) The strategies may include, but are not limited to, provision of training and technical assistance, streamlined provider enrollment processes for home and community-based services and development of special acuity-based rates to meet the more intensive caregiving demands of certain chronic care populations, subject to the availability of funding in each year's appropriations bill.

History (1)

Acts 2008, ch. 1190, § 11.

§ 71-5-1411. Plan to expand cost-effective community-based residential alternatives to institutional care.

(a) The commissioner shall develop and implement a plan to expand cost-effective community-based residential alternatives to institutional care for persons who are elderly or adults with physical disabilities, or both, which may include, but not limited to, the development of multiple levels of assisted-care living facility services, adult family care homes, adult foster care homes, companion care models and other cost-effective residential alternatives to nursing facility care.
Backlinks (1)
- 71-5-1425(a)
(b) The commissioner and the board for licensing health care facilities shall work to develop or modify, or both, licensure requirements for such facilities to support a nursing facility substitute framework for members who want to age in place in residences that offer increasing levels of cost-effective home and community-based care as an alternative to institutionalization as members' needs change.

History (1)

Acts 2008, ch. 1190, § 12.

§ 71-5-1412. Transition period following implementation of managed long-term care service delivery system.

(a) A managed care organization (MCO) shall contract with any nursing facility licensed under title 68, chapter 11, part 2, and certified by the centers for medicare and medicaid services, that provides medicaid nursing facility services pursuant to an approved preadmission evaluation (PAE) and is willing to contract with the MCO to provide that service under the same terms and conditions as are offered to any other participating facility contracted with that MCO to provide that service under any policy, contract, or plan that is part of the TennCare managed long-term care service delivery system. Terms and conditions shall not include the rate of reimbursement.
(b) Nothing in this section shall be interpreted as preventing the bureau of TennCare or an MCO from enforcing a contract between an MCO and a nursing facility or as preventing the bureau of TennCare from adopting reasonable and necessary requirements for the participation of a nursing facility in the TennCare program. All requirements for participation adopted after July 1, 2016, shall be promulgated by the bureau of TennCare as a rule under title 4, chapter 5, part 2, and shall include a hearing under § 4-5-203, prior to the enforcement of such requirement as part of any provider contract, unless otherwise required by federal law.

History (4)

Acts 2008, ch. 1190, § 13
2012, ch. 971, § 3
2014, ch. 859, § 2
2016, ch. 883, § 11.

§ 71-5-1413. Acuity-based reimbursement methodology for nursing facility services.

(a) The commissioner shall develop and implement an acuity-based reimbursement methodology for nursing facility services, based on an individualized assessment of need, as an alternative to the current cost-based nursing facility reimbursement system.
(b) The methodology may include, but is not limited to, the development of enhanced rates for specified chronic care services that may encourage the establishment of chronic care units that specialize in the care of persons with specified chronic care conditions, such as persons who are ventilator-dependent.
(c) The comptroller of the treasury shall set the medicaid rates for nursing facility services under the existing cost-based nursing facility reimbursement system and any acuity-based reimbursement system developed pursuant to this section and adopted by the bureau of TennCare in a rulemaking hearing in which interested persons may provide testimony under the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. To the extent possible, any acuity-based reimbursement system shall be implemented in conjunction with the implementation of § 71-5-1407. Nothing in this section shall prevent TennCare from implementing rate adjustments as required pursuant to an act (including an annual appropriation act) of the general assembly that requires such adjustment. Nor shall TennCare be required to promulgate a rule to implement rate adjustments that are required pursuant to an act of the general assembly, unless such implementation requires a change in the underlying rate methodology.
(d) When both acuity and quality supplemental transition payments as described in § 71-5-1004 are transitioned into the medicaid per diem rates of the nursing home reimbursement system, the bureau of TennCare is authorized to adopt rules necessary to implement a new nursing home reimbursement system, subject to the following limitations:
1. (1) Any rules promulgated by the bureau of TennCare under this subsection (d) shall be developed in consultation with the comptroller of the treasury and with the Tennessee Health Care Association; and
2. (2) Any rules or regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act; provided, however, that the bureau of TennCare shall not promulgate emergency rules under this subsection (d) as authorized in § 4-5-208.
(e) Under any TennCare dual-eligible demonstration project, skilled nursing facilities shall be reimbursed for medicare skilled nursing facility services in an amount that is consistent with the net payment they would have received for the service absent such demonstration in a medicare fee-for-service system, taking together the primary payment by medicare and the secondary payment of cost sharing by medicaid, in accordance with the institutional crossover payment methodology set forth in the medicaid state plan. Nursing facilities participating in any TennCare dual-eligible demonstration project shall be reimbursed for medicaid nursing facility services in a manner that is consistent with the methodology for medicaid nursing facility services delivered outside the demonstration. Nothing in this section shall prevent a skilled nursing facility or nursing facility from agreeing, at its own discretion, to contract with an MCO under any alternative payment methodology including, but not limited to, shared risk or savings arrangements or quality incentive payments that may be offered under such dual demonstration in order to promote evidence-based best practices and to engage the facility in key quality improvements, such as reduced avoidable hospital admissions and reduced hospital readmissions.

Backlinks (1)

71-5-1005(b)

History (5)

Acts 2008, ch. 1190, § 14
2012, ch. 971, § 4
2016, ch. 883, § 16
2017, ch. 377, § 6
2018, ch. 836, § 10.

§ 71-5-1414. Self-directed health care.

(a) The commissioner shall, upon approval of a waiver amendment granting authority from the federal government, develop and make available consumer-directed options for persons receiving home and community-based long-term care services under the long-term care program, which may include, but are not limited to, the ability to select, direct or employ persons delivering unskilled hands-on or support services, such as personal care services, personal care assistants/attendants, homemaker services, in-home respite, the ability to direct and supervise a paid personal aide in the performance of a health care task and the ability to manage, utilizing the services of a fiscal intermediary, an individual home and community-based services budget allowance based on functional assessment performed by a qualified entity and the availability of family and other caregivers who can help provide needed support.
(b) Members eligible to receive home and community-based long-term care pursuant to this part may, subject to regulations promulgated by the commissioner, be permitted to use the budget allowance to direct payment, utilizing the services of a fiscal intermediary, for those home and community-based services that are necessary to meet the member's long-term care needs and to prevent or delay institutionalization and that are a cost-effective use of long-term care funds. Such services shall include only those services that are permitted under the medicaid state plan or any federal waivers or amendments thereto.
(c) Notwithstanding any law or rule to the contrary, a competent adult with a functional disability living in the adult's own home or a caregiver acting on behalf of a minor child or incompetent adult living in the minor child’s or the incompetent adult’s own home may choose to direct and supervise a paid personal aide in the performance of a health care task.
(d) For purposes of this section:
1. (1) A competent adult is a person eighteen (18) years of age or older who has the capability and capacity to evaluate knowledgeably the options available and the risks attendant upon each and to make an informed decision, acting in accordance with the person's own preferences and values. A person is presumed competent unless a determination to the contrary is made;
2. (2) A caregiver is a person who is:
  1. (A) Directly and personally involved in providing care for a minor child or incompetent adult; and
  2. (B) The parent, foster parent, family member, friend or legal guardian of such minor child or incompetent adult;
3. (3) A person's home is the dwelling in which the person resides, whether the person owns, leases or rents such residence or whether the person resides in a dwelling owned, leased or rented by someone else. A person's home may include specified community-based residential alternatives to nursing facility care as promulgated in rules and regulations by the commissioner, but shall not include a nursing facility or assisted-care living facility setting;
4. (4) A paid personal aide is any person providing paid home care services, such as personal care or homemaker services, that enable the person receiving care to remain at home whether the paid personal aide is employed by the person receiving care, a caregiver or by a contracted provider agency that has been authorized to provide home care services to that person; and
5. (5) Health care tasks are those medical, nursing or home health services, beyond activities of daily living, that:
  1. (A) A person without a functional disability or a caregiver would customarily and personally perform without the assistance of a licensed health care provider;
  2. (B) The person is unable to perform for the person's own self due to a functional or cognitive limitation;
  3. (C) The treating physician, advanced practice registered nurse, or registered nurse determines can be safely performed in the home and community by a paid personal aide acting under the direction of a competent adult or caregiver; and
  4. (D) Enable the person to maintain independence, personal hygiene, and safety in the person's own home.
(e) The individual or caregiver who chooses to self-direct a health care task is responsible for initiating self-direction by informing the health care professional who has ordered the treatment that involves the health care task of the individual or caregiver's intent to perform that task through self-direction.
(f) When a licensed health care provider orders treatment involving a health care task to be performed through self-directed care, the responsibility to ascertain that the patient or caregiver understands the treatment and will be able to follow through on the self-directed care task is the same as it would be for a patient or caregiver who performs the health care task for the patient's or caregiver’s own self, and the licensed health care provider incurs no additional liability when ordering a health care task that is to be performed through self-directed care.
(g) The role of the personal aide in self-directed care is limited to performing the physical aspect of health care tasks under the direction of the person for whom the tasks are being done or that person's caregiver. This shall not affect the ability of a personal aide to provide other home care services, such as personal care or homemaker services, that enable the person to remain at home.
(h) The responsibility to initiate self-directed health care tasks, to possess the necessary knowledge and training for those tasks and to exercise judgment regarding the manner of their performance rests and remains with the person or caregiver who has chosen to self-direct those tasks, including the decision to employ and dismiss a personal aide or to decide that a personal aide will no longer perform a health care task.
(i) A description of health care tasks to be performed through self-directed care will be included in the person's care plan.
(j) The commissioner shall promulgate rules that define the qualifications, training and oversight requirements for self-direction of health care tasks. The commissioner shall develop the rules with input from licensed health care professionals, including, but not limited to, representatives of the nursing and medical professions, as well as persons with functional limitations, caregivers and home and community-based services providers.

History (2)

Acts 2008, ch. 1190, § 15
2016, ch. 980, § 24.

§ 71-5-1415. Quality assurance and quality improvement strategies.

The commissioner shall develop and implement quality assurance and quality improvement strategies to ensure the quality of long-term care services provided pursuant to this part and shall specify in contractor risk agreements with contractors responsible for coordination of medicaid primary, acute and long-term care services requirements related to the quality of long-term care services provided. The strategies may include the use of electronic visit verification for data collection and reporting, HEDIS measures pertaining to long-term care services, and shall include mechanisms to ensure direct feedback from members and family or other caregivers regarding the quality of services received. The commissioner shall ensure that recipients of long-term care services are notified how to contact the bureau of TennCare if they have concerns about the long-term care services they are or are not receiving and the process for resolving such issues.

History (1)

Acts 2008, ch. 1190, § 16.

§ 71-5-1416. Funding to increase access to home and community-based services in the state-funded options program.

Subject to the availability of funding, the commissioner shall designate in each year's appropriations bill an amount of money that can be used to increase access to home and community-based services in the state-funded options program for persons who do not qualify for medicaid long-term care services. This funding may be used to provide services such as home-delivered meals, homemaker services and personal care, and to reduce the waiting list for these services under the options program, or to offer transportation services or assistance to non-medicaid-eligible individuals.

History (1)

Acts 2008, ch. 1190, § 17.

§ 71-5-1417. Funding for medicaid long-term care services.

The commissioner shall provide medicaid long-term care services subject to the availability of funding in each year's appropriations bill.

History (1)

Acts 2008, ch. 1190, § 18.

§ 71-5-1418. Long-term care client information, referral and assistance agency.

(a) To address the need of this state to develop for the future the framework and infrastructure for a comprehensive long-term care system that makes an appropriate place for both institutional care and a broad array of home-based and community-based services (HBCS), this section establishes a program that is intended to provide information, referral and assistance on a wide variety of quality, cost-effective and affordable long-term care choices and that should be designed to provide data collection and individual assessment and referral to community-based services and appropriate placement in long-term care facilities.
(b) As used in this section, unless the context otherwise requires:
1. (1) “Area agency on aging” means the agency defined in § 52-8-101;
2. (2) “Assessment services” means prescreening and evaluation of an individual's health and functional status to estimate the need for long-term care services and to identify appropriate service options that meet these needs;
3. (3) “Department” means the department of disability and aging;
4. (4) “Hospital” has the meaning ascribed to such term under § 68-11-201; and
5. (5) “Nursing home” has the meaning ascribed to such term under § 68-11-201.
(c)
1. (1) There is established a long-term care client information, referral and assistance program, which shall be administered by the department and shall be implemented by area agencies on aging in accordance with this section.
2. (2) Individuals in the community seeking long-term care services for the elderly and disabled may obtain information about the available services and receive assistance in accessing needed services from the appropriate area agency on aging. Individuals who are initially prescreened by the area agency on aging will be referred to the local health department if determination of eligibility for medicaid-funded programs is needed. Area agency on aging staff may assist the individual to ensure that appropriate documentation is collected and available when the individual is referred to the local health or human services department for medical and financial eligibility determination.
3. (3) [See the Compiler's Notes.] With the consent of the consumer or the consumer's representative, a copy of the data gathered by the information, referral and assistance provider during the screening process will be provided to the health department to facilitate the preadmission evaluation assessment process and to the department of human services for use in beginning the financial eligibility determination process. Staff from the health department and the department of human services will contact the applicant to collect information for assessment.
4. (4) For those individuals already residing in nursing facilities or awaiting nursing facility placement following hospital discharge or directly seeking nursing home services, the preadmission evaluation (PAE) application will continue to be completed by the nursing facility, hospital staff or the individual's physician and submitted to the division of long-term care of the bureau of TennCare for medical criteria determination.
5. (5) [See the Compiler's Notes.] For those determined to be medically or financially ineligible for medicaid/TennCare funded services, the area agency on aging information, referral and assistance agency will:
  1. (A) Conduct a more in-depth assessment of the person's needs;
  2. (B) Identify appropriate community services to meet those needs, including eligibility requirements;
  3. (C) Identify providers, including government agencies, private non-profit agencies, and for-profit agencies based upon rules and regulations adopted by the commission on aging and disability;
  4. (D) Provide information on “How to Select a Provider”; and
  5. (E) Offer tracking and follow-up to assure the client has received services.
6. (6) Any entity that provides client screening and assessment services pursuant to this section shall not also directly provide long-term care services.
(d) [See the Compiler's Notes.] Prior to January 1, 2000, the commissioner of health in consultation with the department and the commissioner of human services, shall adopt by rule, promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, a long-term care client assessment and referral data entry form. The purpose of this form is for data collection and referral services only, not to determine eligibility for services. Such form shall be concise and questions shall be limited to those necessary to carry out the stated purposes. The long-term care client assessment and referral data entry form shall be used by all information, referral and assistance providers.
(e) [See the Compiler's Notes.] The department and the area agencies on aging shall cooperate in compiling results of all assessment services conducted under this section. Area agencies on aging may provide assessment services under this section to assist persons seeking or needing long-term care. In providing such services, the staff of the area agencies on aging shall provide assessment and referral services.
(f) The department, after consultation with the commissioner of health, shall assure that each area agency on aging shall compile comprehensive resource information for use by individuals and agencies related to long-term care resources, including offices of the department of health, the department of human services and county health departments. This information shall include, but not be limited to, resources available to assist persons in selecting among all available long-term care options, including both institutional and non-institutional care, and such information shall be accurate and balanced.
(g) [See the Compiler's Notes.] Area agencies on aging shall provide to all individuals, or caregivers of individuals in need of long-term care services, comprehensive information on the range of long-term care services that are appropriate for that individual and that are available in that individual's community.
(h) On and after July 1, 2000, the area agencies on aging will operate or contract for a home care ombudsman program supervised by the commission on aging and disability, office of the state long-term care ombudsman. The home care ombudsman will investigate consumer/family member complaints regarding the quality of care, and assist in the resolution of problems between the consumer/family and a case manager or service provider.
(i) The department shall adopt rules to govern such matters, as the department deems necessary for the administration of this program. Such rules shall be promulgated in accordance with the Uniform Administrative Procedures Act.

History (4)

Acts 1999, ch. 477, § 2
T.C.A. § 71-5-1407
Acts 2008, ch. 1190, §§ 1, 8
2024, ch. 688, § 185.

§ 71-5-1419. Operational plan and budget for home-based and community-based services to elderly and disabled individuals.

(a)
1. (1) By January 1, 2000, the long-term care services planning council, in consultation with the long-term care advisory council, shall develop an operational plan and budget projections for a program for home-based and community-based services (HBCS) to elderly and disabled individuals in need of assistance. The program should provide services to elderly and disabled individuals in need of assistance who do not qualify for long-term care services under medical assistance pursuant to part 1 of this chapter. The council shall report on the program to the general assembly.
2. (2) Nothing in the plan developed pursuant to this section shall be construed to create an entitlement for individuals.
3. (3) The plan should identify eligible services, the extent and manner in which such services are allocated and made available to elderly and disabled individuals in need of assistance who do not qualify for long-term care services under medical assistance pursuant to part 1 of this chapter, and the manner in which such services are coordinated with each other and long-term care services available outside the program, including, but not limited to, medical assistance and medicare.
4. (4) The plan shall develop and include mechanisms to include the choice of an individual and the individual's representative regarding which covered services to receive, how services are provided and who provides services.
5. (5) The plan should propose a mechanism to impose cost-sharing to be set by rule with respect to covered services.
6. (6) The plan shall provide for quality assurance and safeguards for the eligible individuals.
7. (7) The plan shall designate a state agency to administer the program or to supervise administration of the program.
(b)
1. (1) HBCS, as defined in § 71-5-103, shall be available to eligible elderly and disabled individuals in need of assistance under the program established by this section. The program shall set limits to services based on available fiscal resources. The services shall be specified in a manner that permits flexibility for providers to meet the needs of eligible individuals in a cost-effective manner with services to be delivered in an individual's home, a range of community residential arrangements, or outside the home.
2. (2) HBCS would be provided under the plan required in this section to program participants if an:
  1. (A) Assessment pursuant to § 71-5-1407 has been made; and
  2. (B) Individualized plan of care is developed with involvement from the individual or the individual's representative.
3. (3) The state shall make reasonable efforts to identify and arrange services described in the plan, but nothing in this section shall be construed as requiring the state to provide all the services such plan may specify.
(c) The commissioner of health is authorized to promulgate rules and regulations to effectuate the purposes of this section. All such rules and regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
Backlinks (1)
- 52-1-107(b)
(d) The department of disability and aging shall equitably allocate funding resources between urban and rural areas to program components that provide services to elderly and disabled individuals in need of assistance who do not qualify for long-term care services under medical assistance pursuant to part 1 of this chapter.
(e) By August 1, 2001, the department of disability and aging shall establish an average maximum statewide unit cost for service provided to elderly and disabled individuals in need of assistance who do not qualify for long-term care services pursuant to part 1 of this chapter. In developing the rate, the department of disability and aging shall take into account the unit of service rate permitted for such service under any federal waiver for providing assistance under this chapter if such service is also provided under the federal waiver and in no case can it be more than twenty percent (20%) above the average statewide unit cost for that specific service.

History (5)

Acts 1999, ch. 477, § 3
2001, ch. 461, § 1
T.C.A. § 71-5-1408
Acts 2008, ch. 1190, §§ 1, 9
2024, ch. 688, § 186.

§ 71-5-1420. Veterans education benefits.

Notwithstanding any other provision of this chapter, to the extent permitted by federal law, the value of federal veterans education benefits received by an applicant shall not be included as any form of income when making eligibility determinations for assistance under this part.

History (3)

Acts 2003, ch. 239, § 10
T.C.A. § 71-5-1410
Acts 2008, ch. 1190, §§ 1, 11.

§ 71-5-1421. Prompt payment of claims and liability for bad faith failure to pay claims promptly.

Any managed care organization shall comply with § 56-32-126 and any prompt pay provisions within the MCO contractor risk agreements with TennCare. In addition, the MCO shall ensure that ninety percent (90%) of clean claims for nursing facility services shall be processed and paid within fourteen (14) calendar days and ninety-nine and one half percent (99.5%) paid within twenty-one (21) days.

History (2)

Acts 2008, ch. 1190, § 25
2012, ch. 971, § 5.

§ 71-5-1422. Pilot project for disabled individuals and family members to self-direct supports and services.

(a) The department of disability and aging shall develop a pilot project proposal in accordance with this section. The long-term care services planning council shall be responsible for evaluating the implementation of the project. If funded in the general appropriations act, the pilot project shall be implemented and shall continue for three (3) years. The department shall annually report on the pilot project to the council, the health and welfare committee of the senate and the health committee of the house of representatives. At the end of the project the department shall report on the project to the council and to the standing committees of the senate and the house of representatives. The council shall also make reports of any evaluations that it might undertake of the project to the standing committees of the senate and the house of representatives.
(b) The department of disability and aging shall develop a pilot project in a county or counties of one (1) of the area agencies on aging and disability (AAAD) and shall enter into a contract with the selected AAAD in order to implement the project. The project shall utilize the services of an aging and disability resource center located in the AAAD. Subject to any approvals required from the department by the contract, a working group from the selected AAAD shall design the project and determine whether to use a program manager in the project. In selecting the AAAD, the department shall consider any administrative and oversight efficiencies that locating the project in any particular AAAD might afford the project.
(c) The project shall offer families with a member with a disability who requires long-term supports and services and individuals with a disability who require long-term supports and services opportunities to direct their own services. The families and individuals shall exercise choice, control and responsibility for their services within a cost neutral framework.
(d) The project may involve the following:
1. (1) Personal control and choice;
2. (2) Encouragement of cost-effective decision-making in the purchase of supports and services;
3. (3) Allowing eligible families and individuals to receive a cash allowance or an individual budget to obtain personal assistant services and related supports; and
4. (4) Providing fiscal agent and supportive broker services to sustain individuals and families in directing their own services.

History (3)

Acts 2008, ch. 1168, § 1
2013, ch. 236, § 50
2024, ch. 688, § 187.

§ 71-5-1423. Hearing on resident’s appeal of involuntary discharge from facility — Timeframe for hearing and final order.

If a resident appeals the facility's notice of involuntary discharge to that resident and a hearing is requested pursuant to 42 C.F.R. § 431.220(a)(3) before the bureau of TennCare:
1. (1) The hearing shall be conducted and a final order rendered within ninety (90) days from the date of the resident's appeal of the facility's involuntary discharge notice;
2. (2) The timeframe specified in subdivision (1) may be extended or continued with the consent of both the facility and the resident; and
3. (3) The timeframe specified in subdivision (1) may be extended by the presiding administrative law judge without the consent of the facility, but only after a showing by the resident, or the resident's representative, that the resident faces a substantial threat of irreparable damage or injury if a continuance is not granted.

History (1)

Acts 2014, ch. 911, § 1.

§ 71-5-1424. Hearing on appeal of TennCare’s initial determination of ineligibility for nursing facility services — Motion to intervene by facility.

If an individual appeals TennCare's initial determination that they are not eligible for TennCare nursing facility services:
1. (1) The hearing on any appeal of an initial determination that the individual is not financially eligible shall be conducted and a final order rendered within ninety (90) days from the date of the individual's appeal; provided, however, that if the individual files a petition for reconsideration of an initial order or appeals an order, other than a final order, pertaining to an initial determination made by TennCare under this section prior to the expiration of the ninety-day period, the running of the ninety-day period shall be tolled pending the outcome of such petition for reconsideration or appeal; and
2. (2) The facility may be entitled to participate in any proceeding and hearing that appeals an initial determination that the individual is not financially or medically eligible through the filing of a motion to intervene in that proceeding under § 4-5-310. The administrative judge or hearing officer shall grant a facility's motion to intervene in the appeal of a resident or former resident's eligibility, absent a showing by one (1) or more parties to the appeal that the facility's participation would cause that party to incur an undue burden or unnecessary expense.

History (2)

Acts 2014, ch. 911, § 1
2020, ch. 750, § 1.

§ 71-5-1425. Guidance regarding whether temporary family healthcare structures are covered — Federal approval of waiver amendment to offer benefit — Applicability of waiver.

(a) As part of the plan to expand cost-effective community-based residential alternatives to institutional care as required pursuant to § 71-5-1411(a), the bureau of TennCare shall seek written guidance from the centers for medicare and medicaid services regarding whether a temporary family healthcare structure, as defined in § 13-7-501, may be covered in whole or in part under the program established pursuant to this part, and, if so, shall, upon appropriation by the general assembly specifically to cover temporary family healthcare structures, seek federal approval of a waiver amendment to offer such benefit to eligible older adults and persons with disabilities who choose temporary family healthcare structures in lieu of care in other settings.
(b) Any waiver approved pursuant to subsection (a) shall apply only to a person who:
1. (1) Meets the CHOICES 2 activities of daily living criteria;
2. (2) Meets financial eligibility requirements for medical assistance under this chapter; and
3. (3) Is either:
  1. (A) A person with a developmental or intellectual disability, as defined in § 33-1-101, who is related to the owner or occupier of the property; or
  2. (B) An older adult who is related to the owner or occupier of the property.

History (1)

Acts 2016, ch. 992, § 2.

Part 15 Ground Ambulance Service Provider Assessment Act

§ 71-5-1501. Short title.

(a) This part shall be known and may be cited as the “Ground Ambulance Service Provider Assessment Act.”
(b) The intent of this part is to enhance EMS services and improve access to emergency medical pre-hospital care in this state.

History (1)

Acts 2018, ch. 874, § 1.

§ 71-5-1502. Part definitions.

As used in this part:
1. (1) “Ambulance provider” means a public or private ground-based ambulance service, other than an ambulance service based on federal property, that bills for transports and has a base of operations within this state;
2. (2) “Assessment” means the medicaid ambulance provider assessment established by this part;
3. (3) “Bureau” means the bureau of TennCare;
4. (4) “Medicaid transport” means qualifying ground ambulance services approved by CMS, and consistent with services identified in 42 CFR 433.56, and paid by medicaid, as recorded by the managed care organization under contract to the bureau;
5. (5) “Net operating revenue” means all revenues, regardless of payer source, collected by ambulance providers for patient services excluding charity care or any other uncompensated patient services, in accordance with 42 CFR 433.68;
6. (6) “Office of emergency medical services” means the office of emergency medical services within the department of health; and
7. (7) “Taxable transports” means the total ground ambulance transports reported during the base period by a provider to the office of emergency medical services that qualify as a permissible service to impose a healthcare-related provider assessment pursuant to 42 CFR 433.56.

Backlinks (1)

71-5-1504(e)(1)

History (2)

Acts 2018, ch. 874, § 1
2022, ch. 1052, § 1.

§ 71-5-1503. Annual coverage assessment on covered hospitals.

(a) An ambulance provider shall pay an assessment to the bureau:
1. (1) In accordance with this part;
2. (2) In the amount designated in § 71-5-1504;
3. (3) Quarterly, on a day determined by the bureau; and
4. (4) No more than thirty (30) business days after the day on which the bureau issues the ambulance provider notice of the assessment.
(b) The bureau shall:
1. (1) Determine the standards and procedures used to implement and enforce this part;
2. (2) Collect the assessment described in subsection (a); and
3. (3) Transfer assessment proceeds to the state treasurer for deposit into the ambulance service assessment revenue fund created in § 71-5-1508.
(c) An ambulance provider shall not increase charges or add a surcharge to ground transports based on, or as a result of, the assessment described in subsection (a).

History (2)

Acts 2018, ch. 874, § 1
2020, ch. 643, § 5.

§ 71-5-1504. Calculation of uniform assessment per ground transport — Quarterly transport data.

(a) The bureau shall calculate a uniform assessment per ground transport for each ambulance provider pursuant to subsection (b).
(b) Except as otherwise provided in subsection (c), each quarter of the state fiscal year, the assessment due from each ambulance provider must equal the rate set in subsection (e) multiplied by each provider's total taxable quarterly transports. The total taxable quarterly transport data must be based on the most recent available completed quarter of transport data recorded by the office of emergency medical services. Ambulance providers shall submit a quarterly reporting of all transports to the office of emergency medical services in a manner determined by the office of emergency medical services and the bureau.
(c) If the quarterly transport data is not adequate or available for the calculation of assessments, then the bureau shall use total taxable transports submitted to the office of emergency medical services from the most recent calendar year that the office of emergency medical services has available. If neither the quarterly transport data nor total taxable transports submitted to the office of emergency medical services are adequate or available, then the bureau shall use the annual cost and utilization report submitted pursuant to § 71-5-1507. The adequacy and availability of the data must be determined solely by the bureau.
(d) The bureau shall apply any annual changes to the assessment rate, calculated as described in subsection (b), uniformly to all assessed ambulance providers.
(e) The assessment must generate the lesser of:
1. (1) Twenty dollars ($20.00) per taxable transport that is part of a provider's total taxable transports as defined in § 71-5-1502; or
2. (2) In the event that twenty dollars ($20.00) per taxable transport causes the statewide assessment to exceed six percent (6%) of statewide net operating revenues, then such an amount on a per taxable transport basis that generates six percent (6%) of statewide net operating revenues.
(f)
1. (1) If a licensed provider assumes the operations of another licensed provider, then the transports of the provider whose operations were assumed are included as part of the assuming provider's annual assessment calculation as described in subsection (b).
2. (2)
  1. (A) If an ambulance provider becomes newly licensed after the most recent calendar year, and does not have annual transport totals available from the office of emergency medical services for the purposes of the annual assessment calculation as described in subsection (b), then the provider shall submit a quarterly report to the office of emergency medical services attesting to the provider's most recent quarterly emergency transport totals no later than the fifteenth day of the first month of each quarter in a manner determined by the office of emergency medical services and the bureau. Upon review, the office of emergency medical services shall report to the bureau the provider's quarterly transport totals, and the provider must be assessed twenty dollars ($20.00) per taxable transport. The bureau shall assess the provider according to the methodology in this subdivision (f)(2) until a full calendar year of transport totals have been reported to and are available to be reported by the office of emergency medical services.
  2. (B) The bureau shall require an ambulance provider that fails to report quarterly transports under this subsection (f) to pay the bureau, in addition to the assessment, a penalty of fifty dollars ($50.00) per calendar day for each day the provider fails to submit a quarterly emergency transport report to the office of emergency medical services. However, the bureau may waive, in whole or in part, penalties accrued under this subdivision (f)(2)(B) upon a determination that there is good cause for such waiver.
3. (3) This subsection (f) does not apply to a change of ownership of an existing licensed ambulance provider.

Backlinks (1)

71-5-1503(a)(2)

History (7)

Acts 2018, ch. 874, § 1
2019, ch. 3, §§ 1, 2
2019, ch. 188, § 3
2020, ch. 643, §§ 1, 2
2021, ch. 122, § 2
2022, ch. 1052, §§ 2, 7
2023, ch. 101, § 1.

§ 71-5-1505. Maintenance of coverage trust fund.

(a) Upon approval by the centers for medicare and medicaid services of the assessment imposed by this part, the bureau shall reimburse each ambulance provider with qualifying ground ambulance service medicaid transports in an amount calculated by the bureau. This calculation must be determined by the bureau's estimate of assessment collections and the resulting available program funding, less an annual amount of seventy-five thousand dollars ($75,000) to offset medicaid administration expenses and an annual amount of eighty thousand dollars ($80,000) to offset administrative expenses for the Tennessee Ambulance Services Association. If less than these amounts is needed to offset the administrative expenses, the bureau shall only deduct the amount needed. The bureau's estimate of assessment collections and the resulting program funding, netting out any amounts for offset administrative expenses, must be divided by the bureau's projected number of medicaid transports. The resulting amounts are the additional payment amount made for each medicaid transport reported by the MCOs on a quarterly basis. This amount may change from quarter to quarter.
(b) The bureau shall disburse directed payments to ambulance providers based on qualified medicaid transports from the base period as determined by the bureau and as authorized by the centers for medicare and medicaid services.

Backlinks (1)

71-5-1508(f)(2)

History (2)

Acts 2018, ch. 874, § 1
2022, ch. 1052, § 3.

§ 71-5-1506. Policy measures to ensure enforcement and compliance — Penalties — Quarterly transport count data.

(a) The bureau has the authority to create policy measures that ensure the enforcement and compliance of this part. The bureau shall require an ambulance provider that fails to pay an assessment due under this part to pay the bureau, in addition to the assessment, a penalty of fifty dollars ($50.00) per calendar day for each day the assessment remains unpaid in full after the date due. The bureau may waive penalties for a delinquent provider if the provider has entered into a payment plan approved by the bureau. If the provider fails to comply with the terms of the payment plan, then the bureau may reinstate the waived penalties. Other enforcement measures determined by the bureau include, but are not limited to, recoupments, withholding of future payments, and loss of medicaid ID.
(b) The bureau shall require ambulance providers to submit quarterly transport count data for all transports to the office of emergency services within thirty (30) days of the end of the quarter.

History (2)

Acts 2018, ch. 874, § 1
2019, ch. 188, § 1.

§ 71-5-1507. Annual cost and utilization report.

(a) For the purposes of this part, all ambulance providers shall file an annual cost and utilization report reflecting the most recently completed calendar year.
(b) The submitted cost and utilization report must include:
1. (1) Specified data on any vehicle owned or operated by the ambulance provider that is used for the purposes of patient transport;
2. (2) Total number of manual ambulance stretchers;
3. (3) Total number of hydraulic ambulance stretchers;
4. (4) Information regarding twelve-lead cardiac capabilities;
5. (5) Revenue data by payer type;
6. (6) Total transport data by payer type; and
7. (7) Any additional information that is required by the bureau.
(c) The cost and utilization report must be filed with the bureau no later than May 31 of each calendar year and must contain data from the previous calendar year. The bureau shall assess a penalty of one hundred dollars ($100) for each day that an ambulance provider does not submit a cost and utilization report in compliance with this section. However, the bureau may waive, in whole or in part, any penalty upon a determination that there is good cause for the waiver. The penalty imposed by this section supersedes any penalty imposed under § 12-4-304.
(d) The comptroller of the treasury is granted audit authority to test the accuracy of any and all cost and utilization reports submitted to the bureau for the purposes of this assessment.

Backlinks (1)

71-5-1504(c)

History (2)

Acts 2020, ch. 643, § 4
2022, ch. 1052, §§ 4, 8.

§ 71-5-1508. Ambulance service assessment revenue fund.

(a) There is created a special agency account in the state general fund to be known as the “ambulance service assessment revenue fund,” referred to in this part as the “fund.” The fund must continue without interruptions and must be operated in accordance with this section.
(b) Unless otherwise specified in this part, revenue generated from the following sources must be deposited in the fund:
1. (1) Assessments collected by the bureau under this part;
2. (2) Penalties collected by the bureau under this part;
3. (3) Donations to the fund from private sources; and
4. (4) Investment earnings credited to the fund.
(c) Any fund balance remaining unexpended at the end of a fiscal year carries forward into the subsequent fiscal year and must not be diverted to the general fund or any other public fund.
(d) Interest accruing on investments and deposits of the fund carries forward into the subsequent fiscal year and must not be diverted to the general fund or any other public fund.
(e) The state treasurer shall invest the moneys in the fund in accordance with § 9-4-603. The bureau shall administer the funds.
(f) Moneys in the fund must not be diverted to the general fund or any other public fund or any other third party, and moneys in the fund may only be used to:
1. (1) Create directed payments for qualified ground ambulance services as determined by the bureau and as authorized by the centers for medicare and medicaid services; and
2. (2) Reimburse the amounts designated in § 71-5-1505 for the purpose of administrative expenses.
(g) In the event that this part is rendered invalid and void:
1. (1) To the extent federal matching is not reduced due to the impermissibility of the assessments, the bureau shall disburse pursuant to subsection (f) the moneys remaining in the fund that were derived from assessments imposed by this part and deposited before the occurrence of the invalidating event;
2. (2) Following disbursement of moneys in the fund pursuant to subdivision (g)(1), the bureau shall refund any remaining moneys to each ambulance provider in proportion to the amount paid by the respective provider during the most recently completed quarterly payment period; and
3. (3) The invalidity does not affect other provisions or applications of this part that can be given effect without the invalid provision or application, and to that end, the provisions of this part are severable. It is the legislative intent that the directed payments referenced in this part must not be made if the state cannot generate the non-federal share of the payments through the ground ambulance provider assessment.

Backlinks (1)

71-5-1503(b)(3)

History (4)

Acts 2018, ch. 874, § 1
2020, ch. 643, § 4
T.C.A. § 71-5-1507
Acts 2022, ch. 1052, § 5.

§ 71-5-1509. Implementation of part — Termination of ground ambulance provider assessment.

(a) The bureau shall implement this part to the extent that it is not inconsistent with the TennCare III federal waiver or any successor federal waiver.
(b) The ground ambulance provider assessment established by this part terminates on June 30, 2025.

History (8)

Acts 2018, ch. 874, § 1
2019, ch. 188, § 2
2020, ch. 643, §§ 3, 4
T.C.A. § 71-5-1508
Acts 2021, ch. 122, § 1
2022, ch. 1052, §§ 6, 9
2023, ch. 101, § 2
2024, ch. 633, § 1.

§ 71-5-1510. Promulgation of rules.

The bureau is authorized to promulgate rules to effectuate the purposes of this part. The rules must be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.

History (3)

Acts 2018, ch. 874, § 1
2020, ch. 643, § 4
T.C.A. § 71-5-1509.

Part 20 Annual Coverage Assessment Act of 2024 [Expires on July 1, 2025.]

§ 71-5-2001. Short title. [Expires on July 1, 2025.]

This part is known and may be cited as the “Annual Coverage Assessment Act of 2024.”

History (1)

Acts 2024, ch. 953, § 1.

§ 71-5-2002. Part definitions. [Expires on July 1, 2025.]

As used in this part:
1. (1) “Annual coverage assessment” means the annual assessment imposed on covered hospitals as set forth in this part;
2. (2) “Annual coverage assessment base” means the total net patient revenue minus the medicare net revenue, for all hospitals as shown in the hospital's medicare cost report for the fiscal year that ended during calendar year 2021, on file with CMS as of September 30, 2023, subject to the following qualifications:
  1. (A) If a hospital does not have a full twelve-month medicare cost report for 2021 on file with CMS but has a full twelve-month cost report for a subsequent year, then the first full twelve-month medicare cost report for a year following 2021 on file with CMS is the hospital's portion of the annual coverage assessment base;
  2. (B) If a hospital does not have a full twelve-month medicare cost report for 2021 on file with CMS and does not have a full twelve-month cost report for a subsequent year, but has a cost report for 2021 that covers at least nine (9) months of 2021, then the hospital's portion of the assessment base is calculated by annualizing the 2021 cost report data;
  3. (C) If a hospital was first licensed in 2021 or later and did not replace an existing hospital, and if the hospital has a medicare cost report on file with CMS, then the hospital's initial cost report on file with CMS is the hospital's portion of the annual coverage assessment base for the hospital assessment. If the hospital does not have an initial cost report on file with CMS but does have a complete twelve-month joint annual report (JAR) filed with the department of health, then the net patient revenue from the first twelve-month JAR is the hospital's portion of the annual coverage assessment base. If the hospital does not have a medicare cost report or a full twelve-month JAR filed with the department of health, then the hospital's portion of the annual coverage assessment base is the hospital's projected net patient revenue for its first full year of operation as shown in its certificate of need application filed with the health facilities commission;
  4. (D) If a hospital was first licensed in 2021 or later and replaced an existing hospital, then the hospital's portion of the annual coverage assessment base is the replacement hospital's initial medicare cost report on file with CMS. If the hospital does not have a medicare cost report on file with CMS, then the hospital's portion of the annual coverage assessment base is either the predecessor hospital's net patient revenue as shown in its medicare cost report for its fiscal year that ended during calendar year 2021, or, if the predecessor hospital does not have a 2021 medicare cost report, then the cost report for the first fiscal year following 2021 on file with CMS;
  5. (E) If a hospital is not required to file an annual medicare cost report with CMS, then the hospital's portion of the annual coverage assessment base is its net patient revenue for the fiscal year ending during calendar year 2021 or the first fiscal year that the hospital was in operation after 2021 as shown in the covered hospital's JAR filed with the department of health; and
  6. (F) If a hospital's fiscal year 2021 medicare cost report is not contained in a CMS healthcare cost report information system file, and if the hospital does not meet another qualification listed in subdivisions (2)(A)-(E), then the hospital must submit a copy of the hospital's 2021 medicare cost report to the division in order to allow for the determination of the hospital's net patient revenue as its portion of the annual coverage assessment base;
3. (3) “CMS” means the federal centers for medicare and medicaid services;
4. (4) “Controlling person” means a person who, by ownership, contract, or otherwise, has the authority to control the business operations of a covered hospital. As used in this subdivision (4), “control” means indirect or direct ownership of ten percent (10%) or more of a covered hospital;
5. (5) “Covered hospital” means a hospital licensed under title 33 or title 68, as of July 1, 2024, but does not include an excluded hospital;
6. (6) “Division” means the division of TennCare;
7. (7) “Excluded hospital” means:
  1. (A) A hospital that has been designated by CMS as a critical access hospital as of July 1, 2024;
  2. (B) A mental health hospital owned by this state;
  3. (C) A hospital providing primarily rehabilitative or long-term acute care services;
  4. (D) A children's research hospital that does not charge patients for services beyond that reimbursed by third-party payers;
  5. (E) A hospital that is determined by the division as eligible to certify public expenditures for the purpose of securing federal medical assistance percentage payments; and
  6. (F) A hospital that has been designated by CMS as a rural emergency hospital as of July 1, 2024;
8. (8) “Hospital” means a facility licensed under title 33 or title 68 to provide inpatient hospital care;
9. (9) “Medicare cost report” means CMS-2552-10 or a subsequent form adopted by CMS for medicare cost reporting, the cost report for electronic filing of hospitals, for the period applicable as set forth in this section; and
10. (10) “Net patient revenue minus medicare net revenue” means the amount calculated in accordance with generally accepted accounting principles for hospitals that is reported on Worksheet G-3, Column 1, Line 3, of the 2021 medicare cost report, excluding net medicare revenue, long-term care inpatient ancillary and other nonhospital revenues, or, in the case of a hospital that did not file a 2021 medicare cost report, comparable data from the first complete cost report filed after 2021 by the hospital.

Backlinks (2)

History (1)

Acts 2024, ch. 953, § 1.

§ 71-5-2003. Annual coverage assessment on covered hospitals. [Expires on July 1, 2025.]

(a) There is imposed on covered hospitals an annual coverage assessment for fiscal year (FY) 2024-2025 as set forth in this part, such that the total assessment on all covered hospitals in the aggregate will be equal to six percent (6%) of the federally recognized annual coverage assessment base.
(b) The annual coverage assessment imposed by this part is not effective and validly imposed until the division has provided the Tennessee Hospital Association with written notice that includes:
1. (1)
  1. (A) A determination from CMS that the annual coverage assessment is a permissible source of revenue that does not adversely affect the amount of federal financial participation in the division; and
  2. (B) Approval from CMS of an adjustment to the budget neutrality agreement with CMS, pursuant to the process set forth in the special terms and conditions in the division's 1115 demonstration project;
    Backlinks (1)
    
    71-5-2005(d)(1)(K)
2. (2)
  1. (A) Approval from CMS for the distribution of the full amount of directed payments to hospitals for TennCare services as described in § 71-5-2005(d)(2) as long as an assessment installment is not collected prior to the distribution of the installment of the directed payments; or
  2. (B) The rules promulgated by the division pursuant to § 71-5-2004(k)(2); and
3. (3) Confirmation that all contracts between hospitals and managed care organizations comply with the hospital payment rate variation corridors set forth in § 71-5-161.
Backlinks (3)
(c) The general assembly intends that the proceeds of the annual coverage assessment are not to be used as a justification to reduce or eliminate state funding to the division. The annual coverage assessment is not effective and validly imposed if the coverage or the amount of revenue available for expenditure by the division in FY 2024-2025 is less than:
1. (1) The governor's FY 2024-2025 recommended budget level; plus
2. (2) Additional appropriations made by the general assembly to the division for FY 2024-2025, except to the extent new federal funding is available to replace funds that are appropriated as described in subdivision (c)(1) and that are above the amount that the state receives from CMS under the regular federal matching assistance percentage.
Backlinks (1)
- 71-5-2004(k)(1)
(d)
1. (1)
  1. (A) The general assembly intends that the proceeds of the annual coverage assessment are not to be used as justification for a division managed care organization to implement across-the-board rate reductions to negotiated rates with covered or excluded hospitals or physicians in existence on July 1, 2024. For those rates in effect on July 1, 2024, the division shall include provisions in the managed care organizations' contractor risk agreements that prohibit the managed care organizations from implementing across-the-board rate reductions to covered or excluded network hospitals or physicians by specific service, category, or type of provider. The requirements of the preceding sentence also apply to services or settings of care that are ancillary to the primary license of a covered or excluded hospital or physician, but do not apply to reductions in benefits or reimbursement for the ancillary services if the reductions:
    1. (i) Are different from those items being funded in § 71-5-2005(d); and
    2. (ii) Have been communicated in advance of implementation to the general assembly and the Tennessee Hospital Association.
  2. (B) As used in this subsection (d):
    1. (i) “Physician” includes a physician licensed under title 63, chapter 6 or 9, and a group practice of physicians that holds a contract with a managed care organization;
    2. (ii) “Services or settings of care that are ancillary” includes ambulatory surgical facilities, free standing emergency departments, outpatient treatment clinics or imaging centers, dialysis centers, home health and related services, home infusion therapy services, outpatient rehabilitation, or skilled nursing services; and
    3. (iii) “Services or settings of care that are ancillary to the primary license of a covered or excluded hospital or physician” include services where the physician or covered or excluded hospital, including a wholly owned subsidiary or controlled affiliate of a covered or excluded hospital or hospital system, holds more than a fifty percent (50%) controlling interest in the ancillary services or settings of care, but does not include other ancillary services or settings of care. For across-the-board rate reductions to ancillary services or settings of care, the division shall include appropriate requirements for notice to providers in the managed care organizations' contractor risk agreements.
2. (2) This subsection (d) does not preclude good faith negotiations between managed care organizations and covered or excluded hospitals, hospital systems, and between managed care organizations and physicians on an individualized, case-by-case basis. This subsection (d) does not serve as justification for managed care organizations, covered or excluded hospitals, hospital systems, or physicians to unreasonably deny a party the ability to enter into individualized, case-by-case good faith negotiations. Good faith negotiation necessarily implies mutual cooperation between the negotiating parties and may include, but is not limited to, the right to terminate contractual agreements; the ability to modify negotiated rates, pricing, or units of service; the ability to alter payment methodologies; and the ability to enforce existing managed care techniques or to implement new managed care techniques.
3. (3) This subsection (d) does not preclude the full implementation of § 71-5-161.
4. (4) Notwithstanding this subsection (d), if CMS mandates a TennCare program change or a change is required by state or federal law that impacts rates, and that change is required to be implemented by the managed care organizations in accordance with their contracts, or if the annual coverage assessment becomes invalid, then this part does not prohibit the managed care organizations from implementing a rate change as may be mandated by the division or by state or federal law.
Backlinks (1)
- 71-5-2004(k)(1)

History (1)

Acts 2024, ch. 953, § 1.

§ 71-5-2004. Amount of annual coverage assessment — Payment — Penalty — Suspension of payments — Civil action. [Expires on July 1, 2025.]

(a) Each covered hospital's annual assessment is a weighted portion of the annual coverage assessment base as determined under § 71-5-2002. The weight for each covered hospital must be determined in accordance with the hospital's classification for children's, tier 1, tier 2, tier 3, psychiatric, and safety net hospitals in the division DSH program. The weights determined pursuant to this subsection (a) are not a rule as defined in § 4-5-102 and are not subject to rulemaking under title 4, chapter 5, part 2. The division shall implement this section in a manner that complies with federal requirements necessary to ensure that the assessment qualifies for federal matching funds. The weights for:
1. (1) Children's hospitals are an inpatient weight of eight-tenths (0.8) and an outpatient weight of three-tenths (0.3);
2. (2) Tier 1 hospitals are an inpatient weight of one (1.0) and an outpatient weight of fifty-five hundredths (0.55);
3. (3) Tier 2 hospitals are an inpatient weight of seventy-five hundredths (0.75) and an outpatient weight of three-tenths (0.3);
4. (4) Tier 3 hospitals are an inpatient weight of fifteen hundredths (0.15) and an outpatient weight of one hundred seventy-five thousandths (0.175);
5. (5) Psychiatric hospitals are an inpatient weight of eleven hundredths (0.11) and an outpatient weight of one (1.0);
6. (6) Safety net hospitals are an inpatient weight of one hundred thirty-three thousandths (0.133) and an outpatient weight of one hundred fifty-seven thousandths (0.157); and
7. (7) Any other hospitals eligible for the assessment have a weight of six percent (6%).
(b) The division may, in consultation with the Tennessee Hospital Association, modify the amount of the individual percentages set forth in this section if necessary to comply with 42 CFR 433.68 or to address additional state appropriations.
(c) The annual coverage assessment must be paid in installments pursuant to this subsection (c) if the requirements of § 71-5-2003(b) have been satisfied. The division shall establish a schedule of four (4) equal installment payments spread as evenly as possible throughout FY 2024-2025 with each installment payment due fifteen (15) days after the FY 2024-2025 directed payments approved by CMS to offset unreimbursed division costs have been made to hospitals.
(d) To facilitate collection of the annual coverage assessment, the division shall send each covered hospital, at least thirty (30) days in advance of each installment payment due date, a notice of payment along with a return form developed by the division. Failure of a covered hospital to receive a notice and return form, however, does not relieve a covered hospital from the obligation of timely payment. The division shall also post the return form on its website.
(e) Failure of a covered hospital to pay an installment of the annual coverage assessment, when due, results in an imposition of a penalty of five hundred dollars ($500) per day until the installment is paid in full. The division at its discretion may waive the penalty if the hospital establishes that it attempted to mail or electronically transfer payment to the state on or before the date the payment was due.
(f) If a covered hospital ceases to operate or changes status to be an excluded hospital between July 1, 2024, and June 30, 2025, then the hospital's total annual coverage assessment is equal to its annual coverage assessment base multiplied by a fraction, the denominator of which is the number of calendar days from July 1, 2024, until July 1, 2025, and the numerator of which is the number of days from July 1, 2024, until the date the health facilities commission has recorded as the date that the hospital changed status or ceased operation.
(g) If a covered hospital ceases operation prior to payment of its full annual coverage assessment, then the person controlling the hospital as of the date the hospital ceased operation is jointly and severally responsible for any remaining annual coverage assessment installments and unpaid penalties associated with previous late payments.
(h) If a covered hospital is sold after July 1, 2024, and before July 1, 2025, then the seller is responsible for annual coverage assessment payments due for the period up to and including the date the sale is final. If the hospital continues to operate in this state and continues to meet the definition of a covered hospital in § 71-5-2002, then the new owner is responsible for paying all coverage assessment amounts due for the period beginning on the day after the date of the sale until July 1, 2025.
(i) If a covered hospital fails to pay an installment of the annual coverage assessment within thirty (30) days of its due date, then the division must suspend the payments to the hospital required by § 71-5-2005(d)(2) until the installment is paid and report the failure to the department that licenses the covered hospital. Notwithstanding another law, failure of a covered hospital to pay an installment of the annual coverage assessment or a refund required by this part is considered a license deficiency and grounds for disciplinary action as set forth in the statutes and rules under which the covered hospital is licensed.
(j) In addition to the action required by subsection (h), the division is authorized to file a civil action against a covered hospital and its controlling person or persons to collect delinquent annual coverage assessment installments, late penalties, and refund obligations established by this part. Exclusive jurisdiction and venue for a civil action authorized by this subsection (j) is in the chancery court for Davidson County.
(k)
1. (1) If a federal agency with jurisdiction over the annual coverage assessment determines that the annual coverage assessment is not a valid source of revenue or if there is a reduction of the coverage and funding of the division's program contrary to § 71-5-2003(c), or if the requirements of §§ 71-5-161 and 71-5-2003(b) are not fully satisfied, or if one (1) or more managed care organizations impose rate reductions contrary to § 71-5-2003(d), then:
  1. (A) Subsequent installments of the annual coverage assessment are not due and payable; and
  2. (B) Further payments must not be paid to hospitals pursuant to § 71-5-2005(d)(2) after the date of the event.
2. (2)
  1. (A) Notwithstanding this part, if CMS discontinues approval of or otherwise fails to approve the full amount of directed payments to hospitals for providing services to division enrollees as authorized under § 71-5-2005(d), then the division must suspend payments from or to covered hospitals otherwise required by this part and must promulgate rules that:
    1. (i) Establish the methodology for determining the amounts, categories, and times of payments to hospitals, if any, instead of the payments that otherwise would have been paid under § 71-5-2005(d)(2) if approved by CMS;
    2. (ii) Prioritize payments to hospitals as set forth in § 71-5-2005(d)(2);
    3. (iii) Identify the benefits and services for which funds will be available in order to mitigate reductions or eliminations that otherwise would be imposed in the absence of the coverage assessment;
    4. (iv) Determine the amount and timing of payments for benefits and services identified under subdivisions (k)(2)(A)(ii) and (iii), as appropriate;
    5. (v) Reinstitute payments from or to covered hospitals as appropriate; and
    6. (vi) Otherwise achieve the goals of this subdivision (k)(2).
  2. (B) The rules adopted under this subdivision (k)(2) must, to the extent possible, achieve the goals of:
    1. (i) Maximizing the amount of federal matching funds available for the division's program; and
    2. (ii) Minimizing the variation between payments hospitals will receive under the rules as compared to payments hospitals would have received if CMS had approved the total payments described in § 71-5-2005(d).
  3. (C) Notwithstanding another law, the division is authorized to exercise emergency rulemaking authority to the extent necessary to meet the objectives of this subdivision (k)(2).
  Backlinks (2)
  
  71-5-2003(b)(2)(B)
  71-5-2005(d)(2)(H)
3. (3) Upon occurrence of an event set forth in subdivision (k)(1) or (k)(2), the division then has authority to make necessary changes to the division's budget to account for the loss of annual coverage assessment revenue.
(l) A covered hospital or an association representing covered hospitals, the membership of which includes thirty (30) or more covered hospitals, has the right to file a petition for declaratory order pursuant to § 4-5-223 to determine if there has been a failure to meet the requirements of this part. A covered hospital shall not increase charges or add a surcharge based on, or as a result of, the annual coverage assessment.

History (1)

Acts 2024, ch. 953, § 1.

§ 71-5-2005. Deposits in maintenance of coverage trust fund — Expenditures — Quarterly reports. [Expires on July 1, 2025.]

(a) The funds generated as a result of this part must be deposited in the maintenance of coverage trust fund created by § 71-5-160, the existence of which is continued as provided in subsection (b). The fund must not be used to replace monies otherwise appropriated to the division's program by the general assembly or to replace monies appropriated outside of the division's program.
(b) The maintenance of coverage trust fund must continue without interruption and must be operated in accordance with § 71-5-160 and this section.
(c) The maintenance of coverage trust fund consists of:
1. (1) The balance of the trust fund remaining as of June 30, 2024;
2. (2) All annual coverage assessments received by the division;
3. (3) Investment earnings credited to the assets of the maintenance of coverage trust fund;
4. (4) Penalties paid by covered hospitals for late payment of assessment installments imposed by this part or a prior statute authorizing an annual coverage assessment; and
5. (5) Intergovernmental transfer of funds from hospitals determined by the division as eligible to certify public expenditures for the purpose of securing federal medical assistance percentage payments up to three hundred million dollars ($300,000,000).
(d) Monies credited or deposited to the maintenance of coverage trust fund, together with all federal matching funds, must be available to and used by the division only for expenditures in the division's program and include the following purposes:
1. (1) Expenditures for benefits and services under the division's program, including those that would have been subject to reduction or elimination from the division's funding for FY 2024-2025, except for the availability of one-time funding for that year only, as follows:
  1. (A) Replacement of across-the-board reductions in covered and excluded hospital and professional reimbursement rates described in the governor's recommended budgets since FY 2011, except for reductions that were included on a list for a given year but then funded in a subsequent year with recurring state dollars;
  2. (B) Funding virtual DSH payments, funding payments to hospitals for uncompensated care to charity patients, and funding payments to hospitals for quality incentive arrangements, with all of those payments being made in accordance with, and as those categories of payments are defined in, the division's 1115 demonstration waiver from the federal centers for medicare and medicaid services to the maximum amount permitted for each category under that waiver;
  3. (C) Maintenance of payments for graduate medical education of at least forty-eight million dollars ($48,000,000);
    Backlinks (2)
    
    49-9-703(e)(3)(C)
    49-9-705(d)(5)
  4. (D) Unless otherwise addressed in a separate appropriation for FY 2024-2025, maintenance of reimbursement for medicare part A crossover claims at the lesser of one hundred percent (100%) of medicare allowable or the billed amount;
  5. (E) Avoidance of coverage limitations relative to the number of hospital inpatient days per year or the annual cost of hospital services for a division enrollee;
  6. (F) Avoidance of coverage limitations relative to the number of nonemergency outpatient visits per year for a division enrollee;
  7. (G) Avoidance of coverage limitations relative to the number of physician office visits per year for a division enrollee;
  8. (H) Avoidance of coverage limitations relative to the number of laboratory and diagnostic imaging encounters per year for a division enrollee;
  9. (I) Maintenance of coverage for occupational therapy, physical therapy, and speech therapy services;
  10. (J) In the total amount of five hundred ninety thousand seven hundred seventy dollars ($590,770) to maintain reimbursement at the same emergency care rate as in FY 2023-2024 for nonemergent care to children twelve (12) to twenty-four (24) months of age;
  11. (K) In the total amount of two million one hundred eleven thousand four hundred dollars ($2,111,400) to the division to offset the elimination of the provision in the division's managed care contractor risk agreements for hospitals as follows: CRA 2.12.9.60-Specify in applicable provider agreements that all providers who participate in the federal 340B program give the division MCOs the benefit of 340B pricing; provided, however, if the division obtains approval from CMS for the adjustment to the budget neutrality agreement, as set forth in § 71-5-2003(b)(1)(B), the expenditure authorized by this subdivision (d)(1)(K) is twenty million, five hundred seventy-nine thousand nine hundred dollars ($20,579,900);
  12. (L) In the total amount of one hundred seventy-five thousand dollars ($175,000) to offset a portion of the hospital cost of providing admissions, discharge, and transfer (ADT) messages to the division to support the division's Patient Centered Medical Home initiative;
  13. (M) In the total amount of one million four hundred twenty-six thousand seven hundred dollars ($1,426,700) to provide funding for stipends for physicians and other healthcare providers who commit to work in designated medically underserved areas in this state; and
  14. (N) In the amount of three million dollars ($3,000,000) to offset the unreimbursed cost of charity care for critical access hospitals to be funded from funds remaining in the trust fund as of June 30, 2024;
2. (2) Directed payments to hospitals for providing services to division patients and the uninsured, as approved by CMS and as set forth in this subdivision (d)(2):
  1. (A) Directed payments to hospitals will be made based on claims paid with the division's utilization and encounter data from the managed care organizations during each quarter of FY 2024-2025. A directed payment must be in an amount set by the division in consultation with the Tennessee Hospital Association and dependent on funding available through this section. The directed payment must include a quality program designed and implemented with the partnership and cooperation of the division and the Tennessee Hospital Association;
  2. (B) If CMS does not approve either the structure of directed payments set forth in subdivision (d)(2)(A) or provide a budget neutrality adjustment, then payments required by this subdivision (d)(2) must be in accordance with this subdivision (d)(2)(B). Directed payments to hospitals must be based on the claims paid to covered hospitals from the managed care organizations during each quarter of FY 2024-2025. Each covered hospital is entitled to payments for FY 2024-2025 for providing services to division enrollees. The amount of payment to covered hospitals must be no less than thirty-seven percent (37%) of unreimbursed division costs for all hospitals licensed by the state that reported division charges, revenue, and total expenses on the 2022 JAR, excluding state-owned hospitals. As used in this subdivision (d)(2)(B), ”unreimbursed division costs” means the excess of the division costs over the division's net revenue. The division's charges and net revenue are calculated using data from Schedule E, items (A)(l)(e) and (A)(l)(f), from the hospital's 2022 JAR filed with the department of health. As used in this subdivision (d)(2)(B), ”division costs” means the quotient of a facility's cost-to-charge ratio, calculated as B(3) (total expenses) divided by A(3)(e) (total gross patient charges) from Schedule E of the 2022 JAR, multiplied by the division's charges;
  3. (C) If CMS does not approve directed payments to hospitals set forth in either subdivision (d)(2)(A) or (d)(2)(B), but instead approves hospital supplemental pools in the division waiver, then payments must be made from the allocated pools to covered hospitals to offset losses incurred in providing services to division enrollees as first priority before any other supplemental payments authorized in the division waiver are distributed;
  4. (D) The payments required by this subdivision (d)(2) must be made in four (4) equal installments. The division shall provide to the Tennessee Hospital Association a schedule showing the payments to each hospital at least seven (7) days in advance of the payments;
  5. (E) Payments required by this subdivision (d)(2) may be made by the division directly or by the division managed care organizations with the direction to make payments to hospitals, or by a designee approved by the division, as required by this subsection (d). The payments to a hospital pursuant to this subdivision (d)(2) are not part of the reimbursement a hospital is entitled to under its contract with a division managed care organization;
  6. (F) In addition to the items and expenditures set forth in subdivisions (d)(1) and (2), other programs and initiatives developed by the division, in consultation with the Tennessee Hospital Association, to offset the unreimbursed costs of providing services to division enrollees and the financial consequences of the public health emergency. The state portion of the funding for programs and initiatives developed under this subdivision (d)(2)(F) must be used to obtain federal matching funds to raise funds up to three hundred fifty million dollars ($350,000,000);
  7. (G) Refunds, in proportion to the amount paid in, to covered hospitals based on:
    1. (i) The payment of annual coverage assessments or penalties to the division through error, mistake, or a determination that the annual coverage assessment was invalidly imposed; or
    2. (ii) Circumstances where the division, in consultation with the Tennessee Hospital Association, has determined a lower coverage assessment would have been required to carry out the purposes of subdivisions (d)(1) and (2); and
  8. (H) Payments authorized under rules promulgated by the division pursuant to § 71-5-2004(k)(2);
  Backlinks (5)
  
  71-5-2003(b)(2)(A)
  71-5-2004(i)
  71-5-2004(k)(1)(B)
  71-5-2004(k)(2)(A)(i)
  71-5-2004(k)(2)(A)(ii)
3. (3) Administrative funding to the division for six (6) full-time state employees to assist with implementation, operationalization, and ongoing management of hospital payment programs in the amount of three hundred eighty-two thousand four hundred dollars ($382,400); and
4. (4) Funding from the trust fund or assessment to offset any public hospital funding shortfalls for state directed payments.
Backlinks (3)
(e) The division shall modify the contracts with the division managed care organizations and otherwise take action necessary to assure the use and application of the assets of the maintenance of coverage trust fund, as described in subsection (d).
(f) The division shall submit requests to CMS to modify the medicaid state plan, the contractor risk agreements, and an applicable Section 1115 demonstration project, as necessary, to implement this part.
(g) At quarterly intervals beginning September 1, 2024, the division shall submit a report to the finance, ways and means committees of the senate and the house of representatives, to the health and welfare committee of the senate, to the health committee of the house of representatives, and to the legislative librarian. The report must include:
1. (1) The status, if applicable, of the determination and approval by CMS set forth in § 71-5-2003(b) of the annual coverage assessment;
2. (2) The balance of funds in the maintenance of coverage trust fund; and
3. (3) The extent to which the maintenance of coverage trust fund has been used to carry out this part.
(h) Notwithstanding another law, no part of the maintenance of coverage trust fund must be diverted to the general fund or used for a purpose other than as set forth in this part.

Backlinks (1)

71-5-2007

History (1)

Acts 2024, ch. 953, § 1.

§ 71-5-2006. Expiration of part — Survival of certain rights and obligations. [Expires on July 1, 2025.]

This part expires on July 1, 2025. However, the following rights and obligations survive the expiration:
1. (1) The authority of the division to impose late payment penalties and to collect unpaid annual coverage assessments and required refunds;
2. (2) The rights of a covered hospital or an association of covered hospitals to file a petition for a declaratory order to determine compliance with this part;
3. (3) The existence of the maintenance of coverage trust fund and the obligation of the division to use and apply the assets of the maintenance of coverage trust fund; and
4. (4) The obligation of the division to implement and maintain the requirements of § 71-5-161.

History (1)

Acts 2024, ch. 953, § 1.

§ 71-5-2007. Audit of expenditure of funds from maintenance of coverage trust fund. [Expires on July 1, 2025.]

The comptroller of the treasury may audit the expenditure of funds pursuant to this part from the maintenance of coverage trust fund. At the discretion of the comptroller of the treasury, the audit may be prepared by a certified public accountant, a public accountant, or the department of audit. Notwithstanding § 71-5-2005, the division and the maintenance of coverage trust fund must bear the full costs of the audit.

History (1)

Acts 2024, ch. 953, § 1.

Part 21 Poor Asylums

§ 71-5-2101. Provision by county legislative body.

There may be provided, at the expense of every county, an asylum for the poor of the county, consisting of a parcel of land of such size, and of buildings on the land of such dimensions and construction, as the county legislative body may consider necessary and proper, a majority of the members being present.

History (7)

Code 1858, § 1594 (deriv. Acts 1826, Private, ch. 56, § 2)
Shan., § 2678
Code 1932, § 4792
impl. am. Acts 1978, ch. 934, §§ 7, 36
T.C.A. (orig. ed.), § 14-801
Acts 1984, ch. 720, § 1
T.C.A. (orig. ed.), § 14-20-101.

§ 71-5-2102. Site and construction.

The site of the asylum shall be selected, and the buildings planned and constructed, solely with a view to promote the health and comfort of the inmates.

History (4)

Code 1858, § 1595 (deriv. Acts 1826 Private, ch. 56, § 2)
Shan., § 2679
Code 1932, § 4793
T.C.A. (orig. ed.), §§ 14-802, 14-20-102.

§ 71-5-2103. Appointment of commissioners.

The county legislative body shall appoint three (3) commissioners to select the site, and to contract for and superintend the necessary buildings, upon such plan and under such rules and regulations as the legislative body may prescribe.

History (5)

Code 1858, § 1596 (deriv. Acts 1826 Private, ch. 56, § 2)
Shan., § 2680
Code 1932, § 4794
impl. am. Acts 1978, ch. 934, §§ 7, 36
T.C.A. (orig. ed.), §§ 14-803, 14-20-103.

§ 71-5-2104. Appropriation of county funds.

The county legislative body may apply any county moneys in the treasury that it may deem proper to the use of the asylum.

History (5)

Code 1858, § 1605
Shan., § 2689
Code 1932, § 4806
impl. am. Acts 1978, ch. 934, §§ 7, 36
T.C.A. (orig. ed.), §§ 14-804, 14-20-104.

§ 71-5-2105. Powers of commissioners.

In the management of the asylum, the commissioners have the power to:
1. (1) Prescribe rules and regulations for the management of the farm and for the treatment of the inmates of the asylum, and modify and change them at pleasure;
2. (2) Prescribe the manner in which the inmates shall live, sleep, be clothed, and labor, if any of them are able to labor;
3. (3) Appoint a suitable superintendent of the asylum;
4. (4) Take from the superintendent a bond, with sufficient surety, in the penalty of five hundred dollars ($500), payable to the state, conditioned for the performance of such superintendent's duties;
5. (5) Cause the superintendent to subscribe an oath, to be written on the back of the bond; and
6. (6) Deliver the bond to the clerk of the county legislative body, to be preserved among the files of the clerk's office relating to the asylum.

History (5)

Code 1858, § 1608 (deriv. Acts 1827 Private, ch. 112, § 6)
Shan., § 2692
Code 1932, § 4809
impl. am. Acts 1978, ch. 934, §§ 7, 36
T.C.A. (orig. ed.), §§ 14-805, 14-20-105.

§ 71-5-2106. Duty of superintendent.

The superintendent shall overlook and manage the asylum and its inmates under such rules and regulations as the commissioners shall prescribe.

History (4)

Code 1858, § 1609 (deriv. Acts 1827 Private, ch. 112, § 6)
Shan., § 2693
Code 1932, § 4810
T.C.A. (orig. ed.), §§ 14-806, 14-20-106.

§ 71-5-2107. Replacement of superintendent.

The commissioners may remove the superintendent whenever they think the good of the establishment requires it, and may fill the vacancy.

History (4)

Code 1858, § 1610 (deriv. Acts 1827 Private, ch. 112, § 8)
Shan., § 2694
Code 1932, § 4811
T.C.A. (orig. ed.), §§ 14-807, 14-20-107.

§ 71-5-2108. Residence of inmates.

No person shall be admitted into the asylum who has not been an actual resident of the county for one (1) whole year preceding the person's application.

History (4)

Code 1858, § 1607
Shan., § 2691
mod. Code 1932, § 4808
T.C.A. (orig. ed.), §§ 14-808, 14-20-108.

§ 71-5-2109. Application for admission.

The commissioners shall examine all applicants for admission into the asylum, and admit or reject any applicant as they may think right. Any applicant who is rejected may appeal to the county mayor, in which case the applicant shall be examined and admitted or excluded in the discretion of the county mayor.

History (7)

Code 1858, § 1606
Shan., § 2690
Code 1932, § 4807
mod. C. Supp. 1950, § 4807
impl. am. Acts 1978, ch. 934, §§ 16, 36
T.C.A. (orig. ed.), §§ 14-809, 14-20-109
Acts 2003, ch. 90, § 2.

§ 71-5-2110. Superintendent's annual report.

The superintendent shall, once every year, in the month of December, submit to the commissioners a statement of the condition of the establishment, showing:
1. (1) The number of its inmates, their names, ages, sex, diseases and maladies;
2. (2) The expenses of the establishment;
3. (3) The production of the farm; and
4. (4) Whatever else the superintendent may be required to report by the commissioners, or may consider necessary to a full showing of the state of the establishment.

History (4)

Code 1858, § 1611 (deriv. Acts 1827 Private, ch. 112, § 9)
Shan., § 2695
mod. Code 1932, § 4812
T.C.A. (orig. ed.), §§ 14-810, 14-20-110.

§ 71-5-2111. Joint institutions.

(a) County legislative bodies may unite in the establishment of joint homes, hospitals, almshouses or poor farms for the care of the indigent or the chronic sick of the respective counties.
(b) The legislative body of a county, by majority vote at any regular session, may sell or otherwise dispose of the property owned by the county and used for such purposes, and may contract with one (1) or more other counties for the joint ownership, construction, control and operation of a common institution, or may contract with one (1) or more other counties for the care of its indigent or chronic sick persons in institutions owned, controlled and operated by the other county or counties.

Backlinks (1)

71-5-2112

History (4)

Acts 1929, ch. 135, § 1
Code 1932, § 4795
impl. am. Acts 1978, ch. 934, §§ 7, 36
T.C.A. (orig. ed.), §§ 14-811, 14-20-111.

§ 71-5-2112. Government of joint institutions.

Any institution established jointly by counties, as provided in § 71-5-2111, shall in all respects serve as a county institution of each of the counties participating, subject to the rules and regulations agreed upon by the legislative bodies of the participating counties. Such contract shall be executed by the governing body of each county by its proper officer.

History (4)

Acts 1929, ch. 135, § 2
mod. Code 1932, § 4796
impl. am. Acts 1978, ch. 934, §§ 7, 36
T.C.A. (orig. ed.), §§ 14-812, 14-20-112.

§ 71-5-2113. Funds for joint institutions.

For the purpose of enabling counties to contribute and participate in such joint enterprises, they are given full power to levy taxes and appropriate county funds.

History (3)

Acts 1929, ch. 135, § 3
mod. Code 1932, § 4797
T.C.A. (orig. ed.), §§ 14-813, 14-20-113.

Part 22 Commissioners of the Poor

§ 71-5-2201. Permanent body — Name — Appointment — Term of office.

(a) The commissioners of the poor shall be a permanent body, by the name of the “Commissioners of the Poor for County.”
(b) In the selection, the county legislative body shall, at its October session, choose at the beginning one (1) commissioner to hold for the term of one (1) year, another for the term of two (2) years, and a third for a term of three (3) years, and annually thereafter for three (3) years each, and to hold until the successor of each is selected and qualified.
(c) Should the court omit to make the appointment at that session, it may be done at any subsequent session.

History (7)

Code 1858, § 1597
Acts 1879, ch. 102, § 1
1889, ch. 150, § 1
Shan., § 2681
mod. Code 1932, § 4798
impl. am. Acts 1978, ch. 934, §§ 7, 36
T.C.A. (orig. ed.), §§ 14-901, 14-20-201.

§ 71-5-2202. Oath of office.

Each commissioner, before entering upon the discharge of such commissioner's duties, shall take an oath before the county clerk, in term or vacation, to well and truly discharge such commissioner's duties as prescribed by law.

History (6)

Code 1858, § 1599 (deriv. Acts 1826 Private, ch. 56, § 4
1831, ch. 89, § 3)
Shan., § 2683
Code 1932, § 4800
impl. am. Acts 1978, ch. 934, §§ 22, 36
T.C.A. (orig. ed.), §§ 14-902, 14-20-202.

§ 71-5-2203. Chair — Minutes.

The commissioners shall appoint one (1) of their number chair, and they shall keep minutes of their proceedings in a well-bound book.

History (4)

Code 1858, § 1600
Shan., § 2684
Code 1932, § 4801
T.C.A. (orig. ed.), §§ 14-903, 14-20-203.

§ 71-5-2204. Compensation.

The county legislative body shall in all cases pay a reasonable compensation to the superintendent and the commissioners.

History (5)

Code 1858, § 1614
Shan., § 2698
Code 1932, § 4815
impl. am. Acts 1978, ch. 934, §§ 7, 36
T.C.A. (orig. ed.), §§ 14-904, 14-20-204.

§ 71-5-2205. Removal — Vacancies.

The county legislative body may remove the commissioners, or any one (1) of them, at pleasure, and proceed to fill the vacancy at any time; and should any one (1) or more of them die, resign, remove from the county, or fail or refuse to act, the county mayor may fill the vacancy, and such appointee shall continue to act as commissioner until an election by the legislative body.

History (7)

Code 1858, § 1598 (deriv. Acts 1827 Private, ch. 112, § 7)
Shan., § 2682
Code 1932, § 4799
mod. C. Supp. 1950, § 4799
impl. am. Acts 1978, ch. 934, §§ 7, 16, 36
T.C.A. (orig. ed.), §§ 14-905, 14-20-205
Acts 2003, ch. 90, § 2.

§ 71-5-2206. Order for expenditures — Warrants.

When money is to be drawn from the county treasury for the purchase of the site of the asylum, the erection of the buildings, for improvements, repairs, or for the ordinary expenses of the maintenance of the poor, it shall be done upon an order of the commission, entered upon its minutes, specifying the purpose to which the money is to be applied; upon production of a copy of which, signed by the county mayor and attested by one (1) of the other commissioners, to the county legislative body, and appropriation shall on approval be made for the amount specified in the order, to be drawn on warrant of the county mayor, as in other cases.

History (6)

Code 1858, § 1601
Shan., § 2685
mod. Code 1932, § 4802
impl. am. Acts 1978, ch. 934, §§ 7, 16, 36
T.C.A. (orig. ed.), §§ 14-906, 14-20-206
Acts 2003, ch. 90, § 2.

§ 71-5-2207. Book of accounts — Items entered.

The commissioners shall keep a book of accounts, in which they shall charge themselves with all moneys drawn by them from the treasury of the county, specifying the number and date of the warrant on which each sum was drawn, and credit themselves with their disbursements, giving the number and date of each voucher, and preserving the same.

History (4)

Code 1858, § 1602
Shan., § 2686
Code 1932, § 4803
T.C.A. (orig. ed.), §§ 14-907, 14-20-207.

§ 71-5-2208. Examination and preservation of accounts.

(a) The book of accounts shall be balanced every year, and, on or before December 31, shall be submitted to the county mayor for settlement, together with the vouchers.
(b) If the county mayor finds the account correct, the county mayor shall write beneath the same the words, “examined and approved,” and sign the county mayor's name to the book of accounts, and retain the vouchers, and cause them to be placed in the office of the county clerk, and carefully preserved in separate files.

History (6)

Code 1858, § 1603
Shan., § 2687
Code 1932, § 4804
impl. am. Acts 1978, ch. 934, §§ 16, 22, 36
T.C.A. (orig. ed.), §§ 14-908, 14-20-208
Acts 2003, ch. 90, § 2.

§ 71-5-2209. Liability for expenditures.

The commissioners shall be jointly and severally liable for the application of any money drawn on their order from the county treasury for the use of the asylum.

History (4)

Code 1858, § 1604
Shan., § 2688
Code 1932, § 4805
T.C.A. (orig. ed.), §§ 14-909, 14-20-209.

§ 71-5-2210. Annual report.

The commissioners shall report to the county legislative body, at its January session every year, the condition of the asylum, making the superintendent's report a part of their own.

History (5)

Code 1858, § 1612
Shan., § 2696
Code 1932, § 4813
impl. am. Acts 1978, ch. 934, §§ 7, 36
T.C.A. (orig. ed.), §§ 14-910, 14-20-210.

Part 23 Miscellaneous Provisions

§ 71-5-2301. Allowances by county legislative body.

The county legislative body may, in its discretion, allow and pay to poor persons who may become chargeable as paupers, and who will probably be benefited thereby, such sums or such annual allowance, to be paid according to the direction of the legislative body, as will not exceed the charge of their maintenance in the ordinary mode.

History (5)

Code 1858, § 1621
Shan., § 2705
Code 1932, § 4821
impl. am. Acts 1978, ch. 934, §§ 7, 36
T.C.A. (orig. ed.), §§ 14-1001, 14-20-301.

§ 71-5-2302. Exemption from road service.

The county legislative body may exempt from working on public roads any person unable, by manual labor or physical exertion, to make a support, whenever it appears to be just and right.

Backlinks (1)

5-5-125

History (6)

Code 1858, § 1620 (deriv. Acts 1845-1846, ch. 97)
Shan., § 2704
Code 1932, § 4820
impl. am. Acts 1978, ch. 934, §§ 7, 36
Acts 1979, ch. 23, § 8
T.C.A. (orig. ed.), §§ 14-1002, 14-20-302.

§ 71-5-2303. Contract for support with use of farm.

The county legislative body may also let out the support of the poor, with the use and occupancy of the poorhouse and farm, for a period not exceeding three (3) years.

Backlinks (2)

History (5)

Code 1858, § 1615
Shan., § 2699
Code 1932, § 4816
impl. am. Acts 1978, ch. 934, §§ 7, 36
T.C.A. (orig. ed.), §§ 14-1003, 14-20-303.

§ 71-5-2304. Contracts for support of poor.

The county legislative body may also contract with any person for the support of any or all the poor of the county, upon such terms as may be deemed reasonable, for a period not exceeding one (1) year.

Backlinks (1)

71-5-2305

History (5)

Code 1858, § 1616
Shan., § 2700
Code 1932, § 4817
impl. am. Acts 1978, ch. 934, §§ 7, 36
T.C.A. (orig. ed.), §§ 14-1004, 14-20-304.

§ 71-5-2305. Employment of poor by contracts.

Such contractors under §§ 71-5-2303 and 71-5-2304 may employ a poor person in any work for which such person's age, health, and strength are competent, but subject to the supervision of the commissioners of the poor, and, in the last resort, of the county legislative body.

Backlinks (1)

71-5-2306

History (5)

Code 1858, § 1617
Shan., § 2701
Code 1932, § 4818
impl. am. Acts 1978, ch. 934, §§ 7, 36
T.C.A. (orig. ed.), §§ 14-1005, 14-20-305.

§ 71-5-2306. Supervision of contractors.

The commissioners of the poor are required, if the poor of the county, or any of them, are bound or farmed out, as provided in §§ 71-5-2303 — 71-5-2305, to:
1. (1) Examine and report upon the manner in which such poor are kept and treated;
2. (2) Prescribe the manner in which they shall be maintained and provided for; and
3. (3) Report the result of the examination in the premises, and their conduct;
4. to the county legislative body.

History (6)

Code 1858, § 1613
Shan., § 2697
Code 1932, § 4814
modified
impl. am. Acts 1978, ch. 934, §§ 7, 36
T.C.A. (orig. ed.), §§ 14-1006, 14-20-306.

§ 71-5-2307. Setting aside contract.

The county legislative body has the power, upon good cause shown, to set aside any contract letting out the support of the poor as above, making proper allowances for the time it has been in operation.

History (5)

Code 1858, § 1618
Shan., § 2702
Code 1932, § 4819
impl. am. Acts 1978, ch. 934, §§ 7, 36
T.C.A. (orig. ed.), §§ 14-1007, 14-20-307.

§ 71-5-2308. Contracts for hospital care.

For the purpose of caring for indigent sick or injured persons, the county legislative bodies are empowered to enter into contract with any reputable hospital for the care and treatment of indigent sick or injured persons, and may make annual contracts with such hospitals for a right, on the part of the county, to the use of one (1) or more beds in the hospital in which the county shall have the right to place patients for hospital treatment to be rendered by the hospital.

History (5)

Acts 1911, ch. 54, § 1
Shan., § 2706a1
Code 1932, § 4823
impl. am. Acts 1978, ch. 934, §§ 7, 36
T.C.A. (orig. ed.), §§ 14-1008, 14-20-308.

§ 71-5-2309. Order to receive county patient.

Whenever any county legislative body has so contracted, and it has been made satisfactorily to appear to the county mayor of any county that a sick or injured person is unable on account of poverty to procure proper care and medical attention, the county mayor shall issue an order to the hospital to receive the person for treatment as a county patient.

History (6)

Acts 1911, ch. 54, § 2
Shan., § 2706a2
Code 1932, § 4824
impl. am. Acts 1978, ch. 934, §§ 7, 16, 36
T.C.A. (orig. ed.), §§ 14-1009, 14-20-309
Acts 2003, ch. 90, § 2.

§ 71-5-2310. Hospitalization attained by county mayor.

In the event any county legislative body fails to make such an annual contract, or in case all the beds contracted for shall at any time be filled, and is made satisfactorily to appear to the county mayor that a sick or injured person is unable on account of poverty to procure necessary care and medical attention, the county mayor may contract with such hospital to take charge of and render to such person the care and medical attention necessary during the illness.

History (6)

Acts 1911, ch. 54, § 3
Shan., § 2706a3
Code 1932, § 4825
impl. am. Acts 1978, ch. 934, §§ 7, 16, 36
T.C.A. (orig. ed.), §§ 14-1010, 14-20-310
Acts 2003, ch. 90, § 2.

§ 71-5-2311. Payment for hospitalization.

(a) Whenever any hospital has entered into either or both of such contracts with any county, the hospital shall render monthly statements to the county mayor of the county showing the name and address of each patient so received and treated at the expense of the county, and the length of time treated, and an account for the keep of the patient, and whether the patient was treated under the annual contract plan or by special contract with the county mayor as provided in this part.
(b) Upon the presentation of the account, the county mayor shall inspect the account, and if found correct, shall issue a county warrant for same, which shall be paid as other county expenses.

History (6)

Acts 1911, ch. 54, § 5
Shan., § 2706a5
Code 1932, § 4827
impl. am. Acts 1978, ch. 934, §§ 16, 36
T.C.A. (orig. ed.), §§ 14-1011, 14-20-311
Acts 2003, ch. 90, § 2.

§ 71-5-2312. Attendance of patients by county physicians.

Whenever any county patient, coming from the county wherein such hospital is located, is without the services of a regular physician, it shall become the duty of the county physician of the county wherein the hospital is situated to attend the patient and to administer medical treatment during the patient's retention in the hospital.

History (4)

Acts 1911, ch. 54, § 4
Shan., § 2706a4
Code 1932, § 4826
T.C.A. (orig. ed.), §§ 14-1012, 14-20-312.

§ 71-5-2313. Welfare recipients may choose optometrist or physician — Exception — Fee schedule.

Whenever under any program for aid to the indigent, the aged, the blind or any other group, which program is supported in whole or in part by funds of the state or of any metropolitan, municipal or county government in this state and which includes services within the lawful scope of practice of a duly licensed optometrist as defined in § 63-8-102, the recipient of such aid or the recipient's parent, guardian or conservator shall be entitled to choose whether such services are to be performed by a duly licensed physician or a duly licensed optometrist, notwithstanding any provision to the contrary in any other statute, except that in the case of federally supported programs, federal statutes and rules and regulations shall be followed where mandatory, and shall be paid for on a parity in accordance with a fee schedule established for such services by the department or agency, or both, administering the program.

History (2)

Acts 1965, ch. 357, § 3
T.C.A., §§ 14-1013, 14-20-313.

§ 71-5-2314. Payment of claims under TennCare partners program.

This section is intended to ensure the prompt and accurate payment of all claims incurred by providers delivering services to enrollees of the TennCare partners program, and to formalize the resolution of all claims disputes arising under the partners program. Accordingly, the standards and requirements set forth at § 56-32-126(b), shall be applicable to the TennCare partners program. Specifically, all entities contracting with the state in the partners program shall have the same rights and obligations as defined for TennCare health maintenance organizations at § 56-32-126(b). The commissioner of commerce and insurance has the authority to conduct periodic examinations of these entities to verify compliance with this section. Any entity found to be in noncompliance with this section shall be subject to the imposition by the commissioner of the same penalties and other remedies set forth at § 56-32-120.

History (1)

Acts 1999, ch. 276, § 2.

Part 24 Tennessee TennCare Pharmacy Advisory Committee

§ 71-5-2401. Establishment — Members — Recommendations concerning drugs on auto-exemptions list.

(a) There is established in the department of finance and administration a state TennCare pharmacy advisory committee. The committee shall make recommendations regarding a preferred drug list (PDL) to govern all state expenditures for prescription drugs for the TennCare program.
(b)
1. (1) The state TennCare pharmacy advisory committee shall be composed of fifteen (15) members. Except for initial appointments, members shall be appointed to three-year terms.
2. (2) Appointments by the governor shall be made as follows:
  1. (A) One (1) practicing psychiatrist who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested psychiatric groups, including, but not limited to, the Tennessee Psychiatric Association. The initial appointee shall serve a three-year term;
  2. (B) One (1) practicing nurse practitioner or physician assistant who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested nursing or physician assistant groups, including, but not limited to, the Tennessee Nurses Association or the Tennessee Academy of Physician Assistants. The initial appointee shall serve a one-year term;
  3. (C) One (1) practicing physician who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested geriatric groups, including, but not limited to, the Tennessee Geriatric Society and the Tennessee Chapter of the American Association of Retired Persons, and who is a gerontologist or whose practice otherwise is primarily among the aged. The initial appointee shall serve a two-year term;
  4. (D) One (1) practicing pediatrician who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested pediatric groups, including, but not limited to, the Tennessee Chapter of the American Academy of Pediatrics. The initial appointee shall serve a one-year term;
  5. (E) One (1) family practitioner who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested family physician groups, including, but not limited to, the Tennessee Academy of Family Physicians. The initial appointee shall serve a two-year term;
  6. (F) One (1) practicing cardiologist who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested cardiology groups, including, but not limited to, the Tennessee Chapter of the American College of Cardiology. The initial appointee shall serve a three-year term;
  7. (G) One (1) practicing pharmacist who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested chain drug groups, including, but not limited to, the Tennessee Chain Drug Council. The initial appointee shall serve a one-year term;
  8. (H) One (1) pharmacy director from a managed care organization participating in the TennCare program. The initial appointee shall serve a two-year term; and
  9. (I) One (1) member of an organization engaged in advocacy on behalf of members of the TennCare program. The initial appointee shall serve a three-year term.
3. (3) Appointments by the speaker of the senate shall be made as follows:
  1. (A) One (1) general internist who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested medical groups, including, but not limited to, the Tennessee Medical Association. The initial appointee shall serve a three-year term; and
  2. (B) One (1) practicing pharmacist who is engaged in the retail distribution of prescription drugs and who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested pharmacist groups, including, but not limited to, the Tennessee Pharmacists Association. The initial appointee shall serve a two-year term.
4. (4) Appointments by the speaker of the house of representatives shall be made as follows:
  1. (A) One (1) general internist who participates in the TennCare program from a list of all general internists provided by interested medical groups, including, but not limited to, the Tennessee Chapter of the American College of Physicians. The initial appointee shall serve a one-year term; and
  2. (B) One (1) practicing pharmacist who is engaged in the distribution of prescription drugs in the nursing home industry and who participates in the TennCare program, who may be appointed from lists of qualified persons submitted by interested pharmacist groups, including, but not limited to, the Tennessee Pharmacists Association. The initial appointee shall serve a three-year term.
5. (5) The pharmacy director and medical director of TennCare; the chair of the health committee of the house of representatives, or the chair's designee; and the chair of the health and welfare committee of the senate, or the chair's designee shall serve as ex officio members of the state TennCare pharmacy advisory committee.
(c) The appointing authorities shall consult with the interested groups listed in subsection (b) to determine qualified persons to fill the positions.
(d) In making appointments to the committee, the appointing authorities shall strive to ensure the committee's membership is representative of the state's geographic and demographic composition with appropriate attention to the representation of women and minorities.
(e) The governor shall appoint a chair and vice chair of the committee, whose terms shall expire on December 31 of the year in which they are appointed or upon the appointment of their successors by the governor, whichever is later.
(f)
1. (1) The chair of the committee shall call meetings of the committee and shall preside at all regular and special meetings of the committee, appoint members to any subcommittees established by the committee, prepare agendas with the assistance of the pharmacy director and the medical director of TennCare, and notify members of their removal from the committee.
2. (2) The vice chair shall exercise all powers of the chair in the event of the absence or inability of the chair to serve and shall perform other duties as the chair may assign to the vice chair.
(g) Committee meetings shall follow Robert's Revised Rules of Order.
(h) Committee meetings shall be subject to title 8, chapter 44; provided, however, that notice of meetings and the agenda for the meetings shall be made available to the public not less than ten (10) days prior to any meeting of the committee.
(i) Committee decisions shall be made based on affirmative votes of the majority of members present at official meetings.
(j) The committee shall keep minutes of all meetings including votes on all recommendations regarding drugs to be included on the state preferred drug list.
(k) A quorum shall be established by the presence of eight (8) committee members present at an official meeting.
(l) The chair may request that other physicians, pharmacists, faculty members of institutions of higher learning, or medical experts who participate in various subspecialties act as consultants to the committee as needed.
(m) Vacancies shall be filled by the appropriate appointing authority in the same manner as full terms for the remainder of the unexpired term.
(n)
1. (1) The TennCare pharmacy advisory committee shall have recommendation authority over any new proposed deletions or additions to drugs currently on the TennCare bureau's auto-exemption list. It is the legislative intent that, insofar as practical, the TennCare bureau shall have the benefit of the committee's recommendations prior to deleting or adding a drug from the auto-exemption list.
2. (2) The pharmacy advisory committee shall establish a special review subcommittee comprised of practicing medical specialists and medical faculty members of institutions of higher learning with expertise in the usage and prescribing of the medications under review to provide expert advice on the new proposed changes. The subcommittee shall be appointed by the chairman in consultation with members of the pharmacy advisory committee.
3. (3) Meetings of the special review subcommittee established pursuant to this subsection (n) shall meet the requirements of the state's open meetings law, compiled in title 8, chapter 44, and documents relating to any recommendations made by the subcommittee to limit access to a medication or biological under review shall be available under the open records law. Members of the public attending the meeting shall be granted the opportunity to comment on information presented prior to the subcommittee making its final recommendation.

Backlinks (1)

4-29-248(a)(42)

History (6)

Acts 2003, ch. 350, § 1
2005, ch. 153, §§ 1, 2
2009, ch. 509, § 1
2012, ch. 699, §§ 3, 4
2012, ch. 825, § 1
2016, ch. 1079, § 7.

§ 71-5-2402. Removal of member.

A state TennCare pharmacy advisory committee member shall be removed by the commissioner of finance and administration from the committee for any of the following causes:
1. (1) Absence from two (2) consecutive meetings without contacting the chair or the vice chair with a satisfactory explanation;
2. (2) Absence from three (3) meetings in a single year without contacting the chair or the vice chair with a satisfactory explanation;
3. (3) Violation of § 71-5-2403(a) and (b); or
4. (4) Violation of § 71-5-197(d).

History (1)

Acts 2003, ch. 350, § 1.

§ 71-5-2403. Conflicts of interest — Compensation.

(a) Members of the state TennCare pharmacy advisory committee shall not enter any financial relationships with pharmaceutical manufacturers or their affiliates during their tenure on the state TennCare pharmacy advisory committee. A member shall not entertain individual lobbying or marketing, or participate in any other activity or discussions with pharmaceutical manufacturers or their representatives for the purpose of influencing the preferred drug list (PDL) that would call into question the member's impartiality in determining drugs to recommend for inclusion on a state PDL. Nothing in this subsection (a) shall prohibit a member from engaging in common business practices or prohibit communications to or from the member that occur in the ordinary course of the member's business or professional activities.
Backlinks (1)
- 71-5-2402(3)
(b) A conflict of interest exists when the member has a significant personal, professional, or monetary interest in a matter under consideration by the state TennCare pharmacy advisory committee. Persons being considered for membership on the state TennCare pharmacy advisory committee shall disclose if they have a real or apparent conflict of interest. Conflicts of interest may include, but shall not be limited to, being the recipient of a grant, hired as a consultant, being part of a speakers bureau, a major stock holder, or the recipient of other financial support from an organization likely to benefit financially from the outcome of the state TennCare pharmacy advisory committee's work.
(c) Members shall dispose of matters before the committee in an unbiased and professional manner. In the event that a matter being considered by the committee presents a real or apparent conflict of interest, such members shall disclose the conflict to the chair and recuse themselves from any official action on the matter.
(d) Members shall receive no compensation for their service on the state TennCare pharmacy advisory committee but may be reimbursed for those expenses allowed by the comprehensive travel regulations promulgated by the department of finance and administration and approved by the attorney general and reporter.

History (1)

Acts 2003, ch. 350, § 1.

§ 71-5-2404. Recommendations for inclusion on preferred drug list.

(a) The TennCare pharmacy advisory committee shall submit to the bureau of TennCare both specific and general recommendations for drugs to be included on any state preferred drug list (PDL) adopted by the bureau. In making its recommendations, the committee shall consider factors including, but not limited to, efficacy, the use of generic drugs and therapeutic equivalent drugs, and cost information related to each drug. The committee shall also submit recommendations to the bureau regarding computerized, voice, and written prior authorization, including prior authorization criteria, and step therapy.
(b) The state TennCare pharmacy advisory committee shall include evidence-based research in making its recommendations for drugs to be included on the PDL.
(c)
1. (1) Any individual shall be permitted to make a public presentation to the TennCare pharmacy advisory committee regarding a drug or classes of drugs under consideration for the TennCare preferred drug list, in accordance with the following:
  1. (A) A presentation shall be limited to an agenda item and there shall be a maximum of three (3) presentations per agenda item;
  2. (B) A request to make a verbal presentation shall be submitted in writing by fax or electronically to the pharmacy director of the bureau of TennCare, or the named designee, with a copy to the chairman of the TennCare pharmacy advisory committee no later than seventy-two (72) hours in advance of the scheduled meeting;
  3. (C) The time limit for a verbal presentation by or on behalf of a pharmaceutical manufacturer shall not exceed five (5) minutes in aggregate per drug per manufacturer or organization, or five (5) minutes by an individual, manufacturer or organization speaking on a particular position. The committee may, by a unanimous vote, extend the time limitation for presentation; and
  4. (D) An individual, manufacturer or organization may present updated or new information, including drug package insert changes, new indications or peer-reviewed journal articles on a product.
2. (2) The committee may receive written studies, data and information relative to the cost-effectiveness of drugs being considered for placement on the preferred drug list. Such written information shall be distributed to the TennCare pharmacy advisory committee members. Such written information must be received by the TennCare pharmacy director no later than five (5) business days prior to the scheduled pharmacy advisory committee meeting.
(d) TennCare or its designee shall provide the state TennCare pharmacy advisory committee, the office of inspector general, and the state's medicaid fraud control unit with clinical and economic research and utilization information as requested on drugs and drug classes.
(e) The TennCare bureau shall consider the recommendations of the state TennCare pharmacy advisory committee in amending or revising any PDL adopted by the bureau to apply to pharmacy expenditures within the TennCare program. The recommendations of the committee are advisory only, and the bureau may adopt or amend a PDL regardless of whether it has received any recommendations from the committee. It is the legislative intent that, insofar as practical, the TennCare bureau shall have the benefit of the committee's recommendations prior to implementing a PDL or portions thereof.

History (3)

Acts 2003, ch. 350, § 1
2004, ch. 673, §§ 16, 17
2005, ch. 259, § 1.

Part 25 TennCare Fraud and Abuse

§ 71-5-2501. Short title.

This part shall be known and may be cited as “The TennCare Fraud and Abuse Reform Act of 2004”.

Backlinks (1)

56-7-2912

History (1)

Acts 2004, ch. 673, § 20.

§ 71-5-2502. Office of inspector general.

There is created a division of state government which shall be known and designated as the office of inspector general. This division shall be located within the department of finance and administration and shall report directly to the commissioner of finance and administration. The office of inspector general shall be headed by an inspector general. The office of inspector general shall be separate and distinct from the TennCare bureau and the medicaid fraud control unit (MFCU).

Backlinks (1)

56-7-2912

History (2)

Acts 2004, ch. 673, § 20
2005, ch. 474, §§ 8, 9.

§ 71-5-2503. Part definitions.

As used in this part and part 26 unless the context otherwise requires:
1. (1) “Abuse” shall be given the same meaning as currently exists in federal regulations located at 42 CFR 455.2, with the following exceptions:
  1. (A) It shall also apply to practices by vendors or other persons or entities; and
  2. (B) It shall also apply to the TennCare program;
2. (2) “Applicant” means any person who has applied for benefits under part 1 of this chapter;
3. (3) “Benefits” means the health care package of services available to TennCare enrollees;
4. (4) “Claim” includes any request or demand for money, property, or services made to any employee, officer, or agent of the state, or to any contractor, grantee, or other recipient of state funds, whether under contract or not, if any portion of the money, property, or services requested or demanded issued from, or was provided by, TennCare;
5. (5) “CMS” (centers for medicare and medicaid services), means the agency within the United States department of health and human services that is responsible for administering Title XVIII (42 U.S.C. § 1395 et seq.), Title XIX (42 U.S.C. § 1396 et seq.), and Title XXI (42 U.S.C. § 1397aa), of the Social Security Act;
6. (6) “Commissioner” means the commissioner of finance and administration;
7. (7) “Department” means the department of finance and administration;
8. (8) “Enrollee” means an individual eligible for and enrolled in the TennCare program or in any successor medicaid program in Tennessee;
9. (9) “Fraud” means an intentional deception or misrepresentation made by a person including, but not limited to, a vendor, recipient, provider, or enrollee, with the knowledge that the deception or misrepresentation could result in some unauthorized benefit or payment to oneself or some other person. It includes any act that constitutes fraud under applicable federal or state law including, but not limited to, the Tennessee Medicaid False Claims Act, compiled in §§ 71-5-181 — 71-5-185;
10. (10) “Inspector general” means the person who directs the office of inspector general, who shall report directly to the commissioner of finance and administration;
11. (11) “Medical assistance” means payment of the cost of care, services and supplies necessary to prevent, diagnose, correct or cure conditions in the person that cause acute suffering, endanger life, result in illness or infirmity, interfere with the person's capacity for normal activity, or threaten some significant disability and which are furnished an eligible person in accordance with the rules, regulations, and statutes governing TennCare. Such care, services and supplies includes services of qualified practitioners licensed under the laws of this state;
12. (12) “MFCU” means the medicaid fraud control unit;
13. (13) “Provider” means an institution, facility, agency, person, corporation, partnership, unincorporated organization, nonprofit organization or any person or entity directly or indirectly providing benefits, goods or services to a TennCare enrollee. Provider also means a provider's agent, contractor or subcontractor, such as a billing agent;
14. (14) “Recipient” means any person who has been determined eligible to receive benefits under part 1 of this chapter, and who has received such benefits;
15. (15) “TennCare” means the program administered by the single state agency, as designated by the state and CMS, pursuant to Title XIX of the Social Security Act (42 U.S.C. § 1396 et seq.), and the Section 1115 research and demonstration waiver granted to the state of Tennessee and any successor programs; and
16. (16) “Vendor” means any person, institution, agency, other entity or business concern providing services or goods authorized under chapter 5, part 1 of this title, and includes, but is not limited to, any health maintenance organization, managed care organization, managed care contractor, administrative services organization, pharmacy benefit manager, prepaid limited health service organization, contractor or subcontractor.

Backlinks (2)

History (3)

Acts 2004, ch. 673, § 20
2005, ch. 474, §§ 8, 16-18
2011, ch. 47, § 106.

§ 71-5-2504. Rules and regulations.

The commissioner is authorized to promulgate rules and regulations, including emergency rules pursuant to § 4-5-208, to effectuate the purposes of this part. All such rules and regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.

History (2)

Acts 2004, ch. 673, § 20
2009, ch. 566, § 12.

§ 71-5-2505. Authority.

The office of inspector general shall have the authority to:
1. (1) Investigate civil and criminal fraud and abuse of the TennCare program, or any other violations of state criminal law related to the operation of TennCare;
2. (2) Cooperate with the MFCU, and where a preliminary investigation of fraud and abuse by a provider establishes a sufficient basis to warrant a full investigation, refer such matters to the MFCU;
3. (3) Refer matters to the appropriate enforcement authority for criminal prosecution;
4. (4) Refer matters to the appropriate enforcement authorities for civil proceedings, and assist in the recovery of funds which have been inappropriately paid by the TennCare program, including, but not limited to, referral to the attorney general and reporter for civil recovery;
5. (5) Cooperate with the appropriate federal departments in any reasonable manner as may be necessary to qualify for federal aid in connection with TennCare;
6. (6) Cooperate with the federal government and other state governments to investigate TennCare and medicaid fraud and abuse;
7. (7) Cooperate with other state agencies to investigate TennCare and medicaid fraud and abuse;
8. (8) Within sixty (60) days after the close of each fiscal year, prepare and print a summary report, which shall be submitted to the governor, members of the general assembly, the TennCare advisory commission, and the commissioner. This report shall include a summary of all activities of the office of inspector general during that fiscal year;
9. (9) Furnish information to acquaint the public with the fraud and abuse laws pertaining to TennCare;
10. (10) Contract with necessary entities to carry out the required duties of this part. All such contracts shall be procured in accordance with the requirements of title 12, chapter 4, part 1; and
11. (11) Exercise any additional powers necessary to carry out the purposes and provisions of this part.

History (7)

Acts 2004, ch. 673, § 20
2005, ch. 474, § 8
2006, ch. 867, § 8
2010, ch. 872, § 7
2011, ch. 410, § 6(g)
2019, ch. 345, § 142
2021, ch. 64, § 127.

§ 71-5-2506. Fraud and abuse cases.

(a) The office of inspector general shall have the authority to provide legal assistance to the attorney general and reporter and the state district attorneys general for the purpose of initiating and handling proceedings in appropriate TennCare fraud and abuse cases. Such assistance may include but not be limited to, the authority to fund assistant attorney general or assistant district attorney general positions in those respective offices, subject to the appropriations made to the office of inspector general and the agreement of the offices concerned. The office of inspector general shall also have the authority to fund public defender positions, subject to the appropriations made to the office of inspector general and the agreement of the officers concerned. The office of inspector general may, with reasonable notice, terminate the funding of any attorney positions which the inspector general has funded in either of these offices.
(b) Venue for civil actions involving fraud and abuse shall be in the county where the offense was committed or in Davidson County. Venue for criminal actions involving fraud and abuse shall be to the full extent permitted by the constitution of the state.

History (2)

Acts 2004, ch. 673, § 20
2005, ch. 474, § 8.

§ 71-5-2507. Enforcement by law enforcement officers.

(a) The staff of the office of inspector general may include law enforcement officers, as defined in § 39-11-106(a) and qualified as defined in § 38-8-106, who have successfully completed a training course approved by the Tennessee peace officer standards and training commission, including surveillance training.
(b) Any duly authorized law enforcement officer who has been specifically designated by the inspector general to enforce this part is authorized and empowered to go armed while on active duty engaged in enforcing this part; and is authorized to make arrests for offenses involving criminal fraud and abuse of the TennCare program and any other violations of state criminal law related to the operation of TennCare. Any such person is also authorized and empowered to execute search warrants and do all acts incident thereto in the same manner as search warrants may be executed by sheriffs and other peace officers.

History (3)

Acts 2004, ch. 673, § 20
2005, ch. 474, § 8
2017, ch. 244, § 1.

§ 71-5-2508. Medicaid fraud control unit.

There is established a medicaid fraud control unit, referred to as the medicaid fraud control division, which is separate and distinct from the state medicaid agency, and is within the Tennessee bureau of investigation or within another appropriate agency at the discretion of the governor. As regulated by federal law, the unit is authorized to investigate and refer for prosecution violations of all applicable laws pertaining to provider or vendor fraud and abuse in the administration of the medicaid program; the provision of goods or services or the activities of providers of goods or services under the state medicaid plan; medicare fraud; abuse, neglect, and misappropriation of funds or property in healthcare facilities receiving payments under the state medicaid plan and in board and care facilities as allowed by federal law; and complaints of abuse, neglect, and financial exploitation of medicaid recipients in any setting. A summary of the unit's work shall be included in a report which must be submitted annually to the governor, judiciary committee of the senate, and criminal justice committee of the house of representatives.

History (6)

Acts 2004, ch. 673, § 20
2005, ch. 474, §§ 19, 20
2013, ch. 236, § 42
2019, ch. 345, § 143
2021, ch. 64, § 128
2023, ch. 88, § 1.

§ 71-5-2509. Powers when investigating fraud or abuse — Judicial enforcement.

(a)
1. (1) The office of inspector general, when conducting any investigation relating to TennCare fraud or abuse, shall have the power to issue subpoenas, and compel the attendance of witnesses, the examination of such witnesses under oath, and the production of books, accounts, papers, records, and documents relating to such investigation.
2. (2) In the case of a failure of any person, firm, or corporation so subpoenaed to attend or to produce the specified records, and after reasonable notice to such person, firm, or corporation, the office of inspector general may seek judicial enforcement of the subpoena by filing, through the attorney general and reporter, a petition with the circuit or chancery court of Davidson County or of the judicial district in which such person, firm, or corporation resides. Such petition shall incorporate or be accompanied by a certification regarding the notice given and the failure of such person, firm or corporation to attend or produce the records.
3. (3) Upon the filing of such a petition in proper form, the court shall order the person, firm, or corporation named in the petition to appear and show cause why they should not comply with the subpoena or be held in contempt for failure to comply. The court shall have authority to employ all judicial power as provided by law to compel compliance with the subpoena, including those powers granted in §§ 29-9-103 — 29-9-106. The court shall be authorized to impose costs and sanctions against any such person, firm, or corporation, in the same manner and on the same bases as may be imposed for failure to comply with judicially issued subpoenas under the Tennessee Rules of Civil Procedure.
4. (4) The court may order the person, firm, or corporation to comply, and shall have the authority to punish each day of failure to comply with such order as a separate contempt of court.
5. (5) The subpoena enforcement remedies set forth in this subsection (a) shall be cumulative, and not exclusive, of any other remedies provided by law for the enforcement of such subpoenas.
(b) The office of inspector general shall have the power to compel the production of current and former employment records during an investigation. Employment records include, but are not limited to, employment details, wages, and insurance information of TennCare applicants and enrollees. Employment records shall be open to inspection and be subject to being copied by an office of inspector general representative at any reasonable time and as often as may be necessary. The office of inspector general shall also have the right to compare information reported to TennCare by applicants or enrollees with data maintained by the credit bureaus.
(c) The complete patient record of an enrollee or recipient generated during the TennCare enrollment period shall be made available to the office of inspector general upon request. This includes any and all services, goods and pharmaceuticals dispensed regardless of payment source. Access to these records under this section may occur during and after enrollment in the TennCare program. Records accessed during an investigation shall be protected in accordance with state and federal privacy laws.

History (2)

Acts 2004, ch. 673, § 20
2005, ch. 474, § 8.

§ 71-5-2510. Investigations of fraud or abuse involving managed care organizations.

Notwithstanding any other provision of this chapter or of title 38, the Tennessee bureau of investigation and the office of inspector general are authorized to investigate allegations of fraud or abuse involving TennCare managed care organizations.

History (1)

Acts 2005, ch. 157, § 2.

§ 71-5-2511. Annual reports.

(a) The inspector general shall annually report by October 1 of each year for the prior fiscal year to the governor and the general assembly on the activities of the inspector general's office. The report shall include actual numbers of complaints, investigation, charges, prosecutions, convictions and appeals.
(b) The director of the Tennessee bureau of investigation shall annually report to the governor and the general assembly on the activities of the medicaid fraud control unit within the criminal investigation division. The report shall include actual numbers of complaints, investigation, charges, prosecutions, convictions and appeals.

History (1)

Acts 2005, ch. 157, § 1.

§ 71-5-2512. Cash reward program for reporting criminal fraud by recipients of the TennCare program.

(a) The office of inspector general shall establish an incentive program to provide a cash reward to citizens who notify the office of inspector general of criminal fraud by recipients of the TennCare program. The cash reward shall be paid if the information provided by the citizen results in a criminal conviction. Such cash awards shall be set at a meaningful amount through a schedule to be established by the office of inspector general.
(b) The office of inspector general shall furnish information to acquaint the public with the existence of the program and the means by which citizens may participate.
(c) The commissioner of finance and administration shall use the commissioner's rule-making authority under this chapter to promulgate rules establishing the program mandated by subsection (a).
(d) The office of inspector general shall file with the commerce and labor committee of the senate and the insurance committee of the house of representatives, by February 15 of each year, an annual report of all moneys paid to citizens pursuant to the program established by this section.

History (4)

Acts 2005, ch. 474, § 26
2013, ch. 236, § 19
2019, ch. 345, § 144
2021, ch. 64, § 129.

§ 71-5-2513. Legislative intent.

The general assembly recognizes that data mining is an important tool that should be used for the detection of fraud and abuse in the TennCare program; therefore, it is the intention of the general assembly that:
1. (1) The office of inspector general shall engage in data mining relating to the receipt of medical assistance and any assistance paid for by TennCare on behalf of recipients, for the purpose of detecting fraud or abuse by recipients;
2. (2) The inspector general shall have prompt, continuing, and effective access to all such data in a manner that will permit effective data mining for these purposes without imposing unduly burdensome or oppressive requirements on persons or entities that provide medical assistance or any assistance paid for by TennCare; and
3. (3) Data mining by the office of the inspector general is not intended to alter the requirements under Title XIX of the federal Social Security Act (42 U.S.C. § 1395 et seq.), including, but not limited to, the requirements that the single state agency designated to administer the medicaid program must have methods and criteria for identifying suspected fraud cases, must have a method for verifying whether services billed were received, and must cooperate with the state's medicaid fraud control unit.

Backlinks (7)

History (1)

Acts 2006, ch. 1010, § 1.

§ 71-5-2514. Definitions.

As used in §§ 71-5-2513 — 71-5-2521, unless the context otherwise requires:
1. (1) “Access” means the ability to extract intelligible information through automated means, and to store, retrieve, use, and otherwise manipulate that information in a way that may lead to meaningful analysis with the aid of commonly available computer software and hardware;
2. (2) “Data” means representations of information, knowledge, facts, concepts, or instructions that are being prepared or have been prepared in a formalized manner, and are intended to be stored or processed, or are being stored or processed, or have been stored or processed in a computer, computer system, computer network or other electronic medium;
3. (3) “Data mining” means the automated extraction of predictive information from data for the purpose of finding patterns of behavior and trends or anomalies that may otherwise escape detection, the advanced statistical analysis and modeling of the data to find useful patterns and relationships, and the use of computational techniques involving statistics, machine learning and pattern recognition to analyze the data;
4. (4) “Single state agency” means the agency of the state of Tennessee that is designated, pursuant to 42 CFR 431.10(b), to administer or supervise the administration of the medicaid program under Title XIX of the Social Security Act (42 U.S.C. § 1395 et seq.); and
5. (5) “TennCare related data” means all data that relates to medical assistance or any assistance to TennCare recipients, applicants, or enrollees as defined in this part. The data includes data evidencing identity and eligibility of recipients and the receipt by recipients of medical assistance or any assistance paid for by TennCare.

History (1)

Acts 2006, ch. 1010, § 1.

§ 71-5-2515. Data provided to the inspector general.

All persons and entities under contract with the TennCare bureau or its agent or designee, including, but not limited to, all managed care organizations, benefit managers, and other managed care contractors, shall promptly provide to the office of inspector general, on request:
1. (1) A copy of, or access to, the same data regularly provided to the bureau in the normal course of business, and in the same format, unless otherwise agreed by the inspector general in writing; and
2. (2) Access to additional TennCare related data or records that may be requested by the inspector general; provided, that, if the data is not easily separated from non-TennCare related data, then all the data shall be provided as necessary to provide meaningful access to the TennCare related data.

History (1)

Acts 2006, ch. 1010, § 1.

§ 71-5-2516. Confidentiality — Liability for providing data — Creation of new records or data — Destruction of data.

(a) All records obtained pursuant to this chapter shall be treated as confidential investigative records of the office of inspector general and shall not be open to public inspection; provided, however, that nothing in this part shall be construed to affect the obligation of the single state agency under federal law to provide the medicaid fraud control unit with access to, and free copies of, all records or information or computerized data kept or stored by the agency pursuant to 42 CFR 455.21(a).
(b) Notwithstanding any other law to the contrary, no person shall be subject to any civil or criminal liability for providing the office of inspector general with access to data as required by this chapter.
(c) Nothing in this chapter shall be construed to require any person or entity to create new records or data that did not exist at the time of the request; provided, that no person or entity may destroy existing data after having been put on notice that access to the data is required pursuant to this section.

History (1)

Acts 2006, ch. 1010, § 1.

§ 71-5-2517. Authority to require periodic provision of specific data — Compliance — Format of data — Charge for supplying data — Sufficient dedicated storage space and access to software — Construction.

(a) The office of inspector general is authorized to require periodic provision of specific categories, types, or collations of data without the necessity of issuing a new request at the commencement of each period.
(b) Compliance with a request by the office of inspector general is not dependent on approval by the bureau of TennCare, and it shall not be a defense to an action for enforcement or sanctions under this part that the bureau of TennCare does not require copies of or access to the requested data.
(c) Data kept in the regular course of business in electronic format shall on request be provided to the office of inspector general in the same electronic format. The data shall be provided in a manner that permits meaningful analysis with the aid of commonly available computer software and hardware. To this end, access to data shall be accompanied by access to any existing record layout, field definitions, or other guides or directions associated with the data.
(d) Notwithstanding any law to the contrary, access to data required pursuant to §§ 71-5-2513 — 71-5-2521 shall be provided to the office of inspector general without charge.
(e) The division of strategic technology solutions shall assist the office of inspector general by providing sufficient dedicated storage space and access to software on the state's computer network to permit the office of inspector general to accomplish the data mining contemplated by §§ 71-5-2513 — 71-5-2521.
(f) Nothing in this part shall be construed to prevent the bureau of TennCare or any other subdivision of the single state agency from conducting data mining, identifying suspected fraud cases, and referring suspected provider fraud to the medicaid fraud control unit pursuant to 42 CFR, Part 455. Nothing in this part shall be construed to affect the obligation of the single state medicaid agency or any of its subdivisions to refer to the medicaid fraud control unit, pursuant to 42 CFR 455, all cases in which the agency has reason to believe, after a preliminary investigation, that an incident of provider fraud or abuse has occurred in the TennCare program.

History (2)

Acts 2006, ch. 1010, § 1
2020, ch. 690, § 21.

§ 71-5-2518. Rules and regulations.

The inspector general shall have authority to promulgate rules and regulations pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, as are necessary to implement §§ 71-5-2513 — 71-5-2521. The rules shall be promulgated as emergency rules. The inspector general is designated as the agency person to review initial orders and issue final agency orders pursuant to the Uniform Administrative Procedures Act.

History (2)

Acts 2006, ch. 1010, § 1
2009, ch. 566, § 12.

§ 71-5-2519. Written petition for objection to providing access to data — Enforcement of obligations.

(a) A person or entity requested to provide access to data pursuant to §§ 71-5-2513 — 71-5-2521 may object to providing all or part of such access by filing a written petition with the inspector general within thirty (30) days of receipt of notice of the request to which objection is made. The petition shall be treated as a contested case pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
(b)
1. (1) In the event a person or entity requested to provide data pursuant to §§ 71-5-2513 — 71-5-2521 fails to do so or to file a timely petition objecting to provision of the data, the office of inspector general has the authority to petition the chancery court of Davidson County through the attorney general and reporter, or by special appointment or delegation from the attorney general and reporter as provided by law, for enforcement of the obligations imposed by this chapter, and for recovery of costs, attorney's fees, and any applicable civil penalties.
2. (2) Upon filing of a petition for enforcement by the inspector general, the court shall order the person or entity named in the petition to show cause why they should not be held in contempt for failure to comply with the request.
3. (3) In ruling on the petition, the court shall be authorized to:
  1. (A) Order the person or entity, on pain of contempt, to comply with the request, and to punish each day of failure to comply with the order as a separate contempt of court; and
  2. (B) Award to the attorney general and reporter and, if applicable, the office of inspector general, reasonable costs and attorney's fees incurred in enforcing the requirement, if the state prevails.
(c)
1. (1) Willful failure to provide data, or access to data, as required by this chapter, shall be subject to the same civil penalty established by law for willful failure to report recipient fraud to the inspector general.
2. (2) A person or entity that has been assessed a civil penalty by the office of inspector general may object to the penalty by filing a written petition with the inspector general within thirty (30) days of receipt of notice of the assessment. The petition shall be treated as a contested case pursuant to the Uniform Administrative Procedures Act.
3. (3) In the event that a person or entity that has been assessed a civil penalty by the office of inspector general has failed to pay the penalty or file a timely objection, the office of inspector general has the authority to file a petition in the chancery court of Davidson County through the attorney general and reporter, or by delegation from the attorney general and reporter as provided by law, for the collection of the penalty, and for enforcement of the request to provide access to data.

History (1)

Acts 2006, ch. 1010, § 1.

§ 71-5-2520. Collections of penalties, fees and costs.

(a) All funds collected as civil penalties, attorney's fees, costs, or costs of investigation by the inspector general, pursuant to this part or part 26, shall be deposited by the state treasurer in a separate account exclusively for the use of that office to defray the expenses of continued operations involving recipient fraud and abuse, including, but not limited to, data mining, litigation, criminal investigation and prosecution, civil and administrative recovery, undercover operations involving recipient fraud, and training and equipment for employees; provided, that no part of the funds shall be used to supplement salaries of any public employee or law enforcement officer.
(b) Funds collected pursuant to §§ 71-5-2513 — 71-5-2521 may not supplant other state funds or appropriations. Any fund balance remaining unexpended at the end of a fiscal year in the account shall be carried forward into the subsequent fiscal year. No part of the fund shall be diverted to the general fund or any other public fund.

History (1)

Acts 2006, ch. 1010, § 1.

§ 71-5-2521. Report.

The office of inspector general shall include in its annual report information on the progress of its data mining efforts, including any difficulties encountered in obtaining access to data from either private or government entities, and suggestions for legislative or other solutions.

Backlinks (7)

History (1)

Acts 2006, ch. 1010, § 1.

Part 26 Prevention of Fraud and Abuse in TennCare

§ 71-5-2601. Offenses — Penalties — Remedies — Limitations.

(a)
1. (1)
  1. (A) A person, including an enrollee, recipient, or applicant, commits an offense who knowingly obtains, or attempts to obtain, or aids or abets any person to obtain, by means of a willfully false statement, representation, or impersonation, or by concealment of any material fact, or by any other fraudulent means, or in any manner not authorized by any rule, regulation, or statute governing TennCare:
    1. (i) Medical assistance benefits or any assistance provided pursuant to any rule, regulation, procedure, or statute governing TennCare to which such person is not entitled, or of a greater value than that to which such person is authorized;
    2. (ii) Benefits by knowingly making a willfully false statement, or concealing a material fact relating to personal or household income, thereby resulting in the assessment of a lower monthly premium than the person would be required to pay if not for the false statement or concealment of a material fact; or
    3. (iii) Controlled substance benefits by knowingly, willfully and with the intent to deceive, failing to disclose to a physician, nurse practitioner, ancillary staff, or other health care provider from whom the person obtains a controlled substance, or a prescription for a controlled substance, that the person has received either the same controlled substance or a prescription for the same controlled substance, or a controlled substance of similar therapeutic use or a prescription for a controlled substance of similar therapeutic use, from another practitioner within the previous thirty (30) days and the person used TennCare to obtain the benefits.
  2. (B) An offense under subdivision (a)(1)(A) is a Class D felony. In addition to restitution, a person who pleads guilty or nolo contendere or is found guilty of violating this section shall be fined:
    1. (i) Two hundred fifty dollars ($250) for the first offense;
    2. (ii) Five hundred dollars ($500) for the second offense; and
    3. (iii) One thousand dollars ($1,000) for a third or subsequent offense.
  3. (C) The fines authorized under subdivision (a)(1)(B) shall be collected by the county court clerk with five percent (5%) of the fine going to the clerk of the court and the remaining ninety-five percent (95%) of the fine transmitted to the state treasurer on a monthly basis for deposit in the general fund.
2. (2)
  1. (A) A person, firm, corporation, partnership or any other entity, including a vendor, other than an enrollee, recipient, or applicant, commits an offense who knowingly obtains, or attempts to obtain, or aids or abets any person or entity to obtain, by means of a willfully false statement, report, representation, claim or impersonation, or by concealment of any material fact, or by any other fraudulent means, including knowingly presenting or causing to be presented to TennCare or any of its contractors, subcontractors or vendors a false or fraudulent claim for payment or approval, or in any manner not authorized by any rule, regulation, procedure, or statute governing TennCare, medical assistance payments provided pursuant to any rule, regulation, procedure, or statute governing TennCare to which the person or entity is not entitled, or of a greater value than that to which the person or entity is authorized. For purposes of this subsection (a), “attempts to obtain” includes making or presenting to any person a claim for any payment under any rule, regulation, procedure, or statute governing TennCare, knowing the claim to be false, fictitious or fraudulent.
  2. (B) An offense under subdivision (a)(2)(A) is a Class D felony unless the value of the property or services obtained meets the threshold set for a Class B or Class C offense under § 39-14-105, in which case the appropriate higher class shall apply. In addition to any other penalty, a sentence that includes a fine, when imposed upon an entity or upon a person for actions benefiting an entity, shall include the corporation fine specified in § 40-35-111.
3. (3)
  1. (A) A person, firm, corporation, partnership or any other entity commits an offense when providing a willfully false statement regarding another's medical condition or eligibility for insurance, to aid or abet another in obtaining or attempting to obtain medical assistance payments, medical assistance benefits or any assistance provided under any rule, regulation, procedure, or statute governing TennCare to which the person is not entitled or to a greater value than that to which such person is authorized. For purposes of this subsection (a), “attempting to obtain” includes making or presenting to any person a claim for any payment under any rule, regulation, procedure, or statute governing TennCare, knowing such claim to be false, fictitious or fraudulent.
  2. (B) An offense under subdivision (a)(3)(A) is a Class D felony unless the value of the property or services obtained meets the threshold set for a Class B or Class C offense under § 39-14-105, in which case the appropriate higher class shall apply. In addition to any other penalty, a sentence that includes a fine, when imposed upon an entity or upon a person for actions benefiting an entity, shall include the corporation fine specified in § 40-35-111.
4. (4) Any person, firm, corporation, partnership or other entity is guilty of a Class D felony that, in connection with the investigation of a violation of offenses set forth in this section, knowingly and willfully:
  1. (A) Falsifies, conceals or omits by any trick, scheme, artifice, or device a material fact;
  2. (B) Makes any materially false, fictitious or fraudulent statement or representation; or
  3. (C) Makes or uses any materially false writing or document.
  Backlinks (1)
  
  39-15-513(b)
5. (5)
  1. (A) A person commits an offense who knowingly sells, delivers, or aids and abets any person in the sale or delivery of a drug and used TennCare to obtain the drug.
  2. (B) As used in this subdivision (a)(5), “drug”, “deliver” and “delivery” shall have the same meaning as set forth in § 39-17-402.
  3. (C) This subdivision (a)(5) shall not apply to any duly licensed physician, nurse practitioner, pharmacist, or other provider authorized to issue or dispense a prescription acting in good faith in the course of that person's profession.
  4. (D) An offense under this subdivision (a)(5) is a Class D felony.
(b) In addition to any other penalties provided for any person, firm, corporation, partnership or other entity under subsection (a), the court shall also:
1. (1)
  1. (A) Order restitution to TennCare in the greater of the total amount of all medical assistance payments made to all providers, or the total amount of all payments to a managed care entity, related to the services underlying the offense; and
  2. (B) Report the person or entity to the appropriate professional licensure board or the department of commerce and insurance for disciplinary action.
2. (2) In addition to any other penalties provided under this section, the court may also, to the full extent permitted by federal law and the TennCare waiver as interpreted by the CMS, order any such person or entity disqualified from participation in the medical assistance program; such disqualification may also apply to any person who is convicted of a criminal offense involving the selling of prescription drugs obtained through the TennCare program. Any person or entity disqualified from participation in the medical assistance program shall make restitution in the total amount of the medical assistance or underpayment which forms the basis for the conviction before such person or entity can reenroll in the TennCare program.
3. (3) A subsequent denial of eligibility or denial of a claim for payment does not, of itself, establish proof of falsity of a statement, representation, report or claim for payment under subsection (a).
(c) Nothing in this section shall be construed as prohibiting a person or entity violating this section from being prosecuted for theft of property or services under title 39, chapter 14.
(d) In addition to any other remedy available, including those provided in this section, the state may recover from any person or such person's estate, or from a firm, corporation, partnership or other entity, including a vendor, the amount of medical assistance benefits or payments improperly paid as a result of fraudulent means or actions not authorized by any rule, regulation, procedure, or statute governing TennCare.
(e) Notwithstanding any other law to the contrary, prosecutions for violations of this section shall be commenced within four (4) years after the commission of the offense.

Backlinks (1)

53-11-402(a)(6)

History (6)

Acts 2004, ch. 784, § 1
2007, ch. 103, § 1
2007, ch. 458, §§ 1, 2
2008, ch. 1139, § 1
2013, ch. 159, §§ 1, 2
2016, ch. 744, §§ 1, 2.

§ 71-5-2602. Record keeping.

(a) Upon submitting a claim for, or upon receiving payment for, goods, services, items, facilities or accommodations under the TennCare program, a managed care organization, provider, vendor, subcontractor, or any other person or entity, shall maintain adequate records for a minimum of five (5) years after the date on which payment was received, if payment was received, or for five (5) years after the date on which the claim was submitted, if payment was not received. The bureau of TennCare shall have the authority to make appropriate and reasonable exceptions to the requirements of this subsection (a) upon a showing of good cause.
(b) Failure to maintain adequate records is defined as negligently failing to maintain such records as are necessary to disclose fully the nature of the goods, services, items, facilities, or accommodations for which a claim was submitted or payment was received by the managed care organization, provider, vendor, subcontractor, or any other person or entity receiving funds originating from the TennCare program. Records include records kept in any form or fashion, including, but not limited to, any and all medical records, documents, data, or items, electronic or nonelectronic, related to the provision of and billing for services and goods. Failure to maintain adequate records during an audit period is punishable by recovery of one hundred fifty percent (150%) of the amount payable to the person or entity, directly or indirectly, using TennCare funds for the TennCare-related services for which the person or entity has failed to maintain records. Failure to maintain adequate records during a subsequent audit period is punishable by recovery of three hundred percent (300%) of the amount payable to the person or entity, directly or indirectly, using TennCare funds for the TennCare-related services for which the person or entity has failed to maintain records. Any further offense within five (5) years of the second offense may result in a recommendation by the office of inspector general to the bureau of TennCare to restrict the person or entity from receiving future TennCare payments. These matters shall be referred to the attorney general and reporter for recovery of funds.

History (2)

Acts 2004, ch. 784, § 1
2005, ch. 474, §§ 21, 22.

§ 71-5-2603. Fraud reporting requirements — Immunity from liability.

(a) All managed care organizations, contractors, subcontractors, providers or any other person or entity shall advise the office of TennCare inspector general immediately when there is actual knowledge, not subject to a testimonial privilege, that an act of recipient, enrollee, or applicant fraud is being, or has been committed. The office of TennCare inspector general shall review the information to determine if there is a sufficient basis to warrant a full investigation. The office of TennCare inspector general is authorized to establish an electronic system for treating physicians to report recipient, enrollee or applicant fraud.
(b) All managed care organizations, contractors, subcontractors, providers or any other person or entity shall advise the medicaid fraud control unit (MFCU) immediately when there is actual knowledge, not subject to a testimonial privilege, that an act of provider fraud is being, or has been committed. The MFCU shall review the information to determine if there is a sufficient basis to warrant a full investigation. MFCU is authorized to establish an electronic system for treating physicians to report provider fraud.
(c) Any person or entity making a complaint or furnishing a report, information or records in good faith pursuant to this section is immune from civil liability for making such complaint or report.
(d) Willful failure to report such fraud shall be subject to a civil penalty of not more than ten thousand dollars ($10,000) for each finding to be assessed by the office of TennCare inspector general.

History (1)

Acts 2004, ch. 784, § 1.

§ 71-5-2604. Administrative remedies — Recovery of costs — Contested cases — Rules and regulations — Final orders.

(a) Without regard to any other civil or criminal liability that might attach, by operation of this section or any other law, the office of inspector general shall have an administrative remedy against an enrollee, recipient, applicant, or person purporting to be an enrollee, recipient, or applicant, who improperly obtains medical assistance benefits or any assistance from the TennCare program, to which the person is not entitled. The office of inspector general shall also have an administrative remedy against any person who assists any enrollee, recipient, or applicant, or purported enrollee, recipient, or applicant in improperly obtaining benefits or assistance.
(b)
1. (1) The administrative remedy established by this section shall be for the recovery of the amount of:
  1. (A) Any medical assistance benefits or any assistance improperly paid for by TennCare as a result of any misrepresentation or omission made by the person, to the extent that the amount has not otherwise been recovered by the TennCare bureau; and
  2. (B) Any unpaid or underpaid premiums that were assessed at a lower monthly amount than would have been set if not for the misrepresentation or omission by the person, to the extent that the amount has not otherwise been recovered by the TennCare bureau.
2. (2) All such persons shall be jointly and severally liable to the state of Tennessee.
(c) The office of inspector general shall also have a right to recover the reasonable costs of proceedings pursuant to this section, including professional fees of court reporters and hearing officers or administrative judges, the reasonable costs of investigating claims arising under this section, reasonable attorney's fees, as well as interest on the amount owed by the person, calculated from the date that the medical assistance or any assistance was improperly received, or from the date the correct premiums should have been paid.
(d) All costs of medical assistance, or any assistance, or unpaid premiums recouped pursuant to this section, and any interest thereon, shall be paid to the TennCare bureau. All costs of proceedings, investigative costs, and attorney's fees pursuant to this section shall be paid to the office of inspector general, except as otherwise provided.
(e) Notwithstanding any other law to the contrary, administrative actions pursuant to this section shall be commenced within four (4) years after the date of discovery by the state of the acts of misrepresentation or omission.
(f) The office of inspector general may invoke the remedy established by this section by initiating a contested case in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. In an administrative action under this subsection (f), the office of the inspector general shall show that the amount sought to be recovered was paid in the form of medical assistance benefits or any assistance as a result of material misrepresentation or omission. The office of inspector general need not show that the misrepresentation or omission was intentional or fraudulent.
(g) The inspector general shall have authority to promulgate rules and regulations pursuant to the Uniform Administrative Procedures Act, as are necessary to implement this part. The rules shall be promulgated as emergency rules. For purposes of rendering a final order pursuant to the Uniform Administrative Procedures Act, the inspector general is designated the agency person to review initial orders and issue final agency decisions. Orders issued by the inspector general shall have the effect of a final order pursuant to the Uniform Administrative Procedures Act.
(h)
1. (1) Whenever an order issued by the inspector general pursuant to this part has become final, a notarized copy of the order may be filed in the office of the clerk of the chancery court of Davidson County.
2. (2) When filed in accordance with this section, a final order shall be considered as a judgment by consent of the parties on the same terms and condition as those recited in the final order. The judgment shall be promptly entered by the court. Except as otherwise provided in this section, the procedure for entry of judgment and the effect of the judgment shall be the same as provided in title 26, chapter 6.
3. (3) A judgment entered pursuant to this section shall become final on the date of entry.
4. (4) A final judgment under this subsection (h) has the same effect, is subject to the same procedures, and may be enforced or satisfied in the same manner, as any other judgment of a court of record of this state.

History (2)

Acts 2006, ch. 1010, § 2
2009, ch. 566, § 12.

Chapter 6 Programs and Services for Abused Persons

Part 1 Adult Protection

§ 71-6-101. Short title — Legislative intent.

(a) This part may be cited as the “Tennessee Adult Protection Act.”
(b)
1. (1) The purpose of this part is to protect adults coming within this part from abuse, neglect or exploitation by requiring reporting of suspected cases by any person having cause to believe that such cases exist. It is intended that, as a result of such reports, the protective services of the state shall prevent further abuse, neglect or exploitation within the limitations set out in this part.
2. (2) It is recognized that adequate protection of adults will require the cooperation of many agencies and service providers in conjunction with the department of human services due to the often complex nature of the risks to this adult group, and that services to meet the needs of this group will not always be available in each community. However, it is desirable that the following services, as well as other services needed to meet the intent of this part, be available: medical care, mental health and developmental disabilities services, including in-home assessments and evaluations; in-home services including homemaker, home-health, chore, meals; emergency services including shelter; financial assistance; legal services; transportation; counseling; foster care; day care; respite care; and other services as needed to carry out the intent of this part.

History (4)

Acts 1978, ch. 899, § 1
T.C.A., § 14-2601
Acts 1986, ch. 630, § 1
T.C.A., § 14-25-101.

§ 71-6-102. Part definitions.

As used in this part, unless the context otherwise requires:
1. (1) “Abuse or neglect” means:
  1. (A) A situation in which a caretaker:
    1. (i) Inflicts physical pain, injury, or mental anguish;
    2. (ii) Deprives the adult of services that are necessary to maintain the health and welfare of the adult; or
    3. (iii) Creates a situation in which the adult is unable to provide or obtain the services that are necessary to maintain the adult's personal health or welfare, including financial abuse as defined in § 36-3-601;
  2. (B) Transporting an adult and knowingly abandoning, leaving, or failing to provide additional planned transportation for the adult if the adult's caretaker knows, or should know, that:
    1. (i) The adult is unable to protect or care for himself or herself without assistance or supervision; and
    2. (ii) The caretaker's conduct causes any of the results listed in subdivision (1)(A) or creates a substantial risk of such results; and
  3. (C) Self-neglect as defined in this section;
2. (2) “Adult” means a person eighteen (18) years of age or older who because of mental or physical dysfunctioning or advanced age is unable to manage such person's own resources, carry out the activities of daily living, or protect such person from neglect, hazardous or abusive situations without assistance from others and who has no available, willing, and responsibly able person for assistance and who may be in need of protective services; provided, however, that a person eighteen (18) years of age or older who is mentally impaired but still competent shall be deemed to be a person with mental dysfunction for the purposes of this chapter;
3. (3) “Advanced age” means sixty (60) years of age or older;
4. (4) “Capacity to consent” means the mental ability to make a rational decision, which includes the ability to perceive, appreciate all relevant facts and to reach a rational judgment upon such facts. A decision itself to refuse services cannot be the sole evidence for finding the person lacks capacity to consent;
5. (5) “Caretaker”:
  1. (A) Means an individual or institution who has assumed the duty to provide for the care of the adult by contract or agreement;
  2. (B) Includes a parent, spouse, adult child or other relative, both biological or by marriage, who:
    1. (i) Resides with or in the same building with or regularly visits the adult;
    2. (ii) Knows or reasonably should know of the adult's mental or physical dysfunction or advanced age; and
    3. (iii) Knows or reasonably should know that the adult is unable to adequately provide for the adult's own care;
  3. (C) Does not mean a financial institution as a caretaker of funds or other assets unless such financial institution has entered into an agreement to act as a trustee of such property or has been appointed by a court of competent jurisdiction to act as a trustee with regard to the property of the adult; and
  4. (D) Includes a person who resides in an elderly person's or disabled adult's personal residence and has assumed the duty to provide care for the elderly person or disabled adult or another person, including a spouse, child, or relative of the elderly person or disabled adult, who also resides in the elderly person's or disabled adult's personal residence and who knows or reasonably should know of the elderly person's or disabled adult's mental or physical dysfunction or advanced age;
6. (6) “Commissioner” means the commissioner of human services;
7. (7) “Department” means the department of human services;
8. (8) “Exploitation” means the improper use by a caretaker of funds that have been paid by a governmental agency to an adult or to the caretaker for the use or care of the adult;
9. (9) “Imminent danger” means conditions calculated to and capable of producing within a relatively short period of time a reasonable probability of resultant irreparable physical or mental harm or the cessation of life, or both, if such conditions are not removed or alleviated;
10. (10) “Investigation” includes, but is not limited to, a personal interview with the individual reported to be abused, neglected, or exploited. When abuse or neglect is allegedly the cause of death, a coroner's or doctor's report shall be examined as part of the investigation;
11. (11) “Protective services” means services undertaken by the department with or on behalf of an adult in need of protective services who is being abused, neglected, or exploited. These services may include, but are not limited to, conducting investigations of complaints of possible abuse, neglect, or exploitation to ascertain whether or not the situation and condition of the adult in need of protective services warrants further action; social services aimed at preventing and remedying abuse, neglect, and exploitation; services directed toward seeking legal determination of whether the adult in need of protective services has been abused, neglected or exploited and procurement of suitable care in or out of the adult's home;
12. (12) “Relative” means spouse; child, including stepchild, adopted child or foster child; parents, including stepparents, adoptive parents or foster parents; siblings of the whole or half-blood; step-siblings; grandparents; grandchildren, of any degree; and aunts, uncles, nieces and nephews;
13. (13) “Self-neglect” means an adult's inability, due to physical or cognitive impairment, including diminished capacity, to provide or obtain services, including medical services, necessary to maintain the adult's own health or welfare; and
14. (14) “Sexual abuse” occurs when an adult, as defined in this chapter, is forced, tricked, threatened or otherwise coerced by a person into sexual activity, involuntary exposure to sexually explicit material or language, or sexual contact against such adult's will. Sexual abuse also occurs when an adult, as defined in this chapter, is unable to give consent to such sexual activities or contact and is engaged in such activities or contact with another person.

Backlinks (12)

History (15)

Acts 1978, ch. 899, § 1
T.C.A., § 14-2602
Acts 1980, ch. 513, § 2
1986, ch. 630, §§ 2, 3
T.C.A., § 14-25-102
Acts 1995, ch. 486, §§ 1, 2, 9, 17
1996, ch. 1029, § 1
2004, ch. 780, § 4
2009, ch. 337, §§ 1, 2
2010, ch. 898, § 1
2013, ch. 431, §§ 1, 2
2016, ch. 1044, § 8
2023, ch. 277, § 3
2024, ch. 512, §§ 1, 2
2024, ch. 772, § 2.

§ 71-6-103. Rules and regulations — Reports of abuse or neglect — Investigation — Providing protective services — Consent of adult — Duties of other agencies.

(a) The commissioner has the discretion to adopt such rules, regulations, procedures, guidelines, or any other expressions of policy necessary to effect the purpose of this part insofar as such action is reasonably calculated to serve the public interest.
(b)
1. (1) Any person, including, but not limited to, a physician, nurse, social worker, department personnel, coroner, medical examiner, alternate care facility employee, or caretaker, having reasonable cause to suspect that an adult has suffered abuse, neglect, or exploitation, shall report or cause reports to be made in accordance with this part. Death of the adult does not relieve one of the responsibility for reporting the circumstances surrounding the death. However, unless the report indicates that there are other adults in the same or similar situation and that an investigation and provision of protective services are necessary to prevent their possible abuse, neglect or exploitation, it shall not be necessary for the department to make an investigation of the circumstances surrounding the death; provided, that the appropriate law-enforcement agency is notified.
2. (2) If a hospital, clinic, school, or any other organization or agency responsible for the care of adults has a specific procedure, approved by the director of adult protective services for the department, or the director's designee, for the protection of adults who are victims of abuse, neglect, or exploitation, any member of its staff whose duty to report under this part arises from the performance of the staff member's services as a member of the staff of the organization may, at the staff member's option, fulfill that duty by reporting instead to the person in charge of the organization or the organization head's designee who shall make the report in accordance with this chapter.
(c) An oral or written report shall be made immediately to the department upon knowledge of the occurrence of suspected abuse, neglect, or exploitation of an adult. Any person making such a report shall provide the following information, if known: the name and address of the adult, or of any other person responsible for the adult's care; the age of the adult; the nature and extent of the abuse, neglect, or exploitation, including any evidence of previous abuse, neglect, or exploitation; the identity of the perpetrator, if known; the identity of the complainant, if possible; and any other information that the person believes might be helpful in establishing the cause of abuse, neglect, or exploitation. Each report of known or suspected abuse of an adult involving a sexual offense that is a violation of §§ 39-13-501 — 39-13-506 that occurs in a facility licensed by the department of mental health and substance abuse services as defined in § 33-2-402, or any hospital shall also be made to the local law enforcement agency in the jurisdiction where such offense occurred.
(d) Upon receipt of the report, the department shall take the following action as soon as practical:
1. (1) Notify the appropriate law enforcement agency in all cases in which the report involves abuse, neglect, or exploitation of the adult by another person or persons;
2. (2) Notify the appropriate licensing authority if the report concerns an adult who is a resident of, or at the time of any alleged harm is receiving services from, a facility that is required by law to be licensed or the person alleged to have caused or permitted the harm is licensed under title 63. The commissioner of health, upon becoming aware through personal knowledge, receipt of a report or otherwise, of confirmed exploitation, abuse, or neglect of a nursing home resident, shall report such instances to the Tennessee bureau of investigation for a determination by the bureau as to whether the circumstances reported constitute abuse of the medicaid program or other criminal violation;
3. (3) Initiate an investigation of the complaint;
4. (4) Make a written report of the initial findings together with a recommendation for further action, if indicated; and
5. (5) After completing the evaluation, the department shall notify the person making the report of its determination.
(e) Any representative of the department may enter any health facility or health service licensed by the state at any reasonable time to carry out its responsibilities under this part.
(f) Any representative of the department may, with consent of the adult or caretaker, enter any private premises where any adult alleged to be abused, neglected, or exploited is found in order to investigate the need for protective services for the purpose of carrying out this part. If the adult or caretaker does not consent to the investigation, a search warrant may issue upon a showing of probable cause that an adult is being abused, neglected, or exploited, to enable a representative of the department to proceed with the investigation.
(g) If a determination has been made that protective services are necessary when indicated by the investigation, the department shall provide such services within budgetary limitations, except in such cases where an adult chooses to refuse such services.
(h) In the event the adult elects to accept the protective services to be provided by the department, the caretaker shall not interfere with the department when rendering such services.
(i) If the adult does not consent to the receipt of protective services, or if the adult withdraws consent, the services shall be terminated, unless the department determines that the adult lacks capacity to consent, in which case it may seek court authorization to provide protective services.
(j)
1. (1) Any representative of the department actively involved in the conduct of an abuse, neglect, or exploitation investigation under this part shall be allowed access to the mental and physical health records of the adult that are in the possession of any individual, hospital, or other facility if necessary to complete the investigation mandated by this chapter.
2. (2) To complete the investigation required by this part, any authorized representative of the department actively involved in the conduct of an investigation pursuant to this part shall be allowed access to any law enforcement records or personnel records, not otherwise specifically protected by statute, of any person who is:
  1. (A) A caretaker of the adult; or
  2. (B) The alleged perpetrator of abuse, neglect or exploitation of the adult, who is the subject of the investigation.
3. (3)
  1. (A) If refused any information pursuant to subdivisions (j)(1) and (2), any information from any records necessary for conducting investigations pursuant to this part may be obtained upon motion by the department to the circuit, chancery or general sessions court of the county where such records are located, or in the court in which any proceeding concerning the adult may have been initiated or in the court in the county in which the investigation is being conducted.
  2. (B) The order on the department's motion may be entered ex parte upon a showing by the department of an immediate need for such information.
  3. (C) The court may enter such orders as may be necessary to ensure that the information sought is maintained pending any hearing on the motion, and to protect the information obtained from further disclosure if the information is made available to the department pursuant to the court's order.
4. (4)
  1. (A) The department may be allowed access to financial records that are contained in any financial institution, as defined by § 45-10-102(3):
    1. (i) Regarding:
      1. (a) The person who is the subject of the investigation;
      2. (b) Any caretaker of such person; and
      3. (c) Any alleged perpetrator of abuse, neglect or exploitation of such person;
    2. (ii) By the issuance of an administrative subpoena in the name of the commissioner or an authorized representative of the commissioner that is:
      1. (a) Directed to the financial institution; and
      2. (b) Complies with §§ 45-10-106 and 45-10-107; or
    3. (iii) By application, as otherwise required pursuant to § 45-10-117, to the circuit or chancery court in the county in which the financial institution is located, or in the court in which any proceeding concerning the adult may have been initiated or in which the investigation is being conducted, for the issuance of a judicial subpoena that complies with the requirements of § 45-10-107; provided, that the department shall not be required to post a bond pursuant to § 45-10-107(a)(4).
    Backlinks (1)
    
    45-10-119(a)
  2. (B) Nothing in this subdivision (j)(4) shall be construed to supersede the provision of financial records pursuant to the permissible acts allowed pursuant to § 45-10-103.
5. (5) Any records received by the department, the confidentiality of which is protected by any other statute or regulation, shall be maintained as confidential pursuant to such statutes or regulations, except for such use as may be necessary in the conduct of any proceedings pursuant to its authority pursuant to this part or title 33 or 34.
(k)
1. (1) If, as a result of its investigation, the department determines that an adult who is a resident or patient of a facility owned or operated by an administrative department of the state is in need of protective services, and the facility is unable or unwilling to take action to protect the resident or patient, the department shall make a report of its investigation, along with any recommendations for needed services to the commissioner of the department having responsibility for the facility. It shall then be the responsibility of the commissioner for that department and not the department of human services to take such steps as may be necessary to protect the adult from abuse, neglect, or exploitation and, in such cases, the affected administrative department of the state shall have standing to petition the court.
2. (2)
  1. (A) Notwithstanding subdivision (k)(1) or any other provision of this part to the contrary, the department of human services shall not be required to investigate and the department of mental health and substance abuse services or the department of disability and aging, or their successor agencies, shall not be required to report to the department of human services any allegations of abuse, neglect or exploitation involving any person that arise from conduct occurring in any institutions operated directly by either the department of mental health and substance abuse services or the department of disability and aging.
  2. (B) Allegations of abuse, neglect or exploitation of individuals occurring in the circumstances described in subdivision (k)(2)(A) shall be investigated, respectively, by investigators of the department of mental health and substance abuse services and the department of disability and aging, or their successor agencies, who have been assigned to investigate the allegations.
(l) In the event the department, or a law enforcement agency, in the course of its investigation, is unable to determine to its satisfaction that sufficient information is available to determine whether an adult is in imminent danger or lacks the capacity to consent to protective services, an order may be issued, upon a showing of probable cause that an adult lacks capacity to consent to protective services and is being abused, neglected, or exploited, to require the adult to be examined by a physician, a psychologist in consultation with a physician or a psychiatrist in order that such determination can be made. An order for examination may be issued ex parte upon affidavit or sworn testimony if the court finds that there is cause to believe that the adult may be in imminent danger and that delay for a hearing would be likely to substantially increase the adult's likelihood of irreparable physical or mental harm, or both, and/or the cessation of life.

Backlinks (4)

History (16)

Acts 1978, ch. 899, § 1
T.C.A., § 14-2603
Acts 1980, ch. 513, §§ 3-5, 8
1986, ch. 630, §§ 5-8
T.C.A., § 14-25-103
Acts 1993, ch. 439, § 3
1995, ch. 486, §§ 2, 14
1999, ch. 247, § 2
2000, ch. 947, §§ 6, 8M
2001, ch. 204, §§ 1, 2
2003, ch. 169, § 7
2009, ch. 212, §§ 1, 2
2010, ch. 1100, §§ 141, 142
2012, ch. 575, § 1
2015, ch. 387, § 1
2024, ch. 688, § 188.

§ 71-6-104. Remedies — Injunctive relief.

(a) Any court with jurisdiction under this part may upon proper application by the department issue a temporary restraining order or other injunctive relief to prohibit any violation of this part, regardless of the existence of any other remedy at law.
(b) The court may enjoin from providing care for any person, on a temporary or permanent basis, any employee or volunteer, who the court finds has engaged in the abuse, neglect or exploitation of an adult as defined in this part, in any situation involving the care of such adult by such employee or volunteer, whether such actions occurred in an institutional setting, in any type of group home or foster care arrangement serving adults, and regardless of whether such person, facility or arrangement serving adults is licensed to provide care for adults.

History (5)

Acts 1978, ch. 899, § 1
T.C.A., § 14-2604
Acts 1986, ch. 630, § 18
T.C.A., § 14-25-104
Acts 1995, ch. 486, § 8.

§ 71-6-105. Reporting or investigating parties — Immunity from liability — Protection from job discrimination.

Any person making any report or investigation pursuant to this part, including representatives of the department in the reasonable performance of their duties and within the scope of their authority, shall be presumed to be acting in good faith and shall thereby be immune from any liability, civil or criminal, that might otherwise be incurred or imposed. Any such participant shall have the same immunity with respect to participation in any judicial proceeding resulting from such report or investigation. Any person making a report under this part shall have a civil cause of action for appropriate compensatory and punitive damages against any person who causes a detrimental change in the employment status of the reporting party by reason of the report.

History (4)

Acts 1978, ch. 899, § 1
T.C.A., § 14-2605
Acts 1980, ch. 513, § 6
T.C.A., § 14-25-105.

§ 71-6-106. Privilege for confidential communications.

Notwithstanding the existence of the privilege for confidential communications between husband and wife, the chancellor at the hearing may compel testimony if, in the chancellor's opinion, disclosure is necessary in the interest of the adult.

History (2)

Acts 1978, ch. 899, § 1
T.C.A., §§ 14-2606, 14-25-106.

§ 71-6-107. Provision of protective services without the consent of the adult.

(a)
1. (1)
  1. (A) If the department determines that an adult who is in need of protective services is in imminent danger if that adult does not receive protective services and lacks capacity to consent to protective services, then the department may file a complaint with the court for an order authorizing the provision of protective services necessary to prevent imminent danger of irreparable physical or mental harm, or both, and/or the cessation of life. The judge or chancellor shall hear the complaint ahead of any other business then pending in court or in chambers. This order may include the designation of an individual or organization to be responsible for the personal welfare of the adult and for consenting to protective services in the adult's behalf. The complaint must allege specific facts sufficient to show that the adult is in imminent danger if the adult does not receive protective services and lacks capacity to consent to protective services. Prior to filing a complaint with the court for an order authorizing removal of an adult from that adult's chosen place of residence, the department shall make reasonable efforts to exhaust all practical alternatives to the removal of such adult from such place of residence.
  2. (B) In situations where the department must present a petition for emergency removal of an adult in imminent danger and a chancellor or circuit judge is unavailable, the department may present petitions to judicial officers with general sessions jurisdiction. Further proceedings shall be conducted in chancery or circuit court.
  3. (C) For the purposes of this section, “sexual abuse,” as defined in this chapter, shall provide grounds for the department to obtain custody of an adult who lacks capacity to consent when such abuse relates to sexual activity or contact.
2. (2) The judge or chancellor or the general sessions court judge, prior to entering the order, must find that the adult is in imminent danger if the adult does not receive protective services and lacks capacity to consent to protective services.
3. (3) Within seven (7) days of entering an order pursuant to this section, or for good cause shown, then up to fifteen (15) days, the court shall hold a hearing on the merits. If such a hearing is not held within such time, the order authorizing the provision of protective services shall be dissolved.
4. (4)
  1. (A) The adult alleged to be in need of protective services and any person to whom the adult is lawfully married, if known and reasonably available, must be served with a copy of the complaint at least forty-eight (48) hours prior to the hearing, unless for good cause shown, a shorter time is allowed by the court. The adult and the adult's spouse have a right to be present and represented by counsel at the hearing. Failure to serve a copy of the complaint on a lawful spouse of the adult, if the spouse is not known or is not reasonably available as determined by the court, shall not prevent the provision of protective services, as ordered by the court, that may be necessary to prevent the adult from suffering imminent harm.
  2. (B) If the adult alleged to be in need of protective services is indigent or, in the determination of the judge or chancellor, lacks capacity to waive the right to counsel, then the court shall appoint counsel for the adult alleged to be in need of protective services.
  3. (C) If the adult alleged to be in need of protective services is indigent, court costs and the cost of representation of the adult shall be borne by the state; otherwise, the costs shall be borne by the adult. The state shall not be liable for the cost of counsel or court costs for the spouse of the adult; provided, however, that if the court finds that the department or an agency acting under subdivision (a)(7) has, without good cause, failed to serve a copy of the complaint on the lawful spouse of the adult, the court may assess attorneys fees for the spouse of the adult and court costs to the department or agency acting under subdivision (a)(7) not to exceed a total of two thousand dollars ($2,000); provided further, however, that the court may exceed the two thousand dollar ($2,000) limit upon making a specific finding of fact that the failure of the department or an agency to serve the complaint resulted in financial hardship upon the spouse or adult in excess of two thousand dollars ($2,000) and that the interests of justice require that the limit be exceeded in the particular case.
  4. (D) If a court determines that appointment of a guardian ad litem is necessary, and if the adult is indigent, the cost for the guardian ad litem shall be borne by the state; otherwise the costs shall be borne by the adult.
5. (5)
  1. (A) Protective services necessary to prevent imminent danger of irreparable physical or mental harm, or both, and/or the cessation of life authorized by order pursuant to this section may include, but are not limited to, taking the adult into physical custody in the home, a medical or nursing care facility, or, if available, an alternative living arrangement exclusive of a developmental center operated by the department of disability and aging; provided, that the court finds that such custody is for the purpose of medical examination and treatment necessary to prevent imminent danger of irreparable physical or mental harm, or both, and/or the cessation of life or protection from abuse or neglect necessary to prevent imminent danger of irreparable physical or mental harm, or both, and/or the cessation of life, and that the court specifically authorizes such custody in its order. In determining what specific custodial authority to grant under this section, the court shall consider whether the imminent danger of irreparable physical or mental harm, or both, and/or the cessation of life is relatively mild or severe and authorize such custody as is appropriate under the circumstances. The department shall review the decree at least annually to determine whether the prerequisites for custody still exist.
  2. (B) Within a reasonable period of time after an adult is taken into physical custody and placed other than in a medical or nursing care facility, the department shall cause an appropriate examination to be made of the adult to determine the cause or causes resulting in the adult's lack of capacity to consent, if such determination had not been made at the time of the final hearing.
6. (6)
  1. (A) In the event that the adult has sufficient resources to defray the costs of a medical or nursing care facility, or an appropriate alternative living arrangement, as decreed by the court pursuant to this subsection (a), and that without such resources the adult would be unable to enter such facility or alternative living arrangement, then the court may appoint a temporary guardian for such period as necessary to secure and disburse the adult's resources for that purpose, but for no longer than six (6) months from the entry of the order authorizing provision of protective services. However, the court in its discretion may extend such period for a period no longer than an additional six (6) months. The guardian appointed pursuant hereto shall file an accounting with the court as to the resources used.
  2. (B) The court in its order may authorize the temporary guardian to exercise a limited power of attorney over any accounts the adult has in a bank, credit union, or other financial institution. The temporary guardian so designated shall deliver a copy of the order of the court to the financial institution prior to taking any action with regard to the accounts. The limited power of attorney shall authorize the temporary guardian to withdraw money from or freeze or unfreeze the account.
  3. (C) Concurrent with the order of the court appointing a temporary guardian, the court shall issue a subpoena directed to the financial institution in compliance with the Financial Records Privacy Act, compiled in title 45, chapter 10, requesting the names of any co-owner or additional authorized signatories on the accounts, unless the temporary guardian has actual knowledge of any co-owners or additional authorized signatories. Upon receipt of the response to the subpoena, or upon actual knowledge of the co-owners or additional authorized signatories, the temporary guardian shall send a copy of the order to any person who is a co-owner of or authorized signatory on the deposit account within ten (10) days of receiving the names of the co-owners or signatories. Nothing in this subdivision (a)(6)(C) shall preclude the temporary guardian from making immediate expenditures from the accounts of the adult necessary to provide protective services for the adult in imminent danger, as defined in this part, pending the response by the co-owners or other signatories to the accounts.
  4. (D) If the court finds that the temporary guardian has, without good cause, failed to provide a copy of the order under this subdivision (a)(6) to the co-owner or additional authorized signatory on the deposit account, the court may assess attorneys' fees for the benefit of the co-owner or additional authorized signatory or court costs associated with the failure of the department or the temporary guardian; provided, that the fees and court costs shall not exceed a total of two thousand dollars ($2,000); provided, further, however, that the court may exceed the two thousand dollar ($2,000) limit upon making a specific finding of fact that the failure of the department or an agency to serve the complaint resulted in financial hardship upon the spouse or adult in excess of two thousand dollars ($2,000) and that the interests of justice require that the limit be exceeded in the particular case.
7. (7) If the department refuses to exercise the powers granted to it by subdivision (a)(1), any private nonprofit agency representing disabled adults may proceed under subdivision (1), after giving notice to the department of intent to do so. If an order authorizing the provision of protective services results, the department's responsibilities are the same as they would have been if the department had sought the order. If the court finds that an order authorizing the provision of protected services is not warranted, any agency proceeding under this subdivision (a)(7) will be responsible for the cost of the court-appointed attorney representing the individual for whom protective services were sought as well as court costs.
(b)
1. (1) If the department determines that an adult is in need of protective services and lacks capacity to consent to protective services, then the department may petition the judge or chancellor for a hearing. The complaint must allege specific facts sufficient to show that the adult is in need of protective services and lacks capacity to consent to protective services.
2. (2)
  1. (A) The adult alleged to be in need of protective services and any person to whom the adult is lawfully married, if known and reasonably available, must be served with a copy of the complaint at least ten (10) days prior to the hearing, unless for good cause shown, a shorter time is allowed by the court. The adult and the adult's spouse have a right to be present and represented by counsel at the hearing. Failure to serve a copy of the complaint on a lawful spouse of the adult, if the spouse is not known or is not reasonably available as determined by the court, shall not prevent the provision of protective services to the adult, as ordered by the court.
  2. (B) If the adult alleged to be in need of protective services is indigent or, in the determination of the judge or chancellor, lacks capacity to waive the right to counsel, then the court shall appoint counsel for the adult alleged to be in need of protective services.
  3. (C) If the adult alleged to be in need of protective services is indigent, court costs and the cost of representation of the adult shall be borne by the state; otherwise the costs shall be borne by the adult. The state shall not be liable for the costs of counsel or court costs for the spouse of the adult; provided, however, if the court finds that the department or an agency acting under subdivision (7) has, without good cause, failed to serve a copy of the complaint on the lawful spouse of the adult, the court may assess attorneys fees for the spouse of the adult and court costs to the department or agency acting under subdivision (7) not to exceed a total of two thousand dollars ($2,000); provided, however, that the court may exceed the two thousand dollar ($2,000) limit upon making a specific finding of fact that the failure of the department or an agency to serve the complaint resulted in financial hardship upon the spouse or adult in excess of two thousand dollars ($2,000) and that the interests of justice require that the limit be exceeded in the particular case.
  4. (D) If a court determines that appointment of a guardian ad litem is necessary, and if the adult is indigent, the cost for the guardian ad litem shall be borne by the state; otherwise the costs shall be borne by the adult.
3. (3) If the judge or chancellor finds that the adult is in need of protective services and lacks capacity to consent to protective services, then the judge or chancellor may enter a decree authorizing the provision of protective services. This decree may include the designation of an individual or organization to be responsible for the personal welfare of the adult and for consenting to protective services in the adult's behalf.
(c) An individual or organization appointed pursuant to subsection (a) or (b) to be responsible for the personal welfare of the adult and for consenting to protective services in the adult's behalf or to serve as temporary guardian shall have only specific authority as the court shall provide in its order. Such authority shall be limited to the authority to consent to specified protective services, including medical care if ordered, and if ordered pursuant to subsection (a), may arrange for, and consent to, appropriate custodial care and gain access to and disburse the adult's resources. If the adult is in need of a person to manage the adult's affairs or to have other responsibilities not addressed in this section, the procedures and requirements for appointment of a conservator pursuant to title 34, chapter 1 or 3, must be followed. Nothing in this section shall be construed as requiring the department to initiate proceedings for the appointment of a conservator or a temporary guardian or to accept such appointment if proceedings are instituted or to initiate proceedings under title 34, chapter 1 or 3.

Backlinks (1)

71-6-124(a)(4)

History (13)

Acts 1978, ch. 899, § 1
T.C.A., § 14-2607
Acts 1980, ch. 513, § 7
1986, ch. 630, §§ 9-14
1986, ch. 892, § 1
T.C.A., § 14-25-107
Acts 1995, ch. 486, §§ 2-5, 7, 10-13, 15, 19
1999, ch. 247, § 3
2000, ch. 947, § 6
2008, ch. 887, §§ 1-3
2008, ch. 1005, §§ 2, 3
2010, ch. 1100, § 143
2024, ch. 688, § 189.

§ 71-6-108. Prohibitions.

No adult may be adjudicated incompetent or committed to a mental institution under this part.

History (2)

Acts 1978, ch. 899, § 1
T.C.A., §§ 14-2608, 14-25-108.

§ 71-6-109. Payment for protective services.

If the department determines that the adult is financially capable of paying for the protective services received, according to standards to be set by the department, the adult shall reimburse the state for the cost of providing the protective services. If the department determines that the adult is not financially capable of paying for the protective services received, the state shall bear the cost of providing the protective services. Otherwise, the department may recover such cost from the adult in any court of competent jurisdiction.

History (2)

Acts 1978, ch. 899, § 1
T.C.A., §§ 14-2609, 14-25-109.

§ 71-6-110. Violation of duty to report.

Any person who fails to make reasonable efforts to make a report required by this chapter or § 39-15-509(a) commits a Class A misdemeanor.

History (6)

Acts 1978, ch. 899, § 1
T.C.A., § 14-2610
Acts 1986, ch. 630, § 15
T.C.A., § 14-25-110
Acts 1989, ch. 591, § 111
2018, ch. 1050, § 16.

§ 71-6-111. Authority and responsibility of department.

It is the legislative intent that the protective services set out in this part be provided and that the department have present authority to provide or to arrange for the provision of the same. However, the provision of the services is subject to budgetary limitations and the availability of funds appropriated for the general provision of protective services to all persons entitled to services.

History (2)

Acts 1978, ch. 899, § 1
T.C.A., §§ 14-2611, 14-25-111.

§ 71-6-112. Funding.

The cost of the administration of this part and the provision of the services hereby authorized shall be limited to the amount of funds specifically appropriated for such purposes by the general assembly.

History (2)

Acts 1978, ch. 899, § 1
T.C.A., §§ 14-2612, 14-25-112.

§ 71-6-113. Cooperation by other departments — Specialized care.

(a) It is the legislative intent that the departments of mental health and substance abuse services, disability and aging, and health, or their successor agencies, shall assist the department of human services with providing the services required under this part.
(b) When the department of human services is unable to find a resource for any person in need of protective services who, because of mental or physical illness, intellectual disability or developmental disabilities, is in need of specialized care or medical treatment, the departments of mental health and substance abuse services, disability and aging, and health, or their successor agencies, shall, based upon available resources, give priority to the person for appropriate placement or treatment if the person is eligible for placement.

History (10)

Acts 1978, ch. 899, § 2
T.C.A., § 14-2613
Acts 1986, ch. 630, § 16
T.C.A., § 14-25-113
Acts 2000, ch. 947, § 6
2009, ch. 212, § 3
2010, ch. 1100, §§ 144, 145
2011, ch. 158, § 41
2012, ch. 575, § 1
2024, ch. 688, § 190.

§ 71-6-114. Jurisdiction and venue.

(a) The circuit, general sessions, and chancery courts have jurisdiction of proceedings arising under this part. Probate courts in counties having a population of not less than seven hundred seventy-five thousand (775,000) according to the 1980 federal census or any subsequent federal census shall have concurrent jurisdiction with the circuit and chancery courts.
(b) A proceeding under this part may be commenced in the county where the adult resides or is physically present.

History (3)

Acts 1986, ch. 630, § 4
T.C.A., § 14-25-114
Acts 1995, ch. 486, § 16.

§ 71-6-115. Cooperation by law enforcement officials.

It is the legislative intent that law enforcement officials shall cooperate with the department of human services in providing protective services under this part. Further, when the department is unable to return an adult to physical custody who voluntarily leaves such custody, law enforcement officials shall assist in returning the adult to such physical custody and shall give priority in providing such assistance.

History (2)

Acts 1986, ch. 630, § 17
T.C.A., § 14-25-115.

§ 71-6-116. Motion for review of court decree.

Either party to a proceeding under this part, or any interested person on behalf of the adult subject to such a proceeding, may file a motion for review of the decree of the court at any time.

History (2)

Acts 1986, ch. 630, § 17
T.C.A., § 14-25-116.

§ 71-6-117. Abused or neglected person defined — Conflict with living will.

(a) For purposes of this part, a person is not abused or neglected or in need of protective services if the person subject to care intentionally and willfully chooses or consents to engage in a religious method of healing in accordance with a recognized religious belief in lieu of medical treatment.
(b) This part does not require or authorize the provision of medical care to a terminally ill person if the person has executed an unrevoked living will in accordance with the Tennessee Right to Natural Death Act, compiled in title 32, chapter 11, and the provision of medical care would conflict with the terms of the living will.

Backlinks (1)

63-7-127(h)(1)(F)(xi)

History (1)

Acts 2023, ch. 277, § 4.

§ 71-6-118. Confidentiality of information, reports and proceedings — Penalties.

(a)
1. (1) The identity of a person who reports abuse, neglect, or exploitation, as those terms are defined in § 71-6-102, as required under this part, is confidential and may not be revealed except as otherwise provided in this section or upon an order by a court with jurisdiction under this part for good cause shown.
2. (2) The identity of a person who makes a report pursuant to § 39-15-509(a), is confidential and may not be revealed except as otherwise provided in this section or upon an order by a court with jurisdiction under this part for good cause shown.
(b) Except as otherwise provided in this part, it is unlawful for any person, except for purposes directly connected with the administration of this part or title 39, to disclose, receive, make use of, authorize, or knowingly permit, participate in, or acquiesce in the use of any list or the name of, or any information concerning, persons receiving services pursuant to this part, or any information concerning a report or investigation of a report made confidential pursuant to subsection (a), directly or indirectly derived from the records, papers, files, or communications of the department of human services or divisions thereof acquired in the course of the performance of official duties.
(c)
1. (1) When necessary to protect elderly or vulnerable adults in a healthcare facility licensed by any state agency, the information, reports, and investigations described in subsection (b) may be disclosed to any agency providing licensing or regulation for that facility; however, the information, reports, and investigations shall retain the protection of subsection (b) when disclosed to such agency and may not be disclosed to, or used by, any other person.
2. (2) Notwithstanding subsections (a) and (b), adult protective services:
  1. (A) May report to law enforcement or public health authorities any information from its investigations or records regarding illness, disease, injuries, or any offense for which reports are made confidential under subsection (a) obtained in the course of an investigation; and
  2. (B) Shall provide to the district attorney general a complete and unredacted copy of adult protective services' entire investigative file, including the identity of the person who reported the alleged conduct, upon the commencement of a criminal prosecution for alleged conduct involving an elderly or vulnerable adult victim obtained in the course of an investigation; provided, however, that the identity of the person who reported the alleged conduct must remain confidential, must be exempt from other provisions of law, shall not be a public record, and shall not be disclosed for any other purpose other than criminal investigation or criminal prosecution.
3. (3) Upon the return of a criminal indictment or presentment arising from a report of alleged conduct involving an elderly or vulnerable adult victim where the identity of the person reporting the conduct has been provided to the district attorney general pursuant to this subsection (c), the district attorney general shall request and the court shall enter a protective order preventing further release of the identity of the person reporting for any purpose other than criminal prosecution.
4. (4) As used in this subsection (c), “elderly or vulnerable adult” includes an adult, as defined in § 71-6-102, an elderly adult, as defined in § 39-15-501, and a vulnerable adult, as defined in § 39-15-501.
(d) Nothing in this section shall preclude the district attorney general from complying with the continuing duty to disclose evidence under the rules of discovery in a criminal prosecution.
(e) A knowing violation of subsection (a) or (b) or subdivision (c)(1) is a Class B misdemeanor.

Backlinks (2)

History (7)

Acts 1986, ch. 630, § 17
T.C.A., § 14-25-118
Acts 1989, ch. 591, § 112
2008, ch. 1005, §§ 4, 5
2018, ch. 1050, § 15
2021, ch. 500, § 18
2024, ch. 655, §§ 1, 2.

§ 71-6-119. [Repealed]

§ 71-6-120. Right of elderly person or disabled adult to recover for abuse or neglect, sexual abuse, exploitation, or theft.

(a) As used in this section, unless the context otherwise requires:
1. (1) “Capacity to consent” means the mental ability to make a rational decision, which includes the ability to perceive, appreciate all relevant facts and to reach a rational judgment upon such facts; or to make and carry out reasonable decisions concerning the person or the person's resources; or to protect the person from neglect, or hazardous or abusive situations without assistance;
2. (2) “Disabled adult” means a person who is eighteen (18) years of age or older and who meets one (1) of the following:
  1. (A) Has some impairment of body or mind that makes the person unfit to work at any substantially remunerative employment;
  2. (B) Lacks the capacity to consent;
  3. (C) Has been certified as permanently and totally disabled by an agency of this state or the United States that has the function of so classifying persons; or
  4. (D) Has been found to be incompetent by a court of proper jurisdiction; and
3. (3) “Elderly person” or “elder” means a person who is sixty (60) years of age or older who has some mental or physical dysfunctioning, including any resulting from age.
(b) In addition to other remedies provided by law, an elderly person or disabled adult in that person's own right, or by conservator or next friend, has a right of recovery in a civil action for compensatory damages for abuse or neglect; sexual abuse or exploitation, as defined in this part; theft of such person's or adult's money or property whether by fraud, deceit, coercion, or otherwise; or abuse or neglect, sexual abuse, or financial exploitation, as those terms are defined in § 31-4-106, by a caretaker. Such right of action against a wrongdoer must not abate or be extinguished by the death of the elderly person or disabled adult, but must pass as provided in § 20-5-106, unless the alleged wrongdoer is a family member, in which case the cause of action must pass to the victim's personal representative; provided, that, if the personal representative is the alleged wrongdoer, then it must pass to any interested party that is not the alleged wrongdoer.
(c) Jurisdiction for such action shall be in the circuit or chancery court where the elderly person or disabled adult may reside or where the actions occurred.
(d) Damages include compensatory damages and costs where it is proven that a defendant is liable for abuse or neglect; sexual abuse or exploitation, as defined in this part; for theft of such elderly person's or disabled adult's money or property whether by fraud, deceit, coercion or otherwise; or for abuse or neglect, sexual abuse, or financial exploitation, as those terms are defined in § 31-4-106, by a caretaker. Costs include reasonable expenses and reasonable attorney's fees. As part of any judgment, the court may declare void and unenforceable any marriage proven to have been entered into as part of a scheme to commit abuse or neglect, sexual abuse or exploitation as defined in this part, or theft of such elderly person's or disabled adult's money or property whether by fraud, deceit, coercion, or otherwise.
(e) In addition to the damages described in (d), a defendant may also be found liable for punitive damages in accordance with applicable common law standards.
(f) Nothing in this section shall be construed as requiring the department of human services to initiate any proceedings pursuant to this section or to act on behalf of any elderly person or disabled adult subject to this section.
(g) This section shall not apply to a cause of action within the scope of title 29, chapter 26; such cause of action shall be governed solely by title 29, chapter 26.
(h) A financial institution, officer, director, or employee of a financial institution, shall not be liable in any civil action brought by or on behalf of a disabled adult or elderly person for recovery of damages under this chapter, unless prior to such civil action, the financial institution, officer, director, or employee of a financial institution, shall have been convicted of a violation of § 39-15-502; provided, however, that this provision shall not apply to theft or conversion by an employee, officer or director of a financial institution or liability arising under other law.
(i) In any will or estate contest provided under title 30, 31, or 32 or in any proceeding contesting the validity of any gifts, bequests, or other transactions, a caretaker found liable under subsection (b) is in a per se confidential relationship with the elderly person or disabled adult so as to raise the presumption of undue influence requiring the caretaker to prove by clear and convincing evidence that the challenged bequest was fair.

Backlinks (3)

History (5)

Acts 1999, ch. 247, § 1
2000, ch. 768, §§ 1-3
2004, ch. 780, § 5
2017, ch. 466, § 6
2024, ch. 772, §§ 3-5.

§ 71-6-121. Posting of contact information on adult protective service.

(a) All offices of physicians licensed pursuant to title 63, chapter 6 or 9, all health care facilities licensed pursuant to title 68, chapter 11, all senior centers, all community centers and all pharmacies shall post the following in the main public entrance:
1. (1) Contact information including the statewide toll-free number of the division of adult protective services, and the number for the local district attorney general's office; and
2. (2) A statement that a person of advanced age who may be the victim of abuse, neglect, or exploitation may seek assistance or file a complaint with the division concerning abuse, neglect, and exploitation.
(b) The information listed in subsection (a) shall be posted on a sign no smaller than eleven inches (11″) in width and seventeen inches (17″) in height.
(c) All nursing homes, assisted living facilities and any other residential facility licensed by the board of licensing health care facilities shall upon admission provide to each resident the division of adult protective services' statewide toll-free number.
(d) Any licensed nursing home that complies with the requirements of § 68-11-254 shall be exempt from the requirements of subsections (a) and (b).
(e)
1. (1) All offices of physicians licensed pursuant to title 63, chapter 6 or 9, all health care facilities licensed pursuant to title 68, chapter 11, all community centers, and all pharmacies shall post in the main public entrance, on a sign no smaller than eight and one-half inches (8 ½″) in width and eleven inches (11″) in height, a statement that any person, regardless of age, who may be the victim of domestic violence may call the nationwide domestic violence hotline, or any other hotline that may be determined by the departments of health and commerce and insurance and communicated to health care providers subject to this section pursuant to subdivision (e)(2), with that number printed in boldface type, for immediate assistance.
2. (2) The departments of health and commerce and insurance, through the various regulatory and licensure boards with oversight of health care providers, shall include a statement notifying providers of the requirements of subdivision (e)(1) in the newsletters or other routine correspondences of such boards and shall post a copy of such statement on the departments' websites. The statement shall include a contact telephone number for providers to request that a copy of the statement be mailed to them. Upon initial licensure, the various boards shall also provide initial licensees with the statement along with instructions for compliance with subdivision (e)(1).
(f) All offices of physicians licensed pursuant to title 63, chapter 6 or 9, all health care facilities licensed pursuant to title 68, chapter 11, all community centers, and all pharmacies shall post on a sign no smaller than eight and one-half inches (8 ½″) in width and eleven inches (11″) in height in the main public entrance a statement that a teen involved in a relationship that includes dating violence may call a national toll-free hotline, with that number printed in boldface type, for immediate assistance.
(g) Notwithstanding the provisions of subsections (a)-(f) regarding the size of the posters, physicians' offices, health care facilities, community centers and pharmacies are authorized to incorporate all of the information required in subsections (a)-(f) in a single poster at least eight and one-half inches (8 ½″) in width and fourteen inches (14″) in height that shall be posted in the main public entrance.
(h) The departments of health and commerce and insurance, through the various regulatory and licensure boards with oversight of health care providers, shall include a statement notifying providers of the requirements of subsections (a)-(g) in the newsletters or other routine correspondences of those boards and shall post a copy of the statement on the departments' websites. The statement shall include a contact telephone number for providers to request that a copy of the statement be mailed to them. Upon initial licensure, the various boards shall also provide initial licensees with the statement along with instructions for compliance with subsections (a)-(g).

History (3)

Acts 2004, ch. 780, § 6
2006, ch. 804, §§ 1, 2
2007, ch. 446, §§ 1, 2.

§ 71-6-122. Toll-free number for reporting elder abuse, neglect or exploitation.

The division of adult protective services of the department of human services shall establish a toll-free telephone service to enable citizens within the state to call the division free of charge to report abuse, neglect, or exploitation and to seek relevant assistance from the division in such matters.

History (1)

Acts 2004, ch. 780, § 7.

§ 71-6-123. Reporting false accusations — Penalties — Investigation.

(a) It is an offense for a person to report to the department an accusation of abuse, sexual abuse, neglect or exploitation of an adult if, at the time of the report, the person knows or should know the accusation is false.
(b) It is an offense for a person to knowingly cause another to report to the department an accusation of abuse, sexual abuse, neglect or exploitation of an adult if, at the time of the conduct, the person knows or should know the accusation is false.
(c) A violation of this section is a Class A misdemeanor.
(d) Notwithstanding § 71-6-118 to the contrary:
1. (1) The department may report to the district attorney general or law enforcement authorities the identity of any person whom it reasonably believes has violated this section; and
2. (2) The information such person reported or caused to be reported may be disclosed and utilized in any manner necessary by the department, the district attorney general or law enforcement authorities as part of any investigation or prosecution of a violation of this section.

History (1)

Acts 2008, ch. 1005, § 1.

§ 71-6-124. Order of protection for adult who has been subjected to abuse, neglect, or exploitation.

(a)
1. (1)
  1. (A) Any relative, conservator, or agent of the department of disability and aging; designated agency or assign of the relative, conservator, or department; or attorney ad litem having personal knowledge that an adult has been the subject of a violation of § 39-15-502, § 39-15-507, § 39-15-508, § 39-15-510, § 39-15-511, or § 39-15-512, or that such adult is threatened with or placed in fear of a violation of any of those sections, may seek relief for the adult pursuant to this section by filing a sworn petition with any court having jurisdiction under this part alleging that the respondent has violated or threatens to violate § 39-15-502, § 39-15-507, § 39-15-508, § 39-15-510, § 39-15-511, or § 39-15-512, regardless of the existence of any other remedy at law.
  2. (B) The petition must allege facts, based upon personal knowledge of the petitioner, that the adult either lacks the capacity to consent or that appearing in court to petition on the adult's own behalf would pose an undue burden on the adult.
  3. (C) An elderly or vulnerable adult, who has been the subject of a violation of § 39-15-502, § 39-15-507, § 39-15-508, § 39-15-510, § 39-15-511, or § 39-15-512, or has been threatened with or placed in fear of a violation of any of those sections, may seek relief pursuant to this section by filing a sworn petition with any court having jurisdiction under this part alleging that the respondent has violated or threatens to violate § 39-15-502, § 39-15-507, § 39-15-508, § 39-15-510, § 39-15-511, or § 39-15-512, regardless of the existence of any other remedy at law.
  4. (D)
    1. (i) Notwithstanding subdivisions (a)(1)(A) and (C), and for good cause shown, the court may issue an ex parte order of protection pursuant to this section upon a sworn petition filed by a law enforcement officer responding to an incident involving an elderly or vulnerable adult victim who asserts in the petition reasonable grounds to believe that the adult is in immediate and present danger of abuse, neglect, financial exploitation, or sexual exploitation as defined in § 39-15-501, and that the adult either has consented to the filing or lacks the capacity to consent; provided, that the person on whose behalf the law enforcement officer seeks the ex parte order of protection is considered the petitioner for purposes of this section. The court may waive any court costs, taxes, or fees for obtaining an order of protection upon a finding that the individual for whose benefit an order of protection has been sought is indigent. If a third party seeking an order of protection represents to the court under oath that the individual for whose benefit the order of protection has been sought is indigent, the court will presume that the individual for whose benefit the order of protection has been sought is indigent absent clear and convincing evidence to the contrary.
    2. (ii) The law enforcement officer may seek on behalf of the adult the ex parte order regardless of the time of day and regardless of whether an arrest has been made.
    3. (iii) If an ex parte order is issued pursuant to this section outside of the court's normal operating hours, the law enforcement officer, judge, or judicial official shall cause the petition and order to be filed with the court as soon as practicable after issuance, but no later than two (2) business days after issuance; and
    4. (iv) Law enforcement officers shall not be subject to civil liability under this section for failure to file a petition or for any statement made or act performed in filing the petition, if done in good faith.
  5. (E) Venue for a petition for an order of protection, and all other matters relating to orders of protection, is in the county where the respondent resides or the county in which the violation of § 39-15-502, § 39-15-507, § 39-15-508, § 39-15-510, § 39-15-511, or § 39-15-512 occurred or is threatened to occur. If the respondent is not a resident of this state, the petition may be filed in the county where the adult resides.
2. (2)
  1. (A) Pursuant to subdivision (a)(1)(A), the court may enter an immediate ex parte order of protection against the respondent if the petition alleges upon personal knowledge of the petitioner, and the court finds in its ex parte order, that the adult lacks capacity to consent or that the adult lacks the ability to be present to petition on their own behalf and is in immediate danger of abuse, neglect, financial exploitation, or sexual exploitation.
  2. (B) Pursuant to subdivision (a)(1)(C), the court may enter an immediate ex parte order of protection against the respondent if the court finds in its ex parte order that the elderly adult is in immediate danger of abuse, neglect, financial exploitation, or sexual exploitation.
  3. (C) Pursuant to subdivision (a)(1)(D), the court may enter an immediate ex parte order of protection against the respondent if the court finds in its ex parte order that the elderly adult is in immediate and present danger of abuse, neglect, financial exploitation, or sexual exploitation, and that the adult has either consented to the filing or lacks the capacity to consent.
3. (3) The petition and any ex parte order issued pursuant to this section shall be personally served upon the respondent, and if filed pursuant to subdivision (a)(1)(A) or (a)(1)(D), upon the adult. If the respondent is not a resident of this state, the ex parte order must be served pursuant to §§ 20-2-215 and 20-2-216.
4. (4) The clerk of the court shall send written notice of the filing of the petition and copies of the petition and the ex parte order of protection against the respondent, if any, to the adult protective services unit of the department of human services in the county where the petition is filed. The department is not responsible for court costs, costs of representation, or costs for a guardian ad litem related to a petition for an ex parte order of protection, or any ex parte order of protection issued pursuant to this section. The department has a right to intervene in the proceeding, but is not otherwise required to initiate any legal action as a result of such notice. The department may, at any time, file a petition pursuant to § 71-6-107 if the department determines the adult who is the subject of a petition for an order of protection is in need of protective services.
5. (5)
  1. (A) Within fifteen (15) days of service of an ex parte order of protection against the respondent, a hearing must be held, at which time the court shall either dissolve any ex parte order that has been issued, or shall, if the petitioner has proven the allegations made pursuant to subdivision (a)(1)(A), (a)(1)(C), or (a)(1)(D), by a preponderance of the evidence, extend the order of protection for a definite period of time, not to exceed one (1) year, unless a further hearing on the continuation of such order is requested by the adult, the respondent, or the petitioner; in which case, on proper showing of cause, such order may be continued for a further definite period of one (1) year.
  2. (B) Any ex parte order of protection shall be in effect until the time of the hearing and, if the hearing is held within fifteen (15) days of service of such order, the ex parte order continues in effect until the entry of any subsequent order of protection, proceedings under title 34, chapters 1-3, are concluded, or the order of protection is dissolved. If no ex parte order of protection has been issued as of the time of the hearing, and the petitioner has proven the allegations made pursuant to subdivision (a)(1)(A), (a)(1)(C), or (a)(1)(D) by a preponderance of the evidence, the court may, at that time, issue an order of protection for a definite period of time, not to exceed one (1) year.
  3. (C) The court shall cause a copy of the petition and notice of the date set for the hearing on such petition, as well as a copy of any ex parte order of protection, to be served upon the respondent, and if filed pursuant to subdivision (a)(1)(A) or (a)(1)(D), upon the adult at least three (3) days prior to such hearing. Such notice shall advise the respondent and the adult that each may be represented by counsel. The court may appoint a guardian ad litem under § 34-1-107.
  4. (D) Within the time the order of protection is in effect, any court with jurisdiction under this part may modify the order of protection, either upon the court's own motion or upon motion of the adult, the respondent, or the petitioner.
(b) An order of protection granted pursuant to this section may:
1. (1) Order the respondent to refrain from committing a violation of this part or title 39, chapter 15, part 5 against an adult;
2. (2) Order the respondent to refrain from threatening to misappropriate or further misappropriating any moneys, state or federal benefits, retirement funds, or any other personal or real property belonging to the adult;
3. (3) Order the return to the adult, the adult's caretaker, conservator, or other fiduciary any moneys, state or federal benefits, retirement funds, or any other personal or real property belonging to the adult obtained by the respondent as a result of exploitation of the adult or as a result of any other misappropriation of such funds or property of the adult by the respondent. The court may enter judgment against the respondent for the repayment or return to the adult or the adult's caretaker, conservator, or other fiduciary of any moneys, government benefits, retirement funds, or any other personal or real property belonging to the adult that are under the control of or that have been obtained by the respondent as a result of exploitation or misappropriation from the adult. This subdivision (b)(3) does not preclude an action under § 71-6-120. The court may, if the amount in question exceeds ten thousand dollars ($10,000), require any caretaker or custodian of funds appointed under this section to post a bond as required by § 34-1-105;
4. (4) Enjoin the respondent from providing care for an adult, or working in any situation involving the care of an adult, whether such action occurs in an institutional setting, in any type of group home or foster care arrangement serving adults, and regardless of whether such person, facility, or arrangement serving adults is licensed to provide care for adults;
5. (5) Prohibit the respondent from telephoning, contacting, or otherwise communicating with the adult, directly or indirectly; and
6. (6) Subject to the limitations otherwise stated in this section, grant any other relief deemed necessary by the court to protect an adult.
(c) All orders of protection shall be effective for a fixed period of time, not to exceed one (1) year. The court may modify its order at any time upon subsequent motion filed by any party together with an affidavit showing a change in circumstances sufficient to warrant the modification. The petitioner, respondent, adult, or the court on its own motion may commence a proceeding under title 34, chapters 1-3 to determine whether a fiduciary or conservator should be appointed, if any party alleges that the conditions giving rise to the order of protection continue or may continue beyond the one (1) year.
(d)
1. (1) If the respondent and the adult have been served with a copy of the petition filed pursuant to subdivision (a)(1)(A) or (a)(1)(D) and notice of hearing, the order of protection is effective when the order is entered. For purposes of this subdivision (d)(1), an order is considered entered once a hearing is conducted and such order is signed by:
  1. (A) The judge and all parties or counsel;
  2. (B) The judge and one (1) party or counsel and the order contains a certificate of counsel that a copy of the proposed order has been served on all other parties or counsel; or
  3. (C) The judge and the order contains a certificate of the clerk that a copy has been served on all other parties or counsel.
2. (2) Service upon a party or counsel must be made by delivering to such party or counsel a copy of the order of protection, or by the clerk mailing it to the party's last known address. In the event the party's last known address is unknown and cannot be ascertained upon diligent inquiry, the certificate of service must so state. Service by mail is complete upon mailing.
3. (3) If the respondent and the adult have been served with a copy of the petition filed pursuant to subdivision (a)(1)(A) or (a)(1)(D) and notice of hearing, an order of protection issued pursuant to this part after a hearing shall be in full force and effect against the respondent from the time it is entered, regardless of whether the respondent is present at the hearing.
4. (4) A copy of any order of protection and any subsequent modifications or dismissal must be issued by the clerk of the court to the petitioner, the respondent, and the local law enforcement agencies having jurisdiction in the area where the adult resides. Upon receipt of the copy of the order of protection or dismissal from the issuing court or clerk's office, the local law enforcement agency shall take any necessary action to immediately transmit it to the national crime information center.
5. (5) Upon violation of an order of protection entered pursuant to this section, a court may order any appropriate punishment or relief as provided for in § 36-3-610.
(e)
1. (1) It is an offense to knowingly violate an order of protection issued pursuant to this section. A law enforcement officer may arrest a respondent who is the subject of an order of protection issued pursuant to this section with or without warrant.
2. (2) In order to constitute a violation of this section:
  1. (A) The person must have received notice of the request for an order of protection;
  2. (B) The person must have had an opportunity to appear and be heard in connection with the order of protection or restraining order; and
  3. (C) The court must have made specific findings of fact in the order of protection that the person committed a violation of this part.
3. (3) Any law enforcement officer shall arrest the respondent without a warrant if:
  1. (A) The officer has proper jurisdiction over the area in which the violation occurred;
  2. (B) The officer has reasonable cause to believe the respondent has violated or is in violation of an order of protection; and
  3. (C) The officer has verified that an order of protection is in effect against the respondent. If necessary, the law enforcement officer may verify the existence of an order of protection by telephone or radio communication with the appropriate law enforcement department.
4. (4) Any person arrested for a violation of an order of protection entered pursuant to this section shall be treated as a person arrested for a violation of an order of protection issued pursuant to title 36, chapter 3, part 6.
5. (5) A violation of this subsection (e) is a Class A misdemeanor, and any sentence imposed is to be served consecutively to the sentence for any other offense that is based in whole or in part on the same factual allegations, unless the sentencing judge or magistrate specifically orders the sentences for the offenses arising out of the same facts to be served concurrently.
(f) Notwithstanding § 71-6-102, for purposes of this section:
1. (1) “Abuse, neglect, or exploitation” includes:
  1. (A) Abuse, neglect, and exploitation, as those terms are defined in § 71-6-102; and
  2. (B) Abuse, neglect, financial exploitation, and sexual exploitation, as those terms are defined in § 39-15-501; and
2. (2) “Adult” means an adult as defined in § 71-6-102 or an elderly adult or vulnerable adult as those terms are defined in § 39-15-501.

History (7)

Acts 2010, ch. 898, § 2
2011, ch. 39, § 4
2011, ch. 158, § 42
2017, ch. 466, § 7
2018, ch. 1050, §§ 10, 11
2019, ch. 474, § 13
2024, ch. 688, § 191.

§ 71-6-125. Vulnerable adult protective investigative team.

(a) By January 1, 2017, the district attorney general of each judicial district shall establish, or cause to be established, a vulnerable adult protective investigative team (VAPIT) for the purpose of:
1. (1) Coordinating the investigation of suspected instances of abuse, neglect, or exploitation of an adult; and
2. (2) Receiving and reviewing information generated by the multi-disciplinary adult protective services evaluation teams as established in § 71-1-110.
(b) As determined by the district attorney general, or the district attorney's designee, the VAPIT shall consist of representatives from within the judicial district, wherever appropriate, of:
1. (1) The district attorney general, or the district attorney's designee;
2. (2) Local law enforcement agencies;
3. (3) The department's adult protective services section; and
4. (4) Any other entity that the district attorney general, or the district attorney's designee, determines is necessary for the successful operation of the VAPIT.
(c) Each VAPIT shall:
1. (1) Meet regularly, as determined by the district attorney general, or the district attorney's designee; provided, that meetings shall be held at least quarterly; and
2. (2) Conduct coordinated responses and investigations of instances of suspected abuse, neglect, or exploitation of adults.
(d)
1. (1) By January 31 of the following year, each district attorney general shall cause to be filed an annual report that summarizes the work of the VAPIT for the previous calendar year with the chairs of the judiciary committee of the senate and the criminal justice committee of the house of representatives. The report may be filed electronically.
2. (2) By January 31 of each year, the department shall report the following information from the adult protective services program to the chairs of the judiciary committee of the senate and the criminal justice committee of the house of representatives:
  1. (A) The number of reports received for investigation by type, such as emotional abuse, physical abuse, sexual abuse, neglect, self-neglect, and financial exploitation;
  2. (B) The number of reports assigned for investigation by type, such as emotional abuse, physical abuse, sexual abuse, neglect, self-neglect, and financial exploitation;
  3. (C) The number of reports not assigned due to not meeting criteria for adult protective services investigation by type, such as emotional abuse, physical abuse, sexual abuse, neglect, self-neglect, and financial exploitation;
  4. (D) The number of final investigative dispositions of cases obtained in the current reporting year by type of disposition as follows:
    1. (i) Unsubstantiated, closed, no services provided;
    2. (ii) Substantiated, closed, client refused services;
    3. (iii) Substantiated, closed, no services provided; or
    4. (iv) Substantiated, closed, services provided;
  5. (E) Demographic information, including age and gender of clients, in cases that are included in subdivisions (d)(2)(D)(ii)-(iv); and
  6. (F) Relationship to the victim of perpetrators identified in cases that are included in subdivisions (d)(2)(D)(ii)-(iv) and that are not related only to self-neglect.
(e)
1. (1) Except as otherwise permitted by law, records, reports, and information concerning reports of abuse, neglect, or exploitation of an adult shall be kept confidential among the VAPIT's members.
2. (2) Disclosure of the items in subdivision (e)(1) may be made to persons and entities directly involved in the administration of this section, including:
  1. (A) Attorneys, next friends, or other representatives of the adult client who are legally authorized to act in the adult client's interest;
  2. (B) Representatives of law enforcement;
  3. (C) Grand juries or courts in the exercise of official business;
  4. (D) Members of the VAPIT; and
  5. (E) Persons engaged in bona fide research or audit purposes; provided, that only information in the aggregate without identifying information may be provided for research or audit purposes and confidentiality of the data is maintained.
3. (3) Unless necessary for the provision of medical, legal, housing, social welfare, or other services, the name of the potential or actual victim or client may only be shared outside of the VAPIT with representatives of law enforcement and organizations devoted to victims' services or advocacy.
4. (4) If adequate resources are available, the VAPIT may maintain a database of information about past and ongoing cases; provided, that identifying information about individual victims and clients shall not be accessed by any person outside of the VAPIT.
5. (5) Identifying information for the person who reports a case of suspected abuse, neglect, or exploitation of an adult shall be kept strictly confidential. The identifying information shall not be disclosed to any person or organization within or without the VAPIT, unless the reporting person expressly consents to disclosure.
(f) Any person participating in good faith in any action or omission authorized or required under this section shall be immune from civil or criminal liability that may result by reason of such action or omission.
(g) Any obligation or duty imposed upon a district attorney general by this section shall be contingent upon the availability of adequate resources.

History (5)

Acts 2016, ch. 1006, § 1
2019, ch. 345, § 145
2019, ch. 474, § 17
2021, ch. 64, § 130
2022, ch. 1081, § 1.

§ 71-6-126. [Repealed]

History (3)

Acts 2019, ch. 135, § 1
2021, ch. 464, § 1
repealed by Acts 2021, ch. 464, § 1, effective January 15, 2022.

Part 2 Family Violence Shelters and Child Abuse Prevention Services

§ 71-6-201. Programs established — Funding.

(a) There are hereby established programs for the establishment and funding of family violence shelters and shelter services and child abuse prevention services. The program for the establishment of family violence shelters and shelter services shall be administered by the department of finance and administration. The program for the establishment of child abuse prevention services shall be administered by the department of children's services. Any reference to the department of human services in any existing statute, regulation, executive order, or contract relating to the administration of these programs shall be deemed to be a reference to the department that has jurisdiction over these programs pursuant to this section. This section does not change the agencies designated to receive certain reports under § 71-6-204.
(b) Funding for such programs shall be limited to the amounts provided in the general appropriations act.

History (3)

Acts 1984, ch. 930, § 1
T.C.A., § 14-33-101
Acts 2002, ch. 697, § 1.

§ 71-6-202. Part definitions.

As used in this part, unless the context requires otherwise:
1. (1) “Child abuse prevention services” means those services designed to prevent the occurrence of child abuse and neglect. They may include, but are not limited to:
  1. (A) Services relating to prevention of child abuse, such as counseling, self-help groups, hot lines and other related services; and
  2. (B) Community and direct education services on child abuse awareness and prevention and related topics, such as parenting, coping with family stress, child development and prenatal care;
2. (2) “Family or household member” means those persons who customarily reside in the household and who are in need of temporary shelter because their lives or welfare are in danger;
3. (3) “Family violence” means causing or attempting to cause bodily injury to a family or household member or placing a family or household member in fear of imminent physical harm by threat of force, regardless of age or mental functioning;
4. (4) “Shelter” means a place where family violence victims and their children can seek temporary refuge twenty-four (24) hours a day and seven (7) days a week, including a program that develops and manages a system under which private homes or commercial lodgings are used as refuge for family violence victims and their children; and
5. (5) “Shelter services” means counseling for family violence victims, counseling for perpetrators, advocacy for family violence victims, referral of family violence victims to other community resources, community education regarding prevention of family violence and rehabilitation of perpetrators.

Backlinks (3)

History (3)

Acts 1984, ch. 930, § 2
1986, ch. 605, § 1
T.C.A., § 14-33-102.

§ 71-6-203. Administration of programs.

In administering these programs, the department with authority over each program:
1. (1) Shall divide all funds received under this part equally, with fifty percent (50%) of the funds to be allocated to the department of finance and administration for family violence shelters and shelter services and fifty percent (50%) to be allocated to the department of children's services for child abuse prevention services, unless the statute or appropriations bill allocating the funds provides otherwise;
2. (2) Shall, in disbursing funds received under this part for child abuse prevention services, give priority, where possible, to services for those children at risk because they reside in households where family violence occurs;
3. (3) In order to assure that funds are distributed statewide, may not disburse more than fifty thousand dollars ($50,000) from state funds provided under this part to any one (1) shelter service or child abuse prevention service in one (1) fiscal year, unless the responsible department finds that exceeding the fifty thousand dollar ($50,000) guideline is warranted by the availability of funds, the area served by the provider, or the best interests of the citizens served by the program;
4. (4) Shall accept federal funds that may be available for use in carrying out this part and may use state funds, in addition to funds generated under this part, as matching funds for federal funds if matching funds are required;
5. (5) Shall assure, to the extent feasible, that any funds allocated under this part shall be used to provide services in addition to those already provided by the department;
6. (6) May expend only those actual amounts reasonably necessary for administration of the funds provided under this part;
7. (7) Shall promulgate rules and regulations in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, necessary to carry out the purposes of this part related to the programs under its jurisdiction. Each department may, upon recommendation of its advisory committee, establish standards for operation of the services, including establishment of a timetable for application and disbursement of funds;
  Backlinks (1)
  
  71-6-205
8. (8)
  1. (A) Shall require an annual report from each service funded, which shall include, in addition to all information required by the department, statistics on the number of persons requesting service, the number of persons served, the type of service rendered and a description of the social and economic characteristics of the person served and the number and type of referrals, including medical, legal and education services, made to other community resources. No information contained in the report shall identify any person served or enable any person to determine the identity of such a person;
  2. (B) Notwithstanding any law to the contrary, the department of children's services may require each child abuse service funded to submit certain identifying information relating solely to recipients of child abuse prevention services for the narrow purpose of tracking the effectiveness of child abuse prevention services. Such information must be maintained by the department of children's services as confidential and may not be released for any purpose. Nothing in this subdivision (8) should be construed as allowing access to any identifying information relating to family violence shelters and shelter services; and
9. (9) Shall establish an advisory committee, which shall review all program criteria adopted by each department and advise the commissioner relative to the allocation of funds under this part. Such committee members will be appointed by the commissioner of the department with consent and approval of the governor. Each committee member shall be selected for a four-year term and may be selected to serve successive terms. However, the commissioner, with consent and approval of the governor, may appoint any member of the current committee previously appointed by the commissioner of human services to a new committee created by this section. Committee members shall be reimbursed for their actual expenses in attending meetings, with the travel expenses to be reimbursed in accordance with the comprehensive travel regulations promulgated by the department of finance and administration and approved by the attorney general and reporter. These advisory committees may be made subcommittees of the social services advisory committee.
  1. (A) The committee on child abuse prevention services shall consist of six (6) members, including one (1) former client of the child abuse prevention service.
  2. (B) The committee on family violence shelters shall consist of five (5) members, one (1) of which should be a former client of the family violence shelter. At least one (1) of the members selected to serve on the committee may be chosen by the department from a list of nominees submitted by the Tennessee coalition against domestic and sexual violence.

Backlinks (1)

55-4-291(c)

History (5)

Acts 1984, ch. 930, § 3
T.C.A., § 14-33-103
Acts 1993, ch. 366, § 1
2002, ch. 697, § 2
2003, ch. 283, § 1.

§ 71-6-204. Incorporation, taxation and reporting prerequisites for receiving funds.

To receive funds under this part, organizations shall:
1. (1) Be incorporated as a not-for-profit corporation, and be tax-exempt under § 501 of the Internal Revenue Code (26 U.S.C. § 501); and
2. (2) Comply with §§ 37-1-403 and 37-1-605 by reporting cases of suspected child abuse or neglect or child sexual abuse to the department of children's services and comply with § 71-6-103 by reporting suspected cases of adult abuse, sexual abuse, neglect or exploitation to the department of human services.

Backlinks (1)

71-6-201(a)

History (3)

Acts 1984, ch. 930, § 4
T.C.A., § 14-33-104
Acts 1996, ch. 1079, § 183.

§ 71-6-205. Prerequisites to receiving funds for shelters or shelter services.

To receive funds under this part for family violence shelter services or shelters, or both, all applicants shall show that they have provided shelter services for at least six (6) months prior to the application for funds under this part, and that the funds provided under this part will enable them to establish or maintain a shelter for victims of family violence within a defined timetable, in addition to any other services provided as described in the standards promulgated under § 71-6-203(7).

History (2)

Acts 1984, ch. 930, § 5
T.C.A., § 14-33-105.

§ 71-6-206. Prerequisites to receiving funds for child abuse prevention services.

To receive funds under this part for child abuse prevention services, all applicants shall show that the funds provided under this part will enable them to provide some of the following services:
1. (1) Counseling for the prevention of child abuse;
2. (2) Child abuse prevention self-help groups;
3. (3) Child abuse prevention hot lines;
4. (4) Community and direct education services on child abuse awareness; and
5. (5) Prevention and related topics, such as parenting, coping with family stress, child development and prenatal care.

History (2)

Acts 1984, ch. 930, § 6
T.C.A., § 14-33-106.

§ 71-6-207. Legislative intent.

It is the legislative intent that in providing services to family violence victims that shelter services be provided to male children twelve (12) to eighteen (18) years of age to the maximum extent feasible.

History (2)

Acts 1984, ch. 930, § 8
T.C.A., § 14-33-107.

§ 71-6-208. Shelter locations privileged — Service of papers or process.

(a) No person can be compelled to provide testimony or documentary evidence in a criminal, civil or administrative proceeding that would identify the address or location of a shelter.
(b) In any proceeding involving a shelter or a person staying at a shelter, the sheriff, constable or other person serving any legal papers or process shall serve any such legal papers or process by contacting the shelter by telephone and making arrangements for service of the papers or process on the shelter or the person staying at the shelter.

Backlinks (2)

History (2)

Acts 1993, ch. 484, § 3
2001, ch. 198, § 1.

Part 3 Sexual Assault Program Services

§ 71-6-301. Program established.

There is established a program for the establishment and funding of sexual assault program services to be administered by the department of finance and administration.

History (1)

Acts 2003, ch. 304, § 2.

§ 71-6-302. Part definitions.

As used in this part, unless the context requires otherwise:
1. (1) “Department” means the department of finance and administration;
2. (2) “Sexual assault” includes victims of any of the sexual offenses set out in § 40-24-108(b)(2);
3. (3) “Sexual assault crisis intervention” includes, but is not limited to:
  1. (A) A 24-hour hotline for victims of sexual assault staffed by a trained person;
  2. (B) Counseling for sexual assault victims and their families and friends;
  3. (C) Accompaniment of victims of sexual assault to courts, hospitals, district attorneys generals' offices, law enforcement, or victim/witness coordinators offices;
  4. (D) Information and referrals for victims of sexual assault;
  5. (E) Advocacy with law enforcement, criminal justice, medical, mental health, school, and other related systems on behalf of sexual assault victims; and
  6. (F) Educational programs for allied professionals and the general public on sexual assault;
4. (4) “Sexual assault program” means a program that provides sexual assault program services; and
5. (5) “Sexual assault program services” means free sexual assault crisis intervention provided by a community-based program to persons who have been victims of a sexual assault and to their families and friends.

History (1)

Acts 2003, ch. 304, § 2.

§ 71-6-303. Powers and duties of department.

In administrating these programs, the department:
1. (1) Shall establish an advisory committee, which shall review all program criteria adopted by the department and advise the commissioner relative to the allocation of funds under this part. The committee shall consist of five (5) members, one (1) of whom should be a former client of a sexual assault program. Three (3) of the committee members shall be appointed by the commissioner of the department with consent and approval of the governor. Two (2) of the advisory committee members shall be appointed by the governor from among persons recommended by the Tennessee coalition against domestic and sexual violence. Each committee member shall be selected for a four-year term and may be selected to serve successive terms. Committee members shall be reimbursed for their actual expenses in attending meetings, with travel expenses to be reimbursed in accordance with the comprehensive travel regulations promulgated by the department of finance and administration and approved by the attorney general and reporter;
2. (2) May not disburse more than fifty thousand dollars ($50,000) from state funds provided under this part to any one (1) sexual assault program in one (1) fiscal year in order to assure that funds are distributed statewide, unless the department finds that exceeding the fifty thousand dollar ($50,000) guideline is warranted by the availability of funds, the area served by the provider, or the best interests of the citizens served by the program;
3. (3) Shall accept any federal funds that may be available for use in carrying out this part and may use state funds, in addition to the funds allocated under this part, as matching funds for federal funds if matching funds are required;
4. (4) May expend only those actual amounts, including travel expenses for advisory committee members, reasonably necessary for administration of the funds provided under this part;
5. (5) Shall promulgate rules and regulations in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, necessary to carry out the purposes of this part related to the programs under its jurisdiction. The department shall, upon recommendation of its advisory committee, establish standards for operation of the services including establishment of a timetable for application and disbursement of funds; and
6. (6) Shall require an annual report from each service funded, which shall include, in addition to all information required by the department, statistics on the number of persons requesting service, the number of persons served, the type of service rendered and a description of the social and economic characteristics of the person served and the number and type of referrals, including medical, legal, and educational services, made to other community resources. No information contained in the report shall identify any person served or enable any person to determine the identity of such a person.

History (1)

Acts 2003, ch. 304, § 2.

§ 71-6-304. Prerequisites to receiving funds.

To receive funds under this part, organizations shall:
1. (1) Be incorporated as a not-for-profit corporation, and be tax-exempt under § 501 of the Internal Revenue Code (26 U.S.C. § 501); and
2. (2) Comply with §§ 37-1-403 and 37-1-605 by reporting cases of suspected child abuse and neglect or child sexual abuse to the department of children's services and comply with § 71-6-103 by reporting suspected cases of adult abuse, sexual abuse, neglect, or exploitation to the department of human services.

History (1)

Acts 2003, ch. 304, § 2.

§ 71-6-305. Prerequisites for sexual assault programs.

To receive funds under this part for sexual assault program services, all applicants shall show that they have provided sexual assault program services for at least six (6) months prior to the application for funds under this part.

History (1)

Acts 2003, ch. 304, § 2.

§ 71-6-306. Necessary expenses of advisory committee.

A portion of the funds generated from the additional fine imposed upon persons convicted of sexual offenses pursuant to § 40-24-108 shall be used to pay the necessary expenses for any meetings of the advisory committee established by this part.

History (1)

Acts 2003, ch. 304, § 2.

§ 71-6-307. Equal distribution of funds.

Funds distributed under this part shall be distributed as equally as possible to serve all geographic areas of the state.

History (1)

Acts 2003, ch. 304, § 2.

Chapter 7 Tennessee Rare Disease Advisory Council

§ 71-7-101. Tennessee rare disease advisory council.

There is established the Tennessee rare disease advisory council, referred to in this chapter as the “advisory council”, to advise the TennCare prescription drug utilization review committee referred to in this chapter as the “DUR”, the TennCare pharmacy advisory committee referred to in this chapter as the “PAC”, and other public and private agencies in this state in providing services for persons diagnosed with rare diseases.

Backlinks (1)

4-29-249(a)(40)

History (1)

Acts 2020, ch. 645, § 1.

§ 71-7-102. Members of rare disease advisory council — Meetings — Administrative attachment.

(a) The advisory council is administratively attached to the bureau of TennCare, and is composed of eleven (11) members as follows:
1. (1) The governor shall appoint:
  1. (A) One (1) representative from the bureau of TennCare;
  2. (B) Two (2) representatives from academic research institutions in this state that receive grant funding for rare disease research;
  3. (C) Two (2) physicians licensed and practicing in this state with experience in researching, diagnosing, or treating rare diseases;
  4. (D) One (1) geneticist licensed and practicing in this state;
  5. (E) One (1) registered nurse or advanced practice registered nurse with experience treating rare diseases who is licensed and practicing in this state;
  6. (F) One (1) resident of this state who is eighteen (18) years of age or older and who:
    1. (i) Has been diagnosed with a rare disease; or
    2. (ii) Is a caregiver for a person who has been diagnosed with a rare disease; and
  7. (G) One (1) representative of a rare disease patient organization operating in this state; and
2. (2) The speaker of the senate and the speaker of the house of representatives shall each appoint one (1) member to the advisory council.
(b) In order to stagger the terms of the newly appointed advisory council members:
1. (1) The persons appointed under subdivisions (a)(1)(A) and (B) serve initial terms of one (1) year, which expire on June 30, 2021;
2. (2) The persons appointed under subdivisions (a)(1)(C)-(E) serve initial terms of two (2) years, which expire on June 30, 2022; and
3. (3) The persons appointed under subdivisions (a)(1)(F), (a)(1)(G), and (a)(2) serve initial terms of three (3) years, which expire on June 30, 2023.
(c)
1. (1) Following the expiration of their initial terms, all appointed members of the advisory council serve terms of three (3) years.
2. (2) Members of the advisory council shall serve until their successors have been appointed, with vacancies to be filled in the same manner as provided in the original appointments.
(d) In making appointments to the advisory council, the appointing authorities shall strive to ensure that the advisory council is composed of persons who are diverse in professional or educational background, ethnicity, race, age, sex, geographic residency, heritage, perspective, and experience.
(e) The advisory council members receive no compensation for their services on the advisory council.
(f)
1. (1) The advisory council shall meet quarterly, and may meet more often as determined by a majority vote of the advisory council. A member may participate in an advisory council meeting by teleconference up to two (2) times each calendar year.
2. (2) The governor shall call the initial meeting of the advisory council no later than October 1, 2020.
3. (3) Members shall elect a chair, vice chair, and secretary whose duties are established by the council.
4. (4) All meetings of the council are at the call of the chair.
5. (5) The council is administratively attached to TennCare for the purpose of submitting meeting minutes compiled by the council secretary to the DUR and PAC.

History (1)

Acts 2020, ch. 645, § 1.

§ 71-7-103. Rare disease advisory council recommendations — Use of information — Input of advisory council.

(a)
1. (1) The Tennessee rare disease advisory council shall advise the DUR, the PAC, and other state entities in their review of products or medications for the treatment of rare and orphan diseases, and drugs or biological products within the emerging fields of personalized medicine and non-inheritable gene editing therapeutics.
2. (2)
  1. (A) All advisory council recommendations must be presented in writing to members of the PAC and DUR and explained to members of the PAC and DUR by representatives of the advisory council during their public meetings.
  2. (B) The advisory council has no authority on any matter relating to TennCare, nor may it require the DUR or PAC to follow its recommendations.
(b) The DUR and PAC shall consider information submitted to them by the advisory council on rare diseases and personalized medicine when making recommendations or determinations regarding:
1. (1) Beneficiary access to drugs and biological products for rare diseases, as defined in the federal Orphan Drug Act of 1983 (21 U.S.C. §§ 360aa — 360ff-1);
2. (2) Drugs and biological products that are approved by the United States food and drug administration; and
3. (3) The emerging fields of personalized medicine and non-inheritable gene-editing therapeutics.
(c) The DUR and PAC shall seek the input of the advisory council on rare diseases and personalized medicine to address topics for consultation under this chapter, including, but not limited to:
1. (1) Rare diseases;
2. (2) The severity of rare diseases;
3. (3) The unmet medical needs associated with rare diseases;
4. (4) The impact of particular coverage, cost-sharing, tiering, utilization management, prior authorization, medication therapy management, or other medicaid policies on access to rare disease therapies;
5. (5) An assessment of the benefits and risks of therapies to treat rare diseases;
6. (6) The impact of coverage, cost-sharing, tiering, utilization management, prior authorization, medication therapy management, or other medicaid policies on patients' adherence to the treatment regimen prescribed or otherwise recommended by their physicians;
7. (7) Whether beneficiaries who need treatment from or a consultation with a rare disease specialist have adequate access and, if not, what factors are causing the limited access; and
8. (8) The demographics and the clinical description of patient populations.
(d) Nothing in this chapter requires the advisory council, the DUR, or the PAC to consult with a person on any matter or requires those entities to meet with any specific expert or stakeholder.

History (1)

Acts 2020, ch. 645, § 1.