Bloomberg Law
May 26, 2023, 2:37 PM

Tennessee Top Court Strikes Down Medicaid ER Reimbursement Cap

Mary Anne Pazanowski
Mary Anne Pazanowski
Legal Reporter

TennCare’s $50 emergency services reimbursement cap is void because it wasn’t promulgated through notice-and-comment rulemaking, Tennessee’s highest court said.

The provision implemented by the state’s Medicaid agency as a cost-saving measure met the Uniform Administrative Procedures Act’s definition of a “rule” and affected matters beyond the state’s internal management, the Tennessee Supreme Court said Thursday.

Tennessee’s UAPA is modeled on the federal Administrative Procedure Act. It requires agencies proposing a new rule to publish the proposal and accept comments from the public before finalizing it.

The procedure applies only to a rule, which the law defines as a “statement of ...

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