Rates for a single case agreement negotiated between the MCOs and hospitals that are not in network with the MCOs to ensure access to services for TennCare enrollees may not exceed the ceiling or be below the floor of the Rate Corridors appropriate for those services.

Authority: T.C.A. §§ 4-5-208, 71-5-105, 71-5-109, and 71-5-2801. Administrative History: Original rule filed June 26, 1985; effective July 26, 1985. Emergency rule filed July 1, 2015; effective through December 28, 2015. Amendment filed September 21, 2015; effective December 20, 2015. 1200-13-05.-07 CHANGES TO HOSPITAL RATES NEGOTIATED BETWEEN MCOS AND HOSPITALS AFTER SEPTEMBER 30, 2015. To ensure that each hospital’s total TennCare reimbursement remains within the Rate Corridors, proposed rate changes after September 30, 2015, shall be evaluated by the Bureau to determine if the proposed rate change will move the hospital’s total TennCare rates outside of the Rate Corridors. If the evaluation indicates the change will put the hospital outside of the Rate Corridors, the Bureau shall provide the adjustments necessary to ensure that the contract is compliant with the limits of the Rate Corridors. TennCare rates between a hospital and an MCO may not be modified after September 30, 2015, without approval from the Bureau. Authority: T.C.A. §§ 4-5-208, 71-5-105, 71-5-109, 71-5-2801. Administrative History: Original rule filed June 26, 1985; effective July 26, 1985. Amendment filed November 10, 1988; effective December 25, 1988. Amendment filed May 8, 1991; effective June 22, 1991. Emergency rule filed July 1, 2015; effective through December 28, 2015. Amendment filed September 21, 2015; effective December 20, 2015.