71-5-1608 - Definition of
71-5-1608. Definition of managed care organization (MCO) Regular review of long-term care services-related programs, functions and activities of the department of health, the commission on aging and disabilities, the department of human services and the TennCare program.
(a) For the purposes of this part, managed care organization (MCO) means any health maintenance organization, behavioral health organization, any entity regulated pursuant to title 56, chapter 32 and contractors of those entities.
(b) The committee shall review regularly the following long-term care services-related programs, functions and activities of the department of health, the commission on aging and disabilities, the department of human services and the TennCare program:
(1) Eligibility and enrollment standards, including determinations of how long-term services recipients are assigned to MCOs, or other matters related to eligibility and assignment of TennCare enrollees and participants in the options program established by part 14 of this chapter;
(2) Provisions of services, facilities or programs by TennCare and options providers, including benefit packages or other related matters;
(3) Education programs for TennCare and options enrollees, MCOs and providers, including eligibility, access to providers and MCOs, benefit package offered, deductibles and copayments required or other related matters;
(4) Review and evaluation of performance of MCOs, including their compliance with contracts entered into with the state, review of MCO contracts entered into with any long-term care services provider or other related matters;
(5) Compliance by the appropriate agencies with provisions of applicable federal waivers, including review of proposed amendments to the waiver for system changes and evaluations or reports prepared for or by the federal government, or other related matters;
(6) Staffing within the department, including recruitment, selection, training, compensation, discipline or other matters;
(7) Management, including planning, budgeting, information systems, organizational structure, rules and regulations, department policies and procedures or other related matters; and
(8) Any other matters considered material.
[Acts 2008, ch. 1190, § 26.]