§ 71-5-101 Short title
§ 71-5-102 Purpose
§ 71-5-103 Part definitions
§ 71-5-104 Administration by department
§ 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
§ 71-5-106 Determination of eligibility for medical assistance
§ 71-5-107 Kinds of medical services
§ 71-5-108 Payment methodology for medicaid enrollees not enrolled in medicare
§ 71-5-109 Expenditures not to exceed appropriation
§ 71-5-110 Application for medical assistance – Application for TennCare enrollment – Notice of change in application information
§ 71-5-111 Investigation – Determination of eligibility
§ 71-5-112 Hearing concerning eligibility
§ 71-5-113 Hearing concerning matters other than eligibility
§ 71-5-114 Subpoena and examination of witnesses
§ 71-5-115 Financial responsibility of relative – When may be considered – Reimbursement from responsible parties
§ 71-5-116 Lien on real estate – Claim against estate – Restrictions
§ 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 int
§ 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 app
§ 71-5-119 Discrimination prohibited
§ 71-5-120 Residency requirement – Determination – Appeal
§ 71-5-121 Transfer of income or resources
§ 71-5-122 Statement of interest of vendors or suppliers holding equity interest in hospitals, apothecaries or nursing homes
§ 71-5-123 Statement of public officials as to interest in vendors or providers
§ 71-5-124 Duties of department of finance and administration
§ 71-5-125 Duties of fiscal review committee
§ 71-5-126 Medicaid expansion under federal Patient Protection and Affordable Care Act prohibited without joint resolution of General Assembly
§ 71-5-127 Conflict with federal law – Single state agency
§ 71-5-128 Contracts with health maintenance organizations – Requirements
§ 71-5-129 Charges for services of physician assistants
§ 71-5-130 Determination of payments to vendors – Audits
§ 71-5-131 Contributed funds
§ 71-5-132 Medicaid providers – Responsibilities – Changes in ownership or controlling interest
§ 71-5-133 Provision of information concerning Norplant and other contraceptives
§ 71-5-134 Rules and regulations – Funding medical assistance
§ 71-5-135 State unemployment health care benefits – Scope – Conditions
§ 71-5-136 Hold harmless requirements prohibited
§ 71-5-137 Disclosures required of persons associated with managed care organizations
§ 71-5-138 Compliance with provisions regarding authorizations for pharmacy services
§ 71-5-139 Protection of TennCare patients’ federal and court ordered rights by health care providers receiving TennCare funds
§ 71-5-140 Deductions for dental services paid by eligible individuals in long-term care facilities
§ 71-5-141 Eligibility of aliens for medical assistance
§ 71-5-142 Confidentiality and disclosure of proprietary information
§ 71-5-143 TennCare advisory commission – Composition – Purpose – Expert assistance – Confidentiality – Conflict – Compensation
§ 71-5-144 Medically necessary items and services
§ 71-5-145 Cost effectiveness of providers
§ 71-5-146 Pharmacy lock-in program
§ 71-5-147 Personal needs allowance – Protecting nursing home residents from diversion of allowance
§ 71-5-148 Health care safety net for uninsured
§ 71-5-149 Disease management program
§ 71-5-150 Reimbursement for TennCare crossover payments
§ 71-5-151 Report on use of technical assistance groups of healthcare providers in developing episode of care
§ 71-5-152 Procedure to obtain data sets derived from all payer claims database – Use of data – Annual report
§ 71-5-153 Verification of information
§ 71-5-154 Annual report relating to coverage of mental health treatment
§ 71-5-155 Prior authorization for CRT or manual wheelchairs prohibited – Exceptions – Section definitions
§ 71-5-156 Development of policy regarding births involving neonatal abstinence syndrome and opiod use by women of childbearing age
§ 71-5-157 Establishment of state policy to avoid use of state funds for elective abortions
§ 71-5-158 Amendment to TennCare ll waiver relating to work and community engagement requirements for certain adult enrollees
§ 71-5-159 Complex rehabilitation technology
§ 71-5-160 Maintenance of coverage trust fund
§ 71-5-161 Hospital payment rate corridors
§ 71-5-162 Identification of child enrollees eligible for federal supplemental security income upon reaching 18 years of age – Counseling – Enrollment assistance
§ 71-5-163 Submission of waiver in order to provide medical assistance to TennCare ll waiver population by means of block grant
§ 71-5-164 Waiver for purpose of establishing Katie Beckett program
§ 71-5-165 Reimbursement of ambulance service provider that provides covered service to TennCare recipient
§ 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
§ 71-5-167 Physical address requirement for telehealth providers
§ 71-5-181 Tennessee Medicaid False Claims Act – Short title
§ 71-5-182 Violations – Damages – Definitions
§ 71-5-183 Civil actions – Employee remedies
§ 71-5-184 Service – Limitations
§ 71-5-185 Venue
§ 71-5-188 Actuarial study of TennCare
§ 71-5-189 Accounting of TennCare funds
§ 71-5-190 TennCare prescription drug utilization review committee
§ 71-5-191 Uniform TennCare claims process
§ 71-5-192 Information management system
§ 71-5-193 Children’s mental health care – Development of interagency projects and programs
§ 71-5-194 Spend down eligibility for medical assistance
§ 71-5-195 Study on use of prescription drugs in nursing homes
§ 71-5-196 Veterans education benefits
§ 71-5-197 Authority over TennCare pharmacy purchases – Confidential information – Exemption from open meeting laws
§ 71-5-198 Prescription drug program waiver
§ 71-5-199 State preferred drug list
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Terms Used In Tennessee Code > Title 71 > Chapter 5 > Part 1 - Medical Assistance Act

  • 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:
    (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:
    (i) Placing the person's, or with respect to a pregnant woman, her unborn child's, health in jeopardy. See Tennessee Code 71-5-103
  • Affidavit: A written statement of facts confirmed by the oath of the party making it, before a notary or officer having authority to administer oaths.
  • Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Applicant: means any person who has applied for benefits under this part. See Tennessee Code 71-5-103
  • Appropriation: The provision of funds, through an annual appropriations act or a permanent law, for federal agencies to make payments out of the Treasury for specified purposes. The formal federal spending process consists of two sequential steps: authorization
  • Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
  • Bankruptcy: Refers to statutes and judicial proceedings involving persons or businesses that cannot pay their debts and seek the assistance of the court in getting a fresh start. Under the protection of the bankruptcy court, debtors may discharge their debts, perhaps by paying a portion of each debt. Bankruptcy judges preside over these proceedings.
  • Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
  • Clerk of court: An officer appointed by the court to work with the chief judge in overseeing the court's administration, especially to assist in managing the flow of cases through the court and to maintain court records.
  • Code: includes the Tennessee Code and all amendments and revisions to the code and all additions and supplements to the code. See Tennessee Code 1-3-105
  • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
  • Continuance: Putting off of a hearing ot trial until a later time.
  • Contract: A legal written agreement that becomes binding when signed.
  • County office: means the county office of the state department of human services in the county wherein the applicant resides. See Tennessee Code 71-5-103
  • Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
  • Decedent: A deceased person.
  • Defendant: In a civil suit, the person complained against; in a criminal case, the person accused of the crime.
  • Department: means the department of health. See Tennessee Code 71-5-103
  • Dependent: A person dependent for support upon another.
  • Deposition: An oral statement made before an officer authorized by law to administer oaths. Such statements are often taken to examine potential witnesses, to obtain discovery, or to be used later in trial.
  • Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
  • Dismissal: The dropping of a case by the judge without further consideration or hearing. Source:
  • Donor: The person who makes a gift.
  • Entitlement: A Federal program or provision of law that requires payments to any person or unit of government that meets the eligibility criteria established by law. Entitlements constitute a binding obligation on the part of the Federal Government, and eligible recipients have legal recourse if the obligation is not fulfilled. Social Security and veterans' compensation and pensions are examples of entitlement programs.
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Fair market value: The price at which an asset would change hands in a transaction between a willing, informed buyer and a willing, informed seller.
  • Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
  • Fraud: Intentional deception resulting in injury to another.
  • Gift: A voluntary transfer or conveyance of property without consideration, or for less than full and adequate consideration based on fair market value.
  • Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
  • Joint resolution: A legislative measure which requires the approval of both chambers.
  • Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
  • Lawsuit: A legal action started by a plaintiff against a defendant based on a complaint that the defendant failed to perform a legal duty, resulting in harm to the plaintiff.
  • Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). Source: OCC
  • Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
  • Lien: A claim against real or personal property in satisfaction of a debt.
  • Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
  • 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. See Tennessee Code 71-5-103
  • 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. See Tennessee Code 71-5-103
  • Minor: means any person who has not attained eighteen (18) years of age. See Tennessee Code 1-3-105
  • 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. See Tennessee Code 71-5-103
  • Month: means a calendar month. See Tennessee Code 1-3-105
  • Mortgage: The written agreement pledging property to a creditor as collateral for a loan.
  • Nolo contendere: No contest-has the same effect as a plea of guilty, as far as the criminal sentence is concerned, but may not be considered as an admission of guilt for any other purpose.
  • Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
  • Oversight: Committee review of the activities of a Federal agency or program.
  • Person: includes a corporation, firm, company or association. See Tennessee Code 1-3-105
  • Personal representative: when applied to those who represent a decedent, includes executors and administrators, unless the context implies heirs and distributees. See Tennessee Code 1-3-105
  • Plaintiff: The person who files the complaint in a civil lawsuit.
  • Plea: In a criminal case, the defendant's statement pleading "guilty" or "not guilty" in answer to the charges, a declaration made in open court.
  • Pleadings: Written statements of the parties in a civil case of their positions. In the federal courts, the principal pleadings are the complaint and the answer.
  • Power of attorney: A written instrument which authorizes one person to act as another's agent or attorney. The power of attorney may be for a definite, specific act, or it may be general in nature. The terms of the written power of attorney may specify when it will expire. If not, the power of attorney usually expires when the person granting it dies. Source: OCC
  • Probate: Proving a will
  • Property: includes both personal and real property. See Tennessee Code 1-3-105
  • Prosecute: To charge someone with a crime. A prosecutor tries a criminal case on behalf of the government.
  • Public law: A public bill or joint resolution that has passed both chambers and been enacted into law. Public laws have general applicability nationwide.
  • Recipient: means any person who has been determined eligible to receive benefits under this part and who has received such benefits. See Tennessee Code 71-5-103
  • Record: means information that is inscribed on a tangible medium or that is stored in an electronic or other medium and is retrievable in a perceivable form. See Tennessee Code 1-3-105
  • Recourse: An arrangement in which a bank retains, in form or in substance, any credit risk directly or indirectly associated with an asset it has sold (in accordance with generally accepted accounting principles) that exceeds a pro rata share of the bank's claim on the asset. If a bank has no claim on an asset it has sold, then the retention of any credit risk is recourse. Source: FDIC
  • Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
  • Reporter: Makes a record of court proceedings and prepares a transcript, and also publishes the court's opinions or decisions (in the courts of appeals).
  • Representative: when applied to those who represent a decedent, includes executors and administrators, unless the context implies heirs and distributees. See Tennessee Code 1-3-105
  • 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. See Tennessee Code 71-5-103
  • 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. See Tennessee Code 71-5-103
  • Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
  • signed: includes a mark, the name being written near the mark and witnessed, or any other symbol or methodology executed or adopted by a party with intention to authenticate a writing or record, regardless of being witnessed. See Tennessee Code 1-3-105
  • State: when applied to the different parts of the United States, includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
  • Statute: A law passed by a legislature.
  • Statute of limitations: A law that sets the time within which parties must take action to enforce their rights.
  • Subpoena: A command to a witness to appear and give testimony.
  • Summons: Another word for subpoena used by the criminal justice system.
  • Testimony: Evidence presented orally by witnesses during trials or before grand juries.
  • Title XIX: means Title XIX of the Social Security Act as amended (P. See Tennessee Code 71-5-103
  • Tort: A civil wrong or breach of a duty to another person, as outlined by law. A very common tort is negligent operation of a motor vehicle that results in property damage and personal injury in an automobile accident.
  • Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
  • United States: includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
  • 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. See Tennessee Code 71-5-103
  • Verdict: The decision of a petit jury or a judge.
  • written: includes printing, typewriting, engraving, lithography, and any other mode of representing words and letters. See Tennessee Code 1-3-105
  • Year: means a calendar year, unless otherwise expressed. See Tennessee Code 1-3-105