Tennessee Code Annotated

Tenn. Code Ann. § 71-5-108 (2026)

Payment methodology for medicaid enrollees not enrolled in medicare

✓ current as of May 2026

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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.

Acts 2007, ch. 409, § 1.

Notes of Decisions

Cited in 6 cases (4 in the last 5 years), 2014–2025 · leading case: Chattanooga-Hamilton Cnty. Hosp. Auth. v. UnitedHealthcare Plan of the River Valley, Inc., 475 S.W.3d 746 (Tenn. 2015).

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Chattanooga-Hamilton Cnty. Hosp. Auth. v. UnitedHealthcare Plan of the River Valley, Inc., 475 S.W.3d 746 (Tenn. 2015). · cites it 17× “Two years later, in response to this DRA provision, the Tennessee General Assembly enacted Tennessee Code Annotated section 71-5-108, entitled “State plan amendment; payment methodology.”

The Chattanooga-Hamilton Cnty. Hosp. Auth. v. Div. of TennCare (Tenn. Ct. App. 2025). · cites it 14× “Tenn. Code Ann. § 71-5-108 (emphasis added).”

The Chattanooga-Hamilton Cnty. Hosp. Auth. d/b/a Erlanger Health Sys. v. Div. of TennCare, Dep't of Fin. & Admin. (Tenn. Ct. App. 2025). · cites it 14× “Tenn. Code Ann. § 71-5-108 . The statute took effect on June 11, 2007, and has not been amended since.”

Dep't of Fin. & Admin., Div. Of TennCare v. The Chattanooga-Hamilton Cnty. Hosp. Auth. D/B/A Erlanger Health Sys. (Tenn. Ct. App. 2021). · cites it 8× “In 2007, the Tennessee General Assembly responded by enacting Tenn. Code Ann. § 71-5-108 : The TennCare bureau is directed to submit a state plan amendment to the centers for medicare and medicaid services [“CMS”] that sets out a payment methodology for medicaid enrollees who…”

The Chattanooga-Hamilton Cnty. Hosp. Auth. D/B/A Erlanger Health Sys. v. United Healthcare Plan of The River Valley, Inc. D/B/A Americhoice & Tennessee Attorney Gen. (Tenn. Ct. App. 2014). · cites it 12× “Tenn. Code Ann. § 71-5-108 (emphasis added).”

The Chattanooga-Hamilton Cnty. Hosp. Auth. d/b/a Erlanger Health Sys. v. UnitedHealthcare Plan of the River Valley, Inc. d/b/a/ AmeriChoice (2025). “See Tenn. Code Ann. § 71-5-108 (2019); TENN. COMP.”

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