Tennessee Code Annotated

Title 63: Professions of the Healing Arts

Chapter 51: Health Care Consumer Right-to-Know Act of 1998

TCA 63-51-111: Annual report and provider profiles -- Availability.

(a) The annual report required by SC 56-32-110(b)(4), and information required for a profile by this section shall be made available to consumers by the department of health through the World Wide Web of the Internet or a toll-free telephone line. Such information shall be made available by May 1, 1999, and shall be updated by May 1 of each succeeding year.

(b) The information made available by the department pursuant to subsection (a) shall be based on reports filed with the department of commerce and insurance pursuant to SC 56-32-110, and shall include, to the extent practicable, the following:

(1) A description of the grievance review system;

(2) The total number of grievances handled through such grievance review system, and a compilation of the causes underlying the grievances filed;

(3) The ratio of the number of adverse decisions issued to the number of grievances received;

(4) The ratio of the number of successful grievance appeals to the total number of appeals;

(5) The average of:

(A) The number of enrollees at the beginning of the calendar year; and

(B) The number of enrollees at the end of the calendar year; and

(6) The number, amount and disposition of health care liability claims made by enrollees that resulted in settlements, court judgments and arbitration awards by the plans during the calendar year.

(c) For each year the reports are filed, the information described in subdivisions (b)(2)-(6) shall be shown for a period of five (5) consecutive calendar years. The information for more than five (5) calendar years shall not be required.

(d) The profile of managed care organizations regulated pursuant to title 56, chapter 32, maintained by the department shall include:

(1) The number of years in existence;

(2) A summary of the financial information, including profits or losses, as reported by the plan in its annual statement filed with the commissioner of commerce and insurance;

(3) The geographic plan area for which the plan is authorized;

(4) The composition of the provider network, including names, addresses and specialties of providers;

(5) Identification of those providers that have notified the plan that they are not accepting new patients;

(6) Measures of quality and consumer satisfaction if the commissioner of health determines by rule that such measures are valid and comparable among organizations;

(7) The certification and accreditation status of the organization, if any;

(8) Procedures governing access to specialists and emergency care services; and

(9) The information voluntarily submitted by the managed care organization to the commissioner relative to consumer satisfaction and quality standards or measures.

History: Acts 1998, ch. 1073, SC 11; 2012, ch. 798, SC 54.