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2019 Tennessee Code
Title 63 - Professions of the Healing Arts
Chapter 32 - Health Care Consumer Right-to-Know Act of 1998
§ 63-32-111. Annual report and provider profiles -- Availability.

Universal Citation: TN Code § 63-32-111 (2019)
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  • (a) The annual report required by § 56-32-110(b)(4) [repealed], and information required for a profile by this section shall be made available to consumers by the department of health through the World Wide Web of the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subsection (a) shall be based on reports filed with the department of commerce and insurance pursuant to § 56-32-110 [repealed], and shall include, to the extent practicable, the following: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.

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