Civil Cases – Opinions Released in Calendar Year 2023

Emergency Medical Care Facilities, P.C. v. Division of TennCare et al. (UAPA / TennCare Reimbursement)

Style: Emergency Medical Care Facilities, P.C. v. Division of TennCare et al.

TSC Docket Number: M2020-01358-SC-R11-CV

Date of TSC Opinion:  May 25, 2023

Opinion of the TSC:  Click here.

TSC Summary of the Opinion:

Article II of Tennessee’s Constitution vests legislative authority in the General Assembly. We have held, however, that the General Assembly may “grant an administrative agency the power to promulgate rules and regulations which have the effect of law in the agency’s area of operation.” Bean v. McWherter, 953 S.W.2d 197, 199 (Tenn. 1997). The General Assembly frequently has done so. But it also established important guardrails for administrative agencies by enacting the Uniform Administrative Procedures Act. One of those guardrails is the requirement that agencies engage in notice-and-comment rulemaking: a process that gives the public and other affected parties an opportunity to weigh in. Here, we consider whether a reimbursement cap imposed by TennCare is a “rule” within the meaning of the Uniform Administrative Procedures Act that should have been promulgated through the notice-and-comment process. We hold that it is and reverse the Court of Appeals’ contrary decision.

Court of Appeals Opinion:

Summary by the Court of Appeals:

This appeal involves a reimbursement limitation that TennCare imposed on “nonemergent” medical services provided by emergency department physicians. TennCare informed its managed care organizations of the reimbursement limitation via email without engaging in rule-making procedures outlined in the Uniform Administrative Procedures Act (“UAPA”). The trial court concluded the reimbursement limitation was a “rule” subject to the rule-making requirements of the UAPA and invalidated the reimbursement limitation. We hold that the reimbursement limitation falls within the internal management exception of the 2009 version of the UAPA and was therefore not subject to the UAPA’s rule-making requirements. The ruling of the trial court is reversed.

Permission to Appeal Granted: April 14, 2022

Appellants’ Briefs Filed: May 13, 2022

Appellees’ Briefs Filed: June 13, 2022

Appellants’ Reply Brief Filed: July 8, 2022

Appellees’ Reply Brief Filed:

Amicus Briefs Permitted:  

Oral Argument Date: October 5, 2022

Link to Oral Argument Video:


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