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

Court of Appeals Opinion: https://www.tncourts.gov/sites/default/files/emergency.medical.corrected.opn_.pdf

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: https://www.youtube.com/watch?v=SSZLHVXHp9M

Date of TSC Opinion:  

Opinion of the TSC: 

TSC Summary of the Opinion: