§ 71-5-2514. Definitions
As used in §§ 71-5-2513 — 71-5-2521, unless the context otherwise requires: “Access” means the ability to extract intelligible information through automated means, and to store, retrieve, use, and otherwise manipulate that information in a way that may lead to meaningful analysis with the aid of commonly available computer software and hardware; “Data” means representations […]
§ 71-5-2515. Data Provided to the Inspector General
All persons and entities under contract with the TennCare bureau or its agent or designee, including, but not limited to, all managed care organizations, benefit managers, and other managed care contractors, shall promptly provide to the office of inspector general, on request: A copy of, or access to, the same data regularly provided to the […]
§ 71-5-2516. Confidentiality — Liability for Providing Data — Creation of New Records or Data — Destruction of Data
All records obtained pursuant to this chapter shall be treated as confidential investigative records of the office of inspector general and shall not be open to public inspection; provided, however, that nothing in this part shall be construed to affect the obligation of the single state agency under federal law to provide the medicaid fraud […]
§ 71-5-2504. Rules and Regulations
The commissioner is authorized to promulgate rules and regulations, including emergency rules pursuant to § 4-5-208, to effectuate the purposes of this part. All such rules and regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
§ 71-5-2505. Authority
The office of inspector general shall have the authority to: Investigate civil and criminal fraud and abuse of the TennCare program, or any other violations of state criminal law related to the operation of TennCare; Cooperate with the MFCU, and where a preliminary investigation of fraud and abuse by a provider establishes a sufficient basis […]
§ 71-5-2506. Fraud and Abuse Cases
The office of inspector general shall have the authority to provide legal assistance to the attorney general and reporter and the state district attorneys general for the purpose of initiating and handling proceedings in appropriate TennCare fraud and abuse cases. Such assistance may include but not be limited to, the authority to fund assistant attorney […]
§ 71-5-2401. Establishment — Members — Recommendations Concerning Drugs on Auto-Exemptions List
There is established in the department of finance and administration a state TennCare pharmacy advisory committee. The committee shall make recommendations regarding a preferred drug list (PDL) to govern all state expenditures for prescription drugs for the TennCare program. The state TennCare pharmacy advisory committee shall be composed of fifteen (15) members. Except for initial […]
§ 71-5-2402. Removal of Member
A state TennCare pharmacy advisory committee member shall be removed by the commissioner of finance and administration from the committee for any of the following causes: Absence from two (2) consecutive meetings without contacting the chair or the vice chair with a satisfactory explanation; Absence from three (3) meetings in a single year without contacting […]
§ 71-5-2403. Conflicts of Interest — Compensation
Members of the state TennCare pharmacy advisory committee shall not enter any financial relationships with pharmaceutical manufacturers or their affiliates during their tenure on the state TennCare pharmacy advisory committee. A member shall not entertain individual lobbying or marketing, or participate in any other activity or discussions with pharmaceutical manufacturers or their representatives for the […]
§ 71-5-2404. Recommendations for Inclusion on Preferred Drug List
The TennCare pharmacy advisory committee shall submit to the bureau of TennCare both specific and general recommendations for drugs to be included on any state preferred drug list (PDL) adopted by the bureau. In making its recommendations, the committee shall consider factors including, but not limited to, efficacy, the use of generic drugs and therapeutic […]