[Effective until 6/30/2025. See the Compiler’s Notes]

Access Tennessee has the general powers and authority granted under the laws of this state to insurance companies licensed to transact the kinds of insurance defined under § 56-2-201. In addition, Access Tennessee has the specific power to:

(1) Enter into contracts as are necessary or proper to carry out the provisions and purposes of this part, including the authority, with the approval of the commissioner, to enter into contracts with similar programs in other states for the joint performance of common administrative functions, or with persons, other organizations or other state agencies for the performance of administrative functions;

Terms Used In Tennessee Code 56-7-2904

  • Access Tennessee: means the nonprofit entity created pursuant to §. See Tennessee Code 56-7-2902
  • Attorney: means the person designated and authorized by subscribers as the attorney-in-fact having authority to obligate them on reciprocal insurance contracts. See Tennessee Code 56-16-102
  • Commissioner: means the commissioner of finance and administration. See Tennessee Code 56-7-2902
  • Contract: A legal written agreement that becomes binding when signed.
  • Program: means the Access Tennessee health insurance program, created in §. See Tennessee Code 56-7-2902
  • Reporter: Makes a record of court proceedings and prepares a transcript, and also publishes the court's opinions or decisions (in the courts of appeals).
  • State: when applied to the different parts of the United States, includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
  • written: includes printing, typewriting, engraving, lithography, and any other mode of representing words and letters. See Tennessee Code 1-3-105
(2)

(A) Sue or be sued, including taking any legal actions necessary or proper to:

(i) Avoid the payment of improper claims against the program or the coverage provided by or through the program;
(ii) Recover any amounts erroneously or improperly paid by the program;
(iii) Recover any amounts paid by the program as a result of mistake of fact or law; or
(iv) Recover other amounts due the program.
(B) For purposes of subdivision (2)(A), as well as for legal representation of Access Tennessee, Access Tennessee is considered to be an instrumentality of the state for the purpose of being represented by the attorney general and reporter, pursuant to § 8-6-109;
(3) Establish and modify, from time to time as appropriate, rates, rate schedules, rate adjustments, expense allowances, agent referral fees, claim reserve formulas and any other actuarial function appropriate to the operation of the program. Rates shall be determined in relation to the coverage provided, the risk experience, and expenses of providing coverage. Rates and risk schedules may be adjusted for age, tobacco use and weight and shall take into consideration appropriate factors in accordance with established actuarial and underwriting practices;
(4) Establish a program to provide premium assistance to low income individuals eligible to participate in the program;
(5) Purchase or issue policies of insurance in accordance with the requirements of this part;
(6) Appoint appropriate legal, actuarial and other committees as necessary, including advisory committees of external experts, to provide technical assistance in the operation of the program, policy and other contract design, and assistance with any other function within the authority of Access Tennessee;
(7) Request an annual audit by the comptroller of the treasury, as otherwise provided by law, or, with the prior written approval of the comptroller of the treasury, contract with an independent public accountant for the audit;
(8) Determine the eligibility requirements for program participants, in accordance with this part;
(9) Establish at least two (2) coverage options, pursuant to § 56-7-2910;
(10) Employ and set the compensation of, or contract with, any persons or entities necessary to assist Access Tennessee in carrying out its responsibilities and functions;
(11) Provide for reinsurance of risks incurred by the program;
(12) Issue additional types of health insurance policies to provide optional coverage;
(13) Provide for and employ cost containment measures and requirements, including, but not limited to, preadmission screening, second surgical opinion, concurrent utilization review, disease management and individual case management, for the purpose of making the program more cost effective;
(14) Design, utilize, contract or otherwise arrange for the delivery of cost effective health care services, including establishing or contracting with preferred provider organizations, health maintenance organizations and other limited network provider arrangements; and
(15) Adopt bylaws, policies, procedures and a plan document detailing program benefits as may be necessary or convenient for the implementation of this part and the operation of the program.
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