Tennessee Medicaid managed care: what plans must pay
Managed-care plans don't publish their provider fee schedules. What is public is the rule each plan must follow, set in Tennessee's plan contracts, statutes and notices. For 12 of 13 service lines, plans must follow a rule tied to the state's published rates.
- Lines with a binding rule
- 12of 13
- Plans on record
- 13
- Directed payments
- 5
- Capitation cells
- —not published
Who sets the rate, by service line
| Service line | Main rule for plans | Rates | Also applies |
|---|---|---|---|
| IDD services | State sets the plan rateThe state sets the rate plans pay | 567 | |
| Dental | State sets the plan rateThe state sets the rate plans pay | 296 | |
| Personal care & attendant | State sets the plan rateThe state sets the rate plans pay | 131 | |
| Other home & community services | State sets the plan rateThe state sets the rate plans pay | 93 | |
| Therapy (PT/OT/speech) | State sets the plan rateThe state sets the rate plans pay | 48 | |
| Pharmacy | Paid by the state, outside plansPaid directly by the state, outside managed care | 26 | |
| Behavioral health | State sets the plan rateThe state sets the rate plans pay | 20 | |
| Transportation | State sets the plan rateThe state sets the rate plans pay | 20 | Plans must pay at least this |
| Physician & professional | State sets the plan rateThe state sets the rate plans pay | 13 | |
| Other | State-directed paymentDirected payments add to plan rates | 8 | Plans must pay at least this |
| Private duty nursing | State sets the plan rateThe state sets the rate plans pay | 6 | |
| ABA / autism services | State sets the plan rateThe state sets the rate plans pay | 4 | |
| Equipment & supplies | Not classified yet | 3 | |
| Hospice | Plans must pay at least thisPlans must pay at least the published rate | 2 |
State-directed payments
Payments CMS approved under 42 CFR 438.6(c) that plans must make on top of, or as a minimum for, their negotiated rates.
| Program | Amount | Effective |
|---|---|---|
| TennCare managed care state directed payments (42 CFR 438.6(c)) | 3.03% | 2026-01-01 |
| TennCare managed care state directed payments (42 CFR 438.6(c)) | 140% | 2026-01-01 |
| TennCare managed care state directed payments (42 CFR 438.6(c)) | 62% | 2026-01-01 |
| TennCare managed care state directed payments (42 CFR 438.6(c)) | $232.50 | 2026-01-01 |
| TennCare managed care state directed payments (42 CFR 438.6(c)) | $4.00 | 2026-01-01 |
Frequently asked questions
Do Tennessee Medicaid plans have to pay the state fee schedule?
For some services. Plans must follow a rule tied to the state's rates for: IDD services, Dental, Personal care & attendant, Other home & community services, Therapy (PT/OT/speech), Behavioral health, Transportation, Physician & professional, Other, Private duty nursing, ABA / autism services, Hospice. For other lines, plans negotiate rates with providers.
Where do these rules come from?
From Tennessee's managed-care plan contracts, state statutes and regulations, provider notices and CMS-approved directed-payment filings. Each rate in the workspace carries its citation.
Can I see what each plan actually pays?
No plan publishes its provider fee schedule. The closest public signals are the binding rules above, state-set rates, directed payments and the state's own payment-level estimates in its directed-payment filings.
← All Tennessee Medicaid rates