Jones v. Bureau of TennCare

OPINION

Beginning in 1994, the Bureau of Tenn-Care (“TennCare”) provided insurance coverage for home health services for one of its enrollees, Carolyn Jones (“Jones”), who is bed-ridden due to rheumatoid arthritis. 1 In 1997, TennCare denied Jones coverage for home health services, and Jones appealed this determination. The Administrative Law Judge held TennCare was not required to provide coverage for home health services to Jones because the services are not medically necessary for her. Under the Uniform Administrative Procedures Act, Jones appealed the administrative agency’s determination…