In the 2018 legislative term, Tennessee introduced and passed legislation thatprohibits healthcare providers from collecting out-of-network charges from an insured unless they provide written notice to the insured (HB 1935/SB 1869). In 2017, Tennessee took steps to increase price transparency among health care providers and passed legislation that requires annual coverage assessments on hospitals.
Tennessee’s most recent legislative session ran from 1/10/2018 – 4/16/2018.
Recent Legislative Developments
|2017-2018||HB 1935 / SB 1869||This bill prohibits healthcare providers from collecting out-of-network charges from an insured if the written notice required by this bill has not been provided and signed by the insured. This bill adds a similar prohibition to the present law provisions governing healthcare providers and facilities, specifying that they are prohibited from collecting out-of-network charges from an insured, or the insurer on behalf of the insured, unless they provide written notice, prior to treatment or service, regarding being out-of-network and the consequences of that on the insured, such as a statement that the insured agrees to receive service from the provider and an estimate of the amount to be charged.||Passed – Signed by Governor 5/4/2018|
|SB 757/ HB 898||Requires a health care provider to provide within two business days of a request by a patient, the estimated amount for a single procedure or episode of care, unless a medical emergency exists.||Inactive/Dead.|
|HB 2465 / SB 2412||This bill requires the state comptroller to study and make recommendations for increasing transparency in the purchasing of prescription drugs through the group insurance plan for state employees.||Inactive/Dead.|
|2017-2018||HB 69/||Direct the Commissioner of Finance and Administration to submit a waiver request to the federal centers for Medicare and Medicaid services to enable the state to provide medical assistance to the existing TennCare II waiver population and person with incomes below 138 percent of the federal poverty line by means of a block grant of federal funds.||Inactive/Dead – Taken off notice for calendar for Health Committee for 4/11/2017.|
|SB 612/HB 1252||Requires a timely reimbursement of health insurance claims that any claim submitted to an insurer by a provider electronically will be paid within 10 days if the provider had obtained pre-authorization for the claim||Inactive/Dead – Taken off notice for calendar for Insurance and Banking Subcommittee 3/22/2017|
|SB 214||Enacts the “Annual Coverage Assessment Act of 2017” which would require an annual assessment imposed on covered hospitals for the 2017-2018 fiscal year.||Passed – Signed by Governor 5/22/17 (Code Ann. 71-5-1501-1504)|
|Prohibits health insurance policies from using prorated dispensing fees or denying coverage for dispensing of medication in accordance with the synchronization of medication; requires health insurance policies to apply prorated cost-sharing to dispensing of medication in accordance with synchronization of medication. Proposes to Amend TCA Title 56 and 63||Inactive/Dead –Failed in Senate Commerce and Labor Committee – 4/4/17|
|SB 1155/HB 290||Re-establishes the TennCare advisory commission, which “will be allowed access to all data concerning operations, management, and program functions of the TennCare program[.]” Members of the commission will provide nonpaid consulting services and may have access to protected health information necessary to perform their advisory function. The commission will include, “(1) representative of the advocacy community; two (2) representatives from the Tennessee business community; and three (3) representatives from the provider community.”||Inactive/Dead.|
We compile state statutes relate to healthcare price and competition, including healthcare transparency, markets, and costs. For a complete listing of all health related statutes visit the State Health Practice Database for Research.
Transparency in Healthcare
- Code Ann. § 56-7-120 prohibits healthcare providers from collecting out-of-network charges from an insured if the written notice required by this bill has not been provided and signed by the insured. This bill adds a similar prohibition to the present law provisions governing healthcare providers and facilities, specifying that they are prohibited from collecting out-of-network charges from an insured, or the insurer on behalf of the insured, unless they provide written notice, prior to treatment or service, regarding being out-of-network and the consequences of that on the insured, such as a statement that the insured agrees to receive service from the provider and an estimate of the amount to be charged.
- Code Ann. § 56-2-125 establishes the state’s all payer claims database (APCD). An APCD is a database for aggregating health care claims data from payer sources in order to compare costs among physicians and health care systems. For more information, see the APCD Council website.
- Code Ann. § 68-11-1625 creates the State Health Planning Division within the Department of Finance and Administration. The Division is responsible for annually updating and maintaining the state health plan, based on the state’s public policy: to improve the health of Tennesseans; that every citizen should have reasonable access to health care; that the state’s health care resources should be developed to address the needs of Tennesseans while encouraging competitive markets, economic efficiencies and the continued development of the state’s health care system; that every citizen should have confidence that the quality of health care is continually monitored and standards are adhered to by health care providers; and that the state should support the development, recruitment and retention of a sufficient and quality health care workforce.
- Code Ann. § 56-7-1013 requires that a health insurer furnish payment and fee schedules to providers when contracting or renewing an existing contract. Providers may not share the payment and fee schedules with unrelated persons without the consent of the insurance carrier and the carrier is permitted to seek injunctive relief to prevent the disclosure.
- Code Ann. § 56-7-1601 through 56-7-1609 requires that health policy forms issued for delivery in the state must meet a reading ease test to facilitate accessibility of insurance information.
- Code Ann. § 56-7-122, relating to disclosure of financial arrangements between a provider and an insurer, states that “[a] provider shall not be prohibited by a health plan, by contract or otherwise, from disclosing to a patient the existence of financial arrangements with the health plan that reward the provider for reducing or limiting the range and amount of medically necessary and appropriate services rendered to the patients enrolled in the health plan.”
- Code Ann. 71-5-1501-1504 enacts the “Annual Coverage Assessment Act of 2017” which would require an annual assessment imposed on covered hospitals for the 2017-2018 fiscal year.
- Code Ann. § 68-11-1607 prevents a healthcare provider or facility from offering new or expanded services without obtaining a Certificate of Need (CON) proving a genuine need in the community for the expanded capacity. The CON process can be anti-competitive by increasing the regulatory burden on new market-entrants, but also potentially gives the state a tool to contain the overhead cost of excess capacity.
- Code Ann. §56-7-2409 Requires a health insurance entity offering employer-based plans to offer to employers no less than one plan option in which the copayment and coinsurance amounts for services rendered during an office visit to a chiropractic physician, physical therapist or occupational therapist are no greater than copayment and coinsurance amounts for the services rendered during an office visit to a primary care physician.
- Code Ann. § 56-7-1016, the “Tennessee Health Freedom Act,” declares that it is the public policy of the state not to penalize any person for refusing to purchase health insurance, and that the state government may not enact any law that restricts the mode of selecting health insurance.
- Code Ann. § 56-26-102 requires that hospital and medical service corporation rates must be filed with the Commissioner of Commerce and Insurance, who will review the rates for commercial reasonableness.
- Code Ann. § 56-8-101 et seq., prohibits unfair trade practice and unfair and deceptive conduct in the business of insurance.
- Code Ann. § 56-54-101 through 56-54-111, the “Tennessee Health Care Liability and Reporting Act,” requires that insuring entities or self-insurers that provide professional health care liability insurance to a facility or provider in the state must submit a report to the Commissioner of Insurance of all claims made under the policy for the purpose of analyzing trends in health care liability claims.
- Code Ann. § 56-7-2209 provides mandatory health benefit plan provisions, restrictions on premiums, disclosures and rating methods for small employer group health benefit plans.
- Code Ann. § 68-11-1303 et seq. states that hospitals may negotiate and enter into cooperative agreements with other hospitals if the likely benefits resulting from the agreements outweigh any disadvantages attributable to a reduction in competition that may result from the agreements. The hospitals may apply for a certificate of public advantage from the Office of the Attorney General, who has continued authority to review the cooperative agreements and terminate the certificate of public advantage if the healthcare benefits no longer outweigh the burden on competition.
- Code Ann. § 56-7-2356 provides that “[e]ach managed health insurance issuer that offers a plan that limits its enrollees’ choice of providers shall maintain a network that is sufficient in numbers and types of providers to assure that all covered benefits to covered persons will be accessible without unreasonable delay.” Network adequacy standards are judge on the basis of primary care provider-covered person ratios and geographic accessibility, among other requisite facility and provider standards.
FY 2018 BUDGET
Tennessee’s fiscal year begins on July 1 and ends on June 30 the following year. Tennessee enacted its FY 2018 Budget during the regular legislative session. To view Tennessee’s FY 2018 Budget, click here.
- Tennessee was one of 16 states to file an amicus brief in the Ninth Circuit case Luke’s Health Care Sys. v. FTC, No. 14-35173 (March 7, 2014), explaining that the acceleration of health care costs due to the growth of large health care provider systems has become a matter of grave concern for the States