Tennessee

SUMMARY

In the current legislative term, Tennessee has proposed legislation that increases price transparency among health care providers and regulates medication prices.

 

LEGISLATION/REGULATION

Legislative Calendar 

Tennessee’s most recent regular legislative session has ended. Legislation from the 2017 session will carry over to 2018.

 

Recent Legislative Developments

Healthcare Transparency

2017-2018

 

 

 

HB 178/

SB 165

Changes administering agency for the Medicaid Program in statute from the Department of Health to the Department of Finance and Administration; Active  Assigned to General Subcommittee of Senate Health and Welfare Committee – 4/10/2017
SB1155 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.”

TN Code §71-5-143 (2015)

Active  Carried over to 2018 legislative session
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
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. Active  Referred to Senate Finance, Ways and Means Committee 4/5/2017

 

 

Healthcare Cost

2017-2018 HB 69/

SB 118

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 – 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 – Taken off notice for calendar for Insurance and Banking Subcommittee 3/22/2017

 

Healthcare Markets

2017-2018 HB 139 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 – Failed in Senate Commerce and Labor Committee – 4/4/17

 

Key Statutes

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. § 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. § 56-7-122, 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.”

 

Healthcare Contracting 

  • 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.

 

Healthcare Markets

  • 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.

 

Network Adequacy

  • 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.

 

LITIGATION/ENFORCEMENT

  • Tennessee was one of 16 states to file anamicus 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

 

KEY RESOURCES

Tennessee General Assembly

Tennessee Office of the Attorney General

Tennessee Department of Commerce & Insurance

Baptist Memorial Health Care Cost Estimator