The key objective is enhancing and solidifying standards for utilization review, increasing cooperation between healthcare providers and utilization review agents, and ensuring adherence to the Prior Authorization Fairness Act. The bill also mandates health insurers to comply with the Prior Authorization Fairness Act. Utilization review involves evaluation of the necessity, appropriateness, and efficiency of healthcare services and treatment plans. Prior Authorization is a requirement that physicians obtain approval from a health insurer before prescribing a medication, treatment, or service to a patient. The bill sets out comprehensive definitions important for understanding the parameters of the act, including definitions for “Chronic condition”, “Healthcare prescriber”, and “Healthcare service”, among others. Moreover, the bill details appeals processes for adverse determinations, specifications for prior authorization submissions, condition stipulations for chronic conditions, and sets expiration dates for prior authorizations. Additionally, it addresses special regulations for patients with opioid use disorders and lays out statistical requirements on how health carrier or utilization review organizations function. Overall, the bill aims to streamline the healthcare process, improve the fairness of authorizations, and enhance the healthcare provider and payer relationship.

As introduced, removes the requirement to obtain a certificate of need to establish or relocate certain healthcare facilities or initiate certain healthcare services, except for the initiation of services for a burn unit or organ transplantation.

As introduced, removes the prohibition on employment of radiologists, anesthesiologists, pathologists, and emergency physicians by hospitals and hospital affiliates

This bill modifies the Tennessee Right to Shop Act, making several amendments related to health and medical insurance. It first clarifies the definitions of “Emergency medical service” and “Healthcare service,” the latter including prescription drugs or devices but not emergency medical services. Next, the bill reduces the maximum time limit from one year to thirty days for certain undefined provisions. Furthermore, it permits enrollees to pay out-of-pocket to out-of-network healthcare providers if they negotiate a lower cost. They can send the payment information to their insurance carrier, who then must account the full amount the enrollee paid towards the enrollee’s deductible or other cost-sharing amount, provided the healthcare service is included in the enrollee’s health plan and that the enrollee negotiated a lower cost than typically paid by the carrier for similar services. Additionally, any monetary limit on incentives outlined in a separate section will not apply to the newly amended section dealing with out-of-pocket expenses. The bill also amends language so that carriers may provide incentives in addition to the requirements of the newly amended section.

This bill aims to amend several titles of the Tennessee Code Annotated, seeking to prohibit healthcare providers from reporting a patient’s medical debt to a consumer reporting agency. It also bars consumer reporting agencies from including a record of a patient’s medical debt in a consumer report. The bill defines ‘healthcare provider’ as any healthcare practitioner, person, or facility licensed or regulated under certain titles of Tennessee Code, and ‘medical debt’ as debt associated with the receipt of healthcare services. The act shall be in effect starting July 1, 2024. Violations of this amendment fall under the Tennessee Consumer Protection Act of 1977, and any legal proceedings can be instituted by the attorney general. 

This bill focuses on the amendment of Tennessee Code Annotated, Titles 56, 63, and 68, pertinent to the payment for healthcare. It outlines the process for the recoupment of overpaid claims by healthcare insurance entities from healthcare providers. In the bill, ‘recoupment’ refers to the action by a health insurance entity to recover amounts previously paid by withholding or deducting these amounts from current payments to the healthcare provider. The bill stipulates that a healthcare provider’s request for a payment correction must be filed no longer than six months following the date that payment for the claim was received. Unless fraud is committed by the healthcare provider, the health insurance entity can only recoup reimbursements during the six months following the payment date. The bill also lists the necessary information that must be included in a recoupment notice and describes the procedure for appealing a recoupment. If a healthcare provider chooses to appeal, neither entity is allowed to withhold payment until all appeals are exhausted. If a health insurance entity fails to adhere to the bill’s requirements, the commissioner can impose a penalty. The bill also prohibits the waiver, nullification, or voiding of these requirements by any contract. 

As introduced, removes the ability of a health insurance carrier to disregard an insured’s assignment of health insurance benefits to an out-of-network facility-based physician under certain conditions. 

As enacted, authorizes a hospital, or an affiliated entity of the hospital, to employ an emergency physician to treat patients at a satellite emergency department, or a physician to treat patients at a primary care clinic or urgent care clinic, which is located in this state, if certain conditions are met.

This bill, also known as the “Prior Authorization Fairness Act”, proposes amendments to the Tennessee Code Annotated, Titles 53, 56 and 71, in relation to healthcare services. The objective of the bill is to ensure that utilization review agents adhere to reasonable standards for utilization review. It aims to increase cooperation between healthcare providers and utilization review agents. The bill also introduces specific requirements for health insurance providers and utilization review organizations, leading to faster and more transparent review processes for patients seeking prior authorizations for healthcare services. It also proposes longer validity periods for prior authorizations for chronic conditions and mandates electronic processing of authorization requests. The proposed law would apply to all health insurance providers except those specifically exempted