Overview
The Tennessee Legislature has been active in promoting price transparency in health care. The state passed the Tennessee Right to Shop Act in 2019 to induce consumer price shopping. An insurance carrier is allowed to provide incentives for enrollees who elect to receive a comparable healthcare service from a network provider, for at least 50% of the carrier’s saved costs for each comparable healthcare service. To protect consumers from surprise or balance billing, the state enacted legislation that requires at least three days notice to an insured for services from an out-of-network facility-based physician and prohibits healthcare providers from collecting out-of-network charges from an insured unless they provide written notice to the insured. Additionally, the law requires annual coverage assessments on hospitals for price transparency among health care providers. However, while the state passed legislation to establish an all-payer claims database, there are no active implementation efforts.
In the provider market, Tennessee requires healthcare specific notice of the sale or conveyance of all public benefit hospitals to the attorney general, with review criteria based on access to affordable care or adverse effect on the cost of services. The state additionally limits non-compete terms in physician contract to no more than 2 years. It also exempts physicians specializing in emergency medicine and any contract. terms entered into during the purchase of sale of a physician practice.
In 2024, the state enacted “Prior Authorization Fairness Act” to increase cooperation between healthcare providers and utilization review agents, and the “Tennessee Right to Shop Act” was enacted, which allows patients to compare prices for healthcare services.
See below for an overview of existing Tennessee state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 1/10/2023 - 5/6/2023 (2023-2024 term). *Current session bill updates are ongoing. Check back weekly for updates.
HB 0055 – Tennessee
Introduced: 2024 Status: In Process
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.
HB 0055 – Tennessee
Introduced: 2023 Status: Inactive / Dead
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. – Amends TCA Section 56-7-120.
HB 0075 (see companion bill SB 0168) – Tennessee
Introduced: 2019 Status: Inactive / Dead
Hospitals and Health Care Facilities – As introduced, increases the period in which notice must be given to the health services and development agency that a health care institution has changed ownership from 30 to …
HB 0090 (see companion bill SB 0236) – Tennessee
Introduced: 2019 Status: Enacted
TennCare – As enacted, changes the basis for the multiplier of the ground ambulance service provider assessment calculation from medicaid transports by a provider to all transports by a provider. – Amends TCA Title 71.
HB 0117 – Tennessee
Introduced: 2019 Status: Inactive / Dead
As introduced, clarifies that TennCare’s monthly statement to the chairs of the senate and house finance, ways and means committees on the estimated fiscal impact of applications for certificates of need approved by the health …
Tenn. Code Ann. §§ 56-7-2401 through 2410: Mandated Scope of Practice – Tennessee
Introduced: Status: Enacted
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 …
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Tenn. Code Ann. §§ 56-7-3301 through 3304: Contracts with Health Care Providers – Tennessee
Introduced: Status: Enacted
Requires health insurance entities to esatblish and maintain an Internet web site, which shall be accessible to providers with whom the entity has a provider agreement or contract.
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Tenn. Code Ann. §§ 56-7-601 through 56-7-610: Tennessee Right to Shop Act – Tennessee
Introduced: Status: Enacted
Beginning upon approval of the next health insurance rate filing on or after January 1, 2021, a carrier offering a health plan in this state shall implement a shopping and decision support program that provides …
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Tenn. Code Ann. §§ 56-8-101 through 113: Unfair Trade Practices and Unfair Claims Settlement Act of 2009 – Tennessee
Introduced: Status: Enacted
No person shall engage in an unfair trade practice from, in or into this state that is defined in § 56-8-104 or § 56-8-106 or determined by rule pursuant to § 56-8-108 to be an …
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Tenn. Code Ann. §§ 63-32-101 through 119. Short title: Health Care Consumer Right-To-Know Act of 1998 – Tennessee
Introduced: Status: Enacted
Health care is a valuable commodity, and the health care consumer needs to make informed decisions when making health care choices. Due to the current trends in health care, patients have a close relationship with …
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Federal Trade Commission and State of Tennessee v. Methodist Le Bonheur Healthcare and Tenet Healthcare – Tennessee
District Court: Western District of Tennessee, Western Division Status: Decided
Joined by the Tennessee attorney general, the FTC filed in federal court for a preliminary injunction to block Methodist Le Bonheur’s proposed $350 million acquisition …
Mountain States Health Alliance and Wellmont Health System to form Ballad Health – Tennessee
District Court: United States of America Before The Federal Trade Commission Status: Decided
On September 19, 2017, after more than two years of opposition from the FTC, the Tennessee Department of Health granted a certificate of public advantage …
United States et al. v. Anthem, Inc., and Cigna Corp. – California, Colorado, Connecticut, District of Columbia, Federal, Georgia, Iowa, Maine, Maryland, New Hampshire, New York, Tennessee, Virginia
District Court: District of Columbia Status: Decided
On April 28, 2017, the D.C. Circuit Court of Appeals affirmed the District Court’s decision to block the proposed $54 billion merger between Anthem and …
Federal Trade Commission and State of Idaho v. St. Luke’s Health System, Ltd and Saltzer Medical Group, P.A. – California, Connecticut, Delaware, Idaho, Illinois, Iowa, Kentucky, Maine, Maryland, Mississippi, Montana, Nevada, New Mexico, Oregon, Pennsylvania, Tennessee, Washington
District Court: District of Idaho Status: Decided
In March 2013, the FTC and the Idaho Attorney General filed a joint complaint challenging the merger betweenSt. Luke’s Health System, Idaho’s largest health system, …
In re: Suboxone Antitrust Litigation (State of Wisconsin, et al. v. Indivior Inc, et al.) – Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin
District Court: E.D. Pennsylvania Status: Pending
In September 2016, 35 state attorneys general and the District of Columbia brought a multi-district case against pharmaceutical manufacturer Indivior, MonoSol RX et al., alleging …
Additional Resources
STATE BUDGET
Tennessee’s fiscal year begins on July 1 and ends on June 30 the following year. The state operates on an annual budget cycle. State agencies submit their budget requests to the governor by October 1. The governor submits the proposed budget to the state legislature by February 1. The deadline for new governors is March 1. The legislature typically adopts a budget between April and June.
STATE LEGISLATURE
The state Legislature has 33 Senators, and the House of Representatives has 99 members. The representatives are elected to two-year terms, and the senators are elected to four-year staggered terms. The Tennessee General Assembly meets convenes on the second Tuesday of January. Each General Assembly meets 90 session days over a two-year period. Generally, legislative sessions last from mid-January through late April or May of each year. Bills carry over from odd to even numbered years.