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.
To promote telehealth services, Tennessee law provides that a health insurance entity shall provide coverage for healthcare services provided during a telehealth encounter in a manner that is consistent with what the health insurance policy or contract provides for in-person encounters for the same service, and shall reimburse for healthcare services provided during a telehealth encounter without distinction or consideration of the geographic location.
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 0282 (see companion bill SB 0869) – Tennessee
Introduced: 2023 Status: In Process
As introduced, authorizes as part of the practice of pharmacy the prescribing of dietary fluoride supplements, certain immunization agents, opioid antagonists, and certain other drugs and products; makes various other changes to pharmacy practice. – …
HB 0352 (see companion bill SB 0352 – Tennessee
Introduced: 2019 Status: Enacted
Consumer Protection – As enacted, makes an unfair or deceptive act or practice certain legal advertisements for claims related to medical devices and pharmaceuticals, and the unauthorized use or distribution of protected health information; creates …
HB 0377 (see companion bill SB 0585) – Tennessee
Introduced: 2023 Status: In Process
As introduced, enacts the “Patient Rights Act.” – Amends TCA Title 8; Title 29; Title 33; Title 34; Title 56; Title 63; Title 68 and Title 71.
HB 0416 (see companion bill SB 0459) – Tennessee
Introduced: 2023 Status: In Process
As introduced, directs the bureau to establish, by January 1, 2024, a statewide program of all-inclusive care for the elderly (PACE) to provide comprehensive, integrated acute and long-term care services for qualifying frail, elderly individuals …
HB 0419 (see companion bill SB 0510) – Tennessee
Introduced: 2019 Status: Enacted
Insurance Companies, Agents, Brokers, Policies – As introduced, enacts the “Tennessee Right to Shop Act.” – Amends TCA Title 8; Title 33; Title 56; Title 63 and Title 68. This bill requires, beginning upon approval …
HB 0419 (see companion bill SB 0510) – Tennessee
Introduced: 2019 Status: Enacted
Insurance Companies, Agents, Brokers, Policies – As introduced, enacts the “Tennessee Right to Shop Act.” – Amends TCA Title 8; Title 33; Title 56; Title 63 and Title 68. This bill requires, beginning upon approval …
HB 0948 (see companion bill SB 1281) – Tennessee
Introduced: 2021 Status: Enacted
AN ACT to amend Tennessee Code Annotated, Title 4; Title 56; Title 68 and Title 71, relative to certificates of need. Hospitals and Health Care Facilities – As introduced, increases from 15 to 30 days …
HB 1342 (see companion bill SB 1120) – Tennessee
Introduced: 2019 Status: Enacted
Health Care – As introduced, requires that the notice to an insured concerning the potential out-of-network status of physicians who will be treating the insured at a facility for purposes of determining billing be given …
HB 1857 (see companion bill SB 1852) – Tennessee
Introduced: 2018 Status: Enacted
This bill requires pharmacy benefits managers to obtain licensure through the department of commerce and insurance. To obtain licensure as a pharmacy benefits manager, the person or entity must demonstrate to the department that the …
SB 1120 (see companion bill HB 1342) – Tennessee
Introduced: 2019 Status: Enacted
Health Care – As enacted, requires that the notice to an insured concerning the potential out-of-network status of physicians who will be treating the insured at a facility for purposes of determining billing be given …
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. Tennessee enacts its annual budget during the regular legislative session. To view Tennessee’s budgetary process, click here.
REGULATION & ENFORCEMENT
- Tennessee was one of 16 states to file an amicus brief supporting the FTC’s winning position in the Ninth Circuit appeal of St. Luke’s Health Care Sys. v. FTC, No. 14-35173 (March 7, 2014), decided February 10, 2015. The States’ brief stated that the acceleration of health care costs due to the growth of large health care provider systems had 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