Healthcare (Medicare)

SB 851 would authorize Tennessee's governor to expand Medicaid coverage for low-income residents under the federal Affordable Care Act (ACA), directly affecting thousands of Tennesseans currently ineligible for Medicaid. The bill specifically allows the governor to negotiate the terms of this expansion with federal officials at the Centers for Medicare and Medicaid Services (CMS). It amends state law to remove barriers to implementing the ACA's Medicaid expansion, which would extend health coverage to more adults with low incomes. The bill does not create new funding but provides the legal framework for the state to join the federal Medicaid expansion program.

SB 1376 prevents out-of-network ambulance providers from balance billing patients for emergency ambulance services covered under their health insurance plan. It caps patient payments at the lesser of their plan's in-network cost-sharing amount, the ambulance provider's full bill, or 325% of the federal Medicare rate for similar services in the area. Health insurers must count any payment made by the patient toward their deductible and out-of-pocket maximum. The law applies to health benefit plans issued or renewed on or after July 1, 2025.

SB 334, the "Tennessee Medicaid Modernization and Access Act of 2025," requires TennCare to update reimbursement rates for key healthcare services - including obstetrics/gynecology, primary care, outpatient mental health, and substance use disorder treatment - to match either the Medicare fee schedule or average commercial rates (whichever is higher) starting in 2025. This directly affects Medicaid beneficiaries (by improving access to these services) and healthcare providers (by ensuring fairer payments). The bill mandates annual rate reviews to maintain alignment with federal guidelines and allows providers to request administrative hearings for payment disputes. It also includes provisions for quality-based incentive payments in underserved areas and requires annual reports on fiscal impacts and service access improvements.