Healthcare (Insurance)

in committee · Tennessee · Senate Apr 28, 2025

SB 428: Opioids - As enacted, authorizes an insurer, for purposes of group insurance plans offered to state employees, to adopt or amend a state preferred drug list (PDL); requires the insurer to ensure that a non-opioid drug approved by the U.S. food and drug administration for the treatment or management of pain is not disadvantaged or discouraged with respect to coverage relative to an opioid or narcotic drug for the treatment or management of pain on the PDL. - Amends TCA Title 8; Title 53; Title 56; Title 63; Title 68 and Title 71.

SB 428 requires insurers offering health insurance plans to Tennessee state employees to treat non-opioid pain medications (FDA-approved for pain treatment) equally with opioids on their preferred drug list, ensuring they are not disadvantaged in coverage or discouraged. It also mandates separate reimbursement for healthcare providers and hospitals when non-opioid pain treatments are provided to covered employees. The law applies immediately upon FDA approval of a non-opioid drug and takes effect July 1, 2025. This directly affects insurers and state employee health plans under Tennessee Code.

Topics ✓ HealthcareSupports HealthcareMandates equal coverage for FDA-approved non-opioid pain treatments vs opioids, expanding patient access to safer alternatives and reducing opioid dependency in healthcare coverage.95% confidence

Sub-Topics Insurance Substance Abuse

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in committee · Tennessee · Senate Feb 12, 2025

SB 463: Insurance, Health, Accident - As introduced, enacts the "Freedom to Grow Our Tennessee Families Act." - Amends TCA Title 56 and Title 71.

SB 463, the "Freedom to Grow Our Tennessee Families Act," requires health insurance plans in Tennessee to cover fertility diagnostic care, fertility treatment, and fertility preservation services starting January 1, 2026. It mandates coverage for up to three complete oocyte retrievals with unlimited embryo transfers (per medical guidelines) and prohibits exclusions based on medical history (like cancer treatment), use of donor gametes, or protected characteristics like race or disability. The bill explicitly excludes coverage for "experimental fertility procedures" as defined by medical standards. This directly affects enrollees with fertility needs, ensuring comprehensive coverage under their health insurance plans.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for fertility services, prohibits exclusions based on medical history or protected characteristics, expanding access to reproductive healthcare.95% confidence

Sub-Topics Insurance

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in committee · Tennessee · House Apr 30, 2025

HB 1318: Insurance, Health, Accident - As enacted, extends the Access Tennessee health insurance program from June 30, 2025, to June 30, 2030. - Amends TCA Section 56-7-2916.

HB 1318 extends Tennessee's Access Tennessee health insurance program, which provides coverage to low-income residents, by changing its expiration date from June 30, 2025, to June 30, 2030. This amendment directly affects qualifying Tennessee residents who rely on the program for health coverage, ensuring continued access through 2030. The bill modifies Tennessee Code Annotated Section 56-7-2916 to reflect the new end date without altering program eligibility or benefits. It is a straightforward extension of an existing state program, not a new policy. The bill became law as Public Chapter 185 on April 30, 2025.

Topics ✓ HealthcareSupports HealthcareExtends Access Tennessee health insurance program, ensuring continued coverage for low-income residents through 2030 without altering eligibility or benefits.95% confidence

Sub-Topics Insurance

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in committee · Tennessee · House May 15, 2025

HB 1244: Insurance, Health, Accident - As enacted, removes the aggregate penalty limits for violations of law concerning pharmacy benefits managers; provides that a pharmacy benefits manager regulated under law relative to pharmacy benefits managers is subject to the insurance laws relative to timely reimbursement of health insurance claims and its requirements for timing of payments to pharmacists; provides that a violation of the prompt pay standards is governed by the penalties set out in insurance laws relative to timely reimbursement of health insurance claims. - Amends TCA Title 56.

HB 1244 requires pharmacy benefits managers (PBMs) in Tennessee to pay pharmacies for prescription claims within 30 days for paper submissions and 14 days for electronic submissions if the claim is "clean" (complete, error-free, and without missing documentation). The bill removes previous caps on aggregate penalties for PBMs that fail to meet these payment deadlines, imposing tiered fines up to $200,000 for failing to process 60% of clean claims annually. It also mandates 1% monthly interest on overdue payments and defines key terms like "clean claim" to standardize processing requirements. This directly affects PBMs and pharmacists, ensuring faster reimbursement for prescription services under Tennessee’s insurance laws.

Topics ✓ HealthcareSupports HealthcareRequires PBMs to pay pharmacies promptly with penalties, protecting provider revenue and patient access to medications.95% confidence

Sub-Topics Insurance Prescription Drugs

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in committee · Tennessee · House Apr 30, 2025

HB 654: Insurance, Health, Accident - As enacted, revises certain protocols for mental health and substance abuse services. - Amends TCA Title 56 and Title 71.

HB 654 requires most Tennessee health insurance plans (including TennCare and CoverKids) to cover mental health and substance abuse services through a specific integrated care model called the Psychiatric Collaborative Care Model (PCCM), starting July 1, 2025. This model involves primary care providers, care managers, and psychiatric consultants working together to coordinate treatment using validated tools. Insurers may only deny coverage for these services based on medical necessity if they already comply with existing state and federal parity laws. The law directly affects insurers, healthcare providers, and patients seeking mental health/substance abuse treatment covered by these plans.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for mental health/substance abuse services via integrated care model, expanding access and coordination under TennCare/CoverKids.95% confidence

Sub-Topics Insurance Mental Health Substance Abuse

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signed · Tennessee · House Apr 28, 2025

HB 37: Opioids - As enacted, authorizes an insurer, for purposes of group insurance plans offered to state employees, to adopt or amend a state preferred drug list (PDL); requires the insurer to ensure that a non-opioid drug approved by the U.S. food and drug administration for the treatment or management of pain is not disadvantaged or discouraged with respect to coverage relative to an opioid or narcotic drug for the treatment or management of pain on the PDL. - Amends TCA Title 8; Title 53; Title 56; Title 63; Title 68 and Title 71.

HB 37 requires insurers offering health plans to Tennessee state employees to treat FDA-approved non-opioid pain medications equally with opioids on their preferred drug lists (PDL). It prohibits insurers from discouraging coverage for non-opioid options used for pain management, though it allows insurers to prefer one opioid over another or one non-opioid over another. This applies specifically to state employee group insurance plans covered under Tennessee Code Annotated sections 56-7-3801 to 56-7-3803. The law, effective January 1, 2026, aims to expand access to non-opioid pain treatments without mandating their preference.

Topics ✓ HealthcareSupports HealthcareRequires insurers to treat FDA-approved non-opioid pain meds equally with opioids in state employee plans, improving patient access to alternatives and reducing opioid reliance.95% confidence

Sub-Topics Insurance Substance Abuse

in committee · Tennessee · House Mar 12, 2025

HB 595: Insurance, Health, Accident - As introduced, enacts the "Freedom to Grow Our Tennessee Families Act." - Amends TCA Title 56 and Title 71.

HB 595, the "Freedom to Grow Our Tennessee Families Act," requires Tennessee health insurers to cover specific fertility services starting January 1, 2026. It mandates coverage for fertility diagnostic care, treatment (to achieve pregnancy), and preservation services (like egg freezing), including at least three egg retrievals with unlimited embryo transfers. The law prohibits insurers from denying coverage based on medical history (e.g., cancer treatment), using donor gametes, or discriminating due to race, gender, or relationship status. It also bans waiting periods and requires insurers to base coverage limits solely on medical guidelines from established fertility organizations. This directly affects Tennessee residents with health insurance plans and the state’s health insurers.

Topics ✓ HealthcareSupports HealthcareMandates insurer coverage for fertility services including diagnostics, treatment, and preservation, prohibiting denial based on medical history. Expands access to reproductive healthcare services.95% confidence

Sub-Topics Insurance

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in committee · Tennessee · Senate May 14, 2026

SB 435: Insurance, Health, Accident - As enacted, requires a health insurer that issues, amends, delivers, or renews a contract or agreement for a health benefit plan to take effect on or after January 1, 2027, to include coverage for biomarker testing; requires a TennCare health benefit plan that is issued, amended, or renewed on or after January 1, 2027, to provide coverage for biomarker testing when medically necessary. - Amends TCA Title 56 and Title 71.

SB 435 requires Tennessee health insurers and TennCare to cover biomarker testing for diagnosis, treatment, or monitoring of diseases starting January 1, 2026. Biomarker testing - medical tests analyzing genes, proteins, or other biological markers - must be covered when supported by FDA approvals, clinical guidelines, or evidence-based standards. Insurers must process prior authorization requests within 24 hours for urgent cases and 72 hours for non-urgent ones, while ensuring coverage avoids repeated biopsies. This affects all private health benefit plans and TennCare enrollees by mandating coverage for specific, evidence-based diagnostic and treatment tests.

Topics ✓ HealthcareSupports HealthcareMandates insurers and TennCare to cover biomarker testing for diagnosis/treatment per clinical guidelines, expanding patient access to essential diagnostics starting 2026.95% confidence

Sub-Topics Insurance

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passed · Tennessee · House Apr 6, 2026

HB 1061: Insurance, Health, Accident - As introduced, prohibits an out-of-network ambulance service provider from balance billing an enrollee in a health benefit plan for emergency ambulance services; establishes allowable billable costs for such services. - Amends TCA Title 56, Chapter 7 and Title 68, Chapter 140.

HB 1061 prohibits out-of-network ambulance providers from charging patients extra fees (balance billing) for emergency ambulance services covered under their health insurance plan. It directly affects patients using emergency ambulance services who are enrolled in health benefit plans, ensuring they pay no more than the lesser of their in-network copay, the ambulance bill, or 325% of the Medicare rate for similar services in their area. The bill requires health insurers to count patient payments toward their deductibles and out-of-pocket limits, and bans providers from asking patients to waive these protections. The law takes effect July 1, 2025, for health plans issued or renewed on or after that date.

Topics ✓ HealthcareSupports HealthcareProhibits out-of-network ambulance balance billing, limits patient costs to in-network copays or 325% Medicare rate, directly protects patient rights and improves access to emergency care.95% confidence

Sub-Topics Insurance Medicare

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signed · Tennessee · Senate Apr 30, 2025

SB 437: Insurance, Health, Accident - As enacted, revises certain protocols for mental health and substance abuse services. - Amends TCA Title 56 and Title 71.

SB 437 requires most health insurance plans in Tennessee to cover mental health and substance abuse services through a specific integrated care model called the Psychiatric Collaborative Care Model (PCCM), effective July 1, 2025. This model involves primary care providers, care managers, and psychiatric consultants working together to coordinate patient treatment using validated tools and regular assessments. Insurance plans may deny coverage only if they comply with existing state and federal mental health parity laws (including the MHPAEA) and medical necessity standards. The requirement applies to TennCare and CoverKids programs when services are deemed medically necessary by program guidelines.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for mental health/substance abuse via PCCM, expanding access and support per bill requirements.95% confidence

Sub-Topics Insurance Mental Health Substance Abuse