SB 890 requires Tennessee health insurance companies to create two digital systems: one allowing healthcare providers to access patient electronic health records and another for processing prior authorization requests (like insurance approvals for treatments). It also shortens the timeline for certain health insurance actions by changing the requirement from 10 working days to 10 calendar days. This law directly affects health insurance entities, healthcare providers, and patients by improving access to medical records and streamlining authorization processes. The bill takes effect on July 1, 2025.
HB 1291 requires Tennessee health insurance carriers to cover mental health services at the same level as coverage for alcoholism and drug dependence. This means insurance plans must provide equal benefits, coverage, and reimbursement rates for mental health treatment compared to substance use disorder treatment. The bill also mandates that insurers include clear explanations of this equal coverage in plan materials. It applies to all health insurance plans issued or renewed on or after July 1, 2025.
SB 225 requires Tennessee health insurers to reimburse chiropractic physicians at the same rate as medical doctors for identical services, amending Tennessee Code Annotated Titles 56 and 63. It prohibits insurers from using separate payment codes or methodologies for chiropractic services compared to physician services, ensuring equal reimbursement based on nationally recognized coding systems like the CPT book. This applies to private health insurance plans but excludes TennCare, CoverKids, and government-provided insurance. The bill aims to eliminate reimbursement disparities for chiropractors offering equivalent services to medical doctors. It was scheduled to take effect July 1, 2025, but failed in committee on March 25, 2025.
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.
SB 1063 removes two notification requirements related to prior authorization for healthcare services in Tennessee. It eliminates the requirement for healthcare providers to notify patients when communicating with insurance companies about missing information for prior authorization, and it removes the requirement for insurance companies to notify patients when additional information is needed from the patient or provider. The bill directly affects healthcare providers, insurance companies, and patients by reducing administrative steps in the prior authorization process. These changes amend Tennessee Code sections 63-1-171 and 56-6-705, effective April 3, 2025.
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.
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.
HB 1074 removes two notification requirements related to prior authorization for healthcare services in Tennessee. It eliminates the obligation for healthcare providers to inform patients when communicating with insurers about missing information for prior authorization requests, and it removes the requirement for utilization review organizations to notify patients when providers fail to submit needed information within seven days. The bill directly affects patients, healthcare providers, and insurance entities by changing communication protocols during the prior authorization process. These changes amend Tennessee Code Sections 63-1-171(b) and 56-6-705(a), effective upon becoming law (Public Chapter 125, enacted April 8, 2025).
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.
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.
