Bill > HB0651

This bill introduces several key provisions targeting healthcare provider network agreements and TennCare managed care organization (MCO) practices. First, the bill prohibits health insurance entities and TennCare MCOs from including "all-products clauses" in network provider agreements, which previously could have required healthcare providers (such as physicians, nurses, and physician assistants) to participate in multiple networks or provide services across different plans as a condition of network participation. If an entity includes such a clause, they will be subject to a $10,000 civil penalty for each occurrence. The bill also establishes new standards for TennCare MCOs, including implementing "secret shopper surveys" to evaluate appointment wait times and provider directory accuracy across various healthcare services like mental health, primary care, and obstetric care. MCOs must ensure that at least 90% of appointments are available within specified timeframes (e.g., 10 business days for mental health services, 15 days for primary care). Additionally, the bill requires the TennCare bureau to develop comprehensive network adequacy standards, publish these standards publicly, and create remediation plans if network deficiencies are identified. The provisions will take effect on July 1, 2025, with implementing rules to be developed by July 1, 2026, aimed at improving healthcare access and transparency for Tennessee residents.