Bill > SB1372

This bill introduces several key provisions related to health insurance and TennCare (Tennessee's Medicaid program) that aim to improve healthcare provider network participation and accessibility. First, the bill prohibits health insurance entities and Managed Care Organizations (MCOs) from using "all-products clauses" in provider agreements, which previously could require healthcare providers to participate in multiple networks or provide services across different plans as a condition of network participation. The legislation defines healthcare providers as physicians, advanced practice nurses, and physician assistants, and establishes a $10,000 civil penalty for each violation of this prohibition. Additionally, the bill mandates that TennCare implement a "secret shopper survey" to assess MCO compliance with appointment wait time standards and provider directory accuracy. Specifically, the surveys will evaluate wait times for mental health, primary care, and obstetric services, with maximum wait times ranging from 10-15 business days depending on the service type. The bill also requires TennCare to develop and enforce network adequacy standards, create remediation plans for identified network deficiencies, and publish these standards publicly. These changes are designed to improve healthcare access and transparency for Tennessee residents, with implementation set to begin on July 1, 2025.

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https://wapp.capitol.tn.gov/apps/Billinfo/default.aspx?BillNumber=SB1372&ga=114