Bill > HB2619

This bill establishes the Tennessee Commission of Insurance Review to address complaints and enforce new regulations concerning health insurance entities in Tennessee, with a stated effective date of July 1, 2026. Key provisions include prohibiting health insurance entities from using "downcoding," which is the practice of adjusting a claim to a less complex or lower-cost procedure code, in a way that prevents healthcare providers from collecting their full fee for services rendered. The bill also prohibits health insurance entities from unilaterally making material changes to provider contracts or fee schedules without providing at least 60 days' notice and an opportunity to negotiate, and allows providers to terminate contracts without penalty if an agreement isn't reached. Furthermore, it restricts health insurance entities from sending enrollees' medical information outside the United States for claim review or other purposes, and mandates that any claim reviews conducted using artificial intelligence must be overseen and approved by a human healthcare provider with relevant experience before a determination is sent to the provider or enrollee. The bill also addresses reimbursement practices, stating that health insurance entities cannot deny reimbursement or pay different rates based solely on a provider's licensure classification if the service falls within their scope of practice and is covered when performed by another classification, and prohibits "lasering," which is the practice of assigning higher deductibles or denying coverage to individuals with known high-cost medical conditions, when underwriting stop-loss plans. Finally, it introduces a prohibition on individuals or entities from simultaneously owning or controlling both a healthcare provider and a health insurance entity, with specific disclosure and utilization requirements for existing dual ownership arrangements.

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https://wapp.capitol.tn.gov/apps/Billinfo/Default?BillNumber=HB2619&ga=114