Bill > SB2155

This bill establishes the Tennessee Commission of Insurance Review to address complaints and enforce new regulations concerning health insurance entities, which are companies that offer health benefit plans. A key provision prohibits health insurance entities from using "downcoding," which is adjusting a submitted claim to a less complex or lower-cost procedure code, in a way that prevents healthcare providers from being paid the full fee for services they actually performed. The bill also prevents health insurance entities from making significant 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 and requires that any claim reviews conducted using artificial intelligence must be overseen by a human healthcare professional before a determination is sent to the provider or enrollee. The bill also prohibits "lasering," a practice where coverage is denied or a higher deductible is applied to individuals with known high-cost medical conditions, when underwriting stop-loss plans. Additionally, it aims to prevent discrimination in reimbursement rates based solely on a healthcare provider's licensure classification, ensuring that providers are not reimbursed less favorably than medical doctors or osteopathic physicians for performing the same services within their scope of practice. Finally, the bill includes provisions regarding the ownership and control of both healthcare providers and health insurance entities by the same person, with a deadline of July 1, 2026, for compliance, and grants the Commission of Insurance Review exclusive enforcement authority over these new regulations.

Business and Industry, Government Affairs

https://wapp.capitol.tn.gov/apps/Billinfo/Default?BillNumber=SB2155&ga=114