SB 676 - HB 754
FISCAL NOTE
Fiscal Review Committee
Tennessee General Assembly
March 1, 2025
Fiscal Analyst: Chris Higgins | Email: chris.higgins@capitol.tn.gov | Phone: 615-741-2564
SB 676 - HB 754
SUMMARY OF BILL: Prohibits a county or municipality from prohibiting the provision of
mental health therapy to help a minor address an inconsistency between the minor's sex and the
minor's perceived gender or perceived sex, and from prohibiting a parent or legal guardian from
consenting to, or withholding consent from, the provision of mental health therapy to help a minor
address an inconsistency between the minor's sex and the minor's perceived gender or perceived sex.
Requires a gender clinic that uses funds provided by the state to directly or indirectly provide or pay
for gender transition procedures to agree to provide or pay for the performance of detransition
procedures as a condition of receiving such funds. Requires gender clinics to report statistics
regarding all gender transition procedures to the Department of Health (DOH) no later than 15 days
after the end of the calendar month during which the gender transition procedure was prescribed or
the referral was made.
Requires the DOH to submit a comprehensive annual statistical report beginning December 31,
2025 to the Speakers of the Senate and the House of Representatives and the Legislative Librarian
based on all data obtained from gender clinics. Requires the DOH to make the statistical report
available to the public on the department’s public website in a downloadable format.
Establishes that a healthcare professional who fails to comply with the legislation is subject to
discipline by the appropriate licensing entity or disciplinary review board with competent
jurisdiction, and the gender clinic which employs the healthcare professional is subject to a civil fine
of up to $150,000. Authorizes the Attorney General and Reporter (AG) to investigate a potential
violation of the legislation, seek production of documents or testimony through a civil investigative
demand, and bring an action to enforce compliance with the legislation.
Requires a policy of insurance that includes coverage for gender transition procedures to also
include coverage for detransition procedures. Requires an entity providing insurance coverage for
detransition procedures to provide statistics regarding insurance claims for detransition procedures
in the state to the DOH no later than 15 days after the end of the calendar month during which a
claim for the gender transition procedure was approved.
Requires the DOH to submit a comprehensive annual statistical report beginning December 31,
2025 to the Speakers of the Senate and the House of Representatives and the Legislative Librarian
based on all data obtained from insurance entities. Requires the DOH to make the statistical report
available to the public on the DOH's public website in a downloadable format.
SB 676 - HB 754 2
FISCAL IMPACT:
STATE GOVERNMENT
EXPENDITURES General Fund
FY25-26 & Subsequent Years $540,000
OTHER FISCAL IMPACT
Potential Impact on Health Insurance Premiums (required by Tenn. Code Ann. § 3-2-111): Such
legislation will result in an increase in the cost of health insurance premiums for procedures and
treatments being provided by plans that do not currently offer these benefits at the proposed
mandated levels. It is estimated that the increase to each individual’s total premium will be less than
one percent.
Assumptions:
• The DOH can compile and submit the required reports utilizing existing personnel and
resources.
• The appropriate health-related boards can conduct disciplinary hearings in the regular
course of business, without a significant increase in expenditures.
• Any additional AG duties resulting from the proposed legislation will be absorbed using
existing resources, without a significant increase in state expenditures.
• Any additional workload on the courts as a result of the legislation can be accommodated
within existing resources and personnel.
• It is assumed that gender clinics that use funds provided by the state to directly or indirectly
provide or pay for gender transition procedures will follow the directives of the proposed
legislation to ensure there will not be a significant impact to funding; therefore, there is not
expected to be a significant decrease in state expenditures.
• The Division of TennCare's managed care organizations do not provide coverage for
gender transition procedures; therefore, there will be no fiscal impact to the TennCare
program or the CoverKids program.
• The plans under the State Group Insurance Program do not cover gender transition
procedures; therefore, no impact to the Division of Benefits Administration.
• Gender detransition procedures are not broadly covered under the state's benchmark health
plan.
• The proposed legislation will be considered a new coverage mandate to the essential health
benefits (EHB) of the qualified health plans (QHPs) offered on and off the Marketplace
Exchange.
• The state will be required to defray the cost of benefits because they exceed those provided
under Tennessee’s EHB benchmark plan.
• As of January 2025, the Centers for Medicare and Medicaid Services (CMS) showed a total
population of 642,867 individuals on QHPs in Tennessee.
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• According to estimates from multiple QHP providers in 2024, the increase in costs per
member per month as a result from the proposed legislation will be approximately $0.07.
This would result in an increase in state expenditures of $540,008 ($0.07 x 12 x 642,867)
annually in order for DCI to defray the costs of this increase.
• The total increase in state expenditures will be $500,008 in FY25-26 and subsequent years.
• Potential Impact on Health Insurance Premiums (required by Tenn. Code Ann. § 3-2- 111):
Such legislation will result in an increase in the cost of health insurance premiums for
procedures and treatments being provided by plans that do not currently offer these
benefits at the proposed mandated levels. It is estimated that the increase to each
individual’s total premium will be less than one percent.
IMPACT TO COMMERCE:
BUSINESS IMPACT
FISCAL YEAR REVENUE EXPENSES
FY25-26 & Subsequent Years $540,000 < $540,000
Assumptions:
• Healthcare providers will experience an increase in business revenue of $540,000 in FY25-
26 and subsequent years for performing gender detransition procedures.
• The increase in business expenditures is estimated to be less than those amounts for
companies to retain solvency.
• Any impact to jobs in Tennessee is estimated to be not significant.
CERTIFICATION:
The information contained herein is true and correct to the best of my knowledge.
Bojan Savic, Executive Director