Tennessee 2025-2026 Regular Session

Tennessee House Bill HB1223 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1
2	2	SENATE BILL 1134
3	3	By Gardenhire
4	4
5	5	HOUSE BILL 1223
6	6	By Howell
7	7
8	8
9	9	HB1223
10	10	000711
11	11	- 1 -
12	12
13	13	AN ACT to amend Tennessee Code Annotated, Title 4,
14	14	Chapter 10 and Title 56, relative to studying
15	15	reimbursements under policies of health insurers.
16	16
17	17	BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
18	18	SECTION 1. Tennessee Code Annotated, Title 4, Chapter 10, is amended by adding
19	19	the following new section:
20	20	(a) The Tennessee advisory commission on intergovernmental relations (TACIR)
21	21	shall perform a comprehensive evaluation of:
22	22	(1) The process by which health insurers approve or deny coverage or
23	23	reimbursement for healthcare benefits under a plan or policy of insurance,
24	24	including the criteria used to determine whether to approve or deny such
25	25	coverage or reimbursement;
26	26	(2) The process for notification of policyholders and healthcare providers
27	27	regarding the denial of a claim or reimbursement for such healthcare benefits;
28	28	(3) The process for appealing the denial of a claim or reimbursement for
29	29	such healthcare benefits, including the process for obtaining a prior authorization,
30	30	if required;
31	31	(4) The process for recoupment by or reimbursement to a policyholder or
32	32	healthcare provider for unpaid claims from a health insurer upon successful
33	33	appeal after denial of such claims or reimbursement for healthcare benefits;
34	34	(5) The manner in which health insurers must maintain and manage
35	35	reserve funds;
36	36
37	37
38	38	- 2 - 000711
39	39
40	40	(6) The aggregate number of denials of claims for coverage and
41	41	reimbursement by health insurers on an annual basis for each of the past five (5)
42	42	calendar years beginning January 1, 2021, including:
43	43	(A) The percentage of such denials based on the aggregate
44	44	number of claims per year; and
45	45	(B) The identification of each health insurer that deviates from the
46	46	aggregate mean by ten percent (10%) or more based on data reported
47	47	under subdivision (a)(6)(A); and
48	48	(7) The manner in which this state and its departments and agencies
49	49	audit individual health insurers and the frequency thereof.
50	50	(b) All appropriate state departments and agencies shall provide assistance to
51	51	TACIR in connection with the comprehensive evaluation conducted under subsection
52	52	(a).
53	53	(c) On or before January 15, 2026, TACIR shall report its findings and
54	54	recommendations, including any proposed legislation, regarding the evaluation
55	55	conducted under subsection (a) to the chairs of the commerce and labor committee of
56	56	the senate and the committee of the house of representatives having jurisdiction over
57	57	health insurance matters.
58	58	(d) TACIR shall not include in its evaluation under subsection (a) healthcare
59	59	policies or plans through contracts with the state to provide insurance through the
60	60	TennCare program or its successor program, codified under title 71, chapter 5, or the
61	61	CoverKids program or its successor program, codified under title 71, chapter 3, part 11.
62	62	(e) As used in this section, "health insurer" means a health insurance entity as
63	63	that term is defined in § 56-7-109.
64	64	SECTION 2. This act takes effect upon becoming a law, the public welfare requiring it.