Tennessee 2025-2026 Regular Session

Tennessee Senate Bill SB1134 Compare Versions

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

Old	New	Differences
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2	2	<BillNo> <Sponsor>
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4	4	SENATE BILL 1134
5	5	By Gardenhire
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7	7
8	8	SB1134
9	9	000711
10	10	- 1 -
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12	12	AN ACT to amend Tennessee Code Annotated, Title 4,
13	13	Chapter 10 and Title 56, relative to studying
14	14	reimbursements under policies of health insurers.
15	15
16	16	BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
17	17	SECTION 1. Tennessee Code Annotated, Title 4, Chapter 10, is amended by adding
18	18	the following new section:
19	19	(a) The Tennessee advisory commission on intergovernmental relations (TACIR)
20	20	shall perform a comprehensive evaluation of:
21	21	(1) The process by which health insurers approve or deny coverage or
22	22	reimbursement for healthcare benefits under a plan or policy of insurance,
23	23	including the criteria used to determine whether to approve or deny such
24	24	coverage or reimbursement;
25	25	(2) The process for notification of policyholders and healthcare providers
26	26	regarding the denial of a claim or reimbursement for such healthcare benefits;
27	27	(3) The process for appealing the denial of a claim or reimbursement for
28	28	such healthcare benefits, including the process for obtaining a prior authorization,
29	29	if required;
30	30	(4) The process for recoupment by or reimbursement to a policyholder or
31	31	healthcare provider for unpaid claims from a health insurer upon successful
32	32	appeal after denial of such claims or reimbursement for healthcare benefits;
33	33	(5) The manner in which health insurers must maintain and manage
34	34	reserve funds;
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36	36
37	37	- 2 - 000711
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39	39	(6) The aggregate number of denials of claims for coverage and
40	40	reimbursement by health insurers on an annual basis for each of the past five (5)
41	41	calendar years beginning January 1, 2021, including:
42	42	(A) The percentage of such denials based on the aggregate
43	43	number of claims per year; and
44	44	(B) The identification of each health insurer that deviates from the
45	45	aggregate mean by ten percent (10%) or more based on data reported
46	46	under subdivision (a)(6)(A); and
47	47	(7) The manner in which this state and its departments and agencies
48	48	audit individual health insurers and the frequency thereof.
49	49	(b) All appropriate state departments and agencies shall provide assistance to
50	50	TACIR in connection with the comprehensive evaluation conducted under subsection
51	51	(a).
52	52	(c) On or before January 15, 2026, TACIR shall report its findings and
53	53	recommendations, including any proposed legislation, regarding the evaluation
54	54	conducted under subsection (a) to the chairs of the commerce and labor committee of
55	55	the senate and the committee of the house of representatives having jurisdiction over
56	56	health insurance matters.
57	57	(d) TACIR shall not include in its evaluation under subsection (a) healthcare
58	58	policies or plans through contracts with the state to provide insurance through the
59	59	TennCare program or its successor program, codified under title 71, chapter 5, or the
60	60	CoverKids program or its successor program, codified under title 71, chapter 3, part 11.
61	61	(e) As used in this section, "health insurer" means a health insurance entity as
62	62	that term is defined in § 56-7-109.
63	63	SECTION 2. This act takes effect upon becoming a law, the public welfare requiring it.