HB 1061 - SB 1376
FISCAL NOTE
Fiscal Review Committee
Tennessee General Assembly
March 18, 2025
Fiscal Analyst: Chris Higgins | Email: chris.higgins@capitol.tn.gov | Phone: 615-741-2564
HB 1061 - SB 1376
SUMMARY OF BILL: Prohibits an out-of-network ambulance service provider from
balance billing an enrollee in a health benefit plan of a health insurer for ambulance services covered
under the enrollee's health benefit plan.
Establishes that an enrollee satisfies their obligation to pay for out-of-network ambulance services if
the enrollee pays the lesser of: (1) the in-network cost-sharing amount specified in the enrollee's
health benefit plan for ambulance services; (2) the ambulance service provider's billed charges; or
(3) 325 percent of the current published rate for ambulance services as established by the federal
Centers for Medicare and Medicaid Services for the same service provided in the same geographic
area.
Requires a health insurer to treat such cost sharing amount determined paid by the enrollee for out-
of-network ambulance services in the same manner as cost sharing for in-network ambulance
services and to apply the cost-sharing amount paid by the enrollee for such services toward the
enrollee's deductible and maximum out-of-pocket payment obligation under the enrollee's health
benefit plan, as applicable.
Prohibits an ambulance service organization from requesting or requiring an enrollee to sign or
otherwise execute by oral, written, or electronic means, a document that would attempt to void,
waive, or alter a provision of this section.
FISCAL IMPACT:
NOT SIGNIFICANT
Assumptions:
• Pursuant to TennCare rule 1200-13-13-.08(1)(a), an out-of-network provider who provides
TennCare program covered services must accept the amounts paid by the TennCare
managed care contractor, plus any copayment required to be paid by the individual, as
payment in full.
• Any impact to the Division of TennCare is estimated to be not significant.
• According to the Division of Benefits Administration, the ambulance benefits provided
under the State Group Insurance Program (SGIP) are in-network, regardless of if the
provider is in- or out-of-network. Therefore, no impact to the SGIP.
• The proposed legislation will not have a significant impact on the policies or procedures of
the Department of Commerce and Insurance.
HB 1061 - SB 1376 2
• Any impact to the operations of the Department of Health or the Emergency Medical
Services Board will not be significant.
IMPACT TO COMMERCE:
NOT SIGNIFICANT
Assumptions:
• The impacts to ambulance services will be dependent on the individual insurance policies of
those billed for out-of-network services; however, the overall impact to commerce in the
state is estimated to be not significant.
• Any impact to jobs in Tennessee will not be significant.
CERTIFICATION:
The information contained herein is true and correct to the best of my knowledge.
Bojan Savic, Executive Director