Tennessee 2025-2026 Regular Session

Tennessee Senate Bill SB1376 Compare Versions

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

Old	New	Differences
1	1
2	2	HOUSE BILL 1061
3	3	By Vital
4	4
5	5	SENATE BILL 1376
6	6	By Watson
7	7
8	8
9	9	SB1376
10	10	003020
11	11	- 1 -
12	12
13	13	AN ACT to amend Tennessee Code Annotated, Title 56,
14	14	Chapter 7 and Title 68, Chapter 140, relative to no
15	15	surprise ambulance billing.
16	16
17	17	BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
18	18	SECTION 1. Tennessee Code Annotated, Title 56, Chapter 7, Part 23, is amended by
19	19	adding the following new section:
20	20	(a) As used in this section:
21	21	(1) "Ambulance" means a privately or publicly owned land or air vehicle
22	22	that is especially designed, constructed, or modified and equipped and intended
23	23	to be used for and is maintained or operated for transportation upon the streets,
24	24	highways, or airways in this state for persons who are sick, injured, wounded,
25	25	otherwise incapacitated, helpless, or in need of medical care;
26	26	(2) "Ambulance service" means the principal use of a privately or publicly
27	27	owned ambulance for transportation of injured or infirm persons with an
28	28	emergency medical condition;
29	29	(3) "Balance billing" or "balance bill" means the practice of charging an
30	30	enrollee in a health benefit plan to recover from the enrollee the balance of an
31	31	ambulance service provider's fee for transportation received by the enrollee for
32	32	ambulance service that exceeds the reimbursable amount for such service under
33	33	the enrollee's health benefit plan;
34	34	(4) "Emergency medical condition" means a medical condition that
35	35	manifests itself by symptoms of sufficient severity, including severe pain,
36	36	regardless of the final diagnosis of the symptoms, that a prudent layperson, who
37	37
38	38
39	39	- 2 - 003020
40	40
41	41	possesses an average knowledge of health and medicine, could reasonably
42	42	expect the absence of immediate medical attention to potentially result in:
43	43	(A) Placing the person's health in serious jeopardy;
44	44	(B) Serious impairment to bodily functions; or
45	45	(C) Serious dysfunction of a bodily organ or part;
46	46	(5) "Health benefit plan" has the same meaning as defined in § 56-7-
47	47	2355; and
48	48	(6) "Health insurer" means an entity offering a health benefit plan.
49	49	(b) For health benefit plans issued or renewed on or after July 1, 2025, an out-
50	50	of-network ambulance service provider shall not balance bill an enrollee in a health
51	51	benefit plan of a health insurer for ambulance services covered under the enrollee's
52	52	health benefit plan.
53	53	(c) An enrollee satisfies their obligation to pay for out-of-network ambulance
54	54	services if the enrollee pays the lesser of:
55	55	(1) The in-network cost-sharing amount specified in the enrollee's health
56	56	benefit plan for ambulance services;
57	57	(2) The ambulance service provider's billed charges; or
58	58	(3) Three hundred twenty-five percent (325%) of the current published
59	59	rate for ambulance services as established by the federal centers for medicare
60	60	and medicaid services for the same service provided in the same geographic
61	61	area.
62	62	(d) A health insurer must treat a cost sharing amount determined under
63	63	subsection (c) paid by the enrollee for out-of-network ambulance services in the same
64	64	manner as cost sharing for in-network ambulance services and must apply the cost-
65	65	sharing amount paid by the enrollee for such services toward the enrollee's deductible
66	66
67	67
68	68	- 3 - 003020
69	69
70	70	and maximum out-of-pocket payment obligation under the enrollee's health benefit plan,
71	71	as applicable.
72	72	(e) An ambulance service organization shall not request or require an enrollee to
73	73	sign or otherwise execute by oral, written, or electronic means, a document that would
74	74	attempt to void, waive, or alter a provision of this section.
75	75	SECTION 2. This act takes effect July 1, 2025, the public welfare requiring it.