TennCare

Plain English Breakdown

The candidate explanation includes a claim about specialists treating immunocompromised patients being exempted, which is not supported by the provided official source material.

Healthcare Providers Must Provide Services Regardless of Vaccine Status

This bill requires healthcare providers participating in TennCare or CoverKids programs to provide services regardless of a patient's vaccine status and sets rules for reporting violations.

What This Bill Does

• Requires healthcare providers participating in medical assistance health benefit plans, including those in managed care organizations contracted with TennCare, not to refuse service based on an enrollee’s refusal or failure to obtain vaccines or immunizations.
• Prohibits the bureau from reimbursing a provider who violates this requirement unless and until compliance is confirmed.
• Allows providers alleged to have violated this bill to seek administrative and judicial review of the violation.
• Requires the director of TennCare to adopt rules necessary for implementing these requirements, including processes for reporting violations and appealing decisions.

Who It Names or Affects

• Healthcare providers participating in medical assistance health benefit plans such as TennCare or CoverKids.
• Enrollees in TennCare or CoverKids programs who refuse or fail to obtain vaccines or immunizations.

Terms To Know

TennCare

A state-run healthcare program for low-income and disabled individuals.

CoverKids

A Tennessee health insurance program for children from families with incomes up to 250% of the federal poverty level.

Limits and Unknowns

• This bill does not apply to specialists in oncology or organ transplant services.
• The effectiveness and enforcement mechanisms are dependent on rules yet to be established by TennCare's director.
• It is unclear how this will impact healthcare providers who are part of larger medical organizations.

Official Summary Text

This bill prohibits a healthcare provider who participates in a medical assistance health benefit plan, including a provider participating in the provider network of a managed care organization that contracts with the bureau of Ten
nCare to provide services under a medical assistance health benefit plan, from refusing to provide healthcare services to an enrollee based solely on the enrollee's refusal or failure to obtain a vaccine or immunization for a particular infectious or comm
u
nicable disease.

This bill prohibits the bureau from providing reimbursement for a medical assistance health benefit plan to a provider who violates this bill unless and until the bureau finds that the provider is in compliance with this bill. However,
this prohibition only applies with respect to an individual healthcare provider. The bureau must not refuse to provide reimbursement to a provider who did not violate this bill based on that provider's membership in a provider group or medical organizati
o
n with an individual physician who violated this bill.

EXEMPTIONS

This bill does not apply to a provider who is a specialist in oncology or organ transplant services.

RULEMAKING

This bill requires the director of TennCare to adopt rules necessary to
implement this bill, including rules establishing the right of a provider who is alleged to have violated this bill to seek administrative and judicial review of the alleged violation.

FEDERAL WAIVER

This bill authorizes the director to seek such federa
l waiver that the director deems necessary to effectuate this bill.

ON APRIL 16, 2025, THE SENATE ADOPTED AMENDMENTS #1 AND #2 AND PASSED SENATE BILL 1389, AS AMENDED.

AMENDMENT #1 changes this bill's prohibition against refusing services for an enroll
ee based solely on the enrollee's refusal to obtain a vaccine or immunization. This amendment instead prohibits a healthcare provider who participates in a medical assistance health benefit plan, including a provider participating in the provider network

of a managed care organization that contracts with the bureau of TennCare to provide services under a medical assistance health benefit plan, from refusing to provide healthcare services to an enrollee based on the enrollee's refusal or failure to obtain
a
vaccine or immunization if the enrollee, or if the enrollee is a minor, the enrollee's parent or legal guardian, has a religious or moral objection to the vaccine or immunization.

This amendment adds the following to the subjects for which this bill req
uires the director of TennCare to promulgate rules:

(1) A process by which an enrollee, the parent or legal guardian of an enrollee who is a minor, or another person may report an alleged violation of this bill to the bureau;

(2) An opportunity for
the individual who reported the alleged violation to attend and provide testimony at a hearing, if any, conducted as part of the administrative and judicial review process established pursuant to the introduced bill; and

(3) A process by which the indivi
dual who reported the alleged violation may appeal a final decision rendered as part of the administrative and judicial review process.

AMENDMENT #2 deletes the provisions of this bill that exempt oncologists and organ transplant specialists and authoriz
e the director of TennCare to seek a federal waiver to effectuate this bill.

ON APRIL 21, 2025, THE HOUSE SUBSTITUTED SENATE BILL 1389 FOR HOUSE BILL 638, ADOPTED AMENDMENT #1, AND PASSED SENATE BILL 1389, AS AMENDED.

AMENDMENT #1 replaces this bill's
rulemaking provisions, restores the exemptions for oncologists and specialists in organ transplant services, and adds an exemption for specialists who treating patients who are immunocompromised, including patients who are immunocompromised because of a d
i
sease or as a result of treatment for a disease. This amendment purports to amend provisions of this bill that were deleted by Senate Amendment #2.

Current Bill Text

SENATE BILL 1389
By Watson

HOUSE BILL 638
By Carringer

HB0638
002021
- 1 -

AN ACT to amend Tennessee Code Annotated, Title 33;
Title 56; Title 63; Title 68 and Title 71, relative to
healthcare providers.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
SECTION 1. Tennessee Code Annotated, Title 63, Chapter 1, Part 1, is amended by
adding the following as a new section:
(a) As used in this section:
(1) "Bureau" means the bureau of TennCare;
(2) "Director" means the director of TennCare;
(3) "Enrollee" means a person who is enrolled in a medical assistance
health benefit plan;
(4) "Healthcare provider" or "provider" means a person who is licensed,
certified, or otherwise authorized or permitted by the laws of this state to
administer health care in the ordinary course of business or practice of a
profession; and
(5) "Medical assistance health benefit plan" means a policy or contract
for health insurance coverage provided under:
(A) The TennCare program administered under the Medical
Assistance Act of 1968, compiled in title 71, chapter 5, part 1, or a
successor medicaid program; or
(B) The CoverKids Act of 2006, compiled in title 71, chapter 3,
part 11, or a successor program.

- 2 - 002021

(b) A healthcare provider who participates in a medical assistance health benefit
plan, including a provider participating in the provider network of a managed care
organization that contracts with the bureau of TennCare to provide services under a
medical assistance health benefit plan, shall not refuse to provide healthcare services to
an enrollee based solely on the enrollee's refusal or failure to obtain a vaccine or
immunization for a particular infectious or communicable disease.
(c) The bureau shall not provide reimbursement for a medical assistance health
benefit plan to a provider who violates this section unless and until the bureau finds that
the provider is in compliance with this section.
(d) Subsection (c) applies only with respect to an individual healthcare provider.
The bureau shall not refuse to provide reimbursement to a provider who did not violate
this section based on that provider's membership in a provider group or medical
organization with an individual physician who violated this section.
(e) This section does not apply to a provider who is a specialist in:
(1) Oncology; or
(2) Organ transplant services.
(f) The director shall adopt rules necessary to implement this section, including
rules establishing the right of a provider who is alleged to have violated this section to
seek administrative and judicial review of the alleged violation. The rules must be
promulgated in accordance with the Uniform Administrative Procedures Act, compiled in
title 4, chapter 5.
(g) The director may seek such federal waiver that the director deems necessary
to effectuate this section.
SECTION 2. This act takes effect July 1, 2025, the public welfare requiring it.