Insurance, Health, Accident

AN ACT to amend Tennessee Code Annotated, Title 56 and Title 71, relative to health care.

Healthcare

Active

The official status still shows this bill as active or still awaiting another formal step.

Sponsor: Williams, Watson
Last action: 2025-03-19
Official status: Taken off notice for cal in s/c Insurance Subcommittee of Insurance Committee
Effective date: Not listed

Plain English Breakdown

The bill summary text is incomplete, which may affect the accuracy of some details.

Health Insurance and TennCare Provider Rules

This bill prohibits health insurance entities and managed care organizations from requiring healthcare providers to join multiple networks or offer services under different plans as a condition of network participation, establishes wait time standards for certain medical appointments, and mandates regular secret shopper surveys.

What This Bill Does

Prohibits health insurance entities from offering network provider agreements that require healthcare providers to participate in another network or provide services under other plans as a condition of network participation.
Requires the commissioner of commerce and insurance to create rules by July 1, 2026, to enforce prohibitions against all-products clauses for health insurance entities.
Prohibits managed care organizations (MCOs) from offering agreements that require healthcare providers to participate in multiple networks or provide services under other plans as a condition of network participation.
Requires the commissioner of finance and administration to create rules by July 1, 2026, to enforce prohibitions against all-products clauses for MCOs.
Establishes wait time standards for routine appointments for mental health, primary care, obstetric/gynecological services, and other specialties identified by the bureau.
Requires TennCare to conduct regular secret shopper surveys to check appointment availability and accuracy of provider directories.

Who It Names or Affects

Health insurance entities
Managed Care Organizations (MCOs)
Healthcare providers including physicians, nurse practitioners, and physician assistants

Terms To Know

All-products clause: A requirement in a network provider agreement that forces healthcare providers to join multiple networks or offer services under different plans.
Managed Care Organization (MCO): An organization contracted with TennCare to manage the delivery of medical and behavioral benefits through a network of qualified providers.

Limits and Unknowns

The bill does not specify how penalties will be enforced or collected.
It is unclear if there are any exceptions for small health insurance entities or MCOs.
The exact wait time standards for other services and specialties beyond mental health, primary care, and obstetric/gynecological services have not been defined.

Bill History

2025-03-25 Tennessee General Assembly
Assigned to General Subcommittee of Senate Commerce and Labor Committee
2025-03-19 Tennessee General Assembly
Taken off notice for cal in s/c Insurance Subcommittee of Insurance Committee
2025-03-19 Tennessee General Assembly
Placed on Senate Commerce and Labor Committee calendar for 3/25/2025
2025-03-18 Tennessee General Assembly
Action deferred in Senate Commerce and Labor Committee to 3/25/2025
2025-03-13 Tennessee General Assembly
Placed on Senate Commerce and Labor Committee calendar for 3/18/2025
2025-03-12 Tennessee General Assembly
Placed on s/c cal Insurance Subcommittee for 3/19/2025
2025-03-12 Tennessee General Assembly
Action Def. in s/c Insurance Subcommittee to 3/19/2025
2025-03-11 Tennessee General Assembly
Placed on Senate Commerce and Labor Committee calendar for 3/18/2025
2025-03-11 Tennessee General Assembly
Action deferred in Senate Commerce and Labor Committee to 3/18/2025
2025-03-06 Tennessee General Assembly
Sponsor(s) Added.
2025-03-05 Tennessee General Assembly
Placed on s/c cal Insurance Subcommittee for 3/12/2025
2025-03-05 Tennessee General Assembly
Sponsor(s) Added.
2025-03-05 Tennessee General Assembly
Placed on Senate Commerce and Labor Committee calendar for 3/11/2025
2025-02-27 Tennessee General Assembly
Sponsor(s) Added.
2025-02-20 Tennessee General Assembly
Sponsor(s) Added.
2025-02-12 Tennessee General Assembly
Passed on Second Consideration, refer to Senate Commerce and Labor Committee
2025-02-10 Tennessee General Assembly
Assigned to s/c Insurance Subcommittee
2025-02-10 Tennessee General Assembly
Introduced, Passed on First Consideration
2025-02-06 Tennessee General Assembly
P2C, ref. to Insurance Committee - Government Operations for Review
2025-02-06 Tennessee General Assembly
Filed for introduction
2025-02-05 Tennessee General Assembly
Intro., P1C.
2025-02-03 Tennessee General Assembly
Filed for introduction

Official Summary Text

PROHIBITIONS FOR HEALTH INSURANCE ENTITIES

This bill prohibits a
health insurance entity
from engaging in any of the following:



Offer
ing
to a
physician, advanced practice registered nurse, or a physician assistant (together, "
healthcare provider
")
a network provider agreement or otherwise condition
ing
the healthcare provider's network participation based on an all-products clause
, which is
a provision in a written or oral network provider agreement between a health insurance entity and a healthcare provider that requires the healthcare provider, as a condition of participation or continuation in a provider network or health benefit plan to

(i)
p
articipate in another provider network that is utilized by the health insurance entity and affiliated with the health insurance entity or

(ii) provide healthcare services under another plan or product offered by the health insurance entity
.



Enter
ing
into a network provider agreement with a healthcare provider or otherwise condition
ing
the healthcare provider's network participation based on an all-products clause
.



Amending or renewing
an existing network provider agreement previously entered into with a healthcare provider so that the network provider agreement as amended or renewed adds or continues to include an all-products clause.

Remedies

If a network provider agreement contains a provision that violates
such prohibitions
, or if a health insurance entity otherwise conditions a healthcare provider's network participation ba
sed on an all-products clause, such provision or condition is void and the commissioner
of commerce and insurance

must
assess the entity a civil penalty of $10,000 for each occurrence.

Rulemaking

On or before July 1, 2026,
this bill requires
the commissioner
of commerce and insurance to
promulgate rules to effectuate
the provisions described above
.

PROHIBITIONS FOR MANAGED CARE ORGANIZATIONS (MCO)

This bill prohibits an MCO from engaging in any of the following:



Offer
ing
to a healthcare provider a network provider agreement or otherwise condition
ing
the healthcare provider's network participation based on an all-products clause
, which is
a provision in a written or oral network provider agreement between a MCO or health insurance entity and a healthcare provider that requires the healthcare provider, as a condition of participation or continuation in a provider network or a health benefit plan to

(i) participate in another provider network that is utilized by the MCO or health insurance entity and affiliated with the MCO or health insurance entity or (ii) provide healthcare services under another plan or product offered by the MCO or health insurance entity.



Entering into a network provider agreement with a healthcare provider or otherwise condition
ing
the healthcare provider's network participation based on an all-products clause
.



Amending or renewing an existing network provider agreement previously entered into with a healthcare provider so that the network provider agreement as amended or renewed adds or continues to include an all-products clause.

Remedies

If a network provider agreement contains a provision that violates
such prohibitions
, or if an MCO otherwise conditions a healthcare provider's network participa
tion based on an all-products clause,
then this bill provides that
such provision or condition is void and the commissioner of finance and administration
must
assess the MCO a civil penalty of $10,000 for each occurrence.

Rulemaking

On or before July 1, 2026,
this bill requires
the commissioner of finance and administration
to
promulgate rules to effectuate
the provisions described above
.

TENNCARE PROVIDER REMEDY PLAN

This bill enacts the
"TennCare Provider Remedy Plan
,
"
which requ
ires the bureau of TennCare ("bureau") to
establish and enforce appointment wait time standards and the accuracy of
physician,
advanced practice registered nurse
, and physician assistant (together, "healthcare provider")
directories by implementing a regul
ar secret shopper survey to determine each MCO's compliance with the standards.

An MCO is in compliance with
such
standards when secret shopper survey results reflect a rate of appointment wait time availability within the standard time frame of at least
90%. The bureau
must
determine if appointments offered via telehealth may be counted toward compliance with appointment wait time availability standards.

Establishment of Wait Time Availability Standards

This bill requires the bureau to
establish wait
time availability standards for routine appointments for the following services, if covered in an MCO's contract, and within the specified limits:



For outpatient mental health and substance use disorder services, adult and pediatric appointment wait times must be no longer than
1
0 business days from the date of request
.



For primary care services, adult and pediatric appointment wait times must be no longer than 15

business days from the date of request
.



For obstetric and gynecological services, appointment wait times must be no longer than 15 business days from the date of request
.



For other services or specialties the bureau may identify, appointment wait times must be no longer than the timeframes specified by the bureau in an evidence-based manner.

Secret Shopper Survey

No less than annually,
this bill requires
TennCare
to
conduct a secret shopper survey to determine the accuracy of the infor
mation for each MCO's most current electronic healthcare provider directories for the following healthcare provider types, if included in the MCO's provider directory
: p
rimary care providers;
o
bstetric and gynecological providers;
o
utpatient mental health
and substance use disorder providers; and
additional p
roviders of services identified by the bureau.

At
a minimum,
this bill requires
a secret shopper survey
to
assess the accuracy of the information in each MCO's most current electronic provider directo
ries that pertains to
(i) t
he provider's active network status with the MCO
, (ii) the p
rovider
's
street address
,
(
iii
)
the p
rovider
's
telephone number
,
and

(
iv
)
w
hether the provider is accepting new enrollees.

When an entity conducting a secret shopper s
urvey on behalf of the bureau identifies an error in an MCO's directory data,
this bill requires
the entity
to
send information sufficient for the MCO to correct the error to the bureau within three business days after the date the error is identified.

Th
e bureau
must
send
such
information to the applicable MCO within three business days after the date the bureau receives the information from the entity that conducted the secret shopper survey.

Establishment of Network Adequacy Standards

This bill requ
ires the
bureau
to
develop and enforce network adequacy standards.
Such
standards must include all geographic areas covered by an MCO. The bureau may establish varying standards for the same healthcare provider type based on geographic area.
However, t
h
e bureau
must
not create exceptions to the network adequacy standards
.

At a minimum,
this bill requires
the bureau
to
develop a quantitative network adequacy standard for MCOs, other than appointment wait time availability standards, for the following pr
ovider types, if covered under an MCO's contract:
a
dult and pediatric primary care;
o
bstetrics and gynecology;
a
dult and pediatric mental health and substance use disorders; and
additional a
dult and pediatric specialists, as designated by the bureau.

This bill requires the
bureau
to
publish the standards on its website in a manner that is easily accessible to the general public.

If the bureau identifies a deficiency in an MCO's network adequacy under the standards, then the bureau
must (i) d
evelop a r
emediation plan to address the deficiency which identifies specific steps for the MCO to complete, contains timelines for implementation and completion by the MCO, and includes a variety of approaches, including increasing payment rates to providers; and
(
ii) s
ubmit the remediation plan to the general assembly for approval no later than 180 calendar days after the date TennCare becomes aware of the deficiency.

Rulemaking

No later than July 1, 2026,
this bill requires
the department of finance and admini
stration
to
promulgate rules to effectuate
the provisions described above
. The rules must include civil penalties for violations of
the provisions described above
.

Current Bill Text

Read the full stored bill text

SENATE BILL 1372
By Watson

HOUSE BILL 651
By Williams

HB0651
001446
- 1 -

AN ACT to amend Tennessee Code Annotated, Title 56
and Title 71, relative to health care.

WHEREAS, the General Assembly finds that since 2012 TennCare payments to
healthcare providers generally reimburse twenty-eight percent through thirty-four percent less
than Medicare; and
WHEREAS, the General Assembly requires TennCare to incentivize better access to
quality health care in rural and underserved communities; and
WHEREAS, recent federal regulations allow states to increase Medicaid payments for
many services to up to the average commercial rate to enable Medicaid plans to compete with
commercial plans when building provider networks; and
WHEREAS, it is prudent that, within the next twelve months, the Bureau of TennCare
develop a plan that identifies a variety of approaches, including increasing payment rates for
healthcare providers to parity with average commercial contracting rates, improving outreach
and problem resolution to providers, reducing barriers to provider credentialing and contracting,
providing for improved or expanded use of telehealth, and improving the timeliness and
accuracy of processes such as claim payment and prior authorization, and submit the plan to
the General Assembly for consideration during the following legislative session; now, therefore,
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
SECTION 1. Tennessee Code Annotated, Title 56, Chapter 7, Part 1, is amended by
adding the following as a new section:
(a) As used in this section:

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(1) "All-products clause" means a provision in a written or oral network
provider agreement between a health insurance entity and a healthcare provider
that requires the healthcare provider, as a condition of participation or
continuation in a provider network or health benefit plan to:
(A) Participate in another provider network that is utilized by the
health insurance entity and affiliated with the health insurance entity; or
(B) Provide healthcare services under another plan or product
offered by the health insurance entity;
(2) "Commissioner" means the commissioner of commerce and
insurance;
(3) "Health insurance entity" has the same meaning as defined in § 56-7-
109; and
(4) "Healthcare provider" means:
(A) A physician acting within the scope of a valid license issued
pursuant to title 63, chapters 6 or 9;
(B) A nurse acting within the scope of a valid license issued
pursuant to title 63, chapter 7 and who has a certificate to practice as an
advanced practice registered nurse issued by the board of nursing under
§ 63-7-126; or
(C) A physician assistant acting within the scope of a valid license
issued pursuant to title 63, chapter 19.
(b) A health insurance entity shall not:
(1) Offer to a healthcare provider a network provider agreement or
otherwise condition the healthcare provider's network participation based on an
all-products clause;

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(2) Enter into a network provider agreement with a healthcare provider or
otherwise condition the healthcare provider's network participation based on an
all-products clause; or
(3) Amend or renew an existing network provider agreement previously
entered into with a healthcare provider so that the network provider agreement
as amended or renewed adds or continues to include an all-products clause.
(c) If a network provider agreement contains a provision that violates this
section, or if a health insurance entity otherwise conditions a healthcare provider's
network participation based on an all-products clause, such provision or condition is void
and the commissioner shall assess the health insurance entity a civil penalty of ten
thousand dollars ($10,000) for each occurrence.
(d) On or before July 1, 2026, the commissioner shall promulgate rules to
effectuate this section. The rules must be promulgated pursuant to the Uniform
Administrative Procedures Act, compiled in title 4, chapter 5.
SECTION 2. Tennessee Code Annotated, Title 71, Chapter 5, Part 23, is amended by
adding the following as a new section:
(a) As used in this section:
(1) "All-products clause" means a provision in a written or oral network
provider agreement between a MCO or health insurance entity and a healthcare
provider that requires the healthcare provider, as a condition of participation or
continuation in a provider network or a health benefit plan to:
(A) Participate in another provider network that is utilized by the
MCO or health insurance entity and affiliated with the MCO or health
insurance entity; or

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(B) Provide healthcare services under another plan or product
offered by the MCO or health insurance entity.
(2) "Bureau" means the bureau of TennCare;
(3) "Commissioner" means the commissioner of finance and
administration;
(4) "Health insurance entity" has the same meaning as defined in § 56-7-
109;
(5) "Healthcare provider" means:
(A) A physician acting within the scope of a valid license issued
pursuant to title 63, chapters 6 or 9;
(B) A nurse acting within the scope of a valid license issued
pursuant to title 63, chapter 7 and who has a certificate to practice as an
advanced practice registered nurse issued by the board of nursing under
§ 63-7-126; or
(C) A physician assistant acting within the scope of a valid license
issued pursuant to title 63, chapter 19; and
(6) "Managed care organization" or "MCO" means an appropriately
licensed health insurance entity contracted with the bureau to manage the
delivery of, provide for access to, contain the cost of, and ensure the quality of
specified covered medical and behavioral benefits to TennCare enrollees through
a network of qualified providers.
(b) An MCO shall not:
(1) Offer to a healthcare provider a network provider agreement or
otherwise condition the healthcare provider's network participation based on an
all-products clause;

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(2) Enter into a network provider agreement with a healthcare provider or
otherwise condition the healthcare provider's network participation based on an
all-products clause; or
(3) Amend or renew an existing network provider agreement previously
entered into with a healthcare provider so that the network provider agreement
as amended or renewed adds or continues to include an all-products clause.
(c) If a network provider agreement contains a provision that violates this
section, or if an MCO otherwise conditions a healthcare provider's network participation
based on an all-products clause, such provision or condition is void and the
commissioner shall assess the MCO a civil penalty of ten thousand dollars ($10,000) for
each occurrence.
(d) On or before July 1, 2026, the commissioner shall promulgate rules to
effectuate this section. The rules must be promulgated pursuant to the Uniform
Administrative Procedures Act, compiled in title 4, chapter 5.
SECTION 3. Tennessee Code Annotated, Title 71, Chapter 5, Part 23, is amended by
adding the following as a new section:
(a) This section is known and may be cited as the "TennCare Provider Remedy
Plan."
(b) As used in this section:
(1) "Bureau" means bureau of TennCare;
(2) "Department" means the department of finance and administration;
(3) "Health insurance entity" has the same meaning as defined in § 56-7-
109;
(4) "Healthcare provider" or "provider" means:

- 6 - 001446

(A) A physician acting within the scope of a valid license issued
pursuant to title 63, chapters 6 or 9;
(B) A nurse acting within the scope of a valid license issued
pursuant to title 63, chapter 7 and who has a certificate to practice as an
advanced practice registered nurse issued by the board of nursing under
§ 63-7-126; or
(C) A physician assistant acting within the scope of a valid license
issued pursuant to title 63, chapter 19;
(5) "Managed care organization" or "MCO" means an appropriately
licensed health insurance entity contracted with the bureau to manage the
delivery, provide for access, contain the cost, and ensure the quality of specified
covered medical and behavioral benefits to TennCare enrollees through a
network of qualified providers;
(6) "Secret shopper survey" or "survey" means a research methodology
where callers who do not identify themselves as evaluators pose as enrollees
trying to schedule an appointment with a healthcare provider to evaluate
appointment wait time availability and the accuracy of healthcare provider
directories; and
(7) "TennCare" has the same meaning as defined in § 71-5-2503.
(c) The bureau shall establish and enforce appointment wait time standards and
the accuracy of healthcare provider directories by implementing a regular secret shopper
survey to determine each MCO's compliance with the standards in subsections (e) and
(f).
(d) An MCO is in compliance with the standards established in subsection (e)
when secret shopper survey results reflect a rate of appointment wait time availability

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within the standard time frame of at least ninety percent (90%). The bureau shall
determine if appointments offered via telehealth may be counted toward compliance with
appointment wait time availability standards.
(e) The bureau shall establish wait time availability standards for routine
appointments for the following services, if covered in an MCO's contract, and within the
specified limits:
(1) For outpatient mental health and substance use disorder services,
adult and pediatric appointment wait times must be no longer than ten (10)
business days from the date of request;
(2) For primary care services, adult and pediatric appointment wait times
must be no longer than fifteen (15) business days from the date of request;
(3) For obstetric and gynecological services, appointment wait times
must be no longer than fifteen (15) business days from the date of request; and
(4) For other services or specialties the bureau may identify, appointment
wait times must be no longer than the timeframes specified by the bureau in an
evidence-based manner.
(f)
(1) No less than annually, TennCare shall conduct a secret shopper
survey to determine the accuracy of the information specified in subdivision (f)(2)
for each MCO's most current electronic healthcare provider directories for the
following healthcare provider types, if included in the MCO's provider directory:
(A) Primary care providers;
(B) Obstetric and gynecological providers;
(C) Outpatient mental health and substance use disorder
providers; and

- 8 - 001446

(D) Providers of the services identified by the bureau under
subdivision (e)(4).
(2) At a minimum, a secret shopper survey must assess the accuracy of
the information in each MCO's most current electronic provider directories that
pertains to:
(A) The provider's active network status with the MCO;
(B) Provider street address;
(C) Provider telephone number; and
(D) Whether the provider is accepting new enrollees.
(g) When an entity conducting a secret shopper survey on behalf of the bureau
identifies an error in an MCO's directory data, the entity shall send information sufficient
for the MCO to correct the error to the bureau within three (3) business days after the
date the error is identified.
(h) The bureau shall send information received pursuant to subsection (g) to the
applicable MCO within three (3) business days after the date the bureau receives the
information from the entity that conducted the secret shopper survey.
(i)
(1) The bureau shall develop and enforce network adequacy standards
consistent with this section.
(2) The network standards established by the bureau in accordance with
this section must include all geographic areas covered by an MCO. The bureau
may establish varying standards for the same healthcare provider type based on
geographic area.
(3) The bureau shall not create exceptions to the network adequacy
standards developed under this subsection (i).

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(4) At a minimum, the bureau must develop a quantitative network
adequacy standard for MCOs, other than appointment wait time availability
standards, for the following provider types, if covered under an MCO's contract:
(A) Adult and pediatric primary care;
(B) Obstetrics and gynecology;
(C) Adult and pediatric mental health and substance use
disorders; and
(D) Adult and pediatric specialists, as designated by the bureau.
(j) The bureau shall publish the standards developed in accordance with this
section on its website in a manner that is easily accessible to the general public.
(k) If the bureau identifies a deficiency in an MCO's network adequacy under the
standards established by this section, then the bureau shall:
(1) Develop a remediation plan to address the deficiency which identifies
specific steps for the MCO to complete, contains timelines for implementation
and completion by the MCO, and includes a variety of approaches, including but
not limited to, increasing payment rates to providers; and
(2) Submit the remediation plan to the general assembly for approval no
later than one hundred eighty (180) calendar days after the date TennCare
becomes aware of the deficiency.
(l) No later than July 1, 2026, the department of finance and administration shall
promulgate rules to effectuate this section. The rules must include civil penalties for
violations of this section. The rules must be promulgated in accordance with the Uniform
Administrative Procedures Act, compiled in title 4, chapter 5.
SECTION 4. This act takes effect July 1, 2025, the public welfare requiring it.