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HB1223 • 2026

Insurance, Health, Accident

AN ACT to amend Tennessee Code Annotated, Title 4, Chapter 10 and Title 56, relative to studying reimbursements under policies of health insurers.

Healthcare
Active

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

Sponsor
Howell, Gardenhire
Last action
2025-02-12
Official status
Assigned to s/c Insurance Subcommittee
Effective date
Not listed

Plain English Breakdown

Checked against official source text during the last sync.

Health Insurance Claim Study

This bill requires TACIR to study how health insurers handle claims and reimbursements for policyholders over the past five years and report their findings by January 15, 2026.

What This Bill Does

  • TACIR must examine how health insurers decide whether to pay or deny healthcare claims.
  • TACIR needs to look at how they tell policyholders and providers about denied claims.
  • The study includes the number of claim denials each year for five years, starting from 2021.
  • TACIR has to report their findings by January 15, 2026, to specific committees in the Tennessee General Assembly.

Who It Names or Affects

  • Health insurers who must provide information about claim denials and reimbursements.
  • Policyholders and healthcare providers who receive notifications about denied claims.
  • TACIR which conducts the study and reports findings.

Terms To Know

Tennessee Advisory Commission on Intergovernmental Relations (TACIR)
A group that studies issues related to state government and its interactions with other levels of government.
Health insurer
An organization that provides health insurance coverage to individuals or groups.

Limits and Unknowns

  • The bill does not specify what actions will be taken based on TACIR's findings.
  • It excludes claims and plans related to TennCare and CoverKids programs from the study.

Bill History

  1. 2025-03-11 Tennessee General Assembly

    Assigned to General Subcommittee of Senate Commerce and Labor Committee

  2. 2025-03-05 Tennessee General Assembly

    Placed on Senate Commerce and Labor Committee calendar for 3/11/2025

  3. 2025-02-12 Tennessee General Assembly

    Assigned to s/c Insurance Subcommittee

  4. 2025-02-12 Tennessee General Assembly

    P2C, ref. to Insurance Committee

  5. 2025-02-12 Tennessee General Assembly

    Passed on Second Consideration, refer to Senate Commerce and Labor Committee

  6. 2025-02-10 Tennessee General Assembly

    Intro., P1C.

  7. 2025-02-10 Tennessee General Assembly

    Introduced, Passed on First Consideration

  8. 2025-02-06 Tennessee General Assembly

    Filed for introduction

  9. 2025-02-06 Tennessee General Assembly

    Filed for introduction

Official Summary Text

Abstract summarizes the bill.

Current Bill Text

Read the full stored bill text 
SENATE BILL 1134
By Gardenhire

HOUSE BILL 1223
By Howell

HB1223
000711
- 1 -

AN ACT to amend Tennessee Code Annotated, Title 4,
Chapter 10 and Title 56, relative to studying
reimbursements under policies of health insurers.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
SECTION 1. Tennessee Code Annotated, Title 4, Chapter 10, is amended by adding
the following new section:
(a) The Tennessee advisory commission on intergovernmental relations (TACIR)
shall perform a comprehensive evaluation of:
(1) The process by which health insurers approve or deny coverage or
reimbursement for healthcare benefits under a plan or policy of insurance,
including the criteria used to determine whether to approve or deny such
coverage or reimbursement;
(2) The process for notification of policyholders and healthcare providers
regarding the denial of a claim or reimbursement for such healthcare benefits;
(3) The process for appealing the denial of a claim or reimbursement for
such healthcare benefits, including the process for obtaining a prior authorization,
if required;
(4) The process for recoupment by or reimbursement to a policyholder or
healthcare provider for unpaid claims from a health insurer upon successful
appeal after denial of such claims or reimbursement for healthcare benefits;
(5) The manner in which health insurers must maintain and manage
reserve funds;

- 2 - 000711

(6) The aggregate number of denials of claims for coverage and
reimbursement by health insurers on an annual basis for each of the past five (5)
calendar years beginning January 1, 2021, including:
(A) The percentage of such denials based on the aggregate
number of claims per year; and
(B) The identification of each health insurer that deviates from the
aggregate mean by ten percent (10%) or more based on data reported
under subdivision (a)(6)(A); and
(7) The manner in which this state and its departments and agencies
audit individual health insurers and the frequency thereof.
(b) All appropriate state departments and agencies shall provide assistance to
TACIR in connection with the comprehensive evaluation conducted under subsection
(a).
(c) On or before January 15, 2026, TACIR shall report its findings and
recommendations, including any proposed legislation, regarding the evaluation
conducted under subsection (a) to the chairs of the commerce and labor committee of
the senate and the committee of the house of representatives having jurisdiction over
health insurance matters.
(d) TACIR shall not include in its evaluation under subsection (a) healthcare
policies or plans through contracts with the state to provide insurance through the
TennCare program or its successor program, codified under title 71, chapter 5, or the
CoverKids program or its successor program, codified under title 71, chapter 3, part 11.
(e) As used in this section, "health insurer" means a health insurance entity as
that term is defined in § 56-7-109.
SECTION 2. This act takes effect upon becoming a law, the public welfare requiring it.