Back to Tennessee

SB0522 • 2026

TennCare

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

Enacted

This bill passed the Legislature and reached final enactment based on the latest official action.

Sponsor
Roberts, Littleton
Last action
2025-04-04
Official status
Comp. became Pub. Ch. 145
Effective date
Not listed

Plain English Breakdown

The official source material does not specify exact dates for when certain provisions take effect beyond July 1, 2025.

TennCare Coverage for Kleefstra Syndrome

This law allows TennCare to provide coverage and benefits for diagnosing and treating Kleefstra syndrome in a similar way to how they cover other genetic disorders, but only if it is medically necessary.

What This Bill Does

  • Defines 'Kleefstra syndrome' as a rare genetic condition that affects multiple body systems and includes specific symptoms like developmental delay, intellectual disability, distinctive facial features, speech and hearing disorders, seizures, gastrointestinal disorders, respiratory infections, autism, obesity, and organ defects.
  • Requires TennCare to provide coverage for diagnosing and treating Kleefstra syndrome in the same way it covers other similar genetic disorders, but only if it is medically necessary.
  • Specifies that this coverage must include early intervention services and therapies to improve quality of life throughout a person's lifetime, but only when determined to be medically necessary.
  • Allows the director of TennCare to apply for federal waivers if needed to implement these changes.

Who It Names or Affects

  • People enrolled in TennCare who have Kleefstra syndrome
  • The bureau of TennCare

Terms To Know

TennCare
A state health insurance program for low-income and disabled individuals in Tennessee.
Kleefstra syndrome
A rare genetic disorder that affects multiple body systems, including the brain, heart, kidneys, and more.

Limits and Unknowns

  • The law only allows coverage if it is medically necessary.
  • Coverage details are permissive rather than mandatory under certain conditions.

Amendments

These notes stay tied to the official amendment files and metadata from the legislature.

Amendment 1-0 to HB0502

Plain English: The amendment adds new coverage and benefits for individuals with Kleefstra syndrome under TennCare.

  • Defines 'Kleefstra syndrome' as a rare genetic disorder affecting multiple organs and functions of the body, characterized by developmental delay, intellectual disability, distinctive facial features, speech and hearing disorders, seizures, gastrointestinal disorders, respiratory infections, autism, obesity, and organ defects.
  • Requires TennCare to provide coverage for the diagnosis and treatment of Kleefstra syndrome in a manner similar to other genetic disorders like autism spectrum disorder or Down syndrome when medically necessary.
  • Allows TennCare to cover early intervention programs, therapies, medications, and other interventions aimed at improving quality of life and development throughout an enrollee's lifetime.
  • The exact extent of coverage for Kleefstra syndrome is not detailed beyond what is provided for similar genetic disorders.
  • It is unclear how the amendment will be implemented or funded, as these details are not specified in the text.
Amendment 1-0 to SB0522

Plain English: This amendment adds new coverage and benefits for people with Kleefstra syndrome under TennCare in a similar way that autism spectrum disorder, Trisomy 21 or Down syndrome are covered.

  • Defines 'Kleefstra syndrome' as a rare genetic disorder affecting multiple organs and functions of the body.
  • Allows TennCare to provide coverage for diagnosis and treatment of Kleefstra syndrome in the same way it covers other similar genetic disorders like autism spectrum disorder, Trisomy 21 or Down syndrome.
  • Includes early intervention services and programs that improve quality of life and development throughout a person's life.
  • The exact details on how coverage will be implemented are not provided in the amendment text.

Bill History

  1. 2025-04-04 Tennessee General Assembly

    Comp. became Pub. Ch. 145

  2. 2025-04-04 Tennessee General Assembly

    Effective date(s) 07/01/2025

  3. 2025-04-04 Tennessee General Assembly

    Pub. Ch. 145

  4. 2025-04-03 Tennessee General Assembly

    Signed by Governor.

  5. 2025-03-27 Tennessee General Assembly

    Transmitted to Governor for his action.

  6. 2025-03-26 Tennessee General Assembly

    Signed by Senate Speaker

  7. 2025-03-26 Tennessee General Assembly

    Signed by H. Speaker

  8. 2025-03-21 Tennessee General Assembly

    Enrolled; ready for sig. of H. Speaker.

  9. 2025-03-20 Tennessee General Assembly

    Companion House Bill substituted

  10. 2025-03-20 Tennessee General Assembly

    Passed Senate, Ayes 27, Nays 2

  11. 2025-03-20 Tennessee General Assembly

    Amendment withdrawn. (Amendment 1 - SA0083)

  12. 2025-03-20 Tennessee General Assembly

    Senate substituted House Bill for companion Senate Bill.

  13. 2025-03-18 Tennessee General Assembly

    Placed on Senate Regular Calendar for 3/20/2025

  14. 2025-03-13 Tennessee General Assembly

    Received from House, Passed on First Consideration

  15. 2025-03-11 Tennessee General Assembly

    Recommended for passage with amendment/s, refer to Senate Calendar Committee Ayes 6, Nays 3 PNV 0

  16. 2025-03-11 Tennessee General Assembly

    Engrossed; ready for transmission to Sen.

  17. 2025-03-10 Tennessee General Assembly

    Passed H., as am., Ayes 94, Nays 0, PNV 0

  18. 2025-03-10 Tennessee General Assembly

    Sponsor(s) Added.

  19. 2025-03-10 Tennessee General Assembly

    H. adopted am. (Amendment 1 - HA0026)

  20. 2025-03-06 Tennessee General Assembly

    H. Placed on Regular Calendar for 3/10/2025

  21. 2025-03-05 Tennessee General Assembly

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

  22. 2025-03-05 Tennessee General Assembly

    Placed on cal. Calendar & Rules Committee for 3/6/2025

  23. 2025-02-26 Tennessee General Assembly

    Rec. for pass. if am., ref. to Calendar & Rules Committee

  24. 2025-02-19 Tennessee General Assembly

    Placed on cal. Insurance Committee for 2/26/2025

  25. 2025-02-18 Tennessee General Assembly

    Rec for pass if am by s/c ref. to Insurance Committee

  26. 2025-02-12 Tennessee General Assembly

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

  27. 2025-02-12 Tennessee General Assembly

    Placed on s/c cal Tenncare Subcommittee for 2/18/2025

  28. 2025-02-11 Tennessee General Assembly

    Sponsor change.

  29. 2025-02-11 Tennessee General Assembly

    Sponsor(s) withdrawn.

  30. 2025-02-10 Tennessee General Assembly

    Introduced, Passed on First Consideration

  31. 2025-02-05 Tennessee General Assembly

    Assigned to s/c Tenncare Subcommittee

  32. 2025-02-05 Tennessee General Assembly

    P2C, ref. to Insurance Committee

  33. 2025-02-03 Tennessee General Assembly

    Intro., P1C.

  34. 2025-01-30 Tennessee General Assembly

    Filed for introduction

  35. 2025-01-29 Tennessee General Assembly

    Filed for introduction

Official Summary Text

Kleefstra syndrome is a rare genetic condition that affects development and involves many
body systems. People with Kleefstra syndrome usually have distinct facial features, developmental delay, intellectual disability, low muscle tone (hypotonia), and communication difficulties. Kleefstra syndrome is caused by a mutation in a gene called E
H
MT1 or the deletion of a specific region of chromosome 9 that includes EHMT1. Other names for Kleefstra syndrome include 9q-syndrome, 9q34.3 deletion syndrome, and chromosome 9q deletion syndrome.

Kleefstra syndrome causes a range of symptoms that can d
iffer from person to person, which may include microcephaly; seizures; hearing loss; wide, short skull (brachycephaly); limited or absent speech; autism spectrum disorders; heart defects; sleep disorders; kidney defects; gastrointestinal problems such as
g
astroesophageal reflux (GERD); protruding jaw; single eyebrow; widely spaced eyes; rolled out lips; large tongue; nostrils that open out; and high birth weight and childhood obesity. In some cases, symptoms may include severe respiratory infections. Chi
l
dren with Kleefstra syndrome may have trouble communicating or interacting socially. Some adolescents may lose interest (apathy), lose developmental skills (regression), or become unresponsive (catatonic).

This bill requires the bureau of TennCare to pr
ovide coverage and benefits on behalf of an enrollee for the diagnosis, including genetic testing, and treatment of Kleefstra syndrome in the same manner and to the same extent that the bureau provides coverage for autism spectrum disorder, Trisomy 21, or

Down syndrome, and other similar or related genetic disorders. Such coverage and benefits must include early intervention and promoting improvements to the enrollee's quality of life and development throughout the life of the enrollee through appropriate

modalities of therapy, appropriate medications, and other interventive programs, education, treatments, clothing, devices, and equipment. The director of TennCare may apply for a federal waiver as the director deems necessary to effectuate this bill.

ON
MARCH 10, 2025, THE HOUSE ADOPTED AMENDMENT #1 AND PASSED HOUSE BILL 502, AS AMENDED.

AMENDMENT #1 makes the following changes:



Revises the requirement that the bureau
provide coverage and benefits on behalf of an enrollee for the diagnosis, including genetic testing, and treatment of Kleefstra syndrome in the same manner and to the same extent that the bureau provides coverage for autism spectrum disorder, Trisomy 21 or Down syndrome, and other similar or related genetic disorders
to, instead, be permissive instead of required and only permissive when determined to be medically necessary.



Revises the requirement that c
overage and benefits
as described above must
include, without limitation, early intervention and promoting improvements to the enrollee's quality of life and development throughout the life of the enrollee through
a
ppropriate modalities of therapy
, a
ppropriate medications
,
and
o
ther interventive programs, education, treatments, clothing, devices, and equipment
to, instead, be permissive instead of required.

Current Bill Text

Read the full stored bill text
HOUSE BILL 502
By Raper

SENATE BILL 522
By Roberts

SB0522
001919
- 1 -

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

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
SECTION 1. Tennessee Code Annotated, Title 71, Chapter 5, 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) "Enrollee" means an individual enrolled in TennCare;
(3) "Kleefstra syndrome" means a rare genetic disorder resulting from a
mutation in the euchromatic histone methyltransferase 1 (EHMT1) gene or a
deletion of a region of chromosome 9 that includes the EHMT1 gene that affects
multiple organs and functions of the body, including the face, brain, heart, and
kidneys, and that is characterized by features including, but not limited to:
(A) Developmental delay;
(B) Intellectual disability;
(C) Distinctive facial features;
(D) Speech and hearing disorders;
(E) Seizures;
(F) Gastrointestinal disorders;
(G) Respiratory infections;
(H) Autism;
(I) Obesity; and

- 2 - 001919

(J) Organ defects.
(b) The bureau shall provide coverage and benefits on behalf of an enrollee for
the diagnosis, including genetic testing, and treatment of Kleefstra syndrome in the
same manner and to the same extent that the bureau provides coverage for autism
spectrum disorder, Trisomy 21 or Down syndrome, and other similar or related genetic
disorders.
(c) Coverage and benefits under subsection (b) must include, without limitation,
early intervention and promoting improvements to the enrollee's quality of life and
development throughout the life of the enrollee through:
(1) Appropriate modalities of therapy;
(2) Appropriate medications; and
(3) Other interventive programs, education, treatments, clothing, devices,
and equipment.
(d) The director of TennCare may apply for a federal waiver as the director
deems necessary to effectuate this section.
SECTION 2. This act takes effect July 1, 2025, the public welfare requiring it.