KLS Keeping Law Simple Legislation in plain English

Straight-ahead summaries built from the official bill text. We keep the source links front and center and leave the decision up to you.

Back to Tennessee

SB1369 • 2026

Health Care

AN ACT to amend Tennessee Code Annotated, Title 4; Title 33; Title 68; Title 71 and Chapter 985 of the Public Acts of 2024, relative to certificates of need.

Healthcare
Active

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

Sponsor
Watson, Garrett
Last action
2026-04-17
Official status
Sponsor(s) Added.
Effective date
Not listed

Plain English Breakdown

The bill's full impact on healthcare costs and access is still uncertain.

Health Care Act for Acute Care Hospitals

This bill changes Tennessee's health care laws to remove the requirement of obtaining a certificate of need for establishing or operating acute care hospitals and satellite emergency departments, while also allowing cardiac catheterization without needing a certificate of need.

What This Bill Does

  • Removes the requirement that acute care hospitals must obtain a certificate of need before opening, effective July 1, 2028.
  • Allows the Health Facilities Commission to license acute care hospitals starting July 1, 2028.
  • Eliminates the need for certificates of need for satellite emergency departments and cardiac catheterization services.
  • Requires licensed acute care hospitals to participate in TennCare and provide charity care comparable to other similar hospitals as of July 1, 2030.

Who It Names or Affects

  • Hospitals planning to open or expand their facilities
  • Health Facilities Commission responsible for licensing
  • Patients seeking acute care services

Terms To Know

Certificate of Need (CON)
A document required by law before a hospital can be established, expanded, or changed.
Acute Care Hospital
A hospital that primarily treats patients with an average length of stay of 25 days or less.

Limits and Unknowns

  • The bill's full impact on healthcare costs and access is not yet clear.
  • Details of the licensing standards for acute care hospitals will be developed by the Health Facilities Commission after January 1, 2031.

Amendments

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

Amendment 1-0 to HB0819

Plain English: House Health 1 Amendment No.

  • House Health 1 Amendment No.
  • 1 to HB0819 Terry Signature of Sponsor AMEND Senate Bill No.
  • 1369 House Bill No.
  • 819* HA0594 014682 - 1 - by deleting "July 1, 2028" in subdivision (6) in SECTION 1 and substituting "July 1, 2030".
Amendment 2-0 to HB0819

Plain English: House Finance, Ways, and Means 1 Amendment No.

  • House Finance, Ways, and Means 1 Amendment No.
  • 2 to HB0819 Hicks G Signature of Sponsor AMEND Senate Bill No.
  • 1369 House Bill No.
  • 819* HA0801 016115 - 1 - by deleting "July 1, 2028" in subdivision (6) in SECTION 1 and substituting "July 1, 2030".
Amendment 3-0 to HB0819

Plain English: Amendment No.

  • Amendment No.
  • 3 to HB0819 Williams Signature of Sponsor AMEND Senate Bill No.
  • 1369 House Bill No.
  • 819* HA0893 016524 - 1 - by inserting the following immediately preceding SECTION 14 and redesignating SECTION 14 accordingly: SECTION __.
Amendment 4-0 to HB0819

Plain English: Amendment No.

  • Amendment No.
  • 4 to HB0819 Williams Signature of Sponsor AMEND Senate Bill No.
  • 1369 House Bill No.
  • 819* HA1049 017534 - 1 - by inserting the following immediately preceding the effective date section and redesignating effective date section accordingly: SECTION __.
Amendment 5-0 to HB0819

Plain English: Amendment No.

  • Amendment No.
  • 5 to HB0819 Garrett Signature of Sponsor AMEND Senate Bill No.
  • 1369 House Bill No.
  • 819* HA1050 017522 - 1 - by deleting all language after the enacting clause and substituting: SECTION 1.
Amendment 6-0 to HB0819

Plain English: Amendment No.

  • Amendment No.
  • 6 to HB0819 Williams Signature of Sponsor AMEND Senate Bill No.
  • 1369 House Bill No.
  • 819* HA1071 017599 - 1 - by deleting the language "described in this subsection (b) for acute care hospitals licensed on or after July 1, 2030" and substituting "described in this subsection (b) for acute care hospitals licensed on or after July 1, 2028".
Amendment 7-0 to HB0819

Plain English: Amendment No.

  • Amendment No.
  • 7 to HB0819 Williams Signature of Sponsor AMEND Senate Bill No.
  • 1369 House Bill No.
  • 819* HA1073 017595 - 1 - by inserting the following immediately preceding the effective date section and redesignating effective date section accordingly: SECTION __.
Amendment 8-0 to HB0819

Plain English: Amendment No.

  • Amendment No.
  • 8 to HB0819 Williams Signature of Sponsor AMEND Senate Bill No.
  • 1369 House Bill No.
  • 819* HA1113 017865 - 1 - by inserting the following immediately preceding the effective date section and redesignating the effective date section accordingly: SECTION __.
Amendment 9-0 to HB0819

Plain English: Amendment No.

  • Amendment No.
  • 9 to HB0819 Garrett Signature of Sponsor AMEND Senate Bill No.
  • 1369 House Bill No.
  • 819* HA1126 017910 - 1 - by deleting all language after the enacting clause and substituting: SECTION 1.
Amendment 1-0 to SB1369

Plain English: Senate Health and Welfare 1 Amendment No.

  • Senate Health and Welfare 1 Amendment No.
  • 1 to SB1369 Crowe Signature of Sponsor AMEND Senate Bill No.
  • 1369 House Bill No.
  • 819* SA0774 015300 - 1 - by deleting all language after the enacting clause and substituting: SECTION 1.
Amendment 2-0 to SB1369

Plain English: Senate Health and Welfare 2 Amendment No.

  • Senate Health and Welfare 2 Amendment No.
  • 2 to SB1369 Crowe Signature of Sponsor AMEND Senate Bill No.
  • 1369 House Bill No.
  • 819* SA0775 016012 - 1 - by inserting the following as new, appropriately designated sections immediately preceding the effective date section, and redesignating the effective date section accordingly: SECTION __.
Amendment 3-0 to SB1369

Plain English: Senate Health and Welfare 3 Amendment No.

  • Senate Health and Welfare 3 Amendment No.
  • 3 to SB1369 Crowe Signature of Sponsor AMEND Senate Bill No.
  • 1369 House Bill No.
  • 819* SA0776 016108 - 1 - by inserting the following as new, appropriately designated sections immediately preceding the effective date section, and redesignating the effective date section accordingly: SECTION __.

Bill History

  1. 2026-04-17 Tennessee General Assembly

    Sponsor(s) Added.

  2. 2026-04-16 Tennessee General Assembly

    Concurred, Ayes 28, Nays 1 (Amendment 8 - HA1113)

  3. 2026-04-16 Tennessee General Assembly

    Concurred, Ayes 26, Nays 1 (Amendment 9 - HA1126)

  4. 2026-04-15 Tennessee General Assembly

    Placed on Senate Message Calendar for 4/16/2026

  5. 2026-04-14 Tennessee General Assembly

    Placed on Senate Message Calendar for 4/16/2026

  6. 2026-04-13 Tennessee General Assembly

    Passed H., as am., Ayes 84, Nays 11, PNV 1

  7. 2026-04-13 Tennessee General Assembly

    Am. withdrawn. (Amendment 7 - HA1073)

  8. 2026-04-13 Tennessee General Assembly

    Am. withdrawn. (Amendment 6 - HA1071)

  9. 2026-04-13 Tennessee General Assembly

    Am. withdrawn. (Amendment 4 - HA1049)

  10. 2026-04-13 Tennessee General Assembly

    Am. withdrawn. (Amendment 3 - HA0893)

  11. 2026-04-13 Tennessee General Assembly

    H. adopted am. (Amendment 8 - HA1113)

  12. 2026-04-13 Tennessee General Assembly

    H. adopted am. (Amendment 9 - HA1126)

  13. 2026-04-13 Tennessee General Assembly

    Am. withdrawn. (Amendment 5 - HA1050)

  14. 2026-04-13 Tennessee General Assembly

    Am. withdrawn. (Amendment 2 - HA0801)

  15. 2026-04-13 Tennessee General Assembly

    Am. withdrawn. (Amendment 1 - HA0594)

  16. 2026-04-13 Tennessee General Assembly

    Subst. for comp. HB.

  17. 2026-04-13 Tennessee General Assembly

    Sponsor(s) Added.

  18. 2026-04-13 Tennessee General Assembly

    Comp. SB subst.

  19. 2026-04-08 Tennessee General Assembly

    H. Placed on Regular Calendar for 4/13/2026

  20. 2026-04-08 Tennessee General Assembly

    Reset on cal. for 4/13/2026

  21. 2026-04-06 Tennessee General Assembly

    H. Placed on Regular Calendar for 4/8/2026

  22. 2026-04-06 Tennessee General Assembly

    Reset on cal. for 4/8/2026

  23. 2026-03-30 Tennessee General Assembly

    Rcvd. from S., held on H. desk.

  24. 2026-03-30 Tennessee General Assembly

    H. Placed on Regular Calendar for 4/6/2026

  25. 2026-03-30 Tennessee General Assembly

    Reset on cal. for 4/6/2026

  26. 2026-03-30 Tennessee General Assembly

    Sponsor(s) Added.

  27. 2026-03-26 Tennessee General Assembly

    Engrossed; ready for transmission to House

  28. 2026-03-26 Tennessee General Assembly

    Sponsor(s) Added.

  29. 2026-03-26 Tennessee General Assembly

    Passed Senate as amended, Ayes 27, Nays 3, PNV 3

  30. 2026-03-26 Tennessee General Assembly

    Senate adopted Amendment (Amendment 3 - SA0776)

  31. 2026-03-26 Tennessee General Assembly

    Senate adopted Amendment (Amendment 2 - SA0775)

  32. 2026-03-26 Tennessee General Assembly

    Senate adopted Amendment (Amendment 1 - SA0774)

  33. 2026-03-26 Tennessee General Assembly

    H. Placed on Regular Calendar for 3/30/2026

  34. 2026-03-25 Tennessee General Assembly

    Sponsor(s) Added.

  35. 2026-03-25 Tennessee General Assembly

    Placed on cal. Calendar & Rules Committee for 3/26/2026

  36. 2026-03-24 Tennessee General Assembly

    Placed on Senate Regular Calendar for 3/26/2026

  37. 2026-03-24 Tennessee General Assembly

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

  38. 2026-03-18 Tennessee General Assembly

    Sponsor(s) Added.

  39. 2026-03-18 Tennessee General Assembly

    Recommended for passage with amendment/s, refer to Senate Calendar Committee Ayes 8, Nays 1 PNV 0

  40. 2026-03-18 Tennessee General Assembly

    Placed on cal. Finance, Ways, and Means Committee for 3/24/2026

  41. 2026-03-18 Tennessee General Assembly

    Rec for pass if am by s/c ref. to Finance, Ways, and Means Committee

  42. 2026-03-17 Tennessee General Assembly

    Placed on Senate Health and Welfare Committee calendar for 3/18/2026

  43. 2026-03-17 Tennessee General Assembly

    Action deferred in Senate Health and Welfare Committee to 3/18/2026

  44. 2026-03-11 Tennessee General Assembly

    Placed on Senate Health and Welfare Committee calendar for 3/17/2026

  45. 2026-03-11 Tennessee General Assembly

    Action deferred in Senate Health and Welfare Committee to 3/18/2026

  46. 2026-03-11 Tennessee General Assembly

    Placed on s/c cal Finance, Ways, and Means Subcommittee for 3/18/2026

  47. 2026-03-11 Tennessee General Assembly

    Action Def. in s/c Finance, Ways, and Means Subcommittee to 3/18/2026

  48. 2026-03-11 Tennessee General Assembly

    Sponsor(s) Added.

  49. 2026-03-05 Tennessee General Assembly

    Sponsor(s) Added.

  50. 2026-03-04 Tennessee General Assembly

    Placed on Senate Health and Welfare Committee calendar for 3/11/2026

  51. 2026-03-04 Tennessee General Assembly

    Placed on s/c cal Finance, Ways, and Means Subcommittee for 3/11/2026

  52. 2026-03-04 Tennessee General Assembly

    Assigned to s/c Finance, Ways, and Means Subcommittee

  53. 2026-03-03 Tennessee General Assembly

    Rec. for pass. if am., ref. to Finance, Ways, and Means Committee

  54. 2026-02-25 Tennessee General Assembly

    Placed on cal. Health Committee for 3/3/2026

  55. 2026-02-25 Tennessee General Assembly

    Sponsor(s) Added.

  56. 2026-02-17 Tennessee General Assembly

    Sponsor(s) Added.

  57. 2025-04-01 Tennessee General Assembly

    Taken off notice for cal. in Health Committee

  58. 2025-03-26 Tennessee General Assembly

    Assigned to General Subcommittee of Senate Health and Welfare Committee

  59. 2025-03-26 Tennessee General Assembly

    Placed on cal. Health Committee for 4/1/2025

  60. 2025-03-26 Tennessee General Assembly

    Sponsor(s) Added.

  61. 2025-03-26 Tennessee General Assembly

    Rec. for pass by s/c ref. to Health Committee

  62. 2025-03-19 Tennessee General Assembly

    Placed on Senate Health and Welfare Committee calendar for 3/26/2025

  63. 2025-03-19 Tennessee General Assembly

    Placed on s/c cal Health Subcommittee for 3/26/2025

  64. 2025-03-19 Tennessee General Assembly

    Action Def. in s/c Health Subcommittee to 3/26/2025

  65. 2025-03-12 Tennessee General Assembly

    Placed on s/c cal Health Subcommittee for 3/19/2025

  66. 2025-03-03 Tennessee General Assembly

    Sponsor(s) Added.

  67. 2025-02-27 Tennessee General Assembly

    Sponsor(s) Added.

  68. 2025-02-24 Tennessee General Assembly

    Sponsor(s) withdrawn.

  69. 2025-02-24 Tennessee General Assembly

    Sponsor(s) Added.

  70. 2025-02-18 Tennessee General Assembly

    Sponsor(s) Added.

  71. 2025-02-13 Tennessee General Assembly

    Sponsor(s) Added.

  72. 2025-02-12 Tennessee General Assembly

    Passed on Second Consideration, refer to Senate Health and Welfare Committee

  73. 2025-02-12 Tennessee General Assembly

    Sponsor(s) Added.

  74. 2025-02-10 Tennessee General Assembly

    Sponsor(s) Added.

  75. 2025-02-10 Tennessee General Assembly

    Introduced, Passed on First Consideration

  76. 2025-02-10 Tennessee General Assembly

    Assigned to s/c Health Subcommittee

  77. 2025-02-06 Tennessee General Assembly

    Filed for introduction

  78. 2025-02-06 Tennessee General Assembly

    P2C, ref. to Health Committee

  79. 2025-02-05 Tennessee General Assembly

    Sponsor(s) Added.

  80. 2025-02-05 Tennessee General Assembly

    Sponsor(s) withdrawn.

  81. 2025-02-05 Tennessee General Assembly

    Intro., P1C.

  82. 2025-02-04 Tennessee General Assembly

    Sponsor(s) Added.

  83. 2025-02-04 Tennessee General Assembly

    Filed for introduction

Official Summary Text

Present law generally requires that a person obtain a certificate of need to establish a hospital, other than a mental health hospital. Effective July 1, 2028, this bill adds that a certificate of need will not be required to establish an acute care hos
pital, which this bill defines to mean a hospital with a primary focus on patients with an average length of stay of 25 days or less.

ON MARCH 26, 2026, THE SENATE ADOPTED AMENDMENTS #1, #2, AND #3 AND PASSED SENATE BILL 1369, AS AMENDED.

AMENDMENT #1 adds authorization for the

health facilities commission to license acute care hospitals and requires that
any person, partnership, association, or corporation, this state, a county or local government unit, and any division, department, board, or agency of a government unit, shall not establish, conduct, operate, or maintain an acute care hospital in Tennesse
e without a license.

This amendment changes this bill's effective date from upon becoming a law for all purposes to upon becoming a law for rulemaking purposes and July 1, 2030, for all other purposes.

AMENDMENT #2 removes the present law requirement for a certificate of need to open a satellite emergency department, in counties where such requirement presently applies.

This amendment authorizes the health facilities commission to license satellite emergency departments and prohibits a person from

establishing or operating a satellite emergency department unless the satellite emergency department is licensed as an outpatient department of a licensed hospital.

AMENDMENT #3 removes the present law requirement for a certificate of need in order to provide

cardiac catheterization.

This amendment authorizes the health facilities commission to license cardiac catheterizations. This amendment prohibits a person from initiating or providing cardiac catheterization services unless the facility providing such services is licensed as an
outpatient department of a licensed hospital; provided, that such prohibition does not apply to a facility providing cardiac catheterization services is in operation as of July 1, 2030.

ON APRIL 13, 2026, THE HOUSE SUBSTITUTED SENATE BILL 1369 FOR HOUSE BILL 819, ADOPTED AMENDMENTS #9 AND 8, AND PASSED SENATE BILL 1369, AS AMENDED.

AMENDMENT #9 incorporates the provisions of Senate Amendments #1, 2, and 3, and changes the effective date for this bill's provisions concerning satellite emergency departments and cardiac catheterization from July 1, 2030, to July 1, 2028.

AMENDMENT #8 adds authorization for the health facilities commission to adopt by rule additional licensing standards for acute care hospitals licensed on or after July 1, 2030, which standards must include requirements that an acute care hospital:

(1) Participate in the TennCare medical assistance program and provide an amount of care to patients who are TennCare enrollees that is comparable to similarly situated acute care
hospitals; and

(2) Provide an amount of charity care that is comparable to similarly situated acute care hospitals.

For purposes of this amendment, "acute care hospital" means a hospital with a primary focus on patients with an average length of stay of 25 days or less.

In developing licensing standards, this amendment requires the commission to complete a report by January 1, 2031, that includes a compilation of payor mix information by geographical area and type of medical treatment or procedure. The payor mix inform
ation must include percentages of patients who are TennCare enrollees, medicare patients, or charity care patients. The report must be developed with participation from and input of various stakeholders.

ON APRIL 16, THE SENATE CONCURRED IN HOUSE AMENDMENTS #8 AND #9.

Current Bill Text

Read the full stored bill text 
HOUSE BILL 819
By Garrett

SENATE BILL 1369
By Watson

SB1369
000843
- 1 -

AN ACT to amend Tennessee Code Annotated, Title 4;
Title 33; Title 68; Title 71 and Chapter 985 of the
Public Acts of 2024, relative to certificates of need.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
SECTION 1. Chapter 985 of the Public Acts of 2024, is amended by deleting SECTION
22 and substituting:
SECTION 22. Tennessee Code Annotated, Section 68-11-1602(10)(B), is
amended by adding the following as a new subdivision:
( ) An acute care hospital;
SECTION 23. Tennessee Code Annotated, Section 68-11-1602, is amended by
adding the following as a new subdivision:
( ) "Acute care hospital" means a hospital with a primary focus on
patients with an average length of stay of twenty-five (25) days or less;
SECTION 24. Tennessee Code Annotated, Section 68-11-1607, is amended by
adding the following as a new subsection:
( ) This part does not require a certificate of need to establish or operate
an acute care hospital.
SECTION 25. For the purpose of promulgating rules, this act takes effect upon
becoming a law, the public welfare requiring it. For all other purposes:
(1) Sections 11 and 18-21 take effect July 1, 2024, the public welfare
requiring it;
(2) Sections 1 and 2 take effect July 1, 2025, the public welfare requiring
it;

- 2 - 000843

(3) Sections 3-8 take effect December 1, 2025, the public welfare
requiring it;
(4) Sections 9, 10, and 12-15 take effect December 1, 2027, the public
welfare requiring it;
(5) Sections 16 and 17 take effect December 1, 2029, the public welfare
requiring it; and
(6) Sections 22-24 take effect July 1, 2028, the public welfare requiring it.
SECTION 2. This act takes effect upon becoming a law, the public welfare requiring it.