Insurance, Health, Accident

Plain English Breakdown

The official source material does not provide specific details on how performance metrics will be determined.

Medical Laboratory Reimbursement Act

This bill changes Tennessee laws to require health insurance companies to pay non-network medical laboratories at least as much for testing services as set by federal Medicare and Medicaid rates, with some exceptions.

What This Bill Does

• Changes the law so that health insurance companies must pay non-network medical labs at least the same rate as set by federal Medicare and Medicaid rules for similar tests.
• Allows managed health insurance issuers to require non-network labs to meet certain performance standards before receiving full reimbursement rates.

Who It Names or Affects

• Health insurance companies and managed health insurance issuers
• Medical laboratories, both in-network and non-network

Terms To Know

Managed Health Insurance Issuer

A company that provides health insurance plans to individuals or groups.

Non-Network Medical Laboratory

A medical laboratory that is not part of a health insurer's network of preferred providers.

Limits and Unknowns

• The bill does not specify how insurers will determine performance metrics for non-network labs.
• It remains unclear if there are additional costs or impacts on the state budget beyond what was initially estimated.

Official Summary Text

Present law prohibits a
health insurance issuer or a managed health insurance issuer
from engaging in the following:



Den
ying
a licensed medical laboratory the right to participate as a participating provider in a policy, contract, or plan on the same terms and conditions as are offered to another medical laboratory under the policy, contract, or plan
. However, this prohibition
does not prohibit
such
a
n
issuer from establishing rates or fees that may be higher in nonurban areas, or in specific instances where
the
issuer determines it necessary to contract with a particular provider in order to meet network adequacy standards or patient care need
s.



Preventing
a person who is a party to or beneficiary of a policy, contract, or plan from selecting a licensed medical laboratory of the person's choice to furnish the medical laboratory services offered under the contract, policy, or plan
as long as
the medical laboratory is a participating provider under the same terms and conditions of the contract, policy, or plan as those offered to another medical laboratory.

This bill generally prohibits a
health insurance issuer or a managed health insurance issuer
from
reimburs
ing
a non-network medical laboratory that is eligible to participate as a participating provider for testing services at a rate that is less than the federal centers for medicare and medicaid services' clinical laboratory fee schedule for medical laboratorie
s in this state.
However, a
managed health insurance issuer may require that, in order to receive
such
rate of reimbursement, a non-network medica
l laboratory
must
meet the same performance metrics required of in-network medical laboratories.

Current Bill Text

HOUSE BILL 1993
By Hill

SENATE BILL 1722
By Harshbarger
SB1722
009797
- 1 -

AN ACT to amend Tennessee Code Annotated, Title 56,
Chapter 7, Part 23, relative to medical
laboratories.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
SECTION 1. Tennessee Code Annotated, Section 56-7-2357(b), is amended by
deleting the subsection and substituting:
(b) A health insurance issuer or a managed health insurance issuer shall not:
(1) Deny a licensed medical laboratory the right to participate as a
participating provider in a policy, contract, or plan on the same terms and
conditions as are offered to another medical laboratory under the policy, contract,
or plan; provided, that this subdivision (b)(1) does not prohibit a managed health
insurance issuer or health insurance issuer from establishing rates or fees that
may be higher in nonurban areas, or in specific instances where a managed
health insurance issuer or health insurance issuer determines it necessary to
contract with a particular provider in order to meet network adequacy standards
or patient care needs;
(2) Prevent a person who is a party to or beneficiary of a policy, contract,
or plan from selecting a licensed medical laboratory of the person's choice to
furnish the medical laboratory services offered under the contract, policy, or plan;
provided, that the medical laboratory is a participating provider under the same
terms and conditions of the contract, policy, or plan as those offered to another
medical laboratory; or

- 2 - 009797

(3) Except as provided in subsection (e), reimburse a non-network
medical laboratory that is eligible to participate as a participating provider under
this section for testing services at a rate that is less than the federal centers for
medicare and medicaid services' clinical laboratory fee schedule for medical
laboratories in this state.
SECTION 2. Tennessee Code Annotated, Section 56-7-2357, is amended by adding
the following new subsection:
(e) A managed health insurance issuer may require that, in order to receive the
rate of reimbursement specified under subdivision (b)(3), a non-network medical
laboratory meet the same performance metrics required of in-network medical
laboratories.
SECTION 3. This act takes effect July 1, 2026, the public welfare requiring it.