Official Summary Text
This bill prohibits health insurance entities from calculating quality measures, quality ratings, incentive payments, or reimbursement tiers for a healthcare provider by including any exempt patient in the denominator of any vaccine-related metric. Furth
er, upon receiving documentation from a healthcare provider that a patient is an exempt patient, the health insurance entity must exclude the patient from the calculation of the provider's vaccination rate performance or any other quality metric related t
o
vaccine status.
This bill also prohibits health insurance entities from terminating a healthcare provider from a network, reducing reimbursement rates, or withholding an incentive payment solely because the provider retains exempt patients in its practice. Any claim fo
r reimbursement that is reduced, denied, or recouped by a health insurance entity in violation of this bill is a clean claim and is subject to the interest penalties and remediation as provided in present law. As used in this prohibition, a "clean claim"
i
s a claim received by a health insurance entity for adjudication that requires no further information, adjustment, or alteration to be paid by the health insurer.
"EXEMPT PATIENT" DEFINED
As used in this bill, an "exempt patient" means a patient, or the parent or legal guardian of a minor patient, who has declined a specific vaccination or series of vaccinations and has provided the healthcare provider with a written statement of refusal
based on religious tenets or medical contraindication as recognized under state law.
APPLICABILITY
This bill applies to contracts entered into on or after July 1, 2026.
ON MARCH 26, 2026, THE SENATE ADOPTED AMENDMENT #1 AND PASSED SENATE BILL 2070, AS AMENDED.
AMENDMENT #1 removes this bill's requirement that a patient must have provided the healthcare provider with a written statement of refusal of a vaccination based on religious tenets or medical contraindication in order to be an exempt patient for purposes
of this bill.
This amendment expands this bill's definition of "quality measure" to include
capitation rate, shared-savings distribution, and downside risk-sharing arrangement.
This amendment specifies that a health insurance entity shall not calculate a "final" quality measure, quality rating, incentive payment, or reimbursement tier for a healthcare provider at the end of each measurement period that is used to calculate prov
ider payments by including an exempt patient documented by a healthcare provider in the denominator of a vaccination-related metric.
Under this amendment, if a provider submits documentation that supports that a patient is an exempt patient and submits an electronic claim containing a standard diagnosis code indicating the immunization was not carried out, then a health insurance enti
ty must exclude the patient from the final calculation of the provider's vaccination rate performance, or any other quality metric derived from vaccination status, for the applicable measurement period.
This amendment makes this bill's prohibition against a health insurance entity terminating a healthcare provider from a network, reducing a provider's reimbursement rate, or withholding an incentive payment because the provider retains exempt patients in
the provider's practice applicable to situations where the termination, reduction, or withholding is based in whole or in part on such retention of exempt patients (instead of when the action is based solely on such retention).
ON MARCH 30, 2026, THE HOUSE SUBSTITUTED SENATE BILL 2070 FOR HOUSE BILL 2243, ADOPTED AMENDMENT #2, AND PASSED SENATE BILL 2070, AS AMENDED.
AMENDMENT #2 prohibits an insurer from downcoding a claim or reducing a reimbursement level solely because the patient is an exempt patient or a preventative care standard was not met due to the patient's exempt status.
ON APRIL 2, 2026, THE SENATE CONCURRED IN HOUSE AMENDMENT #
2
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Current Bill Text
Read the full stored bill text
HOUSE BILL 2243
By Martin B
SENATE BILL 2070
By Watson
SB2070
011174
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AN ACT to amend Tennessee Code Annotated, Title 8;
Title 56 and Title 71, relative to healthcare
provider reimbursement.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
SECTION 1. This act is known and may be cited as the "Stopping Health Insurers from
Excluding Legal Decisions (SHIELD) Act."
SECTION 2. Tennessee Code Annotated, Title 56, Chapter 7, Part 10, is amended by
adding the following as a new section:
56-7-1022. Prohibition on penalizing providers for patient vaccination exemptions.
(a) As used in this section:
(1) "Exempt patient" means a patient, or the parent or legal guardian of a
minor patient, who has declined a specific vaccination or series of vaccinations
and has provided the healthcare provider with a written statement of refusal
based on religious tenets or medical contraindication as recognized under § 49-
6-5001 or other applicable state law;
(2) "Health insurance entity" has the same meaning as defined in § 56-7-
109; and
(3) "Quality measure" means a metric, standard, or benchmark used by a
health insurance entity to determine a healthcare provider's reimbursement rate,
incentive payments, bonus structure, star rating, or network participation status,
including, but not limited to, the Healthcare Effectiveness Data and Information
Set (HEDIS).
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(b) A health insurance entity shall not calculate a quality measure, quality rating,
incentive payment, or reimbursement tier for a healthcare provider by including any
exempt patient in the denominator of any vaccination-related metric.
(c) If a healthcare provider submits documentation to a health insurance entity
indicating that a patient is an exempt patient, then the health insurance entity must
exclude the patient from the calculation of the provider's vaccination rate performance or
any other quality metric derived from vaccination status.
(d) A health insurance entity shall not terminate a healthcare provider from a
network, reduce a provider's reimbursement rate, or withhold an incentive payment
solely because the provider retains exempt patients in the provider's practice.
(e) For purposes of timely reimbursement under § 56-7-109, a claim for
reimbursement that is denied, reduced, or recouped by a health insurance entity in
violation of subsection (b) or (d) is a clean claim, as that term is defined in § 56-7-109,
and is subject to the interest penalties and remediation requirements set forth under §
56-7-109.
SECTION 3. This act takes effect July 1, 2026, the public welfare requiring it, and
applies to contracts entered into, renewed, amended, or delivered on or after that date.