HB 484 requires health insurers and TennCare to cover biomarker testing for diagnosis, treatment, or monitoring of diseases starting January 1, 2026. It applies to all health benefit plans (including private insurance) and TennCare plans, mandating coverage when tests are supported by FDA approvals, clinical guidelines, or evidence-based standards. The bill specifies that insurers must approve or deny prior authorization requests within 24-72 hours and provide clear appeal processes for patients. This policy directly affects patients needing biomarker tests (e.g., for cancer treatment) and insurers managing coverage for these tests.
SB 440 clarifies that standalone dental and vision insurance plans (known as "excepted benefits") are not required to cover specific medical treatments, services, or conditions unless state law explicitly mandates it. This change directly affects health insurance plans offering these stand-alone benefits, removing an implied obligation to cover certain medical needs under those plans. The law applies to all new or renewed insurance policies issued on or after July 1, 2025, ensuring clarity for insurers and policyholders. It does not alter existing coverage requirements for standard health insurance plans.
HB 927 clarifies that certain health insurance benefits (like dental or vision coverage, called "excepted benefits") do not need to be included in standard health insurance plans unless state law explicitly requires them. This affects health insurance providers and policyholders in Tennessee by removing an obligation to cover these specific benefits as part of standard coverage. The bill specifies that excepted benefits are exempt from requirements to cover specific people, providers, treatments, or conditions unless mandated by law. It applies to new or renewed insurance policies on or after July 1, 2025.
SB 449, the "Fertility Treatment and Contraceptive Protection Act," establishes legal rights for individuals in Tennessee to access fertility treatments and contraception without state prohibition. It defines "fertility treatment" broadly to include procedures like in vitro fertilization, genetic testing of embryos, and medication for fertility, while defining "contraception" to cover methods such as birth control pills, emergency contraceptives, and sterilization. The law explicitly states that Tennessee law does not prohibit these activities, overriding conflicting state laws. This act takes effect on July 1, 2025, directly affecting all residents seeking these health services within the state.
HB 1198 requires Tennessee health insurers and TennCare to allow patients to try biosimilar drugs (cost-effective copies of brand-name medications) before covering the original branded drug. It amends state law to permit health carriers to mandate a biosimilar trial for equivalent branded prescriptions, removing prior requirements for generic drug trials. The bill also directs TennCare’s pharmacy committee to consider biosimilar drugs when recommending medications for the state’s preferred drug list. These changes aim to reduce prescription drug costs by increasing biosimilar adoption, as stated in the bill’s legislative findings.
SB 1063 removes two notification requirements related to prior authorization for healthcare services in Tennessee. It eliminates the requirement for healthcare providers to notify patients when communicating with insurance companies about missing information for prior authorization, and it removes the requirement for insurance companies to notify patients when additional information is needed from the patient or provider. The bill directly affects healthcare providers, insurance companies, and patients by reducing administrative steps in the prior authorization process. These changes amend Tennessee Code sections 63-1-171 and 56-6-705, effective April 3, 2025.
SB 577 amends Tennessee's TennCare program by shortening the time frame for implementing the annual coverage assessment from seven days to five days. It also establishes limits on hospital payments under specific circumstances, directly affecting TennCare administrators and participating hospitals. The bill changes the timing requirement in Tennessee Code Annotated Section 71-5-2005(d)(2)(D) and became effective April 3, 2025, after being signed by the Governor.
HB 18 proposes a temporary health coverage program for Tennesseans who don't qualify for existing TennCare or CoverKids. It would provide up to 60 months of medical assistance (resetting at age 21) to individuals under 21 with income ≤138% of the federal poverty level, or adults ≥21 with similar income, subject to strict 12-month/24-month usage limits. The program requires a federal waiver by December 2025, uses 90% federal/10% state funding, and explicitly states it does not replace eligibility for regular programs (benefits pause if enrollment becomes possible). The bill failed in the Insurance Committee on March 5, 2025, and remains inactive.
