Amends TCA Title 8; Title 33; Title 56; Title 63 and Title 68.
This bill requires, beginning upon approval of the next health insurance rate filing on or after January 1, 2020, a carrier offering a health plan in this state to implement an incentive program that provides incentives for enrollees in a health plan who elect to receive a comparable healthcare service from a network provider that is covered by the health plan and that is paid less than the average allowed amount paid by that carrier to network providers for that comparable healthcare service before and after an enrollee's out-of-pocket limit has been met.<br /> <br /> Under this bill, incentives may be:<br /> <br /> (1) Calculated as a percentage of the difference between the amount actually paid by the carrier for a given comparable healthcare service and the average allowed amount for that service, or by another reasonable methodology approved by the commissioner and<br /> (2) Provided as a cash payment to the enrollee, a credit toward the enrollee's annual in-network deductible and out-of-pocket limit, or a credit or reduction of a premium, a copayment, cost sharing, or a deductible. A carrier may let an enrollee choose the method by which the enrollee prefers to receive the incentive.<br /> <br /> This bill requires that the incentive program provide each enrollee with at least 50 percent of the carrier's saved costs for each comparable healthcare service resulting from shopping by the enrollee. However, the incentive program may exclude incentive payments, credits, or reductions for services where the savings to the carrier is $25.00 or less. The average allowed amount must be based on the actual allowed amounts paid to network providers under the enrollee's health plan within a reasonable timeframe, not to exceed one year. The commissioner may approve methodologies that are based on an enrollee's specific health plan, across all plans offered in the state by an insurance carrier, or that utilize a geographic area to set regional averages. Annually, at enrollment or renewal, a carrier must provide notice to enrollees of the right to obtain this information and the process for obtaining the information, and a description of how to earn the incentives. A carrier must provide this notice on the carrier's website and in health plan materials provided to enrollees.<br /> <br /> This bill requires an insurance carrier to:<br /> <br /> (1) Make the incentive program available as a component of all health plans offered by the carrier in this state;<br /> (2) Prior to offering the incentive program to any enrollee, a carrier to file a description of the incentive program with the department of commerce and insurance. Denial of a program by the department requires a resubmission by a carrier until the department approves the program; and<br /> (3) Annually file with the department for the most recent calendar year the total number of comparable healthcare service incentive payments made pursuant to this bill, the use of comparable healthcare services by category of service for which comparable healthcare service incentive payments were made, the total incentive payments made to enrollees, the average amount of incentive payments made by service for the transactions, the total savings achieved below the average allowed amount by service for the transactions, and the total number and percentage of a carrier's enrollees that participated in the transactions. Beginning in 2021 and by April 1 of each year thereafter, the commissioner must submit an aggregate report for all carriers filing the information required by this item (3) to the commerce and labor committee of the senate and the insurance committee of the house of representatives. <br /> <br /> This bill also requires, beginning upon approval of the next health insurance rate filing on or after January 1, 2020, a carrier offering a health plan in this state to make available an interactive mechanism on its publicly accessible website and a toll-free phone number that enables an enrollee to request and obtain from the carrier information on the average payments made by the carrier to network entities or providers for comparable healthcare services, as well as quality data for those providers, to the extent available.<br /> <br /> The interactive mechanism and toll-free phone number must allow an enrollee seeking information about the cost of a particular healthcare service to estimate out-of-pocket costs applicable to that enrollee's health plan and compare the average allowed amount paid to a network provider for the procedure or service under the enrollee's health plan within a reasonable timeframe not to exceed one year. Under this bill, the out-of-pocket estimate must provide a good faith estimate of the amount the enrollee will be responsible to pay out-of-pocket for a proposed non-emergency procedure or service that is a medically necessary covered benefit from a carrier's network provider, including any copayment, deductible, coinsurance, or other out-of-pocket amount for any covered benefit, based on the information available to the carrier at the time the request is made. <br /> <br /> This bill specifies that it does not prohibit a carrier from imposing cost-sharing requirements disclosed in the enrollee's policy, contract, or certificate of coverage for unforeseen healthcare services that arise out of the non-emergency procedure or service or for a procedure or service provided to an enrollee that was not included in the original estimate. This bill requires a carrier to notify an enrollee that the provided costs are estimated costs, and that the actual amount the enrollee will be responsible to pay may vary due to unforeseen services that arise out of the proposed non-emergency procedure or service. <br /> <br /> This bill provides that if an enrollee elects to receive a covered healthcare service from an out-of-network provider at a price that is the same or less than the average allowed amount for that service, the carrier must allow the enrollee to obtain the service from the out-of-network provider at the provider's price and, upon request by the enrollee, must apply the payments made by the enrollee for that healthcare service toward the enrollee's deductible and out-of-pocket maximum as specified in the enrollee's health plan as if the healthcare services had been provided by a network provider. This bill prohibits a carrier from denying or reducing payment for any healthcare service covered under an enrollee's health plan based solely on the basis that the enrollee's referral was made by a provider who is not a member of the carrier's provider network.<br /> <br /> This bill requires a carrier to provide notice to enrollees of enrollee rights under this bill. A carrier must provide the notice on the carrier's website and in health plan materials.<br /> <br /> This bill further requires:<br /> <br /> (1) The state insurance committee to publish a report no later than January 1, 2020, on examples of shared savings incentive programs that directly incentivize current enrollees and retirees to shop for lower cost care in other states and consider implementation of such a program in this state. The state insurance committee may implement such a program as part of the next open enrollment period if it is believed to be cost effective. The state insurance committee must share the report in writing to the government operations committees in both the senate and house of representatives;<br /> (2) By January 1, 2020, and by January 1 of each subsequent year thereafter, a carrier offering a health plan in this state to disclose to the commissioner the number of providers removed from its network during the previous five calendar years. This disclosure must include the reasons for removal. For each reason for removal given, the carrier must include the number of providers removed for the particular reason; and<br /> (3) By January 1, 2020, and by January 1 of each subsequent year thereafter, any person providing healthcare services in this state as a nonprofit or charitable entity to disclose the fiduciary duties the person's directors owe to the individuals benefiting from the charity.<br /> <br /> This bill specifies that it will not apply to the state group insurance plan, except for the provisions described above in (1) regarding the state insurance committee.<br /> <br /> For purposes of promulgating rules, this bill will take effect upon becoming a law. For all other purposes, this bill will take effect January 1, 2020, and apply to all health plans entered into or renewed on or after that date.<br /> <br /> ON APRIL 24, 2019, THE SENATE ADOPTED AMENDMENTS #1 AND #2 AND PASSED SENATE BILL 510, AS AMENDED.<br /> <br /> AMENDMENT #1 revises various provisions of the Tennessee Right to Shop Act, as follows:<br /> <br /> (1) Expands the definition of "comparable healthcare service" to specify that such term includes, but is not limited to, physical and occupational therapy services, radiology and imaging services, laboratory services, and infusion therapy;<br /> (2) Substitutes the term "shopping and decision support program" for "incentive program";<br /> (3) Requires, beginning upon approval of the next health insurance rate filing on or after January 1, 2020, a carrier offering a health plan in this state to implement a shopping and decision support program that provides shopping capabilities and decision support services for enrollees in a health plan;<br /> (4) Postpones this bill's requirement for the provision of incentives to enrollees who elect to receive a comparable healthcare service from a network provider that is covered by the health plan and that is paid less than the network average to "beginning upon approval of health plans offered on or after January 1, 2021";<br /> (5) Removes specific authorization for the commissioner of commerce and insurance to approve additional methodologies for calculating incentives under this bill;<br /> (6) Removes specific authorization for carriers to let an enrollee choose the method by which the enrollee prefers to receive the incentive;<br /> (7) Increases the threshold for exclusion of incentive payments, credits, or reductions for services under the shopping and decision support program from "where the savings to the carrier is $25.00 or less" to "where the savings to the carrier is $50.00 or less";<br /> (8) Deletes this bill's provision that specifies an incentive payment made by a carrier under this bill is not an administrative expense of the carrier for rate development or rate filing purposes;<br /> (9) Authorizes insurance carriers to select the appropriate format for providing to the department of commerce and insurance information concerning the shopping and decision support program;<br /> (10) Deletes the requirement that denial of a shopping and decision support program by the department requires a resubmission by a carrier until the department approves the program;<br /> (11) Establishes January 1, 2022, as the date that carriers must begin filing annual reports with the department concerning incentive payments, and removes this bill's requirement that such reports must include total savings achieved below the average allowed amount by service for the transactions;<br /> (12) Changes the start date for the commissioner to make an aggregate report to certain committees of the general assembly from 2021 to 2022;<br /> (13) Substitutes the term "member portal" for "interactive mechanism";<br /> (14) Deletes the provisions of this bill concerning out-of-network providers;<br /> (15) Adds a requirement that a healthcare entity provide a copy of an order for a comparable healthcare service within two business days of a patient's request;<br /> (16) Deletes this bill's requirement that a carrier offering a health plan in this state annually disclose the number of providers removed from its network during the previous five calendar years;<br /> (17) Deletes this bill's requirement that licensed health care providers and facilities providing healthcare services in this state as a nonprofit or charitable entity disclose the fiduciary duties the person's directors owe to the individuals benefiting from the charity;<br /> (18) Adds exemptions from this bill for any MCO contracting with the state to provide insurance through TennCare or CoverKids and any plan described in Section 1251 of the federal Patient Protection and Affordable Care Act and Section 2301 of the federal Health Care and Education Reconciliation Act. The exemption will not apply to the report issued by the state insurance committee, and any subsequent program implemented by the committee; and<br /> (19) Limits the total value of incentives offered to any one enrollee under this bill to $600 in any year.<br /> <br /> AMENDMENT #2 authorizes, instead of requires, a carrier offering a health plan in this state to implement a shopping and decision support program; makes the provision whereby the shopping and decision support program must provide each enrollee with at least 50 percent of the carrier's saved costs for each comparable healthcare service resulting from shopping by the enrollee discretionary instead of mandatory; removes the exemption from this bill for the state group insurance plan; and changes applicable dates throughout the bill from January 1, 2020, to January 1, 2021.<br /> <br /> ON APRIL 30, 2019, THE HOUSE SUBSTITUTED SENATE BILL 510 FOR HOUSE BILL 419, ADOPTED AMENDMENTS #1 AND #3, AND PASSED SENATE BILL 510, AS AMENDED.<br /> <br /> AMENDMENT #1 removes the provisions of Senate Amendment #2.<br /> <br /> AMENDMENT #3 revises various provisions of this bill, as follows:<br /> <br /> (1) Redefines "comparable healthcare service" to mean the following outpatient health services: physical and occupational therapy; radiology and imaging; laboratory services; and infusion therapy;<br /> (2) Changes, from "beginning upon approval of the next health insurance rate filing on or after January 1, 2021" to "beginning January 1, 2021" the time when a carrier must provide incentives for enrollees who elect to receive a comparable healthcare service from a network provider that is covered by the health plan and that is paid less than the network average;<br /> (3) Specifies that the shopping and decision support program must provide each enrollee with at least 50 percent of the carrier's saved costs for each comparable healthcare service, instead of each comparable healthcare service "resulting from shopping by the enrollee";<br /> (4) Clarifies that the provision for contracting with a third-party vendor to fulfill the requirement for an interactive member portal and toll-free phone number is discretionary not mandatory; <br /> (5) Revises the requirement that a healthcare entity provide a copy of an order for a comparable healthcare service within two business days of a patient's request to make the requirement applicable to licensed healthcare providers instead of healthcare entities; and<br /> (6) Changes, from $600 to $599, the limit of the total value of incentives offered to any one enrollee under this bill to in any year.<br /> <br /> ON APRIL 30, 2019, THE SENATE NON-CONCURRED IN HOUSE AMENDMENTS #1 AND 3.<br /> <br /> ON APRIL 30, 2019, THE HOUSE REFUSED TO RECEDE FROM ITS ADOPTION OF HOUSE AMENDMENTS #1 AND #3.<br /> <br /> ON APRIL 30, 2019, THE SENATE APPOINTED A CONFERENCE COMMITTEE.<br /> <br /> ON APRIL 30, 2019, THE HOUSE APPOINTED A CONFERENCE COMMITTEE.<br /> <br /> ON MAY 2, 2019, THE SENATE ADOPTED THE CONFERENCE COMMITTEE REPORT ON SENATE BILL 510, AND MADE IT THE ACTION OF THE SENATE.<br /> <br /> ON MAY 2, 2019, THE HOUSE ADOPTED THE CONFERENCE COMMITTEE REPORT AND MADE IT THE ACTION OF THE HOUSE.<br /> <br />
This bill requires, beginning upon approval of the next health insurance rate filing on or after January 1, 2020, a carrier offering a health plan in this state to implement an incentive program that provides incentives for enrollees in a health plan who elect to receive a comparable healthcare service from a network provider that is covered by the health plan and that is paid less than the average allowed amount paid by that carrier to network providers for that comparable healthcare service before and after an enrollee's out-of-pocket limit has been met.<br /> <br /> Under this bill, incentives may be:<br /> <br /> (1) Calculated as a percentage of the difference between the amount actually paid by the carrier for a given comparable healthcare service and the average allowed amount for that service, or by another reasonable methodology approved by the commissioner and<br /> (2) Provided as a cash payment to the enrollee, a credit toward the enrollee's annual in-network deductible and out-of-pocket limit, or a credit or reduction of a premium, a copayment, cost sharing, or a deductible. A carrier may let an enrollee choose the method by which the enrollee prefers to receive the incentive.<br /> <br /> This bill requires that the incentive program provide each enrollee with at least 50 percent of the carrier's saved costs for each comparable healthcare service resulting from shopping by the enrollee. However, the incentive program may exclude incentive payments, credits, or reductions for services where the savings to the carrier is $25.00 or less. The average allowed amount must be based on the actual allowed amounts paid to network providers under the enrollee's health plan within a reasonable timeframe, not to exceed one year. The commissioner may approve methodologies that are based on an enrollee's specific health plan, across all plans offered in the state by an insurance carrier, or that utilize a geographic area to set regional averages. Annually, at enrollment or renewal, a carrier must provide notice to enrollees of the right to obtain this information and the process for obtaining the information, and a description of how to earn the incentives. A carrier must provide this notice on the carrier's website and in health plan materials provided to enrollees.<br /> <br /> This bill requires an insurance carrier to:<br /> <br /> (1) Make the incentive program available as a component of all health plans offered by the carrier in this state;<br /> (2) Prior to offering the incentive program to any enrollee, a carrier to file a description of the incentive program with the department of commerce and insurance. Denial of a program by the department requires a resubmission by a carrier until the department approves the program; and<br /> (3) Annually file with the department for the most recent calendar year the total number of comparable healthcare service incentive payments made pursuant to this bill, the use of comparable healthcare services by category of service for which comparable healthcare service incentive payments were made, the total incentive payments made to enrollees, the average amount of incentive payments made by service for the transactions, the total savings achieved below the average allowed amount by service for the transactions, and the total number and percentage of a carrier's enrollees that participated in the transactions. Beginning in 2021 and by April 1 of each year thereafter, the commissioner must submit an aggregate report for all carriers filing the information required by this item (3) to the commerce and labor committee of the senate and the insurance committee of the house of representatives. <br /> <br /> This bill also requires, beginning upon approval of the next health insurance rate filing on or after January 1, 2020, a carrier offering a health plan in this state to make available an interactive mechanism on its publicly accessible website and a toll-free phone number that enables an enrollee to request and obtain from the carrier information on the average payments made by the carrier to network entities or providers for comparable healthcare services, as well as quality data for those providers, to the extent available.<br /> <br /> The interactive mechanism and toll-free phone number must allow an enrollee seeking information about the cost of a particular healthcare service to estimate out-of-pocket costs applicable to that enrollee's health plan and compare the average allowed amount paid to a network provider for the procedure or service under the enrollee's health plan within a reasonable timeframe not to exceed one year. Under this bill, the out-of-pocket estimate must provide a good faith estimate of the amount the enrollee will be responsible to pay out-of-pocket for a proposed non-emergency procedure or service that is a medically necessary covered benefit from a carrier's network provider, including any copayment, deductible, coinsurance, or other out-of-pocket amount for any covered benefit, based on the information available to the carrier at the time the request is made. <br /> <br /> This bill specifies that it does not prohibit a carrier from imposing cost-sharing requirements disclosed in the enrollee's policy, contract, or certificate of coverage for unforeseen healthcare services that arise out of the non-emergency procedure or service or for a procedure or service provided to an enrollee that was not included in the original estimate. This bill requires a carrier to notify an enrollee that the provided costs are estimated costs, and that the actual amount the enrollee will be responsible to pay may vary due to unforeseen services that arise out of the proposed non-emergency procedure or service. <br /> <br /> This bill provides that if an enrollee elects to receive a covered healthcare service from an out-of-network provider at a price that is the same or less than the average allowed amount for that service, the carrier must allow the enrollee to obtain the service from the out-of-network provider at the provider's price and, upon request by the enrollee, must apply the payments made by the enrollee for that healthcare service toward the enrollee's deductible and out-of-pocket maximum as specified in the enrollee's health plan as if the healthcare services had been provided by a network provider. This bill prohibits a carrier from denying or reducing payment for any healthcare service covered under an enrollee's health plan based solely on the basis that the enrollee's referral was made by a provider who is not a member of the carrier's provider network.<br /> <br /> This bill requires a carrier to provide notice to enrollees of enrollee rights under this bill. A carrier must provide the notice on the carrier's website and in health plan materials.<br /> <br /> This bill further requires:<br /> <br /> (1) The state insurance committee to publish a report no later than January 1, 2020, on examples of shared savings incentive programs that directly incentivize current enrollees and retirees to shop for lower cost care in other states and consider implementation of such a program in this state. The state insurance committee may implement such a program as part of the next open enrollment period if it is believed to be cost effective. The state insurance committee must share the report in writing to the government operations committees in both the senate and house of representatives;<br /> (2) By January 1, 2020, and by January 1 of each subsequent year thereafter, a carrier offering a health plan in this state to disclose to the commissioner the number of providers removed from its network during the previous five calendar years. This disclosure must include the reasons for removal. For each reason for removal given, the carrier must include the number of providers removed for the particular reason; and<br /> (3) By January 1, 2020, and by January 1 of each subsequent year thereafter, any person providing healthcare services in this state as a nonprofit or charitable entity to disclose the fiduciary duties the person's directors owe to the individuals benefiting from the charity.<br /> <br /> This bill specifies that it will not apply to the state group insurance plan, except for the provisions described above in (1) regarding the state insurance committee.<br /> <br /> For purposes of promulgating rules, this bill will take effect upon becoming a law. For all other purposes, this bill will take effect January 1, 2020, and apply to all health plans entered into or renewed on or after that date.<br /> <br /> ON APRIL 24, 2019, THE SENATE ADOPTED AMENDMENTS #1 AND #2 AND PASSED SENATE BILL 510, AS AMENDED.<br /> <br /> AMENDMENT #1 revises various provisions of the Tennessee Right to Shop Act, as follows:<br /> <br /> (1) Expands the definition of "comparable healthcare service" to specify that such term includes, but is not limited to, physical and occupational therapy services, radiology and imaging services, laboratory services, and infusion therapy;<br /> (2) Substitutes the term "shopping and decision support program" for "incentive program";<br /> (3) Requires, beginning upon approval of the next health insurance rate filing on or after January 1, 2020, a carrier offering a health plan in this state to implement a shopping and decision support program that provides shopping capabilities and decision support services for enrollees in a health plan;<br /> (4) Postpones this bill's requirement for the provision of incentives to enrollees who elect to receive a comparable healthcare service from a network provider that is covered by the health plan and that is paid less than the network average to "beginning upon approval of health plans offered on or after January 1, 2021";<br /> (5) Removes specific authorization for the commissioner of commerce and insurance to approve additional methodologies for calculating incentives under this bill;<br /> (6) Removes specific authorization for carriers to let an enrollee choose the method by which the enrollee prefers to receive the incentive;<br /> (7) Increases the threshold for exclusion of incentive payments, credits, or reductions for services under the shopping and decision support program from "where the savings to the carrier is $25.00 or less" to "where the savings to the carrier is $50.00 or less";<br /> (8) Deletes this bill's provision that specifies an incentive payment made by a carrier under this bill is not an administrative expense of the carrier for rate development or rate filing purposes;<br /> (9) Authorizes insurance carriers to select the appropriate format for providing to the department of commerce and insurance information concerning the shopping and decision support program;<br /> (10) Deletes the requirement that denial of a shopping and decision support program by the department requires a resubmission by a carrier until the department approves the program;<br /> (11) Establishes January 1, 2022, as the date that carriers must begin filing annual reports with the department concerning incentive payments, and removes this bill's requirement that such reports must include total savings achieved below the average allowed amount by service for the transactions;<br /> (12) Changes the start date for the commissioner to make an aggregate report to certain committees of the general assembly from 2021 to 2022;<br /> (13) Substitutes the term "member portal" for "interactive mechanism";<br /> (14) Deletes the provisions of this bill concerning out-of-network providers;<br /> (15) Adds a requirement that a healthcare entity provide a copy of an order for a comparable healthcare service within two business days of a patient's request;<br /> (16) Deletes this bill's requirement that a carrier offering a health plan in this state annually disclose the number of providers removed from its network during the previous five calendar years;<br /> (17) Deletes this bill's requirement that licensed health care providers and facilities providing healthcare services in this state as a nonprofit or charitable entity disclose the fiduciary duties the person's directors owe to the individuals benefiting from the charity;<br /> (18) Adds exemptions from this bill for any MCO contracting with the state to provide insurance through TennCare or CoverKids and any plan described in Section 1251 of the federal Patient Protection and Affordable Care Act and Section 2301 of the federal Health Care and Education Reconciliation Act. The exemption will not apply to the report issued by the state insurance committee, and any subsequent program implemented by the committee; and<br /> (19) Limits the total value of incentives offered to any one enrollee under this bill to $600 in any year.<br /> <br /> AMENDMENT #2 authorizes, instead of requires, a carrier offering a health plan in this state to implement a shopping and decision support program; makes the provision whereby the shopping and decision support program must provide each enrollee with at least 50 percent of the carrier's saved costs for each comparable healthcare service resulting from shopping by the enrollee discretionary instead of mandatory; removes the exemption from this bill for the state group insurance plan; and changes applicable dates throughout the bill from January 1, 2020, to January 1, 2021.<br /> <br /> ON APRIL 30, 2019, THE HOUSE SUBSTITUTED SENATE BILL 510 FOR HOUSE BILL 419, ADOPTED AMENDMENTS #1 AND #3, AND PASSED SENATE BILL 510, AS AMENDED.<br /> <br /> AMENDMENT #1 removes the provisions of Senate Amendment #2.<br /> <br /> AMENDMENT #3 revises various provisions of this bill, as follows:<br /> <br /> (1) Redefines "comparable healthcare service" to mean the following outpatient health services: physical and occupational therapy; radiology and imaging; laboratory services; and infusion therapy;<br /> (2) Changes, from "beginning upon approval of the next health insurance rate filing on or after January 1, 2021" to "beginning January 1, 2021" the time when a carrier must provide incentives for enrollees who elect to receive a comparable healthcare service from a network provider that is covered by the health plan and that is paid less than the network average;<br /> (3) Specifies that the shopping and decision support program must provide each enrollee with at least 50 percent of the carrier's saved costs for each comparable healthcare service, instead of each comparable healthcare service "resulting from shopping by the enrollee";<br /> (4) Clarifies that the provision for contracting with a third-party vendor to fulfill the requirement for an interactive member portal and toll-free phone number is discretionary not mandatory; <br /> (5) Revises the requirement that a healthcare entity provide a copy of an order for a comparable healthcare service within two business days of a patient's request to make the requirement applicable to licensed healthcare providers instead of healthcare entities; and<br /> (6) Changes, from $600 to $599, the limit of the total value of incentives offered to any one enrollee under this bill to in any year.<br /> <br /> ON APRIL 30, 2019, THE SENATE NON-CONCURRED IN HOUSE AMENDMENTS #1 AND 3.<br /> <br /> ON APRIL 30, 2019, THE HOUSE REFUSED TO RECEDE FROM ITS ADOPTION OF HOUSE AMENDMENTS #1 AND #3.<br /> <br /> ON APRIL 30, 2019, THE SENATE APPOINTED A CONFERENCE COMMITTEE.<br /> <br /> ON APRIL 30, 2019, THE HOUSE APPOINTED A CONFERENCE COMMITTEE.<br /> <br /> ON MAY 2, 2019, THE SENATE ADOPTED THE CONFERENCE COMMITTEE REPORT ON SENATE BILL 510, AND MADE IT THE ACTION OF THE SENATE.<br /> <br /> ON MAY 2, 2019, THE HOUSE ADOPTED THE CONFERENCE COMMITTEE REPORT AND MADE IT THE ACTION OF THE HOUSE.<br /> <br />
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