Amends TCA Title 56, Chapter 61.
This bill revises various provisions under the Tennessee Health Carrier Grievance and External Review Procedure Act concerning external review in cases where a person has received a cancer diagnosis.<br /> <br /> Present law requires a health carrier to establish written procedures for the expedited review of urgent care requests of grievances involving an adverse determination. This bill classifies any request relating to a covered person's diagnosis of cancer as an urgent request. <br /> <br /> Under present law, an expedited review decision must be rendered and the aggrieved person must be notified of the decision as expeditiously as the covered person's medical condition requires, but in no event more than 72 hours after the receipt of the request for the expedited review. This bill adds that if a covered person does not receive the notification of the decision by the health carrier within 72 hours after receipt of the request for the expedited review, the recommended healthcare services or treatment is deemed to be approved and the health carrier's decision reversed. This provision will apply to all urgent care requests, not just those regarding a cancer diagnosis, and will apply to internal and external review, and under the provisions governing requests for review when service or treatment is determined to be investigational.<br /> <br /> Present law provides that a request for an external review of an adverse determination may be filed before the covered person has exhausted the health carrier's internal grievance procedures, whenever the health carrier agrees to waive the exhaustion requirement. This bill extends this provision to also apply when the covered person has received a diagnosis of cancer.<br /> <br /> This bill revises various provisions throughout the Act that apply under present law to persons for whom a delay would seriously jeopardize the life or health of the covered person or would jeopardize the covered person's ability to regain maximum function, to also apply to persons who have a cancer diagnosis.<br /> <br />
This bill revises various provisions under the Tennessee Health Carrier Grievance and External Review Procedure Act concerning external review in cases where a person has received a cancer diagnosis.<br /> <br /> Present law requires a health carrier to establish written procedures for the expedited review of urgent care requests of grievances involving an adverse determination. This bill classifies any request relating to a covered person's diagnosis of cancer as an urgent request. <br /> <br /> Under present law, an expedited review decision must be rendered and the aggrieved person must be notified of the decision as expeditiously as the covered person's medical condition requires, but in no event more than 72 hours after the receipt of the request for the expedited review. This bill adds that if a covered person does not receive the notification of the decision by the health carrier within 72 hours after receipt of the request for the expedited review, the recommended healthcare services or treatment is deemed to be approved and the health carrier's decision reversed. This provision will apply to all urgent care requests, not just those regarding a cancer diagnosis, and will apply to internal and external review, and under the provisions governing requests for review when service or treatment is determined to be investigational.<br /> <br /> Present law provides that a request for an external review of an adverse determination may be filed before the covered person has exhausted the health carrier's internal grievance procedures, whenever the health carrier agrees to waive the exhaustion requirement. This bill extends this provision to also apply when the covered person has received a diagnosis of cancer.<br /> <br /> This bill revises various provisions throughout the Act that apply under present law to persons for whom a delay would seriously jeopardize the life or health of the covered person or would jeopardize the covered person's ability to regain maximum function, to also apply to persons who have a cancer diagnosis.<br /> <br />
Track Tennessee Legislation Like a Pro
Join hundreds of professionals using LegisGo to stay ahead of legislative changes.
Instant Alerts
Get notified when bills you track move through the legislature
AI Summaries
Understand complex legislation in seconds with AI-powered analysis
Full Access
All 132 legislators, committee schedules, and voting records