Amends TCA Title 8; Title 56, Chapter 7; Title 68 and Title 71.

This bill prohibits a health insurance issuer or a managed health insurance issuer (together, "issuer") from doing the following:<br /> <br /> (1) Denying 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 provision does not prohibit an issuer from establishing rates or fees that may be higher in nonurban areas, or in specific instances where an issuer determines it is necessary to contract with a particular provider in order to meet network adequacy standards or patient care needs; and <br /> <br /> (2) 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.<br /> <br /> However, this bill authorizes an issuer to restrict an abusive or heavy utilizer of medical laboratory services to a single medical laboratory for nonemergency services, so long as the restricted individual has been afforded the opportunity to participate in the process of selection of the medical laboratory to be used, or has been given the right to change the medical laboratory to be used to another participating provider of medical laboratory services prior to the restriction becoming effective. After a restriction is effective, the restricted individual may change a medical laboratory assignment based on geographic changes in residence or if the member's needs cannot be met by the currently assigned medical laboratory. <br /> <br /> This bill requires each issuer to apply the same coinsurance, co-payment, deductible, and quantity limit factors within the same employee group and other plan-sponsored groups to all medical laboratory services provided by a licensed medical laboratory as long as all medical laboratories comply with the same terms and conditions.<br /> <br /> However, this bill does not prohibit: <br /> <br /> (1) An issuer from applying different coinsurance, co-payment, and deductible factors within the same employer group and other plan-sponsored groups; or <br /> <br /> (2) Prohibit an employer or other plan-sponsored group from offering multiple options or choices of health insurance benefit plans, including cafeteria benefit plans.<br /> <br /> APPLICABILITY<br /> <br /> This bill applies to policies, contracts, and plans entered into, amended, issued, renewed on or after July 1, 2023.<br /> <br /> ON MARCH 30, 2023, THE SENATE ADOPTED AMENDMENT #1 AND PASSED SENATE BILL 1275, AS AMENDED.<br /> <br /> AMENDMENT #1 revises this bill to delete the authorization for an issuer to restrict an abusive or heavy utilizer of medical laboratory services to a single medical laboratory for nonemergency services. <br />