Amends TCA Title 56, Chapter 7 and Title 63, Chapter 4.
ON APRIL 22, 2024, THE HOUSE ADOPTED AMENDMENT #2 AND PASSED HOUSE BILL 1074, AS AMENDED. AMENDMENT #2 rewrites the bill to, instead, do as follows: (1) In present law relative to reimbursable services within the scope of practice of a chiropractor, changes references of "chiropractor" to "chiropractic physician"; (2) When a health insurance entity is determining the amount of reimbursement to be paid for a service or procedure that is identified and listed in a nationally recognized services and procedures code book that is used by the health insurance entity, prohibits the health insurance entity from discriminating between a chiropractic physician and a medical physician with respect to the methodology used to calculate reimbursement or the amount of reimbursement. A health insurance entity must not attempt to circumvent this (2) by creating a chiropractic-specific code or payment methodology not listed in the nationally recognized code book used by the health insurance entity for determining the amount of reimbursement; (3) Establishes that the bill does not limit the ability of a health insurance entity to utilize national uniform relative value units that account for the relative resources used in furnishing a service or procedure; (4) Establishes that, as used in the bill, a "health insurance entity" means an entity subject to the insurance laws of this state, or subject to the jurisdiction of the commissioner of commerce and insurance, that contracts or offers to contract to provide health insurance coverage, including an insurance company, a health maintenance organization and a nonprofit hospital and medical service corporation; (5) Establishes that a "nationally recognized services and procedures code book," as used in the bill, includes the American Medical Association's Current Procedural Terminology code book; and (6) Establishes that the bill does not apply to (i) the TennCare program or a successor medicaid program; (ii) the CoverKids program or a successor program; or (iii) insurance coverage provided by state or local governments.
ON APRIL 22, 2024, THE HOUSE ADOPTED AMENDMENT #2 AND PASSED HOUSE BILL 1074, AS AMENDED. AMENDMENT #2 rewrites the bill to, instead, do as follows: (1) In present law relative to reimbursable services within the scope of practice of a chiropractor, changes references of "chiropractor" to "chiropractic physician"; (2) When a health insurance entity is determining the amount of reimbursement to be paid for a service or procedure that is identified and listed in a nationally recognized services and procedures code book that is used by the health insurance entity, prohibits the health insurance entity from discriminating between a chiropractic physician and a medical physician with respect to the methodology used to calculate reimbursement or the amount of reimbursement. A health insurance entity must not attempt to circumvent this (2) by creating a chiropractic-specific code or payment methodology not listed in the nationally recognized code book used by the health insurance entity for determining the amount of reimbursement; (3) Establishes that the bill does not limit the ability of a health insurance entity to utilize national uniform relative value units that account for the relative resources used in furnishing a service or procedure; (4) Establishes that, as used in the bill, a "health insurance entity" means an entity subject to the insurance laws of this state, or subject to the jurisdiction of the commissioner of commerce and insurance, that contracts or offers to contract to provide health insurance coverage, including an insurance company, a health maintenance organization and a nonprofit hospital and medical service corporation; (5) Establishes that a "nationally recognized services and procedures code book," as used in the bill, includes the American Medical Association's Current Procedural Terminology code book; and (6) Establishes that the bill does not apply to (i) the TennCare program or a successor medicaid program; (ii) the CoverKids program or a successor program; or (iii) insurance coverage provided by state or local governments.
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