The 114^th Tennessee General Assembly adjourned with the Tennessee Medical Association (TMA) obtaining a win for physicians and the practice of medicine in Tennessee.

SB1753/HB1770, signed by Governor Bill Lee on April 14, strengthens accountability between payers and physicians by ensuring that all physicians in Tennessee, including insurance company medical directors, are held to the same standard of care when making medical necessity determinations. In addition, this law will ensure that any physician who is making medical necessity determinations on patient care must have a Tennessee license.

Past complaints to State departments regarding medical necessity determinations have posed significant challenges for physicians. This law now addresses those concerns by establishing a more direct and accountable relationship between physicians and payers, grounded in clearly defined standards for medical necessity decision-making.

“The General Assembly’s enactment of SB1753/HB1770 effectively places medical necessity/appropriateness determinations into the legal definition of practicing medicine,” says Yarnell Beatty, TMA’s Vice President and General Counsel. “This makes it clear that those decisions are back into the domain of Tennessee-licensed physicians and constrains payer or corporate actors from making independent clinical judgments.”

This groundbreaking new law, the first in the country, gives enhanced oversight to physicians regarding the practice of medicine and increased accountability to insurance companies, especially if they practice medicine without a license. The Board of Medical Examiners and Board of Osteopathic Examination will interpret the laws, rules, and regulations to determine the appropriate standards of practice. The Boards will be responsible for the investigation of alleged violations among both payers and providers.

“Non-licensed individuals cannot independently make determinations about what is clinically appropriate if those decisions require judgment,” says Beatty. “If they do, they could face charges of practicing medicine without a license. Tennessee physicians making such determinations for health insurance plans must meet the same clinical judgment standard expected in patient care—i.e., decisions should be defensible as reasonable medical judgment based on the patient’s condition, records, and accepted standards or face unprofessional conduct charges from the medical boards.”

TMA’s physician leaders and government affairs team spent countless hours working this bill and assuring the amendments desired would level the medical necessity playing field. The bill as amended took effect immediately upon the signature of the Governor. This is a major milestone for healthcare in Tennessee, and TMA will continue to back similar legislation that removes unnecessary barriers from the practice of medicine.

Achieving legislative wins cannot happen without the support of organized medicine. TMA encourages all members to engage in some capacity in the legislative process. Make a difference in this election year by making a donation to TMA’s Political Action Committee (TMA PAC). Your contribution helps elect pro-medicine candidates so TMA can continue to fight for you.

The passage of TMA’s Medical Necessity bill could not have happened without members’ financial support and engagement. Learn more at tnmed.org/legislative.