On Wednesday, a dozen legislators joined a press conference to stand together to call for insurance payer reforms. “It is time for the insurers of Tennessee to stop practicing medicine without a license,” stated Representative Dan Howell (R-Cleveland).

There are a number of bills this session that call on payers to be more accountable on the issues of prior authorization, downcoding, AI, PBMs, step therapy, and transparency. While most of the bills have not been calendared as of this publication, TMA’s “One Big Beautiful Insurance Bill” SB2550/HB2579 will be heard in Senate Commerce Committee on March 3, TMA's Day on the Hill.

ONE BIG BEAUTIFUL INSURANCE BILL (OBBIB)

Despite recent progress in health insurance reform, physicians and medical practices continue to face significant administrative and payment-related challenges that interfere with their ability to operate their practice and provide high-quality care. Excessive prior authorization requirements delay necessary treatment, disrupt continuity of care and, in many cases, worsen patient outcomes.

At the same time, downcoding has become a problem. Downcoding is the practice of insurance companies assigning a lower-level code for a service or procedure performed in order to reduce reimbursement. This systematic underpayment of service is forcing many physicians to divert time away from patient care to dispute improperly adjudicated claims.

Through a comprehensive bill, TMA is seeking targeted updates to several health insurance statutes to ensure health plans process claims fairly, transparently and in compliance with existing state laws. Key changes of OBBIB include the prohibition of automatic downcoding. Claims that are downcoded would first require a review of the patient’s medical record. The bill would eliminate prior auth requirements for routine services and generic medications that are regularly approved, such as biosimilars, immunizations, certain gynecological procedures, outpatient mental health services, opioid use disorder treatment, pediatric hospice care, neonatal abstinence syndrome treatment, services delivered under value-based care contracts, and care for chronic conditions unless clinical criteria have changed.

GOVERNOR’S SCOPE OF PRACTICE LEGISLATIVE AGENDA

As part of the Federal Rural Healthcare Transformation Grant, the Governor’s office has several proposals to increase scope of practice for non-physicians including pharmacists and dental hygienists. There is also a proposal to create pathways for Advanced Practice Registered Nurses (APRNs) and Physician Assistants (PAs) to practice without a formal physician collaboration agreement.

TMA is working with its multi-specialty partners in the Coalition for Collaborative Care to defeat proposed scope expansions and to educate lawmakers on the risks posed to patients.

OPTOMETRIST SURGERY

A bill that would allow optometrists to perform eye surgery in Tennessee was considered in the Senate this week. Despite opposition from TMA and our partners in the Coalition for Collaborative Care, the bill passed out of committee 8-1. As introduced, SB2076/HB1952 by Sen. Bo Watson (R-Hixson) and Rep. Ryan Williams (R-Cookeville) would allow licensed optometrists to perform certain laser eye surgeries.

TMA’s Legislative Committee met this week to take positions on all legislative bills this session. Members are encouraged to participate in the legislative process to help advance or oppose legislative proposals defined as priorities by the House of Delegates. Register for calls-to-action through our Grassroots Action Network and be sure to sign up for TMA’s annual policy briefing and lobby day in Nashville, Doctors’ Day on the Hill, taking place on Tuesday, March 3. In this election year, joining the TMA PAC is critical for physicians. We must elect and retain pro-medicine candidates. Join or renew today!