One of TMA’s priority bills, the medical necessity determination bill, was signed into law by the Governor this week. As amended, SB1753/HB1770 by Sen. Ferrell Haile (R-Gallatin) and Rep. Brock Martin (R-Huntingdon) updates Tennessee statute governing medical practice to keep pace with emerging technologies and healthcare delivery models and clarifies that medical doctors and osteopathic physicians may determine the appropriateness of treatments or procedures for patient conditions. This bill will ensure that ALL physicians, including insurance company medical directors, are governed by the same standard of care criteria when making medical necessity determinations.

Under our current regulatory structure, insurers have wide discretion in crafting their rules of medical necessity, with no effective oversight or recourse for patients who may be harmed by outdated or otherwise flawed rules. Worse, those affected by these rules are often unaware of their existence until a claim is denied. 

This law expands what is referred to as the practice of medicine or osteopathic medicine to involve someone who, using clinical judgment, determines whether a treatment or procedure is clinically appropriate for the symptoms and diagnosis of a condition. It further clarifies that a person is regarded as practicing medicine or osteopathic medicine, which is prohibited without a license as described in present law, if the person determines whether a treatment or procedure is appropriate for the symptoms and diagnosis of such condition.

As the practice of medicine, the Board of Medical Examiners and Board of Osteopathic Examination interpret the laws, rules, and regulations to determine the appropriate standards of practice in an effort to ensure the highest degree of professional conduct. The Boards will be responsible for the investigation of alleged violations.

This is a groundbreaking new law that gives providers one more tool in the arsenal to fight against insurance companies if they practice medicine without a license.

Budget Passes General Assembly

On Thursday, lawmakers approved a $58.3 billion spending plan for 2026-2027 as lawmakers prepared to bring an end to the 114th General Assembly next week. Lawmakers say that this budget will keep a fiscally conservative approach while still making targeted investments in education, healthcare, and infrastructure.

Legislative Republicans took a hatchet to Gov. Bill Lee’s budget proposal, cutting more $200 million in recurring and nonrecurring items. Infrastructure and economic development remain major priorities. Despite “a tight budget year,” lawmakers added $20 million to the state’s rainy day fund, bringing its total to over $2.2 billion, the largest in state history.

The funding plan included $114 million on an expansion to the new statewide school voucher program which narrowly passed in the House and Senate chambers. Tennessee Republican Senate and House members are also taking money from various parts of the state budget to cobble together $137 million to pay for TennCare hospital buybacks and included $97 million in new funding to keep the SNAP program running due to a change in federal funding.

Healthcare highlights:

• $137 million for hospitals, especially rural hospitals, to help cover uncompensated care
• $205 million in shared savings for healthcare initiatives including rural health grants
• $250 million for TennCare to handle inflation, drug costs, and increased use
• $24.2 million to continue the dental pilot program
• $11 million for ALS Research
• $7 million for National Cancer Institute designation at UT Medical Center
• $350 million for a new College of Medicine building at UTHSC in Memphis

In this election year, joining the TMA PAC is critical for physicians. We must elect and retain pro-medicine candidates. Join or renew today!