reglab/statecodes huggingface dataset:
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 25 - MANDATED INSURER OR PLAN OPTIONS (§§ 56-7-2501 — 56-7-2508) › Section 56-7-2508 - Coverage for infant hearing screening test

(a)
"Hearing screening" or "hearing screening test" means a screening or test provided in accordance with current hearing screening standards established by a nationally recognized organization such as the Joint Committee on Infant Hearing Screening of the American Academy of Pediatrics.
(b)
Any individual, franchise, blanket or group health insurance policy, medical service plan contract, hospital service corporation contract, hospital and medical service corporation contract, managed health insurance issuer contract, fraternal benefits society plan, or health maintenance organization plan that provides coverage for hospital and surgical expense insurance and that is delivered, issued for delivery, amended or renewed in this state on or after July 1, 2008, shall provide coverage for infant hearing screening tests as provided in §
68-5-904
.
(c)
The coverage required by this section may be subject to annual deductible, co-pays, co-insurance and contractual requirements established for other similar benefits within the policy or contract; provided, that the annual deductible, co-pays, co-insurance and contractual requirements for the coverage required by this section are no greater or more restrictive than those established for other similar benefits within the policy or contract of insurance.
(d)
Nothing in this section shall apply to accident only, specified disease, hospital indemnity, medicare supplemental, long-term care, disability or other limited benefit insurance policies or to any employer plan exempt from regulation under this title due to § 514 of the Employee Retirement Income Security Act of 1974 (ERISA) (
29 U.S.C. § 1144
).
Acts 2008, ch. 768, § 8.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 26 - MANDATED OFFERINGS OF COVERAGE (§§ 56-7-2601 — 56-7-2607) › Section 56-7-2602 - Alcoholism and drug dependence - Coverage for treatment

(a)
Purpose.
The purpose of this section is to encourage consumers to avail themselves of basic levels of benefits under group health insurance policies and contracts for the care and treatment of alcohol and other drug dependency, and to preserve the rights of the consumer to select the coverage according to the consumer's medical-economic needs.
(b)
Availability of Coverage for Alcohol and Other Drug Dependency.
(1)
Insurers, nonprofit hospitals and medical service plan corporations and health maintenance organizations transacting health insurance in this state shall offer and make available under group policies, contracts and plans providing hospital and medical coverage on an expense-incurred, service or prepaid basis, benefits for the necessary care and treatment of alcohol and other drug dependency that are not less favorable than for physical illness generally, subject to the same durational limits, dollar limits, deductibles and coinsurance factors, and that offer of benefits shall be subject to the right of the group policy or contract holder to reject the coverage or to select any alternative level of benefits if the right is offered by or negotiated with the insurer, service plan corporation or health maintenance organization.
(2)
Any benefits so provided shall be determined as if necessary care and treatment in an alcohol or other drug dependency treatment center were care and treatment in a hospital. For purposes of this section, "alcohol or other drug dependency treatment center" means a facility that provides a program for the treatment of alcohol or other drug dependency pursuant to a written treatment plan approved and monitored by a physician, and which facility is also:
(A)
Affiliated with a hospital under a contractual agreement with an established system for patient referral;
(B)
Licensed, certified or approved as an alcohol or other drug dependency treatment center by the department of mental health and substance abuse services; or
(C)
Accredited as such a facility by the joint commission on accreditation of hospitals.
(c)
Applicability.
This section shall apply to group policies or contracts delivered or issued for delivery in this state more than one hundred twenty (120) days after October 1, 1982; but shall not apply to blanket, short term travel, accident only, limited or specified disease, individual conversion policies or contracts, or to policies or contracts designed for issuance to persons eligible for coverage under Title XVIII of the Social Security Act, known as medicare (
42 U.S.C. § 1395
et seq.), or any other similar coverage under state or federal governmental plans.
Acts 1982, ch. 831, § 1; 1992, ch. 984, § 4; T.C.A., §
56-7-1009
; Acts 2000, ch. 947, § 6; 2010, ch. 1100, § 95; 2012, ch. 575, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 26 - MANDATED OFFERINGS OF COVERAGE (§§ 56-7-2601 — 56-7-2607) › Section 56-7-2603 - Treatment by licensed audiologists or speech pathologists

(a)
(1)
Notwithstanding any other law to the contrary, any insurer providing individual, franchise, blanket or group policy of insurance issued pursuant to this title that provides hospital expense and surgical or medical expense insurance and/or that is entered into, delivered, issued for delivery or renewed in this state after January 1, 1989, shall offer to provide benefits for expense of residents of this state covered under the policy or plan arising from conditions or disorders of hearing or conditions or disorders of speech, voice, or language, so long as such conditions or disorders receive treatment from duly licensed audiologists or speech pathologists, as defined in §
63-17-103
.
(2)
This section is applicable to all health benefit policies, programs, or contracts offered by commercial insurance companies, nonprofit insurance companies, prepaid plans, i.e., health maintenance organizations, and to all health benefit programs provided state government employees.
(b)
Nothing in this section shall apply to any insurance policy that only provides coverage for specified diseases, hospital indemnity, medicare supplement or other limited benefit coverages.
(c)
Notwithstanding any provision of this section to the contrary, this section shall be construed to apply to the state and its political subdivisions.
Acts 1988, ch. 970, §§ 1-3; 1992, ch. 984, § 4; T.C.A., § 56-7-1011.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 26 - MANDATED OFFERINGS OF COVERAGE (§§ 56-7-2601 — 56-7-2607) › Section 56-7-2604 - Health insurance - Newly born children - Coverage - Notification

(a)
After January 1, 1983, every insurer that proposes to issue a group policy or contract in this state and every nonprofit hospital and medical service plan corporation that proposes to issue a group service plan contract in this state that provides maternity benefits shall make available benefits for pediatric nursery care of newly born children. The additional benefit shall be for a specified number of nursery care days and maximum dollar limits as elected by the group policyholder or group contract holder.
(b)
With respect to policies and contracts, as described in subsection (a), that were delivered or issued for delivery in this state on or before January 1, 1983, each insurer and nonprofit hospital and medical service plan corporation shall notify the group policyholder or group contract holder of the availability of coverage described in subsection (a).
Acts 1974, ch. 422, § 1; 1976, ch. 493, § 1; T.C.A., § 56-1165; Acts 1980, ch. 525, § 1; 1982, ch. 710, §§ 1-3; 1992, ch. 984, § 4; T.C.A., §
56-7-1001(e), (f)
.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 26 - MANDATED OFFERINGS OF COVERAGE (§§ 56-7-2601 — 56-7-2607) › Section 56-7-2607 - Coverage for transplantation

(a)
As used in this section:
(1)
"Covered person" means a person on whose behalf a health insurance entity is obligated to pay benefits or provide services, and who has a disability;
(2)
"Disability" has the same meaning as defined in
42 U.S.C. § 12102
;
(3)
"Health insurance entity" has the same meaning as defined in §
56-7-109
; and
(4)
"Transplantation" means the transplantation or transfusion of a human body part into the body of another individual for the purpose of treating or curing a medical condition.
(b)
A health insurance entity that offers plans in this state that provide coverage for transplantation to individuals or groups on an expense-incurred basis shall not deny coverage for transplantation solely on the basis of the covered person's disability.
(c)
This section does not require a health insurance entity to provide coverage for transplantation if the transplantation is not medically necessary.
(d)
This section applies to a state or local insurance program, under title 8, chapter 27, and a managed care organization contracting with the state to provide insurance through the TennCare program.
Added by 2021 Tenn. Acts, ch. 441, s 2, eff. 7/1/2021.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 27 - GENETIC INFORMATION NONDISCRIMINATION IN HEALTH INSURANCE ACT (§§ 56-7-2701 — 56-7-2708) › Section 56-7-2701 - [Repealed] Part definitions

As used in this part, unless the context otherwise requires:
(1)
"Family member" means with respect to an individual, another individual related by blood to that individual;
(2)
"Genetic information" means information derived from genetic testing to determine the presence or absence of variations or mutations, including carrier status, in an individual's genetic material or genes that are scientifically or medically believed to cause a disease, disorder or syndrome, or are associated with a statistically increased risk of developing a disease, disorder or syndrome, that is asymptomatic at the time of testing. The testing does not include either routine physical examinations or chemical, blood or urine analysis unless conducted purposefully to obtain genetic information or questions regarding family history;
(3)
"Genetic services" means health services to obtain, assess, and interpret genetic information for diagnostic and therapeutic purposes, and for genetic education and counseling;
(4)
"Health insurance coverage" means a contractual arrangement for the provision of a payment for health care, including:
(A)
A group health plan; and
(B)
Any other health insurance arrangement, including any arrangement consisting of a hospital or medical expense incurred policy or certificate, hospital or medical service plan contract, or health maintenance organization subscriber contract;
(5)
"Health insurance provider" means an insurer or other entity providing health insurance coverage;
(6)
"Life insurance coverage" means a written contractual arrangement for the provision of life insurance, as defined in §
56-2-201
;
(7)
"Life insurance provider" means an insurer or other entity providing life insurance coverage; and
(8)
"Person" includes a corporation, company, association, firm, partnership, society, and joint stock company, as well as an individual.
Repealed by 2023 Tenn. Acts, ch. 246, s 1, eff. 7/1/2023.
Acts 1997 , ch. 121, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 27 - GENETIC INFORMATION NONDISCRIMINATION IN HEALTH INSURANCE ACT (§§ 56-7-2701 — 56-7-2708) › Section 56-7-2702 - Limitations on insurance cancellation - Genetic testing prohibited - Individual consent required - Exceptions

(a)
A life insurance provider shall not cancel insurance coverage for an individual or a family member of an individual based solely on the individual's or family member's genetic information.
(b)
A life insurance provider shall not request or require an individual to whom the insurer provides life insurance coverage, or an individual who applies for life insurance coverage, to take a genetic test as a precondition of insurability, and shall not require the complete genome sequencing of an individual's DNA.
(c)
A life insurance provider shall not access sensitive medical information, including the genetic data of an individual, without first obtaining the individual's signed, written consent.
(d)
This section does not prevent a life insurance provider from requesting or obtaining existing health information for underwriting, including genetic information contained within an individual's medical record.
Amended by 2023 Tenn. Acts, ch. 246, s 3, eff. 7/1/2023.
Amended by 2023 Tenn. Acts, ch. 246, s 2, eff. 7/1/2023.
Acts 1997 , ch. 121, § 2.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 27 - GENETIC INFORMATION NONDISCRIMINATION IN HEALTH INSURANCE ACT (§§ 56-7-2701 — 56-7-2708) › Section 56-7-2703 - Discrimination on grounds of genetic services prohibited

A health insurance provider may not deny or cancel health insurance coverage, or vary the premiums, terms, or conditions for health insurance coverage, for an individual or a family member of an individual on the basis that the individual or family member of an individual has requested or received genetic services.
Amended by 2023 Tenn. Acts, ch. 246,s 4, eff. 7/1/2023.
Acts 1997 , ch. 121, § 2.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 27 - GENETIC INFORMATION NONDISCRIMINATION IN HEALTH INSURANCE ACT (§§ 56-7-2701 — 56-7-2708) › Section 56-7-2704 - Genetic information - Privacy - Prohibited disclosures

(a)
A health insurance provider may not request or require an individual to whom the provider provides health insurance coverage, or an individual who desires the provider to provide health insurance coverage, to disclose to the provider genetic information about the individual or family member of the individual.
(b)
A health insurance provider may not disclose genetic information about an individual without the prior written authorization of the individual or legal representative of the individual. The authorization is required for each disclosure and shall include an identification of the person to whom the disclosure would be made.
Amended by 2023 Tenn. Acts, ch. 246,s 5, eff. 7/1/2023.
Acts 1997 , ch. 121, § 2.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 27 - GENETIC INFORMATION NONDISCRIMINATION IN HEALTH INSURANCE ACT (§§ 56-7-2701 — 56-7-2708) › Section 56-7-2705 - Applicability

This part does not apply to the underwriting, denial of claims or issuance of a disability income policy, long-term care policy, accident only policy, hospital indemnity or fixed indemnity policy, dental policy or vision policy or any other actions of an insurer directly related to a disability income policy, long-term care policy, accident only policy, hospital indemnity or fixed indemnity policy, dental policy or vision policy.
Amended by 2023 Tenn. Acts, ch. 246,s 6, eff. 7/1/2023.
Acts 1997 , ch. 121, § 2.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 27 - GENETIC INFORMATION NONDISCRIMINATION IN HEALTH INSURANCE ACT (§§ 56-7-2701 — 56-7-2708) › Section 56-7-2706 - Routine examinations and analysis

Nothing in this part shall preclude a health insurer or life insurer from obtaining a routine physical examination or chemical, blood or urine analysis, or from asking questions related to the health of an applicant or the applicant's family.
Amended by 2023 Tenn. Acts, ch. 246,s 7, eff. 7/1/2023.
Acts 1997 , ch. 121, § 2.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 27 - GENETIC INFORMATION NONDISCRIMINATION IN HEALTH INSURANCE ACT (§§ 56-7-2701 — 56-7-2708) › Section 56-7-2707 - Coverage for genetic services not required

Nothing in this part shall require an insurance provider to provide coverage of genetic services, unless the coverage of genetic services is already included within the scope of benefits of the provider's health insurance coverage.
Acts 1997, ch. 121, § 2.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 27 - GENETIC INFORMATION NONDISCRIMINATION IN HEALTH INSURANCE ACT (§§ 56-7-2701 — 56-7-2708) › Section 56-7-2708 - Regulations

The commissioner may promulgate regulations necessary or appropriate to carry out this part in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
Acts 1997, ch. 121, § 2.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 28 - HEALTH INSURANCE PORTABILITY, AVAILABILITY AND RENEWABILITY ACT (§§ 56-7-2801 — 56-7-2814) › Section 56-7-2801 - Short title

This part shall be known and may be cited as the "Tennessee Health Insurance Portability, Availability and Renewability Act."
Acts 1997, ch. 157, § 2.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 28 - HEALTH INSURANCE PORTABILITY, AVAILABILITY AND RENEWABILITY ACT (§§ 56-7-2801 — 56-7-2814) › Section 56-7-2804 - Rules for eligibility - Factors not to be considered

(a)
(1)
Subject to subdivision (a)(2), a group health plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, may not establish rules for eligibility, including continued eligibility, of any individual to enroll under the terms of the plan based on any of the following health status-related factors in relation to the individual or a dependent of the individual:
(A)
Health status;
(B)
Medical condition, including both physical and mental illnesses;
(C)
Claims experience;
(D)
Receipt of health care;
(E)
Medical history;
(F)
Genetic information;
(G)
Evidence of insurability, including conditions arising out of acts of domestic violence; or
(H)
Disability.
(2)
To the extent consistent with other sections of this part, subdivision (a)(1) shall not be construed to:
(A)
Require a group health plan, or group health insurance coverage, to provide particular benefits other than those provided under the terms of the plan or coverage; or
(B)
Prevent the plan or coverage from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the plan or coverage.
(3)
For purposes of subdivision (a)(1), rules for eligibility to enroll under a plan include rules defining any applicable waiting periods for enrollment.
(b)
(1)
A group health plan, and a health insurance issuer offering health insurance coverage in connection with a group health plan, may not require any individual, as a condition of enrollment or continued enrollment under the plan, to pay a premium or contribution that is greater than the premium or contribution for a similarly situated individual enrolled in the plan on the basis of any health status-related factor in relation to the individual or to an individual enrolled under the plan as a dependent of the individual.
(2)
Nothing in subdivision (b)(1) shall be construed to:
(A)
Restrict the amount that an employer may be charged for coverage under a group health plan; or
(B)
Prevent a group health plan, and a health insurance issuer offering group health insurance coverage, from establishing premium discounts or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.
Acts 1997, ch. 157, § 5.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 28 - HEALTH INSURANCE PORTABILITY, AVAILABILITY AND RENEWABILITY ACT (§§ 56-7-2801 — 56-7-2814) › Section 56-7-2808 - Applicability - Determination of creditable service

(a)
Except as modified in this section, this part shall apply with respect to group health plans, and health insurance coverage offered in connection with group health plans, for plan years beginning after June 30, 1997.
(b)
Determination of creditable coverage.
(1)
Period of coverage.
(A)
Subject to subdivision (b)(1)(B), no period before July 1, 1996, shall be taken into account in determining creditable coverage.
(B)
The commissioner shall provide for a process whereby individuals who need to establish creditable coverage for periods before July 1, 1996, and who would have coverage credited, but for subdivision (b)(1)(A) may be given credit for creditable coverage for the periods through the presentation of documents or other means.
(2)
Certifications.
(A)
Subject to subdivisions (b)(2)(B) and (C), the provisions regarding certification shall apply to events occurring after June 30, 1996.
(B)
In no case is a certification required to be provided under this subdivision (b)(2) before June 1, 1997.
(C)
In the case of an event occurring after June 30, 1996, and before October 1, 1996, a certification is not required to be provided unless an individual, with respect to whom the certification is otherwise required to be made, requests the certification in writing.
(3)
Transitional Rule.
In the case of an individual who seeks to establish creditable coverage for any period for which certification is not required because it relates to an event occurring before June 30, 1996:
(A)
The individual may present other credible evidence of coverage in order to establish the period of creditable coverage; and
(B)
A group health plan and a health insurance issuer shall not be subject to any penalty or enforcement action with respect to the plan's or issuer's crediting or not crediting coverage if the plan or issuer has sought to comply in good faith with the applicable requirements under this section.
(c)
(1)
Except as provided in subdivision (b)(2), in the case of a group health plan maintained pursuant to one (1) or more collective bargaining agreements between employee representatives and one (1) or more employers ratified before April 30, 1997, this part shall not apply to plan years beginning before the later of the date on which the last of the collective bargaining agreements relating to the plan terminates, determined without regard to any extension of the collective bargaining agreements agreed to after April 30, 1997, or July 1, 1997.
(2)
Any plan amendment made pursuant to a collective bargaining agreement relating to the plan that amends the plan solely to conform to any requirement of this part shall not be treated as a termination of the collective bargaining agreement.
Acts 1997, ch. 157, § 9.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 28 - HEALTH INSURANCE PORTABILITY, AVAILABILITY AND RENEWABILITY ACT (§§ 56-7-2801 — 56-7-2814) › Section 56-7-2811 - Provisions applicable to individual as well as group markets

The provisions for certification and disclosure of coverage shall apply to health insurance coverage offered by a health insurance issuer in the individual market in the same manner as it applies to health insurance coverage offered by a health insurance issuer in connection with a group health plan in the small or large group market.
Acts 1997, ch. 157, § 12.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 28 - HEALTH INSURANCE PORTABILITY, AVAILABILITY AND RENEWABILITY ACT (§§ 56-7-2801 — 56-7-2814) › Section 56-7-2812 - Applicability of individual market requirements to excepted benefits under sections 56-7-2802 (10)

The individual market requirements of this part shall not apply to any health insurance coverage in relation to its provision of excepted benefits described in §
56-7-2802(10)(A)
or to those described in §
56-7-2802(10)(B), (C), or (D)
if the benefits are provided under a separate policy, certificate or contract of insurance. A health insurance issuer offering health insurance coverage in connection with group health plans shall not be deemed to be a health insurance issuer offering individual health insurance coverage solely because the issuer offers a conversion policy.
Acts 1997 , ch. 157, § 13.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 28 - HEALTH INSURANCE PORTABILITY, AVAILABILITY AND RENEWABILITY ACT (§§ 56-7-2801 — 56-7-2814) › Section 56-7-2813 - Construction with other laws - Enforcement actions

(a)
This part is supplemental to any other laws of this state; however, to the extent that this part is in conflict with other insurance law, this part shall control.
(b)
No enforcement action shall be taken, pursuant to this part, against a group health plan or health insurance issuer with respect to a violation of a requirement imposed by this part before January 1, 1998, or, if later, the date of issuance of the federal regulations to be issued pursuant to the federal act if the plan or issuer has sought to comply in good faith with the requirements.
Acts 1997, ch. 157, § 14.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 28 - HEALTH INSURANCE PORTABILITY, AVAILABILITY AND RENEWABILITY ACT (§§ 56-7-2801 — 56-7-2814) › Section 56-7-2814 - Legislative intent - Rules and regulations

It is the intent of this part to meet the minimum standards established by the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) (
42 U.S.C. § 1320d
et seq.), and the rules and regulations to be promulgated by federal authorities in connection with HIPAA. The commissioner is, therefore, authorized to promulgate rules and regulations according to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, as may be necessary to ensure compliance with the federal law as well as those rules necessary to carry out the proper administration of this part.
Acts 1997, ch. 157, § 15.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 29 - ACCESS TENNESSEE ACT OF 2006 (§§ 56-7-2901 — 56-7-2916) › Section 56-7-2901 - [For postponed repeal effective 6/30/2025, see T.C.A. 56-7-2916] Short title

This part shall be known and may be cited as the "Access Tennessee Act of 2006."
Amended by 2015 Tenn. Acts, ch. 185, s 1, eff. 4/22/2015.
Acts 2006, ch. 867, §§ 3, 14.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 29 - ACCESS TENNESSEE ACT OF 2006 (§§ 56-7-2901 — 56-7-2916) › Section 56-7-2905 - [For postponed repeal effective 6/30/2025, see T.C.A. 56-7-2916] Annual report

Beginning by October 1, 2007, Access Tennessee shall make an annual report to the governor and comptroller of the treasury, to be submitted by October 1 of each year. The report shall be in a form approved by the commissioner and shall summarize the activities of Access Tennessee in the preceding calendar year, including the net written and earned premiums, enrollment, the expense of administration, and the paid and incurred losses. The report shall also include an evaluation of the ability of low income individuals to participate in the program.
Acts 2006, ch. 867, §§ 3, 14.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 29 - ACCESS TENNESSEE ACT OF 2006 (§§ 56-7-2901 — 56-7-2916) › Section 56-7-2906 - [For postponed repeal effective 6/30/2025, see T.C.A. 56-7-2916] Additional powers and duties - Rules

The commissioner may, by rule, establish additional powers and duties of Access Tennessee and may adopt rules necessary and proper to implement this part. The rules shall be promulgated as emergency rules pursuant to §
4-5-208
. The rules shall be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
Acts 2006, ch. 867, §§ 3, 14.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 29 - ACCESS TENNESSEE ACT OF 2006 (§§ 56-7-2901 — 56-7-2916) › Section 56-7-2907 - [For postponed repeal effective 6/30/2025, see T.C.A. 56-7-2916] Audit

The commissioner and the comptroller of the treasury have the authority to review and audit the expenditure of funds made under this part. Nothing in this section shall limit the authority of the commissioner to ensure that program expenditures are maintained within legislative appropriations.
Acts 2006, ch. 867, §§ 3, 14.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 29 - ACCESS TENNESSEE ACT OF 2006 (§§ 56-7-2901 — 56-7-2916) › Section 56-7-2912 - [For postponed repeal effective 6/30/2025, see T.C.A. 56-7-2916] Fraud and abuse

The office of inspector general, created pursuant to §
71-5-2502
, shall have the authority to investigate civil and criminal fraud and abuse of Access Tennessee, or any other violations of state criminal law related to the operation of the program. The powers of the office of inspector general set forth in §§
71-5-2501
- 72-5-2512 relating to the investigation of fraud and abuse in the TennCare program shall also be applicable to its investigation of fraud and abuse of Access Tennessee.
Acts 2006, ch. 867, §§ 3, 14.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 29 - ACCESS TENNESSEE ACT OF 2006 (§§ 56-7-2901 — 56-7-2916) › Section 56-7-2913 - [For postponed repeal effective 6/30/2025, see T.C.A. 56-7-2916] Federal funding

Notwithstanding any law to the contrary, if the state determines not to apply for or accept federal funding for the purposes of this part, any provisions of this part, including any eligibility requirements regarding federally defined eligible individuals as set forth in §
56-7-2908
of this part, would not be subject to nor would the state or board have to comply with any federal requirements mandated as a result of the acceptance of the federal funds.
Acts 2006, ch. 867, §§ 3, 14.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 29 - ACCESS TENNESSEE ACT OF 2006 (§§ 56-7-2901 — 56-7-2916) › Section 56-7-2914 - [For postponed repeal effective 6/30/2025, see T.C.A. 56-7-2916] Legislative review

This part shall be reviewed annually by the commerce and labor committee of the senate, the insurance committee of the house of representatives, the finance, ways and means committee of the senate and the finance, ways and means committee of the house of representatives, and these committees shall recommend necessary changes to the governor and the general assembly.
Amended by 2019 Tenn. Acts, ch. 345, s 127, eff. 5/10/2019.
Amended by 2013 Tenn. Acts, ch. 236, s 17, eff. 4/19/2013.
Acts 2006, ch. 867, §§ 10, 14.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 29 - ACCESS TENNESSEE ACT OF 2006 (§§ 56-7-2901 — 56-7-2916) › Section 56-7-2915 - [Repealed]

Repealed by 2013 Tenn. Acts, ch. 211, s 1, eff. 7/1/2013.
Acts 2006, ch. 867, § 14.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 29 - ACCESS TENNESSEE ACT OF 2006 (§§ 56-7-2901 — 56-7-2916) › Section 56-7-2916 - [Repealed effective 6/30/2025] Repealer

This part shall be repealed on June 30, 2025.
Amended by 2020 Tenn. Acts, ch. 583, s 1, eff. 3/19/2020.
Amended by 2015 Tenn. Acts, ch. 185, s 10, eff. 4/22/2015.
Acts 2006, ch. 867, § 3; 2010 , ch. 872, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 31 - PHARMACY BENEFITS MANAGERS (§§ 56-7-3101 — 56-7-3123) › Section 56-7-3101 - Compliance - Promulgation of rules

(a)
Pharmacy benefits managers shall, and contracts for pharmacy benefits management must, comply with the requirements of this part.
(b)
(1)
The commissioner of commerce and insurance shall promulgate rules to effectuate the purposes of this part and part 32 of this chapter, including, but not limited to, rules to:
(A)
Implement pharmacy benefits manager audits that are necessary to ensure compliance with this part and part 32 of this chapter; provided, such audits must not occur more than once every three (3) years unless the commissioner determines there is a need to investigate the financial condition of or legality of conduct by a pharmacy benefits manager;
(B)
Provide for additional requirements for pharmacy benefits managers to obtain licensure pursuant to §
56-7-3113
;
(C)
Implement a complaint and administrative hearing process to effectuate §
56-7-3110
; and
(D)
Provide for such fees as the commissioner determines are reasonably necessary to administer this part and part 32 of this chapter, including, but not limited to, a fee to cover the cost of supervising compliance with this part and part 32 of this chapter, payable by a pharmacy benefits manager upon being the subject of an audit pursuant to this section.
(2)
Rules must be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. A violation of any rule issued pursuant to this section is a violation of this part.
Amended by 2022 Tenn. Acts, ch. 998, s 1, eff. 5/4/2022.
Acts 2007 , ch. 224, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 31 - PHARMACY BENEFITS MANAGERS (§§ 56-7-3101 — 56-7-3123) › Section 56-7-3104 - Calculation of reimbursement of pharmacy benefits manager

(a)
Reimbursement by a pharmacy benefits manager under a contract to a pharmacist or pharmacy for prescription drugs and other products and supplies that is calculated according to a formula that uses a nationally recognized reference in the pricing calculation shall use the most current nationally recognized reference price or amount in the actual or constructive possession of the pharmacy benefits manager or its agent.
(b)
For purposes of compliance with this section, pharmacy benefits managers shall be required to update the nationally recognized reference prices or amounts used for calculation of reimbursement for prescription drugs and other products and supplies no less than every three (3) business days.
Acts 2007, ch. 224, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 31 - PHARMACY BENEFITS MANAGERS (§§ 56-7-3101 — 56-7-3123) › Section 56-7-3105 - Contract compliance

No contract entered into or amended on or after July 1, 2007, shall contain provisions in violation of this part.
Acts 2007, ch. 224, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 31 - PHARMACY BENEFITS MANAGERS (§§ 56-7-3101 — 56-7-3123) › Section 56-7-3106 - Placement of drug on maximum allowable cost list

(a)
Before a pharmacy benefits manager or covered entity may place a drug on a maximum allowable cost list, the pharmacy benefits manager or covered entity must find that the drug is generally available for purchase by pharmacies in this state from a national or regional wholesaler.
(b)
If a drug that has been placed on a maximum allowable cost list no longer meets the requirements of subsection (a), the drug shall be removed from the maximum allowable cost list by the pharmacy benefits manager or covered entity within five (5) business days after the date that the pharmacy benefits manager or covered entity becomes aware that the drug no longer meets the requirements of subsection (a).
(c)
Nothing in this part shall be construed as preventing a pharmacy benefits manager or covered entity from reimbursing claims for a generic drug at the previously determined maximum allowable cost even if the pharmacy benefits manager or covered entity reimburses for the equivalent brand name drug at the contracted brand rate after confirmation by a national or regional wholesaler and by the manufacturer that the generic drug is generally unavailable for purchase from a national or regional wholesaler.
Added by 2014 Tenn. Acts, ch. 857,s 2, eff. 1/1/2015.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 31 - PHARMACY BENEFITS MANAGERS (§§ 56-7-3101 — 56-7-3123) › Section 56-7-3107 - Information to be provided regarding maximum allowable cost lists - Updating maximum allowable cost lists

(a)
A pharmacy benefits manager or covered entity shall make available to each pharmacy with which the pharmacy benefits manager or covered entity has a contract and to each pharmacy included in a network of pharmacies served by a pharmacy services administrative organization with which the pharmacy benefits manager or covered entity has a contract, at the beginning of the term of a contract and upon renewal of a contract:
(1)
The sources used to determine the maximum allowable costs for the drugs and medical products and devices on each maximum allowable cost list;
(2)
Every maximum allowable cost for individual drugs used by that pharmacy benefits manager or covered entity for patients served by that contracted pharmacy; and
(3)
Upon request, every maximum allowable cost list used by that pharmacy benefits manager or covered entity for patients served by that contracted pharmacy.
(b)
A pharmacy benefits manager or covered entity shall:
(1)
Update each maximum allowable cost list at least every three (3) business days, as required by §
56-7-3104(b)
;
(2)
Make the updated lists available to every pharmacy with which the pharmacy benefits manager or covered entity has a contract and to every pharmacy included in a network of pharmacies served by a pharmacy services administrative organization with which the pharmacy benefits manager or covered entity has a contract, in a readily accessible, secure and usable web-based format or other comparable format or process; and
(3)
Utilize the updated maximum allowable costs to calculate the payments made to the contracted pharmacies within five (5) business days.
Added by 2014 Tenn. Acts, ch. 857,s 2, eff. 1/1/2015.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 31 - PHARMACY BENEFITS MANAGERS (§§ 56-7-3101 — 56-7-3123) › Section 56-7-3109 - Medical products and devices subject to requirements of part

The medical products and devices subject to the requirements of this part are limited to the medical products and devices included as a pharmacy benefit under the pharmacy benefits contract.
Added by 2014 Tenn. Acts, ch. 857,s 2, eff. 1/1/2015.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 31 - PHARMACY BENEFITS MANAGERS (§§ 56-7-3101 — 56-7-3123) › Section 56-7-3110 - Sanctions for violation of part

A violation of this part may subject the pharmacy benefits manager or covered entity to any of the sanctions described in §
56-2-305
.
Added by 2014 Tenn. Acts, ch. 857,s 2, eff. 1/1/2015.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 31 - PHARMACY BENEFITS MANAGERS (§§ 56-7-3101 — 56-7-3123) › Section 56-7-3111 - Disclosure of maximum allowable cost lists and related information

A pharmacy shall not disclose to any third party the maximum allowable cost lists and any related information it receives from a pharmacy benefits manager or covered entity; provided, however, a pharmacy may share such lists and related information with a pharmacy services administrative organization or similar entity with which the pharmacy has a contract to provide administrative services for that pharmacy. If a pharmacy shares this information with a pharmacy services administrative organization or similar entity, that organization or entity shall not disclose the information to any third party.
Added by 2014 Tenn. Acts, ch. 857,s 2, eff. 1/1/2015.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 31 - PHARMACY BENEFITS MANAGERS (§§ 56-7-3101 — 56-7-3123) › Section 56-7-3112 - Fair Disclosure of State Funded Payments for Pharmacists' Services Act

(a)
This section shall be known and may be cited as the "Fair Disclosure of State Funded Payments for Pharmacists' Services Act".
(b)
As used in this section:
(1)
"Pharmacist" means a pharmacist as defined in §
63-10-204
;
(2)
"Pharmacist services" means products, goods, or services provided as a part of the practice of pharmacy as defined in §
63-10-204
to individuals who reside or are employed in this state;
(3)
"Pharmacy" means the same as defined in §
63-10-204
;
(4)
"Pharmacy benefits manager" or "PBM" means an entity that administers or manages a pharmacy benefits plan or program; and
(5)
"Pharmacy benefits plan or program" means any plan or program that is funded by state dollars to furnish, cover the cost of, or otherwise provide for pharmacist services to individuals who reside or are employed in this state.
(c)
A PBM, when seeking payment or reimbursement for pharmacist services provided in connection with a pharmacy benefits plan or program or reporting expenditures for pharmacist services provided in connection with a pharmacy benefits plan or program, shall itemize by individual claim:
(1)
The amount actually paid or to be paid to the pharmacy or pharmacist for the pharmacist services;
(2)
The identity of the pharmacy or pharmacist actually paid or to be paid; and
(3)
The prescription number or other identifier of the pharmacist services.
(d)
A PBM shall pay the amounts it receives for pharmacist services provided in connection with a pharmacy benefits plan or program to the pharmacies or pharmacists that provided the pharmacist services.
(e)
This section does not:
(1)
Require a PBM to set specific fees, rates, or schedules for payment for pharmacist services;
(2)
Prohibit a PBM from charging for any services in addition to pharmacist services; or
(3)
Require a PBM to pay a pharmacy or pharmacist more on any claim than the amount disclosed under subdivision (c)(1).
(f)
A violation of this section is an unfair trade practice under the Tennessee Unfair Trade Practices and Unfair Claims Settlement Act of 2009, compiled in chapter 8, part 1 of this title.
(g)
All documents containing individual claim and payment information specified in subsections (c) and (d) shall be confidential records and not subject to the requirements of title 10, chapter 7, relating to public inspection of records.
(h)
A state agency administering a PBM contract may provide the information described in subsections (c) and (d) to a qualified independent auditor in accordance with §
4-3-1021
; provided, the information is relevant to an audit authorized under §
4-3-1021
, and the independent auditor has agreed to maintain the confidentiality of the information.
Acts 2014, ch. 896, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 31 - PHARMACY BENEFITS MANAGERS (§§ 56-7-3101 — 56-7-3123) › Section 56-7-3113 - Licensure as pharmacy benefits manager

(a)
No person or entity shall administer the medication or device portion of pharmacy benefits coverage provided by a covered entity or otherwise act as a pharmacy benefits manager in this state unless the person or entity has obtained licensure through the department of commerce and insurance.
(b)
To obtain licensure as a pharmacy benefits manager, the person or entity must demonstrate to the department that the person or entity:
(1)
Is authorized to transact business in this state;
(2)
Is financially responsible, as determined by the department; and
(3)
Has not had a prior license to be a pharmacy benefits manager denied for cause or revoked by the department within five (5) years of the date on which licensure is sought.
(c)
(1)
In addition to the showing required by subsection (b), a person or entity seeking licensure as a pharmacy benefits manager shall also provide the following information to the department:
(A)
The person or entity's name, address, telephone number, email address, and website address; and
(B)
If the licensure is sought for an entity, the name, address, telephone number, and email address for a contact person.
(2)
Any material changes in the information described in this subsection (c) shall be filed with the department within sixty (60) days of the change.
(d)
A person or entity's license as a pharmacy benefits manager shall be renewed biennially.
(e)
(1)
Any person or entity seeking licensure as a pharmacy benefits manager shall pay a fee in the amount of one hundred dollars ($100) to the department to obtain the license. Any person or entity seeking renewal of a license as a pharmacy benefits manager shall pay a fee in the amount of fifty dollars ($50) to renew the license.
(2)
All fees paid pursuant to this section shall be used by the department for purposes of administering this section.
(f)
(1)
Failure to obtain licensure or renew a license pursuant to this section while acting as a pharmacy benefits manager in this state shall constitute a violation of this section and shall be punishable by a fine of not less than one hundred dollars ($100) nor more than five hundred dollars ($500).
(2)
Any person or entity assessed a fine pursuant to this section or denied a license or renewal of a license may appeal the fine or denial pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
Acts 2018, ch. 838, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 31 - PHARMACY BENEFITS MANAGERS (§§ 56-7-3101 — 56-7-3123) › Section 56-7-3114 - Right to provide information regarding amount of insured's cost share of prescription drug

A pharmacy or pharmacist has the right to provide an insured information regarding the amount of the insured's cost share for a prescription drug. Neither a pharmacy nor a pharmacist shall be penalized by a pharmacy benefits manager for discussing any information described in this section or for selling a lower priced drug to the insured if one is available.
Acts 2018, ch. 1015, § 3.