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SB 2067

Health Care - As introduced, revises requirement for the department of commerce and insurance to report on coverage for mental health, alcoholism, and drug dependency. - Amends TCA Title 56.

114th Regular Session (2025-2026) Introduced by Bo Watson

SB 2067 requires health plans with participating providers to obtain DCI approval for network adequacy, maintain updated directories, and publicize fixes and penalties for noncompl

Placed on Senate Finance, Ways, and Means Committee calendar for 4/20/2026
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Bill Summary · SB 2067

Summary of SB 2067 (Session 114, Tennessee)

Note: The amendment replaces the original text and outlines network adequacy requirements for health benefit plans with participating providers, as administered by the Department of Commerce and Insurance (DCI).

1) Purpose and Intent

  • Establish and enforce network adequacy standards for health benefit plans that include participating providers.
  • Increase transparency and oversight of health insurer networks to ensure enrollees have timely access to a broad range of providers.
  • Create a formal process for monitoring, reporting, and correcting network adequacy issues, including public notice and penalties for noncompliance.
  • Provide annual reporting to lawmakers and a public-facing dashboard of network information.

2) Key Provisions and Changes

Definitions (amended section 56-7-2356)

  • Clarifies what constitutes a “Health Benefit Plan,” including hospital/medical expense policies and certain contracts/plans offered by insurers or HMOs, with exclusions for TennCare/Medicaid programs, CoverKids, Access Tennessee, state plans, and various limited-benefit policies.
  • Defines terms used in the network provisions:
    • Health insurer, managed health insurance issuer
    • Material change: significant provider network reductions (e.g., 10%+ in a geographic market), removal of a major health system, or changes that fail network adequacy requirements
    • Participating provider: providers contracted with the insurer to furnish services
    • Physician: licensed medical or osteopathic practitioners
    • Provider: any licensed/accredited/certified professional or facility

Network Adequacy Standards (b, c, e, f)

  • Health insurers with plans that have participating providers must:

    • Obtain original approval from DCI for the network’s adequacy compliance before offering the plan (b(1)).
    • Maintain an adequate network and actively monitor compliance; engage with providers to maintain participating status (b(2)).
    • Maintain an online, searchable directory of participating providers updated at least weekly (b(3)).
    • Report any material change to the network adequacy standards to DCI within 15 days of the change (b(4)); provide corrective action within 90 days, or request a 12-month waiver if no uncontracted providers meet the standard or sole community provider refuses to contract (b(4)(A)-(B)).

  • DCI examinations and public notices (c):

    • Upon receiving network data, material change reports, or enrollee complaints, DCI must examine network adequacy (c(1)).
    • Public notice on DCI’s website and, if applicable, on the health plan’s site for the duration of the examination and corrective actions (c(2)).
    • Insurers must submit supporting data during examinations, including a searchable provider database, actuarial data, and documentation of negotiation efforts (c(3)).
    • DCI must notify affected providers of potential examination and allow submissions of evidence (c(4)).
    • Consider testimony and evidence related to provider counts, facility availability, population density, travel time, and access (c(5)).
    • Do not factor balance-billing protections into network adequacy determinations; do not deem a plan inadequate solely due to the absence of a sole provider who refuses to contract on reasonable terms (c(6)).

Examination Rulings and Penalties (d)

  • DCI must issue rulings on approvals or network compliance within:
    • 30 days for original approval requests (d(1)(A))
    • 60 days for material-change reports or enrollee complaints (d(1)(B))
  • May grant a 12-month waiver for a standard if appropriate conditions are met (d(2)).
  • Post-examination, DCI may modify networks, require corrective action, and assess penalties for noncompliance (d(3)-(d)(4)):
    • Monetary penalty up to $10,000 per nonparticipating-provider claim during noncompliance (d(3)(E)).
    • Treble damages for late material-change filings (d(3)(F)).
    • Repeated violations may be referred for unfair trade practice concerns (d(3)(G)).
  • All penalties and corrective actions must be publicly posted (d(4)).

Network Adequacy Standards for Access (unduplicated provisions in section e, f)

  • Plans must ensure:

    • Adequate numbers of primary care and specialty/pediatric providers within reasonable travel times (generally within 30 miles or 30 minutes where feasible) (e(1)-(2)).
    • Availability of facilities (including pediatric, nonprofit, for-profit, and teaching institutions) and hospital services within reasonable distance (e(3)-(4)).
    • Sufficient hospital admitting physicians and timely access to hospital services (e(5)-(6)).
    • Credentialing of providers at affiliated facilities for essential specialties (e(7)).

  • Management of nonparticipating providers:

    • If no participating providers exist for a covered benefit, insurers must arrange referrals to obtain the benefit with no greater cost to the enrollees (f(1)).
    • Timeliness provisions for participating and nonparticipating providers to see patients, with contract-based definitions of timeliness (f(3)-(4)).

Complaints and Transparency (g)

  • Enrollees, providers, or facilities may file complaints with DCI regarding network adequacy (g(1)).
  • Complaints must include plan details, standard questioned, contact information, summary, and supporting documents (g(2)).
  • DCI must acknowledge complaints and inform the complainant of examination status, rulings, corrective actions, and penalties (g(3)).
  • Provisions for information requests with confidentiality protections for proprietary information (g(4)).

Reporting Requirements (h)

  • By January 15, 2027, and annually thereafter, DCI must publish a public report on insurers’ compliance, showing trends in material change reports, complaints, and exam outcomes without identifying individual entities (h(1)).
  • Health insurers must submit annual reports to DCI by October 1, detailing:
    • A copy of their most recent approved provider database (h(2)(A))
    • Changes to the provider list since the last examination (h(2)(B))
    • Original requests, material changes, or complaints filed in the past 12 months and outcomes/corrective actions (h(2)(C))

3) Who Is Affected

  • Health insurers offering health benefit plans with participating providers operating in Tennessee.
  • Enrollees in those health benefit plans (adult and pediatric).
  • Health care providers (physicians, hospitals, and other licensed/credentialed providers) in insurer networks.
  • DCI (Department of Commerce and Insurance) as the oversight and enforcement body.
  • Public at large through enhanced transparency and posted penalties/corrective actions.

4) Procedural and Timeline Aspects

  • Original approval for a network: required before offering a plan (b(1)).
  • Material-change reporting: within 15 days of change (b(4)).
  • Corrective action period: up to 90 days to come into compliance (b(4)(A)).
  • Waiver requests: allowed if demonstrated no suitable uncontracted providers exist or sole provider refuses to contract (b(4)(B)).
  • Examinations and rulings:
    • 30 days for original approvals (d(1)(A)).
    • 60 days for material changes/complaints (d(1)(B)).
  • Public notices: during examinations and corrective actions (c(2)).
  • Penalties and postings: penalties up to $10,000 per claim; treble damages for late filings; all penalties/corrective actions posted (d(3)-(d)(4)).
  • Annual reporting:
    • DCI reports to lawmakers by January 15 each year (h(1)).
    • Insurers submit provider data and change/complaint summaries by October 1 each year (h(2)).

5) Fiscal and Administrative Impact

  • State government: estimated ongoing cost to DCI for two additional Actuarial & Compliance Analyst-2 positions beginning FY26-27, plus one-time setup costs. Totals around $200k+ in FY26-27 and about $196k annually thereafter.
  • Private sector: potential changes in provider network expansions or reconfigurations, with possible effects on provider revenues and insurer costs; overall private-sector impact is not precisely quantifiable and may vary by market.

Overall, SB 2067 (as amended) strengthens network adequacy oversight, enhances consumer transparency, and creates formal processes for addressing network gaps and complaints in Tennessee health benefit plans.

Compiled from official sources — confirm details with the bill’s official record.

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