AN ACT to amend Tennessee Code Annotated, Title 56, Chapter 7, Part 23, relative to medical laboratories.
Summary
HB1993 amends Tennessee insurance law governing medical laboratories and health insurance networks. The bill prohibits health insurance issuers and managed health insurance issuers from denying a licensed medical laboratory the opportunity to participate as an in-network provider on the same terms and conditions offered to other medical laboratories, subject to limited exceptions for higher rates in nonurban areas and for network adequacy or patient care needs. It also bars insurers from steering patients away from a laboratory of their choice when that laboratory is a participating provider under the plan.
The bill further requires insurers to reimburse eligible non-network medical laboratories for testing services at no less than the federal Medicare clinical laboratory fee schedule, unless an exception applies. A new subsection allows managed health insurance issuers to condition that reimbursement rate on the non-network laboratory meeting the same performance metrics required of in-network laboratories. The act takes effect July 1, 2026.
Impact
The bill would amend Tennessee Code Annotated, Title 56, Chapter 7, Part 23, by expanding protections for licensed medical laboratories seeking participation in health insurance networks and by setting a floor for reimbursement to certain out-of-network laboratories. It affects health insurance issuers, managed health insurance issuers, licensed medical laboratories, and insured patients who use laboratory testing services. The measure would likely increase network access for labs and could affect insurer contracting practices, reimbursement rates, and provider network administration.
Sentiment
No committee transcripts or recorded votes are available in the provided material, so there is no direct evidence of debate or formal sentiment from legislative proceedings. Based on the bill text alone, the measure appears pro-provider and pro-consumer in orientation, aiming to preserve patient choice and ensure fair access for medical laboratories within insurance networks. Any opposition would likely come from insurers concerned about contracting flexibility, reimbursement costs, and network management requirements.
Contention
The main points of contention are likely to be the bill’s limits on insurer discretion and its reimbursement floor for non-network laboratories. Insurers may object to being required to admit laboratories on equal terms or to pay at least the Medicare clinical laboratory fee schedule, while medical laboratories and patient advocates would likely support the protections for participation, patient choice, and reimbursement. The bill’s exceptions for nonurban areas, network adequacy, patient care needs, and performance metrics suggest an attempt to balance access concerns with insurer operational flexibility.