AN ACT to amend Tennessee Code Annotated, Title 8; Title 56 and Title 71, relative to healthcare provider reimbursement.
Summary
HB2243, the “Stopping Health Insurers from Excluding Legal Decisions (SHIELD) Act,” would prohibit health insurance entities from using a patient’s vaccination-exempt status against a healthcare provider in reimbursement and quality-measure calculations. If a provider documents that a patient has declined a vaccination or is otherwise exempt and submits the appropriate diagnosis code, the insurer would have to exclude that patient from vaccination-related performance metrics and related quality calculations.
The bill also bars insurers from reducing a provider’s reimbursement rate, terminating network participation, withholding incentive payments, or downcoding claims solely because the provider treats exempt patients or because a preventive-care benchmark was missed due to the patient’s exempt status. It further treats improper denials, reductions, or recoupments as clean claims under Tennessee’s timely reimbursement law, making them subject to interest penalties and remediation requirements. The act would take effect July 1, 2026, and apply to insurance contracts entered into, delivered, amended, or renewed on or after that date.
Impact
The bill would amend Tennessee Code Annotated Title 56 by adding a new section regulating how health insurers calculate provider quality measures, reimbursement tiers, incentive payments, and network status when patients have vaccination exemptions. It would also affect the state’s clean-claim and timely reimbursement framework by classifying certain improper payment actions as clean claims subject to existing penalties and correction procedures. In practical terms, the measure would protect providers from being financially penalized for treating patients who decline vaccinations or qualify for exemptions, and it would limit insurer use of vaccination-related metrics in provider payment systems.
Sentiment
The available voting history suggests the bill was generally well received in committee, with strong favorable votes in both the Insurance Subcommittee and the House Insurance Committee. The subcommittee vote was 6-1, and the full committee vote was 15-1, indicating broad support but not unanimity. No committee transcript was provided, so the record shows support for moving the bill forward with amendment rather than detailed debate on the floor.
Contention
The main point of contention appears to be whether insurers should be restricted from using vaccination-related quality metrics and reimbursement tools when a provider treats exempt patients. Supporters likely view the bill as preventing unfair penalties against providers who comply with patient exemption choices, while opponents may worry it limits insurer oversight, quality measurement, and incentives tied to preventive care. The narrow dissenting votes in committee suggest at least some concern about the bill’s effect on insurer reimbursement practices and quality-based payment models.
AN ACT to amend Tennessee Code Annotated, Title 4; Title 33; Title 47; Title 56; Title 63; Title 68 and Title 71, relative to the protection of minors in healthcare settings.
AN ACT to amend Tennessee Code Annotated, Title 4; Title 33; Title 47; Title 56; Title 63; Title 68 and Title 71, relative to the protection of minors in healthcare settings.