AN ACT to amend Tennessee Code Annotated, Title 8; Title 56 and Title 71, relative to healthcare provider reimbursement.
Summary
SB2070, known as the “Stopping Health Insurers from Excluding Legal Decisions (SHIELD) Act,” limits how health insurance entities may use vaccination-exemption status in provider quality measures and reimbursement calculations. The bill applies when a healthcare provider documents that a patient has declined a vaccination or qualifies for a vaccination exemption, and it requires insurers to exclude that patient from the denominator of vaccination-related metrics used to determine provider performance, quality ratings, incentive payments, reimbursement tiers, network participation, or similar arrangements.
The bill also prohibits insurers from terminating a provider from a network, reducing reimbursement, or withholding incentive payments because the provider treats exempt patients. It further bars insurers from downcoding claims or reducing payment solely because a patient is exempt or because a preventive-care standard was not met due to that exempt status. Claims denied, reduced, or recouped in violation of these rules are treated as clean claims under Tennessee’s prompt-payment law, making them subject to interest penalties and remediation requirements. The act takes effect July 1, 2026, and applies to insurance contracts entered into, delivered, amended, or renewed on or after that date.
Impact
This bill amends Tennessee Code Annotated Titles 56 and 71 to create new protections for providers in reimbursement and quality-measure calculations involving vaccination exemptions. It changes how health insurance entities may evaluate provider performance and payment by excluding documented exempt patients from vaccination-related metrics and by preventing adverse reimbursement actions tied solely to exempt status. It also ties violations to Tennessee’s clean-claim and timely-reimbursement framework, giving providers a statutory remedy if insurers improperly deny, reduce, or recoup payment.
Sentiment
The bill appears to have been broadly supported in the legislative process. It passed the Senate Commerce and Labor Committee unanimously, passed the Senate floor with strong support, and later received House concurrence without opposition. The vote history suggests little formal resistance, indicating a generally favorable sentiment toward protecting providers from reimbursement penalties related to vaccination exemptions.
Contention
The main policy issue is whether insurers should be allowed to include exempt patients in vaccination-based quality metrics or use exempt status to affect reimbursement, network status, or incentive payments. Supporters appear to favor shielding providers from penalties when patients decline vaccination for legal or medical reasons, while any opposition would likely center on concerns that the bill limits insurer quality-management tools and could weaken vaccination-related performance incentives. The recorded votes show no significant floor-level contention, but the underlying tension is between provider reimbursement protections and insurer oversight of preventive-care metrics.
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.