On May 5, Tennessee Gov. Bill Lee enacted a landmark network adequacy law after several years of persistent advocacy by the Tennessee Society of Pathologists (TSP) and the CAP in collaboration with the Tennessee Medical Association (TMA). The TSP, CAP, and TMA successfully advocated for several provisions to strengthen network adequacy review of health insurance plans by the state insurance commissioner.

As advocated by TSP and CAP, the law mandates managed health insurance plans to include a report for each in-network hospital with the percentage of specialty physician providers in-network such as pathologists, emergency medicine, radiologists, and anesthesiology subject to state insurance commissioner oversight.

This protection will help ensure health plans cannot deceptively or falsely advertise commercial insurance plans that claim adequate networks of in-network physicians while plans have failed to contract sufficiently with specialty physicians at in-network hospitals and facilities.

Of note, the TSP and CAP successfully advocated for insurance commissioner oversight over managed health insurance plans to report ‘material changes” to their approved network plans at least 15 days before such changes take effect. This fundamental protection will ensure enrollees do not have unexpected, disrupted access to care and physicians can provide timely care to Tennessee patients.

Additionally, the new law mandates health insurance plans to contract with a “sufficient number of contracted providers practicing at the same in-network facilities with which the managed health insurance issuer has contracted to reasonably ensure enrollees have complete and comprehensive in-network access for covered services delivered at those in-network facilities.”

The CAP advocates for states to require health plans to have adequate networks of hospital-based physicians, including pathologists. Tennessee joins a handful of states that have enacted state insurance network adequacy oversight of specialty physicians.

Lastly, the legislation directs the state commissioner of insurance to conduct a study on the federal No Surprises Act implementation and subsequent implications to Tennessee physicians and health care facilities by November 1, 2023.

The CAP will continue to partner with TSP in the months ahead.