Right to Shop Act – Healthcare consumers will be aided by the Right to Shop Act approved by the General Assembly in 2019. Public Chapter 407 enacts a consumer-driven program which provides patients with more transparency regarding the costs of healthcare services in their network.
The new act calls on health insurance providers to implement a shopping and decision support program which discloses the costs of non-emergency outpatient services or procedures to their enrollees, so patients can make informed choices that fit within their budget or deductible. Approximately 40 to 50 percent of all healthcare services are shoppable, including physical and occupational therapy services, radiology and imaging services, laboratory services, and infusion therapy. In addition, the legislation allows insurers to offer incentives to enrollees for choosing the lower-cost option, such as providing consumers up to 50 percent of the difference for going to a less expensive provider, as long as the enrollee’s reward does not exceed the cap of $599 per year. Insurance companies, however, are not allowed to require or steer a patient to use a lower cost provider. It is strictly voluntary on the part of the patient.
Proton Therapy Access Act — Another new statute, Public Chapter 193, seeks to provide greater access to care for employees of the State of Tennessee provides that those diagnosed with cancer can receive hypo fractionated proton therapy if the physician and patient believe that it would be more beneficial to their treatment plan. The measure requires the state insurance plan to cover proton therapy at the same rate that would be paid for traditional radiation therapy (IMRT), as long as certain conditions have been met. This bill was vetoed in 2018 by Governor Bill Haslam, but in 2019 made its way through the General Assembly and was signed by Governor Bill Lee.
Consumers / Hospital Billing Transparency – A new law was passed by the General Assembly this past year calling for more transparency in hospital billing practices by restricting statements from including any language that refers to specialty healthcare services rendered at the hospital. Often times, hospital bills include charges for supplies and equipment labeled as specialty service charges which are mistaken by patients as the total amount being billed by their physician. Public Chapter 341 aims to help healthcare consumers avoid confusion in determining if the bill came from their specialty physician. It follows legislation passed by the General Assembly which called for transparency in medical charges by requiring a hospital to provide an estimate to patients regarding out-of-network charges.
As always, I am truly humbled and honored to be your voice in Nashville. If there is ever any issue I can assist you with, please contact my office by calling 615-741-2190 or emailing me at: [email protected] I look forward to hearing your thoughts, ideas, concerns, and suggestions as we continue to protect Tennessee’s conservative values throughout the remainder of the 111th General Assembly.