Senate Bill 2155, also known as House Bill 2619, amends the Tennessee Code Annotated to introduce regulations concerning health benefit plans and the use of artificial intelligence in the insurance sector. The bill establishes a new part under Title 56, Chapter 7, defining key terms such as "artificial intelligence," "downcoding," and "health benefit plan." It creates the Tennessee Commission of Insurance Review, composed of seven members, including healthcare professionals and legislators, tasked with reviewing complaints and enforcing the new regulations. The commission is granted authority to adopt rules, issue subpoenas, and conduct informal hearings regarding violations. Additionally, the bill prohibits health insurance entities from employing downcoding practices that hinder healthcare providers from collecting fees for services rendered and mandates that any material changes to health benefit plans be communicated to providers with at least 60 days' notice.

The legislation further protects enrollee medical information by prohibiting health insurance entities from sending this information outside the United States and requires that any coding or claim reviews using artificial intelligence be reviewed by a qualified human healthcare provider before decisions are made. It restricts the removal of enrollees from group plans and prohibits lasering in stop-loss underwriting. The bill also addresses ownership and operation of healthcare providers and health insurance entities, ensuring that individuals with ownership in both cannot mandate the use of specific providers. The Tennessee Commission of Insurance Review will have exclusive enforcement authority over these regulations. The act is set to take effect on July 1, 2026, applying to conduct occurring on or after that date.

Statutes affected:
Introduced: 4-29-249(a), 4-29-249, 56-7-1013(c), 56-7-1013, 56-7-3302