Tennessee SB 1270: Health Care - As enacted, requires the emergency medical services board to establish standards for a community paramedic through promulgation of rules. - Amends TCA Title 68, Chapter 140, Part 3.

Bill Text

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PUBLIC CHAPTER NO. 183
SENATE BILL NO. 1270
By Johnson
Substituted for: House Bill No. 1304
By Lamberth, Cochran, Hill, Helton-Haynes
AN ACT to amend Tennessee Code Annotated, Title 56 and Section 68-1-115, relative to insurance.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
SECTION 1. Tennessee Code Annotated, Title 56, Chapter 2, Part 1, is amended by adding
the following as a new section:
56-2-1_. Claims experience report.
(a) As used in this section, unless the context otherwise requires:
( 1) "Group health plan" or "plan" means an employee welfare benefit plan, as
that term is defined in§ 3(1) of the Employee Retirement Income and Security Act of
1974 (ERISA) (29 U.S.C. § 1002(1)), including insured and self-insured plans, to the
extent that the plan provides medical care, as that term is defined in § 2791 (a)(2) of the
Public Health Service Act (PHS Act) (42 U.S.C. § 30099-91 (a)(2)), including items and
services paid for as medical care, to employees or their dependents directly or through
insurance, reimbursement, or otherwise, that:
(A) Has fifty (50) or more participants as defined in section 3(7) of ERISA
(29 U.S.C. § 1002(7)); or
(8) Is administered by an entity other than the employer that established
and maintains the plan;
(2) "Health benefit plan issuer" means a company or insurance company, as
those terms are defined in§ 56-1-102, or a health maintenance organization, as that
term is defined in § 56-32-102, that qualifies as a health insurance entity as that term
is defined in§ 56-7-109;
(3) "Plan administrator" means an administrator, as that term is defined in 29
U.S.C. § 1002(16)(A); and
(4) "Plan sponsor" has the same meaning as defined in 29 U.S.C. §
1002( 16)(8).
(b) No later than thirty (30) days after a health benefit plan issuer receives a written
request for a claims experience report from a plan, plan sponsor, or plan administrator, the
health benefit plan issuer shall provide the report to the requesting party.
(c) To the extent such information is available to the health benefit plan issuer and is
relevant to the request made under subsection (b), a report provided pursuant to subsection
(b) must include the following information for the thirty-six-month period preceding the date of
the request, for the entire period of coverage, or for the period of time specified in the request,
whichever period is shortest:
(1) Aggregate paid claims experience by month, including claims experience for
medical, dental, and pharmacy benefits, as applicable;

SB 1270
(2) Total premium or premium equivalent earned by month;
(3) Total number of covered employees on a monthly basis by coverage tier,
including whether coverage was for:
(A) An employee only;
(B) An employee with dependents only;
(C) An employee with a spouse only; or
(D) An employee with spouse and dependents; and
(4) An aggregate report of all claims exceeding seventy-five thousand dollars
($75,000).
(d) In the case of a request made under subsection (b) after the date of termination of
coverage, the report provided under subsection (b) must contain the information outlined in
subsection (c) that is available to the health benefit plan issuer as of the date of the request
and is relevant to the request for the thirty-six-month period preceding the date of termination
of coverage or for the entire policy period, whichever period is shorter.
(e) No later than thirty (30) days after the date of termination of coverage under a
group health plan, a health benefit plan issuer shall provide to a plan, plan sponsor, or plan
administrator who made a request under subsection (b) before the date of termination of
coverage a supplemental written report of the information described in subsection (c) to
update the claims experience report with information that was not included in the original
report.
(f) A plan, plan sponsor, or plan administrator may use information in a written claims
experience report provided under this section only as permitted or required by the Health
Insurance Portability and Accountability Act of 1996 (HIPAA) (42 U.S.C. § 1320d et seq.) and
its implementing regulations.
(g) Except where the release of information is otherwise prohibited by law, a health
benefit plan issuer that releases information in accordance with this section has not violated
a standard of care and is not liable for civil damages resulting from, and is not subject to
criminal prosecution for, releasing such information.
(h) This section applies to the extent not preempted by ERISA.
SECTION 2. Tennessee Code Annotated, Section 56-2-208(b)(6)(F)(vi)(c), is amended by
deleting the language "active" and substituting "inactive".
SECTION 3. Tennessee Code Annotated, Section 56-2-208(b)(8)(C)(iii), is amended by
adding the language "; provided, that the commissioner shall not remove from the list a reciprocal
jurisdiction as defined under subdivisions (b)(8)(A)(ii)(a) or (b