Healthcare consumers will be aided by the Right to Shop Act approved by the General Assembly in 2019. The legislation enacts a consumer-driven program which provides patients with more transparency regarding the costs of healthcare services in their network.
The new law 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 shop-able, 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. This is Public Chapter 407, effective May 21st, 2019.
The General Assembly is encouraging the expansion of Multiple Employer Welfare Arrangement (MEWAs). A MEWA is a pool of two or more self-insured employers, in the same profession, who pool resources and contributions in order to provide their employees with healthcare benefits. These health insurance plans are a way for small Tennessee businesses to offer employee benefits outside of government-run health insurance by sharing risks and costs.
The legislation clarifies the means by which a MEWA is able to determine insurance rates. It authorizes MEWAs to use case characteristics, claim experience, health status, or duration of coverage since issuance in determining the initial or adjusted premium rates for such employers pooling their liabilities. This bill became law on April 23rd, 2019, Public Chapter 182.
As always, I am truly humbled and honored to be your voice on Capitol Hill. If there is every any issue I can assist with, please reach out to my office by calling 615-741-2190 or emailing me at email@example.com. I look forward to hearing your thoughts, ideas, concerns, and suggestions during the 111th General Assembly.