[{"_1":2,"_112":-5,"_113":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76,88,100],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6661148,"mediaKeyId","2416668-09c94616d8ce69e78a68d237b58046d8","parentId",2416668,"title","Commerce & Insurance explains rate review, solvency oversight, PBM audits and mental-health parity findings","audioSeconds",1355,"startMs",2049000,"endMs",3404000,"viewUrl","/Search/View?dp=1&key=2416668-09c94616d8ce69e78a68d237b58046d8&start=2049&end=3404","thumbnailUrl","https://assets.pipeline.soar.com/2416668-09c94616d8ce69e78a68d237b58046d8/thumbnail_2049000.jpg","articleUrl","/articles/6661148/Tennessee/Commerce-Insurance-explains-rate-review-solvency-oversight-PBM-audits-and-mental-health-parity-findings","mediaUrl","https://secure.pipeline.soar.com/6661148-1c0a513d9b435f89a9647325234310a3/orig.mp4?Expires=1776508829&Signature=R80G3c0117IAv3pB47NuPWrE1Nb6d-rmdoNcKg~FZuIcbCu3jZclVVipyZag-M1rMEGTJWdl7UejJ32q3KlaRk-gF1gGmPYLJ~2KjkBJb4ovDDU8gMvrMq98LtRSqcruEYNpjBoKtU1qH73JHoD6tB6I6KReXgjHQM4ZM8rNYvsilLR3rZXumZWnsJmeZprXO0uX46c9QuCAxh3P5FS-xEqhndeNg2ZGI2G4LjO8jXpoxhOZuxfGdiwdH54Kb99LA7762mjJ9t81sQELzmIsTqmnYk6ARc28sFxYrdz94SpNk7EfZUDapTxMs01VxwAwz~HxOeM274T86Diw6YP3VA__&Key-Pair-Id=KUT5TJCACFTXG","author","TN House of Representatives","date","2025-02-27T00:39:21.317Z","article","Commissioner and senior staff from the Tennessee Department of Commerce and Insurance on Feb. 25 briefed the House Insurance Committee on how the state regulates insurance rates, solvency and market conduct, and on recent work on pharmacy benefit manager (PBM) audits and mental-health parity enforcement.

Commissioner (Department of Commerce and Insurance) said Tennessee’s insurance division handles about $75 billion in premium volume with roughly 28 personnel directly in the insurance division and emphasized state-based regulation through the National Association of Insurance Commissioners. He described Tennessee as a competitive, pro-market state that focuses on solvency and consumer protection.

Zach Crandall, director of the department’s policy analysis section, summarized rate- and form-review procedures. \"Prior approval means that any form or rate that an insurance company intends to utilize in this state for personal, property and casualty insurance and life accident health insurance must be submitted to the department and reviewed and approved by the department before they can utilize those,\" Crandall said. He noted the department receives over 5,000 submissions annually, reviews filings with a 12-person team and has up to 30 days to approve or object to a filing. He also cited Tennessee Code Title 56, Chapter 5, Section 103, requiring rates \"neither inadequate, excessive, nor unfairly discriminatory.\"

Trey Hancock, director of financial affairs, described solvency oversight: on-site exams at least every five years for domiciled companies and quarterly financial-analysis reviews. The department receives audited financial statements and other investment disclosures to monitor insurer solvency and to allow reciprocal reliance with other states.

Scott McAnally presented the department’s fourth annual mental-health parity report. He said complaints rose from four in 2023 to five in 2024 while filings objections remained at zero for a second consecutive year; one company under examination will include mental-health parity findings in its exam report later this year. Crandall and McAnally also noted new federal mental-health parity rules finalized in September 2024 and linked those rules in the report available on the department’s website.

Assistant Commissioner Bill Huddleston described consumer-facing work: consumer insurance services receives roughly 25,000 initial contacts annually and about 3,600 formal complaints across lines in the last year. The department said mediation and enforcement produced a record $17.5 million in restitution to policyholders last year.

On PBMs, the department said it has implemented regulatory steps under Public Chapter 1070 (2022) and has completed five PBM audits to date, planning five audits annually. The department has promulgated emergency rules for appeals processes and audit procedures and said it continues to use the statutory authority to audit PBMs and to pursue enforcement where warranted.

Committee members asked about consumer outreach, insurer examinations, the role of credit in underwriting and whether Tennessee’s actions could affect domicile decisions by insurers. Staff said ZIP-code-based proxy discrimination is prohibited by state law and that companies must justify underwriting factors with actuarial support; the department does not currently recommend restricting credit scoring statewide and would defer to the General Assembly if members pursue changes.

Committee members thanked the department and then moved to other business.","mediaType","Video","parentTitle","House Insurance Committee- February 26, 2025- House Hearing Room 1","oneSentenceSummary","Officials from the Tennessee Department of Commerce and Insurance briefed the House Insurance Committee on Feb. 25 about rate-review procedures, solvency monitoring, consumer complaints, PBM audits and the department’s mental-health parity report.","taxTitle","Insurance, House of Representatives, Committees, Legislative, Tennessee","taxId",35385,"location","Tennessee","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6661158,"House panel advances bill to let TennCare consider patients’ overall condition in medical-necessity reviews",533,1219000,1752000,"/Search/View?dp=1&key=2416668-09c94616d8ce69e78a68d237b58046d8&start=1219&end=1752","https://assets.pipeline.soar.com/2416668-09c94616d8ce69e78a68d237b58046d8/thumbnail_1219000.jpg","/articles/6661158/Tennessee/House-panel-advances-bill-to-let-TennCare-consider-patients-overall-condition-in-medical-necessity-reviews","https://secure.pipeline.soar.com/6661158-75924ae1c6de202fadd4a5d659e22368/orig.mp4?Expires=1776508829&Signature=SPCS8hF8hP9VWlDn6BsdLEjqfp0mrQZOqYPBSCV0jKw2ciJmt2DJi4XFrChSGtRfu5VmYYkM~mx7i9r7dvTEwKys1cA7iHM9NdBIEfS4nfiq05gPXjD93ql34Y5Lg0iU4wfENPZw5wwJZpqjX5MiJwYyAqwGlRa6fMmbzBgXbC4QTEZmzK2BHjyalFw~41qPX0I2aT~hjLkN3dK-mXZ3m7kx02vxQwTFRiaCjXQTjRFk613C2SA4Z4KPOkhufLmOFIK4xcYLNh7Xk2xiWludqU-dDRjUMuLu90Kg9~hPcRb4Te1jfmAI3Le3fQFwYBDR7qzCB8khqG104D4DwpuOGg__&Key-Pair-Id=KUT5TJCACFTXG","The Tennessee House Insurance Committee on Feb. 25 voted 18-0 to advance House Bill 0364, which would direct TennCare’s medical-review process to consider a patient’s overall condition when determining medical necessity and funding for services.

Representative Alexandra presented the bill and members heard emotional testimony from Mark and Jody Herod about their daughter, Emma, who suffered severe brain injury in 2016 and now requires 24-hour care, a tracheostomy, a feeding tube and nighttime ventilator support. Mark Herod said TennCare helped the family but that a later funding reduction removed nursing hours when Emma no longer met a single-hour threshold used in prior eligibility decisions.

\"We would not be here today without it,\" Mark Herod said of TennCare support. He told the committee that a 2023 court decision had left the family without relief, saying in the hearing that the judge ruled current law required a patient to be on a ventilator for 12 hours a night to preserve prior funding levels. The Herods and Representative Alexandra said the bill would let TennCare consider other clinical indicators, not only a single-hours-per-night ventilator threshold.

Under the bill’s language presented to the committee, the bureau making medical-necessity determinations would take into account a patient’s mobility and ability to turn, cognitive awareness and communication, need for constant nursing supervision, and need for ventilator or other life-sustaining equipment \"regardless of the number of hours per day the patient uses\" such equipment.

Representative Alexandra brought the family to describe the practical impact. Mark Herod told the committee that when TennCare reduced funding after Emma no longer used a ventilator for 12 hours nightly, \"that funding helped provide nursing care for Emma. By reducing the funding, we lost some of her nursing care.\" He described medical letters stating loss of nursing care could be detrimental.

Committee members asked no substantive questions before the roll call. The clerk reported 18 ayes and 0 nays; the bill was forwarded to the Senate Finance Ways and Means Subcommittee.

The bill would not itself change TennCare’s budget; it changes the criteria reviewers use when assessing medical necessity. Representative Alexandra said her intent was to require a comprehensive medical review so decisions reflect the patient's total needs rather than a single utilization metric.

The committee did not specify implementation dates or budgetary effects; TennCare would carry out any changes to its review procedures if the bill becomes law.

Votes at a glance: House Bill 0364 — motion carried 18-0; forwarded to the Senate Finance Ways and Means Subcommittee.

The committee returned to other items on the agenda after the vote.","The Tennessee House Insurance Committee on Feb. 25 voted 18-0 to advance House Bill 0364, which would direct TennCare’s medical-review process to consider a patient’s overall condition when determining medical necessity and funding for services.",{"_33":89,"_35":36,"_37":38,"_39":90,"_41":91,"_43":92,"_45":93,"_47":94,"_49":95,"_51":96,"_53":97,"_55":56,"_57":58,"_59":98,"_61":62,"_63":64,"_65":99,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6661143,"Insurance Committee roundup: four bills advanced, one rolled",1261,742000,2003000,"/Search/View?dp=1&key=2416668-09c94616d8ce69e78a68d237b58046d8&start=742&end=2003","https://assets.pipeline.soar.com/2416668-09c94616d8ce69e78a68d237b58046d8/thumbnail_742000.jpg","/articles/6661143/Tennessee/Insurance-Committee-roundup-four-bills-advanced-one-rolled","https://secure.pipeline.soar.com/6661143-887be08aa735ad8c37fc6a519ba38c8e/orig.mp4?Expires=1776508829&Signature=evSRrzim9j3rK~pele6L3iSgruARoSKWW~4Js5TYaMry4wMXPhEBrpnbtCEmxeTayd3JCxExdXqxbR0eo0-Q7g8ZhqVCzGTrD7KWMTNNBpBbSSiXxobVm7iovUf9IrDZtsyCMnP0MvI6kYiSL~sJKnDmCpf~xKnGTUskOn8J4DQYTf3WHKFVo9JV9U5JGC5caon-FLHxNWXQ3Rj-ATvDWE4~MBWgxiX-vaYBLWblCGQrdM7ur51-i7LNa4ZgacIa87py0PkWOQICmYU-f50oENBh1tc4J4j7PQMgejZ3BlVxxFwALAXELa9UhgdgyR7str5NJDpkYwmz2bn9xReZgA__&Key-Pair-Id=KUT5TJCACFTXG","The Tennessee House Insurance Committee handled several short items on Feb. 25 and recorded these actions:

- House Bill 0119: Sponsor described the bill as consolidating the cash-or-bond/certificate-of-bond process under the Department of Revenue so customers would deal with a single state department rather than two. Committee roll call: 18 ayes, 0 nays. The bill was forwarded to Calendar and Rules.

- House Bill 0329: Sponsor said the bill would permit Tennessee banks to access cost-effective health insurance through a multiple employer welfare arrangement (MEWA), modeled after a North Carolina arrangement established by the North Carolina Bankers Association. Committee roll call: 18 ayes, 0 nays. The bill was referred to the Government Operations Committee.

- House Bill 0161: Sponsor described the bill as a parity measure raising the limit on property-and-casualty insurers’ investments in foreign-owned assets from 1% to 20% to match the allowance for life insurers. Committee roll call: 18 ayes, 0 nays. The bill was forwarded to Calendar and Rules.

- House Bill 0018: The committee rolled the bill by one week (no vote recorded on the substance during this meeting).

All recorded roll-call tallies in the meeting were read by the clerk and reflect the committee’s votes as announced on the record.

Votes at a glance: HB0119 — 18-0 to Calendar and Rules; HB0329 — 18-0 to Government Operations; HB0161 — 18-0 to Calendar and Rules; HB0018 — rolled by one week.

The committee’s brief descriptions did not include detailed fiscal notes or sponsor-provided cost estimates during the meeting; those details would appear in committee files and subsequent analyses if requested.","The Tennessee House Insurance Committee on Feb. 25 took final or procedural action on multiple bills: three passed out of committee and one was rolled for a week.",{"_33":101,"_35":36,"_37":38,"_39":102,"_41":103,"_43":104,"_45":105,"_47":106,"_49":107,"_51":108,"_53":109,"_55":56,"_57":58,"_59":110,"_61":62,"_63":64,"_65":111,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6661152,"Committee approves amendment and advances bill to cover diagnosis and treatment for Klystra syndrome under TennCare",188,894000,1082000,"/Search/View?dp=1&key=2416668-09c94616d8ce69e78a68d237b58046d8&start=894&end=1082","https://assets.pipeline.soar.com/2416668-09c94616d8ce69e78a68d237b58046d8/thumbnail_894000.jpg","/articles/6661152/Tennessee/Committee-approves-amendment-and-advances-bill-to-cover-diagnosis-and-treatment-for-Klystra-syndrome-under-TennCare","https://secure.pipeline.soar.com/6661152-f892af02bd795a490a8fdfd5e8798868/orig.mp4?Expires=1776508829&Signature=aShez-URQKFOY4I7-Py1uwDiIguZP2mFcLo8fxi7bKqq8~j61MV6hP8gwobo9eidwI-Xx1xiTCOyOmgSWGV~wKLGnaszO~rPv-jU0VoLpkAUhcoBEDezY6dobl6TQcRCs6eaKokBpG5YeBpX4HoQZke3lQ~ixYsddvLbK53cAR~vycTlExsHbRSvhx3o2BfzBSKPK3XGikG1V5mtVwMcDuVtN7uNtVD8f~HbfyGhdfeLJAZr6c-RKMvnd7TFWQZ7uvfZI-gcprtGFsvyEhNJTGTwXvxrmSC3X~~NcVIb8GneK1lV2EzWgSTRlIvLk1nBy7-vjkFfErELt~gaMZwXAw__&Key-Pair-Id=KUT5TJCACFTXG","House Bill 0502 cleared the Tennessee House Insurance Committee on Feb. 25 after an amendment was attached and a roll-call vote of 17-0, sending the bill to Calendar and Rules.

Chairlady Littleton introduced the bill as a measure to authorize the TennCare division to provide coverage and benefits for diagnosis (including genetic testing) and treatment of Klystra syndrome \"in the same manner and in the same extent as the division provides coverage for autism and Down syndrome,\" according to her presentation.

Littleton told the committee Klystra is very rare — she said fewer than 1,000 diagnoses exist nationwide and eight cases are known in the United States, with two in Tennessee — and that affected families sought recognition of Klystra as its own diagnosis rather than being categorized under autism or Down syndrome.

\"They just want Klystra to be noticed and known as Klystra and not as Down syndrome or autism,\" Littleton said. She asked the committee to approve the amendment (number 003665); members agreed and then approved the amended bill by roll call.

The clerk reported 17 ayes and 0 nays. The committee recorded no further questions after the amendment was added; Littleton thanked the chairman and committee for their consideration.

Votes at a glance: House Bill 0502 (as amended) — amendment 003665 adopted; roll call 17-0; forwarded to Calendar and Rules.

The committee did not discuss funding specifics or implementation timelines during the hearing; the bill’s language instructs TennCare to provide coverage \"in the same manner and in the same extent\" as existing covered conditions if enacted.","House Bill 0502, as amended, passed out of the House Insurance Committee with a voice vote and roll call (17-0). The bill directs the TennCare division to provide coverage for diagnosis (including genetic testing) and treatment of Klystra syndrome in the same manner and extent as coverage for autism and Down syndrome.","actionData","errors"]

Article not found

Commerce & Insurance explains rate review, solvency oversight, PBM audits and mental-health parity findings

House panel advances bill to let TennCare consider patients’ overall condition in medical-necessity reviews

Insurance Committee roundup: four bills advanced, one rolled

Committee approves amendment and advances bill to cover diagnosis and treatment for Klystra syndrome under TennCare