Tennessee’s Provider Stability Act, which was supported by the Tennessee Medical Association and other healthcare advocacy organizations, takes effect January 1, 2019. The law contains important provisions ensuring transparency and fairness in provider contracting. 

            Under the Provider Stability Act, contracted healthcare providers are entitled to copies of their fee schedules with commercial health insurance carriers. Health insurers may either provide access to the fee schedules through a secure website or via e-mail within ten days after written request from a provider. In addition, unless an exception applies, commercial health insurance carriers are required to give providers at least 90 days advance notice before making changes to their fee schedules. Important exceptions to this provision include any changes in standard codes and guidelines, such as the Current Procedural Terminology (CPT)® codes maintained by the American Medical Association, any changes in fee schedules due to contractual escalator or de-escalator clauses, and payments made pursuant to values or quality measures explicitly described in the provider’s contract.  

            Commercial health insurers are also required to give contracted providers 60 calendar days’ notice prior to implementing a material change made in the sole discretion of the insurer to the insurer’s provider manual, reimbursement rules, and policies. Insurers are required to identify these changes through the use of bold print or a font or both, which must be at least as large as that used throughout the policy or manual, and through the use of a specially categorized communication to providers. Providers will receive such notices either through an Internet posting on a web-accessible section of the manual or policy, or through written communication to the provider’s dedicated e-mail address. 

            The Provider Stability Act does not apply in certain situations, including to enrollee’s benefit packages and coverage terms, contract amendments required by state or federal law, and contracts for the provision of services provided to Medicare Advantage and TennCare beneficiaries.  

The law’s protections are similar to those originally included in settlement agreements reached with several health insurers in class action multidistrict litigation filed on behalf of physicians and nineteen state and county medical societies, including the Tennessee Medical Association. Joe Whatley, Edith Kallas, and other attorneys with Whatley Kallas, LLP represented the physician class and the medical societies in the MDL litigation and negotiated the settlement agreements. 

NOTICE: This information provided in this article constitutes general commentary on the issues discussed herein and is not intended to provide legal advice on any specific matter or to create any attorney-client relationship.