Insurance, Health, Accident - As enacted, enacts the "Stopping Health Insurers from Excluding Legal Decisions (SHIELD) Act." - Amends TCA Title 8; Title 56 and Title 71. Companion bill has been assigned Public Chapter Nu, the official text

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                             PUBLIC CHAPTER NO. 797

                                                    SENATE BILL NO. 2070

              By Watson, Stevens, Hensley, Bowling, Pody, Walley, Crowe, Harshbarger

                                           Substituted for: House Bill No. 2243

            By Brock Martin, Moody, Hill, Reneau, Hale, Capley, Grills, Hakeem, Renea Jones

AN ACT to amend Tennessee Code Annotated, Title 8; Title 56 and Title 71', relative to healthcare
          provider reimbursement.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:

          SECTION 1. This act is known and may be cited as the "Stopping Health Insurers from
Excluding Legal Decisions (SHIELD) Act."

          SECTION 2. Tennessee Code Annotated, Title 56, Chapter 7, Part 10, is amended by adding
the following as a new section:

          56-7-1022. Prohibition on penalizing providers for patient vaccination exemptions.

                    (a) As used in this section:

                             (1) "Exempt patient" means a patient, or· the parent or legal guardian of a
                    minor patient, who has declined a specific vaccination or series of vaccinations;

                             (2) "Health insurance entity" has the same meaning as defined in§ 56-7-109;
                    and

                             (3) "Quality measure" means a metric, standard, or benchmark used by a
                    health insurance entity to determine a healthcare provider's reimbursement rate,
                    incentive payments, bonus structure, star rating, or network participation status,
                    capitation rate, shared-savings distribution, or downside risk-sharing arrangement,
                    including, but not limited to, the Healthcare Effectiveness Data and Information Set
                    (HEDIS).

                    (b) A health insurance entity shall not calculate a final quality measure, quality rating,
          incentive payment, or reimbursement tier for a healthcare provider at the end of each
          measurement period that is used to calculate provider payments by including an exempt
          patient documented by a healthcare provider in the denominator of a vaccination-related
          metric.

                    (c) If a healthcare provider documents that a patient is an exempt patient in the
          patient's medical record and submits an electronic claim containing a standard diagnosis
          code indicating the immunization was not carried out, including, but not limited to, the
          International Classification of Diseases (ICD) codes Z28.0, Z28.1, or Z28.2, or such codes'
          equivalents in any subsequent revision of the ICD, then a health insurance entity must
          exclude the patient from the final calculation of the provider's vaccination rate performance,
          or any other quality metric derived from vaccination status, for the applicable measurement
          period.

                    (d) A health insurance entity shall not terminate a healthcare provider from a network,
          reduce a provider's reimbursement rate, or withhold an incentive payment, in whole or in
          part, because the provider retains exempt patients in the provider's practice.
SB 2070
                    (e) For purposes of timely reimbursement under § 56-7-109, a claim for

          reimbursement that is denied, reduced, or recouped by a health insurance entity in violation
          of subsection (b) or (d) is a clean claim, as defined in § 56-7-109, and is subject to the
          interest penalties and remediation requirements set forth under§ 56-7-109.

                    (f) A health insurance entity shall not downcode a claim or reduce a reimbursement
          level solely because:

                              (1) The patient is an exempt patient; or
                              (2) A preventative care standard was not met due to the patient's exempt
                    status.
          SECTION 3. The heading in this act is for reference purposes only and does not constitute a
part of the law enacted by this act.· However, the Tennessee Code Commission is requested to
include the heading in any compilation or publication containing this act.
          SECTION 4. This act takes effect July 1, 2026, the public welfare requiring it, and applies to
contracts entered into, delivered, amended, or renewed on or after that date.

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         SENATE BILL NO. 2070

PASSED:  Apri I 2, 2026

         ~ t2.--.).~ ""-- ..."~ RANIJY~cNALLY

                                       SPEAKER OF THE SENATE

                                                ...,..XTON, SPEAKER
                                                   'EPRESENTA TIVES

APPROVED this ;2_/-S+- day of /Jpr,-(           2026

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                            BILL LEE, GOVERNOR