2026 General Assembly Priorities and Legislative Update

2026 General Assembly Priorities and Legislative Update

The TN General Assembly is in full swing after convening on Jan. 13th. Governor Bill Lee is in his final year in office and his priorities this year include expansion of school freedom scholarships, immigration reform and implementation of the state’s successful $206M first year award from the federal government’s Rural Health Transformation Program grant. Committees are moving quickly and we anticipate most closing by late March for the budget negotiations to start in earnest. Anticipated adjournment is mid-late April.

It is an election year with the top race being for Governor. The two leading Republican candidates are U.S. Senator Marsha Blackburn and Congressman John Rose. The highest profile Democratic candidate at this time is Memphis City Councilwoman Jerri Green. The candidate filing deadline is March 10 for all state and federal races.

TRS 2026 Legislative Issues
1) Health Insurance Company Reform Legislative Package
a) THEMES- Downcoding prohibition; Prior Authorization Reform; TN Medical Specialty Review for AI Denials; Prompt Pay Reforms; Recoupments limitations; Network Adequacy Reporting and Enforcement at Dept of Commerce;

Network Adequacy Reform (TN Society of Anesthesiologists- led)
SB 2067 / HB 1930 – Sen. Bo Watson / Rep. Kevin Vaughan

● Requires insurance plans to meet minimum network standards and increases transparency regarding physician network deficiencies.
● Strengthens the regulatory complaint process with clearer timelines and enforceable penalties.

Patients First Act
SB 2155 / HB 2619 – Sen. Bo Watson / Rep. Dan Howell

● Prohibits insurers from downcoding claims, making unilateral contract changes without notice, engaging in ‘lasering,’ and outsourcing medical data outside the U.S.
● Requires human review of AI-processed claims, prevents discriminatory reimbursement based on provider licensure, limits insurer-provider ownership conflicts, and strengthens appeal rights.

Prior Authorization & Billing Reform (“TMA’s Big Beautiful Insurance Bill”)
SB 2550 / HB 2579 – Sen. Shane Reeves / Rep. Sabi Kumar

● Reduces burdensome prior authorization requirements and requires denials to be issued by a licensed physician reviewing the patient’s medical history.
● Prevents mid-treatment authorization barriers and prohibits downcoding without full medical record review.
● Ensures payment policies account for severely sick patients.

Patients’ Right to Know Act (THA- led)
SB 2554 / HB 2162 – Sen. Shane Reeves / Rep. Iris Rudder

● Holds insurers accountable by requiring reporting on denials, prior authorization practices, payment timelines, and audit activity.

Health Insurance Fair Practices Act (THA- led)
SB 711 / HB 1076 – Sen. Richard Briggs / Rep. Scott Cepicky

● Requires clinician oversight, disclosure of automated decision making, same-specialty review, and clear standards for payment timelines and audits.
● Ensures fairness while preserving the spirit of the managed care system.

Step Therapy Elimination for Cancer Patients
SB 2081 / HB 1956 – Sen. Bo Watson / Rep. Rebecca Alexander

● Ends ‘fail-first’ step therapy requirements for all cancer patients.
● Ensures timely access to prescribed cancer medications without insurer-mandated delays.

Biomarker Coverage for Patients
SB 435 / HB 484 – Sen. Shane Reeves / Rep. Brock Martin

● Mandates coverage of medically necessary biomarker testing supported by medical and scientific evidence.
2) Defending Physician Scope of Practice and maintaining collaborative care models.
a) Part of the Rural Health Transformation Grant application by Governor Lee included promises to increase scope of practice for NPs, PAs, pharmacists
and dental hygienists. The Administration is going to file legislation to do so but at this point, legislative leadership has strong hesitations and we will be actively opposing.
b) TRS serves as part of the Collaborative Care Coalition, made up of various specialties. We are working with that group against scope expansion for optometrists to do laser surgery and psychologists to prescribe.

3) Pushing for a TennCare Provider Rate Increase – We are supporting TMA-led legislation that would increase TennCare provider rates for targeted billing codes which would increase rates by $150M through designating a portion of the current MCO tax collected to support rates.

4) Remote Contrast Administration Supervision – This fall, TRS pushed for a rule change to allow for remote direct supervision of imaging personnel during contrast procedures. This change was approved by the Board of Medical Examiners through our advocacy and is now working its way through the rulemaking process (internal reviews, published, public comment, legislative govt operations review and approval, then will likely be finalized in late 2026.

There are two ways to contribute to the TN Radiologists’ PAC