HB 1866

On or after July 1, 2026, this bill prohibits a health insurance issuer that uses an artificial intelligence, algorithm, or other software tool for the purpose of utilization review or utilization management functions, based in whole or in part on medical necessity, or that contracts with or otherwise works through an entity that uses such an artificial intelligence, algorithm, or other software tool for such purpose s , from deny ing , delay ing , or modify ing healthcare services based, in whole or in part, on medical necessity unless the request for prior a uthorization for such healthcare services is reviewed by a licensed healthcare professional or healthcare provider. A determination of medical necessity must be made only by a licensed physician or a licensed healthcare professional competent to evaluate the specific clinical issues involved in the healthcare services requested by the provider by reviewing and considering the requesting provider's recommendation, the enrollee's medical or other clinical history, as applicable, and individual clinical cir cu mstances. As used in this bill, a "health insurance issuer"" includes an insurance company, a health maintenance organization, nonprofit hospital and medical service corporation, pharmacy benefits manager, third-party administrator, the TennCare program, the CoverKids program, the Access Tennessee program, or another plan managed by the health care finance and administration division of the department of finance and administration, or the state group insurance plans. REMEDIES This bill provides that a violation of the prohibition described above is an unfair claims practice, punishable as provided under the "" Tennessee Unfair Trade Practices and Unfair Claims Settlement Act of 2009, which authorizes the commissioner of commerce and insurance to bring an action in the chancery court of Davidson County to enjoin a violation and to enforce compliance. In addition to such remedy, an individual aggrieved by a violation may bring a private cause of action in a court of competent jur isdiction. If the court finds that a health insurance issuer violated this bill, then the court must award to the plaintiff a ctual damages, p unitive damages, and r easonable court costs and attorney fees. RULEMAKING This bill authorizes t he department of commerce and insurance to promulgate rules to effectuate this bill ."