HB 638

This bill prohibits a healthcare provider who participates in a medical assistance health benefit plan, including a provider participating in the provider network of a managed care organization that contracts with the bureau of Ten nCare to provide services under a medical assistance health benefit plan, from refusing to provide healthcare services to an enrollee based solely on the enrollee's refusal or failure to obtain a vaccine or immunization for a particular infectious or comm u nicable disease. This bill prohibits the bureau from providing reimbursement for a medical assistance health benefit plan to a provider who violates this bill unless and until the bureau finds that the provider is in compliance with this bill. However, this prohibition only applies with respect to an individual healthcare provider. The bureau must not refuse to provide reimbursement to a provider who did not violate this bill based on that provider's membership in a provider group or medical organizati o n with an individual physician who violated this bill. EXEMPTIONS This bill does not apply to a provider who is a specialist in oncology or organ transplant services. RULEMAKING This bill requires the director of TennCare to adopt rules necessary to implement this bill, including rules establishing the right of a provider who is alleged to have violated this bill to seek administrative and judicial review of the alleged violation. FEDERAL WAIVER This bill authorizes the director to seek such federa l waiver that the director deems necessary to effectuate this bill. ON APRIL 16, 2025, THE SENATE ADOPTED AMENDMENTS #1 AND #2 AND PASSED SENATE BILL 1389, AS AMENDED. AMENDMENT #1 changes this bill's prohibition against refusing services for an enroll ee based solely on the enrollee's refusal to obtain a vaccine or immunization. This amendment instead prohibits a healthcare provider who participates in a medical assistance health benefit plan, including a provider participating in the provider network of a managed care organization that contracts with the bureau of TennCare to provide services under a medical assistance health benefit plan, from refusing to provide healthcare services to an enrollee based on the enrollee's refusal or failure to obtain a vaccine or immunization if the enrollee, or if the enrollee is a minor, the enrollee's parent or legal guardian, has a religious or moral objection to the vaccine or immunization. This amendment adds the following to the subjects for which this bill req uires the director of TennCare to promulgate rules: (1) A process by which an enrollee, the parent or legal guardian of an enrollee who is a minor, or another person may report an alleged violation of this bill to the bureau; (2) An opportunity for the individual who reported the alleged violation to attend and provide testimony at a hearing, if any, conducted as part of the administrative and judicial review process established pursuant to the introduced bill; and (3) A process by which the indivi dual who reported the alleged violation may appeal a final decision rendered as part of the administrative and judicial review process. AMENDMENT #2 deletes the provisions of this bill that exempt oncologists and organ transplant specialists and authoriz e the director of TennCare to seek a federal waiver to effectuate this bill. ON APRIL 21, 2025, THE HOUSE SUBSTITUTED SENATE BILL 1389 FOR HOUSE BILL 638, ADOPTED AMENDMENT #1, AND PASSED SENATE BILL 1389, AS AMENDED. AMENDMENT #1 replaces this bill's rulemaking provisions, restores the exemptions for oncologists and specialists in organ transplant services, and adds an exemption for specialists who treating patients who are immunocompromised, including patients who are immunocompromised because of a d i sease or as a result of treatment for a disease. This amendment purports to amend provisions of this bill that were deleted by Senate Amendment #2.