TCA § 56-32-137 — Discrimination prohibited — Coverage not created
Managed health insurance issuers may not discriminate against providers based only on license or certification, and may not bar covered provider classes from network membership.
A managed health insurance issuer shall not discriminate with respect to participation, referral, reimbursement of covered services, or indemnification as to any provider who is acting within the scope of the provider's license or certification under state law, solely on the basis of the license or certification. In selecting among providers of health services for membership in a provider network, a managed health insurance issuer or other network shall not discriminate against a class of providers who provide services that are covered by the plan by prohibiting the class of providers from membership in the provider network. As used in this section, “class of providers” means licensed physician assistants as defined in § 63-19-102 , certified nurse midwives as described in § 56-7-2407 , and nurses in advanced practice as defined in § 56-7-2408 . This section shall not be construed as prohibiting managed health insurance issuers from including providers or classes of providers only to the extent necessary to meet the needs of the managed health insurance issuer's plan and its enrollees or from limiting referrals or establishing any other measure designed to maintain quality and control costs consistent with the responsibilities of the plan. This section shall not be construed as creating coverage for any service that is not otherwise covered under the terms of the managed health insurance issuer's plan. Acts 2001, ch. 88, § 1; 2002, ch. 554, § 1; T.C.A. § 56-32-237 . Code Commission Notes. Former part 2, §§ 56-32-201 — 56-32-238 , was redesignated as part 1, §§ 56-32-101 — 56-32-138 , by the code commission in 2008. Compiler's Notes. Former part 1, §§ 56-32-101 — 56-32-109 (Acts 1971, ch. 419, §§ 1 — 5; 1978, ch. 818, § 1; T.C.A., §§ 56-4101 — 56-4105; Acts 1981, ch. 202, § 1; 1981, ch. 262, § 1; 1983, ch. 374, § 1; 1985, ch. 354, §§ 4, 5), concerning health maintenance organizations, was repealed by Acts 1986, ch. 713, § 27. For provisions relating to health maintenance organizations, see this part.