TN HB1866

Health insurers using AI, algorithms, or software for utilization review cannot deny, delay, or modify healthcare services based on medical necessity unless a licensed healthcare professional reviews the prior authorization request

Medical necessity determinations must be made by a licensed physician or healthcare professional who reviews the provider's recommendation, enrollee's medical history, and individual clinical circumstances

Applies to insurance companies, HMOs, pharmacy benefits managers, third-party administrators, TennCare, CoverKids, and state employee group insurance plans

Violations constitute unfair claims practices; aggrieved individuals may bring private lawsuits and recover actual damages, punitive damages, court costs, and attorney fees

Takes effect July 1, 2026, for enforcement purposes; rulemaking authority takes effect immediately upon passage