TN SB2010

Health insurers using AI, algorithms, or software tools 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 competent to evaluate the specific clinical issues, considering the provider's recommendation and the patient's medical history

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

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

Takes effect July 1, 2026 for enforcement purposes; Department of Commerce and Insurance may promulgate rules immediately upon enactment