The Tennessee Orthopaedic Society (TOS) remained actively engaged throughout the 2026 legislative session, advocating on several major healthcare policy issues impacting orthopaedic surgeons, patient care, and medical practice operations across Tennessee. From insurer accountability and prior authorization reform to scope of practice legislation and rural healthcare transformation, TOS maintained a strong presence at the Capitol while working to protect physician-led care and uphold high clinical standards.
Insurance Reform and Downcoding Remain a Top Priority
One of the most closely watched efforts this session involved legislation targeting insurer downcoding practices, prior authorization burdens, and claims transparency through SB 2155 / HB 2619. TOS strongly supported the bill, which aimed to require clinical review before downcoding claims, strengthen physician appeal rights, improve transparency in insurer payment practices, and establish additional protections surrounding prior authorization decisions.
The legislation gained considerable momentum in the House, advancing unanimously through the House Insurance Subcommittee, House Insurance Committee, and House Government Operations Committee. However, the Senate companion ultimately failed in the Senate Commerce & Labor Committee on April 7, 2026, by a narrow 5–4 vote. The House bill was later taken off notice in the Finance, Ways & Means Subcommittee, ending its legislative path for this session.
Although the legislation did not pass, TOS successfully elevated the issue of insurer accountability into a major statewide healthcare discussion. The organization has already begun preparing for the next legislative session and is working alongside physician partners, legislators, and stakeholders on a more targeted proposal focused on clinical review standards, transparency requirements, appeal protections, and safeguards against inappropriate or automated downcoding practices. Committee restructuring anticipated next session may also improve the bill’s path forward.
Athletic Trainer Legislation Advances with Clinical Guardrails
TOS also participated heavily in discussions surrounding athletic trainer scope of practice legislation through SB 502 / HB 658. The final bill recognizes athletic trainers as healthcare providers while authorizing certain expanded responsibilities, including the use of physical modalities, emergency rectal core thermometer administration, blood glucose monitoring, limited injection administration, wound closure excluding sutures or staples, and limited IV administration with appropriate training.
Throughout the legislative process, physician stakeholders, including TOS, worked to ensure the legislation maintained important clinical safeguards while supporting reasonable modernization of athletic trainer responsibilities. Amendments adopted by the House removed lidocaine from the list of authorized injections and established an effective date of July 1, 2026. The Senate later concurred with those amendments on April 16, 2026.
Importantly, the legislation explicitly states that athletic trainers are not authorized to practice medicine, osteopathic medicine, podiatry, chiropractic, physical therapy, or nursing.
TOS Monitors Podiatry Scope Expansion
TOS also remained engaged on podiatry scope of practice legislation through SB 2358 / HB 2021. The enacted law expands podiatric scope from treatment limited to the foot, ankle, and soft tissue structures below the distal tibial metaphyseal flare to now include soft tissue of the lower leg distal to the tibial tuberosity.
Governor approval came on April 7, 2026, with the bill becoming Public Chapter 675.
Throughout negotiations and legislative review, TOS worked to ensure the expansion maintained clear clinical boundaries and avoided inappropriate overlap with orthopaedic surgical care. The organization has indicated this area will remain under close observation moving forward.
Rural Health Transformation and CON Reform Reshape Healthcare Access
In addition to scope of practice issues, TOS monitored major healthcare delivery reforms tied to rural access and Certificate of Need (CON) modernization.
Tennessee is currently participating in the federal Rural Health Transformation Program, receiving approximately $206.9 million during Budget Period 1 to support rural healthcare access, infrastructure upgrades, workforce stability, technological modernization, and improved care delivery systems.
Related CON reform legislation, SB 1369 / HB 819, was signed into law on May 5, 2026. The legislation phases out CON requirements for acute care hospitals, satellite emergency departments, and cardiac catheterization services while shifting more oversight responsibilities to licensure standards administered by the Health Facilities Commission.
The final law also establishes additional requirements for acute care hospitals licensed on or after July 1, 2030, including TennCare participation obligations and charity care standards comparable to similarly situated facilities.
Looking Ahead
While not every legislative priority crossed the finish line this year, the Tennessee Orthopaedic Society played a key role in shaping healthcare policy discussions throughout the 2026 session. From insurer reform efforts and scope of practice debates to broader healthcare access initiatives, TOS continued advocating for policies that prioritize patient safety, preserve physician-led care, and maintain appropriate clinical standards across Tennessee healthcare.
With groundwork already underway for the 2027 legislative session, TOS plans to continue pushing for meaningful reforms surrounding insurer accountability, transparency, and patient access while remaining actively engaged in emerging healthcare policy discussions statewide.