Capitol Hill Week for February 24, 2017

State Senators hear testimony on the changing national landscape of healthcare

NASHVILLE — Senate Committees worked at “full steam” this week as state senators examined the budgets of 11 agencies and departments of state government and approved a number of important bills.  The budget hearings, which will continue through March 16, are part of the process of reviewing how taxpayer dollars are spent to examine whether taxpayer money is being used efficiently and effectively to meet the state’s goals.  They also provide lawmakers with an opportunity to talk with state officials about a wide variety of important state issues.

Among agencies appearing before Senate committees this week were the Tennessee Division of Health Care Finance and Administration, which administers the state’s TennCare program, and the Department of Commerce and Insurance, which regulates the state’s health insurance industry.  Both agencies talked about the changing national landscape as Congress and President Donald Trump consider measures to revise, repeal and replace the Affordable Care Act (ACA), which is also known as Obamacare.

The federal government has steadily increased requirements on states in regard to populations and services that must be covered by TennCare, which serves the state’s Medicaid population.  These federal regulations block or severely limit a state’s ability to innovate and make changes designed to control costs or promote personal responsibility.

Tennessee Commerce and Insurance Commissioner Julie Mix McPeak told members of the Senate’s Commerce and Labor Committee that Congress should return as much flexibility as possible to the states to address their respective marketplace needs as they consider revisions to the ACA.  In the meantime, she stressed the need to stabilize the state’s individual markets by focusing on key areas that can provide immediate assistance like rating factors, essential health benefits, special enrollment periods and grace periods.

As President-elect of the National Association of Insurance Commissioners, McPeak could weigh in on proposals pending in Congress as she recently testified before the U.S. Committee on Health, Education Labor and Pensions.

McPeak also stressed the need for Congress to remain transparent and to engage stakeholders to minimize surprises in the regulatory system.  She said markets need clarity so that carriers do not exit markets in mass because they do not have an idea of what to expect in terms of regulation over the next several years.

Tennessee has seen rates steadily increase since Obamacare was implemented.  Approved rate increases ranged from seven to 19 percent in 2015, up to 36 percent in 2016 and have increased substantially for 2017.  In addition, a co-op that provided coverage from 2014 to 2015 had to be placed in receivership due to its instability to provide health coverage to enrollees.

Even with rate increases, Tennessee’s individual insurance market continues to struggle, McPeak said. Presently, the state has three insurance carriers, BlueCross BlueShield of Tennessee, Cigna, and Humana, offering policies on our Federally Facilitated Marketplace (FFM).  However, the future of Humana is in question after the insurer announced last week that it plans to stop selling insurance on the FFM in 2018.  The move particularly impacts the greater Knoxville area where no other insurers are present on the exchange.  McPeak said she is continuing talks with Humana in an effort to get the company to continue coverage.

In 73 of Tennessee’s 95 counties, particularly the more rural areas of the State, Tennesseans only have one insurer option. This is down from 2016 when the state had two carriers offering policies in all Tennessee counties.

“We are in a unique situation in that we are not just contemplating legislation in terms of its efficacy or how well it may or may not benefit the people of Tennessee, but we are also in a very uncertain landscape with regards to what’s going on in Washington,” said Senate Commerce and Labor Committee Chairman Jack Johnson (R-Franklin).  “We are in a situation where our constituents, through no fault of their own, have enrolled in insurance coverage through health care exchanges where they’re either being priced out of it or the carriers can no longer afford to take the losses associated with participating in the exchanges, so they’re pulling out. So, there is a new element of concern as we contemplate legislation over the next few weeks that impacts the health insurance market in Tennessee.”

Senate Transportation Committee approves vertical driver’s license for drivers under age 21 to curb underage drinking / Legislation enhancing Tennessee’s Driving Under the Influence (DUI) memorial signing program advances 

The Senate Transportation and Safety Committee approved legislation this week requiring all new drivers’ licenses issued to persons under the age of 21 in Tennessee be printed in a vertical format to help businesses easily identify those who cannot drink alcohol.  Senate Bill 384 would give drivers the option to change their license to horizontal upon turning age 21 for the reduced cost of a duplicate license.

Presently, a tiny red bar along the side of the photo on the license indicates a person is under the age of 21.

“What this really addresses is underage drinking,” said Senator Massey.  “Excessive drinking is responsible for more than 4,300 deaths nationwide among underage youths each year.  Servers have found the small red bar presently on Tennessee licenses is hard to read, especially in high volume hours when a clerk or waiter is very busy.  This legislation will make it much quicker and easier to identify a person who is under the age of 21 to curb any unintentional mistakes that might otherwise occur.”

In 2016, there were 28 traffic fatalities in Tennessee with youth aged 15 to 20 years old measuring a blood alcohol level greater than .01 percent.  Reports also indicate that the percentage of young Tennesseans ages 12 to 20 who consumed alcohol in the past month was almost 17 percent.

It is unlawful to serve, sell or permit the furnishing of alcohol to anyone under the age of 21 in the state.  Tennessee made national headlines in 2007 when it became the first state to make store clerks card everyone who bought carry-out beer. The carding requirement for off-premise consumption was expanded in 2014 to include liquor and wine as part of the wine-in-grocery-stores law.

Massey said more than two-thirds of the states across the nation have vertical licenses for drivers under the age of 21.

The bill now goes to the Senate Finance, Ways and Means Committee for consideration before moving to the full Senate for a final vote.

The Transportation Committee also approved a bill which enhances the Driving Under the Influence (DUI) memorial signing program passed by the General Assembly last year.  The Tyler Head Law, upon request, erects and maintains memorial signs on the state highway system commemorating victims who died as a result of a DUI-related accident after an offender’s conviction.  The new law, however, inadvertently omitted the opportunity to erect a sign for victims when the offender also dies as a result of the crash.

Senate Bill 17, sponsored by Senator Kerry Roberts (R-Springfield), comes after the mother of Shadow “Shada” Brooke Lowe, who was a victim of a drunk driver, applied for a memorial sign and was denied due to the requirement that the offender, who was deceased, must be convicted.  This legislation closes the loophole to allow for these DUI victim’s families to have the opportunity to have a memorial sign erected in their family member’s honor.

Senate Education Committee approves two lifesaving bills

 Two bills which aim to save lives were approved by the Senate Education Committee this week.  Senate Bill 458, sponsored by Senator Mike Bell (R-Riceville), requires the State Board of Education (SBE) to develop guidelines to help ensure that every public school in the state has an opioid antagonist on hand to counteract a life-threatening opioid drug overdose by a student.  The legislation also requires each local education agency (LEA) implement a plan based on those guidelines.  Schools would then be authorized to purchase two doses if the medication is not available through donation.

The opioid antagonist, Naloxone, which is sold under the brand name Narcan among others, is a safe medication used to block the effects of opioids, especially in overdose.  The life-saving medication may be administered through a nasal spray or injected.

“This medication, which is already being used in emergency rooms and by first responders, can save lives if administered timely,” said Senator Bell.

The bill now goes to the Senate Finance, Ways, and Means Committee for consideration.

Similarly, committee members approved a bill which authorizes school personnel to inject medication for adrenal insufficiency to a student with Addison’s Disease who is experiencing an adrenal crisis. Addison’s disease is a life-threatening illness that prevents a person’s body from creating hormones that help it respond to stress.  An adrenal crisis can be triggered by an injury, surgery, infection or emotional stress.  Death may occur without immediate treatment.

Currently, only school nurses are authorized to administer these injections, but under Senate Bill 117, any willing school personnel receiving the proper training may be permitted to aid a student in an adrenal crisis.

“In this bill the LEA is only required to train personnel when the LEA is notified by a parent or guardian that a student has been diagnosed with adrenal insufficiency,” said Senator Richard Briggs (R-Knoxville), sponsor of the bill.  “I do want to emphasize that this is voluntary and no one will be forced to do something they don’t feel comfortable doing.”

The bill was inspired by the Adzima Family and their son, Landon, who testified before the committee about the student’s near-death experience while at a wrestling tournament. The coaches saw the importance of being able to help in this kind of emergency situation in the future but current policy prohibited their assistance. In the absence of a school nurse, there is no backup plan to aid these students when a crisis occurs.

Letters of support from Landon’s doctor were presented to the committee stating that non medically-trained personnel are able to learn how to administer the injections and no harm can come from the wrong dosage or application of this drug.

The bill now goes to the full Senate for final consideration.

In Brief..

Campaign Finance — Legislation advanced in the Senate State and Local Government Committee this week requiring that campaign funds be deposited into a traditional bank or credit union insured by the FDIC.  Current law allows campaign funds to be invested in a private or publicly traded company, causing ethics concerns and a gap in transparency in the state’s campaign finance laws.  Under Senate Bill 377, sponsored by Senator Doug Overbey (R-Maryville), any investment not authorized would be prohibited and the candidate, or in the case of a multicandidate political campaign committee, the treasurer, would be subject to a civil penalty by the Registry of Election Finance of not more than $10,000 or 115 percent of the amount invested.

Domestic Violence — The Senate Judiciary Committee heard heart-wrenching testimony this week from Danny Hensley, father of Leigh Ann Hensley, who was murdered 15 years ago in an act of domestic violence by her former boyfriend.  Hensley was joined by Judge Mike Hinson and Police Chief Sam Livingston in support of Senate Bill 1149 which would strengthen the state’s laws regarding orders of protection.  Hensley and Hinson told committee members that many cases of domestic violence could be avoided if stronger penalties for a knowing violation of an order of protection are put into place. Hinson called for an automatic injunction until the violator appears in court.  He also advocated no contact orders should be given for victims, as well as their perpetrator, to reduce the opportunity for violence.  Tennessee is ranked among the 10 worst states for domestic violence.  Action of the bill, which is sponsored by Senator Joey Hensley (R-Hohenwald), was deferred for two weeks while amendatory language to the proposal is drafted.

Medical Licensure Compact — Legislation which would enact an “Interstate Medical Licensure Compact” to facilitate the expedited licensure of physicians in multiple participating states advanced through the Senate Government Operations Committee this week.  Senate Bill 595, sponsored by Senator Bo Watson (R-Hixson), follows the passage of similar compacts, including those involving nurses and physical therapists, which increase easier access to care.  One of the reasons for the development of the compact includes telehealth and its expanding technologies which cross state boundary lines.  Telehealth is particularly important to rural areas where there is a shortage of physicians.  The legislation could also address physician recruitment to reduce shortages by enabling physicians to work across state lines.

January Revenues – The General Assembly received good news this week about Tennessee’s tax revenues for the month of January.  Finance and Administration Commissioner Larry Martin announced that overall January revenues, driven by a very large one-time franchise and excise tax payment, were $1.4 billion. Total revenues were $169.1 million more than the state budgeted and 10.54 percent more than revenues received in January of last year.  On an accrual basis, January is the sixth month in the 2016-2017 fiscal year.   Year-to-date revenues were $524.6 million more than the budgeted estimate.

Convention of States — The Senate Judiciary Committee approved a resolution on Wednesday that appoints commissioners to the planning convention for a prospective Article V convention for the purpose of adopting a federal balanced budget amendment.  Article V provides that upon the application of two-thirds of the state legislatures, Congress shall call a convention of the states to propose amendments to the U.S. Constitution.  The Tennessee delegation for the planning convention would be Senate Government Operations Committee Chairman Mike Bell (R-Riceville), Senate Judiciary Committee Chairman Brian Kelsey (R-Germantown), Senate Republican Caucus Chairman Bill Ketron (R-Murfreesboro), Representative Sheila Butt (R-Columbia), Representative Dennis Powers (R-Jacksboro), Representative G.A. Hardaway (D-Memphis) and Representative Jay Reedy (R-Erin).  Senate Joint Resolution 48 also provides an oath for the commissioners to take to ensure discussions are limited to the planning of the convention, including recommendations for rules and procedures, and the initial date and location in which it would meet.  The resolution follows Senate adoption of Senate Joint Resolution 9 which makes the initial call for a convention of states in Nashville on July 11, 2017.  The convention would be the first formal meeting of the states since 1861.

Autism Spectrum Disorder – The full Senate has approved a bill designed to help those affected by Autism Spectrum Disorder (ASD).  Senate Bill 199 creates the Tennessee Council on Autism Spectrum Disorder – a dedicated committee that will focus solely on aiding those with special needs and their families.  Along with establishing a long-term plan for a system of care for individuals with ASD, the Council will also make recommendations and provide leadership in program development regarding matters concerning all levels of ASD services in health care, education, and other adult and adolescent need areas.  The Autism Society currently estimates that about one percent of the world population has ASD, affecting over 3.5 million Americans. The organization also notes that Autism Spectrum Disorder is the fastest growing developmental disability in the United States.  The legislation is sponsored by Senator Doug Overbey (R-Maryville).

Stroke Centers — Legislation which aims to reduce the risk of preventable complications and death due to stroke passed the Senate Health and Welfare Committee this week.  Senate Bill 544 comes from recommendations from the Tennessee Stroke Best Practices Task Force.  The legislation strengthens the state’s existing Stroke Registry by requiring all certified comprehensive and primary stroke centers to share blinded data with the registry in order to compile a complete report on stroke care in Tennessee. The data would enable health organizations to study the fifth highest killer of Tennesseans in depth, including best practices for treatment.  It will also provide evidence to allow hospitals and Emergency Medical Services (EMS) agencies to apply for federal level grants.  The legislation is sponsored by Senator Bill Ketron (R-Murfreesboro).

Education Efforts — Tennessee Education Commissioner Candice McQueen testified before the Senate Education Committee this week as members considered her department’s budget for the 2017-2018 fiscal year.  McQueen listed the department’s “big goals” which includes the state: ranking in the top half of state on the National Assessment of Educational Progress (NAEP) by 2019; raising the average ACT composite score to 21 by 2020; raising the state’s post-secondary graduation or certification rate to a majority of high school graduates from the class of 2020; and to have 75 percent proficiency in reading by third graders by 2025.  In order to accomplish this task, McQueen listed numerous steps the department is taking to raise education attainment in Tennessee.  Among these steps is a major effort to engage stakeholders.  The department has received input from over 2,000 stakeholders from May to November, which includes dozens of listening sessions and informational meetings with teachers, parents, community members, advocates and legislators.  In addition, the department has six working groups with 67 members across the state which are tackling challenges facing Tennessee students.

Student Assessments – Commissioner Candice McQueen told members of the Senate Education Committee that the department is working to reduce the number of student assessments.  The department is streamlining 3rd and 4th grade assessments, with up to 50 percent reduction in social studies and science test length and time.  The student assessments will report student results for science and social studies with two performance levels, instead of four.  In the continuing review of the 11th grade End of Course (EOC) assessments, McQueen reported that the department is gathering data through three years of TNReady administration and will assess opportunities for reduction based on student outcome and evidence of redundancy.


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