Capitol Hill Week for February 9, 2017

Tennessee’s Stroke Registry Task Force reports on steps taken to implement a robust system of care to reduce risk of preventable complications and death

NASHVILLE, Tenn.Health issues highlighted this week’s action on Capitol Hill as members of the Senate Health and Welfare Committee heard a report from Tennessee’s new Stroke Registry Task Force about how to ensure the rapid identification, diagnosis and treatment of strokes.  The committee also heard from country music legend Randy Travis, who suffered a massive stroke in 2013, and his wife Mary, who came to support the Task Force’s efforts to implement a robust system of care to treat patients and reduce the risk of preventable complications and death.


Stroke is the fifth leading cause of death in Tennessee.  It is the leading cause of acquired adult disability which has a significant physical, emotional, and economic impact on patients, their family caregivers and the state’s health care system at large.  To address the high incidence, the General Assembly approved legislation sponsored by Senate Republican Caucus Chairman Bill Ketron (R-Murfreesboro), Health and Welfare Committee Chairman Rusty Crowe (R-Johnson City), Senate Majority Leader Mark Norris (R-Collierville), Senator Doug Overbey (R-Maryville) and Senate Finance Committee Chairman Bo Watson (R-Hixson) last year forming the task force.


“Tennessee needs a robust stroke system of care in place to treat these patients that starts at the community level with stroke risk factor recognition by our citizens and appropriate management,” said Dr. Brian Wiseman, a physician at the University of Tennessee Medical Center who chairs the task force.  “It also means that EMS (emergency medical services) need standardized protocols working with a network of stroke center hospitals that can deliver the most appropriate timely treatment for the best possible outcome of these patients. It also means post-acute care and rehabilitation.”


The task force’s recommendations include:

  • A Stroke Advisory Task Force made up of experts and key stakeholders to develop and recommend rules and regulations and report to health care facilities and emergency medical services boards to improve health outcomes;
  • Mandatory submission of data to the Stroke Registry housed at East Tennessee State University’s (ETSU) College of Public Health to analyze further the disease and best practices of care;
  • State-sanctioned designation of stroke centers denoting their readiness to accept and treat acute care patients, including a level one algorithm for comprehensive stroke centers, level two for primary stroke centers and level 3 for acute stroke-ready hospitals; and
  • Standardized destination guidelines for EMS personnel when transporting and identifying stroke patients in the field.


The standardized guidelines for EMS providers will help ensure that acute stroke patients are transported to centers that have endovascular clot retrieval capability which has proven most effective in treating patients with ischemic strokes caused by an emergent large vessel occlusion (ELVO).  Tennessee currently has 34 stroke centers. There are six comprehensive stroke centers, 27 primary stroke centers and one acute stroke-ready hospital across the state.


Randy and Mary Travis also spoke about the need for stroke awareness and expedient care.  “Expediting care is a vital aspect to caring for stroke patients and preventing permanent damage,” said Ms. Travis.  “Randy stared death in the face and death blinked. That’s why we are here today.”


The country music star was given only a one to two percent chance of survival after his stroke.


“You’ve brought so much joy to people with your music, but what you are doing right now saves lives,” said Senator Richard Briggs (R-Knoxville), who is a thoracic and cardiac surgeon.  “You can do more than all of us science and medical people by bringing awareness to this, and I want to thank you, but I think the song you’re singing now may be your greatest hit.”


Senate Health and Welfare Committee hears update on Tennessee’s overall health status


Dr. Randy Wykoff, Dean of East Tennessee State University’s College of Public Health, spoke to the Senate Health and Welfare Committee this week regarding Tennessee’s overall health.  According to the United Health Foundation, Tennessee ranks 44th in the nation based on 27 measures used to evaluate a state’s overall health.


Wykoff said that unhealthy choices are a key factor in the state’s low health ranking, with tobacco use, obesity and drug abuse accounting for some of the highest death rates in the behavioral categories in Tennessee.


Tennessee ranks 43rd in the nation for the use of tobacco, with 29.1 percent of adults still smoking compared to a national rate of 17.5 percent.  Linking the impact of smoking to the state’s economic health, Wykoff said that, if Tennessee could reduce smoking to the national rate, it would impact about 250,000 smokers and save about $600 million per year in annual health costs.


Similarly, Wykoff said approximately 33.8 percent of Tennesseans are considered obese which places the state at 42nd in the nation in obesity.  He said that if Tennessee had the national average obesity rate of 29.8 percent, approximately $300 million could be saved in annual healthcare costs impacting approximately 224,000 people.   As a result, Tennessee has a high incidence of diabetes with the state ranking 5th highest in the nation for the disease.


On prescription drug abuse, Tennessee ranks 49th in the nation in the number of painkiller prescriptions issued per hundred.  “The death rate associated with drugs is a national epidemic and perhaps worse here than anywhere else in the country,” Wynkoff said.


Wykoff also linked economic development and educational attainment to poor health outcomes among Tennesseans.  He urged lawmakers to continue advancing education and pushing for economic development improvements, as there is a huge life expectancy gap based on income.


He complemented the legislature for drastically changing the state’s ranking in education attainment, one of the factors used to determine the state’s overall health.  Tennessee has moved from the worst state in the nation for high school completion in 2005 to ninth best in 2016. “So, these things can change,” Wynkoff said.  “We have obviously had significant leadership from the legislature, and from the governor’s office over time to commit to education and we are seeing the impact of that.”


Further explaining the impact of poverty on health outcomes, Wykoff said that there is a five to seven year difference between the richest and poorest counties of Tennessee in life expectancy based on income alone.  “We will not be successful at improving health in our state until we have economic development, education, job creation and so on,” he said.


The General Assembly and Governor Bill Haslam have been very aggressive in improving education and job opportunities for Tennesseans over the past several years.


“Dr. Wykoff provides very valuable information to us each year, especially his emphasis on the need to encourage healthier behaviors to prevent premature death in our state,” said Senate Health and Welfare Committee Chairman Rusty Crowe (R-Johnson City).  “We are all very appreciative of his testimony.”


State’s new BEP Calculator makes Tennessee’s education funding more transparent and understandable


State Comptroller Justin Wilson appeared before the Senate Education Committee this week to explain his new educational tool that helps legislators, educators, stakeholders and citizens understand the state’s Basic Education Program (BEP).  The BEP, which provides education funding to K-12 public schools, represents a huge portion of the state budget totaling nearly $4.4 billion for the 2016-2017 fiscal year.


For years, the BEP has been calculated by the Tennessee Department of Education (TDOE) without any way to verify the results.  However, the Tennessee Comptroller’s Office has created a method to independently calculate and verify the BEP called the BEP calculator.  The purpose is to make Tennessee’s very complicated education funding formula as transparent and understandable as possible.


“It is in the best interest of all Tennesseans that the BEP formula be transparent, understandable, and verifiable,” said Comptroller Justin P. Wilson during his presentation before the committee.  “Although it is basic education, the BEP is not a basic calculation.”


The Comptroller’s Office of Research and Education Accountability (OREA) has reconstructed the entire BEP calculation from scratch using input data for student enrollment, unit costs, and other factors.  Details and dollar amounts for every school district in Tennessee can now be viewed and downloaded from the Comptroller’s website. Users can even create their own scenarios using different inputs – teacher salaries, insurance premiums, etc. – to see how fiscal changes impact BEP allocations.  The Comptroller has also created an interactive map where interested persons can easily view of snapshots of essential BEP facts and figures for each of Tennessee’s 141 school districts.


“The Comptroller is bringing transparency to the BEP formula by making the BEP Calculator available to all Tennesseans,” said Senate Education Committee Chairman Dolores Gresham (R-Somerville).  “This is an extremely valuable tool for Tennesseans to use to understand how tax dollars are spent on education, and I congratulate Comptroller Wilson and his staff for a job well done.”


The Comptroller’s independent calculation of the BEP found the Department of Education’s formula for fiscal year 2016-2017 was off by less than one one-hundredth of a percent. TDOE has indicated it will address the points the Comptroller’s Office identified for revision in fiscal year 2017-2018.


Senate Approves resolution calling for Convention of State

Judiciary Committee Approves legislation clarifying Tennessee’s Faithful Delegate Act


The Senate approved a resolution this week calling for a convention of states in Nashville for the purpose of planning a future Article V Convention. The convention would be the first formal meeting of the states since 1861.


Senate Joint Resolution 9, sponsored by Senate Judiciary Committee Chairman Brian Kelsey (R-Germantown), provides that the convention of states would be for the limited purposes of 1) planning for, and recommending rules and procedures for an Article V Convention to amend the U.S. Constitution and 2) recommending to Congress the initial date and location in which they would meet.  The legislation is co-sponsored by Senate Government Operations Committee Chairman Mike Bell (R-Riceville), Senate Republican Caucus Chairman Bill Ketron (R-Murfreesboro), Senator John Stevens (R-Huntingdon), Senator Rusty Crowe (R-Johnson City), Senator Frank Niceley (R-Strawberry Plains) and Senate Majority Leader Mark Norris (R-Collierville).


“It is time for states to step up and solve the problem with almost $20 trillion of national debt that has been amassed in Washington,” said Sen. Kelsey.  “The Tennessee Balanced Budget Amendment Planning Convention will create a structure for the Balanced Budget Amendment Convention and will address many of the unanswered questions as to how an amendment convention will function.”


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 resolution sets the date for a convention of states for July 11, 2017, with the Article V Convention following as early as November.


Presently, 28 of the necessary 34 states have passed the application resolution limited to proposing a balanced budget amendment.  The organizational structure for the Tennessee Balanced Budget Amendment Planning Convention will be virtually the same as the convention for proposing the amendment as each are a convention of the states. State legislatures will choose a delegation to represent the state at the convention, each state will have one vote, and the convention will deliberate and make recommendations.


Similarly, the Senate Judiciary Committee approved a bill sponsored by Sen. Kelsey this week that clarifies Tennessee’s Faithful Delegate Act of 2014.  The Faithful Delegate Act requires that in the event of a constitutional convention, the General Assembly would adopt a resolution and provide instructions to the delegates and alternates regarding the rules of procedure and any other instructions relating to the convention. The delegates would then be required to obey those limits or face immediate removal and a Class E felony offense for knowingly or intentionally voting outside the scope of the instructions.


If delegates are elected, Senate Bill 31 prescribes that the General Assembly shall appoint delegates and alternate delegates so that as near as is practical the three divisions of the state are equally represented.  Current law provides that two delegates must reside in different grand divisions of the state and that one of the two alternate delegates shall reside in the grand division not represented by the two delegates to the potential convention.  The bill now moves to the Senate Finance Committee for consideration before moving to the floor for final for a final vote.


In Brief..


Autism Spectrum Disorder — On Wednesday, the Senate Government Operations Committee approved a bill, sponsored by Senator Doug Overbey (R-Maryville), 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.


Capital Projects / Real Estate Strategy – Tennessee Department of General Services Commissioner Bob Oglesby came before the Senate Finance, Ways and Means Committee this week to present Governor Bill Haslam’s 2017-2018 capital budget plan and to talk about the state’s real estate strategy.  Commissioner Oglesby reiterated the department’s goal of creating and maintaining a fiscally responsible real estate portfolio that efficiently meets the needs of the state. Tennessee occupies approximately 10.1 million square feet of space in state-owned or leased buildings.  Oglesby said the department will continue to look for efficiencies to keep costs low.  Some of the capital projects highlighted by Oglesby, which are included in the governor’s budget proposal, are: $23.2 million for the School for the Deaf, $52.4 million for state parks, $10 million for the West Tennessee Veterans Nursing Home, $2.8 million for the East Tennessee State Veterans Cemetery Expansion, $8.5 million for the new Tennessee Highway Patrol Center in Knoxville and $29.5 million for a Multi-Agency Law Enforcement Training Center.  In higher education, the projects include $25.8 million for Motlow State Community College’s Rutherford County Teaching Site, $23 million for the East Tennessee State University Lamb Hall Renovation, $12 million for Walters State Community College Sevier County Campus Addition, $44 million for the University of Memphis Music Center, $79 million for Tennessee Colleges of Applied Technology statewide, $27 million for the Pellissippi State Community College Multi-Purpose Building, $126 million for the UT Knoxville Engineering Services Facility and $65 million for the UT Martin New Classroom Building (STEM).


Treasurer Report / Tennessee’s Consolidated Retirement System — The Tennessee Consolidated Retirement System (TCRS) is in a stronger financial position than most state pension plans according to State Treasurer David H. Lillard, Jr. who appeared before the Senate Finance, Ways and Means Committee this week.  The TCRS, which is recognized for fully funding the actuarially determined contribution, has been rated as one of the top five pension plans in the nation by credit agencies.  Treasurer Lillard outlined some of the challenges to the state’s pension plan which include a low earnings environment during the last two fiscal years and a greater life expectancy for retirees.  Tennessee has taken a conservative approach to financing pension costs utilizing a conservative investment strategy as opposed to states who have taken more risks in their portfolios.


Gatlinburg Wildfires – Senator Doug Overbey (R-Maryville) guided passage of legislation through the Senate State and Local Government Committee this week authorizing local governing bodies, by a two-thirds vote, to prorate real and personal property damaged by the November wildfires.  Senate Bill 114  is modeled after similar legislation which granted tax relief to victims of the 2010 floods in Nashville.  It is the first piece of legislation to be heard by lawmakers to help wildfire victims.  The legislation calls for prorating the 2016 tax assessment for a homeowner’s real property or business owner’s personal property, if the property was damaged as a result of a FEMA certified disaster between September 1, 2016, and December 31, 2016.  It would not become effective until approved by a two-third vote of the local governing body of the county and/or city in which the property is located.  If the tax computed for the 2016 tax year has been paid prior to the proration, the victim would receive a refund under the bill.  The legislation is retroactive to January 1, 2016.


Election Ballot – The full Senate has approved legislation making it easier for voters to locate local election candidates on the ballot in the midst of a presidential primary year.  Senate Bill 47, sponsored by Senator Becky Massey (R-Knoxville), calls for reordering the ballot to allow candidates for state, municipal and county election to immediately follow the names of the presidential candidates.  The names of presidential primary delegates would then follow.   The bill also increases the number of vertical columns for each respective party’s primary election on the ballot from two to three to help ease a voter’s search.  The legislation comes after a long list of delegates were listed on the 2016 presidential primary ballot, which was confusing to some voters wanting to access local election races.  The bill is pending action in the House of Representatives where it will be heard in the Local Government Committee next week.


FOCUS ACT / AppointmentsSenate Joint Resolutions 29, 30 and 32  passed on the Senate floor this week and Senate Joint Resolutions 31, 33 and 34  were approved in the Senate Education Committee  to confirm appointments to several  of the state’s university boards.  The appointments follow passage of the Focus on College and University Success (FOCUS) Act last year granting four-year state universities additional autonomy to empower each institution to be successful in improving student outcomes.


Honoring Tennessee Veterans — State Senator Rusty Crowe presented Senate Joint Resolution 76 on the Senate floor on Wednesday to honor and celebrate the sacrifices made by Tennessee’s veterans for their state and country.  The resolution coincided with “Veteran’s Day on the Hill” in which veterans from across the state come to the Capitol to meet with lawmakers and view the legislative proceedings.   The resolution expresses the State of Tennessee’s lasting debt of gratitude to all of these heroic Tennessee Veterans who have sacrificed so much to defend the lives and liberty of their fellow citizens.


Guides to Practice / Professions — Senate Commerce and Labor Committee Chairman Jack Johnson (R-Franklin) and Senate Government Operations Committee Chairman Mike Bell (R-Riceville) held a press conference this week to announce the introduction of new legislation to ensure transparency, full vetting and public input regarding “guides to practice” for all licensed professions in Tennessee.  Senate Bill 449 requires all professions which adopt guides to practice to promulgate rules subject to the state’s Uniform Administrative Procedures Act (UAPA).  Any rules or code of ethics developed or approved by a private organization or association must be adopted in accordance with the proposed law.  Under the UAPA, a hearing on the rules to formally adopt a code of ethics is generally held by the department of state government which governs the profession.  The rules draft is reviewed by the State Attorney General to determine its legality and constitutionality before moving forward to a hearing by the legislature’s Joint Committee on Government Operations where the public has an opportunity to comment.  Johnson said as a result of the proposed legislation, he will not pursue passage of Senate Bill 1 that would have required the State Board of Professional Counselors to promulgate their own code of ethics to be used for licensure requirements.  Presently, the state automatically accepts the code of ethics from a private organization headquartered in Alexandria, Virginia.


Tourism — The Senate Energy, Agriculture and Natural Resources Committee heard testimony this week from Tennessee Department of Tourist Development Kevin Triplett who presented the department’s budget and discussed the state’s efforts to improve tourism.    Tourism is currently the second largest of Tennessee’s industries, with an economic impact of $18.4 billion.  It generates 152,900 jobs for Tennesseans and produces $1.6 billion in state and local sales tax revenue.  Travel to Tennessee recently topped 100 million, achieving 101.3 million person stays, a first in Tennessee history. The department’s marketing activities promote Tennessee to vacationers in the United States as well as internationally. The department also operates 14 Welcome Centers along the interstate highway system in Tennessee.  The committee sent a unanimous recommendation to the Senate Finance Committee to approve the department’s proposed budget for the 2017-2018 fiscal year.


State Supreme Court — Tennessee Supreme Court Chief Justice Jeffrey S. Bivins spoke to the Senate Judiciary Committee this week regarding the successful state of our judiciary branch. He opened by commenting on how fortunate the State of Tennessee is to have three branches that can work in harmony with one another despite differences in opinion. He discussed the priorities of the court, which includes their efforts to be more transparent and available to the public. Tennessee is currently ranked ninth in the nation for accessibility to the court to citizens in the state.   Other accomplishments of the court include their award-winning SCALES program which has given 32,000 students the firsthand opportunity to see how the courts work. Chief Justice Bivins also spoke on the court’s volunteer program which aids victims of the Gatlinburg fires, as well as the new online tool that provides free legal advice to those who might not otherwise be able to afford it. This tool serves as a model for 30 other states. Tennessee’s Recovery Courts served as another area of emphasis by Bivins. These courts offer intensive supervision, substance abuse treatment services, and other incentives to address the unique needs of drug-addicted, non-violent offenders. A number of these courts also serve veterans and people with mental health issues.



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