CAPITOL HILL WEEK: Governor Haslam announces Tennessee Plan to reform Healthcare / Will not expand TennCare rolls

NASHVILLE, Tenn. –  Healthcare highlighted a very busy week on Capitol Hill, with Governor Bill Haslam’s announcement that he will not expand TennCare rolls under the federal Affordable Care Act.  The Governor, instead, said he is working on a “Tennessee Plan” to reform health care that leverages federal dollars to purchase private health insurance for Tennesseans without access to coverage. 

“Tennessee has shown the nation how to produce true reform in education, based on students’ results and educational outcome.  We’re beginning to do the same thing with reforming government service – again by measuring outcome and results rather than just years of service as a state employee,” Haslam said.  “I believe Tennessee can also be a model for what true health care reform looks like; reform that will take significant steps to save the state and the nation from the unsustainable path we are on now.”

Haslam’s plan, which takes on the critical issue of aligning incentives among users, payers and healthcare providers would:
• Leverage available federal dollars to purchase private health insurance for Tennesseans up to 138% of the federal poverty level who don’t have access to health insurance, which would translate to 175,000 more insured Tennesseans;
• Allow co-pays for those who can afford to pay something;
• Include a definitive circuit-breaker or sunset of the plan that could only be renewed with the General Assembly’s approval; and
• Reform the payment structure for providers so they are compensated for health outcomes, not just based on services performed.

“Governor Haslam offered a good solution, rather than expanding an unsustainable and broken plan,” said Senate Republican Caucus Chairman Bill Ketron (R-Murfreesboro).  “Unlike Washington, Tennessee has been working hard to control health care costs.  Hopefully, Washington will see our 20-year record of working through the problems we face with our healthcare system and agree to work with us on a plan that will truly be beneficial to improving healthcare outcomes in our state and that is financially sustainable over the long run.”

The governor will not ask the General Assembly for approval to accept the Medicaid expansion federal funds as he continues to work for the flexibility needed to implement his plan.

Major legislation to curb abuse of prescription drugs is approved in Senate Health and Welfare Committee

State Senator Ken Yager (R-Harriman) won passage of legislation in the Senate Health and Welfare Committee this week designed to curb the abuse of prescription drugs in Tennessee.  Yager said the bill is a result of “comprehensive and collaborative effort by citizens, legislators, law enforcement and medical professionals to enhance and tighten the regulations on prescribers and pain management clinics.” 
Senate Bill 676 is named the Addison Sharp Prescription Regulatory Act of 2013.  Addison Sharp was a resident of Knoxville, Tennessee whose young life was tragically cut short in 2012 by an overdose of prescription medication.  Since this tragedy, his family has been working with legislators, law enforcement and medical professionals to attempt to decrease the number of lives being taken by this growing epidemic. 

“Prescription drug abuse is at epidemic levels in Tennessee.  It not only adversely affects the public health, but the public safety and economy.  This legislation provides additional and useful tools to fight this scourge.”

Provisions of the bill would:
• Direct the Commissioner of Health to develop a standard of care on prescribing the most commonly abused prescription medications and provide this information to the various licensing boards who oversee prescribers; 
• Require two hours of training for medical professionals every two years on these guidelines and other pertinent requirements such as medicine addiction and risk management;
• Limit the dispensing of Schedule II-IV drugs to 30 days.  (The prescription may still be issued for 90 days, but this will limit it to a 30-day supply at a time);
• Require reporting to the Controlled Substance Monitoring Database by all prescribers who dispense at their offices; 
• Clarify the definition of manufacturer and wholesaler of drugs and require the reporting of the drug distribution; 
• Strengthen the definition of pain management clinics by closing a loophole in the law that has allowed some operators to avoid registration;
• Require a patient of pain management clinics to have a current and valid government-issued identification or health insurance card for monitoring purposes;
• Limit the medical director at pain management clinics to four clinics total; 
• Limit money order payments as method to reimburse pain management clinics for services to put an end to cash business; and
• Enhance the fine for violations on unregistered clinics to between $1,000 – $5,000 per day to substantially impact those who choose to operate illegally.
“The current fine is considered just the cost of doing illegal business for unscrupulous pain clinic operators,” said Yager.  “This will make the fines higher, while expanding who can be fined and the frequency of fines, to attack the problem of illegal operations in our state which contributes to our prescription drug problem.”

In other news on efforts to curb prescription drug abuse, Senator Yager led passage of Senate Bill 500 through the full Senate this week.  The bill clarifies Tennessee’s TennCare Fraud law to make it easier to prosecute in the jurisdiction where law enforcement authorities made the arrest.  The proposal also changes the phrasing in state law prohibiting “doctor shopping” to provide that a violation occurs when the TennCare benefits are used instead of when TennCare pays for the clinical visit or for the controlled substances.  Written to stop fraudulent use of TennCare benefits, especially in the case of controlled substances, this law ensures that a person who knowingly sells, delivers or aids and abets fraud will face a Class E Felony, which includes mandatory jail time. 

Legislation calls for reinstituting legislative system for placing party nominees on the ballot for U.S. Senate

The Senate State and Local Government Committee has approved legislation sponsored by State Senator Frank Niceley (R-Strawberry Plains) that would partially reinstitute a pre-1913 method to nominate candidates for U.S. Senate through the Tennessee General Assembly’s political party caucuses.  Niceley said the Senate Bill 471 aims to help roll back power in Washington that has taken place over the last century.

Before the Seventeenth Amendment was adopted, the original Constitution left selection of Senators to state legislatures.  The Framers of the Constitution desired two houses that could act as an internal check on each other. The U.S. House of Representatives was intended to be the popularly elected “People’s House,” while the U.S. Senate was supposed to represent the sovereign states.

“We’re the parent, and Washington’s the child,” Niceley said.  “But, what we have seen is the growth of massive federal power over the past century at the expense of the states.  This legislation just injects into Tennessee’s U.S. Senate nomination process the legitimate concerns of the Framers of the Constitution that senators should be ambassadors from state governments as a means to curb abuse of power by the federal government.”

The people would continue to have the right to elect their U.S. Senators in the general election.  The bill simply addresses the process of how nominees are placed on the general election ballot by Democrats and Republicans, which courts have left to the discretion of the states. 

Senate Tax Subcommittee approves legislation for small business tax holiday

The Senate Tax Subcommittee has approved legislation sponsored by Senator Jim Tracy (R-Shelbyville) that gives Tennessee small businesses a “Business Tax Holiday.”  Senate Bill 1293 would provide a refund for the total amount of state and local sales tax paid by small business owners to retailers for purchases made in conjunction with their operations during any one continuous 24-hour period between January 1, 2014, and June 30, 2014.

“This legislation is similar to the annual Sales Tax Holiday that is enjoyed by consumers in August on back-to-school items and clothing,” said Senator Tracy.  “It simply gives much needed tax relief to our small businesses.”

To receive a refund under this bill, a Tennessee small business must file a single application with the Department of Revenue by August 31, 2014.  The total amount of the refund may not exceed $5,000.  No purchases made using cash would be eligible for refund.

The bill applies to small businesses located in the state with total annual gross receipts of no more than $2 million averaged over a three-year period and that employs no more than 10 persons on a full-time basis. Those businesses under three years old may receive the refund if they have total gross receipts of no more than $2 million in the year immediately preceding application. If a business has been in operation for less than one year, such business must have projected total gross receipts of no more than $2 million for the year in which the application is made.

“Many small businesses have suffered over the past several years.  This legislation is a means to help them, while providing an economic incentive for them to invest in their business and the economic growth of our communities,” Tracy concluded.

Legislation offers scholarships to children of disabled veterans

Senator Mark Green (R-Clarksville) pushed Senate Bill 254 through the Senate Education Committee on Wednesday, creating a college scholarship program for the children and spouses of retired disabled veterans.  The legislation becomes active for the upcoming 2013-2014 school year for the dependents of veterans who have suffered a service-related disability and were honorably discharged.

As part of the Tennessee HOPE Scholarship Program, the new scholarships will be made available in the same amounts offered to current HOPE recipients.  Unlike traditional scholarship applicants though, dependents of retired disabled veterans will not have to meet usual academic standards necessary, specifically a 21 ACT or 980 SAT score and 3.0 grade point average.  In the case of veterans’ children, they must both apply and enroll in a postsecondary institution prior to their 27th birthday, after which they become ineligible for HOPE funds.  Students who receive the scholarship will still have to satisfy the usual academic requirements to keep funding.

“The State of Tennessee has an obligation to make sure veterans who suffer a disability in the line of duty are adequately taken care of, and that includes their families,” Sen. Green said.  “Many of these veterans lose their ability to support their families completely, and this bill provides both an incentive for education and a means to success for veterans’ spouses and children.”

The bill now goes to the Senate Finance, Ways, and Means Committee for approval before being voted on in the State Senate.

Legislation requiring ignition interlocks for all persons convicted of drunk driving is approved by Senate Judiciary Committee

The Senate Judiciary Committee approved key legislation this week to curb drunk driving which requires the use of ignition interlocks for all convicted drunk drivers.  In 2011, 257 people were killed in Tennessee in alcohol-related crashes, which is approximately 27% of all traffic fatalities in the state. 
Senate Bill 670, sponsored by Senator Mae Beavers (R-Mt. Juliet) decreases, from 0.15 percent to 0.08 percent, the breath or blood alcohol concentration (BAC) that is considered an enhanced offense for purposes of issuing a restricted driver license. The bill also requires the interlock device be capable of taking a photo, to ensure that another person does not provide the sample for a convicted offender.

Interlock devices are small pieces of equipment attached to the steering wheel of a car with a tube that the driver must breathe into in order to allow the ignition to start.  The newest ignition interlock technology makes it easier for courts to require DUI offenders to utilize the device, including cameras to ensure that the person tested is the correct driver. 

 “Ignition interlocks are critical to eliminating drunk driving, as 50% to 75% of convicted drunk drivers will continue to drive on a suspended license,” said Senator Beavers.  “According to the Centers for Disease Control and Prevention (CDC), requiring interlocks for all convicted drunk drivers saves lives and is effective in reducing drunk driving recidivism by 67%.”

In December, the National Transportation Safety Board (NTSB) and American Automobile Association (AAA) came out in support of requiring ignition interlocks for all convicted drunk drivers.  The NTSB’s recommendations follow the July 2012 enactment of Surface Transportation Reauthorization legislation, known as MAP–21, which includes a number of drunk driving reforms, including providing incentive grants to states that adopt all-offender ignition interlock laws.

“The average first offender has been on the road 80 times drunk before their first arrest,” said Millie Webb, Tennessee native and former President of Mothers Against Drunk Driving (MADD), who testified before lawmakers in favor of the bill.  “This lifesaving legislation is a solution to a deadly problem.”

In Brief….

College Scholarships — Senate Bill 194 by Senate Majority Leader Mark Norris (R-Collierville) passed the full Senate on final consideration on Wednesday to increase the number of post-secondary graduates in Tennessee.  This bill requires the Tennessee Student Assistance Corportation (TSAC) to administer a need-based grant program funded through an endowment for Tennessee citizens seeking an associate’s degree from the state’s public colleges or technology centers. It also gives the Treasury some additional investment vehicles to use for broadening scholarship opportunities for students.  The bill enables TSAC to transfer at least $35 million out of the existing fund for those investment purposes to serve more students and increase the state’s graduation rate.  

Tennessee Alternative Diploma Act – State Senators voted to approve the Tennessee Alternative Diploma Act on final consideration this week.  There are over 930,000 individuals over age 18 that do not have a high school diploma or a GED.  Senate Bill 105, sponsored by Senator Becky Massey (R-Knoxville), provides an alternative to the current GED diploma due to increased cost for the test and the new mandatory online format. Massey said a Task Force consisting of the Department of Education, the Department of Labor and Work Force Development, the State Board of Education, the Tennessee Higher Education Commission and the Board of Regents came up with a viable alternative that meets current requirements but is “portable, affordable and accessible.”  The implementation of the Tennessee Alternative Diploma Act will provide a means to improve economic development to have as many adults as possible qualify to pursue better employment opportunities.    

Increasing College Graduates — Graduating Legislation that would provide affordable access to quality post-secondary programs for working adults has been approved by the full Senate.  According to the most recent data, 20.8% of Tennesseans age 25 and over have some college but no degree.  Senate Bill 195, sponsored by Senate Majority Leader Mark Norris (R-Collierville), enables the state to partner with Western Governors University (WGU) to create an online, competency-based university that is geared to the 800,000 adult Tennesseans that have some college credit but didn’t graduate with an associate or four-year degree.  After a one-time investment in WGU Tennessee, the University will provide an effective means to address workforce needs in Tennessee without any ongoing cost to the state.  The Governor has set the goal of increasing the percentage of Tennesseans with a postsecondary credential from 32% to 55% by 2025. WGU Tennessee fills a critical gap in the state’s postsecondary landscape to help achieve that goal.

Cockfighting — The Senate Judiciary Committee has approved legislation which strengthens penalties against spectators and participants of cockfights.   Senate Bill 285, sponsored by Senator Bill Ketron (R-Murfreesboro), closes a loophole in existing law used by offenders to avoid prosecution by increasing penalties for being a spectator at any type of animal fight to a Class A misdemeanor, with a minimum $500 fine.    Currently, those who are charged with owning, possessing, keeping or training a rooster in Tennessee for cockfighting purposes face a Class A misdemeanor offenses which carries up to $2,500 in fines and a maximum of 11 months, 29 days in jail.  The legislation increases the penalties for the owners, trainers and promoters of cockfights upon a second or subsequent offense to a Class E felony, punishable by up to six years in prison and a fine of up to $3,000.  On the spectator side, currently it is a Class B misdemeanor to attend a dog fight and a Class C misdemeanor to attend a cockfight.  Animal fighting is now illegal in all 50 states and is a felony offense in 40 states.

Conservatorship – The State Senate gave final approval to legislation to tighten requirement on how emergency conservatorships are handled. Senate Bill 555, sponsored by Senator Doug Overbey (R-Maryville), establishes an explicit emergency conservatorship procedure which has been missing from current law.  Other needed protections in the bill include requiring notice of conservatorship within 48 hours and a review hearing within five days.  It also outlines that an emergency conservatorship which only could be ordered when a judge finds that the ward would be harmed if the conservatorship was not ordered.  In addition, the bill requires that more frequent financial reports are filed and that conservatorships be reviewed each year to determine if a ward still requires a conservator to handle their affairs. 

Veterans / Charitable Funds — A resolution seeking to amend Tennessee’s Constitution to allow 501 (c) (19) charitable veterans groups to raise funds, in the same manner as other 501 (c) (3) charitable organizations, has received final Senate approval.  Veterans groups were left out of the Constitutional Amendment approved by voters in 2002 that allowed charitable groups registered with the Internal Revenue Service as 501 (c) (3) organizations to conduct an annual fundraising event like duck races, cake walks, raffles and other games of chance.  Senate Joint Resolution 60, sponsored by Senator Rusty Crowe (R-Johnson City), requires that any funds raised by the games go to purposes that benefit the community, veterans or retired veterans.  It was approved by the 107th General Assembly and must receive a two-thirds plurality in the current 108th General Assembly. Upon passage in the House of Representatives, it then goes to voters in a statewide referendum in November 2014, where it must receive a simple plurality of votes cast in the race for governor. 

Classroom Discipline — The full Senate gave final approval to legislation this week that requires principals to suspend or expel students who cause bodily injury to a teacher, bus driver or other school personnel.  Presently, Tennessee law states a principal “may” suspend a student for a variety of reasons, including assault or violence against school employees.  Senate Bill 264, sponsored by Senate Education Committee Chairman Dolores Gresham (R-Somerville), authorizes school administrators  to suspend a student from school for using vulgar, obscene or threatening language toward a principal, a teacher, a school bus driver or other personnel at anytime on school property.  It also applies when such conduct is exhibited off school property if it includes a threat to the teacher of bodily harm.  The bill, however, makes the punishment mandatory when a student escalates to committing an act that results in bodily injury. 

State Legislators / Per Diem — Legislation that would end routine per diem payments for lodging for state legislators who live within 50 miles of Tennessee’s State Capitol Building was approved by the State Senate on Thursday.  Senate Bill 107, sponsored by Senator Ferrell Haile (R-Gallatin), only allows for hotel payment upon special circumstances like inclement weather as approved by the House and Senate Speakers, but receipts for the hotel stay must be provided.

Workers’ Compensation — Legislation to reform Tennessee’s workers’ compensation system is one step closer to passage after the Senate Finance Committee gave approval to the measure this week.  Senate Bill 200, sponsored by Senate Majority Leader Mark Norris (R-Collierville) and Senate Commerce and Labor Committee Chairman Jack Johnson (R-Franklin), would make the state more attractive to job creation, while protecting injured employees.  The bill aims to cut costs to businesses, create more predictability, improve the efficiency of claims management, simplify the physician selection process for injured employees and reduce benefit delays to workers. 

Mental Health  — Senate Bill 884 passed the Senate Health Committee Tuesday in its final day of business for the year.  Sponsored by Senator Joey Hensley (R-Hohenwald), the bill authorizes a surrogate to apply for voluntary admission for mental health treatment in the place of a patient for a maximum of 21 days, while also making medical records available for a surrogate.  After that period, either a petition for non-emergency involuntary admission by the surrogate or a voluntary admission by the patient is required for continued inpatient treatment.

Embryo / Legal Process — Senator Becky Duncan Massey (R-Knoxville) moved Senate Bill 473 successfully through the Senate Judiciary Committee, providing a legal process for embryo donors to transfer rights to an embryo to future parents.  Upon passage of the bill, “legal embryo custodians,” those who hold the full legal rights to an embryo, will be able to contract the relinquishment of rights prior to the inception of an embryo into a female uterus to future parents.  Written in accordance to guidelines from the American Society of Reproductive Medicine, the bill will both protect donors from future liabilities or complication and clarify the legal rights of future parents who choose in vitro fertilization.

Child Custody — Senator Becky Duncan Massey (R-Knoxville) also presented Senate Bill 749, which passed unanimously in the Senate Judiciary Committee.  The bill updates the standards that Tennessee courts use to decide child custody in the case of a parent with a disability.  The disability shall not create a presumption for or against awarding custody but may be a factor considered by the court.

Public Assistance / Education— Senate Bill 132 was approved in the Senate Health & Welfare Committee on Tuesday. The legislation, sponsored by Senator Stacey Campfield (R-Knoxville), would enable the state to garner the amount of Tennessee Assistance for Needy Families (TANF) funding a family received by 30% if a child is underperforming in school. The legislation would not apply to mentally handicapped children or children with learning disabilities. An exemption would also be granted if the parent enters a parenting class or shows involvement in the child’s schooling such as, enrolling the child in a tutoring program or attending parent teacher conferences. Currently, the bill is waiting to be placed on the Senate’s floor calendar for final consideration.

Photo ID / TANF Benefits — The Senate Health & Welfare Committee has passed legislation to create a summer study committee that would be charged with exploring the possibility of issuing photo identification cards to heads of households to use when purchasing goods with food stamps or TANF benefits. Senate Bill 948, sponsored by Senator Stacey Campfield (R-Knoxville), now heads to the Senate floor for final consideration.

TennCare Oversight — Legislation that would create a new TennCare Oversight Committee and require the TennCare program to go through its own sunset oversight process was approved by the Senate Health and Welfare Committee. Under current law, TennCare is audited with the Department of Finance. Senate Bill 1246, sponsored by Senator Joey Hensley (R-Hohenwald), would create two independent audits. 

HOPE Scholarship / Tennessee Students Overseas — The full Senate approved legislation to ensure that children of Tennessee citizens who are working overseas due to a transfer from a state headquartered business will have an opportunity to receive a HOPE scholarship.  Senate Bill 719, sponsored by Senator Rusty Crowe (R-Johnson City), does require these students to meet all the usual criteria in order to be eligible for the scholarship funds.

Infant CPR — State Senators voted this week to require hospitals, birthing centers, healthcare facilities and healthcare professionals that interact with parents or caregivers of a newborn to make available instruction concerning the appropriate use of infant cardio pulmonary resuscitation (CPR).  Senate Bill 665, by Senator Dolores Gresham (R-Somerville), is an effort to save infant lives.  The measure also provides for civil immunity for healthcare practitioners acting within the scope of their practice in making the information available. 

Cutting the Size of Government — Legislation aimed at cutting the size of Tennessee government has been approved by the full Senate on final consideration. Senate Bill 595 establishes the Office of the Repealer with the sole responsibility of making recommendations to the legislature in areas of government waste, duplication, and out-of-date regulations that should be removed from the law books. The office would be a one-time, four-year position funded by existing resources and will be housed under the Secretary of State.

Jobs / Government Regulations — The full Senate passed legislation this week that is designed to increase the number of jobs available to unemployed workers.  Senate Bill 35, sponsored by Senator Brian Kelsey, provides that no local government can impose on any business additional mandates regarding health insurance benefits, minimum wage requirements, family leave, or wage theft requirements that deviate from those required by state law.  According to a 2011 study by the Chicago Urban League, the jobless rate of African American teens was 42%.  Local government minimum wage regulations are a large contributor to that figure.  The bill, which has already passed the House of Representatives, now goes to the Governor for his signature.

Jails / Work Program — Senate Bill 524 won passage in the Senate Judiciary Committee Wednesday. The legislation, sponsored by Senator Janice Bowling (R-Tullahoma), requires any person convicted of a felony and sentenced to a local jail to be required to work in the jail’s work program. Currently, the inmates have the option of opting out of a jail’s work program. This legislation would incorporate participation in a work program into the violator’s sentencing. An inmate would be excluded from participating if the County Sheriff thanks he or she poses a security or escape risk, suffers from physical or mental health conditions, or if the county cannot afford to provide the security or transportation for the inmates sentenced to the work program.

Volunteer Firefighters — State Senators voted Wednesday to define “volunteer firefighter” for the purpose of workers’ compensation insurance.  Senate Bill 1174, sponsored by Senator Janice Bowling (R-Tullahoma), would make sure that all volunteer firefighters are able to be covered fully by both workers’ compensation insurance and medical benefits.


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