4.16.21 TDC Weekly Public Policy Update

Blue background with white lettering that says the Coalition's Weekly Policy Update

As we race down the final stretch of the 2021 session, the Governor’s annual wrench, in the form of his Administrative Budget Amendment, has made its way into the machinery. It’s an expected wrench, it’s lobbed every year, but it gives lawmakers a stark window into the Governor’s legislative priorities. What bills will he fund? What projects get the go ahead? Just how large will the rainy day fund get? (The Sycamore Institute is on it) Now, it’s up to lawmakers who don’t find their legislation funded in the budget to toss some wrenches of their own by way of legislative budget amendments. It’s a wild dance, I tell ya. Notably, we at the Coalition are a bit disappointed with where our priority bills fell in the budget; namely, not in it (yet). We were expecting to see a raise to DSP wages that isn’t there yet, and the text-to-911 and Pharmacy Benefit Manager reform bills will unfortunately require budget amendments to find themselves into law. Read more budget thoughts here.  I look forward to seeing how the wrenches fall!

TDC Priority Bill Update


  • ID Death Penalty Bill – this bill modernizes the state’s definition of ID and provides a pathway for individuals sentenced to death to be evaluated for ID with this modern definition.
    • Compared to the long, toiling weeks of rolling down the committee calendar, this bill is on quite the actual roll: last week it passed the House Criminal Justice subcommittee, this week the House Criminal Justice full and Senate Judiciary committees. 
      • The bill is suddenly on to Calendar and Rules in both chambers, with huge floor votes on the horizon. 
    • We feel tentatively very probably pretty good about this bill – it passed through committees with only a couple dissenters and has the full force of the TDC family behind it.
      • And of course, the bill righteously protects the constitutional rights of people with disabilities from unconstitutional execution, so we’ve got that going for us.
    • It is possible the bill gets heard on the House and Senate floor next week – stay tuned and get GRASSROOTS ENGAGED:
  • Health Benefit Plan Network Access and Adequacy Act – this bill establishes standards for the creation and maintenance of insurance networks and establishes processes that ensures people can obtain care and benefits at reasonable/in-network rates.
    • This bill has been the subject of a lot of discussion, a bevy of expert witnesses and numerous deferments over the past couple months – finally it is starting to have some movement. 
      • We like this bill because it asks the state to establish standards for health insurance networks that ensure access to care, either through adequate number of providers or through requiring in-network rates for networks without adequate numbers and/or types of providers.
    • The bill faces some significant hurdles in its reform effort – first, insurance providers don’t like it because it regulates network adequacy more strictly than Federal standards require; second, discussion has centered around whether this reform would result in actual savings for consumers; and third, it has a small fiscal note that would require a budget amendment. 
    • The bill will be heard in House Government Operations next Monday and in Senate Commerce and Labor on Wednesday.
  • Medical Necessity Definitions – this bill establishes a uniform, state-wide definition of “medically necessary” for the purposes of insurance coverage.
    • I haven’t given this bill a ton of policy update space, which doesn’t accurately reflect the importance of the bill. 
      • This bill essentially places significantly more authority into a physician’s or other health care provider’s opinion about the most prudent course of care for their patients,
        • Typically, health insurance providers can choose not to cover certain types of care, procedures or diagnostics because they don’t believe them to be “medically necessary”, even if that opinion is not shared by the doctor providing care. 
    • The bill hasn’t had much movement – it’s been rolled and rolled in the House, and last week, it was assigned to the first calendar of 2022 in the Senate Commerce and Labor committee. 

Other stuff next week:

Federal Updates

Last week, we talked a bit about changes to state 1115 Medicaid waivers around the country, and I promised to touch on some of the big changes happening in Tennessee. 

  • The first thing to know is that CMS approved Tennessee’s section 1115 TennCare III demonstration waiver, that established the state’s new, first-in-the-nation Medicaid modified block grant financing system.
    • CMS policy wonks sometimes call this the “aggregate cap”
  • Second, there are a number of unusual components (beyond the whole block grant thing) to TennCare III:
    • Normally, state waiver plans are approved for 3-5 years, Then, waivers must be evaluated, modified and resubmitted, and this includes a period for the public to comment to CMS
      • This one received a 10-year approval, meaning that the public doesn’t get to tell CMS how a never-before-used Medicaid financing plan affects the Tennesseans who receive the services until 2031
    • Tennessee gets to reap up to 55% of its “savings” when it does not spend the entirety of the block of money 
      • This could incentivize TennCare to use cost-cutting measures, such as reducing or eliminating services, establishing enrollment caps and lower provider repayment rates, in an attempt to capture “savings”
    •  Tennessee may also choose to limit access to certain prescription drugs
      • This is common in private health insurance plan, but never been done in Medicaid programs
    • The new plan does not address the “expansion gap”, or people earning less than 138% of the poverty level, who don’t qualify for TennCare or other ACA healthcare subsidies.
  • Finally, TennCare III overlaps with the department’s plan to “integrate” DIDD (Dept of Intellectual and Developmental Disabilities) services with TennCare.
    • The big one here is that it moves DIDD supports and services into Managed Care Organizations (MCOs).
      • Because “integration” is part of the TennCare III demonstration, this could be viewed as the first move in a series of cost-cutting measures
        • Until then, people can keep the same Waiver services they have now, but they will be provided by an MCO
        • They can keep the same providers, but MCO’s will now pay them
        • The MCO will continue to contract with Independent Support Coordinator (ISC) agencies
        • DIDD and TennCare have assured folks that they won’t change their services at all, but only up until Sept. 1, 2022.
          • Then, they can start to change whatever they want, and there won’t be a public comment period until 2031 to let CMS know how it’s working out
  • Overall, TennCare III and the TennCare/DIDD “integration” plan concern us greatly – it could lead to fewer services, less access to care and diminished quality of life for Tennesseans with disabilities. 
  • It’s also possible that the Biden Administration rescinds approval for TennCare III, undoing the whole waiver proposal 
    • But, GRASSROOTS, I suggest we don’t wait around to find out:

Media Highlights


  • Murfreesboro Post – HB1039/SB1402, which cuts in half the number of weeks Tennesseans can receive unemployment insurance, is slowly making its way through the General Assembly. Proponents say it encourages people to get the jobs that are out there, opponents say it stingy and doesn’t get at the root of unemployment.
  • The Chattanoogan – The new Tennessee State Library and Archives opened up on Monday adjacent to the Bicentennial Mall. I love a good library, and this one looks pretty darn nice.
  • Nashville Scene – local iconic music venue, the Exit/In, is in the middle of a real estate power struggle. After a GoFundMe fundraising campaign, the current owners were able to match the bid of AJ Capital (a group known for building luxury hotels), but did not win the bid. Now, there’s a grassroots effort to save the Exit/In from becoming Nashville’s latest shiny hotel – but is it too late?

Thank you for popping in, dear reader, and I hope you have the most wonderful of weekends. 

- Jeff