Written by Curtis Johnson
Tennessee State Representative
Nashville, TN – The first session of the 110th Tennessee General Assembly adjourned on May 10th, 2017, after passing major legislation that will benefit Tennesseans for generations to come. This is Part 4 of a 12 Part report.
This includes a measure making Tennessee the first state in the nation to offer all adults without a degree tuition-free access to community college; a new law rebuilding a safe and reliable transportation network, while reallocating revenues to maximize taxpayers’ return on that investment; and a bill which provides a responsible path to improve access to broadband through investment, deregulation, and education.
Action in the General Assembly also included passage of a balanced budget which takes on no new debt, as well as legislation protecting the elderly, enhancing the state’s robust job growth, cracking down on crime, and boosting efforts as the fastest improving state in the nation in K-12 student achievement. Following is a report on key legislation passed this year.
This year’s action in the General Assembly saw a number of important changes made in health care, including allocation of $54 million in the budget for the fiscal year 2017-2018 to fully fund TennCare inflation and utilization growth. The budget also restored TennCare prior year cuts at $42.2 million.
Other bills passed by the General Assembly in 2017 aim to improve access and the quality of health care in Tennessee. In addition, legislation was passed making improvements to the state’s health care professions to better serve patients.
Medication Therapy Management
A major bill was approved by the General Assembly in 2017 which establishes a medication therapy management (MTM) pilot program to provide high quality, cost-effective services for TennCare enrollees. MTM is a group of services provided by pharmacists whose aim is to optimize drug therapy and improve therapeutic outcomes for patients. The program is particularly beneficial to patients who do not take their medication according to the prescribed timing, dosage, frequency, and directions.
Any situation when the patient does not take their medication according to one of these factors is referred to as medication non-adherence. It is highest among patients with chronic illnesses and results in an increased risk of side effects, adverse events, hospitalizations, disease state complications, drug-related problems, or even death. Direct costs of medication non-adherence to our health care system are estimated at up to $290 billion annually and are considered the largest fixable problem in health care today.
Other persons benefiting from the program include those who use several medications, have multiple health conditions, are taking medications that require close monitoring, have been hospitalized, or who utilize more than one pharmacy.
The MTM services will be delivered by Tennessee-licensed pharmacists practicing under a collaborative pharmacy practice agreement with prescribers within their routine scope of practice. They will work in consultation with patients, caregivers, prescribers, and other health care providers. Any cost savings realized by TennCare through this pilot program will be prioritized for use in expanding the administration of the MTM pilot program.
The new law modeled after similar successful programs in 17 other states. According to a U.S. Public Health Service report, pharmacist-provided services such as MTM have demonstrated an average return on investment of $3.00 to $5.00 in savings for every $1.00 spent.
Autism Spectrum Disorder
Legislation creating the Tennessee Council on Autism Spectrum Disorder (ASD) has been passed to initiate a dedicated committee focusing 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 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.
Legislation was passed this year to reduce the risk of preventable complications and death due to stroke by strengthening the state’s existing Stroke Registry. It requires 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 will 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 comes from the Tennessee Stroke Best Practices Task Force.
A State Task Force on Palliative Care and Quality of Life was created under a new law passed this year. The purpose of the legislation is to promote patient-centered and family-focused palliative care in the state.
Palliative care is an approach intended to improve the quality of life of patients and their families who are facing serious or life-threatening illnesses. It aims to prevent and relieve their suffering by means of early identification, impeccable assessment, and the treatment of their pain, physical, psychosocial, spiritual, and various other ailments.
The new law creates a nine-member task force charged with consulting and advising the Department of Health (DOH) on matters relative to the establishment, maintenance, operation, and outcome of palliative care initiatives.
Over the last decade, a multitude of studies have shown the benefits of palliative care, including improved quality of life, reduced patient and caregiver burden, and an overall reduction in total health care costs. Currently, 16 states have laws establishing these Advisory Councils, and an additional seven states introduced comparable bills during their most recent legislative sessions.
Pornography / Public Health
Pornography has been recognized as a public health hazard leading to a broad spectrum of individual and societal harms under a resolution passed by the General Assembly. The measure acknowledges the need for education, prevention, research and policy change at the community and societal level in order to address it.
The resolution particularly stresses the harm pornography poses to children due to advances in technology and the universal availability of the internet which has led to young children being exposed at an alarming rate. Twenty-seven percent of millennials reported they first viewed pornography before reaching puberty.
Internet safety is the 4th top ranked issue on the list of health concerns for U.S. children. Utah, South Dakota, and Virginia have all declared the pornography industry to be a public health crisis.
Senate Joint Resolution 35 / by Beavers, Haile / Status: Signed by Gov. on April 24th.
Legislation seeking to prevent suicide by providing training to medical professionals and others who are most likely to interact with troubled individuals passed this year, enacting the “Kenneth and Madge Tullis, MD, Suicide Prevention Training Act.” Studies indicate that not all professionals are properly trained in assessing, treating, and managing suicidal people, nor do they know how to refer them for proper treatment. This legislation addresses the need to implement effective training for the recognition of at-risk behavior and the delivery of effective treatment.”
The new law requires professional counselors, marital and family therapists, pastoral therapists, social workers, alcohol and drug abuse counselors, and occupational therapists to undergo suicide prevention training. It calls for the program to be in place by January 1st, 2020.
Professionals affected would then have exactly two years to complete the initial training required with follow-up training every five years thereafter. Likewise, any professionals joining the field after 2022 would have two years to complete the training with a refresher course following every five years after.
The bill is named after Dr. Kenneth Tullis, a survivor of seven suicide attempts and multiple addictions, is an award-winning psychiatrist specializing in mood disorders, addictions, psychological trauma, and suicide prevention. Tullis and his wife, Madge, organized and co-chaired Tennessee’s first-ever Suicide Prevention Conference. Together with the Tennessee Department of Mental Health and Developmental Disabilities, they founded the Tennessee Suicide Prevention Network (TSPN), which has become a model for other states.
Tennessee’s annual Hospital Coverage Assessment for the 2017-2018 fiscal year was approved, continuing the current 4.52 percent rate. The action prevents more than $1.2 billion in potentially catastrophic TennCare cuts from taking effect on July 1st, 2017. The assessment, which has saved Tennessee over $2.6 billion over the last seven years, is used to draw down federal funds available through a Medicaid match program approved by the Centers for Medicare and Medicaid Services (CMS).
The legislature has passed a new law implementing the Ground Ambulance Service Provider Assessment Act. It allows the state to receive additional federal dollars from Medicaid to be redistributed to the local private and public ambulance services for transporting patients covered by the program. The bill is expected to generate approximately $19.6 million in additional federal funds. The legislation has the support of the State Ambulance Service Association.
House Bill 879 / Status: PC 258 / Effective Date: For the purpose of rulemaking, this act shall take effect upon becoming a law on May 2nd, 2017. For all other purposes, this act shall take effect on July 1st, 2017.
Approval was given this year to legislation that excludes from the definition of marijuana a cannabidiol product which is approved as a prescription medication by the U.S. Food and Drug Administration (USDA). Tennessee law defines marijuana broadly to include all parts of the cannabis plant and any derivatives, even though oil and hemp are exempted.
Unlike the main psychoactive cannabinoid in marijuana, tetrahydrocannabinol (THC), cannabinoid oil does not produce euphoria or intoxication. This measure ensures that USDA-approved medications containing cannabidiol oil, which are used for a variety of medical conditions such as epilepsy, multiple sclerosis, Parkinson’s disease, and certain mental health disorders, are allowed under Tennessee law.
Drug Repository / Indigent and Uninsured
Legislation which sets up a repository program to help indigent or uninsured individuals who cannot afford their prescribed medications was approved this year. The new statute authorizes the DOH, in cooperation with the Board of Pharmacy, to operate a voluntary prescription drug donation repository program under which any individual, medical facility, or company may donate prescription drugs and supplies to help eligible persons.
For the donation to be accepted, the drugs must be in the original sealed or tamper-evident packaging and within the given expiration date. The donated prescription drugs include cancer and anti-rejection medications but would exclude any controlled substances. The donation must be inspected by a licensed pharmacist before being distributed to ensure it is not contaminated or misbranded.
The program calls for the donations of these specified prescription drugs and supplies to be made on the premises of a medical facility or pharmacy that has elected to participate in the drug repository program and meets the standards set forth under provisions of the act. A facility that receives donations may, in turn, distribute them to another eligible facility for distribution.
Because it is a donation program, the legislation provides civil and criminal immunity to donors or participants except in the case of gross negligence, willful misconduct, or bad faith. Experts believe most of the donations will likely come from long-term care facilities who throw them away to dispose of them.
House Bill 137 / Status: PC 392 / Effective Date: For purposes of promulgating rules, this act shall take effect upon becoming a law, the public welfare requiring it. For all other purposes, this act shall take effect on January 1st, 2018.
Drug Donation Repository Program / Nursing Homes
Likewise, the General Assembly voted this year to authorize a nursing home to participate in a drug donation repository program for prescription drugs that are not controlled substances. This new law also permits facilities to dispose of controlled substances and other prescription drugs by destruction using any means permitted by the Federal Drug Enforcement Agency.
Drug Use / Needle Exchange
Legislation which seeks to reduce the spread of HIV and Hepatitis C due to injection drug use has been approved. The new law allows the Tennessee DOH to identify and approve nonprofit companies to engage in syringe exchange at no cost to the state.
People who inject drugs not only imperil their health but that of their partners and offspring, not to mention the cost of treatment for the diseases. Needle exchange programs distribute clean needles and safely dispose of used ones, and also generally offer a variety of related services, including referrals to drug treatment and HIV counseling and testing.
Schools / Telehealth / Health care
Legislation was approved in 2017 adding health care services provided to a patient at a public elementary or secondary education school be subject to the definition of telehealth services for which health insurance entities are required to reimburse in a manner consistent with reimbursement for in-person encounters. In addition, it requires that schools be staffed by a health care services provider.
Schools / Addison’s Disease
The State Legislature passed a new law 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 the new law, any willing school personnel receiving the proper training may be permitted to aid a student in an adrenal crisis on a volunteer basis. The bill was brought to the legislature 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.
Schools / Opioid Antagonist
Legislation passed during the first half of the 110th General Assembly which calls on the State Board of Education (SBE) to develop guidelines to help ensure that every school in the state has an opioid antagonist on hand to counteract a life-threatening opioid drug overdose by a student.
The new law also requires each local education agency (LEA) implement a plan based on those guidelines. Schools will be authorized to purchase two doses if the medication is not available through donation. The opioid antagonist, Naloxone, is sold under the brand name Narcan, among others, and 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.
Legislation that ensures rule-making authority is provided to allow for the practice of “community paramedicine” and “mobile integrated health care” has been approved on final consideration. The new statute implements an act previously adopted by the General Assembly to allow paramedics to operate in expanded roles to provide routine health care services to underserved populations.
These are both emerging health care professions, and they are particularly important in rural parts of the state and even in some urban areas that are underserved.
Provider Stability Act
A new law which seeks to provide greater transparency between health care providers and health insurance payers was passed during the first session of the 110th General Assembly. The measure also limits fee schedule changes to once a year. Under measure, insurers must provide a 60-day notice of a material change in the insurance carrier’s provider manual reimbursement rule or policy, and a 90-day notice of any change to health provider’s fee schedule.
It requires insurance companies to identify and provide notice of any change they make to the provider’s fee schedule, including the effective date. The notice only applies to changes made in the carrier’s sole discretion and is applicable to increases and decreases in the reimbursement for services for a procedure performed pursuant to a provider’s contract with the carrier. The legislation gives health care providers more financial predictability and stability in their business.
Legislation updating Tennessee’s law regarding the relationship between advanced practice nurses and physicians has passed. The new statute defines the relationship to be one of collaboration, representing what is happening in health care currently.
Medical Licensure Compact
The General Assembly has enacted the “Interstate Medical Licensure Compact” to facilitate the expedited licensure of physicians in multiple participating states. Passage of the bill follows action taken on 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 measure could also address physician recruitment to reduce shortages by enabling physicians to work across state lines.