After multiple weeks of advocacy and a coordinated lobbying effort, a proposal that would authorize psychologists to prescribe medication was stymied for the year.

The bill, SB911/HB996 by Sen. Ferrell Haile (R-Gallatin) and Rep. Brock Martin (R-Huntingdon), would have created a new license certificate allowing psychologists with post-doctoral masters’ degrees to prescribe medication under certain circumstances.

Among several witnesses who testified on the legislation, TMA member and President of the Tennessee Psychiatric Association, Dr. Michelle Cochran, voiced her opposition to the measure, citing concerns with limited training requirements and the potential for improper and over-prescribing.

Speaking directly on behalf of her specialty and the Coalition for Collaborative Care, Dr. Cochran pointed to alternative policy solutions intended to address behavioral health shortage and improve access to care in Tennessee, such as psychiatric collaborative care models (PCCMs), a proposal which is already progressing through the legislature and likely to pass this session.

While many committee members felt strongly that behavioral health access was an issue in Tennessee, they conceded that further discussion needed to be had before enacting legislation. The measure was subsequently referred to summer study for evaluation and negotiation outside of the legislative session. The procedural move means the issue of psychologists prescribing is effectively dead for 2025, though it is likely to re-emerge next session.

ABORTION EXCEPTIONS

TMA’s effort to clarify the medical necessity exception of the Human Life Protection Act (HPLA) is advancing, though not as originally intended.

Earlier this session, TMA filed a bill to codify the 2024 ruling of Blackmon v. State of Tennessee, a decision which outlined certain pregnancy complications that qualify as medical emergencies requiring termination in order to save a patient’s life or prevent irreparable harm. The proposal also sought to allow physicians to terminate pregnancies when fatal fetal anomalies are diagnosed.

Despite weeks of negotiations with stakeholders and legislators alike, the bill’s opposition proved insurmountable. In an effort to achieve some progress while simultaneously reducing ambiguity of Tennessee’s abortion laws, several core components of the legislation were adopted onto another caption bill.

As amended, SB1004/HB990 by TMA members Sen. Richard Briggs, MD (R-Knoxville) and Rep. Bryan Terry, MD (R-Murfreesboro) expands the list of affirmative defenses to criminal abortion to include inevitable abortions and terminations done to prevent serious risk of substantial and irreversible impairment of major bodily function. These terms are defined as follows:

• Inevitable abortion - “dilation of the cervix prior to the viability of the pregnancy, either by preterm labor or cervical insufficiency;”
• Serious risk of substantial and irreversible impairment of major bodily function– “any medically diagnosed condition that so complicates the pregnancy of a woman as to directly or indirectly cause the substantial and irreversible impairment of major bodily function, including:
  • Previable preterm rupture of membranes;
  • Inevitable abortion;
  • Severe preeclampsia;
  • Mirror syndrome associated with fetal hydrops; and
  • Infection that could result in uterine rupture or loss of fertility”

The language is nearly identical to that of TMA’s original bill save for one key provision: it does not include exceptions for pregnancy terminations done for fatal fetal diagnoses. While the omission of this component is disappointing for TMA’s larger objective, it does squelch the primary points of opposition and clears the way for successful passage. This progress, even if small, will help protect patients facing pregnancy complications and the physicians who care for them.

On Tuesday and Wednesday this week, the proposal gained unanimous approval in both the Senate Judiciary Committee and the House Population Health Subcommittee. Having overcome its biggest obstacles, the measure is expected to advance without issue. Once passed, the law will take effect immediately.

INQUIRIES OF GUN OWNERSHIP

On Wednesday, a bill aimed at limiting the ability for health care providers to inquire about firearms was deferred to 2026.

As introduced, SB474/HB387 by Sen. Janice Bowling (R-Tullahoma) and Rep. Ed Butler (R-Rickman) would prohibit health care providers from inquiring about patients ownership, possession of or access to firearms and ammunition, in addition to prohibiting them from denying treatment based upon the patient’s response. A practitioner who violates this prohibition would be subject to disciplinary action by his or her licensing board and a fine of $1,000 per violation.

The proposal cleared the House Health Subcommittee last week after adopting an amendment to exclude qualified mental health professionals, practitioners providing emergency services or transport and home health providers from its scope. The amendatory language also clarifies that health care providers may assess lethality risk of a patient if he or she poses a “credible, actual risk to themselves or others.”

Four physicians testified in opposition in the Senate Health & Welfare Committee, including TMA member and Assistant Professor of Pediatrics at Vanderbilt University Medical Center, Dr. Kelsey Gastineau. Each raised concerns that if passed, the law would inhibit his or her ability to protect children from preventable firearm injury and educate parents about safe gun storage. The panel denied that physicians exhibit bias toward patients who own firearms, and that these types of inquiries were simply generalized risk assessments akin to asking about domestic violence or safety in the home.

The group’s compelling testimony proved successful, prompting the sponsor to defer the bill to 2026. While not officially dead, no further action will be taken in the legislature’s upper chamber this year. The House companion bill is set to be considered in the House Health Committee on Tuesday at 1:30pm CT. TMA Legislative Committee member, Dr. Dale Criner, is scheduled to testify on behalf of the association.

TENNCARE REMEDIAL PAYMENTS

As the legislative session begins to wind down, discussions surrounding the budget begin to ramp up. Legislators on the Senate and House Finance Committees will soon commence discussions on which bills, capital investments and other budgetary priorities get funding for the upcoming fiscal year.

For months now, TMA has been actively lobbying for increased reimbursement for TennCare providers in an effort to protect network adequacy and offset practice losses. While the association’s legislative proposal, SB1372/HB651 by Sen. Bo Watson (R-Hixson) and Rep. Ryan Williams (R-Cookeville) has stalled for the year, TMA is pursuing a $100 million budget appropriation to give TennCare providers a one-time supplemental payment totaling 10% of their average TennCare reimbursement for fiscal years 2022, 2023 and 2024. The funds would be paid out of TennCare reserves and be allocated in the 2025-2026 fiscal year.

While end-of-session budget negotiations are largely an opaque process, TMA garnered support from both Senate and House leadership, including nearly every member of the Senate Finance, Ways & Means Committee. Though a decision is not likely for another few weeks, TMA will update members on the outcome of the budgetary request as more information becomes available.