The uptick of legislative proceedings was palpable this week as numerous measures tracked by TMA’s government affairs team were up for consideration in their respective committees. Among them, efforts to eliminate vaccine requirements for children (SB2641/HB2452) and abolish the corporate practice of medicine doctrine (SB2919/HB2298).

As TMA lobbyists took a defensive stance on these proposals, they were simultaneously whipping votes for the association’s two remaining policy priorities: insurer clawbacks and the hybrid team-based care model. After months of negotiations and a plethora of amendments, both measures are set to be considered in the House and Senate committees next week.

Insurer clawbacks (SB2328/HB2076) by Sen. Ken Yager (R-Kingston) and Rep. Brock Martin (R-Huntingdon) will retain almost all of TMA’s original language, including requiring insurers to give advance notice (30 days) of intent to recoup and provide detailed information on the basis of recoupment; prohibiting insurers from recouping any monies before all appeals are exhausted; and prohibiting insurers from collecting the entire contested claim amount versus just the overpayment amount. In exchange, TMA has agreed to increase the timeframe insurance companies may clawback from the original language of six months to 15 months.

With the compromise firmly in place, TMA expects the measure to pass both the House Insurance Subcommittee and the Senate Commerce & Labor Committee when considered. The House bill will be taken up next Tuesday, March 19 at 12:00 pm CT. Senate Commerce will not be convening next week, but is expected to hold a hearing the following week.

The final TMA proposal yet to be considered this legislative session is the scope of practice bill, otherwise referred to as the hybrid team-based care model. Sponsored by Sen. Shane Reeves (R-Murfreesboro) and Rep. Ryan Williams (R-Cookeville), SB2136/HB2318 seeks to address some of the perennial concerns raised by nurse practitioners and physician assistants related to practice authority.

As amended, the bill modernizes the physician-led, team-based care model to give medical practices greater oversight flexibility for mid-level providers with over 6000 hours of post-graduate clinical experience. Under this new collaborative format, protocols would be less prescriptive and allow the collaborating physician and employer to determine the level of oversight needed based on each individual’s training, experience, and competence. For the first time, the scope of practice for these professionals would be codified, placing in statute their ability to diagnose and treat patients in collaboration with a physician, including ordering tests and durable medical equipment. Certain safeguards for these providers would be in place to protect patient care, such as requiring collaborative practice agreements to be with physicians in active practice in the same specialty, in addition to a strict truth-in-advertising provision that would prohibit NPs and PAs from using specialty medical designations in their practice name. The bill would not apply to mid-levels with less than 6000 hours of post-graduate clinical experience.

The bill language was crafted in consultation with the Coalition for Collaborative Care, a multi-specialty organization of physicians of which TMA is a member, as an alternative to full independent practice. While there is conceptual agreement by the PAs on most provisions, the Tennessee Nurses Association remains opposed to the bill.

The proposal will begin its journey through the legislative process next Tuesday, March 19, where it will travel through both the Senate Health & Welfare Committee and House Health Subcommittee. TMA is asking members to contact these committees to bolster support for a “yes” vote. Talking points are included in the call-to-action linked below.

MATURE MINOR DOCTRINE

 A bill that would grant parents “exclusive liberty” to direct the upbringing, education, health care, and mental health of their child is progressing through the legislature despite concerns about the unintended consequences.

As filed, SB2749/HB2936 by Sen. Ferrell Haile (R-Gallatin) and Rep. Jeremy Faison (R-Cosby) would prohibit healthcare professionals from treating, diagnosing, operating on, prescribing for, or administering any medication without the consent of the minor’s parent, including for psychological services. While the bill would not apply to a minor that is emancipated, needs emergency treatment, or in the armed forces/reserve, it would effectively eliminate the longstanding Rule of Sevens that dictates how physicians may treat consenting minors in all other circumstances.

Although similar measures have been introduced this session, this particular proposal has gained the most traction due to its sponsors. TMA, along with the Tennessee Chapter of American Academy of Pediatrics, have actively worked on amendatory language to mitigate potential harm for minor children who may be endangered due to familial abuse or neglect. The version that passed through the Senate Judiciary Committee last month included this provision; however, the House sponsor has yet to adopt it.

The measure is set to be considered in the Children & Family Affairs Subcommittee next Tuesday, March 19 where it is expected to advance with little difficulty. To become law, both the Senate and House version must be identical, necessitating that one chamber concur to the other. It remains unclear what the fate of the TMA amendment will be at that juncture.