Happy January, TDC Family!
The session started this week! And where many of us Cordell Hullables feel dread at this point in the legislative cycle, this year I feel urgency. Our community has built a lot of momentum over the past few years, notching some important legislative wins (with a couple losses sprinkled in too, of course), and to me, it feels like that progress has only expanded the horizon for what we should be doing. As such, we’ve spent the last 8 months speaking to partners, advocates and self-advocates about our sense of urgency, and where we should be focusing our efforts, energy and capital. So this year, we’ve got an ambitious slate of bills to offer up, which of course means I’m gonna need a whole lot out of the GRASSROOTS, and a whole lot out of our elected officials (and TennCare and DDA). But fear not, TDC family; you’ve proven time and time again that you’ve got what it takes, and I’ll ensure that you’ve got all our tools at your disposal to make the difference. Onward!
Things to know this year:
- This is the first year of a 2-year session, meaning it’s all new (pretty much)
- Every bill that hopes to make its way to Governor Lee’s desk for a signature must go through the full bill process – here’s a video with a quick reminder about what that process looks like
- I’d expect north of 2,000 bills proposed this session – maybe even 3k!
- We’ve got some new faces this year – 9 new Representatives in the House, and 3 new Senators in the other chamber
- A fond farewell to Good Friends and former Representatives Darren Jernigan and Sam Whitson, and a less fond farewell to a few who shall not be named here
- We’ve also got some new places this year! Speaker Cameron Sexton shook up the committee structure and chairmanships for the 114th
- Representative Mark White now chairs the broadly titled “Education Committee” (last year, it was the Education Administration Committee, which is now a subcommittee)
- Representative Gary Hicks now leads the powerful House Finance, Ways and Means Committee after former Rep Patsy Hazelwood’s shocking loss in the primary in August
- This also elevates Rep Ryan Williams to chair the Finance Subcommittee
- Good Friend Rep David Hawk is out of the Health Committees, losing his chairmanship of the Health Subcommittee
- But, in the best news of the nascent session so far, Good Friend and Good Guy Rep Michael Hale leads the new TennCare Subcommittee!
- I’ll talk more about this in the future, but that means that TennCare (and their customer service, provider networks and 3rd party vendors) all get a white hot spotlight for review by House Representatives
- And every bill having to do with TennCare, of which we have several, must start in front of the TennCare subcommittee
- We’ve officially moved on from the days of billion dollar-plus surpluses, meaning the purse strings will remain just a bit tighter
- Our tax revenue collection is currently about $18 million behind expectations (which is only .2% shortfall so far)
- But don’t expect a windfall in revenue any time soon
- And to kick things off in controversial and adversarial fashion, the Governor has called for a Special Session starting January 27th
- The Special Session will be limited to bills related to universal private school vouchers, immigration and disaster relief.
The Important Stuff – 2025 TDC Priority Bills
- Caveats – it’s still early, and we still need sponsors for some of these, but this is a preview of our legislative slate this year, subject to change with the whims of the GA
- Freedom for Family Care Act – (aka Paid Family Caregiving: Part 1) this bill would prohibit TennCare for developing or implementing policies that discriminate against family caregivers in the employment of DSP’s
- The bill also requires TennCare to develop a “policy guide” to standardize the hiring procedures of family caregivers
- This is one that’s been a looong time comin’
- We hear interest in the concept and legislation on a near-daily basis, and have worked with dozens of advocates and partner orgs over the last year to refine our approach
- And, as the keen reader might note, this bill represents part 1 of a multipart effort to get TennCare to actually support family caregivers
- In part 2, we are looking to provide support, training and “test-out” opportunities to ensure family caregivers are paid the appropriate wage for the complexity of the work they do
- This one will be a big lift, mostly because despite protestations to the contrary, TennCare isn’t gonna like it
- Expect to hear “we already do this” many, many times from TennCare in the coming session
- And to be very clear – this is not a silver bullet, and this does not solve all the problems inherent to the waiver programs (like ECF)
- But it’s a start, and we think that it can help families in the now and in the future
- This one is priority 1A this year, so we will be sure to let you how you can plug in for the effort
- Because we’re going to need a lot of GRASSROOTS for this one
- However, step 1 is to place a hold on February 5th at 6:00pm CST for a “Paid Family Caregiver Campaign Kickoff Webinar”, which promises to be thrilling and informative
- TennCare Network Reporting Reform – this bill would require TennCare to collect and publish data about percent service utilization, appointment wait times and time between approval for a service and start of the service, broken down by county and waiver program
- I’m not going to lie to you and tell you this is a sexy bill, but this bill is priority 1B for a reason
- Below is a long, tedious explanation of why we need this bill and what it does, just to get that out of the way for ya
- In Tennessee, TennCare is responsible (along with the MCO’s) for developing and maintaining an adequate provider network
- Provider network: doctors, specialists, DSP agencies, etc. that enroll Medicaid members in a given state and provide care or service
- CMS is watching from DC, and requires that the state prove that its provider network is good enough for Medicaid members to access services
- To prove it, TennCare must demonstrate that providers are within a certain “time and distance” from Medicaid members
- Time and distance requirements vary by the type of provider and where you (Medicaid members) live
- For you fellow nerds out there who are interested: here are those requirements (link)
- And here is TennCare’s incomprehensible 2023 EQRO report on their time and distance network adequacy (link)
- Time and distance requirements vary by the type of provider and where you (Medicaid members) live
- TennCare scores very well on the EQRO report, indicating that it has a dense and easily accessible provider network, across a wide variety of specialties and geographic areas
- But both you and I know, dear reader, that it can be VERY difficult to access a provider and actually receive the care you’re promised
- This is because the “time and distance” standard obscures several important factors that contribute to this inaccessibility
- It does not account for providers that have one and only one Medicaid client
- Or are not taking new Medicaid clients
- Or are taking new Medicaid clients but the wait time is 18 months
- Or that don’t take out-of-area Medicaid clients
- And the list goes on to describe the inadequacy of this standard
- So this is a new standard for network adequacy, flipping from supply side (providers) to the demand side (Medicaid consumers)
- Instead of time and distance, TennCare would have to report on:
- Percent service utilization (the amount of services promised divided by the amount of services received)
- Appointment wait times
- Time between approval for a service and receipt of that service
- The above broken down by county, waiver program and some demographic information
- We believe this to be a more accurate depiction of the quality and density of a provider network and the accessibility of care and services for consumers
- Instead of time and distance, TennCare would have to report on:
- Once again, I’ve got a big caveat for you: this is again no silver bullet, and it doesn’t ACTUALLY change anything
- BUT, it does (likely) give us vital and persuasive leverage to get TennCare and the state to do something about the lack of available providers in the near future
- Like increase provider rates, provide provider bonuses for network inaccessible areas, pay to recruit new providers to the state, etc.
- BUT, it does (likely) give us vital and persuasive leverage to get TennCare and the state to do something about the lack of available providers in the near future
- This will be another one, given its complex and boring nature, that will require some big time GRASSROOTS involvement
- Because we have to make the abstraction of a lacking provider network more concrete and human
- And to do this, our lawmakers need to hear human stories about a lack of available providers, care and services, and what that means
- There will be many opportunities to engage here, I’ll keep you on speed-dial
- In Tennessee, TennCare is responsible (along with the MCO’s) for developing and maintaining an adequate provider network
- Katie Beckett Part A Wraparound Improvement Act – this bill would permit Part A families to utilize HCBS wraparound services funds using an HRA, similar to that in Katie Beckett Part B
- I have heard time and again that families enrolled in the KB part A program cannot functionally utilize the $15k offered to them to pay for wraparound services
- This is, in part, due to the fact that they must spend those funds through an MCO
- So, if you need, say, a specific type of diapers, you must:
- Get a letter of medical necessity
- Present it to the MCO
- Who will likely look for the cheapest alternative to that type of diaper
- Make you try it until you can show it doesn’t work
- Ask TennCare if you can buy the specific type of diaper
- Find a 3rd party vendor who sells it
- Who then upcharges the diaper by several dozen percent
- And then you can get them
- So, if you need, say, a specific type of diapers, you must:
- Part B does not have these same hurdles to obtaining necessities, so this bill very simply makes Part A wraparound funding look a bit more like Part B wraparound funding
- There also might need to be some work done on caps within certain spending categories, which are also quite inhibitory, but we will play it as it lies
- This is, in part, due to the fact that they must spend those funds through an MCO
- I have heard time and again that families enrolled in the KB part A program cannot functionally utilize the $15k offered to them to pay for wraparound services
- Threats of Mass Violence Disability Protections – this bill would expand the protections for people with disabilities from being charged for a threat of mass violence, and provide some discretion to school personnel in reporting non-valid threats
- So, big caveat to start: no child deserves to learn under threat of violence, and no teacher, admin or support professional deserves to work under threat of violence
- But, this real problem is encountering far too blunt an instrument to effectively resolve the issue of threats of violence against schools
- At last note, more than 1,000 students have been charged under this law, which would indicate that this tool is not achieving the ostensible goal of reducing these threats
- And the big issue is that this is a law contradictory to existing law, and what we know about disability
- There currently exists in the code a “zero-tolerance” law that requires the expulsion of a student who makes a “valid” threat of violence toward a school
- In legal terms, “valid” means that it is an actionable threat that one could reasonably assume to be true
- This law, the one that charges children with felonies, lacks that “valid” language, meaning you may be charged with a felony but not expelled from school for the same action
- Second, IDEA requires that we consider the manifestation of a disability when using exclusionary discipline or considering a change of placement
- Because we know that some behavior is a function of a disability, and children are less culpable in those instances
- This law exempts those with intellectual disabilities, but that’s it
- This is contradictory to what we know about and how we accommodate manifestations of disability in the school setting
- There currently exists in the code a “zero-tolerance” law that requires the expulsion of a student who makes a “valid” threat of violence toward a school
- So, we would like to expand the disability protections in the existing law to, at minimum, include developmental disabilities
- And also align the felony law with the expulsion law to ensure that threats are “valid” and actionable before handcuffing the kids
- Accommodations in the Open Meetings Act – this bill would require all “governing bodies” subject to the state’s Open Meetings Act to provide reasonable accommodations, as required by the ADA
- This one is plain and simple: you have to follow federal law, including the Americans with Disabilities Act
- But is unfortunately necessary, because we have repeatedly heard that individuals serving on “governing bodies” have been denied reasonable accommodations for their participation
- This one is plain and simple: you have to follow federal law, including the Americans with Disabilities Act
- ECF Innovation Resolution – this resolution urges TennCare and the state to modernize the ECF CHOICES program to ensure that all members receive the types of supports and services that they need to live independent lives in the community
- This one is a still a work in progress, so details forthcoming
- But, we know that ECF is broken, right down to the foundation, and needs a whole lot of fixing
- As advances in medical technology and care have allowed people with high-acuity disabilities and complex medical needs to live longer
- And we no longer routinely institutionalize individuals with disabilities
- ECF is not built for this and does not offer adequate services to meet a higher level of need
- To fix ECF, however, we need to establish its brokenness
- And that is what we hope this resolution facilitates
- Other stuff – see what else I’m keeping an eye on at this early stage (disclaimer: this is an incomplete list that will update as I come across other proposals of note)
Federal Update
- Medicaid is on the chopping block in Congress these days
- I’ll get into the details later, but here is a decent primer (link)
- Don’t panic just yet, but stay vigilant
- We’re planning to work on this proposal this year (link) – stay tuned
That’s all for today (because it’s a lot), but I’ll be back with a full Policy Update once the Special Session kicks off the week of January 27th.
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