Ah, February, the most romantic month of them all, in which us drones down at Cordell Hull beg for bill slots, clash with legal and run bill jackets down to the (exhausted) clerk. The Special Session is over, and the real session hasn’t quite begun. But that gives us a second to survey the playing field, gather the troops and make a plan to get our bills to their logical and righteous destination – the Tennessee Code (which is also very romantic). Grab your Brachs (which are delicious, don’t let anybody tell you otherwise), order some roses and make some dinner reservations, it is time to woo our elected officials. And nobody better to send the love than the TDC family. XOXO!
The Important Stuff – 2025 TDC Priority Bills
- HB712/SB1178 – Freedom for Family Care Act – (aka Paid Family Caregiving: Part 1) this bill would prohibit TennCare from developing or implementing policies that discriminate against family caregivers in the provider-based employment
- We are signed and filed! You can see the bill in the linked bill number in the above description
- So, the following is going to be true of our 3 bills this year:
- All will very likely start in the TennCare Subcommittee
- Which, as you may remember, is chaired by Good Friend Representative Michael Hale
- All will very likely start in the TennCare Subcommittee
- I’d expect that we won’t see them introduced on the House side until AT LEAST the week of February 24th (two weeks out)
- Typically, bills move in the House before the Senate, in part, because there are more subcommittees and committees to get through on the House side
- So I wouldn’t expect to see movement on the Senate side until they’ve started on the House side
- None of them should cost the state substantial funds (if any)
- But it is likely that the state (and their pals at Fiscal Review) will say that it does
- If the bill receives a Fiscal Note indicating that it costs money, it will have to go through Finance, Ways and Means (on both sides)
- Reminder, a Fiscal Note is an estimate by Fiscal Review as to how much passage and implementation of a bill would cost the state
- (and state businesses, for some reason)
- Reminder, a Fiscal Note is an estimate by Fiscal Review as to how much passage and implementation of a bill would cost the state
- I’ll go further into cost structures as these bills progress
- They will all likely face the “Senate Commerce Trap”
- The trip is in place because private payers (aka insurance companies aka MCO’s) have A TON of influence on members of that committee
- So if a member of the Insurance Mafia (truly, it’s what they call themselves) doesn’t like a bill, that Senate Commerce Trap comes into play
- All of these bills will need substantial GRASSROOTS support
- It’s important that these are not abstractions, but connected to real live human beings facing real life issues with the system
- I will keep you all in the loop about how you can be involved here
- It’s important that these are not abstractions, but connected to real live human beings facing real life issues with the system
- Next up:
- Committee Assignments
- HB711/SB706 – 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
- Reminder, bill language in the link in the above bill description
- Second reminder, the above is also true for this bill, BUT:
- Two of these things will be especially true: the need for GRASSROOTS and the Senate Commerce Trap
- This is one where we will really need to demonstrate that this is meant to highlight the lack of services available to Tennesseans with disabilities and their families
- So we’ll need to have folks prepared to say “TennCare has no network here, and thus, I receive no services”
- Or something like that
- So we’ll need to have folks prepared to say “TennCare has no network here, and thus, I receive no services”
- MCO’s will also hate this one, because they are ultimately responsible for ensuring an adequate provider network
- And they have lucrative contracts with TennCare to do so
- We’ll need to get to Senate Commerce early
- (but not yet, hold your fire)
- This is one where we will really need to demonstrate that this is meant to highlight the lack of services available to Tennesseans with disabilities and their families
- Two of these things will be especially true: the need for GRASSROOTS and the Senate Commerce Trap
- Next up:
- Committee Assignments
- HB1158/SB1053 – 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 FOUND A HOUSE SPONSOR
- And it is….. Representative Susan Lynn!
- And she’s also got a menagerie of other House members who want to work on this alongside her
- Rep Lynn was the House Finance chair when Katie Beckett passed, and told me she has a personal connection to seeing it thrive
- And it is….. Representative Susan Lynn!
- The above also applies to this one, but I know we’ve got a fantastic group of KB pt A families standing at the ready to work on this one
- This one will have a longer timeline to implementation (should it pass)
- The bill language (in the link in the description) directs TennCare to submit a waiver amendment (should they need to) to achieve the goals of the bill
- And waiver amendments can take FOREVER
- We’re still waiting on approval for the waiver amendment establishing Medicaid Buy-In, which passed into law in April 2024
- But we’ll see what is ultimately necessary to make this happen
- And waiver amendments can take FOREVER
- The bill language (in the link in the description) directs TennCare to submit a waiver amendment (should they need to) to achieve the goals of the bill
- This one is also the bill most subject to change
- The sponsors want to work with families to determine what, if anything else, needs to be fixed with Part A
- Next up:
- Committee Assignments
- I FOUND A HOUSE SPONSOR
- 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
- As the keen reader may note, there is no bill number linked in the description
- And that’s because we won’t be able to run a bill working on this issue this year
- I’m very sorry to say
- And that’s because we won’t be able to run a bill working on this issue this year
- I had a conversation with one of last year’s bill sponsors who was adamant that the law not be changed
- And without his blessing (and, by a couple degrees, the Speaker’s), any bill would have been doomed to fail
- And any ill-fated attempt would have substantially diminished the chances we could pass our other bills
- And without his blessing (and, by a couple degrees, the Speaker’s), any bill would have been doomed to fail
- We’re not done on this yet, but progress must now wait
- But keep beating the drum – the only way this changes is to convince the legislature that it needs to change
- This is a great opportunity for folks at DDH to make the difference in laying the foundation for change
- Explain to last year’s bill sponsors why we need to include developmental disabilities in the exempted disabilities
- Explain that this law is unaligned with the zero-tolerance law regarding threats of mass violence
- (in theory, a student can be charged with a felony but not expelled for the same offense)
- Explain that while mass threats are a real problem, this is far too blunt an instrument to address it
- Or just tell your story, and put legislators in the position to tell you “no”
- But keep beating the drum – the only way this changes is to convince the legislature that it needs to change
- Next up:
- 2026
- As the keen reader may note, there is no bill number linked in the description
- 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
- Similarly, I’m sorry to say that I could find no takers to sponsor this resolution
- New House rules mean that a “substantive resolution”, to which this is classified, require a bill slot
- And those have proven to be elusive this year
- (and will become more elusive next year, when the House rules cut the limit from 12 down to 10)
- (down from 15 last year)
- (and will become more elusive next year, when the House rules cut the limit from 12 down to 10)
- And those have proven to be elusive this year
- New House rules mean that a “substantive resolution”, to which this is classified, require a bill slot
- So we’ll need to take a different tact here this year – ECF needs and deserves the spotlight and some wide-spread revamping
- We’ll brainstorm here about how to keep the ball moving in lieu of a resolution
- I’m also wide open to brilliant ideas from the GRASSROOTS – feel free to shoot me an email
- We’ll brainstorm here about how to keep the ball moving in lieu of a resolution
- Next up:
- Getting creative
- Similarly, I’m sorry to say that I could find no takers to sponsor this resolution
Other stuff:
- HB932/SB897 – Cell Phone Ban in Schools – this bill would require local boards of education to develop policies that ban the use of cell phones during instructional time, with some exceptions
- This one makes a comeback after failing in committee last year (on the House side)
- This is one of several versions of this bill that were introduced, with the rest ultimately being withdrawn
- That said, this bill has less clear and forceful language that would have protected the use of assistive technology devices for students with disabilities
- This is what it says now:
- (4) Permits a student to use a wireless communication device during instructional time if the student's use of the wireless communication device is included in the student's:
- (A) Individualized education program under the Individuals with Disabilities Education Act (20 U.S.C. § 1400 et seq.); or
- (B) Active 504 plan developed under Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. § 794); and
- (4) Permits a student to use a wireless communication device during instructional time if the student's use of the wireless communication device is included in the student's:
- That’s…. ok
- I guess
- But could be better – it does not include students in the process of an evaluation, or those awaiting an IEP
- And would prohibit the use of assistive technology in the course of an intervention (like during the Functional Behavior Assessment Process)
- And if a student uses it now, but it’s not currently in their IEP (which is very possible), they’re gonna be out of luck until a new IEP can be developed
- Which, I don’t need to tell you, takes a minute
- We’ll work on this one – I know some great advocates that would be itching to teach the General Assembly a thing or two about special education and assistive technology
- Next up:
- Committee Assignments
- HB372/SB334 – Tennessee Medicaid Modernization and Access Act of 2025 – this bill would require TennCare to match its reimbursement rates to providers for obstetrics/gynecology, primary care, outpatient mental health and substance use disorder treatment to the greater of Medicare or commercial rates
- Hey! We’re not the only ones out here trying to codify aspects of the HCBS Access Rule that was finalized last summer!
- (TennCare Network Reporting Reform Act – see above)
- This one doesn’t build upon the rule, like ours does, but it gets the ball rolling and gets it into the code
- And this is good! Medicare and commercial networks don’t face the same issues that Medicaid networks do
- As in, they have far more providers, because they pay more!
- Fancy that!
- As in, they have far more providers, because they pay more!
- And this is good! Medicare and commercial networks don’t face the same issues that Medicaid networks do
- It is, however, limited to those four areas of care, but it is indeed a good thing to get something in the books to start
- Because once you open the door, anybody (or specialty care) has a better shot of getting in the house
- This one, however, faces a steeper battle than ours, I think
- It’s gonna cost money, and a lot of it, and TennCare, the General Assembly and the state government as a whole HATE spending money
- And the law “takes effect upon becoming law”, which means TennCare and their pals would have to begin paying the higher rate as early as April 2025
- That said, it has a great Senate Sponsor in Sen Rusty Crowe, who chairs the Senate Health and Welfare Committee
- And, as is tradition, it’ll run into the Senate Commerce Trap at some point, of which it will need to evade
- The bill language does note, however, that passage of the law does not automatically appropriate funds to facilitate its implementation
- That would have to be done separately as a line item in the final GA budget
- Which is normal, but of note that it is iterated in the bill language
- That would have to be done separately as a line item in the final GA budget
- Next up:
- House TennCare Subcommittee – TBD
- Awaiting Senate committee assignment
- Hey! We’re not the only ones out here trying to codify aspects of the HCBS Access Rule that was finalized last summer!
- HB1101/SB851 – Medicaid Expansion – this bill authorizes the Governor to expand Medicaid eligibility to 138% of the Federal Poverty Line (FPL)
- Hey, somebody has got to do it
- We were all raring to go with interested sponsors with “R’s” next to their name, but were dissuaded by the push to eliminate the Affordable Care Act
- And with it, the possibility of Medicaid expansion
- But I’ve heard that story before…
- We were all raring to go with interested sponsors with “R’s” next to their name, but were dissuaded by the push to eliminate the Affordable Care Act
- To be clear: Medicaid expansion is good, there is a lot of evidence that this is true, both fiscally and for population health, and there are additional incentives for the state to pursue expansion
- To the last point, in TN, that is $1.2 BILLION in bonus funds for Medicaid, paid out over the first two years of expansion
- AND, a 90% match to pay for the expansion population
- To be VERY clear, Medicaid Expansion is and should be a no-brainer
- And assign the presence-of-brain requirements to Tennessee’s lack of Medicaid Expansion as you will
- I’m feeling optimistic today, so if we can get this one to committee, I think anything can happen
- It, nonetheless, qualifies as a Very Good Bill (VGB) and we’ll be supporting it
- Next up:
- Committee Assignments
- Hey, somebody has got to do it
- Other other stuff:
- House Subcommittee Calendar – not this week, I guess
- House Committee Calendar
- Senate Committee Calendar – not this week, again, I guess
- Big Net List 2025
- I’m sorry, I’m like 700 bills behind (in just the House!) in my review process
- So this list is short and incomplete
- I’ll do better next week
Federal Update
- What have I gotten myself into with attempting to provide a weekly federal update??
- Whelp, here we go
- The administration is in the process of taking the ax to federal spending
- And firing thousands of federal workers, taking over financial systems, changing functions of departments and agencies and evaluating federal spending at home and abroad
- Whatever your partisan leanings may be, I think it is safe to say that this has been, at very minimum, disruptive to the standing functions of federal agencies and departments
- And, of note, creating a constitutional question about who has the last word on spending federal funds – the legislative branch or the executive branch (or Elon Musk)
- I won’t belabor, but I think it’s worth noting, because it falls within the purview of our mission at TDC: more access to necessary healthcare is good, less access to necessary healthcare is bad
- So, pausing payments for global health outreach is bad, under this framework
- Some efforts, like PEPFAR, which attempts to, and has been very successful at, preventing the transmission of HIV and treating AIDS, received limited waivers to operate
- But, as KFF points out here, malaria, tuberculous and polio prevention efforts are paused, as are maternal and child health efforts, nutrition assistance and outbreak investigation and prevention efforts
- Some efforts, like PEPFAR, which attempts to, and has been very successful at, preventing the transmission of HIV and treating AIDS, received limited waivers to operate
- So, pausing payments for global health outreach is bad, under this framework
- I have a personal belief (and please note the “personal” caveat) that if you have something to give, whatever it is, you should give it whenever you can
- And I personally believe that America has a lot to give, as well as the capacity to give a lot, and thus, I believe we should
GRASSROOTS Update
- It’s gonna be a quiet couple of weeks right here, waiting for our bills to be introduced
- So drink up 8 glasses of water per day, get your 8 hours of sleep in, exercise daily and eat nutritiously and I’ll put you to work soon
Media Update
- Disability Scoop – Illinois is in the process of trying to close down its state-run institutions for residents with intellectual and developmental disabilities. But it’s running into problems. The state of TN no longer formally or explicitly runs institutional settings for people with IDD, but this should raise alarm bells about the potentiality for abuse and neglect in large-scale residential facilities for people with disabilities, as well as their intractability once they are up and running.
- NY Times – a new(-ish) rule from the CMS that establishes new minimum requirements for staffing nursing homes is in jeopardy after 20 state Attorneys General and dozens of non-profits filed suit. This opinion piece from the New York Times argues that the rule should stay; others say it puts the nursing home industry in jeopardy and would force closures that would harm the aging population. The debate will play out in court, it seems.
- The New Yorker – The New Yorker publishes a short documentary – 13 minutes or so – that is worth your time. The story follows three women who are blind who, every Friday night, go bowling together. It’s a cool story, I recommend it.
Alright, we’re at the lull-before-the-storm part of session (with some other metaphor to account for the recent special session). It may seem quiet over the next couple of weeks (at the Tennessee General Assembly, that is), but don’t believe it – we’ve got lots to do. And hang in there when it comes to stuff outside the work of the Tennessee General Assembly – it may seem like the storm is upon us, but if I know anything, it’s the Tennessee disability community that’s got the biggest boat. See you next week – onward!