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3.15.24 TDC Weekly Public Policy Update

The Tennessee State Capitol building lit up at night and behind a set of ascending stairs

As the avid reader may be aware, I am a huge college basketball fan. My team, the proud University of Minnesota Golden Gophers, made big strides this year, improving from 2 conference wins to 9 this year. But alas, those nine are not going to be enough to get us to the Big Dance, aka the NCAA Tournament, aka March Madness. However, March Madness is not resigned to just basketball – Cordell Hull has an annual March Madness period as well! And our bills have us in the big dance. And as everybody knows, anything can happen in March Madness – good and bad. So reader, come dancing with us, and lets see our bills through the tourney, avoid the upsets and raise the hardware at the end. ::Gymnasium horn blast::

 

2024 TDC Priority Bills

  • TennCare for Working Adults – this bill would create an option for working adults with disabilities to pay a premium to access TennCare services (like HCBS), while having income and assets above the current Medicaid eligibility threshold
    • Just as it went in the House Insurance Subcommittee, the bill sailed smoothly through Insurance full
    • Next up is the marathon session that is set to be Senate Health and Welfare
      • I heard, through eavesdropping outside a legislative office, that Senate Health will close after next Tuesday
        • And that means that all (or most) of the 74 bills on the calendar will get their one shining moment
          • Which should take us well into the evening
      • We happen to be 57th on that list, which means we’ll be around for a while
    • I’m not super worried about conceptual support for the bill – it’s been nothing but flowers and rainbows on the House side
      • It’ll really come down to the money
        • And, if you’ll recall, the state estimates that our bill will cost far more than we estimate it will cost
          • Which would mean that there would not be enough shared savings leftover for our bill (they theoretically have obligated like $300 million already!)
      • But we’ve got a plan, in the coming weeks we’ll work with the sponsors to challenge the fiscal note
        • Which means that they will potentially revise their estimate
          • And I think we’ve got a good case that they should
    • The bill will also be up in House Finance next week
      • Where I’d expect they pass the bill, send it to full Finance and “place it behind the budget”
        • Which means that its final passage is contingent on inclusion in the House’s final budget
          • So NBD at this point
    • Stay tuned, but don’t worry (yet)
    • Next up:
  • Right to Repair pt. 2 – this bill would require suppliers of power and manual wheelchairs to offer twice-annual preventative maintenance and to repair malfunctions, and creates a pathway for independent repair persons to do some types of repair. 
    • Who woulda ever thunk that an innocent ol’ wheelchair repair bill with a cost under $10k woulda caused so much ruckus
      • But ruckus was the name of the game last week
    • Remember last week about the deal we struck with the insurance mafia? Well, that lasted not even through the weekend
      • Hugging my phone until 9:30 Friday night, we awaited their approval
    • So we scrambled – we put out a call to the GRASSROOTS, we hoped, we wished, we prayed
    • PHRMA, private payers and TennCare had an all-out brawl in Commerce over a bill to limit manipulation of medication-assistance programs 
      • It’s an interesting bill, I’ll tell you about it another time
        • But their argument took so long that they ran out of time and didn’t get to our bill
          • Which was, at the time, likely dead in arrival to the Commerce vote
        • And our good friend and sponsor Sen. Watson had the brilliant idea of going out of order on the calendar and letting non-Commerce members share their bills first
    • So we live to fight another Committee meeting
      • Which will happen in two weeks
    • In the meantime, we need to take advantage of our miraculous reprieve 
      • Keep an eye out for a link to an ACTION PACK to come out two Mondays from now, which is the day before committee
        • You will be able to find a link to send an email, a video to remind you of the deets of the bill and our one-pager in case you need to send it to somebody
    • It truly is a miracle this didn’t fail last week, let’s make it count
    • Next up:
  • TCA Placard Cleanup – this bill would update language related to disability placards found in the Tennessee Code that refers to people who use wheelchairs as “confined to a wheelchair”; this bill would modernize that language

 

Other stuff:

  • HB2497/SB2146 – IDD Residential CON – this bill would increase the allowable bed limit for a Certificate of Need (CON) for residential facilities that serve individuals with intellectual and developmental disabilities
    • This is the other big one this coming week – it’s set to be heard in House Health sub on Tuesday, and it’s bad
    • So, quick recap of this one
      • The bill allows two facilities in the state to skirt the state’s anti-institutionalization laws so that they can build a large residential facility for people with disabilities
        • Those protections prohibit residences of more than 4 unrelated persons with disabilities, and require they be no closer than 500 yards from another residence that serves people with disabilities
          • It may seem crude, but it has protected against institutions for decades now
        • Now, you may be thinking, “hey, we really do need more residential options for people with disabilities”
          • And I’d wholeheartedly agree!
            • But this isn’t it
        • Our state’s histories with institutions means that these protections must be maintained as a firewall from reverting to those options
          • See here for the reasons why
          • And any erosion of that protection, as well-intentioned as it may be, crosses a red line from which we can’t come back
        • Even though these two facilities are private pay (no state dollars), what’s to stop anybody from (probably rightfully) saying that if wealthy people have this option, why can’t poor people
          • And you know who serves people with disabilities living in poverty in Tennessee? The state 
            • And boom, there you have a state institution
        • Ultimately, this comes down to integrated and included settings vs segregated and congregate setting
    • So, not to sound all apocalyptic about this one, but this cannot pass
    • Talking points:
      • This proposal is for a segregated, congregate facility
      • This proposal sets us down the slippery slope back towards institutionalization
      • Any exception to the rules erodes an important protection against institutions
      • Tennessee’s history with institutions/large residential facilities is awful
      • There are better options to address the state’s lacking availability of residential options for folks with disabilities (here’s one you could note)
    • Next up:
  • HB2759/SB2809 – School Phone Ban – this bill would require LEA’s to develop a cell phone policy that prohibits their presence in most circumstances during the school day
    • This is an interesting one, and the concept is sort of trending nationally
      • Essentially, the bill bans phones/laptops/ipads/etc. in schools during instructional time
      • There is mounting evidence that phones in the classroom contribute to lower academic achievement, higher levels of anxiety and increased unwanted behavior
        • That said, evidence is new and mixed
    • However, from our perspective, one population depends on the use of technology to access their education – (some) kids with disabilities 
      • And originally the bill did not address that
    • Well, the bill was amended to ensure that students whose IEP’s permit them to use assistive tech as an accommodation maintain their ability to use those devices
    • On a different note, I’m very interested to see how this plays out, and what the impact (if any) would be on students
    • Next up:
  • HB1183/SB503 – The Voucher Bill – this bill would create a statewide private school voucher program 
    • After taking a break for a week, this quagmire is set to start moving again next week
      • Quick reminder, we have concerns:
        • the right to special education supports and services is substantially diminished in a private school and those supports and services that are offered are likely to be more generic and lesser in quality
        • civil rights protections and due process rights are not extended to students with disabilities enrolled in private schools
        • the unrestrained proliferation of schools will stretch an already thin and finite cadre of special education teachers and specialists even thinner
        • Plus, research
    • So I don’t really have a substantive update, but here’s some gossip:
      • I’m hearing that both the House and Senate will likely pass their versions of the bill, which will then require conference committee
        • Conference committee is when the House and Senate sit in a room and negotiate the differences in their respective versions of a bill
      • It is very possible that the thing could die right there – the House and Senate (within the supermajority) aren’t exactly getting along
        • And they both want to use this behemoth of a bill to flex their muscles over the other side
          • And in the name of flex, they might just let the thing crash and burn (and blame the other side)
      • And even then, if they get a compromise, both sides are likely to look at the updated version of the bill as something entirely different than what they previously voted for
        • And that could doom any vote on the compromise bill after that
      • But, like I said, that’s gossip, and I might be proven entirely wrong
        • But I hope not
    • Next up:
  • HB368/SB322 – Pre-K-2 Suspension Ban – this bill would prohibit suspension or expulsion of pre-k through 2nd grade students except for behaviors that threaten safety of the student or others
    • This is an interesting one that I haven’t touched on – the research on exclusionary discipline shows that it really doesn’t do much good, and often does some harm
      • And this is especially true for younger students
    • Where we cross over into disability world is that students in pre-k through 2nd grade may have a disability, but haven’t been in school long enough to be evaluated or have an IEP implemented
      • So we could be seeing lots of exclusionary discipline as a result of behaviors manifesting from a disability
    • Prohibiting suspension/expulsion for these kids outside of behavior that threatens safety is a good thing
      • I personally don’t think you’re accomplishing much by suspending a 6 year old for “mouthing off” or “not sitting crisscross-applesauce at the story circle”
    • I am hearing, however, that the bill likely won’t move forward this year because it doesn’t have the votes it needs
      • Which is a shame
        • I think we’re better off having the conversation, even if it doesn’t result in the passage of a bill
        • And you can always have a chat, take it off notice and save some face, if that’s the primary concern
    • Next up (in theory):
  • Other other stuff:
    • House Subcommittee Calendar
    • House Committee Calendar
    • Senate Committee Calendar
      • So apparently we're not updating the website on either side these days
    • Big Net Calendar Report
      • What's going on next week, you ask? Check out this calendar report!

 

Federal Update

  • It’s not really a federal update in the sense of “here’s new legislation”, because Congress is busy perpetually fighting over temporary spending measures, but I thought it was cool
    • CMS released a new interactive tool to measure, in quite a few different ways, the relative health and access to care of a given US county
      • Try, for example, examining the Social Determinants of Health tab
        • Choose “Tennessee”
        • Choose “Health Care Access and Quality”
      • And see how few folks are able to access basic preventative care in TN counties
        • Especially as compared to some of our neighboring states
    • We should do something about that

 

GRASSROOTS Update

  • The next two weeks are all about Right to Repair: Part 2, HB2497, and Pathways to TennCare
    • Right to Repair:
      • Reach out to Senate Commerce and tell them to pick Tennesseans in wheelchairs over Big Insurance
      • Curse Blue Cross under your breath
    • HB2497
    • Pathways to TennCare
      • Reach out to Senate Health and tell them this is a VGB
      • Cross your fingers we can convince some influential people that the fiscal note is wrong
      • And if you’re a math whiz, try running the numbers for yourself!

 

Media Highlights

  • NY Times – A new Alzheimer’s drug expected to hit the market this year is on pause as the FDA convenes a special panel to evaluate its efficacy. This comes after a much-celebrated Alzheimer’s treatment, Aduhelm, was abandoned by its manufacturer for lack of evidence from clinical trials that it worked. 
  • AOL (lol) – Rutherford County schools shared a plan to get themselves sued move students with autism and students with behavior needs to separate schools. This quote says it all: “It is too much of a burden on an administrator…”
  • The Atlantic – I love a good opportunity to snob out on books, because either I like snobby books or I have convinced myself that I have. I’ve read a good chunk of these – some of my favorites from the bunch are: Invisible Man (Ellison), any Hemmingway (cause I’m basic like that), Passing (Larsen), The Corrections (Franzen), Underworld (Delillo), Infinite Jest (Wallace) and Their Eyes Were Watching God (Neal Hurston). Love me a good book list, let’s hear your top 5!

 

It’s Selection Sunday this weekend, where we all learn who made the Big Dance and whose bubble burst. Likewise, it’s Selection-End-of-the-Session at Cordell Hull, and I’m really hoping we go dancing. We’re going to need all the support we can get in the coming weeks (and starting now); reach out to me with questions, concerns, offers for help, snacks and/or a pillow, and let’s raise that banner when we adjourn sine die.