Daylight savings time starts this weekend! Coming from gloomy and cold upper-Midwest winters, daylight savings time always marked the beginning of the end – sunshine, tulips and Leinenkugel’s Summer Shandy were just around the corner IF you can hang in there for another half-dozen weeks. You knew that those six weeks would offer tantalizing glimpses of those days – a high in the mid-40’s; a sunny, sloppy day; Spring Training! – but that we weren’t quite there yet. Now, if you know these updates well enough, you may have already recognized that this was going to be a metaphor for this year’s General Assembly session. Calendars are starting to close on the Senate side, bills are starting to reach their end-points and our elected officials are beginning to get real cranky. But, that also means that if we hang in there a few more weeks, we’ll see a real spring. And our spring looks like the passage of our bills and the (hopefully positive) resolution of bills that give us heartburn. And maybe a Summer Shandy? So stick with me as the days get longer and the summer blooms ever closer on the horizon.
- 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
- We’re through our first committee on the House side!
- To great acclaim and much fawning, House Insurance Sub passed the bill on to Insurance Full for next week
- Robby, our intrepid self-advocate who brought the idea to us, gave GREAT testimony (watch it at the link!)
- So good in fact that the doctors up at Cordell Hull for their hill days came out to throw flowers at him
- And tell him how brave he was
- But this is good news for a VGB
- And tell him how brave he was
- So good in fact that the doctors up at Cordell Hull for their hill days came out to throw flowers at him
- That said, we got our fiscal note back, and it is…. not what we wanted to see
- We had estimated (generously) that 500 Tennesseans with disabilities would enroll in the first year, and then topping out around 1100-1200 total after year 5
- We also estimated, based on Maryland’s spending, that each enrollee would cost the state about $9800
- Finally, based on the experience of Massachusetts in establishing a buy-in-style program, that 80% of enrollees in the program would already be in Medicaid
- And this totaled about $1.6 million the first year, up to $2.3 million after year 3
- Well, fiscal review, with a big assist from TennCare, estimated 3300 enrollees the first year
- At $13.5k per person per year
- With an odd inclusion of 500 additional participants (the math isn’t adding up here) costing $27k per year
- At $13.5k per person per year
- Totaling a whopping $18 million per year
- Oh yeah, plus $10 million to “upgrade IT systems” and nine new employees earning a combined $764k/year
- So yeah, I don’t think that’s accurate
- But, we’ve got an option to fix that
- We can (and have) asked our sponsors to “challenge” the fiscal note, which entails a meeting explaining why we think the note is wrong
- And we think we’ve got good data and a strong case for lowering that number
- We can (and have) asked our sponsors to “challenge” the fiscal note, which entails a meeting explaining why we think the note is wrong
- So stay tuned on the cost
- But, we’ve got an option to fix that
- That said, we’ll be up in House full next week, and hopefully on Senate Health the following week
- And we’ve got until it hits the House and Senate finance committees to get the numbers right
- But tune in on Tuesday for Robby’s testimony part 2!
- Next up:
- We’re through our first committee on the House side!
- Paid Family Caregiving Resolution – this resolution would urge the state (and TennCare) to work with community stakeholders in developing a comprehensive statewide paid family caregiving policy and program
- And this one is (halfway) through!
- We passed on the Senate floor unanimously (via consent calendar)
- So we’re on to the House, where we wait for our sponsor on that side to file and move it
- But we’re on track (in the short and long game) on this one!
- Next up:
- House committee TBD – TBD
- HB1939/SB2036 – Parkinson’s Charge – this is the other PFC bill that Representative Antonio Parkinson is working on
- This, dare I say, VGB(?) passed on the House floor this week
- And the Senate floor!
- This, dare I say, VGB(?) passed on the House floor this week
- And now it’s headed for some signatures and the TCA
- So the bill ended up getting watered down to exclude home health care and private duty nursing (so HCBS only)
- But that’s ok – this codifies TennCare’s unspoken, unofficial policy to prohibit paying family caregivers if they live in the same home
- Which means that when we come back next year with a big bill creating such a program, we can point to the code if anybody (cough TennCare) opposes
- But that’s ok – this codifies TennCare’s unspoken, unofficial policy to prohibit paying family caregivers if they live in the same home
- Next up:
- Signatures and the code
- And this one is (halfway) through!
- 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.
- Whooo boy was this one fun this week
- The insurance mafia (seriously, the call themselves “the family”), had some “issues” with our bill
- Essentially, they didn’t like being told what to do, even if that dictate is a good thing
- The insurance mafia (seriously, the call themselves “the family”), had some “issues” with our bill
- First things first though – we rolled the bill in both the House and Senate, so no legislative progress forward just yet
- And it was necessary
- But - I learned that TennCare and the insurance mafia are philosophically opposed to “fees”
- Such as a schedule of things that they might reimburse for – think, in this case, mileage, labor, parts, etc.
- Like a bill from your auto mechanic
- They prefer contracts, where they pay out a lump sum for the contract and the contractor does as much (or as little) of the thing in the contract
- Such as a schedule of things that they might reimburse for – think, in this case, mileage, labor, parts, etc.
- So when our bill proposes a fee schedule, the mafia felt some sort of way about it
- And because of their feelings, they went around and poisoned the well in Senate Commerce, meaning that if we didn’t amend, it was dead in the water upon reaching that committee
- So we did some negotiating at the request of Rep. Hale, and came to this amendment:
- A flat fee replaces the fee schedule
- 1 preventative maintenance visit instead of two
- Bummer, but it’s at least a start
- Some explicit language around the requirements for service to be reimbursed by the mafia
- Like an independent repair person can’t charge insurance if they are not registered as a insurance-accepting entity, for example
- All things considered, I think we did pretty well we were all set to pull out any directive language about payment and make it permissive
- Which would have left suppliers out to dry
- But hey! We didn’t have to go there
- Which would have left suppliers out to dry
- So I think this is far better
- Perfect? No. But good.
- So Friday we’re finalizing our language and sending it to legal, who has to get it back to us/the sponsors, who must file it by noon on Saturday
- So time is of the essence
- But I think we’re at an agreement that paves the way for this one to move
- Unless we’ve got some bad actors doing bad stuff behind the scenes
- We don’t have a calendar date yet – you’ll see it in Senate Commerce for next week, but it is unlikely we’ll get to it
- Seriously, we’re 105th on the list
- But you’ll see it on the calendar because it’s already final calendar in Commerce, and if you’re not on this one, you aren’t getting heard at all
- Seriously, we’re 105th on the list
- Next up:
- Whooo boy was this one fun this week
- Tennessee Disability and Aging Act – this bill establishes a new Department of Disability and Aging to serve the state’s population of Tennesseans living with disabilities
- Still no problems here – it’s cruising right along
- It passed Gov Ops on the Senate side
- But they didn’t get to it on the House side, so in Gov Ops it remains for this week
- It passed Gov Ops on the Senate side
- Next up:
- Still no problems here – it’s cruising right along
- Super-Secret 6th TDC Priority Bill of 2024 – this bill is a super-secret until I see it amended, posted to the GA website and smiles from everybody
- I know I teased it, but I’ve got bad news: we’re not going to get to this one this year
- We’re just out of time and legislative bandwidth to make this happen
- In part, because it would have been a huge lift to get across the line
- We’re just out of time and legislative bandwidth to make this happen
- But we still want/plan to do it next year, so I’ll just tell you what it is:
- The bill would have transitioned some of the funds for HCBS available to participants in part A into an HRA
- Similar to that in Part B
- We’ve been working with families for about a year now to evaluate the state of Katie Beckett after 3 years of implementation, and this was one of the biggest issues with the program that we heard
- Funds in Part A had to go through TennCare and a 3rd party vender to acquire anything
- Which proved to be so ineffective and inefficient that folks in part A pretty much couldn’t use the funds at all
- Funds in Part A had to go through TennCare and a 3rd party vender to acquire anything
- The bill would have transitioned some of the funds for HCBS available to participants in part A into an HRA
- TennCare won’t like it, but that’s never stopped us before
- We want to continue to work with the sponsors and KB part A families over the summer to make sure we get this thing right
- Sorry for the buildup and subsequent let-down, but such is life at Cordell Hull
- Next up:
- 2025
- I know I teased it, but I’ve got bad news: we’re not going to get to this one this year
Other stuff:
- HB1183/SB503 – The Voucher Bill – this bill would create a statewide private school voucher program
- So this one is consolidating here and the sponsors are working from this bill number
- However, the House and Senate versions are FAR, FAR apart
- The bill passed House Ed Admin with a 12-7 vote, which is closer than it was for K-12
- Which means opposition is getting stiffer – concerns range from finances to vouchers-as-a-concept protecting public schools to the nature of the process (moving too fast)
- The bill also passed Senate Ed 7-1, with one present not voting
- Which is pretty good for its first hurdle (for passage, that is)
- So I promised to tell you when I thought it was the right time for the disability community to jump in
- And I think it’s now (or never, for that matter)
- The substance of the bill will not be the concern of the respective finance committees, so we better address the substance before then
- Sorry, fight in the Senate
- The substance of the bill will not be the concern of the respective finance committees, so we better address the substance before then
- But it should be noted, the disability community is not a monolith, and some have very good reasons to support such a bill
- (though we’ve already got IEA’s)
- But some may have other reasons to support too
- (though we’ve already got IEA’s)
- And I think it’s now (or never, for that matter)
- But if you want to make your voice heard, I’ll reiterate my talking points here:
- 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
- My primary concern is the last one – parents pretty much know what they’re getting into when they accept a voucher, but what about those who remain in public school?
- Dilution of resources through their transfer to private schools leaves local public schools scrambling to meet their IDEA obligations
- By no choice of public school students
- I worry that dilution of resources means unavailable services, lesser supports and greater opposition from schools and districts to good, comprehensive IEP’s
- Will the school fight expensive services harder if the schools are more strapped for funds?
- And, as I previously mentioned, there are only so many school psychologists in the state!
- Dilution of resources through their transfer to private schools leaves local public schools scrambling to meet their IDEA obligations
- So, if you plan to engage here, here are my suggestions:
- Stay in the disability lane – let others fight the other fights
- Recognize that our community is not universally in support or opposition, and respect that choice
- Focus on the concept of vouchers, not the bill itself
- Temper your expectations about the impact of advocacy (see below)
- The vibe at Cordell Hull is that this thing is a runaway train bound to pass on both sides
- And then be negotiated in conference committee
- Where the House and Senate navigate the differences between the versions they respectively passed
- (I have some issues with this process, but that’s for another time)
- And the negotiated compromise will then have to pass both chambers
- Where the House and Senate navigate the differences between the versions they respectively passed
- And then be negotiated in conference committee
- But nevertheless, it’s important that our concerns are iterated and heard, and I think that the time for that is now
- Next up:
- So this one is consolidating here and the sponsors are working from this bill number
- 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
- I hear this one might start moving this week (or next)
- So I want to touch base
- This is a dreaded VBB
- It erodes the anti-institutionalization protections in the state, and creates congregate, segregated facilities for individuals with disabilities
- Essentially, the bill permits the creation of two private institutions in Tennessee
- Which, preaching to the choir here, is bad
- Essentially, the bill permits the creation of two private institutions in Tennessee
- It erodes the anti-institutionalization protections in the state, and creates congregate, segregated facilities for individuals with disabilities
- So if it does move, next week or the following, I think we need to be prepared here
- It’s important that the sponsors and committees that will hear the bill understand our opposition
- We are not opposed to improving and increasing options for residential living for folks with disabilities
- We are sorely lacking adequate numbers to meet the demand in TN
- And we’re not opposed to allowing people to choose where and how they live
- We are opposed to rolling back anti-institutionalization protections (4 or fewer folks within 500 yards of another facility)
- We are opposed to congregate facilities
- We are opposed to segregated settings
- And this is all 3 of those things
- It’s important that the sponsors and committees that will hear the bill understand our opposition
- So stay tuned here, this is one of those red-line-in-the-sand-y-hill-to-die-on types of bills, and we need to act accordingly
- Next up:
- I hear this one might start moving this week (or next)
- Other other stuff:
- House Subcommittee Calendar
- House Committee Calendar
- (they’re late on publishing to the website!)
- Senate Committee Calendar
- TDC Big Net Calendar Report
- Want to know what of relevance is happening next week? Here is a great place to find that out!
Federal Update
- There is an important and relevant case before the Supreme Court right now: Braidwood vs. Becerra
- So the legal attacks on the Affordable Care Act (ACA) are never ending, and from a wide variety of angles
- This one asserts that the provision in the ACA that requires access to many types of preventative care is unconstitutional
- Saying that it violates the non-delegation doctrine and appointments clause
- There is also a religious freedom argument that I’m not going to touch on here
- This one asserts that the provision in the ACA that requires access to many types of preventative care is unconstitutional
- Essentially, the argument is that the ACA’s establishment of an expert panel to suggest preventative maintenance procedures to be included in the ACA’s no-cost-sharing coverage is unconstitutional
- The non-delegation doctrine is being used quite a bit these days, that says congress has to explicitly delegate an authority to
- And the appointments clause says that those sitting on the expert panel must be nominated by the president and approved by the Senate
- Which would leave any and all of these positions unfilled, given the 60 vote threshold for confirmation hearings
- In practice, a ruling in favor of Braidwood would severely limit access to preventative services, such as cancer screenings, vaccinations and contraceptives.
- Because most insurance companies and CMS would impose cost-sharing, driving the price of these services way up
- And out of the range of many
- Or, insurers would simply choose not to cover them at all because of their cost
- Either of which would be a bad thing
- Because most insurance companies and CMS would impose cost-sharing, driving the price of these services way up
- Other stuff on the non-delegation doctrine from across the legal spectrum:
- So the legal attacks on the Affordable Care Act (ACA) are never ending, and from a wide variety of angles
GRASSROOTS Update
- Alright, my GRASSROOTS fiends, I’ve got some stuff for you this week
- Consider your stance on the voucher debate and advocate on it
- As noted above, we’re getting to the now-or-never inflection point
- Cheer on our R2R2 advocates by letting House Insurance full members hear your support
- Oppose HB2497 – calmly and carefully explain your/our opposition to the erosion of anti-institutionalization protections
- Have a discussion about it with a friend or reach out to the sponsors (gently, narrowly and with the grace of assumed good intentions)
- And please, these guys aren’t trying to lock up people with IDD, they are just trying to help
- They are just misguided in their solution
- And we can explain our concerns in a reasonable and understanding way (see above “other stuff”)
- As always, reach out to your legislators if you haven’t recently and just check in!
- The better your relationship now, the better your advocacy is when you need it
- Consider your stance on the voucher debate and advocate on it
Media Highlights
- The 74 – from my old teaching district, new data shows high levels of chronic absenteeism among students with IEP’s in the Minneapolis Public School District. Absenteeism is a huge deal, especially in special education, where it exacerbates gaps between students with and without disabilities. Schools are legally and ethically obligated to remedy this issue.
- Nashville Scene – another piece on our Pathways to TennCare bill, this time from Shreya Gupta and Nashville Scene. The more coverage the better!
- NY Times – after our own hilarious controversy about school lunch food here in TN, New York City public school children recently scored a victory on the side of the kids: they got French toast sticks returned to the school lunch menu. I love a good advocacy story, and I love classic school lunch food items (in theory, that sounds gross to me now). Well done, young’uns, well done.
That’s it folks, we’re hitting the stretch run of winter here. We’ve got some sloppy puddles, some shockingly unwavering salt-filled snow piles and false alarm beginnings-of-spring to come, but the days are about to get a lot sunnier. Hang in there, grit your teeth and maybe crack a Summer Shandy, we’ve got some work to do before its summertime.