Legislation aiding healthcare consumers advances in Tennessee Senate

Several bills aiding healthcare consumers advanced in the State Senate this week, including the Tennessee Right to Shop Act, a consumer-driven program which provides patients with more transparency regarding the costs of healthcare services in their network.  Senate Bill 510 seeks to disclose the cost for certain procedures so the patient can make an informed choice that fits their within their budget or deductible. It requires health insurance providers to implement a shopping and decision support program which discloses the costs of non-emergency outpatient services or procedures to enrollees in their plan. 

Approximately 40 to 50 percent of all healthcare services are shoppable, including physical and occupational therapy services, radiology and imaging services, laboratory services, and infusion therapy. 

A consumer choice of a lower-cost option could also benefit insurance companies.  Under the legislation, health insurers would be allowed to offer incentives to enrollees for choosing the lower-cost option, such as providing consumers up to 50 percent of the difference for going to a less expensive provider, as long as the enrollee’s reward does not exceed the cap of $600 per year.  Insurance companies, however, would not be allowed to require or steer a patient to use a lower cost provider.  It is strictly voluntary on the part of the patient. 

Health Care Consumers / Transparency in Billing Practices – The full Senate also passed the Healthcare Billing Clarity Act which will help patients determine what charges come from a hospital and what charges come from a specialty physician who works there.  According to the Urban Institute, 54 percent of patients in the United States claim that their medical billing paperwork and invoices are confusing.

Often times, hospital bills include charges for supplies and equipment labeled as specialty service charges which are mistaken by patients as the total amount being billed by their physician.  Senate Bill 613 restricts hospital billing statements from including any language that refers to specialty healthcare services rendered at the hospital to avoid confusing the patient into thinking the bill came from their specialty physician.

Last year, the General Assembly approved legislation which called for transparency in medical charges by requiring a hospital to provide an estimate to patients regarding out-of-network charges. 

Elderly Healthcare Consumers / Medical Device Fraud – Legislation aiming to protect Tennessee’s elderly from being scammed by unscrupulous companies looking to steal their medical information and write a fraudulent prescription for medical devices advanced in the Senate Judiciary Committee this week. 

Senate Bill 265 creates a Class D felony for any person who knowingly uses a phone or an electronic device to obtain information from an elderly person regarding their medical history or health, and then sends unsolicited medical supplies or prescriptions to them in order to file a claim. The bill will now be heard on the Senate floor.

Addressing Physician Shortages – In other healthcare action this week, the Senate Finance, Ways, and Means Committee approved a resolution asking Congress to take action to increase critical programs addressing physician shortages in rural and underserved areas.  Senate Joint Resolution 525 expresses Tennessee’s support for U.S. Senator Lamar Alexander’s efforts to renew the Teaching Health Center Graduate Medical Education Program and the National Health Service Corps which are now before Congress. 

The current workforce projections show Tennessee with a shortage of 1,050 doctors by 2025.

Governor Bill Lee’s proposed budget includes $3 million in recurring funds to match $5.7 million of federal funding to support the Graduate Medical Education program in the Bureau of TennCare.  This critical incentive program provides financial support to resident physician who commit to living and working in the state’s rural communities.  Doctors are more likely to permanently live and work close to where they receive residency training.  This proposal will help provide care in these underserved communities and will hopefully result in physicians setting up long-term practices there.

Critical Funds to Support Hospitals – Members of the Senate Finance, Ways, and Means Committee voted this week to continue the hospital assessment adopted since 2010 to prevent potentially catastrophic cuts to Tennessee hospitals.   The hospitals asked the General Assembly to enact the coverage assessment for another year in order to raise $600 million in state funds, which in turn allows Tennessee to draw down $1.1 billion in federal matching funds.  The action prevents more than $1.7 billion in potentially catastrophic TennCare cuts from taking effect on July 1, 2019.  

The critical funds are necessary to provide hospitals a portion of their unreimbursed TennCare costs.  A few examples of programs, in addition to the reduction in payments to hospitals and health professionals, that would be affected without passage of , Senate Bill 474 are:  critical access hospitals; the Graduate Medical Education program, x-rays, physician office procedures, various therapies, and the enrollment cap for the medically needy. 

Medicaid Block Grant Waiver – Finally, major legislation was approved by the Senate Health and Welfare Committee this week calling for Tennessee’s Commissioner of Finance and Administration to request a block grant waiver from the Centers for Medicare and Medicaid Services (CMS) to better serve recipients of the state’s TennCare program was approved by the Senate Commerce and Labor Committee this week.  Senate Bill 1428 is designed to maximize flexibility in constructing an innovative plan that serves the needs of Tennesseans, while ensuring the state continues to receive its full share of federal Medicaid dollars.  The overall goal is to provide an effective and innovative plan that is specific to the healthcare needs of all Tennesseans, while lowering costs and increasing access to patient-centered care.  The bill now heads to the Senate floor for a final vote.

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