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URGENT ACTION REQUIRED - Pain Management Bill Moves In the House, Stalls in Senate
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TMA Position: Support– Part of TMA Legislative Package
Bill Summary: This bill prohibits advanced practice nurses and physician assistants from performing any invasive procedure involving the spine, spinal cord, sympathetic nerves or block of major peripheral nerves in a setting that is not a licensed facility unless under the direct supervision of a licensed physician who is actively practicing spinal injections and has current privileges to do so at a licensed facility. "Direct supervision" is defined as being physically present in the same building as the advanced practice nurse or physician assistant at the time the invasive procedure is performed. The supervising physician who violates this bill is subject to disciplinary action by the physician's licensure board including civil penalties of up to $1,000 per violation.
Bill Status: Passed in House Professional Occupations Subcommittee and Rescheduled for Senate General Welfare Committee next week. The bill is on the House Health Committee for next Tuesday but will likely not be heard until the following week.
The House Subcommittee passed the bill but it was not without antics by the opponents. There was an attempt to put an amendment on the bill to study the issue over the summer (watch discussion). While the vote was close, TMA prevailed and the bill came out.
In the Senate, there was significant testimony heard from both sides in the General Welfare Committee. Dr. Chris Young, a Chattanooga anesthesiologist and TMA Board member, and Dr. John Culclasure, anesthesiologist and pain management specialist from Nashville, spoke in support of the legislation. A representative from the state associations for the CRNA’s and the physician assistants also gave testimony. Senator Doug Henry asked to hear from Colleen Conway-Welch, the Dean of the Nursing School at Vanderbilt and from the Department of Health on the bill. Not surprisingly, Conway-Welch opposes the legislation even though Vanderbilt is neutral on it. The Administration (and by definition the Department of Health) had thus far been neutral on the legislation. However, when Commissioner Susan Cooper, RN addressed the committee her comments were far from neutral. Commissioner Cooper, who is a nurse, indicated that this was not the right approach and there was no scientific evidence or study to say that this was a real issue. TMA representatives spoke with top officials in the Administration who indicated that the Commissioner was in no way speaking on behalf of the Bredesen Administration and that their position was to remain neutral.
We made significant progress in the House this week but it is critical that we continue to rally the support of Committee members in both the House and the Senate. We desperately need your help! APNs, PAs and chiropractors are continuing to contact lawmakers in large numbers. To pass this legislation, it will take even stronger interest by the physician community. Passing legislation is a marathon, not a sprint, so show your endurance and take action. In the House this will be heard by a new Committee so this may be the first time they have been contacted by our side. It is critical that contacts be made. Regardless of your specialty, we need your help and the help of your staff and patients.
TAKE ACTION NOW by clicking here even if you have already contacted lawmakers, please do so a second time.
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THA Coverage Fee
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TMA Position: Support
Bill Summary: The Senate amendment which makes the bill will assess a 3.5% fee to a hospital’s net patient revenue. This will eliminate many of the proposed cuts in TennCare. The hospital coverage fee proposes to fund some of the most significant TennCare cuts of concern to the medical community, otherwise scheduled to take effect on July 1, 2010:
- Reduce the across-the-board 7% provider reimbursement cut to hospitals and physicians down to 6%(this infusion of new funds would not affect the 14% cut announced by BCBST earlier this year on specialists in East and West Tennessee)
- Postpone the elimination of $50 million for Graduate Medical Education
- Postpone adoption of the cap of:
- 8 office visits per year for non-pregnant adults
- 8 physician office procedures per year for non-pregnant adults
- 8 lab/x-ray occasions of service per year for non-pregnant adults
- $10K per year on in-patient care for non-pregnant adults
- Postpone the elimination of covered benefits for PT/OT/Speech for non-pregnant adults
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Assignment of Benefits
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TMA Position: Support
Bill Summary: As amended, this legislation will require insurance companies to accept assignment of benefits for out-of-network providers. Additionally, the legislation will require that a facility notify patients that services may be provided by facility based physicians who may not have a contract with the patient’s insurer and that the patient may receive a bill for services unpaid by the carrier. Should the patient entering a facility on an elective basis not receive the notice, the carrier would have the option not to honor the assignment. As written, the provisions of this amendment would not affect patients entering a hospital through the emergency department.
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Independent External Review by Insurance Carriers
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TMA Position: Support – Part of TMA’s Legislative Package
Bill Summary: As amended, the bill creates a process whereby providers and patients will have the ability to request an independent and impartial external review and final determination if they believe that a procedure or claim was denied improperly.
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Copying Fees for Medical Records
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TMA Position: Support – Part of TMA Legislative Package
Bill Summary: Increases the cap limiting the amount a health care provider may charge for copying a patient’s medical records. Also establishes new fees to certify the record and for a digital copy of the patient’s record. An amendment was placed on the bill in House Finance to include the provision of a notarized affidavit by the custodian of records when an attorney needs a certified copy of the medical records as well as eliminate the fiscal note.
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Colorectal Screening Insurance Coverage
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TMA Position: Support
Bill Summary: As introduced, requires the department of health to develop and implement a program to provide colorectal cancer screenings for uninsured individuals between ages 50 and 64 and for any other uninsured individuals determined to be at high risk for developing colon cancer; requires health insurance companies to cover colorectal cancer screenings. The bill has been amended in the House subcommittee to eliminate the fiscal note but still includes the requirement for insurance carriers to cover colorectal screenings.
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Workers' Compensation Silent PPO
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TMA Position: Support
Bill Summary: Requires a contracting agent who sells, leases, assigns, transfers or conveys its list of contracted medical providers and their contracted reimbursement rates to disclose to the medical provider whether the list can be sold or leased. Requires contracting agents to maintain a web page which provides a complete listing of customers to whom a network is sold or leased.
Status: Passed the House and has been sent to the Governor for his signature. |
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Requirement to Check Elder and Sexual Abuse Registries
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TMA Position: Neutral if Amended
Bill Summary: With the amendment agreed to by all parties this week, the bill will require physician practices to check the state’s elder abuse registry and the national sexual offender registry if a criminal background check has not been performed on new applicants for employment. Anyone on any of the registries could not be employed in a position where direct patient care is provided.
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DUI Ignition Interlock Device
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TMA Position: Support
Bill Summary: Requires certain DUI offenders (BAC of .15 or higher, DUI with an adolescent in the vehicle) to operate a motor vehicle only if the vehicle is equipped with a functioning ignition interlock device.
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Medical Marijuana
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TMA Position: Oppose
Bill Summary: The bill creates a licensure and enrollment program for the production, distribution, and dispensing of cannabis for a qualifying medical condition. It authorizes a person with a qualifying medical condition to enroll in the safe access program where the patient can receive a prescription from a licensed practitioner for cannabis and receive the product from a licensed pharmacist at a participating pharmacy. Qualifying patients in the program will receive a safe access identification card through the Department of Health. Producers and distributors of the cannabis to be used in the program are to be licensed by the Department of Agriculture. All information obtained during the enrollment and verification process is confidential. It creates a Class B misdemeanor offense for any person to breach the confidentiality of information. It creates a Class C misdemeanor offense for fraudulent representation to a law enforcement officer of any fact or circumstance to avoid arrest or prosecution.
Status: Rescheduled for House Health Committee for next week. We anticipate discussion but the sponsor will not ask the committee to vote on the bill.
Cannabis is still a Class I drug which makes dispensing the product an illegal act. TMA continues to oppose any such legislation until such time as it can be properly studied to determine the true efficacy of the drug. |
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TMA Legislative Package Update At A Glance
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Bill Number
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Senate Sponsor
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House Sponsor
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Description
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Status
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Eligibility Verification – Puts processes in place so that physicians will have better information about a patient’s insurance coverage and eligibility
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Taken off notice
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Independent External Review – Sets up a process to ensure that patients and health care providers have access to an independent external review for insurance claims underpayments/denials
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Passed Senate
Working its way through the House Committee System
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Doctor Shopping – Makes corrections and clarifications to last year’s doctor shopping law
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Signed into law by the Governor on 3/31/2010
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Medical Record Copying Fees - Increases the cap on which health care providers can charge for copying a patient’s medical records
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Passed House
Awaiting action by the full Senate
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Pain Management – Clarifies under what conditions an APN or PA may perform certain procedures/treatment for chronic pain conditions
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Working its way through the House and Senate
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Level III Office-Based Surgery – Reinstates unusual Incident reporting for Level III office-based surgery
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Signed into law by the Governor- Public Chapter 637
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Other Bills TMA is Actively Supporting
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DUI Interlock Devices – Expands the use of ignition interlock devices for individuals convicted of certain DUI offenses
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Working its way through both the House and Senate Committees
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Colorectal Screenings – Requires insurance companies to cover colorectal screenings
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Working its way through both the House and Senate Committees
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EMTALA - Changes the liability standard from negligence to gross negligence in medical malpractice cases involving physicians rendering care in a hospital emergency room
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Never calendared
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Hospital coverage Fee – Revenue generated from this bill will temporarily eliminate cuts in the TennCare program
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Moving its way through the House and Senate Committees
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Assignment of Benefits – Clarifies that Assignment of Benefits statute applies to out-of-network providers
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Passed the full Senate. Moving its way through the House Committees
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Doctor of the Day Slots are Still Available
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A special “thank you” goes out to Dr. Alan Drake of Sparta who served as this week’s Doctor of the Day.
Please sign up to be Doctor of the Day. It is very rare that an organization has the opportunity to highlight themselves to state lawmakers. However, this is one opportunity for legislators to be reminded weekly from the floor of the House and Senate that TMA is present and is supporting their health care needs just as you support the needs of all their constituents. The General Assembly has really appreciated physicians’ willingness to participate in this program in the past. If you have a free Thursday, please click here and sign up today. It is a great opportunity to not only to support TMA but also learn about the legislative process. |
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Quick Links
For information, call TMA's Division of Government Affairs at 1-800-659-1862 or 615-385-2100, or send e-mail to gary.zelizer@tnmed.org.
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