By CLINT CUMMINS
CEO and executive vice-president, Memphis Medical Society
This year has already proven to be an interesting legislative year, as you will see below. One of the most interesting items from the medical perspective is what we are NOT proposing or battling - scope of practice (I’m almost scared to write that statement). The rest of the state legislative agenda for us represents a great lesson in advocacy. More times than not, we have to come to the table with a spirit of compromise and be content in making ANY progress on an initiative, even if the ultimate goal is not (yet) met. TMA, MMS, and MGMA have already travelled to Nashville on March, 4, to advocate for better healthcare for Tennesseans and a better environment to practice medicine in our state. Still, calls to action will be submitted to our stakeholders to impact bills that affect our profession (and one at the federal level right now). This article was written March, 10 so the status of these could be changed by the time you read this. Before I get into legislation, I want to take a moment to celebrate one of the best TMA Day on the Hill events we have ever had. Our turnout from Memphis was historical – we had too many registrants for one single bus! Our goal is to take two buses next year! A special thank you goes to our partners at University of Tennessee Health Science Center, Baptist University College of Medicine, and Mid-South MGMA for contributing to the great turnout.
Prior Authorization Notice (SB1063/HB1074)
If you’ve worked for three seconds in healthcare, or you have been a patient who has had to wait for a drug, treatment, or surgery that you needed, then you have been impacted by prior authorization. In the clinic setting, we are beyond administratively and financially burdened by having multiple full-time employees dedicated to managing prior authorization.
These bills seek to remove the requirement of healthcare providers to contact the patient when the insurance carrier needs additional information to make a decision. This creates unnecessary additional administrative burden on the provider, particularly when it is the insurance company requesting the additional information (not the provider).
As of the writing of this article, these bills have been sent to the Senate Calendar Committee (to be voted on by full Senate) and to House Insurance Committee on March 12.
TennCare Provider Remedy Plan (SB1372/HB651)
Once again, if you’ve worked in healthcare for three seconds, you know the challenges of accepting any form of government payment. TennCare is no exception.
These bills establish a study committee to analyze TennCare provider rates for purposes maintaining network adequacy and patient accessibility standards.
As of the writing of this article, these bills have been referred to the Senate Labor and Commerce and to House Insurance Subcommittee. They should both be heard this week.
In addition to the study committee, TMA is asking for an additional $100 million in the 2025-2026 fiscal year to help cover provider losses related to TennCare reimbursement.
Exceptions For Lethal Fetal Anomalies (SB1425/HB1241)
Reproductive rights is one of the most polarizing topics we discuss in healthcare. TMA and Memphis Medical Society have members with many unique opinions on the topic, much like broader society. We also know where our state legislature stands on the matter. So, this issue is one of the textbook examples of where we have to compromise. Our request for these exceptions is focused on the practice of medicine and protecting those who must exercise life-saving judgement without fear of prosecution.
Specifically, these bills clarify the medical necessity of the Human Life Protection Act to make clear that physicians may terminate a pregnancy to prevent death or serious risk or substantial or irreversible impairment of major bodily function of the pregnant woman. It further provides exceptions to the offense of criminal abortion if a lethal fetal anomaly is diagnosed prior to the 24th gestational week. Finally, it defines lethal fetal anomaly as “a fetus incompatible with life outside the womb where medical intervention would be futile, and death would occur imminently thereafter.”
As of the writing of this article, these bills have been referred to Senate Judiciary Committee and House Population Health Subcommittee.
Medicare Patient Access and Stabilization Act (FEDERAL H.R. 879)
Our attention toward federal legislation is growing, partly due to the desperate reimbursement environment and partly due to the changing policies of the new presidential administration.
H.R. 879 seeks to stop the financial bleeding of providers from the Medicare program. This legislation, if passed, would, effective April,1, prospectively cancel the 2.83 percent payment cut that went into effect on January 1, while also providing a 2.0 percent payment update, helping to stabilize physician practices and protect patients' access to care. The American Medical Association has a great website titled Fix Medicare Now, which has all the relevant resources to learn more and take action. I encourage everyone to go to that website and fill out their form to contact your local representative. For what my opinion is worth, Memphis congressional leaders have been very receptive to this message previously. They need to hear more from us!
Finally, I would like to give a special shoutout to the local leaders who volunteer their time to advocate on behalf of these issues. Several board members from Memphis Medical Society and Mid-South MGMA were present at TMA’s Day on the Hill, and it is their presence and leadership which continues to move the needle on these important issues.
And to the rest of you – I encourage you to get involved via these organizations or on your own as a constituent. Change starts with you!
