►
Description
House Finance, Ways & Means Subcommittee House Hearing Room 3
B
A
Thank
you,
sir,
and
apologize
for
that.
I
mean
mr
clerk
apologize
all
right
good
afternoon.
I'd
like
to
begin
by
welcoming
everyone
here
to
the
financial
ways
and
maine
subcommittee
certainly
look
forward
to
working
with
everyone
this
year
and
I
look
forward
to
the
first
year
of
the
112th
general
assembly,
especially
as
it
pertains
to
this
committee,
and
I
certainly
appreciate
the
opportunity
to
work
with
the
members
and
staff
of
this
committee
as
we
work
through
legislation
that
finds
its
way
on
our
calendars.
A
Now
members,
we
will
spend
more
time
on
introductions
and
review
of
our
policies
and
procedures
in
our
next
meeting,
but
for
now
and
in
the
interest
of
time
we
will
now
take
up
our
calendar.
So
with
that
said,
item
number
one
on
your
calendar
is
hjr18
leader
lambeth.
You
are
recognized,
there's
a
motion.
A
second
please
go
right
ahead.
Famous
chairman.
C
And
again,
thank
you
for
your
leadership
on
our
fiscal
responsibility
here
in
the
great
state
of
tennessee.
I
stand
ready
for
questions.
I
know
that
all
of
you
have
had
an
opportunity
to
read
over
this
very
short
resolution.
This
has
been
a
multi-year
process
that
we've
all
been
embarking
on,
in
which
we
now
have
an
opportunity
to
really
take
advantage
of
a
shared
savings
plan.
This
began
as
a
block
grant
proposal
that
we
were
that
we
sent
to
the
feds
and
they
have
sent
us
back
a
carefully
negotiated
win-win
scenario
for
every
tennessean.
C
A
D
C
Famous
chairman-
and
I
will
attempt
to
do
so
and
if
there
are
more
detailed
questions
that
you
would
like
to
have
from
the
folks
that
are
actually
doing
this
every
day
and
have
helped
gain
those
savings.
I
will
be
more
than
happy
to
step
aside
and,
and
mrs
chairman
would
recommend
that
we
go
out
of
session
for
those
folks
to
answer
those
questions.
I
would
like
to
ask
at
this
point:
do
you
would
you
like
me
to
make
an
attempt
at
answering
that,
or
would
you
like
to
hear
from
them?
Madam
chairman.
C
You
recognize
famous
chairman,
so
at
this
point,
the
way
we
would
gain
those
savings
is
to
continue
to
run
the
ten
care
program.
The
way
we
have
been
running
it,
there
are
savings
that
are
within
that
that
tenncare
has
been
able
to
accomplish
where
we
run
it
better
than
what
other
states
do,
and
so,
as
part
of
that
that
money
right
now
is
simply
just
going
unutilized.
It
either
remains
in
the
federal
coffers
or
it
is
just
not
being
utilized.
C
There
are
opportunities
for
us
to
be
able
to
negotiate
certain
savings
with
companies
that
contract
with
health
care,
there's
lots
of
different
ways
that
we
can
both
continue
and
begin
some
additional
savings
with
10
care
now
the
way
that
those
would
be
leveraged
and-
and
I'm
going
to
give
just
kind
of
a
overview
of
some
of
the
initial
priorities
that
we
could
go
into
with
those
savings.
We
could
definitely
and
there's
a
myriad
of
opportunities
out
there,
but
we
could
definitely
improve
maternal
health
coverage.
We
can
enhance
that
health
coverage
right
now.
C
C
That's
something
that
could
be
an
opportunity
to
provide
some
additional
services
for
a
population
that
desperately
needs
that
not
saying
we
will.
But
it's
an
option.
We
could
clear
the
wait
list,
or
at
least
do
a
long
way
toward
clearing
the
wait
list
on
adults
with
developmental
disabilities.
That's
a
population,
that's
eligible
right
now
for
tenncare,
and
we
just
need
some
additional
funds
to
be
able
to
do
so.
C
That's
that's
something
that
I
think
would
be
a
very,
very
beneficial
usage
of
this
money
and
then,
lastly,
and
the
list
goes
on,
we
could
address
any
crisis.
Healthcare
need
that
pops
up
and
we
would
have
the
flexibility
to
do
that
here
at
the
state
level
without
having
to
pursue
an
additional
grant
of
flexibility
or
exception
to
the
current
tenncare
structure,
and
this
would
give
us
that
flexibility
here
at
the
state
level.
So
I
I
don't
want
to
belabor
the
point
any
farther.
I
don't
know
if
I've
answered
a
question.
D
Just
one
follow-up
question:
I
know,
as
probably
many
of
my
colleagues
were
getting
emails
and
calls
from
some
of
our
constituents
who
are
concerned
about,
and
I
believe
this
to
be
a
misrepresentation,
but
I'd
like
to
hear
you
speak
to
it.
There
is
a
concern
that
somehow
this
will
cap,
enrollment
or
cap
services
or
even
take
away
some
services.
So
if
you
could
just
address
those
concerns,
please.
C
A
C
Famous
chairman,
thank
you,
madam
chairman.
This
in
no
way
will
cap
enrollment
or
cap
services.
It
just
simply
will
not
do
that.
That
is
why
this
is
different
than
any
other
plan
that
has
been
approved
in
the
country
thus
far.
This
is
a
first
of
its
kind,
but
it
can
definitely
be
the
model
for
how
states
could
pursue
this
down
the
road,
it's
a
win-win
for
the
federal
government
and
for
the
state
government,
and
it
is
certainly
a
win
for
our
constituents.
C
But
it
is
not
a
cap,
it
does
not
cap,
enrollment
or
services.
It
does
have
the
opportunity
to
improve
the
services,
while
the
actual
number
of
10
care
recipients
fluctuates
up
and
down
as
it
does.
Naturally,
I
mean
during
tough
times.
Obviously
there
are
more
folks
that
need
tenncare
during
good
times.
We
normally
see
that
enrollment
go
down,
so
it
it
allows
for
that
ebb
and
flow
of
the
population
and
controls
for
that
within
here
and
and
does
not
count
that
cap
that,
at
all.
C
Famous
chairman
and
the
short
answer-
and
we
can
go
into
this
in
more
detail-
is
that
if,
if
our
quality
of
care
were
to
decrease
for
some
reason-
and
we
hope
that
that
would
not
happen-
and
all
of
us
should
keep
a
close
eye
on
that
make
sure
it
doesn't
happen.
But
if
it
were
to
decrease,
we
get
less
savings,
so
we
are
financially
punished
so
to
speak,
we
get
less
savings
in
it
still
have
the
baseline.
Still
it
does
not
affect
our
cap.
C
I
mean
it's
it's
it's
kind
of
like
there
are
plans
out
there
throughout
the
country
from
time
to
time
where
a
doctor
will
take
on
a
set
of
medicare
patients
and
if
they
are
able
to
improve
the
health
care
and
the
quality
of
care,
it
improves
their
health
overall
and
many
times.
There
are
some
some
financial
benefits
to
that
to
that
group
of
individuals
with
this
that
looks
at
our
entire
state
population.
C
But
if
the
quality
of
care
goes
up,
we
have
every
incentive
to
make
sure
that
it
does,
because
we
get
additional
shared
savings
that
then
it's
it
can
be
reinvested
over
and
over
again,
and
it's
kind
of
a
snowball
effect
that
your
patients
are
doing
better
you
should
it
should
cost
less,
but
instead
of
that
cost
savings
just
going
to
the
feds.
We
keep
it
here
to
help
additional
patients.
E
A
E
Thank
you.
Thank
you
for
being
here.
I
appreciate
it
earlier.
I
was
watching
the
insurance
subcommittee
today.
I
wasn't
sure
we
were
going
to
get
the
presentation
here.
So
I
watched
some
of
it
today
and
representative
thompson
asked
a
question
about
the
people
that
had
been
added
to
the
roles
and
it
was
something
about.
E
F
I'd
be
happy
to
so.
We've
got
protections
built
into
the
agreement
to
take
care
of
the
very
situation
that
you're
talking
about
with
the
the
covid
cost.
So
one
we
have
a
very
advantageous
base
block
grant
amount
for
us,
but
then
two
we've
got
that
that
adjustment
for
enrollment
increases.
So,
as
you
mentioned,
we've
increased
by
about
seven
percent
since
march
of
of
2020
about
a
hundred
thousand
members,
and
so
we've
got
a
built-in
protection
because
we
get
an
adjustment
to
our
enrollment
cap
for
that
type
of
enrollment
increase.
F
E
Okay,
thank
you
for
the
clarification,
so
we
can
go
back
to
cms.
Okay,
appreciate
that
the
other
question
is
around
the
utilization
of
the
funds
that
we're
saving
the
shared
savings.
The
sponsor
mentioned
earlier
that
we
expect
to
have
a
greater
flexibility
with
the
shared
savings.
So
the
question
I
have
is
one:
will
those
savings
be
reinvested
back
into
ten
care?
F
So
we've
committed
that
we
will
reinvest
those
funds
back
into
tenncare
or
in
areas
that
will
provide
additional
benefits
and
services
to
tenncare
members.
So
it's
possible
that
there
could
be
some
initiatives
that
we
would
want
to
utilize
those
funds
for
that
would
be
outside
traditional
medicaid,
but
would
still
have
a
positive
impact
on
the
health
of
our
10
care
members
that
that's
the
commitment
that
we've
made.
F
E
E
E
A
G
Thank
you
very
much
and
nice
to
see
you,
commissioner.
Our
sponsor
talked
about,
if,
if
quality
of
care
improves,
and
is
that
a
reference
to
health
outcomes,
in
other
words,
if
we
see
the
10
care
population
or
the
populations
with
better
outcomes,
better
health
in
some
way,
the
metrics
is
improve
is.
Is
that
what
that's
a
reference
to
and
whether
in
in
terms
of
quality
of
care,
or
is
that
something
else
well.
F
I
think
it's,
I
think
it's
two
different
issues,
so
the
shared
savings
piece
is
dependent
upon
us
meeting,
certain
certain
quality
metrics,
and
so
we
we
will
choose
10
quality
metrics
from
this
cms
core
quality
set.
These
are
objective
measures
that
all
states
have
to
have
to
report
on,
and
so
it's
things
like
childhood
immunizations
or
flu
vaccines.
F
Cervical
cancer
screenings
things
like
that,
but
to
the
other
point
that
the
leader
was
making
is
that
it's
only
to
our
advantage
to
make
improvements
in
quality
and
health
outcomes,
because
if
we
do
that,
that
actually
is
going
to
lower
health
care
costs,
which
will
then
generate
additional
shared
savings,
which
we
can
then
reinvest
back
into
into
these
areas.
So
it's
it's
kind
of
a
you
know
circular
thing
that
that
just
benefits.
G
G
I
absolutely
love
her,
but
she's
still
on
10
care
for
a
little
bit
and
she
went
to
her
gynecologist
and
was
really
unhappy
with
the
service
there
and
I
almost
called
y'all
and
I
asked
her
if
she
wanted
me
to
call
I
did
and
she
declined,
but
so
how
do?
How
do
we
measure
that
I
don't
know
if
there's
any
sort
of
patient
satisfaction
survey
or
anything
like
that,
but
I
did
tell
her
you
know
I
can
look
into
that.
I
can,
and
you
know,
she's
still
a
little
shy.
F
That's
a
really
good
question:
it's
something
that
we've
talked
about
as
an
executive
team
at
ten
care,
because
I
think,
most
of
the
time
when
we
think
about
quality,
we're
thinking
about
health
outcomes,
but
there's
also
a
piece
of
quality.
That's
tied
to
the
actual
services
customer
service
that
people
are
receiving.
F
So
one
thing
that
we
do
is
we
have
a
survey,
that's
of
our
membership,
that's
conducted
by
the
university
of
tennessee
every
single
year
and
for
the
last
10
years
we've
been
a
we've
been
above
90
percent.
So
I
would
you
know
I
would
compare
that
I'd
put
us
up
against
any
other
insurance
provider
out
there.
G
And
I
have
to
say,
I
think
tank
care
absolutely
provides
excellent
customer
service
and
so
do
many
of
the
service
providers.
The
physicians
and
I
think
that
this
experience
was,
you
know,
just
the
physician
and
maybe
their
bedside
manner.
I'm
not
sure,
but
something
like
that,
and
so
that's
kind
of
a
hard
thing.
She
did
not
blame
tenncare.
G
A
F
Representative,
I
can't
I
can't
predict
the
savings
we
we
have
to
get
through.
We
have
to
get
some
experience
with
this.
I
mean
we
do
anticipate
that
over
the
course
of
the
of
the
10
years
of
this
agreement,
that
we
will
have
significant
shared
savings,
but
I
can't
make
a
prediction
about
year,
one
also,
it's
probably
important
to
note
that
our
greatest
opportunities
for
shared
savings
are
in
the
the
latter
years.
You
can
kind
of
look
at
this
as
two
five
year
periods
because
we
get
rebased
at
year
five.
F
So
if
you
look
at
the
first
five
year
period,
probably
years
three,
four
and
five
are
our
best
chances,
because
we
get
the
benefit
of
the
of
the
president's
budget
trend
year
over
year
and
historically,
we
are
below
that
year
over
year.
So
our
greatest
opportunity
is
not
in
the
first
year,
it's
in
it's
in
those
later
years,
so.
H
F
It
I
mean
it
is
to
be
determined
because
we
do
have
to
we
have
to
experience
this,
but
if
we
look
at
our
historical
performance,
then
we
know
that
we
will
have.
I
mean
we're
confident
we're
gonna
have
significant
savings.
What
I
can
tell
you
is,
while
I
can't
guarantee
you
what
the
shared
savings
will
be.
If
we
don't
do
this,
I
can
guarantee
you.
The
share
savings
will
be
zero.
F
H
H
What
what
what's
the
selling
pitch
on
this,
because
I
mean
you're,
a
good
guy,
you're,
certainly
professional.
I
think
you
do
a
good
job.
You
just
testified
that
the
quality
of
care
that
your
department
provides
is
in
the
90
percentile
or
above
so
that
leaves
single
digits
to
improve,
and
the
selling
point
is
we're
going
to
improve
the
quality
of
care,
but
you're
already
a
pub
90
percent.
H
So
what
is
it?
What's
the
selling
point
to
tennessee
to
adopt
this
and
again
you're
a
professional,
your
department
does
a
good
job,
you're,
always
responsive
and
that's.
This
is
not
a
aggressive
question,
but
I
think
a
lot
of
people
are
still
unclear
as
to
exactly
what
this
block
grant
does.
Can
you
boil
that
down
for
this
committee,
if
somebody's
listening
in
cookeville
tennessee
this
afternoon,
I
mean,
what's
the
deal.
F
H
I
I
It
mirrors
exactly
what
you've
said
several
times
through
our
committee
that
it
is
difficult
to
quantify
at
this
moment,
but
I
do
want
to
talk
about
a
couple
of
aspects
of
the
fiscal
note
that
we
do
have
before
us.
It
says
specifically
under
the
demonstration
the
state
may
only
expand
benefits
and
coverage
under
this
demonstration
authority
benefits
and
coverage
cannot
be
reduced.
I
F
That's
exactly
right.
We
tried
to
we
tried
to
make
that
point
over
and
over
this,
this
will
not
result
in
any
reductions
in
eligibility
benefits
services,
what
we
pay
our
providers
and
in
terms
of
the
benefits
and
services
and
eligibility.
You
actually
see
that
in
the
agreement,
it's
in
the
standard
terms
and
conditions.
I
We've
got
a
wish
list
and
I
think
it
it's
a
tremendous
list
that
we've
got
some
initiatives,
but
we
get
this
in
place
and
then
we
start
start
that
process.
So
can
you
mention
as
well-
and
I
mentioned
block
grant-
has
become
the
word,
but
this
is
really
a
modified
block,
grant
more
of
a
shared
savings
plan
for
tennessee.
If
you
could
address
that
to
a
degree,
it.
F
Is-
and
I
I
know
we-
we
kind
of
get
caught
up
in
these
in
these
terms,
but
if
you
just
really
look
at
what
the
agreement
is
and
and
what
it's
not
it,
it's
it's
not
a
traditional
block
grant
by
any
means,
because
it's
not
a
fixed
spending
cap,
it's
a
it's
a
cap,
that's
trended
forward,
and
then
we
get
adjustments
for
enrollment.
So
we've
kind
of
used
this
term
the
modified,
a
modified
block,
grant
proposal
and
cms
uses
the
term
an
aggregate
cap
model.
F
J
Sir,
thank
you,
mr
chairman.
I
guess
I
I
want
to
summarize
some
things
that
are
in
the
letter
that
cms
has
sent
the
state
and,
if
I
mischaracterize
anything
or
if
it's
out
of
context,
so
I'd
just
like
you
to
to
comment
on
that.
If
it's
not,
you
can
just
say,
that's
that's
accurate,
because
I
want
to
make
sure
I've
summarized
this
appropriately.
J
The
state
will
use
a
budget
neutrality
structure
bound
by
an
aggregate
cap
on
demonstration
funding.
It's
not
a
block
grant,
as
you
just
stated,
but
rather
gives
the
state
flexibility
in
operating
its
program
under
a
defined
cap
by
putting
expenditures
at
risk
based
on
based
on
both
cost
and
population
growth
and
is
consistent
with
existing
cms
policy
outlined
in
the
budget
neutrality
policies
for
section
1115.
J
It
also
allows
the
state
to
approximately
appropriately
excuse
me
manage
costs
within
a
fixed
budget.
That's
very
important
to
us.
Obviously,
on
this
committee,
up
to
55
percent
of
the
any
savings
achieved
may
be
earned
by
the
state
in
the
form
of
additional
federal
matching
funds
that
can
be
reinvented
invested
in
the
state
health
programs.
J
Cms
will
allow
the
state
the
discretion
to
make
certain
changes
in
the
programs
within
parameters
established
without
additional
federal
approval.
It
gives
some
administrative
flexibility
that
may
allow
the
state
to
be
better
equipped
to
respond
to
changes
in
demographics,
economic
conditions
or
emerging
public
health
issues
without
time
delays
in
order
to
more
effectively
manage
their
medicaid
program,
which
I'm
considering
at
this
point
with
the
pandemic,
with
a
lot
of
people
unemployed,
cobra
running
out
with
some
individuals.
J
You
know
we
could
see
some
changes
that
need
to
be
made,
and
so
I
thought
that
was
a
real
positive
aspect
of
this.
It
gives
us
some
flexibility
to
be
mobile
on
that
also
any
coverage
or
benefit
changes
to
existing
populations
covered
or
limited
to
those
that
are
additive
in
nature
has
already
been
stated,
and
the
state
is
not
authorized
to
make
reductions
to
its
current
approved
coverage
or
benefit
package
without
approval
of
an
amendment.
J
So
that's
another
safeguard
built
in
and
again
several
of
us
have
received
comments
from
the
public
in
certain
organizations
that
maybe
don't
see
the
details
of
this
like
what
has
been
sent
to
us
and
so
wanted
to
make
sure
those
things
were
on
the
record
and
are
accurate
if
you
could
just
affirm
that
please.
Thank
you.
F
D
Thank
you,
mr
chairman,
in
a
presentation
that
I
sat
through
earlier
that
you
made
you
mentioned
that
whether
we
go
forward
with
this
process
or
not
our
current
tenncare
program,
that
waiver
is
running
out
and
we
will
have
to
renegotiate
with
cms,
and
that
is
a
total
unknown.
We
have.
You
know
we
have
in
front
of
us
an
offer
if
you
will
from
cms
where
there
are
many
unknowns.
D
That's
been
addressed
here
in
terms
of
how
it
will
play
out
and
exactly
how
much
savings,
because
we
don't
know
what
the
economy
is
going
to
do.
If
there's
going
to
be
a
big
run
on
tenncare
or
it's
going
to
a
lot
of
people
are
going
to
be
able
to
get
jobs
and
get
out.
You
know
they're
just
so
many
unknowns.
But
can
you
just
speak
to
I
guess
in
terms
of
risk
what
we
are?
D
F
F
If
we
don't
go
forward
with
this
with
this
deal,
then
we're
still
going
to
have
to
negotiate
a
new
waiver
and
we're
still
going
to
have
a
budget
neutrality
cap.
That's
not
something
that
is
unique
to
this
agreement
that
we're
talking
about
and
that
budget
neutrality
cap
by
all
indications
will
be
less
than
what
we
have
negotiated
with
this
agreement.
F
So
there's
more
risk.
There
also
we've
negotiated
a
10-year
agreement
and
we
are
going
to
get
credit
because
of
our
negotiations.
We're
going
to
get
we're
going
to
get
credit
for
6
billion
of
accumulated
past
savings
that
are
going
to
be
available
to
us
for
the
full
10
years.
That
means
that
if
we
exceed
our
cap,
we
have
that
6
billion
dollars
as
kind
of
overdraft
protection,
we'll
have
it
for
the
full
10
years.
F
If
we
do
a
traditional
waiver
renewal,
that
will
only
be
available
to
us
for
five
years,
so
this
agreement
provides
some
real
stability
to
our
program,
and
I
would
argue
that
we
have.
We
have
a
greater
risk
with
a
traditional
waiver
renewal
than
we
have
with
this,
and
we
get
no
reward
at
all
with
a
traditional
waiver
renewal
and
we
get
a
reward
opportunity
with
this.
So
when
you
compare
it
against
where
we
would
be
otherwise
to
me,
it's
an
easy
decision.
F
So
we
we
feel,
like
we've,
got
these
built-in
protections
and
also
remember
it's
a
10-year
agreement,
and
so
when
we're
talking
about
the
shared
savings
opportunities,
it
may
be
that
in
one
or
two
or
a
couple
of
the
10
years
we
don't
achieve
shared
savings.
But,
overall,
when
you
look
at
the
life
of
the
demonstration
period,
we
feel
confident
that
we
will
achieve
those
shared
savings.
A
A
All
right,
seeing
none
are
you
ready
to
vote
all
right,
see
no
objection.
We
are
now
voting
on
house
bill,
hjr,
18,
moving
on
to
full
finance,
all
those
in
favor
say
aye,
all
those
opposed.
No,
the
eyes
hat
hdr18
moves
on
to
full
finance
members.
This
does
complete
our
business.
For
today
we
do
have
I'm
going
to
send
it
to
chair
lady
hayden
wood.
If
she
wants
to
make
a
quick
announcement
on
full
finance
and
when
we
will
be
meeting
there.