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From YouTube: House Health Committee- April 14, 2021
Description
House Health Committee- April 14, 2021
A
A
A
A
A
A
A
A
C
C
A
C
Chair
and
committee
this
bill
as
it
stands
now,
the
amendment
was
put
on
there
brought
to
me
by
the
department
of
education
to
help
me
get
rid
of
the
fiscal
note
that
was
on
the
original
bill.
You,
if
you
look
carefully
you'll
notice,
that
the
fiscal
note
on
the
amendment
is
now
not
significant,
so
we'll
go
through.
So
let
me
briefly
explain
as
amended
what
the
bill
does.
The
purpose
of
the
bill
is
to
ensure
that
the
family
life
curriculum
information
meets
state
standards,
that's
tennessee,
state
standards.
C
Additionally,
the
bill
allows
a
parent
of
a
student
to
request
to
review
the
information
in
that
curriculum
and
opt
student
out
of
any
portion
of
the
family
life
curriculum
without
penalty,
which
is
very
similar
to
a
bill.
You
heard
on
the
floor
today,
but
not
the
same
as
this
only
applies
to
that
family
life
curriculum.
C
The
requirements
in
the
bill
are
first
off
that
information
presented
in
that
family
life
curriculum
must
be
medically
accurate
age
appropriate
and
in
compliance
with
this
part,
which
is
also
requiring
that
the
lea
review
it
and
ensure
that
it
meets
state
standards.
That
is
the
bill,
as
amended
explained,
and
I
stand
ready
to
answer
questions.
A
Okay,
seeing
none
we
will
be
voting
on
house
bill
577
as
amended.
All
those
in
favor
say
aye
opposed
eyes.
Have
it
bill
goes
on
to
government
operations?
Thank
you,
mr
chair
and
committee.
All
right,
thank
you
and
I
am
going
to
go
out
of
order
here.
We
have
some
folks
that
we're
here
to
testify
and
make
sure
that
they
get
to
testify
today
and
I've
spoken
with
the
sponsor
on
this
as
well.
D
D
Standard
medical
practice
does
not
involve
prescribing
hormone
treatment
for
gender
dystrophic
or
gender
incongruent,
pure
pivotal,
minors
accept,
as
provided
in
the
subsequent
section.
So
it
is
not
standard
medical
treatment
and
we
are
basically
taking
that
fact
and
codifying
it
into
house
bill
through
house
bill.
1027.
A
D
E
E
Thank
you,
mr
chairman,
and
and
thank
you
sponsor,
I
I
you
know
standard
of
care
standard
of
care.
If
we
don't
want
to
cut
a
fight
in
one
instance,
why
would
we
want
to
call
identified
in
another
just
for
some
specific,
maybe
personal
view
or
other,
and
it's
been
stated
already
that
this
is
not
being
done
because
it's
the
accepted
standard
of
care.
So
I
failed
to
see
the
purpose
for
the
bill
and
I
want
to
make
sure
and
I'm
worried
about
us
being
consistent,
whether
they're
going
to
codify
standard
of
care
or
not.
D
Thank
you,
mr
chairman,
represent
clemens.
The
one
point
to
note
here
is
that
there
have
been
previous
guidelines
by
various
professional
societies
that
have
been
that
are
being
progressively
changed
and
transgressed,
so
there
is
a
tendency
towards
going
towards
earlier
and
earlier
age,
and
this
is
an
effort
to
avoid
that
creep
mission
creep
so
to
so
to
speak
so
that
we
don't
continue
down
that
path
and
there,
if
you
look
at
the
2017
guidelines,
there
has
been
definitely
a
change
in
since
that
time.
D
E
A
Okay,
seeing
none
without
objection,
we're
going
to
vote
on
amendment
5771,
all
those
in
favor
say:
aye
aye
opposed
eyes,
have
it:
okay,
we
are
back
on
the
bill
as
amended
and
pursuant
to
the
question
that
just
got
proposed,
I'm
going
to
go
out
of
session.
We
have
a
couple
of
folks
here
that
are
wanting
to
testify.
F
Thank
you,
I'm
cassie
brady.
I
am
with
the
pediatric
endocrine
division
at
vanderbilt
children's
hospital,
so
my
name
is
dr
cassie
brady.
I'm
a
board
certified
pediatrician
in
pediatric
endocrinologist
at
the
monroe-carroll
junior
children's
hospital
at
vanderbilt,
I'm
the
co-director
of
our
multidisciplinary
team,
providing
care
for
transgender
youth,
I'm
speaking
today
on
behalf
of
my
team,
the
transgender
patients
that
we
serve,
the
other
medical
providers
across
the
state.
Seeing
these
patients
and
the
patients
families
they
see,
the
care
of
transgender
youth
is
complex.
F
A
great
deal
of
care
is
taken
at
every
step
of
the
process
to
ensure
the
safety
and
welfare
of
the
children
and
families
we
serve.
Doctors
and
mental
health
providers
adhere
to
extensively
research,
professional
guidelines
set
forth
by
national
and
international
specialty
organizations,
including
the
endocrine
society,
the
american
academy
of
pediatrics,
the
world
professional
association
of
transgender
health,
the
american
psychological
association
and
other
organizations
providers
across
this
state
utilize.
These
guidelines,
when
initiating
affirming
medical
care
for
transgender
youth.
F
There
are
safeguards
at
every
step
of
the
process
that
are
above
and
beyond
what
is
required
for
other
pediatric
conditions.
Decisions
to
begin
hormone
therapy
are
always
informed
by
the
current
best
practice
guidelines
and
include
input
from
mental
health
providers.
Other
expert
physicians
on
our
teams,
as
well
as
by
the
individual
parent
and
their
caregivers
detailed
informed
consent,
is
obtained
from
the
patient
and
guardians
prior
to
starting
any
medical
care,
such
as
the
puberty
blockers
or
reform
affirming
hormone
therapy.
These
treatments
we
provide
are
life-saving.
F
Transgender,
youth
are
an
increased
risk
for
suicide.
Nearly
half
consider
it
and
a
third
actually
attempt
it
when
receiving
gender,
affirming
care
suicide
risk
declines,
and
these
individuals
live
longer.
Healthier
lives,
house,
bill,
1027,
focuses
on
hormone
treatment
of
pre-pubertal
minors
diagnosed
with
gender
dysphoria.
Our
guidelines
already
state
that
the
use
of
blockers
or
gender
affirming
hormones
is
not
medical
practice
in
children
who
are
in
tanner
stage.
One
of
pubertal
development
physiologically
blockers
do
not
work
unless
a
patient
is
in
puberty,
while
house
bill
1027
does
reflect
the
current
standard
of
care.
F
D
Thank
you.
Thank
mr
chairman,
thank
you,
dr
brady,
for
being
here,
and
I
think
you
have
confirmed
what
we
are
saying
mutually.
We
agree
that
hormonal
therapy
in
tanner
stage,
one
which
is
very
pre-puberty,
is
not
current
current
treatment
standard
medical
treatment.
We
agree
on
that.
We
do
okay
good.
D
E
F
Well,
I
I
can't.
I
would
like
to
comment
on
the
fact
that
when
we
talk
about
age
and
how
that's
creeping
back
and
using
this
hormone
therapy,
we
don't
base
our
hormone
treatment
or
our
pubertal
blocking
treatments
on
age.
We
base
it
on
tanner
stage,
pubertal
development
and
that's
based
on
physical
exam
and
laboratory
findings,
and
puberty
can
start
as
early
as
eight
in
girls
and
as
early
as
nine
in
boys
and
be
completely
normal.
F
These
hormone
treatments
are
used
already
in
precocious
or
early
puberty
and
are
completely
reversible,
safe
medications
that
have
been
used
for
many
years,
so
I
don't
have
concerns
using
them
in
this
population
or
any
other
population.
I
use
them
in,
and
I
agree
with
the
fact
that
you
brought
up
earlier
that
maybe
my
standard
care
that
I'm
using
shouldn't
be
put
into
code
all
right.
F
D
Characters
of
pubertal
development
have
not
occurred
yet
and
stage
being
five
being
that
they
are
fully
developed
in
their
secondary
sex
characters.
After
having
done
that,
I
don't
think
that
we
are
taking
the
standard
of
care
of
care,
borrowing
it
and
putting
it
in
code.
I
think
it
just
happens
that
the
opinions
and
feelings
of
the
public
officials
that
we
are
putting
into
code
happen
to
fortunately
coincide
with
the
standard
of
care.
H
F
F
H
All
right
you're,
what
recognized!
Thank
you
thank
you
for
that.
I,
I
guess
the
the
next
question
for
me
is,
if
I
come
in
with
my
son
or
daughter,
and
my
son
or
daughter,
is
interested
in
this
hormone
therapy.
What
what?
What
is
the
process
for
you
as
a
physician
determining
whether
or
not
you
want
to
assist
with
this
therapy?
I
guess
what
are
the?
What
are
the
parameters
that
you're
looking
at
as
a
clinician
as
it
as
it
relates
to
how
you
will
move
forward
with
this
person
or
not?
You.
F
As
a
physician,
I'm
guided
by
the
mental
health
providers
that
these
children
are
required
to
see
and
once
that
mental
health
provider
has
made
their
assessment
and
written
a
very
formal
assessment
and
letter
and
parents
have
provided
informed
consent,
the
child
is
in
tanner
stage,
2
development
and
I've
met
with
them
and
agree.
Then
we
move
forward.
It
can
take
several
months.
H
F
H
E
Thank
you,
mr
german,
and
I
just
want
to
return
back
to
something
my
colleague
asked
you
about
is
the
new
reference.
Was
the
mental
health
care
that
the
children
receive?
Can
you
elaborate
on
what
that
mental
health
care?
I
know
you
don't
provide
it
yourself,
but
can
you
elaborate
on
what
that
is
before
they
ever
get
to
you.
F
F
These
individuals
can
be
depressed
and
anxious
and
other
things,
but
that
should
not
be
clouding
the
picture
in
any
way
and
that's
when
the
therapist
works
very
very
closely.
They
meet
with
the
therapists
far
more
than
they
meet
with
me,
weekly,
sometimes
bi-weekly,
sometimes
every
every
other
week,
depending
on
what
therapist
sees
fit.
E
E
C
Thank
you
doctor,
and
thank
you
for
being
here
this.
If
this
piece
of
legislation
passes
out
of
our
committee
today,
will
this
preclude
you
from
administering
treatment
to
any
patients
that
you
believe
need
need
treatment,
or
is
it
a
one
of
those
hey?
I
don't
like
to
see
my
standard
of
care
written
in
code,
I'm
trying
to
find
out
if,
if,
if
this
would
diminish
your
practice,
or
is
it
just
guard
rails
that
you
really
don't
want
to
have
for
you
that
that's
that's
my
question
then.
F
A
Thank
you
very
much.
Thank
you.
Follow
up
on
that
question.
So
what
if,
if
this
bill
did
go
through
someone
that
is
not
following
the
standard
of
care
and
I'm
not
saying
that,
there's
anybody
that's
out
there,
that's
not,
but
assuming
that
somebody
did
not
follow
the
standard
of
care,
this
would
put
something
in
place
to
have
an
action
on
them.
I
I
D
Thank
you,
mr
chairman.
I
would
like
to
assure
for
one
thing
that,
with
this
bill,
if
it
becomes
legislation,
it
will
not
interfere
with
your
practice.
One
two
also
concerns
about
increased,
suicidal
ideations
and
attempts,
and
so
on
the
care
that
children
at
this
age,
pre,
pubertal
children
will
receive,
is
going
to
continue,
and
this
will
not
in
any
way
at
all
interfere
with
that.
D
Also,
as
far
as
searching
our
code
and
searching
the
standards
of
care
there
is
it's
not
going
to
be
easy
to
find
out,
and
I
would
say
that
it's
not
that
there
is
not
any
standard
that
is
not
in
the
code
or
anything
like
that.
I'm
sure
one
can
be
found
and
it's
not
our
intent.
Our
intent
is
certainly
not
that
our
intent
is
that
we
tread
into
this
territory
very
carefully,
because
discrimination
comes
to
mind.
Nobody
likes
to
be
blamed
of
that.
D
We
don't
want
to
be
in
that
role,
certainly,
and
we
are
very
very
aware
that
these
are
children
that
need
love
and
care.
They
should
not
in
any
way
feel
that
they
are
being
singled
out.
That's
not
our
intent
and,
as
I
said,
we
tread
very
carefully
and
very
slowly
into
this
direction.
Yet
it
seems
that
there
is
a
need
to
protect
these
children
who
are
young,
and
the
other
blessing,
of
course,
is
that
they
are,
of
course
under
the
care
of
good
professionals
like
yourself
and
the
mental
health,
counselors
and
so
on.
D
J
F
Anyone
who's
under
the
age
of
18
is
a
minor,
at
least
in
our
clinic
and
with
our
guidelines,
say,
should
have
consent,
informed
consent
from
both
parents
and
for
our
clinic
in
particular.
I
can't
speak
to
every
other
clinic
in
the
state,
because
I
don't
fault,
I'm
not
in
their
clinics,
but
we
have
to
have
both
parents
there,
and
so
that
means
if
parents
are
divorced
and
one
disagrees
and
one
agrees,
then
that
child
cannot
have
the
hormone
or
hormone
blocking
therapy.
F
J
Today
we
had
a
piece
of
legislation
that
allowed
for
parents
to
opt
out
of
education,
curriculum
that
would
have
taught
the
kids
about
lgbtq
and
and
sexuality
and-
and
the
statement
was
made
at
that
point-
that
we
need
to
let
the
parents
choose
and
it
sounds
like
we've
got
an
opportunity
right
here
to
really
practice
what
we
preach
and
and
and
let's
let
the
parents
choose.
So
thank
you.
H
H
Parents
yeah,
I
I
think
you
know
to
my
good
friend
from
nashville's
comments.
You
know
the
parents
are
involved
in
this
process.
We,
at
least
by
your
recollection,
that
they
are
for
your
clinic.
I
think
one
of
the
interesting
parts
about
what
we
find,
whether
it's
as
it
relates
to
this
kind
of
care
or
every
year
I've
had
people
come
to
my
my
office
and
say
I
want
to
change
this
in
my
practice
act.
H
I
want
to
be
able
to
do
this
instead
of
the
other
thing
we
codify
what
physicians
and
physical
therapists
and
optometrists
and
ophthalmologists
can
do
all
the
time
this
bill,
as
amended,
would
not
prevent
any
parent
from
doing
that.
It
would
simply
much
like
practice.
Act
set
a
guideline
or
what
an
expectation
is
and
then,
if
it
changes
and
children,
decide
to
to
do
that,
the
age
goes
up
or
comes
down.
Then
we
can
have
a
discussion
about
it.
H
I
I
think
it's
very
important
that
for
us,
and
particularly
all
of
us,
regardless
what
side
of
the
aisle
on
that
the
parents
are
involved,
I
think
it,
but
not
everyone's
practice
may
be
like
yours.
You
know
not
every
physician
in
their
community
may
require
the
parent
to
be
involved.
I
don't
know
by
your
own
testimony
a
minute
ago
and
communicating
with
the
process.
H
D
Thank
you,
mr
chairman.
Once
again,
thank
you.
It's
a
good
discussion.
I
think
this
is
important.
It
will
serve
to
reassure
these
children
who
may
be
too
young
or
their
parents,
that
there
is
no
agenda
here.
Guidelines
in
my
experience
in
medicine
are
exactly
what
they
are.
They
are
guidelines
and
I
think
you
would
agree
that
variations
from
guideline
are
quite
common
in
the
practice
of
medicine
and
surgery.
So
for
that
reason
I
think
it's
a
reasonable
precaution
to
take
once
again,
the
intent
is
to
protect
these
young
children
and
with
our
concern
for
that.
J
F
H
A
D
A
Thank
you
thank
you
for
coming
today.
I
do
want
to
tell
the
committee
and
those
in
the
audience
those
listening
you
and
I
had
an
extensive
conversation
on
this
and
everything
from
what
happens
before
puberty
during
puberty
all
the
way
through
surgery,
the
detransition,
the
psychological
background,
all
that
and
you're
very
well
versed,
and
you
educated
our
committee-
and
it
was
a
pleasure
talking
to
you
at
that
time,
pleasure
having
you
in
front
of
the
committee
today
and
again,
thank
you
for
for
coming.
A
K
K
K
K
K
K
K
D
D
Anything
that
we
are
doing
here
today
is
meant
to
protect
children
from
getting
treatment
at
two
earlier
stage
of
life,
and
also
the
fact
that
it
is
inconsistent.
It's
completely
consistent
with
the
current
practice
of
medicine.
So
in
that
sense,
except
for
putting
in
our
books,
we
are
not
in
any
way
interfering
there
is.
D
It
will
not
interfere
with
the
current
treatment
of
of
transgender
children.
It
will
not
at
all
interfere
in
any
way
about
their
mental
health,
suicidal
tendencies,
and
I
think
those
things
are
very,
very
important
to
us.
We
we
represent
citizens,
we
represent
you
and
we
represent
the
values
that
our
constituents
transmit
to
you
to
us,
and-
and
we
do
that
in
a
most
meaningful
way.
I
think
these
are
leaders.
These
are
thoughtful
people.
D
All
of
these
people
have
been
elected
and
they've
been
trusted
with
doing
the
right
thing,
and
what
we
do
is
also
open
to
you,
and
you
can
see
that
and
that's
why
you're
here
today,
once
again,
thank
you
for
coming.
I
assure
you
that
we
are
not
in
any
way
interfering
in
the
treatment
of
these
children.
We
are.
D
J
Thank
you,
mr
chairman,
and
I
I
would
would
be
remiss
if
I
didn't
comment
and
thank
everyone
in
the
audience
wearing
purple
in
support
of
this
cause
today.
I
I
just
want
to
comment
on
one
thing
that
that
you
brought
up
and
that's
the
the
stigmatization
that
we're
putting
on
this,
and
you
know
we
we
have
situations
today
where
best
practice
is
hormone
therapy
for
kids
and
for
for
prepubescent
kids,
that
we
don't.
We
don't
talk
about
that.
That's
not
a
concern
here.
J
J
D
A
B
Thank
you,
mr
chairman,
and
I
had
a
discussion
yesterday
with
a
constituent,
a
mother
of
a
a
young
lady,
that's
10
years
old,
and
it
was
a
a
very
moving
discussion
and
the
challenges
they
face
is
with
their
young
daughter
and
chairman
kumar.
I
understand,
sir,
that
this
does
not
change
any
of
the
treatment.
That's
currently
providing
these
children,
but
I
just
want
to
make
sure
that
we
don't
have
any
more
amendments
placed
on
this
when
it
makes
to
the
floor.
Do
you
agree
with
that?
Sir
chairman
kamar.
I
Yeah.
Thank
you,
mr
chairman.
I
oppose
this
legislation
because
it
creates
new
standards
of
legislative
interference
with
physicians
and
parents
as
they
deal
with
some
of
the
most
complex
and
sensitive
matters
concerning
our
use.
It
is
undisputed
that
the
number
of
minors
who
struggle
with
these
medical
conditions
is
extremely
small,
but
they
too
deserve
the
guiding
hand
of
their
parents
and
the
counseling
of
medical
specialists
in
making
the
best
decision
for
their
medical
and
individual
needs.
I
This
legislation
puts
the
state
as
the
defensive
oracle
of
medical
care,
overriding
parents,
patients
and
health
care
experts,
while
in
some
instances
the
state
must
act
to
protect
life,
the
state
should
not
presume
to
jump
in
the
middle
of
every
medical,
human
and
ethical
issue.
This
would
be,
and
is
a
vast
government
overreach,
and
I
wish
I
could
say
I
was
that
eloquent
to
have
wrote
those
words,
but
it
was
the
governor
of
arkansas
asa
hutchinson
as
he
vetoed
similar
legislation
last
week
in
arkansas.
I
I
You
know
I'm
hearing
separate,
but
equal.
You
know
we're
we're
not
doing
anything
different,
but
it's
different.
It's
the
only
thing
we're
codifying
so
it's
separate
than
all
the
other
standards
of
care,
so
we're
creating
separate,
but
equal
I
mean
what's
next:
where
are
we
going
next?
Ladies
and
gentlemen,
you
know
I'm
just
I'm
just
worried
sound.
It
sounds
too
familiar.
I
D
D
Once
again,
we
cannot
really
draw
a
line
in
our
society
between
medicine,
politics
and
ethics.
These
these
domains
constantly
crisscross
and
overrun.
As
I
mentioned,
we
interfered
in
the
practice
of
medicine
by
limiting
the
opioid
prescriptions
we
were
treading
into
medicine,
certainly
and
ethics.
Our
very
medical
ethics
are
very
much
a
part
of
the
law
and
we
are
lawmakers,
so
there
is
not
a
hard
line
between
these
domains
as
we
work
in
the
public
sphere
and
we
they
constantly
crossover,
and
I
think
this
is
one
of
those
situations.
Thank
you,
mr
chairman.
A
E
Thank
you,
mr
chairman,
and
I'll,
be
brief
as
possible
here,
because
the
debate
itself
is
what
is
harmful
here.
We
we've
established
that
through
expert
testimony
here
today
that
even
treating
pre
miners
would
be
ineffective.
In
some
cases
it
would
be
reversible.
In
some
cases
the
standard
of
care
is
being
codified.
E
E
E
E
E
You
would
not
be
having
this
debate
or
bringing
this
legislation,
because
this
very
discussion
and
putting
this
in
the
headlines
repeatedly
repeatedly
is
what's
leading
to
this.
It's
the
stigmatization.
It's
the
discrimination,
please
out
of
order,
please
I
I
beg
of
you.
Let's
stop!
This
is
unnecessary
and,
let's
end
the
debate.
Thank
you,
mr
chairman.
All
right,
thank
you.
A
A
A
B
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
G
This
bill
authorizes
certain
health
care
professionals
licensed
in
another
state
to
practice
telehealth,
while
providing
health
care
services
on
a
volunteer
basis
through
a
free
clinic
under
present
law.
A
health
care
provider
must
be
licensed
to
practice
in
this
state
in
order
to
provide
telehealth
services,
and
I
have
miss
caroline
caroline
deberry
from
remote
area
medical
here
to
speak.
If
you
all
would
like
to
go
out.
G
A
L
L
A
L
All
right,
thank
you,
I'm
caroline
deberry,
I'm
chief
external
affairs
officer
for
remote
area,
medical
and
thank
you
so
much
chairman
terry
for
allowing
me
to
speak
today.
It
is
an
honor
to
be
here
to
speak
in
favor
of
representative
carringer's
house
bill
967,
which
would
ensure
the
future
of
free
telehealth
for
those
who
need
it
most
remote
area.
Medical
is
an
international
nonprofit
that
provides
dental
vision
and
medical
services
for
free
and
has
been
doing
so
for
over
35
years.
L
Typically,
we
do
this
with
mobile
in-person
clinics,
but
in
response
to
the
pandemic,
last
year
we
launched
a
free
telehealth
program
and
thanks
to
governor
lee's
executive
orders,
we
were
able
to
do
so.
We
worked
with
commissioner
piercy's
team
to
ensure
that
we
were
crafting
the
program
in
such
a
way
that
it
allowed
this
telehealth
program
to
continue
what
made
it
so
special
is
that
the
majority
of
our
telehealth
providers
doing
this
on
a
volunteer
basis,
have
unencumbered
licenses
from
out
of
state.
L
This
is
the
same
spirit
of
volunteerism
that
the
general
assembly
endorsed
and
encouraged
back
in
the
1990s
with
the
volunteer
health
care
services
act.
The
volunteer
healthcare
services
act
permits
out-of-state
licensed
providers
in
good
standing
with
licenses
in
good
standing,
of
course,
to
provide
in-person
care
at
free
clinics
and
has
again
been
doing
this
since
the
1990s
remote
area.
Medical
has
really
benefited
from
this
because
it
maximizes
the
amount
of
free
services
we
can
provide
tennesseans
who
need
it
most.
L
M
L
Wonderful
question.
Thank
you
so
much
for
that.
We
welcome
anybody
at
our
clinics.
We
do
not
typically
design
our
clinics
for
veterans
specifically,
but
I
can
say
that
I
have
been
working
on
different
efforts
to
collaborate
with,
for
example,
phillips
and
others
that
intend
to
target
veterans
if
we
can,
but
that's
something
that
is
very
important
to
us.
At
this
point,
though,
we
do
not
have
events
there,
specifically
for
veterans
only.
L
That's
a
wonderful
question
as
well.
Thank
you,
sir.
I!
So
we
actually
that's
something
that
we
will
talk
to
people
about
both
for
our
in-person
and
our
telehealth
clinics,
and
I
would
say
I
would
hope
not.
These
are
patients
that,
sadly,
are
not
going
to
be
going
to
the
doctor.
Otherwise,
for
example,
they're
working,
two
or
three
jobs-
and
they
don't
have
time
during
the
week
to
take
off
to
go,
see
a
doctor
or
maybe
they
don't
have
health
insurance,
or
maybe
the
health
insurance
that
they
do
have
the
deductibles
are
too
high.
I
A
N
G
A
B
You're
recognized,
thank
you,
mr
chairman.
This
is
a
bill
to
just
continue
on
with
the
elder
abuse
committee.
We
were
supposed
to
have
a
report
back
to
the
legislature
of
january
of
20
2021
and
our
coveted
campus
from
doing
that.
So
that
extends
this
committee
to
another
year
and
our
report
will
be
due
to
the
committees
on
january.
A
Any
questions
for
the
sponsor
of
the
bill:
okay,
see
none.
We
are
voting
on
house
bill,
345.,
all
those
in
favor
say
aye
aye
opposed
eyes.
Have
it
bill
goes
on
to
government
operations.
Thank
you,
mr
chairman
committee.
Thank
you.
That
brings
us
to
item
number
seven
house
bill.
14,
1464,
representative,
cochran,
you're
recognized.
You
have
a
motion.
A
second.
O
Okay,
thank
you,
mr
chairman
house,
bill
1464..
We've
obviously
talked
about
this
in
subcommittee
some,
but
essentially
this
is
ensuring
that
anyone
with
a
cognitive
disability
is
not
discriminated
against
on
the
transplant
list.
So
as
long
as
it,
their
condition
does
not
affect
the
viability
of
the
organ
that
they
are
receiving.
O
A
A
A
C
Thank
you.
This
amendment
rewrites
the
bill,
and
it
also
incorporates
all
the
changes
that
were
made
with
the
amendment
that
was
put
in
on
the
health
in
the
health
sub,
the
drafting
code
6452,
and
it's
relative
to
the
establishment
of
the
board
of
physician
assistants.
It
adds
to
the
traditional
language
to
cover
the
period
of
time
between
the
board
of
physician.
A
A
A
O
Thank
you,
mr
chairman.
The
amendment
makes
the
bill
what
this
amendment
and
bill
seeks
to
do.
It
is
a
much
needed
and
well
thought
out
reform
to
tennessee's
certificate
of
need
program.
It
makes
various
changes,
creates
more
regulatory
flexibility.
It
eliminates
some
of
the
protectionist
aspects
of
a
certificate
of
need.
It
reduces
some
of
these
certificate
of
need.
Regulation
of
certain
facilities
and
services
lowers
the
population
thresh
mark
which
triggers
certificate
of
need
for
certain
categories
like
non-pediatric
mri
services
and
pet
services,
from
the
current
250
000
threshold
down
to
the
175
000
threshold.
O
But,
more
importantly,
it
eliminates
a
lot
of
the
red
tape,
makes
the
process
quicker,
easier,
cheaper,
reduces
paperwork
speeds
up
the
process,
and
it
requires
the
hsda
executive
director
to
develop
a
plan
to
merge
the
certificate
of
need
program
with
the
healthcare
licensor
into
a
single
agency
no
later
than
january.
The
first
of
2023
that
report
would
be
submitted
to
the
general
assembly.
Mr
chairman,
I
can
take
any
questions
that
anyone
has,
and
I
also
have
hsda
director
logan
grant
available
to
testify
if
needed.
O
O
Us
thank
you,
mr
chairman,
and,
and
that's
a
that's,
a
great
question,
and
this
this
actually
was
well
thought
out
and
I
was
about
to
about
to
answer
it,
but
actually
representative,
robin
smith,
had
the
other
day
had
one
of
the
best
answers.
I've
ever
heard
of
that,
and
so
I'm
going
to
prefer
to
heard.
Mr
chairman,
if
you'll
allow.
O
All
them.
Thank
you.
Thank
you,
mr
chairman.
I
don't
disagree
and
I-
and
there
was
a
lot
of
thought
that
went
into
this
and
a
lot
of
collaboration,
and-
and
this
is
the
number
that
that
all
of
the
stakeholders
when
they
came
together,
including
a
lot
of
the
folks
in
the
general
assembly-
that's
the
number
that
we
kind
of
ironed
out
and
I,
but
I
don't
disagree
with
you.
I
think
a
lot
of
people
would
like
to
see
it
expand.
H
Thank
you
chairman,
chairman
boyd.
Before
I
ask
you
or
comment
on
the
bill,
I
just
wondered
if
you
could
tell
me
what
hsda
stands
for,
I'm
just
kidding
the
so
chairman
boyd.
I
want
to
thank
you
for
this
bill.
I
I
do
agree
with
representative
smith.
This
has
been
a
long
time
coming.
I
think
c-o-n
is
a
in
integral
part
of
what
how
we
did
medicine
corporately
across
the
state.
It
have
a
time
and
place
for
it,
and
I
do
think
that
these
changes
are
really
good.
H
I'm
going
to
support
this
bill.
I
do
think,
though,
much
like
my
good
friend
from
god's
country
in
the
upper
east
tennessee,
there's
one
component,
that
I
think
that
I
would
wish
that
we
would
change
in
particular,
that
would
be
important
to
my
own
community,
and
that
is-
and
I
have
a
bill
to
do
this,
but
I've
agreed
not
to
run
it,
because
this
is
really
important,
and
that
is
mental.
Health
services
are
a
huge
challenge
for
rural
tennessee,
rural
tennessee.
H
I
carried
it
one
of
the
first
telemedicine
bills
because
there
wasn't
a
lot
of
mental
health
and
and
psychiatry
services
in
rural
tennessee,
and
so
we
were
able
to
do
telemedicine
that
way,
but
in
tennessee
in
tennessee.
If
someone
presents
in
a
hospital
at
cookbook
regional
medical
center,
sometimes
they
wait
for
four
to
five
days
to
be
able
to
get
in
representative
smith's
district
and
mocks
and
ben
to
get
the
help
that
they
need.
H
I
think
if
we
limited
it
to
distressed
areas
or
rural
designated
areas,
then
it
would
exhort
or
encourage
development
in
rural
tennessee
in
the
same
fashion,
fashioner
way
that
it
this
certificate
of
need,
process,
facilitated,
large
hospitals
and
large
communities,
but
I
am,
as
I
said,
I'm
going
to
support
this
bill,
but
I'd
hope
that
going
forward
we
would
consider
ways
in
order
to
try
to
get
mental
health
facilities
and
services
in
rural
tennessee.
Thank
you.
Thank
you.
Chairman
thank.
O
P
P
We-
and
I
could
not
vote
for
this
if
it
didn't,
have
the
the
population
limit
on
it.
What
happens
my
hospital?
A
lot
of
these
rural
hospitals
have
unreimbursed
care
of
levels
that
city
hospitals
don't
even
face,
so
my
hospital
collects
about
four
to
26
to
30
cents
on
a
dollar
as
far
as
charges,
and
so
what
happens
when
other
competing
businesses
come
in?
G
O
O
B
O
O
O
Thank
you,
mr
chairman.
So
if
a
hospital
went
in
while
they
were
distressed
and
then
they
got
taken
off
the
distress
list,
the
hospital
could
continue
to
exist.
But
if
they
came
off
of
the
distress
list
and
said
you
know,
we
were
on
it
last
year,
we'd
like
to
do
it
that
you
that
rule
would
no
longer
apply.
You
would
have
to
be
distressed
at
the
time
that
you
applied.
B
O
H
Williams,
thank
you
chairman
terry.
I
just
recognized
a
bearded
man
who
just
walked
into
the
back
of
the
room,
he's
half
the
person
he
used
to
be
in
size,
and
that
is
the
former
state
representative
tim
wargo
we'd,
like
to
welcome
back
to
the
house
health
committee
good
to
see
you
tim
burgo.
Thank
you.
A
All
right,
thank
you.
We're
on
the
amendment
any
further
questions.
Okay,
the
question
has
been
called
on
the
amendment.
We
are
voting
on
amendment
6740.
All
those
in
favor
say
aye
opposed
eyes
have
it.
We
are
back
on
the
bill
as
amended
any
further
questions
for
the
sponsor
okay,
seeing
none
we're
going
to
vote
on
house
bill
948
as
amended,
all
those
in
favor
say:
aye
aye
opposed
eyes
have
it
bill
goes
on
to
calendar
and.
B
B
A
Okay,
we
have
still
a
robust
calendar,
but
with
we
only
have
five
minutes
left
here
in
for
our
time
frame,
they
have
to
clean
the
room,
and
so
all
these
bills
that
we
did
not
get
to
today
will
be
heard
next
week.
So
without
objection,
all
remaining
bills
will
be
rolled
to
last
calendar,
seeing
no
further
business
before
us
today
we
are.