►
Description
House Insurance Committee- March 8, 2022- House Hearing Room 1
B
A
C
A
D
A
D
B
F
A
Thank
you,
representative
hall,
just
to
add
context
to
it,
the
point
being
that
patients
when
they
are
being
treated.
They
are
expected
to
move
in
a
stepwise
fashion,
and
that
is
called
step
therapy.
The
idea
being
take
the
standard
left,
less
expensive
drugs
first,
which
they're
standard
and
less
expensive,
because
they've
been
around
a
while
they're
safe
and
they
will
help
most
patients.
A
This
bill,
I
believe,
will
make
it
possible
for
the
physician
to
move
beyond
step
therapy
when
in
the
physician's
judgment
this
is
so
indicated,
and,
yes,
they,
it
will
add
expense
to
the
matter,
but
at
the
same
time
it
will
help
the
patient,
which
is
the
main
purpose,
that
physicians
are
there
and
our
constituents,
whom
we
are
here
to
help
members.
Do
we
have
any
questions.
A
G
Okay,
yes,
thank
you,
representative
hall,
just
a
couple
of
questions
when
we're
going
from
in
in
the
step
therapy,
when
you're
going
from
one
company
to
another
and
you've
already
been
through
the
step
therapy
and
you're
going
to
this
other
company,
and
I'm
not
sure
why
would
there
be
a
note
why
why
would
that
be
an
increase
in
cost?
If
you
say
you
went
all
the
way
through,
you
went
through
drug
a
and
you
got
to
drug
e
and
and
the
other
company
picks
it
up
and
they
start
covering
drug
e.
G
F
Recognized.
Thank
you,
mr
chairman.
That's
a
great
question
and
that's
been
our
battle
cry
all
along
is
that
we
think
it's
going
to
be
cost
avoidance
due
to
the
due
to
the
fact
that
we're
stepping
we're
we're
bypassing
ineffective
and
inefficient
drugs
and
going
straight,
but
but
more
important
than
the
cost.
F
G
So,
okay
yeah,
so
they're
going
from
step
therapy.
This
would
also
include
like
going
from
one
doctor
to
another.
If
you
had
to
change
doctors
for
some
reason,
if
they
retire
or
whatever,
then
it
would
include
that
too
correct,
jefferson
hall.
That
is
great,
sir.
Okay,
all
right!
Thank
you.
Thank
you,
mr.
B
Chairman
chairman
white
you're
recognized,
thank
you
chairman,
chairman
hall.
I
just
had
a
question
and
I
support
you
bill
bill
where
it's
talking
about
requires
insurance,
step
therapy
protocols
for
prescription
drugs.
Is
it
only
prescription
drugs?
I
know
in
pain
management.
Sometimes
a
drug
is
not
the
answer,
maybe
the
implantation
of
a
of
electrode
or
something
for
you
know
electrical
shock.
H
F
H
B
H
F
A
I
think
I
would
like
to
add
the
fact
that
certainly
this
is
a
half
a
step
and
yes,
10k
enrollees
would
not
benefit
from
this
bill,
but
certainly
it
is
on
our
mind.
It
is
on
thank
you
for
reminding
us
that
that
is
a
gap
in
medical
care
for
tennessean
and
I
think
we
will
work
towards
it
and
it's
a
matter
of
again
arranging
funding
so
that
everybody
can
benefit.
I
think
that
should
really
be
our
ultimate
goal.
A
A
Yes,
we
see
amendment
zero,
one,
four,
one,
nine
seven,
that
is
correct
members.
We
have
a
motion
and
second
on
attaching
an
amendment
one
four,
one:
nine
seven
to
house
bill,
two
five,
four,
four,
all
those
in
favor,
please
say
aye
oppose
the
amendment
goes
on
the
bill.
You're
recognized
on
the
amended
bill.
E
This
is
concerning
insurance
coverage
on
mammograms,
and
the
bill
will
update
this
bill
will
update
the
statute
to
better
reflect
all
the
technology
that
is
utilized
for
breast
imaging
now
and
for
cancer
screenings.
Today,
the
passage
of
this
bill
patients
will
have
access
to
all
those
all
low-dose
mammography
services,
including
breast
tumor,
synthesis,
which
is
3d
imaging
digital
mammography
and
x-ray.
E
A
A
A
A
D
Thank
you,
mr
chairman.
Thank
you,
members
for
being
patient
with
us.
Last
year
we
passed
historic
pbm
reform
legislation
and
one
of
the
intents
of
that
legislation
was
for
pharmacies
to
be
reimbursed
no
less
than
the
actual
cost
of
a
drug
or
device
dispensed
to
a
person.
During
the
summer.
It
came
to
our
attention
that,
due
to
a
definition
issue
that
intent
wasn't
realized
in
the
legislation.
D
D
As
long
as
the
pharmacy
agrees
to
accept
the
same
terms
and
conditions
that
the
pbm
has
established
for
at
least
one
of
its
networks
and
one
of
the
clarifying
languages
in
the
amendment,
mr
chairman
and
members,
is
it
clarifies
that
the
external
appeals
process
created
by
the
department
of
commerce
and
insurance
must
be
done
using
existing
resources
there
so
there'll
be
no
charge.
Anybody
else.
That's
what
the
bill
does
members,
and
I
I
renew
my
motion.
H
D
D
H
Mitchell,
because
you
are
setting
the
price
of
the
dispensing
fees
and
the
dispensing
fees
are
a
whole
lot
less
in
a
lot
of
self-funded
health
plans
in
this
state
currently
and
those
fee,
your
your
fees
are
more
than
double
what
the
dispensing
fee
is
on
a
lot
of
health
plans
in
this
state
and
it's
going
to
cost
a
whole
lot
more
money
for
for
health
plans
and,
of
course,
that
employer
is
going
to
bring
that
cost
down
on
his
employees.
They're
going
to
have
to
pay
more.
A
C
H
A
Motion,
mr
chairman,
very
good
just
to
cover
the
fact
and
the
reason
that
you
brought
this
bill.
We
are
taking
care
of
the
major
problems
and
complaints
that
we
were
faced
with,
that
is
the
pharmacies
small
town
pharmacies
getting
paid
below
their
cost.
That
is
resolved
one
ish.
The
other
issue
that
stands
out
also
is
about
the
pbms
and
the
rebates
that
they
receive.
We
were
hoping
for
transparency
of
those.
Where
does
this
build
stand
on
that.
A
A
A
I
So
it's
a
simple
notification.
I
thank
the
committee
for
their
recommendations
last
week
on
this
amendment.
I
think
it
is
much
better
that
we
have
a
written
acknowledgement,
so
there's
no.
He
said
she
said
as
to
if
they
were
notified
at
the
time
of
their
employment.
With
that,
mr
chairman,
I
stand
ready
to
take
questions.
I
G
Yes,
thank
you,
mr
chairman,
and
thank
you
to
the
sponsor
for
working
on
this
and
getting
it
amended.
I
really
think
this
is
a
good
bill
being
in
the
property
and
casually
insurance
business.
I
run
into
this
all
the
time
and
you
know
if
somebody
had
a
an
agreement
with
one
company
and
they
go
to
work
for
another
company.
G
You
know
they
may
not
have
that
same
agreement,
and
this
is
going
to
take
care
of
that,
and
so
many
people
have
an
accident
and
don't
find
out
until
after
that
that
they
don't
have
coverage
for
their
commercial
activity.
So
I
appreciate
you
bringing
this
bill
forward
and
I'll
be
supporting
it.
Thank
you.
G
A
A
I
I
Thank
you,
mr
chairman
and
committee.
This
is
another
gig
economy
and
safety
for
our
consumers.
In
tennessee
wisely,
when
when
rideshare
companies
such
as
uber
and
lyft
came
into
the
state
of
tennessee,
they
said
you're
not
going
to
be
regulated
by
any
taxi
cab.
Companies
you're
not
going
to
be
regulated
by
anyone,
but
we
want
you
to
have
a
million
dollars
in
liability
insurance.
I
I
If
you
are,
if
you
are
hit,
while
in
a
common
carrier
and
have
no
insurance,
which
I
have
to
tell
you,
40
percent
of
kids
going
to
college
have
no
driver's
license,
so
they
would
have
no
insurance.
So
you,
if
they're
hit
by
a
uninsured
motorist,
there's
no
coverage
for
them.
Now
the
ride
shares
have
come
to
see
me
and
say:
well:
we've
got
15
000
med
pay.
I
I
I
and
that's
50
000
per
person.
100
per
accident,
as
I
feel
sure
chairman
powers,
can
explain
what
that
all
means,
but
yeah
I
did
want
to
put
in
and
in
subcommittee
a
lot
of
several
of
the
members
did
not
want
the
ride,
share
companies
to
be
treated
different
from
the
common
carriers
or
the
commercial
carriers
of
taxis.
Even
though
taxis
are
highly
regulated,
their
medallions
can
be
taken
away,
etc
and
punished,
whereas
with
uber
they're
self-policing.
I
But
I
will
have
to
say
that
next
year
I'm
going
to
come
back
and
look
at
all
commercial
carriers,
because
I
feel
that
when
you
or
I
or
my
child
gets
into
one
of
these
commercial
carriers,
they
need
to
make
sure
that
they
are
safe
and
they
are
covered
from
and
also
the
driver.
If
you
think
about
it,
the
driver
has
no
uninsured
motorist
for
an
injury
from
an
uninsured
motorist.
I
I
B
B
I
Thank
you,
mr
chairman.
Right
now
there
is
no
law
for
ride
shares
as
to
what
they
have
to
cover
for
uninsured
motorists.
Their
liability
is
a
million,
but
uninsured
motorists
is
not
mentioned
whether
that
was
you
know.
I
think
that
was
oversight
when
they,
when
they
passed
the
law,
but
we're
just
requiring
them
you
as
an
individual
in
the
state
of
tennessee.
I
Your
liability
requirement
is
25.50,
that's
minimum
in
the
great
state
of
tennessee,
with
ten
thousand
dollars
in
property
damage.
Now
I'm
not
an
insurance
agent.
So
if,
if
I
misquoting,
we
have
insurance
agents
on
the
committee
here,
so
what
we're
saying
is
that
as
a
it's,
a
common
carrier
for
ride
share
that
you're
going
to
have
to
have
a
minimum
of
50
000.
G
Thank
you,
mr
chairman,
to
the
sponsor
the
thing
about
currently
so
you're
talking
about
when,
when
they're
engaged,
only
so
is
there
any
or
you're
not
trying
to
increase
the
requirement
when
they're
not
engaged
in
the
in
the
ride
share
when
that,
when
the
app's
not
on
whether
in
their
own
personal
vehicle
because
they're,
an
independent
contractor
you're
not
trying
to
increase
that
at
all
you're,
just
trying
to
increase
it
when
they
are
engaged.
Is
that
correct.
I
That's
exactly
right,
chairman
powers,
and
it's
just
like
it's
under
the
same
code
where
the
liability
engages
when
they
engage
on
that
app
you're
exactly
right,
and
I
I
apologize.
I
made
that
point
in
sub-committee
but
forgot
to
make
it
in
full
committee.
So
it
strictly
goes
to
when
they're
in
that
commercial
activity
and
hit
that
app.
G
I
B
G
J
Thank
you,
mr
chairman
committee
members.
This
is
joe
messina.
I'm
an
attorney
on
the
insurance
legal
team
at
uber
appreciate
the
opportunity
to
speak
to
the
committee
today
and
explain
why
we
are
opposed
to
this
bill.
There
are
a
few
points
that
I
thought
would
be
helpful
for
the
committee
as
it
considers
the
requirements
first,
tennessee's
existing
tnc
insurance
requirements
are
the
results
of
a
model
bill
that
took
several
years
to
develop
and
required
alignment
across
many
different
stakeholders,
including
legislators,
insurance
carriers,
tncs
and
others
and
tennessee.
J
Like
most
other
states
in
the
country,
adopted
the
insurance
provisions
within
that
model
without
any
substantive
revision,
and
that's
because
we
believe
they
made
sense,
then
they
make
sense
now
and
they're
working
in
accord
with
that
statute.
Uber
currently
maintains
substantial,
auto
liability
insurance,
just
like
other
tncs,
do
on
behalf
of
drivers
while
operating
on
the
app
that
includes
a
million
dollars
of
auto
liability
insurance.
Once
the
ride
has
been
accepted.
Now
the
driver
doesn't
need
to
do
anything
to
benefit
from
that
insurance.
J
J
Transportation
network
company-
okay-
thank
you.
Every
other
driver
in
tennessee
is
not
required
to
maintain
uninsured
motorist
coverage.
I
wasn't
under
the
impression
that
taxis
are
required
to
maintain
it.
It's
my
understanding
that
taxis
are
regulated
at
the
city
or
the
county
level
and
again
it's
my
understanding
that
the
vast
majority,
if
there
are
any
counties
within
the
state,
actually
don't
require
this
coverage
of
taxis.
J
The
proposed
uninsured
motorist
coverage
limits
here
would
even
be
well
outside
the
norm
when
you
consider
this
on
a
state-by-state
basis
across
the
country,
22
states
right
now
don't
require
transportation
network
companies
to
maintain
this
coverage
at
all.
Only
10
states
require
it
in
significant
limits,
like
the
amounts
that
we're
talking
here
and
two
of
those
10
washington
and
georgia
are
currently
considering
bill's
bills
to
repeal
those
requirements
or
to
substantially
reduce
them.
J
J
Of
uber
trips,
don't
involve
an
uninsured
motorized
claim
and
to
the
extent
that,
in
that
rare
instance
in
which
it
it
might
arise,
uber
does
maintain
gratuitously
without
any
requirement
under
law
medical
payments
coverage
and
that
medical
payments
coverage
is
actually
in
many
ways
better
than
uninsured
motorist
coverage.
If
you're
familiar
with
the
differences,
uninsured
motorist
coverage
actually
requires
a
determination
of
liability
that
takes
a
very
long
time
in
many
cases
and
that's
why
folks
consider
uninsured
motorist
coverage
claims
to
be
very
long
tail.
J
J
A
A
J
J
It
is,
and
that's
in
the
rare
instance
and
in
the
very
rare
instance
that
there's
not
any
liability
on
the
alleged
on
the
part
of
the
driver,
so
we're
talking
a
very
small
subset
of
claims
where
100
of
the
liability
is
alleged
to
be
on
the
uninsured
motorist.
I
mean,
I
think,
in
the
as
you
can
understand
the
vast
majority
of
cases.
J
I
I
I
We
do
not
need
to
wait
for
a
great
tragedy
to
come
to
run
back
here
to
this
committee
and
say:
oh,
we
should
have
had
uninsured
motors
on
ride
shares.
We
need
to
make
sure
any
of
the
insurance
agents
on
this
commit
on
this
committee
can
tell
you
that
we
buy
insurance
for
things
that
are
unforeseen
for
things.
That
don't
happen
that
often
so
to
say
that
this
doesn't
happen.
That
often
is
not
a
defense.
I
50
000
per
person,
100
000
per
injury
and
and-
and
I
want
to
go
back
to
if
the
drivers,
if
their
driver
is
at
fault-
yes,
you're
covered
under
that
million
dollar
policy,
if
he,
if
he
runs
the
red
light
and
hits
somebody
uber's
insurance
is
liable
for
the
actions
of
the
driver,
but
if
the
driver
is
innocent,
only
coverage
that
they're
providing
is
five
thousand
dollars.
That
does
not
protect
our
people.
I
G
I
G
Correct
and
and
even
when
you
get
into
a
rideshare
car,
actually,
if
you
have
uninsured
motorists
on
your
policy,
you're
you're
actually
covered
if
you're,
because
I've
even
had
people
that
have
been
hit
beside
of
the
road
standing
out
there
and
they've
had
by
an
uninsured
motorist.
They
have
coverage
so
they
have
coverage
on
their
own
individual
policy,
their
that
follows
them.
G
Here's
the
problem.
I've
got
with
the
bill
right
now,
we're
not
requiring
these
are
individual
people
into
independent
contractors,
a
little
bit
different
from
what
you
recall
what
we
were
talking
about
with
the
taxi
cab
riders
of
the
commercial
vehicle.
These
are
independent
contractors
that
are
doing
this
part
time.
Some
of
them
may
be
doing
them
full
time,
but
if
we're
not
requiring
requiring
a
person
or
an
individual
or
anybody
else
to
carry
uninsured
motorists,
no
matter
if
we're
driving
a
vehicle,
we're
not
actually
required
to
carry
it.
G
G
What
would
be
the
most
uniform
throughout
the
state
or
throughout
the
country
if
we're
doing
this
for
a
particular
for
a
particular
reason,
and
so
I
just
don't
really
think
we're
at
the
point
right
now,
where
we
need
to
re,
require
anyone
to
carry
liability
or
uninsured
motorists
like
that
on
their
individual
vehicles
or
require
the
company
to
provide
that
form.
At
this
point,
maybe
at
some
point
we
might
be.
I'm
sorry.
I
I
I
The
people
in
the
back
seat,
like
I
said,
40
percent
of
kids,
that
go
into
college,
don't
have
a
driver's
license.
If
you
don't
have
a
driver's
license,
you're
not
covered
under
anybody's
policy.
You
don't
have
your
own
policy.
We
need
to
make
sure
that
when
just
like
an
ins
keeper
that
you
are
safe,
you,
they
have
a
higher
duty
of
care
because
you
are
paying
to
stay
in
their
hotel
or
motel.
I
I
J
Thank
you,
mr
chairman.
Just
just
one
point
to
clarify
your
piece:
it
is
being
discussed
at
length.
It
is
not
necessarily
the
case
that
the
driver's
own,
uninsured
motorist
coverage
would
not
apply
just
because
the
driver
is
driving
with
a
transportation
company.
The
driver
may
still
have
an
applicable
coverage,
and
I
think
that's
important
to
keep
in
mind
here.
In
addition
to
that,
the
rider
may
have
their
own
applicable,
uninsured
motorist
coverage,
which
would
not
be
excluded.
J
C
Thank
you-
and
I
appreciate
you
coming
I
just
need
to
this-
was
something
that
was
brought
up
in
a
question
that
I
had
actually
had
in
my
office.
So
I
just
want
to
clarify,
and-
and
this
goes
back
to
you
know
free
will-
you
have
the
free
will
to
get
into
the
into
the
uber
the
lift
the
rideshare
company.
C
C
And
then
the
the
point
being
brought
up
that
40
percent
of
college
students
may
not
have
insur
or
may
not
have
a
driver's
license,
but
that
my
understanding
with
the
affordable
care
act
up
to
age
26
they
could
be
on
their
parents,
a
health
insurance
plan
that
could
cover
an
accident
as
well.
Is
that
correct,
correct?
Well,
thank
you.
A
A
I
I
A
H
H
G
I
mean
you
know,
maybe
maybe
that's
not
even
enough
what
we're
talking
about.
Maybe
we
need
to
to
look
at
another
figure
or
whatever,
because
there's
so
many
different
variables
in
here,
like
they
were
talking
about
a
minute
ago,
people
that
don't
have
that
they're
not
on
an
auto
policy.
They
wouldn't
be
covered
on
an
uninsured
motorist
claim.
So
I
think,
there's
some
things
that
we
really
need
to
work
through
and
I
I
really
think
we
need
to
do
a
summer
study.
A
I
Yes,
thank
you,
mr
chairman.
I'm
I'm
really
confused,
because
any
good
insurance
agent
would
recommend
that
you
have
uninsured
motorists.
My
insurance
agent
always
reminds
me
to
make
sure
that
I
have
uninsured
motorists.
It
is
almost
malpractice
on
the
point
of
a
of
an
insurance
agent,
not
to
make
sure
that
you
have
uninsured
motorists.
Because,
ladies
and
gentlemen,
even
though
we
require
insurance
out
there,
there's
thousands
tens,
hundreds
of
thousands
of
people
run
around
without
insurance.
We
don't.
I
This
is
a
very
simple
bill.
If
we
want
to
study
afterwards
that
if
we've
put
enough
responsibility
on
common
carriers-
which
I
don't
think
this
is
enough
for
common
carriers,
but
I
can't
imagine
an
insurance
agent
saying:
don't
buy
uninsured
motorists
in
the
great
state
of
tennessee,
don't
do
it.
You
know
she's
very
seldom,
but
boy
when
it's
used,
you
could
have
tens
of
hundreds
of
thousand
dollars
in
medical
bills
and
need
that
coverage,
but
don't
do
it
and
you
know
it's
just
it
just
I
don't
know
why
we
would
it's
very
simple.
G
Yeah
and
that's
not
I'm
sorry,
thank
you,
mr
chairman,
and
that's
not
what
I'm
saying
I
I'm
not
saying,
for.
I
would
never
tell
anybody
not
to
carry
it.
I
would
never
do
that.
I'm
just
saying
right
now
the
state
law
says
that
you
don't
have
to
carry
it.
You
know
there
is
no
state
law
that
says
you
have
to
carry
uninsured
motors.
So
that's
why
another
reason
I
think
that
we
need
to
work
on
it
over
the
summer,
because
we're
trying
to
mandate
to
a
company
to
to
do
something.
G
I
I
State
law
requires
you
to
waive
it.
These
people
getting
into
their
vehicles
are
not
knowingly
waving
anything.
They
need
to
be
covered.
Those
those
young
people
who
don't
have
a
policy
who
can't
go
back
on
anybody
are
expecting
to
be
safe
in
their
vehicles.
They're,
not
a
drunk
driver,
hits
them
fi.
Here's
your
five
thousand
dollars
have
a
nice
day.
A
A
E
E
A
A
So
final
diagnosis
will
have
no
bearing
on
insurance
coverage.
Prior
authorization
will
have
no
bearing
or
any
contractual
agreements
between
the
provider
and
the
insurance
company
will
not
have
any
bearing.
So
if
a
person
genuinely
believes
that
and
a
lay
person
would
think
that
they
have
a
medical
emergency
and
they
go
to
seek
treatment,
they
will
get
coverage
for
that
condition.