►
Description
House Insurance Subcommittee - April 6, 2021 - House Hearing Room 2
A
A
Thank
you,
chairman
detects
a
quorum.
Does
anyone
have
any
personal
orders
that
they'd
like
to
state
before
we
begin
seeing?
None?
We
do
have
a
calendar
before
us
and
I
will
make
some
announcements
on
a
few
pieces
of
legislation.
As
we
go
forward
item
number
one
on
our
calendar
today
is
house
bill.
988,
chairman
williams
has
asked
that
we
take
that
bill
off
notice
without
objection
house
bill
988
is
taking
off
notice.
A
A
We
do
have
a
calendar
before
us
and
we
have
item
number
two
as
we've
disposed
of
it
number
one
off
notice.
I'm
number
two
on
our
calendar
is
house
bill,
736
by
representative
miller,.
A
C
C
This
bill
does
not
require
medicaid
expansion,
but
it
does
empower
the
governor
to
explore
the
opportunity.
Here's
why
it's
important
that
we
do
this
now.
The
american
rescue
plan
that
was
recently
approved
by
congress
and
signed
into
law
creates
an
incredible
opportunity
for
states
that
have
not
expanded
medicaid.
C
If
the
governor
chooses
to
expand,
that's
enough
money
to
completely
pay
for
an
expansion
program,
free
and
clear
of
state
dollars
for
seven
years,
not
only
would
we
get
insurance
to
working
families.
These
funds
could
also
be
used
to
boost
provider
rates
which
are
major
problem,
or
we
could
even
enhance
coverage
options.
C
Here's
the
catch,
the
clock
is
ticking.
The
offer
include
an
american
rescue
plan
doesn't
last
forever.
If
we
wait,
we
could
miss
out
on
some
of
these
dollars.
That's
why
the
bill
is
needed
right
now
when
the
general
assembly
closes.
We
should
leave
here.
Knowing
the
governor
can
take
action
to
pull
these
dollars,
it's
a
limited
amount
of
time
and
we
could
cover
between
200
and
300
000
tennesseans,
who
cannot
afford
private
insurance.
C
In
the
process
of
that,
the
state
of
tennessee
has
foregone
several
potentially
several
billion
dollars
in
lost
revenue.
Let
me
say
this,
mr
chairman
and
committee
members
about
this
bill
number
one.
The
bill
hadn't
been
flagged
by
the
governor
and,
of
course,
you
know
anytime,
even
your
bills,
if
it's
something
that
the
governor
cannot
support
doesn't
support.
C
C
C
C
A
D
And
I'll
be
quick,
so
I
appreciate
my
colleagues,
you
know
hearing
hearing
sponsor
the
bill
out.
You
know
we
can't
continue
down
this
path.
We
can't
continue
making
an
eight
billion
dollar
mistake
in
this
state.
You
know
I
don't.
I
don't
know
where
we
are
on
calendar,
mr
chairman,
but
you
know
for
some
unknown
unforetold
reason
the
senate
does
do
something
with
us
tomorrow,
I'd
hate
to
know
we
missed
out
on
the
opportunity.
I
don't
know
if
we're
meeting
again
next
week,
but
if
we
could
just
you
know,
roll
this
for
a
week.
A
Make
two
clarifications,
as
you
ask
the
question
and
I'll
clarify
for
the
for
the
sponsor
the
legislation
as
well.
We
are
we
have
announced
our
last
calendar
will
be
next
week,
so
we
do
have
a
last
calendar
for
next
week.
Additionally,
the
the
legislation
has
received
a
a
flag
from
the
governor,
I'm
not
sure
how
recent
the
flag
in
opposition
to
to
the
legislation,
but
it
has
been
noted
that
there
is
a
flag
of
opposition
from
the
governor
on
this
particular
piece
of
legislation
as
well.
D
Thank
you,
mr
chairman,
since
I
hint
a
cold
wind
blowing
in
here,
but
I
I
would
say
you
know
part
of
the
judgment
of
the
chair
if
we
could
and
and
the
sponsor
agreeing
to
if
we
could
just
roll
this
to
next
week
and
for
some
reason
that
it
does
go
forward
in
the
senate
hear
from
him
again.
But
if
it
dies
in
the
senate,
the
sponsor
will
agree
that
he'll
take
it
off
notice.
D
A
I
understand
and
as
we've
most
recently
worked
on
the
what
chairman
terry
reminds
me
of
our
shared
savings
plan
and
and
what
we're
looking
at
and
the
opportunities
we're
looking
at
there
so
and
chairman
terry
has
a
piece
of
legislation
that
he's
also
addressing
later
on
this
calendar
as
well.
That
has
some
similar
aspects
to
it.
A
I
will
allow
a
roll
call
vote.
Chairman
miller,
you
are,
you
are
recognized
for
closing
comments.
C
C
No
gain
no
loss,
I
mean
what
is
it
that
we're
avoiding
understand?
You
know
it's
a
simple
there's
billions
of
dollars
that
are
the
federal
government
has
changed
their
rules
in
order
to
be
more
acceptable
to
those
states
ex,
including
tennessee
that
are,
for
whatever
reason
has
been
resisting
for
over
10
years.
A
B
You
have
two
nose
chairman
and
I'm
sorry,
two
eyes
and
eight
no's.
A
Eight
nose
two,
yes,
the
the
bill
fails.
Thank
you.
A
We
are
now
on
item
after
rolling
house
item
number.
Three
we're
on
item
number:
four:
on
a
calendar
chairman,
terry
you're,
recognized
item
number
four
house
bill,
875.
a
question
in
a
second
on
the
legislation
sharing
terry.
Are
you
recognized?
Thank
you.
E
Chairman
committee
and
I
ran
a
bill
last
year,
and
this
is
similar
to
the
last
bill
that
we
heard
in
that
I
am
looking
for
a
way
for
us
to
have
a
discussion
on
the
uninsured
and
it's
you
know
with
estimated
number
of
tennesseans
that
have
no
insurance.
You
know
approximately
one
in
ten
in
the
state
and
those
are
healthy
and
are
uninsured.
Most
of
those
are
healthy
and
uninsured
and
unable
to
afford
private
insurance
with
increasing
health
insurance
rates.
E
Healthier
individuals
tend
to
opt
out
of
the
market
when
they
leave
the
pool
of
insured
the
risk
for
those
that
remain
increases,
which
in
turns
causes
insurance
rates
to
increase
more.
E
The
question
that
I
pose
is
with
a
significant
number
of
uninsured
tennesseans.
Is
there
a
way
for
us
to
increase
insurance
access
without
expanding
medicaid?
Can
we
offer
an
affordable
commercial
health
insurance
plan
to
these
uninsured
individuals,
utilizing
a
private
sector
driven
alternative
to
10
care
or
to
medicaid
expansion?
E
This
is
a
conversation
that
I
do
think
we
need
to
have
is
what
can
we
do
from
a
private
sector
standpoint
to
help
those
uninsured
I'm
at
the
will
of
the
committee
on
this,
whether
it's
to
have
a
actual
summer
study
on
this
last
year?
E
When
I
ran
the
bill,
dci
is,
my
understanding
is
pretty
run
pretty
lean
and
it
had
a
like
a
90
000
fiscal
note
on
that,
and
so
it
was
derailed
by
covid,
but
it
would
have
gone
behind
the
budget,
but
I
do
think
that's
a
discussion
that
we
need
to
have
as
far
as
what
we
can
do.
So
I'm
at
the
will
of
the
committee.
E
F
You
I
really
admire
german
terry
for
addressing
a
problem
of
so
many
people
who
are
uninsured
and
what
to
do
about
it.
Sincerely
I'd
be
happy
to
join
you,
for,
if
you
choose
to
do
a
study,
it's
a
balance.
How
do
we
decide
what
people
need?
Do
they
need
a
catastrophic
insurance
that
will
cover
them
for
expenses
that
are
much
larger,
yet
few
people
will
need
that
insurance
or
do
we
need
an
insurance
that
caps?
F
The
benefit
is
equally
inexpensive,
but
caps,
the
benefits
at
let's
say,
20,
30,
000
or
so,
which
is
the
insurance
that
they
will
are
more
likely
to
use
for
common
illnesses
that
happen
more
commonly,
and
I
think
it'll
be
great
for
us
to
be
able
to
discuss
those
matters,
and
I
I
I
thank
you
for
bringing
this.
I
think
this
is
good.
We
really.
Finally
addressing
this.
The
situation
I'd
be
happy
to
join
you
and
thank
you,
mr
chairman,.
E
Just
thank
you
for
the
comments
and
I
mean
if
we
are
truly
going
to
study
this.
If
that's
a
motion
for
this
committee,
I
mean
I,
I
think
it's
something
that
we
do
need
to
discuss
and
we
do
need
to
study
and
see
how
we
can
get
private
insurance
affordable
to
these
individuals.
Okay,.
A
I'm
going
to
go
to
representative
thompson
in
just
a
moment,
sir
I'll
come
to
you
in
just
a
moment.
Then
representative
mitchell.
I
do
want
to
ask
of
the
of
chairman
terry.
Would
you
like
us
to
adopt
the
amendment
to
have
that
a
working
document,
if,
if
we,
if
we
do
intend
to
send
the
bill
to
summer
study,.
A
A
B
B
B
Now
I'm
not
going
again,
I
I'm
I'm
just
as
confused
as
anyone
about
why
we
rejected
the
previous
bill,
but
I'm
certainly
not
going
to
say
no
to
any
any
plan
that
will
potentially
cover
the
tennesseans,
so
I
would
be
agreeable
to
a
summer
study.
The
only
thing
it
would
ask
is
that
the
summer
study
also
include
a
head-to-head
comparison
between
this
plan,
the
the
affordable
care
act
and
any
other
plan
that
might
come
up
come
up
besides
this
one.
Thank
you.
A
D
Yeah,
like
my
colleague,
I'm
going
to
be
consistent,
I'm
going
to
support
this
legislation.
I
don't
know
if
summer
study
is
the
best
thing,
but
anything
that
will
that
says,
title
71
and
keeps
the
possibility
of
covering
300
000
tennesseans
alive
in
the
state
I'm
for
it,
I'm
just
asking.
If
we're
going
to
go
to
a
summer
study,
you
know
let
let's
go
to
a
summer
study
and
hang
our
dnr
at
the
door
and
worry
about
dollars
and
cents
and
we're
in
about
the
300
000
tennesseans
that
don't
have
health
care.
D
I
don't
care
if
the
previous
democratic
sponsor
of
the
legislation
walks
up
there
and
we
pass
it
or
my
republican
colleague
next
to
me
pass
it.
I
don't
care
who
passes
it
as
long
as
we
get
health
care
for
300,
000
tennesseans,
I'm
for
it.
So
I'm
for
his
legislation.
Let's
I
say
we'll
keep
it
live
until
our
last
meeting.
Thank
you.
A
Potion
before
us
is
for
a
summer
study
on
house
bill
875
as
amended
here
a
second.
Do
you
hear
a
second
all,
those
in
favor
of
sending
house
bill
875
to
summer
study,
please
signify
by
saying
aye
any
of
those
posts.
Please
say
no,
the
ice
have
it.
Your
bill
is
sent
to
summer
study.
Sir
all
right,
we
are
now
on
item
number.
Five.
On
our
calendars
item
number
five
is
house
bill,
1258,
1258,
representative
smith.
You
are
recognized.
Thank.
G
A
G
Thank
you,
mr
chairman
and
committee.
The
health
services
development
agency
has
brought
this
bill
to
me
requesting
enabling
legislation
to
pursue
a
three
mil
a
two
and
a
half
million
dollar
grant
that
was
created
through
federal
legislation
back
in
december
2020
in
the
united
states
code.
That
addresses
surprise
billing.
Within
that
federal
legislation,
expenditures
were
made
available
for
states
that
do
not
have
an
all
payer
claims
database.
G
All
payer
claim
data
databases
are
employed
currently
in
23
states.
Tennessee
does
not
have
such
a
database
and
the
purpose
of
a
database,
for
that
would
be
to
use
a
geographic
mapping
of
chronic
diseases.
I
know
that
in
our
previous
committee
in
health
we
heard
some
testimony
and
references
to
the
commission
on
aging
and
disability
task
forces
such
as
the
opioid
task
force,
the
tracking
of
information
about
alzheimer's.
G
H
Thank
you,
mr
chairman,
chair
lady
smith.
One
of
the
concerns
I
have
on
this
bill
is:
is
data
security?
Can
you
talk
about
the
data
security
because
there's
going
to
be
a
third
party
handling
all
this?
Is
this
correct
and
then
it's
addressed
the
data
security
to
make
sure
that
we're
taking
all
the
necessary
precautions
to
make
sure
that
this
doesn't
have
a
breach.
G
A
A
A
A
And
I'll
recognize
chairman
supiki
to
either
restate
your
question
or
or
if
you're
ready
to
go.
Mr
graham.
I
Sir
sorry
23
other
states
have
already
established
all
pays
claims
databases
and,
in
that
the
vendor
contracts
go
through
very
detailed
work
protocols
for
how
to
protect
patient
data
and
they're.
To
my
knowledge,
there
have
been
no
breaches
so
far.
They'd
adhere
to
the
same
standards
that
the
insurers
do
and
transferring
data
the
way
that
they
do
it
primarily
most
commonly
is.
They
will
create
a
special
encryption
key
for
each
submitter
of
the
data.
I
The
data
will
then
be
encrypted
in
that
special
form
and
then
once
it's
submitted,
it
will
be
stored
under
a
different
encryption
and
then
only
a
few
designated
people
are
able
to
even
access
the
database
at
our
agency.
It
would
be
limited
to
maybe
two
or
three
people
who
can
even
access
the
database,
all
their
movement,
all
the
research
that
they
do
in
that
database
would
be
tracked
and
logged.
So
there
would
be,
I
think,
there's
very
adequate
protection
of
health
of
patient
data.
H
Up
so
just
for
clarification,
I'm
working
for
your
department
and
I'm
one
of
those
key
access
people
and
I
decide
to
leave
your
department
what
happens
next
with,
because
I
have.
I
have
the
ability
to
gain
access
because
of
whatever
codes
or
combinations
you
have
set
forth.
How
do
you
address
that
issue?
Well,.
I
F
I
So
that
that
is
the
that
is
correct.
The
state
of
tennessee
established
an
all-payers
claims
database
in
2009.
that
was
under
the
british
administration
at
the
time,
and
what
happened
was
that
was.
It
was
still
kind
of
a
novel
concept
we
were
on.
We
were,
there
were
only
a
few
states
that
had
them
at
that
time
and
when
administrations
shifted.
I
I
think
I
don't
know
that
there
was
necessarily
any
buy-in
as
to
how
to
implement
it,
and
I
would
say
that
that
when
they
ran
into
difficulties
how
an
implementation
they
had
trouble,
I
know
that
they
had
trouble
with
the
vendors.
I
F
You
just
full
disclosure,
I'm
I
it's
not
that
I'm
smart!
I
had
that
information.
I
was
told
by
the
department,
so
it
was
not
functioning
well,
I
understand
because
of
poor
reporting
and
not
enough
enforcement,
do
we
do
you
think?
I
would
hope
that
now
what
we
established
will
be
better
functioning
and
we've
taken
steps
to
ensure
that.
D
I
In
the
23
states,
I
can't
recite
how
many
there
are
exactly.
I
know
that
there
are
there's
three
that
we
spoke
to,
that
each
do
it
in
probably
two
or
three
at
least
two
or
three
states.
D
Center
for
medicare
services-
I
mean
you,
they
they
put
out
data
on
on
the
cost
and
the
number
of
different
procedures
for
everything
medicare
does.
I
Correct
that
they
have
medicaid
specific
data,
and
we
would
right
this
would
also
go
through
a
process
by
which
we
can
obtain
medicare
data
from
them.
I
G
All
right,
thank
you,
mr
chairman,
and
I
think
one
of
the
questions
that
was
prompted
by
chairman
tsupiki,
that
I'm
not
I
want
to
make
sure
that
you
read
into
the
testimony
is
that
this
will
be
housed
in
health
services
development
agency
and
it
will
be
used
only
within
the
confines
of
the
state.
This
will
not
be
a
public.
No
one
can
go
onto
a
portal
and
access
this
information
and
even
within
the
state,
to
look
at
it.
G
Let's
say
that
the
commission
on
agent
aging,
wants
to
look
at
this,
that
there
would
be
have
to
be
a
memorandum
of
understanding
engaged
with
the
department
of
health
and
that
then,
that
information
will
be
de-identified
for
the
purpose
of
utilization.
If
you
could
speak
kind
of
to
that
process,
because
I
want
people
to
understand
that
this
is
not
something
that's
going
to
be
a
public
price
list,
it
can
be
used
to
analyze,
cost
and
value.
G
But
but
this
issue
of
having
a
very
robust
protection
about
information
is
important
to
all
of
us,
but
we
also
know
that
this
is
a
valuable
tool
and
then,
secondly,
if
you
wouldn't
mind,
as
I
understand
at
the
federal
level,
there
is
a
construct
of
the
database,
that's
being
put
forward
like
a
template
that
there
are
minimum
standards
that
have
to
be
met.
If
you
could
speak
to
those.
Thank
you,
mr
chairman.
Absolutely.
I
So
to
your
first
question
about
the
protections
for
access
to
the
database,
it
will
not
be
accessible
by
the
public.
The
data
com,
the
database
will
actually
be
governed
by
a
health
information
committee.
I
The
health
information
committee
is
going
to
have
includes
some
state
officials,
some
health
care
providers
and
representatives
of
the
insurance
industry
and
some
consumer
representatives
appointed
by
the
house
and
senate
speakers,
as
well
as
the
governor,
and
I
think
additionally,
there's
also
going
to
be
two
legislative
non-voting
members
in
order
to
maintain
legislative
oversight,
I'm
very
proud
of
this
model
as
a
something
that
would
really
provide
a
lot
of
opportunity
for
collaboration
and
oversight
by
the
general
assembly.
I
think
that
it
will.
I
The
committee
will
have
to
approve
all
memorandums
of
understanding
with
other
departments,
and
we
are
on
this
legislation
we
are
still
working
on.
We
are
still
open
to
language
that
would
tighten
it
up
further.
I
believe
we've
had
some
discussions
about
that,
just
to
put
further
guard
rails.
I
believe
that
the
amendment
in
front
of
you
does
have
adequate
protections
in
place,
but
there's
more
that
could
be
stipulated
that
we're
working
on.
F
Yes,
thank
you,
mr
chairman.
Thank
you
again
overall,
it
seems
like
a
useful
thing.
If
we
have
data
that
is
good,
available
and
well
managed,
that
can
be
useful
for
pandemics
and
well.
I
would
rather
ask
you:
what
will
that
data
be
used
for
and
who
will
it
be
available
too?.
I
Thank
you.
That's
a
great
question,
some
of
the
some
of
the
areas
that
I'm
particularly
interested
in
looking
into
our
tracking
the
utilization
of
telemedicine,
trying
to
evaluate
where
that's
writ
that
is
being
adopted
very
commonly.
Where
is
it
successful,
especially
in
rural
areas?
Is
it
really
increasing
access?
Is
it
lowering
costs?
Is
the
quality
it's
the
quality,
improving.
We
just
there's
a
whole
lot
of
things
like
that.
We
could
do
additionally
tracking
chronic
the
prevalence
of
chronic
diseases.
I
If
there's
a
particular
chronic
disease
in
a
certain
area
of
the
state,
we
could
identify
that
and
begin
asking
questions.
Why
is
that
the
case?
Why
is
that
the
way
it
is
additionally?
Hopefully
I
think
this
could
be
very
useful,
the
department
of
health,
because
they
fund
a
lot
of
different
types
of
interventions,
public
health
interventions.
F
A
H
I
H
H
A
Thank
you
and
that
went
down
the
line
of
questioning
that
I
was
going
to
present
as
well.
The
the
collection
of
medicare
supplement
plans
and,
and
the
costs
they're
in
that
that
that
may
express
a
concern
to
some
of
us,
I'm
going
to
go
to
chairman
terry
and
then
we'll
go
to
chairman
lafferty
after
that.
E
Thank
you,
chairman,
and
during
this
discussion
it
kind
of
brought
up
some
thoughts
here.
The
pro
provoke
some
questions.
My
understanding
is
that
the
the
insurers
do
have
information
on
like
regional
costs,
for
if
you're,
repairing
somebody's
car
or
home
or
roof
roof,
or
something
along
along
those
lines
that
they
can
compare
to,
and
then
you,
but
there's
nothing
say
it's
a
car.
There's
no
tenncare
for
a
car.
E
We
would
be
able
to
compare
that
potentially
to
what
we're
doing
in
tenncare
compared
to
commercial
insurance,
at
least
in
that
region,
and
the
issue
that
I
that
I've
tried
to
bring
up
has
to
do
with
rural
providers
and
rural
procedures.
E
And
if
we
want
to
protect
our
hospitals
in
those
rural
areas,
we
have
to
attract
providers
and
those
that
have
the
revenue
producing
procedures
in
that
area.
And
so
this
would
allow
us
to
kind
of,
compare
and
look
at
that.
And
if
we
have
some
shared
savings
from
tenncare
3.0,
we
could
potentially
direct
that
in
those
areas.
Is
that
correct.
J
I've
heard
the
number
two
two
point:
something
million
dollars
is
a
grant
from
the
federal
government
to
set
this
up,
and
then
I
look
at
the
fiscal
note,
and
it's
marked
as
not
significant.
J
I
It
is
a
one-time
grant
of
two
and
a
half
million
dollars,
so
it
would
get
the
claims
database
established
and
running
for
the
first
two
years
of
operation.
At
that
point,
I
would
have
to
come
to
the
general
assembly
and
request
an
appropriation
for
to
for
it
to
continue
and
talks
with
the
vendors
that
I've
had
the
they
expect
for
a
state,
the
size
of
tennessee.
I
J
I
Yes,
sir,
they
we
do
have
health
departments
across
the
state
and
they
do
provide
lots
of
tracking
of
public
health
data.
There
are.
There
are
ways
that
you
can.
They
can
provide
some
data,
but
you're
not
going
to
collect
all
the
data,
because
not
everything
is
reported
to
a
county
health
department,
for
example.
I
I
believe
it
was
discussed
in
our
meeting
with
the
insurers
that
it
wasn't
until
tenncare
did
their
episodes
care,
that
they
discovered
that
there
was
a
pro
prevalence
of
childhood
asthma
in
two
particular
parts
of
the
state,
and
so
that
led
them
to
start
trying
to
investigate
why
that
is,
and
also
it's
helped,
probably
be
beneficial.
I'm
sure
they
have.
D
So
so
let
me
understand
this
so
with
cms
right
now
I
can
tell
you
what
a
facility-
let's
just
say-
let's
say
it's
gallbladder
surgery,
so
I
can
tell
you
what
xyz
facility
in
the
tri-cities
or
nashville
or
in
rural
tennessee
are
accepting
as
payment,
and
I
deal
mostly
with
facilities.
So
I
I
don't
get
down
to
the
physician
physician
level,
but
if
they're
accepting
medicare
you
can
so
I
can
tell
you
what
they're
accepting
so
in
my
private
business,
we
do
something
called
value-based
pricing,
so
there's
not
a
network.
D
The
only
information
I'm
getting,
though,
is
from
medicare
whoever
this
vendor
is
this
third-party
vendor
they're,
going
to
have
all
the
information
they're
going
to
be
able
to
have
the
cms
site
as
well
as
private
payers
sites?
Now,
so
I
just
know
what
you're
doing
in
creating
this
and
and
who
has
that
information
and
where
that
information
may
go
and
how
they
use
that
information,
whether
you
use
that
for
good
or
you
use
that
for
profit,
just
know
what
you're
creating.
B
B
I
The
payer
I
mean
the
payers
have
the
information
that
in
their
own
records,
and
so
they
would
put
it
in-
rearrange
the
files
in
a
data
layout
set
that
is
going
to
be
established
by
the
us
secretary
of
labor
and
then
they're
going
to
submit
that
data
to
the
vendor.
Vendor
will
store
that
data.
It
will
be
stored
in
a
de-identified
state.
I
The
the
no
private
health
information
can
be
made
public
under
any
circumstances,
but
in
order,
but
it
is
important
that
the
data
be
able
that
data
be
collected
in
the
first
place
to
provide
individual
patient
identifier
numbers
that
way.
We
can
track
individual
patients
across
multiple
payers
of
multiple
provider
settings
and
it's
going
to
be
crucial.
I
For
self
for
a
specific
type
of
plan
that
is
correct
and
a
self-funded
plan
governed
by
erisa,
we
cannot
would
not
be
mandatory
under
this.
It
would
be
voluntary.
A
lot
of
states
have
have
a
voluntary
process
for
submitting
that
data.
The
federal
the
federal
bill
that
was
passed
late
last
december
tasks,
the
u.s
secretary
of
labor,
with
developing
a
common
data
layout
that
can
be
used
also
for
voluntary
submissions
by
large
self-funded
employers
across
multiple
states.
B
B
I
Well,
if
I
may,
sir,
if
if,
if
we
don't
have,
even
if
we
are
missing
some
of
the
data,
if
you're
I
mean,
if
you
use
it
intelligently,
if
you
adjust
for
what
you're
missing,
you
can
still
keep
that
from
skewing
the
data
that
you
have,
for
example,
if
we're
collecting
all
the
medicare
but
we're
under
collecting
on
some
of
the
commercial
pairs,
we
just
simply
need
to
adjust.
I
You
know
what
portion
of
the
medicaid
we're
using
and
what
portion
of
the
commercial
pair,
because
it's
still
fundamental
statistics,
so
you're
using
a
sample
size,
the
more
we
have,
the
better.
The
data
is
it's
true,
but
if
you're
I
mean,
if
you
do
it
intelligently,
you
can
keep
it
from.
You
can
minimize
how
much
it
affects
your
the
outcomes
of
your
data.
G
Thank
you
chairman,
and
I
want
to
go
back
to
something
my
colleague
said.
Actually
two
things
chairman
sapicki
made
the
comment
about
sharing
this
with
the
federal
government
and
then
my
colleague,
mr
mitchell,
references
that
cms
would
have
access.
Would
you
revisit
again,
I
mean
is:
is
this
going
to
be
used
for
any
way
for
a
profit
situation,
data
sharing
with
any
sort
of
third
parties
for
for
personal
business,
private
business?
G
This
is
all
for
analysis
of
tennesseans
health,
developing
a
long-range
health
plan
and
looking
at
things
just
like
the
episodes
of
care
things
like
that.
I
want
to
make
sure
that
we're
all
clear
on
the
record
that
that
the
information
you
have
is
not
going
to
be
shared
at
the
federal
level
or
for
that
matter
with
any
private
entity.
I
That
is
correct.
The
federal
government
would
not
be
able
to
access
the
database.
Additionally,
the
vendor
is
stipulating
the
legislation
that
the
state
will
be
the
sole
owner
of
the
data
and
that
at
the
termination
or
conclusion
of
a
vendor
contract,
the
vendor
would
have
to
provide
the
data
to
the
state
in
its
current
in
its
most
current
form
and
then
provide
a
certificate
of
destruction
for
the
data
that
they
had,
so
it
would
and
at
the
conclusion
that
there
would
be
no
risk
of
the
data
being
used
in
another
way.
D
A
Thank
you
any
further
questions
or
comments
from
mr
grant.
Mr
grant.
I
do
have
concerns
the
the
amount
of
money
that
we're
talking
about
coming
in
from
the
federal
government
on
grants.
I
do
have
concerns.
Can
you
once
again
point
out
to
me
in
the
committee
on
how
we
plan
to
invest
these
dollars,
how
we
plan
to
continue
those
long
term
and
more
specifically,
for
the
finance
committee
member
in
my
brain
here
and
the
other
member
on
the
chairman
of
the
finance
subcommittee.
I
I
Through
those
revenues,
the
federal
grant
will
be
used
solely
for
the
vendor
contract,
the
vendor
contract,
as
I've
discussed
with
three
different
vendors
they
have.
They
have
told
me
that
two
and
a
half
million
over
a
three
year
period
would
be
enough
money
to
get
one
up
and
running
and
pull
pull
some
reports
and
have
access
to
the
data.
The.
I
I
think
that
the
benefit
to
moving
forward
with
a
plan
like
this
is
that
the
general
assembly
will,
rather
than
having
to
obligate
state
and
taxpayer
dollars
on
something
on
a
you
know,
a
vision
of
something
you
will
actually
get
a
chance
to
see
it
up
and
running
and
see
what
the
value
of
the
database
is
before
having
to
commit
any
further.
And
I
the
estimates
that
I
have
received
limit
the
say
that
the
upper
end
of
what
the
state's
obligation
would
be
to
continue
the
database
would
be
seven
hundred
fifty
thousand
dollars.
A
All
right,
thank
you,
see
no
further
questions
or
comments.
Thank
you,
mr
grant.
We
do
have
a
couple
other
folks
on
the
on
the
list.
I
don't
know
if
anyone
has
any
questions
or
comments
for
anyone
else,
I
will
not
call
anyone
else
up
unless
anyone
the
committee
has
questions
or
comments
from
any
of
our
anyone
else.
Okay,
we
are
back
in
session.
A
All
right,
we
are
back
in
session
questions
or
comments
for
representative
smith
as
we
go
forward.
B
A
Seeing
none
all
those
in
favor
of
sending
house
bill
1258
to
summer
study,
please
signify
by
saying
aye
aye
any
of
those
opposed.
Please
say:
no!
No!
The
ice
habit
house
bill
1258
is
sent
to
summer
study.
Thank
you.
Thank
you.
A
G
You,
mr
chairman
and
committee,
I
do
have
a
couple
of
amendments.
I
need
to
add
to
that.
This
is
house
bill
636,
and
there
are
two
amendments
on
the
bill.
A
All
right,
we
do
have
a
motion
in
a
second
on
the
legislation
we
have.
Two
amendments
is
that
accurate
chair,
lady
smith,
that.
G
That
is
correct,
sir.
It's
a
first
amendment
that
needs
to
be
added
is
six
two,
three
nine.
A
A
promotion
we
have
a
second
okay,
all
those
in
favor
of
placing
and
will
be
described
here
in
a
moment
all
those
in
favor
placing
tracking
code
amendment
6239
on
the
bill,
please
signify
by
saying
aye
aye
any
opposed.
Please
say
no,
the
eyes
have
it.
Amendment
number
one
is
on
the
bill.
Amendment
number
two
tracking
code,
as
as
the
chair,
lady
smith,.
B
A
G
A
Thank
you
and-
and
forgive
me
I
should
have
made
the
motion
as
we
were
amending
those
with
those
two
amendments.
I
I
will
make
the
request,
and
hopefully
without
objection
from
the
committee
to
roll
those
two
amendments
into
one
legal
staff
has
advised
me
that
we
can
and
should
do
that.
So
without
objection
from
the
committee.
A
Those
two
amendments
will
be
rolled
into
one.
Thank
you
very
much.
Thank
you.
Any
questions
or
comments
for
representative
picky,
you're
recognized.
H
G
G
Cms
has
to
govern
all
tenncare
waiver
and
or
tenncare
programs
separately,
and
should
this
be
under
the
jurisdiction
of
the
department
of
commerce
and
insurance,
it
would
instantly
be
out
of
compliance
at
the
federal
level
and
to
avoid
a
a
standing
that
would
be
inappropriate
within
cms.
Certainly
we
don't
want
to
do
that
to
our
tenncare
bureau.
However,
there's
nothing
that
that
prevents
this
committee,
nor
the
department
of
health
for
for
seeking
a
adequacy
report
separate
from
the
tenncare
bureau
that
would
model
such
a
a
report
that
would
be
available
for
all
these
paying
plans.
G
So
I
think
that
upon
this
becoming
law
and
us
being
able
to
see
the
utility
to
make
sure
that
patients
do
have
access
to
mental
health
services
to
substance
abuse
services,
to
make
sure
that
you
know
all
of
these
services
are
available.
I
think
it
would
serve
as
a
tremendous
model
for
tenncare
to
come
forward
with
a
similar
access
plan
to
report
to
this
body
on
a
regular
basis.
J
You,
mr
chairman,
sponsor
I
just
wanted
to
make
sure
I
heard
you
right.
This
is
strictly
a
reporting
bill.
This
is
not
compelling
any
agencies,
any
departments,
any
insurance
carriers,
anybody
to
do
anything
other.
B
A
G
It
it
within
the
bill.
It
empowers
the
department
of
commerce
and
insurance
to
accept
these
access
plans
and
to
monitor
to
make
sure
that
plans
are
indeed
you
know
adequate.
It
does
not
stipulate
within
the
bill
specifics
of
that
definition.
It
looks
at
the
number
of
providers
that
would
be
necessary
to
take
care
of
a
population
according
to
a
plan,
the
distance
and
and
demographics.
G
However,
it
leaves
it
up
to
the
department
to
make
that
those
determinations,
but
there
it
just
receives
the
access
plans
that
are
submitted
on
an
annual
basis
and
it
directs
the
department
to
ensure
that
patients
do
have
access
to
an
adequate
network.
G
A
A
K
H
So
to
clarify,
if
you
know
this
is
a
very
complex
bill,
so
you
got
to
work
through
this
with
me.
Please,
so
you
guys
manage
your
adequacy
yourselves
right
now,
correct.
K
H
K
K
H
H
Million,
pretty
close,
that's
a
big
hole
in
our
data
on
network
adequacy,
because
is
there
an
overlap
between
the
two?
Would
there
be
an
overlap
between
the
two?
If
we
don't
share
the
data?
Sorry
am
I
going
to.
Let
me
better
question
that
I'm
sorry
would
there
be
holes
in
this
bill
if
you
did
not
share
the
data.
K
G
If
I
might,
I
might
want
to
take
the
opportunity
to
address
chairman
sapicki
in
his
line
of
questioning
there
about
the
holes
in
the
information
you
know
one
of
the
things
I
want
to
make
sure
that
there's
no
part
of
this
bill,
that's
tied
to
the
all
payers
claims
database.
This
is
a
standalone
reporting
mechanism,
where
the
department
of
commerce
and
insurance
would
receive
adequacy
plans
on
an
annual
basis
through
determination
and
review
about
primary
care
access,
especially
access
as
well
as
any
intermediaries.
G
There
would
not
be
any
data
submitted
and
housed
as
because
I
think
we're
confusing
the
two
bills.
I
want
to
make
sure
that
there
there's
no
confusing
the
all
payers
claims
database.
So
there's
not
any
information,
that's
shared
other
than
just
a
generic
access
plan
to
overview
the
the
patient
policy
holders
and
their
access
to
to
care.
Thank
you,
mr
chairman.
H
And
I
do
appreciate
that
and
the
chairman
knows:
I've
had
some
issues
with
this
bill.
To
me
it
appears
the
possibility
of
heavy-handedness
here
on
providers.
I
need
personally,
I
need
more
information
on
this
bill.
F
A
All
right,
ladies
and
gentlemen,
any
questions
or
comments
for
the
chair,
lady
smith,
on
the
legislation.
A
A
All
right,
forgive
me
as
I
turn
my
page
here,
I'm
I
feel
like
my
head's
on
a
swivel
up
here
quite
often,
and
I
and
I
know
I'm
I'm
going
back
and
forth
like
a
tennis
match,
as
this
is
going
on,
trying
to
trying
to
make
sure
I
hear
and
see
everyone.
So
thank
you
all
very
much
for
your
patience.
We
are
now
on
item
number.
Seven.
On
our
calendars
item
number
seven
is
house
bill.
Two
charlie
smith,
you're
recognized
on
house
bill
two.
G
Thank
you,
mr
chairman
and
committee.
There
is
a
drafting
code,
an
amendment
traveling
65,
41
motion.
A
A
All
right
tracking
code,
6541
is
amendment
number
one
to
house
bill,
2.
we'll
go
ahead
and
entertain
a
motion
on
that
motion.
A
G
Thank
you
chairman.
This
is
essentially
codifying
the
federal
law
public
chapter
l116-260,
which
is
u.s
code
9816.
G
in
december.
I've
referenced
this
already
in
december
2020,
the
federal
surprise.
Billing
act
went
into
law
and
this
simply
puts
into
tennessee
code
that,
despite
the
fact
that
that
law
was
written
to
cover
the
erisa
plans,
the
employee
retirement
investment
securities
act
plans
that
our
department
of
commerce
and
insurance
will
enforce
that
law
on
all
plans
and
give
individuals
an
opportunity
for
remediation.
G
This
particular
amendment,
mr
chairman,
has
two
other
provisions
that
I
want
to
bring
the
the
committee's
attention
to
should
this
pass
out
of
this
committee.
Those
two
provisions
will
be
stricken
and
this
will
be
solely
a
bill
that
codifies
the
u.s
code
into
state
law
to
make
sure
that
we
have
all
of
our
lives
covered
through
surprise
billing
fixes
and
with
that
I'll,
be
happy
to
take
specific
questions.
Mr
chairman,.
F
A
A
Forgive
me
I
I
forgive
me
I
do.
We
do
have
a
department
of
commerce
and
insurance.
Is
that
your
request,
chairman
kumar.
F
A
Seeing
no
objection
into
going
into
recess,
we
are
now
in
recess.
Gentlemen,
if
you
could
please
introduce
yourself,
tell
us
who
you
are
and
who
you're
with
and
begin
your
testimony.
L
Thank
you,
mr
chairman
committee.
I'm
alex
lewis
with
the
department
of
commerce
and
insurance
also
with
me,
is
patrick
merkel,
he's
the
director
of
insurance
at
the
department
in
our
division
of
insurance,
so
I'll.
Let
patrick
give
some
opening
remarks
and
then
we'll
be
available
for
questions.
Mr.
M
M
I've
done
quite
a
bit
of
studying
and
listened
to
a
number
of
calls
with
the
nisc
insurance
commissioners
and
staff
across
the
country
as
well
as
cms,
and
it's
it's
the
department's
feeling
that
the
federal
law
will
cover
those
plans
that
are
regulated
by
the
department,
the
individual
plans
sold
on
and
off
marketplace,
as
well
as
the
small
group
plans
that
we
regulate.
M
F
F
F
M
F
M
M
I
think
you're
correct
with
the
statement
that
there
is
a
lot,
a
lot
of
things
that
are
unclear
and
that
there's
going
to
be
a
lot
more
clarity
as
the
year
progresses
and
the
department
of
human
services,
the
department
of
labor,
surprisingly,
the
department
of
transportation-
and,
I
think,
there's
probably
two
other
federal
agencies
that
are
involved
all
kind
of
work
to
to
to
sort
of
sort
of
give
some
a
little
bit
more
framework
to
the
the
provisions
that
were
passed.
M
L
The
the
federal
act
amended
three
sections
of
federal
law,
the
tax
code
erisa
as
the
representative,
the
sponsor
mentioned,
but
also
the
phsa,
the
pub
public
health
services
act,
and
that
is
the
provision
that
makes
the
federal
act
applicable
to
those
traditionally
thought
of
as
state
regulated
plans.
So
it's
not
that
the
department
will
make
some
determination
that
we
will
apply
this
to
state
plans.
It's
that
congress
in
passing
the
law
applied
it
to
those
state
plans,
and
so
chairman
kumar,
I
think
to
you
to
the
heart
of
your
question.
L
F
G
If
this
is
not
in
our
tennessee
code,
and
yet
those
plans
are
governed
by
the
department
of
commerce
and
insurance.
Unless
I
misunderstood
you,
you
could
not
give
me
a
firm
answer
that
there
would
not
be
a
remedy
that
patients
would
still
be
at
risk
in
those
situations
because
of
potential
lawsuits.
G
M
So,
there's
a
an
idea
that
you
know
with
enough
amount
of
money
and
and
a
lawyer,
that's
willing
to
file
the
suit
you
can
anybody
can
sue
anybody?
I
think
that
you
will
probably
see
some
lawsuits.
I
don't
think
that
they
will
be.
M
And
I
think
that
the
providers
will
get
paid
under
this
and
there
will
be
the
that
the
carriers
are
going
to
follow
the
idr
process
and
we're
going
to
go
forward
on
that
way.
And-
and
I
think
that
if
there
are
carriers
that
are
not
doing
this,
we're
going
to
be
having
conversations
with
them
and
under
our
statutes
and
saying
you
need
to
be
following
the
law.
Or
else
there
will
be
ramifications.
L
G
If
the
tennessee
medical
association,
if
they're
on
the
list
to
testify
I'd,
love
to
hear
their,
if
not,
if
not,
that's,
not
a
problem,
sir.
N
N
It
would
be
whatever
we
brought
would
be
fair
to
both
the
payers
and
the
providers,
and
I
feel
like
we
did
that
what
I
am
very
concerned
with-
and
it
would
be
easy
for
the
tennessee
medical
association
to
sit
here
today
and
say:
okay,
let's
just
let
the
federal
bill
go
and
then,
if
there
is
a
lawsuit,
have
people
fall
through
the
cracks?
I
don't
want
that
to
happen
to
your
constituents.
N
I
don't
want
there
to
be
a
lawsuit,
because
I
do
think
that
there
was
enough
ambiguity
in
the
federal
law
that
could
lead
providers
and
particularly
providers
and
a
posture
that
on
the
in
the
state
regulated
market,
they
could
file
lawsuits
potentially
get
injunctions
to
hold
off
the
federal
law
and
then
down
low
and
behold
20
to
30
percent
of
the
markets
that
are
in
your
communities.
Patients
fall
through
the
cracks.
N
It
is
obviously
been
a
big
issue.
We
had
a
what
was
23
page
bill
that
we
filed
that
was
pretty
similar
layout
to
the
federal
law.
There
were
some
exceptions,
dr
kumar,
and
I
have
spoken
about
some
of
his
concerns
in
the
original
bill.
So
we
made
it.
We
tried
to
cut
this
down
to
make
it
really
really
clear
that
just
to
make
sure
that
there
was
no
question
that
tennessee
was
going
to
follow
the
federal
law
as
it
related
to
the
commercial
to
the
state
regulated
insurance
market.
N
I'm
not
sure
that
my
providers
are
going
to
just
take
it
on
the
the
chin
that
there's
that
the
insurance
company
is
going
to
give
them
the
actual
rate.
That's
why
there
are
things
like
all
claims,
databases
that
were
put
into
the
federal
law
to
be
created
so
that
you
will
would
have
independent
verifiable
data
for
for
your
arbitrators
to
look
at
that's
going
to
come
out
in
the
the
full
committee.
N
As
I
understand
it,
but
again,
if
you
all
don't
want
to
move
forward,
I
I
understand
that,
but
I
do
think
that
you
could
potentially
be
putting
some
of
your
patients
at
risk.
I
respectfully
disagree
with
the
department.
I
think
there
are
patients
that
could
fall
through
the
cracks,
and
I
I
think
that
this
bill,
as
amended,
will
ensure
that
that
doesn't
happen.
A
A
A
N
N
It's
it's
muddy
and
muddy
at
best,
and
I
think
that
most
anyone
you
ask,
would
tell
you
it's
muddy.
At
best
I
will
and
I'm
going
to
point
out,
congressman
rowe
former
congressman
rowe
was
a
key
member
of
the
negotiating
group
that
negotiated
the
federal
bill,
and
he
has
told
me
that
the
state
probably
needs
to
put
in
their
own
language
to
ensure
that
the
state
regulated
market.
N
It
applies
to
the
state
regulated
market,
because
there
is
so
much
unclear
clarity,
there's
so
much
clarity
that
needs
to
be
done
with
a
federal
law
and
again
the
rulemaking.
Yes,
I
do
believe
that
we
might
get
some
clarity
with
the
rule
making,
but
even
that
can
be
negotiated
and
fought.
So
we
just
wanted
to
make
sure.
H
H
H
So
could
we
not
allow
the
federal
law
to
be
implemented
with
all
the
rules
and
the
procedures
and
then
know
what
to
fix,
because
right
now
we're
trying
to,
if
I
understand
right,
we're
trying
to
fix
something
that
we
don't
know
how
to
fix
because
it
hasn't
been,
it
hasn't
been
implemented
yet
so
why
would
we
I'm
just
struggling
here?
Why
would
we
try
to
fix
something
that
we
can
next
year?
We
can
come
back
and
fix
it
next
year,
if
we
have
to
based
off
of
what
we
see.
N
I
don't
know
what
the
the
problem
with
making
it
clear
that
you
all
want
to
make
sure
everybody
is
covered
when
that
when
that
law
begins
in
2022
or
23
22.,
the
federal
law
will
go
into
place
in
2022.
N
N
G
I
do
think
that
there
is
no
harm,
there's
no
cost
to
put
this
into
code,
but
I
will
listen
to
the
committee
and
at
the
at
the
advocates
of
our
our
tennessee
providers
and
patients,
but
in
the
meantime,
again
we're
not
trying
to
fix
something
we're
trying
to
make
sure
that
there
aren't
patients
that
fall
through
the
cracks
as
the
fix
is
applied.
Thank
you,
mr
chairman.
A
F
F
We
tennessee
law
can
be
sued
too,
and
we
think
that
federal
law
is
so
open
of
with
holes
that
we,
the
there
can
be
lawsuits,
then,
if
it
is
that
bad
or
lawful
of
holes,
why
do
we
want
to
codify
into
our
tennessee
law
we're
importing
the
same
problems
by
taking
the
same
law?
Considering
that
any
lobby
pass
is
also
equally
open
to
lawsuit?
Considering
that
we
think
federal
law
is
open
to
lawsuits?
Why
do
we
want
to
adopt
it?
I'm
trying
to
figure
out
why
we
are
doing
this.
F
The
lack
of
clarification,
because
the
rules
are
not
available
yet
is
equally
concerning,
and
I
don't
know
why
we
need
to
act
on
it.
I
know
shelly
smith,
you
have
worked
very
hard
on
it.
You
have
put
a
number
of
amendments
trying
to
adjust
things,
and
I
admire
you
for
that,
but
I
sincerely
would
request
that.
Please
consider
rolling
it
to
next
year
or
studying
it
through
a
summer,
so
that
we
have
the
federal
rules
available
and
then
fix
what
we
think
needs
to
be
fixed.
We
need
clarity
before
proceeding.
G
And
we're
back
in
session
is
that
right,
sir
I'll,
I
will
make
a
motion
to
put
this
on
the
first
calendar
of
the
insurance
company
and
insurance
calendar
in
2022,
and
I
would
ask
that
sabi
kumar
be
the
the
primary
co-sponsor
on
the
bill
and
we
will
work
toward
resolution.
Thank
you,
mr
chairman,
may
I
have
a
second
on
that
emotion,
that
emotion.
A
Okay,
we
have
a
parliamentary
concern.
The
the
number
of
number
of
calendars
that
this
bill
has
been
on
has
produced
a
a
concern,
absent
passage,
we're
not
quite
sure
if
we
can
take
that
initiative
on
this
piece
of
legislation,
so
we're
going
to
have
just
a
quick
reference
there,
charlie
smith,
what
we're
discussing.
G
A
All
right,
thank
you
very
much
and
and
we've
got
some
wonderful
rules
that
that
we
are
working
through
and
and
they're
somewhat
different
for
us.
So
as
we
work
our
way
through
this,
this
is
the
the
first
year
under
these
the
the
roles
and
the
the
times,
we're
allowed
to
have
some
roles
absent
absent
passage
of
this
legislation.
A
The
the
motion
that
we
heard
cannot
be
accepted.
So
that
is
the
posture
in
which
we
are
chairman.
Kumar,
chairman
chairman
lafferty,
you
recognized,
forgive
me,
you
had
raised
your
hand
earlier.
I
forgive
me.
J
Always,
mr
chairman,
thank
you.
I
just
I
haven't
faced
this
situation
from
the
top
down.
I
have
had
a
couple
of
instances
with
our
colleagues
in
other
committees,
where
we
have
taken
policies
and
tried
to
codify
those.
J
F
Thank
you,
mr
chairman,
and
I'm
sure
the
sponsor
understands
with
all
this
confusion
and
things
going
on,
it's
really
a
matter
of
semantics,
whether
we
say
put
it
on
next
year's
calendar
or
summer
study.
With
that
understanding,
I
think
what
fits
in
the
picture
at
this
time
is
that
I
am,
I
will
make
a
motion
for
summer
study.
A
A
The
ice
haven't
yeah
chairman
here's.
Here's
knows,
excuse
me,
here's
eyes,
the
the
bill
will
be
placed
in
summer
study.
So.
Thank
you
very
much,
ladies
and
gentlemen,
thank
you
for
your
diligent,
hard
work
and
attention.
This
has
been
a
tough
committee.
This
has
been
a
tough
day
for
many
of
us
and
most
folks
watching
don't
know
it's
been
a
tough
day
for
many
of
us.
So
I
want
to
thank
you
for
indulgence.
Thank
you
for
the
time
that
you
spent
today
entertain
a
motion
that
we
will
adjourn.