►
Description
House Insurance Committee- February 1, 2022- House Hearing Room 1
A
Thank
you,
members.
Do
we
have
any
personal
orders
this
morning,
I'm
gonna
go
first,
because
I
can-
and
I
would
just
like
to
say
that
let's
keep
chairman
kumar
and
his
wife
linda
in
our
prayers.
She
is
recovering
from
some
recent
surgery
and
we
just
wish
miss
linda
a
speedy
recovery.
A
Members
today
will
be
hearing
from
a
presentation
from
the
department
of
commerce
and
insurance
on
the
no
no
surprise
act,
but
first
we
have
one
bill
to
discuss.
That
brings
us
to
house
bill
1705.
C
You
chair,
lady
and
members
of
the
committee
house
bill
1705
is
essentially
a
cleanup
bill
for
the
comptroller
of
the
treasury.
It
will
remove
unnecessary
requirements
to
the
approval
access
tennessee
plan
of
operations.
C
The
current
law
requires
access,
tennessee
board,
to
submit
a
plan
of
operation
and
amendments
to
to
this
plan,
to
the
commissioner
of
finance
and
administration,
but
also
the
controller
of
the
treasury
for
approval.
Submitting
this
plan
to
the
comptroller's
office
for
approval
creates
conflict
due
to
the
statutory
requirement
that
the
comptroller
also
audits.
This
plan.
Removing
this
requirement
that
the
plan
be
submitted
to
the
comptroller's
office
will
eliminate
this
conflict.
C
A
Seeing
no
further
questions
we're
ready
to
vote
if
there's
no
objection,
all
those
in
favor
sending
house
bill
1705
to
calendar
and
rules
signify
by
saying
aye,
those
opposed
no
eyes
at
house
bill.
1705,
most
calendar
rules.
A
Please
introduce
yourselves
for
the
record
and
begin
whenever
you're
ready.
D
Good
morning,
madam
sharon,
thank
you
for
the
time
to
be
with
you
today.
My
name
is
carter
lawrence,
I'm
the
commissioner
of
the
department
of
commerce
insurance.
I
have
with
me
here
bill
huddleson,
who
is
the
assistant
commissioner,
at
commerce
insurance.
I've
got
a
few
other
folks
from
my
department,
most
of
whom
are
familiar
faces
to
y'all,
so
wanted
to
briefly
speak
with
you
about
the
federal,
no
surprises
act,
what
it
is,
what
it
does,
what
it
does
not
do
and
then
have
some
time
to
answer
questions
as
well.
D
So
generally,
the
federal
law
creates
new
protections
for
consumers,
whether
covered
under
group
or
individual
plans
or
self-pay,
which
in
this
case
will
use
to
mean
the
uninsured.
So
the
law
prohibits
surprise
medical
bills
when
an
individual
receives
most
emergency
services
or
non-emergency
services
from
out-of-network
providers
at
an
in-network
facility
and
services
from
out-of-network
air
ambulance
service
providers
through
new
rules
aimed
to
protect
consumers,
excessive
out-of-pocket
costs
are
restricted
and
emergency
services
must
continue
to
be
covered
without
prior
authorization
and
regardless
of
whether
a
provider
or
facility
is
in
network.
D
The
no
surprises
act
also
establishes
an
independent
dispute
resolution
process
for
payment
and
reimbursement
disputes.
These
disputes
now
occur
solely
between
the
plans
and
providers
which
I
think
bears
repetition,
meaning
that
the
consumers
will
not
actually
even
receive
that
paperwork
which,
I
think
from
our
part
we
could
agree,
is
a
real
benefit
to
the
consumers
to
not
even
receive
that
in
the
mail.
D
So
the
no
surprises
act
also
creates
a
new
dispute
resolution
for
uninsured
and
self-pay
individuals
who
may
receive
a
medical
bill
that
is
substantially
greater
than
a
provider's
good
faith
estimate
under
the
new
law.
Providers
must
give
a
good
faith
cost
estimate
72
hours
prior
to
the
medical
service.
The
good
faith
estimate
becomes
the
baseline
for
any
future
reimbursement
disputes.
D
D
So,
as
you
can
see
on
the
graphic,
a
balance
bill
occurs
when
a
patient
receives
care
at
an
out-of-network
facility
from
an
out-of-network
provider.
So,
for
example,
if
the
provider
charges
a
hundred
dollars
and
the
allowed
amount
is
70,
the
provider
can
still
bill
for
that
balance
of
30
dollars
contrasted
with
a
surprise.
Bill
occurs
when
a
patient
receives
care
to
an
in-network
facility
from
an
out-of-network
provider.
D
The
key
differential
between
balance
and
surprise
billing
is
whether
the
facility
is
in
network
or
out
of
network,
with
the
exception
of
emergency
services,
and
another
key
term
to
talk
about
is
independent
dispute
resolution
which
we'll
just
shorten
down
to
idr.
For
the
remainder,
so
idr
is
the
dispute
process,
that's
utilized
by
the
plan
and
the
out-of-network
provider.
At
the
end
network
facility.
D
D
The
two
groups
will
then
initiate
the
idr
process,
which
includes
the
selection
of
a
third
party
which
is
called
the
idr
entity
for
this
purpose,
then
both
the
plan
and
the
provider
submit
their
reimbursement
offers
the
idr
entity
will
select
one
of
the
offers
or
an
alternate
offer,
which
becomes
the
out
of
network
rate
for
the
medical
service.
Just
as
an
aside,
this
is
what's
referred
to
as
baseball
arbitration
and
is
what's
adopted
by
the
feds
in
this
model.
D
Generally,
the
idr
process
and
payments
between
parties
should
be
resolved.
40
days
after
the
initiation
of
the
idr
process,
cms
established
a
rule
with
a
50
administrative
fee
for
providers
and
payers
that
use
the
federal
process
and
sets
a
range
of
200
to
500
for
the
fees
paid
to
idr
entities
for
conducting
a
single
determination.
D
The
qualifying
payment,
which
is
the
median
in
network
rate
inflated
by
cpi,
as
set
by
the
irs,
is
the
most
heavily
weighted
of
the
criterion
used
throughout
the
process.
It's
also
important
to
note
the
intensive
process.
An
entity
must
go
through
to
become
an
idr
as
part
of
the
application
process.
An
organization
seeking
idr
entity
status
must
demonstrate
expertise
in
arbitration
and
claims
administration,
billing
and
coding
managed
care
and
health
care
law.
D
D
All
right
so
having
talked
a
little
bit
more
about
set
the
terms,
go
back
into
the
act
and
talk
a
little
bit
more
about
what
it
does
and
then
also
I'll
get
to
some
of
what
it
does
not
do.
There
are
certain
aspects
of
the
no
surprises
act
that
do
not
change.
Do
not
fundamentally
reform
the
medical
system,
the
law
directs
hhs,
to
conduct
a
study
and
create
a
report
on
ground
ambulances.
D
The
law
itself
does
not
cover
ground
ambulance
services.
The
main
reason
the
legislation
does
not
address
ground
ambulance
providers
is
due
to
the
unique
local
and
state
laws
across
the
country.
The
study
and
subsequent
report
are
to
further
inform
congress
on
the
unmet
needs
across
the
country
separately.
If
a
consumer
chooses
to
use
an
out-of-network
provider,
the
provider
must
give
a
good
faith
cost
estimate
at
least
72
hours
before
the
service
is
provided,
and
the
patient
must
also
sign
a
consent
waiver
acknowledging
the
out-of-network
status
of
the
provider.
D
So
in
these
scenarios
a
balance
bill
is
allowed
to
be
sent
from
the
provider
to
the
patient,
and
some
states
have
asked
cms
to
clarify
if
the
consumer
consent
applies
to
only
one
procedure
or
if
that
applies
to
all
moving
forward,
and
that's
something
we
have
not
yet
received.
Clarity
on
all
right
last
slide,
tdci
just
a
little
bit
about
no
surprises
and
what
we've
done
from
informing
consumers.
D
First,
just
to
brag
on
us
a
little
bit.
We've
returned
over
10
million
dollars
to
tennesseans
in
2021,
and
we
will
continue
to
seek
further
mediation
efforts
to
to
return
consumers.
Their
heart
earned
money
when
they
were
wrongfully
denied
claims
at
the
beginning
of
january,
which
was
right
after
the
law
went
into
effect.
Tdci
issued
a
bulletin
2201
to
give
providers
further
guidance
on
how
to
stay
in
compliance
with
the
new
law.
So
we've
sent
the
bulletin
an
op-ed,
many
blog
posts
and
press
releases
to
thousands
of
tennesseans.
D
A
B
Thank
you,
madam
chair,
commissioner,
your
team,
thank
you
so
much
for
being
here.
Let
me
go
back
to
the
flow
chart
slide
that
you've
got
and
as
we're
going
through
the
the
the
idr
process.
B
D
B
D
Because
assistant
commissioner
bill
huddleston
has
been
the
from
commerce
insurance
most
directly
engaged
with
cms
on
those
phone
calls
hearing
from
it.
Let
me
turn
now
to
assistant
commissioner
huddleson.
Thank
you.
E
Sure,
thank
you
for
the
question
chairman.
We
have
been
on
quite
a
number
of
phone
calls
with
cms
about
this,
and
we've
had
some
back
and
forth
correspondence
with
them.
The
bad
faith
negotiations.
E
So
as
far
as
that
goes,
the
idr
entity
is
responsible
for
the
that
it's
responsible
for
making
a
decision
in
the
case
and
they're
also
responsible
for
being
free
of
conflict
of
interest.
So
as
far
as
the
payer
and
provider,
the
idr
looks
at
the
information
submitted
and
makes
that
determination.
E
If
the
idr
entity
itself
is
found
to
be
a
bad
actor,
there
is
a
suspension
process
for
the
idr
entity
and
that
actually
there's
pretty
good
guidance
on
cms's
website
about
the
idr
process.
It's
it.
I
could
get
through
it
because
it
was
only
48
pages.
It
actually
left
out
some
details,
but
because
it
was
not,
you
know
because
it
was
shorter,
but
but
it
is
a
pretty
good
guideline
and
it
addresses
some
of
that
process.
B
F
Thank
you
all
for
being
here.
As
you
know,
surprise
billing
is
a
big
deal.
There
are
members
in
this
chamber
that
have
surprise
bills
that
are
unpaid
right
now,
and
we've
tried
to
have
a
state
solution,
and
so
my
question
is:
if
the
state
were
to
bring
a
bill
the
session
next
session,
whenever
that
would
address
the
nature
of
uncovered
lives
that
don't
have
an
option
or
address
this
from
a
different
angle.
F
What
is
the
department's?
I
guess
position,
would
you
you
know,
enforce
the
state
option
the
state
bill?
Would
you
enforce
it
at
the
federal
level?
And
a
second
part
of
that
question
and
built
into
the
federal
bill
is
the
support
of
an
all
payers
claims
database
that
is
used
as
a
tool
to
look
at
rates
and
and
quips
the
independent
reviewer
kind
of
speak
to
those
two
questions,
and
I
may
have
a
follow-up.
Thank
you.
Ma'am
yeah.
D
Thank
you.
So
I
guess
let
me
pick
up
first
with
the
idr,
so
we
have.
We
only
mentioned
one
of
the
criterion
that
they
have
to
consider
the
median
in
network
rate,
but
there
are
lots
of
factors
that
they
are
directed
to
consider
as
part
of
their
process
for
making
the
determination
as
to
the
appropriate
amount.
D
And
so
I
I
think,
if
I'm
falling
with
the
the
thread
there
about
all
of
the
other
factors
I
would
refer
back
to
and
I
think
it'd
be
appropriate
if
we
could
to
send
to
madam
chair
to
then
distribute
out
to
the
to
all
the
members
what
he
was
referencing
about
the
idr
process
and
those
entities
for
everyone's
illumination,
like
he
said
it's
48
pages,
and
so
we
didn't
have
time
to
get
into
all
of
that
today,
but
we'd
be
happy
to
distribute
that
back
to
the
first
part
of
the
question.
D
What
one
of
the
things
that
I
wanted
to
do
today
was
talk
a
little
bit
about
the
federal
act,
what
it
does,
what
it
doesn't
do
and
in
so
doing
leave
off
the
question
about
anything
about
any
potential
legislation.
I
I
know
that
this
has
been
a
big
issue
for
many
years.
As
a
brief
aside,
I
think
I'm
one
of
the
better
educated
consumers
and
when
I
had
to
have
some
emergency
surgery.
D
Last
year
I
was
laying
on
the
table,
and
I
asked
the
anesthesiologist
whether
he
was
in
network
out
of
network
and
of
course
he
doesn't
know
which
was
sort
of
the
point,
and
what
am
I
going
to
do
anyway,
even
if
he
said
he
was
out
of
network.
I
wasn't
going
to
say
no
cut
me
while
I'm
not
while
I'm
awake,
but
my
point
is
that
this
is
a
big
issue
has
been
for
a
long
time
and
we
want
to
be
engaged.
We
are
really
appreciative
of
this
solution.
What
it
means
for
consumers.
F
You're
recognized,
thank
you,
madam
chairman,
and
also
I've
got
another
question,
but
don't
leave
off
the.
If
would
you
support
an
all-payers
claims
database
as
a
tool
that
we
could
use
here
but
but
sec?
My
second
question
is:
you
know
this
term
independent
dispute
resolution.
F
There
is
a
federal
lawsuit
pending
right
now
against
the
federal
rule
and
that
lawsuit
stipulates
that
it
that
the
hands
are
tied
of
the
independent
dispute
resolution
members,
because
the
presumptive
rate
that
will
be
paid
is
the
in-network
rate.
F
So
if
you
wouldn't
mind
speaking
to
the
record
as
to
is
that
something
that
you
believe
as
the
department
of
commerce
and
insurance
here
at
the
state
of
tennessee,
that
you
believe
that
all
in-network
rates
should
be
the
default
presumptive
fair
rate
and
that
carrying
on
with
the
the
the
rule
of
the
biden
administration,
that
really
you
know,
providers
and
patients-
don't
have
a
real
say
in
this.
It's
really
that
that
is
considered
the
default,
and
the
burden
of
proof
is
on
someone
else,
rather
than
it
being
a
true
independent
dispute
resolution.
D
All
right,
so,
if
I
may,
let
me
pick
up
with
the
first
component,
where
you
asked
about
whether
we
would
support
the
all
players
claims
database
legislation
for
tennessee.
I
would
I,
and
I
know
it's
going
to
sound
like
a
cop-out.
We
have
no
position
separate
from
the
governor's
position,
so
this
is
one
where
I
would
have
to
talk
with
my
boss.
D
I
think
the
general
principles,
though
about
appropriate
transparency,
would
be
the
guiding
principle
there,
and
so,
if
he
asked
me,
that's
what
I
would
say
back
well,
we
think
appropriate
transparency
and
data
sharing
would
be
important
and
can
serve
as
a
really
important
component
for
the
idr
process
and
helping
them
determine
where
the
rates
fall
and
making
that
accurate
determination.
D
So
to
the
second
part
of
your
question,
and
I
apologize
if
I
drop
the
thread
and
please
clarify,
if
I
miss
anything
as
to
what
rate
is
appropriate
again,
the
idr
entity
is
not
considering
just
one
factor.
So
what
I
gave
the
example
of
the
most
heavily
weighted
for
the
median
network
is
just
that.
It
is
one
of
the
factors
that
has
to
be
considered
and
from
what
I
understand
from
the
rules.
D
G
Thank
you,
madam
chair,
and
thank
you
all
for
being
here,
I'm
actually
in
the
middle
of
one
of
these
right
now.
So
I
do
have
a
question
about
it.
I
went
to
a
in-network
facility
and
then
I
get
a
bill
from
an
out-of-network
provider
and
the
bill.
Ballpark
figures,
like
thirty
eight
hundred
dollars
total
and
they
told
me
to
send
eight
hundred
dollars
and
then
file
a
an
appeal.
So
I
did
do
that.
What
what
process
do
you
have
after?
You
appeal
this?
If
there's
no
nothing
resolved
at
that
point
in
time.
D
Yeah
so,
first
again
I
hate
to
hear
that
it
happened
to
you
after
january
1st
of
this
year.
That
is
not
to
happen
anymore,
and
I
I
skipped
this
over
from
the
very
first
slide
where
this
came
about
was,
I
think
it
was
december.
27Th
of
2021
was
when
the
federal
no
surprises
act
was
passed
as
a
part
of
one
of
those
big
omnibus
bills,
and
it
didn't
actually
take
effect
until
back
about
a
month
ago.
D
So
I
hate
to
hear
that
yours
happened
at
a
period
where
you
were
not
covered
from
the
protections.
I
think
the
mediation
process
that
we
offer
would
be
the
most
appropriate
next
step
for
you
and
that's
what
we
try
and
inform
consumers
about
when
they
have
issues
when
they
have
questions
to
always
reach
out
to
congress
insurance.
So
we'll
we'll
follow
up
directly
with
you
to
put
in
contact
about
our
mediation
process,
but
broadly
the
message
that
we
would
have
to
everyone
in
here
and
just
like
the
consumers
reach
out
to
us.
D
A
Are
there
any
more
questions?
Yes,
representative
lafferty.
B
Thank
you,
madam
chair.
This
is
getting
probably
out
there
a
little
bit
but
the
dispute
resolution
process.
I
don't
know
how
many
of
those
take
place
in
a
given
year,
but
if
the
intent
is
to
help
consumers
to
be
protected
a
little
bit
to
save
a
little
bit
of
money,
if
we
are
having
dozens
hundreds,
thousands
of
independent
dispute
resolutions,
have
we
just
taken
the
cost
out
of
the
medical
side
that
the
consumer
sees
and
just
transferred
it
over
to
us
or
you
all
as
an
agency
handling
these
dispute
resolutions.
B
D
Great
question
from
if
I'm
following
there
about
for
the
idr
process
itself,
that's
not
something
that
is
handled
by
commerce
insurance.
Those
idr
entities
are
separate
and
there
are
fees
that
are
paid
in
order
to
cover
that.
So
it's
not
a
direct
cost
that
would
be
given
on
to
the
consumer.
Theoretically,
of
course,
that
the
cost
for
the
idr
would
be
built
into
either
the
payer
the
provider.
Ultimately
so
in
the
in
the
way
that
that
50
for
the
idr
selection-
and
I
think
200
to
500,
is
the
single
idr
entity.
D
Determination
cost
would
ultimately
be
passed
on
to
consumers
in
some
manner.
Yes,
what
I
believe,
though,
the
thought
process
behind
the
idr
is
that,
eventually,
through
the
settling
of
enough
disputes,
you
come
up
with
a
better
understanding
of
what
those
out-of-network
rates
properly
are
and
that
eventually
there
are
fewer
of
the
idr
processes
initiated.
D
So
I
I
think
from
what
we
would
expect
from
the
federal
law
and
what
has
been
observed
in
other
states.
You
would
see
a
period,
an
initial
period
of
higher
number
of
idrs.
That
would
ultimately
begin
to
drop
off,
as
that
out
of
network
rate
is
greater.
Clarity
is
provided
on
it,
which
isn't
to
say
that
there
aren't
aberrations
from
it
and
that
there
aren't
valid
disagreements,
but
I
believe
what
we've
seen
in
other
states
and
maybe
assistant
commissioner
huddleston,
could
add
to
this.
D
B
I
guess
the
nature
of
my
question
was
to
just
try
and
get
the
thought
out
there
that
we
aren't
doing
a
lot,
perhaps
at
this
point
yet
to
bend
the
cost.
If
you
will
that's
a
term
that
I
hear
a
lot
around
medical
issues
is
the
cost
is
still
not
transparent
to
the
consumer
and
my
belief,
if
you
don't
know
what
you're
paying
for
or
what
it
cost
and
some
arbitrary
insurance
company
out
there
is
writing
the
check.
B
Then
we
don't
have
a
whole
lot
of
downward
pressure
on
competition
or
price
shopping,
or
anything
like
that
I'll.
Let
that
one
go
for
now.
That
was
just
a
thought:
the
10
million
dollars
that
does
get
reimbursed
back
from
the
providers.
That
money
comes
from
wrongful
claim.
A
Are
there
any
more
questions
chairman
terry.
G
Thank
you
appreciate
you
guys
coming
here
just
a
couple
questions
as
far
as
narrow
networks
and
sometimes
in
this
process
providers
may
want
to
be
in
a
network,
but
they
either
the
rate
that's
offered
to
them
is
significantly
lower
in
order
to
keep
a
neural
network
or
you're
just
not
allowed
in
those
networks.
G
I
just
wanted
to
bring
that
up
that
you
know
and
some
plans
that
that
where
there
are
bills
or
your
actual
bill,
that's
going
out-
that's
sometimes
labeled.
A
surprise
bill
is
because
you've
been
left
out
of
a
plan.
For
whatever
reason
and
to
that
point,
can
you
speak
on
the
process
for
the
plans
that
fall
under
the
affordable
care
act
and
if
you,
whether
the
hospital
or
the
providers,
are
not
able
to
be
in
those
plans,
are
they
able
to
balance
bill
that
patient?
D
So
broadly,
there
would
be
the
prohibition
against
the
surprise
bills
even
for
the
aca
plans,
so
it
like
we
covered
earlier.
That
is
not
a
iron-clad
rule
and
there
are
some
exceptions
that
we
went
through
earlier.
I'm
positive,
there's
some
exceptions
that
we
left
off
of
here
that
again
assistant
commissioner
huddleston
from
his
deep
engagement
here
would
be
aware
of,
but
to
the
the
first
part
of
your
question
about
the
network
itself
and
the
construction
of
that
network.
D
You
all
are
aware
that
the
that
our
ability
to
control
network
adequacy
is
constrained
is
I'm
trying
to
choose
my
words
here
carefully
because
representative
smith,
I
see
you
taking
great
interest
here
that
we,
our
authorities,
derives
from
the
feds
in
the
case
of
network
adequacy
and
so
for.
The
construction
of
the
plan
itself
would
be
a
contractual
matter
that
commerce
insurance
would
not
be
properly
engaged
to
step
into
as
to
forcing
a
provider
forcing
a
carrier
to
accept
a
provider
into
their
network.
G
F
I
would
just
simply
say
what
I'm
hearing
you
say
is
if
the
most
heavily
weighted
criterion
in
this
panel
of
criteria
is
the
in-network
rate,
and
then
you
just
confirmed
that
you
don't
have
or
or
it's
not
the
the
mission
of
the
of
the
department
to
ensure
the
adequacy
of
a
network,
then
what
I'm
hearing
is.
We
are
constructing
a
very
perverted
system
that
incentivizes
very
low
reimbursement
rates,
very
narrow
networks
and
increasing
costs
to
the
patient,
and
so
that
is
more
of
a
statement
of
opinion.
But
I'm
happy
to
to
hear
yours.
D
Thank
you
for
the
opportunity
to
clarify.
I
did
not
intend
to
say
that
to
say
that
what
I,
what
I
was
trying
to
draw
a
distinction
between
was
that,
in
the
same
way
that
for
the
no
surprises
act,
that
our
authority
is
limited
and
what
authority
we
have
is
coming
from
the
feds
that
network
adequacy
for
us
is
also
derives
from
the
feds
and
from
cms.
D
That
we
are
loath
to
engage
in
contract
disputes
when
it
comes
to
a
specific
provider
and
whether
or
not
they're
in
network
and
that
network
adequacy
is
a
component
of
that.
But
our
authority
derives
from
the
feds
there,
and
that
was
the
distinction
that
I
was
attempting
to
draw,
and
I
apologize
in
artfully
addressed
it
just
now
and
be
happy
to
follow
up
with
you
later.
A
Are
there
any
more
questions,
seeing
none?
Thank
you
so
much
for
being
here
with
us
today.
Thank
you.
Before
we
go
back
into
session,
I
will
have
enough
would
like
to
acknowledge
someone.
I
understand
we
have
a
doctor
of
the
day
here
with
us
today.
It's
dr
john
scott,
with
internal
medicine,
vanderbilt
university
university
medical
center.
Welcome,
dr
scott.