►
Description
House Insurance Subcommittee - March 1, 2022 - House Hearing Room 2
A
We
advocate
for
our
patients.
You
deserve
better
as
patients
we
deserve
patient
better,
as
Physicians
Tennessee
deserves
better
than
this
charade.
This
was
supposed
to
go
to
two
o'clock.
Today,
your
chairperson
decided
to
cut
it
a
half
hour
early
because
they
didn't
want
to
deal
with
it,
because
the
Tennessee
Medical
Association
and
the
Tennessee
hospitals.
A
B
A
B
C
B
B
We
certainly
want
to
notice.
Today
is
Pharmacy
day
on
the
hill.
It
looks
like
we've
got
a
lot
of
students.
Why
don't
you
stand
up?
Let's
recognize
all
of
our
all
of
our
pharmacies.
B
I
will
call
I
saw
a
couple
of
of
colleagues
from
from
Sullivan
County
I'm,
not
sure
if
they
made
it
into
the
room
or
not
Gary
Stidham
and
Sam
Jones
Gary
Sam
did
you
all
make
it
in
the
room?
B
B
Let
me
go
ahead
and
take
care
of
a
little
business
before
we
get
started.
We
do
have
some
action
of
some
roles
on
a
few
bills
that
we're
going
to
take
care
of
before
we
get
started.
Item
number
two
on
our
calendar
today:
House
Bill
1772
by
chairman
powers
that
bill
is
going
to
be
rolled
to
the
final
calendar.
B
House
Bill
item
number
three
on
the
calendar:
House
Bill
2225
by
chairman
Powers,
also
will
be
rolled
to
the
final
calendar
and
item
number
five
on
our
calendar.
House
Bill
2351
by
Vice,
chairman
Mark
Hall
that
will
be
rolled
and
the
request
is
going
to
be
rolled
to
the
heel
of
our
final
calendar
and
we
will
grant
that
without
objection.
Those
three
bills
will
be
rolled.
B
I
will
remind
folks
that
next
week
we
have
called
for
the
final
calendar
of
the
insurance
subcommittee.
We
do
have
an
hour
and
a
half
that
we
meet
in
this
meeting.
It
may
or
may
not
be
our
final
meeting,
so
we
are
going
to
look
at
our
final
calendar
next
week
for
insurance
subcommittee.
Thank
you
for
all
the
work
that
you've
done.
We
do
have
a
calendar
before
us
and
we
will
begin
with
item
number
one
on
the
calendar.
B
D
B
All
right
as
we're
making
the
bill
we'll
go
ahead
and
put
the
amendment
on
the
bill
and
ask
you
to
the
to
explain
the
bill
as
a
minute
after
that,
so
all
those
in
favor
of
adding
Amendment
01448
tracking
code
to
house
bill
2661.,
please
signify
by
saying
aye
aye
any
opposed
the
eyes
have
it.
The
amendment
is
on
the
bill.
You
are
recognized
chairman
sapicki.
D
Thank
you
Mr,
chairman
and
members
good
afternoon
members.
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
dispense
to
their
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
B
You
chairman
and
I
appreciate
that
very
much
I
know
this
has
been
an
ongoing
effort.
Chair
and
Lady
Helton
worked
on
this
bill
last
year
and
and
speaker
Sexton
has
a
lot
of
interest
in
this
legislation
this
year
in
correcting
some
language.
Any
questions
or
comments
for
the
sponsor
of
the
legislation.
Representative
Mitchell
you're
recognized
yeah.
E
D
E
A
lot
of
pbms
eight
dollars
on
top
of
the
cost
of
drugs
that
that's
a
that's
a
high
dispensing
fee
for
a
lot
of
you
know,
self-funded
plans
and
I
just
know
from
doing
self-funded
plans.
You
know
that's
just
another
line
item
in
the
cost
and
eight
dollars.
That's
a
significant
number
A
lot
of
times
so
I'm
just
wondering
if
by
law
they
they.
Unless
it's
you
know
unless
it's
agreed
upon
by
contract
or
something
because
I
mean
I,
I,
think
you're
you're,
costing
a
lot
of
self-funded
plans
a
lot
of
money.
D
Understand
your
concern
there,
the
potential
is
there.
I
do
I
agree
with
you,
there's
nothing
in
the
bill
that
requires
those
those
payments
to
be
made
and
not
the
cost
absorbed
by
the
PBM.
They
could
do
that.
They
don't
have
to
pass
that
cost
on,
but
in
the
bill
it
does
State
We,
already
pay
pharmacies
across
the
state,
10
care
rates
and
on
some
things,
10
care
rates
is
more
money,
and
this
is
a
business
that
these
that
these
Pharmacists
and
pharmacies
are
entering
into.
D
B
B
F
F
Historically,
when
a
patient
is
diagnosed
with
the
disease,
they're
required
to
go
through
a
regiment
and
a
protocol
of
drugs
that
may
be
substandard.
That
may
or
may
not
be
effective.
It's
it's
often
referred
to
as
failed.
First
House
Bill
677
eliminates
that
and
changes
all
of
that.
F
It
puts
the
patient
in
the
best
chance
of
success
and
it
eliminates
the
the
substandard
drugs
and
goes
to
the
most
effective
treatment
and,
of
course
the
first
rule
of
medicine
is
to
do
no
harm
and
delayed
treatment
is
harm,
and
this
this
makes
the
most
effective
and
most
efficient
treatment
between
both
the
patient
and
the
physician.
The
physician,
it's
my
belief
that
no
bill
on
the
hill
this
year
will
benefit
more
tennesseans
than
house
bill.
677..
B
Thank
you
chairman.
We
are
going
to
be
looking
at
Amendment
tracking
code
013781
on
this
legislation.
Is
that
correct,
chairman
Hall?
That
is
correct.
That
is
correct.
All
right
and
we'll
put
the
amendment
on
and
allow
us
to
go
through
conversation,
a
lot
to
explain
the
amendment
to
us
as
well,
all
those
in
favor
of
placing
Amendment
code
013781
on
the
house
bill
677,
please
signify
by
saying
aye
any
of
those
opposed.
Please
say
no!
Your
Amendment
goes
on.
B
F
You
Mr
chairman,
it's
my
understanding,
we're
eliminating
TennCare
and
just
through
cost
avoidance,
I
think
would
be
a
cost.
Savings
and
I
also
want
to
read
to
to
reinforce
the
fact
that
this
has
already
been
approved
in
25
other
states
and
it
and
since
you're
since
you're,
avoiding
a
protocol
of
substandard
drugs,
it
eliminates
the
cost
also.
B
Picky,
did
you
have
a
question?
Okay,
I
think
we
do
have
some
folks
that
may
want
to
testify,
but
we'll
sure,
okay,
we
do
have
a
couple
folks,
chairman
Hall,
who
would
like
to
present
testimony
in
the
legislation
on
the
list.
I
have
Kristen
Hatcher,
who
is
someone
who
certainly
we
would
welcome
to
speak.
Additionally,
we
have
Dr
George
Woodbury,
who
would
like
to
speak.
B
And
without
objection
from
members
of
the
committee,
we
will
go
out
of
session
and
Miss
Hatcher.
If
you
could
tell
us
who
you
are
and
and
who
you're
with
and
you've
got
three
minutes
we're
going
to
start
a
timer.
So
three
minutes
you're
limited
three
minutes
in
your
initial
conversation,
but
we'll
engage
you
in
conversation
and
that
can
keep
us
here
for
a
little
while
longer,
if
need
be
so
miss
Hatcher.
You
are
recognized.
Thank.
G
You,
my
name,
is
Kristen
Hatcher
I'm,
originally
from
Elizabethton
Tennessee.
This
is
my
first
time
here
so
I
apologize
if
I
seem
nervous,
I'm,
a
rare
disease
patient,
it's
terminal,
it's
called
Alpha
One,
antitrypsin
deficiency.
It
affects
my
lungs,
it's
genetic,
it's
nothing!
I
did
it
just
was
passed
down
to
me
and
there's
a
really
great
treatment,
and
my
doctor
knows
the
treatment
and
every
time
I
change.
Insurance
I
have
to
go
to
a
different
one.
B
G
G
Illness,
it's
called
alphorn
antitrypsin
deficiency,
it's
rare
only
one
in
3,
500
people
have
it,
and
most
people
in
my
family
don't
make
it
until
about
60
years
old.
G
G
G
So
eliminating,
or
at
least
helping
with
step
therapy
would
be
a
godsend
to
so
many
people
that
just
really
truly
struggle
to
live.
I
have
I'm
a
teacher.
I
was
a
teacher.
I
can't
teach
anymore,
I
can't
be
in
my
classroom,
but
I
would
really
appreciate
the
chance
to
get
effective
medications
that
allow
me
to
live
longer
and
have
a
better
quality
of
life
without
having
to
fight.
A
Thank
you
and
appreciate
you
being
here
and,
and
your
nervousness
is
not
not
coming
through,
in
fact
I
think
we're
probably
more
nervous
up
here
so,
but
can
you
just
explain?
I
mean
and
and
I
I
appreciate
everything
that
your
testimony
here
but
you're
you
go
through
remission
or
you're
controlled
and
then,
when
Insurance
changes
or
something
like
that,
then
you
have
to
go
through
different
steps
to
get
back
potentially
on
the
medicine.
A
That's
got
you
controlled
and
during
that
time
you
may
go
out
of
remission
or
you
may
have
an
exacerbation
of
that
and
that
not
just
for
the
disease
that
you
have,
but
it
could
be
for
Crohn's
disease
or
any
other
disease
like
that.
Can
you
just
kind
of
explain
a
little
bit
of
that
misature
you're
recognized.
A
So
when
you
have
that
you
know
it's
a
trip
to
the
ER,
potentially
a
trip
to
hospitalization
I've
got
severe
asthma
and
I
know,
I,
know
what
works
for
me
and
you
know
being
taken
off
certain
medicines
throughout
my
lifetime.
I
know
what
would
end
me
up
in
the
hospital,
and
so
you
know
I
empathize,
with
what
you're
with
and
appreciate
you
being
here.
B
I
will
tell
you
Elizabeth
and
I'll
drive
about
the
same
distance.
You
drive
to
come
down
here
from
Greenville,
so
I
know
how
long
it
took
you
to
get
here.
So
thank
you
very
much
for
for
for
being
here.
What
is
the?
What
is
the
drug
that
that
helps
you
best
and
helps
your
family
members
the
best
and
just
to
give
me
an
idea
where
what
medicine
do
you
start
with,
and
what
do
you
end
up
with
to
treat
your
particular
malady?
You.
G
Start
with
zumera
and
it's
I
wish
I
could
tell
you
what
it
was,
but
I
don't
really
know
about
much
about
that
medicine,
but
you
end
up
on
prolastin
and
prolastin's
the
medication
that
really
helps-
and
it's
proven
it's
effective
and
my
doctor
actually
moved
here
to
Nashville
and
to
be
closer
to
my
my
doctor.
For
that
reason,
because
she
fights
for
me,
it's
really
hard
to
find
a
doctor
that
can
can
really
fight
with
the
insurance
companies
to
make
you
live
long
enough
to
reap
the
benefits.
B
B
H
Name
is
Dr
George
Woodbury
I'm,
a
board
certified
dermatologist
with
a
company
called
Rheumatology
and
dermatology.
My
wife
is
an
arthritis
doctor
or
a
rheumatologist
I'm,
a
dermatologist
I
take
care
of
skin
hair
and
nails
issues.
We
also
have
a
pediatric
rheumatologist
in
our
practice,
and
we
do
fully
understand
that
in
this
modern
era,
with
escalating
costs
for
pharmaceuticals,
there
needs
to
be
some
reason,
and
sometimes
it's
important
to
try
one
medication
first
before
another
medication,
so
as
a
practicing
dermatologist
I'm
not
opposed
to
the
idea
of
Step
therapy.
H
However
I
know
the
patient
better
than
maybe
the
insurance
company
knows.
The
patient
and
I
may
know
as
an
example.
Maybe
a
patient
that
comes
and
sees
me
with
severe
psoriasis.
That's
ruining
his
life.
I
know
that
maybe
he's
had
an
issue
with
alcohol
in
the
past
and
he's
maybe
reformed
himself,
but
he's
still
got
this
awful
awful
skin
condition
and
I
know
that
he
would
benefit
from
injectable,
embryo
or
Humira.
However,
step
therapy
protocols
call
for
six
months
of
Methotrexate,
which
is
a
tablet.
H
I
know
as
the
doctor
that
that
six
months,
if
he's
forced
to
go
in
that
first,
could
be
fatal.
So
I
can't
put
him
on
six
months
of
Methotrexate,
but
the
Step
therapy
protocol
that's
been
written
up
says
he
must
take
that
first
before
he
can
get
to
the
medication
he
needs.
So
this
house
bill
677
actually
establishes
that
there
will
be
a
clear,
easily
accessible
and
convenient
process
for
applying,
for
an
exception
to
usual
step
therapy
protocols
and
I
think
this
would
really
make
good
sense.
H
We
deal
with
this
as
practicing
Physicians
on
a
daily
basis,
with
these
patients
all
the
way
from
pediatricians
that
are
trying
to
figure
out
asthma
medications
to
internists
to
rheumatologists
to
dermatologists.
This
is
really
for
me
to
do
my
job
as
a
physician.
I
need
to
be
able
to
access
therapy
and,
if
I
know,
the
patient's
allergic
to
a
certain
drug,
I
need
to
have
an
exception
Loop.
So
that's,
basically
what
this
bill
does
and
I
would
just
say.
We
appreciate
your
considering
this
important
legislation.
B
Thank
you
hang
on
just
a
second
doc.
Any
questions
or
comments
start
with
representative
Thompson
and
then
represent
Smith
after
that
represent
Thompson,
you're
recognized,
okay,.
C
Dr
Woodberry
is
there
any
way
you
can
give
an
estimate
of
of
how?
What
percentage
of
of
of
cases
that
that
you
feel
need
and
exception
to
the
step
therapy.
H
An
exception
to
step
therapy
I
deal
with
this
I,
don't
know
almost
on
a
daily
basis,
with
the
patients
that
I
see
I
work
five
days
a
week
in
Cordova,
so
I
I
don't
know,
maybe
maybe
it's
five
percent.
Ten
percent
of
patients
that
come
in,
but
those
cases
are
really
important
cases.
You
know
psoriasis
can
ruin
your
life
and
if
you
can't
get
to
therapy,
that's
going
to
work
for
you
so
I
deal
with
this
every
day,
but
it's
not
every
patient.
H
Generally
is
something
that
that
does
help
contain
cost
and
I'm
not
opposed
to
having
step
therapy,
but
give
us
a
clear,
easily
accessible
and
convenient
exception
Loop
to
allow
us
to
not
have
to
go
through
a
step
that
didn't
work
for
the
same
patient.
You
know
with
a
previous
insurer
or
which
is
toxic
for
this
patient,
or
maybe
the
patient
is
known
to
be
allergic
to
this
therapy,
give
us,
as
the
providers,
nurse
practitioners
or
Physicians
the
opportunity
to
get
into
an
exception.
Loop
that's
what
we're
asking
for.
C
Okay,
yeah
one
more
quick
one,
also
what
and
again
I'm
going
to
ask
you
to
give
a
estimated
percentage,
but
as
the
percentage
of
patients
that
do
that
come
to
your
office
that
you
treat
that
do
not
have
any
kind
of
Group
Insurance.
C
H
I
Are
recognized,
thank
you
chairman
and
just
so
that
the
the
folks
can
understand
Step
therapy
when
you're
dealing
with
antibiotics
like
amoxicillin
versus
Augmentin
or
some
other
powerful
medication.
I
That
makes
sense
because
that
fits
along
with
the
standard
practices
of
medicine,
but
as
it
relates
to
patients
who
have
arthritis
or
who
have
a
debilitating
disease
dealing
with
their
Immunology
that,
like
the
patient,
that
you
have
get
a
paint
the
picture,
if
you
wouldn't
mind
just
as
testimony
into
the
record
that
like
for
Methotrexate,
you
mentioned
that,
specifically
that
side
effect
profile
can
actually
be
very
dangerous
for
certain
patients.
I
If
you
wouldn't
mind
kind
of
speaking
to
the
record
that
you
know,
while
a
step
therapy
can
be
very
appropriate
for
ibuprofen
for
for
other
modalities,
but
when
you're
treating
someone
with
a
chronic
disease,
if
you
wouldn't
mind
kind
of
paint
us
a
little
bit
of
a
clinical
picture
so
that
people
understand
we're
not
just
fighting
with
insurance
companies
for
the
sake
of
fighting
with
insurance
companies,
this
has
a
clinical
outcome.
Thank
you,
Mr
chairman
this.
H
Is
quite
true
this
this
677
will
hopefully
save
expense
for
insurance
companies,
because
the
doctor
or
nurse
practitioner
may
know
already
that
it's
going
to
waste
six
months
of
expense.
Putting
this
person
on
a
drug
that
we
know
is
not
going
to
work
for
this
patient.
So
I
would
say
that
this.
H
This
actually
is
a
is
a
helpful
piece
of
legislation,
because
it
enables
us
more
specifically
in
a
tailored
fashion,
working
with
a
certain
patient
or
group
of
patients,
we're
able
to
say
we
can
see
in
more
detail
what
we
think
will
be
helpful
and
maybe
less
toxic,
and,
quite
frankly,
as
a
as
a
physician,
I,
don't
know
what
the
law
would
be.
I
would
have
to
Simply
decline
to
treat
this
patient
completely.
If
I
knew
Methotrexate
could
be
fatal,
I
couldn't
prescribe
it.
H
Even
if
the
step
therapy
said
you
must
prescribe
it
first,
I'd
have
to
say
Mrs
Smith
you're,
going
to
have
to
find
a
different
doctor,
because
in
Tennessee
I
can't
I
don't
have
an
exception
loop.
It's
not
built
into
our
state
law
that
I
can
apply
for
an
exception
and
I'm
not
going
to
prescribe
Methotrexate
because
it
could
kill
you.
J
Thank
you,
Dr
Woodbury.
We
feel
for
you
in
the
sense
that
you're
treating
a
patient
and
you
are
dealing
with
them
every
day
in
your
practice,
and
you
realize
what
the
best
thing
for
them
is
then
you're
having
to
fight
for
it.
It
can
be
very
time
consuming
at
this
time.
Tell
me
what
is
the
appeals
process
posing?
You
have
a
patient
who,
on
step
therapy
is
going
to
where
you
know
level
one
drug
or
step
one
drug
and
you
think
they're
better
off
at
step
two.
H
At
the
moment,
for
instance,
with
step
therapy,
I
would
have
to
tell
the
patient
your
insurance
company's
protocol
says.
You
must
go
on
drug
a.
If
you
want
your
insurance
to
pay
for
drug
B,
which
I
think
will
be
more
effective
for
you.
Unfortunately,
you
will
have
to
pay
out
of
pocket
for
it,
because
that's
a
requirement
of
your
insurance
and
some
of
these
patients
cannot
afford
ten
thousand
or
twenty
thousand
dollars
a
year
for
these
arthritis
treatments.
J
H
We
very
frequently
do
so,
but
we
have
encountered
instances
where
the
insurance
company
says
we're
sorry.
You
must
go
on,
for
instance,
as
an
example,
you
must,
if
a
child
has
juvenile
rheumatoid
arthritis,
you
must
go
on
Methotrexate
and
then
the
dad
changes
insurance
and
then
the
new
insurance
says,
even
though
we
know
the
child
didn't
respond
to
six
months
of
Methotrexate
that
child
for
her
juvenile
rheumatoid
arthritis
must
go
on
six
months
of
Methotrexate.
There
is
no
other
option,
so
it
is
a
real,
significant
issue.
I'm,
not
saying
that
always
happens.
H
Sometimes
we
can
appeal.
Our
nurse
in
our
office
actually
does
appeal
to
the
insurance
company
to
reevaluate
a
situation,
but
we
need
a
clear,
readily
accessible
mechanism
built
in
for
an
exception.
Loop,
that's
what
we
need,
because
we
don't
have
time
to
spend.
Two
hours
is
trying
to
make
phone
calls
and
phone
calls
and
phone
calls.
We
have
too
many
patients
we're
trying
to
provide
services.
H
J
Certainly,
that's
why
we're
here
and
that's
why
representative
Hall
has
brought
this
legislation
to
try
to
help
smooth
the
process
and
provide
you,
as
you
say,
a
good
exception
route.
Certainly,
we
are
sympathetic
to
that,
but
I
wanted
to
make
sure
and
clarify
the
fact
that
insurance
companies
do
have
an
appeals
process.
Then,
if
you
appeal
them
a
lot
of
times,
certain
boxes
have
to
be
checked
and
if
it
does
not
fit
their
protocol,
then
it
may
be
that
you
have
to
do
that.
J
I
I,
apologize,
Mr,
chairman,
but
I
think
it's
very
important
that
we
clarify
that
we
don't
scare
other
people.
We
are
running
Methotrexate
down,
I,
know
patients
who
are
taking
this
drug
I,
don't
want
them
to
get
alarmed
that
this
is
a
dangerous
drug
and
so
on.
I've
known
people
take
it
for
a
long
time
for
rheumatoid
arthritis
and
other
conditions,
and
so
on.
So
we
are.
We
really
need
to
be
careful
that
we
don't
I
would
leave
that.
H
J
Certainly
I
just
wanted
to
not
have
somebody
watching
the
tape
be
concerned
about
it
and
again,
thank
you
and,
as
I
said,
that's
what
we
are
here
for
and
we
are
sympathetic
to
the
idea
but
again
wanted
to
clarify
that
appeals
process
does
exist.
It
does
not
completely
eliminate
or
smooth
the
process.
Hopefully
this
bill
will
do
that
for
you,
but
ultimately
it's
going
to
still
depend
on
following
certain
rules
and
guidelines
and
walking
through
the
Hoops,
so
to
speak,
and
thank
you
for
doing
that
for
your
patience.
Thank
you.
Mr
chairman
you're,.
B
I
E
Yeah
Mr,
sponsor
I,
am
totally
for
your
legislation.
I'm
glad
you're
able
to
get
the
the
physical
note
off
of
it,
but
I'm
voting
for
this,
but
the
way
we're
having
to
get
the
physical
note
off
of
it
just
hurts
me
and
it
you
know
it
just
is
another
reason,
on
top
of
another
reason,
why
we
need
to
expand
Medicaid
in
this
state
and
give
everyone
the
access
to
this
life-saving
treatment.
C
Thank
you,
Mr
chairman
I'm,
going
to
reflect
his
his
comments.
That's
not
what
I
want
to
ask
about
the
yeah.
You
know
with
this
bill
and-
and
you
know,
I
I
know
we.
We
need
to
correct
the
defects
of.
K
C
Of
the
step
Therapy
Program,
but
you
know,
there's
going
to
be
a
cost
in
the
the
cost
passed
on
to
to
people
who
who
have
Group
Insurance
programs
and
that's
the
majority
of
us.
Is
there
some
estimate
as
to
the
the
amount
or
or
estimated
amount
that
individuals
would
have
to
pay
for
their
insurance?
As
a
result
of
this
chairman
Paul,
you
recognizing.
F
B
We
do
have
one
more
commenter
on
the
we
do
have
a
withdrawal,
Jimmy
Kumar
you're
recognized.
Thank.
J
You
Mr
chairman,
and
thank
you
Jim
and
speaker
for
allowing
me
to
vent
a
bit
again.
Life
is
a
balance,
and
certainly
this
balance
is
the
patients
needs
with
the
expense
step.
Therapy
is,
of
course,
one
way
to
try
to
expenses
keep
expenses
in
control,
but
where
does
that
value
of
the
dollar
go
when
if
it
interferes
with
somebody's
quality
of
life
and
the
people
we
are
trying
to
serve
and
I?
Think
that's
what
your
bill
does
and
thank
you
for
doing
that.
I
admire
your
persistence
with
it.
J
I
do
have
to
sympathize
and
I.
Do
have
a
feeling
in
my
heart
that
we
are
by
removing
the
fiscal
note
which
needed
to
be
done.
We
are
creating
two
classes
of
patience
to
Those,
whom
step
therapy
will
still
apply
and
to
for
others
for
whom
they
will
be
a
more
easier
route
and
for
whom
it
will
not
apply
and
I
think
we
have
to
recognize
that,
and
that
is
again
based
on
balancing
things
in
life
and
balancing
the
expense
to
society,
but
leaving
10
care
out.
B
Thank
you,
Dr
Kumari,
in
the
the
practicality
of
it,
the
heartstrings
that
are
pulled
are
definitely
definitely
there
as
we
listen
to
the
legislation.
I
do
share
some
of
the
concerns
that
Dr
Kumar
shares
and
we
do
still
have
a.
B
Although
much
smaller
fiscal
note,
there
is
still
a
minimal
fiscal
note
that
we'll
have
to
work
through
and
and
if
it
makes
it
too,
chairman
Hicks
committee
we've,
given
him
more
work
to
do,
but
this
is
certainly
something
that
that
does
pull
our
heartstrings
I
do
have
similar
concerns
and
I've
expressed
this
to
other
supporters
of
the
legislation
that
we
are
not
creating.
B
A
blanket
coverage
for
the
whole
state
of
Tennessee
that
that
does
worry
me
that
we
are
creating
patients
that
will
have
this
opportunity
and
patients
that
will
not
have
this
opportunity.
So
that
is
certainly
frustrating
any
more
questions
or
comments.
C
You
I
just
want
to
follow
up
because
I'm
I'm,
not
the
made
me
sort
of
sound
like
a
cruel
heartless
person,
but
no
I
I
am
just
concerned
that
and
I'm
satisfied
that
this
would
not
make
people's
premiums
go
out
the
route,
but
we
have
hundreds
of
thousands
of
people
in
this
state
with
no
health
coverage
at
all
and
that's
a
dangerous
proposition
right
there
and
and
and
and
I
am
I-
am
concerned
about
that,
and
this
is
in
this
case
no
we're.
C
This
is
a
good
bill
and
and
I
don't
think
it's
going
to
cause
that
much
grief
from
for
for
any
interest
out
here.
Thank
you
are.
B
B
K
You
Mr
chairman
I,
have
a
amendment
that
makes
the
bill.
K
B
We
have
Amendment
drafting
code
zero,
one
four,
two
one
five:
does
this
amendment
make
the
bill,
sir?
It
does
all
right,
I'll,
entertain
a
motion
on
the
amendment
so
moved
and
seconded
all
those
in
favor
of
adding
Amendment
code
zero,
one
four,
two
one:
five
to
House
Bill
1941,
please
signify
by
saying
aye
any
opposed.
K
You
so
much,
ladies
and
gentlemen,
this
is
another
one
of
my
gig
economy,
legislative
agendas.
K
What
has
become
apparent
is
that
when
you
press
that
app
to
to
summon
a
ride,
share
rather
Lyft
or
Uber
and
the
wisdom
of
our
legislature
before
I
got
here,
the
legislature
said
that
there
has
to
be
a
million
dollar
liability
policy
in
place.
So
if
that
driver
for
Uber,
while
there
is
someone
in
the
car
hit
someone
and
that
that
passenger
is
injured,
that
injury
is
covered
up
to
a
million
dollars
by
the
ride
share
company.
K
What
was
left
out
of
that
legislation
was
that
the
uninsured
or
underinsured
motorist
coverage
would
equal
or
mirror
the
liability
insurance
coverage
of
a
million
dollars.
So
what
some
of
the
ride
share
companies
have
done
is
they're
only
covering
you
for
the
state
minimum,
which
is
25
050
on
uninsured
or
underinsured
motorists.
K
This
bill
would
do
exactly
that.
Bring
require
the
companies
that,
when
you're
in
that
car,
that
you're
covered
not
only
for
liability
but
under
uninsured
motorists,
if
you'll
notice
on
your
personal
policies,
you're
under
insured
motorists,
usually
mirrors
image,
your
liability
limits
and
that's
all
this
bill
is
asking
for,
because
I've
had
several
people
say
well.
Your
personal
policy
covers
you
also,
while
you're
in
that
vehicle
for
underinsured
motorists.
Yes,
that's
true,
but
a
lot
of
them.
The
younger
people
don't
have
auto
insurance
because
they
don't
own.
K
An
auto
I
know
that's
foreign
to
most
of
us,
but
it's
true.
They
either
walk
bike
or
Uber
or
or
lift
Rideshare
anywhere
that
they
go.
They
don't
have
automobile
insurance,
so
if,
if
they
are
hit
by
a
drunk
or
a
uninsured,
motorist
they're
all
that
the
company's
liable
for
is
twenty
five
thousand
dollars
for
injury
and
that
injury
could
be
a
concussion.
I
Thank
you,
chairman
I
know
the
in
ride
share
we've
almost
forgotten
that
there
was
this
thing
called
a
taxi
or
a
cab.
What
what
do
people
that
operate,
taxis
or
cabs?
What's
do
they
carry
the
same
type
of
policies
that
you're
referencing
or
is
there
parity
within
that
world?
Thank
you,
Mr
chairman.
K
The
million
dollar
ride
share
code
that
I'm
that
I'm
referencing
in
this
bill
was
strictly
created
for
the
ride
share
companies
when
they
came
in
I,
chairman
Smith
I'm,
not
sure
on
taxis,
I'm,
not
sure
if
that's
left,
because
you
know
if
you're
a
lot,
you
have
local
taxi
boards,
I'm,
not
sure
if
that's
not
left
up
to
the
locals
to
require
how
much
insurance
I
really
I
apologize.
But
I,
don't
know
the
answer
to
your
question.
I,
don't
know
if
legal
does
or
not.
I
B
And
chairman
or
leader
back
as
you
addressed,
that
too
I
think
there
is
concern
that
that
we're
potentially
looking
at
the
ride,
share
having
to
do
more
than
what
the
normal
insurance
policy
or
more
traditional
insurance
policy
might
be
as
well,
which
could
be
capped
at
three
hundred
thousand
dollars
even
for
a
fairly
substantial
policy.
So
I'll,
let
you
address
representative
Smith
and
and
my
questions
combined
there,
sir
you're
recognized.
K
Etc
have
have
risen
so
much
that
the
minimum
that
we
have
in
this
state
is
25
000..
And
if
you,
if
you
get
right
now
on
your
policy,
I'll
bet
that
you
have
under
uninsured
or
underinsured
motorists,
where
you're
buying
Insurance
out
there
for
all
the
crazy
people
that
don't
have
insurance
on
their
vehicles
and
that's
how
you
are
protected.
We
are
saying,
like
an
Innkeeper,
has
a
higher
level
of
responsibility
for
the
people
that
stay
at
their
end.
K
Then,
when
you
have
contract
you're
paying
for
that
Uber
or
that
lift
which
are
not
small
companies,
I
would
I
would
take
issue
with
you
there
that
they're
they're
small
businesses
they're
both
on
the
New,
York,
Stock,
Exchange
and
very,
very
large
businesses,
and
do
and
do
a
great
service
I'm,
not
I'm,
not
I'm,
just
saying
that
they
need
to
be
protected
just
like
when
we
he,
as
a
legislature
before
I,
came
said
that
coming
into
this
state
to
do
business,
you're
going
to
have
to
have
a
million
dollar
policy
and
that's
not
per
person,
that's
cumulative!
K
So
if
there,
if,
if
you
got
five
I'm,
not
sure
how
many
people
they
allowed
a
car
but
say,
there's
four
people,
that's
just
ensuring
four
people.
Twenty
two
hundred
fifty
thousand
dollars
a
piece
for
whatever
for
whatever
could
happen.
And
yes,
that's.
The
purpose
of
uninsured
motorists
is
to
buy
insurance
for
all
those
idiots
out
there
who
don't
have
insurance.
K
That's
for
your
your
your
safety
and
and
and
and
and
and
mine
when,
when
we're
on
the
roads
and
it's
I
know
it's
very
very
rarely
used,
but
it's
there
when
you
need
it
and
any
of
our
insurance
friends
can
tell
you
how
important
that
is.
D
K
Okay,
this
statute
is
only
for
ride,
share
companies
that
came
in
Uber
and
Lyft.
This
particular
statute
does
not
reach
those
pedal.
Taverns
Etc
I
know
that
the
locals
require
them
to
have
a
percentage
of
insurance.
I,
don't
know
what
it
is
and
I
apologize
for
that
I
probably
should
have
studied
up
on
that
and
I
will
before
full,
but
this
particular
statute
was
specifically
made
for
the
ride.
Share
companies
that
started
business
in
this
state
about
10
years
ago.
B
Okay,
thank
you
any
further
questions
or
comments
leader,
Beck
I,
can
be
a
blunt
instrument
sometime
and
help
me
understand
this.
A
little
better,
we're
talking
about
the
passenger
in
the
vehicle
having
to
carry
a
million
dollars
or
who,
who
is
carrying
this
insurance,
walk
me
through
that
one
more
time.
Please,
sir,
need
a
record
recognized
just.
K
Like
the
requirement
that
this
legislature
placed
on
the
companies
doing
business,
Uber
and
Lyft
and
any
other
Rideshare
that
opens
up
that
they
carry
a
million
dollars,
they're
responsible
for
the
million
dollars
liability
insurance
that
clicks
on
as
soon
as
you
click
on
that
app
and
get
that
car.
The
uninsured
motorist
is
carried
by
Uber
and
Lyft
for
the
person
who
sits
in
that
car
and
and
it's
not
uninsured
motorists
until
that
passenger,
that
is
paying
for
that
Uber
or
Lyft
gets
in
that
vehicle.
B
B
B
K
Back
this
statue
that
this
is
under
only
applies
to
ride
share.
It
was
specifically
crafted
before
I
came
into
the
legislature.
When
these
companies
came
to
Tennessee
and
said
we
want
to
do
business
in
your
state
and
they're,
not
regulated
by
the
taxi
boards.
There
are
there's
no
regulation.
Besides
this
on
the
ride,
shares.
I
And
so,
if
the
taxis
are
not
carrying
the
million
dollar
policy,
if
the,
if
whether
they're
regulated
by
a
board
or
not
I,
just
think
that
there
needs
to
be
parity,
that
we
don't
want
to
put
one
burden
on
a
group
of
drivers
that
doesn't
exist
on
another's
on
another,
and
so,
if,
if
whether
that,
if
we
know
that
from
code
I'm
just
trying
to
make
sure
that
we're
not
disincentivizing
the
innovation
of
of
Rideshare
at
the
and
again
I'm,
not
accusing
you
of
trying
to
protect
taxis
but
I
just
want
to
make
sure
that
somehow
we
go
on
to
the
record
to
understand.
B
K
Back
you
recognized
to
answer
your
question.
I
think
I
know
the
theory
behind
it
and
the
theory
is
regulation.
Taxi
taxi
cabs
have
to
meet
certain
requirements
for
their
taxi
boards
locally.
In
order
to
get
that
Medallion
to
drive
a
taxi
other
than
this
other
than
this
requirement.
There's
no
other
requirements,
there's
nothing
else
in
our
statute
about
ride
share.
So
that's
the
reason
the
ride
share
is
different
than
the
taxis.
K
K
Neck
I
can't
bring
one
this
session
because
I
don't
have
another
open
the
code,
but
I'll
I'll
bring
one
next
session
to
to
establish
parity,
because
it's
very
important
that
people
who
are
paying
for
a
service
are
protected
just
like
when
you
pay
for
your
hotel
room,
there's
a
higher
level
of
security
and
and
and
and
and
and
what
you
expect
from
your
from
your
Innkeeper.
D
B
B
Thank
you.
We
are
now,
and
forgive
me
reps
of
Alexander
has
has
built
the
last
bill.
It
was
on
the
addendum
and
she's
had
to
go
to
state
government
committee
so
to
present
a
couple
of
bills,
so
we
are
going
to
take
up
chairman
Kumar's
Bill
next
and
if
we
need
to
stay
here
for
a
few
minutes
after
chairman
Kumar's
bill
is
completed,
we
will
wait
for
representative
Alexander
to
come
back
into
committee,
because
we
do
have
a
bill.
It
was
placed
on
the
agenda
for
a
for
a
specific
reason.
B
So
we
are
now
on
item
number.
Seven
on
our
calendar
is
House
Bill
2855,
chairman
Kumar
you're
recognized.
We
have
a
motion
and
a
second
on
the
bill.
We
do
Jeremy
Kumar.
If
you
want
to
describe
the
situation,
we
do
have
an
amendment
that
has
been
untimely
filed,
but
an
amendment
that
will
that
will
make
the
bill
and
kind
of
give
us
an
idea
where
we
are
chairman
and
then
we'll
have
to
take
a
couple
of
procedural,
potentially
take
a
few
procedural
votes
here
in
a
few
moments,
so
Dr
Kumar
you're
recognized
thank.
J
You
Mr
chairman,
thank
you
committee,
amendment
number
is
14116
and
it
was
led
by
about
one
hour
to
our
office
and
since
it
makes
the
bill
I
requested,
the
committee
kindly
go
ahead
and
adopt
it
and
I
would
appreciate
it.
B
B
We
have
a
motion
to
consider
the
amendment
tracking
code
is
zero,
one
four
one,
one
six.
We
have
a
second
on
that
as
well
all
those
in
favor
of
consideration
of
amendment
zero,
one,
four
one,
one,
six,
please
signify
by
saying:
I
I
any
of
those
opposed
the
eyes
have
it.
We
are
now
in
a
posture
where
we
can
consider
consider
the
amendment
and
since
it
will
make
the
bill
pause.
Just
a
second
pardon
me.
B
B
J
You
Mr
chairman
and
thank
you
committee
for
the
Indulgence
House
Bill
2855
applies
The
Prudent
layperson
standard
to
an
emergency
Condition,
it's
a
situation
being
that
if
a
patient
has
a
severe
pain,
they
think
it's
a
heart
attack.
They
go
to
the
emergency
room.
J
The
bill
says
that
coverage
for
that
judgment
by
The
Prudent
layperson
that
they
have
an
emergency
will.
The
coverage
will
be
provided
regardless
of
the
fact
whether
on
evaluation
in
the
emergency
room,
the
condition
turns
out
to
be
non-emergent
and
whether
there
is
prior
authorization
required
and
whether
there
is
contractual
lack
of
contractual
agreement
that
the
place
of
service
is
out
of
network.
J
B
You
very
much
any
questions
or
comments
for
the
sponsor
I
I
do
think.
We've
got
a
situation
where
representative
Smith
had
worked
on
some
similar
legislation
to
this
and
I
believe
it's
passed
on
the
house
floor.
So
we've
got
a
similar
situation.
Don't
think
that
these
will
be
in
conflict
and
potentially
they
could
mesh
with
each
other
fairly.
Well
as
we
go
forward
so
I
have
called
your
name
representative,
Smith,
so
you're
recognized
and.
I
I
want
to
acknowledge
chairman
Kumar.
He
had
been
working
on
this
bill
I
think
last
year.
The
intent
of
the
piece
of
legislation
that
we
passed
on
the
house
floor
and
we'll
be
moving
in
the
Senate
was
to
expand
and
make
site
neutral
the
definition
of
emergency
services,
so
that
you're
in
an
urgent
care
center
or
at
a
freestanding
emergency
department.
I
What
this
simply
does
is
it
establishes
that
the
practice
that
has
been
adopted
by
some
insurance
companies
to
pay
for
the
end
diagnosis,
rather
than
the
treatment
pathway
that
you
assume
could
be
the
worst
in
emergency
care,
would
be
reimbursed.
So
I
think
that
these
do
absolutely
work
in
Tandem
and
I'll
be
wholeheartedly
supporting
it.
Thank
you,
Dr
Kumar.
Thank
you.
Thank.
B
A
B
Hey
those
opposed,
please
say
no,
the
eyes
habit
your
bill
moves
forward.
Thank
you,
Dr
Kumar,
representative
Alexander.
Thank
you.
So
much
and
I've
explained
to
the
committee
that
that
you've
had
to
be
two
places
at
once
and
I
know
exactly
how
that
feels.
If
you're
prepared,
if
you'd
like
to
take
a
deep
breath
or
two,
we
are
ready
to
to
recognize
you
on
House
Bill,
2544.
B
We
have
a
motion
on.
We
have
a
motion
on
the
bill
and
actually
we
do
have
an
amendment
that
will
make
the
bill
and
I
will
give
you
that
drafting
code.
The
drafting
code
is
zero.
One
four
one,
nine
seven
is
that
accurate.
B
We
have
a
motion
and
a
second
on
the
amendment,
all
those
in
favor
of
adoption
of
amendment
014197,
please
signify
by
saying
aye.
Any
of
those
opposed.
Please
say
no.
The
eyes
have
at
the
amendment
is
adopted.
Representative
Alexander.
If
you
could,
please
describe
your
legislation
now,
as
amended
sure.
L
L
With
passage
of
this
bill,
patients
will
have
access
to
all
those
dose
mammography
services,
including
breasts
breast
tomosynthesis,
and,
if
you
don't
want
to
say
that
word,
you
just
say:
3D
imaging
digital
mammography
x-ray.
The
bill
also
includes
coverage
of
supplemental
and
diagnostic
screenings,
utilizing
MRI
and
ultrasounds
when
necessary,
for
women
with
a
personal
family
history.
Like
myself,
my
grandmother
had
breast
cancer.
My
aunt
had
breast
cancer.
My
first
cousin
had
breast
cancer
and
other
high-risk
factors
such
as
dense
breast
tissue,
which
is
what
I
had
I,
cannot
tell
you
from
a
personal
level.
L
What
I
went
through
for
the
last
32
years
of
my
life
mammograms?
Sometimes
four
and
five
in
a
day,
Ultra
sounds
needle
biopsies
everything
you
could
possibly
imagine.
Until
the
radiologist
looked
at
me
and
said,
we
can
no
longer
tell
whether
you
have
breast
cancer
or
you
don't
I
had
to
make
the
hard
decision
of
having
a
double
mastectomy
and-
and
it
was
a
tough
one,
but
when
I
came
to
Vanderbilt
and
the
breast
doctor
re-looked
at
what
they
had
from
Johnson
City,
the
doctor
said:
I
need
to
do
my
own
MRI.
L
L
L
It
is
able,
because
it's
a
robot
and
it
is
able
to
detect
cancer
at
the
back
of
the
bones,
where
you
can't
see
that
in
a
mammogram,
so
I
bring
you
this
bill,
because
this
will
allow
coverage
for
those
women
who
have
dense
breasts
like
myself,
to
get
a
additional
screenings
and
have
their
insurance
pay
part
of
it.
It's
it
I'm
not
asking
for
parity
here,
I'm,
just
asking
for
insurance
to
cover
these
tests
that
are
life-saving.
L
I
And
I
had
my
yearly
mammogram
in
December
and
I
paid
extra
for
the
technology
to
perform
the
dense
breast
examination
because
our
insurance
doesn't
cover
it.
So
it
is
important.
I
applaud
you,
I
pray
for
you
you're,
a
tough
cookie
you're,
going
to
lead
the
way
this
is
going
to
be
a
terrific
Bill.
Thank
you
for
your
leadership.
We're
going
to
stand
with
you
and
again
this
body
I'll
say
it
so.
The
last
committee
I'll
say
it
in
this
one:
we
want
to
treat
patients
in
this
general
assembly
and
not
insurance
plans.
J
You
recognized
thank
you,
Mr
chairman,
thank
you,
Madam
representative,
for
bringing
this
I
and
thank
you
for
opening
your
heart.
Personally,
those
things
are
really
important.
Breast
cancer
is
calm
and
affects
one
in
eight
women,
and
really
these
are
the
efforts
that
we
make
to
change
society
and
the
society
that
elected
us
and
sent
us
here,
and
we
came
to
serve
them
and
thank
you
for
doing
that.
J
As
a
as
a
as
a
point,
I
would
like
to
mention
that
about
two
years
ago
we
did
pass
special
legislation
with
support
from
American,
Tennessee,
Radiology
society
and
others
about
the
care,
so
that
all
options
are
available
to
those
with
tense
press,
and
it
was
very,
very
important
and
I
know
people
personally
in
my
community
that
benefited
from
it.
Thank
you
for
doing
it
and
that's
what
we
came
here
for
and
I
think
it
helps
a
lot
of
women.
Thank
you
very
much.
Thank.
L
B
Representative
Alexander,
thank
you
very
much.
It's
it's
never
easy
to
share
all
the
information
that
you've
just
shared
with
us.
So
thank
you
very
much.
Are
you
ready
to
vote
others
all
those
in
favor
of
sending
House
Bill
2544
as
amended
to
full
insurance
committee?
Please
signify
by
saying
aye
any
opposed.
Please
say
no,
the
eyes
have
it
your
bill
moves
forward.
Thank
you
very
much.
Thank.
B
Ladies
and
gentlemen,
thank
you
very
much
for
for
your
diligent
work
today,
chairman
Dr,
Kumar
I.
Think
we've
given
us
a
lot
of
work
in
full
committee,
as
as
we've
heard
from
others
that
We've
passed
a
few
bills
that
we'll
still
take
some
time
and
energy
to
to
work
on
a
full
committee
and
I
I
know
you
welcome
that
challenge
to
Chairman
Dr
Kumar,
any
other
business
to
come
before
the
subcommittee.