The Tennessee State Senate this week unanimously passed legislation that ends the practice of surprise or unexpected medical billing in Tennessee, also called balanced billing.
Balanced billing occurs when providers bill a patient for the difference between the amount they charge and the amount the patient’s insurance covers. The amount that insurers pay providers is almost always less than the providers’ “retail price.” Some providers will bill the patient for the difference or balance, thus it’s called balanced billing.
Sponsored by Sen. Bo Watson (R-Hixson), Senate Bill 1 ensures patients are not held responsible for balanced bills. Consumers will no longer get balanced bills when they seek emergency care or when they receive non-emergency care in an in-network hospital, but are unknowingly treated by an out-of-network physician or laboratory.
“This is a patient protection piece of legislation,” said Sen. Watson. “The patient should not be held responsible for bills that they’re not aware of.”
Under the bill, patients will pay only the deductibles and co-payment amounts that they would pay under the in-network terms of their insurance plans. The bill also creates an independent dispute resolution process between insurers and providers.
“I know that one of the problems Tennesseans worry about the most, especially from a patient perspective, is the problem of being able to afford an unexpected medical bill,” said Sen. Rusty Crowe (R-Johnson City), who co-sponsored the bill. “Sen. Watson and myself have been working on this legislation for the past six years. I am very proud of this piece of legislation as it fundamentally protects patients from getting a bill for which they didn’t know they’d be responsible.”
The bill mirrors the federal “No Surprises Act,” which took effect earlier this year.
Senate Finance Committee hears report regarding infrastructure needs and requests
The Senate Finance, Ways and Means Committee received a report from the Tennessee Advisory Commission on Intergovernmental Relations (TACIR) on Tuesday regarding the state’s infrastructure needs and requests. The General Assembly passed legislation in 1996 requiring TACIR to compile and maintain an inventory of infrastructure requests and present them to lawmakers each year. The inventory, by law, is designed to support the development by state and local officials of goals, strategies and programs that could improve the quality of life for Tennesseans and enhance economic development statewide.
TACIR staff work with Tennessee’s nine developmental districts to gather information from state and local officials of both public infrastructure needs and other projects that reflect the hopes and desires of communities. This year’s report for 2020-2025 reflects about $61.9 billion in projects that fall into both of these categories. That’s an increase of $3.4 billion from the report delivered by TACIR last year.
“The State of Tennessee gets really high reviews all across the country due to the fact that we are one of the few states that actually takes time to do an inventory like this,” said Senate Finance, Ways and Means Committee Chairman Bo Watson (R-Hixson). “Most states have no idea of what their capital needs may be infrastructure-wise.”
Transportation, utilities, and education account for the 89 percent of the projected $3.4 billion increase in conceptual projects which were in the inventory. Transportation and utilities are always the largest categories of infrastructure inventoried and account for $2 billion in this report. The education inventory increased by $987 million, mainly attributable to post-secondary education needs and reflects the building or renovation requests for K-12 schools. The next largest increase was in the health, safety, and welfare category at $575 million. TACIR officials explained the bulk of these requests were for law enforcement and fire protection. In addition, TACIR has projected an increase of $7 million for recreational projects.
TACIR’s staff is reviewing the currently available federal funding for public infrastructure to see how it might meet some of these needs. They estimate the American Rescue Plan (ARP) will provide Tennessee state government with $3.9 billion and Tennessee local governments with $2.3 billion; while they project the Infrastructure Investment and Jobs Act (IIJA) could provide $8 billion for infrastructure projects. In August 2021, Tennessee’s Financial Stimulus Accountability Group dedicated $1.35 billion of the state’s fiscal ARP recovery funds for water, wastewater and stormwater infrastructure. The IIJA funds are still being reviewed but can be used for roads, bridges, broadband and other specific infrastructure needs.
Committee approves report on refugee issues
The Joint Study Committee on Refugee Issues on Thursday approved a report that includes a series of recommendations related to refugee issues in Tennessee that could become the basis for future legislation.
The committee was formed by Lt. Gov. Randy McNally (R-Oak Ridge) and House Speaker Cameron Sexton (R-Crossville) in May of 2021 to investigate the federal government’s immigration program within Tennessee.
The committee heard testimony regarding immigration in Tennessee during four meetings held between June and November of that year. Those meetings culminated in the report, which includes a summary of committee activity as well as a series of policy recommendations. The report will be published in the coming days.
Gov. Lee issues statement regarding public education funding review
Gov. Bill Lee released the following statement on Jan. 26 regarding the full review of Tennessee public education funding:
“Since last fall, thousands of Tennesseans have engaged with us to share how public school funding can better serve our students, teachers and families. We have completed 16 townhalls and meetings across the state hosted by the Department of Education and Tennessee General Assembly, provided more than 1,000 opportunities for public comment, and this week, the work of 18 subcommittees will come to a close. I commend the work of these dedicated Tennesseans and look forward to reviewing their recommendations. I encourage Tennesseans to join me in reviewing their work as we navigate what the future of K-12 public school funding can look like in Tennessee.”
Details about public education funding can be viewed here.
Testimony in Senate Transportation and Safety Committee Focuses on Airport Funding Needs
The Senate Transportation and Safety Committee heard testimony this week on airport funding needs from a group of officials representing the state’s five commercial services airports. The airports have been working since 2015 to find solutions to these needs as the Transportation Equity Trust Fund has decreased significantly since then.
When comparing collections to the Tennessee Transportation Equity Trust Fund from the state’s Fiscal Year (FY) 2014 to FY 2021, collections are down 59 percent due to legislative changes and market conditions. This fund provides the Tennessee Department of Transportation’s (TDOT) Aeronautics Division grant funds that are used by 78 public-use airports for planning, development, construction, and operations throughout the state. Metro Nashville Airport Authority CEO Doug Kreulen told legislators that the current dwindling jet fuel tax is a key factor in the decline. In addition, he said the airports are challenged by stagnate federal infrastructure funds and passenger facility charges. He said Tennessee currently ranks fifth among its eight neighbor states in airport aid programs.
The group provided several recommendations to improve airport funding, including replacing the current funding model to make Tennessee more competitive with surrounding states. Kruelen said the new model should provide recurring funds; prioritize funds based on statewide impact and tax generation; support future infrastructure requirements critical to economic, community and tourism development; and ensure existing infrastructure is maintained.
The state’s five commercial airports generate approximately $19.5 billion in economic activity in Tennessee. They provide about 131,843 jobs with a total payroll of approximately $7.3 billion.
Tennessee General Assembly Veterans Caucus
The veterans caucus during a regular meeting Jan. 26 took in a presentation on the upcoming renovation of the Military Branch of the Tennessee State Museum, previewed upcoming legislation relating to veterans, and expressed interest in continued funding for an organization that treats veterans suffering from mental illness.
Home to the Military Branch of the Tennessee State Museum, the War Memorial and Legislative Plaza buildings are set to be renovated within the next four to five years. As part of the renovation, the museum will see new and updated exhibits, oral histories of veterans, and interactive programming, said Ashley Howell, executive director of the Tennessee State Museum.
Later in the meeting, caucus members briefly summarized legislation in the works. Expect to see a bill offering a $5,000 tax credit to veterans for purchasing automobiles every five years, another bill restoring the opportunity for disabled veterans to get two license plates rather than one, a veterans tuition bill, and another one that allows for increased tax relief on home purchases by disabled persons.
Finally, the caucus heard a presentation by Centerstone Military Services, which treats veterans suffering from mental illness at no out-of-pocket cost to them. The organization specializes in providing high-quality military, culturally-competent mental health services for veterans, military families, active duty personnel and veterans from all eras throughout the state of Tennessee, said Chief Executive Officer Blas Villalobos. The organization is based in Nashville, operates a clinic in Clarksville and has an additional 248 community-based providers throughout the state.
Villalobos said 20 veterans die by suicide every day in the United States while in Tennessee, three veterans on average take their own lives every week. He noted 95% of Centerstone clients have reported no longer experiencing suicidal ideations 120 days into treatment.
Centerstone currently receives $700,000 a year from the state and is asking lawmakers to increase that appropriation to $1.5 million annually so it can expand and serve even more veterans.
“I’ve seen this operation and all I can tell you is it’s sorely needed in and around the military community,” said Sen. Bill Powers (R-Clarksville). “I’d urge everyone here to please get on board with this.”
Education Recovery and Innovation Commission make recommendations to modernize education and mitigate impact of pandemic on student learning
The Senate Education Committee heard testimony this week from officials with the Education Recovery and Innovation Commission to modernize education in Tennessee and mitigate the impact of the pandemic on student learning. In 2020, the Tennessee General Assembly formed the Commission through Public Chapter 792 to examine the short- and long-term effects of the COVID-19 pandemic on education in the state. The group was charged with addressing learning gaps and modernizing the state’s education system from kindergarten through career.
In their second of two reports, the Commission listed a wide variety of recommendations to improve outcomes for students. The Commission has identified nine priority areas where improvements could be made to address learning losses, student well-being, postsecondary and career preparedness, and technology gaps. A menu of options are listed to support each of their recommendations.
The recommendations include policies ensuring students master literacy and numeracy skills; addressing learning remediation and acceleration needs; and strengthening, retaining, expanding, and diversifying the state’s education professionals. They also recommend equipping Tennessee schools and districts to address students’ well-being; optimizing capacity for flexible, high-quality school options; and incentivizing locally-led innovation. In addition, the Commission recommends that schools be redesigned to ensure students have access to flexible pathways to college and careers and that the state’s postsecondary systems be streamlined to facilitate lifelong learning.
Commission member, Dr. Joey Vaughn, expanded on the recommendation to support the well-being of students by calling for more nurses, school counselors and social workers. “I can tell you that this year’s second graders are the students that are really beginning to show the gaps in their learning because of the pandemic,” he said. “I can also say when we are looking at students who are having social emotional issues, that is across the gamut. That is from pre-school all the way to the 19-year-old I talked to two weeks ago.”
The Commission’s report states that impacts of COVID-19 and other disruptions to schooling in the past two years extend far beyond academics, negatively impacting students’ social development, as well as their mental, emotional, and physical health. The report states: “These domains not only affect students’ academic achievement but also underlie the development of skills such as critical thinking and analysis, problem-solving, self-management, and working with people — all of which are skills increasingly prioritized by employers.”
Many of the Commission’s recommendations will be considered through legislation during the 2022 legislative session.
In Brief:
Redistricting — The Senate this week approved the House redistricting map after approving new Senate and Congressional maps last week. Drawn by the House, the new House map has an overall population range of 9.9%, and splits 30 counties: nine in West Tennessee, nine in Middle Tennessee and 12 in East Tennessee. It includes six districts with no incumbents, and maintains the current number of majority-minority districts, which is 13. Six districts in the map remain exactly as they are today.
Registers of deeds — A bill seeking to transfer approximately $11.3 million in mortgage and transfer tax collections annually from the state to the counties was unanimously recommended for passage by the State and Local Government Committee this week. SB 1663 will next be considered by the Senate Finance, Ways, and Means Committee.
County Register of Deeds currently contain 2.4% of mortgage and transfer tax collected and this bill would increase that number to 5%.
“This bill would provide additional revenue to the counties, further supporting smaller counties who struggle to meet their budgets,” said Sen. Todd Gardenhire (R-Chattanooga), who sponsored the bill. He noted the rate was lowered to 2.4% roughly 16 years ago to address a state budget deficit.
Sen. Ken Yager (R-Kingston) said the bill is “long overdue” and will be a benefit to taxpayers.
“This will be a benefit to your local property tax payers as well,” he said. “In many counties, the county general fund was subsidizing those offices at the expense of the county property tax payers.”
Confirmation hearing — The Judiciary Committee this week held a confirmation hearing for Judge John W. Campbell for the Court of Criminal Appeals. With 40 years of criminal practice in Shelby County, Judge Campbell is currently serving as a criminal court judge to Criminal Court Division VI.
Asked which U.S, Supreme Court judges in recent history he admires most, Judge Campbell answered Justice Clarence Thomas and Justice Samuel Alito. He was also asked about his constitutional theory.
“I strongly believe in following what’s on the paper,” he said, referring to the U.S. and Tennessee constitutions. “I don’t feel like I should be going in there and substituting my interpretation. … I feel very strongly that we should follow the law as its written.”
The committee voted in favor of sending a confirmation resolution for Judge Campbell to the Senate.
Election rules — The Senate this week approved SB 515, which expands the period of time political or campaign signs can be posted to “60 days before voting begins.”
On the same topic, the State and Local Government Committee has agreed to remove a provision in a bill related to election laws because that provisions will run separately in a parallel bill. The committee amended SB 1664 so that it now simply prohibits a political party from requiring a person to pay a fee in order to run as that political party’s candidate for public office.
Previously, the bill also sought to require nonpartisan elections for chancellors, circuit court judges, criminal court judges, and judges of any other state trial court of record. That provision will run in a separate, stand-alone bill.
Veterans Organizations — Currently, the directors, trustees, or members of the governing body of various types of nonprofit organizations are immune from certain types of lawsuits in Tennessee. SB 1660, which was approved by the Senate Commerce and Labor Committee this week, extends that immunity to 510(c)(19) nonprofits, which are veterans organizations.
Firefighters — The Senate Commerce and Labor Committee this week also advanced legislation that amends the “Barry Brady Act,” which provides compensation to firefighters for certain types of cancers. SB 1569 adds testicular cancer and leukemia to the list of cancers covered under the law.
New jobs in Maury County — The composite decking, railing and cladding company Fiberon this week announced it will establish new manufacturing and distribution operations in Columbia, Tennessee, creating 310 new jobs over the next five years.
Founded in North Carolina in 1997, Fiberon is a leading U.S. manufacturer of wood-alternative decking, railing and cladding, and prides itself on serving customers with high-quality, eco-friendly products. Today, the company employs more than 600 people across the U.S. through its bicoastal manufacturing and distribution operations in New London, North Carolina and Meridian, Idaho.
In the last five years, the Tennessee Department of Economic & Community Development has supported nearly 20 economic development projects in Maury County resulting in roughly 3,700 job commitments and $4.3 billion in capital investment.
“We congratulate Fiberon on their decision to locate this new facility in Maury County and create 310 new jobs,” said Sen. Joey Hensley (R-Hohenwald). “Helping to foster job creation is a key part of our efforts, and we are proud to partner with Governor Lee, TNECD and our local officials to help further that mission.”