Senate, House committees approve TennCare legislation
NASHVILLE (AP) — Legislation reforming the state’s financially mushrooming TennCare program cleared its last committee hurdle in the Senate on Tuesday and is headed for consideration by the full chamber.
The Senate Finance Committee unanimously approved the measure, which was later approved by the House Commerce Committee after lawmakers added a provision that gives them a few more seats at the table.
Proposals to make significant changes to the measure and more spirited debate seemed likely later in the week.
“I think the Senate floor and the House floor will be the major places” for debate, Finance Commissioner Dave Goetz said after Senate Finance’s 11-0 vote.
Gov. Phil Bredesen’s administration, which proposed the legislation, plans to submit a “cleanup amendment” this week that will revise several portions of the bill.
“It will make some of the changes the legislators have suggested,” Goetz said.
One change has already been made at the request of Rep. Kathryn Bowers, D-Memphis.
The House Commerce Committee approved the bill without dissent on a voice vote after approving her provision requiring the TennCare Advisory Commission to submit its annual progress report to legislators, as well as to the governor, and expanded the membership from 11 to 13 people. The governor will choose those two members from a slate of three each submitted by the House and Senate speakers.
Bredesen hopes to stem growth in TennCare spending, which will total $7.8 billion in federal and state funds in next year’s budget, by $2.5 billion over the next four years. The overhaul has been the most significant initiative of his 15-month administration.
The plan includes a limit on prescription drugs for about 450,000 of the 1.3 million TennCare enrollees and will require using cheaper generic and over-the-counter medications wherever possible. It also limits the number of hospital stays, doctor visits and lab work, and sets up a tiered co-payment system with charges ranging from $1 to $40.
Goetz, who presented the bill to Senate Finance, faced several questions from committee members concerning “medical necessity” as defined in the governor’s legislation — an issue raised earlier in the week by advocates for enrollees.
They argue that the state would not have to pay for preventative care — such as cancer screenings, immunizations and Pap smears — under the proposed definition.
Goetz, echoing the governor’s comments on the subject a day earlier, called the accusations “nonsense.”
“I have no idea how people constructed those cases,” he said. “It seems to me to be an effort to panic you in the Legislature.”
In the House committee, Goetz assured lawmakers and Sheryl McCormick, an advocate for TennCare enrollees with mental illnesses, that their concerns were being taken into consideration.
Work also continued on the “cleanup” amendment Tuesday, as administration officials, legislators and lobbyists worked toward a proposal to satisfy everyone.
Sen. Ron Ramsey, R-Blountville, says he’s working with the administration to attach a provision that would require enrollees to receive prescription drugs only from a specific pharmacy with which they’ve registered.
Current TennCare rules allow this so-called “lock-in” to be done already, but both Ramsey and Goetz say it hasn’t been implemented the way it should.
“This is a major component in TennCare reform,” Ramsey said. “… (And) I think it will drastically reduce the over-utilization of drugs on the TennCare program.”
Goetz said a “lock-in” would be used for people who get too many prescription drugs, not for all enrollees.
“Lock-in has never been intended for anything other than when you have incredibly high utilization,” Goetz said. “You want to make sure they’re not getting prescriptions that may be harmful to them, so you lock them in to one pharmacist.”
TennCare would determine who the over-users are through the records of its pharmacy benefits manager, Goetz said.
“It’s something that should have been done to control costs,” he said.
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On the Net:
Read SB3394/HB3512 and SB3392/HB3513 at http://www.legislature.state.tn.us