[{"_1":2,"_124":-5,"_125":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76,88,100,112],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6092740,"mediaKeyId","2852422-b13310b36101a970ce93246314ad28eb","parentId",2852422,"title","Committee approves code changes for PANS/PANDAS to help TennCare providers identify and treat condition","audioSeconds",181,"startMs",4407000,"endMs",4588000,"viewUrl","/Search/View?dp=1&key=2852422-b13310b36101a970ce93246314ad28eb&start=4407&end=4588","thumbnailUrl","https://assets.pipeline.soar.com/2852422-b13310b36101a970ce93246314ad28eb/thumbnail_4407000.jpg","articleUrl","/articles/6092740/Tennessee/Committee-approves-code-changes-for-PANSPANDAS-to-help-TennCare-providers-identify-and-treat-condition","mediaUrl","https://secure.pipeline.soar.com/6092740-9523a37302b88d3289657e70aa5974e8/orig.mp4?Expires=1776508740&Signature=e3JAImwXk5VRpoapN8Mjb8ockFJct~qeoSUYEeOw5d~UbNeOv4g6aoGpTMcsjDH9lXjD~5tnd4gISGHrRR6fuGToZs4rYKZ0yOnzDwUgDqyHBUWkvothAupMQkPbxMz9SW8Wv2C3j1yjGD6mS791FfXBgC5pWXiVi9jxUvP0EIkx1P5vZTJdwnvthGWiImsrkFJOI-4YQWtQLxPto4i7V7YUtU25VVKL7qjYQXYaIpKkWnt7~K4jG3heCtAY4ymax3fijjgsfZW72cbJtqiIFiuWSXeo6opANVkVovai9O7h469Fol0FREzzIdygeMg41fm1I63XFUIbzA2tzgpaYQ__&Key-Pair-Id=KUT5TJCACFTXG","author","Tennessee Legislature","date","2025-04-02T00:00:00Z","article","The House Insurance Committee voted to advance an amended House Bill 411 that would add diagnostic and billing codes in TennCare for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, commonly referred to as PANS/PANDAS.

Sponsor Chair Liddy Lin told the committee the bill seeks to recognize PANS and PANDAS as medical, not solely psychiatric, conditions and to add codes so that physicians who suspect the disorders can investigate and follow a clear path for treatment and billing. \"It is a medical condition, not a psychiatric condition,\" Lin said during her explanation.

A constituent and family members attended to put a face to the condition; the sponsor said having codes on TennCare would reduce confusion among clinicians and families and make treatment pathways clearer.

The committee attached Amendment 5,243 to the bill and then voted. The clerk recorded 12 ayes, 0 nays; House Bill 411 moves to Calendar and Rules.

Committee discussion was limited to the medical nature of the condition and the practical effect of adding codes to TennCare's billing system; no fiscal notes were addressed in this session.","mediaType","Video","parentTitle","House Insurance Committee\tApr 2, 2025\t1:04 PM","oneSentenceSummary","An amended House Bill 411 that adds codes for PANS and PANDAS to TennCare passed the Insurance Committee and moves to Calendar and Rules after sponsors said the codes will help physicians identify the disorder and route patients to appropriate treatment.","taxTitle","Insurance, House of Representatives, Committees, Legislative, Tennessee","taxId",35385,"location","Tennessee","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6092744,"Committee approves bill to hold pharmacy benefit managers to insurer-like prompt-payment standards",87,1369000,1456000,"/Search/View?dp=1&key=2852422-b13310b36101a970ce93246314ad28eb&start=1369&end=1456","https://assets.pipeline.soar.com/2852422-b13310b36101a970ce93246314ad28eb/thumbnail_1369000.jpg","/articles/6092744/Tennessee/Committee-approves-bill-to-hold-pharmacy-benefit-managers-to-insurer-like-prompt-payment-standards","https://secure.pipeline.soar.com/6092744-ab52705e45ba2e7d7283e7dcea8bbd24/orig.mp4?Expires=1776508740&Signature=nJEYexc~WkG4QcPpa-nyh-1686j~etztZ5qBNH9gCpBrwu3JFOt-xgcwpfnIEooxQP2G0UG0TQs-ned7JQ1w15u4we40xST0Kj1tS6BkZ2mc6IPDcrRx8Yhae53IVWVQ6Y~rUu7voftnvEvKMPgJBrORMN0xzoNTU3BcVk5bEPO8DNr-VQmlB2o-qFetiu7N-lT9xalX2cCq8Qrbe~17ZPhV-jy0WKMCe5wdj5ki840GWRqneGsjWHpFveFnKK7-hYRQ5f0UOAibqdBvgJw2-UAcPc-pU5eYo7PKtOkOEHLn8Oll98h-ntJsJH2rV5VTtMnGVf3wHkXDDF4aYi~36A__&Key-Pair-Id=KUT5TJCACFTXG","The House Insurance Committee voted to advance House Bill 1244, an amended measure that would hold pharmacy benefit managers to prompt-payment standards similar to those applied to health insurers and would remove limits on individual and aggregate penalties for violations by PBMs.

Sponsor Representative Martin explained the amendment (No. 5,191) and said the bill removes limits on penalties and requires PBMs to meet prompt-payment standards comparable to insurers. \"This bill holds pharmacy benefit managers accountable for prompt payment standards similar to health insurers and also removes limits on individuals and aggregate penalties for violating the law made by pharmacy benefit managers,\" Martin said.

Committee members declined an offered witness and voted without further debate. The clerk recorded 14 ayes, 0 nays. House Bill 1244 will proceed to the Government Operations Committee.

No fiscal notes or additional policy references were discussed on the Insurance floor during this session; the committee attached Amendment 5,191 to the bill before voting.","House Bill 1244, as amended, passed the Insurance Committee and moves to Government Operations; the amendment removed statutory caps on individual and aggregate penalties and attached prompt-payment standards for pharmacy benefit managers (PBMs).",{"_33":89,"_35":36,"_37":38,"_39":90,"_41":91,"_43":92,"_45":93,"_47":94,"_49":95,"_51":96,"_53":97,"_55":56,"_57":58,"_59":98,"_61":62,"_63":64,"_65":99,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6092749,"Committee approves Save Rural Hospital Act targeting hospitals with fewer than 50 beds",164,1185000,1349000,"/Search/View?dp=1&key=2852422-b13310b36101a970ce93246314ad28eb&start=1185&end=1349","https://assets.pipeline.soar.com/2852422-b13310b36101a970ce93246314ad28eb/thumbnail_1185000.jpg","/articles/6092749/Tennessee/Committee-approves-Save-Rural-Hospital-Act-targeting-hospitals-with-fewer-than-50-beds","https://secure.pipeline.soar.com/6092749-5a568663e77106915b4b52149e503937/orig.mp4?Expires=1776508740&Signature=NALH4YzknFKlTTyZWkKdmOCzBE1hWqhLgMHngoOE5vQm1Fy00OFlMvcBw8ElWt9yPfIG1BkKA8yMwTG0sPpZiimmq4G5Xp9qNFGeCJ5NzjVJ~Bb1etP4eppXt8d0UXV1uqCbwBCFOObRueszfq078CchebxO111UkwZR9ZcVCskROPGbpLDcVhjO55mjBwQclBZ6GZS56ZzgHEvgdPOzmNPJjScAuy4DdysSHUEwbJjPyuEOhQIXyA3ZIczxHAcfy4bXvWOcuZsp-UYl8ZzerB9GsTOeNR0Jt0qGC1FsaTnNSvU4i0~v81Gf-QkjKsNHP0Y2n30Fr0ml28t773~Txw__&Key-Pair-Id=KUT5TJCACFTXG","The House Insurance Committee approved House Bill 173 and sent it to the Finance and Ways and Means Committee after a brief explanation by the bill sponsor, Representative Martin.

Martin described the bill as the \"Save Rural Hospital Act,\" saying it targets rural hospitals and would allow rural-hospital reimbursement rates to move toward break‑even levels used in urban settings. \"This would just allow rural hospital reimbursement rates to... get to the break even point,\" Martin said, adding the bill would apply to hospitals operating with no more than 49 beds in a rural area.

Representative Draper called the question, and the committee voted. The clerk recorded 14 ayes, 0 nays. House Bill 173 will proceed to Finance and Ways and Means for fiscal consideration.

The discussion on the bill at the Insurance Committee level was brief and focused on the 49-bed threshold in the bill's definition of \"rural hospital.\" Committee members asked for clarification of that definition; the sponsor pointed to the statutory language in the bill that defines a rural hospital as one with no more than 49 beds operating in a rural area.

There were no amendments offered and no extended public testimony on this item during the Insurance Committee session.","House Bill 173, the Save Rural Hospital Act, was approved unanimously by the Insurance Committee and sent to Finance and Ways and Means; the sponsor said the bill would target reimbursement changes for rural hospitals with 49 or fewer beds.",{"_33":101,"_35":36,"_37":38,"_39":102,"_41":103,"_43":104,"_45":105,"_47":106,"_49":107,"_51":108,"_53":109,"_55":56,"_57":58,"_59":110,"_61":62,"_63":64,"_65":111,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6092754,"Committee advances bill asking TennCare to consider health-reimbursement option for Katie Beckett Part A families",1633,4631000,6264000,"/Search/View?dp=1&key=2852422-b13310b36101a970ce93246314ad28eb&start=4631&end=6264","https://assets.pipeline.soar.com/2852422-b13310b36101a970ce93246314ad28eb/thumbnail_4631000.jpg","/articles/6092754/Tennessee/Committee-advances-bill-asking-TennCare-to-consider-health-reimbursement-option-for-Katie-Beckett-Part-A-families","https://secure.pipeline.soar.com/6092754-5d131da935d59b849e747789704711d2/orig.mp4?Expires=1776508740&Signature=QgEM22UewmSg79NYmvDDaBxMZJMyZY-i~oHuWlj543-~WA3Z1-yN4mUHCnp7rSABMfkARyYkxOMEiTeZXKtlQilbcTcxZ2GdtEtopO9l6XYQE9Pd2zgrlRIlpHQyjTMgkLw0RjGal5Ia5YB7w-lnyjgZX9B6rxifXNApVR0Qtzgocz2Mkplw8y5sN3AS4KJYxUZKrGXelpfBfVjI5KpDOi7a8g-nG46cHocKJHbnCsUA48YEKvpWHUrQi5Y3JQZOrn5cc5zzsl1Ik7L7enyy0B4DV4AbptQ9gUJOQLyq0r5r6zcALYaAmL4CakVy6kniW930CYv9dltdg8bKeHjyZg__&Key-Pair-Id=KUT5TJCACFTXG","The House Insurance Committee voted 14–0 to advance House Bill 1158, which would ask TennCare to pursue authority so that families enrolled in Katie Beckett Part A could access a health-reimbursement account to help pay for home- and community-based services.

Sponsor Chair Liddy Lin (Chairwoman Liddy Lin) told the committee the measure responds to family concerns that Katie Beckett Part A enrollees — the most medically fragile children served by the state program — do not always receive the same ease of access to home- and community-based services available to some families in Part B. \"These families feel that they are not getting all that they need,\" the sponsor said.

The nut graf: TennCare officials said the apparent shortfall is driven by program design, existing utilization patterns and federal rules; they warned that a Part A-only HRA could raise equity issues across Medicaid and might require a federal waiver or other CMS approval.

Drew Staniewski, deputy director at TennCare, told the committee Katie Beckett Part A is budgeted at $25,000,000 for full capacity of 300 slots and that actual average annual Medicaid utilization for Part A enrollees is about $76,000 per member. \"There is a misconception in the testimony that it is an allotment of $15,000 per year for that family to use, but that is actually not the case,\" Staniewski said. He described the $15,000 figure as a benefit limit for certain home-and-community services (HCBS), not a prepaid allotment.

Staniewski also said TennCare had moved $20,000,000 from Part A to Part B in recent years to expand Part B capacity because demand for Part B was higher; that transfer opened roughly 2,000 additional Part B slots without new state dollars, he said.

Katie Evans, TennCare’s director of long-term services and supports, described program checks on vendors, including a requirement for competitive bids (a minimum of three bids for home-modification projects) and MCO oversight. She said TennCare monitors claims and can remove vendors from networks or refer suspected fraud to program-integrity investigators. Evans noted HCBS project limits: a project cap of $6,000, a lifetime limit of $20,000 and a per-year cap of $10,000; TennCare said it has requested a CMS amendment to remove the project cap because rising materials costs have tightened access.

Advocates and family members told the committee they routinely face cumbersome MCO processes and difficulty securing needed equipment and services; committee members described specific cases brought to their offices, including contested DME (diaper) coverage and requests for portable oxygen devices.

On the bill’s equity concerns, Staniewski said providing an HRA to Part A members but not to similarly situated children elsewhere in Medicaid could raise fairness questions and could complicate federal approval. \"If you do the HRA, no other Medicaid population is getting an HRA benefit,\" he said.

Committee members pressed TennCare officials on budget handling and reversion. Staniewski explained the agency’s approach: earlier conservative budgeting (the program was initially budgeted at $150,000 per member), observed per-member costs below that expectation, and reallocations within the Katie Beckett budget to meet demand in Part B. Several members urged TennCare to work directly with families to resolve urgent equipment issues and vendor disputes.

After questions, the committee voted to advance HB 1158 to Finance, Ways and Means (clerk recorded 14 ayes, 0 nays). TennCare told the committee that implementing a Part A-only HRA would likely require federal review and that fiscal and equity implications would need further study.

The committee also heard staff contact details from TennCare and was told the agency maintains member advisory groups and technical advisory groups to collect feedback from families and advocates.","Lawmakers advanced House Bill 1158 to Finance, Ways and Means after a lengthy debate over whether TennCare can or should establish a health reimbursement account (HRA) for the most medically fragile children enrolled under Katie Beckett Part A; TennCare officials warned of equity and federal-approval constraints.",{"_33":113,"_35":36,"_37":38,"_39":114,"_41":115,"_43":116,"_45":117,"_47":118,"_49":119,"_51":120,"_53":121,"_55":56,"_57":58,"_59":122,"_61":62,"_63":64,"_65":123,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6092759,"House committee advances bill to raise TennCare physician pay after testimony on rural shortages",2502,1593000,4095000,"/Search/View?dp=1&key=2852422-b13310b36101a970ce93246314ad28eb&start=1593&end=4095","https://assets.pipeline.soar.com/2852422-b13310b36101a970ce93246314ad28eb/thumbnail_1593000.jpg","/articles/6092759/Tennessee/House-committee-advances-bill-to-raise-TennCare-physician-pay-after-testimony-on-rural-shortages","https://secure.pipeline.soar.com/6092759-c66252df94e5e67c151a06693037ce6b/orig.mp4?Expires=1776508740&Signature=hTxlnyhCS2ky0wxCzsEzYKCPtXgICVqVQuGtsR8xZkwXhWZVzspmTS1R0C7UfJ2XZVCR5E4pAL75kb2lKjLAqtd9sUMba0jmLxjHHPzv5SEdQeaREmO-4BIMZMB0FNyVjdlvzW2~GIRwjtcW1Mepq4DoA5dJDMcXTjNJaENfOYbVO3S5z3SXuU5jbMIp5hcab7Th7fcDqUSVL6blxahVZIv81~8q4CLEYS4jFS-70fBi1KMZo92l30sWuJaNl8Sdr1dLWObWHCLgJNPlxyCxBLwr86p0JSqM5ImacYJOi1E2wQcyCdulhumoc60VDTHmP-Eh0HMq5xxwb0~7uHfUTg__&Key-Pair-Id=KUT5TJCACFTXG","The House Insurance Committee voted unanimously to advance House Bill 372 to the Government Operations Committee after physicians and pediatric and mental-health providers testified that TennCare reimbursement rates are forcing doctors out of Medicaid networks and shrinking access in rural areas.

The bill’s sponsor, Representative Halsey, told the committee the measure aims to improve access for current TennCare enrollees by encouraging greater physician participation. \"This bill says we got a problem, and we gotta fix it financially to pull doctors' rate of pay up for treating TennCare patients,\" Halsey said. He added Tennessee is currently “the only state in the United States that does not have a Medicaid fee schedule.”

The nut graf: doctors who treat TennCare patients described low pay and operational strain as immediate drivers of access problems in rural counties, testimony that committee members said they needed to hear before the bill moves to budget discussions.

Several physicians and specialists described the practical effects in their practices. Dr. Jot Hallman, an OBGYN from Johnson City who said his multispecialty group provides about 2,000 deliveries per year, told lawmakers that TennCare reimbursement is frequently lower than Medicare and commercial payers and creates a “disincentive to caring for TennCare patients and results in harm.” He said patients in some counties now travel 60 to 90 minutes for care and that one-third of Tennessee counties are designated maternity-care deserts by the March of Dimes.

Dr. Rakesh Kumar Patel, a board-certified psychiatrist who practices in a rural area, told the committee behavioral-health access is bottlenecked: long outpatient waits and crowded community clinics push people to emergency departments when they need timely care. \"We're asking [to] open up the ability for mental-health providers and other specialists to come and help these patients,\" Patel said, describing difficulty maintaining financially viable behavioral-health practices under current reimbursement.

Betty Coyata, a pediatrician with Heritage Medical Associates in Middle Tennessee, stressed that TennCare covers a majority of children in the state and that low reimbursement strains pediatric practices. \"TennCare reimbursement rates are often far below the actual cost of providing care for these kids,\" she said, adding that sustained underinvestment increases long-term costs by shifting care from prevention to emergency care.

Committee members pressed witnesses on causes and remedies. Witnesses and legislators discussed several factors beyond rates: an aging physician workforce, limited residency slots and debt burdens on new doctors, and lifestyle and burnout issues that make long hours less attractive to newer physicians. Witnesses and some members suggested incentives such as loan-repayment tied to TennCare service and adding residency positions; lawmakers said recruiting and retention would ultimately involve budget trade-offs.

Representative Freeman urged the committee to view the issue as one of compensation and market signals: \"Let's stop asking them to take pennies on the dollar for work that they could go elsewhere for,\" he said.

After roughly an hour of member questions and public testimony, Representative Raper called the question and the committee voted. The clerk recorded 14 ayes, 0 nays. House Bill 372 moves to the Government Operations Committee for further consideration, including any fiscal implications.

Members signaled the next steps will focus on finance trade-offs: raising fees for TennCare providers would require action in Finance, Ways and Means and budget decisions beyond the Insurance Committee.

The committee heard the testimony during the agenda item for House Bill 372; the vote was recorded immediately afterward.","The House Insurance Committee voted unanimously to send House Bill 372 to the Government Operations Committee after hours of testimony from rural physicians, who said low TennCare reimbursements are driving provider exits and creating “maternity care deserts.”","actionData","errors"]

Article not found

Committee approves code changes for PANS/PANDAS to help TennCare providers identify and treat condition

Committee approves bill to hold pharmacy benefit managers to insurer-like prompt-payment standards

Committee approves Save Rural Hospital Act targeting hospitals with fewer than 50 beds

Committee advances bill asking TennCare to consider health-reimbursement option for Katie Beckett Part A families

House committee advances bill to raise TennCare physician pay after testimony on rural shortages