TennCare Subcommittee advances CHIP extension, ambulance and hospital funding measures; approves doula, sickle-cell and caregiver bills

The TennCare Subcommittee met Tuesday in March and voted to advance a package of health-care measures to the full Insurance Committee, taking final action on several bills and approving others that will require further federal review before funds flow.

Representative Mayberry presented House Bill 319 to extend the repeal date for Tennessee’s Children’s Health Insurance Program (CoverKids/CHIP) from June 30, 2025, to June 30, 2030; the committee moved the bill on to full Insurance. Representative Mayberry said the program “covers about 440,000 individuals in Tennessee.”

The subcommittee also approved multiple ambulance-related measures and an annual hospital assessment authorization. Chairman Hicks’ House Bill 201 would raise TennCare reimbursement rates for ground-based ambulance nonemergency runs; Chairman Martin’s House Bill 195 (the “Save Rural Ambulance Act”) targets higher reimbursements for rural ground ambulance services that committee members said are operating at a loss; and Chairman Reedy’s House Bill 171 extends the ground ambulance assessment that helps draw down federal matching funds. Representative Gantt’s House Bill 150 raises the TennCare air-ambulance reimbursement to at least 67.5% of Medicare’s allowable charge. Committee members repeatedly noted that these rate and assessment changes require federal approval by the Centers for Medicare and Medicaid Services before additional federal matching funds or payment changes take effect.

Chairman Hicks brought House Bill 1000, amended, to authorize TennCare to continue hospital assessments and make directed payments for the fiscal year 2025 hospital assessment while the state awaits full CMS approval. The bill’s sponsor said last year’s legislation modernized the hospital assessment structure and that partial federal approval has been received; additional legislative authority is requested to allow TennCare to continue assessments and payments during the federal review.

On narrower coverage and certification items, Representative Love’s House Bill 295 would add doula services provided by verified, certified doulas to the list of TennCare-covered medical assistance services and direct the Department of Health to adopt rules for verification. “Doulas are nonmedical professionals,” Representative Love said, explaining their role before, during and after childbirth. The bill was approved by the subcommittee and will move to full Insurance.

Representative Love also sponsored House Bill 15, a narrowly scoped authorization to allow the governor to seek a federal waiver to extend TennCare eligibility for people with sickle cell disease. The fiscal note cited about 1,474 people currently insured and an estimated additional 306 people who could become eligible under the proposal. The subcommittee approved the measure on a 5-2 vote; members who opposed raised concerns about expanding TennCare and long-term fiscal implications, while supporters described the proposal as a small, targeted authorization to let the governor negotiate with CMS.

The measure reported from the Tennessee Disability Coalition and carried by Chairman Hale, House Bill 712, would direct TennCare and the Department of Disability and Aging to create clear processes for provider agencies to hire qualified family caregivers as home- and community-based service providers and to standardize access so family members are not disqualified by relationship or residence. Jeff Strand of the Tennessee Disability Coalition told the committee the bill addresses caregiver shortages and that family caregivers often “spend 25% of their annual income” on out-of-pocket caregiving costs. The subcommittee approved that bill unanimously.

Votes at a glance

- HB 319 (Rep. Mayberry) — Extend CHIP (CoverKids) repeal date to 06/30/2030; moved to full Insurance (vote tally not specified on record). - HB 201 (Chairman Hicks) — Increase TennCare reimbursement for ground ambulance nonemergency runs; moved to full Insurance; tally recorded as 6 ayes, 0 nays. - HB 1000 (Chairman Hicks) — Authorize TennCare hospital assessment and directed payments for FY25 while awaiting CMS approval; amended and moved to full Insurance; tally recorded as 6 ayes, 0 nays (the bill had previously been rolled to the hill earlier in the meeting). - HB 195 (Chairman Martin) — Save Rural Ambulance Act (increase ground ambulance reimbursements; address rural ambulance losses); moved to full Insurance; tally recorded as 6 ayes, 0 nays. - HB 171 (Chairman Reedy) — Extend ground ambulance assessment for one year and add reporting requirements; moved to full Insurance; tally recorded as 7 ayes, 0 nays. - HB 150 (Rep. Gantt) — Increase TennCare air-ambulance reimbursement to at least 67.5% of Medicare allowable; moved to full Insurance; tally recorded as 7 ayes, 0 nays. - HB 295 (Rep. Love) — Add doula services with a verification/certification process; moved to full Insurance; tally recorded as 7 ayes, 0 nays. - HB 15 (Rep. Love) — Narrow TennCare expansion authorization for people with sickle cell disease (estimated +306 people); moved to full Insurance; tally recorded as 5 ayes, 2 nays. - HB 712 (Chairman Hale) — Create pathway and standardize access for family caregivers to be hired by provider agencies for TennCare home- and community-based services; moved to full Insurance; tally recorded as 7 ayes, 0 nays.

What happens next

Most bills approved by the subcommittee now go to the full Insurance Committee. Several items that change payment methodology — including the ambulance reimbursement changes, the ground ambulance assessment extension and the hospital assessment amendment — require federal approval from the Centers for Medicare and Medicaid Services before new payments or federal match dollars take effect. Committee members noted that federal review can approve, modify or deny state requests, and that passage here does not itself guarantee federal funding.

Sources: Committee proceedings and testimony recorded during the TennCare Subcommittee meeting in March (committee transcript).