Subcommittee advances bill to broaden TennCare medical-necessity factors for high-need home care cases

Representative Alexander described House Bill 364 and urged committee members to consider broader medical-necessity factors for certain high-need patients; committee members expressed support but noted fiscal concerns.

"This bill says when making a determination, a medical necessity, the bureau shall take into considerations the patient's overall condition and use such overall conditions as a factor to determine the level of funding and what medical items and services the patient receives," Representative Alexander said. He told the committee about a constituent identified as Emma who became severely disabled after an illness in college and whose family provides 24-hour home care.

Alexander said Emma was previously funded by TennCare because she required a ventilator for 12 hours; after she weaned to 8 hours, funding was cut despite continued need for full-time care (suctioning, trach care, repositioning and constant supervision). The sponsor said the bill would require a comprehensive medical review that "includes, but not limited to, the consideration of a patient's mobility or ability to move and turn, the patient's cognitive awareness and ability to communicate, the patient's need for constant nursing supervision, and the patient's need for a ventilator or other life sustaining equipment like a trach." He urged affirmative votes for what he called "our most vulnerable patients."

Representative Parkson acknowledged the human need and said fiscal implications were a concern: "I'm looking at this, you know, this fiscal note and, you know, it's it's a little bit of, well, quite a bit of money actually... I hope we can get hope they they give this some real consideration when it comes to the budget and when it comes to finance so we get this over the over the hump. And I'll I'll be voting for it." Other members praised the bill and asked whether the sponsor had consulted the administration; Representative Alexander said he had spoken with administration leaders and with Chairman Hicks in prior discussions.

The committee voted to advance House Bill 364 to the full Insurance Committee. The transcript records committee agreement to move the bill but does not include a clerk-reported tally in the record excerpt.

Members emphasized the fiscal note will be the main hurdle in later consideration; no specific dollar amounts or fiscal estimates were provided during the committee exchange in the transcript excerpt.