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Lawmakers press administration on certificate-of-need, policy strings in federal rural health application
Summary
Legislators pressed presenters over policy commitments referenced in Tennessee's RHTP application, including possible certificate-of-need reforms and scope-of-practice changes; members raised concerns about future funding being conditioned on such reforms and the risk of federal clawbacks.
Members of the joint Ways and Means committee used the RHTP presentation to press the administration about policy commitments referenced in the state's application, particularly proposals tied to certificate-of-need (CON) reform and scope-of-practice changes for nurse practitioners, physician assistants, dental hygienists and pharmacists.
"In our application, we did mention policy items," a presenter said during questioning; committee members repeatedly asked whether draft legislation exists and how failure to pass policies could affect future competitive funding. One member summarized the worry: if the state fails to follow through on policy commitments, the federal program could make Tennessee less competitive for future awards and may claw back some funds, presenters told the committee.
Several lawmakers said they were concerned about tying future federal dollars to state policy changes. Committee discussion noted that CMS's NOFO cites external sources (including the Cicero Institute study) as inputs for scoring policy items; one member pointed out that those data sources predate some state reforms and asked how CMS will credit recent changes.
Fiscal and governance concerns also surfaced: a member noted CON fees currently generate roughly $865,000 annually and asked whether the Health Facilities Commission budget would be affected by any reform. Committee members asked how many legislators would serve on the RHTP governance body and whether that body would include meaningful legislative representation for future spending decisions.
Officials repeatedly said no specific legislation had yet been filed but that the administration intended to study reforms and work with lawmakers. They also acknowledged CMS offered an invitation to pursue policy change rather than an explicit, detailed rubric for future awards and that CMS had not provided precise formulas for how policy steps would translate into additional money.
The committee ultimately voted to allow the state to accept the first-year award, but members said they expect further briefings and more detailed fiscal and governance information as the program moves toward procurement and implementation.
