Committee adopts Shield Act amendment to prevent vaccine-decliners from lowering provider quality scores
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Summary
The committee approved an amendment to SB 2070 (the Shield Act) to prevent insurance quality-measure formulas from counting patients who declined certain vaccinations in denominator calculations, a change sponsors said aligns state practice with recent federal CMS guidance and protects pediatricians' reimbursements.
Chairman Watson introduced SB 2070, the Shield Act, telling committee members the bill would stop managed care organizations from including patients who documented that they declined a vaccine in the denominator for vaccination-related quality metrics used to calculate provider payments and tiers.
Drew Schonaker, who described himself as the bill's primary technical architect, said the legislation was designed to preserve pediatricians' revenues after federal changes. "The purpose of this bill is straightforward and ensures that our pediatricians are not financially penalized simply for treating Tennessee families who choose to follow new federal guidance," Schonaker testified. He said the Centers for Disease Control and Prevention had reclassified six childhood vaccines to shared clinical decision-making and that CMS had removed those vaccines from mandatory quality reporting; without state action, outdated contracts could still penalize providers.
Schonaker told the committee the Shield Act requires MCOs to remove an exempt patient from the denominator of vaccination metrics so providers are not automatically downgraded when a family declines a vaccine for individualized reasons. He said the amendment had been worked with TennCare and that the change had no significant fiscal impact in the fiscal review.
The committee adopted the amendment making the bill and voted to move SB 2070 to the calendar. The clerk recorded eight ayes and one pass in committee reporting.
Supporters said the bill is not a debate over vaccination policy but a contract- and reimbursement-focused correction to avoid unintended financial consequences for providers.