Capitol Hill Update from State Representative David Byrd September 2, 2020

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   Legislation encourages lower health care costs through Association Health Plans

   Legislation which aims to lower premiums and overall health care costs for small businesses through Association Health Plans (AHP) was approved this year. The new law, Public Chapter 515, aligns Tennessee’s AHP laws with new federal rules put into place by President Trump’s administration to help small businesses purchase affordable, high quality health insurance as a result of increased flexibility. 

  AHPs allow small businesses and entrepreneurs to band together with other businesses to purchase insurance with the bargaining power of a big company. The plans are similar to comprehensive large group or self-insured insurance policies offered by most large employers, covering the same types of treatments and procedures.

   Since 2003, average family premiums for Tennessee small employers have increased over 75 percent, while at the same time deductibles have spiked. As a result, almost 30,000 fewer workers at small businesses have private insurance coverage due to the decreased affordability.   

   New law expands Health Care Empowerment Act to all medical professionals

   State lawmakers voted this year to expand Tennessee’s Health Care Empowerment Act to allow all licensed medical professionals, instead of only physicians, to use direct medical care agreements without regulation by the insurance laws of this state Public Chapter 739 seeks in increase access to care and empower patients regarding their healthcare decisions. 

   The Health Care Empowerment Act is designed to give health care consumers who are struggling to pay the increasing costs of premiums or who have been priced out of the market, an affordable option to contract directly with their physician for health care services. The new law holds that a person seeking medical care outside of an insurance plan, TennCare or Medicare programs and chooses to pay out of pocket, does not forfeit their coverage plan. 

   Legislation allows nurse practitioners and physician assistants to prescribe buprenorphine for medication assisted treatment

   Public Chapter 771 was approved this year to create greater access to medication assisted treatment (MAT) at Federally Qualified Health Centers (FQHC), Community Mental Health Centers (CMHC) and Office Based Opioid Treatment (OBOT) facilities for patients with substance use disorder. The measure continues the legislature’s multi-year effort to curb opiate abuse in Tennessee.

   MAT uses buprenorphine in combination with counseling and behavioral therapies to provide a “whole-patient” approach to the treatment of substance use disorders. This treatment is important as Tennessee is experiencing an opioid crisis. These treatment facilities are a trusted place to receive care for uninsured and TennCare patients, but they are experiencing wait lists due to the limited amount of doctors in their organization available to prescribe these medications. During the quarantine caused by the COVID-19 pandemic, many more addicts have struggled with their addiction, increasing the demand for treatment and highlighting the shortage of prescribing physicians.

   The new legislation allows nurse practitioners (NPs) and physicians assistants (PAs) in FQHC, CMHC, and OBOT facilities to prescribe buprenorphine if certain conditions are met. Utilizing NPs and PAs to prescribe, allows these facilities to meet the needs of more uninsured and TennCare patients seeking treatment.

   Safeguards are included in the new law to ensure medications are being prescribed properly. In FQHCs and CMHCs, the prescribing NPs and PAs must be supervised by a licensed physician who holds a waiver from the FDA to prescribe buprenorphine products. The physician is limited to supervising four NPs or PAs at a time. The NPs and PAs can prescribe to no more than 50 patients who must be treated through the employing FQHC or CMHC. Along with other safety measures, it limits buprenorphine dosage to protect against overprescribing. Any FQHC or CMHA would be required to obtain an OBOT license if the facility reaches a total of 150 patients being prescribed buprenorphine. In OBOT facilities, NPs and PAs can also prescribe buprenorphine under the legislation, but only under the direct supervision of a physician who is actively treating patients in the same OBOT facility. Additionally, supervising physicians can only oversee two NPs or PAs at a time in OBOT facilities, and prescribing is limited to 100 patients per prescriber.

   All treatment facilities must be licensed with TennCare and accepting new patients in order for NPs and PAs to have prescribing abilities.

   The legislation also prohibits cash or pre-paid gift cards as a form of payment for treatment; prohibits prescribers from being compensated on a ‘per patient’ basis; and requires TennCare members to be treated by a TennCare provider for buprenorphine treatment.

   As always, I am truly humbled and honored to be your voice on Capitol Hill. If there is ever any issue I can assist with, please reach out to my office by calling 615-741-2190 or emailing me at rep.david.byrd@capitol.tn.gov.