Legislative Alert: February, 2000
by Louise Browning, CAE
Executive Director and Lobbyist
The 101st General Assembly reconvened on January 11, 2000. Passage of TNA’s bill on nondiscrimination in managed care in the Senate is still a top priority.
Nondiscrimination in Managed Care for Advanced Practice Nurses
SB 1690 by Davis & Crutchfield, TNA’s Senate bill on nondiscrimination in managed care, did not make it out of the General Subcommittee of the Senate Commerce Committee where it was referred last year. The House bill, HB 1772, by Ronnie Coledid pass out of the House Industrial Impact Subcommittee and the House Commerce Committee with very little opposition, and passed the House with flying colors 93-0 in 1999.
Please talk to your State Senators now and tell them we need to find a way to get SB 1690 out of the Senate Commerce Committee and to the floor of the Senate for a vote this session. If you will convince your Senators of the need for this legislation, they may help us convince the members of the Senate Commerce Committee to bring the bill out of the General Subcommittee, pass it out of the full Commerce Committee, and send it to the floor of the Senate for a vote.
Remember, about 150 bills that affect managed care went into this same subcommittee last year as the result of an agreement made in 1998 among certain health care providers (not including us), insurers, business, and members of the Commerce Committee to place a two-year moratorium on passage of any new legislation in order to pass the Consumer Health Care Advocacy Act. That means it would be 2001 before any new bills could be passed.
The House obviously did not take this moratorium quite as seriously as the Senate, as they passed several managed care bills last year, including ours!
We are not ready to throw in the towel, so please discuss this bill with your Senators especially members of the Senate Commerce Committee. They are Senators Cooper (chairperson), Graves (in charge of the negotiations on the Consumer Advocacy Act), Clabough, Dixon, Carter, Crutchfield, Elsea, Rochelle and Williams.
Talking Points
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This is not an “any willing provider” bill. It does not require health plans to contract with all nurses in advanced practice. It simply prevents discrimination based solely on licensure or certification against this class of health care providers (APNs) acting within their scope of practice under the law. |
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It does not prohibit MCOs from limiting numbers of providers only to the extent necessary to meet the needs of the MCO’s plan and its enrollees, or from limiting referrals, or from establishing any other measure designed to maintain quality and control costs consistent with the responsibilities of the plan. |
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The bill does not create coverage for any service that is not otherwise covered under the terms of the MCO’s plan. |
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RegisteredNurses in Advanced Practice are defined as primary care providers in the TennCare contracts, but surprisingly, a few TennCare MCOs sometimes deny reimbursement. |
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APNs are many times the only providers in some of the rural areas, yet access to their services are often denied due to lack of reimbursement by selected MCOs. |
SENATE BILL 1690 BY LINCOLN DAVIS
AN ACT to amend TCA, Title 56, Chapter 32, Part 2, relative to health insurance issuers and registered nurses
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE
SECTION 1. Tennessee Code Annotated, Section 56-32-229(b), is amended by deleting the language “and chiropractors” and by substituting instead the language and punctuation “chiropractors, certified nurse midwives as described in õ56-7-2407, and nurses in advance practice as defined by õ56-7-2408.”
SECTION 2. This act shall take effect upon becoming a law, the public welfare requiring it.
TNA’s bill on nondiscrimination in managed care amends Section 56-32-229(b) of the Health Maintenance Organization Act as follows, with new language in brackets that would be added when our bill passes:
56-32-229. Scope of Services
(a) The managed health insurance issuer shall not discriminate with respect to participation, referral, reimbursement of covered services or indemnification as to any provider within a class of providers who is acting within the scope of the provider’s license or certification under state law, solely on the basis of such license or certification. In selecting among providers of health services for membership in a provider network, the managed health insurance issuer or other network shall not discriminate against a class of providers who provide services that are covered by the plan by prohibiting such class of providers from membership in the provider network. This section shall not be construed as prohibiting managed health insurance issuers from including providers or classes of providers only to the extent necessary to meet the needs of the managed health insurance issuer’s plan and its enrollees, or from limiting referrals or establishing any other measure designed to maintain quality and control costs consistent with the responsibilities of the plan. This chapter shall not be construed as creating coverage for any service that is not otherwise covered under the terms of the managed health insurance issuer’s plan.
(b) As used in this section, “class of providers” means optometrists, ophthalmologists and chiropractors, [certified nurse midwives as described in õ56-7-2407, and nurses in advanced practice as defined by õ56-7-2408].
SB 1690 references the following two sections in the current Insurance Code, as this was simpler than trying to redefine nurses in advanced practice in our bill:
56-7-2407 Nurse midwife services.
(a) Whenever any contract, plan, or policy of insurance issued in this state provides for reimbursement of any service which is within the lawful scope of practice of a nurse midwife, duly licensed by the Tennessee board of nursing as a registered nurse and also duly certified as a nurse midwife by the American college of nurse midwives, the insured or other person entitled to benefits under such contract, plan, or policy shall be entitled to reimbursement for such services, whether such services are performed by a duly licensed physician or by a duly licensed and certified nurse midwife.
(b) Reimbursements shall be made in a timely manner.
(c) The provisions of this section relating to nurse midwife services shall apply to all contracts, plans, or policies issued or renewed on or after July 1, 1994. [Acts 1994, ch. 945, õ 1.]
56-7-2408. Reimbursement for services by nurse in advanced practice.
(a) Whenever any contract, plan, or policy of insurance issued in this state provides for reimbursement of any service which is within the lawful scope of practice of a nurse in advanced practice, the insured or other person entitled to benefits under such contract, plan, or policy shall be entitled to reimbursement for such services, whether such services are performed by a duly licensed physician or a duly licensed nurse in advanced practice. For purposes of this section, “nurse in advanced practice” means a registered nurse who is duly licensed by the Tennessee board of nursing and who is also a nationally certified nurse practitioner, a nationally certified registered nurse anesthetist, or a nationally certified clinical specialist.
(b) Reimbursements shall be made in a timely manner.
(c) The provisions of this section relating to the services of a nurse in advanced practice apply to all contracts, plans, or policies issued or renewed on or after July 1, 1996. [Acts 1996, ch. 627, õ 1.]
TNA Members:
Please make every effort now to talk to your Senator about this bill. All Senators need to understand this issue, as many will be willing to help us get this bill out of the Senate Commerce Committee by influencing their colleagues who serve on the committee of the need for this legislation.
Members of the Senate Commerce Committee:
Senator Jerry Cooper – Chairperson – Morrison
Senator Bill Clabough – Vice Chairman – Maryville
Senator Roscoe Dixon – Secretary – Memphis
Senator JoAnn Graves – Gallatin – (In charge of negotiating the Consumer Health Care Advocacy Act in 1998 and the two-year moratorium on new managed care legislation)
Senator Bobby Carter – Jackson
Senator Ward Crutchfield – Chattanooga
Senator Gene Elsea – Spring City
Senator Bob Rochelle – Lebanon
Senator Mike Williams – Maynardville
The other 24 Senators:
Lt. Governor John Wilder – Mason, Senators Ben Atchley – Knoxville, Marsha Blackburn- Brentwood, Tim Burchett – Knoxville,Charlotte Burks – Monterey, Steve Cohen – Memphis, Rusty Crowe – Johnson City, Lincoln Davis – Pall Mall (prime sponsor of our bill), John Ford – Memphis, David Fowler – Signal Mountain, Thelma Harper – Nashville,Tommy Haun – Greeneville, Joe Haynes – Goodlettsville, Douglas Henry – Nashville, Roy Herron – Dresden, Rosalind Kurita – Clarksville, Jim Kyle – Memphis, Tom Leatherwood – Bartlett, Randy McNally – Oak Ridge, Jeff Miller – Cleveland, Curtis Person – Memphis, Ron Ramsey – Blountville, Pete Springer – Centerville, Andy Womack – Murfreesboro
