State Rep. Bryan Terry, Tennessee House Work to Make Telemedicine Permanent in State’s Health Practices

(NASHVILLE, Tenn.) — As the aggressive Covid-19 pathogen spreads across Tennessee,  State Representative Bryan Terry, MD (R-Murfreesboro) and the House of Representatives continue to put our patients first by creating conservative health care solutions that increase access to high quality services, while lowering overall costs.

Before temporarily recessing on March 19, members approved House Bill 1699, sponsored by State Rep. Robin Smith (R-Hixson) and co-sponsored by Rep. Terry with an 88-0 bi-partisan vote. This initiative paves the way to increase the electronic delivery of care in Tennessee through telemedicine. The legislation defines provider-based telemedicine by adding a private location that a patient deems appropriate to receive services. This bill has been carefully vetted to prioritize Tennessee patients having access to their own health providers.

“As Chairman of the House Insurance Committee and sponsor of this legislation, I believe this conservative solution to health care delivery in Tennessee will provide an extraordinary benefit to our citizens, whether in response to this virus pandemic or by meeting the needs of Tennessee patients in their homes or place or work,” said Rep. Smith. “It is an honor to partner with Speaker Sexton and Chairman Terry to utilize innovation and increase access to quality health services for more of our citizens through telemedicine.”

House Bill 1699 protects existing tele-health arrangements that do not require an existing doctor-patient relationship. It also creates a structure for all providers to use telemedicine with established patients who have been seen in their practice in the last 18 months for follow-up care at home, in their place of work or other mobile locations as long as the provider has access to the relevant public record. Chronically ill patients with ailments such as diabetes and congestive heart failure will benefit from the inclusion of remote patient monitoring which is currently a service provided by Medicare.

“This legislation will help many of our citizens who can’t visit a doctor’s office for a well visit or in a non-emergency situation to address an important health need,” said Rep. Terry. “Access and affordability are vital to our health care system and leveraging technology like telemedicine can help our Tennessee patients have improved health and outcomes.”

House Bill 1699 also includes a key provision for payment parity among doctors, nurse practitioners, and physician assistants because providers and hospitals should be equally reimbursed by insurance companies for the services they provide. This measure, preceding the emergency actions of the Centers for Medicare and Medicaid Services (CMS) to prioritize telemedicine and its reimbursement during the Covid-19 outbreak, incorporates existing technology in the care of Tennesseans on an ongoing basis, leveraging successful outcomes already achieved in response to the urgent pandemic.

House Bill 1699 is a key component of the Republican CARE Plan, which is designed to transform health care in Tennessee through Consumerism, increasing Access, improving Rural health systems, and Empowering patients. First introduced in 2019, the plan uses free market concepts to reshape health care through patient-centered solutions that enable Tennesseans and their loved ones to make informed decisions about the type of care they need, not providers or insurance companies.

“The electronic delivery of specialized care through telemedicine will drastically improve patient safety by reducing the likelihood of Covid-19 exposure in the weeks and months ahead,” said Tennessee House Speaker Cameron Sexton (R-Crossville). “This innovative concept will also untangle our current monopolistic approach to health care in Tennessee by increasing access to resources – especially in our rural communities – so we can better serve citizens.”

Consultants who have recently conducted evaluations on several rural hospitals receiving grants under the Rural Hospital Transformation Act have also strongly endorsed this initiative. Under the Tennessee Department of Economic & Community Development (TNECD) , the grant program funds evaluations of current practices being conducted at these facilities to ensure they are able to continue serving their communities. Telemedicine was cited by 92 percent of hospitals enrolled in the state program as an opportunity to sustain their rural hospital.

“Experts that have partnered with TNECD to evaluate our rural facilities believe a successful telemedicine program is a vital component to a sustainable business model,” added Chairman Smith. “Telemedicine aligns with the overall goal of the Rural Hospital Transformation Act, and I am pleased this tool will soon improve operational efficiency within more of our rural hospitals so they can continue to effectively address the unique needs in the communities they currently serve.”

Telemedicine has provided a tremendous benefit and safe alternatives to inpatient visits under the current circumstances. Utilizing this innovative tool will help continue to flatten the virus curve and reduce an anticipated surge of patients in Tennessee. House Bill 1699 will also  ensure this effective tool remains a key part of health care delivery for all Tennesseans.

For more information about House Bill 1699, click HERE.

Governor Bill Lee has taken several actions over the last couple of days dealing with orders for citizens to remain home, displaced healthcare workers, medicaid, personal protective equipment, mental health, and more. Below are some summaries.

Wednesday, April 01, 2020 | 06:30pm

As the Coronavirus situation evolves in Rutherford County, Governor Lee continues to take wide-reaching actions dealing with business taxes, emissions testing for tag renewal, Real-ID, school closures, licensing for nurses, physicians and other professionals, unemployment, and more.

Below are some summaries. You can find more information HERE.

Thursday, March 26, 2020 | 05:00pm

Wednesday, March 25, 2020 | 05:00pm

With the 2020 Tennessee General Assembly session upon us, I wanted to take the opportunity to give District 48 and others that are interested a preview of what I see coming down the legislative pike this session.  Having knocked on tons of doors, talked with a multitude of constituents, received feedback on my legislative survey, and having spoken to leadership, I’ve compiled a list of several of these issues.

Refugees:

One of the top issues that I’ve received emails about is concern over the refugee resettlement decision by Governor Bill Lee.  To refresh everyone’s memory, the General Assembly put forth a lawsuit exercising our 10th Amendment right to control not only who is relocated to our state, but how our state tax dollars are used.  Unlimited and poorly screened refugee resettlement into Tennessee enriches those companies who place refugees at the expense of Tennessee taxpayers and strains community resources.  

President Trump, to his credit, has worked on improving the screening of refugees and decreased the numbers from around 100,000 to 18,000.  He, then, issued a Presidential Executive Order that allowed a governor’s the sole discretion to decide whether their respective states would participate in refugee resettlement.  Part of that executive order, also, allowed county executives to determine if their counties would accept refugees if their governor elected to participate.

Prior to Governor Lee’s decision, I took the opportunity to speak to our House leadership and members of the Lee Administration to voice my opposition to continuing refugee resettlement in Tennessee and in particular to Rutherford County at this time.  While I appreciate President Trump’s 10th Amendment approach and the need to relocate persecuted refugees, to me, a decision to continue relocating refugees into Tennessee would undermine two important constituent related issues.

First, in my opinion, it would send the wrong message by undermining the lawsuit set forth by the General Assembly.  If part of our argument with the lawsuit involves unfunded mandates from the federal placement of refugees into Tennessee, then agreeing to accept more refugees sends the message that using state dollars to fund a federal program isn’t a problem for Tennessee.

Secondly, Rutherford County and Murfreesboro have just significantly raised property taxes due to unrestrained growth.  Adding more individuals that absorb local resources does not benefit our taxpayers. Even though our county executive has been given the authority to refuse to accept placement of these refugees, any acceptance of refugees that absorbs state dollars, by default, takes funds from taxpayers.

There is a bill that has been filed that places restrictions on the process for counties to accept refugees. I’ve met with legal services and I’m told that the bill is likely unconstitutional.  There are other pieces of legislation being explored. I’ll continue to oppose the policy for constituents and work for solutions that will work for our district.

Temporary Assistance for Needy Families(TANF):

Due to the improved economy and conservative leadership, the number of Tennesseans needing TANF assistance has decreased from around 61,000 to 21,000.  The federal government block grants $191 million per year to Tennessee in a reimbursement grant for TANF. That means Tennessee must spend our own funds and then get reimbursed by the feds.

Tennessee went from overspending our grant by $50-60 million per year to running a $120 million surplus.  As such, Tennessee has built a $732 million dollar reserve. This information was not readily distributed to the General Assembly by DHS, but was brought to light by the Beacon Center.

Immediately upon hearing from the Beacon Center, I contacted them to begin to address the issue as I firmly believe that Tennessee was missing an opportunity to help Tennesseans move from poverty to prosperity.  As I led on this issue, I was named to a bicameral working group to address the issue and subsequently I was elected chairman of that committee. We are working to determine the best way to utilize the funds in a fiscally responsible manner including opioid treatment, workforce development, and other measures.  

TennCare Block Grants:

Tennessee is currently $6.8 billion dollars below our budget neutrality cap for Medicaid.  And though this saves Tennessee taxpayers $2.4 billion dollars a year(fed portion is 4.4 billion), it signals a significant underpayment to hospitals and providers, especially in rural areas.  In essence, what this means is that, over the past 10 years, there has been $54 billion in underpayment to hospitals and providers, particularly in rural areas and we are looking at potentially a greater than 68 billion underpayment over the next 10 years.

The block grant proposal is not a traditional block grant, but would allow for growth if the TennCare population grew.  However, the waiver proposal has the potential to bring in $550 million more in federal dollars to TennCare without raising taxes on Tennesseans.  While bringing in extra federal funds would be beneficial to Tennessee, I’m not completely sold on the waiver because TennCare has consistently made decisions that I believe are not beneficial to patients and I’m not convinced that TennCare would utilize the $550 million in the most productive manner.  We will be awaiting the federal response.

Clinical Cannabis:

Over the summer and fall, I go door to door talking with folks and handing out surveys.  I’ll, also, mail out surveys, as well. It’s one of my ways of keeping my finger on the pulse of the district.

The survey certainly isn’t scientific, but provides me with feedback from the community and an opportunity to listen.  One subset of the community that I have targeted on the issue of medical or clinical cannabis is Republican Primary voters.  In a survey from a previous year, this subsection responded with a ratio of 85/15% in favor of legalizing cannabis in either a clinical or recreational manner.  15% opposed any and all cannabis legalization including research or in clinical settings.

This year’s results were more profound.  A full 95% of those that responded in this group were in favor of legalizing cannabis for at least clinical or research purposes.  Of that 95%, a little over 21% were for recreational uses. Only 5% were opposed to any and all uses of cannabis.  

Let me repeat that.  95% of Republican Primary voters who responded to my survey were supportive of clinical uses of cannabis(research or medical uses).  Again, the survey certainly isn’t scientific and there are more precise ways to measure results, but these results are pretty profound.  

The Alabama commission overwhelmingly recommended that Alabama move forward with legalizing and regulating the medical use of cannabis.  I’ve been working diligently to draft legislation that will move Tennessee in that same direction where research and clinical uses aren’t prohibited for Tennesseans who may see some benefit.  

Criminal Justice Reform:

Whether it is from the Lee Administration or from leadership, time and time again I hear that criminal justice reform will be a top priority this session.  However, nobody has been able to provide me with specifics. When discussing the issue with constituents, having safe neighborhoods and communities while ensuring that we aren’t wasting taxpayer dollars on non productive incarcerations seems to be the recurring theme.  That is a lofty goal that in concept appears easier said than done. We will know more when the bill filing deadline approaches in February.

That being said, 1/2 ounce of cannabis currently carries a misdemeanor charge.  1/2 ounce of 20% THC cannabis has around 2800 mg of THC. Patients who use FDA approved, lab made THC in the form of the drugs Syndros or Marinol, may use up to 2800-3000 mg per month.  We could save taxpayers over 2 million dollars by decriminalizing patients who use cannabis based treatments with less than or equal to 2800 mg of THC.

Taxes:  

Tennessee is, once again, running a  surplus of revenue and is looking at our options.  A few years ago, Oklahoma cut taxes to the point where they ended up with a billion dollar deficit.  Tennessee does not want to end up in that situation.  

With that being said, Tennessee will be looking at doing away with the Professional Privilege Tax once and for all.  It is a discriminatory and redundant tax on certain professions that already pay licensing fees to the state. In 2019, the General Assembly removed the tax for all professions except for a handful.  Originally, the tax was going to be reduced from $400 to either $100 or $200 per profession. However, in a purely political move, it was determined to remove the taxes for some professions while leaving it intact for others.  The General Assembly should correct this injustice this year.

Additionally, with taxpayers expressing frustration over rising property taxes promoted and passed by counties and municipalities, I expect Tennessee to be looking for solutions that will help our homeowners and taxpayers while ensuring counties and municipalities can deal with the increased burden of growth.  I frequently hear elected officials and politicians proclaim their desire for “smart growth”; yet, their priorities as put forth in their budgets and tax plans do not reflect those stated goals.   

Health Care:

The Tennessee House Republicans began 2019 working on the CARE Plan with included a series of bills and initiatives to help transform health care in Tennessee.  The goals were to interject Consumerism, improve Access, focus on Rural health systems, and Empower patients in their health decisions. Several measures passed and some have been adopted on the federal level.  I expect further initiatives to be introduced including expanding access for patients by reducing the burden of narrow networks promoted by insurance companies, reforming Certificate of Need laws, telemedicine, and working towards solutions for the uninsured.

Education:

In my discussions with leadership, I hear that some form of pay increase for teachers will once again be looked at in the budget.  While Tennessee has taken strides in this area, often, not all of those resources budgeted for pay increases end up in the hands of teachers as LEA’s(Local Education Associations) have had flexibility in how to use those funds.  

I, also, expect the Basic Education Program(BEP) formula to be revisited.  The BEP formula is designed to provide LEA’s with state funding for education.  In simple terms, the formula views a county as if it were one giant school, then based on the number of students, it calculates the number of required teachers and ancillary personnel needed to fund the school system.  For instance, for every 100 students, the BEP formula may fund four teachers. Unfortunately, the BEP doesn’t take into account that there are a multitude of schools within each LEA and the school district may have had to hire six teachers for the 100 students.   Growth counties like Rutherford County are at a disadvantage in this calculation.

Social Issues:

Gun rights and pro-life issues will, once again, be on the agenda at the Capitol.  I hear a lot of concern from constituents about Red Flag laws. While someone may put forth a Red Flag bill, I don’t expect one to move in this session.  

Last year, the House passed a Heartbeat bill.  It stalled in the Senate as they decided to send it to summer study.  The bill has been amended and will be heard again in the Senate. Should they pass it, the House will have to confirm or send it to a conference committee.

Representative Bryan Terry, MD (R-Murfreesboro), Chairman of the House Health Committee of the 111th Tennessee General Assembly, issued a formal invitation to Michael J. Fox and the Michael J. Fox Foundation, asking that Mr. Fox appear before the House Health Committee during the convening of the 2020 Session to give his testimony regarding the Foundation’s efforts to support expanding research on medical cannabis. 

According to a recent article released by Culture Magazine, the Michael J. Fox Foundation is working to support legislation such as The Medical Cannabis Research Act of 2019, The VA Medical Cannabis Research Act of 2019, and The Expanding Cannabis Research and Information Act. This package of bills will play a crucial role in rescheduling cannabis in order to facilitate the expansion of cannabis research that could provide relief for cancer and pain patients and allow veterans to gain access to relief through the use of cannabis based medicines.

These pieces of legislation on the Federal level correlate with Chairman Terry’s efforts to improve access for patients and development of cannabis based medicines at the state level.  Terry has proposed legislation such as HB 919, which would guarantee Tennesseans the right to participate in cannabis related research programs by allowing them to possess their research medicines in Tennessee, and HB 573, which would add patients with severe cancer pain and inflammatory bowel disease to the medical conditions already allowed to possess 0.9% THC cannabis oils in Tennessee. Also, Chairman Terry’s HB 1011 would create a comprehensive clinical cannabis program designed to help facilitate research in Tennessee for the purpose of developing cannabis based treatments for patients.  Terry’s bills do not allow for smokeable nor recreational uses of cannabis, and aim to decrease the black market by providing patients with safer alternatives in a clinical setting.

In his invitation, Chairman Terry states that “the health of many Tennesseans is being negatively impacted by the existing, restrictive cannabis laws” and that the addition of the voice(s) of the Michael J. Fox Foundation “to the growing support for medical cannabis research would help to convey the urgency for research programs in our state.” Chairman Terry’s goal has always been, and continues to be, focused strictly on safe medical uses for legitimate patients who might, without clinical cannabis based treatments, have no other viable options for relief.  

Chairman Bryan Terry, MD represents Tennessee House District 48, which is the eastern portion of Rutherford County and a portion of Murfreesboro. Terry lives in Murfreesboro and can be reached by email at: Rep.Bryan.Terry@capitol.tn.gov or by calling (615) 741-2180.