Yesterday was interview day as I was interviewed for this article and on another issue. This article is behind a paywall, so I can’t share it.  But I can share my take on the issue as I am working on legislation and chaired the working group.

TANF(Temporary Assistance for Needy Families) is a federal program that allots funds to each state as a block grant in order to support needy families.  TANF replaced the old AFDC welfare program and has  requirements and limitations like a work requirement and maximum length of time on the program is 60 months.  The recipients on average earn less than $10 per hour at their jobs while the Tennessee average hourly private wage is over $25/hour.

The funds can essentially be used a few ways and there are restrictions/strings on each.

1)Held in a reserve 

2)Cash assistance

3)Wrap around services (2Gen grants)

4)Workforce Development

5)Overhead

6)30% transfer to a qualified program like the Child Care Development Fund

In order to receive the annual allotment, each state must prove their “maintenance of effort”(MOE) in the program.  Basically, each year a state must meet a spending threshold on needy families before the feds will grant the allotment.  For Tennessee, the allotment is $191 million per year.

During the Bredesen years, Tennessee’s needs exceeded the $191 million and Tennessee spent the MOE + TANF allotment + Additional funds from our General Fund.  

During the Haslam/Lee years as Tennessee’s economy improved and less people needed TANF, Tennessee only needed to utilize the MOE + a portion of the TANF allotment.  As less and less of the TANF allotment had to be used for cash assistance, the reserve grew to around $732 million.  

This issue was brought to our attention by the Beacon Center.  Subsequently, Speaker Sexton and Lt. Governor McNally appointed a bipartisan TANF Working Group to look into the issue and see if we could assist DHS in determining fiscally sound ways of utilizing the funds to better serve Tennesseans.

I was subsequently elected by the Senate and House members to chair the working group.  Though the Comptroller’s office audits the various departments, it is usually a combination of a 30,000 ft audit with some targeted metrics.  We asked for a more forensic audit of the program and for guidance in how much of a reserve we needed to keep.

The audit discovered that as the economy improved and less of the TANF allotment was needed, DHS actually continued to spend monies from the General fund above and beyond the MOE.  In essence, instead of using federal dollars for TANF recipients, DHS used state dollars to the tune of $221 million.  We ensured that they put an end to that practice and worked to get reimbursed by the feds from our $732 million reserve which would have brought the reserve down to $511.  They denied Tennessee that request.

Left with $732 million + $191 million annual allotment, we worked with DHS to set an adequate reserve while looking at other avenues to utilize the funds in a fiscally sound manner.  

Of note, overhead is roughly $35 million(Yes, it is that much) and cash assistance is roughly $35 million.  So Tennessee has been spending about $70 million of the $191 million.  Prior to COVID, DHS had put forth a $50 million dollar plan for 2Gen grants which would have brought the utilization up to $120 million.  The $50 million isn’t necessarily spent in one year, but for conceptual purposes, I will present the numbers that way.

We, also, were working on a bill that was the original “Pathway to Prosperity” which would have increased a family’s assistance(cash or wrap around services) up to 100% if they actively participated in an apprenticeship, technical college, or other educational endeavors(TN reconnect) that would get them on a pathway off of TANF.  TANF recipients are currently required to work, but we know that it takes about two years of additional education or training for an individual to improve their workforce skill set or educational background to experience upward income mobility.  This would fall under workforce development and would be up to $35 million.  

There were a few other bills out there, but on paper, it would have been 35+35+50+35 or approximately utilization of 155 of the 191 with the the capacity to entertain other legislation or amendments.

However, when the tornado and COVID hit, we did not know the extent of new need.  I looked at how we could assist those victims and amended my bill for emergency utilization.  The fiscal note was around $56 million.  However, the administration and DHS found a way where we could possibly assist thousands of more Tennesseans.  The potential utilization could have been well over $400 million.  Thus, in order to ensure we still had a reserve, other bills were held.  The 2 Gen grant program was already moving forward and didn’t need legislation.  Ultimately, only $25 million of the potential $400 million was needed.  

For the year, DHS essentially utilized 35(overhead)+35(cash assistance)+50(2Gen, but not all counts for this year)+25(emergency assistance)+60(CCDF pandemic child care transfer) = 205

The article focus on the growth of the reserve from last year and makes the point that there isn’t a specific plan in place to spend the funds.  In my interview, I pointed out most of the details above and that obviously, circumstances had evolved and changed.  I met with DHS this week to discuss the situation and the potential legislation for next year.  They provided an update to the Working Group members, as well.  Next week, we are meeting to go over more specifics and dive a bit more into legislation.

Hope this helps everyone to better understand the issue.

With liberty,

Bryan

The future of health care is consistently one of the top issues facing Tennesseans and America.  Encouraging steps are being made to address access with recent announcements by Belmont University to launch a new college of medicine and Middle Tennessee State University’s medical school partnership with Meharry Medical College.  While these programs will increase medical providers, Representative Bryan Terry, MD (R-Murfreesboro) has been working on solutions to improve patient access and care. 

“Health care is always one of the top issues for constituents,” stated Terry, an anesthesiologist and Chairman of the Health Committee of the Tennessee House of Representatives. “When it comes to health care, quality, affordability, and access are the three pillars that need to be addressed.  But the issues are not as simple as some candidates or elected officials blindly opine.  A lack of understanding by many, not just of the industry but of human nature, places patients and communities at risk.  That’s why I’ve been introducing solutions and continue to fight for patients.”

During his tenure in the House, Terry has not only served as the chairman of the Full Health Committee, but also chaired the Health Subcommittee and the Temporary Assistance of Needy Families(TANF) Working Group.  In addition, he has served on the Public Health, Mental Health and Substance Abuse, Facilities, Licensure, and Regulations, TennCare, and Insurance Committees.

Terry’s extensive experience has provided him the opportunity to have a significant impact on health care policy like the TN Together opioid law, Telemedicine, and the TennCare Katie-Beckett Waiver that provides home-based medical needs for children.

Terry points out that over time the health care system has evolved and adapted because of the negative market conditions and regulations, but these changes don’t necessarily address the three pillars of quality, affordability, and access.  The consequences of the changed system have included leakage of revenue producing providers from rural areas and independent medical groups across the state with the end result impacting small practices, hospitals, and patients.

“Tennessee is ranked as one of the best states for providers and we have some nationally ranked facilities for patient care and research.  So overall, Tennessee is satisfying the quality pillar,” explained Terry.  “But the issue is often ensuring affordable access to these providers, particularly in certain pockets of our state.  Since I’ve been elected, Tennessee has 8,000 new physicians, 5,000 new nurse practitioners, and an additional 5,000 licensed hospital beds.  While that is great news, the reality is that because of onerous regulations and narrow insurance networks related to the Affordable Care Act, increased medical practice overhead, and provider reimbursement disparities between rural and urban areas, these recruitment efforts are still facing significant challenges to address access and affordability.”

Terry has offered solutions to address these disparities to promote access and affordability.  Two measures he has offered include the Healthy Adults Opportunity Block Grants(HB 2573) and Anti-predatory contracting legislation (HB 709).  HB 2573 instructed the Department of Commerce and Insurance to research the viability of a Trump Administration program that could help cover uninsured with non-Medicaid insurance via a combination of federal funds along with employer and patient contributions.  The second bill, HB 709 would require fair contracting for providers, particularly in rural areas, if that provider or facility accepts TennCare patients.  This measure would help address the payer mix disparities between urban and rural providers and facilities, and decrease provider leakage.  This would improve access in rural areas while promoting competition in urban areas.

Terry has, also, put forth legislation that would protect patients with pre-existing conditions, as well as address the issue of balance billing.  “In the 1980’s, President Ronald Reagan signed into law the Emergency Treatment and Active Labor Act (EMTALA).  Hospitals and providers were required to treat emergency or laboring patients regardless of their ability to pay, but the law never required insurers to cover those emergency treatments.  Addressing the issue of uncovered emergency treatment would fix 95 percent of balance billing,” explained Terry.  “I’ve offered legislation to protect patients with pre-existing conditions, as it can be addressed at the state level, as well.”

Terry pledged to continue to work on these health care measures.  “As a patient, a provider, and a business owner, I see the various aspects of health care.  It is a complex balance of ensuring quality, affordability and access,” Terry said. “Regardless of the issue, people want solutions. Socialism, and in particular socialized medicine, is not a solution. It’s surrender.”  

“In times like these, qualifications, experience, and trust matter.” – Rep. Bryan Terry, MD

Representative Bryan Terry, MD is a husband and father who represents District 48 guided by  Christian, Constitutional and community oriented principles.  He employees a business-like process to help find solutions to issues and concerns for the district, community, and state.  With a passion for improving the lives, liberty, and livelihoods of Tennesseans, his self governance training makes him an effective advocate and voice for District 48.

While others run on resumes long on empty rhetoric and short on solutions, Rep. Bryan Terry offers an unmatched set of qualifications to meet the diverse needs of District 48.  Beginning with his blue collar, auto salvage roots and family farm background, and extending through his career as a physician and as an Affiliated Associate Professor for UT Graduate Medical Education, Rep. Terry’s experience in a diverse array of fields provides him with a unique perspective on the livelihoods of Tennesseans.  This frame of reference enables him to be a better voice and advocate for Tennessee families.

In addition to his professional background, Rep. Bryan Terry holds the exclusive distinction of being the only Native American tribal member in the Tennessee General Assembly.  He has, also, had to respond to a natural disaster and domestic terrorism when his family farm was hit by an EF-5 tornado and when he worked as an intern for victims of the Oklahoma City bombing.  These life experiences have helped shape his commitment to others while preparing him to be uniquely suited to address the challenges of today.  His commitment is exemplified  by his prime co-sponsorship of legislation like the Racial Profiling Prevention Act and the Right to Farm Act, and his leadership to address drug trafficking.

Rep. Terry has served as the chairman of the Health Committee, as well as the Health Subcommittee chairman, where he has been a strong patient advocate and has worked to find solutions for the opioid crisis, patient access, lowering of prescription drug prices, and patient protections.  He has served on the Insurance, TennCare, Consumer and a Human Resources, Public Health, Mental Health and Substance Abuse, and Civil Justice committees where he has worked on policy to improve the lives and livelihoods of Tennesseans while protecting our liberties.

Being respected by community leaders statewide, Rep. Terry was named to the Temporary Assistance For Needy Families (TANF) working group where he was elected by both Senate and House members to be the chairman to oversee 732 million dollars.  Under his leadership, he helped discover 221 million in improperly used Tennessee taxpayers dollars and helped develop a program entitled “Pathway to Prosperity” which will help needy families develop marketable workforce skills to improve their livelihoods.

Having earned recognition from various groups as a Legislator of the Year, Taxpayer Hero, Family Champion and a Model Public Servant, Rep. Terry has consistently provided District 48 with factual and up-to-date information on taxes, education, health care, the land-fill and more.  He is a voice of reason and trust with endorsements of organizations such as the Tennessee Professional Firefighters Association and the National Federation of Independent Business.

In times like these, qualifications, experience, and trust matter and Representative Bryan Terry, MD is the only candidate with a proven resume to effectively advocate for the shared values of District 48.

NASHVILLE, Tenn. (Aug. 31, 2020) – The NFIB Tennessee PAC, the political action committee of the state’s leading small business advocacy organization, has endorsed State Rep. Bryan Terry, MD (R-Murfreesboro) in the 48^th District State House race. The NFIB Tennessee PAC is comprised exclusively of NFIB members.

“Our members support the candidates who they believe will support small business, and Rep. Terry has shown us that he truly understands the challenges facing Tennessee’s job creators,” said Jim Brown, the National Federation of Independent Business’ state director for Tennessee. “Dr. Terry is committed to creating and maintaining an environment where small businesses can grow and create jobs.”

“I am honored to have secured the support of the NFIB Tennessee PAC as I look to continue serving the citizens of District 48,” said Rep. Terry. “Our small businesses are the backbone of our local and statewide economies, and now more than ever, they need our support. I will never stop fighting for additional resources — both now and once this pandemic subsides — that contribute to their long-term success and future sustainability.”

The NFIB Tennessee PAC endorsement is critical to candidates’ campaigns. Small business owners and their employees vote in high numbers and are known for actively recruiting friends, family members, and acquaintances to go to the polls. NFIB Tennessee PAC’s political support is based on the candidates’ positions and records on small business issues.

To learn more about NFIB in Tennessee, visit www.NFIB.com/TN and follow @NFIB_TN on Twitter.

NASHVILLE, Tenn. – State Rep. Bryan Terry, MD(R-Murfreesboro) called on Governor Lee and the Department of Commerce and Insurance to ensure that the newly unemployed have their surgical health insurance coverage honored because of the moratorium on elective procedures.  Due to an unintended consequence of banning elective procedures, many Tennessee patients may have paid premiums and had valid insurance during the ban, but then they had their surgery delayed.  Now that they are unemployed, they may get stuck with the bill through no fault of their own.  Rep. Terry is working to correct that.

On March 23, Governor Lee issued Executive Order 18 which banned all elective surgeries in Tennessee to conserve personal protective equipment(PPE).  Prior to and during the ban, insurers have been approving elective surgeries through a process called “prior authorization”.  It is a process by which insurers agree to pay for the procedure or surgery of the insured.  While Governor Lee did urge insurers to uphold their coverage commitments to Tennesseans, unfortunately, many Tennesseans have lost their job or their employers have not been able to continue paying premiums.  This means that the insurance policy that was valid prior to or during the ban may no longer be valid.  This situation places patients, providers, and facilities in a bind.

Explained Rep. Terry, “Through no fault of their own, we have newly unemployed individuals who needed surgery and had valid insurance, but now they are in a situation where they are at the mercy and grace of the insurers.  Premiums were paid.  Providers were willing to operate, but the COVID-19 pandemic halted their medical care.  The state needs to ensure that these patients and providers aren’t punished by a government decision.  Those commitments need to be honored.”

Many patients who were scheduled to have necessary, but elective medical or dental procedures before Gov. Bill Lee’s executive order halting all non-emergency procedures may now be left to cancel or pay out of pocket for previously approved procedures unless action is taken to address the issue.  While some insurance companies are offering extensions for these prior authorizations or grace periods to catch up on premiums, there isn’t any guarantee that patients won’t receive a bill or providers won’t be reimbursed.

In a letter to Lee and Hodgen Mainda, Commissioner for the Tennessee Department of Commerce and Insurance, Terry suggested a recoupment moratorium could be put in place for surgeries approved prior to or during the halting of elective surgeries brought through Executive Order 18.  Terry said this would not only help patients, but also hospitals and medical or dental practices that have experienced major financial setbacks as a result of the cancellations and postponements of elective surgical procedures.

“TennCare has frozen their termination process and they are going to honor those commitments to patients.  Private insurance carriers who took the premiums should do the same,” said Terry.  “I understand that Governor Lee urged a grace period and some insurers have said they will comply.  But patients and practices need guarantees during these uncertain times.  They do not need additional financial burdens and hardships when they are complying with Executive Orders.”

Terry said that he is working with Commissioner Mainda, Speaker Cameron Sexton (R-Crossville), and Insurance Chairman Robin Smith (R-Hixson) on the issue and has offered guidance and solutions.  “With over 400,000 newly unemployed, as well as businesses that need time to catch back up after they reopen, the state doesn’t know how big of a problem that this is.  With the state reopening elective surgery on May 1st, time is of the essence and this issue needs to be addressed properly and expeditiously by the state.”

Rep. Bryan Terry, MD represents District 48 which is the eastern half of Rutherford County.  His office can be contacted at 615-741-2180 or Rep.Bryan.Terry@Capitol.Tn.Gov 

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