NEWS

COVID19 Update: Taxes, School Closures, Unemployment, Healthcare Licenses, Real ID, More

March 27, 2020 By Admin

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

Governor Bill Lee provided an update on Tennessee’s efforts regarding COVID-19 relief.

Gov. Lee’s daily press conferences can be viewed live each day this week at 3 p.m. CDT here. Gov. Lee has also established a website specific to COVID-19 updates which can be found here.

Key Updates

COVID-19 Unified Command

On March 23, Tennessee Governor Bill Lee established the COVID-19 Unified Command, a joint effort to be led by Commissioner Stuart McWhorter, to streamline coordination across the Tennessee Emergency Management Agency (TEMA), Tennessee Department of Health and Tennessee Department of Military. This group launched a website today which includes helpful resources, FAQs, and local and global data related to COVID-19.

Public Service Announcement Campaign

Today, the State of Tennessee launched a public service announcement campaign that urges all Tennesseans to adopt preventive health measures to slow the spread of coronavirus. “Do your part, stay apart” features Governor Bill Lee, First Lady Maria Lee and dozens of music artists, athletes and sports organizations who collectively reach millions of Tennesseans. View Governor and First Lady’s video here. Additional information can be found here.

Administration Actions

Unemployment

Tennessee is experiencing an unprecedented number of unemployment claims through the Department of Labor & Workforce Development. Since last week, Tennessee has received 39,096 claims and counting compared to 2,702 the week prior, a 1,300% spike in unemployment.

The state is spearheading a public-private partnership with the Tennessee Grocers and Convenience Store Association, Tennessee Retail Association, and Hospitality TN to create the Tennessee Talent Exchange powered by Jobs4TN.gov.

The goal of the exchange is to quickly match Tennesseans who are out of work due to COVID-19 with companies currently experiencing a surge in business and making immediate hires. The Department of Labor & Workforce Development has modified the state’s workforce development website to quickly post job openings and match job seekers with employers. Additional information can be found here.

Executive Order 20

Today, Gov. Lee signed Executive Order 20 to ensure Tennessee can further mobilize health care workers to fight COVID-19.

The executive order accomplishes the below actions, among others:

· Loosens restrictions around retired medical professionals to help get qualified individuals back in the workforce.

· Temporarily suspends continuing education requirements so professionals can continue working through the pandemic.

· Calls for the availability of phone assessments for individuals with mental illness or emotional disturbances.

· Expands telemedicine efforts so that all licensed providers may utilize telemedicine during COVID-19 as long as they are practicing within their normal scope of practice.

Wednesday, March 25, 2020 | 05:00pm

Governor Bill Lee provided an update on Tennessee’s efforts regarding COVID-19 relief.

Gov. Lee’s daily press conferences can be viewed live each day this week at 3 p.m. CDT here. Gov. Lee has also established a website specific to COVID-19 updates which can be found here.

Key Updates

Tornado Disaster Recovery

FEMA has approved Tennessee’s disaster declaration for the remaining counties. All affected counties are now covered: Benton, Carroll, Davidson, Putnam, Smith and Wilson. Additional information can be found here.

Administration Actions

CDC Funding

The CDC has pledged $10 million for Tennessee’s efforts to fight COVID-19. Tennessee has purchased additional testing capacity and supplies per guidance from the CDC.

In looking at the testing response of other states, Tennessee continues to be a proportional leader compared to states much larger in the region.

Child Care and Human Services

The Department of Human Services has deployed on the $10 million emergency response and recovery grants for existing child care facilities. A church, gym, or non-profit can open an emergency temporary child care facility by registering with the Department of Human Services. Additional information can be found here.

Gov. Lee has directed the Department of Human Services to personally reach out to each existing child care facility in the state to help organizations secure supplies.

Tuesday, March 24, 2020 | 06:00pm

Governor Bill Lee provided an update on Tennessee’s efforts around COVID-19 relief.

Gov. Lee’s daily press conferences can be viewed live each day this week at 3 p.m. CDT here. Gov. Lee has also established a website specific to COVID-19 updates which can be found here.

Key Updates

National Guard Mobilization

Gov. Lee has mobilized the National Guard to assist with expanded testing efforts. 250 personnel, including 150 medical personnel, are preparing to assist 35 remote assessment facilities in rural areas.

State Employee Workforce

State employees who are currently working from home within the Alternative Workplace Solutions program (AWS) should remain working from home until April 24.

School Closures and Educational Resources

Gov. Lee extended statewide school closure to April 24, 2020.
The Department of Education has secured a partnership with PBS to offer instructional content on television while students are at home.

Administration Actions

Franchise & Excise Tax Deadline Extended

The filing deadline for franchise and excise taxes has been delayed until July 15, 2020. Taxpayers will have until July 15 to file returns and make any payments, including quarterly estimated payments, originally due in April. Additional information can be found here.

Real ID and Emissions Testing

Drivers Services has suspended issuing REAL ID through May 18, 2020 as the federal government waived the deadline for REAL ID.
Emissions testing requirements have also been waived through May 18, 2020.
Additional information can be found in the governor’s executive order here.

Utilities

The Attorney General, in consultation with the Lee Administration, has filed an emergency petition asking the Tennessee Public Utility Commission to prohibit utilities from disconnecting service for non-payment during the state of emergency. More information can be found here.

Insurance Premiums

Gov. Lee has directed the Department of Commerce and Insurance to issue guidance to insurance providers requesting as much flexibility as possible for employers and individuals during this crisis. Additional information can be found here.

Rep. Bryan Terry: Clinical Cannabis-Research & Medicinal Developments

March 3, 2020 By Admin

As the world embraces the benefits and science surrounding cannabis based treatments, Tennessee patients look to our General Assembly with the hope that they, too, could utilize the medicinal properties in the chemicals in cannabis. Chairman Bryan Terry, MD (R-Murfreesboro) has filed The Clinical Cannabis Authorization and Research Act which provides such a pathway for Tennesseans. The Act would allow Tennesseans, under medical direction, to participate in a statewide clinical cannabis program where the foundation is formed by medical research and patient safety.

From its seeds, to the whole plant, to the chemicals extracted from the plant, cannabis has been utilized for medicinal purposes for centuries amongst various cultures. The World Health Organization referenced the evidence based medical research available on cannabis to state that cannabis does, in fact, have medicinal value, and recommended removing the restrictive classification of cannabis in order to promote more research and development of cannabis based treatments. Today, over two thirds of the states in America recognize the clinical value of cannabis and have exerted their 10th Amendment rights to help patients by providing them an alternative to the black market. Yet, Tennessee continues to languish in draconian policy by denying Tennesseans the ability to participate in research and development of cannabis based treatments, as well as prohibiting patients from their right to determine their own health care decisions. The Clinical Cannabis Authorization and Research Act looks to change all that.

“The World Health Organization, Federal judges, and a multitude of scientists, researchers, and medical professionals, to name a few, have opined about the medicinal value of the chemicals in cannabis,” stated Terry. “Unfortunately, outdated laws and unconstitutional treaties relying on erroneous information brought forth a prohibition of cannabis on all uses, including medical treatments and research. States are correcting this injustice across the nation and standing up for patients. It’s time Tennessee does so, as well.”

Tennessee is currently ranked third in the nation in an illicit marijuana market behind California and Kentucky. Much of the black market is generated by legitimate patients who, in looking for alternative treatments for things like chronic pain or other debilitating diseases, put their lives and livelihood at risk in search of relief. Other Tennessee patients, who could benefit, but do not go to the black market, either continue to suffer or look for relief in another state. The bill, as it is drafted, decriminalizes patients by offering a clinical pathway whereby patients can enroll in a clinical cannabis program that includes research and use of non-smokable cannabis based modalities under medical supervision. Once passed, having a safe alternative for patients should decrease the demand on the black market.

“Criminal justice reform is a big issue coming from the administration and on the national level. It is my belief that most elected officials do not want to criminalize patients, and this bill is a positive step towards reforming an archaic and cruel system that harms patients,” explained Terry. “If we, as a state, are going to be serious about criminal justice reform, we need to ensure that we are sending criminals to jail and not patients.”

The Clinical Cannabis Authorization and Research Act authorizes medical treatments in the form of oils, pills, breathing treatments, patches, creams, and known medical modalities. It explicitly prohibits recreational forms of cannabis including smoking, vaping, candies, or anything marketed towards children. Cannabis flower, which is the portion of the plant most known for being smokable, is only allowed for utilization in extracting the chemicals to make the medicines. The bill does not allow for the raw flower to be sold.

In addition to focusing on extract only medical modalities, the bill bases its safety and decriminalization regulations on current science and criminal statutes. Dosage and possession monthly limits of non-flower THC containing medical modalities mirror those of known medical standards and Tennessee statutes. One half ounce of cannabis flower on the black market may contain up to 2800 mg of THC which correlates to some off-label uses of lab made THC medicines. If purchased on the street, that amount of flower may last a patient a month, but it, also, carries the risk of a simple possession charge which is a Class A misdemeanor. In essence, the bill decriminalizes the possession of non-smokable, non-recreational cannabis based medicines for patients that enter the medical and research based program.

“Having spoken with many legislators including legislators from other states that have reformed medical cannabis, patients, medical providers, and researching the science, I’m convinced that we have developed a program that is beneficial for Tennessee patients and can pass our General Assembly,” concluded Terry.

HB 2454 is scheduled to be presented on Tuesday, March 3 in the Facilities, Licensure, and Regulations Committee.

Rep. Terry Continues to Fight for Students with Academic Freedom Act

March 1, 2020 By Admin

Informally known as the “Academic Freedom Act”, HB 2438, proposed by State Rep. Bryan Terry, MD (R-Murfreesboro), seeks to provide students with an avenue to address grievances related to free speech violations in the classroom. Even with the Campus Free Speech Protection Act, co-sponsored by Terry in 2017, students still feel as though their free speech is restricted, fearing that their grades or treatment in the classroom by professors may be impacted if they voice their true opinion. The bill aims to resolve these concerns.

Known as a champion for students, Terry has taken up the issue on behalf of both high school
and college students through previous pieces of legislation and initiatives. In the past, Terry has
sponsored the Right to Try Act for Central Magnet School students and the Racial Profiling Prevention Act on behalf of MTSU students. And when the voting rights of Tennessee college students were being stripped, Terry was the legislator who answered the call. When students shared concerns over repercussions they experienced when voicing their opinion in class or on an assignment Terry stepped up for students.

“One of the main reasons I ran for office is to make a positive difference in our state for the future of my children and their generation. When these issues arise, I look to help them take a stand,” Terry said. “With the cost of college and the other stressors in life, our students shouldn’t have to be on guard and feel intimidated in a classroom about their political beliefs.”

A 2018 survey published on behalf of Yale University’s William F. Buckley, Jr. Program found that 53 percent of students felt intimidated to share their ideas, opinions, or beliefs in class if they were different than those expressed by their professors. Additionally, the survey found that 52 percent of students felt their professors used class time to express their own political or social views not related to course content.

“When I talk to Tennessee students, they echo the same concerns found in the Yale survey. It can be difficult to speak up in class or even find the right words when writing a paper,” Terry said. “But when one has to be concerned about offending their professor and risk getting alower grade, that is an unhealthy learning environment,” explained Terry. “In the end, if a student receives a lower grade based on their expressed beliefs, that is discrimination.”

Though Tennessee enacted the Campus Free Speech Protection Act in 2017, that act did not put forth any specific enforcement in the event that a student faced discrimination in their coursework for expressing a political view. The “Academic Freedom Act” amends current statute to allow students a remedy if they face discrimination for their views in the form of a cause of action against the offending institution.

“Proving discrimination occurred against a student who expressed a political opinion is a high bar to attain. But if the discrimination occurs and negatively impacts a student and their life trajectory, the institution should be held accountable. This bill does just that,” concluded Terry. HB 2438 has been placed on notice in the Higher Education Subcommittee. 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

Rep. Bryan Terry’s Take: The TANF Issue

February 19, 2020 By Admin

A few months ago, it was discovered that Tennessee had accumulated $732 million in a Temporary Assistance for Needy Families(TANF) reserve fund available for utilization by the state in the form of a recoupment grant. These are federal funds that the state has available to use in a fiscally responsible manner to assist Tennesseans under certain circumstances. As the TANF process is in the form of recoupment, the state must first spend state funds within certain parameters under federal guidelines, then get reimbursed from the federal government.

As a background, Tennessee is eligible for $191 million in TANF recoupment funding each year. However, one must understand that in order for Tennessee to be eligible for the $191 million in TANF recoupment grant funding, the state must first spend a “Maintenance of Effort”(MOE) amount which is roughly $88 million in state funds. Once Tennessee has spent the MOE, additional state dollars spent on TANF may be recouped from the $191 million.

Unappropriated and non-recouped dollars from the annual allotment go into a reserve dedicated to Tennessee. Though our state has utilized TANF funds to assist needy Tennesseans, the unused portion has grown while Tennessee has been only using about a third of what is available. Over time, the reserve has built up to $732 million. The growth of the reserve led to the concern that the Tennessee Department of Human Services(TDHS) wasn’t utilizing the funds in an effective manner for Tennesseans.

With this concern in mind, Speaker Cameron Sexton appointed me to serve on a joint bipartisan and bicameral TANF Working Group to look into the issue. I was subsequently elected to chair the group. Goals set forth for the TANF Working Group included providing an action plan of recommendations for the utilization and distribution of the TANF funds in a fiscally responsible manner. Other goals included improving communication between TDHS, the administration and the legislature as it relates to feedback about the fiscal accountability and effectiveness of the program.

We began investigating what had transpired to bring about such a large reserve and had the Tennessee Comptroller of the Treasury office open an inquiry into the funding. Though on the surface the issue sounded fairly simple, as we began to investigate, we discovered multiple layers of complexity leading to a much more elaborate situation. What we have learned thus far is eye opening and an opportunity for Tennessee to make some positive changes.

First, Tennessee spent state funds above the MOE to the tune of $221 million dollars. It’s a common practice for states to spend above the MOE to bypass certain federal regulations or avoid fines. However, if the state meets all the regulations and thresholds, recouping the funds should be a priority. Unfortunately, it appears as if Tennessee did not recoup the overspent state dollars. At this point, it is unclear as to whether Tennessee can recoup the overspent state funds or if so, how much could be recouped. Our TANF Working Group has made this a priority step for DHS.

Second, as the economy improved, the TANF rolls dropped from around 61,000 Tennesseans to approximately 21,000. Though Tennessee increased the cash assistance benefit amount, more and more of the $191 million per year was not utilized. Adequate processes were not in place to ensure that all state dollars were recouped, and the process in place to explore fiscally responsible alternative uses for TANF funds was lacking. Additionally, functional communication to the General Assembly concerning the growth of the unused funds was missing. Instead, the reserve continued to accumulate to $732 million.

Legislators, constituents, and most importantly, taxpayers have a right to be irate and begs the question “If this is occurring in one department, what is going on in the others?” The good news is that our Working Group, which was bipartisan and bicameral, functioned in a productive manner. We investigated the issue and put forth initial recommendations for corrective action by DHS, which included recouping Tennessee taxpayer money, changing the culture and processes of the department, and improving communication between the department and the legislature.

One of our recommendations was to open a spring enrollment for 2Gen grant applications with a ceiling on the total grant amount, a priority list for utilization, and a process for reporting back to our group. The grant application process opened this week and can be accessed at the Tennessee Department of Human Services website.

Understanding that citizens often mistrust government is one of the reasons why I ran for office. I’ll continue doing my part by holding government accountable and working to ensure our tax dollars are utilized effectively.

Rep. Bryan Terry Rated Among Most Conservative In Tennessee

January 27, 2020 By Admin

Representative Bryan Terry, MD (R-Murfreesboro) earned the Award for Conservative Excellence, the top designation from the American Conservative Union(ACU) which was
published this past week. He has been invited to the Conservative Political Action Conference (CPAC) annual meeting to be held in National Harbor, Maryland to accept the award.

“Whether it is standing for the sanctity of life, our Second Amendment rights, our liberties, or sound fiscally conservative policy that enhances our economy, I’m honored to be recognized for
taking the concerns of District 48 to Nashville and producing positive results,” stated Rep. Terry.

The honor from the ACU follows previous recognition Rep. Terry received for his legislative
efforts by Club for Growth and the TN Legislative Report Card. With Club for Growth, Rep.
Terry’s score ranked second amongst all legislators including both House and Senate members.
Whereas, with TN Legislative Report Card, Rep. Terry was named a “model public servant”.

“I appreciate the awareness these various groups bring forth by recognizing the efforts, work,
and results many legislators put forward. Helping citizens be informed is of vital importance, but
in the end, what really matters is the opinion of the constituency,” explained Rep. Terry. “I’ll
continue to value the faith that our community places in me and I’ll keep working for the
betterment of our district and the state of Tennessee.”

Rep. Terry represents District 48 which is the eastern half of Rutherford County. He serves as
the Chairman of the House Health Committee and serves on the Insurance and Calendar and
Rules committees. He, also, serves on the TennCare, Mental Health and Substance Abuse,
Public Health, and Facilities, Licensure, and Regulations subcommittees.

What to expect in 2020 legislative session- refugees, cannabis, healthcare, taxes & more

January 13, 2020 By Admin

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.

Bryan Terry Invites Michael J. Fox to Testify On Cannabis Research

December 4, 2019 By Admin

Chairman Bryan Terry Invites Michael J. Fox to Tennessee to Testify About Cannabis Research — ***Chairman Bryan Terry Invites Michael J. Fox to Tennessee to Testify***
***About Cannabis Research***

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.

Rep. Bryan Terry Publishes 3 Part Series on Opioid Crisis

October 29, 2019 By Admin

The opioid crisis is a complex issue impacting Tennesseans of all demographics. Most recently, I opined on the issue in a three part series discussing the supply and demand of opioids including what steps have been taken at the state and where we need to go from here.

Please, follow the links to the articles and feel free to provide me any feedback at BryanTerry4TN@gmail.com

Part 1 Introduction:

The Supply and Demand of Opioids: An Intricate Dynamic

Part 2 Supply:

The Supply and Demand of Opioids: Tackling the Supply Problem

Part 3 Demand:

The Supply and Demand of Opioids: Tackling the Demand Problem

Rep. Terry Talks Block Grants

October 1, 2019 By Admin

The Lee Administration has proposed an innovative, hybrid block grant solution to better address the unique needs of citizens who utilize TennCare for access to quality healthcare. The proposal is currently under a public comment period.

As a background, TennCare is a 12.7 billion dollar program where there is a 65/35 split in federal/state funding. The federal government provides 65% of the funds and the state supplies the other 35% via a required state match. If enrollment increases, the state must increase spending to meet the funding for additional patients unless the state/MCO’s decrease payment rates to providers and hospitals.

Of note, MediCare often doesn’t pay providers or hospitals the amount necessary to even meet the cost of providing the care to those patients. TennCare, which is Medicaid, pays providers and hospitals significantly less than Medicare, sometimes even 40-60% less. TennCare’s motto promotes high quality, cost efficient care. Providers and hospitals provide TennCare patients the same care as privately insured patients, but, often, at a financial loss. It is because of the low reimbursements from TennCare that the third leg of the health care stool-access- suffers.

In order for providers to keep their medical practices open, they must have a positive payer mix. TennCare, for the most part, does not improve a provider’s payer mix; thus, expanding TennCare in any traditional sense isn’t going to improve a payer mix nor improve access. In order to stay afloat, many providers have to limit the number of TennCare patients that they can or will see. More patients without an improvement in reimbursement isn’t going to change the number of TennCare patients that a provider can see.

While the TennCare program is 12.7 billion dollars, Tennessee is currently 6.8 BILLION under our waiver cap. That means that TennCare saves the government 6.8 billion dollars a year(roughly 4.4 federal and 2.4 state). The state receives “credit” for about 1/4 of that when they look at our waiver. So, one way of looking at TennCare’s efficiency is that the state saves federal and state taxpayers 6.8 billion dollars a year. The other way of looking at it is that TennCare has been underpaying hospitals and providers significantly since its inception-roughly $54 billion alone over the last decade.

The hybrid block grant proposal aims to leverage Tennessee’s efficiency into receiving a portion of the saved federal dollars via a mechanism called “shared savings”. If Tennessee saves the federal government two billion, then we should receive half of that in the form of funding without burdening Tennessee taxpayers with an additional match of 35%. The hybrid proposal, also, has safeguards for Tennessee in that if our enrollment numbers increase, our block grant will increase, as well. Additionally, it includes a yearly increase to keep up with inflation or growth.

The current federal system of Medicaid rewards states that overtax and overgrow their Medicaid system while punishing states like Tennessee that are efficient. A proposal that rewards fiscal soundness and conservativeness should be promoted, not punished. In a world where government waste and taxpayer abuse runs rampant, a proposal that protects taxpayers while ensuring constituent services are protected should be applauded.

Of course, the devil is in the details. If Tennessee is granted the funds, but expands services or enrollees without addressing the payment disparity, especially amongst rural providers, the block grant will not be addressing the third leg of health care which is access. Any proposal that does not look to improve payments to hospitals and providers who take a disproportionate number of TennCare patients, particularly in rural areas, will be missing an opportunity to better serve Tennesseans.

That being said, I find it ironic that most of those who advance the idea of Medicaid expansion never look to address the access problem current TennCare recipients have. They just speak about expanding the rolls without regards to the stress on the system due to the payment disparities that lead to poor payer mixes and restricted available appointments. Expanding rolls without first addressing the underlying problems does not benefit current recipients nor does it protect taxpayers.

A hybrid block grant, if constructed the correct way, has the potential to help address the payment problems that plague rural providers while, also, helping improve access for current recipients. If Tennessee can accomplish those goals while protecting Tennessee taxpayers, shouldn’t that option be seriously considered?

I’ve attached an article that discusses the block grant proposal, as well as some of the stakeholder’s comments.

From the article:

“The Lee administration argues TennCare’s managed care approach has already led to an estimated $2 billion in annual cost savings for Uncle Sam over what a traditional fee-for-service Medicaid program would cost the federal government.

So Lee hopes to negotiate a 50/50 split on those and additional cost savings in which the state could reap as much as $1 billion, which Lee hopes to plow into improving rural health care and other initiatives.”

Rep. Bryan Terry: Intricate Dynamic of Opioid Supply & Demand

September 22, 2019 By Admin

Much has been opined about the opioid crisis including what caused it, whose fault is it, and what can be done about it. Across the country, opioid related overdose deaths deceased four percent. Yet, Tennessee’s rate of overdoses continues to climb despite measures taken at the state level.

While many of the measures I have advocated for have passed, some of the more vital measures have not. The opioid crisis is a multifaceted problem with many intertwined and complicated parts. Unfortunately, many have a myopic view of the issue while others are just looking to do something for the sake of claiming they did something. Add in that many are advocating for seemingly unrelated issues, and it is easier to understand why this epidemic is a difficult problem to solve.

Understanding the supply and demand dynamics of the opioid crisis can help us find solutions, but it requires those looking for solutions to have open minds and a willingness to step away from failed strategies. To appreciate the supply and demand dynamics of opioids, one must first understand that there is both a legitimate and illicit demand for and supply of opioids.

Legitimate demand comes in the form of patients. Whether it is an acute injury like a broken bone, a perioperative need either before, during, or after surgery, or chronic pain associated with conditions like cancer, failed surgery, or a nerve injury, there is a consistent and endless market for the use of opioids. And while there are new drugs reaching the market all the time, until one becomes as effective in alleviating pain while minimizing side effects, the demand for opioids will continue.

Ironically, another legitimate demand from patients is that from one that is addicted to opioids. Patients who are addicted to heroin, fentanyl, or another opioid often undergo treatment in which methadone — another opioid — is often substituted. Buprenorphine, an agonist that produces opioid effects and an antagonist that blocks certain opioid effects is frequently used for treatment as well.

Illicit demand comes in several forms. Obviously, the most common cases involve those who are addicted to opioids. The process usually begins with initial use that may lead to tolerance, then to dependency and finally addiction. It may start as a legitimate patient who progresses to addiction or addiction that develops via recreational usage. Regardless of the route taken, addiction drives much of the illicit demand.

Another form of illicit demand includes those looking for a recreational use. Whether it is in the form of a party or one looking for a route of escape from reality or a psychological, physical, or emotional trauma, there are those who turn to opioids, which increases demand for the deadly drugs.

Perhaps, one of the more unfortunate illicit demands for opioids is from legitimate patients who have a physical need, but are under treated or mistreated by the system. Some patients in chronic pain or with cancer pain may look to alcohol, marijuana, or street opioids in order to function normally.

As physicians and as legislators, treating patients with a legitimate need for an opioid while preventing or decreasing the illicit demand is where many efforts need to be addressed. Decreasing the risk for patients to get on the on ramp to addiction is vitally important; it is just as important to prevent those who have gotten off the addiction highway from getting back on by ensuring there is proper addiction treatment available.

The supply side also has a legitimate and an illicit aspect. Legitimate supply comes in the form of a prescription from a medical related need by a patient. Opioids are supplied via a doctor, pharmacy, or hospital. Real patients with legitimate needs delivered in a safe, and effective manner drives much of the supply side of opioids.

Unfortunately, the legitimate supply side has been contaminated by the government, big pharma, and unscrupulous providers leading to an oversupply of unnecessary opioids into the marketplace. The government, by making pain the fifth vital sign, tying Medicare payments to patient satisfaction surveys, and instituting laws like the Intractable Pain Treatment Act didn’t just incentivize prescribing opioids, they mandated it. Big Pharma pushed controlled release opioids like OxyContin as a safer alternative, and many providers abused the new medical landscape placing pain profit over patients.

The illicit supply side of opioids involves two main sources: diversion or the selling or distribution of FDA approved opioids, as well as the trafficking of illicitly manufactured opioids. Unused prescription opioids and addiction treatment opioids are being sold on our streets or used in a recreational setting, and it has been a major concern in their illicit supply.

While appropriate and inappropriate uses of FDA approved opioids are a major concern, especially when mixed with other drugs, it is the trafficking of illicit opioids like heroin, fentanyl, and carfentanil that should scare people. As an anesthesiologist, I treat patients with fentanyl almost every day. For its indicated use and under the right medical direction, it is a valuable tool. However, when traffickers can possess millions of lethal doses and push it into our communities, it becomes a major health concern. To make matters worse, many of these illicit opioids are being manufactured in China and wind up in our communities through Mexico.

As one can see, the supply and demand side of the opioid equation is quite intricate. If we truly want to be able to address this complex issue, focusing on one aspect while avoiding or neglecting the others will ultimately lead to failure. It is going to take a multifaceted approach with a willingness to attack all sides of the supply and demand equation to get Tennessee on the pathway to a better tomorrow.

Bryan Terry, MD (R-Murfreesboro) is the Chairman of the Tennessee House Health Committee. This is Part One of a two part series on Opioids: Supply and Demand.