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Hi All,
 
I've been working with a guy named Bob Smiddie, he is from Ohio, who has helped me write a single-payer plan for Tennessee.  Below is the letter I sent it to state Senator Roy Herron and state Rep. Tidwell.  If we can get the tax portion vetted by legislative services I want to ask them to sponsor the bill. 
This was one of my campaign promises. :-)
 
Howard Switzer
 
 
 
Dear Representative Tidwell,
 
Thank you for your support of policy that generally makes good sense.
 
You may remember me, I live here in Perry County and write letters often.
 
I am writing you because during my recent run for Governor, as a Green, I found a lot of support out there for a single-payer health insurance system.  I even went to a forum on healthcare at Vanderbilt University where a panel of 6 experts in the field, doctors, nurses, health facility administrators etc. unanimously concluded that implementing a single-payer system was our best chance of solving the multitude of problems facing our healthcare system, not the least of which is access.  They also noted that our adversary in doing that is the profiteering healthcare insurance industry itself.  People have begun to notice that the profits posted by the industry come directly from their healthcare dollar.  It is time we demonstrated some serious compassion.
 
Here is a plan that I have put together for your kind consideration.  It is posted below and attached as a Word file.  I would like to see the funding mechanism, the tax portion in Section 28, reviewed by legislative services to see if it is sufficient.  Please note I may have some of the page numbers in Tennessee law wrong.  I hope they can correct that for us.
 
I think we also should talk a little bit about how the State Board would be put together.  Since I don't know at this time exactly how the county director of health gets his or her job - I went ahead and said all the elected county officials would select the members of the advisory board for the region.    And the Advisory board would select the two state board members for the region.  This of course should be modified to fit our current structure if possible.
 
The number of uninsured Tennesseans rose dramatically in 2006 with our governors cuts in TennCare.  Lack of health insurance coverage is now the sixth-leading cause of death for adults between the ages of 25 to 64 in Tennessee.  Please give this important plan serious consideration.  If you have questions about a single-payer system and wonder what is myth and what is fact please check out this link by Physicians for a National Healthcare Plan: http://www.pnhp.org/facts/singlepayer_myths_singlepayer_facts.php
 
Please let me know what you think of this plan and when you can turn it into legislative services.
 
thank you very much,
 
Howard Switzer
931-589-6513
 
 

TENNESSEE SINGLE PAYER HEALTH INSURANCE PROGRAM   (DRAFT)

 

 

Sec.  1. As used in this chapter:

 

                (A) "Blind trust" means an independently managed trust in which the beneficiary has no management rights and in which the beneficiary is not given notice of alterations in or other dispositions of the stock, mutual funds, or other property subject to the trust.

 

                (B) "Health care facility" means any facility, except a health care practitioner's office, that provides preventive,

diagnostic, therapeutic, acute convalescent, rehabilitation, mental health, mental retardation, intermediate care, or skilled nursing services.

 

                (C) "Provider" means a hospital or other health care facility, and physicians, podiatrists, dentists, pharmacists,

chiropractors, and other health care personnel, licensed, certified, accredited, or otherwise authorized in this state to furnish health care services.

 

                Sec.  2. (A)(1) There is hereby created the Tennessee health care plan, which shall be administered by the Tennessee health care agency under the direction of the Tennessee health care board.

 

                (2) The Tennessee health care plan shall provide universal and affordable health care coverage for all Tennessee residents, consisting of a comprehensive benefit package that includes benefits for prescription drugs. The Tennessee health care plan shall work simultaneously to control health care costs, control health care spending, achieve measurable improvement in health care outcomes, increase all parties' satisfaction with the health care system, implement policies that strengthen and improve culturally and linguistically sensitive care, and develop an integrated health care database to support health care planning.

 

                (B) There is hereby created the Tennessee health care agency. The Tennessee health care agency shall administer the Tennessee health care plan and is the sole agency authorized to accept applicable grants-in-aid from the federal and state government, using the funds in order to secure full compliance with provisions of state and federal law and to carry out the purposes of sections - to - of the Revised Code. All grants-in-aid accepted by the Tennessee health care agency shall be deposited into the Tennessee health care fund established under section  -  of the Revised Code.

 

                Sections 101.82 to 101.87 of the Revised Code do not apply to the Tennessee health care agency.

 

                Sec. 3. (A) There is hereby created the Tennessee health care board. The Tennessee health care board shall consist of fifteen voting members, consisting of the director of health and fourteen members elected in accordance with this section.

 

                (B) For purposes of representation on the Tennessee health care board, the state shall be divided into seven regions each composed of designated counties as follows:

 

                (1) Region 1: Lake, Obion, Weakley, Henry, Dyer, Gibson, Lauderdale, Crockett, Madison, Carroll, Benton, Tipton, Haywood, Henderson, Decatur, Shelby, Fayette, Hardeman, McNairy, Wardin;

 

                (2) Region 2:  Perry, Hickman, Lewis, Maury, Marshall, Bedford, Coffee, Wayne, Lawrence, Giles, Lincoln, Moore;

 

                (3) Region 3: Stewart, Montgomery, Robertson, Sumner, Houston, Cheatham, Davidson, Trousdale, Humphreys, Dickson, Williamsom, Rutherford, Wilson;

 

                (4) Region 4:  Franklin, Grundy, Sequatchie, Bledsoe, Rhea, Meigs, Marion, Hamilton, Bradley, McMinn, Polk;

 

                (5) Region 5: Macon, Clay, Pickett, Smith, Jackson, Overton, Fentress, Putnam, DeKalb, White, Cumberland, Cannon, Warren, Van Buren;

 

                (6) Region 6: Scott, Campbell, Claiborne, Morgan, Anderson, Union, Grainger, Roane, Knox, Jefferson, Hambien, Monroe, Louden, Blount, Sevier, Cocke;

                (7) Region 7: Carter, Johnson, Washington, Sullivan, Hawkins, Hancock, Greene, Johnson.

 

                (C)(1) The county commissioners of each county in the state of  Tennessee shall call a meeting of all elected county officials of their county within 90 days following the effective date of this section.

                (2.) At the meetings called pursuant to division (C) (1) of this section the county officials shall elect one resident from their county to represent the county on a regional health advisory committee established for the region.  The county officials of the most populous county within each region shall also set a date, not sooner than one hundred days and not later then one hundred and ten days after the effective date of this section, for the intial meeting of the regional advisory committee.

                (3) Following the initial meetings called pursuant to division (C) (1) of this section the elected county officials of their county shall convene a meeting every two years to elect representatives to the regional health advisory committee in accordance with this division.  Each biennial meeting shall be held within five days of the same day of the same month as in initial meeting. 

(4) Each representative elected under this division shall hold office for two years, starting on the date of the representative's election. Any individual appointed to fill a vacancy occurring prior to the expiration of the term for which a representative is elected shall hold office for the remainder of the predecessor's term.

 

                (D)(1) Each of the seven regional health advisory committees shall elect a chairperson from among the representatives to their committees. Each chairperson shall convene and preside over the initial meeting of that regional health advisory committee on the date set pursuant to division (C) of this section. At the initial meeting of the regional health advisory committees, the committees' representatives shall elect two residents from the region to represent that region as members of the Tennessee health care board. One of the two residents elected from each region to serve on the Tennessee health care board shall be a resident of the region's most populous county and the other shall be a resident of any county in the region other than the region's most populous county.

               

                Except for the elections to the Tennessee health care board at the initial meeting of each regional health advisory committee, each resident elected to the board shall be elected to a two-year term of office. At the initial meeting, the resident from the most populous county in the region shall be elected to a term of three years.

 

                (2) Annually, beginning in the second year following the initial elections to the Tennessee health care board, the chairperson of each regional health advisory committee shall convene a meeting within five calendar days of the same date of the same month as the initial meeting of that regional health advisory committee to elect a resident from the region to serve as a member of the Tennessee health care board. The regional health advisory committee shall elect a resident of a county as is necessary to meet the representation requirements set by division (D)(1) of this section. No individual may serve as a member of the Tennessee health care board for more than four consecutive terms.

 

                (3) In addition to meeting for the election of Tennessee health care board members, the regional health advisory committees shall meet as necessary to fulfill any functions and responsibilities assigned to them under sections 1 to - of the Revised Code. Meetings shall be held at the call of the chairperson and as may be provided by procedures adopted by the regional health advisory committee.

 

                (4) In addition to the fourteen members of the Tennessee health care board elected by the seven regional health advisory committees, the state director of health shall be a voting ex officio member of the Tennessee health care board.

 

                (E)(1) The director of health shall set the time, place, and date for the initial meeting of the Tennessee health care board and shall preside over the Tennessee health care board's initial meeting. The initial meeting shall be set not sooner than one hundred fifteen days and not later than one hundred twenty-five days after the effective date of this section.

 

                (2) The members of the Tennessee health care board annually shall elect a member of the board to serve as chairperson at meetings of the board. Meetings shall be held upon the call of the chairperson and as provided by procedures prescribed by the Tennessee health care board. Two-thirds of the members of the Tennessee health care board shall constitute a quorum for the conduct of business at meetings of the board. Decisions at meetings of the Tennessee health care board shall be reached by majority vote.

 

                (3) All meetings of the Tennessee health care board are open to the public unless questions of patient confidentiality arise. The Tennessee health care board may go into closed executive session with regard to issues related to confidential patient information. The fourteen  members of the Tennessee health care board elected by the seven regions shall receive an annual salary and benefits established by the general assembly.

                               

                (F) The seven regional health advisory committees shall act as advisory bodies to the Tennessee health care board, representing their individual regions. The regional health advisory committees shall oversee the management of consumer and provider complaints originating in their respective regions and shall hold a hearing on all such complaints. The regional health advisory committees shall offer assistance to resolve consumer and provider disputes and shall seek the agreement of all parties to the dispute to submit the dispute to negotiation or binding arbitration. A regional health advisory committee shall transfer any dispute that is not resolved at the regional level to the director of the Tennessee health care agency's department of consumer affairs within six months; however, the committee may vote to transfer individual disputes at an earlier date.

 

                (G)(1) If a vacancy occurs on the Tennessee health care board for any reason, resulting in a region being without full representation on the board, that region's health advisory committee shall elect a resident of that region to fill the vacancy. Any resident elected to fill a vacancy shall serve the remainder of the departing member's term. The health advisory committee shall elect a resident of a county as necessary to meet the representation requirements set by division (D)(1) of this section.

 

                (2) A serving member of the Tennessee health care board shall continue to serve following the expiration of their term until a successor takes office or a period of ninety days has elapsed, whichever occurs first.

 

                (H)(1) Members of the Tennessee health care board and employees of the Tennessee health care agency, and their immediate families, are prohibited from having any pecuniary interest in any business with a contract, or in negotiation for a contract, with either the Tennessee health care board or Tennessee health care agency, or that is subject to the Tennessee health care board's oversight. No member of the Tennessee health care board or employee of the Tennessee health care agency shall receive remuneration for health care service of any kind during their term of service or employment. No member of the Tennessee health care board or employee of the Tennessee health care agency, nor members of their immediate families, shall receive consulting fees of any kind from any source that is directly or indirectly related to the delivery of health care services pursuant to the Tennessee health care plan. Members of the Tennessee health care board and employees of the Tennessee health care agency, and their immediate families, are prohibited from owning stock in, and from investing in mutual funds holding stock in, pharmaceutical companies, health maintenance organizations, or other businesses that relate directly or indirectly to the delivery of health care services, unless the stock or mutual funds are in a blind trust.

 

                (2) No member of the Tennessee health care board, except for the director of health, who shall receive no additional salary or benefits by virtue of serving on the board, shall hold any other salaried state public position, either elected or appointed, during the member's tenure on the board.

 

                (3) The chairperson of the Tennessee health care board shall conduct hearings to determine if a violation of this division has occurred. Notice of any hearing, the conduct of the hearing, and all other matters relating to the holding of the hearing shall be governed by Chapter -. of the Revised Code. If a member of the Tennessee health care board, or of the member's immediate family, is found to have violated this division, the Tennessee health care board shall remove the member from the board by a two-thirds vote.  If an employee of the Tennessee health care agency, or of the employee's immediate family, is found to have violated this division, the Tennessee health care agency shall take appropriate disciplinary action against the employee, which action may include termination of employment.

 

Sec. 4. (A) The Tennessee health care board is responsible for directing the Tennessee health care agency in the performance of all duties, the exercise of all powers, and the assumption and discharge of all functions vested in the Tennessee health care agency. The Tennessee health care board shall adopt rules in accordance with Chapter  - . of the Revised Code as needed to carry out the purposes of, and to enforce, Chapter  - . of the Revised Code.

 

                (B) The duties and functions of the Tennessee health care board include, but are not limited to, the following:

               

                (1) Implementing statutory eligibility standards for benefits;

 

                (2) Annually adopting a benefits package for participants of the Tennessee health care plan;

 

                (3) Acting directly or through one or more contractors as the single payer for all claims for health care services made under the Tennessee health care plan;

 

                (4) Developing and implementing separate formula for determining budgets under sections -to - of the Revised Code;

 

                (5) Annually reviewing the formulae for determining the appropriateness and sufficiency of rates, fees, and prices;

 

                (6) Providing for timely payments to providers through a structure that is well organized and that eliminates unnecessary administrative costs;

 

                (7) Implementing, to the extent permitted by federal law, standardized claims and reporting methods for use by the Tennessee health care plan;

 

                (8) Developing a system of centralized electronic claims and payments;

 

                (9) Establishing an enrollment system that will ensure that all eligible Tennessee residents, including those who travel frequently, those who cannot read, and those who do not speak English, are aware of their right to health care and are formally enrolled in the Tennessee health care plan;

 

                (10) Reporting annually to the general assembly and the governor, on or before the first day of October, on the performance of the Tennessee health care plan, the fiscal condition of the Tennessee  health care plan, any need for rate adjustments, recommendations for statutory changes, the receipt of payments from the federal government, whether current year goals and priorities were met, future goals and priorities, and major new technology or prescription drugs that may affect the cost of the health care services provided by the Tennessee health care plan;

 

                (11) Administering the revenues of the Tennessee health care fund pursuant to section  -  of the Revised Code;

 

                (12) Obtaining appropriate liability and other forms of insurance to provide coverage for the Tennessee health care plan, the Tennessee health care board, the Tennessee health care agency, and their employees and agents;

 

                (13) Establishing, appointing, and funding appropriate staff for the Tennessee health care agency throughout Tennessee;

 

                (14) Procuring requisite office space and administrative support;

 

                (15) Administering aspects of the Tennessee health care agency by taking actions that include, but are not limited to, the following:

 

                (a) Establishing standards and criteria for the allocation of operating funds;

 

                (b) Meeting regularly with the executive director and administrators of the Tennessee health care agency to review the impact of the agency and its policies on the regional districts established under section 3 of the Revised Code;

               

                 (c) Establishing goals for the health care system established pursuant to the Tennessee health care plan in measurable terms;

                 

(d) Establishing statewide health care databases to support health care services planning;

 

                 (e) Implementing policies, and developing mechanisms and incentives, to assure culturally and linguistically sensitive care;

 

                 (f) Establishing standards and criteria for the determination of appropriate compensation and training for residents of Tennessee who are displaced from work due to the implementation of the Tennessee health care plan;

 

                 (g) Establishing methods for the recovery of costs for health care services provided pursuant to the Tennessee health care plan to a participant that are covered under the terms of a policy of insurance, a health benefit plan, or other collateral source available to the participant under which the participant has a right of action for compensation. Receipt of health care services pursuant to the Tennessee health care plan shall be deemed an assignment by the participant of any right to payment for services from any policy, plan, or other source. The other source of health care benefits shall pay to the Tennessee health care fund all amounts it is obligated to pay to the participant for covered health care services. The Tennessee health care board may commence any action necessary to recover the amounts due.

 

                (16) Appointing a technical and medical advisory board. The members of the technical and medical advisory board shall represent a cross section of the medical and provider community and consumers, and shall include two persons, one being a provider and the other representing consumers, from each region designated in section 3 of the Revised Code. The members of the technical and medical advisory board shall be reimbursed for actual and necessary expenses incurred in the performance of their duties. The technical and medical advisory board's duties include:

 

                (a) Advising the Tennessee health care board on the establishment of policy on medical issues, population-based public health issues, research priorities, scope of services, expanding access to health care services, and evaluating the performance of the Tennessee health care plan;

 

                (b) Investigating proposals for innovative approaches to the promotion of health, the prevention of disease and injury, patient education, research, and health care delivery;

 

                (c) Advising the Tennessee health care board on the establishment of standards and criteria to evaluate requests from health care facilities for capital improvements.

 

                (C) The Tennessee health care board shall employ and fix the compensation of Tennessee health care agency personnel, with the approval of the department of administrative services, as needed by the agency to properly discharge the agency's duties. The employment of personnel by the Tennessee health care board is subject to the civil service laws of this state. The Tennessee health care

board shall employ personnel including, but not limited to, the following:

 

                (1) Executive director;

 

                (2) Administrator for planning, research, and development;

 

                (3) Administrator for finance;

 

                (4) Administrator for quality assurance;

 

                (5) Administrator for consumer affairs;

 

                (6) Legal counsel to represent the board in any legal action brought by or against the board under or pursuant to any provision of the Revised Code under the board's jurisdiction.

 

                (D) No member of the Tennessee health care board or individual on the staff of the Tennessee health care board or Tennessee health care agency shall use for personal benefit any information filed with or obtained by the Tennessee health care board that is not then readily available to the public. No member of the Tennessee health care board shall make, participate in making, or in any way attempt to use their position as a member to influence a decision of the board or any other governmental body.

 

                Sections 101.82 to 101.87 of the Revised Code do not apply to the technical and medical advisory board established pursuant to this section.

 

                Sec. 5. The executive director of the Tennessee health care agency appointed under section 4 of the Revised Code is the chief administrator of the Tennessee health care plan and shall administer and enforce Chapter 3922. of the Revised Code. The executive director shall oversee the operation of the Tennessee health care agency and the agency's performance of any duties assigned by the Tennessee health care board.

 

                Sec. 6. (A) The executive director of the Tennessee health care agency shall determine the duties of the administrator of planning, research, and development. Those duties shall include, but not be limited to, the following:

 

                (1) Establishing policy on medical issues, population-based public health issues, research priorities, scope of services, the expansion of participants' access to health care services, and evaluating the performance of the Tennessee health care plan;

               

                (2) Investigating proposals for innovative approaches for the promotion of health, the prevention of disease and injury, patient education, research, and the delivery of health care services;

 

                (3) Establishing standards and criteria for evaluating applications from health care facilities for capital improvements.

 

                (B)(1) The executive director shall determine the duties of the administrator for consumer affairs. Those duties shall include, but not be limited to, the following:

 

                (a) Developing educational and informational guides for consumers that describe consumer rights and responsibilities and that inform consumers of effective ways to exercise consumer rights to obtain health care services. The guides shall be easy to read and understand and available in English and in other languages. The Tennessee health care agency shall make the guide available to the public through public outreach and educational programs and through the internet web site of the Tennessee health care agency.

 

                (b) Establishing a toll-free telephone number to receive questions and complaints regarding the Tennessee health care agency and the agency's services. The Tennessee health care agency's internet web site shall provide complaint forms and instructions online.

                (c) Examining suggestions from the public;

 

                (d) Making recommendations for improvements to the Tennessee health care board;

 

                (e) Examining the extent to which individual health care facilities in a region meet the needs of the community in which they are located;

 

 

(f) Receiving, investigating, and responding to all complaints about any aspect of the Tennessee health care plan and referring the results of all investigations into the provision of health care services by health care providers or facilities to the appropriate provider or health care facility licensing board, or when appropriate, to a law enforcement agency;

 

                (g) Publishing an annual report for the public and the general assembly that contains a statewide evaluation of the Tennesseehealth care agency and of the delivery of health care services in each region established under section 3 of the Revised Code;

 

                (h) Holding public hearings, at least annually, within each region established under section 3 of the Revised Code for public suggestions and complaints.

 

                (2) The administrator for consumer affairs shall work closely with the seven regional health advisory committees on the resolution of complaints. In the discharge of the administrator's duties, the administrator shall have unlimited access to all nonconfidential and nonprivileged documents in the custody and control of the agency. Nothing in Chapter  -. of the Revised Code prohibits a consumer or class of consumers, or the administrator of consumer affairs, from seeking relief through the courts.

 

                (C) The executive director, in consultation with the technical and medical advisory board, shall determine the duties of the administrator of quality assurance. Those duties shall include, but not be limited to, the following:

 

                (1) Studying and reporting on the efficacy of health care treatments and medications for particular conditions;

               

                (2) Identifying causes of medical errors and devising procedures to decrease medical errors;

 

                (3) Establishing an evidence-based formulary;

 

                (4) Identifying treatments and medications that are unsafe or have no proven value;

 

                (5) Establishing a process for soliciting information on medical standards from providers and consumers for purposes of this division.

 

                (D) The executive director shall determine the duties of the administrator of finance. Those duties shall include, but not be limited to, the following:

 

                (1) Administering the Tennessee health care fund;

 

                (2) Making prompt payments to providers;

 

                (3) Developing a system of centralized claims and payments;

 

                (4) Communicating to the treasurer of state when funds are needed for the operation of the Tennessee health care plan;

 

                (5) Developing information systems for utilization review;

 

                (6) Investigating possible provider or consumer fraud.

 

                Sec. 7. (A) All Tennessee residents and individuals employed in Tennessee, including the homeless and migrant workers, are eligible for coverage under the Tennessee health care plan. The Tennessee health care board shall establish standards and a simplified procedure to demonstrate proof of residency. The Tennessee health care board shall establish a procedure to enroll eligible residents and migrant workers and to provide each individual covered under the Tennessee health care plan with identification that providers may use to determine eligibility for health care services under the Tennessee health care plan.

 

                (B) If waivers are not obtained under sections .31 to 33 of the Revised Code from the medical assistance and medicare programs operated under Title XVIII or XIX of the "Social Security Act," 49 Stat. 20 (1935), 42 U.S.C. 301, as amended, the medical assistance and medicare programs shall act as the primary insurers for Tennessee residents and workers for applicable coverage and the Tennessee health care plan shall serve as the secondary or supplemental plan of health coverage. Until such time as waivers are obtained, the Tennessee health care plan will not pay for services for persons otherwise eligible for the same benefits under medicare or medicaid.

 

                (C) A plan of employee health coverage provided by an out-of-state employer to an Tennessee resident working outside of Tennessee shall serve as the employee's primary plan of health coverage and the Tennessee health care plan shall serve as the employee's secondary plan of health coverage.

 

                (D) The Tennessee health care agency shall bill out-of-state employers or the employers' insurers for covered services rendered to residents of this state employed by the out-of-state employer.

 

                (E) The Tennessee health care plan shall reimburse Tennessee health care board approved providers practicing outside of Tennessee at Tennessee health care plan rates for health care services rendered to a plan participant while the participant is out of state.

 

                (F) Any employer operating in Tennessee may purchase coverage under the Tennessee health care plan for an employee who lives out of state but who works in Tennessee.

 

                (G) Any institution of higher education, as defined in section - of the Revised Code, located in Tennessee may purchase coverage under the Tennessee health care plan for a student who is not otherwise a resident of this state.

 

                (H) Any individual who arrives at a health care facility unconscious or otherwise unable due to their mental or physical condition to document eligibility for coverage shall be presumed to be eligible.

 

                Sec. 8. (A) The Tennessee health care board shall establish a single health benefits package that shall include, but not be limited to, all of the following:

 

                (1) Inpatient and outpatient provider care, both primary and secondary;

 

                (2) Emergency services, as defined in division (A) of section - of the Revised Code, twenty-four hours each day on a prudent layperson standard. Residents who are temporarily out of state may receive benefits for emergency services rendered in that state. The Tennessee health care agency shall make timely emergency health care services, including hospital care and triage, available to all Tennessee residents, including all residents not enrolled in the Tennessee health care plan.

 

                (3) Emergency and other transportation services to covered health care services, subject to division (B) of this section;

 

                (4) Rehabilitation services, including speech, occupational, and physical therapy;

 

                (5) Inpatient and outpatient mental health services and substance abuse treatment;

 

                (6) Hospice care;

 

                (7) Prescription drugs and prescribed medical nutrition;

 

                (8) Vision care, aids, and equipment;

 

                (9) Hearing care, hearing aids, and equipment;

 

                (10) Diagnostic medical tests, including laboratory tests and imaging procedures;

 

                (11) Medical supplies and prescribed medical equipment, both durable and nondurable;

 

                (12) Immunizations, preventive care, health maintenance care, and screening;

 

                (13) Dental care;

 

                (14) Home health care services.

 

                (B) The Tennessee health care plan shall provide necessary transportation in each county to covered health care services. Independent transportation providers shall be reimbursed on a fee-for-service basis. Fee schedules for covered transportation may take into account the recognized differences among geographic areas regarding cost. A covered transportation benefits account is hereby created within the Tennessee health care fund.

 

                (C) The Tennessee health care plan shall not exclude or limit coverage of its participants' pre-existing conditions.

 

                (D) Residents enrolled in the Tennessee health care plan are not subject to copayments, point-of-service charges, or any other fee or charge, and shall not be directly billed by providers for covered benefits provided to the resident.

 

                (E) The Tennessee health care board, with the consent of the technical and medical advisory board, shall remove or exclude procedures and treatments, equipment, and prescription drugs from the Tennessee health care plan's benefit package that the board finds unsafe, experimental, of no proven value, or which add no therapeutic value.

 

                (F) The Tennessee health care board shall exclude coverage for any surgical, orthodontic, or other medical procedure, or prescription drug, that the technical and medical advisory board determines was or will be provided primarily for cosmetic purposes, unless required to correct a congenital defect, to restore or correct disfigurements resulting from injury or disease, or that is determined to be medically necessary by a qualified, licensed provider.

 

                (G) Participants shall have free choice of the providers eligible to participate in the Tennessee health care plan.

 

                (H) No provider shall be compelled by the Tennessee health care agency to offer any particular service, provided that the provider does not discriminate among patients in providing health care services.

 

                (I) The Tennessee health care plan and the providers participating in the plan shall not discriminate on the basis of race, color, national origin, gender, age, religion, sexual orientation, health status, mental or physical disability, employment status, veteran status, or occupation.

 

                Sec. 9. (A) The Tennessee health care fund is hereby established in the state treasury. The administrator of finance of the Tennessee health care agency shall administer and monitor the Tennessee health care fund. All moneys collected and received by the Tennessee health care plan shall be transmitted to the treasurer of state for deposit into the Tennessee health care fund, to be used to finance the Tennessee health care plan and to pay the costs of compensation and training for displaced workers pursuant to section 12 of the Revised Code.

 

                (B) The treasurer of state may invest the interest earned by the Tennessee health care fund in any manner authorized by the Revised Code for the investment of state moneys. Any revenue or interest earned from the investments shall be credited to the Tennessee health care fund.

 

                (C) All provider claims for payment for health care services rendered under the Tennessee health care plan shall be transmitted to the Tennessee health care fund by the provider or the provider's agent. The format of, and the method of transmitting, provider claims shall be determined by the Tennessee health care board.

 

                (D) All payments for health care services rendered under the Tennessee health care plan shall be disbursed from the Tennessee health care fund. The administrator of finance of the Tennessee health care agency shall establish a reserve account within the Tennessee health care fund. When the revenue available to the Tennessee health care plan in any biennium exceeds the total amount expended or obligated during that biennium, the excess revenue shall be transferred to the reserve account. The Tennessee health care board may use the money in the reserve account for expenses of the Tennessee health care agency or the Tennessee health care plan.

 

                (E) The administrator of finance of the Tennessee health care agency shall notify the Tennessee health care board when the annual expenditures or anticipated future expenditures of the Tennessee health care plan appear to be in excess of the revenues or anticipated revenues for the same period. The Tennessee health care board shall implement appropriate cost control measures based on the notification. The Tennessee health care board shall seek a special appropriation for the Tennessee health care fund if the cost control measures implemented do not reduce the Tennessee health care plan's expenditures to an amount that may be covered by its revenue.

 

                Sec. 10. (A) The Tennessee health care board shall establish written procedures for the receipt and resolution of disputes and grievances. The procedures shall provide for an initial hearing before the appropriate regional health advisory committee in accordance with division (F) of section 3 of the Revised Code. The board shall accord to plaintiffs the right to be heard at the hearing.

 

                (B) Any party aggrieved by an order or decision issued pursuant to the procedures established in division (A) of this section may appeal the order or decision to the court of common pleas. The appellant shall file a notice of appeal with the Tennessee health care board within fifteen days of the filing of the appeal with the court of common pleas.

 

                (C) Appeals of denied claims may be submitted by Tennessee health care plan beneficiaries or providers, or businesses selling medical equipment and supplies to the plan. The Tennessee health care board shall conduct appeals in compliance with both Tennessee and federal laws.

 

                Sec. 11. (A) The department of job and family services shall determine which residents of this state employed by a health care insurer, health insuring corporation, or other health care related business, have lost employment as a result of the implementation and operation of the Tennessee health care plan. The department also shall determine the amount of monthly wages that the resident lost due to the plan's implementation. The department shall attempt to position these displaced workers in comparable positions of employment with the Tennessee health care agency.

 

                (B) The department of job and family services shall forward the information on the amount of monthly wages lost by Tennessee residents due to the implementation of the Tennessee health care plan to the Tennessee health care agency. The Tennessee health care agency shall determine the amount of compensation and training that each displaced worker shall receive and shall submit a claim to the Tennessee health care fund for payment. A displaced worker, however, shall not receive compensation from the Tennessee health care fund in excess of sixty thousand dollars per year for two years. Compensation paid to the displaced worker under this section shall serve as a supplement to any compensation the worker receives from the department of job and family services.

 

                Sec. 12. (A) Any employer providing employees with benefits under a public or private health care policy, plan, or agreement as of the date that benefits are initially provided pursuant to Chapter 3922. of the Revised Code, which benefits are less valuable than those provided by the Tennessee health care plan, may participate in the Tennessee health care plan or shall provide additional benefits so that, until the expiration of the policy, plan, or agreement, the benefits provided by the employer at least equal the amount and scope of the benefits provided by the Tennessee health care plan. If an employer chooses to provide additional benefits to match or exceed the benefits provided by the Tennessee health care plan the additional benefits shall include the employer's payment of any employee premium contributions, copayments, and deductible payments called for by the policy, contract, or agreement. Employers are exempt from all health taxes imposed under Chapter 3922. of the Revised Code until the expiration of the policy, plan, or agreement, at which point the employer and the employer's employees become participants in the Tennessee health care plan.

 

                (B) A person covered by a health care policy, plan, or agreement that has its premiums paid for in any part with public money, including money from the state, a political subdivision, state educational institution, public school, or other entity, shall be covered by the Tennessee health care plan on the day that benefits become available under the Tennessee health care plan.

 

                (C) Health care insurers, health insuring corporations, and other persons selling or providing health care benefits may deliver, issue for delivery, renew, or provide health benefit packages that do not duplicate the health benefit package provided by the Tennessee health care plan, but shall not, except as provided by division (A) of this section, deliver, issue for delivery, renew, or provide health benefit packages that duplicate the health benefit package provided by the Tennessee health care plan.

 

                Sec. 13. The Tennessee health care agency is subrogated to all rights of a participant who has received benefits, or who has a right to benefits, under any other policy or contract of health care.

 

                Sec. 14. (A) All providers, as defined in section 3922.01 of the Revised Code, may participate in the Tennessee health care plan.

 

                (B) The Tennessee health care board and the technical and medical advisory board shall assess the number of primary and specialty providers needed to supply adequate health care services to all participants in the Tennessee health care plan, and shall develop a plan to meet that need. The Tennessee health care board shall develop incentives for providers in order to increase residents' access to health care services in unserved or underserved areas of the state.

 

                (C) The Tennessee health care board annually shall evaluate residents' access to trauma care, and shall establish measures to ensure participants have equitable access to trauma care and to specialized medical procedures and technology.

 

                (D) The Tennessee health care board, with the advice of the technical and medical advisory board and the administrator of quality assurance, shall define performance criteria and goals for the Tennessee health care plan and shall report to the general assembly at least annually on the plan's performance. The Tennessee health care board shall establish a system to monitor the quality of health care and patient and provider satisfaction with that care and a system to devise improvements to the provision of health care services.

               

(E) All providers subject to the Tennessee health care plan shall provide data upon request to the Tennessee health care board, which data the board requires to devise methods to maintain and improve the provision of health care services.

 

                (F) The Tennessee health care board, with the advice of the technical and medical advisory board, shall coordinate the Tennessee health care plan's provision of health care services with any other state and local agencies that provide health care services

directly to their residents.

 

                Sec. 15. In the absence of fraud or bad faith, county and city health commissioners, regional health advisory committees, and the Tennessee health care board and Tennessee health care agency and their members and employees, shall incur no liability in relation to the performance of their duties and responsibilities under sections 3922.01 to 3922.15 of the Revised Code. The state shall incur no liability in relation to the implementation and operation of the Tennessee health care plan.

 

                Sec. 21. (A) The Tennessee health care board shall prepare and recommend to the general assembly an annual budget for health care, which budget specifies and establishes a limit on total annual state expenditures for health care provided pursuant to sections 3922.01 to 3922.15 of the Revised Code. The budget shall include all of the following components:

 

                (1) A system budget covering all expenditures for the system, in accordance with section 3922.22 of the Revised Code;

 

                (2) Facility and provider budgets for the fee-for-service and integrated health delivery system and for individual health care facilities and their associated clinics, in accordance with section 3922.23 of the Revised Code;

 

                (3) A capital investment budget in accordance with section 3922.24 of the Revised Code;

 

                (4) A purchasing budget in accordance with section 3922.25 of the Revised Code;

 

                (5) A research and innovation budget in accordance with section 3922.26 of the Revised Code.

 

                (B) In preparing the budget, the board shall consider anticipated increased expenditures and savings, including, but not limited to, projected increases in expenditures due to improved access for underserved populations and improved reimbursement for primary care, projected administrative savings under the single-payer mechanism, projected savings in prescription drug expenditures under competitive bidding and a single buyer, and projected savings due to provision of primary care rather than emergency room treatment.

 

                Sec. 22. (A) The system budget referred to in division (A)(1) of section 21 of the Revised Code shall comprise the cost of the system, services and benefits provided, administration, data gathering, planning and other activities, and revenues deposited with the system account of the Tennessee health care fund. The Tennessee health care board shall limit administrative costs to five per cent of the system budget and shall annually evaluate methods to reduce administrative costs and report the results of that evaluation to the general assembly. The board shall also limit growth of health care costs in the system budget by reference to changes in state gross domestic product, population, employment rates, and other demographic indicators, as appropriate. Moneys in the reserve account of the Tennessee health care fund shall not be considered as available revenues for purposes of preparing the system budget.

 

                (B) The board shall implement cost control measures pursuant to division (A) of this section. However, no cost control measure shall limit access to care that is needed on an emergency basis or that is determined by a patient's provider to be medically appropriate for a patient's condition. Mandatory cost control measures include, but are not limited to, some or all of the following:

 

                (1) Postponement of the introduction of new benefits or benefit improvements;

 

                (2) Postponement of new capital investment;

 

                (3) Adjustment of provider budgets to correct for inappropriate provider utilization;

 

                (4) Establishment of a limit on provider reimbursement above a specified amount of aggregate billing;

 

                (5) Deferred funding of the reserve account;

 

                (6) Establishment of a limit on aggregate reimbursements to pharmaceutical manufacturers;

 

                (7) Imposition of an eligibility waiting period in the event of substantial influx of individuals into the state for purposes of obtaining health care through the Tennessee health care plan.

 

                Sec. 23. (A) Th