Struggling hospitals in Tennessee hurt by flawed federal Medicare reimbursement formula
A resolution asking the federal government to change the flawed reimbursement formula currently paid to Tennessee hospitals for Medicare patients was approved by the full Senate on Thursday. Enactment of a fair reimbursement rate would help struggling hospitals in Tennessee which receive disproportionately low payments compared to other areas of the country for the same services. Reimbursements in the state are among the lowest in the country.
Senate Joint Resolution 98 asks Tennessee’s representatives in Congress and the U.S. Department of Health to fix the flawed formula, which is critical to the state’s healthcare system.
While the original goal of the Medicare wage index was to reflect variations in the country’s labor markets, the formula has been manipulated with a multitude of exceptions and political fixes. This has resulted in California and New York having some of the highest reimbursement rates due to the number of representatives and the influence they have in Congress. Tennessee hospitals may receive as little as half of the reimbursement received by their counterparts in these larger states.
The formula, which is unnecessarily complex, also has inconsistencies in data collection, resulting in labor costs at Tennessee hospitals being inaccurately reflected in the current wage index. A 2018 U. S. Office of Inspector General Report identified significant vulnerabilities in the wage index and recommended an overhaul of the system. The report pointed out that the federal government lacks authority to penalize hospitals that submit inaccurate wage data and that Medicare’s administrative contractors’ limited reviews don’t always detect inaccuracies.
In addition, when the Affordable Care Act mandated that the wage index must be budget-neutral, an action which widened the disparity between hospitals with the lowest and highest reimbursement rates.
The wage index formula also has an effect on private insurance contracts which are negotiated on a coefficient of the amount paid for healthcare services by Medicare. The resolution calls for a revision in the Medicare Wage Index in a manner that more accurately reflects labor costs in Tennessee.
Gov. Bill Lee prepares to give State of State / Budget Address on Monday
Announces major mental health, suicide prevention and criminal justice initiatives
Governor Bill Lee announced major mental health, suicide prevention and criminal justice initiatives this week as he gets ready to give his first State of State / Budget Address on Capitol Hill Monday night. The governor is also preparing regional State of the State addresses in Knoxville on Tuesday and in Memphis on Thursday.
On mental health, Gov. Lee is proposing an additional $11.2 million to expand access to services for Tennesseans living with serious mental illness to cover an additional 7,000 uninsured Tennessee adults through the state’s Behavioral Health Safety Net program. It also addresses increasing costs at the state’s four regional mental health institutes and ensures that those facilities will continue to provide high quality care to Tennesseans with the most significant psychiatric needs.
In addition, Gov. Lee is proposing a $3 million investment to the Creating Homes Initiative, a program which has created more than 20,000 quality, permanent housing opportunities for those living with mental illness. This new investment will expand recovery housing options for Tennesseans struggling with substance abuse.
To address the state’s high rate of suicide, Governor Lee has called for a $1.1 million investment that will expand the state’s partnership with the Tennessee Suicide Prevention Network (TSPN) to establish a new regional outreach model. It will also increase the Department of Mental Health and Substance Abuse Services’ efforts to focus on interventions at the community level using evidence-based practices. Tennessee’s suicide rate is 20 percent higher than the national average.
The Governor’s criminal justice and public safety initiative will supplement mental health efforts by expanding the recovery court system and programming. His budget will ask for $1.7 million in additional funding to expand the Recovery Courts capacity by 20 percent to serve an additional 500 Tennesseans each year.
He also called for eliminating the $180 state expungement fee associated with clearing records of certain criminal charges and expanding higher education programming to help inmates secure employment instead of re-entering the prison system. Over 30 percent of inmates in Tennessee prisons do not have a high school equivalency. “By offering quality education programming, inmates have a 43 percent lower chance of re-entering prison than those who do not receive this education,” Lee said.
Once the Governor’s budget is delivered to lawmakers, a thorough examination will be conducted in the Senate’s nine standing committees. Fifty-nine hearings of all departments and agencies of state government have been scheduled beginning March 12. The hearings are expected to wind up in early April.
Tennessee’s budget totals $37.7 billion in the current 2018-2019 fiscal year ending on June 30. Governor Lee’s State of the State / Budget Address will be streamlined on the General Assembly’s website at: http://www.legislature.state.tn.us/ at 6:00 p.m. on Monday. Details for the State of East Tennessee address and the State of West Tennessee address can be found at https://www.tn.gov/governor/sots.
Legislation seeks to protect children from child abuse
Legislation aiming to protect child abuse victims advanced in the Senate Judiciary Committee. Senate Bill 1403 amends current reporting requirements and expedites response time when a referral is made by a health or education professional. The purpose of this bill is to get the eyes on the child as soon as possible to avoid further injury from the alleged perpetrator.
The bill was prompted by the Tennessee District Attorneys Generals Conference, according to Amy Weirich, Attorney General for the 30th judicial district, who testified before the committee regarding the need for the bill. Weirich told committee members about a six-year old boy in Shelby County who died as a result of child abuse, even though the boy’s teacher reported suspected abuse to the Department of Children’s Services (DCS) twice.
Presently, when a child is killed or almost killed, members of the General Assembly are required to be notified. This legislation would add the District Attorney’s Office to the notification process.
The proposal also expedites the response time on referrals made to DCS from licensed health care and education professionals. Currently, when a referral is made to the child abuse hotline, it is given a response time based on the allegation’s severity. Referrals are given either priority one, which is responded to within 24 hours; priority two, which gets a response within two business days; or priority three, which warrants a response within three business days. The legislation would ensure that all referrals made by health and education professionals are given priority one so that there is a face-to-face contact with the child no later than 24 hours after allegations are made.
The bill now goes to the Senate Finance, Ways, and Means Committee before it moves to the floor for a final vote.
Middle College Program Scholarships – The Senate Education Committee approved Senate Bill 1379 increasing Tennessee’s Middle College Scholarship from $600 to $1,000 per semester. Middle College is a public community college program that, in partnership with the local education agency (LEA), permits high school students to earn both a high school diploma and an associate degree during their junior and senior years. Although the program facilitates a seamless transition to post-secondary education, due to the requirement that recipients have a high school degree, the students have not been eligible for the Tennessee Promise Scholarship. The scholarship helps offset the cost of tuition and books during the two-year program. This is a program that encourages our best and brightest to get a jump start on their education and compliments the governor’s Drive to 55 to accelerate the number of Tennesseans with post-secondary degrees or certifications. Middle College students are among the most sought-after students in the nation by four-year colleges and universities and typically achieve 100 percent proficiency on high school benchmark exams.
Election Laws – Three proposals that aim to strengthen the state’s election process advanced in the Senate. The first bill, Senate Bill 1258 intends to close loopholes in the state’s election laws by prohibiting a candidate who has been defeated in a primary election from qualifying as a write-in candidate for the general election. The second bill, Senate Bill 1354 requires that in the event a party’s state executive committee removes a candidate’s name from the ballot, that person must receive notice in a reasonable amount of time for them to respond. Both proposals were approved by the Senate State and Local Government Committee and are pending final action by the full Senate. The third bill, Senate Bill 1264 aims to prevent incidences of voter fraud by prohibiting a person convicted of this crime in another state from assisting a person with either early voting or casting an absentee ballot in Tennessee. That proposal was unanimously adopted by the full Senate and awaits action in the Finance, Ways and Means Committee in the House of Representatives.
Election Laws / Vacancies – The Senate State and Local Government Committee also approved legislation calling for a change in the process to fill a vacancy in the State Senate if it occurs within 45 days or less before a November general election. Current law requires a write-in election under such a scenario. Senate Bill 1355 establishes that if such a vacancy occurs, the county executive committee for the respective party of the vacant seat may nominate a candidate for the November ballot within 48 hours of notice. Independents can also run by filing a petition by noon of the same day that the candidates are being certified. The proposal allows the county election commission to publish the sample ballot on its website or on the Secretary of State’s website due to brevity of time. If early voting occurred prior to the vacancy, persons who have already voted would be allowed to cast a ballot in this election.
Emergency Response / Automated External Defibrillator – The Senate Judiciary Committee passed legislation designed to remove barriers to individuals using an automated external defibrillator (AED) as part of an emergency rescue for a person who is in cardiac arrest and unresponsive. Senate Bill 314 provides that any entity responsible for the AED shall not be civilly liable for any personal injury that results from an act or omission related to the use or maintenance of the AED that does not amount to misconduct or gross negligence. The goal of the legislation is to encourage more facilities to use an AED in emergencies, rather than discourage facilities from using the life saving device for fear of liability if the device does not work properly.
Smoking / Vaping – Two bills that address regulation of smoking tobacco and vapor products were approved by the Senate Commerce and Labor Committee this week. Senate Bill 26 prohibits the use of vapor products in certain areas where children are often present. Areas prohibited include child care centers, group care homes, healthcare facilities, and others. The legislation also expands the definition of vapor products to include visible or non-visible vapors and the substances used to fill a vapor cartridge.
The second bill, Senate Bill 932 would give local governments decision-making authority regarding the use of smoking tobacco on property owned or leased by a municipality or county, airport authorities, and hospitals within their jurisdiction.
County Road Relief Act – Legislation which continues indefinitely a 2015 law that gives counties more opportunities to tap into State Aid Road Grant Program funds was approved by the Senate Transportation and Safety Committee. Senate Bill 1364 lifts a 2019 sunset date of the 2015 law which has makes it easier for counties to access state funds to upgrade, repair and improve local roads. Before, in order to receive funding through the State Highway Aid System, local governments had to provide a 25 percent local match. The 2015 law allows local governments to use state highway aid for a project, as long as the county contributes at least 2 percent of the approved project cost or provide in-kind work as approved by the Department of Transportation. The County Road Relief Act was modeled after the County Bridge Relief Act lowering match to allow local governments to access unused funds in Tennessee’s State Aid Bridge Grant Program. That program has allowed counties to access unused funds to improve bridges in disrepair.
Student Health / Morning Mile – A group of 8th grade students from Jonesborough Middle School appeared before the Senate Health and Welfare Committee to talk about the “Morning Mile” program at their school to increase activity and establish healthy habits. The group also shared their research findings regarding the positive effects of exercise on attendance and grades, as well as improved physical and behavioral health. The Morning Mile was created by Niswonger Children’s Hospital to help children in Northeast Tennessee and Southeast Virginia develop healthy habits by getting them off to an active start every morning before the school day begins. The student’s research showed that the program has beneficial health effects on various conditions like ADHD and obesity. They asked lawmakers to help promote the program statewide. Last year, more than 49,000 kids participated in the Morning Mile, completing over 325,000 miles.
AG Launch – Last Wednesday, the Senate Energy, Agriculture and Natural Resources Committee heard from AgLaunch, an organization that works to help agtech startups, facilitate the development of new agriculture and food value-chains and build collaborative farmer networks. Pete Nelson, Executive Director of AgLaunch, told committee members that Tennessee has unique assets with abundant water and good soil, small and large farms, different types of production environments, and established farmers who are willing to try new technologies and ideas. These assets allow Tennessee to be very diverse in the crops grown in the state. The goal of AgLaunch is to ensure citizens have good local food and farmers have opportunities to participate in value-added enterprises by growing companies, enabling research, aligning capital, and continuing to be led by farmers.
Automobile License Plates – The Transportation and Safety Committee unanimously passed Senate Bill 435 which creates a specialty license plate for the American Veterans (AMVETS). The organization’s mission is to enhance and safeguard the entitlements for all American veterans who have served honorably and to improve the quality of life for them, their families, and the communities where they live through leadership, advocacy and services. The AMVETS license plate will be added to the current list of 40 military and memorial license plates provided in Tennessee. The bill now moves to the full Senate floor for a final vote.
Enhanced Penalties / Theft of a Gun – Legislation enhancing penalties for theft of a firearm advanced in the Senate Judiciary Committee. Senate Bill 681 increases the penalty of theft of property that includes a firearm valued at less than $2,500 to a Class D felony. Current law penalizes theft of a firearm valued at less than $1,000 as a Class A misdemeanor. It is estimated that approximately three-fourth of guns stolen are valued at less than $1,000. Under this proposal, stealing any firearm would be punishable as a felony offense. If the value of the firearm is determined to be over $10,000, the penalty would be graded higher.
Safe at Home Program / Domestic Violence — At a press conference on Thursday, Secretary of State Tre Hargett, announced the new state program, Safe at Home, to protect domestic abuse victims, is taking effect on March 1, 2019. The Safe at Home Program was established through legislation passed by the General Assembly last year. The program provides victims with a government-managed substitute address for both themselves and their children, which can then be used to obtain a driver’s license, register to vote, and complete most other government forms without disclosing their home address.
The Secretary of State’s office will receive all mail sent to the substitute address and then forward that mail to the participant. Under current law, abusers can access their victims’ private information making them extremely vulnerable. Safe at Home will protect the victims’ information allowing them to escape their abusers and start a new life. Hargett predicts that approximately 1,500 Tennesseans will participate in Safe at Home helping protect over half of the 2,169 repeat domestic violence victims.
More information about the Safe at Home program can be found at sos.tn.gov/safeathome.