Category Archives: nursing homes

Contractor problems created backlog in TennCare nursing home applications

Nursing home applications got so backed up when TennCare changed its processing system that administrators reported more than half of their patients did not get timely eligibility determinations, reports The Tennessean.

Jesse Samples, executive director of Tennessee Health Care Association, which represents nursing homes, told TennCare Director Darin Gordon in an email that the problem was causing serious cash flow issues for its members and stressful circumstances for patients.

Gordon responded that the agency’s internal statistics showed better performance but admitted its “more limited approach” in communicating applications was causing frustrations.

The emails obtained by The Tennessean through an open records request reveal that TennCare cannot place all the blame for its backlogged Medicaid applications on the federal government. After a class action lawsuit was filed on behalf of people seeking coverage, the state agency argued in court papers that, the federal insurance exchange, had caused the issues. But nursing home applications were not filed through that website.

Nursing home applications got backlogged because TennCare stopped having state employees with the Department of Human Services process them and outsourced that work to a private contractor. The applications got sent to a new service center operated by Cognosante LLC, which was awarded a four-year, $31 million contract.

…The state wound up taking punitive actions, levying a fine of almost $1 million, said Sarah Tanksley, a TennCare spokesperson.

“TennCare’s new service center, Tennessee Health Connection, experienced an unexpectedly high volume of applications in the first quarter of 2014 while also experiencing some technical difficulties associated with the startup of this new call center,” Tanksley said. “As a result, the state took significant actions to address the problems and levied significant fines against the vendor.”

Cognasante and TennCare then worked for several weeks to improve the service, she said, and resolved the application problems early last year.

Audit finds $2M Medicaid overcharge by nursing home company

News release from state comptroller’s office:
A large corporation that operates dozens of nursing homes in Tennessee included nearly $2 million in improperly allocated Medicaid costs in one of its reports, according to an audit released by the state Comptroller’s office today.

Auditors uncovered $1,929,205 of expenses not allowed under Medicaid rules and regulations at Signature HealthCARE, LLC, a Louisville-based corporation that operates 112 long-term care locations in nine eastern and southeastern states, including 26 nursing facilities in Tennessee.

In its home office cost report for the 2009 calendar year, Signature reported total operating expenses of $46.3 million, of which $29.2 million were claimed as allowable Medicaid costs and allocated to its subsidiary operations.

The Comptroller’s office performs examinations of nursing facilities participating in Tennessee’s $900 million Medicaid Long-Term Care Program and has authority to audit any costs reported on annual Medicaid cost reports, including expenses that are allocated from home office operations located outside the state of Tennessee.

The auditor’s report identifies expenses that are not allowed for reimbursement by the state’s Medicaid program. These included improper charges for costs not related to patients’ care, marketing expenses and compensation for nursing facility owners. The allocated share of the disallowed expenses to 22 of Signature’s Tennessee nursing facilities is $561,624. The balance of the improper expenditures was allocated to facilities in other states.

“The finding in our report exposes significant non-allowable costs that were allocated to long-term care facilities operating in Tennessee,” Comptroller Justin P. Wilson said. “It is important to understand that often there are substantial costs incurred on behalf of Tennessee nursing facilities by large healthcare home offices both inside and outside the state. These costs must fit into certain categories in order to be subsidized by Medicaid. Unfortunately, a number of Signature’s expenses during the reporting period didn’t fit into those categories.”

To view the report online, go to:

State stops admissions to two TN nursing homes

MEMPHIS, Tenn. (AP) — Tennessee Health Commissioner John Dreyzehner has suspended new admissions to two West Tennessee nursing homes because of alleged inadequate conditions at the facilities.

A news release from the Tennessee Department of Health says Dreyzehner has suspended admissions to Oakwood Community Living Center, a 50-bed licensed nursing home in Dyersburg, and Ripley Healthcare and Rehabilitation Center, a 144-bed licensed nursing home in Ripley.

Department investigators found violations of administration, performance improvement and nursing services standards at Oakwood. The department says surveyors found violations of administration standards at Ripley Healthcare.

The state imposed penalties of $1,500 for each of the facilities. A special monitor will review their operations.

The nursing homes can have the right to a hearing before the Board for Licensing Health Care Facilities or an administrative judge.

Nearly 3,000 rejected for TennCare nursing home coverage under new point system

In an effort to curtail costs while meeting the health needs of aging baby boomers, TennCare officials have put in place new rules that create a higher hurdle for families to qualify for nursing home coverage. Since then, The Tennessean reports that nearly 3,000 people who probably would have been judged to need nursing home care in early 2012 are instead getting only limited home visits.

The new guidelines are under fire from state legislators and advocates for the elderly and disabled. They question why TennCare launched the point system by emergency rule — a move that limited the degree of public input. Only one hearing, attended by 36 people, was held, just two months before the rules took effect in July 2012.

“I would contend that it was really without any real legislative or stakeholder input at that point in time,” said Jesse Samples, executive director of the Tennessee Health Care Association, which represents nursing homes.

Now that the system is in place, however, the state intends to keep it. Patti Killingsworth, TennCare’s chief of long-term care, told a state Senate committee in December that the agency has no plans to abandon the point system, saying there could be a “significant financial impact if standards were relaxed.”

The agency’s goal was to save $47 million in fiscal 2013 by diverting 20 percent to 25 percent of nursing home applicants to home or community-based care, Killingsworth said. The state is just under that range with a 19.6 percent diversion rate.

…Tennessee, which previously allowed people to qualify for Medicaid-funded nursing home care with only one deficiency of daily living, such as not being able to walk, now stipulates that applicants score nine points on a 26-point evaluation administered by TennCare nurses.

Someone could be incontinent, have problems walking, be unable to manage their medicines and still not score nine points.

…After complaints from families and nursing homes, a state Senate committee asked TennCare officials to explain the system at a hearing in December.

Since that hearing, legislators have introduced two bills — one that would require the director of the Tennessee Commission on Aging and Disability to have input on decision making about the Choices program, and another that would require an accounting of the money that Medicaid-contracted insurers make under the program.

TennCare provides incentives to these contractors, known as managed-care organizations, to lower overall health spending.

TennCare also has taken some actions since the hearing. In a follow-up letter to Sen. Joey Hensley, R-Hohenwald, Killingsworth said the agency may consider more information from applicants who seek a “safety determination,” an override that has allowed more than 750 people to qualify for nursing home care when they did not score nine points.

Killingsworth said TennCare will give nursing homes a 10-day window to submit additional information when an application has been denied, and it may expand some definitions — for instance, including diagnoses other than dementia when evaluating an applicant’s behavior.

Legislative liaison for state Dept. of Human Resources starts new charity

News release from Sunlight Project:
NASHVILLE – John McManus, 29, today announced the formation of a new charitable group dedicated to bringing happiness and relief to the elderly and people with disabilities living in Tennessee’s nursing homes and assisted living facilities.

“I’m so happy to be able to announce this new initiative,” said Founder & Executive Director John McManus. “There are so many forgotten souls living in our community’s nursing homes and assisted living facilities and it’s time for my generation to step up to the plate and make a difference there. Too many people, the elderly and people with disabilities, live without anyone to visit them, talk to them, watch after them, make them happy or make them smile. The Sunlight Project , through personal visitations and gifts of home-made art, aims to bring a smile and companionship to people who need it most.”

The Sunlight Project will work with local nursing homes and assisted living facilities as well as families, volunteer groups, and other charities and non-profits to strategically identify those in their facilities that are in most need of visitors and friends.

“This is a way to build an organized structure that maintains a network of compassionate volunteers to provide companionship to people in need in a very sustainable way,” said McManus. “We’ve incorporated artwork into the process not only to provide residents with a beautiful gift to enjoy but as a way to engage people that want to use their creativity in a way that improves the quality of life for others.”

John McManus is a native of Memphis and a resident of Nashville. He has spent his entire adult career in public service at the state and federal levels specializing in regulatory, administrative, legislative and media affairs. He is currently with the Tennessee Department of Human Resources, serving as the agency’s Legislative Liaison and Public Information Officer.

To learn more about the Sunlight Project, please visit

Note: McManus advises via email that he will remain in his Department of Human Services positions; the new project will be a part-time endeavor. Excerpt from the email: We don’t raise money or lobby or anything like that. The only kind of donations I’m asking for is time and talent of volunteers who are interested in visiting some good folks in nursing homes.

Latest Haslam Task Force to look at aging

News release from governor’s office:
NASHVILLE – Tennessee Gov. Bill Haslam today announced the formation of the Task Force on Aging, a group charged with creating a plan to improve the lives and care of older Tennesseans and their families through a collaboration of public, private and nonprofit leaders.

According to the U.S. Census Bureau, more than 14 percent of Tennesseans are 65 years of age or older, and the national average is 13.7 percent. Tennessee’s number is expected to grow to more than 22 percent by 2020.

Haslam has asked the task force to focus on three areas: promoting healthy aging; creating livable communities; and supporting family caregivers.

“I want to thank the task force and all those involved for dedicating their time and effort to improving the lives of others,” Haslam said. “The Task Force on Aging will develop a strategic plan, drawing on the public, private and non-profit sectors to better meet the needs of older Tennesseans and their families, now and into the future.”

Lipscomb University’s Charla Long, Dean of the College of Professional Studies and The School of TransformAging, will chair the 11-member task force. The remaining members are:
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Charities to Get $40M in Settlement of Nursing Home Litigation

News release from Tennessee Attorney General’s office:
MURFREESBORO, Tenn. — National Health Investors, Inc., (NYSE:NHI), National HealthCare Corporation (NYSE MKT: NHC, NHC.PRA), the court-appointed Receiver for two Tennessee nonprofits, SeniorTrust of Florida, Inc., (“SeniorTrust”) and ElderTrust of Florida, Inc., (“ElderTrust), and the Tennessee Attorney General announced today that they have agreed to resolve a long-standing dispute that has been the subject of litigation. The resolution of the litigation, together with the Receiver’s sale of 14 nursing homes and liquidation of the nonprofits’ assets, will ultimately result in approximately $40M for charitable purposes in Tennessee.
The Tennessee Attorney General had previously asked the Davidson County Chancery Court to place both of these nonprofits in receivership. The Receiver subsequently filed suit against National Health Investors, Inc. (“NHI”) and National HealthCare Corporation (“NHC”).
NHI helped to establish SeniorTrust and ElderTrust, two Tennessee 501(c)(3) nonprofit corporations, in 2000. Between 2001 and 2004, NHI sold a group of skilled nursing facilities in Missouri and Kansas to SeniorTrust and a group of skilled nursing facilities in Massachusetts and New Hampshire to ElderTrust. The Receiver’s primary dispute with NHI concerned the financial terms on which NHI had sold and financed the purchase of the facilities to the nonprofits.
In 2007, NHC acquired the lease of a long-term care facility in Chattanooga, Tennessee, known as Standifer Place from SeniorTrust. The Receiver’s primary dispute with NHC concerned the financial terms on which NHC acquired the lease.
The Receiver for SeniorTrust and ElderTrust claimed that the financial terms of the various transactions with NHI and NHC were unfair to the nonprofits, a claim NHI and NHC disputed.

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TN Nursing Homes Assessed $4M in Fines (6th highest in nation)

Tennessee collected a little more than $4 million in fines from nursing homes over the past three years, the sixth-highest total of any in the country, according to data collected by ProPublica,
From The Tennessean:
The state imposed 86 fines, with the average fine being the second-highest in the nation. The fines, ranging from $2,015 to more than $525,000, were imposed on 42 of the more than 300 licensed nursing homes operating in Tennessee.
The largest single fine, $525,188, was imposed on Bristol Nursing home in Bristol. The second highest, $465,195, was imposed on Colonial Hills Nursing Center in Maryville, Tenn.
Data show that 40 nursing homes in the state were found to have serious deficiencies

The ProPublica state-by-state list is HERE.