Tag Archives: assessment

Smooth Sailing for ‘Assessment’ Bills

Legislation to renew three special state “assessments,” all used to collect more money for health care facilities from the federal government and sometimes called taxes, are moving quickly through the committee system with very little discussion.
All are slated to expire on June 30 unless renewed. All involve facilities paying the “coverage assessment” with the resulting revenue then being used to trigger federal government payments of about $2 for every state dollar. Gov. Bill Haslam’s budget plan anticipates all of them being renewed.
The bill imposing a $2,225 levy on each bed in a nursing home (SB430) had been previously known as a “bed tax.” This year’s bill, sponsored by Republican Sen. Doug Overbey of Maryville, changes the terminology to “assessment.” It is otherwise unchanged from current law and is projected to bring in $235 million for TennCare payments to nursing homes.
The hospital assessment (SB441) imposes a 4.52 percent levy on net patient revenues of hospitals, producing $450 million in state revenue that brings in federal matching funds of about $843 million. It is the newest of the assessments, launched in 2010 at the urging of the Tennessee Hospital Association. U.S. Sen. Bob Corker has called it a “gimmick” and has filed legislation in Congress that would phase out such programs over a 10-year period.
The bill imposing a 5.5 percent levy on gross receipts of institutions serving the mentally disabled (HB157) brings in $11.4 million in state revenue, according to legislative staff, including $5.1 million paid by the Department of Intellectual and Developmental Disabilities.
The latter two bills got no discussion at all in winning voice vote approval of the House Health Subcommittee last week with Rep. Mike Harrison, R-Rogersville, as sponsor. The Senate Health Committee had only brief discussion on Overbey’s bills dealing with nursing homes and hospitals before they were unanimously approved.
The nursing home levy has, in the past, been renewed for longer periods. Asked why this year’s bill only gives a one-year extension, Overbey said the idea is to put all the levies on an annual renewal basis so they can be discussed regularly as developments unfold at the federal level on health care.
“I think if you took a poll (of legislators), most of us would like to take the hospital assessment fee and vote on it every 10 years,” quipped Sen. Lowe Finney, D-Jackson.
Several incumbent legislators — including Overbey — last year faced opponents who accused them of supporting a tax increase by voting for the assessment.

Hospice Counseling Again Proposed as TennCare Cut

By Eric Schelzig, Associated Press
NASHVILLE, Tenn. (AP) — TennCare officials on Monday again proposed eliminating counseling services to hospice patients and their families if the state’s expanded Medicaid has to reduce spending by 5 percent, though Gov. Bill Haslam stressed that it’s his “firm hope” that the deepest cuts can be avoided.
The Republican governor has asked each agency to plan to spend 5 percent less for the upcoming budget year.
TennCare’s proposal would result in a cut of about $343 million, including ending hospice counseling services, reducing reimbursement rates to providers, cutting a $10 million grant and eliminating coverage for prescription-strength allergy medications.
“In a list of a lot of really difficult decisions, none of them really are too appealing,” said TennCare Director Darin Gordon.

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Federal Budget-Cutters Eye Provider Fees Used in TN, Hospitals Worry

The funding mechanism that rescued TennCare is in the deficit reduction crosshairs, creating a billion-dollar worry for Tennessee hospitals that could turn into real health-care woes for the state’s poorest residents, according to The Tennessean.
“I just can’t imagine that the state of Tennessee or the federal government would want to see the health-care safety net eviscerated,” said Dr. Jeff Balser, the dean of the School of Medicine at Vanderbilt University.
Vanderbilt University Medical Center and the patients it serves are particularly vulnerable as the 12-member congressional supercommittee considers lowering the cap for matching Medicaid provider fees.
Vanderbilt serves more TennCare patients than any other hospital in the state. They comprise 22 percent of Vanderbilt’s patient mix. The percentage is even higher for many rural hospitals.
Tennessee hospitals came up with the idea of using provider fees to keep the state from losing federal matching money when the legislature slashed TennCare’s budget. Hospitals replaced the state money last year and this year by agreeing to pay an “enhanced coverage fee.” (Note: Actually, the preferred term at the Legislature was ‘enhanced coverage assessment,’ since ‘fee’ sounds too much like a ‘tax.’)
That fee will generate about $450 million and leverage just over $707 million in federal funding — adding up to more than $1 billion for TennCare. But now Congress may decrease or stop its matching money for the provider fees.
But now Congress may decrease or stop its matching money for the provider fees.
“It would devastate a lot of our safety-net hospitals,” said Craig Becker, president of the Tennessee Hospital Association. “We’re not talking about just the Metro Generals of the world but our rural hospitals as well. They are extremely vulnerable and they do a lot of TennCare.”
…Forty-six states and the District of Columbia have some type of Medicaid-related provider fee, according to the National Conference of State Legislatures. The only states that don’t are Alaska, Delaware, Hawaii and Wyoming.
In Tennessee, there are actually two provider fees: a bed tax paid by nursing homes and the hospital “enhanced coverage fee.” The hospitals asked the legislature to allow them to assess the fee as a temporary measure.

On the Death of a Property Tax Assessor in Loudon County

Jack McElroy looks at the political pressures that apparently were involved in the suicide of Chuck Jenkins, who had been property tax assessor in Loudon County since 2006 and who previously worked for the Republican National Committee and the administration of the first President George Bush.
Jenkins looked into what appeared to be inappropriate assessments of property by his predecessor and provided his findings to the local district attorney general, who decided not to prosecute.
Reporter Hugh Willett, who wrote many stories about the Arp-Ross shenanigans for the News Sentinel, relied on Jenkins as a source in his reporting. But whistle-blowing turned Jenkins into a pariah in some GOP circles in Loudon County, where Arp had become mayor.
“He stuck his neck out and went on the record in the face of tremendous political pressure from supporters of Arp and other powerful people in the county,” said Willett. “While I was interviewing him he often made reference to the notion that the only reason he was doing this was because he knew what happened was wrong and he didn’t want to be a part of covering it up. He knew that he was making a lot of powerful enemies in Loudon County.”
More recently, Jenkins had been battling Tate & Lyle and Kimberly-Clark, two of Loudon County’s largest businesses, over their assessments. The companies recently appealed to the state equalization board, triggering a yearlong process.
Suicides have no simple explanations or causes, and no one can tell what demons haunted Jenkins in his final hours. But the burden of being an honest and dedicated public official must have taken a toll.
“It really hurt Chuck when the special prosecutor found that there was nothing to prosecute in the Arp case,” Willett remembered. “He laughed and told me, ‘No good deed goes unpunished.’ “

Haslam Planning Budget Changes to Avoid Some TennCare, Mental Health Cuts

Gov. Bill Haslam intends next week to revise his proposed state budget for the coming year to reduce or eliminate many previously-planned cuts to mental health services and TennCare, legislators said Thursday.
Lawmakers called a recess to Thursday’s House floor session so that key legislators could meet with the governor to discuss the pending changes before a House vote on increasing state fees that are being charged to hospitals to cover TennCare costs.
After the closed-door conference, Rep. Joe Armstrong of Knoxville dropped plans to lead a push by Democratic legislators for raising the hospital fee to a higher level than had been agreed upon.

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Political Games on Hospital Assessment Fee??

By Eric Schelzig
NASHVILLE, Tenn. — Senate Majority Leader Mark Norris on Thursday accused Democrats of gamesmanship for their reluctance to quickly renew a hospital fee designed to avoid millions in TennCare cuts.
The Collierville Republican said Democrats are “holding health care hostage” because they don’t want to support the measure before evaluating the final version of the state’s annual spending plan.
“I think you should pick a better fight — you’ve got lives at stake here,” Norris said. “They don’t seem to be too worried about that.”
Democratic Senate Minority Leader Jim Kyle of Memphis called Norris’ characterization a “stretch.” He said Democrats haven’t taken a formal position on the measure, but want to have more input into the overall budget.
“Before anyone would vote to raise taxes, one should have an idea what’s going on,” Kyle said. “I just expressed to (Norris) that I’m just looking for assurances that we will be informed.”
Republican Gov. Bill Haslam’s budget proposal assumes that lawmakers will adopt the more than $400 million in hospital fees, which would qualify for a 2-to-1 match by the federal government

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