Gov. Bill Haslam has signed every bill the Legislature put on his desk since taking office. So why doesn’t he ever veto some of those bills that he obviously doesn’t like very much. The answer as reported by TNReport: It’s a fair question, but some of those laws pass with 80 percent vote. In the end, a governor’s veto can be overridden with just one vote positive. So I think the lesson is to try to engage in the process as much as you can. And then there’s certain things that are things that you might say, ‘That’s not exactly what I would do, but I don’t think it’s necessarily harmful to the state.’ Other things you say, ‘I think that is harmful to the state,’ and you jump in. Note: For other thoughts on the vetoing matter, see Betsy Phillips.
And, as for the news media reporting a lot on silly bills: “Look at the amount of coverage on certain issues which may or may not ever get passed … and then weigh them against their impact on the state. Whether that be an education initiative, or changing the tax structure, or some crime prevention, those are things that really, really impact Tennesseans every day. And some of the ones that grab headlines, I think they’re fun for discussion, but a month from now and a year from now they’re really not going to impact Tennessee that much.
Q: But you don’t blame the lawmakers for bringing those in the first place, knowing full well that they’re shiny objects that will draw attention?
Haslam: (Laughing) You’re pointing fingers awfully a lot. I will blame them when the media says, ‘Yeah, we can do a better job of being substantive about issue coverage.’
Some Tennessee hospitals are questioning why they should continue paying a self-imposed tax to prop up the state’s Medicaid program, reports The Tennessean. It seems hospitals raising the questions are losing money treating TennCare patients while some others are being paid much higher reimbursements. Hospital executives were shocked to learn that insurance contractors for TennCare, the state health-care program for the poor, were paying more than four times as much to some hospitals as to others for outpatient procedures. In some cases, the disparities amounted to millions of dollars — enough to make or break a hospital’s budget.
The tension threatens to fracture a carefully negotiated alliance that keeps the state from losing hundreds of millions of dollars in federal matching money.
One of the state’s largest hospitals, Methodist Le Bonheur Healthcare in Memphis, has left the Tennessee Hospital Association, the organization that came up with the idea for the “enhanced coverage fee,” a 3.5 percent assessment on patient revenue.
Craig Becker, THA president, said a solution is in the works. His organization has asked TennCare to set new guidelines to narrow the disparities in reimbursements. The state agency has agreed to a more equitable payment scale, and a bill is moving through the legislature to do that.
…Hospitals can receive different reimbursements for a variety of reasons. One with a trauma center or a neonatal intensive care unit would provide more expensive treatment.
But the biggest variable is the fact that TennCare contracts with three managed-care organizations that negotiate with individual hospitals to set reimbursement rates.
Those rates are considered proprietary business information, so hospitals did not realize how much disparity there was until TennCare proposed a new rule as a cost-saving measure. The rule said no hospital should receive more than what Medicare — the federal insurance program for the elderly and disabled — would pay for a procedure.
That proposal raised eyebrows, because TennCare typically pays less than Medicare.
After hospitals complained about disparities, the THA hired Aon Consulting, the same firm that serves as TennCare’s actuary, to analyze reimbursements.
Aon found that for outpatient services, some hospitals got just 60 percent of what Medicare would pay, while others got more than four times the Medicare rate.
For routine hospital stays, some hospitals received reimbursements higher than Medicare’s, while others got as little as one-fifth of what Medicare would pay.
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.
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
While a special 4.5 percent levy on hospitals appears to have broad support among legislators as a way to avoid $1.3 billion in cuts to TennCare in the coming year, some are proposing an even bigger fee to bring even more federal money into the state health care system.
“We do have an opportunity to pull up to the pump, and we ought to fill all the way up and not just fill up part of the way,” Rep. Joe Armstrong, D-Knoxville, said last week in advocating a 5.5 percent “enhanced coverage assessment.”
The assessment – proponents insist that it should not be called a “tax” – was initiated last year at the urging of the Tennessee Hospital Association to avoid a 7 percent cut in TennCare payments to health care providers and doctors. The levy was approved almost unanimously by the General Assembly in the 2010 legislative session, but it expires June 30.
In the current year, hospitals pay the fee based on 3.52 percent of their net patient revenues. The resulting revenue is used to trigger federal matching funds on the basis of roughly $2 in federal money for each $1. The money – both the new revenue from the assessment and the resulting federal funding – go to TennCare, which uses it to avoid cuts that would otherwise be made.
For the coming fiscal year that starts July 1, THA has agreed – with the support of Gov. Bill Haslam and key lawmakers – to raise the assessment level to 4.52 percent. That translates into about $450 million in state revenue from hospitals and a flow of $870 million from the federal government, or a total of $1.32 billion for TennCare.
Without that money, payments to health care providers would be cut by 8.5 percent, a loss that proponents of the move say would force some hospitals to close their doors and some providers to refuse TennCare patients.
Rest of the story HERE.
See also reports in the News Sentinel and the Chattanooga Times-Free Press on the impact of pending cuts to TennCare even with enactment of the ‘enhanced coverage assessment.” The News-Sentinel’s Kristi Nelson also has a story on the federal health care law’s impact on TennCare.