Enhancing criminal penalties has long been a favored pursuit of lawmakers, the major restraint on this inclination being the cost to taxpayers of locking up the wrongdoers and provisions of state law and legislative rules that say the enhanced spending must be covered in the state budget.
An interesting debate back in the 2013 legislative session, worthy of more attention than it received as us media types focused on stuff deemed more interesting in the fast-action session, concerned what may be seen an evolution of compromise in this inherent conflict.
That is, enhance the punishment, but only when the victim is a member of a chosen profession.
The chosen professional victims in this year’s session were doctors, nurses and other health care providers in one bill (HB306) and firefighters and emergency workers in another (SB66). Starting July 1, the effective date of both new laws, if you, for example, punch an on-the-job paramedic (covered by both laws), the maximum penalty upon conviction of assault will be more severe than if you punched a preacher, a retired grandmother or a newspaper reporter.
The House has approved, 64-31, legislation that increases the penalty for assault when the victim is a health engaged in his or her professional duties.
The bill by Rep. JoAnn Favors, D-Chattanooga, was roundly criticized by some making health care providers a separate and special class of citizen. Favors and others noted that there is already a law making the punishment for assault on a law enforcement officer harsher than for others.
Favors, a nurse, said the bill (HB306) is needed because there has been an increase in workplace violence against doctors, nurses and other health care workers. Nevada has such a law, she said, and such attacks have declined since enactment.
NASHVILLE, Tenn. (AP) — Workers are putting the finishing touches on a renovation of the state Capitol as they prepare to re-open the 153-year-old building later this month.
The nearly $16 million project largely focused on upgrading electrical, mechanical and plumbing systems. Parts of the building also got new carpets, paint and security upgrades.
The governor, executive staff, constitutional officers and legislative workers are in the process of moving back into the building that has been closed since May. The public will be able to gain entry on Dec. 17.
Visitors will now have to have their driver’s licenses scanned upon entry to the building, and a more extensive internal and external video surveillance system has been installed.
Officials declined to explain details or the rationale for the enhanced security.
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.