Tag Archives: medicare

Haslam: At least Insure TN is getting ‘more airtime’

By Erik Schelzig, Associated Press
NASHVILLE, Tenn. — Gov. Bill Haslam said Thursday that he is willing to risk a second defeat of his Insure Tennessee proposal to highlight the need for improving health standards in the state.

The Republican governor told reporters after a prayer breakfast at Lipscomb University that the more often lawmakers take up his plan, the more chances his administration has to quell concerns about the proposal to extend health coverage to 280,000 low-income Tennesseans by drawing down $2.8 billion in federal Medicaid funds.

“I don’t think it’s a bad thing at all for it to be discussed every chance that it gets to be discussed,” Haslam said. “Obviously we’re hoping it passes, but if it doesn’t pass, there’s still that much more airtime for the issue and for people to understand it.”

Haslam’s original proposal failed in a special legislative session last month, but has been revived by a Democratic lawmaker in the Senate. The resolution sponsored by freshman Sen. Jeff Yarbro of Nashville was approved by the Senate Health Committee on a 6-2 vote on Wednesday evening, but faces tough prospects at its next stop in the Senate Commerce Committee.

“It’s going to be tough sledding,” Senate Speaker Ron Ramsey, R-Blountville, said after the breakfast. “I’m not going to try to sway them one way or another. I just want everyone to vote their conscience.”

The revived proposal incorporates three new elements to address concerns raised by lawmakers during the special session. They include adding a “lockout provision” for enrollees who repeatedly fail to pay premiums; assurances from Haslam not proceed if the U.S. Supreme Court rules against federal health insurance marketplaces; and requirements for the federal government to guarantee that Tennessee can drop the program if it ends up being more expensive than planned.

“This is a complex and difficult issue that a lot of people have a problem with,” Haslam said. “I think we have answers to all those problems, whether it be: ‘Will it really cost the state anything? No. Can we get out of it? Yes. Can this improve health outcomes? Yes.'”

The governor added that the renewed effort also removes concerns some lawmakers raised about running the proposal in a special session apart from the budget process. “Well now we have a chance of discussion during a regular session,” Haslam said.

Hospitals have agreed to cover the $74 million state share to draw down the federal Medicaid money, but many Republicans are still wary of the political implications of supporting a key element of President Barack Obama’s health care law.

Under a 2014 state law supporters dubbed the “Stop Obamacare Act,” Haslam must seek legislative approval before striking an agreement with the federal government on Medicaid expansion. Tennessee lawmakers have been joined by counterparts in Wyoming and Utah in rejecting Republican governors’ Medicaid expansion proposals this year.

Those outcomes stand in contrast to the experience of Indiana’s Republican Gov. Mike Pence, who didn’t need legislative approval for his Medicaid expansion deal with the federal government in January.

Pending Boehner-Pelosi Medicare deal helps TN hospitals

By Alan Fram, Associated Press
WASHINGTON — House aides released an outline late Friday of an emerging bipartisan deal shielding physicians from Medicare cuts and pumping more funds to popular programs for children’s health and community health centers.

In a first hint of some of the measure’s fine print, the bare-bones summary said lawmakers would raise money partly by targeting Medicare providers who are tax scofflaws. In the winner’s category, the agreement would also help Tennessee hospitals serving large numbers of poor patients and makers of medical equipment who bid for Medicare business.

The one-page document provides no price tags and few specifics. But as lawmakers, congressional aides and lobbyists have said for days, it would cost roughly $210 billion over a decade, with around $140 billion financed by adding to federal deficits, aides said Friday. The remaining $70 billion would be split about evenly between Medicare providers and beneficiaries.

House Speaker John Boehner, R-Ohio, and Minority Leader Nancy Pelosi, D-Calif., have been seeking the agreement for two months in hopes of resolving a problem that has haunted Congress for years.

As medical inflation soared, a formula in a 1997 budget law aimed at reining in Medicare costs has ended up threatening doctors with deep cuts in Medicare reimbursements that lawmakers have staved off every year since 2003. Physicians have warned the constant threat of cuts could prompt them to stop treating Medicare patients.

The bipartisan compromise would erase that formula, including averting a 21 percent cut in physician Medicare reimbursements set for April 1. Instead, the plan would give Medicare physicians 0.5 percent annual fee increases for the next five years and offer financial incentives to charge patients for quality of care, not for each treatment.
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Haslam says he’ll ‘probably’ submit a Medicaid expansion plan this fall

Gov. Bill Haslam said Thursday that he will “probably” submit a proposal for Medicaid expansion in Tennessee to federal officials sometime this fall, though giving no specifics.

From the Chattanooga Times-Free Press:
“I think we’ll probably go to them sometime this fall with a plan … that we think makes sense for Tennessee,” the Republican told reporters
Haslam’s statements on Thursday came in response to reporters’ questions following a Legislative Plaza rally by the state NAACP and other advocates.

The 40 to 50 participants castigated the governor and Republican Lt. Gov. Ron Ramsey, the state Senate speaker, for refusing to expand the program.

“Governor, do the right thing, do the moral thing,” urged Walter Davis, executive director of the Tennessee Health Care Campaign, who joined Tennessee NAACP President Gloria Sweet-Love and other advocates in a rally on the Legislative Plaza.

Lower-income people are suffering as are hospitals, which had anticipated the money, advocates said.

Asked by reporters about the comments, Haslam revealed he spoke earlier this week with Burwell and was already working to schedule a meeting with her.

Haslam said what’s changed is his administration can now follow the experience of other states where governors, many of them Republicans, have obtained approval for waivers of traditional Medicaid rules.

“One of the things we’re able to do now is look and say well they said yes to this with this state, no to that … so we’re kind of learning through that whole process as well,” Haslam said.

From The Tennessean:
The governor said he wants to do what “works financially for the state long term.” He said he talked to U.S. Health and Human Services Secretary Sylvia Mathews Burwell by phone this week and hopes to talk to her in person in Washington as soon as a meeting can be arranged.

…Craig Becker, president of the Tennessee Hospital Association, (said), “We’re very pleased if it’s true. We are very anxious to see what the plan is and see if we can help him to get it approved.”

Haslam made the comments to reporters after the state chapter of the NAACP and other advocates for health care staged an event urging the governor to act. About 50 protesters gathered on the War Memorial Plaza across the street from the state Capitol.

…Michele Johnson, executive director of the Tennessee Justice Center, said she hopes action follows the latest comments from Haslam.

“It’s urgent that the governor submit a serious plan to accept federal funds to expand health coverage for Tennesseans,” Johnson said. “The consequences of delay are devastating for both the health-care infrastructure we all reply upon and for hard-working Tennesseans.

“As we wait for a plan, Tennesseans lose $2.7 million a day. We can’t get that back. Meanwhile, other governors of both parties have implemented plans that strengthen their states and give their citizens the peace of mind only health coverage can provide.”

Pennsylvania on Thursday became the 27th state to expand its Medicaid program. Republican Gov. Tom Corbett’s administration and the U.S. Department of Health and Human Services agreed to a plan that lets private insurers administer Medicaid-funded coverage that adheres to Medicaid’s existing rules.

Further, from WPLN:
“It’s nice to say, ‘let’s put politics aside.’ But at the end of the day, you also have to get it passed the legislature. So you better be able to get something that you can get 50 votes in one house, and 17 in the other,” Haslam told reporters Thursday.

Haslam’s announcement to send federal officials the state’s own expansion proposal follows the governor’s request that U.S. Health and Human Service officials send Tennessee a recommended course of action.

“They never really came back with anything, so we’re proceeding,” Haslam said.

Ambulance service to pay $500K for false Medicaid/Medicare claims

David Rivera, U.S. Attorney for the Middle District of Tennessee, says a Nashville-based service provider, First Call Ambulance. will pay $500,000 to settle false claims allegations, reports the Nashville Post.

The United States accused First Call of upcoding ambulance billings of Medicare and Medicaid patients and falsifying the medical necessity of ambulance transports. In a complaint unsealed Thursday, former First Call employee Jason Gaskin reported that he was often “confronted with a patient who plainly did not need to be transported by ambulance. Indeed, some patients were so ambulatory that they were able to walk to the vehicle and enter unassisted.”

The company is also accused of submitting claims for advanced life support in place of basic life support, which is reimbursed at a lower rate.

In addition to the settlement payment, First Call has entered into a corporate integrity agreement with the U.S. Department of Health and Human Services requiring certain compliance measures to reduce the likelihood of future violations. Officials with First Call could not be reached for comment Friday.

CMS Says 30 TN Medicare Contractors Not Licensed in TN

Joint news release from Tennessee congressional delegation:
WASHINGTON – Members of the Tennessee United States congressional delegation today announced that their inquiry into whether the administration awarded Medicare contracts to businesses not licensed in Tennessee has resulted in the finding that 30 of 98 suppliers were not licensed and will have their contracts voided.
On May 21, Senators Lamar Alexander and Bob Corker (R-Tenn.), along with Representatives Marsha Blackburn (R-Brentwood), Phil Roe (R-Johnson City), John J. Duncan, Jr. (R-Knoxville), Chuck Fleischmann (R- Ooltewah), Scott DesJarlais, (R-Jasper), Jim Cooper (D-Nashville), Diane Black (R-Gallatin), and Steve Cohen (D-Memphis) sent a letter to the administration requesting details on its policy of awarding Medicare contracts for durable medical equipment to businesses not licensed in Tennessee, a violation of the administration’s bid policy and a violation of Tennessee state law. Durable medical equipment includes products that are intended for at-home care of sick or injured individuals. The category includes wheelchairs, crutches, blood pressure monitors, and hospital beds.
In a letter responding to the May 21 inquiry from the members, the administrator of the Centers for Medicare and Medicaid Services, Marilyn Tavenner, said: “We have determined that certain out-of-state suppliers that were licensed in their home state, but that did not meet aspects of existing Tennessee licensing requirements at the time of bid submission, were awarded contracts. As a result, CMS will take steps to void contracts for these suppliers in the Tennessee competitive bidding areas, consistent with the policies and guidelines established for the competitive bidding program. This applies to approximately 30 out of the 98 contract suppliers in the Tennessee Competitive Bidding Areas.”
Note: The full text of the CMS response is below:

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$41M Settlement in ET Medicare Fraud Case

In a case that mirrors the Biblical tale of a David, the lowly shepherd boy who defeated a giant, federal authorities on Tuesday revealed that two workers in a global firm with a work force 6,000 strong would prove the undoing of a business they say defrauded taxpayer coffers of untold millions in nearly a decade.
More from Jamie Satterfield’s account:
Federal prosecutors announced Tuesday a $41.8 million civil fraud settlement in a “whistle-blower” lawsuit against international medical equipment supply company, Hill-Rom Company Inc.
The settlement is the largest ever recovered by the U.S. Attorney’s Office for the Eastern District of Tennessee, U.S. Attorney Bill Killian said at a Tuesday afternoon news conference. The negotiated settlement, however, is likely a drop in the bucket to the actual amount authorities allege Hill-Rom overbilled the Medicare federal insurance program from 1999 to 2007.
Hill-Rom, a global firm headquartered in Batesville, Ind., agreed to the settlement to avoid criminal prosecution for years-long improper billing to Medicare for various equipment used to help treat bed sores for patients, Killian said.
“Hill-Rom submitted false claims for medical equipment for patients who did not qualify for the equipment, including patients who had died, were no longer using the equipment or had been moved to nursing homes,” Killian said.
Assistant U.S. Attorney Betsy Tonkin said a 2003 internal audit alerted Hill-Rom to billing problems, but the firm did nothing to correct them.
In a statement released Tuesday evening, Hill-Rom denied any intentional wrongdoing.
“Hill-Rom is dedicated to the highest standards of business conduct and integrity. We vigorously disagree that there was any wrongdoing in this situation and this settlement does not represent any admission on our part. We remain committed to adherence with all applicable laws and regulations,” the statement read.
Two registered nurses — Laurie Salmon of Knoxville and Lisa Brocco of Nashville — in 2005 filed a lawsuit under the False Claims Act in U.S. District Court in Knoxville, an action known as a “whistle-blower” lawsuit and kept under seal while authorities investigate the claim.

Reports on Federal Spending Policies in TN

Three reports released in recent days provide a window into what federal spending policies mean to Tennessee, according to Bill Theobald’s report from Washington.
-Democratic administration report responding to the House Republican budget, which would repeal last year’s health-care reform law, says 93,356 Medicare beneficiaries in Tennessee would pay an additional $52 million for prescription drugs in 2012.
That’s because the reform law that Republicans want to repeal is designed to fill the “doughnut hole” gap in prescription drug coverage that many seniors face.
…A report by the Kaiser Family Foundation, which researches health care policy, estimates the GOP plan would reduce federal Medicaid spending in Tennessee from $106.6 billion to $68.5 billion over 10 years.
Medicaid payments to hospitals in Tennessee would fall from $5.9 billion to $3.5 billion in 2021 — a 42 percent drop.
…A report by the Northeast-Midwest Institute found that in 2009, Tennessee received $1.56 in federal funding for every $1 it sent to Washington in taxes, fees and other money.
That ranked Tennessee 24th in the country, with the top rankings occupied by states that got the most money back compared with what they sent Washington.

Health Care Compact Passes Senate

The Senate today gave its approval, 22-9, to creation of a “Health Care Compact,” which could lead to a state takeover of all health care programs – including Medicare and Medicaid – now operated by the federal government.
The bill by Sen Mae Beavers, R-Mount Juliet, puts into state law a framework for Tennessee’s participation in a Health Care Compact. The bill envisions the state taking over all health care programs and the federal funding to pay for those programs. Congress would have to approve the idea before it could ever be implemented.
“It would simply give Tennesseans a choice in a few years, should Congress approve,” said Beavers.
“Don’t you think we can do things more efficiently than Washington? I think we could,” she said.
Some Democrats, however, contend the move sets the stage for major cutbacks in funding of the federal programs to provide health care for the aged, poor and disabled.
The bill, SB326, is dead for the year in the House. But the House can take up the matter next year and pass the measure. Since any sign-off by Congress is likely two or three years away, proponents say the delay in the House won’t hamper the Health Care Compact vision in the longer term.

TN Health Care Campaign Against ‘Scary’ Health Care Compact

News release from Tennessee Health Care Campaign:
Nashville, TN – Under a bill proposed in the Tennessee state legislature (HB0369, SB0326), and to be voted on by the House Health and Human Resources sub-committee on Tuesday, the federally protected and administered Medicare program would move under the control of the Bureau of TennCare.
“This could jeopardize security, choice and benefits for over 1 million seniors and people with disabilities in Tennessee who rely on the Medicare program for their health care coverage”, says Beth Uselton, Executive Director for the Tennessee Health Care Campaign.
The Health Care Compact bill, HB0369 sponsored by Representative Mark White and SB0326 carried by Senator Mae Beavers, is the most recent political attempt to exempt Tennessee from the new federal health care law, the Patient Protection and Affordable Care Act.
“Unfortunately Tennessee seniors are being played like pawns in this reckless attempt to thumb our noses at the federal government. I have seen nothing in the Compact bill which leads me to believe that the state has a plan for how to administer Medicare in the best interest of the people who depend on it” says Tony Garr, Policy Director for the Tennessee Health Care Campaign.
“Since 1965, Medicare beneficiaries have received guaranteed benefits, protections, and have never once had to worry about their Medicare. In fact, over the years, their Medicare has been improved. Now, under the Compact bill, the one (1) million Medicare beneficiaries in this state will have a lot to worry about if TennCare takes over their Medicare,” according to Garr.
In 2005, 170,000 TennCare enrollees thought that they had guaranteed coverage and were cut off TennCare by Governor Bredesen. The state legislature did not stop these cuts. A year later, almost 100,000 Tennesseans who had SSI, Supplemental Security Income benefits under TennCare, thought that they had the protections of the federal court, but Governor Bredesen cut them off as well. The state legislature did nothing. “Tennessee seniors have good reason to worry about a state takeover of Medicare,” says Garr.
“Medicare beneficiaries could lose their choice of doctors under the Health Care Compact bill being considered by the State Legislature,” according to Tony Garr. Under this legislation, TennCare, which relies on Managed Care Organizations to administer benefits, would decide which doctors beneficiaries could see. Most doctors in Tennessee do not accept TennCare because its payment rates are lower than Medicare. This is especially true for many specialists such as heart and orthopedic specialists. Medicare beneficiaries living in rural Tennessee would even have fewer choices of doctors, leaving many without access to care and without protections for coverage.
“This bill is scary because it carries with it impacts and consequences for all Tennesseans who rely on federal laws to protect their health care. This is just the tip of the iceberg. Under the Compact bill, Tennessee citizens could lose many rights and protections they don’t even realize are in danger.”