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.
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.
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.
CHATTANOOGA, Tenn. (AP) — TennCare officials say it is getting more difficult for low-income seniors to qualify for nursing homes and other services.
Officials say under old rules, elderly people could qualify for up to $55,000 to pay for a nursing home, adult day care or assisted living if they weren’t able to groom themselves. Under rules that began on July 1, TennCare will take an overall assessment of a person’s need before that level of funding is allocated. Being able to groom oneself is just one measure that TennCare uses to assess a person’s ability to handle activities of daily life.
TennCare spokeswoman Kelly Gunderson said those who don’t qualify for the maximum assessment can still get up to $15,000 annually. She said those who think they need more can ask their health care coordinator for another assessment.
The change has led to concerns.
Serenity Adult Day Care Center owner DeNessa Cartwright told the Chattanooga Times Free Press (http://bit.ly/Oj5nnV) that $15,000 might not be enough for the level of care some seniors require.
“A person can be lacking in only one ADL, but that one ADL could be so major that you still have many needs and need maximum funding,” said Cartwright.
Gunderson said changing the rules will save the agency $47 million a year and it will be able to redistribute money to serve more people.
“This is a critical next step in helping the state continue to expand access to home-based care, delay and/or prevent the need for nursing facility placement, when appropriate, and rebalance the state’s long-term care system for the elderly and adults with physical disabilities,” Gunderson said.
But Tennessee Justice Center Executive Director Gordon Bonnyman said he is concerned the state will be unable to provide needed services.
“It just defies common sense that you’re going to actually be able to maintain everybody, meet those needs and yet take $47 million out of the budget once used to pay for those services,” Bonnyman said
With a prod from the federal government, the state Health Department has posted on its website thousands of pages of inspection reports on licensed nursing homes across the state, according to The Tennessean. The posting marks the state’s effort to come into compliance with a little-known provision of the new federal health-care reform law, known formally as the Affordable Care Act. The law set a Jan. 1 date for states to come in to compliance.
Eventually, inspection reports for nursing homes, hospitals and other licensed facilities will be posted going back four years, said Health Department spokeswoman Shelley Walker.
While the inspection reports have been considered a matter of public record, obtaining copies of the reports previously required an individual request.
So far, one year of nursing home reports has been scanned in to the system. Note: The reports are available HERE.
State Rep. Tony Shipley, who is under investigation in a case that questions his dealings with the state Board of Nursing, has been named chairman of a legislative committee that has oversight of all such health-related boards.
Shipley, R-Kingsport, said he views the appointment as a display of confidence in his integrity and innocence by legislative leaders. The Tennessee Bureau of Investigation should now publicly state that the probe has turned up no wrongdoing by either him or Rep. Dale Ford, R-Jonesborough, who is also under investigation, he said.
“There’s nothing there and I believe they know that,” said Shipley last week. “It’s not Shipley that’s stinking. It’s other things that are stinking now.”
TBI spokesman Jason Locke said as a matter of general policy the agency launches investigations at the request of a district attorney general and, similarly, would close an investigation and issue a statement of exoneration only with the assent of the district attorney general involved.
“The TBI investigation was originated at the request of District Attorney General Torry Johnson (of Nashville). It is, at this time, still active and ongoing,” Locke said in an email response to a reporter’s inquiries about the Ford-Shipley investigation.
The investigation, initiated in June, revolves around ultimately successful efforts by Shipley and Ford to have the Board of Nursing reinstate the licenses of three upper East Tennessee nurse practitioners.
NASHVILLE, Tenn. (AP) — A federal delay may cause rate cuts for TennCare providers in areas including nursing homes, home health providers, transportation services, dentistry and labs and X-rays.
The state’s expanded Medicaid program announced Friday that it no longer anticipates receiving the federal money in time to stop the rate cuts from growing from 4.25 percent to 8.5 percent in January.
Lawmakers last session approved a TennCare budget contingent on receiving an estimated $82 million from the federal government to make up for billing mistakes for people eligible for disability benefits from the Social Security Administration.
The U.S. Department of Health and Human Services now expects it will require federal legislation to resolve the money owed to the states.
Gov. Bill Haslam said three weeks ago the state may face deep cuts in federal funding, with services for the poor and disabled disproportionately affected.
TennCare would possibly cut up to $2.2 billion. The program serves 1.2 million people.
See also The Tennessean, which focuses on nursing home cuts. An excerpt: Staffing is the only place nursing homes can cut back, said Jesse Samples, executive director of the Tennessee Health Care Association. Labor accounts for 70 percent of costs, he said, while the other 30 percent are for fixed costs.
“You’re looking at personnel,” Samples said. “It’s not like the facilities are going to be taking care of the same number of patients with less staff. What they are going to have is less patients to go along with that less staff. What will happen will be an access problem.”
An explanatory note to media from TennCare officials is below.
Even as a large segment of the population moves into its later years of life and might require nursing home care, Tennessee is moving toward lighter regulation of nursing homes, fewer state investigations and laws that make it more difficult to bring potentially costly lawsuits against operators, according to The Tennessean. Many nursing homes in Tennessee also now require patients or their families to sign agreements waiving their rights to a trial before admission.
A measure passed earlier this year by the legislature places strict new limits on the rights of nursing home patients and their families to sue nursing homes for poor care. That law, which caps the amount a jury can award, goes into effect this week.
This comes just a couple of years after the legislature in 2009 vastly reduced oversight of the 325 nursing homes in the state by eliminating regulations mandating that nursing home operators file detailed reports on adverse events affecting patients. Also eliminated were requirements that the state investigate those incidents. Officials said the change was needed so they could spend their time investigating more serious complaints.
Tennessee has not fared well compared with other states in some key quality measures of nursing homes. And federal officials have said the state has failed in its regulation of such homes. A report issued this year by the U.S. Government Accountability Office gave the state Health Department failing scores for its performance in investigating serious complaints against nursing homes. It said there was a backlog of cases that had gone uninvestigated, and it cited a staff shortage as a factor.
…Data compiled by the federal Centers for Medicare & Medicaid Services show Tennessee ranks fourth out of 50 from the bottom in the number of hours per patient per day provided by certified nurse assistants. It ranks seventh from the bottom in registered nurse hours per patient per day, according to the CMS data.
The latest data show Tennessee nursing homes provide an average of 0.62 hours of registered nursing care per patient per day. Assistant Health Commissioner Christy Allen said that was comparable to other states in the region. Neighboring Kentucky provides 0.8 hours, while Florida provides 0.64. The states that provide the most hours are generally lower-population states: Hawaii nursing homes average 1.36 hours, Delaware provides 1.22 hours and Alaska 1.86 hours.
According to state health officials, current law and regulations require licensed nursing personnel to provide only 0.4 hours of direct care per patient each day.
In his Sunday column, Robert Houk reports on a talk with state Rep. Dale Ford, who says he’s disappointed in Gov. Bill Haslam’s response to reports of a TBI investigation into his dealings with the Board of Nursing….and that he’s been assured by the TBI that he has “nothing to fear” from the probe. If you don’t already know, Ford is a retired major league umpire (he has also refereed some big-time NCAA men’s basketball games). And while professional sports have often been touched by wrongdoing on the part of athletes, owners and officials, Ford said there’s never been a scandal involving MLB umpires. I have no doubt that’s true, but it doesn’t mean umpires don’t blow a call every now and then. Just ask the Atlanta Braves, who lost a 19-inning heartbreaker to the Pittsburgh Pirates last week because of a bad call at home plate.
The question is: Did Ford overstep his boundaries as a state lawmaker when he interceded on the part of the disciplined nurses? That’s what TBI officials are trying to determine. Ford says he has been assured by the TBI he “has nothing to fear” from its investigation. The Washington County lawmaker also told me he is confident that he did nothing unethical in the case.
“If they say I did, then there’s a lot of lawmakers who have helped their constituents who are also in trouble,” Ford said.
Lt. Gov. Ron Ramsey was quick to come to the defense of Ford and Shipley, telling reporters that legislative oversight of state regulatory boards must continue. Gov. Bill Haslam told the Associated Press he is awaiting the outcome of the TBI investigation in the case, but added he doesn’t “like it when people use their leverage to accomplish a personal agenda.”
Ford said he was disappointed that Haslam did not speak up on his behalf. “The governor should come out and make a strong statement that he knows me and know I wouldn’t try to bully anyone,” he said.
Ford’s critics might say it’s not so much that he tried to help his constituents as it was how he went about doing it. In addition to meeting with health officials, Ford also introduced legislation that would create a special legislative committee to hear appeals from those who have had their professional licenses revoked or have been fined $1,000 or more by a state regulatory board. Ford said he later scrapped the bill after learning its “fiscal note” (cost to implement) made it impossible to pass this year.
The Jonesborough lawmaker says he understands the role of state regulatory boards, but believes they need legislative oversight. He said professionals who come before these boards need to be able to tell their side of the story.
“There are two sides to every story,” Ford said. “The truth is usually somewhere in the middle.”
(Note: Updates, expands and replaces earlier post.)
KINGSPORT, Tenn. (AP) — A Republican state legislator who helped three nurse practitioners get their licenses back says he advocated for them because he felt their constitutional rights were violated. (It ‘offended me, constitutionally,” he said.)
Rep. Tony Shipley of Kingsport is one of two lawmakers who have acknowledged using their legislative positions to some degree to force the Tennessee Board of Nursing to reconsider the suspensions of Bobby Reynolds II, David Stout Jr. and Tina Killebrew.
The Tennessee Bureau of Investigation was probing fatal overdoses among patients of the now defunct Appalachian Medical Center, where the nurse practitioners once worked, when the TBI began looking into whether lawmakers improperly intervened with the state board.
TBI spokeswoman Kristin Helm told the Kingsport Times-News by email that the agency is investigating the nurses’ cases in a separate probe and has turned the matter over to Washington County District Attorney General Tony Clark.