MHA Press Room

Statement of Sam Cameron of MHA on reauthorization of Medicaid at June 30th press conference

Statement of Sam W. Cameron, President/CEO, Mississippi Hospital Association

Good Morning. I’m Sam Cameron, President of the Mississippi Hospital Association. 

Last night around 11:00, House and Senate negotiators reached an agreement with the Executive Branch regarding Medicaid funding and reauthorization of the Division of Medicaid.  I was not here last night when that agreement was reached.  An MHA staff member, though, was here and he had a direct conversation with Governor Barbour and his Chief of Staff.  

In that conversation, Governor Barbour made it clear that MHA had to endorse the agreement or he would not issue the call to reauthorize and fund the Division of Medicaid. 

He made it clear that the bill would have to be adopted by both chambers last night (remember, this was around 11:00 p.m.) or he would not issue the call for a Special Session to extend the Division of Medicaid before it “sunsets” tonight. 

He made it clear, in no uncertain terms, that if the bill was not passed last night, hospitals would face far more drastic measures from the Governor’s Office if he were to run the Division of Medicaid by Executive Order.

Since neither MHA nor the Legislature met those deadlines or conditions (and since the Governor has obviously had time to “sleep on it,”) I am not here to respond to the Governor’s threats. I am here to address what I understand to be in the agreement reached between the House, Senate, and Governor Barbour last night.

My understanding is that all of MHA’s requested protections are included in the agreed-upon bill. If that is the case and we are trying to verify that, this is certainly something we can endorse.  But, as I said, that endorsement is subject to verification.

I understand there are sufficient taxes levied on hospitals that will finally provide the Division of Medicaid with a permanent source of funding, or for at least three years. While the current Division of Medicaid is yet to demonstrate its ability to plan, project, and administer any budget, we accept and endorse the tax amounts and assessment methodologies contained in the bill.

I want to warn everyone that there are hospitals who cannot afford to pay the tax provisions in this bill. I want to warn everyone that service and staff reductions in local hospitals may occur as a result of this bill. I want to warn everyone that, regardless of the amount of taxes contained in this bill, the Division of Medicaid will continue looking for additional taxes or cuts in services in the near future.

To protect the 600,000 of our most vulnerable citizens who depend on Medicaid for their health care, to protect the interests of hospitals who provide that care, to preserve as much as possible the economic health of those cities and towns in which hospitals are the largest employers, and —most importantly—to prevent Governor Barbour from trying to run the Division of Medicaid by Executive Order, I ask members of the Mississippi House and Senate to adopt this bill.

 

Statement from Sam Cameron on Medicaid reauthorization

A Statement from MHA President/CEO Sam Cameron:

Because of the Governor’s refusal to call a Special Session of the Mississippi Legislature, it appears the Division of Medicaid will cease to exist after midnight on June 30, 2009. The Governor’s lack of action will have disastrous results for Medicaid patients and all health care providers who serve them.

While most legal experts agree the Governor can “run” the agency without reenactment of the Division, they also agree the Legislature cannot appropriate funds to an agency that does not exist. 

Pure chaos will result.  

For example, any payments to Medicaid staff or vendors after July 1st would be considered illegal gratuities, leaving the Governor with no staff to run the program.  Since there will be no Division of Medicaid, there will be no authority by which the state can collect provider taxes or draw down federal matching funds, leaving the state liable for 100% of provider payments. There is also the possibility the state would have to refund the $190 million it has already received in federal Medicaid stimulus funds.

Further complications result from the Division of Medicaid’s recent notification that it will not reimburse health care providers for treatment of Medicaid patients until the beginning of the new fiscal year.  If the agency does not exist as of midnight on June 30th, there will be no agency to pay providers for the care they extended.  Providers would then be forced to sue the State of Mississippi to recover cost of those services which, according to one estimate, could be as high as $150 million.

Many hospitals and other health care providers have already informed their vendors they will not be paid until the providers are reimbursed by the Division of Medicaid.  These delays impact the health and viability of thousands of small businesses across the state.

Beginning tomorrow, auditing firms retained under contract by the Division of Medicaid to audit hospitals will be asked to begin terminating their work with an expected departure date of June 30th.  Since the contractual agreements under which such firms are retained will be nullified with the dissolution of the Division, hospital auditors will have no standing to be in health care facilities (unless they require medical attention).

While these arguments address the “economics” side of the Governor’s inaction, MHA is most concerned with the “human” side.

Also beginning tomorrow, many hospitals will begin informing their Medicaid patients that, if the Division of Medicaid is not extended prior to July 1st, the beneficiaries may become liable for the total cost of their care.  No patient will be denied care or treatment by any hospital, but without the existence of the Medicaid program, beneficiaries will be considered “private pay” patients responsible for the whole cost of their treatment and care.   Loss of coverage will not be limited to just hospital services but will include all Medicaid services, ranging from nursing home care to physician visits, from prescription drugs to dialysis centers, from home health services to special needs children, from nurse mid wives to psychiatric treatment facilities.

Medicaid recipients - those among us who are most vulnerable and most in need of our care and compassion - should not be made victims of this stalemate between our Legislative and Executive branches.  On behalf of the 600,000 of our fellow citizens who depend upon continued Medicaid coverage, we implore the Governor to call the Special Session to reauthorize the Division of Medicaid before it expires at midnight on June 30th.

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MHA Official Statement: Certificate of Need

Mississippi currently uses the certificate of need process for hospital projects to control costs and avoid duplication of services. It is the Mississippi Hospital Association’s position that if one hospital must go through this mandated certificate of need process, then all hospitals should be required to follow the same rules. Projects should not be allowed to be “cherry picked” through legislative measures and bypass or ignore the official state process.

Sam W. Cameron
President/CEO
Mississippi Hospital Association

Print-ready four-color photo of Sam Cameron: Download samcameron4c.jpg

MHA Statement: HB 1013 dying in committee

HB 1013 would have provided $174 million in new revenue for our state’s Medicaid and trauma care programs through a $1 cigarette tax. We think it’s a shame that the bill never even made it out of committee, as Mississippians deserve to know where their senators stand on this important public health issue. Unfortunately, it has become an issue of right or left instead of right or wrong.

Medicaid spends $264 million on tobacco-related health care expenditures. The state's current excise tax on cigarettes is the 49th lowest in the nation. It just makes no sense to say you are against a tax on cigarettes (which sends people to our state’s hospitals) to fund the Medicaid program and for a tax that could shut the doors of your local hospital that provides that care when needed.

Letter to the Editor/Op-Ed Piece: Sam W. Cameron, Mississippi Hospital Association

By Sam W. Cameron
President/CEO
Mississippi Hospital Association

Governor Barbour presented his 2008 State of the State address to the Mississippi Legislature this week. A major topic of the Governor’s address was the financial situation of Mississippi’s Medicaid program – predicting an $86 million deficit for the current fiscal year and an additional projected need of $168 million over current appropriations for state fiscal year 2009. 

In his address, the Governor indicated that he would again attempt to pass legislation authorizing a tax on the sick people of Mississippi through a gross revenue tax on hospitals. Fifty of our state’s hospitals (43%) currently operate at a zero or negative profit margin, and this proposed tax has the potential of causing cuts in services and the loss of jobs in communities statewide. Because of this potential negative effect on hospitals and the communities they serve, the Mississippi Hospital Association will again oppose this ill-conceived tax. 

Governor Barbour also indicated that he will attempt to cut the amount and duration of services currently mandated in the Medicaid statutes. Considering the fact that, based on Medicaid’s own estimates, hospitals are already paid approximately 13% less than their allowable costs to treat Medicaid patients, there is no legitimate financial basis for cutting reimbursement even further.  Taking away a sick person’s Medicaid card or cutting the amount of services for which Medicaid pays will NOT stop that sick person from accessing health care - it will simply shift the burden of cost from a 74%/26% Federal/State match to 100% State monies. 

This tax issue is being framed as a public hospital versus private hospital debate. The conception is that public hospitals provide the lion’s share of uncompensated care in our state and private hospitals are benefiting from this. This is simply not true. Based on 2006 cost report data, Mississippi hospitals provided over $631 million in uncompensated care – of that total number, public hospitals provided 50.68% of the uncompensated care and private hospitals provided 49.32%. (And note that Barbour’s gross revenue tax would also include a tax on this uncompensated care.)

This is not a public hospital versus private hospital issue. Many of our state’s public hospitals are not considered disproportionate share hospitals (DSH). Some of our private hospitals are. This is an access to care issue that affects all Mississippians. Any hospital that has an emergency room is mandated by federal law to provide care to all who come through their doors – whether they have insurance or not. This tax severely hurts three-quarters of those hospitals with open doors.

Mississippi’s hospitals are already paying significant dollars into the Medicaid program.  Through currently mandated bed taxes, gross revenue assessments, and inter-governmental transfers, hospitals are paying over $140 million annually to the Division of Medicaid. Contrary to statements that you have heard regarding “not raising anybody’s taxes” in the past four years, the fact is bed taxes on hospitals have more than doubled – going from $1.50 per bed, per day, to $3.25 per bed, per day. For those health care systems and facilities that have associated nursing homes, bed taxes have more than tripled – going from $3.00 per bed, per day, to $9.27 per bed, per day!

And this is most definitely not just a tax on hospitals – it’s a tax on anyone who works at a hospital, anyone who depends on a hospital for quality health care and any business that provides health care insurance to its employees. Hospitals exist to serve our community, but we have to be able to keep our doors open – to make payroll, to have money available for capital and technological improvements, to continue to provide much-needed services, like emergency care, that often end up costing money to operate but are critical to our communities.

The Division of Medicaid’s leadership has made the statement that there are only two options for funding their deficit:  1) cut services or 2) tax hospitals.  We believe there are other options that should be explored and the Mississippi Hospital Association stands ready to cooperate with the legislature, the Governor’s Office, and the Division of Medicaid to explore these options.

Addressing Mississippi’s Nursing Shortage: Taking the First Steps Toward Preparedness

In 2005, millions of people tried to prepare for Hurricane Katrina and we all watched at the crippling of a region due to a lack of emergency and health system preparedness. Today, the urgency for Americans to prepare for the next disaster has never been greater. Across this state, local leaders and residents are planning for possible health crises, from pandemic flu to an act of terrorism. However, there is one issue that will make the response to emergencies even more difficult. It is the shortage of experienced nurses.

We all count on nurses for the personal, quality care they provide when we are sick or injured. This care is currently threatened by the ever increasing shortage of trained and experienced registered nurses. A recent report by the Trust for America’s Health indicates that 40 states face both a current and future shortage of nurses. Mississippi is one of those forty states. In October 2006, the Mississippi Office of Nursing Workforce conducted its ninth annual survey of hospitals. The hospital registered nurse vacancy rate increased to 9.1% in 2006 from 7.9% in 2005. The nursing shortage makes it difficult for our healthcare sector to meet current needs. In any kind of emergency, the presence of registered nurses will be key to the ability to provide care for an influx of additional patients, many disabled, seriously ill or injured.

Although Mississippi is not alone in struggling with this problem, the Mississippi Hospital Association Health, Research, & Educational Foundation (MHA Foundation) through the Mississippi Office of Nursing Workforce (ONW) is taking the first step towards finding a solution. A unique partnership has been formed to develop solutions to establish a stable, adequate nursing workforce to prepare for whatever issues we face. This partnership is part of a national program, known as Partners Investing in Nursing’s Future, led by the Robert Wood Johnson Foundation and the Northwest Health Foundation, to encourage local foundations to act as catalysts in developing grassroots strategies to address the nursing shortage.

The MHA Foundation, ONW, and the Mississippi Nurses Association have come together to address one of the root problems contributing to the nursing shortage - the nursing faculty shortage. The Mississippi schools of nursing report an anticipated 35.5% faculty vacancy rate by the end of the 2008 – 2009, according to the Southern Regional Education Board on Collegiate Education for Nursing survey of schools of nursing.

The Mississippi Critical Nursing Faculty Shortage Initiative is a multi-dimensional approach to increase and retain nursing faculty that more accurately reflect the ethnicity and gender of our population by the following objectives: 1) develop an innovative, accelerated educational path to a nursing faculty career; 2) develop an evidence-based image and recruitment campaign to showcase nursing education as a desirable career; 3) develop multiple adjunct faculty roles with formal relationships between education and service; and 4) improve education and clinical workplace cultures.

One of the goals of the Initiative is to develop a pilot project between service and education to be used as a model across the state. Hospitals and schools of nursing in the Jackson, Mississippi area are developing a pilot project. This will allow service and education to partner and develop adjunct faculty roles. The project will be implemented in the fall of 2007 and then be used in other regions across the state.

Although we’ve only just taken the first steps, the project shows great promise in strengthening the nursing workforce here in Mississippi. Initial research already shows the nursing community is eager to embrace these new initiatives. Hospital nurse executives are interested in providing adjunct faculty, classroom space, and financial support. Also, most nurses are interested in obtaining an advanced degree which would allow them to teach.

As we mark National Public Health Week, April 2 – 8, the Mississippi Hospital Association Health, Research, & Educational Foundation is committed to working with our community to address the health issues that face Mississippi, including ensuring that we have a prepared nursing workforce.

Nurses are a cornerstone of our health care system and need to be skilled, appreciated, and empowered to enjoy long-term careers. Efforts like this are necessary to ensure that an abundant nursing workforce is in place when we need it. Without trained and experienced registered nurses, we could face the effects of a Katrina-like disaster again in Mississippi. This is not someone else’s problem to fix. Here’s what you can do to help: As a member of the community, you can be an advocate for encouraging our legislatures to appropriate funds for faculty salaries as well as innovative paths to nursing education.

Debbie Logan, RN, MHA is the Project Director of this Initiative at the Mississippi Office of Nursing Workforce. Email her at dlogan@monw.org. Information about this program can be found at www.PartnersInNursing.org.

*Note to Editor: For more information on the Trust for America’s Health Report – Ready or Not? Protecting the Public’s Health From Diseases, Disasters, and Bioterrorism 2006, visit http://healthyamericans.org/reports/bioterror06/

MHA testifies at House Medicaid Committe Hearing on Effects of Proposed Cuts

On January 18, 2007, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule that would make significant changes to the way states finance their share of Medicaid and the State Children’s Health Insurance Program (SCHIP) and how CMS pays government hospitals and other public providers. The proposal carries out some of the $12.2 billion in administrative savings submitted by President Bush last February in his budget plan for fiscal year 2007.

At a hearing on the effect of the proposed changes to Mississippi before the House Medicaid Committee on March 1, the Mississippi Hospital Association submitted a statement on the effects of the proposed rule to our state (attached below). The hearing was called by Rep. Dirk Dedeaux, chairman of the House Medicaid Committee, to assess the impact of the proposed changes on our state’s health care system.

The rule limits payments to government hospitals, required individual hospitals to retain payments made, changes the upper payment limit calculation, proposes a new definition of public hospitals, and imposes new certification and transfer payment requirements. The Mississippi Hospital Association strongly opposes the proposed rule, which would reduce Medicaid funding nationwide by an estimated $3.8 billion over five years and harm the more than 57 million children, poor, disabled and elderly people who depend on Medicaid as their health care safety net.

This issue is of paramount importance to our state's health care safety net – the cuts translate to a five-year total loss of approximately $250 million in cuts to Mississippi’s Medicaid program. Last year, a majority of the House and Senate asked the administration to drop the proposal, but that direction was ignored.

Download cms_rules_changes_effects.doc

MHA Official Statement: Audit of MHA's UPL Contract

Attached below is an Acrobat document containing MHA’s official statement on the audit of MHA's UPL contract with Medicaid and a copy of a letter sent to State Auditor Phil Bryant by MHA on Aug. 1.

Any sentence in the official statement can be attributed as a direct quote from Sam Cameron, per his approval. Though the comments are in Acrobat format, the text is editable. If you prefer plain text be e-mailed to you, contact Shawn Lea at (800) 289-8884, (601) 368-3237 or slea@mhanet.org.

Download statementaudit.pdf