A dispute between Blue Cross/Blue Shield and transport companies has Sen. Kathy Sheran in action.
MINNESOTA — Residents of rural long-term care facilities have been scrambling to find rides to medical appointments due to a change enacted by Blue Cross/Blue Shield.
The insurer canceled its contracts with transportation companies in rural Minnesota in late 2013, saying the companies would need to work with a broker, Medical Transportation Management, to continue doing business with Blue Cross as of Jan. 1.
The transportation companies refused to work with Missouri-based MTM, citing its history of antitrust and Medicaid fraud settlements and troubled track record in serving the Twin Cities area. MTM also is offering the transport companies rates 30% lower than their previous levels, according to the Minneapolis Star Tribune.
Sen. Kathy Sheran (Mankato), a member of the state's Democratic-Farmer-Labor Party, said she has heard concerns from long-term care facilities frantically trying to arrange rides for residents, according to the Free Press.
Sheran also told the Mankato newspaper that she was considering proposing a legislative fix to enable better transport for individuals.
Big spending for LTC
MASSACHUSETTS — The Bay State has the highest per-capita healthcare spending in the United States, driven to a significant degree by long-term care utilization and prices, according to a recently released report.
Per-capita healthcare spending in Massachusetts was 36% higher than the national average as of 2009, the state's Health Policy Commission announced in its December report. Long-term care expenditures accounted for more than 30% of that total difference.
Massachusetts residents use healthcare services more frequently than people living in other states, and the cost of services is also high, according to the report.
Average personal healthcare expenditures for Medicaid beneficiaries were $1,400 higher than the U.S. average, the report stated. Long-term care and home health services expenditures accounted for 73% of that difference.
Personal healthcare expenditures for Medicare beneficiaries were $912 higher than the U.S. average, the commission determined. Higher reimbursements for long-term and home health services accounted for 53% of that difference.
$7 million for rural homes
NEW YORK — Four not-for-profit nursing homes in the Adirondack region will receive more than $7 million from the state to help offset losses from Medicaid cuts while they seek ways to partner with each other.
The Department of Health announced the funding in December.
The four facilities, known as the Blue Line Group, aligned with each other in 2013. The funding will give the facilities flexibility to pursue operational changes while they face Medicaid rates that fall far short of actual costs of care, Blue Line Group leaders said.
Hal Payne, administrator at Adirondack Tri-County in Johnsburg, said reducing staff — including administrators and medical directors — is on the table. His facility and the others in the Blue Line Group also are seeking ways to help each other operate more efficiently.
“Even though we are 50 to 60 miles apart, there are opportunities to share services,” Payne told local newspaper the Post Star.
Bill for patient status clarity
PENNSYLVANIA — Hospital patients would have to be notified of being designated “observation status” after being moved from the emergency room to a bed, under a bill introduced in the House of Representatives.
The measure stipulates that if a patient is moved from the ER and spends 24 hours in a hospital bed, the hospital must tell the patient whether he or she has been designated as an inpatient or as an outpatient under observation. The hospital also would have to explain the implications of this designation, such as that Medicare covers post-acute care only for those who spend at least three midnights as an inpatient.
The Pennsylvania Health Care Association and Center for Assisted Living Management praised the bill for increasing transparency.
The lead sponsor is Majority Whip Stan Saylor (R-York).
Battle brews over VA facility
south dakota — A fight over the fate of a historic veterans nursing home reached a new stage last month, when the Department of Veterans Affairs announced it will move forward with a study into the environmental impacts of closure.
The facility in Hot Springs is listed on the National Register of Historic Places, and activists have been protesting since the VA first floated the idea of closure in 2011.
Both of the state's U.S. senators, John Thune (R) and Tim Johnson (D), expressed displeasure after the VA announcement, as did state lawmakers and members of Save the VA, a group formed to preserve the facility.
Veterans Affairs argues that it needs to close the VA Black Hills Health Care System building to provide a more modern facility in Rapid City. Those opposed, including the National Trust for Historic Preservation, say renovating is a more cost-effective option that would help preserve the historic building, according to local reports.
Advocate presses governor
oklahoma — In a recent closed-door meeting with Gov. Mary Fallin (R), a prominent advocate for seniors called for seven high-ranking officials to resign over conditions in Oklahoma's nursing homes.
Wes Bledsoe, founder of long-term care watchdog group A Perfect Cause, believes that state overseers are not conducting prompt and thorough investigations of nursing homes after receiving complaints, according to local reports.
New ombudsman takes post
florida — Leigh Davis, a former program administrator with the state's Agency for Health Care Administration, will begin serving as Florida's long-term care ombudsman this month, the Department of Elder Affairs announced in January.
Davis has more than three decades of experience in healthcare, including long-term care, according to Elder Affairs Secretary Charles T. Corley.
Davis' two immediate predecessors left the post under clouds of controversy.
Brian Lee sued the state and two provider associations, leveling charges that he was unlawfully forced from office.
Lee's successor, Harold J. “Jim” Crochet, retired from the position after he was placed under administrative leave while being investigated by the Elder Affairs Office of the Inspector General. The OIG did not provide information about possible charges.
Information pertaining to alleged misconduct can be kept confidential until an investigation concludes, the OIG said in response to a Freedom of Information Act request from Lee's advocacy group, Families for Better Care.
ADL scorecard blasted
TENNESSEE — The state's Choices program has come under fire from people who say it uses a flawed process for determining who qualifies for Medicaid coverage of nursing home care.
As of 2012, Choices scores people on their ability to perform activities of daily living to determine eligibility for at-home or facility-based services under TennCare. Critics say people are falling through cracks in the system, being scored out of assisted living then denied nursing home care, according to local reports.
TennCare commissioners have said they will evaluate ways to improve the program, The Tennessean reported.
Facilities face chemical spill WEST VIRGINIA — Long-term care facilities in nine West Virginia counties were in emergency response mode in early January after a huge chemical spill created a federally declared disaster and rendered tap water unusable.
The incident started when a tank at Freedom Industries Inc. in Charleston began to leak a chemical into the Elk River. The U.S. Attorney's office has launched an investigation into the cause of the spill.
Freedom makes products for the mining and water treatment industries.
Because exposure to the chemical involved could sicken and possibly kill people, West Virginia Gov. Earl Ray Tomblin (D) instructed people in the area not to use tap water for anything except flushing toilets. About 300,000 people were affected.
The emergency response agencies did a good job of responding swiftly, according to Candy Sanchez, administrator at the 184-bed Eastbrook Center in Charleston.
“At our facility, the local government agencies have been wonderful and we have plenty of water,” Sanchez told McKnight's on the second day of the crisis.