By Bill Britt
Alabama Political Reporter
MONTGOMERY—Imagine it’s the middle of the night. A call goes out that a homebound, 75 year-old woman, living in a rural county is in desperate need of oxygen. Her doctor says she can’t live without it, her insurance will pay for it and the medical equipment provider will deliver it, even though it may cost them more money than they will make.
Many similar scenarios play out every day for the sick and dying in Alabama, who depend on Durable Medical Equipment (DME) providers, homehealth nurses, and those who offer hospice care.
Those who deliver these life-saving products and services are subject to strict Federal and State government regulations, including how they are paid, what they can charge and how they conduct business.
For example: when a doctor writes a prescription for oxygen and their is no one in that location to fulfill the order for the patient, he will call a provider such as a DME owner in a different county. That sounds simple, but here’s the problem: When the DME provider crosses from its primary business location into another county, they are required to purchase a business license for that specific city, town or county. They may only service that patient once, but they must still purchase a business license for that location. Unlike a commercial retailer like an appliance store, the DME cannot by law charge a delivery fee.
While those who offer such equipment and services have a business license for their primary business location, outside counties and municipalities are requiring licenses and levying fines on these companies for doing business.
“They have no control…and the cities are gouging the devil out of them,” said Rep. Johnson.
Rep. Ron Johnson, (D-Sylacauga) and Senator Jabo Waggoner, (R- Vestavia Hills) want to fix this problem which Johnson says harms lives and has the potential of bankrupting those who provide such patient care.
HB185 and SB237 would stipulate that companies and employees who provide these healthcare needs would only be required to maintain licenses in the municipality or county at which its headquarters or branch offices are located.
Peter Czapla, whose company, Quality Homes Healthcare, Inc., supplies home medical equipment says that it is important to understand that “First and foremost, this is about patient care…We provide absolutely necessary home care services in patient’s homes…they may require oxygen, wheelchairs, rehab, wound care and hospice, which is incredibly important part of the services we provide.”
But under the current broad powers of municipalities to levy taxes and fines on those services, there is a real and present threat that such services could be greatly curtailed or stopped all together for some patients.
John Beard, President of Alacare, which provides nurses, home care aides, therapists, medical social workers, chaplains and volunteers for home health and hospice needs knows all too well the growing need for such services, but also the restrictions and regulations that are working against providers and ultimately against patients.
“Right now what is happening in all of our [healthcare] categories is the government is seeking to get more value for their dollar…We are all getting payment cuts as we go forward with Health Care Reform,” which he says can lead to decreased services offered to those in need. Alacare is the oldest and largest family-owned, Medicare-certified home health agency in the State and Beard has seen these opportunities and obstacles first hand.
Unlike a free market enterprise where supply and demand sets the cost of goods and services, Medicare/Medicaid and Third Party insurers are dictating reimbursement fees for medical services.
According to Beard and Czapla this means that their companies work on a very tight margin. By adding another level of county and municipal taxation, the companies which offer these services are in danger of being forced to cut services and, in extreme cases, being forced out of business altogether.
“This is something where the Federal, and State government and Third-Party Insurance tell you what they’re gonna pay you. And if your profit on an item is $20-$25 and you still have to provide maintenance and you have to give the city a minimum of $100.00 to service your patients, well that’s just stupid,” said Johnson.
Municipalities and cities claim that these healthcare providers use their roads, etc, and should pay for a license, wherever they deliver products or services. To that Johnson responses, “The cities don’t care, all they care about is making money. Ninety percent of the time they provide no service to justify getting the money [fee; license]…they say that the companies and nurses are using their highways and roads.” He scoffs at the notion saying, “The cities don’t pay for that, that money comes from the Federal government passed down through the State.”
In one documented instance, a company netted $150.00 but had to purchase a $1,500.00 license for a specialized piece of equipment.
“Many municipalities have very broad authority and they can require us to purchase a business and/or a delivery license in every single place that we go to, and oftentimes they base the amount of the licenses on gross receipts, not net, gross,” said Czapla.
Johnson, who has studied the matter extensively says, this is a very unfair and restrictive practice that needs immediate attention. He says that many rural counties just do not have the providers and therefore physicians must rely on those outside the county to fulfill the prescribed treatment and equipment. But, when they are restricted in what they can charge, and mandated to carry out the orders, “it just doesn’t make sense to charge them one more time.”
This is a problem Johnson and Waggoner want to fix.
“We’re not going to get a do-over:” Alabama health officer on Thanksgiving and COVID-19
There were 1,427 hospitalized COVID-19 patients in Alabama on Monday, the most since Aug. 11.
Alabama State Health Officer Dr. Scott Harris on Monday pleaded with the public to avoid gatherings over Thanksgiving as COVID-19 continues to surge in Alabama and hospitals statewide are filling with coronavirus patients.
“We don’t want this to be the last ever Thanksgiving for someone in your family, like your parents or your grandparents,” Harris said during a press conference Monday.
Harris said Alabama’s numbers aren’t headed in the right direction and more than 230,000 Alabamians — roughly 4 percent of the state’s population — have been infected by the coronavirus.
“We are adding a couple of thousand new cases a day, at least, that we are aware,” Harris said. “This is a time for people to be vigilant. This is a time to be careful and to think about what you’re going to be doing.”
Alabama added 1,574 new coronavirus cases on Monday, and the state’s 14-day average for new daily cases was at a record high 2,087. In the last two weeks, the state has added 29,223 cases, the most cases in any two week period since the pandemic arrived in Alabama in March.
There were 1,427 hospitalized COVID-19 patients in Alabama on Monday. The last time so many were hospitalized in the state was on Aug. 11, during Alabama’s summer surge.
Harris said that he and his wife will be staying home for Thanksgiving instead of having his family’s regular large, intergenerational gathering. What happens with Alabama’s COVID-19 numbers over Thanksgiving will impact what the state’s December holiday and Christmas season will look like, Harris said.
“Are we gonna be here a month from now trying to have the same conversation? I really, really hope not,” Harris said.
Dr. Mary McIntyre, the Alabama Department of Public Health’s chief medical officer, said during the briefing that her home usually sees between 15 and 20 family members arriving for Thanksgiving. They’ve limited this year’s Thanksgiving to three additional people from out of their household, for a total of seven people, she said.
Everyone must wear masks and have temperatures checked at the door, she said.
Everyone will be seated six feet from one another and a Zoom video conference will be set up for those family members who won’t be attending in person, McIntyre said. They’ll use disposable plates, cups and utensils and have the ability, weather permitting, to eat outdoors.
“If we want to live to see another Thanksgiving, and I do, that it may mean stepping back this Thanksgiving and really limiting the number of people, and some of the things that we do,” McIntyre said. “Now is not the time to get out to do Black Friday shopping.”
Dr. Kierstin Kennedy, UAB’s chief of hospital medicine, in a separate press briefing Monday echoed concern over the possibility of spikes following Thanksgiving and Christmas if the public doesn’t do what’s needed to keep themselves and others safe.
“We are very much worried about the potential spike in numbers. We’ve also seen some of our own staff getting sick,” Kennedy said. “And unfortunately that’s not been at work. It’s been because we are just like you. We’re tired. We’re lonely. We want to try to socialize, and some of us have let our guards down and, as a result, have gotten sick.”
Kennedy said while there’s is concern over future spikes following the upcoming holidays “there is a way for all of us to help prevent that from happening.”
Kennedy said when Gov. Kay Ivey first issued her statewide mask order and social distancing requirements, the public masked up, businesses enforced the orders, and coronavirus numbers improved.
“It didn’t get nearly as bad as we thought, and we are really hopeful that the community is going to come together and do that again for us,” Kennedy said. “Because it’s more than just not having enough space for the COVID patients. It’s also those patients who do not have COVID that have other conditions. They rely on us for routine care, and we want to make sure that we’re available to provide that.”
Kenedy said UAB has an incredible group of staff members, who’ve proven themselves to be quite resilient, but that “the group is tired.”
“We’ve been doing this every single day since March, and so as you can imagine, people are very tired. It’s very emotional, especially as we see younger patients getting sick with this and getting sick in ways that we weren’t expecting,” she said.
Harris again urged the public to make smart decisions that will help slow the spread of coronavirus and save lives.
“Ladies and gentlemen, we’re not going to get a do-over on this,” Harris said. “This is a big national holiday, and we’re in the middle of a pandemic, and our numbers are worse than they have ever been during this entire response. Please be careful. Please be safe. And please try to take care of those people who are most vulnerable.”
Governor allocates $3.6 million in CARES Act funds to food banks
The money is to go to the nonprofit Alabama Food Bank Association, which will administer the funds.
Gov. Kay Ivey on Monday announced that $3.6 million in federal CARES Act money will be used to reimburse food banks for COVID-19-related expenses.
“Alabama is a state where neighbors help neighbors, even in the most difficult times,” Ivey said in a statement. “The Coronavirus pandemic presented significant challenges around the world, as well as here at home in our own state. Food banks in communities across Alabama have been a lifeline for those in need, and I am proud to be able to put these funds toward the Alabama Feeding Initiative. I have told Alabamians that I remain committed to getting these CARES Act funds into the hands of those who need it.”
The funds are to go to the nonprofit Alabama Food Bank Association, according to the memorandum of understanding. The association will administer the funds to eight participating food banks across the state, which can be reimbursed for the following:
- The purchase of food, packaging and related supplies to meet increased demand.
- operational expenses, including fuel and maintenance, incurred due to handling a higher amount for food, as well as open-air distribution events.
- Rental costs of storage space and vehicles to handle increased volumes of food.
- To purchase PPE, screening equipment and decontamination services to prevent the spread of COVID-19.
Unless Congress extends the deadline, Alabama and other states have until Dec. 30 to spend CARES Act funds or the money reverts back to the federal government. Ivey has just under $1 billion left to spend before the deadline.
Alabama Education Association, Board of Medical Examiners meet over excuses to break COVID-19 quarantines
Prior to the meeting, the AEA on Nov. 5 threatened legal action against the board over the matter.
Officials with the Alabama Education Association and the Alabama State Board of Medical Examiners met on Thursday to discuss a concern the association has with doctors who write excuses to allow students to return to school before their mandated COVID-19 quarantine periods expire.
At the meeting between Theron Stokes, associate executive director of the Alabama Education Association, and William Perkins, executive director of the Alabama State Board of Medical Examiners, Stokes learned that the board wasn’t aware of the problem, the AEA said in a press release.
“Both groups agreed to set up a meeting with educational and medical organizations on the front lines of the COVID-19 pandemic in Alabama,” the AEA said in the release. “A meeting should be held before the end of the year and will allow the AEA and the Board of Medical Examiners, as well as other educational and medical organizations, to review existing guidelines issued by the Alabama Department of Public Health and the Centers for Disease Control and ensure conformity in following those guidelines.”
In a letter to Perkins on Thursday, Stokes wrote that it was AEA’s understanding that the board was aware of the problem, but he wrote that during their meeting he became aware that neither the board nor Perkins was aware of the problem.
“It was not the intent of AEA to cause any unnecessary problems for you, the doctors you represent, or your organization regarding this matter,” Stokes wrote.
Prior to the meeting, the AEA on Nov. 5 threatened legal action against the board over the matter.
“It is our firm belief that there exists no medical scenario under which these students could be written out of quarantine and that to do so is violative of ADPH and CDC quarantine recommendations,” Stokes wrote in the Nov. 5 letter.
Stokes in his recent letter notes that both agreed in the meeting to bring together representatives of the other organizations to come up with a uniform procedure for following state and federal guidelines.
“I agree with your plan to conduct this meeting and finalize our goals before the holidays,” Stokes wrote.
Caravan to honor the life of longtime State Rep. Alvin Holmes
The caravan is being organized by community activists Ja’Mel Brown and William Boyd.
There is a car ride caravan honoring the life and service of Rep. Alvin Holmes in Montgomery at 2 p.m. Monday. The caravan is being organized by community activists Ja’Mel Brown and William Boyd.
On Saturday, Holmes passed away at age 81. He was born in 1939 into a very segregated Montgomery and spent his life battling in favor of civil rights causes. He was one of the first Black state representatives to serve in the Alabama Legislature after implementation of the Voting Rights Act.
There had been Black legislators during Reconstruction in the 1870s, but Jim Crow segregation during much of the 20th Century had effectively disenfranchised millions of Black Alabamians for generations.
Holmes served in the Alabama House of Representatives, representing House District 78 from 1974 to 2018. Holmes participated in the civil rights movement. He was a professor and a real estate broker.
The chairman of the Alabama Democratic Party, State Rep. Chris England, D-Tuscaloosa, released a statement mourning Holmes’s passing.
“Representative Alvin Holmes was a great Democrat and a fighter,” England said. “He stood on the frontlines of the fight for civil rights and was willing to sacrifice everything in his fight for justice for all. He not only had a long and distinguished career as a civil rights leader, but also as a member of the Legislature, serving his constituents faithfully and dutifully for 44 years. Alabama has lost a giant, whose wit, intelligence, fearlessness, selfless determination, and leadership will be sorely missed. My prayers are with his friends, family, and colleagues.”
State Rep. Kirk Hatcher, D-Montgomery, fondly remembered Holmes, whom he defeated in the 2018 Democratic primary.
“Today we lost a dedicated warrior for social justice. Representative Alvin Holmes was a true public servant,” Hatcher said. “What an amazing legacy he has left us! He could always be seen waging the good fight for equality in all aspects of state government and beyond. His public service is legendary and without peer.”
“In recent years, I am profoundly grateful for the grace he showed me in his willingness to share with me his blueprint for effectively serving our people—and by extension the larger community,” Hatcher said. “Today, my fervent prayers are with his beloved daughter Veronica, her precious mom (and his best friend), as well as other cherished members of his family and friends as they mourn his passing. I humbly join the many voices who offer a sincere ‘Thank You’ to Mr. Alvin Holmes for his dedicated service to our Montgomery community and our state. ‘May angels sing thee to thy rest.’”
State Rep. Tashina Morris, D-Montgomery, also fondly remembered Holmes.
“Sending Prayers to The Holmes family,” Morris said. “Alvin Holmes was the epitome of greatness working for his people!! May you Rest Well !!!”
Republican insider and former State Rep. Perry Hooper Jr. also served with Holmes in the Alabama House of Representatives and the Montgomery legislative delegation.
“I served with Alvin for 20 years in the Alabama Legislature,” Hooper said. “We often disagreed on the issues, but even after a heated floor debate, we could shake hands at the end of the day. I always considered him a friend. He loved Montgomery and he was a great representative of his district and its issues. He was always willing to go the extra mile for one of his constituents. When I served as Chairman of the Contract Review Committee, he was one of the committee’s most conscientious members. He was always questioning contracts so he could be assured that the contract represented a good use of taxpayer’s dollars which as Chairman I greatly appreciated. He was one of a kind pioneer in the Alabama Legislature and will be sorely missed.”
Alabama Secretary of State John Merrill served with Holmes in the Alabama House of Representatives prior to his election as secretary of state.
“I just learned that former State Rep. Alvin Holmes passed away today,” Merrill said on social media. “I enjoyed the privilege of serving with him from 2010-14. There was never a dull moment whenever he was in the Chamber. I appreciated him for his candor & for his desire to work on behalf of his constituents!”
Holmes was a member of the Hutchinson Missionary Baptist Church, Kappa Alpha Psi Fraternity, Montgomery Improvement Association, Southern Christian Leadership Conference, Alabama Southern Christian Leadership Conference Board, and the National Association for the Advancement of Colored People. He has one daughter, Veronica.