Tuesday, the Centers for Medicare & Medicaid Services announced changes to the Inpatient Prospective Payment System proposed rule that provides relief from the increasing disproportion of reimbursement to hospitals created by the Medicare wage index.
U.S. Sen. Richard Shelby’s office said that while CMS uses wage index data based on regional labor costs to determine Medicare reimbursement levels for hospitals in a particular area, many hospitals – particularly in Alabama – have been negatively affected as a result of flawed data.
“The Medicare Wage Index has negatively affected Alabama hospitals for over 20 years,” Shelby said. “After two decades of working to address a problem that significantly contributes to heightened hospital closures throughout our state, I am glad to see Administrator Verma and CMS taking steps to solve this dire issue. I look forward to continuing my work with the agency to make sure that this sort of careless imbalance is eliminated moving forward.”
According to Shelby, in November 2018, the Office of Inspector General for the Department of Health and Human Services issued a report that outlined concerns with the current wage index calculations, including incorrect or incomplete wage data, insufficient reviews of information and the inaccuracy of rural floor and hold-harmless provisions. With the lowest wage index in the country, Alabama’s urban and rural hospitals have suffered from lower reimbursement levels, while hospitals in heavily populated states have taken advantage of overpayments illustrated in the report.
Last month, Shelby sent a letter signed by the entire Alabama Congressional delegation to CMS Administrator Seema Verma encouraging the agency to provide Alabama hospitals relief from the Medicare wage index through the use of its rule-making process authority. Prior to the letter, Shelby participated in many calls, meetings and discussions with Verma and other CMS officials to encourage the proposed adjustment.
Under the old rules, Alabama has the lowest wage index. According to the Alabama Hospital Association, approximately 88 percent of Alabama hospitals are currently operating in the red and cannot cover the cost of delivering care. Thirteen hospitals in Alabama have closed their doors since 2011, seven of which were in rural areas.
U.S. Sen. Doug Jones applauded the Centers for Medicare and Medicaid Services for a move that could provide badly needed relief for Alabama hospitals.
“As I have traveled across Alabama meeting with health care leaders in both rural and urban communities, I have heard two refrains consistently: fix the Medicare Wage Index formula and expand Medicaid,” Jones said. “The decision by CMS to propose a new reimbursement formula is welcome news and a great first step for the health care providers across our state who have struggled for years with an inexplicably low reimbursement rate. These hospitals provide care to all Alabamians, regardless of their insurance status, and they have to absorb the costs when that care isn’t reimbursed. That puts the entire system on slippery financial footing and can hurt the broader community if a hospital is forced to close its doors.”
“After meeting with Administrator Verma, Sen. Shelby and Congresswoman (Terri) Sewell last September about this issue, I was very hopeful about the prospects of getting this long-overdue change made,” Jones said. “I look forward to continuing to work with CMS to make sure that its final rule reflects what is in the best interests of Alabama, as well as advocating for Alabama to take the next step by finally expanding Medicaid.”
“For nearly three decades, Alabama hospitals have been facing declining Medicare reimbursement due to a fundamentally flawed reimbursement system known as the Medicare Wage Index,” said Congressman Bradley Byrne, R-Montrose. “This system has put an incredible strain on Alabama hospitals and has been a leading contributor to the string of rural Alabama hospital closures over the last decade. Immediately after President (Donald) Trump was took office, I began working with his Administration and CMS Administrator Seema Verma to address these disparities. I’m proud to have played a part in making today’s announcement possible because it is a major step in the right direction to help save our rural hospitals.”
“Since coming to Congress, I have worked with my colleagues in the Alabama delegation, Alabama’s hospitals and the Alabama Hospital Association to address disparities in the area wage index formula and increase Medicare reimbursements for Alabama’s hospitals,” said Congresswoman Terri A. Sewell (D-Selma). “I have been proud to introduce the Fair Medicare Hospital Payments Act during the past two Congresses, which would address disparities in the area wage index.”
“Last Congress, Sens. Richard Shelby and Doug Jones and I called CMS Administrator Seema Verma into our offices to hear from us on the ever-growing challenges our medical providers, especially Alabama’s rural hospitals, are facing due to low reimbursement rates,” Sewell said. “Today’s proposed change to ensure Alabama hospitals receive their fair share in Medicare reimbursement dollars is proof positive that CMS heard us loud and clear. Increasing the Medicare wage index for struggling hospitals in low-income states like Alabama will help our hospitals provide critical care and keep their doors open, especially in rural parts of our state.”
“I am eager to work with Members of Congress from Alabama and similarly situated states to ensure that CMS’s proposal is finalized,” Sewell said. “While this proposed change is a good first step, there is still work to be done to support our hospitals so they can meet all of our communities’ health care needs.”
“Last month, I joined the entire Alabama congressional delegation in signing Senator Richard Shelby’s letter to CMS Administrator Verma encouraging the agency to provide Alabama hospitals relief from the Medicare Wage Index,” said Congresswoman Martha Roby, R-Montgomery. “The Medicare Wage Index has negatively impacted our Alabama hospitals for many years, and I am so glad to finally see CMS taking steps to resolve this serious problem by proposing an adjustment. I appreciate Sen. Shelby’s leadership on this important issue.”
Byrne’s office said he secured the Request for Information that CMS used as the basis for the reforms implemented in this rule.
Alabama lawmaker pre-files legislation to allow removal of Confederate monuments
If passed, the measure would permit counties and cities to relocate historic monuments currently located on public property.
Alabama State Rep. Juandalynn Givan, D-Birmingham, introduced legislation this week in advance of the 2021 legislative session that, if passed, would permit counties and cities to relocate historic monuments currently located on public property. Givan’s bill, HB8, would also provide for the relocation of historic memorials to sites appropriate for public display.
“Across the state of Alabama, citizens are calling for the removal of prominently placed statues and monuments that are insensitive or offensive to the communities that surround them,” Givan said. “City and county governments must be able to address the demands of their citizens. This legislation provides a tool for local governments to safely remove these artifacts so that they can be moved to a site more appropriate for preserving or displaying the historical monument.”
Removing the monuments and historical markers is currently illegal under Alabama’s Memorial Preservation Act, which the state Legislature passed in 2017. Givan has been an outspoken opponent of that Republican-sponsored legislation. In 2018, Givan introduced a measure to repeal the bill that barred the removal of monuments.
“I believe HB8 can achieve bipartisan support,” Givan said. “My bill seeks to balance the wishes of the people. It respects the will of communities that want the monuments removed. It also respects those who wish to preserve history. With this legislation, Confederate monuments could be relocated to a public site, like Confederate Memorial Park, whose purpose and mission is to interpret and tell these stories. When the Legislature convenes, I hope to have the support of both the House of Representatives and the Senate.”
If enacted, HB8 would permit county and municipal governments to remove memorial monuments, including permanent statues, portraits and markers, located on public property in their jurisdictions. It would require a transfer of ownership of the removed monuments to the Alabama Department of Archives and History or the Alabama Historical Commission. Finally, the bill would instruct Archives and History or the Historical Commission to maintain and display monuments removed by local authorities in a location accessible for public display.
The Southern Poverty Law Center, which keeps track of Confederate monuments and memorials across the country, released an update to its Whose Heritage report, which tracks symbols of the Confederacy on public land across the United States. They report at least 30 Confederate symbols have been removed or relocated since George Floyd’s death on May 25, 2020.
These include 24 monuments removed, 5 monuments relocated and the Mississippi state flag replaced. Since the Charleston church shooting in 2015, 115 total symbols have been removed from public spaces. These include 87 monuments that have been removed or relocated from public spaces. At least 78 monuments were removed and nine were relocated.
SPLC says there are still nearly 1,800 Confederate symbols on public land, and 739 of those symbols are monuments. The SPLC has prepared an “action guide” to help community activists target Confederate historical markers and memorials for removal.
President Donald Trump has denounced what he calls “cancel culture” that seeks to remove historical monuments and statutes.
“There is a growing danger that threatens every blessing our ancestors fought so hard for, struggled, they bled to secure,” Trump said. “Our nation is witnessing a merciless campaign to wipe out our history, defame our heroes, erase our values, and indoctrinate our children.”
Marsh’s budget hearing compared to revenge porn
Senate President Pro Tem Del Marsh, R-Anniston, has scheduled a general fund budget hearing for early July — purportedly to prepare for the 2021 Legislative Session that begins in February.
But that is not the real reason for the budget hearing, according to Senate insiders who spoke on the condition of anonymity to avoid provoking Marsh. The actual purpose of public hearings, according to multiple sources, is to try to find a way to embarrass Gov. Kay Ivey.
In a press release from his office, Marsh says the budget meetings will focus on funding prison reform and rural broadband.
However, an agenda circulated for a July 9 budget committee meeting obtained by APR makes no mention of broadband and focuses entirely on the Ivey administration’s spending.
In the press release, Marsh said that the budget hearing is needed to address “a potential $2 billion-dollar prison reform proposal.”
But according to the Governor’s Office and published reports about Ivey’s prison reform plan, there is no mention of a $2 billion proposal as Marsh claims.
He also states that the other reason for the hearings is to address “a stunning lack of rural broadband investment.” However, broadband is not an item on the agenda.
Marsh’s enmity toward Ivey was on full display in the days after the governor revealed his “Wish list” in May, to spend federal relief money on a variety of projects only vaguely related to the economic crisis caused by the COVID-19 pandemic.
According to those who regularly interact with the Senate, he is still angry that Ivey exposed his plan to appropriate nearly $1.9 billion in federal relief money to finance pet projects, which included spending $200 million on a new State House.
The money the state received under the CARES Act was to be allocated to shore up business, citizens’ interests and institutions ravage by the shutdown due to the spread of COVID-19.
First, Marsh denied the existence of a “wish list,” then he said Ivey asked for it, and finally, he took ownership of the list and said he thought $200 million for a new State House is a “good idea.”
For weeks after the debacle, Marsh aided by some Senate Republicans tried to spin what happened without success.
Marsh had also wanted to use $800 million in CARES Act funds to build out rural broadband and had reportedly hoped to use the budget meeting to push his broadband plan forward.
Ivey blocked his plan to use CARES Act funds for pork projects and convinced the Legislature to reject Marsh’s preferred budget in favor of Ivey’s executive amendment.
“First Ivey made him look greedy and foolish and then she turned most of the Legislature against him,” said one of APR‘s sources.
Recently, Ivey was once again a step ahead of Marsh when just days after he announced his July budget hearings to consider broadband expansion, Ivey released her plan to spend $300 million on rural broadband, stealing his thunder.
According to APR‘s Senate sources, Ivey’s latest move was another blow to Marsh’s ego.
“Del, [Marsh] has power, but he’s never had to deal with a governor who knows how to counter him,” said another Senate insider.
Another regular observer of Marsh said, his latest move to hold budget hearings is akin to “revenge porn.”
“She dumped him, and now he wants to get even, sounds a lot like revenge porn to me,” the source said.
At the July hearing, Ivey Administration officials will be questioned on CARES Act spending, budgets for the department of corrections and pardons and parole.
Finance Director, Kelly Butler, will testify to what CARES funds have been spent and what remains.
ADOC Commissioner Jeff Dunn will be queried on several issues, including hiring, overtime pay, prison construction, and Holman prison’s status and personnel.
Pardons and Paroles Commissioner, Charles Graddick, will face the committee to discuss personnel costs, equipment purchases with an “emphasis upon computers, software, vehicles, office furniture and other substantial expenditures,” according to the document.
Lastly, the committee will question Personnel Department Director, Jackie Graham, to give an account for DOC and ABP&P personnel growth plans.
While it is wholly within the Legislature’s purview to approve and exercise oversight of government spending, this is not what the budget hearings are about according to APR’s sources.
According to several Senate insiders and others with knowledge of Marsh’s thinking, this is a move to paint Ivey’s administration as “out of control on spending.”
“This is a trap Marsh hopes to use for PR, but what if there’s nothing to see, how does he spin it,” asked an individual with close ties to the administration. “She’s kicked his tail before; she’ll likely do it again,” the source said.
Senate pro tem requests general fund committee begin hearings in July
Senate President Pro Tempore Del Marsh, R-Anniston, announced today that he has asked Senate Finance and Taxation General Fund Committee Chairman Greg Albritton, R-Range, to begin holding General Fund Committee meetings in preparation for the next session.
In an effort to be better prepared because of uncertainty in state revenue as a result of COVID-19 pandemic Senator Albritton has agreed with Senator Marsh and has invited Legislative Services, the Department of Finance, Pardons and Paroles, Corrections and the Personnel Department to provide updates to the committee.
“Typically, we begin this process closer to sessions however because of uncertainty about state income and possibility of special sessions, we felt like it was important to get started much earlier than usual in this process,” Senator Albritton said. “The Legislature has done an excellent job managing our budgets over the past few years. So much so that Alabama was able to weather the storm of the COVID-19 shutdown this year with little impact to our vital state services. We understand that we will not have final revenue projections until after July 15th, but we must continue to do our due diligence and ensure that we use taxpayer money sensibly.”
“We want to make sure that all public money is being used wisely, now and in the future,” Senator Marsh said. “We have many pressing issues facing the state such as a potential $2 billion-dollar prison reform proposal and a stunning lack of rural broadband investment which need to be addressed whenever the Legislature is back in session and it is our duty to make sure we are prepared and kept up to speed on these matters. Furthermore, the taxpayers deserve a clear and transparent view of how their money is being used.”
The hearings are scheduled to begin July 9 in the Alabama State House.
Part-time employee in lieutenant governor’s office tests positive for COVID-19
A part-time employee in Lieutenant Governor Will Ainsworth’s office, who the office said works only a handful of hours each week, tested positive for COVID-19 on Sunday, according to a press statement.
The employee, whose work area is separated from the rest of the staff, last worked in the office on the morning of Thursday, June 18.
All members of the office staff have been tested or are in the process of being tested for COVID-19 in response, and, thus far, no additional positive results have been reported.
In addition, the State House suite has been thoroughly cleaned and will remain closed until all employees’ test results have been returned.
Employees are working remotely from home, and phones are being answered in order to continue providing services to the citizens who need them.