Georgia Sues Biden Administration over Objections to Gov. Kemp’s ‘Pathways to Coverage’ Medicaid Expansion

The State of Georgia and Georgia Department of Community Health (GDCH) launched a lawsuit on Friday against the Biden administration over its objections to Governor Brian Kemp’s limited Medicaid expansion, the Georgia Pathways to Coverage.

Georgia, the lawsuit explains, entered into a five-year agreement with the Centers for Medicare and Medicaid Services (CMS) to implement Pathways, but in January 2021, CMS told Georgia it “preliminarily determined” the program was “unlawful and should be suspended.”

Read the full story

Republican Governors Say CMS Staffing Rule Would Close Nursing Homes

A proposed long-term care staffing rule from the Centers for Medicare and Medicaid Services would not improve care but would force nursing homes to close, 14 Republican governors said in a letter to CMS.

The rule changes would require long-term care facilities to conduct a facility assessment that includes a staffing plan within 60 days of the rule’s implementation. The second phase of the rule mandates a registered nurse must be onsite 24 hours a day.

Read the full story

Commentary: The Left’s Misguided Attempt at a Drug Pricing ‘Fix’

Here in Tennessee, we stand up for what’s best for our communities and do what we can to encourage our elected officials to act in the best interests of our families and taxpayers. In health care, it often becomes convoluted and hard to decipher what will actually improve the lives of patients. When it comes to prescription drug affordability, prices continue to skyrocket and we need our lawmakers to do what they can to effectively lower costs and reject policies that will actually hurt patients and families.

Read the full story

Pennsylvania Republicans Consider Paths to Hospital Price Transparency

A committee of GOP Pennsylvania lawmakers on Thursday gathered in downtown Lewisburg to consider ways to make patients aware of hospital service prices ahead of time. 

At the House Republican Policy Committee hearing at the Open Discourse Coalition headquarters, policy experts testified that, despite a new federal rule requiring price transparency, many hospitals still fail to accurately inform patients of procedures’ costs. Representative David Rowe (R-Middleburg), who organized the event, recalled constituents telling him they’ve faced shocking examples of pricing opacity.

Read the full story

Maury County Mayor Andy Ogles Declares State of Emergency in County to Protect Health Care Workers’ Rights

Maury County Mayor Andy Ogles — flanked by several state legislators — declared a state of emergency in the county at a press conference  on Thursday.

Ogles said the U.S. Constitution entitles health care workers to religious exemptions and other rights of conscience to refuse the COVID-19 vaccine. He also said the U.S. Constitution protects those workers from harassment or even job loss.

The Biden administration now mandates that healthcare workers vaccinate themselves against COVID-19, and Ogles warned his constituents Thursday that more than 1,000 local health care employees in Maury County could lose their jobs.

Read the full story

Ohio Gov. DeWine Orders Flags to be Lowered Until Friday at Sunset

  COLUMBUS, Ohio – Ohio Republican Governor Mike DeWine ordered all United States and State of Ohio flags to be lowered Tuesday to half-staff on all buildings and public grounds throughout the state until sunset on Friday. The proclamation is in lockstep with the president of the United States who ordered flags to be lowered in remembrance of 500,000 deaths believed to be caused by COVID. On Monday the Ohio COVID dashboard reported 1,611 cases, 120 hospitalizations, 16 ICU visits and 58 deaths against a 21-day average of 2,681 cases, 145 hospitalizations, 269 deaths and 16 ICU visits. According to State of Ohio data, the highest number of cases in one day was 13,523 on November 30. The height of hospitalizations was also November 30 at 401. Deaths peaked at 209 on December 16. During a Monday COVID briefing, DeWine reported 343 new COVID cases in Ohio nursing homes, a sharp decline from the one-day December high of 2,832. According to the COVID tracking dashboard, Ohio has reported a total 16,874 deaths due to the virus since the global outbreak began. Those numbers coupled with vaccinations administered to nursing home residents and employees coalesced to compel the governor to remind…

Read the full story

Tennessee Legislature Approves Modified Block Grant for State’s Medicaid Program

Tennessee’s General Assembly approved the Medicaid waiver, granting the state to apply federal healthcare funding to an aggregate gap model of spending. The legislature filed the bill when it first convened on Tuesday. Just three days after the bill’s introduction, legislators took their final votes on Thursday and Friday. The six subcommittees who reviewed the waiver all recommended its passage over the course of a few days.

The waiver allows the state to establish a self-imposed, fixed budget to last over a ten-year period, known as TennCareIII. It also allows the state to reserve a portion of the unused funds and apply them to other government programs, with potential for those savings to be matched with additional federal funds for healthcare programs.

Read the full story

Federal Government Approves Tennessee’s Medicaid Proposal, Swapping a Block Grant for an Aggregate Cap

The federal government approved Tennessee’s proposed Medicaid aggregate cap, granting a lump sum for a self-imposed, fixed budget. The ten-year agreement, referred to as “TennCare III,” is the first of its kind nationwide. It also allows for the state to reserve any unused funds and apply them to other government programs, with up to 55 percent of those savings potentially matched by additional federal funds for state health programs.

The Centers for Medicare and Medicaid Services (CMS) described the measure as an “innovative financing approach.” Unlike what various reports claimed, federal officials explicitly stated that this agreement wasn’t a block grant. This agreement allows the state government to be flexible with its spending cap under certain circumstances – like last year’s pandemic and related unemployment crisis. 

Read the full story

Audit: TennCare Gave Out Money to Dead People and People in Prison

TennCare gave out more than $700,000 to duplicate members and also to people who were already dead or incarcerated, according to a new state audit. All of those recipients were ineligible to receive TennCare money. The findings, released late last week, cover July 2016 through December 2017. Generally, TennCare must refund the federal share of Medicaid overpayments to the Centers for Medicare and Medicaid Services, auditors wrote. “TennCare should investigate providers who billed for services that took place after a member’s date of death or during a member’s incarceration to determine if fraud occurred,” auditors wrote. As for people in prison, auditors said “TennCare should work with the Tennessee Department of Correction and its incarceration data contractor to establish a more effective process for identifying and verifying TennCare members who are incarcerated and suspending those members immediately.” TennCare, auditors went on to say, should also retroactively recoup any payments made on behalf of incarcerated TennCare members. TennCare officials should weed out payments made to members with multiple TennCare identification numbers, auditors wrote. In a written response to auditors, TennCare officials said they concur with some of the findings. TennCare officials, though, said they disagreed with Comptrollers’ findings on payments to…

Read the full story