MHA Chief Sam Cameron Explains Fine Print, Behind-the-scenes Negotiations
By the time Gov. Haley Barbour approved House Bill 71 on June 30 to extend the Medicaid benefits until 2012 by having hospitals finance the state Medicaid program, there had been so much haranguing over it that some details may have been lost in the fine print.
The Mississippi Medical News asked Sam Cameron, longtime president of the Mississippi Hospital Association (MHA), to enlighten our readers.
How does the bill define hospitals’ role in financing the state Medicaid program?
The Medicaid Technical Amendments bill brought forward code sections related to all patient services and provider assessments governed by Mississippi’s Medicaid statutes and regulations. This year, an additional code section and issue had to be addressed in the legislation, that being the re-authorization of the Division of Medicaid. Because of continued budget shortfalls within the Division of Medicaid, the Technical Amendments bill became the “vehicle’ for lawmakers to levy new taxes on hospitals. MHA supported reasonable hospital assessments, but sought certain protections to help insure hospitals’ ability to pay the new taxes. Gov. Barbour, the Legislature, and the Mississippi Hospital Association finally reached agreement on both funding Medicaid and protecting hospitals and the patients we serve.
What surprised/disappointed you about this bill?
Our greatest surprise was also our greatest disappointment. We were surprised and disappointed throughout the process that it was the Republicans (mainly Gov. Barbour, Lt. Gov. Bryant, and Sen. Alan Nunnelee) who were such strong advocates for such a huge tax increase. It was the House Democrats who recognized the financial impact of levying $210 million in new taxes on hospitals and opposed it. The House leadership’s concern for, and acquired knowledge of, the role hospitals play in local economies, followed by their willingness to support their local hospitals, continues to be the most gratifying part of the negotiations that produced this legislation.
What are your members saying about the bill?
Our members understand the realities of the political process and appreciate the position we were in as the state faced huge deficits in the Medicaid program. They also took very seriously Gov. Barbour’s ‘threats’ about what he would do to hospital reimbursement rates and payments if the Division of Medicaid was not re-authorized and he ran the agency by Executive Order. While no one wants to pay additional taxes, and this is a huge increase, hospitals were and are willing to do their part to continue providing care to our Medicaid patients. Our members are also aware that, had the protections not been included in the bill, the Governor’s Office-Division of Medicaid would have secured $210 million in new taxes and still would have been empowered to make further cuts in hospital reimbursement rates and levy even more taxes on hospitals.
What trends should we expect to take shape as a result of this bill?
It’s really too soon to answer. The tax provisions of the bill do not become effective until the federal government (CMS) approves a state plan amendment currently being developed by the Division of Medicaid.
Listed in the protections section, implementation of managed care will be allowed in January 2010, if the program is limited to 15 percent of the Medicaid population. How will the program work?
It’s also too soon to determine the impact of the statute’s managed care provisions. The law requires that CMS grant a waiver or letter of agreement under which any patients moving from Medicaid to managed care will not affect hospital reimbursements under the DSH and UPL programs. I understand the Division of Medicaid is also working on securing that waiver.
The bill also notes that effective January 1, 2010, the 5 percent cut in physician reimbursement rates enacted during the Musgrove Administration will be restored. How will that be funded?
Medicaid faced a budget shortfall in fiscal year 2002 that required cuts in the program to balance both the Division’s budget and the State General fund. One of the cuts implemented by statute was a reduction in reimbursement rates paid to physicians who treat Medicaid patients. We restored the physician reimbursement rates to those in effect prior to 2002, with funds for the increase coming from the additional hospital taxes.