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Press Releases

TDVA Veteran’s Homes All Receive 5-Star Ratings from U.S. News & World Report

Press release from the Tennessee Department of Veterans Affairs; March 6, 2015:

NASHVILLE – Tennessee Department of Veterans Affairs Commissioner Many-Bears Grinder joins the Tennessee State Veterans Homes (TSVH) Board in celebrating the announcement from U.S. News & World Report 2015 which names the Tennessee State Veterans Homes in Murfreesboro, Humboldt and Knoxville among the best in the country.

U.S. News and World Report rated more than 16,000 nursing homes using data research on nursing home safety, health inspection and staffing. The source of the data originates from the Centers for Medicare and Medicaid Services (CMS). In 2014, CMS issued five star ratings to the Tennessee State Veterans Home in Murfreesboro, the W.D. “Bill” Manning Tennessee State Veterans Home in Humboldt and the Senator Ben Atchley Tennessee State Veterans Home in Knoxville.

“Tennessee State Veterans Home residents are among some of the most fascinating and precious people I have ever met and they deserve the most compassionate and highly qualified care possible,” Grinder said. “I applaud the hard working and caring administrators and staff of each home for their commitment to excellence in care.”

“The federal rating system has been revamped to raise performance targets for care and I am proud that our staff not only makes the grade, but they make a difference,” TSVH Executive Director Ed Harries said. “Raising the bar on quality care is what our residents need and deserve and we are committed to continue this tradition.”

“Five stars will get these high quality homes noticed, but it is the residents and their stories of heroism that motivate the staff to offer nothing short of their best,” TSVH Board Chair Mayor Rogers C. Anderson said. “The warmth of these homes make them unique, memorable and worthy of national recognition.”

The future Brigadier General Wendell H. Gilbert Tennessee State Veterans Home at 250 Arrowood Drive in Clarksville is expected to open in the summer of 2015.

The waiting list for admissions has been opened and interested potential residents can contact Admissions Director Brittany Irvin at (615) 895-8850 ext. 1013. Eligibility requirements are listed on the Tennessee State Veterans Home website.

Applications for open positions at the new Clarksville location are now being accepted. Information regarding open positions will be listed on www.tsvh.org and will also be posted at the Tennessee Career Center at Clarksville at 523 Madison Street, Suite B.

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Health Care NewsTracker

TennCare Computer System’s Completion Date Still Unknown

Although he won’t speculate as to when the state’s new TennCare computer system will be completed, Darin Gordon, the program’s director, told members of the General Assembly he hopes a planned third-party audit will provide that answer.

Gordon gave testimony Tuesday to the Joint Fiscal Review Committee on the progress, or lack thereof, of the Northrop Grumman Corporation in developing the new “Tennessee Eligibility Determination System” for TennCare.

Tennessee has so far paid Northrop about $4.7 million of the $35.7 million it committed to the cybersecurity contractor in December of 2012, when they signed a three-year contract to develop the new system made necessary by the Affordable Care Act, Gordon said.

TEDS was supposed to go live in October 2013, and Northrop was last paid in January, Gordon added.

There are four “different tools” for the agency to ensure contractors comply with contract stipulations: penalties, liquidated damages, withholds and non-payment, in order of weakest to strongest. “We’re using the biggest tool that we have at this point to make sure that everybody is properly motivated to getting to where we want to be,” Gordon said.

Gordon said that Northrop, one of five firms to bid on the contract, made the lowest bid to produce the system. The next lowest was for $58 million, with the highest bid coming in at $109 million.

Wyoming, one of the other states to use Northrop to produce their system, is also “having challenges,” Gordon said.

Gordon told the committee that he had no idea as to when the system would be completed, because he’s “lost confidence in people’s ability to accurately predict” a timeline for completion.

Northrop is currently 99 percent done with its systems integration testing, the second phase of its five phases of implementation — but that doesn’t mean that phase is nearly done, Gordon said, because when issues with testing arise, developmental changes need to be made and the phase “can be at 99 percent for a longer period of time.”

The company is also about 80 percent complete with its third phase — user integration testing, but can’t start on the last two phases until the others are completed, Gordon explained.

“These are complex systems, there’s a lot of working in a very tight time-frame, and we want to make sure that what we do turn on, works,” Gordon said.

On Aug. 18, TennCare signed a no-bid contract with KPMG, an audit and advisory services firm, to run a 14-week audit of Northrop’s progress at a cost to the state of $1.2 million, Gordon told the committee. That report is expected to be ready sometime in late November or early December.

Following Gordon’s testimony, the committee also approved an extension of a contract with Policy Studies, Inc., the contractor who provides eligibility determination and processes application for the state’s children health insurance program. The contract, which is being extended through Dec. 2015 as a result of the delay in implementing TEDS. The contract extension is eligible for a 75 percent federal match.

The total cost to the state of the delay in getting the computer system on-line is not currently known, Gordon said.

The failure in bringing the new system online is one reason that TennCare is facing a lawsuit from the Southern Poverty Law Center, the National Health Law Program and the Tennessee Justice Center on behalf of several Tennesseans who have allegedly been denied coverage, though they claim eligibility.

“These system failures have serious impact on vulnerable Tennesseans and the health care infrastructure we all reply upon. It’s time for the state to spend less time blaming others and more time managing problems that have devastating consequences for our state,” said Michele Johnson, executive director for the TJC, in an e-mail.  Tennessee’s “lack” of a TennCare enrollment process “makes us unique in the nation,” she added.

The TJC filed the lawsuit because despite having met with TennCare officials since October of last year, “at some point it became clear that their willingness to problem-solve was not there,” and the Tennesseans they represent “couldn’t wait any longer,” Johnson told TNReport Wednesday.

Gordon was questioned by state Rep. Brenda Gilmore, a Nashville Democrat, about whether anything was being done to help hospitals cope with financial problems stemming from the inability to process emergency Medicaid applications because of the delay in TEDS implementation.

Gordon told Gilmore that because of the pending litigation the only information he could give was already included in his response to the federal Centers for Medicare & Medicaid Services, or in the briefs filed in the lawsuit.

However, the Gordon assured Gilmore that TennCare is in contact with the Tennessee Hospital Association “pretty much every week.”

Johnson told TNReport that she “thought it was interesting” the administration continued to say they couldn’t comment on anything related to the lawsuit because government agencies are required to “answer questions that the legislature has for their constituents.”

The next hearing in the federal case is scheduled for Friday.

Gordon noted to the committee that although TennCare has appeared before the legislature in the past, it wasn’t a result of computer system problems.

“Every state in the country all started from different starting points,” Gordon said. “Some had some modern technology already in place, and only had to adapt that technology to the new requirements. Other states, such as ourselves, had to start from scratch because our system was an old legacy system not capable of handling the changes that would be necessary to comply with the ACA.”

Additionally, the changes required by Obamacare have been “some of the most complicated” for the system since it began, Gordon explained.

Several other states — such as California’s backlog of hundreds of thousands of enrollees, or Oregon’s broken website and over-taxed Medicaid rolls — have had their own problems in developing a working system, Gordon said.

“These are complex systems, and are being implemented on a very quick runway, and so I think, if you look across the country, a lot of folks have had challenges with these,” Gordon said.

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Featured Health Care NewsTracker

Haslam: TennCare Signing Up Lots of New Enrollees

The Volunteer State’s Medicaid program, TennCare, has been criticized by the Obama administration for not providing enough assistance to seekers of government aid under the Affordable Care Act.

But Gov. Bill Haslam this week defended the program, which enables lower-income residents to obtain taxpayer-financed health insurance and medical care. He said the number of Tennesseans finding their way on to TennCare’s rolls is on record pace.

“I think it’s worthy of note, we’ve signed up more people for TennCare this year than we ever have in the history of the program since it originated,” Haslam told reporters following an event to promote his new free-community-college program.

Actually, the governor’s estimates may be stretching it some. But 2014 does indeed appear so far to be tracking among years with the highest number of new sign-ups, John Goetz, a spokesman for the TennCare program, told TNReport in an email.

First-quarter TennCare signups this year were “the third highest in the 20-year history of the program,” wrote Goetz.

Dave Smith, Haslam’s spokesman, told TNReport by email that the governor had in fact “combined two stats: the number of new enrollees added in the first quarter was the highest in at least the last four years and the third highest in the 20-year history of the program.”

According to numbers pulled about three weeks ago, TennCare added 67,411 “new enrollees” to the program in the first quarter of 2014. The program enrolled 57,737 in the first quarter of 2013, 60,325 in the first quarter of 2012 and 62,065 in the first quarter of 2011.

TennCare was criticized by the federal Center for Medicare and Medicaid Services in late June for failing to provide aid and services required under the Affordable Care Act.

The Haslam administration was told by the Obama administration to quickly develop plans for getting its still-under-construction computer system online. In the meantime, the feds want Tennessee to establish a more adequate temporary enrollment process for hospitals to sign people up for government-funded insurance.

The feds claim that in wake of ACA implementation, Tennessee stopped providing personnel to help people sign up for TennCare, and instead began directing them to use the federal health care exchange at healthcare.gov — which has had problems of its own.

TennCare officials don’t see things in quite the same light.

The director of the state’s Medicaid program, Darin Gordon, sent Cindy Mann, federal director of Medicaid, a 16-page letter saying Tennessee “must respectfully disagree” with much of the Obama administration’s criticisms. Gordon’s letter asserted that in every county in Tennessee a TennCare agent is on duty and available for face-to-face meetings with potential aid-recipients to help them negotiate the complexities of state-and-federal Medicaid bureaucracy.

As for the state’s computer system, Gordon said that Northrop Grumman, the company who won the contract to produce the computer system, has missed several deadlines. Gordon added that while TennCare will continue to work toward “successful implementation” of the system, they would not “go live with a system that has not been adequately tested.”

The letter did include an “updated mitigation plan,” but Gordon also wrote in the letter that it was only an “interim solution pending completion” of a new computer enrollment system.

TennCare is also being sued by the Southern Poverty Law Center, the National Health Law Program and the Tennessee Justice Center on behalf of several Tennesseans who say they were illegally denied coverage.

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Featured

Improper Release of Health Info Highlighted in Federal Report

The private health information of more than 13,000 Tennessee Medicare recipients was released to the public by a state contractor — the most wide-ranging breach nationally uncovered by federal investigators.

A just-released report, from the Department of Health and Human Services Office of the Inspector General, found 14 breaches of protected health information between 2009 and 2011 by the federal agency that administers Medicare and Medicaid. The largest breach of records took place in Tennessee.

Those are exactly the kind of records that, if in the wrong hands, can lead to medical identity theft, a scam that hurts both those on Medicare and the taxpayer. Scams run the gamut from the simple, when thieves use someone’s medical information to get prescription drugs, to the complex, when sham doctors’ offices use the information to bill the government for quick cash.

“The information obtained can be used to file false claims under Medicare or TennCare,” Yarnell Beatty, the Tennessee Medical Association’s director of legal and government affairs told TNReport. TennCare is the state’s version of Medicaid, the healthcare program for the poor. “Even one breach is cause for concern.”

The report stated that medical identity theft “can lead to erroneous entries in beneficiaries’ medical histories and even to the wrong medical treatment” and “may also lead to significant financial losses for the Medicare Trust Funds and taxpayers.”

Beatty also noted that given the millions — and perhaps billions — of Medicare transactions each year, some breaches are to be expected.

If the breaches are a concern, so was how federal officials’ reacted in wake of those breaches, according to the report. Medicare recipients at risk of having their medical information stolen were notified, but it appears those notifications left much to be desired.

From the report:

The notifications for these breaches often were missing required information. Notably, the notification letters for six of the breaches did not explain how the contractors were investigating the breach, mitigating losses, or protecting against further breaches. … Moreover, notification letters for half the breaches, including the largest breach [in Tennessee], were missing either the date the breach occurred or the date it was discovered.

Many times, the information inadvertently released included beneficiaries’ names, Medicare identification numbers, dates of birth, diagnoses and services received.

The Tennessee breach affected 13,412 beneficiaries. A printing error by a Medicare contractor caused the notices to be sent to incorrect addresses, according to the report.

Most of the breaches, including the one in Tennessee, were accidental, according to the report, but one of the 14 breaches was found to be criminal in nature.

“You can’t totally eliminate human error, although you strive to,” Angie Madden, the director of eHealth Service at the Tennessee Medical Association, said.

But Madden pointed out a silver lining. She said that the Centers for Medicare & Medicaid Services — the federal agency that oversees both those entities and was the subject of the report — “have done a fairly good job of education the public and beneficiaries” when it comes to fraud.

Click here to find out more about Medicare fraud.

Editor’s Note: This story was updated on Oct. 25 to make clear that the printing error leading to the data breach was made by a Medicare contractor.

Trent Seibert can be reached at Trent@TNReport.com or on Twitter at @trentseibert.

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Featured Health Care Tax and Budget

TennCare Cuts Expected, Haslam Wants Feds To Release Funds

On a day when he met with his health and wellness task force, Gov. Bill Haslam on Monday lamented the predicament the federal government has put Tennessee in on $82 million in TennCare funds.

First, the feds said they goofed and owed the state the money due to an accounting error. Now, they say they owe the money but that it might take an act of Congress to release the funds, creating a delay.

Haslam isn’t happy.

“We were really disappointed,” Haslam said. “They had told us. They said, ‘We owe you that money.’ There was no question about that.

“The question was how they were going to refund it to us, and now they said, ‘Well, we do owe it to you, but we can’t pay it back to you without some specific legislation,’ which doesn’t seem right to me.”

The Haslam administration originally had planned for an 8.5 percent reduction for certain providers in TennCare in the state budget. But while a 4.25 percent reduction was put in place beginning this July 1, the rest was postponed to Jan. 1, 2012, since the state expected the funds to come from Washington. Paired with better-than-expected revenues at the time, the state was able to dodge a financial bullet when it amended the original budget plan this year.

But now, with the delay, the other 4.25 percent in cuts will apparently be applied. Haslam referred twice to the amount Monday as about “4 and a half percent,” but an aide pointed out it is the 4.25 percent.

“It’s just wrong that they say, ‘We owe that to you, but we can’t pay you ‘till we pass new legislation,'” Haslam said.

Further, Haslam isn’t confident the state will get its money.

“I’m really not. I wish I was,” he said. “What they had told us last spring was, ‘Definitely we owe it to you. We’ll figure out a way to get that money to you.’ And then the message came back last week, ‘Well, actually, we don’t think we can get it to you without specific legislation.’

“And I think in today’s Washington, specific legislation to send money away out of the federal government to us, even though it’s owed to us, I think will be difficult.”

TennCare officials announced last week they believed it is “highly improbable” the legislation could be introduced and passed in Congress by Jan. 1. So the cuts, which would affect nursing homes, managed care administrative rates, transportation providers, lab and X-ray providers, dentists and home health providers, are expected.

Haslam was asked if the state had any recourse.

“I don’t know that. That’s a really good question. We don’t know that we do,” he said.

The funds are caught in a mix-up involving two federal programs, Medicaid and Medicare. Over 35 years, about 300,000 people applying for disability payments were involved. Federal officials had mistakenly considered the applicants under Medicaid when they should have been covered by Medicare. States have to pay for a share of Medicaid coverage while Medicare is covered by the federal government. TennCare is Tennessee’s version of Medicaid.

But while the state grapples with the federal government, a group tasked with coming up with a plan to improve Tennesseans’ health had its first meeting Monday.

Haslam welcomed his health and wellness task force to Conservation Hall at the Tennessee Residence and formally issued a release announcing the 16 members, who are health care leaders from across the state.

The governor made the case that health is related to education and economic development, and the state has a lousy record on health and wellness in national rankings.

“We have to face facts,” Haslam said. “In Tennessee, we rank 42nd in terms of health and well-being. Some of those are preventable, addressable issues.

“We’ve brought together, I think, some of the finest people from across the state who work on this every day, from different aspects, to see if we can address this.”

Haslam said he wanted a clear strategy that has “measurable outcomes” from the group. He noted that about one-third of the state budget goes to health care costs.

“When we bring back up this budget next year you’ll see again how much involvement we have in health care,” he said.

The task force is chaired by Dr. John Lacey III, chief medical officer for the University of Tennessee. Haslam said he would like to see an outline of a plan from the group in the first half of 2012.

Haslam did say the state has made some recent progress but that the state is still in the 40s when ranked nationally. In a slideshow presentation, Ben Leedle Jr., CEO of Healthways, headquartered in Franklin, said the state had climbed from the ranking of 42nd in 2009 that Haslam mentioned to 40th in 2010.

“To your point, we’re making progress,” Leedle said. “But I want to point out something really important in this data.

“The mid-year 2011 well-being data shows Tennessee has slipped from 40th to 45th. Anybody see what’s probably driving that? Look at the ‘healthy behavior’ line. Dead last in the U.S.”