LYNNE JETER

Cheryn Baker will be quite busy during the 2008 session of the Mississippi Legislature.

As counsel and vice president of government relations for the Mississippi Hospital Association (MHA), Baker is charge of the statewide organization’s complex legislative agenda, which covers Medicaid, certificates of need, workforce, state trauma network, patient safety, licensing, and community hospital issues.

“This year, MHA will continue to work on securing full funding for the state’s Medicaid program by means other than a tax or assessment on the hospitals,” explained Baker of the association’s top priority item. “The Medicaid program is facing a shortfall in the current fiscal year, which will need to be funded when the legislature meets in January. It also will need to find some additional funding to prevent a shortfall in the 2009 fiscal year.”

Even though the Division of Medicaid hopes to increase the gross revenue assessment on hospitals to cover needed funding, MHA members believe the current state law does not authorize it to make such an increase administratively.

“The lawsuit filed last year by 43 hospitals against the division is about this issue,” said Baker. “It is still in place and will stay in place until hopefully the funding issue is resolved by the legislature in the 2008 session. Over half of our hospitals are already operating at break even or negative operating margins, so an increase in taxes to pay for Medicaid would have a serious adverse financial impact on them, likely negatively affecting the access to healthcare in their communities. Hospitals might have to reduce services if they are required to pay higher taxes.”

Specifically, MHA aims to clarify in the Medicaid statutes that only state lawmakers — not the executive branch without legislative authority — have permission to increase taxes, change payment methodologies and decrease reimbursement rates. The association advocates additional funding to cover deficits in the current and 2009 fiscal years from state appropriations or a $1 increase in the tobacco tax or a combination of both options.

Other recommended Medicaid revisions: introducing and supporting legislation to make reimbursement for Medicaid services for critical access hospitals to be based on the cost of service and revising the LTAC hospital services to delete references to “pediatric” LTAC since there are none in Mississippi.

“By deleting the reference to ‘pediatric,’ the LTACs would receive Medicaid payments outside of the Medicaid per-diem for providing these services to Medicaid patients,” explained Baker. “This change would improve access to care to Medicaid patients who need long-term acute care.”

Recommended Changes to the CON Process
“Other issues we are working on are to continue to support certain changes to the state’s Certificate of Need (CON) Program, which were proposed last session but did not ultimately pass,” said Baker. “These changes would make the program more efficient and speed up the CON process, which would allow hospitals to more quickly make improvements to their infrastructures and to replace outdated equipment with newer, better equipment. These changes would benefit their communities with improved access to care in shorter timeframes than under the current review system.”

Specifically, MHA advocates legislation requiring CON review of single specialty ASCs, indexing the capital expenditure review threshold for facilities (now at $2 million) for inflation to account for rapid increases in construction and financing costs, and exempting from CON review all non-clinical expansions and certain types of clinical expansions up to $5 million, such as parking lots and medical office buildings.

“Requiring a CON for a medical office building if it is on a hospital campus but not requiring a CON approval for the same expenditure to construct a medical office building elsewhere is not equitable,” explained Baker. “The negative effects of hospital campus medical office buildings are limited and usually are not systematic. They are seldom disruptive to the healthcare system.”

Also on the agenda: advocating changes to legislation to establish a Patient-Level Health Data System.

“Mississippi is one of only two states that do not have patient level hospital discharge data systems,” said Baker. “The data are needed to permit better informed and more precise planning that is required to improve CON regulation and ensure fairness and equity among service providers.

“While there is legislation in place that authorizes a data system, certain changes need to be made to it to implement the system and better define MHA’s role in the system.”

Workforce Issues
MHA will also support initiatives to address the physician and nursing shortages in Mississippi, and will support increased funding and other improvements to be made to the State’s Trauma Network.

“A task force has been studying this network and will be making recommendations to the governor on how to fund the network and on certain other recommended changes,” said Baker. “We’ll be supporting these recommendations on behalf of our hospitals to help them get more equitable reimbursement for providing trauma care to uninsured patients. This is important so these hospitals can continue provide care to persons who are injured in auto and hunting accidents, falls, and by other causes of trauma.”



January 2008