Governor’s Handshake Didn’t Help EMS Agencies

BLOUNTVIILLE, Tenn. – Tennessee Gov. Phil Bredesen’s handshake is not as binding as was hoped, said Mark Vance, Sullivan County’s emergency medical services operations director.

On Friday, Vance was one of five county ambulance service officials who held a news conference to announce displeasure with $11.4 million in recent state budget cuts to EMS transportation funding.
 
Vance said he spoke personally with Bredesen about the issue before the state’s 2008-09, $27.9 billion budget was approved. The cuts, which affect county services statewide, came in the form of a TennCare recommendation.

“I explained to the governor that EMS transportation services statewide cost TennCare about 1 percent of its budget,” Vance said. “He promised me he would help us. He shook my hand. But it looks like he’s not a man of his word.”

The Herald Courier e-mailed and left telephone messages with Bredesen’s office Thursday and Friday seeking comment on the EMS cuts and Vance’s statements. On Friday, Lydia Lenker, Bredesen’s spokeswoman, said the governor had not had a chance to speak on the subject and “the governor will not be available.”

EMS directors from Carter, Washington and Greene counties gathered Friday at Sullivan County EMS headquarters in Blountville in an effort to gain exposure for their cause.

“Gov. Bredesen’s budget is impacting EMS service in the region and could cost taxpayers more money or force services to be cut,” said Terry Arnold, president of the Northeast Tennessee EMS Directors Association. “Every governor has tried to fix TennCare. It can’t be fixed.”
 
Arnold said EMS and TennCare officials met in Nashville on Aug. 19 at a rules hearing, but there was no sign at the time the cuts had been made.

“We were not notified – any of us,” he said. “We contacted our legislators, and they told us they were not aware of the cuts. We spoke to them Thursday, and we’re hoping they can help us get the funding reinstated. We’ve tried for 10 years to talk with the administration. They don’t sit down with us; they tell us what to do.”

TennCare reimburses providers, including ambulance services, that have contracts with Medicare, said Marilyn Wilson, TennCare spokeswoman.

“Medicare reimburses 80 percent, and for most providers that’s all they receive,” Wilson said. “What’s changing is that providers that had been reimbursed by both Medicare, as well as getting a 20 percent co-pay from TennCare, Tennessee’s version of Medicaid, has changed. Our policy is we no longer pick up the 20 percent.”

Wilson said the agency sent notices of the change after July 1, when the policy change was officially set in the state’s budget.

“When we do have to tighten our belts, we have to make a change,” she said. “When we looked at all the things we could tighten up in our budget, we did find this inequity where the majority of providers were not receiving this extra check.”

Wilson admitted that TennCare was responsible for making the payments, but she could not nail down the failure within the system.

“It was a reimbursement policy used by TennCare for a long time, and quite frankly, we found that a reimbursement to a handful of providers was not very efficient,” she said.

The $11 million reduction was not the only cut made by TennCare this year and the change was “in keeping with the state’s goal of tightening the budget,” Wilson added.

Steve Croley, EMS operations director in Washington County, Tenn., said his agency learned about the cuts “when our claims started being denied.”

“When you take $11 million out of ambulance service funding across the state, it’s going to seriously hurt. We’ll be losing $400,000,” he added.

Tennessee Lt. Gov. and Senate Speaker Ron Ramsey, R-Blountville, said the issue has been a “he said, she said kind of thing,” but ultimately, the cut was included in TennCare’s recommended budget to legislators.

“That’s what we approved – a recommendation, not a specific line item,” he said Friday. “The governor’s goal was to get the budget tightened. Would everybody like to give this back to the EMS folks? Sure. But if we do that, we then have to cut something else.”

Ramsey, who admitted he was not originally aware of the funding cut for ambulance reimbursements, said any reversal of the EMS cuts would have to come in January when the General Assembly convenes. 

“You would need a majority from both the House and Senate to get it done,” Ramsey added.

State Rep. Jason Mumpower, R-Bristol and House minority leader, said Thursday that he did not know the cuts were in the budget.

TennCare’s current budget is $7 billion, about 27 percent of the state’s total budget.

Mumpower said “the $11 million may have been a line item that didn’t attract a lot of attention.”

At the end of Friday’s news conference, Vance said emergency medical personnel have “an obligation to transport patients whether they have insurance or not. If they’d [TennCare] have done an impact study ... but they didn’t. They just rolled it on in.”

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State cuts to local emergency medical services agencies:
* Sullivan County – $276,000
* Carter County – $201,000
* Washington County/Johnson City – $400,000
* Greene County – $175,000