Just days following the approval of monumental rate increases for the Memorial Place Assisted Living Center, members with the Seminole Hospital District's Board of Directors will consider possible rate increases for private and semi-private pay patients at the Memorial Health Care Center facility.

That consideration is one of 12 business items up for consideration in Monday evening's regular meeting of the SHD's Board of Directors, which will convene in a 6:30 p.m. regular meeting at the Administration Boardroom, located on the campus of Memorial Hospital, located at 209 N.W. 8th St. The meeting is open to the general public, for those local residents who wish to attend.

The rate increase consideration, according to previous SHD accounts, comes in the wake of a projected $2.2 million total loss the district is anticipating to face in the 2014 fiscal year, which included a $1.8 million loss in generated tax monies which were refunded to hospital district taxpayers in the wake of the Jan. 28 SHD rollback election process.

In the board's April 7 regular meeting, Seminole Hospital District Board Directors tabled action related to any proposed changes to the SHD's Memorial Health Care Center census population.

SHD Directors continued budget discussions carried over from an April 3 special meeting, in which district officials crunched numbers and discussed various options related to pulling the 69 bed facility out of a roughly $1 million budget shortfall for the 2014 fiscal year.

The facility, which has a license to host 62 Medicaid patient beds, offers rates for private pay, semi-private pay and Medicaid patients, according to SHD officials.
Funded primarily by resources generated from the Memorial Hospital campus, including SHD tax dollars -- which amounts to roughly 20-percent of the SHD's generated revenue -- the MHCC has seen financial hits over the year due to staffing shortages and delayed Medicaid and other governmental reimbursement payments.
Seminole Hospital District CEO Betsy Briscoe stated the facility had been struggling for years with staffing issues, which resulted in the facility to hire the services of outside nursing agencies to fill the void.

In addition to the staffing issues, the MHCC recently closed admissions into the facility several months ago, according to Briscoe in an informational packet distributed to SHD Board Directors and members of the general public in Thursday's meeting.

To address the staffing shortage issue related to the number of patients currently in the facility, SHD officials in two separate April board meetings, hosted the discussion of possibly cutting down the number of available beds within the facility to a more manageable total figure, and/or the possibility of installing higher private pay and semi-private pay room rate increases to patients.

"We are making an honest attempt to correct a bad situation," said Geoff Gray, SHD Board President in an April 9 story produced by the Seminole Sentinel. "It doesn't mean that whatever we do has to stay that way forever. We just have to decide on doing something at the present time to address the (budget shortfall) issue we're facing now."

Other options discussed in previous meetings included possible cut of available beds at the MHCC and potential private pay and semi-private pay rate increases -- a move which had not been conducted by SHD Board members since the 2006 calendar year, according to administration officials.

As for reimbursements, SHD officials state receiving governmental paybacks for Medicaid-based facilities "have been a challenge for quite some time."

According to SHD information in last Thursday's meeting, in 2011, Medicaid reimbursement was cut to 3-percent. In 2013 legislative action, a 2-percent increase was approved for 2014, with a 4-percent reimbursement was approved for 2015.

"These increases will help, but do not address the complete issue of reimbursement," said Briscoe.

Senate Bill 7, which passed in the 83rd Texas Legislative session, included a provision which expanded Managed Medicaid into the nursing facility realm, according to Thursday's informational packet.

"The reason and goal for this move is to reduce costs to the State for the provision of Medicaid long-term care and other healthcare services," wrote Briscoe. "The Medicaid MCO program introduces a middle-man that will develop protocols and control payments to a nursing facility based on those protocols."

Briscoe added that a positive for long-term care reimbursement is the new Upper Payment Limit program. The UPL program has been in existence for hospitals for several years. Based on the State’s move to Medicaid Managed Care, facilities State-wide were able to negotiate implementation of the UPL.

"These payments are structured to off-set some of the decrease in reimbursement from managed care," said Briscoe. "We are expecting about $667,000 in UPL payments for this year."

Back on Jan. 28 SHD taxpayers approved of a rollback petition, in which local hospital district taxpayers asked the hospital district to rollback their 2014 maintenance and operations taxing rate from an 15.5-cent per $100 valuation above-rollback tax rate  -- enacted by SHD Board Directors in September 2013 -- to the district's 12.1456-cent rollback rate, which was established by the Gaines County Appraisal District as part of the 2014 fiscal year budget process.

In early March, checks totaling to $1.854 million from tax funds gathered by the SHD through were refunded back to hospital district taxpayers as a result of the rollback election process, which saw a projected $250,000 net profit for the hospital district's 2014 fiscal year dwindle toward a negative budget for the medical taxing entity.

Rates to Increase for Assisted Living Center
Following lengthy discussion in the board's two-plus hour meeting on April 7, SHD Board Directors unanimously approved of a proposed rate increase to residents residing at the SHD's Memorial Place Assisted Living facility.

Currently, according to figures produced by SHD officials, the cost for a studio apartment room at the 16-apartment facility is quoted at $1,551 per month, while a one-bedroom apartment is quoted at $1,779 per month and a one-super bedroom apartment fee is set at $1,901 per month.

Based on area averages, which saw the similar room rates range from $3,106 to $3,740 to $4,350, respectively, SHD Directors unanimously approved of a 40-percent room rate increase to be effective within a 60-day period following Monday's vote, and an additional 60-percent rate increase within a four month period.

Effective on Oct. 1 -- the Seminole Hospital District's fiscal year start date -- room rates new effective room rates will be set at $3,150 per month for a studio apartment, $3,450 per month for a one-room apartment, and $3,900 per month for a super-one room apartment. In addition, residents at the Assisted Living Center facility will see a 5-percent cost of living adjustment rate increase on each subsequent Oct. 1, to help fund operations of the facility, which suffered a $472,000 loss last fiscal year.

"Our rates are well behind some of the area's assisted living facility rates, and have been for some time," said Briscoe.

Blaine Nichols, Place 4 SHD Board member, said the decision was a difficult one to make, but necessary to get the facility back on track financially.

"This hole didn't happen over night," he said. "This took the better part of 10 years or more to happen. We won't be able to fix this problem immediately. It will take some time, but I feel doing (the rate increase) is a step in the right direction for us."

Memorial Place Assisted Living Center provides 24 hour attendance and daily activities. Residents are provided three home cooked meals a day, access to two graceful parlors with fireplaces, a craft room, a beauty shop, a conference room and library.

Back on April 7, SHD Board Directors cut one service area from the hospital district's line-up.

In the board's previous meeting, held on April 7, one service area of the Seminole Hospital District was cut from the district's line up.

In a unanimous 7-0 vote of SHD Board Directors, hospital district officials approved the closure of the district's Provider Assistance Program, a service provided by the local medical district since the 1998 calendar year.

In the program, district employed home health aides provided personal care and homemaker services to local residents in the program. Some services included with the program included household cleaning, laundry services and meal preparation and was paid for by local residents through Medicaid or through private pay arrangements.

Briscoe stated the program had filled a need within the Seminole community upon its inception in 1998, but began running in the red within the hospital district's budget in 2003.

In the last fiscal year alone, the program reported a loss of around $400,000, according to Briscoe in a discussion of the proposed closure prior to Monday's board approval.

"This is just not a viable service for our district to continue forward with anymore," she said prior to the SHD Board's April 7vote.

The closure of the Provider Assistance Program effects 30 local residents and five SHD employees, according to SHD officials. The five employees affected by the closure were given the opportunity to transfer to various positions within the Seminole Hospital District.